HomeMy WebLinkAbout02-06-80
r/.2.1/11
Fa rm RC C- 33
COMMONWEALTH OF PENNSYLVANIA ~'\
DEPARTMENT OF REVENUE ~
BUREAU OF COUNTY COLLECTIONS
COUNTY OF CLrx01A)a"nti..
:.:>11-l6Y-I$
RESIDENT DECEDENT
BIPOItTAST: This return must be completerl In detail and filed in duplicate, with will attached, with the
Register of Wills of the County Vo'here decedent resided; Return Is due within one year after
date of death, unless an exten.'ilon Is granted tly the Secretary of Revenue. (Section 703 of
the Inheritance and Estate Tax Act of 1961.)
IN TIlE MATTER OF TIlE ESTATE OF }
AFFIDAVIT OF
__HYRDETl{.._L o..J'R:r(::j::.__._._.__..._.._._.__._ - ---- ----- EXECUTOR
(St.ale full name or d~edent)
ADMINISTRATOR
Late or _......Cumberland..._..._. ......_....._..._....._..._.... Counly
Sial< or _.._.pennsylvania..._.____...._.__..__}
ss:
County or Cumberland.._.._....___.._.__.__..._.
_.._.._.___._.___.. ..PA VJ;_P_R,
DQPJL
.._...~~.__... ..... Executor
AdmtmMratcr-
or thr estate of the above-named dfcedent bring duly !iiworn, drpo~
and say
.....d.nl died .._.. .Apri.L... 2..
(Month)
19...-78,...1 te,tate leaving a hit _ill, copy of which i. hereto attached. }
(Yt1lr) l inte.t.te
(I Illy)
Name and address of attorney
other authoriled representative
whom 811 correspondence should
mailed.
.,}
t.
b.
PA
17011
David Ro_ Dodd..
3133 Chestnut Street,
Camp Hill,
That as such ......EXe.Cll.tO.r................. deponent is familiar with the affairs of said estate and the property con-
,1-:X''f'\Iw,r-At!mini"lr"h,r)
stituting the assets thereof and their fair market value.
That at the time of death there was no safe deposit bux 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 NANE OR NAMES or
RELATIONSHIP or JOINT
HOLDERS TO DECEDENT
Thllt the contents of s1t.irl safe deposl t box or boxes are i temizerl under Schedules
return, with the exception of the following, for the reasons hereinafter set forth:
of this
ThA.t SCh@du/@ A at.tached }lereto and marle 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, g:iving
the amount still due at death, name of mortgagee, date, rate of interest, and book ann 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 8 attached hereto and made part hereof sets forth f'ully and in detail all personal
property wheresover situated owned by the rlecedent at the time of deathj all moneys left by the decedent
lit the time of death, whether in decedent's immerliate possession, standing to decedent's credit in banks
of deposit, savings banks, trust companies, or other institutions, whether indivlrlually, or In trust for
/toy oUlf~r person or persons giving also separA.tely the accnled 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 certi flcates or notes nnd other evidence of in-
debtedness of the Uni ted States to t~e decedent; all obliRations, whether by statute or agreement they
are designated as tax free, of the United States, or Hny state, or political subdivision thereof, or of
any forf>ign country, which are o.....ned flt the time of death; all wellring apparel, jewelr:r, silverware, pic-
tures, fJooks, works of Ilrt, household furniture, horses, carriages, automobiles, boats, and any and all
other personal chattels of whatsoever kind or nature, lef't by decedent, together .....'ith the fllirly est1materl
market Vllllle thf>reof; all bonds anrl mort~6tleS held by rlecedent and of all claims due and owing decedent
.It the time of (lea:h, anrl all promissory notes or other instruments In writing for the payment of money
of .....hich dpcellent died possessed, of' whntsoever nature, with interest thereon, if Iln:r, giving the face
vtdue Itnrl estimlltetl fair mtt.rket value thereof", anrl if' such estimated fair mtt.rket value be less than the
f/tce vallie, it sets forth briefly the reasons for such depreciation fiS to each Item; all moneys payable
to the P.S tate from 11 f'e 1 nSlIrancp. pol iel es carri erl b)' rleceden tj all annul ty and endowmen t con trac ts the
Jlr()cee~ls of which .....ere payable upon the .Ienth of the decedentj ami all the corporate stocks and dividends
dll(~ thereon and unpaid as of the dul(> of' death, honds and accrued interest thereon to tht" rlnte of dece-
lltmt's flel1th ant! other investment securi ties ownerl by the decedent at the time of fleflth, wi th the market
valup thereof nt. such time.
