HomeMy WebLinkAbout07-28-78
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PCC-33 (4.,73)
RESIDENT DECEDENT
JUt 281978 \0
COUNTY OF CTTMRF.RT.:AND
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
,
IMPORT ANT
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
hy the Secretary of Re'otenue. (Section 703 of the Inheritance and Estate Tax Act of 1961.)
co"J
EXECUTOR
1"- TilE MATTER OF THE ESTATE OF
AFFIDAVIT OF
__ ANNE C. PAGE
'.' riTE FULL NAME OF DECEDENT)
Late 0 f _______ ____CJ.:unb..e..J:l.an d
~lXR
Sta'e of__
pp-nnsy1v~ni~
} '"
County 01.________.__. Cumberland
j\JCM~
___________ PATTT. P:A~F.,
01 the estate of the above-named decedent being duly sworn, deposeS
Executor
and say S
l~v10NTH)
(DAY)
, 19-11L-{testate leaving a last will, copy of which is hereto attached. }
(YEAR) ~
Decedent ,lied
May 8
Nam~ (Hloi oddrco:;s ,~t atto'"nc'y or }
other author;zed representative to whom
all correspondencE.' she.,!
Gp-orgp- M _ HOllC'!k, :At:i-nrnE'y-~t-T,~W
Nation~ 1 R~nk Rl ng _, MeC'!h~n ; C'!shllrg, p~ _, 17055
That a~ ~UCIL_._ExeC'!lltor deponent is familiar with the affairs of said estate and the property constituting
I c:x ECU TO R-ADMIN 1ST RA TO R)
the assets thereof and their fair market value.
Thilt at lhe time of death there was no safe deposit box registered in decedent's individual name, or jointly with, or
as agen~ 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 f\~!r
IN WHICH
1 ,~D:JRESS OF BANK OR OTHER INSTITUTION THIS SAFE DEPOSIT BOX RENTED RELATIONSHIP OF JOINT
DECEDENT RENTED A S.,FE DEPOSIT BOX IN NAME OR NAMES OF HOLDERS TO DECEDENT
None 1\1,.,.... ~ Nnn",
-
-
That rhe contents of said safe deposit box or boxes are itemized under Schedules
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 III 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.
rhat Schedule B attached hereto and made part hereof sets forth fully and in detail all personal property
wher1csner 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 possession, 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 prior to decedent's
death in the case of savings banks, and to the date of decedent's death in all other case..,; all bonds, postal
s av ing.." trea s ury certificates or note s and other evidence of indebtednes s of the United 8ta te s 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;
u:: "',UllI10 al'pal~;. ,jewe;!}, silverware, pictures, books, works of art, household furniture, horses, carriages,
a utomobiles , boa ts, and any and all other personal chattels of whats oever, kind or nature, left by decedent,
together with the fairly estimated market value thereof; all bonds and mortgages held by decedent and of all
claim~ 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 (jf which ':iayable upon the death of the decedent; all and the corporate stocks and dividends
due tnert'(ill and unpaid ;ISJ' tl,-~ date of death, bonds and accrued interest thereon to the date of decedent's
death and other 1':" owned by the decedent at the time of death, with thel'l1arket value there-
of at such tiE"',
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RC C-34 (4-7:3)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMI:NT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
TRANSFER INHERITANCE TAX
RESIDENT DECED~~I
SCHEDULE "A"
REAL PROPERTY
*'
Real property in Pennsylvania, with statement of mortgage encumbrances upon each parcel at death of dece-
dent. Property held by the decedent as tenant .in common with another or other, should be identified
as to quantum of interest and the estimated value should be that of the decedent's interest only. (Property
held IClS joint tenants with right of surviorship or tenancy by entireties should be reported on Schedule "E.")
