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HomeMy WebLinkAbout05-16-80 (4) ~ . REV-449 (8-78) ... -<_)./7 ~ -5L.t; i~ may / 6_lq~11 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF FIELD OPERATIONS SUPPLEMENTAL RESIDENT DECEDENT COUNTY OF CUMBERLAND 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 by the Secretary of Re'llenue. (Section 703 of the Inheritance and Estate Tax Act of 1961.) Late of CUMBERLAND } AFFIDAVIT OF EXECUT<<R IX ~ County SUPPLEMENTAL IN THE MATTER OF THE ESTATE OF THOMAS J. EDDY (STATE FULL NAME OF DECEDENT) County of PENNSYLVANIA CUMBERLAND } u, StatPof }gamml<<iKIX JOYCE L. KEISTER of the ..state of thu above.nomed decedent being duly sworn, depose ExecuttXr ix and say Decedent died June 1, (DAY) , 19~ testate leaving a last will, copy of which is hereto attached. } ~X~ (MONTH) Name and address of attorney or } other authorized representative to whom all correspondence should be mailed. Jerry R. Duffie, Myers, Myers, Flower & Johnson P. O. Box 125, Lemoyne, Pa. 17043 That as such Execu'trix--deponent is familiar with the affairs of said estate and the property constituting (EXECUTOR-ADMINISTRA TOR) 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 THIS SAFE DEPOSIT BOX RENTED IN NAME OR NAMES OF RELATIONSHIP OF JOINT HOLDERS TO DECEDENT That the contents of said safe deposit box or boxes are itemized under Schedules wi th 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, s tanding 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 pri~ 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, silverware, pictures, books, works of art, household furniture, horr,;es, 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 close or family corpcrations, 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 nusiness. 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 ~he 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 deatlli 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 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 co~y 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 passes 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 life 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 decedent, the dates of their death, their issue, and the relationship of such issue to the beneficiary. 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 vestiture 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 fUneral expenses paid; family exemption, where applicable; costs of administration 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 services, in consequence of the death of the decedent; debts and claims owing and Impaid 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 pvoof 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", "C", "E", and "F" as directed therein, have been carried forward and properly registered in the Summary. . . I ~ fl.. Subscnbed and sworn to before me th18 ....... ......................... Q iJ '> I . . I / ',,- (... C . .L"' ..(.......!:f.(;iftH~~,if~i...........:....................... Joyce L. Ke~ster, Executr~x .-R.......n.......-#t~t;~1i~~~}......................................_...-..-.. .Car.~i.s.~e..,......P..enns.~1.v.an.ia....l..7.'013............. (City or Town and State) _mmmmmmm__. .. . ....1: of ~~'f!);~mm 19m_~Q ___;~;~~;;~~ ;~~;;~ f!Mc. ... ..._- lemoyne, Cumbedc:nd Co., Pa. My Commission Expires Oct. 25, 1982 NOTE: Before signing affidavit 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 and unlisted securities, securi ties 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 "Summary" has been properly completed as above-directed. .. SUPPLEMENTAL RE V-451,(8-78) COMMONWEAL TH OF PENNSYLVANIA TRANSFER 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 with another or others must be listed under Schedule liE". 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 tentative trust accounts, must be listed, despite the fact that they are not of the adminis tered estate. Tangible personal property should be listed first (e.g. jewelry, wearing apparel, household goods, and furni shings, books, paintings, automobiles, boa ts, 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 payable 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. I1EM List and describe fully UNIT VALUE ESTlMA TED MARKET VALUE DEPARTMENT VALUATION (Do not write in this space) 1. Reimbursement for lifetime transfers - Joyce L. Keister, Executrix and Personal Representative of the Estate of Thomas J. Eddy, Deceased, late of the Borough of Mechanicsburg, Plaintiff v. Faye A. Robb and Douglas W. Bowman, Defendants Civil Action - Equity No. 31 EQUITY 1978 Received January 30, 1980 -- 7,000.00 Insert thi s total opposite "Personal Property", Schedule "B" in the "As Reported" column on the last page of this return. xx 7,000.00 I ~ ,'--(-t. ~( -~'