HomeMy WebLinkAbout05-21-79
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
RESIDENT DECEDENT
'COUNTY OF CUMBERLAND
IMPORTANT,
This return must be completed in detail and filed in duplicate, with all attached, with the Reg"isler 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\t.enne. (Section703 of ~he Inheritance and Estate Tax Act of 1961,)
Cumberland
,"oJ
EXECUTOR
,-,"
IN THE MATTER OF THE ESTATE OF
Emmett Shelley
lSTATE FULL NAME OF DECEDENTl
AFFIDAVIT OF
Late of
ADMINISTRATOR
State o-f
Pennsylvania
County of
Cumberland
} 5"
Administrator
George E. Hoffer
of the estate of the above-named decedent being duly sworn, depose
. Executor
and soy
(MONTH)
Nome and address of ot'orney or }
other authorized representotive to whom
011 carres.ponden'ce should be moiled.
(DAY)
19~{testate leaving a last will, copy of.~hich !s"here!o attached. )'
(YEARl bllHX1KH
Decedent died
March 27
George E. Hoffer
'9 Irvine Row,. Carlisle; Penna. 17013
, .
the assets th'ereoF and their Fair market value.
That a~ such 'R~p('l1rn,.. deponent is Familiar with the aFfairs of said estate and the property constituting
(EXECU TO R-ADMINIST RA TO R)
.
That at the time of death there was no saFe deposit box registered in decedent's individual name, O.T jointly with, or
as agent or deputy of another, or in decedent's individual name, \vith 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 S....FE DEPOSIT BOX
THIS SAFE DEPOSIT BOX RENTED
IN NAME OR NAMES OF
REL A TIONSHIP 0 F JOIN T
HOLDERS TO DECEDEN T
NONE
That the contents of said safe deposit box or boxes are itemized undei Schedules
wi th 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 interes.t therein., It also ~ets 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 pa~e o~ record thereof. .It also sets forth i~ tIi~
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 dt?tail all personal property
wheresover sit~~~Jt?d owned by the decede'nt 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 I trust companies, or other institutions, whether individually, or in trus t fo.r, any other person or person,s
giving also separately the accrued ip.terest 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;.aH'\~,p'~d~',"pbstal
savings, treasury certificates or notes and other evidence of indebtedness of the United~~SJri'~'~:;'Q"~tlie/-d't:':
. ~.., -- .. .....;,' ~'r.- ~ \Y -:.
cedent; all'~bbligations, whether _ by ~statute or agreement they are designated as tax free.:--~of::the,JJ.ri~'tea~S.t'a-te.s', ~
.~. . _...... _ .~-.../ J/t.-~_
or any state, or political subdivision thereof, or of any foreign country, which are owne"}J at"th"e time of dfith.P;.
all wearing apparel,. jewelry, si-Iv.erware, pictures, books, works of art, household f~rnit~rle,:hQ.rsesrCa~ri'-ges~-~E
. . . ,... ' ........ - -
automobiles, boats, .and any and all other personal chattels of whatsoever. kind or na{ur:::.;-)~; by dec,fd:~nt, g
together with the fairly- estimated market value thereof; all bonds and mortgages held bY. dece-d~ent?aJd.-6r;8:-ll~
, - ,,"" / '- """'.'............
claims due and owing decedent at the time of death, and all promissory notes or other'ins.~r.u'nie.n'(s:'-iri..~ri(ing. '
for the payment of money- of which decedent died possessed, of ~hatsoever .natuc'e, ~ith iriLe'r~si.fnc7e6~~ if
any, giving the face value and estimated fair market value .thereof, a~d if such est~m~ted fair'mar~~t .value he
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 deced~nt; all annuity and e'ndowment co'ntracts
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 sccuriti,;s owned by the decedent at the time of death, with the.market value there.
of at such time.
;
,
In the case of securities of close or famll;y corporations, the values reported are as f'ar as
possible substantiaten by financial statements of the corporations, showing the assets and liabilities
tht"reof ftS of the date of death. The schedule also sets forth the interest of rtecedent at the time of
dl?at.h In an~' co-partnership or business, and in support of the value of such interest there Is annexed to
said schf>ctule, flnflnctal statements showing the assets and liabilities of said co-partnership or huslness.
