HomeMy WebLinkAbout09-28-78
RC'C-33 (4-73)
SEP 28.197
COMMONWEAL TH OF PENNSYLVANIA . ...
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
:.6rend.cd or ~~unpler.nntal ~Cax :-'.(;turn
RESIDENT DECEDENT oriCfinal ];.et.urn filed ~~ept. 7, 1978[OUNTY OF Cur:lerland
IMPORTANT:
This return must be completed in detail and filed in duplicate, with all attached, with the Register of Wills of the
County where decedent resided; Return is due within nine months after date of death, unless an extension is granted
by the Secretary of Re'ltenue. (Section 703 of the Inheritance and Estate Tax Act of 1961.)
Late of
CuruJerlanc
} AFFIDAVIT OF
EXECUTOR
ADMINISTRA TOR
IN THE MATTER OF THE ESTATE OF
Carrie
'Jav ;-.nd(':rran
(STATE FULL NAME OF DECEDENT)
County
State of
Penns~.'l vani.a
County of
l)aupLin
}"
Administrator
Poh:~rt T). (I' Lara
of th.. estate of the above-named decedent being duly sworn, depose
Executor
and say
Decedent died
~June
12
, 19 7B {test.ate. leaving a last will, copy of which is hereto attached. }
(YEAR) i~OUC
(MONTH)
Name and address of attorn"y or }
other authorized repres,entative to whom
all correspondence should be mailed.
(DAY)
Y'<.:urice
F
~._, .
~'haffer
223 north Pront St., P.G. LO:: 1188 ],:arris'urr,
F'}".
171"8
That as such E~Xc:cutor deponent is familiar with the affairs of said estate and the property constituting
(EX ECU TO R-ADMIN I ST RA TO R)
the assets thereof and their fair market value.
That at the time of death there was no safe deposit box registered in decedent's individual name, or jointly with, or
as agent or deputy of another, or in decedent's individual name, with right of access by another as agent or deputy, with the
exception of the following: -
NAME AND ADDRESS OF BANK OR OTHER INSTITUTION THIS SAFE DEPOSIT BOX RENTED RELATIONSHIP OF JOINT
IN WHICH DECEDENT RENTED A SAFE DEPOSI T BOX IN NAME OR NAMES OF HOLDERS TO DECEDENT
Cl::'l.\berlalld Coun t:y .. .' 1 }3an}: ~.j.l\. (' - . T:. .i\ndernan ... one
..0. 1:l0na~ .....arrle
f- . (J. J_~O:~ " r- ]'JCi iO'7ne }"..?':.. 17()4.1
:J .) .
That the contf:nts of said safe deposit box or boxes are itemized under Schedules r:
with the exception-of the following, for the reasons hereinafter set forth:
of this return,
That Schedule A attached hereto and made part hereof sets forth fully and in detail all the real property
in the Commonwealth of Pennsylvania of which decedent died having an interest therein. It also sets forth the
mortgage encumbrances upon each parcel of real property at the date of death, giving the amount still due at
death, name of mortgagee, date, rate of interest, and book and page of record thereof. It also sets forth in the
columns provided therefore the assessed valuation of each of said parcels, the estimated market value thereof
as of date of death of decedent.
That Schedule B attached hereto and made part hereof sets forth fully and in detail all personal property
wheresover situated owned by the decedent at the time of death; all moneys left by the decedent at the time of
death, whether in decedent's immediate pos session, standing to decedent's credit in banks of deposit, savings
banks, trust companies, or other institutions, whether individually, or in trust for any other person or persons
giving also separately the accrued interest thereon, if any, down to the last interest day prilOf to decedent's
death in the case of savings banks, and to the date of decedent's death in all other cases; all bonds, postal
savings, treasury certificates or notes ~nd other evidence of indebtedness of the United States to the de-
cedent; all obligations" whether by statute or agreement they are designated as tax free, of the United States,
or any state, or political subdivision thereof, or of any foreign country, which are owned at the time of death;
all wearing apparel, jewelry, silverware, pictures, books, works of art, household furniture, horses, carriages,
automobiles, boats, and any and all other personal chattels of whatsoever, kind or nature, left by decedent,
together with the fairly estimated market value thereof; all bonds and mortgages held by decedent and of all
claims due and owing decedent at the time of death, and all promissory notes or other instruments in writing
for the payment of money of which decedent died possessed, of whatsoever nature, with interest thereon, if
any, giving the face value and estimated fair market value thereof, and if such estimated fair market value be
less than the face value, it sets forth briefly the reasons for such depreciation as to each item; all moneys
payable to the estate from life insurance policies carried by decedent; all annuity and endowment contracts
the proceeds of which were payable upon the death of the decedent; all and the corporate stocks and dividends
due thereon and unpaid as of the date of death, bonds and accrued interest thereon to the date of decedent's
death and other investment securities owned by the decedent at the time of death, with the market value there-
of at such time.