In the case of securities of close or fnmily corporations, the vRllles reported are as t'ar as
possible substRntiaten b~' financial statements of the corporations, showing the asset.s ann liahilities
tht"reof fiS of' the flllte of deat.h. The schedule also sets fort.h the interest of decedent at the time of
death in any co-pllrtnership or business, and in support of the value of sHch interest there is Hnnexed to
said schedule, financial statements shovdn~ the assets and liabilities of said cn-part.nership or business.
A copy of thp co-pflrtnership agreement, (if oral, a statement setting forth the nature of Uie agreement)
together with a statement. setlinJ.!; forth the character of the business, its location, and such other facts
pprtaintng to the business fiS ma,y be pertinent to a fair nnd just allpraisal of the decedent' 5 interest
therein mtL<;t be suhml tted. It should also set forth in itemized form, together wi th t.he fair market value
thereof, an;y" other propertJ' owned or bequeathed by the decedent at the time of death.
The Schl?du/e C attached hereto und made part hereot' sets forth a true answer to ench inllHiry
contained tllerein anlt 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
af'ter derlth, sairl schedule sets forth the nature anfl vtllup- of such property, t.o whom transferred, the
relationship of the transferees to the ftecedent, the proportionate share received by each transferee and
all other facts of a pertinent nature regarding sairt transfers. In the case of transfers intenderl t.o
t.ake etTect in possession or enjoJ11lent at or after rleflth, there is also nt.tscheri to the scflellule tl conY
of the deed, trust tlgreement or other instrument creating t.he trust. Ther.~ is also set forth in said
schedule a list of all property, real and personal, with Its value, which pa~:ses at decedent's death by
virtue of the exercise by decedent, either individuall;r, or jointly with another, or any power of appoint-
ment. vest.ert iudecedent, either inrl1vidually or Jointly, by the will, deed, or other instrlUnent of another,
with a copy of the instrument creating such power nttached to the scherlule.
Thflt Schedule 0 fittacherl hereto snd made part hereof sets forth t.he nflmes anrl addresses of all
persons beneficially interested in this estate at the time of decedent's (leath, the nature of their res-
pective interests, their relationship, if any, to the decedent, together with the nges Ilt the time of
decedent's death of nIl minors, annuitants ann beneficiuries for life unrler flecedent's \HIl. It also
contains Ii stlitement showing which of the beneficiaries named in the d~cedent's wil), if "ny, died prior
to decedent, the dates of their denth, their issue, and the rela.tIonship of such issue to the benertciary.
That Schedule E attacherl hereto and maete a part hereof sets forth all property, rCfll IUlIl per-
sonal, owned by the decedent Jointly with another or others. including intanp;ible, standing in the nflme
of the decedent Anrl ot.hers, plus the date nnd plnce of record of instnuuents effecting the vestiture of
rea) estflte and the date of flcquisition of personfilty, plus the name, aftrlress IUllt relationship, if any,
of co-owners to the deceden t.
