HomeMy WebLinkAbout12-21-78
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.,r' R~C-33 (4.73)
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COMMpNWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS 01~
, UtC ~ i \-,
COUNTY OF
RESIDENT DECEDENT
Cumberland
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 extension is granted
by the Secretary of Re'\tenue. (S'cction 703 of the Inheritance and Estate Tax Act of 1961.)
IN THE MATTER OF THE ESTATE OF
,.oJ
EXECUTOR
f:?
AFFIDAVIT OF
Eleanor T. McCombe
(STATE FULL NAME OF DECEDENT)"
La'e af~bf'rland
S'ate of pennsyl vania
County of C\.Unberland
ADMINISTRATOR
:J ",
rice
ExecutM
AtImmt"stTztm
Marcia E. Mroczkowski
of the estate of the above.nof'lcd decedent being duly sworn, depose S and says
Apri 1 ? t) 19-2H-{~estole leaving 0 lasl will, copy of which is hereto attached..}
(MONTH) (D'AY) (YEAR) 1'I'IteS"t<rie
. ,
} I
Name and address of attorney or np;:in "A
other authorized representative to whom
all correspondence should be moiled. P . o. Box 845, Harr i sburq, p.A. . 17108
Decedent died
Wpinnprr
224 North Sf'cond Street.
That as such Executrice 'deponent is familiar with the affairs of said estate and the property constituting
(EXE CUTO R-AOMIN1ST RA TOR)
the assets thereof and their fair market value.
That at the time of death there was nb 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: - . .
NAME AND ADDRESS OF BANK OR OTHER INSTITUTION THIS SAFE DEPOSIT BOX RENTED RELATIONSHIP OF JOINT
IN WHICH DECEDENT RENTED A SAFE DEPOSIT BOX IN NAME OR NAMES OF HOLDERS TO DECEDENT
CCNB Bank, N.A.
Cedar cliff Mall. New Cumberland A Eleanor T. McCombe N/A
;
That the contents of said safe d.eposit box or boxes are itemized under SChedulesNjA of this return,
with the exception'of the following, for the reasons hereinafter set forth:
No contents - box empty
That Schedule A attached hereto and 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-Jorth the
mortgage encumbrances upon each par~el 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 assess~d 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 fully and in delail all personal property
wheresover situated owned by the decep.ent 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, ~avings
banks. trust companies. or other institutions, whether individually, or in trust for any other persori~;"""r:~}~6ns
~.~ .' v i' ~..(; '?I"~ ~~
giving also separately the accrued interest thereon, if any, down to the last interest day pri6T"to~deced.erl'i(s~......
death in the case of savings banks, and to the d~te of decedent's death in all other case'~; ali~bi~:d~Opc;s;~~~
. . ~~, .~~-
savings, treasury certificates or notes and other evidence of indebtedness of the UnitC?~d States t~o the-':de:~ :::
cedent; all obligations, whether by statute or agreement they are designated as tax free,:pf ,th~UnitedlStat~>s; ~"
, ...../ - ~ ....
or any state, or political subdivision thereof, or of any foreign country, which are owned~at...:the~.:time of de~H; ;:
...",. ~.f/ '''''/,........
all wearing apparel, jewelry, silverwar~, pictures, books, works of art, household furniture"~..horses~t)'rri'age.~\'j
automobiles. boats, and any and all other personal chattels of whatsoever. kind or nature,....~l~ft'by,.(fec;a.eni.,-...~
. '~, . ~ ~" 1-.~;;"
together with the fairlY,estimated mar~et value thereof; all bonds and mortgages held by decedent..:,.?l].d.'o"f 'all
claims due and owing decedent at the I time of death, and all promissory notes or other".instruments in writing
for the payment of money of which de!cedent died possessed, of whatsoever nature, with interest thereon, if'
any, giving the face value and estimated fair market value thereof, and if such estimated fair,market value be
less than the face value, it sets forth briefly the reasons for such depreciation as to each item; all money~
payable to the estate from life insura~ce policies carried by decedent; all annuity .and endowment contracts
the proceeds of which were payable up~m 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 qwned by the decedent at the time of death, with the-market value there-
of at such time.
L~
.. r ' .
"
In the case of securities of close or family corporations, the values reported are as tar as
possible 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, t"inancial statements showing the assets and liabilities of said co-partnership or husiness.
