HomeMy WebLinkAbout12-14-78
RCC~33 14.73)
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
'*
RESIDENT DECEDENT
COUNTY OF Cumber land
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 Rellenue. (Section 703 of the Inheritance and Estate Tax Act of 1961.)
IN THE MATTER OF THE ESTATE OF
} AFFIDAVIT OF
EXECUTOR
A~M~~
Sa.rah B. Crowe
(STATE FU~LL NAME 9F DECEDENT),
/___( . .'. < / < {< j .__ ~---" --: -( /'.'2>'/,___--<- ,r:~__-"'/
Late of MEK;hafH.csburg.., Cumberland County
State of
ppnn~ylv.ilnii'l.
)"
County of
Dauphin
~~~
Mary F. Burgoon
Executl5d.X
of the estate of the above-named decedent being duly sworn, depose S
and say S
Decedent died
July 26,
(MONTH)
Name an,d address of attorney or }
other authorized representative to whom
all correspondence should be moiled.
(DAY)
, 19-..1!L..{~estate leaving a last will, copy of which is hereto attached.,}
(y EA R) .n1vSftrtw
William J. Madden, Jr.
240 N. Third St., P. O. Box 877, Harrisburg, Pa.
17108
That as such Executrix deponent is familiar with the affairs of said estate and the property constituting
(EX ECU TO R-ADMINIST 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 DEPOSIT BOX IN NAME OR NAMES OF HOLDERS TO DECEDENT
None
That the 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 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
wh(~resover 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 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
palyable 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 corporations, the values reported are as far as
possible ~ubstantiated 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 rlecedent 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 r)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
pertaining to the business as may be pertinent to a fair and just appraisal of the decedent's interest
therein m\lst be submitterl. It should also set forth in itemized form, together with the fair mlirket value
thereof, any other property owned or bequeathed by the decedent at the time of death.
The Sd'edule 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 decerlent, the proportionate share receiverl by each transferee and
all other facts of a pertinent nature regarding said transfers. In the case of transfers intended to
take ef'fect in p(jssession or enjoyment at or after death, there is also attached to the schedule a cOllY
of the deed, trust agreement or other instrument creating the trust. There is also set forth in said
schenule a list of all property, real and personal, with its value, which pa~ses at decedpnt's neath by
virtue of the exercise hy decedent, either individually, 0,1' jointly with another, or any power of' appoint-
ment vested in decedent, either individually or jointly, by the will, deed, or other instrwnent at' another,
with a copy of the instrwnent creating Osuch 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 ('1' their res-
peetive lnterests, their relationship, if any, to the decedent, together with the ages at the time of
decedent's death of all minors, annuitants ann 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 iiesti ture 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, incluning funeral expenses paid;
family exemption, where appUcable; costs of arlministration of this estate; counsel fees and f\ldiciary'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 decenent; debts and claims owing ann Impair! at time of
death; taxes accrued chargeable for period prior to decedent's neath (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 amollnt 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 Schenules "A", "B", "e", "E", and "F" as directed therein,
have been carried forward and properly registered in the Sununary.
Subseribed and sworn to before me this .",,,,,,,,,.,,.,,,,,,,,,,.......
(..lxi; td)~~, /--c 78
."w..."."........."..,.."" day of ...... ..,.,.~'!:~.l:,..""-t,.;:.",,.. 19......"...""
mmm. ...CZ-d"fl. .-;:/~~
~i:JL.: .
.,.We.,sl,e.y".,Drive.,.....Be.t.hany.,..Vil.laQ.e.....,
(Street Number)
,.~~~~i:\:!.l.~.~,~,~~.;-.9"L..p.~~~~..~."",....~.?9?,?"..".".
(City or Town and State)
NOTE: Bef,:,re signing affidavi t 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 requi red 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.
RCC:441"7~1)
COMMONWE:AL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLI.ECTIONS
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE (CAlf
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 prClperty locatsd In the Commonwealth of Psnnsylvanla .hould be
described b:f lot and block numbsr, .trsst and .trset numbsr, togsthsr wIth
a gsneral delScrfptlon of the property, with a reference to the record of the
conveyance by which the decedent took tItle; if a farm .tate number of a.
ere.; 01.0 statement of mortgage encumbrance. upon sach parcel at death
of decedent" Taxe., a.....ments, accrued Intere.t on mortgages, etc.,are
to be lI.ted on Schedule "F" and must not b. deducted from thIs schedule.
