HomeMy WebLinkAbout01-29-79
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p .RCC:'33 (4-731
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
.~- --
11.
-<
RESIDENT DECEDENT
COUNTY OF
Cumberland
IMPORT ANT,
This retum ,must be completed in detail and filed in duplicatey 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 Revenue. (Section 703 of the Inheritance and Estate Tax Act of 1961.)
Cumberland
} AFFIDAVIT OF
XXlllCmEK
ADMINISTRATOR
IN THE MATTER OF THE ESTATE OF
Daniel S. Cavallaro
(STA.TE FULL NAME OF DECEDENT)"
Late of
County
State of
Pennsylvania
'County of
r.",."hprl"l1d
} ..,
Administrator
'F~~n~~$'A C~v~ll~rn
of 1he estate of the above-nomed decedent being duly sworn, depose
~~
and 50y
April
(MON TH)
Nome and address of attorney or }
other authorized rl"presenfotive to whom
all correspondence should be mailed.
12
. 19~{~K!GrNK~X!l\!=Il{Jq~R~ua<<K_~..}
{y EAR) Intestate
Oecedent died
{DAY}
Leonard Tintner. Esquire
P.O. Box 3787. Harrisburg,
Pennsylvania
17105
That as such administratrix deponent is familiar with the affairs of said estate and the property constituting
{EX ECU TO R-ADMINISTRA TOR)
the assets thereof and their rairmarl.:ct value.
That at the time of death th.ere 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 n<lme, with right of access by another as agent or deputy, with the
exception of the following: -
NAME AND ADDRESS OF BANK OR OTHER INSTlTUrlON THIS SAFE DEPOSIT BOX RENTED RELATIONSHIP OF JOINT
IN WHICH DECED~N.r RENTED A S.-\FE DEPOSIT BOX IN NAME OR NAMES OF HOLDERS TO DECEOEr-l T
.
_---NONE
That the contents of said safe deposit box. or boxes are itemized under Schedules
with the exception' of the following, for the reasons hereinafter ~et.forth:
of this return,
That Schedule A attached hereto and made part hereof sets forth fully and in delail a!lthe 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 fuBy 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' ;-
. - v
banks, trust companies, or other institutions, whether individually, or in trust for any other person or p~rSOJl.s'''. ./
. :/ j;.
giving also separately the accrued interest ihcrcon, 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 ?ases; aU bonds, J)o"stal-
savings, trt:asury certificates or notcs and other. evidence of indebtedness of the United States to. ~l1e d(:-;
cedent; an obligations, whether by statute or agreement they are designated as tax free, of the United.States.,
or any state, or political subdivision thereof, or of .any foreig~' c6un"try, which are .owned at the lime of death~
nil wearing apparel. jewelry, silverware, pictures, books, \'vorks of ..ir;t, liou.schold furniture, horses, carriages,
automobiles, boats, and any and all other personal chattels of whatsoever. kind or.. nature, left by d~cedcnt,
together with the fairly estimated market value thereof; all bonds and mortgages held by decedent and of all
claims doe and owing decedent at the time of death, and all promissory notc~ or other. instruments in ",-riting
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 thcTCQf, and -if such estimated fair. market "alue be
.legs than the face \'ilItle, it sets forth briefly the reasons for. such depreciatiun as to each item; a11 moneys
payable to the estate from life insurance policies carried by dccedcl1t~ all annuity and eJl~owment cOntracts
the proceeds of which were payable upon t~le death of the deccdcl1t; all and the corporate stocks and dividends
due thereon and unpaid as of the date of ,1e~lth, bonds and accrued interest thereon to the date of dl'ccdcnt'ii
death and other investment securities owned uy the decedent at the time of death, with the market value: there-
of at sllch time.
~
In the case of securities of close or ramil)" corporations, the values reported are as far as
possible substantiated by financial statements of the corporations, showing the assets and liabilities
there{lf tlS 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 there is annexed to
said schedUle, 'financial statements showing the assets 'and liabilities of said co-partnership or huslness.
A copy of the co-partnership agreement, (~f oral, a statement setting forth the nature of the 4greement)
together with a statement setting forth the character of the business, its location, and such other f'acts
l'ertainlng to the business as may be pert.inent to a fair and Just appraisal of the decedent's interest
therein must be submitted. It should also set 'forth In itemized form, together wi th the fair market value
thereof, any other propert)- 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 ortransf'ers of property, real or personal, within two years of decedent's
death, in contemplation of decedent' 5 death, or intended to t'1ke e"ff'ect in possession or enjoyment at or
after death, saicl schedule sets forth the nature and value of such property, to whom transferred, the
relationShip o"f 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 CORY
of' the deed, trust agreement or other instrument creating the trust. Therl'! is also set forth in said
$cherlule 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 individuall)-, 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 R copy o"f the instrument creating such power attached to the schedule.
