HomeMy WebLinkAbout12-28-78
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. .
RESIDENT DECEDENT
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF. REVENUE
BUREAU OF COUNTY COLLECTIONS
DEe 28 1978
COUNTY OF Cumberland
IMPORTANT,
This return must be completed in detail and filed in duplicate, with all attached, with the Register of Wills of the
County where decedent resided; Return is due within nine months after date of death, unless an extension is granted
by the Secretary of Rellenue. (Section 703 of the Inheritance and Estate Tax Act of 1961,)
IN THE MATTER OF THE ESTATE OF
Roy G, Harro, Jr.
(STATE FULL NAME OF DECEDENT]
} AFFIDAVIT OF
EXECUTOR
~
Late of
Cumberland
County
State of
Pennsylvania
County of
Cumberland
} ss:
~
CCNB Bank, N.A.
of the estate of the above-named decedent being duly sworn, depose
Executor
and soy
March 23,
(MONTH]
Name and address of attorney or }
other authorized representative to whom
011 correspondence should be moiled.
(DAY)
19~J testate leaving a tast witl, copy of which is hereto attaChed..}
(YEAR) ~HKDI:
Decedent died
Jon F. LaFaver
317 Third Street, New Cumberland, Pa. 17070
That as such Executor deponent is familiar with the affairs of said estate and the property constituting
{EXECUTOR-~X~
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 S.-\FE DEPOSIT BOX IN NAME OR NAMES OF HOLDERS TO DECEDENT
Marine National Bankt wi' ,"PM "A" " Ty '"
1>"..'<_~ " n T.H.~
r.r.NR Rank '" A T p.------ n_
- -
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
wheresover situated owned by the decedent at the time of death; all moneys left by the decedent at the time of
death, whether in decedent's immediate possession, standing to decedent's credit in banks of deposit, savings
banks, trust comifiulies, or other institutions, whether individually, or in trust for any other person or persons
giving al so separately the accrued interes t thereon, if any, down to the last interest day prior, to~'d~~edent' s
'death in the case of savings banks, and to the date of decedent's death in all other case"s;. au.-b.on-ds,,-~'stal
savings, treasury certificates or notes and other evidence of indebtedness of the Unite\! Sta~t~.~~t'g/.'the ....((e-
'.....;:--. ~ </ -
cedent; all obligations, whether by statute or agreement they are designated ..as tax free, of ~le Utlit,ed St~tes,
or any state, or political subdivision thereof, or of any foreign country, which are owned at the.tirt,e of death;
~.., ~... ..-
all wearing apparel, jewtdry, silverware, pictures, books, works of art, household furniture, horses, carii~ges,
automobiles, boats, and any and all other personal chattels of whatsoever. kind or natur~;:tl~ft by-de~edent,
together with the fairly, estimated market value thereof; all bonds and mortgages held by dec~aent a'nd'of all
claims due and owing decedent at the time of death, and all promis sory 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 esti~ated 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 cf:lrried 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 dea~h, with the.market value there.
of at such time.
"
. "
In the case or securities of close or family corporations, the values reported are as far as
possible substantiated by financial statements of the corporations, showing the assets and liabilities
thereof as of the date of death. The schedule also sets forth the interest of decedent at the time of
death In any co-partnership or business, and in support of the value of such interest t~ere Is annexed to
said schedule, financial statements showing the assets and liabilities of said co-partnership or '!luslness.
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 ~alr and just appraisal o~ the decedent's interest
therein must be submitted. It should also set ~orth in itemized ~orm, together with the fair market value
thereof, any other property owned or bequeathed by the decedent at the time of' death.
The Schedule C attached hereto and made part hereof sets forth a true answer to each inquiry
contained therein and in the case of transf'ers 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 propert)', to whom transf'erred, the
relationship of the transferees to the decedent, the proportionate share received by each transferee and
all other facts of' a pertinent nature regarding said transfers. In the case of transfers intended to
take effect in possession or enjoyment at or af'ter death, there is also attached to the schedule a CORY
of the deed, trust agrp-ement 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 passes at decedent's death by
virtue of' the exercise by decedent, either individually, or jointly with another, or any power of appoint-
ment vested in decedent, either individually or jointly, by the will, deed, or other instrument of another,
with a copy of the instrument creating such power attached to the schedule.
