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AREV.449, {Joo80J
'COMhliQf4.W-UL"TH OF PEN~SYL..} ~!..;
DEPARTMENT aF REVENUE
TRANSFER INHERITANCE T,i....~
RESIDENT DECEDENT
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p.JJ;-frl <X.I-"7 ~ 19f1
Y AMENDED RETURN (June 1980) I
AFFIDAVIT OF
FIDUCIARY
(Instructions on Reverse Side)
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Estate of Pauline J. Hummel
Dote of Death
April 5. 1978
189-07-9388
Lost Address 1700 Bri c'lgP Strpet
New Cumberland, PA 17070
Saci 01 Secu ri ty No.
Bureau Fiie No.
(CITY)
{STATEl
(ZIP)
County File No.
21-78-194
1. Decedent di ed:
( ) Intestate (without 0 will)
( X) Testate (leaving 0 lost will--capy attached)
2. Is the filing of 0 Federal Estate Tax Return required for this estate'
Yes_ No
X
3. (X) Executor/Executrix
( ) Administrator! Administratrix
Nome Ellis Euqene Hummel
Ad6eu P. O. Box 297
Npw ~llmhpr1i'mc'l. PA 17070
(CITY) (STATE) (ZIP)
4. All correspondence should be moiled to (X) Attorney
) Fiduciary.
5. If on attorney is representing the estate, indicate:
Nome
G. Thomas Miller
Address
Box 1166
I'
Harrisburq, PA17108
(CITY)" \~TATEl (ZIP1
List all safe deposit boxes registered in the decedent's individual nome or jointly with:~r os on agent or dei_'" 'I-
of another, or in decedent's individual nome with right of acCess by another os agent or deputy. Indude th~ no,.-
_" _ and address of the bonk or other institution where the sofe deoosit box is located, the nome (s) in which tlor hex
, is registered and the relationship of the joint holders to the decedent.
-.-'- -~
NA~E AND ADDRESS OF BANK ,OR OTHER INSTITUTION
IN WHICH DECEDENT MAINTAINED A SAFE DEPOSIT BOX
NAME OR NAMES iN WHiCt';
SAFE. DEPOSIT BOX IS REGISTEREC-
RELATIONSHiP (:I" J(iU:":
HOLDERS TO OECE:<r';j
0,-
None
c
Under penalties of perjury, I declare that I hove examined this return, 'ncluding accompanying schedules and
statements, and to the best of my knOWledg~l~it ~ru c ect 0 complete.
Ellis ~n 7/J~/Yd
SIGNATURE OF FIDUCIARY
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PENNSYLVANIA INHERITANCE TAX GENERAL INFORMATION'
PERSONS RESPONSIBLE FOR RETURN
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Section 701 of the Inheritance and Estate Tax Act of 1961 provides that the following persons shall prepare and file
a return:
a. The personal representative of the estate of the decedent as to property of the decedent administered by him
and such additional property which is or may be subject to Inheritance Tax of which he/she shall have or
acqui re knowl edge;
b. The transferee of properly upon the transfer of which Inheritance Tax is or may be imposed by the 1961 Statute,
including a trustee of property transfew ':. trust, pro\'ide~ that no separate return need be made by the transferee
of property included in the return of a pel sonal representatl ve.
2. PLACE FOR FILING
Tne returll is to be filed in duplicate with the Register of Wills of the county wherein the decedent resided.
3. ""',r Fe F; FILlN G
ne relLT is due nine months after the decedent's death, unless an extension for filing has been applied for and
~:a!, ted by the Secretary of Revenue wi thin the nine-month period.
40 FAiLURE TO FILE RETURN
Sec'.c.l 7S1 of the 1961 Statute provides that" . . .any person who willfully fails to file a return or other report
re,,: 'rc~ of him. . .shal! be personally liable. . .to a penalty of 25% of the tax ultimately found to be due or $1,000
w",i:Le\'fi is the lesser to be recovered by the Department of Revenue as debts of like amount are recoverable by
lal,\'. i'
5. lAX F;-iTES
Ir,he;itanCt Tax is payable at the rate of 6% on transfers to lineal descendants, such as father, mother, husband, wife,
sen, d3ughter, grandchildren, grandparent, son-in-law and daugl1ter-in.law and at the rate of 15% as to all others.
6. p~,YtmH OF TAX
The tax assessed on the transfer of properly reported in the return is due 9 months after the decedent's death. Interest
a1 thE ratE of6% per annum accrues thereafter until payment is made. All payments received are first applied to any
interest wrich may be due with any remainder applied to the tax. IF TAX IS PAID WITHIN 3 MONTHS AFTER THE
DECEDENT'S DEATH, A DISCOUNT OF 5% OF THE TAX PAYMENT IS ALLOWED.