In the case of securities of clotte, or family corporations, the values reported are as far as
possible substantiated by financial statements of the corporations, showing the assets and liabilities
thereof as of the date of death. The schedule also sets forth the interest of decedent at the time of
death in any co-partnership or business, and in support of the value of such interest there is annexed to
said schedule, financial statements showing the assets and liabilities of said co-partnership or business.
A copy of the co-partnership agreement, (if oral, a statement setting forth the nature of the agreement)
together with a statement setting forth the character of the business, its location, and such other facts
pertaining to the business as may be pertinent to a fair and just appraisal of the decedent's interest
therein must he submitted. It should also SEt forth in itemized form, together with the fair market value
thereof, any other property owned or bequeathed by the decedent at the time of death.
The Schedule C attached hereto and made part hereof sets forth a true answer" to each inquiry
contained therein and in the case of transfers of property, real or personal, within two years of decedent's
death, in contemplation of decedent's death, or intended to take effect in possession or enjoyment at or
after death, said schedule sets forth the nature and value of' such property, to whom transferred, the
relationship of the transferees to the decedent, the proporttonate share received by each transferee and
all other facts of a pertinent nature regardtng said transfers. In the case of transfers intended to
take effect in pGssession or enjoyment at or after death, there is also attached to the schedule a copy
of the deed, trust agreement or other instrument creating the trust. There is also set f~rth in said
schedule a list of all property, real and personal, with its value, which pa~ses at (h,cedenr's death by
virtue of the exercise by decedent, et ther indtvidually, or jointly wi th another, or any power of appoint-
m~nt vested in decedent, either indivtdually or jointly, by the will, deed, or other instrument of another,
with a copy of the instrument creattng such power attached to the schedule.
That Schedule D attaehed hereto and made part hereof sets forth the names amI addresses of all
persons beneficially interested in this estate at the time of' decedent's death, the nature ,iI' their res-
pective interests, their relhtionship, if any, to the decedent, together with the ages ht Ule time of'
decedent's death of all minors, annuitants and beneficiartes for lif'e under decedent's Will. It also
contains a statement showing whieh of the beneficiaries named in the decedent's will, if' any, died prtor
to decedent, the dates of their death, their issue, and the relationship of such issue to the bHlef'iciary.
That Schedule E attached hereto and made a part hereof sets forth all property, real and per-
sonal, owned by the decedent jointly with another or others, including intangible, standing in the name
of the decedent al)(1 others, plus the date and place of record of instruments effecting the vesttture of
real estate and the date of acquisi tion of personal ty, plus the name, address and rela tionship, if any,
of co-owners to the deceden t.
That Schedule F attached hereto and made a part hereof sets forth fully and in detail all debts
and deductions claimed for and on behalf of this decedent's estate, includtng funeral expenses paid;
family exemption, where applicable; costs of arlmtnistratton of this estate; counsel fees and fudiciary's
commissions paid or to be paid; cost expended for burial trusts, tombstones or gravemarkers, and reli-
gious servtces, tn consequence of the death of the decedent; debts and claims owing and III1]Hdd at time of
death; taxes accrued chargeable for pertod prior to decedent's death (except those allowed lInd(~r Seetion
651 of the Inheritance and Estate Tax Act); together with a statement of collateral pledged for obliga-
tions, if any. It is agree(j that the fiduciary will present proof of said claimed obligation'; upon re-
quest, that if the amount actually paid in settlement of any fee, commission or debt is less than the
estimated amount cl atming and allowed, that the same will be reported to the Register of Wil Is, and that
the amount of tax assessed can be reassessed in accordance therewtth.
