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HomeMy WebLinkAbout07-01-78 .P ,........ ~; . ~_...-i ..' R:CC-SS (4-731 =</-7%- ~07.S r COMMONWEAL TH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS RESIDENT DECEDENT JUt 1 n lfi., COUNTY OF. . CUMBERLAND . IMPORTANT, 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 extension is granted by the Secretary of Re~enue. (Section 703 of the Inheritance and Estate.Tax Act.of 1961.) Late of Cumberland ~} AFFIDAVIT OF' EXECUTOR ~~ County IN THE MATTER OF THE ESTATE OF ., ABBIE S. McCULLOH (STATE FUL.L. NAME OF DECEDENTl State of Pennsylvania . Cumberland J '5O County of ~iaHKMIlIl Merlin LeRoy McCulloh of the estate of the above-named decedent being duly sworn, deposll6 and sayS Decedent died April 10, 19 i"s .jJ tes:.at~ leaving a last will, copy of which Is hereto allach~d.~} r (MONTH) (DAY) (YEAR] ~1t~1{ . .'. ,. NamaandOdd,...alatta,n.ya,} John E. Slike, Esq.," Arnold, Slike & Bayley other authorized representative to whom allaa"...and.n" ,haald b. mailed. 2109 Market Street, .Camp Hill,. PA 17011 Executor executor That as such, .... deponent is familiar with the affairs of said estate and the property constituting (EX ECUTOR-ADMINIST RA TOR) the assets thereof and their fair market value. , That at the time of death there was no safe .deposit box registered in decedent's individual name, or jointly with, or as agent or deputy. of another, or in decedent's individual name, with right of access by another as agent or deputy, with the exception of the following: - I. l t. '~~.. Of. f'A~ "t " , That the contents of said safe deposi.t..box or boxes are it~mized under Schedules B-E of this return, with ~he exception.of the following, for the.,reasons h~reinafter set fort]t:,.. ',p' in .,~he 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 th~ date of death, giving the amount still due at >"de"ath, name of mortgagee, date, rate oLinterest, and .bo~k ~~d page of.re~ord thereof. It also sets. forth in the f. ~' , columns provided therefore the assessed valuation of each of said parcels, the estimated market value thereof:. k,,_ . as of date of death of decedent. .... .~'.' ~. ) f. " NAME AND ADDRESS OF BANK OR OTHER INSTITUTION . . THIS SAFE OEP.OSlT BOX RENTED REL.ATIONSHIP OF JOINT IN WHICH DECEDENT RENTED A S."FE DEPOSIT BOX IN NAME OR NAMES OF HOL.DERS TO DECEDENT CCNB Bank. N.-A. Decedent or Son 21st and Market Streets M. L. . McCulloh. Camp Hill, Pa. . , .. , 'j"- That Schedule B attached hereto and.made part hereof sels forth fully 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 banks, trust companies, or other institutions, whether individually, or in trust for any other person or persons . ..~~ giving also separately the accrued interest thereon, if any, down to the last interest day priElT to dec~dent's ;.... death in the case of savings banks, and to the date of decedent's death in all other cases; all bon'ds';Jpostal savings, treasury certificates lor.:notes and other evidence of. indebtedness of the United Stli~~s~"-to the-:~l;'~'.. .l.-. ~ J. .... ~ cedent; all obligations, whether by statute or agreement they are designated as .tax free,lof/t!HY'United ~tateS;:;_\'O- or any state, or political s'u'b'dlvi;ion thereof, or of any foreign 'country, which a-re ow~~ci a~t~'e:Y)n""e of d~th;;''''.~ all wearing ~ppare}, jewelr~,~ ~s~!~~rware.,~pictures, books, works of art, household furniiure~ I.~or~~s, catriag~~.... ~ automobiles, boats, and. any and all other personal chattels of whatsoever, kind or nature, leit;'~y decedent, .:: together with the fai;l.y,.estimated market value thereof; all bonds and mortgages held by..a~i'ed.e~t .and'of~a.ll-..-::' ~., , i ~":. ,!. ,. i ...:" ~ . . .. ~'" claims ,due and owing decedent at the time of death, and all promissory notes or other'instt"u~ellfs:in writing. for the" .payment of money of which decedent died possessed, of whatsoever nature, .with int~'1"e~titja""et~~n;if . t t . . . . ~ ..(J.. ..., any, giving t~e,face value and estimated fair ma~ket value thereof,.and if such estimated fair,market value be less than the face value, it sets forth briefly ~e re~.sons for such depreciation as to each item; all moneys payable to the estate from life insurance policies carried by decedent; all annuity and endowment contracts the proceeds of which were payable upon the death of the decedent; all and the corporate stocks and dividends due thereon and unpaid as of the date 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. ..