The real property located In the Commonwealth of Pennsylvania should be (1) (2) (3)
described b)' lot and block number, street and street number, together with DEPARTMENT
a general description of the property, with a reference to the record of the ASSESSED VALUE VALUA TION
conveyance by which the decedent took title; If a farm state number of a- FaR YEAR OF ESTIMATED CAUTION
cres; also sl'atement of mortgage encumbrances upon each parcel at death
of decedent. Taxes, assessments, accrued Interest on mortgages, etc.,are DECEDENT'S MARKET VALUE (00 not write
to be listed on Schedule "F" and must not be deducted from this schedule. DEATH In this spoce)
NONE NONE NOOL
Insert this total opposite "real propeiiY", Schedule "A" in the X X X X X
"As Reported" column on the last page of this return.
NONE
tJ.6'YU..,..
Ree -35
COMMON'NEALTH OF PENNSYLVANIA
TRANS8~R INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "B"
PERSONAL PROPERTY
INSTRUCTIONS: This Schedule 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 wi th 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 anyundistributed
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.
10.
11.
12.
13.
14.
ITEM
List and describe fUlly
UNIT
VALUE
ESTIMATED
MARKET VALUE
1.
Checking Account #222-106841-0, Common-
wealth National Bank:
Savings Account #22-0005ll4-8~Common-
wealth National Bank: ,...-:'
Savings Account #14-0015423-1, Comrnon-
\veal th National Bank:
Savings Account #20 02 001326,VBank of
New' Hampshire, Nasshua, Ne\v Hampshire:
Sa'ITings'Share Account #15l8,...-Athol-
Clinton Cooperative Bank, Athol, Mass-
achusetts:
94 Shares Capital Stock, Athol-Clinton
Cooperative Bank, Athol, Massachus~ts:
Term Deposit Certificate #70675-6YPithol
Savings Bank, Athol, MassachuseJ.ts:
Certificate of Deposit #3903,~11is
AmE~rican Bank, Sarasota, ~orida:
Savings Account #06-4790, Manchester
Federal Savings & Loan Association:
1080 Shares Common Stock, L. S. Starrett
Company, Athol, ~.lassachusetts:
78 Shares Common Stock, American Tele-
phone & Telegraph Company:
93 Shares Common Stock, RCA Company:
Check of Blue Shield of Florida, dated
lo1ay 4, 1978:
Check of Blue Shield of Pennsylvania,
dated May 4, 1978:
I
4.00 ~'r.
10 .00 r
2,080.70
2.
1,621.57
3.
4,970.62
4.
15 , 100 . 68
5.
207.12
6.
200.
18,800.00
7.
13,275.50
8.
1,014 . 43
9.
15,084.55
24.00
I
25,920.00
612.1875
218.0625
I
4,850.66
2,609.81
DEPARTMENT VALUATION
(Do not write in
this space)
~ O~O.10
I
I ~d..I. 57
)
~I q10.1.o~
IS \ 00. lP8
I
~07.1;)...
r\ '8, ~OD. 00
~3 ~75'.50
I
I o/Lt.43
I
I S, D i~.S6"
d.~ ctd,D. 00
I
~ 8~O.lt,G:.
I
t9., (0 Oq. 8' I
~.oo
to.oo
Insert this total opposite "Personal Property", Schedule "H" in
the "As Repor~ed" column on the last page of this return.
x X 105,549.64 .\(f'\t:::' 5LlQ LtJ
\.AJ1 ,. ,. \DI
RCC-36
COMMO;-';WEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
SCHEDULE "e"
TRANSFEIlS
RESIDEU DECEDENT
(1) Did decedent, within two years of death, make any transfer of any material part of his estate, without
rec,~iving a valuable and adequate consideration therefor? (Answer yes or no) No
(2) Did decedent, within two years of death, transfer property from himself to himself and another or
oth,~rs (including a spouse) in joint ownership? (Answer yes or no) No
(3) If the answer to (1) or (2) above is in the affirmative state:
(a) Age of decedent at time of transfer
(b) State of decedent's heal th at time of making the transfer. (Note 1).