That Schedule 0 attached hereto and made part hereof sets forth the flAmes 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 dec~dent, together with the ages at the time of
decedent's death of all minors, annuitants and benef'iciaries for life under decedent's Will. It also
contl\lns a statement showing which of the beneficiaries named in th~ deceitent' 5 will, if any, died prior
to clecedp.nt, the dates or their death, their issue, and the relationship of such issue to the beneficiary.
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
01' the decedent Rnd others, plus the date and place of record of' instrlDTJents effecting the .....estiture of
real estate and the date o"f 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 de<luct.lons claimed ror and on behal l' of' this deceden t' s estate, including funeral expenses paid;
family exemption, where applicable; costs of anminlstration of this estate; counsel -fees and fudiciary's
conmlls~ions paid or to be paid; cost expended for burial trusts, tombstones or gravemarkers, and reli-
gious Fl.er\;!ces, ill consequ~nct! of the death or the dE-cedent; de1.ts and ~laim!i Gwing ann nnpatr' fit. time of
death; taxes accrued chargeable for period prior to decedent's death (except those allowed under Section
651 ('If the Inheritance and Estate Ta.x Act); together with a statement of collateral pledgerl 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 nmount claiming and allowed, that the same will be reported to the Register of Wills, and that
the umount of tax assessed ean be reassessed in accordance therewi th.
That the totals of the appropriate columns in Schedules "Aft, "Bft, "e", "E", and "F" as directed therein,
have been r.arried forward and properly registered in the Summary.
Subscribed and sworn to before me this ...
L'l:!. .. . day of .}!I,!11,l?:EY. .. .... 19..J.~
.21~~;Nc~Ub~"'.""
H~rri"burQ, ~c::urEh'n.:.os"Ma;Ch 20. 1982
My commiSSion Xpf.
..~I.l.l!~1-'~m_......._._..
(Executor-Administnr.to!" )
.Q.~.QQ....Hunt.i.ngg..Q);L.S..!;;.r..~..~.J;_...._..........._..__..
(Street Number)
...I:Ia..t::;:!::l.I:>.~:;:g,.....~~.......:J.:T1..!~.........._..........._"'.'
(City or Town and Sto.te)
NOTE: Hefore signing affidavit make sure all blank spaces in toe af"fidavit and schedules annexed are
filled in with details or the word "None", nnrl in case the assets includ~ ra.re anrl unlisted securities,
secur'it.les of close or family corporntt()ns or lin intp.rest in any co-partnership or business, that the
dllt.fl find stfttements ref)uired under the partlgraph above relating to Schedule "B" are Rttachert. Also make
c;ertfdn that column #1 in the "Sul'I1laryn has been properly conrpllJterl as nbove-rllrecterl.
.
RCC-34 (1-&4)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
TRANSFER INHERIT ANCE TAX
RESIDENT DECEDENT
SCHEDULE "A"
REAL PROPERTY
*'
.:. Real property in Pennsylvania, with statement of mortgage encumbrances upon each parcel at death of dece-
dent. Where property held as joint tenant or tenancy by entireties, report on Schedule "E". Property held by
the decedent as tenant in common with another or others, should be identilied as to quantum 01 interest and
the estimated value should be that of the decedent's interest only.
The real property located In the CommOr1wealth of Pennsylvania should be (II (2) (3\
described by lot and block number, street and street number, together with DEPARTMENT
a general d'esc'ription of the property, with 0 reference to the record of the ASSESSED VALUE VALUATION
conveyance by which the decedent took title; If a farm state number of a~ FOR YEAR OF ESTIMA TED CAUTION
eres; also statement of mortgage encumbrances upon each parcel at death DECEDENT'S MARKET VALUE (00 not write
of decedent. Toxes, assessments, accrued interest on mor'gages, ete.,ore DEA TH In this space)
to be listed on Schedule llF" and must not be deducted from this schedule.
NONE -0-
.
-O- N ~
Insert this totol opposite "real property", Schedule "Au in the X X X X X
"As Reported" column on the last page 01 this return.
.