(1 )
(2)
(3)
DE PA RTMENT
VAL.UATION
CAUTION
(Do not write
In this .pace)
ASSESSED VAL.UE
FOR YEAR OF
DECEDENT'S
DEATH
ESTIMA TED
MARKET VALUE
NonL
NONE
Insert this total opposite "real property", Schedule "A" In the X X X X X
"As Repor1red" column on the last page of this return.
~ 0\\ L-
ECC --35
~
1lWJA.. :.::, t\A
~
CO~~IONWEALTH OF PENNSYLVANIA
TRfu~SB~R INHERITANCE TAX
RESH;;:::~\ I DECEDENT
SCHEDULE "B"
PERSONAL PROPERTY
I NSTFlUCTIONS: 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 Itt 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 ~lrnishings, 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 tel 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.
I tern
NO.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
ITEM
List and describe fully
UNIT
VALUE
ESTIMATED
MARKET VALUE
1970 Plymouth Satellite
10 Shs. A. T. & T. Stock @ 60.80
Teachers Federal Credit Union
Holy Spirit Hospital, refund
Medicare, refund
School pens10n
AARP
American Life Assurance Co., cancer policY'
lvtedicare, refund
Ivtajor Medical
Columbia Health & Accident Ins.
$800.00 ......-""-
608.00
634.00..'''' -'
27 .00 v'~
517.40 "f"'fo
..
402.84 ~/ .
157. 50 v/~
2,387.00 .......
413.76 V,
5,192.80 ~
523.33 v"/
DEPARTMENT VALUATION
(Do not write in
this space)
<gOD. 00
~O~.C6
ltJ 3'-1. f)()
;j 1. 00
5\1. io{b
1.\ ()~. -g L\-
\ 5'. 50
a 'a ~ 1. OD
,
'+ l~. 11,
~I I,J. to
5';J.3.aa
Insert this total opposite "Personal Property", Schedule "B" in
the "As Reported" column on the last page of this return.
x X ~11,663.63 \1 LL a L"2.
.... . } 1.11 U1 -..J. ID ;J
I
I
pcc-V,
CllMMO\WEAT.TH 0[-' l'l:\\:~YL\i\\;I \
Tf{A\SF'-'!\ I\FT.'lUP,\CFnx
SCHEDfT2 !Ie"
T J~ \ \' c;: n:it,'~
~~
~..(~ ..
,'<-.~,~ ',\ ~"
~:';'I~/ . I"L.
n!,.::,~~~
"''::~'' ,'-"r~{jJ-~'i,,-,>;,'r?
ilES IJ)FXT D1TF])].'\T
(1) Did (if~c('d(>nt, wIthin two years of'deat.h, m:tke iUI.V tl'Li.nsfer or any mat(~r'irll part ~)f hio;;; pstatf:'~ wJthout
receiv ing a valuable ar~d adequate consi,krn tiun til","" for? (Answer yes or no) _N9____
(2) Did decedent, within two p~ars of dfOllth, transfe,' 1'1'or)(~rLY f'rom himsel r to l.imself and another 0"
(,thers (inclwling a spouse) in joint ownership? (An:;wer yes or no)_NQ__
un 1 r the answer to (1) or (2) above Is in the af'fi rmaLive state:
(Ii) Age of decedent at time of transfer _____
(b) State of decerlent's lwalth at time of making the transfer. (Note 1).
(c) Cause of decedent's de'J.th. (Note 1).
(4) Did decedent, in hi:; lifetime, make any transfer of property without receiving a valuable or adequate
consirleration therefor which was to tiike effect in possession or enjoymer>t at or after !tis dpath?
(Answer yes or no) No
(a) Was there any possibility that the property transferred might return to transferer or his
estate or be subjpct to his power of disposition? (Answer yes or no)
(b) What was the transferee's age at time of decedent's rleath? ___
(5) Did decpdent in his lifetime make any transfer without receiving a valuable and arle'luate consideration
therefor under which transferor expressly or impliedly reserves for his 1 ifp or finy period which does
no I, in fact end before his death:
(a) The possession or eT'joyment of or the right to income from th(' property transferred?
C\.nswer yes or no) No
(11) The right to designate the persons who shall possess or enjoy the property transferred or
income th(~rcfrom? (Answer yes or no) No
(fJ) If the answer to (5) (b) above is in the affirmative, state whether the right was reserved in decedent
alone ()r others ,______
(7) Dhl decerlent in his lifetime make a transfer, the consideration for which was transferee's promise to
pay income to or for the Ilenefit of care of tl'ansferor? (Answer yes or no) No
(8) Did decedent, at any I, ime, transfer prope r ty, the b(mef'i cial enj oymen t 0 f which was subj ec t to change,
because of Ci reserved power to al tel', amend, or revoke, or which cOllld revert to rlecedent 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 thp bereficiary reserved in the decedent alone or the decedent and others?