A copy of the 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
pertaining to the business as may be pertinent to a fair and just appraisal of the decedent's interest
therein must be submitted. 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 personal, within two years of decedent's
death, in contemplation of decedent's death, or intended to take effect in possession or enjoyment at or
after death, said schedule sets forth the nature and value of such property, to whom transferred, the
relationship of 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 copy
of the deed, trust agreement or other instrument creating the trust. Ther~ is also set forth in said
schedule a lIst of all property, real and personal, with its value, which passes at decedent's death by
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 Instrtmlent of another,
with a copy of the instrument creating such power attached to the schedule.
That Schedule 0 attached hereto and made part hereof sets forth the names 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 decedent, together with the ages at the time of
decedent's death of all minors, annuitants and beneficiaries for life under decedent's Will. It also
contains a statement showing which of the beneficiaries named in the decedent's will, if any, died prior
to decedent, the dates of their death, their issue, and the relationship of such issue to the beneficiary.
That S~~edule 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
of the decedent and others, plus the date and place of record of instruments effecting the vestlture of
real estate and the date of acquisition of personalty, plus the name, address and relationship, if any,
of co-owners to the decedent.
That Sc~edule F attached hereto and made a part hereof sets forth fully and in detail all debts
and deductions claimed for and on behalf of this decedent's estate, including funeral expenses paid;
family exemption, where applicable; costs of administration of this estate; counsel fees and fUdiciary's
commissions paid or to be paid; cost expended for burial trusts, tombstones or gravemarkers, and reli-
gious services, in consequence of the death of the decedent; debts and claims owing and lmpaid at time of
death; taxes accrued chargeable for period prior to decedent's death (except those allowed under Section
6~1 of the Inheritance and Estate Tax Act); together with a statement of collateral pledged fbr 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 amount claiming and allowed, that the same will be reported to the Register of Wills, and that
the amount of tax assessed can be reassessed In accordance therewith.
That the totals of the appropriate columns in Scherlules RAR, -Bw, wCw, "EW, and .F- as directed therein,
have been carried forward and properly registered in the Summary.
. . '7td--
SuQscribed BD<lswom to before me thIS ....j... ......................
............,._....._.. . .... . ...." day of:Jfl~m.... 19...7JL..
...................?4~.~.;~~~
/ H~:!";d:,,~"CI, [j,-,L.'~:;" CJ. f';>.
-/~','i C:J11r....-L:s~i0n L, J. ~~ ,..,:,~~ch 23, 1981
.......~~~.~.~-_...._...
....9.04....Drexel....Hi.ll.6_...Bl:.y:d~............__.
(Street Number)
Ne~..G~.~!:J.~!}QL...I?~.......:!79..:z9........m.
(City or Town /1M StD.tII)
NOTE: Before signing afridavit make sure all blank spaces in the affidavit and schedules annexed are
filled in with details or the word WNone", and in case the assets include rare and unlisted securities,
securities of close or family corporations or an interest in any co-partnership or business, that the
data and statements required under the paragraph above relating to Schedule "BW are attached. Also make
certain that column #1 in the "Summary" has been properly completed as above-directed.
.-
f ... " ..
RCC-.34 [4.73'
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT.OF REVENUE
BUREAU OF COUNTY COLLECTIONS
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "A"
REAL PROPERTY
*'
Real property in Pennsylvania, with s~atement of mortgage encumbrances upon each parcel at death of dece-
dent. Property held by the decedent as tenant ,in cammon with another 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 an Schedule "E.")
The real property located In the Commonwealth of Pennsylvania should be (1) (2) (3\
described by lot and block number, street and street. number, together with DEPARTMENT
a general description of the property, with 0 reference to the record of the ASSESSED VALUE VALUATION
conveyance by which the decedent took title; If a fa~m .tote number of a. FOR YEAR OF ESTIMA TED CAUTION
eres; also statemont of mortgage encumbranceu upon each porcel at death DECEDENT'S MARKET VALUE (Do not write
of decedent. Taxes, assessments, accrued Interest 'on mortgages, ote.,ore DEATH In this .poce)
to be listed on Schedule llF" and must not' be deducted from this schedule.
NONE
~
,
,
i
,
N~
Insert this total opposite "real property", Schedule "A" in the X X X X X 0
"As Reported" column on the lost page ~f this ret",",
.' RCC'-35
~...'
WIlt
,COMMOXWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "B"
PERSONAL PROPERTY
Item
No.
1.
2.