(c) Cause of decedent's death. (Note 1).
(4) Did decedent, in his lifetime, make any transfer of property without receiving a valuable or adequate
consideration therefor which was to take effect in possession or enjoyment at or after his death?
(Answer yes or no)---1i~
(a) Was there any possibility that the property transferred might return to transferer or his
estate or be subject to his power of disposition? (Answer yes or no) No
(b) What was the transferee's age at time of decedent's death?
(5) Did decedent in his lifetime make any transfer without receiving a valuable and adequate consideration
therefor under which transferor expressly or impliedly reserves for his life or any period which does
not in fact end before his death:
(a) The possession or enjoyment of or the right to income from the property transferred?
(Answer yes or no) No
(b) The right to designate the persons who shall possess or enjoy the property transferred or
income therefrom? (Answer yes or no) No
(6) If the answer to (5) (b) above is in the affirmative, state whether the right was reserved in decedent
alone or others
(7) Did decedent in his lifetime make a transfer, the consideration for which was transferee's promise to
pay income to or for the benefit of care of transferor? (Answer yes or no) No
(8) Did decedent, at any time, transfer property, the beneficial enjoyment of which was subject to change,
because of a reserved power to alter, amend, or revoke, or which conld revert to decedent under terms
of transfer or by operation of law? (Answer yes or no) No
(9) If the answer to (8) above is in the affirmative, was the power to alter, amend, or revoke the inter-
est of the beneficiary reserved in the decedent alone or the decedent and others?
(Answer yes or no) No
NOTE 1: The answers to these questions should be su~ported by affidavit by the attending physician as
well as a copy of the death certificate.
NOTE 2: If anSwer to any of the above questions is yes, set forth below a description of the property
transferred, it's fair market value at date of death, dates of transfers and to whom transferred, with
relationship of transferees to decedent, if any. Submit copy of any trust deed or instrument, if trans-
fers are claimed to be non-taxable, also submit detailed statement of facts on which said claim is based.
NOTE 3: List applicable property below in manner in which provided in Schedules A, B, or E.
ITEM
DESCRIPTION
MARIillT VALUE
(Es tima ted)
DEPT. VALUATION
(Dept. Only)
f\i(f'{\L
NONE
NONE
Insert this total opposite "Transfers", Schedule "C" in the
"As Reported" colunm on the last page of this return.
NONE
~\ d'fu...,
LAST WILL rolD TESTAMENT
OF
Nnn; C. P AG!<:
* * * * * * * * * * * *
I, A~NE C. PAGE, beinq a resident of Sarasota County, Florida,
make this my Last Wl11 and Testament, hereby expressly revoking
any former wills, codicils and letters of testamentary import by
:me at any time heretofore made or publiShed.
FIRST - DEBTS
I direct that all of my legal debts, inoluding funeral and
testamentary expenses and estate and inheritance taxes, if any,
he paid.
SECOtTD :: 4'QEVI~!: ~m BEQUEST _2r. ~NDER
I9'ive, devise and bequeath all the rest, residue and remainder
c)f my estate to my husband, PAUL PAGE; if my husband predeceases
n~ then as follows:
a. I give and bequeath my home that I am living in at the
t,ime of ~ (lecease to my stepson, PETER ~1. PAGE.
b. I 9'i ve and bequeath the car I may own at the time of my
decease to my stepson, WILLIM1 PAGE.
c. ! qive and bequeath the sum of five thousand dollars ($5,000.00)
t,o my stepdaughter, MARCIA c. MAHOEFFER.
d. I give and bequeath the 9U~ of five thousand dollars ($5,000.00)
tl' my stepdaughter, THERESA ~TENRS.
e. If any of the foregoing beneficiaries predecease me his
o]~ her share shall lapse and be distributed according to Sub-paragraph
"ft! following.
f. I giv~ and bequeath all the rest, residue and remainder
of my estate, in equal shares, to my stepsons, PF.TER M. PAGE and
WILLIAM PAGE, and to my cousin, MARIE r~\"IS. If my stepson, WILLIAM
P~.GE OR PETER M. PAGE, predeceases me, such decedent I s share shall
qo. in equal shares to ,MARIE LEWIS and the survivor of my two stepsons;
if MARI1~ LEWIS predeceases me, her share shall go to her children
that survive me, in equal shares.