That SChedule F attached hereto and made a part hereof set.s forth fullJ, anlt in rIp-tail all flehts
fitl(l deductions claimed for anft on behal l' of this decedentls estate, inc)lle!ing C"uneral expenses paid;
family exemption, where appl icable; costs of arlminist.ration of this estate; counsel fees and furHciaryt s
commissions paid or to be paid; cost expemIee! for burial trusts, tombstones or gravemnrkers, lilHl reli-
gious services, in consequence of the death of the decedent; lIebts and claims owin~ and llnpnid at time of
death; taxes accrued chargeahle for perioli prior to decedent's (leath (except those allowed uneler Section
651 of the Inheritance and Estate Tax Act): together with 11 statement of collateral plerlp;ed for ohliga-
tions, if any. It is agreed that the fiduciary will present proof of sllid claimed ohli~llt1ons upon re-
quest, that if the amount nctunlly paid in settlement of any fee, commission or debt is less than the
estimated amount clniming Hnd allowed, that the same will be reported to the Register of' \\"i115, Ilnd that
the amount of tflX llssessell can be reassessed in accordnnce therewi th.
That the totals of the appropriate columns in Sche~1111es "A", "fi", "e", "E", ami "F" ftS dlrect.ed therein,
have been carried forwnrd and properly registered in the Summar:.'.
Subscribed and sworn to before me this .....dr.J...t..~....
mmm 197..9..
.........J~.....1.....~d.._...........................................
(Executor..Administrator )
. -J133......CA.l...:1Ln.u..l......dt......................................
(Street Number)
COJiY...pC;,kl.l....,..!?JdmJl0/L ..m..
(City or Town and State)
.... day of
9uhl
.&J..fL/LL Iv
~0AL'(2.,LA).. a.
SlISAH A. RUPNIK. Notory Public:
"1- '
"" ,
Itr Commiulon Expire. Otl. 22. 19711
sorE: Bpfore sl~rdng ftffidavit makf> sure nl) hlank spaces ill the Ilf'firlavit. Iwd scheelules annexefl nre
1'lllfO'ci in ~ith detfllls or the ~'orci "Sone", flnd in case the flssets inclllfte rare anfl unlisted securities,
securt tips of close or f'lImlly corporntions or fln interest in allY co-partnership or husiness, that the
d1tta Mill sUl.tpmpnts requlrer} under t.he pll.l'n~rliph nhove relattn~ to Schecillle "B" are Ilttflcllect. Also make
cprtltin that column #1 in the "SwlImllry" hllS he en properly completer! as Ilhllve-r11re-ctecl.
/
-RCC-34 '4-731
.COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "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 os tenant in cammon 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 Pennsylvania shauld be
described by lat ond block number, street and street number, together with
a general description of the property, with a reference to the record of the
conveyance by which the decedent took title; If a farm state number of 0-
cres; also statement of mortgage encumbrances upon each parcel at death
of decedent. Taxes, assessments, accrued Interest on mortgages, etc.,are
to be listed on Schedule IIF" and must not be deducted from this schedule.
(1)
ASSESSED VAlUE
FOR YEAR OF
DECEDENT'S
DEATH
All that certain tract of ground situate in
Lower Allen Township, County of Cumberland,
State of Pennsylvania, being more fully
bounded and described in Deed Book l8-X,
Page 61, in the Office of the Recorder of
Deeds.
Having thereon erected a dwelling house know
and numbered as 5 Grinnel Drive, Camp Hill,
Pennsylvania.
The value of $49,900.00 was the fair market
selling price under Agreement of Sale dated
May 15, 1978, to Helen V. Apostolopoulos
handled by Grandon Real Estate, Inc. The
said sale was consummated on October 19, 197
as more particularly recorded in Deed Book
_, Page
.fJ 10,
Insert th,s total opposite "real property", Schedule "A" in the X X X X X
"As Reported" column on the last page of this return.
(2)
(3)
DEPARTMENT
VAlUATION
CAUTION
(Do not write
In this spece)
ESTIMA TED
MARKET VAlUE
$49,900.001/
$49,900.0( ~~
"If'f cf 00, ()-{) .
J
RCC -35
'*
COll\lONWEALTJI OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "B"
PERSONAL PROPERTY
ISSTHUCTIOSS: 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 aCColUlts, must be listed, despite the fact that they are not of the administered estatft.
Tangible personal property shoulci. be listed first (e.g. jewelry, wearing apparel, household
goods, Rnd f\lrnlshlngs, books, paintings, automobiles, boats, etc.)