3 .
4.
INSTRUCTIONS: This Schedule must disclose all tangible and intangible personal property owned individually
by the decedent, at the time of his d~athl Property owned by the decedent jointly wi th another or others
must be listed under Schedule nE". 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 aCcoWlts, must be listed, despite the fact that they are not of the administered estatlf.
Tangible personal property should be listed first (e. g. jewelry, wear'tog "apparel, hOllseho.ld
goods, and fUrnishings, books, paintings, automobiles, boats, etc.)
Intangible personal property, such as bonds, treasury certificates, cash on hand and in bank,
stocks, mortg~ges, 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
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
List and describe fully
UNIT
VALUE
DEPARTMENT VALUATION
(Do not write in
this space)
ESTIMATED
MAlIKEI' VALUE
Table, charrs, single chair and desk
$175.00
Miscellaneous personal property sold
by Bricker's Auction House - May 17, 1978
(Gross Sale Price)
1,114.95
.. ~,Mi s ce llaneous _personal:,'property cnotr,s 61 d
1 .f ~ . ,
200.00
Delbrook Manor Apartments (Property
Management Corp.) Security Deposit (net)
122.27
5. Connecticut Medical Service
Medical insurance check
6.
Willimantic Trust Company, Willimantic,
Conn. - Balance in checking account
No. 0374059 Main
q
f(,'
7. CCNB Bank, N.A., Cedar Cliff Mall Brahch,'?/
Checking account No. 14-00697 7
8. CCNB Bank~ N.A., Cedar: Cliff Mall Branch,
Savings Account No. 72945-0 (includes
interest)
9.
10.
11.
12.
Internal Revenue Service, 1977 Income Ta
Refund (check)
115.00
State of Connecticut
(25 days of April)
Retirement check
235.39
Willimantic Trust Company, Trust proceed
of Trust established by decedent on
April 11, 1962 - Net proceeds paid
to Executrices
.
34,661.49
. .,Sta te roT- Connecticut';-'GI'oup.'_Life~.Insuran e
policy No. 14 714 R
2,073.80
,
Insert this total opposite "Personal Propertyft, Schedule "Bft in
the "As Reported" column on the last page "of this return.
x
~$45',110~ jl\ S -. OSI: l6
.RG.c ~36
COMMpNWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
SCHEDULE "c"
TRANSFEIlS
RESIDENT DECEDENT
(1) Did decedent, .....ithin two years of de nth, make any transfer of' any material part of his estate, without
receiving a valuable and 9.dequate consideration therefor? (Answer yes or no) YP~
(2) Did decedent, within two years of death, transfer properLY 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 affirmative state:
(a) Age of' decedent at tinie of transfer f\q
(b) State of decedent' 5 heal th at time of' making the trans:fer. (Note 1). Stable
(c) Cause of decedent' 5 death. (Note 1). chronic lung disease
(4) Did decedent, in his lifetime, make any transfer of property without receiving a valuable or adequate
considera tion therefor which was .to take effect in possession or enj oyment at or after his death?
(Answer yes or no) No .
(a) Was there any possibiiity that the property transferred might return to transferer or his
estate or be ~:ubject ~o his power of disposition? (Answer yes or no) N/A
(b) What was the transferee's age at time of decedent's death? 1>1 In.
(5) Did decedent in his lifetime make: any transfer without receiving a valuabl~ and adequate consideration
therefor under which transferor expressly or impliedly reserves for his life or any period which does
not in f1l.ct end before hi~; death:
(a) The possession or enjoyment of or the right to income from the propertj" transferred?
(Answer yes or no) No
(1)) The right to designate the persons who shall possess or enjoy the property transferred or
income therefrom? (Answer yes or no) Nn
(0) If the answer to (5) (b) aoove is in the affirmative, state whether the right was reserved in decedent
alone or others N fA
(7) Did rlecedent 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, transf~r property, the beneficial enjoyment of which was subject to change,
because of a reserved power to alter, amend, or revoke, or which C01lld revert to decedent under terms
of transfer or by operation of law? (Answer yes or no) Nn
(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 supporten by affidavit by the attending physician as
.....ell as a copy of' the death certificate.
NOTE 2: If' answer to any of the above questions is yes, set f'orth below a description of the property
transferred, it's fair market value ~t date of death, dates of transf'ers and to whom trllnsferred, 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.