(Answer yes or no)
NOTE 1: The answers to these questions should be SUllporterl by affidavit by the attending physician as
well as a copy of' the death certificate.
NOTE 2: If answer to any of the above qucstions is yes, set forth below a description of the property
transferrerl, it's fair mflrket value at date of death, dates of transfers and to y'hom transferrerl, with
relat ionshi]' of transferees to decedent, if any. Submit copy of any trust deed or instrument, i r tra:1S-
fers are claimed to be non-taxable, also submit ctetailed statement of' facts on which said claim is based.
"aTE 3: List applicable property below tn manner in which provid.erl in Schedules A, B. or E.
ITE~I
UESCIUPTlON
~t\.RKET VALUE
(Es Uma ted)
DEPT. VALCAT~ON
(Dept. Onl y)
N D ()Q...r
NONE
Insert this tot'l.l opposi te "Transfers", Schedule "C" tn the
"As Reported" colunlll on the last page of this return.
None
~ () f'\t..-
I ,),;,j(,\}~ B. CRO'.\T, of Betlldr.:,: VilLlqe, :--'lcl..~hcCl.njc:)Lurq.
,..urr!J\'Y L,\!, j i~ounty, Pennsylvan.lc\, do hereby In;lKc mv L~st WJ,11 ,10
t,,'stc:lllll.'nt, r\?VoJ<in~l all testamentary di.5ry):~itjons hpretofore Hle\'.!!'?
l'y 01(:.
1. 1 d1rect my hereinafter named Executor to pay my
church pledge to the Camp Curtin Memorial tTnited Methodist ChureD,
dnd all other debts and expenses as soon after my de~th as it can
cnnven j en t ly bE' rlone.
2. T direct that my funeral be cOllductpd by thp f~ees'"?
Funeral Home, 91 J N. Second Street, Harrisburg, P('nnsylvcH'i:l, if
;-'lr. i?ichard ~J. Reese is still operating the busuj('ss at the time
() f my dea, t h .
If he is not, r di.rect the funerJ.l ~",hollld he con-.
due,ed by the MYE~rs Funeral Home, 190:; 1\o1arkct ~)trE'(~t, Camp }Ul1,
; \. n;' ~~ \' !. V (":\ n i i"l .
T direct th2.1. there sll<.1.11 be no vipwing.
3. All the rest, residue and r0majnde~ of my estd~e.
real and personal and wheresoever situate, r 91ve to my sister,
M~ry F. Burgoon, if she survives me.
4. If my said sister, i':lary F. eurg\'OrJ, predpC\'2\SeS 111",
T dispose of my estate as folluws:
(a) I give to Miss La~ue ~hoemaker, 4011 Cheryle
Drive, llarrisburg, Pennsylvania, thre~ 13%) percen1 of my net
estate available 10r distribution, if she survives me.
(b) 1 give to ~lrs. Sarah :-.;andy, 3018 Boas Stri.'cr ~
Ilarrl~bur9, Fennsylvania, OtH:~ and one-half (l).r>.;) percent 0: m~:
rH~t estate r.ivai.lable for distribution, if sh~ surviv'::s flh'.
((.) I giVE: to Dr. Carroll F. burgoon, Ye~low Sprin~;s
}(o..\d. ,~'h~.>s 1 e1' ';P11 ngs, l"ennsy 1 van ia. th rce
3;'0) percer; t 01 my rli'1.
Pst.df~ d\',.j Lit,Je: for distriuution, if h: survives me.
(d) I give to Mr. and Mrs. John R. Burgoon, 147
Sporting Hill Road, Mechanicsburg, Pennsylvania, or the survivor
of them, three (3%) percent of my net estate available for distri-
bution, if either survives me.
(e) I give to Mrs. Raymond Moore, 893 Halstead,
Deltona, Flor1da, three (3%) 'percent of my net estate available
for distribution, if she survives me.
(f) I give to Miss Hilda ~ibbel, 1924 Market Street,
Camp Hill, Pennsylvania, one and one-half (l~%) percent of my net
estate available for distribution, if she survives me.
(g) I give to Miss Hazel Rexroth, 3009 Market
Street, Camp Hill, Pennsylvania, one and one-half (l!z%) percent
of my net estate available for distribution, if she survives me.
