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HomeMy WebLinkAbout12-05-78 ~CC-33 (4..73) COMMONWEAL TH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS .. '," , - ~ i.:;! 0 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'lenue. (Section 703 of the Inheritance and Estate Tax Act of 1961.) IN THE MATTER OF THE EST ATE OF Late of Cumberland } AFFIDAVIT OF EXECUTOR ~ Mary C. Bond (STATE FULL NAME OF DECEDENT) County State of Pennsylvania Cumberland } .., County of ~x Alfred G. Bond Executor of the estate of the above-named decedent being duly sworn, depose and say (MONTH) Nome and address of attorney or } other authorized repres.entative to whom all correspondence should be mailed. (DAY) , 1W1L-{testate leaving a last will, copy of which' is hereto attached.,} ( YEA R) llilill:lili Decedent died June 27 Charles H. Stone, Esq. 310 Bridge Street, New Cumberland, Pa. 17070 That as such executor 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 IN WHICH DECEDENT RENTED A SAFE DEPOSIT BOX THIS SAFE DEPOSIT BOX RENTED IN NAME OR NAMES OF RELATIONSHIP OF JOINT HOLDERS TO DECEDENT CCNB Bank, N. A. 331 Bridge Street New Cumberland Pa. Mar C. Bond That the contents of said safe deposit box or boxes are itemized under Schedules B wi th 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 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 interes t thereon, if any, down to the last interest 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, 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 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 1:J,usiness. A copy of the co-partnership agreement, (if oral, a statement setting forth the nature of tne 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 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 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. Therp. is also set forth in said schedule a list of all property, real and personal, with its value, which pa8ses at decedent's death by virtue of the exercise by decedent, either individually, or jointly 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 instrlooent 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, andthe 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 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", "en, "E", and "F" as directed therein, have been carried forward and properly registered in the Summary. SUbscribe~WOrn to before me this ..............,......;.~..... ............................0.1...'\ ... day of h.~..~. 19............... .........~~..t4J,..u,..A ~. ...~. ...................... ." '."" I. ,,' . " ,.. :, . ~ . '" I r\,,:: ,l':.. ~_:', 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, 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 "Summary" has been properly completed as above-directed. FlC C.34 (4.73) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS TRANSFER INHERITANCE TAX RESIDENT DECI!DEN1' SCHEDULE "Aft 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 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 P.nn.ylvanla .hould be (1 ) (2) (3) d..crlb.d by lot and block numb.r, .treet and .treet number, tog.ther with DEPARTMENT a general de.crlptlon of the property, -with a reference to the record of the ASSESSED VALUE VALUATION conveyance by which the d.ced.nt took title; If a farm .tate number of a. FOR YEAR OF ESTIMA TED CAUTION cr..; 01.0 .tat.ment of mortgage encumbrance. upon each parcel at death DECEDENT'S MARKET VALUE (Do not write of deced.nt. Taxe., a.....m.nt., accrued Inter..t on mortgage., etc.,are DEATH In thl. .pace) to b. II.ted on Schedule II FOI and mu.t not be deducted from thl. .chedule. t\l ont., NON E , 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. Non~ RCC -35 