HomeMy WebLinkAbout08-31-78
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RC!=-.s.9 (4-7~.
"nUG 1 i lQ78
COMMONWEALTH OF PENNSYLVANfX ' ""' lit. .
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
RESIDENT DECEDENT
COUNTY OF
CUMBERLAND
IMPORT ANT,
This retum must be completed in detail and filed in duplicate, with all attached, with the Resister of Wills of the
County where decedent resided; Return is due witbin 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
GEORGE E. DARHOWER
(STATE FULL NAME OF DECEDENT)
. } AFFIDAVIT OF
. EXECUTOR
C. .,' ADMINISTRATOR
ounty
Late of Cllmhp-rl.qnil
County of
Pennsvlvania
Cumberland
} 50'
State of
X~..C6"A
EDMUND F. STEVENS
Execut.or
of the estote of the above-nomed decedent being duly sworn, depose
and .01
(MONTH)
Nome and address .of attarney or }
other authorized fepres-elntative to whom
all corres.pondenu should be mailed.
[DAY)
',19 7~_J testate lea.vlng a l~.t w1l1, copy of whIch 1. he rote attached.,}
~M"f6H .
Decedent died
March
30
Roger B. Irwin
44 South Hanover Street. Carlisle. PA
That as such Executor deponent is familiar with the affairs of said estate and the property constituting
. (EXECUTOR~:R!f;!!K.I~~
the assets thereof and their fair market value.
That at die 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 SAFE DEPOSIT BOX IN NAME OR NAMES OF HOLDERS TO DECE.DENT
NONE
That the contents of said safe deposit box or boxes are itemized Under Schedules
wi th the exception. of the following, for the._ reasons herein.after' set forth:
of this return,
That Scher/ule 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 Scher/ule B attached hereto and made part hereof sets forth fully and in detail all personal property
where saver 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 companies, or other institutions, whether individually, or in trust for any other person or persons
giving also separately the accrued interest thereon, if any, down to the last interest day prior to dec.edent's
death in the case of savings banks, and to the date of decedent's death in all other cases; all bctnd.~~postal'
savings, treasury certificates or notes and other;'.evidence of indebtedness of the United State's. to the de~
- ,-
cedeht; all obligations, whether by statute or agreement they are designated as tax free, of th~""l}nited States,
or any state, or political subdivision thereof, or ofa.!lY foreign country, which are owned at the-time of death;
all wearing apparel, jewelry, silverware, pictures, books, ,,'arks of art, household furniture, horses, carriages"
automobiles, boats, and any and all other personal chattels of whatsoever. kind or natl;l~" left by decedent,
together with the fairlY,estimated market value there?~; all bonds and mortgages held by deCerlent:..a~d'.of ap_ .
claims due and owing decedent at the time of death, and all promis~sory notes or other.instruments.in\yriting
for the payment of money,of which decedent died possessed, of.. whatsoever nature, with interest thereon, if
any, giving the face value and estimated fair market value thereof, and if such estimated fair ,market value be
less than the face value, it sets forth briefly the reaSons for such depreciation as to each item; all moneys
payable to the estate from life insurance policies carried by decedent; all annuity and endowment contracts
the proceeds of which were payable upon the death of the decedent; all and the corporate stocks and dividends
due thereon and unpaid as of the date o~ death, bonds and accrued interest .thereon to the date of decedent's
death and other investment securities owned by the decedent at the time of death, with the-market value there-
of at such time.
~
.-.
=':::J
In the case of securities of close or family corporations, the values reported are as far as
pos~ible 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 sueh interest there is annexed to
said schedule, financial statements showing the assets and liabilities of said co-partnership or nusiness.
. A copy of the co-partnership agreement, (if' oral~ a statement setting forth the nature of Uie 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 fair and just 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 Schedule 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 death, or intended to take effect in possession or enjoyment at or
after death, said schedule sets forth the nature and value of such property, to whom transferred, 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 after death, there is also attached to the schedule a co~y
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 wi th 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 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 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 benef'iciary.