Intangible personal property, such as bonds, treasury certificates, cash on hand and in bank,
stocks, mortgllges, notes, together with accrued interest or dividends, salaries or wages, insurance pay-
able to the estate or fiduciary in said capacit)', 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 t.he time of death, should be listed in this schedule.
Item
No.
ITEM
List am! describe fully
UNIT ESTIMATED
VALUE MARKET VALUE
DEPARTIlENT VALUATION
(00 not write In
this space)
1.
Clothes, shoes and costurre jewelry
Miscellaneous pieces of furniture and household
items
$
25.00 ---
2.
150.00/'
3.
Proceeds from Annuity Insurance Policy; The
Fidelity Mutual Life Insurance Carpany, Policy No.
1032231
8,054.81....
4.
One (1) share Certificate No. 001-00-07354 State
Capital Savings & loan Association; accrued
interest
300.00"'--
7.98/
500.00......
500.00/'
5.
U.S. Savings Bonds (2), Series H, #626, 751 Paid UJ
6.
EskinD Pie Corp. CCXlIlDl1 stock, 10 shares at 6 1/4
on death
62.50 ....
7.
AIrerican Finance Corp. CCXlIlDl1 stock, 16 shares
at 8 5/8 on death
138. Ocr-
8.
Tri-Centre Gas and Oil Co. cornron stock, 20 shares
at $1.00 par va1ue-canpany out of existence as
certified by stockbrokers, Bache Inc.
no value /'
y.
Checking Acct 1169-43-559-6 Dauphin Deposit Bank
and Trust Carpany
Savings Acct #15-6-0837-9 Dauphin Deposit Bank and
Trus t Carpany
Hindsor Fund (Vanguard Group) Mutual Funds Acct.
1160040003, 161. 702 shares at 9.84
United Fund of l"h.1tua1 Funds Acct 1t7-37-009105-01
715.373 shares at 5.89
4,213.55 ,/
2,344.97./
AO.
3,927.64/
11.
1,591.15/'
12.
...13.
Certificates of Deposit (2) Dauphin Deposit Bank
and Trust Co. Acct #15-03-011904 OK -
Acct #15-03-723853 (all accrued interest was auto-
transferred to Savings acct. listed in Item 10.)
Cash on hand at t:ilre of death
22.00 ./
8,000.00 ....
..
5,000.00
14.
15.
April insta1l1rent, Fidelity Mutual Ins. Co.
Annui ty Payrrent
Interest of U.S. Savings Bonds (2) Treasury check
259.60./
32.52./
16.
Insert this total opposl te "Personal Propert)''', Schedule "8" in
the "As Reported" column on the last page of this return.
x X $35,129.72
d.."l ):). 9. '7 c2...
,
RCC-36
.w,
'.'
cmIMO~WEALTlI OF PE:-')lSYLVA:>I A
TH.A~SFEl\ I~HEl\lTAXCE TAX
SCHEDULE "c"
T HA:-'S FEllS
HESIIlE~T IlECEIlE:-'T
(1) Dirt decedent, within two years of'deuth, mnke any transfer of an~' material part of his estate, without
receiving a \Tuluable and adequate consideration therefor? (Answer )'es or no) nn
(2) Did rlecedent, within t.....o years of neath, transfer properLY from himself' to himself and another or
others (including a spouse) In joint ownership? (Ans'IIier )'es or no) no
(3) If the answer to (1) or (2) above Is in the affirmative state:
(a) Age of decedent at time of transfer M I!J
(b) State of decedent's health at time of ~aklng the transfer. (Note 1).
(e) Cause of decedent's death. (Sote 1).
(4) Old 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) Vias 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) n/,q
(b) What was the transferee's age at time of decedent's death? n/~
(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 ewI berore his o.enth:
(a) The possession or enjoyment or or the right to income from thl' propert)' transferred?
