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RCC-33 (4-73)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
-d- 1.3-77
.:t./-7?- "~;L,o
*,0-"'-'
>
RESIDENT DECEDENT
COUNTY OF
Ctmlberland
IMPORT ANT,
This return must be completed in detail and filed in duplicate, with all attached; with the Register of Wills of the
County where decedent resided; Return is due within nine months after date of death,..unless an e.xtension is granted'
by the Secretary of Re'\tenue. (Section 703 of the Inheritance and Estate T8:x ,Act of 1961.)
Late of
Carlisle, Ctmlber1and
Pennsylvania
Ctmlberland
} AFFlDAVITOF
.EXECUTOR .
~
. . ,,,.,
IN THE MATTER OF THE ESTATE OF
Kathryn I. Forsythe
(STATE FULL NAME OF DECEDENT)
;',
County
County of
} ..,
. Mariae:er
&', T.ax - _-:Ex.cc'titor
State of
The Commonwealth National Bank by Robert P. Conway, Vice Pres.
AdmtOlstrator of the estate of the above-named decedent being duly sworn, depose and -soy
(MONTH)
Nome and address of ottorney or }
olher outhorized representotive to whom
011 correspondence should be moiled.
(DAY]
, 19~{'cslale leaving (lIas.' wiU, cop~ of.w.hi~h is here;o,altoche:d..,}":
(YEAR) i~K
. .
Decedent died
July
31
The Commonwealth National Bank
10 S. Market Square, Harrisburg, Pennsylvania
Th h Executor d . f .1' . h h ff'
at as suc .._ _ eponent IS ami lar Wit t e.a airs
(EXECUTOR-~~~
the assets thereof and their fair f!1arket value.'
-; That at the_ time of death there was no safe deposit box registered in dece~ent'.s individual name, or jointly w.i.th, or
as agent or deputy of another, or in decedent's individual name, with right of access by another as agent or dep.uty, with the
ex<;:eption.of the following: -:-
of said estate and the property constituting
NAME 'AND ADDRESS OF BANK OR OTHER INSTITUTION THI.S SAFE DEPOSIT BOX RfONTED RELATIONSHIP OF JOINT
IN WHICH DECEDENT RENTED A S....FE DEPOSIT BOX IN NAME OR NAMES OF HOLDERS TO DECEDENT
-Wone
-
That the contents of said safe deposit box or boxes ar~ itemized under Schedules N/A-of this re~urn,
with the exception-of the following~ for th'e. reasons hereinafter set forth:
That Schedule A. attach~d hereto ~nd 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 dat.e of death, giving th~ ~m~~'nt' siill 'due at
death, name of mortgagee, date, rate of interest, and book and page of record thereof. It also sets forth)n the
columns provided therefore the assessed valuation of each of sa.id parce~s, the estimated market value ther(?of .
as of date of death of decedent.
,
That Schedule B attached hereto and made part hereof sets forth fully and in detail all personaL property
wheresover situated owned by the decedent at the time _of death; all moneys l~ft by the decedent at the time of
death, whether in decedent's immediate possession, standing to decedent's credit in banks of deposit, savings
. ~anks, tf.1,~st _comp.anies ,'_ or-:-,other institl;ltions, whether individually, or in' trust for a.ny other person or p,ersons _
---~. .-..~ .., - ,,-'- --~ -..-.. - -- " ~-_..
,",,- g-i~-ing also separately the 'accrued interest thereon, if any, down to the last interest day prior to deced'eiii;s',:':/I~.....