(h) I give to Mrs. Culver Willhide, R. D. 6,
Carlisle, Pennsylvania, one and one-half (11~) percent of my
net estate available for distribution, if she survives me.
(i) I give to Miss Jeanne Gulliver, 4011 Cheryle
Drive, HarriSburg, Pennsylvania, one and one-half (l~) percent
of my net estate available for distribution, if she survives me.
(j) I give to Hrs. Cleon S. Criswell, 400 E. Seventh
Street, Lansdale, Pennsylvania, my fur stole, jacket, three mink
neck pieces and coat; my automobile; my amber 'beads, bracelet and
earrings; my black cameo pin which was her grandmother's; my watch
pendant; my two strings of pearls and crystals; my cameo ring; my
pansy pin with pearl; my two pearl rings; one diamond ring; my two
strings of crystal beads; my two gold chain necklaces; and my two
silver chain necklaces and earr1ngs.
(k) I give to f.1iss LaRue S:1Oemaker my cameo p1n
with filigree; my crystal beads, earrings and bracelet; and
bracelet with small pearls.
2.
,I) If at the time of my death I own the following
articles, I dispose of them as tallows:
(1) I give to Miss LaRue Shoemaker, 4011 Ch(>~yle
Drive, HarrJ..sburg, Pennsylvania, my following Hummel figures:
The Whistling Boy (with basket on back)
Angel wi th Lamb
Angel wood carving
Singing Lesson (Angel with hirds)
Chimney Sweep
Goat Herder
Hanging Cherry What-Not
(2) I give to Mrs. Cleon Criswell, 400 E. seventh
Street, Lansdale, Pennsylvania, my following Hummel figures:
To Mother (girl with bouquet)
Little Gardner
School Girl
School Boy
Goose Girl
Girl Feeding Chicks (girl standing)
(3) I give to Mrs. Wallace Cummings, 212 E.
ljrange Street, Shippensburg, Pennsylvania, my following Hummel
lJ.yures:
Retreat
Hirthday Cake
Soloist
Street Singer
Playmates
Boy with Lamb
Large all white Flower Madonna
(4) I give to Mrs. Mary Willhide, R. D. #6,
Carlisle, Pennsylvania, to be held by her for Deanna L. Armstrong,
my following Hummel figures:
HOY in Tree ) pair
Girl in Tree }
Prayer before Battle
(5) I give to Mrs. Margaret Haer, ~43 Brandt
Avenue, New Cumberland, Pennsylvania, my Strolling Along Hummel
Figure.
(~) 1 gJ..ve to Mrs. David F. tlurgoon, 9605 Green-
3.
tlurst Drive, Sun City, Arizona, my foll.ow~ng Hummel figures:
Friends
First MUS~C Lesson
Spr1ng {g~rl at gate)
Mary on Donkey
1 a~so 9~ve to the sa1d Mrs. David F. tlurgoon, Joseph and Bl.ue Angel
and my ~ay-wren figur1ne.
(7) I give to Mrs. John Burgoon, 347 Sporting
Hill Road, Mechanicsburg, Pennsylvania, my wooden carved horses.
lS) I give to Mrs. Cleon Criswell, all my
Dresden White Angel figures from Germany and other ceramic angels.
(9) The balance of the contents of my apartment
not hereinbefore disposed of I give to Mrs. Clean Criswell and Miss
LaRue Shoemaker. Mrs. Criswell may select any items she may WiSh
for herself and for her children, and Miss Shoemaker may select
any items she desires. After they have made their selections, any
undisposed of items may either be given to friends of mine who
desire them, or shall be d1s~osed of as Mrs. Criswell and Miss
Shoemaker shall determine.
5. I give eighty and one-half (80~) percent of my net
E?state available for distribution, excluding all articles of tan-
gible personal. property hereinbefore bequeathed, in equal shares,
to the following persons who surv~ve me;
(a) Mrs. Cleon S. Criswell, 400 E. Seventh street,
lAnsdale, Pennsylvania.
(b) Mr. and Mrs. David F. Burgoon, 9605 Greenhurst
Dr~ve, Sun City, Arizona, or the survivor of them.
6. I direct that all estate, inheritance and succession
taxes on property passing under this my will or any codicil thereto,
or resulting in any manner because of my death, sllall be paid out
of the principal ot my general estate to the same effect as if said
4.
taxes were expenses of administratlon, and all legacies, devises
and other gifts of principal and income made by this my will, or
by any codicil thereto, shall be free and clear thereof.