That Schedule 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 of record of' instruments effecting the ,estiture 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 Sc~edul. F attached hereto and made a part hereof sets fbrth fully and in detail all debts
and ded~ctions claimed for 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 Impald at time of
death; taxes accrued chargeable for peri?d prior to decedent's death (except those allowed under Section
6~1 of the Inheritance and Estate Tax Act); together with a statement of collateral pledged 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 &mount 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 therewith.
That the totals of the appropriate columns in Schedules .A., WB", "e., ~E., and "F" as directed therein)
have been carried forward and properly registered in the Summary.
Subscribed and sworn to before me this
m..._._.._...._.~O . . .... day of ..
..m.....S~.m t\,
..Q.,,&~~.. lLI.?..
~ ~;<l!I.G~~RY PUBLIC
......CMll~iltl1\ll';Jl:I!l,ill'~fl.ilElUNTY
MY COMMISSION EXPIRES DEC. 15, 1980
Member. Pennsylvania As~ociationof Notarlil
x~a:~ ~---
EDM&~CUJ~1T1\r~
R,D,ts1:1e~~;i~f"""-""-"'-"'------
Carlisle PA 17013
..........................................:L......._...m....................".M.'_n.
(Citu tYr Toum "M SttJte)
NOTE: Be fore sIgning af'fidavi t make sure all bl ank spaces in the affidavit and schedules annexed are
filled 1n with details or the word "None", a~d 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 ~der the paragraph above relating to Schedule "B. are attached. Also make
certain that column #1 in the .Summary. has been properly completed as above-directed.
RC C-34 l4;-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 as tenant in common with another or other, should be identified
os 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 af Penn'sylvanla should be
described by lat and block number, street (:lnd 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 a.
eres; also. statement of mortgage encumbrances upon each parcel at death
of deceden.. Taxes, assessments, acc.rued Interest on mortgages, e.e.,are
to be listed on Sc.hedule II F" and must no'- be d.educted from this schedule.
(I)
(2)
(3\
DEPARTMENT
VALUA TION
CAUTION
(Do. not writ.
In thIs .pelIce)
ASSESSED VALUE
FOR YEAR OF
DECEDENT'S
DEATH
ESTIMA TED
MARKET VALUE
House and lot of ground located at
453 North Pitt Street, Carlisle, FA
Cumberland County Deed Book "D",. Vol.
15, Page 520.
Value based on assessment....... ........
7,280.00
/
z~pa.oQ
ftllJ'l.J..~ I J ~ ~O
J.1!#fJ 7'~
ff1-.,:;:I
~
1
7,280.00
1J-fo.()O
Insert this total opposite "reol property", Schedule "A" in the X X X X X .
"As Reported" column on the last poge of this return.
RCC -35
RESIDENT DECEDENT
SCHEDULE "B"
PERSON AL PROPERTY
.
COMMONWEALTH O~ 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. Property 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 limdted to P.O.D. U. S. Savings Bonds and tenta-
tive trust accounts, must be listed, despite the fact that they are not of th~ administered estate.
Tangible personal property should be listed first (e.g. jewelry, wearing apparel, househo~d
goods, and furnishings, books, paintings, automobiles, boats, etc.)
Intangible personal property, such as bonds, treasury certificates; cash on hand and in. bank,
stocks, mortgages, notes, together with accrued interest or dividends, salaries or wages, insurance pay-
able to the estate or fiduciary in said capacity, partnership interests, interest .in any 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 the time of death, should be listed in this schedule.
Item
No.
ITEM
List and describe fully
UNIT ESTIlIATED DEPARTMENT VALUATION
VALlIE MARKEl' VALlIE (Do not write in
this space)
$ 5'0.'0'0 1>'-0. (J 0
1,2'0'0.00 ~ ?-OO.d~
119.'00 /I'!. fI"4
159.'0'0 I f"'. (fd
2,'090.67 ~/ ~~(J",
;: Oa
5.00 }.d. d 0
20.00
_~>y..rr<V"'_ Iw-"~'" ..-"~.,"~ry-y.....,."".,,,Y'Yv~"i
I
1
1969 Ford Sedan
Title number C19923666....