(Answer yes or no) no
(h) The right to designate the persons who shall possess or enjoy the property transf"erred or
income therefrom? (Ans...'er yes or no) no
(11) If the ans....er to (5) (b) above is in the affirmative, state whether the right was reserved in decedent
alone or others n/:=I
(7) Did decedent in his lif"etime make a transfer, the consideration for ....hich was transferee's promise to
pay income to or for the benef! t of care of transferor? (Answer yes or no) no
(8) Did decedent, at any time, transfer property, the benef'icial enjoyment of which ....as subject to change,
beCRuse of a reserved power to al ter, amenl!, or revoke, or which could revert to decedent Imder terms
of transfer or by operation of lB.""'? (Answer yes or no) no
(9) If the answer to (8) above is in the affirmative, was the pOI/o'er to RIter, amend, or revoke the inter-
est of the beneficiary reserverl in the rlece(lent alone or the decedent and others?
(Answer yes or no) n/a
SOTE1: The answers to these questions should be sUJlporterl: by affidavit by the atteruling physician as
well as a copy of the death ceni ftcate.
NOTE 2: I f answer to any of the above questions is yes, set forth below a description of the property
transferred, it's fair market vullle at date of death, dates of transfers and to whom trllnsferred, with
relationship ot' trnnsferees to rlecerlent, if any. Submit copy of any trllst deed or instrument, if trans-
fers nre claimerl to be non-tnxtlble, also submit detallerl statement of facts on I/o'hich suid claim is based.
SOTE 3: List appl icable property below in manner in which provideli in Schedules A, U, or Eo
ITEM
UESCIII I'TI ON
llAllKET VALUE
(Es tim. ted)
DEPT. VALUATION
(Dept. Only)
NONE
Insert this total opposite "Transfers", Schedule 'Ie" In the
"As Heported" column on the last page of this return.
l tnu...)
"RCC-3T (12:63)
CClM~IO:>;\\"EALTII OF PE:>;1'SYYLA:>;IA
TRANSFF.R INIIERITA:>;CE TAX
RESIDENT DECEDE:>;T
SCHEDULE "0"
BEK'EFICIARIES
BEI'\EFICIARIES AND ADDRESSES RELATIO~SlIIP SURVIVED DATE [I'\TEREST OF
(If step-<:hildren or
State full names and addresses of all who illegitimate children DECEDE~T OF BENEF[C[ARY
ave an interest. vested, contingent or other are involved. set STATE YES [1'\ ESTATE
wise in estate) forth this fact.) OR NO BIRTH
Rev. William Knorr brother ves 11-24-11
R!) ? Rrw 1 <;n
11,," ~~ 1 1" NY 1 ,RlLQ
D~.. ,,~~_1;_~ v_ neohew "es 6-21-45
49 Park Street I
B;n~t.. NV 1190~ I
Rev. c;~M..~_~ V. n"nh~.. n~~ 1?_"l_~Q
1012 East 13th Street
The Da11es OR 970~il
Sylvia Jean .. n;",.." n~~ ?_t'.. ./.b.
"oi 1 1 " NV 1?1,lL I I
Hrs. Rubv Clifford si """ 1 ?_1_n<;
227 Cameron Street
"t..~~~,,;_ U^ 17>>'7?
Richard S. Clifford . """ 7-9-?>>'
ne
1.1(1 T.T~_ --1n D~~--1
"m..-h U~~n~~" D^
Jack Clifford nenhew v,,~ l?-??-?h
404 Neis Avenue
Eno-1ewood OH
Pe""v Lou r1iffrn-rl I1nrlikp nipf'<> V~~ 1 n._h.. "l1 I
136 Juniner Drive
Levit town PA
FrlTJ"rr1 ^ ,.,1 ~ ff~~--1 n, ... ..~~ 111_ ?/, _? <;
2470 Beeler Avenue
York. PA
Kenneth Knorr hr"rh"r """ t'._1t'._?b.
,,~~ <;')(1
. 1 1" n^
(
h
Deponent further says that all the above-named beneficiaries are living at this time except below:
NAME
DATE OF DEATH
RESIDENCE
pro loemed
A
~
o .