In the
absolute discretion of my Executor, such taxes may be paid im-
med1atply, or payment may be postponed on future or remainder
interests until the time possession thereot ~~crues to the
beneficiary.
7. I nominate. constitute and appolnt my sister,
~Iary F. Burgoon, to be the Executrix of my estate. if the said
Mary F. ~urgoon is unable or unwllling to so act, 1 appoint
DauphLn Deposit Hank and ~rust Company, Harrisburg, Pennsyl-
van~a, to be my Executor.
11'1 WITNESS WHEREOf<', I have hereunto set; my hand and
1
seal to this my las t will ana testament th~s ,'2 ) ,tL-/ clay of
Mc..l.rCn, 1978.
Signed, sealed, published and
declared by the above-named
Sarah B. Crowe, as and for her
last will and testament in the
presence of us who, at her re-
quest and in her presence and
in the presence of each other,
have hereunto subscribed our
names as witnesses this ,:? .:Jh4:(
day of March, L978. '
I ,/~ /
/, ~~7~ I I_~.- - //
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.,.L L/ .fL,' ./' " \.. "--~.-'Lrz _ "t)' .'"
(SEAL)
.-
'- / \(.
"
WILLIAM J. MADDEN, JR., ES~--!UIRE
240 North Third Street
Harrisburg, Pennsylvania
5.
RCC-37 (12-63)
CO!l!l\lO~WEALTll OF PE:'\:'\SYYL\\iI:\
TRANSFER INHERITA!\CE TAX
RESIDENT DEC!-:DENT
SCHEDULE "D"
BE1\:EFICIAEIFS
Mary F. Burgoon
Wesley Drive
Bethany Village
Mechanicsbura. Pa. 17055
RELATIONSHIP
(If step-children or
illegitimate children
are involved, set
forth this fact.l
Sister
SUHVIVED
DECEDENT
STATE YES
OR NO
BENEFICIARIES AND ADDRESSES
\State full names and addresses of all who
have an interest, vested, contingent or other
wise, in estate)
Yes
DATE
OF
BI RTH
Of Age
INTEREST OF
BENEFICIARY
IN ESTATE
Entire estate
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D'~Jlonent 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")
... ccccc... .c.c.(Sch. "B")
...c. (Sch. "C")
... (SGn. .~c c c. "Ell)
Real Property
Personal Property c.....
Transfers
.J qi,nt:I.Y c cOWn~q c.P~op~xty
Gross Taxable Estate
( 1 )
(As Reported)
$ None
$.1.1.'c99:;3 .6.~
$ c .No.I1c~
$11,!?79.B~
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$~3,Z.4.3..4~cc.
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(As Determined)
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C'<CC-38
RESIOE'IT DECEDENT
SCHEDULE" E"
JOINTL Y OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
INSTRUCTIONS: This schectule must disclose all property, real and personal, owned by the rtecertent 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 lmder 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 shoulct 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
~::"O'd of In"'umen', whe'e Real E,'a,e.
Unit
Value
percen tage
Share
Estate
Valuation
DEPARTMENT VALUATION
CAUTION-Do not Write
In This Space.
Value of Value of
Entire Decedent's
Property Interest
"x;
v
In namE~ of decedent and Mary F. Bur-
goon, sister
1.
Dauphin Deposit Bank and Trust
Company, checking accou.nt
#24-77-355-7/ ($1,879.42
~ 1.1'. \ I..J. i
1,"11 : IJ!I
@'~7)
')
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q 41f.Lt~
2.
Dauphin Deposit Bank and Trust
Company, check.;ng account
#IB-64-369-8/ {3,860.63
'.0...;,._'-'"
J) 7t~~.. )3
1930.32
c f", , . '-',1 1 4..
.51;; ,..);.,. '11~'K. -oJ
3.
Dauphin Deposit Bank and Trust
Company, Savings account
#07-72274 459.12/,
Interest 2.42 ~~
229. 56 ~l~'
1.21,,;,'
d.d.q.b~
\. d-./
4.
Dauphin Deposit Bank and Trust
Company, saviQgs account
#08-80260 V 4,887.27.,;'
l'
2443.68.....
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~,'-t43.~~
5. Dauphin Deposit Bank and Trust
Company, certificate of deposit ;:) SOD. D 0
#08-05-008134 tI"""~ 5,000.00 ~. 2500.00 .~.
