HomeMy WebLinkAbout10-19-78
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RCC-33 (4-73)
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
...~..
/
~~
RESIDENT DECEDENT'\:.
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'.lenue. (Section 703 of the Inheritance and Estate Tax Act of 1961.)
COUNTY OF
Cumberland
MILDRED
J.
RISSINGER
} AFFIDAVIT OF
~
IN THE MATTER OF THE ESTATE OF
(STATE FULL NAME OF DECEDENT)
Cumberland
County
Late of
State of
Pennsylvania
Dauphin
J 55:
Dinie1
Executor
County of
K.
I.
JmJGJOIXQUC
of the estate of the above-named decedent being duly sworn, depose
and say
(MONTH)
Name and address of ottorney or }
other authorized repres,entative to whom
all correspondence should be mailed.
(DAY)
, 19~{testate leoving a last will, copy of which is hereto attached. }
(YEAR) lX~
Decedent died
August 14
K. I. Daniel
Elizabethvi11e, Penna
17023
That as such Executor deponent is familiar with the affairs of said estate and the property constituting
(EX E CUTO R-ADMINI ST R A 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 flax RENTED RELATIONSHIP OF JOINT
IN WHICH DECEDENT RENTED A SAFE DEPOSIT BOX IN NAME OR NAMES OF HOLDERS TO DECEDENT
Dauphin Deposit Trust Co_ MJ.1dred J. RJ.ssJ.naer
3045 Market St. Ethel M. Daniel Sister
~.mn ~H 11 17011
,
B & E
That the contents of said safe deposit box or boxes are itemized under Schedules of this return,
wi th the exception of the following, for the reasons hereinafter set forth: No exceptions
That Schedule A attached hereto and made part hereof sets forth fully and in detai 1 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 moneY' left by the decedent at the time of
death, whether in decedent's immediate pos session, 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 prim tc 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 at such time.
,
RC C.34 (4-73)
.. COMMONWEALTH OF PEN~SYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE ee A"
REAL PROPERTY
*
Real property in Pennsylvania, with statement of mortgage encumbrances upon each parcel at death of dece-
dent. Property held by the decedent as tenant in common with another or other, should be identified
as to quantum of interest and the estimated value should be that of the decedent's interest only. (Property
held as joint tenants with right of surviorship or tenancy by entireties should be reported on Schedule "E.")
The real p,operty loeated In the Commonwealth of Pennsylvania should be (1) (2) (3)
described by lot and block number, street and street number, together wi th D!;PARTMENT
o gener<,1 des:..:ptlon of the property, with a referenee ta the reeord af the ASSESSED VALUE VALUATION
conveyance by whi ch the decedent took title; If a farm state number af a- FOR YEAR OF ESTIMA TED CAUTION
cres; also statement of mortgage encumbrances upon eaeh pareel at death DECEDENT'S MARKET VALUE (Do not write
of decedent. Taxes, assessments, acerued Interest on mortgages, ete.,are DEATH In this space)
to be listed on Schedule "F" and must not be deducted from this schedule.
NONE
~ -,
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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.
'a' -' '.,~B'S AUL~101'1 H.ot'SE
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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 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.
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 undis tributed
estate of or income from any property held in trust under the will or agreement of another, even though
located outside of the State, at the time of death, should be listed in this schedule.
Item
No.
10
11
12
13
14
ITEM
List and describe fUlly
UNIT
VALUE
1
All household goods, furnishings, and
personal property of every item except
as listed below.
All items sold at public sale at
Wimer Auction house
Net receipts from sale
Rug and drapes in Apartment
Refund of rent deposit on Apartment
1973 Ford Torino 2 Dr. # 3B30H1470l6
Cash on hand at time of death
Patient refund - Polyclinic Hospital
Checking alc # 71990623 - DAuphin
Deposit Trust Co Harrisburg, Pa.
900 Shares Common Stock C.C.N.B. Corp.
New Cumberland, Penna. ~ Bid
~avings alc # 0022013677~State Capital
Sav. & Loan Ass1n, dated August
25, 1977 due Aug 25 1981
Accrued interest due on same to/
Aug 14 1978
'~nvestment Certificate # 10815 dated
Aug. 28 1975 due 1979 - Dauphin
Deposit ~rust Co Harrisburg, Pa.
