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Form RCC-33
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COMMONWEALTH OF PENNSYLVANIA
,
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
I COUNTY OF
IMPORTANT: This return must be completed in detail and filed in duplicate, with will attached, with the
,
Register of Wills of the County where decedent resided; Return is due within one year after
date of death, unless an extension riS granted l1y th~ Secretary of Revenue. (Section 703 .of
the Inheritance and Estate Tax Act o"f 1961.)
CUMBERLAND
RESIDENT DECEDENT
IN THE MATTER OF THE ESTATE OF
Late of ...
Cwnberland
}AFFIDAVIT OF
..~
~
County
~lildred M. Zvarich, legatee
.....!:lPNRx.c.,_~.RAQiMAN
(State full name of decedent)
County of
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.. ... .Mildred~M'LZvarich,Legatee.............
of the estate of the above-named decedent being dwy sworn, depose S
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19 . 78
....., 19...........
~r
Slale of ..
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and say S
Decedent died
... ,J<ll1,llaI}'
(Month)
(Imy)
.......1 testate leaving
L~e
a last will, copy of which is hereto attached. }
Name and address of attorney or}
other authorized representative to
whom all cor respondence should be ........ . ..... ........~.. ...,......~....~....~
mailed. I
That as such ........J~~.'1.~~.~.................... deponent is familiar with the affairs of said estate and the property con-
lExel~lltor-AdminiBtmWr) I
stituting 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 joh'ltly
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:-
none
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
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That the contents of said safe deposit~boX or boxes are itemized under Schedules of this
return, with the exception of the fOllowing, fori the reasons hereinafter set forth:
That Schedule A attached hereto and ~ade part hereof sets forth fully and 1n deta11 all the
real property in the Commonwealth of Pennsylvani~ of which decedent died having an interest therein. It
also sets forth the mortgage encumbrances upon e~ch 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 colwnns pr~vided therefore the assessed valuation of each of said
parcels, the estimated market value thereof as of date of death of decedent.
I
That Schedule 8 attached hereto and made part hereof" sets f"orth fully and in detail all personal
property wheresover situated owned by the decede~t at the time of' death; all moneys ~er~~"'-.b'y;:the~ d~/c';,dent r
at the time of death, whether in decedent's immediate posseSSion, standing to decedent's_ cre4it 'I!} banks
of deposi t, savings banks, trust companies, or other ins ti tutions~ whether Indi vldually~-':';r./' .itl.";trus~t "';f'or
. ,'-...... :/-
any other person or persons giving also separately the accrued interest thereon, if' any; do.~ to~he last
interest day prior to decedent's death in the case of savings banks, and to the date ~of dec:dent''''s death
. ..~ ~-
in all other cases; all bonds, postal savings, treasury certificates or notes and~other evidence of tn-
. ' . -" ...::.,...,....
debtedness of the United States to the decedent; all obligations, whether by statute o~~agreemerlt~they
are designated as tax free, or the United States, or any state, or political subdivision thereof', or or
any roreign country, which are owned at the t~melof death; all wearing apparel, jewelry, silverware, pic-
tures, books, works of art, hOl:lsehold furniture, horses, carriages, automobiles, boats, and any and all
other personal chattels of whatsoever kind or nature, left by decedent, together with the rairly estimated
market value thereof'; all bonds and mortgs.l!es h~ld by riecedent and of all claims due and 'OWing decedent
.
at the time of death, and all promissory notes or other instruments 1n writing for the payment or money
.
of which decedent died possessed, of' whatsoever' nature, with interest thereon, if any, giving the race
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value and estimated fair market value thereof, and if .such estimated fair market value be less than the
,
race value, it sets forth briefly the reasons f~r such depreciation as to each i tern; all moneys payable
to the estate rrom life insurance polici'es carried by decedent; all annuity and endowment contracts the
proceeds of which were payable upon the death orlthe decedent; and all the corporate stocks and dividends
due thereon and unpaid as of the date of death, fbonds and accrued interest thereon to the date or dece-
dent's death and other investment securities owned by the decedent at the time of death, with the market
value thereof' at such time.