Ail cheds should be made payable to the Register of Wills of the county wherein the decedent resided and are
re:er".:j subject to the final determination of the Department of Revenue.
i. FAilURE TO PAY
iilS taxes imposed, together with any interest thereon, are a lien upon real properly, which lien remains in effect until
ti,e tiiX6S and interest have been paid in full. The taxes may be sued for against any real property in the decedent's
estat3 or against any property belonging to a transferee liable for the tax.
B. FILING OF FALSE RETURN
Any person who willfully makes a false return or report required of him shall, in accordance with Section 793 of the
19S1 Statute, be guilty of a misdemeanor and, on conviction thereof, shall be sentenced to pay a fine not exceeding
$:,OGG or undergo imprisonment not exceeding one year or both.
. ~
"AMENDED RETURN (June 1980)
SCHEDULE" A"
REAL PROPERTY
"iEV~":'3:: ".e::1
; COMMONWEAL TH OF PENNSYLVANIA
DEf'ARTi~T OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
(Instructions on Reverse Side)
EST ATE OF Pauline J. Hummel
ITEM
NO.
DESCRIPTION
Added by this Amendment
Vacant lot 25 feet x 140 feet, Fairview
Township, York County, PA., deed dated
May 13, 1965, Recorded Volume 57U page 80,
York County, PA. Value per county real
estate tax record market value
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TOTAL THIS PAGE
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EST/MA TED
MARKET
VALUE
DEPARTMENT
VALUATION
(OFFICIAL USE
ONL Y)
6,200.00/
tl,200.00)
4"1>0. DO
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INSTRUCTIONS FOR COMPLETING SCHEDULE "An
... .
Schedule "A" should include 0 detoiled description of all real property located in Pennsylvania
nd held solely by the decedent or held jointly with another individual (s) as tenants in common. List the
eeedent's percentoge of ownership and the estimated market value of the deeedent's interest. (Property held
s joint tenants with the right of survivorship or tenants by entireties should be reported on Schedule "E".)
All real estate located in Pennsylvania should be described by lot and black number, street
ddress, number of acres and general description of land and buildings. Also, include the baok and page
umber in which the deed is recorded and the exact title as indicated on the deed. If the property has been
Id, attach 0 copy of the settlement sheet. If the property is subject to a mortgage encumbrance, include
e nome of the mortgagee, date, rote of interest and the outstanding balance on the date af death and
ttach a statement from the mortgagor verifying the outstanding balance.
i
i Praperty taxes and interest on mortgages as of the date of death, assessments and other
tncumbrances should be listed on Schedule "F". Do not deduct them on Schedule "A".
REV.451 (1.,80)
COMMONWEAL TH OF PENNSYLVANIA
DePARTM\!-NT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
.
Pauline J. Hummel
Estate of
ITEM
NO.
No Change
DESCRIPTION
SCHEDULE "8"
PERSONAL PROPERTY
(Instructions on Reverse Side)
UNIT
VALUE
TOTAL THIS PAGE
ESTIMATED
MARKET
VALUE
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DEPARTMENT
VALUATION
(OFFICIAL USE ONL Y)
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INSTRUCTIONS FOR COMPLETING SCHEDULE "8"
Schedule "B" must include all tangible and intangible personal property
owned individually by the decedent at the time of death. Property owned
jointly with another party or parties should be listed on Schedule "E" - - Jointly
Owned Property. Intangible personal property, titled in the name of the decedent,
but payable at death to another party or parties, including but not limited to
P. O. D. U. S. Savings Bonds and Tentative Trust Accounts, must be listed on
Schedule "B".
Tangible personal property should be listed first. Examples of tangible
personal property are jewelry, wearing apparel, household goods and furnishings,
books, paintings, automobiles, boats, snowmobiles, aircraft, etc.
Intangible personal property includes cash-on-hand and in the bank, stocks,
dividends, bonds, mortgages, treasury certificates, notes, together with accrued
interest, salaries or wages, insurance payable to the estate or fiduciary in said
capacity, partnership interest, etc. An interest in any undistributed estate or
income from any property held in trust under the will or agreement of another
even though located outside of Pennsylvania at the time of death should be
listed on Schedule "B".
A completed Partnership Interest Report (REV-894) must be attached for
each partnership or joint venture, and a completed Closely Held Corporate Stock
Information Report (REV-893) must be attached for each closely-held business
interest or sole proprietorship reported on Schedule "B".