ITEM
DESCRIPT ION
MARKET VALUE
(Es tima ted)
DEPT. VALUATION
(Dep t. anI y)
1.
$2,000 cash gift to William McCombe, son
of deceden~ on or about August 23, 1976
as part of a regular program of making g
to her children
,//
2.
$4,000 cash gift to Martha M. Kieffer,
daughter of decedent, on or about
October 13, 1977, as part of making gift
to her children
4,000.
3. 1972 Ford Galaxie, Serial No. 21E5851648 5,
in fair condition, to Martha M. Kieffer,
daughter of decedent, in February, 1978,
due to eye surgery completely unrelated
to the causes of her death, the decedent
could no~longer drive her auto and there
fore gave it to her 'daughter.
X v~\ v-
~
,
l ,-oo.ou
Insert this total opposite ftT:ransfers", Schedule "eft in the
"As Reportedft colunm on the ld.st -page of this return.
($7,200.00 )
None Taxable
~ o-k J.rRs-
,~\.t... ",""'
., ""-'
RCP-37 112-63)
COMMONWEALTH OF PENNSYYLANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "D"
BENEFICIARIES
(
h
BENEFICIARIES AND ADDRESSES - RELATIONSHIP SURVIVED
(If step-children or DATE INTEREST OF
State full names and addresses of all who illegitimate children DECEDENT OF BENEFICIARY
ave an interest, vested, contingent or other are involved,- set STATE YES IN ESTATE
wise in estate) forth this fact.) OR NO BI RTH
William J. McCombe
33 Manle Blvd. . .
l'i.r5f. 33
Pan'inrT "'y '2Sk4 Son Yes 6/22/<R One t-hirrl
M~r~;~ '" .
904 Drexel Hills Blvd.
"'0',. I~n'" D" Yp"," R 17 1 A 1 ,",no t-h;rrl
,,--~...- M U;oFFer
.
anA ,..~t-"'pr;np ~t-
Kou. '.'o~t- ""~ <<nAn T"\~"rTht-or Vo~ 0/7 IA 1 ,",ne t-h;rrl
.
Deponent further says that all the above-n~med beneficiaries are living at this time except below:
NAME DATE OF DEATH RESIDENCE
"'~no
.." r . ..
..
o '
.<~
" ..
..
.. =
"a.~ e
.-.... :3
s"-
_0.0
- S u
~ 0'
"u"O
o "
'$1;;1::
!: " 0
&l s ~
~ 0:
SUMMARY
... ......... (Sch, "A")
( Sch, "B")
..(Sch. "C")
Real Property
Personal Property
Transfers
Gross Taxable Estate
(1 )
(As Reported)
$.. -0-
$45,110.04 .
$ -0-
$.
$
$45,110.0.4
(2)
(As Determined)
$
$
$
$
$
$
~ "0
Z
a t.:i ill 0-
" ..l
.. ;:0 "
>- !: 'rl ~
t.:i QJQ .<: ell
ell Ul -
- ~
--: il l:: " llIii
~ r... :li '\j 'S
"" 0 0 l:: II.
0 " II.
"" U 8 III ..::
~ --: '" ~
:c t.:i U .-i ;.,
t.:i ... ~ :;: l:: I-< ~ Q
2:i :t .. <<: QJ QJ == Z
ci ~ 0 ~ . '\j ~ ii ~
Z ell 8 ~ ""
r... t.:i - i-
~ 0 I-< III U 0 llIii
= ~ 0 :r:: :; 0
0 l:: II.
:c t.:i III ~ ""
'" t: QJ - , llIii
b H 0 C
~ < 0
'" [iI - l:'
0 ~
= 'E '" .. ::
:;"'0 3 i5 5
...< U U
:1C(-:-,:3
,; :. "*.. '-
jJ~
1$.!~, ~
"'ij~"("""~')''''
1/.' ,;c-, ~A
y ~~!.tI;S' l~
'",. -.':-.0'-("
tL....~~J-,.-..>J
.i.:<-;r"-<jj!J'.J.;.?-'X-~
C::..\M~\()i\'1;\';;:.\LTfl UF 1'E~~~Yl.V'\NIA
.. '.
Tnl\\~;.':\g r:\lll'~IU'L\;'\rF TV,
itF~1 DE:\T JlECEDE:\T
SCIlEnI'LE I' E!!