A eopy r)1' thp co-partnership ag;reement, (if oral, a statement setting forth the nature of the I'l.~reement)
to,gt>tllf'l' .'lith Il statement setting forth the character of the business, its location, and such other facts
p!;>rtdjnir~c: to the business tlS may be pertinent to a fair and just appraisal of the decedent's interest
thf'rpill J'lIlSt he suhmitted. It should also set forth in itemized form, together with the fair market value
thero:'()f. I'ln~. other propert;y owned or bequeathed by the decedent at the time of death.
Thf" Sc/1edule C attached hereto and made part hereof sets forth a true I'lnswer to each inquiry
contatnf>d Hll'rein and in the case of' transf'ers of'property, real or personal, within two years of decedent' 5
death, in C(Hltemplation of decedent's death, or intended to tll.ke ef"f'ect in possession or enJoyment at or
arter death, said schedule sets forth the nature and value of' such property, to whom trlUlsferred, the
relationship of the transferees to the liecedent, the proportionate share received by each transferee and
all other facts of a pertinent nature re.e;ardin,g; sairl transf'ers. In the case of transfers intended to
take ef'fect in possession or enjoyment at or af'ter deat.h, there is also attachen to the schedule a copy
of the deed, trust agreement or other instrument creatin!!; the trust. Tl1er,~ is also set forth in said
schedule a list of all property, real and personal, wit.h its value, which pa~ses at decedent's rleath by
virtue of the exercise by decedent, either individually, or jointly with another, or any power of appoint-
ment vl~sted In decedent, either inrlividually or jointl;y, by the will, deed, or ot.her instrument of' another,
with It copy of the instrmnent creating such power attached to the schedule.
That Sc/1edufe D attached hereto and made part hereof' sets forth the names anrt addresses of all
persons l;('l1eficially interested in this estate at the time 01' decedent's death, the nature 01' their res-
pective interests, their relationship, if any, to the rlecedent, to~ether with the ages at the time of
decf>dent!s death of all minors, annuitants and beneficiaries for life nnder rlecedent's Will. It also
contains a statement showing which of the beneficiaries named in the decedent's will, if any, died prior
to der:edent, the dates of their death, their issue, lUlrl the relationship of such issue to the beneficiary.
That 5..-t>edule E attached hereto and made a part hereof SE"ts forth all property, real and per-
sonal, aImed by the decedent jointly with another or others, inclurHng intangible, standing in the name
of the decedent and others, plus the date and place of record of instruments effecting the \-esti ture of
real pstnt,t> and the date of acquisition of' personalty, plus the name, address and relationShip, if any,
of co-owners to the decedent.
That Sct>edule F attached hereto and made a part hereof sets forth fully and in dPtail all rleilts
and deductions claimed for and on behalf of this decedent's estate, includin~ hlneral expenses patd;
family exemption, where applicable; costs of Rrlministration of this estatej counsel fees anrl fudlcinry'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 ann Ilnpatrl at time of'
deathj taxes accrued chargeable for periorl prior to decedent' 5 death (except those allowed under Section
651 of the Inheritance and Estate Tax Act); together with tl statement of collateral plerl.e;erl for obliga-
tions, if any. It is agreed that the fiduciary will present proof of said claimed obligations upon re-
quest, that if the amount actually paid in settlement of any fee, commission or debt is less than the
estimated amount claiming and allowed, that the same will he reported to the Register of Wi) Is, f1.nd thfl.t
the amount of tax assessed can be reassesserl in accordance therewith.
That the totals of the appropriate columns in Scherlules "A", "B", "e", "E", ann "F" as directed therein,
have heen carried forward and properly registered in the Summary.
Subscribed and sworn to before me this ....................
,&J~J.. .... ..d~y of '--[h~. .............. 19Jq
,~}~tU--mcuJluJ:.~...
MERLENf gARHEVKA, NoIary Poblic;
odislo,'Cumbed""a Counti'p.... f .
. Cotnml..IOilbpl.. ~"I.1t I:\d...
~
.................-.........
(Street Number)
Carlisle, Penna. 17013
(City or Town aM Stnte)
NOTE: .Flefore- sigu~ng af'f'idavit make sure f1.11 blank Sllaces in the f1.ffidavit and schedules annexed are
filled in wtth details or the word "None", and in case the assets include rare ami unlisted securities,
securities of' close or family corporations or fl.n interest in any co-partnership or business, thl'lt the
Qutll flnri statements required under the pnragraph above relating; to Scherlule "B" are attachert. .\lso make
cp-rtldn that col\unTl #1 in the "Surmlary" hilS been properly completerl as flbove-tlirected.