COMMONWEALTH 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 or 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 or 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 ract that they are not or the administered estate. Tangible personal property should be listed rirst (e. g. jewelry, wearing apparel, household goods, and furnishings, books, paintings, automobiles, boats, etc.) Intangible personal property, such as bonds, treasury certiricates, 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 fiducial'Y in said capacity, partnership interests, interest in any undis tributed estate or or income from any property held in trust under the will or agreement or another, even though located outside or the State, at the time or death, should be listed in this schedule. Item No. ITEM List and describe fully UNIT VALUE 1. Miscellaneous personal effects and household good 2. CCNB Bank, N. A., checking account #079-800-9 3. CCNB Bank, N. A., savings account #001-007085-2 4. Proceeds of H bonds 5. Bell Telephone Co., refund 6. General Electric hospitalization policy 7. Metropolitan Life Insurance Co., policy #4703243, proceeds 8. Metropolitan Life Insurance Co., hospital indemnity plan 9. INA Insurance, refund 10. Electric Co., shares common stock, 12 49.75 11. CCNB Corp., common stock 12.00 12. Proceeds of .6632 share of General Electric Co. common stock held on dividend reinvestment plan 13. Capital Blue Cros~ refund 14. Raymond Grandon, M. D., refund 15. Commonwealth of Penna., rent rebate 16. Pa. Blue Shield, refund Insert this total opposite "Personal Property", Schedule "B" in the "As Reported" column on the last page of this return. x X ESTIMATED MARKEr VALUE DEPARTMENT VALUATION (Do not write in this space) $ .a b. q , ~.~~ \ ~.OD \d.9.LDO ~i.DO 300.00 8a1.~ "'I, toQl. \6 ~o Doo.oO I ~. .5(.0 a10.00 \ J 1 5 o. 00 .3"\0. 00 1&f.50 5 qi. DO ,;)1 ~. DO 28,917.44 ~1IqI1.~* RCC- % COMMO:\WEALTIl OF PENNSYLVANIA TRAN~FF1\ I:\HF!UTA5C'F TAX SCHEDULE "c" TH.IcNSFEllS fmSIDENT DECEDENT (1) Did decedent, within two years of death, make any transfer of any material part of his estate, wj.thout receiving a valuable and adequate consideration therefor? (Answer yes or no) nn (2) Did decedent, within two years of death, transfer property from himself to himself and anot.her or ot.hers (incllloing a spouse) in joint ownership? (Answer yes or no) no (3) If the answer to (1) or (2) above is in t.he affirmative st.ate: (a) Age of decedent at time of t.ransfer (b) St.ate of decedent's healt.h at time of making the tra~sfer. (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) (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 cr 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 al tel', amend, or revoke, or which c0111d revert to rlecedent under terms of transfer or by operation of law? (Answer yes or no) no (9) If the answer to (8) above i3 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) NOTE 1: The answers to these questions should be supported 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 ,,'horn 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 MARKET VALUE (Es tima ted) DEPT. VALUATION (Dept. Only) NON E N5Y\.LI Insert this total opposite "Transfers", Schedule "e" in the "As Reported" colunm on the last page of this return. -0- N6YLU RCC-37 (12-63) COMMONWEALTH OF PENNSYYLANIA TRANSFER INHERITANCE TAX RESIDENT DECEDENT SCHEDULE "D" BENEFICIARIES ( h BENEFICIARIES AND ADDRESSES RELATIONSHIP SURVIVED (If step-children or DATE INTEREST OF State full names and addresses of all who illegitimate children DECEDENT OF BENEFICIARY aye an interest, vested, contingent or other are involved, set STATE YES IN ESTATE wise, in estate) forth this fact.) OR NO BIRTH Vir~inia Herrman Fetrow. R.D. 1,1 Box 411, New Cumberland, Pa. cousin yes legal $ 500.00 and personal T/U/U properTy Minerva Snyder Bond, sister-in-law yes legal $1,000.00 and 1/5 of residue Anna Bond Miller, 473 Waters ......;,.,,.,., ves leQ:al 'oersonal orooertv " .