\ II ~..~~';},..... .,' 1<' RCC-36 COMMONWEALTH OF PENNSYLVANIA TRANSFER INHERITANCE TAX SCHEDULE "c" TRANSFERS *~ RESIDENT DECEDENT (1) Did decedent, within two years of'denth, make any transf'er of any material part of' his estate, without receiving a valuable and adequate consideration therefor? (Answer yes or no) Nn (2) Did decedent, within two years of death, transfer property from himself to himself and another or otherS (including a spouse) in joint ownership? (Answer yes or no) ~o (3) If the answer to (1) or (2) above is in the affirmative state: (a) Age of decedent at time of' transfer (b) State of decedent's heal th at time of making the transfer. (Note 1). (0) Cause of decedent's death. (Note 1). (4) Did decedent, in his lifetime, make any transfer of property without receiving a valuable or adequate consideration therefQt which was to take ef'f'ect in possession or enjoyment at or after his death? (Answer yes or 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 was the transferee's age at time of decedent's death? No (5) Did decedent in his lifetime make any transfer without receiving a valuable and adequate consideration therefor under which transferor expressly or impliedly reserves for his life or any period which does not in fact end before his death: (a) The possession or enjoyment of or the right to income from the property transferred? (Answer yes or no) No (b) The right to rlesignate the persons who shall possess or enjoy the property transferred or income therefrom? (Answer yes or no) No . (6) If the answer to (5) (b) above is in the affirmative, state whether the right was reserved in decedent alone or others (7) Did decedent in his lifetime make a transfer, the consideration for which was transferee's 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 reserved power to alter, amend, or revoke, or which conld revert to decedent under terms of transfer or by operation of law? (Answer yes or no) No (9) If the answer to (8) above is in the affirmative, was the power to alter, amend, or revoke the inter- est of the beneficiary reserved in the decedent alone or the decedent and others? (Answer yes or no) 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 date of death, dates of transfers and to whom transferred, with relationship of transferees to decedent, if any. Submit copy of any trust deed or instrument, if trans- fers are claimed to be non-taxable, also submit detailed statement of facts on which said claim is based. NOTE 3: List applicable property below in manner in which provided in Schedules A, B, or E. I II ITEM DESCRIPTION llARKET VALUE (ES tima ted) DEPT. VALUATION (Dept. Only) NONE r , , I Insert this total opposite "Transfers", Schedule "C" in the "As Repor'ted" colunm on the last -page of this return~ . RC C-2 (2-64) . August 10, 1978 COMMONWEALTH OF PENNSYLVANIA DATE . DEPARTMENT OF REVENUE RESIDENT INHERITANCE TAX Cumberhmil BUREAU OF COUNTY COLUCTIONS COUNTY HARRISBURG, PENNA, 17127 APPRAISEMENT FILE NO. 21-78-0225 Whereas, Abbie S. McCulloh late of Camp Hi 11 in the County of Cumberland Commonwealth of Pennsylvania, having died on the 10th day of April 19 78 , seized and possessed of an estate subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania; Therefore, I, Ira K. Gleim . , 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 de-cedent after the expiration of any estate for Ufe 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. Unit Appraisement Delcrlpllon of Anat Value. Made for Inheritance Tall Purpous REAL ESTATE -0- $ -0- PERSONAL PROPERTY 996.64 996 64 JOINT-HELD PROPERTY 14,867.94 14,867 94 TRANSFERS -0- -0- TOTAL ESTATE $15,864.58 $15,864 58 , . ,. , . Having been duly sworn according to law, I do hereby certify that the above appraisement is made in con- formity with law on this 10th day of August 8.. h. I9~. . ~&_J(,. ~ Appraiser (~mbeT and Stnet) HarrisburR . Penna. (Post om.,.) "" .,;..... ~\ .,; '" ~ " - \ ;j 0 '" p< ~ .. I y ~ .. a) ~ ~ Q l.,;. ~ ~ i: i< \ .. ~ ~ '" ~ .. ~ -e t: .. "i '" c ~ .. ... <: ... .~ i 0 ~ -D .; S .~ ~ ~ ~ ... ... t:. .... <: ~ '=> ... ... ... C'( i" " ~ 0 .; S "0:: "0:: "0:: 1 .. ~ en "0 " ... - !! I ~ " -l .. ... ~ ~ ., 1:; ~ t ~ .. ... co ~ '" - 3 :s 1: .. I'< ~ €is .. 1. t C' a r- '" ~ 1: " .. c '" .. Oi <; \ ... I:l: jQ " .... Ul ~ "i 0;; ~ .. -.:: - " := I o~ .. y Ul .. .. ~ \ - 1: ~ I:l: I'< " .; - z '" o~ "0:: '" " t:., e "'- '" ~