2 1973 Mercury Coupe
Title number B24289767..................
Model 98 Mauser 8~1 rifle
#8792. .. .. .. . .. . . . . . . . . . . .
3
4 Model 760 Remington 270
#74'06354................................ .
5 Farmers Trust Company, account
#5-0139-5
6
Untitled junked 1967 Dodge
aut omobile. . .. . . . . . . . . . . . . . . . . . . . .
7 Two hunt ing dogs. . . . . . . . , . . . . . . . . . . . . . . . .
T
5 o 0 0
11'" v v. 1
9.0 0
1 5 9. 0 0
2.0 9 O. 6 7
5.0 0
2 o 0 0
3. 6 4 3. 6 7 T
$ 3 643.67
3'113,67
Insert this total opposite npersonal Propertyn, Schedule nan in X X
the nAs Reportedn column on the last page of this return.
',1978 .:~
,
SEE WHAT'S
NEWlODAY
INA "
CHEVROLET.
~
€fe Chevrolet, Inc.
35 CLAY STREET
CARLISLE, PA. 17013
. PHONE 243-5021
.~
April 20, 1971.1
TO lVlIOM IT NAY CONCERN:
h our opiniol1 the approx. values of the two cars owned
bY' the late George E. Darhower are.
Ford (Ser. No. 7B55H22l1h3) i50.00V
Nerour,. (Ser. No. }R07F545a651 ~l200.00""----
c
Rufe Chevre let, Inc.
e/ ({ ~ v.Q;"
R. A. Keiser, Sales Mgr.
~o
~
~
~1JA
~'o
.,.,. " <
," >- 10'''~'~''\:
~ ~''''~ ~~\ -~
; f"~' ~y:;.i '!,..,,,,~:'tl:-'
... ,.," "'\ ,:Jq
,
.-.Q~
~
Impala
~
Fleefllde PICkup
~
Ca~)rlce CIQ5,lc
~..'....
CON... . . Ch.', Von '
-ot}~ .
.-~-,..-....'> 'I
I
.; ,I
. l'
....
:,:,?-:;".,t,
,
~.....
. GttS5761
SHEAFfER BROS. SPORTING GOODS, INe.
. FISHING TACKLE
'. HUNTING SUPPlIES
. TOYS
HANOVER & NORTH STS.
CARLISLE, PA. 17013
PHONE 243-2161
. HOBBY SUPPUES
. ATHlETIC CLOTHING
. TEAM SPORTS EQUIPMENT
,
19/6
Sold To
Address
Sold""
Calh
dN. Paid 0...1
hid.
II QUAN
PRICE
DV~
DO/
~'.....
THANK YOU
'...W.".. INC. MfCHANlCSIUllG. ~". 17~S
o
c,
\.....,,~
FARMERS TRUST COMPANY
CARLtSLE. PENNSYLVANIA
JUL 2 6 RfC'!/
Dale July', 24, 1978
Roger B. Inrin
'44 S. Hanover St.
Car1is1e..Pa. .17013
Re: Estate of George E. Darhower
Date of Death ,March 3, 1978
i
Dear ,Roger Irwin.
In answer to your request concerning accounts owned, either separately or jointly, by
the above referenced decedent and the balance in each account as of the date of
death, we have checked our records and are submitting the following information in
duplicate. We suggest that you file one of these letters attached to the Pennsylvania Inven-
tory forms (ReC) to substantiate the balance you report. .
Note that we have shown the correct registration for each account. Also, interest accrued to
the date of death, if any, is listed as a separate figure.
--
Balance on account #5-0139-5 $2,090.67
Oliva Bolinger
.Supervisor
Bookkeeping Dept.
~----
Rec - 36
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
SCHEDULE "c"
TRANSFERS
*~
RESIDENT DECEDENT
(1) Did decedent, within two years ofdeo.th, make any transf'er of any material part of 1115 estate, without
receiving a valuable and adequate consideration therefor? (Answer yes or no) Nu
(2) Did decedent, within two years of death, transfer property from himself to himself and another or
others (including a spouse) in joint ownership? (Answer yes or no) NO
'(3) If the answer to (1) or (2) above 1s in the affirmative state:
(a) Age of' decedent at time of transfer N/A
(b) State of decedent' 5 health at time of' making the transfer. (Note 1).