<'," "
RCC-34 (4-73)
,,/COMMONWEAL1'HOF PENliSYLVAl'U'A
. DEPART.MENT 01' 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 other, should be identified
as to quantum of interest and the estimated value should be that of the decedent's interest only. (Property
held os 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
Q generol description of the property, with Q reference to the record of the
conveyance by which the decedeM 'took 'tl'tle; If a farm state number of a.
eraS; also statement of mortgage encumbrances upon each parcel at death
of decedent. TDxes, assessments, accrued Interest on mortgages. etc.,are
to be Ilsted- on Schedule.. F'. and must not be deducted from this schedule.
(1)
(2)
(3\
DEPARTMENT
VALUATION
CAUTION
(Do not write
In this space)
ASSESSED VALUE
FOR YEAR OF
DECEDENT'S
DEATH
ESTIMA TED
MARKET VALUE
House at34 South East Street, Carlisle, Pa.
containing two apartments. One occupied by
Emmett Shelley, the other. rented to
Mr. and Mrs. Hummer, situated on two tracts
as recorded August 8, 1975 in Deed Book "E",
Vol. 26, Page 675
5,750.00)/
28,800.00",1--
. /',
,
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.
28,800.00
). ? K (){J. () tJ
)
/
, ~.... . '
".
RCC -36
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. "
COMMONWEALTH OF PENNSYLVANIA
, TRANSFER INHERITANCE TAX
SCHEDULE lIB"
PERSONAL PROPERTY
Item
No.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20;'
21.
22.
23.
RESIDENT DECEDENT
INSTRUCTIONS: This Schedule must disclose all tangible and l.ntangible personal property owned individually
by the decedent, at the time or his death. Property owned by the decedent jointly with another or others
must be listed under Schedule "En. Intangible personal property, titled in the name of the decedent, but
payable at death to another or others, including but not limited to P.D.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 ~lrst (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 ~iduciary in said capacity, 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~e time of death, should be listed in this schedule.
ITEM
List and describe fully
UNIT
VALUE
DEPARTMENT VALUATION
(Do no t wri te in
this space)
ESTIMATED
MARIlli"1' VALUE
Household goods and furnishings, appraisal attach
1934 Ford Roadster, appraisal attached
1963 Pontiac Sedan, appraisal attached
1952 Lincoln, salvage value
Coin collection, appraisal attached
Cash
40 shs. Carlisle Corp. ~,~. O'~'
Balance Checking Acct. 4 3690 9, Farmers Trust Co.
Balance Checking Acct. 5 2159 0, Farmers Trust Co.
National Ben Franklin Life Insurance Co.,
Immediate Relief Fund
National Ben Franklin Life Insurance Co.,
policy proceeds . .
Savings Acct. 1256808, Farmers Trust Co.~~~
Interest accrued on item 12 until date of death
Savings Acct. 6631, Carlisle Building & Loan Assn.
Interest accrued on Item 14 until date of death
March rent, Mr. and Mrs. Hummer
Eagles' Benefit
Pa. Income Tax refund
Revocable Trust, Farmers Trust Co.
Mortgage Participations
50M par Pfizer Notes 8.875% due
8/15/85 @ 102.125
Income
1. 8125
1,965.50'
3,500.00
300.00
100.00
388.0
25.02
872. 50
2 ,092 . 15,
2,293.47
1,000.on
,,"
\""It> .
1,000.00'
4,183.96
%,4J...~
4,668.46
56.82
125.0
262.00
61. 36
30,000.00
51,062.50
233.33
Refund, Old Town Run Lodge
Refund, Blue Shield
Refund, Medicare
Refund, U.S. Treasury
81,295.83
400.00
1.4
5.60
537.00
x x
\05 l '8'0. ~'\
J
lnsert this total opposite "Personal Propertyn, Schedule I1B" in
the "As Reported" column on the last page of this return.
105,194.4
~ -(\l-
"--:?-
GEORGE E. HOFFER
,
'ATTORNEY-AT-LAW
9 IRVINE ROW
CARLISLE, PA.