RCC -35
RESIDENT DECEDENT
SCHEDULE "B"
PERSONAL PROPERTY
*'
COMMONWEALTH O~ PENNSYLVANIA
TRANSFER INHERITANCE TAX
INSTRUCTIONS: This Schedule must disclose all tangible and intangible peI"sonal 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 nE". Intangible personal property, titled in the name or 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 accormts, must be listed, despite the fact that they are not of the administered estate.
Tangible personal property should be listed first (e.g. jewelry, wearing apparel, househo~d
goods, and furnishings, books, paintings, automobiles, boats, etc.)
I Intangible personal property, such as bonds, treasury certif'icates, cash on hand and in bank,
stock~, mortgages, notes, together with accrued interest or dividends, salaries or wages, insurance pay-
able to the estate or f'iduciary in said capacity, partnership interests, interest in anyundistributed
,
estate of' or income f'rom any property held in trust under the will or agreement or another, even though
,
located outside of the State, at the time of death, should be listed in this schedule.
I
Item
No.
ITEM
List and describe fUlly
UNIT
VALUE
ESTIMATED
MARKEr V ALOE
DEPARTMENT VALUATION
(Do not write 1n
this space)
Checking Account - Commonwealth Nationa
Bank - No. 111-221501-5
194.3
Credit Balance - J. C. Penney
1,352.8
1,267.2
18.9
Personalty
Cash on hand
43 Series E Savings Bonds - Redeemed
Value Deposted May 15, 1978
Residuary Bequest from Estate of Harry
B. Hippensteel, deceased, as confirmed
by Cumberland County Court 1/9/79
1979 Ford Granada - 8E822124085
1,870.8
37,044.59
4,812.8
Refund Check - Sears, Roebuck & Co.
Overpayment in finance charges -
National Central Bank
612.65
Insert this total opposite "Personal Property", Schedule "a" in
the "As Reported" c.olumn on the last page of' this return.
x X
47,258.31
41\....5S..::.(
~--.-
<".,..
.! <'.'i"':,i~': _'
~'-~'!/S~:f~;~'.
...........~'--. "~
'..- ., _i ';'\'.':=~'~~::t l'~
. ,:.'
;~~'.".
. ~li~~::'~1
-/<:"'-~', :-/
~:':
. . ~-...:::h-,..-~~-.
'-"-:;".~..
~'~_";~ i-. ..;
RCC-j6
COMMONWEALTH OF PENNSYLVANIA
TRANSrcR INHERITANCE TAX
. ~
/)tU,;,;...~ 't\
.,
. l1' - . -~
SCHEDULE "c"
TRANSFEltS
RESIDENT DECEDENT
(1) Did decedent, within two years of'death, make any transfer of any-material part of his estate, without
receiving a valuable and adequate consideration thel'ef'or? (Answer yes or no) TIn . _
(2) Did decedent, within two years of death, transf'er property from himself to himself and another or
others (including a spouse) in joint ownership? . (Answer yes or no)' nn
(3) If' the answer to (1) or (2) above is In the affirmative state:
(n) Age or decedent at -time of' transfer
(b) State of decedent's health ~t time of making the transf'er. (Note 1)0-
(e) Cause of decedent's death. (Note 1).
(4) Did decedent, In his lifetime,_ make any transf'er of property without receiving a valuable OT adequate
~onslderatlon thereror 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
es~ate or be subject to his power of' disposition? (Answer yes or no) no
(b) What was the transferee's age at time of decedent's death?
(5) . Did decedent in his li:fetime make any transfer wi thout receiving a valuable and adequate consideration
therefor under which transferor expressly or impliedly reserves for his life or any period which do~s
not in fact end befoTe his death:
(a) The possession or enjoyment of or the right to income Crom 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 theref"rom? (Answer yes or no) no
(6) If the answer to (5) (b) above is in the affirmative, sta~e whether the right was reserved in decedent
alone or others
(7) Did decedent 1n his lifetime make a transf'er, the consideration for which was transf'eree's promise to
pay income to or for the_ benefit of care of' transf"e~or? (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 al ter, amend, or revoke, or which cOllld revert to .decedent under terms
of' transf'er 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 bene:flclary reserved in the decedent alone or the decedent ann others?
(Answer ,yes or no)
NOTE 1: The answers to these questions should be supported by affidavit by the attending physician as
well as a copy of the death certiricate.
NOTE 2: If answer to any of' the above- questions is yes, set forth below a description of' the property
transf'erred, it's fair'market value at date of' death, dates of transfers and to whom transferred, with
relationship of' transf'erees to decedent, if any. Submit copy of_ any trust deed or instrument, if' trans-
fers are claimed to be non-taxable, also submit detailed statement of facts on which said claim 1.5 based..