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In the case of securities of close or family corporations, the vRIlIes reported are as rar as
possible substantiaterl by financial statements of the corporations, showing the assets and liabilities
thl"reof as of the date of death. The schedule also sets forth the interest of rlecedent at the time of
death in an~' 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 ] labilities of sRid co-partnership or busIness.
A copy of th", co-partnership agreement, (if oral, a statement settin.e; f'orth the nature of the agreement)
together with a statement settIng f'orth the character of the business, its location, and such other facts
pertaining to the business as may be pertinent to a fair and ,1ust appraisal of the decedent's interest
therein must be submitted. It should also set forth in itemized form, together with the fair market value
thereof, any other property owned or bequeathed by the decedent at the time of death.
The Scf>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 neath, or intended to tRke effect in possession or enjoyment at or
after death, said schedule sets forth the nature and value of' such property, to whom transf"erred, the
relationship of the transferees to the ~ecerlent, the proportJonate share received by each transf"eree and
all other facts of a pertinent nature regarding sain transfers. In the case of transfers intended to
take effect in possession or enjoyment at or after death, there is also attached to the schedule a COllY
of the deed, trust agreement or other instrument creating the trust. Ther'~ is also set forth in said
schedule a list of all property, real and personal, with its value, which pa~ses at decedent's death by
virtue of' the exercise by decedent, either individually, or jointly with another, or any power of appoint-
ment vested in decedent, either individually or jointly, by the will, rleed, or other instrument of another,
with a copy of the instrument creating such power attached to the schedule.
That Schedule 0 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 d~ath, the nature of their res-
pective interests, their relationship, if any, to the decedent, together with the ages at the time of
decedent's death of all minors, annuitants anci beneficiaries for life under rlecedent's W1l1. 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, anrl the relationship of such issue to the beneficiary.
That Schedule E attached hereto and marle n part hereof sets forth all property, real and per-
sonal, owned by the decedent jointly with another or others, inclurling intangible, standin~ in the name
of the decedent anrl others, plus the date and place of record of instrmnents effecting the vestiture of
real estate anrl the date of acquisition of personalty, plus the name, Rrlrlrf'SS 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 rletail all debts
and deductions claimerl for and on behalf' of this decedent's estate, inclllrling; funeral expenses paid;
family exemption, where applicable; costs of administration of' this estate; counsel fees anrl fudiciary's
connisslons paid or to be paid; cost expenderl ror burial trusts, tombstones or gravemarkers, and reli-
gious services, in consequence of the death of' the decedent; rl~bts anrl claims owing ann unpairl at time of
death; taxes accrued chargeable f'or period prior to decedent' s rlpat.h (ex('ept thos~ allowed under Section
65101' the Inheritance and Estate Tax Act); together wit.h a statement of collateral plefll2;erl f'or obliga-
tions, if' any. It is agreed that the f'iduciary will present proof of salrl claimed ol)ltgations upon re-
quest, that if the amount actually paid in settlement of' any fee, commission or deht is less than the
estimated amount claiming and allowed, that the same will be reported tu the Register of Wills, and that
the amount of tax assessed can be reassessed in accorrl.fUlce therewi tho
That the totals of the appropriate columns in Schedules "A", "B", "e", "E", anrl "F" as directed therein,
have been carried forward and properly registered in the Sununary.
day of
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...19............
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(Eslllllllills~lIIf)
123 East Green Street
................... ....-.-...--.
(Street Numb....)
Shi remanstOWl},l'~Y}YaIliam .mm.
(City or Town and State)
Subscribed and sworn to before me this ..J.::.'::.
Lu.lJ-- (\. ,0it:tD
IOU A. ZlnD, Notary Public
lemcyn'.:', C:,,~,~ :":.~;"":d CO:Jnty, Pa.