I
Interest 36.03 V' 18.02,....... \8.0 ~
6. Dauphin Deposit Bank and Trust
Company, certi~te of deposit 500.00 ~"'-' '5Do . DD
#08-03-729165 1 , 000 . 00 V"
Interest 3.43 I 1.71.. \. ., I
7. State Capital Savings, Account ~ fi1)1) . 61)
#001-20-16914 6,000.00 V". 2000. 00... ....~
Interest 31.33 ~ 15.66.. .,...'. l~. ~ to
Insert this total opposite "Jointly Owned Property", SChedul~-~
in the "As Reported" column on the last page of this return~..L?f:::>'G!9
1\, "'\I.\~. oS
~
Dauphin Deposit Banl<
and Trust Company
MA1N OFFICE: 2\3 MARKET STREET, HARRISBURG, PENNSYLVANIA 17105
717/255-2121
Member Federal Deposit Insurance Corporation
September 11, 1978
B1eckley & Nadden
Payne Shoemaker Building
240 N. Third st.
H~3.rrisburg, Pa. 17108
Be: Sarah B. Crowe
July 26, 1978 Deceased
Attn: William J. Madden
Dl~ar Mr. Madden:
In regards to the above mentioned, we submit the following information
~s of the date of death:
Checking account #24-77-355-7 balance $1,879.42
- Checking account #18-64-369~ balance $3,8~63 /
Savings account #b7-7227~alance $459.12Y1nterest $2.42~
rSavings account #08-80260 balance 4,887.27 interest $12.84
Certificate of Deposit #08-05-008134 balande $5,000.00 interest $36.03
Certificate of Deposit #08-03-729165 balance $1,000.00 interest $3.43
If we can be of any further assistance, please do not hesitate to
ccmtact us.
Very truly yours,
~~v' f'&'~
Barry L. Elliott
Assistant Manager
BI,E/lms
september 8, 1978
""\
~
Beckley & Madden
Attorneys At Law
Payne Shoema};:er Building
240 North Third street
P.O. Box 877
Harrisburg, Pa. 17108 RE:
Sarah B. Crowe Estate
D.O.D- 7-26-78
Dear Sir:
In response to your request, we show the following
account infor~mati~or the above named decedent:
#~-2Q-16914 BALANCE AS OF DATE
OF DEATH
ACCRUED INTEREST
DATE OF DEATH VALUE $
DATE ORIGINALLY OPENED
$
6,000.00 v/
31.337
6,031.33
#_-
BALANCE AS OF DATE
OF DEATH $
ACCRUED INTEREST
DATE OF DEATH VALUE $
DATE ORIGINALLY OPENED
#_-
BALANCE AS OF DATE
OF DEATH $
ACCRUED INTEREST
DATE OF DEATH VALUE $
DATE ORIGINALLY OPENED
#_-
BALANCE AS OF DATE
OF DEATH $
ACCRUED INTEREST
DATE OF DEATH VALUE $
DATE ORIGINALLY OPENED
If you have any further questions, please feel free
to contact this office.
Sincerely,
t1~' /-i~ (
!Jc--;n 1c;~;- --;;/ /L t'2:t"- -< . . <C_
~onna Hagdinec (Miss)
R.exx~e:x:ExxMaure:r;ctM::r::sX )
Savings Investment Servicer
FEM
11
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C,l...r',p H;il-;r:U<1L;-;,--:'-'(:tc~r -it t-L~l"r:~:;bu(q E.ast rv~;t!j
[jl_;.1"fc" r;!L'.; ~.: !ir'sttY'.vn H'~_>j,.~ w I-J,,~,;n-, \'~aP ".;.
; fl, ~J'IVd::li.-; C>tri:;~ T()....iri~:
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
HARRISBURG
17127
II.Or:- r -1
'i\~\' L..l
;Q~,l
l' '; \J
RCC-43 (4- 71)
NOTE: TO BE SUBMITTED IN TRIPLICATE
REPORTING FINANCIAL INSTITUTION
ADDRESS
D~h1n Oeposit 88hk .nd Truet Co.
213 M8rk.' St...,
Harrisburg, Psnnavlvani.
