HomeMy WebLinkAbout07-09-79
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RCC-33 (4-7.'H
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
RESIDENT DECEDENT
COUNTY OF
CUMBERI AND
IMPORT ANT,
This return must be completed in detail and filed in duplicate, with all attached. wlth 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 Re\tenue. (Section 703 of the Inheritance and -Estate Tax Act of 1961.)
Borough of Carlisle
} AFFIDAVIT OF
EXECUTOR .
ADMINISTRATOR
"'~,' .
IN THE MATTER OF THE ESTATE OF
Shirley L. Thompson
(STATE FULL NAME OF DECEDENT)
',. ,
Late of
County
State of
Pf'nn<;ylvania
} <$,
National Bank by: John E. Garry. Estate Tax Manaqer
Execut.or
County of Cumberl and
The Commonwealth
Administrator
of the estate of the obove.nomed decedent being duly swo~n, depose
and soy
Decedent died
5
. 19~{~csta~e leaving 0 lost will,~op~ of ~hi'~.~ i~ ,here:t? ~'ttoc'hed.. }..
(YEAR) ,"testate . "
April
(MONTH)
Nome and address of ottar"ey or }
other authorized representative to whom
011 correspondence should be mailed.
(DAY)
The Commonwealth National Bank
10 South Market Square Harri sburg, Pennsyl vani a 17108
That as such sworn deponent is familiar with the
(EXECUTOR-~M~XX~
the assets thereof and their fair market value.
That at the time of death there was no safe deposit box registered in decedent's indiviciual name, o~ jointly with,.or
as agent or deputy of another, or in decedent's individual name, with right of access by' another as agent or cj.eputy., with the
excepti9n of the following: -
affa.irs of said estate and the property constituting
",'
NAME AND ADDRESS OF BANK OR OTHER INSTITUTION
IN WHICH DECEDENT RENTED A S....FE DEPOSIT BOX
THIS SAFE DEPOSIT BOX RENTED
IN NAME OR NAMES OF
RELATIONSHIP OF JOINT
HOLDERS TO DECEDENT
The Commonwea lth
Carli~l" o"po<;.
Carli~l", Pa
That the contents of said safe deposit box or. 'boxes are itemize~ under Schedules
with the exception-of the following, for the_reasons hereinafter set for~:
R' 'of t.his .f~'t"i.lfn~.:
ThaI Schedule A altached hereto and made parI hereof sets forth fully"and in delaii al.'Ihe real. property
in the Commonwealth of Pennsylvania of which decedent died having an intere~t th~~'ein. It also sets forth'the
mortgage encumbrances upon each parcel of real property at the date :of death, giving. 'the' amou~t still d~e at
death, name of mortgagee, date, rate of interest, and book and page of record thereof. I~ also ~ets forth i_p- th'e'
columns provided therefore the ass~ssed valuation of each of said parcels', the estimated ~arket value., .the.reof
as of dale of death of decedenI.
That Schedule B aItached hereto and made parI hereof seIs forIh fully and in detail all pers.onal properly
wheresover s'ituated 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 pos,session, standing to decedent's credit in banks of deposit, savings
banks, trust companies, or other institutions, whether individually, or in trust for any o.ther person or person~'
giving also separately the accrued interest thereon, if any, dow:n to the last Interest 'day prior'to decedeni's
death in the case of savings banks, and to the date of decedent's death in all other cases; all bonds, postal'
savings, .treasury certificates or notes and other evidence of indebtedness of th'e United States.t~~ite' .de~':""
cedent; all obligations, whether by statute or agreement they are designa,ted as tax free, of the U;;iled....States:~ ~
or any state, or politica~ subdivision thereo~,.or of any foreign country, which are owned at th~~t_!ine -2f;deaih;~.-"'-.":....
all wearing apparel, jewelry, silverware, pictures, books, works of art, household furniture, ho;s~;~arriages, ~:~;:
automobile~, boats, .i.md an~ and all other personal chattels of whatsoever. ~~i"l~d"'1'0:~~~a'iu:~~J.~~;2.e~~t~dent, ..~ ~ ~
.together With the falfly, esttmated market value thereof;. all bonds and .mortgages~~'h.eld")("by aece,,~~I}f~.4:~.p.f all ~ :::
claims ,due and owing decedent at the time of death, and all promissory noies~or oth~r'instrumenls '''n':-writitlg'\~.