My Com:r;io':iJn ~>:;;ir2:: ''/k:rch 20, 1982
SOTE: Bef'ore signtng aff'idavit mHke sure all bll\lIk spaeps ill {t,e t-tt'ftdavit and. schedules annexed are
filled in with detftlls or U1P 'fIiorrl "None", anct ill CllSP the assets irl('lndp rare anrl unltsterl securities,
securities Qf ('lose or f'n.mily corporations or nn iTltf'rest in 'tn~ f'O-jlllJ"tllprship or husiness, that the
nata ll.nrl stll.tf'ments rerIuireft under thp flflrH.grtlph ahn\"p r.'lilting 10 '-;pllf'dlllp "8" arp flttadl(>li. Also make
cprtain that column 41 in the "SlInl"llllry" ll!lS hf'pn 11rojH-'rl y complf'tPd :IS ntlll\"P-directf'rl.
RCC.34 (4.73)
COMMOliWEAL TH 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 as tenant ln1common with another or ather, should be identified
as to quantum of interest and the estimated valuel should be that of the decedent's interest only. (Property
held as joint tenants with right of surviorship or ienancy by entireties should be reported on Schedule "E.")
!
The real property located In the Commonwealth of Pennsylvanlo should be
described by lot and block number, street and street number, together with
o general description of the property, with 0 reference to the reco"rd of the
conveyance by which the decedent took title; If a form state number of a.
cres; also statement of mortgage encumbrances upon eoch parcel at death
of decedent. Taxes, ossessments, accrued Interest on mortgages., etc.,ore
to be listed on Schedule uF" ond must not' be d_educted from this schedule.
(1)
(2)
(3\
DEPARTMENT
VALUA TION
CAUTION
(Do not write
In thl. spaco)
ASSESSED VALUE
FOR YEAR OF
DECEDENT'S
DEA TH
ESTIMA TED
MARKET VALUE
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NONE. I 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. .
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. Rce -35
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COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
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SCHEDULE "B"
PERSONAL PROPERTY
RESIDENT DECEDENT
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 wi th another or others
must be listed nnder Schedule "E". Intangible pe:r~onal property, titled 1n the name of' the decedent, but
payable at death to another or. others, including b~t 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, automobi~es, boats, etc.)
Intangible personal property, such as b~nds, 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 anyundlstrlbuted
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 ITEM I UNIT ESTIMATED DEPARTMENT VALUATION
No. List and describe fully VALUE MAIlIlFr VALUE (Do not write in
this space)
I V
1. 1971 Ford Sedan automobile, serial mnnber 500;00 500.00
lH36F19l609 (see appraisal letter, attached)
2. Clothing and miscellaneous itelTlS 100.00 l/ 100.00
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Insert this total opposite "Personal Pr-operty", Schedu~e "B" in X X $
the "As Reported" column on the last page of this return. 600.00
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. L.B.SMITH.
L.B. Smith,l~c. Ford Division
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Market Street at, Twelfth, P. O. Box 138
Lemoyne, Pennsylvania 17043
Phone: 717 - 761-6700
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RCC-36
COMMONWEALTH OF PENNSYLVANIA
TRANSr~R INHERITANCE TAX
SCHEDULE "c"
TRANSFERS
*
RESIDENT DECEDENT
I
(1) Did decedent, within two years of death, make a~y transfer of any material part of his estate without
receiving a valuable and adequate consideration therefor? (Answer yes or no) N.o '
(2) Did decedent, within two years of death, transfer property from himself to himself and another or
others (including a spouse) 1n joint ownership? (Answer yes or no) NO
(3) If the answer to (1) or (2) above is 1n the afflrmatlve state:
(a) Age of decedent at time of transfer 1 t'J./A
(b) State of decedent's health at time of mAking the transfer. (Note 1).
(e) Cause of' decedent's death. (Note 1).
(4) Did decedent, in his lifetime, make any transfer of property without receiving a valuable or adequate
consideration therefor which was to take effect in possession or enjoyment at or after his death?