ZIP CODE 171DS
Pennsylvania Department of Revenue
Bureau of County Collections
Gable Building, 3rd, Floor
411 S. Second Street
Harrisburg, Pennsylvania 17127
Pursuant to Section 742, Pennsylvania Inheritance and Estate Tax Act
of 1961, we herewith submit the following report:
ACCOUNT NO. OF JOINT, TRUST OR
INVESTMENT DEPOSIT
os D3 7291~
NAMES ON ACCOUNT OR
INVESTMENT
8.1'.-, B. ern.- bf' MIII'V F. Burgoon
DATE OF DEATH
July 26,1978
DECEASED JOINT DEPOSITOR, TRUSTEE
OR INVESTOR
ADDRESS
e.t:h,.ny \lill~., Bnt{ fi&
MRch.nic8bul'g, p~&
SlI1'eh B. Craw
COUNTY t3..#rdr..e/daJU)(
ZIP CODE 17055
SURVIVING DEPOSITOR,
BENEFICIARY OR INVESTOR
M8l'Y F. e..argool"
ADDRESS
RELATIONSHIP TO DECEDENT
s....
Sistsr
DATE DEPOSIT OR INVESTMENT
WAS ESTABLISHED
July 9,1975 /'
/
11,000.00, Interest ~3.43
[\i\ ~
' . \ \ \.
\''d "\j:\l-v,,- C-.Y-7U .
Sig ure
Jo Ann C. Stover
A.elet.nt Meneger
Oepoei' Account Servlc..
/'
~
BALANCE, INCLUDING INTEREST
DUE, AT DATE OF DEATH $
TITLE
COMMONWEAL TH OF PENNSYLV ANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
HARRISBURG
17127
AUG 0 11978
RCC-43 (4-71)
NOTE: TO BE SUBMITTED IN TRIPLICATE
REPORTING FINANCIAL INSTITUTION
ADDRESS
O.uphin O.poalt Bank & Trust Ca.
21] Market StrBet
Harrisburg, Pennsvlvania
ZIP CODE 17105
Pennsylvania Department of Revenue
Bureau of County Collections
Gable Building, 3rd, Floor
411 S. Second Street
Harrisburg, Pennsylvania 17127
Pursuant to Section 742, Pennsylvania Inheritance and Estate Tax Act
of 1961, we herewith submit the following report:
ACCOUNT NO. OF JOINT, TRUST OR
INVESTMENT DEPOSIT
08 05 008134
NAMES ON ACCOUNT OR
INVESTMENT
Ear'" S. Crows or Mary F. Burgoon
DATE OF DEATH
Julv 26,1978
DECEASED JOINT DEPOSITOR, TRUSTEE
OR INVESTOR
SI!l1'IIh s. era...
COUNTY ~l.rnJJ.e~fl cL
ZIP CODE 1?1D5
ADDRESS BathanV \li1l..;_, Box &&
Mach~ic.~.~D, PAnn.v1van'.
SURVIVING DEPOSITOR,
BENEFICIARY OR INVESTOR
ADDRESS
Hery F. Burgoon
Same
RELATIONSHIP TO DECEDENT
Sister
DATE DEPOSIT OR INVESTMENT
WAS ESTABLISHED
June 9,1975
/...
$5,000.00, lntere.t
/'
i36.03
BALANCE, INCLUDING INTEREST
DUE, AT DATE OF DEATH $
~~,~j)..
Jo Ann C. Staver
Aeel.tent Men-oer
Oepo.lt Account Service.
----
..'-<?:::\)
TITLE
COMMONWEAL TH OF PENNSYLV ANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
HARRISBURG
17127
AUG 011978
RCC-43 (4- 71)
NOTE: TO BE SUBMITTED IN TRIPLICATE
REPORTING FINANCIAL INSTITUTION
ADDRESS
OBUphin Depasit Benk & Trust Ca.
213 Harket Strest
Harriaburg. Pennsylvania
ZIP CODE 17105
Pennsylvania Department of Revenue
Bureau of County Collections
Gable Building, 3rd, Floor
411 S. Second Street
Harrisburg, Pennsylvania 17127
Pursuant to Section 742, Pennsylvania Inheritance and Estate Tax Act
of 1961, we herewith submit the following report:
ACCOUNT NO. OF JOINT, TRUST OR
INVESTMENT DEPOSIT
24 77 355 7
NAMES ON ACCOUNT OR
INVESTMENT
SII1"IIh B. era... ar H1IrV F.. 8ul"goon
DATE OF DEATH
July 26,1978
DECEASED JOINT DEPOSITOR, TRUSTEE
OR INVESTOR
Ser.... 8. era...
ADDRESS 8eth..., Vi11..
P.O. Box 6&, HReh., P..