. . -' '". ~
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 ~uch estimated fair.ma~~e(~~I~e be
less than the face value, it sets forth briefly the reasons for .such depr.eciation a~ .to'each ~tem; all m-on~ys
payable to the estate from life insurance policies carried by decedent; all annuity and endowment contracts
the proceeds of w.hich 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, b~nds 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
Pos~lble substantiated by financial statements of the corporations, showing the assets and liabilities
th~reof as of the dAte of death. The schedule also sets forth the interest of rlecedent at the tiMe of
death In any eo-partnership or business, and In support of the value of such interest there Is annexed to
said scherlllle, f'lnanclal statements showing the assets and liabilities or said co-partnership or nuslness.
A copy of thp co-partnership agreement, (if oral, a statement setting forth the nature of the agreement)
together 'Ililth a statement setting forth the character of the buslneoss, 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
ther~in must be submlt~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 Sch~du/~ C attached hereto and made part hereor sets forth a true answer to each inquiry
contained therein and in the case or transrers orproperty, real or personal, within two years of decedent's
death, in contemplation of decedent's death, or intended to t~ke ertect in possession or enjoyment at or
after death, said schedule sets forth the nature and value or such property, to whom trfdls1'erred, the
relationship of the transferees to the decerlent, the proportionate share received by each trlUlsreree and
all other facts of a pertinent nature regarding said transrers. In the case of transrers intende~ 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. Ther~ is also set forth in said
schedule a list of all propert)', real and personal, with its value, which pa~ses at decerlent.'s rl~ath 1/;0.
virtue of the exercise by decedent, either individually, or Jointly with another, or any power of appoint-
ment ~'ested in decedent, either individually or jointly, by the will, deed, or other instrument or another,
with a copy of the instrument creating such power attached to the schedule.
That Sch~du/~ D attached hereto and made part hereor sets forth the n~mes ann addresses of hll
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, togetner with the ages at th~ time of'
decedent's death or all. minors, annuitants and beneficiaries for life unrler decedent's Will. It o.lso
contains a statement showing which of the beneficiaries named in the decerlent's will, if any. died prior
to dec.edent, the dates or their death, their issue, anrl the relationship ot' such issue to the h('n...1~clary.
That Schedule E attached hereto and marle 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 or record of instruments erfecting the \estlture of
real estate and the date of acquisition of personalty, plus the nameJ addl'ess and r~lationgl:':'l" if :lPY.
or co-owners to the decedent.
That Sc/!,dul, F attached hereto and made a part hereof sets 1'orth t''ltll v 1t'I<1 in o1"",l-lll 'oll r\-=:ht.~
a.nd deductions claimed for anrt on behalf of this decedent's estate, inclucUng nmcral t"x;Hmses paid:
f&al11y exemption, where applicable; costs of aroninistration or this estlltfC!; Cn1m~"'l fe~~ anrt f'lldic1ery':-.
commissions paid or to be paid; cost expended for burial trusts, tombstones or g.r-a.\"~nlar1..:e:'~. "~;~ r~1 i-
gious services, in consequence or the death of the decedent; debts and claims owing ann nnpa1rt at time 01'
death; taxes accru~d chargeable for period prior to decedent's death (except those t.Lllowed unth~:' Section
651 of the Inheritance ann Estate Tax Act); to.c;ether with 8. statement "f' ('o11:.l1yral ;ll,~d~~.:d ~'.I!" t)llli.t!~.-
tions, if any. It is agreed that the fiduciary will present proof of su.id cl.;,iillt~,t oIJli;:ji-!''1:''i ll~\vn 1,--
quest, that if the amount actually paid in settlement or any ree, commdssion or debt is l~ss th&l the
estimated amount claiming and allowed, that the same will be reported to the Register of W1l1s~ 6J1d that
the amount of tax assessed can be reassessed in accordance therewith.