NOTE 3: List applicable property below in manner in which provided in Schedules A, B, or E.
ITEM
MARKET VALUE
(Es tima ted)
-0-
DEPT. VALUATION
(Dept. Only)
DESCRIPTION
None
Insert this total opposite "Transfers", Schedule "e" in the
"As Reported" column on the last page of this return.
N~
_. .,L_o;. '..-.:-
"
u~: ~~~--::"~0"~~
t...-__~...
'.
"
RCC-37 '(12-63)
COMMON\\'EALTH OF rENNSYYLANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE"D"
BENEFICIARIES
"
'\ RELATIONSHIP
BENEFICIARIES AND ADDRESSES , (If step-children or SURVIVED DATE INTEREST OF
(State full names and addresses of all who illegitimate children DECEDENT OF BENEF1CIARY'
ave an interest. vested, cQntingent or other are involved, set STATE YES IN ESTATE "
- wise. in estate) forth this fact.) OR NO BIRTH
.
Frances A. Cavallaro ,wife Yes 5/25/29 one-half
62hOl . Street
,
Harrisburg, PA 17111 .
.,
,'.i .\
{- ,
" daUl1:hter 12/21/51
Mary J" Mosrnanno Yes two-ninths
.l-D Badl!er Road
Arundel Estates "
Annapolis, MD
,
Lisa Cavallaro daughter Yes 3/26/57 two ninths
'.!,. r~r^ .. , ~, ,~
. '" '0, 17111
,Harrisburl! PA
,
Donna Cavallaro daughter Yes 2/17/55 two-ninths
6260 Huntington Street .
Harrisburp' PA 17111
,
,
\
h
,
Deponent fUrther says that all the above-named beneficiaries are living at this time except below:
NAME
DATE OF DEATH
RESIDENCE
none
.. ~
o .
- -
e<"
-" "
.r;"" 6
.-.... ::s
6"-
"C0.8
< 6.
L. 0"
oU"g
---
::l w ..
u ::l 0
"6'"
~ "
~ 0::
SUMMARY
..(Sch. "A")
........... (Sch. "B")
......... . (Sch. "C")
Real Property ........................................
Personal Property ...................................
Transfers ....................... ..................
.......................,............. ................
Cross Taxable Estate.
(1)
(As Reported)
$.......,0.,
$41,25.8.31
$..............
$...... ...... .
$......................
$47.,258.3L....
(2)
(As Determined)
L
$
$.
$.
$
$ .
.....'.'.......
. ,
.
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Z "
~ iii .w
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>< .... .U -0:
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'E .... Ill. .; S
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RCC.38
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
. SCHEDULE HE"
f JOINTLY OWNED PROPERTY
'*
lNSTRUCTlONS: Tilis scherlule must disclose all property, real and personal, owned by the decedent jointly
wi th another or others, including intangibles, standing in the name of' the decedent and others. List
real estate first, as entireties, or joint tenants, giving brief' description, as indicated under Schedule
"A", plus the date a.nd 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
Schedul e "B", plus cia teof a.cquisi tion, and the name, address and relationship (1 f' any) of c~-o,wners to
the de~e(fent.
Description of' Property, Date of Acquisition, Name
Address and Relationship of Co-Owners, and Place
of Record of' Instrument, where Real Estate.
;Z~3&:%~>>
'J
NONE
'^
x
(X
~~>>
Unit
Value
percentage
Sh are
0<:
Estate
Valuation
:&~
-0-
Insert this total opposite "Jointly Owned Property", Schedule "E"
in the "As Reported" column on the last page of this return.
DEPART/,IENT VALUATION
CAUTION-Do not Write
I n This Space.
Value of Value of
Eritlre Decedent's
Property Interest
-0-
10~
~ ... .,
, .
RCC-39 (5--681
COMMONWEAL TH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SlJMMARY
Estate of Cavallaro. Daniel S.
(Last Name) (First Name) (Initial)
DATE OF DEATH
4:' 12-78 FILE NO.
REPORT OF INHERITANCE TAX APPRAISER
I, the undersigned duly appointed Inheritance Tax Appraiser in and for the County of
pennsylvania, do respectfully report that I have 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 "A", "8", "C", and "E".