OCTOBER 27, 1978
APPRASIAL MADE FOR: EMMETT SHELLY ESTATE, 34 SOUTH EAST STREEi
1 ST. FLOOR APARTMENT. CARLISLE, PA.
SOUTH FRONT BEDROOM:
MARBLE TOP DRESSER (ROUGH)-------------------- $
VICTORIAN STYLE SOFA--------------------------$
ADMIRAL COLOR TV------------------------------$
WALNUT 4 DRW. CHEST OF DRWS. W/PORCELIAN PULLS $
2-BEDROOM CHAIRS------------------------------$
LAMPS, FAN & MISC ITEMS-----------------------$
LIVING ROOM:
SYLVANIA COLOR TV-----------------------------$
OAK CASE GRANDFATHER CLOCK--------------------$
SOFA BED------ ---- --------------___________..__ $
WING TYPE LIVING RM. CHAIR-----------------..--$
PLATFORM ROCKER-------------------------------$
EASY CHAIR------------------------------------$
WRITING DESK----------------------------------$
2-END TABLES & COFFEE TABLE-------------------$
RECORD PLAYER & CABINET-----------------------$
TABLE LIGHTS, PICTURES & MISC. ITEMS----------$
NORTH FRONT BEDnOOM:
DBL. WOODEN BED---------------~---------------$
WRITING DESK & CHAIR--------------------------$
VINYL EASY CHAIR------------------------------$
MARBLE CHEST OF DRWS. W/MIRROR----------------$
4 DRW. CHEST OF DRWS.-------------------------$
TABLE LIGHTS & RUG-~--------------------------$
65.00
165.00
77.50
200.00
10.00
22.50
85.00
365.00
32.50
37.50
25.00
15.00
10.00
12.00 SET
35.00
17.50
15.00
17.50
14.00
97.50
35.00
12.00
.0 0 T
65.00
J 6 5.00
7 7.50
2 0 0.0 0
1 0.00
22.50
85.0 O.
:5 6 5.0 0
32.5 0
37.50
2 5.00
1 5.0 O.
I 0.00.
1,2.0 O.
3 5.0 0
1 7.50 .
J 5.00 '
1 7.50
I 4.00
9 7.50
3 5.0 0
1 2.0 O.
1,365.50T-
<
~-.-.,.
"'~. .......
EMMETT SHELLY ESTATE, CONT.
KITCHEN:
.
5 PC. WOODEN BREAKFAST SET--------------------$
PEDESTAL BAR &: SHELF UNIT---------------------$
RCA REFRIGERA~OR,OK---------------------------$
DISHES, POTS &: PANS-------------------~-----..-$
PICTURES &: MISC. ITEMS------------------------$
GARAGE AT THE REAR OF HOUSE:
ALUM DBL. LADDER------------------------------$
2-0LD BENCH DRILL PRESSES---------------------$
CHAIN HOIST-----------------------------------$
ROTARY LAWN MOWER-----------------------------$
SNOW BLOWER (NEEDS REPAIR)--------------------$
MISC. HAND TOOLS, WRENCHES, ETC.--------------$
BASEMENT OF 1ST. FLOOR APT.
MISC. HAND & GARDEN TOOLS---------------------$
35.00
22.50
65.00
37.50
8.00
.00 T
35.00
22.50
6 5.00
37.50
8.0 0
30.00,
27.50
1 7.5 o-
J 7.0 0
1 5.00'
C 5 0.0 0 .
" 5.00
6 0 0.0 0 T
30.00
27.50
17.50
17.M
15.00
250.00
75.00
1. 3 6 5.5 0
6 0 0.0 0
1. 9 6 5.5 0 T
THE ABOVE APPRASIAL WAS MADE BY: ROY D. GOTTSHALL, AUCTIONEER
ROUTE # 1
BOILING'SPRINGS, PA.
.// ""
.'co? 'Lr.e;;/ ~-U. ~d7~-C/C_, /C
-=----
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~\i:o/-u.r.\~y"
en/ele ~ c/luto SafeJ.
CHARLES ZIMMERMAN. OWNER
CARUSLE. PA 17013 . PHONE 243.0777
}!AY 25. 1'70
I?. GE:OttGE Ii:. BorfER. ATTY.
9 IRVINE ROW,
CARLISlE, PEllNA. 1701.)
SU5JECT, ESTATE 011' EY.METT SIlEtI.EY, USED CAR VAIlJATIONS.