- L~.uau, lurK, rt::lllla. .L ''"tv... Eileen Baumeister Barthel, niece yes legal personal property and 2108 Burlison Drive, 1115 of residue -- T" r.n^. , . ~~~ Ruth Bond Bayless, 2350 Joppa niece yes legal personal property Rd. , York, Penna. 17403 Dorothv Baumeister Diehl 21 Inersnn<:ll nronprrv and Heatherland Rd., Middl~"t.?wn, P~ . niece yes legal 1/15 of residue . ,n ~ ^ 1 +~,.A f' 1),._ A ,;?" ,,^ 1 ,._ -: ~ 1 Ave., York, Penna. 17043 brother yes legal 1/5 of residue Margaret Fisher Bond, 588 West sister-in-law ves leQ:al 1/5 of residue Market St., York, Pa. 17404 C. Howard Fitzgerald, 241 Hill- nephews yes legal 1/5 of residue cresTave., ~t:at:e L;oLlege, 7a. <:In rlTnhn A 1 -Frorl' : 1 A 5598 Reynolds Rd., Lake City, ( a. 30252 Bradlev W. Baumeister. 2920 neohew ves legal 1/15 of residue Scioto St., Cincinnati, Ohio 45219 Deponent fUrther says that all the above-named beneficiaries are living at this time except below: NAME DATE OF DEATH RESIDENCE .... o . ....en.... e<'lI: t;;= = '13 OJ 8 's Q) .z 'OQ.2 < 8. .:.2:0 o OJ ............ ::s en .... u ::s 0 ~8g. ~ ~ SUMMARY Real Property ................... .................. ............... ....... (Sch. "A") Personal Property.......................... ............................. ...(Sch. "B") Transfers ............................................... ......................... .......... (Sch. "C") ...,......~....................... ................. Gross Taxable Estate (2) (As Determined) ( 1 ) (As Reported) $ N.()~E $... ~.~.~ .n? ~.4.4 .. $....:NONE . $. $.... $...Z~.,n7.44. $ $. $ $ $.. $ 00: N 0\ .-t r-- Z :'0 .OJ ..c:: ~ W .en '(lI ~ ~ Q) ~ :4/ >< :u 0: < W 'OJ Q ~. fI} en 0: - - < -< ~. (1j Cll: ~ t.. "C: .8 ~ "C: =- 0 ~: ~: (1j =- ~ ~ 1Il O. Cll: "C ..:: < -< := w ~. ..-I: ~ :.>, W ... r-- ~: Cll '" Q -< . : Q): ..-I C 2::: :I: ~ c ~ 0 0 r-- u: 1- k ~ Z r-- CJ'J Q): W >,: ..0: ..... t.. ~: u: ~: !- ------ 0 Cll: 0 Cll: ~. ~. u: ...c 0 ~ Q): .:::: W z ,0;: =- QJ [.I.l !: ..... ::: Cll: 0 c -< ..... .c- o - 0 E - ..... QJ :: ,.. - .... .... c ~ (1j 0 0 ~ U U . R C C-38 RESIDENT DECEDENT SCHEDULE" E" JOINTL Y OWNED PROPERTY COMMONWEALTH OF PENNSYLVANIA TRANSFER INHERIT ANCE TAX INSTRUCTIONS: This schedule must disclose all property, real and personal, owned by the decedent jointly with 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 NON E N~ Insert this total opposite "Jointly Owned Property", Schedule "E" in the "As Reported" column on the last page of this return. N6Yu.J R E v-e \8 (8-78) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF FIELD OPERATIONS P.O. BOX 2970 HARRISBURG 17105 IN YOUR REPLY PLEASE REFER TO *' Inheritance Tax Division NOTICE OF FILING OF APPRAISEMENT Alfred G. Bond 625 Colonial Avenue York.:E'A 17043 (Executor or Adm inistrator) In Re: Estate of Mary C. Bond Cumberland County - Fi Ie No. 21-78-0357 Dear Mr. Bond: You are hereby notified that the original appraisement in the estate of Mary C. Bond has been fi led in the office of the Register of Wi lis of Cumberland County on February 28 ,19~, Said appraisement reflects the following valuations: Real Estate Personal Property Transfers Jointly Owned Total None 28.917.44 None None $28.917.44 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 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. 373.__ '~-.\<_ _' \_._~ tf ,--' \,.-' February 28. 1979 .--- .Q.>2:> \.. \",_,"'-c~v-,,--,-_J.J.-.J Date . Signed CJ U Title Administrative Officer L.---~ "....~.". Note: This is not a bill.