That the totals of' the appropriate coluans in Schedules -A., -B", .e., wEw, anei .F- as directed therein,
have been carried forward and properly registered in the SUIIIIl&rllllE COMMONWEALTH NATIONAL BANK BY:
.......__....L.J...~....
..........~~
.
d:t~~~~ta.;_~, ~"'"
(Street Numb,..;
IGi;l;<Y l'\l[.;JCH.Clr:r:i~~l!r:9.!..~~I:!I!~X!Yill1.til 171 O?..............
.. - ".... O<lolw 13. '* (City or T""", and State)
NOTE: Be~llttng afr~tc.~e sure 11.11 blllnk spaces In the arridavit and schedule!' :mnexe-rl ."l.re
f'tIled In with details or the worci "None", ann in case the assets include rare anti unlisted se('Hrit.ie:ro:,
secur! ties of close or family corporations or an interest in any co-partnership or business. that tho'!
data I\nc1 stlltements requirert unrler the pllra~raph above relating to Scherlule liD" nre nttacherl. \lso Illilb."
c~rtrdn that colWllll #1 in the "Sulmlary" ha.s been properly completed as llhove-tl1rected.
Subscribed and sworn to before me this ........................._....
day of ~... 19._29
A.~......._.
~ .... ~.
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AC C-34 1~7~1
CO.....ONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "A"
.71:,,>, ~ 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 onother or other, should be identified
as to quantum of interest and the estimated value should be that of the decedent's interest only. (Property
held as joint tenants with right of surviorship or tenancy by entireties should be reported on Schedule "E.")
The real property located In the Commonwe(llth (If Pennsylvanl(l should be (1) (2) (3\
described by Jot and block number, street and street number, together with DEPARTMENT
a general description of the property, with a reference to the record of the ASSESSED VALUE VALUATION
conveyance by which the decedent took title; If a f(lrm state number of a. FOR YEAR OF ES TIMA TE D CAUTION
cres; 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 this spoce)
to be listed on Schedule llF" and must not be deducted from this schedule.
NONE N. 0 r\L
.
I
-
-
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Insert this total opposite "real property", Schedule" AU in the X X X X X
"As Reported" column on the last poge of this return.
NONE
Nof).L
; .i"
J~.C': -~A
,
COMIIlONWE.u'TH OF PENNSYLVANIA
T!lANSFER INHERITANCE TAX
..~.....
~..
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RESIDENT DECEDENT
SCHEDULE "B"
PERSONAL PROPERTY
IN"STRUCTIONS: This Schedule must disclose all tangible and intangible personal property owned individually
by the decedent, at the time or his death. Property owned by the decedent jointly with another or others
must be listed under Schedule "E". Intangible personal property, titled in 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, ami 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 anyundistributed t.
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
VALUE
ESTIMATED
MARKET V AWE
Trust Account No. 13229-00-0 with The Commonweal h
National Bank consisting of:
1
7415 UnUs Collective Investment Fund A-I
7,415.00
2
Interest accrued on item no. 1 to 4/5/78
3.55
3
Principal Cash
Income Cash
76.63
4.
375.85
5
Refund from Medi care
506. 72
6
Refund from Villa Teresa
901. 50
7
Refund from Pa. Blue Shield
114.18
8
Refund from Capital Blue Cross
18.70
.
Insert this total opposite "Personal ~roperty", Schedule"B" in
the "As Reported" colunm on the lust page of' this return.
x X . $9,4i2.13
DEPARTMENT VALUATION
(Do no t wri te in
this space)
1} ltl5'. 00
3.S'!'-
7/,.113
315. ?6
5D(".1~
q D t. 50.