That the totals of the appropriate columns in Schedules "A", "B", "e", "E", and "F" as directed therein,
have been carried forward and properly registered in the Summary.
,.. \
i,//lX. I .r
..................(......... .~.......
l!~'f\!\ J. P.:t:. '.',' )..;~ Public
~;,Jrri~b:,'.rJ.. f'.':i ":i~l 'r"~' ~:2.
My Cc/!:m':.sic'l] h;::rc; !/\Ji'ch 9, ]981
.'
"
~~~:~~
(ExeC'Utor-Administrator )
13(J r'tlf'T'",,1 'TCD1'C'
Subscribed and sworn to before me this
..,1. ~
.. ...{.e..!.:.....
day of . f' (~E1:en} .(~~- ............ 19.....7..G...
(Street Number)
",..,." ~,~ .:.~E ~ :.:..~.~. ?~. .~. ..... ~.~.~~.. ...., "" ~;-..7,.}. ~ ,.~...,.,
(City or Town and State)
NOTE: Before signing aff'tdavit make sure all blank spaces in the afftdavit and schedules annexed are
filled in with details or the word "None", and in case the assets include rare and unlisted securities,
securities of close or family corporattons or an interest tn any co-partnership or business, that the
data and statements required under the paragraph above relating to Schedule "B" are attached. Also make
certain that column #1 in the "Surrnnary" has been properly completed as above-directed.
\i{'~(11:~~I- G,';:,'
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..piAiTMINTO'.IV,"UI " ·
'Uft.AU 0' COUNTY COLLECTIt,)NS
; TR.MS','. INHERIT AN ell "AX
'Uf~~ 1;!.t:I!DI~T
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SCHEDULE' "A"
REAL PROPERTY
, .'
":, -", , .,.-' .. ,.' '.' ',' -..' .'.' .':.'.' .'.'.' ,,'.' ,,'.'.': .' : .' .", .' " .' .....' .' .-:.~-
R.alplOp.rty i"P.nnsylvanla, with statement of mortgage encumbrances upon .Qchparq{ at d.ath of ~'C:"'::'
deftt. Prop"ty h.ld by th.deced.nt as tenant in commo.. with another or other, should be rct.ntifi.dc
otto quantum of int.rest and the estimated value should be that of the dec.d.nt's inter..t ~I,. (Property
h:"d as iolnt tenal'lts with right of surviorship or t.nan~y by entireties should be r.port.d.,. Sth.dule HE/')
f
. '....
,'...".._.f...~ I.c.....t,,"'. .C.mm."....lth of Ponftl)'h,anl a ahould. bo
.~,"I'" by let an" Woek ftlmllHtr, .tr..t .nd .tro.t nllmlHtr, tog.thor with
........~4...'lptIOft.f th.,~...rty, wUh a r.forenco to tho rocord .f tho
""""""."'whlclt.. UCH.'" ..ok tltl.; If . farm .tato numh.r of a.
.,~.,..... .t......"t .f ""p,. .nculll~rone.. upon each ,a,eol at .loath
". ,,"* ......... 1'...., ........".., ace,.,." Inter..t an lllortgagOI, otc.,ar.
........... 0," ,Jchtltlvl. ,.,.. ..... m",tMt b. d.duet.d from thl. ,chodulo.
(1)
(2)
(3)
DI'. aT"'NT
VALUA 110M .
CAUTION
(0. ".. ..Ite
...tIll. ..~)
ASSESSED VAL.UE
FOR YEAR 0'
DICEDENT'S
DEATH
ESTIMATID
alUKIT VALUI
NONE
,
\
I
11
..
..
".
'.
/
IOAt,
lr--~
.
Insert this totol opposite "real property", Schedule "A" in the X X X X X
"A, Reported" column on the last page of this return.