~.:;:-:d.~~,~~ 'in:j~.e',case of savings banks, and to "the date of decedent's death in, ap other cases; all b?n.d~5)~~~af~~..(~"'-"'-:.
savings, treasury certificates or notes and other evidence of indebtedness of the United state}--.!.o..tItt)d8.;.:.:/.....~~
cedent; aH-o_bligations, whether,by'statute~or agreement they are designated as tax free, of the Un'ite'd$'tates, \--.:...yo:;
or any st~at~; ~r political"subdivision 'the~eof, or of any foreign country, 'which are owned at the~im'_e:;r;'deafii~ ~:t)"'.g
all wearing.-ap-ii,!rel, .jewelry, 'silvtrrw3ie; 'pictures, books, works of art, household furniture, horsis,: c;g..iage'~, ,~-~;::; ~
..- .... -...... -~'''C-
automobiles, boats, and any and all other personal chattels of whatsoever. kind or nature, left~hy..aeled.ent, \....'\.~..,:y.f
together with the fairly; estimated market value thereof; _ all bonds and mortgages held by decede;("...",~4;:~'f~i-I::..'J ~~,,,~
claims due and owing decedent at the time of death, and all promissory notes or other'ins'trurl1ents in<w';"inng "'>'"..\0
for the payment of money of which decedent died possessed, of whatsoever nature,~wiih._~nterest the'reo'~~' if
any. giving the face value and estimated fair market value the~eof,aitd i( such estirriat_e~ fai~:f!1arkei val~e be
less than the face value, it sets forth .briefly the reasons fo~ such, depreciation as to e~.ch i~em;. all money,s
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 of death, bonds and accrued interest thereon to the date of decedent's
death and other investment securities owned by the decedent at the time of death, with the.market value 'there-
of at such time.
/
, .
.
In the case of securities of' close or family corporations, the values reported are as far as
ros~ihle substantiated by financial statements of the corporations, showing the assets and liabilities
thereof as of the date of death. The schedule also sets forth the interest of decedent at the time of
death In any co-partnership or business, and In support of the value of such interest there Is annexed to
said schedule, financial statements showing the assets and liabilities of said co-partnership or huslness.
A copy of thp co-partnership agreement, (if oral, a statement setting forth the nature of the agreement)
together with a statement setting forth the character of the business, its location, and such other facts
-pertaini.n!!: to the business as may be pertinent to a fair and just appraisal of the decedent's interest
therein must be submitt~d. 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 personlll, within two years of decedent's
death, in contemplation of decedent's death, or intended to t-9..ke effect in possession or enjoyment at or
after death, said schedule sets f'orth the nature ano. value of such propel'ty. to whom trl1.Tls{f~rred, the
relationship of the transferees to the decedent, the proportionate share received by each transferee awl
all ot.her f'acts of a pertinent nature regardin/?; said transfers. In the case of transf'ers int~nderf to
take effect in possession or enjoyment at or after death, there is also attached to the schedule a copy
of the deed, trust agreement or other instrument creating the trust. Ttler.~ is also set forth in said
schedule a list of all property, real and personal, with its value, which pa~:ses at decf>dent,' s r}o.:>ath t)~.
virtue of the exercise by decedent, either individually, or jointly with another, or any power of appoint-
ment vested in decedent, either individually or jointly, by the will, deed, or other instrwnent of another,
with a copy of the instrument creating such power attached to the schedule.
That Schedule D attached hereto and made part hereof sets forth the names ann andresses of ~ll
persons beneficially interested In this estate at the time of decedent' 5 death, the nature or their res-
pecti\'E~ interests, their relationship, if any, to the rlecedent, togetl1er with the ages at the time (I{'
decedent's death of all minors, annuitants anrl beneficiaries for life unrler decedent' So Will. It .'11so
contains a statement showing which of' the beneficiaries named in the fiecerlent's will, if any. died prior
to decedent, the dates of their death, their issue, ami the relationship of such issue to thp 1"'r1':'>1'iciary..
That S.:f1edule E attached hereto and marle a part hereof sets rorth all property, real and per-
sonal, owned by the decedent jointly wi th another or others, including; intang;ible, stamHng in the mim~
of the decedent and others, plus the date and place of record of instrlwents eff~cting the \estiture of
real estate and the date of acquisition of' personalty, plus the nallle, findl'es~ and r"l<ltir.Jl~!l;:., If ,-
of' co- owners to the deceden t.