That Schedule D attached hereto and made part hereof' sets forth the names and addresses or all
persons benericially interested in this estate at the time of decedent's death, the nature of their res-
pective interests, their relationship, if any, to the decedent, together with the ages at the time of
decedent's death of all minors, annuitants and beneficiaries for life under decedent's Will. It also
contains a statement showing which of the beneficiaries named in the decedent's will, if any, died prior
to decedent, the dates of their death, their issue, and the relationship of such issue to the beneficiary.
That Sc~edule 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 o~ record of instruments effecting the vestiture of
real estate and the date of acquisition of personalty, plus the name, address and relationship, if any,
of co-owners to the decedent.
That Schedule F attached hereto and made a part hereof sets forth fully and in detail all debts
and deductions claimed ror and on behalf of this decedent's estate, including funeral expenses paid;
family exemption, where applicable; costs of administration of' this estate; counsel fees and fudiciary's
commissions paid or to be paid; cost expended for burial trusts, tombstones or gravemarkers, and reli-
gious services, in consequence of the death of the decedent; debts and claims owing and lmpaid at time of
death; taxes accrued chargeable f'or period prior to decedent's death (except those allowed under Section
65101' the Inheritance and Estate Tax Act); together with a statement of collateral pledged ror obliga-
tions, if any. It is agreed that the fiduciary will present proof of said claimed obligations upon re-
quest, that if the amount actually paid in settlement of any fee, commission or debt is less than the
estimated amount claiming and allowed, that the same will be reported to the Register of Wills, and that
the amount of tax assessed can be reassessed in accordance therewit~
That the totals of the appropriate columns in Schedules "A", "B", new, "E", and "F" as directed therein,
have been carried forward and properly registered in the Summary.
Subscribed and sworn to before me this
..............2::?:c. ...... d&y of']R~gll1(f~!'?
... 1928:
CCNB Bank, N.A., Executor of
the Roy G. Harro, Jr. Estate
.........~y...:...._~~......b..~._..........._...
(Ezeeu ~1'<
.......2.1Ql...Ma.I:ke.t...S1:.1:ee.t..............._......_................_.....__..
(StTeet. Number)
.....C;ll,II1P!.li.J,:t..g;!,....1?9.1J....... .
(City or T01Dn Clnd StAte)
~:J:..~;..
(~.....~.....................
~;LLlS J. ROSS, NoI,ry PubRa
Cel"p Hill. Cumberlucl Co., 'i.
My Commiuion bpir., WIt 5t ""
NOTE: Before signing affidavit make sure all blank spaces in the affidavit and schedules annexed are
filled in with details or the word "None", and in case the assets include rare and unlisted securities,
securities of' close or family corporations or an interest in any co-partnership or business, that the
data and statements required under the paragraph above relating to Schedule ftB" are attached. Also make
certain that column #1 in the "Summary" has been properly completed as above-directed.
...01
RC C-34 \ 40') 3)
COMMONWEAL TH OF P,ENNSYL"VANIA
DEPAR,'MENT 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;in common with another or ather, 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 should be
described by lot and block number, street and street number, together with
o general description of the property, with (l reference to the record of the
conveyance by which the decedent took title; If a farm state number of a.
cres; also statement of mortgtlge encumbrances upon oac\' parcel at death
of decedent. TO:lC8S, assessments, accrued Interest on mortgages, ote.,are
to be listed on Schedule IlFtJ and must not be d~ducted from this schedule.
(1)
(2)
(31
DEPARTMENT
VALUA TION
CAUTION
(Do not write
In this span)
ASSESSED VALUE
FOR YEAR OF
DECEDENT'S
DEATH
ESTIMATED
MARKET VALUE
NONE
- 0 -
"
- 0 -
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.
Nof'(L..