1'34 rOll!) ltD. (ANTIQUE) MFG. NO. 1661700'
$3500.00
1963 PONTIAC SEDAN
MFC. NO. B63w45,a7
$ 300.00
I'd!. 1l0Fb'E~, ITIS MY OPINION TiE Allon PRICES WOULD RED'I&CT
TODAYS 1'.ARIET V A.llJES .
'?" ECTrULY~
%) I
",--.-.- . ,~
. .{M '1',/
ClIAS. D. ZIN~1jj;i'(}'.Alr
~
~
Emmett Shelley Estate-Coin Collection
U. S. Coins
Face Value
$ 42. 59
22 Foreign Coins
Numismatic Value of coin collection
$ 388.00
fG~La~~
Appraiser
,
"., t"J .----- -
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ETT:SI'IELLlri<-=-F-;-:-~ =<~~ '9089' II
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EMN'.ETT SHELLEY
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CARLISLE, PA. 17013 . ... It; 'A'l '-- (~ 7 ~ $o;l~2
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MEMO
The CARLISLE Building &. Loan Association
17 WEST HIGH STREET
CARLISLE. PA. 17013
TO.~. t~f;
FROM ~. r/i fl~ e-.<- _ DATE
UJ~-~JU7
t2-e- d # t t. 3/
(}3.d ~ i 3h7/7.i' <It?? <Ie
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RCC.43 (S.65).
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COMMONWEAL Tij;OF PENNSYLVANIA
, DEPARTMENT OF REVENUE . ,
HARRISBURG
Fj; 3111
(
1),
'~,-. : "''.1:
, ,~' eV"''''
NOTE: TO BEStJBMITTED IN TRIPLICATE
"
Pennsylv'~niaDepartin~nt of Revenue
Bureau ~f County Collections
26,S. 4th Street
Harrisburg, Perinsylv,ania
Dear Sir:
Pursuant to Section 742, Pennsylvania In'heritance and Estate Tax Act of 1961,
we herewith submit the fallowing report:
NAME OF REPORTING
FINANCIAL INSTITUTION
tvn.~~ ~'11:t+. '1(!~f.iIV
ADDRESS
ACCOUNT NO. OF JOINT,
TRUST OR INVESTMENT DEPOSIT
NAMES ON ACCOUNT
OR INVESTMENT "
1 West Htcl'i ,Street Cll.t'1.t.s1l'l.. Pa.;' i7nl~
1-2S68Q..8
~tShG1i61 '
DECEASED JOINT DEPOSITOR,
TRUSTEE 'OR INVESTOR
ADDRESS
DATE.OF:,DEATii
SURVIVING DEPOSITOR,
BEN EFI ClARY OR INVESTOR
El:lmott 6he13.ey
34 S. &.st Street Ga.rltslej1'a.. 11013,
M$rcll 27. 1911
ADDRESS'
". ,.... ,. .' ~;'::,
.'. ..;....i:.,.....
RELATIONSHIP TO DECEDENT
DATE DEPOSIT OR INVESTMENT
WAS ESTABLISHED .r.1nAP~ lQon:
BALANCE, INCLUDING INTEREST
DUE, AT DATE OF DEATH. $ , $4.183.86
. '.,
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RCC - 36
.
Cl)~Ml)\W"EAl.TII lW PE~N~YLrJ\NI'"
TRA\~r,~i\ I\Hl':!\IH.1\CE TAX
SCHEDULE "c"
THANSFEIIS
;\ES I nE\T DECFnENT
(1) Did decedent, within two years ordeath, make any truns:fer of any material part of his estate, without
receiying tl valuable ar.cl adequRte consideration theref'or? (Answer yes or no) no
(~) Dirl rlecerlent, wi t.hin two years of rleuth, transfer l'rol'erLY from himself to himself anrl another or
c.thers (inclllrling It spouse) in joint ownership? (Answer yes or no) no
(:J) If the answer to (1) or (2) above is in the aff'irmative state:
(a) Age of decedent at time of transfer
(b) State of' decedent' 5 heal th at time of making the transf'er. (Note 1).
(6) Cause of' decerlent' 5 death. (Note 1).
(4) Did decedent, in his lifetime, make any trans:fer of' property without receiving a valuable or adequate
consideration there~or which was to take effect 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 decerlent In his lifetime make any transfer without receiving a valuable anrl arlequate consideration
therefor. under which transferor expressly or impliedly reserves for his life or any period which does
not in fllct end berore his death:
(n) The possession or enjoyment of or the right to income rrom 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) nn .