That Sc/1edule F attached hereto and made a part hereof' sets forrh t'IlJl,. .",,1 ir. d.'r'~il ',11 '{'"'hl'"
and deductions claimed f'or and on behalf of this decedent's estate, Inellldinl-': i'l,-llerll.l t'x;"'nses IHttrl:
f'amilyexemption, where applicable; costs of administration of this e~tllty: ",pl''';''l 1"'-:':;' :lr,'1 l'wl1.c11t!":''''-
commissions paid or to be paidj cost expended for burial trusts, totn:J~r(lI;"-.; Lr ;:.:-;'- "-I; d.__,.:...., ;.,;,~ ,"'11-
gious services, 1n consequence of the death of the decedent; debts and claims owing anrl. llnpairl. at time of
death; taxes accrued chargeable for period prior to decedent's death (except those tllluwed unli,~l' S~'ctil)n
651 of the IntJeritanep. fillli Estat.e Tax Act); to~p.th~r with fI. statemf'Pj- "f ('(tl~',lt'r:11 ~d",\,-",,! ~',,~ ,dJ1i~',-
tions, if any. It 1s agreed that the fiduciary will present proof of saLi d..iill,'d 'H,li:~:_LI .:.... ,1;,,)]1 1,'-
quest, that if the amount actually paid in settlement of' any ree, commission or debt is less than the
estimated amount claiming and allowed, that the same will be reported to the Register of WiJls, awl thHt
the amount of tax assessed can be reassessed in accordance therewith.
That the totals of' the appropriate columns in Scherlules "A", "B", "e", "E", and "F" as directed therein,
have been carried forward and properly registe!'ed in the Summary.
j~W day of .. .... ..~l.lL ...... 1971
r~Nb4.wV .
M C-:>mmissiOl\ Ex~ires Q[t()')(!f n. ,Q80
v Dauphin County
liarnsburQ. PA
The Commonwealth National Bank
_-~~:~~~=~~~~~~:~t
- (Ea:ecutor-AdministratC>T)
l.g....~()Il~~m~.l:l.~~l:!.~....Sqllare ...mm....m.
Harrisbt~g~~1~~h~ylvania
..... ........................................
(City or Town and State)
Subscribed and sworn to before me this
NOTE: Before signing arfidavit make sure all blank spaces in ttle affidavit and schedules :lnnext:'rl arp
filled in wi th details or the word "None", ann in case the assets incluoe rltre anrf unl istp;1 sN'urit ips.
securities of' close or family corporations or /in interest in any co-partnership or husinpss. ttlat the
data /lnti stlltements requirerl unl1er the parap;raph above relatin~ to Scherlule "B" are /-lttached. \lSll IiHlk"
certliin that column #1 in the' "SuJmlary" has been properly completed as Ilhnve-rlirected.
.~-~
, ,
l""'
!h::C~34 ~4~73' _
. COMMONWEAL T'H 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 encumhrances upon each parcel at death of dece-
dent. Property held by the decedent as .tenant;in cammon with another or ather, should be identified
as to quantum of interest and the estimated value should be that of the decedent's interest only. (Property
held as joint tenants with right of surviorship or tenancy by entireties should be reported on Schedule "E.")
The real property I~cated In the Commonwealth of Pennsylvania should be (1) (2) (31
described by lot and block number, street and street number, together with D~PARTMENT
a general description of the property, with a reference to the record of the ASSESSED VALUE VALUA TION
conveyance by which the decedent took tltlei If a farm stote number of a. FOR YEAR OF ESTIMATED CAUTION
creSi also statement of mortgage encumbrances upon each parcel at death DECEDENT'S MARKET VALUE (Do not write
of decedent. Taxes, assessments, accrued Interest on mortgages, etc.,are DEATH In thl, space)
to be listed on Schedule "F" and must not be deducted from this schedule.
None
Insert this total opposite "real property", Schedule "A" in the X X X X X
"As Reported" column on the lost page of this return.
None
,
HCC -3.~
RESIDENT DECEDENT
SCHEDULE "B"
PERSONAL PROPERTY
.