(Answer yes or no)~______ ~
(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~~~ or no) IV fA
(b) What was the transferee's age at time of decedent's death? ~
(5) Did decedent in his lifetime make any transfer without receiving a valua Ie and adequate consideration
therefor under which transferor expressly or impliedly reserves for his life or any period which does
not in fact end before his death:
(a) The possession or enjoyment of or the right to income from the property transferred?
(Answer yes or no) 1"40
(b) The right to designate the persons who ~h~ll possess or enjoy the property transferred or
income therefrom? (Answer yes or no) ('.1.0 '
(6) If the answer to (5) (b) a9Pve is 1n the affirmative, state whether the right was reserved in decedent
alone or others II/A
(7) Did decedent in his lif~time make a transfer, the consideration for which was transferee's promise to
pay income to or for the benefit of care of transferor? (Answer yes or no) M ~
(8) Did decedent, at any time, transfer property, the beneficial enjoyment of which was subject to change,
because of a reserved power to alter, amend, or revoke, or which could revert to decedent under terms
of transf'er or by operation of law? (Answer yes or no) Nl""\
(9) If the answer to (8) above is in the affirmative, was the power to alter, amend, or revoke the inter-
est of the beneficiary reserved in the decedent alone or the decedent and others?
(Answer yes or no) N fA
NOTE 1: The answers to these questions should be supported by aff'idavit by the attending physician as
well as a copy of the death cer-tificate.
NOTE 2: If answer to any of' the above questions is yes, set forth below a description of the property
transferred, it's fair market value at date of death, dates of transfers and to whom transferred, with
relationship of transf'erees to decedent, if any. Submit copy of any trust deed or instrument, if' trans-
fers are claimed to be non-taxable, also submit detailed statement of facts on which said claim is based.
NOTE 3: List applicable property below in manner in which provided in Schedules A, B, or Eo
ITEM
DESCRIPTION
MARKET VALUE
(Es tima ted)
DEPT. VALUATION
(Dept. Only)
NONE None
.
Insert this total opposite "Transfers", Schedule nc; in the
"As Reported" column on the last page of this return.
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RCC-37 (12-63)
COMMONWEALTH OF PENNSYYLANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
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SCHEDULE "D"
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BENEFICIARIES
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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
ave an interest, vested, contingent or other are involved, 'set STATE YES IN ESTATE
wise, in estate) forth this fact.) OR NO BIRTH
Mi 1 dred . M 7u~.,.i rh I
Istep-daughter yes entire
123 EastGteen~Street I
Shiremans town Pa.
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Deponent further says that all the above-named beneficiaries are living at this time except below:
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NAME DATE OF DEATH RESIDENCE
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SUMMARY
(Sch. "A")
(Sch. "B")
(Sch. "C")
.S(:h ~'E"
Real Property
Personal Property
Transfers
oJ o:illt:l Y.. CJWIlecI. p:rqp~rty..
Gross Taxable Estate
(I)
(As Reported)
$
$ 600.00
$
$ 21,534.01
$
$ 22,134.01
(2)
(As Dt'termined)
$
$
$
$
$
$
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~CC.38
,
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "E"
JOINTLY OWNED PROPERTY
INSTRUCTIONS: This schedule must disclose all property, real and personal, owned by the decedent jointly
wi th another or others, including intangibles, standing in the name of the decedent and others. List
real estate f'irst, as entireties, or joint tenants, giving brief description, as indicated muler Schedule
"A", plus the date and place of record of Instrwnent effecting vestlture, but 00 not include entireties
or out of state real estate value in estate valuation column. Personal property should be listed as in
Schedule "B", plus date of' acquisition, and the name, address and relationship (if an~r) of' co-owners to
the decedent.
Description of Property, Date of Acquisition, Name
Address and Relationship of Co-Owners, and Place
of Record of Instrument, where Real Estate.
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1.
Savings account No. 002-1000089 with the
State Capital Savings and Loan Assoc.,
108 North 2nd Street, Harrisburg, Pa.,
17101, created in 1975 and owned jointly
since 1975 with Mildred M. Zvarich, 123
East Green Street, Shiremanstown, Pa.