THIRD - COMMON DISASTER
If any person required to Burvi ve me in order to take property
under this will and I should die simultaneously or unc~r circumstances
which make it difficult to determine which of us died first, I
direct that I shall be deemed to have survived such person for
the purpose of this will and that the provisions of this will shall
be construed upon that assumption and basis.
!~~L..::.. PERSON}\.~ REPRESE~ATI~
I appoint my husband, PAUL PAGE, as personal representative
of my estate. HILLIAM PAGE is named as first alternate and PETER 14.
PAGE is named as second alternate. Neither my personal representative
nor al ternate shall be required to qive hond.
FIFTH - POWERS
In addition to the powers given them by ~~e laws of the State
of Florida, I authorize my personal representative, successors
or substitutes, and each of them to have the following powers and
discretions, as, in the unrestricted jUdgment of my said personal
representative, is deemed advisable for the better management and
preservation of my estate, without resort to any person or court
for further authority:
8. to sell any of the property in my estate, real or personal.
for cash or on such other terms as may seem advisable;
b. to borrml money or to make such pledges and mortgages
in connection therewith as ~ay be reasonably necessary;
c. to hold my said estate in the form of cash, free from
any liability for failure to convert such cash into productive
investments;
d. to contin\~ the operation of any business or business
interest, regardless of entity, which is an asset of the estate;
e. to make distributions hereunder, either in cash or in
kind at fair market value;
f. to settle or comprise all claims against my estate or
those my estate may have against othersr
g. to retain any investments received by them as part of
my estate or to sell the same or any part thereof and reinvest
the proceeds, not being confined to those investments authorized
by law for the investment of funds held by a fiduciary.
All of the foregoing powers to be exercised without any order
of court. Grant of the foregoing powers to my personal representative
shall not be construed to require their exercise, and any decision
or act, or failure to act, made or done, or omitted in good faith,
shall be bindinq and conclusive upon every person interested in
my estate.
SIGNED this
9th
day of March, 1973.
/sl J\.1.!!!!...s.. Page _
Anne C. Page
SIGNED by the Testatrix, ANNE C. PAGE,
to be her Last Will
and Testament, in the presence of us, who were present at the same
time, and who at her request and in her presence and in the presence
of each other, have signed our names as witnesses.
Lsl
w. E,~gene JI/lll.iams ___.
residing in Venice, Florida
~~nne Marie Tallo~,. ~
residing in Venice, Florida
RCC-37 (12-63)
COMMONWEALTH OF PENNSYYLANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "D"
BEI\EFICIARIES
BENEFICIARIES AND ADDRESSES
,State full names and addresses of all who
have an interest, vested, cont ingent or other-
wise, in estate)
RELATIONSHIP
(If step-children or I
illegitimate children I
are involved, set I
forth this fact.)
SURVIVED
DECEDENT
STATE YES
OR NO
DATE
OF
BI RTH
INTEREST OF
BENEFICIARY
IN ESTATE
Paul P
802 ell r1es S
17055
I i
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Deponent further says that all the above-named beneficiaries are living at this time except below:
NAME
DATE OF DEATH
RESIDENCE
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SUMMARY
( Sch. "A")
". (Sch. "B")
... (Sch. "C")
.. (Sch.."E")
Real Property
Personal Property ."...
Transfers
. Jo in tly. ..OwnedProperty
Gross Taxable Estate .