RCC -35
. .
RESIDENT DECEDENT
SCHEDULE "B"
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
INSTRUCTIONS: This Sehedule must disclose all tangible and intangible personal property owned individually
by the decedent, at the time of his death. Property owned by the decedent jointly with another or others
must be listed under Schedule "E". Intangible personal property, titled in the name of the decedent, but
payable at death to another or others, including but not limited to P.O.D. U. S. Savings Bonds and tenta-
tive trust accounts, must be listed, despite the fact that they are not of the administered estate.
Tangible personal property should be listed first (e.g. jewelry, wearing apparel, household
goods, and furnishings, books, paintings, automobiles, boats, etc.)
Intangible personal property, such as bonds, treasury certificates, cash on hand and in bank,
stocks, mortgages, notes, together with accrued interest or dividends, salaries or wages, insurance pay-
able to the estate or fiduciary in said capacity, partnership interests, interest in any undis tributed
estate of or income from any property held in trust under the will or agreement of another, even though
located outside of the State, at the time of death, should be listed in this schedule.
Item
No.
ITEM
List and describe fully
UNIT
VALUE
ESTIMATED
MARKEr VALUE
DEPARTMENT VALUATION
(Do not write in
this space)
~'''~li;'3 lS
"ctur;1.
7, 1')7:.3.
<:1 .".(~J"'-<~n(13~(1 or ~~Ul,;r,ler~ental ~(1~.:
(~'J~'i~;~_J,1al i._Ct.il]:'"J1 f.:'il(;cl [:e}Jter:};cr
;'rude:n-tial ::n~)urance ~()r})2n=r of l')'crica
;-C)lic:i"t1:7()7')4~2G, issued FeLruar:' 17,
L 47 on t: ie Ii <:e of Carrie ':a:' 2'ndcIT,an,
,'i~-:;j (esicnrt:cc' ) ,eneficiarJ l1cr 11US1)and,
(~1~.,~.?:"lA r; 1 . }":'.;i.(1erriZl11, ,,;.1'110 c1.ierl ]\_11.SI1]r;t 15,
lSS3. ;)rOC8C(1;> paid to c:-;tate of
princi~)al ;)cJwf i ts of $147. 75, 1Ji th
accrued interest o~ ~l.OO.
TO'I'7\:L 'Ti\LUr
--
:4J.7SV--/ijg,75
!)ruden1:ic"ll In~)ur",ncc CCl1pan:l of l';-'crica
])olic'1 !~B198:Jt1,18, L,cmc(~ 7\pril 21,1')]"\
nn t1,P. li~C' of Carrie H. 7\r.rernan. -jo
de~; i(jD2 tr~(l bp.ne f i ciar:r . :P rocecc1.s ,)3:i_ ('
to 2~tate of ~rincinal ~enefits or
..~ ., 4 A 4 ') . t 1 .- . ~'. 1=.'-:-
.;~. . !.. ..., "l _ 1 .3ccrucn In terest 0_,: ;,1. t) 7 .
~'C'r:nl\L V7\LtTr
;>Hi. ')Q./ p- 1-/6. (J /
~TTl-'LLHEn'I'l\L ~C'Or[,J\L Vl\IX'r;
]Q4.84
:,r)'tOto::;tatic cO),:l 0:- State,lcnt of Clair:
jjenefi t i::;sued 1w the Prudential
Insurance Con~;;arl'l of ;';;-erica is attClchec1.
3?'1,PY
Insert this total opposi t.e "Personal Property", Schedule "B" in
the "As Reported" column on the last page of this return.
x X
304.84
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COMMOSWfAL'l'H OF PENl\"SYl1VANIA
,TRANSF'ER I~HFllITI\~cr~ TAX
s r; HEl)liLE U C II
TH\N"n'1mS
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RCC - '36'
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onEs mt.:NT DEC'Ef.lE:\T
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(1) Did decedent, within two years ofdel1lh, mltkH any .transfer of Ilny material part o.f his estate, without
,receiving a ".aluable, and adeqUilte eonsirlerlltion therefor? (Answer yes or no) Nq
tzl DHi decedent, within two years of death, transfer propeny from himself' tOh!.tlelf;A'nd another o~
others (inc1ucUng a '&pouse) in Joint ownership? (Answer yes or no) -No
'(3) If the answer to (1) or (2) above is in the affirmative stat.e:
(a) Age of decedent at Ume of transfer
(b) State,ofdeced,ent's h.~alth at. time of OInking the lrli-nsfar. (Note 1).