Accrued ~nterest due on above
13.56
35.93
$
225.0
25.0
600.0
2
3
4
5
6
7
8
9
$
5
8 00.00
27.43
......--
Investment Certificate # 10927 dated
March 18, 1976 due 1980 - First Federal
Savings & Loan Ass-n Harrisburg Pa.
29 00.00
Accrued interest due on the above
to August 14, 1978
57.60
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)
"
I. .)
6 ~ ,;UI,ro
!J- ')- ~ O' (J
'7 ~-, c) 0
I~"I')<OO
4435.93
225.00
75.00
1600. r.'"
26.
85,
1281
10800
T
5000
6. 8 2 4. 5 0
2 2 5. 0 0
7 5. 0 0
1.600.00
2 6. d 1
o 0
13
8000
27
20000
1. r
1 O. 8
.5.00000
1 3. 5 6
8.00000
27.4 3
20.00000
57.60
.5 4. 0 1 6. 6 6 T
57
~
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51,628.09 ";-4/ 0/ b, " ,
RCC - 36
Cl1MMO:\WEALTl! OF PENNSYLVANIA
TH.ANSFFH PiHFIUTANCE TAX
SCHEDULE "c"
TR\NSFF:nS
RESIDENT DECEDENT
(1) Did decedent, within two years or 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 d'~ath, transfer property from himsel l' to himsel l' and another or
others (including a spouse) in joint ownership? (Answer yes or no) no
(3) If the answer to (1) or (.2) above is in the arfirmative state:
(a) Age of decedent at t1me or transfer
(b) State or decedent's heal th at time or making the transrer. (Note 1).
(c) Cause or decedent's death. (Note 1).
(4) Did decedent, in his U.retime, make any transfer of property without receiving a valuable or adequate
consideration therefor which was to take erfect 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 liretime make any transfer w1thout rece1v1ng a valuable and adequate cons1deration
therefor lU1rler which transreror expressly or impl1edly reserves ror his lire or any per10d which does
not 1n fact end berore h1s death:
(a) The possession or enjoyment of or the right to 1ncome from the property transferred?
(Answer yes or no) no
(b) The r1ght to des1gnate the persons who shall possess or enjoy the property transrerred or
income thererrom? (Answer yes or no) no
(6) If the answer to (5) (b) a'bove 1s 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 transreree's promise to
pay income to or 1'01' the benefi t of care of transferor? (Answer yes or no) no
(8) Did decedent, at any time, transfer property, the beneficial enjoyment or which was subject to change,
because or Ii reserven power to alter, amend, or revoke, or which conld revert to ctecedent under terms
of transrer or by operation of law? (Answer yes or no) no
(9) 11' the answer to (8) above is in the arfirmative, was the power to alter, amend, or revoke the inter-
est or 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 supporterl by afridavi t by the attending physician as
well as a copy or the death certificate.
NOTE 2: 11' answer to any or the above questions is yes, set forth below a description or the property
transferred, it's fair market valne at rlate of rleath, dates of transrers and to whom transferrerl, with
relationship or transrerees to rlecedent, if any. Submit copy of any trust deerl or instrument, if trans-
fers are claimerl to be non-taxable, also submit rletailed statement of facts on which said claim 1s based.
NOTE:J: List applicable property below 1n manner 1n which provided in Schedules A, B, or E.
ITEM
DESCRIPTION
MARKET VALUE
(Es tima ted)
DEPT. VALUATION
(Dept. Only)
NONE
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Insert this total opposite "Transfers", Schedule "CO in the
"As Reported" column on the last page of this return.
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Count!) PennA)lvn
undpJ'f. ';And ~ ng, (',',
Wl11 flnd 'i'~stAr."
former \'#1112 ry
form fnllnwi r1~
FIRS'l' :
SEco:m:
THIltD:
FOURTH:
FIFTH:
SIXTH:
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y.!}!;~,
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f.t)fl6'~!'l/.i')I"':, ~... f't,,;.r.:, JJ'\' Tl'W1'lShlr, C.lmbf'trh. f'r.
