HomeMy WebLinkAbout08-08-79 (2)
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. RCC-33 (4-73) ,
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
RESIDENT DECEDENT
COUNTY OF CUMBERLAND
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~enue. (Section 703 of the Inheritance and Estate Tax Act of 1961.)
Late of
Cumberland
} AFFIDAVIT ~F
EXECUmR~X
X~K~~
IN THE MATTER OF THE ESTATE OF
THOMAS J. EDDY
(STATE FULL NAME OF DECEDENT)
County
State of
PENNSYLVANIA
CUMBERLAND
}"
County of
~
JOYCE L. KEISTER
ExecutKir'ix
of the estate of the above-named decedent being duly sworn, depose
and say
Decedent died
June
1,
(DAY)
, 19~{testate leaving a last will, copy af which is hereto attached. }
(YEAR) inHHaliK
(MONTH)
Name and address of attorney or }
other authorized representative to wham
a II correspondence should be ma i led.
Jerry R. Duffie, Myers, Myers, Flower & Johnson
P. O. Box 125, Lemoyne, Pennsylvania 17043
That as such Executrix deponent is familiar with the affairs of said estate and the property constituting
(EXECU 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
IN WHICH DECEDENT RENTED A SAFE DEPOSIT BOX
The Commonwealt Nat~ona
Main & Market Streets
Mechanicsburq, Pa. 17055
THIS SAFE DEPOSIT BOX RENTED
IN NAME OR NAMES OF
Decedent
RELATIONSHIP OF JOINT
HOLDERS TO DECEDENT
That the contents of said safe deposit box or boxes are itemized under Schedules B
with the exception' of the following, for the reasons hereinafter set forth:
of this return,
That Schec/u/e 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 Schec/u/e 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 deced~nt 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' orpersons
giving also separately the accrued interes t thereon, if any, down to the last interes t day prim! 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 and 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, ~ilverware, pictures, books, works of art, household furniture, hors es, carriage s,
automobiles, 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
claims due and owing decedent at the time of death, and all promis sory note s 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 d;;i~ (If death, bonds and accrued interest thereon to the date of decedent's
death and other investmcnl ~(""" 'I).lled by the decedent at the time of death, with the market value there-
of a t such time.
"
In the case of securities of close 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 l)usiness.
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
rertaining to the business as may be pertinent to a fair and just appraisal of the decedent's interest
therein must be 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 t!l.ke 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 proportionate share received by each transferee and
all other facts of a pertinent nature regarding said transfers. In the case of transfers intended to
take effect in possession 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. Ther'~ is also set forth in said
schedule a list of all property, real and personal, with its value, which pa~ses at decedent's death by
virtue of the exercise by decedent, either individually, orjointly with another, or any power of appoint-
ment vested in decedent, either individually or jointly, by the will, deed, or other instrument of another,
with a copy of the instrument creating such power attached to the schedule.
That Schedule D attached hereto and made part hereof sets forth the names and addresses of all
persons beneficially interested in this estate at the time of decedent's death, the nature of their res-
pective interests, their relationship, if any, to the decedent, together with the ages at the time of
decedent's death of all minors, annuitants and beneficiaries for lif'e under decedent's Will. It also
contains a statement showing which of the beneficiaries named in the decedent's will, if any, died prior
to de,;edent, the dates of their death, their issue, and the relationship of such issue to the benef'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 and others, plus the date and place of record of instruments effecting the yestiture of
real estate and the date of acquisition of personalty, plus the name, address and relationship, if any,
of co-owners to the decedent.
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, including hlneral expenses paid;
family exemption, where applicable; costs of administration of this estate; counsel fees and hldiciary's
commissions paid or to be paid; cost expended for burial trusts, tombstones or gravemarkers, and reli-
gious services, in consequence of the death of the decedent; debts and claims owing and unpaid at time of
death; taxes accrued chargeable for period prior to decedent's death (except those allowed under Section
651 of the Inheritance and Estate Tax Act); together with a statement of collateral pledged for obliga-
tions, if any. It is agreed that the fiduciary will present proof of said claimed obligations upon re-
quest, that if the amount actually paid in settlement of any fee, commission or debt is less than the
estimated amount claiming and allowed, that the same will be reported to the Register of Wills, and that
the amount of tax assessed can be reassessed in accordance therewith.