( 1 )
(As Reported)
$. . None
$105,549..6.4
$... ..N.one
$. ""None
$
$.]..05,549.64
(2 )
(As Determined)
$
$
$
$
$
$
t- "0
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0
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R C C-38
RESIDENT DECEDENT
SCHEDULE" E"
JOINTLY OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
INSTRllCTIONS: This scherlule must disclose all property, real anrl personal, owneri. by the ri.eceri.ent jointly
wi th another or others, including intangibles, standing in the name of the decedent and others. List
real estate first, as entireties, or joint tenants, giving brief description, as indicated Imri.er Schedule
"A", plus the date and place of record of instrument effecting vestiture, but do not include entireties
or out of state real estate value in estate valuation column. Personal property should be listed as in
Schedule "B", plus date of acquisition, and the name, address and relationship (if any) of co-owners to
the decedent.
Description of Property, Date of Acquisition, Name
Address anri. Relationship of Co-Owners, and Place
~Reeoe'l or To'te,m,'nt, wheee ReaT E,tate.
Unit
Value
percentage
Share
Estate
Valuation
DEPARTMENT VALUATION
CAUTION-Do not Write
In This Space.
Value of Value of
Entire Decedent's
property Interest
All jointly owned property held
by husband and wife, as tenants
by the entireties.
None
N~
Insert this total opposite "Jointly Owned Property", Schedule "E" None
in the" As Reported" colurrm on the last page of this return.
N6'i\L..,
RCC-81 (6-73)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
HARRISBU RG
17127
IN YOUR REPLY PLEASE
REFER TO
Inheritance Tax Division
NOTICE OF FILING or APPRAISEMENT
Mr. Paul Page
802 Charles Street
Mechanicsburg, FA 17055
(Executor or Administrator)
In Re: Estate of
Anne C. Page
Cumberland
County - Fi Ie No.
21-78-0260
Dear l'lr. Page:
You are hereby notified that. the Original
appraisement in the estate of &'me C. Page
has been fi led in the office of the Re,gister of Wi lis of Cumberland
County on September 21 , 19~_, Said appraisement reflects the following
valuations:
Real Estate
Personal Property
Transfers
Jointly Owned
Total
None
105,549.64
None
None
$105,549.64
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 twelve months when death occurred prior to December 22, 1965) from date of death,
interest at the rate of six (6%) percent per annum is charged.
Any party in interest who is aggrieved by this notice may obiect 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. 373~
) i/ ~./I
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\\~,;i "'c ~~.~.--< '"'~' .-
September 21, 1978
Signed
Date
Title
Chief Appraiser L, ~
(
Note: This is not a bill.
R C C-2 (2-64)
COUNTY
September 21, 1978
Cumberland
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
HARRISBURG, PENNA, 17127
COMMONWEALTH OF PENNSYLVANIA
RESIDENT INHERITANCE TAX
APPRAISEMENT
DATE
FILE NO.
21-78-0260
late of Borough of Mechanicsburg
Cumberland I
in the County of Commonwea th of Pennsylvania, having died on
the tlth day of May 19~, seized and possessed of an estate
subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania;
Therefore, I, Ira K. 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,
Anne C. Page
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.
I I
Unit Appraisement
Oelcrlptlon of Asset Values Made for In heri tance
T ax Purposes
Real Eroperty $ None
-- -
l'ersonal Property 105,549 64
-
Transscers None
Joint-Held Property None
TOTAL ASSETS $105,549 64
.
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Having been duly swo.rn aCCOrding to law, I do hereby certify that the above appraisement is made in con-
o 2 st d f ' .. Se}2tember 1978
formity with law on th1s ay 0 .. , /- v;, ('. -.
(' v~~,-'- r/ j \. .~ v.... t...:
Appraiaer
(l'I\Imber and Street)
Harrisburg p
_ , enna.
(PaoIt 0ftI.,.\
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