,lJ;lnf, ,.r ~" ,:, 'r',d ells 'H31ng mitld, rr,2mory and
.~\ nuhl\C[; :,!l(j'c:clr.r'(' th18 '"n b~ my LaRt
, i" l' e by yo t' " ') k ~. n f, "1 ~:-l ~ :;' ;T ~ ~! ~;" () i :, pn y : H, dell
~, ,ny t.il,I:' Lf."'. )fnpe ;'.!'J\lf', ~n f:lFlny','] Find
.l. "r'il~r end CUTf'Ct t.nb":. .""'.', :'Y jl'ft de;)),,~, furer8l
e.,)f~n8e8 Rnd fir.:, tf:XPS sr'I:':..' r)e 'J;,'lc1 fJ'~"l my estutA.
... t;.,1."'t", dev~8e E'r'(j l)f'~(,:l~nt.h 'H!tr my S~f;'<':~, l.:tht-:ll.)anjel
my f:lr r.OAt FH~d Rt' 'P, eLu ::(1 I hfl\'''~ en'. f)t tl1H t~[1t'! of
my d.eeefi se .
l. rrd<.'r f'nd dirf'ct !'.1y f'Xf'rllt"r) hf':rF~ltl[ftPl' lAmed, to
sell any flnd pll rf"8: Aste'! Hh'('r, I 'rl,f'Y hpve, at e1.ther
n',)1'1~(' nr D,..',V~'.t,e c, '~>, "'Y'" "}>'."7.~ t.he Pl(f,'ut'lr to
8~.~"r" st~81, fl{',n)r)VI\.f~(l.t',t~J <1' U' .'V~l' Clt'.\(t~~ ~rl t'Pf' f11.mnle
to the pur('haserf~ therp-of.
Should my mether, tolE\zip 'j'r0:opll 8urv1ve ne, I ~ive, c!pv1eA
ann bAOUeE'lth my h81n1'1ce of l'iY p.stp.te unto her.
I
Shou1..d my m()ther not ~urv~ 'If' me, then And 11'1 thpt. CBSP,
I order F'nd direct my ~x~cutor to dlvld~ ~y estflte 1nto
s~Wf'n eaupl ~hF'r~H;, fmd Ie:~vP, devi,,;e nnn ~ol1eAth !)ne
ew!pI El}LF~re UlltO ppeh of my \'1I'othprs 8Yld R~ sters,
lrene Hped, halnh '.L'ro)(f'lll, ~ll1.p.s ':'r(lXAll, Guy Troxell,
Ethel DAn'el, Hernert TroYAll flllQ IRa 'l'roxell, ~nd, unto
th~1r he'-rs.
~
1
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t
.
And r do here~y nominate, co'Cstit'lte an1 Annolnt K. I.
D['n~el :11' ElizebAth"ill~, Pp" to be thp pxecutor ~f this
my Last Wlll and TeRtAI'lent) ...lith full vowflr end fiuthor1ty
to carry its nrnvisions 'ntn effe~t.
In witness whereof, I, h\ldrert ". hts.slnp;er, the tefltfltr1x,
have to th'\ s my .Lopst Will and Ter:tFlnent, hereunto Sf~t my hEtOO E\nd
seel th~s ? d8Y of Decfimbel', A.D. 19(;1.
,......
'..1..v"_J~-~tr
S1g!"'ed, seplAd, ~ublishp.d and deelF1r~n. ,
by the ahove nRrnfld l'llldred ..J. n~ sa ~.np,er, fl S '
and for ht1lp last will 8nd tpst:,PBent, in th~
prFsence of IlS, who at her request, in her
oreser.ce and in the nreF(>rC~ of eflch other hfl,\'e
herAunto subscribed our rflmes as witneRRes.