Illf. Ii
1~,16
<1)111<<.13
,
RCC- 3S
,
CllMMOXWEALTII OF PEX":-;YLYA"irA
TRA"i~FFl{ I:iHE!\lTgCE TAX
SCHEDULE "c"
T R-\"i S FEns
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~..,,--~-,y
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k.; .,----, ~A
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rtEs I1JEH DECFl1E"iT
(1) Dirt decedent, within t.....o years of'den.th, make any transfer of an;)' material purt of his estate, without
receh'ing a valuable ann adequate consideration therefor? (Answer ye!:l or no)---NO--
(2) Did decedent, within two years of death, transfer property from himself to himself and another or
Gthers (inclwUng a spouse) in joint ownership? (Answer yes or no) NO
(3) If the answer to (1) or (~) above Is in the Ilf'f'irmative state:
(n) Age of decedent at time of transfer --N/.l\
(b) State of decedent's hefllth at time of making the transfer. (Note 1).
(c) Cause of decedent's death. (Kate 1).
(4) Did decedent; in his lifetime, make any transfer of property without receiving a valuable or adequate
consideration therefor which was to take effect in possession or en10yment at or after his death?
(Answer yes or no) NO ..
(a) Was there any possibility that the property transferred might return to transferer or his
estate or be subject to his power of disposition? (Answer yes or no) NO
(b) What W~5 the transferee's age at time of decedent's death? N/.t\
(5) Did decedent in h1s lifetime make any transfer without receiving a valuable and adequate consideration
therefor unner which transferor eJ..llressly or impliedly reserves for his life or any veriod which does
not in fact end before his death:
(a) The possession or enjo:rment of or the right to income from the property transferred?
(Answer yes or no) Yes
(b) The right to designate the persons who shall possess or enjoy tl1e property transferred or
income therefrom? (Answer yes or no) Ne
(6) If the answer to (5) (b) above is in the affirmative, state whether the right was reserved. in decedent
alone or others npc.pdpnt r:llonp .
(7) Did decerlent in his lifetime make a transfer, the consideration for whj.ch was transferee's promise to
pay income to or for the benefit of care of transferor? (Answer yes or no) yes
(8) Did. decedent, at any time, transfer property, the beneficial enjoyment of which was subject to change,
because of a reserverl po.....er to a} ter, amend, or revoke, or which cOllld revert to decedent under terms
of transfer or by operation of law? (Answer yes or no) YPC:
(9) If the answer to (8) above is in the affirmative, was the power to 0.1 t.er, amend, or revoke the inter-
est of the beneficiary reservert in the decedent alone or the decedent and others?
(Answer yes or no) YPC:
NOTE 1: The answers to these questions should be sUllPortec1 by af-fldavit 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 date of death, dates of transfers and to .....hom trflnsferred, with
relationship of transferees to c1ecedent, if any. Submit copy ,of H.nj' trust deed or instrument, if trans-
fers are claimed. to be non-taxable, also submit detail_eel 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
.
MAlUillT VALUE
(Es tima ted)
DEPT. VALUATION
(Dept. Only)
-
1
Revocable Trust Account No. 13229-00-0 with The
Commonwealth National Bank
NonL-
See Schedule B items 1 though 4
-,
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Insert this tnt:t.l opposite "Transf'p.rs", Schedule "e" in the
"As Reported" colunm on the last -page of this return.
NONE
Non~
,
l~jJX()
National Bank ~
D,'te.. ~ I( I t"l.,........ ....
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C,l~h Amollnt $ . 1~..'.h.::\_~I'.,......_ '. ~. .. .::... ~.'
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Trust Agreement No. ___....L'..-:.__ .\':_"-:.~__J_____'..\:.~......
,
This TRUST is established betwe~n The Commonwealth National Bank as Trustee and the undersigned as
senior. The settlor hereby gr<.II.115 & conveys to thl! Trustee all li~Jhl. title and intcfp.sl in the cash <1mOllll1 indiCi:ltcd
above and to any ot~er assets or liabilities set forth on Schedule "A". which may be attached to and made a port
of this agreement.