..
ROC-35
RESIDENT DECEDENT
SCHEDULE "B"
PERSONAL PROPERTY
*~
C0M110NWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
INSTRUCTIONS: This Schedule must disclose all tangible and intangible personal property owned individually
by the decedent, at the time of his death. P~operty owned by the decedent jointly with another or others
must be listed under Schedule ftEn. Intangible personal property, titled 1n 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 fa.ct 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 anyundistributed
estate or 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.
ITEM
List and describe fUlly
UNIT
VALUE
ESTIMATED
MARKEl' VALUE
DEPARTIfEN'f VALUATION
(Do not write in
this space)
1.
67 Shares Tides Inn, Inc. Closely Held
Stock @ $1367.11
Common /,0\
\~ '"2.-
:) ~
91,596.23
7.
Returned check from State of New Jersey
1.00
2.
1977 Oldsmobile Sedan (Blue Book Value)
4,800.00
3.
1972 Oldsmobile Vista Cruise Station Wagon
(Cash Received at Public Sale)
1,300.00
4.
Credit Refund from Mic Life Insurance Company
of Payoff of Loan on Car
235.62,
5.
GMAC Rebate
26.15
6.
Insurance Premium Refund
64.87
8.
Insurance Premium Refund
12.00
9.
Cash Refund from Telephone Company
1.85
Insert this total opposite npersonal Property", Schedule "B" in
the "As Reportedft colunm on the las t "-page of this return.
x X
98,037.72
q~ Ool.1:t.
,
icc- 36
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
SCHEDULE "c"
TRANSFERS
RESIDENT DECEDENT
(1) Did decedent, within two years of'death, make any transfer of any material part of his estate, without
receiving Ii valuable and adequate consideration therefor? (Answer yes or no) No
(2) Did decedent, wi thin two years of d"ath, transfer property from himseH to himseH 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 aff'irmative state:
(a) Age of decedent at time of transfer No
(b) State of' decedent' 5 heal th at time of making the transf'er. (Note 1).
(c) Cause of decedent' 5 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 eff'ect in possession or enjoyment at or af'ter his death?
(Answer yes or no) No
(a) Was there any possibility that the property transf'erred might return to transferer or his
estate or be subject to his power of disposition? (Answer yes or no)
(b) What was the transferee's age at time of decedent's death?
(5) Did decedent in his lifetime make any transfer without receiving a valuable and adequate consideration
therefor under which transferor expressly or impliedly reserves for his life or any period which does
not in f'act end before his death:
(a) The possession or enjoyment of or the right to income from the property transferred?
(Answer yes or no) No
(b) The right to designate the persons who shall possess or enjoy the property transferred or
income therefrom? (Answer yes or no) No
(6) If the answer to (5) (b) above is in the affirmative, state whether the right was reserved in decedent
alone or others
(7) Did decerlent in his lifetime make a transfer, the consideration for which was transferee's promise to
pay income to or for the benefit of care of transferor? (Answer yes or no) No
(8) Did decedent, at any time, transfer property, the beneficial enjoyment of which was subject to change,
because of a reserved power to alter, amend, or revoke, or which conld revert to decedent 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 the benef'iciary reserved in the decedent alone or the decedent and others?
(Answer yes or no) No
NOTE 1: The answers to these questions should be supported by af'fidavi t by the attendi.ng physician as
well as a copy of' the death ce.-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 ctecenent, if any. Submit copy of any trust need or instrument, if trans-
f'ers are claimed to be non-taxable, also submit detailed statement of facts on wh1.ch said claim j,s based.
NOTE 3: List applicable property below in manner in which provided in Schedules A, B, or E.
ITEM
DESCRIPTION
MARKET VALUE
(Es tima ted)
DEPT. VALUATION
(Dept. Only)
NONE
Insert this total opposite "Transf'ers", Schedule "e" in the
"As Reported" colunm on the last page of this return.
- 0 -
~ON..,
"RCC-37 ,0.2-63)'
t'OMMO:>l\\'EALTH OF PE~i~SYn,ANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "D"
d'
~~l
/j "". 1\
";:1,
fi, '"",..