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llCC-37 (12-63)
COl\1l\1ONWEALTH OF PENNSYYLANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "D"
BENEFICIARIES
(
n
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
Mazie Troxell Deceased mother no Feb 8 1876
Irene Reed sister yes 1/7
Star Rt. Spring Glen, Penna 1 79 7~
Miles Troxell brother yes 1/7
4706 Ordhard St. Harris purg Pa l7l0c
Guy Troxell brother yes J.II
1203 Cedarbrook DRive, Rome, N. Y, 1~44n
-
Ethel Daniel sister yes 1/7
Elizabethville, Penna 17023
Herbert Troxell brother yes 1/7
4703 Delbrook Road Mec tlanicsburg, p, nna.
Ralph Troxell brother no
Marilvn Henry Neice yes 1/14
R.D. # 1 Marysville, P Ii.
Mary Mensch Neice yes 1/14
100 Curvin Drive Harr ~sburg, PEnna 17112
( both daughters of Ral ph Troxell de eased )
Leo Troxell brother no
Grace Troxell Sister in L w yes 1/21
3222B Wakefield Road Harrisburg P nna.
Patricia Barrouk Neice yes "L/bj
R.D. # 2 Lewisberry, Penna.
Dennis Troxell Nephew Yes 2/63
2417 N. 2nd St. Harri sburg, Penna.
Christine Snell Neice yes "L/b3
R.D. # 2 Etters, Penn a.
( Widow & children of Le o Troxell )
Deponent further says that all the above-named beneficiaries are living at this time except below:
NAME DATE OF DEATH RESIDENCE
Mazie Troxell Dec 24 1961 Gratz, Penna!,
Leo Troxell Mav 26.1971 R.D. . Newberrv. Penna.
Ralph Troxell Feb. 9, 1973 Gratz, Penna.
. .
. >
R '-.'-38
RESIDENT DECEDENT
SCHEDULE" E"
JOlNTL Y OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
INSTRUCTIONS: This schedule must disclose all property, real and personal, owned by the rlecedent jointly
wi Ih another or others, including intangibles, standing in the name of the decedent and others. List
r..al pstate first, as entireties, or joint tenants, giving brief description, as indicated Imder Schedule
"An, plus the (late and place of record of instrument effecting vesti ture, 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 aCljllisi tion, and the name, address and relationship (if any) of co-owners to
the decedent.
Description of Property, Date of Acquisi tion, Name Unit percentage Estate
Address and Relationship of Co-Owners, and Place Value Share Valuation
of Record of Instrl@ent, where Real Estate.
DEPARTtfENT VALUATION
CAUTION-Do not Write
In This Space.
Value of
Entire
property
Value of
Deceden t's
Interest
Savings Certificate # W 6553 dated
5th Sept. 1974 - State Capital Saving
& Loan Ass'n in names of Mildred
J. Rissinger or Ethel M~. Daniel,
sister, Elizabethville, Penna.
Principal $ 20,000.00
Accrued interest to 8-14-78
$ 20 000.( 0/
54.~3
v--
50% $ 10027.12
I
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;/
Savings Certlificate # 113510 dated
Oct. 14, 1974 - Harris Savings Ass'n
Harrisburg, Pa. in names of Mildred
J. Rissinger and Ethel'M. Daniel,
sister, Elizabethville, Penna.
Principal $ 20,000.00 $ 20 OOO.CO
Accrued interest to 8-14-78 58.LlO.
50% $ 10029.2011'
/00 ?-~~()
"/
Certificate Passbook # 22822 with
date of last entry in Passbook being
Jan. 4th, 1972 - Harris Building and
Loan Assn. Harrisburg Pa. in names
of Mildred J. Rissinger and Ethel M.
Daniel, sister, Elizabethville, Pa.
Co-owner .
Principal $ 20,000.00 $ 20,000.OD'
Accrued interest to 8-14-78 126.9)
50% $ 10063.48 ,
/0 O{,] .Plf
/
~Certificate of Deposit # 347 dated
August 23, 1973 - Dauphin Deposit
~
Trust ranch # 14, due Aug 23 1977 -
1981, Harrisburg, Penna. in names
Mildred J. Rissinger or Ethel M.Daniel
sister, Elizabethville, Pa.