(c),Cause of decedent's dfHlth. (Note 1).
(4)I)id deeedent, tn his 11 t'etime, make any trails fe I' 0 f' proper ly wi t.hout receiving" val_hIe or adequat.
con"illeration therE<lforwhich was to t./.ke effect in p06session or enJoyment at or'uter his dl't8.th? '
(A...wer yes or no) Jqo .
(I1)W85 there any 'Possibll it y Um t the property trans ferrednllght retUJlg ,to tt"ansferar 01' hI..
est..llta 91' pe subJect to his power of' disposition? (Anslrer yes or do} ,'.
, (b) ~l1~t was the transferee's age at time of decedent's Ileath?
,,OS) DlddecedeptJn his lifetime make any transfer without receiving a valuableanti,.,ditquate consideration
the,..ero.rt.ll1t\e~ lIhl~'" transferor expressly or impliedly reserves for his Ufe or.".y pet-tad whichdo.s
I19t. in f'a<:tendbefQte his death: . \ . , ".. . .
. ({'l,)'l~he POf\l,Sl3'5dQn or enJoyment of or the right to income 1'1'0'81 t}.{. ,prQp~l'tY't:ra...teJ'r_? .
(J\n$W~"~s or no) NO " ", .
. ;~:,)=~:e::f~::~gn~1~s~:; ~::s~~sn:~O' sNg possess or enJ~ the p..~~ytr.nsr.rreltC)r
If'/t~;,,.~J' toO (15) (b) llbO've is in the affirmative, state whether the right w~ ....~'fed 'lndecedElnt
alflfle M ,othl'tn
(1t:Dl"',d.ec~degt 11I1Ms lifetime make a transfer, the const<:terat:lon 1'0'1' which wast,r:lNlSferee' s prolldse to
" " p.yimrome t(l ')1" fur the benefit ot' care of tl'ansferor? (Answer yes or no)!qO
(~) 1>.id de(ledeint~ ,at aqyt;lme, transfer property, the beneficial enJoyment of which was .sUbJect to' ch4n~e,
bee:au$e ofa'r'eseJ"veli power to III tel', amend, or revoke, or which cmlld revert f:o rleoetient under tel"lllS
oftilansf.r ot'byoperation 0'1' law? (Answer yes or no) No
(~) If'the anSW<i!r to. (8) above U in t.he affl.rmative, was the power to alter, amend, <<:It' revoke the int.,,...
e$.tof the bettefictary rese,rvcrl in the decedent. alone or the decedent and other.s?
(An_wer yes arno)
.N.q~ l(Th. a.,.wnrs to these questions shoul(1 be SU11l1orterl by uffljlavil by tp~,e.ttenIUng phy&ichn as
..,11: a$ a tlGP{O'f tM.deathcertlficllte. It.
H9'J(t 2: .,It anewel'l:o. Il.rl)' of the above questions Is yes, set fort.h below e. des,crtptl11n of the property
U:an.t'IIl..nct, ~lt'$flUr~l'ke't vallie at date of death, dales of transfers Ilndto "'hellJ transferred, wUh
..el.t:t.@JlenlP,o( ,tranSferees to decedent., if I1ny. Submit copy of Imy truRt deed orlt'lJit.Ji.unent, 11,' trans-
r.';' ~" elall\lfJ,f"tobe non-taxable, also suhm.it detaill>.rl stlitement offMts onwhte!l$Id~'c;I.:t1ll 1s baaed.
N()!Ilh. l!t~t ap\fh.Ci\.bh JllI"operty below in manner In which prO'virle'l in Schedules A, 8, or E.