, REV"4S2 I"sol
. CO~MONWE",L TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE .
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
ESTATE OF _ 'P~lll ; np .T. HllmTTlpl
SCHEDU~
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INSTRUCTIONS:
1. Answer the questions on reverse side.
2. If the answer to any of the questions on the reverse side is "Yes," provide a description of the property transferred per
Schedules "A," "B," or "E," its estimated market value at date of death, dates of transfer, to whom transferred and
relationship of transferees to decedent. Attach a copy of any trust deed or instrument relating to the transferred property.
ITEM
NO.
DESCRIPTION
ESTIMATED DEPT. VALUATION
MARKET VALUE (OFFICIAL USE ONL Yl
No Change
TOTAL THIS PAGE
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QUES nONS CONCERNING PROPERTY TRANSFERS
..
1 Did decedent, within two years of death, make any transfer of any material part of his estate without receiving
valuable and adequate consideration? (Answer "Yes" or "No".)
2 Did decedent, within two years of death, transfer property from himself/ herself to himself/herself and another party
or parties (including a spouse) in joint ownership? (Answer "Yes" or "No".) _
3 If the answer to one or two above is "Yes" and the transfers are claimed to be nontaxable, provide the following
information:
a. Age of decedent at time of transfer.
b. Copy of death certi fi cate.
c. Affidavit by the attending physician indicating the state of decedent's health at time of transfer.
d. All other information supporting nontaxability of transfer.
4 Did decedent, in hisiher 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 hisiher death? (Answer "Yes" or "No".)
a. Was there any possibility that the property transferred might return to transferor or hisiher estate or be subject
to his/her 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/her lifetime make any transfer without receiving a valuable and adequate consideration therefor
under which transferor expressly or impliedly reserves for his/her life or any period which does in fact end before hiS/her
death:
a. The possession or enjoyment of or the right to income from the property transferred? (Answer "Yes" or "No".)
b. The right to designate the persons who shall possess or enjoy the property transferred or income therefrom?
(Answer "Yes" or "No".)
6 If the answer to five b. above is "Yes," state whether the right was reserved in decedent alone or others.
7 Did decedent in his/her lifetime make a transfer, the consideration for which was transferee's promise to pay income
to or for the benefit or care of transferor? (Answer "Yes" or "No".)
8 Did decedent, at any time, transfer property, the bElleficial enjoyment of which was subject to change, because of
a reserved power to alter, amend, or revoke, or which could revert to decedent under terms of transfer or by operation of
law? (Answer "Yes" or "No".)
9 If the answer to eight above is "Yes," was the power to alter, amend or revoke the interest of the beneficiary reserved
in the decedent alone or the decedent and others? (Answer "Yes" or "No".)
. REV--4'$3 (l.BO}
COMMoNWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
T~':'NSF_EFi: INHERiTANCE tAX
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Est.,: of
Pauline J. Hummel
- SURVIVED DAn OF ! IrnEREST OF BENEFICI".~"
SHJEFICIARIES AND ADDR~SSES RELATIOr;SHIP . Dr:CEDENT BIRTH
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he above beneficiaries are livinget this tim~ eltcf'pt for th~ following:
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"'!.".f'.~~ f OATE or C~AiH
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REV-454 (1":';':':
COMM()N:.r\.IE'f.~ "!"..: ,".,' -'... "" SCHEDULE HE"
DEPAR"li'':,.-:;,j';' , , , ~
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TRANSFEr! .", - .' :'/-'.:;: JOINTL Y OWNED PROPERTY
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RESIDt::ra D~G~DE7'.'~'
(Instructions on Reverse Side) --
Estate of Pauline J. Hununel
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TOTAL E VALUE OF DEPARTMENT
R
ITEM DESCRIPTION MARKET C DECEDENT'S 'VALUATiDr'J
NO. VALUE E INTEREST IOffie;el the '"',Iy)
N
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No Change
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TOTAL THIS PAGE
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INSTRUCTldNSFOR COMPLETING SCHEDULE "E"
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Schedule "E" must include all property, real and personal, owned by the decedent jointly with another
party or parties as joint tenants with right of survivorship. Both tangible and intangible property are to be
included. List real esta!e. first. .
. .
1. Describe all real property as indicated in the instructions for Schedule "A". Describe all personal property
as indicated in the instructions for Schedule "B". Include the name, address'imd relationship to the
decedent of the co-owner (s) and the date the joint ownership was established.