In managing these and any other assets subsequently transferred to this TRUST, the Trustee is charged with
the following duties: keep the aSsf~ts safely; use th.e care and attention which a reasonably prudent man would devote
to the management of his own financi(ll aff~irs consid(lring the' .economic conditio;ls of the time; advise the settlor
monthly of the past month's transactions and the valuation of assets held at .month (lnd, ami annually of any neces"
sary information for the preparation of the settlor's tax returns; tr(lnsfer.the net incom!! each month' to the principal
of the TR UST for reinvestment, to or for the use of the. settlor, to-the settlor's checking account as indicated below,
pr to other persons in amounts described in a separate letter delivered to the Trustee.
In_ addition to those powers granted by law, the Trustee may exercise the followitlfl powers in order to 'perform
the above duties: receive proceeds from the sale, maturity, call or conversion of TRUST assets; invest in and buy or
sell assets' (including real or personal property, common funds managed by the Trustee, and obligations, deposit
accounts, or stock of the- bank or its <Iffiliates) subject to the settlor's fluidclincs indicated below; borrow money at
reasonable rates and pledge TRUST <1ssets as collateral, should it lw prudel~t to do so; P3Y .1I1Y I1P.C~SS;H Y (!XIWnses':~
includillg reasonal>le Trustee's compensation; allocate transactiuI1S l)(!lwecll income and prillcipal tiS the Tlllstee dl~.e!!lS
best; and handle routi"ne matters' according te the Trustee's best judgment, including but not limited to making
timely' exchange of temporary issues 'for permanent, executing proxies or votin9 shares, buying or selling fractionat..-.
shares, and exercising, holding, or selling warrants representing rights received in corporate rccapitalizatiOlis or
reorganizat_ions.
The settlor may alter or amend this TRUST in any way provided that such change docs not result in making
the TRUST. (rrevocahle or creating dispositive provisions to take' effect at or after the settlor's dcatJl. The settlor
may add to or withdraw from the TRUST'S income or principal at any time, subject only to providing reasonable.
notice, and may provide for automatic funding by indicating below. The TRUST shalf terminate upon the settlor's
death with principal and undistl ibuted income being paid into the settlor's estate. The Trustee may expend TRUST,
income or principal in behalf of the settlor at his direction or in behalf of any named beneficiary to the extent of his
beneficial interest. Only. the settlor shull have the power to. assign or encumber his interest in the TRUST or other-
wise cause its asse,ts to become liable for the payment of a benefic'iary's personal obligation or debt. The Trustee is
responsible for losses c'aused' by it~ gross negligence but not for other losses such as, but not limited. to, tho.se creat~d
by fluctuation in market" valuations. The Trustee is not reqyii'cd to acc,Ount to anyone, except as described above,
unless expressly directed in writing by the settlor or his personal representative. Either party may terminate this
TRUST at any time, subject only to providing reasonable notice.
This agreement is not bindin!] upon the bank until such time! as it has brien accepted by an admin'istrative officer.
who will be assigned to th~ TRUST; this officer will be in contact with the settlor anu may be called upon by him
at any time.
Dat;;i:l{-elrtt.u.--......
COIlU,lUn\\.lc.:dtlJ r,;.-\til.t'r..(.:\1\~:;,~\.n! I' '''1'-
rn\'h.:~.r .~)( ilt1(ll"l)(...l. 'iO.l/~;./i.1."'i.L'V/1 .
; .-- ""/'~' T~
J.::...~!.'.(),'''I~~~:I'...l\j':;./';i.l.f'r':,... t '~/V
Signature t r l\~ (:1 J
'-" \ \ '--I'"~ ". '\ .
\.JI.LiL L~Juut_"_m .1h,.X!.q~:~:'.~..~
Pri~ed name .... ' _,' \
, , .' \. \" 1
. .\.\.\ m..::', ,.. u \::',.IL L \ ~:!'::...:. .:'::.~..
.! ."!:\. ;--.: i :,', "/'-"1"" Street address_ " ' "
I '. .,,: 1'.. ( .." \' . ',J "1' "'-
mmmhu'mhu .. ',\0<.[ '., C. ...'. I" \ .