That the totals of the appropriate columns in Schedules "A", "B", "e", "E", and "F" as direc ted therein,
have been carried forward and properly registered in the Summary.
Subscribed and sworn to before me this .......I.k...............
:--:---- i_ . ~ay:~ ~ 19_7_:.
~"N_ Not." ,""Uo
I emoyne. Cumberland Co., Pa.
My Com~;s'iion Expires Oct. 25, 1982
b~~~~~k:-------
....R....-D.......#l)'....Box....3.95....................................................................
(Street Number)
...G~:t.~~J.:~.l.....~.?Y!Y?I.?:.~....!.?~~~.............................
(City or Town and State)
NOTE: Before signing aff'idavit make sure all blank spaces in the affidavit and schedules annexed are
filled in with details or the word "None", and in case the assets include rare ann unlisted securities,
securities of close or family corporations or an interest in 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 "Sununary" has been properly completed as above-directed.
'RC C-34 (.4.73)
COMMOMWEAt-TH OFPENNSYLVANIA
bEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "Au
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 identiH ed
as to quantum of interest and the estimated value should be that of the decedent's interest only. (Property
held as 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 by 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 VALUATION
conveyance by which the decedent took title; If a farm state number of a- FOR YEAR OF ESTIMATED CAUTION
cres; also statement of mortgage encumbrances upon each parcel at death DECEDENT'S MARKET VALUE (Do not write
of decedent. Taxes, assessments, accrued Interest on mortgages, etc.,are DEATH In this space)
to be I isted on Schedule" F" and must not b. deducted from this schedule.
NCJ:\JE
Insert this total opposite "real property", Schedule "A" in the X X X X X
"As Reported" column on the last page of this return.
NCNE
I\lO~E
RCC -'35' ,
. .
PAGE 1
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "B"
PERSONAL PROPERTY
I NSTRUC'l'IONS: 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 any undistributed
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)
1 . Assets of the Estate of Catherine Eddy
a/k/a Katherire Eddy, decedent's late sister
(Date of Death: March 22, 1969), a New York
resident, whose Estate was in administration
at the tine of decedent's death. Thanas J.
Eddy being tre sole beneficiary.
A. 217 shares Anerican Te1eIilore and
/'
Te1egraIil Cc:>npany c:x:>IlIIDn stock @ 61.00
p/sh (value as of 6/1/78)
B. AT&T dividend payrrents outstanding
from 4/1/69 to Jure 1, 1978
13,237.00 ,,/
,
6,440.56
C. Savings Acoount ~. 053-491890 -
Chemical Bank, Jackson Heights, N. Y .
2,469.92/
D. 12 - $50.00 - Series "E" Bonds in
the narre of Katherire Eddy (deceased)
(values as of 6/1/78 - see attached)
/
1,320.00 I
E. 1 - $25.00 Series "E" Bond in the
name of Katrerire Eddy - date 4/42
1 - $25.00 Series "E" Bond in the
name of Katrerire Eddy - date 6/42
1 - $25.00 Series "E" Bond in tre
name of Katherine Eddy - dated 7/42
1 - $25.00 Series "E" Bond in the
name of Katherine Eddy - date 6/42
72 .54
74.01
71.85 ,./
74.01 ,/
F. 5 - $25.00 Series "E" Bonds in the
name of Katherire Eddy - dated 3/51;
5/51; 6/51; 7/51; 8/51 -
(values as of 6/1/78 - see attached)
lr
279.02 ./
G. 3 - $50.00 Series ''E'' Bonds in the
name of Katherine Eddy, payable at
death to 'Ihomas J. Eddy - dated
2/43; 3/43 & 9/43 (see attached)
421.82 .'