C step-daughter )
2.
Certificate of Deposit No. 002-20-08162
with the State Capital Savings and Loan
Assoc., acquired originally in 1975 and
owned jointly since 1975 with Mildred M.
Zvarich C step-dauglJ.ter )
.7
Account No. 20486 with the Cumberland
Valley Savings and Loan Assoc., 3216..
Trind1e Road, Camp Hill, Pa. 17011,
opened in 1975 and owned jointly since
1975 with Mildred M. Zvarich C step-
daughter ) - savings account
3.
4;
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Savings Account No. 006-052059-0 with
CCNB Bank, N.A., 331 Bridge Street,
New Cumberland, Pa. 17070, opened in 1975
and owned jointly since" 1975 with Mildred
M. Zvarich
v---
Certificate of Deposit No. 121196 with
CCNB Bank, N.A., renewed on 3 January.'
1978 but originally purchased in 1975,
owned jointly with Mildred M. Zvarich
C step-daughter )
5.
6.
",--
Certificate of Deposit No. 12207 with
CCNB Bank, N.A., renewed recently but
owned jointly since 1975 with Mildred M.
Zvarich C step-daughter )
7.
/
Certificate of Deposit No. 15629 with
CCNB Bank, N.A., recently renewed but
owned jointly since 1975 with Mildred M.
Zvarich C step-daughter )
unit
Value
percentage
Share
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Insert this total opposite "Jointly Owned Property", Schedule "Eft
in the" As Re Jorted" colunm on the last page of this return.
50%
50%
50%
50%
50%
50%
50%
DEPARTJ~NT VALUATION
CAUTION-Do not Write
In This Space.
Value of Value of
Entire Decedent's
./ property Interest"
Estate
Valuation
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4,739.90'" 6f) l{i.~. ~ I
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5,016.90
7,019.88
3,247.41
501.37
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Fehruary 27, 1978
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State Capital Savings & Loan AssOc.
108-114 Second Street
Harrisb'Jrg, Fa. '17101
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t./j,11ianl or Milt1red I'L Zvai::ich
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This :' s to cc.rti fy tbat we have two accol11'tS, 002-1000689
and, 002-20-011) is/. reg; f'l:l~rl1tJ in 1:1,(, no'lnes Or ~1ilclred ZVarieh
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Savings !nVEH.ltrhertt Servicer
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3216 Trindle Road, Camp Hill, Pennsylvania 17011 737-3479
William o~ Mild~ed M. Zvarich
123 ]~ast Green st.
Ghi~emanstown, Fa. 17011
February 10, 1978
llE:
;120486
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To vfuom It Cbnce~ns:
This is to eertifiCl1te thnt tie havEi a account /.12\)486 with'
Henry C; llrilchrill'..n or Hilr1r~d N. ~varieh, '123Ci~een Street, ShiI-elnanstow,
Fa. 'Tl1io ilCcount pays an interest rate of 5-?%, compoUnded daiiy.
It is i1 regular sbook savings account.
This s
1~14,()39.17.
on January 19,
!~14,ciOi .OO,and
1978 was worth a total ot
Interest of 38.77.
feel
If you Should have fihY questions concerning this inatte~,.
free to contact this offiCe at any time.
please
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SihCerely you~s, '.
. 8al~I t.t':~.;Ldlji
Ilarry<!L. Luckenbaugh
Branch HiJ.nager
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MAIN OFFICE 331 BRIDGE STREET NEW CUMBERLAND PENNSYLVANIA 17070 17171238-<l!l41
CCNI!I BA~. NA.
,
February 20,1978
TO WHOM IT MAY CONCERN:
V
This is to certify that we have a savings account #006-052059-0, with
Henry C. Brachman or Mildred M. Zvarich, 123 Green Street, Shiremanstown,
Pa. This account pays an interest rate of 4%, interest paid every three
months. It is a regular passbook savings account.
This Savings Account on ~nuary 19, 1978 was worth a total of $6,494.82.