CO~~IONWE.~TH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
INSTRUCTIONS: This Schedule must disclose all tangible and intangible personal property owned individually
by the decedent, at the time of his death. 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 limited to P.O.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 first (e. g. jewelry, wearing apparel, household
goods, and furnishings, books, paintings, automobiles, boats, etc.)
Intangible persona~ property, such as bonds, treasury certi~icates, cash on hand and in bank,
stocks, mortgages, notes, together with accrued interest or rlividends, salaries or wages, insurance pay-
able to the estate or fiduciary in said capacity, partnership interests, interest in anyundistributed
estate of or income ~rom any property held- in trust under the will or agreement of another, even though
located outside of the State, at the time o~ death, should be listed in this schedule.
Item
No.
ITEM
List and describe fully
UNIT
VALUE
ESTIMATED
MARKEr VALUE
DEPARTMENT VALUATION
(Do no t write in
this space)
1.
Tangible Personal Property
Jewelry -Appraisal attached
Intangible Personal Property
10,777 units Common fund A-l with The
Commonwealth National Bank held in the
Kathryn I. Forsythe Guardian account
No. 13809009
165.00
2.
10,777.0
3.
Interest accrued to date of death on
I tern 1t2
Checking account #1813615786 with The
Commonwealth National Bank
59.0
51"0.-:"0
864.50.
4.
5. Refund from PP&L overpayment electric
service
6. Refund from United Telephone Co.
7. Refund from Medicare
8. Refund from Blue Shield
9. Refund fromSwairn Health Center
10. Income and principal cash of the
Kathryn I. Forsythe Guardian Account
No. 13809009 with The Commonwealth
National Bank
t3J'l.~c{.S
13,'{lt.l.5"l.-
Insert this total opposite "Personal Property", Schedule "B" in X X
the "As Reported" column on the last page of this return.
s
Samuel C. Bo,!el'
de'lJelE.'t
Registered Jeweler, American Gem Society
Jewelry
Appraisal
Property of Katheryn Forsythe. Estate
Add c/o Commonwealth Natio.nal
ress
Bank
October 12, 1978
Date
"
I ESTIr-fATED REI'LACE!\lENT
COST
DESCRIPTION OF ARTICLE
.
Ladies chrom and stilibless weter resistant caseone jewel, pin
escanement movement. a Wetch not in'running order. Speidel
stainless expansi~n band attatched.
$5.00
Ladies small 1hK yellow gold 17 jewel S~nss movement wrist watch
wi th a yellow speidel expansion band. Dial badly deterioated.
Watch in good conditbn. Twenty years old.
35.00
Ladies 14K yellow gold b",dlyworn diam~nd ring' set with one diamond
approximately .15 carats with l",rge chip from table to girdle. White
color, p00r make, free of major flaws.
75.00
ladies 14K yellow gold badlY worn diamond ring set~1jth two 1.;' paint
diamond melee and one aPT'roximately .12 cerat yellow ve'ry shallow
make V.S. perfection grade.
50.00
Fee $10.00
These e~lim~l('d rcploccmcnt costs arc
ba~cd only on cslimatcs of the quality
of the stones (unlc,:,: specifically slnlet!
that the sloll!.'s were remol'ed and
graded). WC"HsumCno liability with
respect to <Iny-aClion that Ill;lY hI.' taken
dt /t:~he ;isis o2eappraisaJ. _
,/0 /., J ') " // '
~__f0//-J/''.-(.'(./I/ -:..r:..." /- ",,-:':'.Jl___....L>'(: ._..--"
, Appr~~
.
Commonwealth J\...
National Bank ~~
January 30, 1979
Hr. Robert K. Reitzel
Trust Hanager
Commonwealth National Bank
Carlisle-Deposit Office
Re: Estate of Kathryn I. Forsythe
Dear Mr. Reitzel:
In reply to your letter dated January 17, 1979 on the above estate, the
following information listed below is as of.D.O.D. July 31, 1978:
Checking Account - #181-361578-6
$570.30 Opened on or before 4/6/76
Account in her name only.