(G) If the answer to (5) (b) above is in the affirmative, state whether the right was reserved in decedent
alone or others
(7) Did decedent .in hls lifetime make a transfer, the consideration for which was transferee's promise to
pay income to or f'or the benef'it 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 reserverl power to 0.1 tel', amend, or revoke, or which cOllld revert to ctecedent under terms
of' transfer or by operation of' law? (Answer yes or no) nn
(9) If' the answer to (8) above is in the affirmative, was the power to alter,
est of the beneficiary J'eserverl in the decedent alone or the decedent and
(Answer yes or no) ,
NOTE 1: The answers to these questions should be SUPpoT'ted by affida.vit by the attenrUng ph;ysician as
well as a copy of the death cert.ifi.cate.
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 rtate of death, dates of transfers and to whom transferred, with
relationship of transferees to ciecedent, 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 E.
-
amend, or revoke the inter-
others?
ITEM
IIAJUillT VALUE
(Es tima terl)
DEPT. VALUATION
(Dept. Only)
DESCRIPTION
NONE
i
,
,
,
;
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Insert this tntrJ..l opposite "Tra.nsfers", Schedule "e" in the
"As Reported" colunm on the last page of this return.
NONE
r__
/",w -(rJ J)-d'^' f
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REV-405S (8-18)"
T COMMONWEALTlI OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "D"
BENEFICIARIES
-
BENEFICIARIES AND ADDRESSES RELATIONSHIP - -
(State full names and addresses of all who (If' I!l.tep--chiLdren or SURVIVED DATE INTEREST OF
have an interest..vested. contingent or other- illegitimate children DECEDENT OF BENEFICIARY
wise,. in estate) are involved, set STATE YES BIRTH IN ESTATE
forth this fact,) OR NO - -
GeOrge E. Hoffer Trustee Under D__'
-
Agreement dated 8/19/77
9 Irvine Row
Carlisle Penna. 17013
Farmers Trust Co. Trusree U~"o~ Residue
Agreement dated 7/28/75
-
P.O. Box 220
-
Carlisle Penna. 17013
Beneficiaries of both these trus s are Mr. Shelle ,,'s "randch 1dren
David Mallov and She11pv M""- -
,
-
.
.
-,
-
,
-
Deponent further says that all the above-named beneficiaries are living at thi s time except below~
NAME DATE OF DEATH RESIDENCE
-
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SUMMAR Y
Real Property
Personal Property
Transfers
(Sch. "A") $
(Sch. "8") $
(Sch, "C") $
$
$
$
(1)
(As Reported)
28,800.00
105,194.42
.00
n~ .'~Qt.. t..?
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(2)
(As Determined)
$
$
$
$
$
$
Gross Taxable Estate
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RF~IDENT DECEDENT
SCHEDULE nEn
JOINTLY OWNED PROPERTY
c COMM0lo1WEI\l;rH OF I'ENNSYLV,\NIA
THI\~~}l:1t !XHl,lUTANCE TAX
I:'\STRl'CTIOSS: This sched.ule must disclose all property, real and personal, owner! 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 lmder Schedule
"A", plus the date and pl.ace of record of instrument effecting vestiture, 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, Name' unit -
percentage Estate DEPARTJ{ENT VALUATION
Address and Relationship of Co-Owners, and Place 1 Value Share Valuation CAUTION-Do not Write
of Record of Instrument, where Real Estate. , In This Space.
,
= <X- XX ~ :xx ~ ~ :x> X ~ :xx % Value of' Value of'
:x Y> X)<. ~ :xx xX :x
~ :x> Y> Y> Xi< ::x ::x Entire Decedent' 5
:x ..JV< :x> ;(9' :x xX ;X :x >0<: Property Interest
:x
NONE
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Insert this total opposite "Jointly Owned Property", Schedule "En
in the" As Reported" column on the last page of' this return.
NONE
.
REV-S1B (3-79)
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF FIELD OPERATIONS
P. 0: BOX 2970
HARRISBURG
17105
IN YOUR REPL V PLEASE
REFER TO
I nV8stigation Division
NOTICE OF FILING OF APPRAISEMENT
George E. Hoffer
9 Irvine Row
Carlisle, Penna.