Dated:
INHERITANCE TAX APPRAISER
REPORT OF THE REGISTER OF WILLS
I, the undersigned duly elected Register of lVills in .nd for Cumberland County, Pennsylvania, do respect-
fully report that I have allowed deductions in the amountS claimed by deponeD[. except as to 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
Real Property (Schedule A)
Personal Property (Schedule B)
Transfers (Schedule C)
Joint - Held Property (Schedule E)
TOTAL GROSS ASSETS
Less Debts and Deductions
(SCHEDULE F)
CLEAR VALUE OF ESTATE
VALUE AS REPORTED
$ UL-
47 2'iR III
. g~
47.?'iR ~
6,516. _67
$40,741. L
VALUE AS APPRAISED
$ j-
1=
E
VALUE AS REAPPRAISED
$
Valuation of life estates or
annuities. . . . . . . . . . . . . . . . . . .
$
-0-
t=
t=
t=
ESTATE TAX ASSESSMENTS
$
FOR USE OF REGISTER ONLY
Tax on $
Tax on $
Tax on $
Tax on $
Tax on $
Exemptions
Total Estate
COMPUTATION OF TAX
2%
6%
5%
10%
15%
*
$
$
$
$
$
TOTAL TAX
s
(oo) As evidenced by Charitable
Exemption Certificates issued
by the Secretary of-Revenue.
$
t=
Less tax previously paid
BALANCE
Less 5% of tax if paid within
3 months after death
$
$
BALANCE OF INHERITANCE TAX DUE
Add interest at rate of 6% from
to
AMOUNT OF ESTATE TAX ASSESSED $
Estate tax paid $
BALANCE DUE
Add interest at rate of 6% from
to
$
t=
$
C
$
1-
t=
$
TOTAL TAX BALANCE $
PAID $
FOR USE OF REGISTER ONLY ADJUSTMENTS
NOTE: Where subsequent adjustments are made [0 the above computation of tax by the Register of Wills, for proper reason,
same should be noted below, with short explanation.
. .
.
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R E V..S t6 (S"78 ,
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF FIELD OPERATIONS
P.O. BOX 2'170
HARRISBURG
17105
IN YOUR REPLY Pl.EASE
REFER TO
*'
Inheritance Tax Oivisit'n
NOTICE OF FII.ING OF APPRAISEMENT
Frances A. Cavallaro
6260 Huntingdon St.
Harri3hurg, r~ 11111
(Executor or Administrator)
In Re: Estate of
Daniel"SA rRVnl1M~O
C1imnerlalla
County - File No.
21 78 201
Dear
You ore hereby noti fied that the 01"; '" in" 1
oppraisement in the estate of Dan;plS. ('"v,,11"1"n
has been filed in the office of the Register of Wills of r.llmhp1"l "n il
County on ? R M aJ:'ch , 19-1-9-, Soid opproisement reflects the following
va luotions:
Real Estote
Persono I Property
Tronsfers
Jointly Owned
Total
N'nnt:>
U7,?SR ql
NOTIP-
None
$47.258.31
As to such tax that is paid within three months from date of death, a five (5%)
perce"t discount is allawable. As to ony tax that remains unpaid alter nine (9) months
(filteen 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 olter 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. ~~.
, QA:::,
Date ~ 8 Hal?Gh 1979 Signed c:7
\="t 0 . ~.
, '0-J~V--.
Title Administ:rtAt:; VP Oof-Fi "'~'r'
L
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Note: This is not a bill.
.
.
.
REV-457 (8-78) COMMONWEALTH OF PENNSYLVANIA DATE 3-28-79
DEPARTMENT OF REVENUE RESIDENT INHERITANCE TAX COUNTY f"nTrlr..o......1-=>.....ri
BUREAU OF FIELD OPERATIONS
: P.O. BOX 2970 APPRAISEMENT FILE NO, 21-78-201
HARRISBURG. PENNA. 17105
.
Whereas, D:a:R7':'~ ~ . ~~u~llLlt?g late of New Cumberland
in the County of rllmhp'l"'l;:ll1n Commonwealth of Pennsylvania, having died on
the 12tH day of ^FJFil 19 ~, seized and possessed of an estate
subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania;
Therefore, I, To...... 'r'11'g;~;+; , 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
VAL.UES Made for Inheritance
Tax Purposes
$
D. . - n
D__~__~' n ,nt-" "-7 ry<;A ~1
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~. - -, ",,~ non n .
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-,
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Have been duly sworn according to law, I do hereby cer;~ that the above appraiJ;emeQ.t is made in conformity
with the law on this 28th day of ~1arcli r->"; . · 19 79 .
C7~ " \""-'''--S: --
\...J Appraiser
(Number and Street)
Il];g.
(Post Office)
, Penna.
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