COUNTY
ZIP CODE
1?D55
SURVIVING DEPOSITOR,
BENEFICIARY OR INVESTOR
MIIl'Y F. Burgoon
RELATIONSHIP TO DECEDENT
Unknown
Slater
ADDRESS
DATE DEPOSIT OR INVESTMENT
WAS ESTABLISHED
Not Av.s.labla
BALANCE, INCLUDING INTEREST
DUE, AT DATE OF DEATH $
'1.AAA.9~
\~)l-V'- t. ~-u*- V
TITLE
/
Ja Ann c. Stover
A.slstent Menager
Dapasit Account SBrvlcBB
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
HARRISBURG
17127
..
RCC-43 (4-71)
NOTE: TO BE SUBMITTED IN TRIPLICATE
REPORTING FINANCIAL INSTITUTION
ADDRESS
Deuphln aepoelt B8Mk & Trust Co.
213 ~et Street
Harrleburg, Pannsylvenl.
ZIP CODE 17105
Pennsylvania Department of Revenue
Bureau of County Collections
Gable Building, 3rd, Floor
411 S. Second Street
Harrisburg, Pennsylvania 17127
Pursuant to Section 742, Pennsylvania Inheritance and Estate Tax Act
of 1961, we herewith submit the following report:
ACCOUNT NO. OF JOINT, TRUST OR
INVESTMENT DEPOSIT
18 61t 369 8
NAMES ON ACCOUNT OR
INVESTMENT
Mary ,. Burgoon or SlIl'eh B. Crowe
Jul y 26,1978
DATE OF DEATH
DECEASED JOINT DEPOSITOR, TRUSTEE
OR INVESTOR
SU'eh B. Cra..
ADDRESS Seth.,y Vl11... COUNTY
P.O. Sax 66, Mech., Pe. 17055 ZIP CODE
SURVIVING DEPOSITOR,
BENEFICIARY OR INVESTOR
ADDRESS
MII1"Y ,. Burgoon
Unkno....
RELATIONSHIP TO DECEDENT
Sister
DATE DEPOSIT OR INVESTMENT
WAS ESTABLISHED
12-26-61
BALANCE, INCLUDING INTEREST
DUE, AT DATE OF DEATH $
13,571.50
/
I '- '\., ~ I
TI TLE
Jo Ann C. Staver
A.ele'." Henegsr
Dsposlt Account Servlces
R E V-5t8 (8-78)
COMMONWEALTH OF PENNSYLV ANIA
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
Mary F. Burgoon
Wesley Drive
MeC'.h;m; C'l'lhnrg, PA 17055
(Executor or Administrator)
\n Re: Estate of
Sarah R. c'rm.Jp
Cumberland
County - Fi Ie No. 21-7R-04 ':\9
Dear
You are hereby notified that the Or; g;n""l
appraisement in the estate of Sarah Eo c'rm.J~
has been fi led in the oHi ce of the Reg i ster of Will s of Cnmhp1:'land
County on 28 February ,19--79' Said appraisement reflects the following
valuations:
Real Estate
Personal Property
Transfers
Jointly Owned
Total
None
ll,f;63.63
Nonp
11 ,44':\. 01)
$23,106.6R
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.
Date
28 February 1979
Signed
Title.
Administrative Officer.
Note: This is not a bill.
REV-457 (8..78)
DEPARTMENT OF REVENUE
BUREAU OF FIELD OPERATIONS
P.O. BOX 2970
HARRISBURG, PENNA. 17105
COMMONWEALTH OF PENNSYLVANIA
RESIDENT INHERITANCE TAX
APPRAISEMENT
DM; t. _28 ~February 1979
COUNTY Cumberland
FILE NO. ....2.l=IB n111q
Whereas, '),p'''''' R r.rnt.TP late of Mechanicsburl!
in the County of Cumberland Commonwealth of Pennsylvania, having died on
the _ 26th day of July 19 E..., seized and possessed of an estate
subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania;
Therefore, I, Lp.o Fll1~initi ,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:
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 collatera!
rate on any such future interest.
DESCRIPTION OF ASSET UNIT Appraisement
VALUES r.J1adc for Inheritance
Tax PUfPOS8S
-
$
Real Estate None
Personal Property " hh 1 61
- ~ .., None
Jointly Owned 11 11111 In<;
Total $23,106 68
,
!
I ------r-=
i
I
Have been duly sworn according to law, I do hereby c~~~~ that the above appraisement is made in conforrmty
with the law on this 28th day of . e ruary.., . 19 -.
-.- . " . -', - "',.' \. - , .'~
(.- ;r ".--.-
,.~)
Appraiser
Harrisburg
(Number and street)
. Penna.
(Post Office)
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