(c) Cause of decedent' 5 death. (Note 1).
(4) Did decedent, 1n 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)~O______
(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) N/A
(b) What was the transferee's age at time of decedent's death? N/A
(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 end before his death:
(a) Th~ 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 N A
(7) Did decedent in his lifetime make a transfer, the consideration for which wB.~branSferee' s promise to
pay income to or for the benefit of care of transferor? (Answer yes or no)
(8) Did decedent, at any time, transfer property, the beneficial enjoyment of which was subject to change,
because 0 f a reservec1 power to 0.1 te-r, amend, or revoke, or which could 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 beneficiary reserved in the decedent alone or the decedent and others?
(Answer yes or no) N/A
NOTE 1: The answers to these questions should be supported by affidavit by the attending physician as
well as a copy of the death certificate.
NOTE 2: If answer to any of the above questions 1s 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 transferees 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 1s based.
NOTE 3: List applicable property below in manner in which provided in Schedules A, B, or E.
ITEM
DESCRIPTION
MARKET VALUE
(Es tlma ted)
DEPT. VALUATION
(Dept. Only)
NONE
NONE
Insert this total opposite "Transfers", Schedule "C" in the
"As Reported" column on the last page of this return.
RCC-81 (1S~73)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
HARRISBURG
17127
IN YOUR REFLY FLEASE
REFER TO
Inheritance Tax Division
NOTICE OF FILING or APPRAISEMENT
Edmund F. Stevens
R.D. fl9
r.~rli~lp, ppnn~~
(Executor or Administrator)
In Re: Estate of
~PnrgP F. n~Thn~aT
Cumberland
County - File No.
21-78-0190
,
Dear
You are hereby notified that the Original
opproisement in the estate of George E. Darhower
hos been filed in the office of the Register of Wills of Cumberland
County on . .11-29 , 19~, Said oppraisement reflects the following
valuations:
Real Estate
Personal Property
Transfers
Jointly Owned
Total
7.280.00
3.643.67
None
None
10,923.67
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 objeci thereto within
sixty days after receipt of said notice as provided by Section 1001 of the Inheritance and
Estate Tax Ac.t of 1961, 72 P. S. 2485-1001, P. L. 373~
11-29:"78 }'/. O-t" , /J .
Date. Signed \. ~
Title
Chief Ao"raisPT
-------
~-
Note: This is not a bi II.
--"~'
RCC-37 (12-63)
COMMONWEALTH OF rENNSYYLANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "D"
~.1\
.~
BENEFICIARIES
,I
I
\
h
RELATIONSHIP .
BENEFICIARIES AND ADDRESSES (If step~children or SURVIVED 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 facL) OR NO BIRTH
SHIRLEY ANN DARHOWER DAUGHTER YES House and lot. at
453 N. Pitt Street 453 North Pitt Stree'
-. CarUsl,:,_ PL17013 -<0.,.. ., ...... -, -- --- - Carlisle, PA;
.-._- . ".' .....- .. "
1/10 residue
EDMUND STEVENS SON-IN-LAW YES 8 MM Mauser rifle
R. D. #9
Carlisle PA 1701'
I ------
BARD E. DARHOWER SON YES Remington Model
453 North Pitt St. 7hn ~;f'lc' 10hO R,,~,-1
Carlisle, PA 17013 S pd.a.I4-.l923..J11er.cm::~L
, Coupe, hunting dogs
1/10 residue
JENNIE M. DARHOWER WIFE YES $5.00
7 North East Street
Carlisle PA 17 01 ~
GEOR()R R nAR .TR ~nN YR.q 1/1 n ~c~ ;,-1nn
~r:; HiO'h Stcrpptc .