If you have. any questions, please feel free to contact us.
:;;;:: ;;;~AI
John R. Hart
Sr. Credit Analyst
JRH/cg
The Commonwealth National Bank, 10 South Market Square, Harrisburg, Pa. 17108 (717) 564-9500
He\::- 36
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
SCHEDULE "Cn
TRANSFERS
*~
liES IDE);T DECEDENT
(1) Did decedent, within two years of'death, make any transfer of any material part 80 his estate, without
receiving a valuable and adequate consideration theref'or? (Answer yes or no)
(2) Did decedent, within two years or death, transfer proper~y 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 is in the ai':fffIJIAtive state:
(a) Age of' decedent at time of transfer. I,
(b) State of decedent' 5 heal th at time of making the transfer. (Note 1).
(e) Cause of decedent' 5 death. (Note 1).
(4) Did decedent, in his lifetime, make any transfer of property without receiving a valuable or adequate
consideration theref~ which Was to take effect in possession or enjoyment at or after his death?
(Answer yes or no) 1"0
(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 Ji&.. or no) .NO
(b) What was the. transferee's age at time of decedent's death? N 1\
(5) Did decedent in his lifetime make any "transfer without receiving a valuable and adequate consideration
therefor under which transfer~r expressly or impliedly reserves for his life or any period which does
not in fact end before his death:
(a) The possession or en~oent of or the right to income from th(' 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) No
(6) If the answer to l5)/ (b) above is in the affirmative, state whether the -righ.t was reserved.in decedent
alone or others N A
(7) Did decedent in his lifetime make a transfer, the consideration for which was t.J:ansferee' 5 promise to
pay income to or for the benefit of care of transferor? (Answer yes or no) NO
(8) Did decedent, at any time, transfer property, the beneficial enjoyment of which was subject to change,
because of a reserven power to alter, amend, or revoke, or which cmtld revert to rlecedent 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 al tel', amend, or revoke the inter-
est of the beneficiarY_feserved 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 is yes, set forth below a description of the property
transferred, it's fair market value at rlate of death, dates of transfers and to whom transferred, with
relationship of transferees to decedent, if any. Submit copy of any t~ust 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.
ITEM
DESCRIPTION
MARKET VALUE
(Es tima ted)
DEPT. VALUATION
(Dept. Only)
None
~~
Insert this total opposite "Transfers", Schedule "eft in the
ftAs Reportedft column on the last page of this return.
None
RCC-3~ (12-63)
l'OltMON\I"EALTll OF PENNSYYLANIA
TRANSFER INm:RITANCE TAX
RESIDENT DECEDENT
SCHEDULE "D"
*""
itJ., t\
... .-~> ."',L, .
....&. . . '. ---- ..
"
BENEFICIARIES
\
h
BENEFICIARIES AND ADDRESSES RELATIONSHIP SURVIVED ' '
. (If step-children or DATE INTEREST OF
State full names .~nd addresses of all who ' illegitimate' children DECEDENT OF, ' IlENEFICIARY ,
avp an interest. vested. contingent or other are involved. set STATE YES IN ESTATE
wise, in estate) forth this fact.) OR NO BIRTH
Linda Mountz . Gr anddaughte' Yes Le2:al ~ nee:ific bequest of
645 Highland Avenue . " C i,EIond solitaire
Mt. ,H,olly SP:ril1g;~'.:':'i\ '. .. ,... ' .,. " . .. .. , . 1 iIl~., $50.00.value.
.. ~ --. . -.' .. _.. .. n._..... ",,",
Charlene Bisker , Legal pecific beauest of
K. Daughter Yes
4 E. Louther St. P.O. Box 8 115 ( iamond ring, $75.00
Carlisle, PA 17013 , alue and other
jewelry, $40.00 value
~ ind one-third residue.
J an~t McGinnis Daughter Yes ' Legal One-third residue.