(Executor or Administratorl
In Re: Estate of
Ennnett Shelley
Cumberland
County - File No.21~78c,;0188
Dear
You are hereby notified that the Original
appraisement in the estate of Ennnett Shelley
has been fi led in the office of the Register of Wills of Cumberland
County on 18 June ,19Z2-. Said appraisement reflects the following valuations:
Real Estate
Personal Property
Transfers
Jointly Owned
Total
28,800.00
105.180.49
None
None
133.980.49
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
.18 June 1978
Signed
Le~ ~~~
Administrative Officer
Title
NOTE: This is not a bill.
REV-457 (8..76)
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.
18 .Tune tq79_
Cumberland
-
21-78-0188
Whereas, Emmett Shelley late of Carlisle
in the County of Cumberland Commonwealth of Pennsylvania, having died on
the 27th day of March 19'~, seized and possessed of an estate
subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania;
Therefore, I, Leo Fulginiti ,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 Ilfe or for years. the Commonwealth hereby expressly reServes the right to appraise and assess transfer inheritance taxes at the lawful collateral
rat~ on any such future interest
DESCRIPTION OF ASSET UNIT APpraisement
VALUES Made for J nheritance
Tax Purposes
Real Estate $ ?ll linn nn
In~ Illn L.Q
None
T_<_~"" U..I..l
\"
, Total" Assets 133,980 49
"
.
,
.
.
Have been duly sworn accf'sding to law, I do hereby certify that the abj,ve appraisement is made in con.f~rmity
with the law on this day of \ une _. 19'~ _.
'----.(2._^''' ~ ( 0 ......:A:)
U . Appraiser
(!::iLJmber at'J,d Street)
llarrisDurg,
(Post Office)
. Penna.
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TRUS'!' AGREEMENT
THIS AGREEMENT entered into by and between E!<U~ETT SHELLEY,
of Carlisle, Cumberland County, Pennsylvania, hereinafter called
SETTLOR,
l\ND
FA~ffiRS TRUST COMPANY, of Carlisle, Cumberland county,
Pennsylvania, hereinafter- called TRUSTEE:
WHEREAS, Settlor desi.res to place certain funds in the hands
of Trustee for the purpose of investing the same and paying the
income to Settlor for and during his lifetime;
NOW THEREFORE, Settlor does hereby deposit wi,th Trustee the
sum of Eighty Thousand Dollars ($80,000.00) and Trustee does
hereby acknowledge rece~pt of said sum, IN TRUST, NEVERTHELESS,
upon the following t:erms and conditions:
1. Trustee shall invest and reinvest the corpus of the Trust
and pay the income derived therefrom and so much of the principal
as agreed upon by the Settlor und Trustee from time to time to
the Settlor upon a monthly basis.
2. Settlor shall have the right to add to the corpus of this
Trust from time to time.
3. Settlor shall have the right to terminate the Trust in
whole or in part upon ninety (90) days written notice to the
'frustee.
4. Trustee shall be paid as compensation for its services
a fee of one-half of one percent per annum based upon the
invested principal as of ,July 31 of each year. In no evcn1:, hO\oI-
evel-, shnll the annual compensation be less than Fifty Dollars
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($50.00). Trustee shall not be entitled to any ad~itj.onal fee
upon termination of the Trust. Should the Trust be terminated
within one year from the date of this Agreement, Trustee shall be
entitled either to receive the full annual fee or a reasonable
fee for the work performGd to date which shall not exceed the
annual fee.
5. Trustee shall have full powers of investment as
provided by law and in addition thereto shall have the following
powers:
(A) 'ro hold investments either in its own name or the
name of its nominee.
(B) To pay on account of the Settlor reasonable expenses
of medical care and support of Settlor should Settlor be incapa-
citated for any reaso~nd should insurance proceeds or other funds
not be readily available to provide such care and support. should
thG income be insufficient to carry out the provisions of thG
above paragraph Trustee is au.thorized to use Trust prine ipa 1 for
such purpose or purposes. .
(e) In the event of any incapacity to act in Settlor's
place <Jnel ste<Jd to receive <Jnd dispurse funds to meet sUCh obil-
gations as Settlor would otherwise be required to meet in the
normal course of events.
6. If not sooner terminated, upon the death of the Settlor
The Trustee sl1all pay all estate, inheritance, succession and
similar taxes becoming due and payable by reason of the Settlor's
death, whether or not levied upon property forming a corpus of
the Trust, as well as all administraU.ve expenses upon the estate
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of the Settlor, including both trust and non-trust property.