H. 1 - $25.00 Series "E" Bond in the
narre of Katherine Eddy, payable at
death to 'Ihomas J. Eddy - dated
July 1944 - see attached
67.24 .....1..--
2.
16 - $25.00 Series ''E'' Bonds in the name of
the decedent, payable at death to Katrerire
Eddy (deceased) - see attached for dates
and values.
495.70/
Insert this total opposite "Personal Property", Schedule "B" in X X
the "As Reported" colillr~ on the last page of this return.
Rec -35 '
CO~WONWEALTH OF PENNSYLVANIA
T~\NSFER INHERITANCE TAX
PAGE 2
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 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.
Tangibl e personal property should be listed first (e. g. jewelry, wearing apparel, household
goods, and ~urnishings, 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.
ITEM
List and describe fully
UNIT
VALUE
ESTIMATED
MARKET VALUE
DEPARTMENT VALUATION
(Do not write in
this space)
3.
30 - $25.00 Series "E" Bonds in decedent's
narre, payable at death to Mrs. Mary Byrne.
(See attached for dates & values)
892.84/
4.
Bank Accounts: Connonweal th National Bank
Checking Account No. 142-103221-8
Savings Account No. 14-0010039-0
Savings Account No. 14-0002817-9
369.64/
15,510.83./
3,755.57/
I
5.
9 - $25.00 Series "E" Bonds in decedent's
narre, payable at death to Mrs. Mary Byrne.
256.80 ,.
Insert this total opposite "Personal Property", Schedule "B" in X X 45,809.35
the "As Reported" column on the last page of this return. Total - Page 1
& Page 2 I
4 6, ~O~l oS
RCC- 36
COMMO\,VVEA.LTH OF PENNSYLVANI A.
TM\'SFER I:'\HEIUTA\'CE TAX
SCHEDULE "c"
T RAN S F1:ms
I1ESIDE:\T DECEDE\TT
(1) Did decedent, within two years of death, make any transfer of any material part of' his estate, without
receiving a valuable and adequate consideration therefor? (Answer yes or no) No
(2) Did decedent, wi thin two years of death, transfer properr.y from himself to himself' and another or
ot.hers (including a spouse) in joint ownership? (Answer yes or no) No
(3) II:' 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) No
(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) ~) above is in the affirmative, state whether the right was reserved in decedent
alone or others one
(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 cOllld revert to r!ecedent 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 al tel', amend, or revoke the inter-
est of the beneficiar~ reserved in the decedent alone or the decedent anr! others?
(Answer yes or no) NO
NOTE 1: The answers to these questions should be supporter! 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 r!eed 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
MARKET VALUE
(Es tima ted)
DEPT. VALUATION
(Dept. Only)
NONE
Insert this total opposite "Transfers", Schedule "C" in the
"As Reported" column on the last page of this return.
NOr\l~
RE V-453 (8-78)
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "0"
BENEFICIARIES
BENEFICIARIES AND ADDRESSES RELA TIONSHIP
(State full names and addresses of all who (If stcp-dtildren or SURVIVED DATE INTEREST OF
have an interest, vested, contingent or other- iIlegi tima te children DECEDENT OF BENEFICIARY
wise, in estate) are involved, set STATE YES BIRTH IN ESTATE
forth this fact.) OR NO
Marv Bvrne Cousin Yes Adult One-third residue
Center Street Specific Bequest -
Phonecia, New York 12464 2.L] shares ~ ~flcan .
Comron Stock
Thomas Shannon Cousin Yes Adult One-third Residue
230 East 51st. Street
New York, New York 10022
Ann Mooney Cousin Yes Adult One-sixth residue
406 Pulaski Drive
F:~!';i- Northnort N.Y. 11731
John Beamish Cousin Yes Adult One-sixth residue
308 East 81st Street
New York, New York 10028
Deponent further says that all the above-named beneficiaries are living at this time except below:
NAME
DATE OF DEATH
RESIDENCE
(Sch. "A") $
(Sch. "8") $
(Sch, "C") $
$
$
$
(1)
(As Reported)
-.0--
413 . :5 (J:) . 15
-p-
(2)
(As Determined)
...