~1Il~
~<(
u:;: C
'c 0.> E
.- C) :::I
6-'0
"0 0. "
<( E.
s:..3=o
o "
---
~ . ~
" ~ 0
~Efr
~ 0:
SUMMARY
.......(Sch. "A")
.........(Sch. "n")
......(SCh. "C")
Real Property...............................
Personal Property........
Transfers ......
Gross Taxable Estate.
E- "0
Z "
~ til ~
" " ""
<l> ..... " <
;... til a: ell
<J) Cl -
:;;: <
" QC
~ t.<- '" ...
"" 0 " ...
"" ..:: <
'" -< ::: til ;..
i= til i= E- S Q
c5 ~ ... -< ~ z
b 0 E- <
% <J) ""
t.<- til ~ E-
o
~ 0 QC
c 0::: 0
c ...
"" til <; ..
" !: ~ ;. QC
~ c -
- c
~ -< ~ ~. c
'c c ~
a~ ..... ~
. ~ .:.l U U
- -<
-
(I)
(As Reported)
$
S
S.
S
$
$
(2)
(As Dl'terrnilled)
s
s
s
s
s ..
S.
RCC.-3i'i
'*
COM\lONWEALTII OF PENNSYLVANIA
TRA/liSFER INIIERITANCE TAX
RESIDENT DECEOENT
SCIIEDULE "E"
JOINTL Y OW/liED PROPERTY
I;\ISTRllCTIONS: This schedule must disclose all property, real and personal, ownerl by the decedent jointly
with flnuther or others, including intangibles, standing in the name of the decedent and others. List
rt'al f"state first. liS entireties, or joint tenants, giving brief description, as indicated under Schedule
"A", plus the dllte lind place of record of instrument effecting vestiture, but (10 not include enUre ties
or out of state real estate vlilue in estate valuution culumn. Persona.l property should be listeli as in
Schedule "B", plus date of Rcquisition, und the name, address and relationship (if' any) of co-owners to
the decedent.
Descript ion of Property, Date of Acquisition, Name (nit percentage Estate DEPART~lliST VALUATION
Address and Relationship of Co-O.....ners, and Place Value Share Valuation CAUTION-Do not Write
of I\ecorrl of Instrument, where Heal Estate. In This Space.
). '^ :xx ~ ::;0 << , 30<: X>
~ <<~ ~ ;/'). 8,< ~ Value of Value of
~ ~ 6< X> ~ ~ ~ << X> X> "")lUre Decedent's
'Y 'V\ 'V\>> xX ~~ %< 6< 6<~ ~ xX Property Interest
NON E
Insert this total opposite "Jolntl). Owned Propert).", Schedule "E"
in the "As Heported" column on the last pagP. of this return.
VlI\U )
REV~41J4 fa-18)
County, Number and Nome
File Number
Date 01 Death
21 - Cumberland
21-78-0173
April 2, 1978
Myrdeth
(FIRST NAME)
Estate Nome
Price
(LAST NAME)
SUMMARY
L.
(INITIAL)
COMMONWEAL TH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
REPORT OF INHERIT ANCE TAX APPRAISER
I, the under5igned duly appointed Inheritance Tax Appraiser in and for the County of Cumberland
Pennsylvanio, do respectfully report that I have appraised the real and personal property as reported in the foregoing return at
h . h . . h I I h' h . S h d I "A" uB" "C" d "E"
the values set fort opposIte eac Item In t east co umn to t e rig t In c e u es , , , an .
Doted:
January 16, 1980
~ II riA /1 j Jb-ru)
/ INHERITANCE TAX APPRAISER
REPORT OF THE REGISTER OF WILLS
I, the undersigned duly elected Register of Wills in and for County, Pennsylvania, do respect-
fully report that I hove allowed deductions in the amounts claimed by deponent, except as to those items where a greater or
lesser amount is set forth in the lost column to the right in Schedule t'F", which greater or lesser amount represents the sum
(.a11"'rled as a deduction.