, ", ,.' '," ,,' ", " ',,','-', ' -- , " -""', -.... ' ' ',' , . ~
..
lJESCRIPTION
MARKET VALuE
(Es t1ma ted)
DEPT. VALl'AT,';ON
(Dept. Only)
";~~
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.
Ins.,rt this total opposite "Transfers", Schedule "e" in the
"As Rep()rte~" column nnthe J Ilst p'Lge of' this return.
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. -.o...tf (3.2..63)
t~O:U"~.'; . ~.EA.L TH OF rEX;\:SY)"t.:\~IA
TRA'NsttR INHERITANCE TAX ..
RESIDENT DECEDENT
J.
"ri"':'~~:::?;.:"':- '.",,-,
--
SCIIEDU LE "D"
BENEFJCIAHlES
None Yes 6/22/20
I
___[ N." ~me __ i
Yes 9/28/20
f'
RELATIONSHIP I
(If step-children or ,
illf'~itimate cr BrlTm
are ,nvolved, set.
forth this fact.)
'EfifEFlCIARlES AND ADDRESSES
.' \.~.h,t\tll names and addreBses of all who
ha'", an ti,ter~.t. vested. cont ingent or ot.her
wise,. in eatat!)
'.
Z'J
The S~vlltion Army
11220"eeD Street
lIW,>>wb.,. t>A 17105
None
...~er.ra1.PaJse., Center
15' South 80th Street
CatntHiU, PA 17011
None
'.
.
,.
CUt.en '.F:ire 'cprnoanv
-
) ,Wtst H'~"~VM\ltA
,1' 'bA ....... A"
None
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I4r-t.:.Louis eGorsbin
'. 102 ..Street
,. '" _ ".~~:" .'_,_.'_' . " ' , ' " , ' '. t, r
,.>~labF.' PA 17111
'. '. ,'"
r. _ ".,,,,1 !.
'.ell"''-' .:;.... Sbiner
,;::... .,'i. ~BRj
. . ,.~'.,t
~iliJlb"j[. 'fA'. "1'104 ..
None
Sr.
None
,'fI.~ ~Sbila.j"
'1430:S_.t';~,.t,
BuJ*lab\J,rg, P A 17104
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Robert D. O'Hara
130 Hummel Avenu~
Le:moyne, PA 17043
t=
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SUHVIVED
DECEI>ENT
ST ATE YES
OR NO
DATE
OF
BIRTH
;~:.~...~-......-
"i.
Spec1ficBeques t
of C!etbing ..
.
. .....
Sn~j.ftC.aeg,uest
.." .
of $1...0OQ.O~' .
Soecific Bequest
nf . $.aOQ..' 0.0...
SnecUic BeQues t
of $3. 000. 00
.~ :"
SDecitic Beau-filet of
S5. OOO.O~Qt 1/2 ..bar~
Reflidu.Jl.1"Y.l!'4It~...
Specific Bequest
of $5. 000.00
..
.
Speeific Beques t of ...
&5. OOO~ OO~ 11:Labare.
Residuarv Estate
-i'
.-.-....-----------I-------..--~-_..-. .
NAME -r- DATE OF' DEATH
Yes
Yes
Yes
Yes
11/13/08
Yes
1/13/11
Deponent further says that all the above-named benefi ciaries are Hving at this time except below:
RESIDENCE
.________L_._....___
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~~~.. ."(12-63) . '
;~...' ' ~~AVTn OF rENSSYYIIANIA
'rIAN INHERITANCE TAX' .
atsloEN1' DEl"EDENT
.'
SCHEDULE "D"
1"
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t
I' h:....~d^:'f.'~~~~~F;!\l .h.
av. an laterest. vestech COflt ingent or ot.her
1 wise, in estate)
, .
J4il p~, St-At1Sl'
~l~~P~lA Rtr~.
San .":,,,~ "'.. ,011 t nA
BENEFICIARIES
':j
RELATIONSHIP I
(If step-children or t
iII~~itlmate ctliJdrea
are IOvolved, set .
forth this fact>
SURVIVED
DECEDENT
ST AT~ YES
OR NO
DA'fE
OF
BIR'rH
".