Boiling Springs. PA
JAMES LEE DARHOWER "SON YES 1 /1 n ~c~;,-1"a
100 Front .
Street
Boiling Springs. PA
JOHN C. DARHOWER SON YES 1/10 residue
, Street .,;
- East
Mount Hollv Snrings PA
,
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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(2)
(As Determined)
I
Real Property ..
Personal Property
Transfers
SUMMARY
d(Sch. "A")
"d(Sch. "8")
(Sch. "C")
(1)
(As Reported)
$d1.2.8.0.0.0....
$..3..~~3..67...
$.......... .............. . .
$ddd.dd.....d.
$.ddd.dddd
UO.923.61d
.......
$
$.
$.
$
$...
$
Gross Taxable Estate. .
GO
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RCC-37 (12-63)
COMMONWEALTH OF PENNSYYLANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
.
~*~
SCHEDULE "0"
BENEFICIARIES
. j
h
BENEFICIARIES AND ADDRESSES," RELATIONSHIP SURVIVED
(1/ step,children or DATE INTEREST OF
(State full names ftnd addresses of .11 who illegitimate children DECEDENT OF BENEFICtARY
ave an interest, vested, contingent or other are involved, set STATE YES IN ESTATE
wise, in estate) forth this f.cL) OR NO BIRTH
ROBERT W. DARHOWER SON YES 1/10 residue
R. D. .#q. Box 1"0.. ''"'r'
QarlisJ,e" P[', 17013 .. '-'-.~ . -- " " " ' , '
, " ".'-. .., , " -- ' .. .." . "
JACQUELINE RASMUSSEN DAUGHTER YES 1/10 residue
117 Susan Lane
Carlisle. PA 17013
LOIS E. SHREVE DAUGHTER YES 1/10 residu~,_,_,__,_
I I
455 North Pitt Street
,
Carlisle, PA 17013
I
LANA K. STEVENS DAUGHTER , YES 1/10 residue
R. D. #q Box 1"i8
Carlisle PA 1701"1
MARC IA R. FRIED DAUGHTER YES 1/10 'residue
523 S. 41ST. Street
'Philadelphia, PA ;
, ,
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Deponent further says that all the above-named beneficiaries are living at this time except below:
NAME
DATE OF DEATH
I RESIDENCE
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(As Determined)
Real Property
Personal Property
Transfers
SUMMARY
.......(Sch. "A")
(Sch. "B")
....(Sch. "CO)
(1)
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Gross Tuable Estate. .
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RCC-36
RESIDENT DECEDENT
SCHEDULE "E"
JOINTLY OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
INSTRUCTIONS: This schedule must disclose all property, real and personal, owned by the rlecedent jointly
wi th 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 tmrler Schedule
"A", plus the date and place 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", lllus 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 pe reen t age Estate DEPART/tENT VALUATION
Address and Relationship of Co-Owners, and Place Value Share Valya tion CAUTION-Do not Write
of Record of Instrument, where Real Estate. In This Space.
~~ <<::8<:;>< ~ << >> 8; 0)< )< :s& Value of Value of
~ <<)< <<>>%;;:9: ><S('XV> Entire Decedent's
> 3< XV> 3< Property Interest
~
NONE
t?~
NONE
Insert this total opposite "Jointly Owned Pr.operty", Schedule "E"
in the "As Reported" column on the last page of this return.
. .
. .
RCCoS9150077J .
County, Number a2'd Na'lle Cumb er land SUMMARY
File Number 1-7 -190
Date of Death r1~"Y1l">n jn lCn!i
.
File Date COMMONWEAL TH OF PENNSYLVANIA
Estete Name J)^pnfQF~R r1RC1Rr1R R TRANSFER INHERITANCE TAX
(LAST NAME' (FIRST NA.ME) (INITIAL)
RESIDENT DECEDENT
.
REPORT OF INHERITANCE TAX APPRAISER
I, the undersigned duly appointed Inheritance Tax Appraiser in and far the County of CUMBERLAND ,
Pennsylvania, do respectfully report that I have appraised the real and personal property a. reported in the foregoing return at
the values set forth opposite each item in the last column to the right in Schedules CIA", "-8", flC", and liE".