Principal $ 20,000.00
Accrued interest to 8-~~-78
~ ,
^ '
50%
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~0160.71
)61{,~~6[/
;/
$ 20,~OO.0)
~2f. 4 -,
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T
1 O. 0 2 7 1 2
1 r 2 9. 2 ()
1 .0 6 3. 4 g -
1 . 1 6 2 6 8
4 0 2 8 2.4 8 s
It 0, 2 >3 2.4 8 T
L/o')t).I/~
'/
pposite "Jointly Owned Property", Schedule "E"
" colllnm on the last page of this return.
$ 40, 280 . 5 ~...'
'- .
RCC-42 (4-77)
CbMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
\ B~N~ N~.
I ",", -ll';Tl "'.
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t DATE FILED
~ .J~ n .,,,,,r:G
i ,~. '--t '-",'C)
NOTiCE OF DECEDENT ACCOUNT STATUS
Submit in truplicate within 10 days after knowledge of
the death.
RETURN COMPL ETED
FORMS TO LOCAL COUNTY
INHERITANCE TAX OfFiCE
SURVIVlt>4G DEPOSITCIR (Beneflcla.y) INfORMATION
NAME ! RELATIONSHIP
I TO DECEDENT.
.thel . . :;c.ni,~.l ft
!
ADDRESS
~.:; orin. r:.:et: treet
:liz'C b-.t'iv:ill r, b 1 '7('.,~
BANK/INSTITUTION ADDRESS
tfT't'i('C: !\ (' j'
, " __ J ,"-' J 1.."",."
CI I, 1':1(' r~
, .~. ,-,ox 1711
Hi.1rrisburg, l'a. 17105
.
IST,AT.US OF ACCOU,NT NO.: \JOINT. TRl!ST, OR INVESTME~T
L. Glnt tf n:^,nt:..; \',1 S:1 '~1,_- Y'}f fIt of survJ. vorship
EST UP, "
Cctoh0r :~, lS74
NA~~~ ~~:f:~~::) .;in; n 1'0" A~ "~U. ':; NUM''''''
DECEDENT INFORMATION
?
NAME
; iJ ';rr.{'
iDATE OF DEATH
C"/ '/r-i (".
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.iE:dnger
I
JADDRESS
I
rlTY
c/o Herhert Troxell
L'H''--;, 'clhrcok 'oad
j eChanicsburg, I'll
, COUNTY
I l-umberla.nd
,. ZIP CODE
l 17nr:s
.-. -.,
.\_,' .'';'
BAi..ANCE OF ACCOUNT AT DOD $
INTEREST ACCRUED AND COLLECTIBLE AT DOD $
TOTAL $ ;i ,(:l,E..h(:
i BANK AUTHORIZA TION
I, HEREBY CERTIFY THAT THE INFORMATION CONTAINED HEREIN IS A
lCORRECT REPRESENTATION OF INFORMATION IN OUR FILES IN ACCORD
iWITH SECTION 742 P I II E TAX ACT OF 1961.
r,
lSI~Nt TU RE~.F FINA~ CIAL IN :,ST;:A TO R
":,r,. L0
DATE
RCC-42 (4-77)
tOMMONWEA L TH OF P ENNSYL 'I ANIA
DEPARTMENT OF REVENUI:
BANK NO.
, "
DATE FILED
NOTiCE OF DECEDENT ACCOUNT STATUS
Submit in truplicate w~thin 1
the death.
,(JOIt'l.T, TR,-!ST,. ~R 1";..vESTME~T
, , ,.. . ,:, ;.., ;', ;,'.~ ,;- '"l ,', \r
,~ .,)- :~- ""'
RETURN COMPL ETED
FORMS TO LOC AL COUNTY
INH ER IT AN CE TAX OFF! CE
NAME
SURVIVING DEPOSITCIR (Beneficiary) INfORMATION
! RELATIONSHIP
! TO DECEDENT.
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ADDRESS
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BANK/INSTITUTION ADDRESS
i. ~', (.,,-,
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J!HrriEburp:, .J>
17105
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ISTAT!JS OF ACCOUNT NO:
IE~TA'~~;SH~'UUAI~ '
, r~ 4 '.