X'~ '""'~ /;!,.I)
"",,~~
, -
BENEFICIARIES
\
h
BENEFICIARIES AND ADDRESSES RELATIONSHIP SURVIVED
(If slep-childron or DATE INTEREST OF
State full names and addre5ses of Rll who illegitimate children DECEDENT OF BENEF1CJARY
:l,'e an interest. vested. contingent or other are jnvolved. set STATE YES IN ESTATE
wise, in estate) forth this fact) OR NO BIRTH
Pauline M. Harro Wife Yes Legal All
14 Chelten Circle
Carnn Hill ' Pa. 17011
,
Deponent further says that all the above-named beneficiaries are living at this time except below:
NAME DATE OF DEATH RESIDENCE
-
.
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Y 0 0
~ E fr
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SUMMARY
(Sch. "A")
(Sch, "B")
(Sch,"C")
Heal Property
Personal Property
Transfers
Gross Taxable Estate
(\)
(As Report<><))
$ -0-
$'L. 803. 72
$ -0,,-
$
$
$, ,9,803,72
(21
(A, Dd..rmilll'd)
$
$
$
$
$
$
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t' RC~-3a'
.
RESIDENT DECEDENT
SCHEDULE "En
JOINTLY OWNED PROPERTY
COMMONWEAL TH OF PENNSYL VANIA
TRANSFER INHERITANCE TAX
INSTRUCTIONS: This scherlule must disclose all property, real and personal, owned by the decedent jointly
wi t-h 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 lmcler Schedule
"A", plus the date and place of record of instnunent 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' acquisition, and the name, address and relationshIp (if any) of co-owners to
the decedent.
Description of Property, Date of' Acquisition, Na.me
Address and Relationship of' Co-Owners, and Place
of Record of Instrument, where Real Estate.
:;x: :x >6 ~ ~ AI Y') ><X & ~:x0<
>0 % ,X: ::x << X> vex 30 30
:x ox :x 'Y
NONE
Unit
Value
percentage
Share
Estate
Valua tion
:x
::x
:x
0<:)<
DEPARTMENT VALUATION
CAUTION-Do not Write
In This Space.
Value of Value of
Entire Decedent's
Property Interest
)<)
::x
-0-
.
~
Insert this total ollPosite IIJointly Owned Property", Schedule tiE"
in the tlAs Reported" column on the last page of this return.
~o\.\.€
REV-484 (8-78)
.
Cilunty, Number end N~me 21 - Cumberland SUMMARY
File Number 21-78-0183
Dete ef Deeth 03/23/78
COMMONWEAL TH OF PENNSYLVANIA
Estete Neme HARRO . Jr. Roy G. TRANSFER INHERITANCE TAX
(LAST NAME) (FIRST NAME) (INITIAL) RESIDENT DECEDENT
~ REPORT OF INHERITANCE TAX APPRAISER
I, the undersigned duly eppointed Inheritence Tex Appraiser in end for the County of Cumberland ,
Pennsylvania, do respectfully report that I hove appraised the real and personal property as reported in the foregoing return at
the values set forth opposite each item in the last column to the right in Schedules HAil, u8", HC", and liE".
Deted: September 26. 1979 ~ha) J-Lrn.eJ
. INHERlfANCE TAX APPRAISER
REPORT OF THE REGISTER OF WILLS
, I, the undersigned duly elected Register of Wills in end for County, Pennsylvania, do respect-
fully report that I have 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 ItF", which greater or lesser amount represents the sum
allowed as a deduction.
Deted:
REGISTER OF WILLS
ADJUSTMENTS
INVENTORV V ALUE AS APPRAISED ODE (HARRISBURG USE ONL VI REMAINDER APPRAISEMENT CODE
Real Property (Schedule A) $ none 0(1+ 92+
Personal Property (Schedule Bl 98 037 72 1(1+
Joint-Held Property (Schedule E) none 2(1+
Transfers (Schedule C) none 3(1+
TOTAL GROSS ASSETS 98 037 72
Less Debts and Deductions 4ll- , 93-
(SCHEDULE FI
CLEAR VALUE OF ESTATE
Valuation of life estates or -"'--- PRINCIPLE FACTOR VALUE ~
annuities.................... . $ . 1== !