Da~ed:
INVENTORY
VALUE AS APPRAISED
S
Real Property (Schedule Al
Personai Property (Schedule Bl
Joint.Held Property (Schedule E)
Transfers (Schedule C)
TOTAL GROSS ASSETS
Less Debts and Deductions
(SCHEDULE FI
CLEAR VALUE OF ESTATE
Valuation of life estates or
PRINCIPLE
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onnulfles....................._ S
ESTATE TAX ASSESSMENTS
s
FOR USE OF REGISTER ONLY
T ox on $
Tax on S
Tax on $
Tax en $
Tall en S
Exemptions
Totol Estate
CODE
2%
6%
15%
TOTAL TAX
Less tax previously paid
BALANCE
Leu 5% of tax if paid within
3 months after death
s
s
s
BALANCE OF INHERITANCE TAX DUE
Add interest at rote of 6% from
to
AMOUNT OF ESTATE TAX ASSESSED
Estate tax paId
BALANCE DUE
Add interest at rate of 6% from
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s
s
REGISTER OF WILLS
ADJUSTMENTS
ODE IHARRISBURG USE ONL YI
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20+
30+
REMAINDER APPRAISEMENT CODE
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FACTOR
VALUE
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COMPUTATION OF TAX
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TOT AL TAX BALANCE S
PAID S
Supplemental Codes: (FOR USE IN HARRISBURG ONL Y)
48-Adjuotment
4? .-Adjuotment
56-Annuity
6O-Lile Eotate
92+Remoinder Appraisal
93-Rema inder Oedu ction
FOR USE OF REGISTER ONLY
93C-Charity
94-Remainder Reiidue
96-Succeuive
Lile Estate
ADJUSTMENTS
NOTE: Where subsequent adjustments ~re made to the above computation of tax by the Register of Wills, for proper reason,
some ihould be noted below, WIth short explanation.
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REV-451 (8-18)
DEPARTMENT OF REVENUE
BUREAU OF FIELD OPERATIONS
P.O. BOX 2970
HARRISBURG, PENNA. 17105
COMMONWEALTH OF PENNSYLVANIA
RESIDENT INHERITANCE TAX
APPRAISEMENT
DATE
COUNTY
FILE NO.
January 16, 1980
Cumberland
21-78-0173
Whereas, Ml'rnpth T. Pri ~p late of f!n"'r Hi 11
in the County of Cumberland Commonwealth of Pennsylvania, having died on
the 2nd day of Anril 19 .BL, seized and possessed of an estate
subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania;
Therefore, I, Sandra L. Stone ,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 el/ent 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 e)lpressly reserl/es the right to appraise and assess transfer inheritance ta)les at the lawful collclt"ral
rate on any such future Interest.
DESCRIPTION OF ASSET
UNIT
VALUES
Apprais(-ment
Made for Inll'Hllance
Ta)l Purp'lses
Real Pro ert
.
Personal Pro ert
Jnint-Hplrl Prnpp~ty
Transfers
None
None
TOTAL ASSETS
Have been duly sworn according to law, I do hereby certify that the above appraisement is made in conformity
with the law on this 16th day of ~ ~;;{J 19 .80_.
v:J. .f) tlJlaJ ~.-1 )
~ ,... Appral~er
Harrisburg
(Number and Street)
(Post Office)
. Penn.l.
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Date
January 16. 1980
Si gned
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF FIELD OPERATIONS
P. O. BOX 2970
HARRISBURG
17105
IN YOUR REPLY PLEASE
REFER TO
I nvestigation Division
NOTICE OF FILING OF APPRAISEMENT
David R. Dodd
3133 Chestnut
Camp Hill, PA
Street
17011
(Executor or Administrator)
In Re: Estate of Hyrdeth L. Price
Cumberland
County - File No. 21-78-0173
Dear Mr. Dodd:
You are hereby notified that the original
appraisement in the estate of /{yrdeth L. Price
has been filed in the office of the Register of Wills of Cumberland
County on .TRnl"'ry 16 ,19-8Q.. Said appraisement reflects the following valuations:
Real Estate
Personal Property
Transfers
Jointly Owned
Total
49.900.00
35,129.72
None
None
$85,029.72
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
(6'10) 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.
Title
Appraiser
NOTE: This is not a bill.