2. Indicate the total market value of the jointly owned property.
3. Indicate the percentage of the decedent's interest.
4. . . Indicate the market value of the decedent's interest.
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File Number
SUPPLEMENTAL
INHERITANCE TAX SUMMARY SHEET
(BUREAU USE ONLY)
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REV-484 EX+ (3-80)
Estate Name
Date af Death
Social Security Number
REPORT OF INHERITANCE TAX APPRAISER
I, the undersigned duly appainted Inheritance Tax Appraiser in and far the Caunty 01 Cumberland
Pennsylvanio, do respectfully ..eport that I hove appraised the real and personal property as reported in the loregoing
return at the values set ~rth opposite each item in the last column to the right in Schedules IlAU, IIBIt, "C.., and "E"
Dated:
October 23, 1980
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INHERITANCE TAX APPRAISER
AOJUSTMENTS REMAINDER APPRAISEMENT CODE
INVENTORY VALUE AS APPRAISED CODE (HARRISBURG USE ONLY)
Real Property (Schedule A) $ ~. 000 (){J 00+ 92+
Personal Property (Schedule 8) () 10+
Joint-Held Property (Schedule E) t? 20+
Transfers (Schedule C) f} 30+
TOTAL GROSS ASSETS ..:z {J(){J 'IJ(J
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Less Debts and Deductions 40- 93-
(SCHEOULE F)
CLEAR VALUE OF ESTATE
Valuation of life estates or
annuities. . . . . . . . . . . . . .
RATE
FACTOR
PRINCIPLE
VALUE
CODE
T ax on $
lS%
COMPUTATION OF TAX
$
$
$
$
$
.
FOR USE OF REGISTER ONLY
CODE
Tax on $
6%
T ax on $
Tax on $
T ax on $
Exemptions
Total Estate.
TOTAL TAX
INTEREST FROM
BALANCE
TO
$
$
$
Less Credits
DATE OF PAYMENT
AMOUNT PAID
DISCOUNT
INTEREST
TAX CREDIT
$
- $
=
$
+ $
+
=
BALANCE
TO
INTEREST FROM
BALANCE DUE
$
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RE,V.SlS FO (7.S0)
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NOTICE OF FILING OF APPRAISEMENT
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF FIELD OPERATIONS
October 23, 1980
Ellis E. Hummel
R. D. ill, Box 297
New Cumberland, PA 17070 '
RE: Estate of
County of
File No.
Pauline, J. ' Hummel
Cumberland
21:"78:"0194
Dear Mr. Hummel:'
You are hereby notified that the supplemental
approisement in the estate of Pauline J.' Huinmel'
has been filed in the office af the Register of Wills of Cumberland
County on October 23 , 19 80.' Said appraisement reflects the following valuations:
Real Estate
Personal Property
Jointly Owned
Transfers
Total
2,000.00
None "
None
None
$2,000'.00 "
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
October 23, , 1980 '
Signed
#e~: IJ I 'If,/./' An )olj
Title Chief Appraiser
NOTE: This is not a bill.
--
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REV-457 (1-80)
<;OMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SUPPLEMENTAL
INHERITANCE TAX
APPRAISEMENT
Estate of
!lu1,ltJe ~ /kMMeL
aMb~/(/"'NJ
File No.
02..1- 7 1- 0/91-
County
Date of Death
4-5'-73
In the event that any future interest in this estate is transferred in possession or enjoyment to collateral heirs of the decedent aftet 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.
PROPERTY REPORTED BY THE ESTATE DEPARTMENT'S
APPRAISED VALUE
1. TOTAL REAL PROPERTY - SCHEDULE "A" .L ""0. 00
2. TOTAL PERSONAL PROPERTY - SCHEDULE "8" ,
- 0 -
3. TOTAL TRANSFERS - SCHEDULE "C" .- 0 .."..
4. TOTAL JOINTLY OWNED PROPERTY - SCHEDULE "E" . - -. - 0 -
- -
- ,
TOTAL REPORTED PROPERTY I
r:(, () 0 IJ. 00
PROPERTY NOT INCLUDED IN RETURN BUT APPRAISED BY THE COMMONWEAL TH !
,
.
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,
TOTAL UNREPORTED PROPERTY - ~ .-
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TOTAL GROSS ASSETS c2. () (J(). 00
LIFE ESTATE OR ANNUITY CALCULATION
I do hereby certify that the above appraisement is made in conformity with Pennsylvania law and has been filed this day
with the Register of Wills.
PJlvr}/I) '-fP'~/I,n{/l)
APPRAISER
10/23/80
DATE"
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