- t=
-
ESTATE TAX ASSESSMENTS -$ L ,
.
FOR USE OF REGISTER ONL.Y CODE COMPUTATION OF TAX
Tax on $ 2% $
Tax on $ 6% $
Tax on $ 15% $
Tax on $ $
Tax on $ $
Exemptions * (*) As evidenced by Charitable
Total Estate Exemption Certificates Issued
TOTAL TAX $ by the Secretary of Revenue.
Less tax previously paid $ 1=
BALANCE $
Less 5% of tax if paid within
3 months after death $
BALANCE OF INHERITANCE TAX DUE ti. I
Add interest at rate of 6% from
to $
AMOUNT OF ESTATE TAX ASSESSED $ l=
Estate tax paid $ I
BALANCE DUE $
Add interest at rate of 6% from
to $
TOT AL TAX BALANCE $
PAID $
r.....--.
Supplemental Codes: (FOR USE IN HARRISBURG ONL Y)
48-Adjustment 6O-Life Estete 93C-Cherity 96-Success i ve
49+Adjustment 92+Remeind.r Appreisel 94-.Remaincler Residue Life Estete
56-Annuity 93-Remeinder Deduction
FOR USE OF REGISTER ONLY ADJUSTMENTS
NOTE: Where subseh'ent adjustments are made to the above computation of tax by the .Register of Wills, for proper reason,
same should e note below, with short explanation.
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REV-S18 (3-79)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF FIELD OPERATIONS
P. O. BOX 2910
HARRISBURG
17105
IN YOUR REPLY PLEASE
REFER TO
Investigation Division
NOTICE OF FILING OF APPRAISEMENT
Craig C. Dunn, Trust Officer
CCNB Bank, N.A.
2101 Market Street
Camp Hill, PA 17011
{Executor or Administrator}
In Re: Estate of
Roy G. Harro, Jr.
Cumberland
County - File No. 21,...78'-0183
Dear Mr. Dunn:
You are hereby notified that the original
appraisement in the estate of Roy G. Harro,. Jr.
has been filed in the office of the Register of Wills of Cumberland
County on September 26. ,1979.. Said appraisement reflects the following valuations:
Real Estate
Personal Property
Transfers
Jointly Owned
Total
none
98,037.72
none
none
$98,037.72 -.
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%) 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
September 26, 1979
Signed~n.dAo..) ~jb-rv)
/ /
Title Appraiser
NOTE: This is not a bill.
. c, September 26, 1979
. COMMONWEALTH OF PENNSYLVANIA DATE
REV-457 (B-78)
DEPARTMENT OF REVENUE RESIDENT INHERITANCE TAX COUNTY Cumberland
BUREAU OF FIELD OPERATIONS
P.O. BOX 2970 APPRAISEMENT FILE NO. 21-78-0183
HARRISBURG, PENNA. 17105
,
Whereas, Roy G. Harro. Jr. late of Lower Allen TotJT1~hi p
in the County of Cumberland Commonwealth of Pennsylvania, having died on
the 23rd day of March 19 -1], 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 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 collateral
rate'on any such future interest.
DESCRIPTION OF ASSET UNIT Appraisement
VALUES Made for Inheritance
Tax Purposes
Real Property $
none
Personal Pronertv 98,037 72
Joint-Held Property none
Transfers none
TOTAL,ASSETS 98 037 72
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Have been duly swor2e:ccording to law, I do hereby certify th.ilt the above ~~~;aisnt~;nt is made in conformity
with the law on this th day of b S t"m 19 7..2.--,
\ /1/1 n /y /)/1 j 'vtrfVi~ J .
../ 7 Appraiser
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, (Number and Street)
Harrisburg . Penna.
(Post Office)
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