204 East Second St.
Escondido, California 9202
Richard Clevish Grandson Yes Minor One-third residue.
c/o Mrs. Marion Elsesser
4545 South Mission lt2l
Tuscon, Arizona 86714
,
.
,
"
..
,"
..
," J
.
. , ..
.. " ' ..
..
, "
:
,
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 G.l e
.... 't ='
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",,'0
E.....Q,l
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i:: " 0
r:lE~
_ 0::
SUMMARY
.......(SCh. "A")
.. (Sch. "8")
.....(SCh. "e")
Real Property
Personal Property
Transfers
Gross Taxable Estate . .
(1)
(As Reported)
*
$..
$...
$...
$.. .
S
(2)
(As DderminLod)
$
$
$
$
$
$
l- 1
z rz:l
.. W
oS - ~ Z ..l
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t.l ell
V'l -
- ~
-< ~. .. "
~ {<. ~. '"
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.-I :>.
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0 '" ::: is ..: ....... Ql. c ~
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Z l- ~. 10. B l><
'" t.l '" -
~ 0 ~. ...... 0 ~
k U .J:
C ~ .. .:: ~
0 t.l ~. U ..
'J: u W
.. !:: - ~ "
b 0 c
'" ... - 0
:g :;:: 0 :C. E
E " = E
~"'C - i5
.:i 0
,0<: U U
RCC-38
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 decedent jointly
with 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
"An, 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 'liB", plus date of acquisition, and the name, address a~d relationship (if any) of co-owners to
the decedent.
Description of Property, Date of Acquisition, Name unit percentage Estate DEPARTMENT VALUATION
Address and Relationship of Co-Owners, and Place Value Share Valuation CAUTION-Do not Write
of Record of Instrument, where Real Estate. In This Space.
;& X ~5& X ~a; ~ :xx: Value of' Value of'
~ gs '^ 'V'.:%
X)< :x C>O ~ ;x(< <J<. V, Entire Decedent's
>Q< ;x(< <x;:x property Interest
None
N~.
Insert this total opposite "Jointly Owned Property", Schedule "E" None
in the "As Reported" column on the last page of this return.
" .
. ;
RCC-39 (8-77)
Co~nty, Number and Name SUMMARY
File Number
Date 01 Death 7/31/78
Forsythe Kathryn I COMMONWEAL TH OF PENNSYLVANIA
Estate Name TRANSFER INHERITANCE TAX
(LAST NAME) (FIRST NAME) (lNITIALI RESIDENT DECEDENT
REPORT OF INHERITANCE TAX APPRAISER
I, the undersigned duly appointed Inheritance Tax Appraiser in and lor the County 01 ,
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 flA", "8", lie", and liE".
Dated:
INHERITANCE TAX APPRAISER
1 REPORT OF THE REGISTER OF WILLS
/ I, the undersigned duly elected Register 01 Wills in and lor County, Pennsylvania, do respect..
fully report that I have allowed deductions in the amounts claimed by deponent, except as to those items where a greater or
lesser amount is set forth in the last column to the right in Schedule ifF", which greater or lesser amount represents the sum
allowed as a deduction.
Dated:
REGISTER OF WILLS
ADJUSTMENTS
INVENTORY VALUE AS APPRAISED ODE (HARRISBURG USE ONLY) REMAINDER APPRAISEMENT CODE
Real Property (Schedule A) $ None 00+ 92+
Personal Property (Schedule B) 14.Zb~ lZ 1l>t
Joint-Held Property (Schedule EJ None 2l>t
Transfers (Schedule Cl l~One 3l>t
i TOTAL GROSS ASSETS ILl-, Lt>~ lZ
. 4.181 52 .
less Debts and Deductions 40- 93-
1 (SCHEDULE F)
,
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CLEAR VALUE OF ESTATE 10 087 20
Valuation of life estates or ~ PRINCIPLE FACTOR VALUE ,="
annuities.................... ._ $ .t= t=
-
ESTATE TAX ASSESSMENTS -$
~
FOR USE OF REGISTER ONLY ~ COMPUTATION OF TAX
$ ~
Tax on $ 2% ,
Tax on $ 6%. $
Tax on $ 15% $
Tax on $ $ , ,
Tax on $ $ .