We also have (3) Certificates of Deposit
".,.-- ~ .
#121196. ...$l;OOO.OO,Continuous Compounding, for 30 mos.@6.50%, dated
1-3-78....therefore for (16) days since purchase of CD to the date of
death. ..this certificate received interest for (16) days... ... ......$2.74 ~
...---- ....-- L---
#12207. . . . . . . . . . . Income Certificate..... ..$.l,.llO.O...on. . . . . . . . . . . . . . . . . . $3.42
-- .~
1/15629.......... .Income Certificate...... .$.4.,.QO.Q..0.Q................ .$13.68
These certificates are registered in the names of Henry C. Brachman or
Mildred" M. Zvarich, 123 Green Street,Shiremanstown, Pa. 17011..
If you should have any questions concerning this matter, please feel free
to contact this office at any time.
Sincerely,
vIJ-J j-' X . / /
/I)C:;~ !/V,1...tl_,.-rrlr')
M. E. Grundon
Supervisor
~
RCC-81 (6.73)
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
HARRISBURG
17127
IN YOUR REPLY PLEASE
REFER TO
Inheritance Tax Division
NOTICE OF FILING or APPRAISEMENT
M.U.cItl.ed M. ZvcvUc.h
123 E. GJr.een St.
SfWLellll1J'L6town, Pa. 17024
(Executor or Administrator)
In Re: Estate of
H enJLl/ C. BJw.chman
CwnbeJll.a.nd
County - File No.21~78-0181
Dear
You ore hereby notified that the Oug.i.na.e. .
approisement in the estate of Hel1Jl.y C. BJw.cltma.n
hos been filed in the office of the Register of Wills af CwnbPl11.a.nd
County on June 22. ,19R., Said oppraisement reflects the following
voluations:
Real Estote
Personal Property
Transfers
Jointly Owned
Total $
None
600.00
None
23,IH4.01'
23,634.01
As to such tox that is poid within three months from date of death, 0 five (5%)
percent discount is ollowable. As to ony tox thot remoins unpoid after nine (9) months
(fifteen months when death occurred from December 22,1965 to June 16, 1971, inclusive;
ond twelve months when death occurred prior to December 22, 1965) from dote of death,
interest at the rote of six (6%) percent per onnum is chorged.
Any porty in interest who is aggrieved by this notice may object thereto within
sixty days after receipt of soid notice os provided by Section 1001 of the Inheritonce and
Estate Tax Act of 1961, 72 P. S. 2485.1001, P. L. 373.
Date
June 22,. 1978
Signed
Title CHIEF. APPRAISER
~
".
Note: This is not a bill.
RCC-2 (2-64)
DEPA.RTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
HARRISBURG, PENNA, 17127
COMMONWEALTH OF' PENNSYLVANIA
RESIDENT INHERITANCE TAX
APPRAISEMENT
DATE
June 22. 1978
CumbeJl1.a.nd
COUNTY
FILE NO. 21-78-0181
ereas, .
in the County of CwnbeJl1.a.nd Commonwealth of Pennsylvania, having died on
the 19th day of Janua/lY 19~, seized and possessed of an estate
subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania;
Therefore, I, IILa. K. GlUm , 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 foIlowing 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 appralse and assess transfer
inheritance taxes at the lawful collateral rate on any such future interest.
Unit Appraisement
DezcrJpllon of Anet Value. Made for Inheritance
Tall Purpons
$ .
Real PMJOeJttU None
PeMonat PltoJOeJttu 600 00
Jo).nt Held PM L 1~ n~A n~
TJr.an6l.eM None
TOTAL ASSETS 23 634 01
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Having been duly sworn accordin5 to law, i do hereby certify that the above appraisement is made in con-
formity with law on this 22n day of JunP'~L /<" Y/)JJ2-L-,.-..-.:.19-1L,
Appraiser
(lC'umber and 8tr.et)
H aJrJU6 bWLg , Penna.
(Pm Offiet!)
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H eMU C BlLa.c.hman
late of
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