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4/30/03
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6/25/12
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4/24/09
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Deponent further says that all the above-named beneficiaries are Hving at this time excep.t below:
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NAME
RESIDENCE
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..wENT DECEDENT
SCHEDULE" E"
JOINTL Y OWNED PROPERTY
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COMriION,WEALTHOF PEN~!f'VLV ANIA
TRANSFER INHERITANCE TAX
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1NS'I.P,UC'TlONS: This schectule must dIsclose all property, real andpersono.l, OWMdbYf..... decedent )olntly,
wi dr llI'lQ.t,hel" OJ' oth'ers, including intangibles, stan~ing in the name of the deced8ntand others. List.
rfila' esta,te tint, a.s entireties, or joint tenants, glv.ing brief description, as ll'id..t.~ated~der Selle_I..
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-..... HI.... the date/md place ofl"ecord of instrument effecting vestiture, butdon<)~lncl,'lde enU...tl... r
or IllUtCltstate ,..u.l ~$tl.l.te value 1n estate valuation colullll1. Personal prop...tY.hO,\4d"11.~a. 1" \"
$.ea.cw1e,ItS-, illull date 01' acquisition, and the name; address and relaUonsh.lp (1t......> GtCo-OW."~". to
'l:tb.',dece4ent.. ..
D.-.rlpUonot;P"operty, Date \>f Acquisition, Name Unit percentage E!lhte
A_ea. -4 Relatfon'sh:lp of Co-Owners, and Place Value Share V.Iuation
"f'.Be rdot"lnlit nt where Real Estate. ace.
Value of
Decedent.'.
Inte,.st
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Insert this total opposite ",Jointly Owned Property", Scheciule "E"
in the "As RCJlort,ed" COllll!B1 on the last page of this return.
RCc-Sll (5077)
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County, Number and Name ;;0.
File Number
Date of Death .-rlln2
File Date
Estate Name ;\j:L(:C~:::-1 '<1n
(UIST NAME)
21-78-324
Cunt~erlcT,d
SUMMARY
l:~, 1~78
('a~~rie
(FIRST NAME)
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(INITIAl..)
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
REPORT Of INHERITANCE TAX APPRAISER
I, the undersigned duly appointed Inheritance Tax Appraiser in and for the County of
Pennsylvania, do respectfully report that I have appraised the real and personal property as reported in the foregoing return at
the values set forth opposite each item in the last column to the right in Schedules "A", "8", "C", and "E".
Dated:
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INHERITANCE TAX APPRAISER
REPORT Of THE REGISTER Of WILLS
I, the undersignec!1 duly elected Register of Wills in and for County, Pennsylvania, do respect-
fully report that I have allowed deductions in the amounts claimed by deponent, except as to those items where a greater or
lesser amount is set forth in the last column to the right in Schedule "f", which greater or lesser amount represents the sum
allowed as a deduction.
Dated:
REGISTER OF WII..I..S
INVENTORY VALUE AS REPORTED VALUE AS APPRAISED CODE VALUE AS REAPPRAISED COD
Rea 1 Property (Schedu Ie A) $ $ 004+ 00+
Personal Property (Schedule B) 30,4 8 t1 10+ 10+
Joint-Held Property (Schedule 'E) 20+
Tranllfers (ScheduleC) 30+
TOTAL GROSS ASSETS
Less Debts and Deductions 40.
(SCHEDULE F)
CLEAR VALUE OF ESTATE 3'14 84
E
PRINCIPLE
FACTOR
VALUE
CODE
1-
Valuation of life estates or
...:i.-
ESTATE TAX ASSESSMENTS _ $
t=
t=
annuitles....................._ $
FOR USE OF REGISTER ONLY
Tax on $
Tax on $
Tax on $
Tax on $
Tax on $
Exemptions
Total Estate
CODE
COMPUTATION OF TAX
2%
6%
5%
10%
15%
$
$
$
$
$
(*) As evidenced by Charitable
Exemption Certificates issued
by the Secretory of Revenue.
..