Soc. Sec. No. ..';.~~.-.'.\.t-ft\/:\.slait-,-z~p_.t\)i:{em..m..-m.
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",>s:.,,\";:;.~:;;!.....
occupation
. - .... -.. .-. c- hec-i<1 n-g "Accour\t" N 0: ~ -- - - -... - -.-
INVESTMENT GUIDELINES
mmum Commercial paper
~_.m..wTreasury bills
m.__.____ Taxable bonds
.n...._.__ Tax exempt bonds
....m__.. Common stocks
.-....0-. Trustee's discretion
INCOME TRANSFER
mUmm For reinvestment
........... To checking AIC
u..umn To address shown
AUTOMATIC FUNDING
( ) The Trustee is to charge my checking
account $ mmm_mmm_m..:_____ on the
_...._._.________________ of each _____.__.__________
and add it to this TRUST for investment
;\L\ ~,.l\ \ \\~
fiho-rie-No-.---------u..-
DNL Y YOUR ATTORNEY CAN PRDVIDE LEGAL ADVICE
<
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FORM 197 JKG
CUSTOMER'S COPY
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1 County, Pennsylvania, d,eclare this instrument to be my
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III and Testament, in manner and fom followinr;:
I 1. I hl'l'd,y c.xpre""d,y t'c.vnkl' ,,1.1. wi u.'; [me! GOd,i,ci.ls hereto-
fore made by me.
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Ii funeral and administrative e:~peri.ses out of my esta, te, as soon as
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II prncticable after my death.
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I my sister, Naomi Brock; and if she is not then living, to my
I nieces, Edith Hilliams and Gladys Esthers, in equal shares.
I,
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.... .,;.
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II this
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II Testatrix, SHIRLEY L. THOHPSON, as and for her Last Hill and
I Testament, in our Iresence, vJho, in her presel(ce, at her request,
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I and in the presence of each other, have hereunto subscribed our
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LAST FILL /\ND TEST/,HENT OF SHIRLEY L. THOHPSON
cumberla1d
, I
Last Hill
I, SHIRLF:Y L. TIlOHPSON, of the BorouGh of Carlisle,
?
~.
I hereby direct my E:~ecutor to pay all my just debts,
3.
I devise and bequeath the remainder of my estate to
4.
I nominate and appoint Commonwealth National Bank,
Harrisburg, Pcnnsylvania, as Executor of this my Last Hill and
Testament.
1;-'
IN HITNESS HIlE?EOF,
'I' :it. f'\ i I
. ,'-:- day of i'v-0'i
(j I
I have hereunto set my hand and seal
, 1976.
:'"
".,' ','~
I' (",J-!' 'J' ,"..
, 1 ~ ~ ~ c~l " , ' , ",
/t4~;'b,1' -c",,-, "'y;J/th'rv:~YL-- (SEAL)
pnirley L. Thompson
Signed, sealed, published and declared by the above named
names as attesting witnesses.
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flCC-37 (12-63)
COmlllN\\"EALTIl OF PEl>NSYYLANIA
TRANSFER INm:H1TANCE TAX
RESIDENT DECEDENT
SCHEDULE "D"
, ,
BENEFICIARIES
BENEFICIARIES AND ADDRESSES RELATIONSHIP SURVIVED
(If step-children or DATE INTEREST OF
,state full names a.nd addresses of all who illegitimate children DECEDENT OF BENEFICIARY
"Hl\"E' an interest. vested. contingent or other are involved, set STATE YES IN ESTATE
, WiSE< in es"tate) forth this fact.) OR NO BIRTH
Naomi Brock Sister ves leqal Residue
115 Baum St. .
. .. Harrisburq~Pa. __.17103 .
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Deronent further says that all the above-named beneficiaries are living at this time except below:
NAME DATE OF DEATH RESIDENCE
.