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,
NAMES ON ACCOUNT
r"~~ """,, N""''''''
DECEDENT INFORMATION
1.11
, 1 , ,
?
NAME
>i "t '-~""("l~
.. .
DATE OF DEATH
'1,;,,:,:~ nj"'cr
-',/) : ,/r;t
-rDDRESS
{~/(1 .'I':;~x'rt 'roxell
~. "," '7 ;"'11' """'01-: o'::ld
CITY
I COUNTY",
, ZIP CODE
~
I"~ c;-c
, ' .
<'OJ :<";::'01.;0 urt ,
BAi..ANCE OF ACCOUNT AT DOD
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1 ",,"'r r.
.;~ I ...../
$ . .'
. (~ ,~('
INTEREST ACCRUED AND COLLECTIBLE AT DOD $ , .
TOTAL $ ,r',J:C.rJ;
I BANK AUTHORIZATION
I HEREBY CERTIFY THAT THE INFORMATION CONTAINED HEREIN IS A
CORRECT REPRESENTATION OF INFORMATION IN OUR FILES IN ACCORD
WITH SECTION 742 PI 8< E TAX ACT OF 1961.
SIGNATURE OF FINANCIAL INVESTIGATOR
DATE
-or
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
HARRISBURG
17127
RCC-43 UI-- 71)
NOTE: TO BE SUBMITTED IN TRIPLICATE
REPORTING FINANCIAL INSTITUTION
ADDRESS
Pennsylvania Department of Revenue
Bureau of County Collections
Gable Building, 3rd, Floor
411 S. Second Street
Harrisburg, Pennsylvania 17127
DlI4Ihln D....' ... I ThII' Ca.
113 ~., It.._'
"_..1.8'" ,,,,".~..lIJtl.
ZIP CODE 1'105
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 1" D7 .,.,..,
NAMES ON ACCOUNT OR
INVESTMENT Mil.._ J. RlMl"lllI' 01' EVtel ... D.-ll11
DATE OF DEATH "....' 1",1171
COUNTY
ZIP CODE ,7DJJ
SURVIVING DEPOSITOR,
BENEFICIARY OR INVESTOR
RELATIONSHIP TO DECEDENT
E ttwl M. D.-tal
UM.....
11.'..
ADDRESS
DATE DEPOSIT OR INVESTMENT
WAS ESTABLISHED
1-1),,"
BALANCE, INCLUDING INTEREST
DUE, AT DATE OF DEATH $
1IO,IX1D.DD. lnt.....' 1325.36
Signature
TI TLE
Ja Ann C. sUva
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ETHVILLE,. P .
;1 ELIZAB 17) 362-8474
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RCC-87 (10-681
COMMONWEALTH OF PENNSlLVANIA
Department of Revenue
SAFE DEPOSIT OOX INVENTORY
~
~- {- 2J-
Date of Entry)
1. Name of decedent. "'1/ 1.fJ REf) \)1 R )(~.! IA'6-EfZ
2. Address of decedent. ?J {" :;. t ~ t? P J, IJ A 7t / E: ft? A-."A,/ P jf / L LIP A '
3. Date of death. A (' rf/ ) LJ/ ~~ '7 t
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4. Name and address of person who requested the opening of the box.
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5. Names, addresses, and relationship, if any, to decedent of persons present at
opening of the box.
l~ 11 t f A (J A
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6. Name and address of the financial institution where the safe deposit box is
located. f) fj L I PH/,il AJEfJ{l~-'/7 /?;A./t'k
~ A M fJ Jj. I 2-, I ~ P A /
7. Date of contract to rent box. 0 )j A / Jr') i 'J {. ~9>
/
8. Number of box.
J1--?
9. Title under which box is registered. ),1 R " , ),11 L JA Ed ~, A} g $ /,{ /(f-E!(
11 n. f~ lAo'l ;1.1/ fJ IL f /1 f L
10. Names and addresses of persons having access to box.
. c? It ~1 [ A s
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ll. Name and tttle of employee charged with the duty of making the inventory.