TOTAL TAX
$
t=
Less tax previously paid
BALANCE
Less 5% of tax if paid within
3 months after death
$
$
$
BALANCE OF INHERITANCE: TAX DUE
Add interest at rote of 6% from
to
AMOUNT OF ESTATE TAX ASSESSED
Estate tax paid
$
$
c
$
$
BALAI~CE DUE
$
$
TOT AL TAX BALANCE $
PAID $
Add interest at rote ';f 6% from
to
Supplemental Codell: (FOR USE IN HARRISBURG ONL Y)
48-Adjustment
49+Adjustment
56-Annuity
6O-Life Estate
92+Remainder Appraisal
93-Remainder Deduction
93C-Charity
94-Remainder Residue
96-Successive
Life Estate
fOR USE OF REGISTER ONLY
ADJUSTMENTS
NOTE: Where subsequent adjustments are made to the above computation of tax by the Register of Will s, for proper reason
,"ome should be noted below, with short explanation. '
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RCC-81 (6-73)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
HARRISBURG
17127
IN YOUR REPLY PLEASE
REFER TO
Inheritance Tax Division
NOTICE OF FILING or APPRAISEMENT
Robert D. O'Hara
130 Hummel Ave.
T,pmnynp, Ppnn::l
(Executor or Administrator)
In Re: Estate of
c.::Irr;p M::IY AnnprmRn
Cumberland
County - Fi Ie No.
21-78-0324
Dear
You are hereby notified that the Supplemental
appraisl:lment in the estate of Carrie May Anderman
has been filed in the office of the Register of Wills of Cumberland
County on 30 October , 11L, Said appraisement reflects the following
va I uatic)ns:
Real Estate
Personal Property
Transfers
Jointly Owned
Total
None
394.84
None
None
394.84
As to such tax that is paid within three months from date of death, a five (5%)
percent discount is allowable. As to any tax that remains unpaid after nine (9) months
(fifteen months when death occurred from December 22,1965 to June 16,1971, inclusive;
and tWEdve months when death occurred prior to December 22, 1965) from date of death,
interesll at the rate of six (6%) percent per annum is charged.
Any party in interest who is aggrieved by this notice may object thereto within
sixty days after receipt of said notice as provided by Section 1001 of the Inheritance and
Estate Tax Act of 1961, 72 P. S. 2485-1001, P. L. 313.
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10-30-78 igne..!! . ",,[ , tc-. t?-
Date
Title
Chief Appraiser
.--
C .--/
Note: This is not a bill.
R C C-2 (2-6.4)
10-30-78
. DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLL.ECTIONS
HARRISBURG, PENNA, 17127
COMMONWEALTH OF PENNSYLVANIA
RESIDENT INHERITANCE TAX
APPRAISEMENT
DATE
COUNTY
Cumberland
FILE NO.
21-78-0324
Carrie M. Anderman late of
Cumberland
in the County of Commonwealth of Pennsylvania, having died on
the 12th day of .J\m8 191.8.-, seized and possessed of an estate
subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania;
Therefore, I, Ira Gleim , an appraiser duly appointed according to law,
having been designated to make a fair and conscionable appraisement of the said estate, and to assess and fix
the cash value of all annuities and life estates growing out of said estate, hereby file the following appraisement:
Whereas,
Lemoyne
In the event that any future interest in this estate is transferred in possession or enjoyment to collateral heirs of the decedent after
the expiration of any estate for life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer
inheritance taxes at the lawful collateral rate on any such future interest.
Unit Appraisement
Description of Anet Value. Made for Inheritance
Tax Purposes
--
$ None L_ _
ae.l Property ~-
Personal Property 394
Transfers None
Jointly Held Pr, !\Tn",.. L
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Having been duly' sworn according to law, I do hereby certify that the above appraisement is made in con-
formity with law on this 30th day Of'l!.t'.t.o::;r ):vO'r.; 0 . 1928-.
(.-1- - . ~-v,-t.. of ..-~..__
Appraiser
(It\Imber and Street)
HarrisburJ!:.
(Poet OlIIee)
, Penna,
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