The Trustee shall then hold the renaining balance of the Trust in
further trust and pay the net income derived therefrom to Nellie
E. Myers in either monthly or quarter-annual payments.
7. At the death of said Nellie E. Myers. or at the death
of Settlor should he survive her, the Trust shall continue under
the following terms:
(a) The benefic-iaries of the Trust shall be Settlor's
daughter, Mary Jane Malloy, and Settlor's two grandchildren. or
their issue, per stirpes;
(b) The beneficiaries of the Trust shall share equally
in the Trust;
(c) One year from the death of the survivor of Nellie
E. Myers or Settlor, the Trustee shall pay to the beneficiaries
One-sixth (1/6) of the principal and accumulated income; and each
respective year thereafter, the Trustee shall pay to the benefi-
ciaries One-fifth (1/5), One-fourth (1/4), One-third (1/3),
One-half (1/2), and the r~aining balance of the fund until the
Trust is liquidated. (it being the intention of the Settlor that
the Trust shall terminate seven years (7) from the date of death
of the survivor of Settlor or Nellie E. Myers);
(d) Upon the death of Mary Jane Malloy during any period
v
of the existence of this Trust, the interest of Mary Jane Malloy
in ,this Trust shall terminate.
IN WITNESS WHEREOF, the Settlor has hereunto set his hand and
-3-
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.
~
,
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seal. and the Trustee has caused this Agreement to be executed
by the Trust Officer and its corporate seal affixed hereto this
.z.!"
day of .:It.-Ii,!
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VlITNE~p?
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(SEAL)
FARMERS TRUST COMPANY
BY:
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Trust
Officer
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SECOND AMENDMENT TO TRUST AGFEEMENT
BY AGREEMENT of the parties hereto, the following amendment
is made to the Amendment to Trust Agreement dated August 27, 1975:
I hereby revoke completely the Amendment to Trust Agreement
dated August 27, 1975. It is my specific intention that
Terry Owen Malloy is not and shall not be a beneficiary of my
Trust Agreement which is dated July 28, 1975.
IN WITNESS WHEREOF, The Settlor has hereunto set his hand
and seal and the Trustee has caused this amendment to be executed
by the Trust Officer and its corporate seal affixed hereto this
19th day of August, 1977.
HITNESS:
/'\
y: - .1\ j.
c.f7)."",,~.v:..k..ll',.f/-,,- ......:-L~,_.
Emmett Shelley
./'1
FARMERS/TRUST
/,. .
BY: /:;/
Trust
(SEAL)
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REVOCATION OF AMENDMENT
TO TRUST AGREEMENT
BY AGREEMENT of the Parties hereto, the Amendment To
Trust Agreement dated August 27, 1975, is hereby revoked.
and declared null and void. The Trust Agreement shall be
as originally stated on July 28, 1975.
IN WITNESS WHEREOF, the Settlor has hereunto set his
hand and seal and the Trustee has caused this revocation of
amendment to be executed by the Trust Officer and its cor-
porate seal affixed hereto this ~.f41\ day of October. 1975.
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ATTEST:
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Secretary
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FARMERS TRUST COMPANY
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BY:!;'! /IL{ r;'",
Trust Officer
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AMENDMENT 12 TRUST AGREEMENT
BY AGREEMENT of the parties hereto. the following amendments
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are made to the Trust Agreement dated July 28, 1975:
~aragraph 7 (a) is amended to read as follows:
(a) The beneficiaries of the Trust shall be
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Settlor's daughter, Nary Jane Malloy; ~ettlor' s son-in-law,
Terry O\"en Malloy; and Settlor's two grandchildren. or thel.r
issue, per stirpes;
Paragraph 7 is amended to include sub-paragraph (e) as
follows:
(e) Upon the death of Terry Owen Malloy during any
period of the existence of this Trust. the interest of
Terry Owen Malloy in this Trust shall terminate.
IN \HTNESS \1HEREOF, the Settlor has hereunto set his
hand and seal and the Trustee has caused this amendment to be
executed by the Trust Officer and its corporate seal atfixed
hereto this 1.. 7 day of August 1975.
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,.p...t.<..~~//.k't."(""~.....~__ (SEAL)
Emmett She}ley !
WITNESS:
FA~lERS TRUST COMPANY
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