Dated: 1/-. If-, '1- 7f' ~AA___ J< . JL-.
INHERITANCE TAX APPRAISER
.-.
REPORT OF THE REGISTER OF WILLS
I, the undersigned duly elected Register of Wills in and for CTTMRF.RLA ND County, Pennsylvania, do respect.
fully report that I have allowed dedu.ctions in the amounts claimed by deponent, except as te those items where a greater or
lesser amount is set forth in the last column to the right in Schedule "F", which greater or lesser amount represents the sum
allowed as a deduction.
Dated:
REGISTER OF WILLS
INVENTORY VALUE AS REPORTED V ALUE AS APP RAISED CODE VALUE AS REAPPRAISED CODE
Real Property (Schedule A) $ 7280 00 $ 7. ~\('-f) <,tJ 004+ 00+
Personal Property (Schedule B) ., Ch., k7 'X .t.-LJ <l "'7 10+ 10+
Jolnt.Held Property (Schedule E) ~rn~m 20+
Tran$fers (ScheduleC) "" ,T'" 30+
TOTAL GROSS ASSETS 1002"1 67 It), 6 f;. '" Ir7
Less Debts and Deductions 40.
(SCHEDULE F)
CLE AR V ALUE OF EST A TE
Valuation of life estates or ~ PRINCIPLE FACTOR VALUE 10000
annuities.......... III....... "_ $ t= , E=
-
ESTATE TAX ASSESSMENTS -$
..
FOR USE OF REGISTER ONLY ~ COMPUTATION OF TAX
Tax on $ 2% $
Taxon:.$ 6% . $
Tax on.$ 5% $ .
Tax l?riS 10% $
T ox on $ 15% $
Exemptions , ('j As evi~enced by Charitable
Total Estate Exemption Certificates issued
TOTAL TAX $ by the Secretary of Revenue.
..
Less tax previously paid $ t=-
BALANCE $
Less 5% of tax if paid within
3 months ofter death $
BALANCE OF INHERITANCE TAX DUE $ I
Add interest at rate of 6% from
'0 $
AMOUNT OF ESTATE TAX ASSESSED $ t=
Estate tax paid $ I
BALANCE DUE $
Add interest at rate of 6% from
to $
TOT AL TAX BALANCE $
PAID $
Supplemental Code.: (FOR USE IN HARRISBURG ONL Y)
48-Adjustment 6O-Life Estate 93C-Chari.ty 96-Succes5 i v~
49+Adjustment 92+Remainder Appraisal 94-Remainder Residue Li Ie Estate
56-Annuity 93- Rema inder Dedu ction
FOR USE OF REGISTER ONLY ADJUSTMENTS
NOTE: Where subsete"t adjustments are made to the above computation of tax by the -Register of Wills, for proper reason,
same ahould e note below, with short explanation.
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R C C-2 "(2-641 DATE \ \ - L ~ - ( B
COMMONWEALTH OF PENNSYLVANIA
1.. ;.. COUNTY~
DEPARTMENT OF REVENUE RESIDENT INHERITANCE TAX
BUREAU OF COUNTY COLLECTIONS
HARRISBURG, PENNA, 17127 APPRAISEMENT FILE NO. L- \-I'6-U\."\O
,
Whereas, C,)~Q....l, D~~ late of L. F~~
~
in the County of ~ Commonwealth of Pennsylvania, having died on
the '3 o-\;:::.L day of IY\ OJVJL.... 19( S, seized and possessed of an estate
subject to Inheritance Tax un~er the laws ~the CommO,nwealth of Pennsylvania;
Therefore, I, ~ ~. 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 1n terest.
Unit Apprllisement
Description of Auet Valuel Made ror Inheritance
Tn PurpOles
\ <. ~jl ?~ --"- $'1.'280
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Having been duly sworn accordin~ to law, I do hereby cert~~h~raisement is made in.cr13
formity with law on this -"'2- day of \ . A-~ 19_.,
Appraiser
\+-t~ Penna.
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