,JOINTLY O~\'i\En PBOPEWry
Ii'iSTHrCTTO~~: 1'ld;::; 5(;li,~dl.de ITlll~t diSclo~(~ aU property, !"ea] and personal, {)wn(}d by t.he de~er:lcnt jotntly
W1111 <!rlllther pr ntlll'rs, in~-IJI(ling tnt.:mgil!les, stanrUng; in the n;IlTlf~ of tJw deced(~YlL :lllf} others. T.:i.st
real (!st.al.e (,.il'st.. as cnt.'il'cties, or joint tenants, givtng hrief' rl'~scrlpt.Jnn; as indj (:.1. L(;il lltltkr Schcclu]e
"A", pLus tile ~hte and p]lwe of :'ccord of instrument. eff'eeving "es!;jtllr'e~ hilt do llot inclllde l)nt:ircti(~s
or out of staL0. r,:)<l] \~staLe value 'in estai:t~ valuation column. P,:rsona] proJ)I~rt.:v shou'Jd be listed as in
Schedule nun, pIllS date of' ncqll:isiUon,: and the nanlc, address 011d l'\::},lt,ionship (if ,any) of co-owners to
th') dt~cedent.
NONE
Insert this total O'PI)Qslte ".Joi.ntly Owned Propertytt, Sehedule lIE"
in. the "As Hepo rted" COlllllD1 on tile last page of' this return.
L
VAIJjATJO~
not Wl'itp.
Space.
Vn]uc of'
J)ce(~den t t 5
Interest
~
, .
*
REV-518 (8"78)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF FIELD OPERATIONS
P.O. BOX 2970
HARRISBURG
17105
IN YOUR REPLY PLEASE
REFER TO
Inheritance Tax Division
NOTICE OF FILING OF APPRAISEMENT
Marcia ~. Mroczkowski
90~ ~r~xelHills Bl~d.
"rnmhp'1"'1;:!nn) PA ;17n7n
(Executor or Administrator)
In Re: Estate of
.F.l ~.i=lnn'r' ~1' _ M t"'(":nmnp
Cumberland
Caunty - File No.
21-78-0226
Dear
You are hereby notified that the 0...; g; n" 1
appraisement in the estate'of .Eleanor> ;T. ~I,,('omhp
has been filed in the office of the Register of Wills of Cllmbpr>l and
County on 1 I< .M"y , 19--7.S, Said appraisement reflects the following
valuations:
Real Estate
Personal Property
T rilns fers
Jointly Owned
Tatal
Nnn&:1>
$l<s',ns'7.1 n
7,200.00
None
'$52.,25;7.16
As to such tax that is paid within three months from date of death, a five (5%)
percent discount is allowable. As to any tax that remains unpaid after nine (9) months
(fifteen months when death occurred from December 22, 1965 to June 16, 1971, inclusive;
and twelvemonths when death occurred prior to December 22, 1965) from date of death,
interest at the rate of six (6%) percent per annum is charged.
Any party in interest who is aggrieved by this notice may object thereto within
sixty days after receipt of 'said notice as provided by Section 1001 of the Inheritance and
Estate Tax Act of 1961, 72 P. S. 2485.1001, P. L.~~'" _ ~ ".
. . ~ -c--~~~-t.:.....
Date 1'1 May 1979 Signed
Title Administrative Officer>
Note: This is nota bill. :
,
.,
REV-457 (8-78)
DEPAR"i'M~NT OF REVENUE
BUREAU OF FIELD OPERATIONS
P.O. BOX 2970
HARRISBURG, PENNA. 17105
COMMONWEALTH OF PENNSYLVANIA
RESIDENT INHERITANCE TAX
APPRAISEMENT
DATE
COUNTY
FILErm.
J II M'5ljl' , 0'79
~nmhp,.,.l;:1nn
"'_7R_n??f=\
Whereas, -r.lt:lo=no'l"l 'T~' Ml"'r:nmhp late of H~mptipn Tnwn~h;n
in the County of Cumberland. Commonwealth of Pennsylvania, having died on
the ? , + h day of A p.... i 1 19 ..1.ll, 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 herEibY 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. .~ ,,~ n'" 1 "
~ <0. ., ?nn nn
T_'_~'" . u.
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,
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Have been duly sworn according to law, I do hereby certify that the above aPJlrais~ment is made in confor"?w
with the law on this 14th ilayof ~v ~ '"\ ' . 19 _'
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~ - U Appraiser
Harrisburg
(Number and Street)
(Post Office)
. Penna.
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