.Il~H )< I ff-lE)J1 {5:II)rJ~ APfJA1Jl~F/L
12. Was there B. will in the box? (Yes or No) A,/ i~
13. If yes, state date of will, name and address of personal representative, if
named in the will, and name and address of attorney, if any.
.A/ A/~1! tJ; 61 I-A-~ r ~_~/rA y
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Pag,e 2
SAFE DEPOS IT rox INVENTORY
Instructions: (1)' CASH: Report total only. (2) STOCK: List in detail every common or
preferred certificate, warrant or other rights found ~~ box. Stocks are to
be designated by name of company, certificate number, date of csrtificate,
name in which stock is registered, number of sh~res and class of stock.
(3) OBLIGATIONS of U.S. GOVERNMENT: Number of pieces, dates of issue, face
value, names in which registered. (4) BONDS: Designate uy name, amount,
serial number, or otherwise. (5) SAVINGS BANK or PASS_ BOOKS: State name
of depclsitor, number of book, last date appearing in book, name of bank and
branchJ. and balance. (6) JEWELRY, coms, STAMPS, MANUSCRIPTS, ETC.: List
and describe as fully as possible. (7) List Deeds, Mortgages, Current
Insurance Policies or other evidences of indebtedness. (8) All other contents.
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9. PAPOf),f tJ-e A/t' fA-Lur
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And now this ,5 day of \, C{ t? p~ , 19 ~ f: I hereby
certif'y under penalty of perjury that the above record is correct and complete
to the best of lIlY knOldedge and belief. &" " ~,,'
r LCl -- /(, A!~< ~~- -~
Signature
TAP:r /1, eL.6N ~/~t? A-Pf~j)ISr4
Print Name and Title
NOTE: Use separate sheets if necessary.
"
..
R E v-e 18 (8-781
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
K. 1. Daniel
E1izabethvi11e. FA 17023
(Executor or Adm ini strator)
In Re: Estate of
Mildred J. Rissinger
C':l1mhprl ;::mn
County - Fi Ie No. 21-72-0/15'.
Dear
You are hereby notified that the Or; g;n.ql
appraisement in the estate of Mi1dred.J _ Hi !'l!'linepr
has been filed in the office of the Register of Wi lis of C"mber1 and
County on 26 Jannary , 1919-, Said appraisement reflects the following
valuations:
Real Estate None
Personal Property 54.016.66
Transfers None
Jointly Owned 40.282.48
Total $94.299.14
As to such tax that is paid within three months from date of death, 0 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 d(IYs 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 ?f. T.qn1Jary 79 Signed L.--z-<: \=',--.~~':"'-"-", ~~
',-- )
Title Administrative Officer
(
----
-----
___~_ __ __ u__, ~~_.._._
Note: This is not a bi II.
RCC-2 (2-64)
,DEPARTMENT OF REVENUE
BtlREAU OF COUNTY COLLECTIONS
HARRISBURG, PENNA, 17127
COMMONWEALTH OF PENNSYLVANIA
RESIDENT INHERITANCE TAX
APPRAISEMENT
DATE
26 January 79
COU~~Y Cumberland
FILE NO. 21-78-0454
Whereas, Mildred J. RilSii:MI.gQr late of Rn,..nl1gh nf r.::Imp Hi"
in the County of Cl1mb~rl and Commonwealth of Pennsylvania, having died on
the , 4t"h day of Allgm:;t" 19-1.a., seized and possessed of an estate
subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania;
Therefore, I, T.~n Fill gin; ti , 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 Ufe or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer
inheritance taxes at the lawful collateral rate on any such future interest.
Unit Appraisement
Description of A..et Value. Made for Inheritance
Tax Purpoles
l1o<ll $
None
P~rRnna 1 Prl 54.016 66
Transfers "T
Jointly Owned L..n ?R? L..R
Total <:OL.. ?OO lL..
Having been duly swo.rn according to law, I do hereby certify that the above appraisement is made in con-
formity with law on this 26th day of .Taei"_...:::. t ",-.'-:c.~. ~~..:..:. 19~.
/. ) Appraiser
(N\lmbe1' and Street)
Harrisburg
(Poet otIl"" I
, Penna.
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