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RESIDENT DECEDENT
SCHEDULE "E"
JOINTL Y OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
INSTRUCTIONS: Tllis schedule must disclose all property, real and personal, ownerl by the decedent jointly
wi th another or others, including intangibles, standing in the name of' the decedent and others. List
real es ta te fi rst, as en ti reties, or j oint tenants, giving brief description, as indicated 1UIner Sche~ule
"An, plus the date and place of record of instrument effecting vestiulre, but do not include entiretIes_
"^,
or out of state real estate value in estate valuation column. Personal property should be listed as in
Schedule "Bf'I, plus clate of acquisition, and the name, address and relationship (if any) of co-owners to
the decedent.
Description of Property, Date of Acquisitio.n, Name
Address and Relationship of Co-Owners, and Place
of Record of Instrument, where Real Estate.
~ ~ xxZ>>8&~ 88 ~ ~ ~
X>O< X:>O XX
unit percentage Estate DEPARTllENT VALUATION
Value Sh are Val ua t ion CAUTION-Do not Write
In This Space.
6<; 8< ~ ~~ Value of Value of
><;>oc~9 Entire Deceden t t S
~O< property Interest
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NONE
No nfL-
.
Insert this total opposite tlJointly Owned Propertytl, Schedule "Etl NONE
in the" As Reportedtl .column on the last page of this return.
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REv..sta (8"78)
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF FIELD OPERATIONS
P.o. BOX 2970 '
HARRISBURG
17105
IN YOUR R~PLY PLEASE
REFER TO
Inheritance Tax Division
NOTICE OF FILING OF APPRAISEMENT
Jo1m E. Garry
Commonwealth National Bank
1Q S Market Square, Hbg., PL 17108
(Executor 01 Admin; strator)
In Re: Estate of
Shirley ~. TRQmpsQa
Cnmhprl.Qnn
County - Fi Ie No.
?1-7A-0??3
Dear
You are hereby notified thot the Original
appraisement in the estate of Shirley L. Tho1l1Pson
has been filed in the office of the Register 01 Wills of Cumberland
County an ] ~ Fphrl1""y ,19-19., Said appraisement reflects the following
valuations:
Real Estate --
Personal Property
Transfers
Jointly.Owned
Total
Nona.
Q ,1.1? 13
Nonp
Nonp
$9,412.]1
As to such tox that is paid within three months from dote of death, a live (5%)
percent discouni 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 as provided by Section 1001 of the Inheritance and
Estate Tax Act of 1961, 72 P. S. 2485.1001, P. L. 373.
Dote 11 FE'hruarJr 1979 SignedL-€A:-. E'~~
Title Administrative Officer
/
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Note: This is not a bi II.
REV-457 (-B-78)
DEPARTMENT OF REVENUE
BUREi\U OF FIELD OPERATIONS
P.O. BOX 2970
HARRISBURG, PENNA. 17105
COMMONWEALTH OF PENNSYLVANIA
RESIDENT INHERITANCE TAX
APPRAISEMENT
DATE 11. ....~hrll::ary
COUNTY rllmho1"'l ::anrl
1Q/7q
FILE NO. 21-78-0223
/
Whereas, Shirley L. Thomp.son late of Carlisle
in the County of Cumberland Commonwealth of Pennsylvania,having died on
I the 'l"h day of April 19 ZlL., seized and possessed of an estate
subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania;
Therefore, I, Leo Fulginiti , an appraiser duly appointed according to law,
having been designated to make a fair and conscionable appraisement of the said estate, and to assess and fix the cash
value of all annuities and life estates growing out of said estate, hereby file the following appraisement:
In the event that any future interest In this estate is transferred in possession or enjoyment to collateral heirs of the decedent after the expiration
Of any estate for 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. ., n ..
" 0 412 13
Transfers None
T,,<. .,. None
$9.412 13
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Have been duly sworn according to law, I do hereby certify that the above appraisement is made in conformity
with the law on this , 'l"h day of L~r~:~~'-0 ~. 19 .J9..
Appraiser
Harrisburg
(Number and Street)
(Post Office)
. Penna.
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