Exemptions , (') As evidenced by Charitable
"
Total Estate " Exemption Certificates .issued
TOTAL TAX $ by the Secretary of Revenue.
"'
Less tax previously paid $ 1= .
BALANCE $
Less 5% of tax if paid within
3 months after death $ .
BALANCE OF INHERITANCE TAX DUE ~ I,
Add interest at rate of 6% from
to $
I AMOUNT OF ESTATE TAX ASSESSED $ 1=
Estate tax paid $ I
, BALANCE DUE $
Add interest at rate of 6% from
to $
TOT AL T AX BALANCE $
I PAID $
Supplementdl Codes: (FOR USE IN HARRISBURG ONL Y)
48-Adjustment 6O-Lile Estate 93C-Chari:ty 96-Successive
49+Adjustment 92+Remainder Appraisal 94-Rema inder Residue Lile Estate
56-Annuity 93-Remainder Deduction
FOR USE OF REGISTER ONLY ADJUSTMENTS
NOTE: Where subseb'ent adjustments. are made to the above computation of tax by the .Register of Wills, for proper reason,
same should e note below, with short explanation.
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COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF FIELD OPERATIONS
P.o. BOX 2970
HARRISBURG
17105
IN YOUR REPL Y Pl.EASE .
REFER TO
Inheritance Tax Division
NOTICE OF FILING OF APPRAISEMENT
Robert Conway, Vice Pr~s.
The Commonwealth National Bank
19 ~. M3rket ~qu3re, H_g., PA
(Executor or Adm ini strator)
In Re: Estate of
K~+h~yn -r Fn~~y+hp
-
Cumberland
County - File No. 21-78-0220
Dear
You are hereby notified that the Original
appraisement in the estate of Kathryn ;1. Forsythe
has been filed in the office of the Register of Wills of ~umberland
County on U Apy,; 1 , 19-2.9-, Said appraisement reflects the following
valuations:
Real Estate
Personal Property
T ronsfers
Jointly Owned
Total
NnT'lt:>
$1:<,Q7U S?
Nonp.
None
$13,974.52
As to such tax that is paid within three months from date of death, 0 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 rote 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 os provided by Section 1001 of the Inheritance and
Estate Tax Act of 1961, 72 P. S. 2485.1001, P. L. 37~ r> ",
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Date 'I Apl'i1 1979 Signed
'--"
Title Administrative Officer
Note: This is not a bi II.
~
-
REV-45i (8.78) .
DEPARTMENT OF REVENUE
BUREAU OF FIELD OPERATIONS
P.O. BOX 2970 .
HARRISBURG, PENNA. 17105
COMMONWEALTH OF PENNSYLVANIA
RESIDENT INHERITANCE TAX
APPRAISEMENT
DATE It n.F......~) '070
COUNTY Cumberland
FILErm. ,21-78-0220
Whereas, Kathrvn I. Forsvthe late of Carlisle
in the County of f'''m''o~' onrl Commonwealth of Pennsylvania, having died on
the ~ 1.';... day of .T" 1 JT 19 ..:z..a, seized and possessed of an estate
subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania;
Therefore, I; T. p" F'n 1 g; n ; T; , an appraiser duly appointed according to law,
having been designated to make a fair and conscionable appraisement of the said estate, and to assess and fix the cash
value of all annuities and life estates growing out of said estate, hereby file the following appraisement:
In the event that any future interest In this estate is transferred in possession or enjoyment to collateral heirs of the decedent after the expiration
of any estate for life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance taxes at the lawful collateral
rate'on any such future Interest.
DESCRIPTION OF ASSET UNIT Appraisement
VALUES Made for Inheritance
Tax Purposes
n. .T ~ $ "~~o
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Have been duly sworn according to law, I do hereb~ rtify tha
with the law on this 'I tll day of) .
O-~
Appraiser
(Number and Street)
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(Post Office)
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