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e ell:
SUMMAR Y
Gross Taxable Estate
4:;$.(1(;9.35
$
$
$
$
$
$
Real Property
Personal Property
Transf ers
a
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.RCC-38
RESIDENT DECEDENT
SCHEDULE" E"
JOINTLY OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
INSTRUCTIONS: This schedule must disclose all property, real and personal, owned by the decedent 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 tmder 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 and Relationship of Co-Owners, and Place
of Record of Instrument, where Real Estate.
Unit
Value
percentage
Share
Estate
Valuation
DEPARTMENT VALUATION
CAUTION-Do not Write
In This Space.
Value of Value of
Entire Decedent's
Property Interest
NONE
Insert this to tal opposite "Jointly Owned Property", Schedule "E"
in the "As Reported" column on the last page of this return.
NONE
R,CC-39 (8-;77)
County, Number and Name
File Number
Cumberland
21-78-0315
SUMMARY
Date of Death Jnnp 1, 1978
Estate Name F.nDY, THOMAS
(LAST NAME) (FIRST NAME)
il
II
REPORT OF INHERITANCE TAX APPRAISER
J.
(INITIAL)
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
I, the underliigned duly appointed Inheritance Tax Appraiser in and for the County of Cumberland
Pennsylvania, do respectfully report that I have appraised the real and personal property ali reported in the foregoing return at
the values set forth opposite each item in the lalit column to the right in Schedules "A", "B", "C", and "E".
Dated:
September 18. 1979
~&iIUJj ~J
INHERITANCE TAX APPRAISER
REPORT OF THE REGISTER OF WILLS
I, the undersigned 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 WILLS
INVENTORY
Real Property (Schedule A)
Personal Property (Schedule B)
Joint-Held Property (Schedule E)
Transfers (Schedule C)
TOTAL GROSS ASSETS
Less Debts and Deductions
(SCHEDULE F)
CLEAR VALUE OF ESTATE
$
ADJUSTMENTS
ODE (HARRISBURG USE ONLY)
00+
10+
20+
30+
REMAINDER APPRAISEMENT CODE
92+
40-
93-
Valuation of life estates or
~
PRINCIPLE
FACTOR
VALUE
CODE
!-
annuities....................._ $
~
t=
ESTATE TAX ASSESSMENTS _ $
FOR USE OF REGISTER ONLY
Tax on $
Tax on $
Tax on $
Tax an $
Tax on $
Exemptions
Total Estate
CODE
COMPUTATION OF TAX
2%
6%
15%
$
$
$
$
$
*
TOTAL TAX
$
(*) As evidenced by Charitable
Exemption Certificates issued
by the Secretary of Revenue.
Less tax previous Iy po id
BALANCE
Less 5% of tax if paid within
3 months after death
$
$
$
t=
BALANCE OF INHERITANCE TAX DUE
Add interest at rate of 6% from
to
AMOUNT OF ESTATE TAX ASSESSED
Estate tax paid
$
$
$
$
c
j
BALANCE DUE
Add interest at rate of 6% from
to
$
$
TOT AL TAX BALANCE $
PAID $
Supplementdl Codes: (FOR USE IN HARRISBURG ONL Y)
48-Adjustment
49+Adjulitment
56-Annuity
6O-Life Estat"
92+Remainder Apprai sal
93-Remaindt;t Deduction
9 3C-Chority
94-Remainder Residue
96-Success i ve
Li fe Estate
FOR USE OF REGISTER ONLY ADJUSTMENTS
--_...._......~_._~.-- -----.-.--
NOTE: Where subsequent O'llustm"nts are made to the above computation of tax by the Register of Wills for proper reason
same sho..!,.1 be pO'ed below, with "hort explanation. "
tJl
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