HomeMy WebLinkAbout04-17-78
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. ":'R"c:p!33 (4-73) COMMONWEALTH OF PENNSYL
. ~ ..
c DEPARTMENT OF REVEN
BUREAU OF COUNTY COLLEC
RESIDENT DECEDENT
IMPDRTANT, This return must be completed in detail and filed in duplicate, w
County where decedent resided; Return is due within nine mont
by the Seqetary of Rc'\tenue. (Section 703 of the Inheritance an
IN THE MATTER OF THE ESTATE OF } """'IT
Clifford C. Lynn _ JEltXIllll!JlOl.R
B (STATE -~LL ~A1!; OF1Cl..EC1DENTl
oroug 0 ar 1S e :l!mM~:X
Late of Cumberland County
. penns~~J
State of
, Cumberland . - so,
County of
Hazel L. Lynn
XiK.K!KiIUliJr.r of tho estate of the obove.noroed decedent being duly sworn, del'
Decedent died December 20 , 19-1L{tcltate leayln
(MONTH) (DAY) (YEAR) i"'e'!l~+e
Nome and odd"" of otto,."y a' } William F. M
other authorized representative to whom 10 East High
011 correspondence should ~~ m"iled.
That as such_Executrix depunent is familiar with the
(EXECUTO R-ADMINISTRA TO R)
the assets thereof and their fair market value.
That at the t(me of death there was no safe deposit bo~ registered
as agent or deputy of another, or in decedent's individual.name, with righ
exception of the following: -
NAME AND ADDRESS OF BANK OR OTHER INSTITUTION THIS SA FE
IN WHICH DECEDENT RENTED A SAFE DEPOSIT BOX . IN NAM
Farmer.s Trust Company Cl1tto
One West High Street Hazel
Carlisle . Pa. 17013
.
,
That the coinents of said safe deposit box or boxes are_ item
with the exception' of the following, for the reasons herein.after set fo
That Scheaule A attached hereto and made part hereof sets f
. - .
in the Commonwealth of Pennsylvania of which decedent died havin
mortgage encumbrances upon each parcel of real_ property at the d
death, name of mortgagee, date, rate of interest,. and book and page
col umns provided therefore the assessed valuation of each of said
as of date of death of decedent.
That Scheaule B attached hereto and made part hereof sets fo
wheresover situated owned by the decedent at the time of death; all
,
death, whether in decedent's immediate possession, standing to dec
banks, trust companies, or other institutions, whether individually,
giving also separately the accrued interest thereon, if any, down
/ death in the case of savin'gs banks, and to the date of decedent's
/ ~'s~av il)gs,' trea~~ury' certifi.ca~es'or ~.note.s and other eviden~e' of ind
~~
cedent; all oblig;:Ltiot:1~, :w~ether ,by .s~atute" or agreem{nt they are d
or any state, or political subdivision thereof, or of any foreign COll
an y';caring ap'pare':i', jewelry, silverware,:pi"c,tures, boo~s, works of
automobiles, boats, and any and all other personal chattels of wh
together with the fairly. estimated market value thereof; all bonds
claims due and owing decedent at the tim'e of death, 'and' all.promi
for the payment of money of which de'cedent died possessed, of
any, giving the face value and estim~ted fair market value ther~.of,
less than the face value, it sets forth briefly the reasons for sue
payable to the estate from life insurance policies carried by dece
the proceeds of which wer: payable upon the death of the decedent;
due thereon and unpaid as of the date of death, bonds and accrue
death and other ioves.tment secllj";ties owned by the decedent at the
of a t such time.
".
VANI~P~ lit 19..
UE
TIONS
;2 J~ 'IF: 0/
I
COUNTY OF
Cumberland
ith all attached. with the Register of Wills of the
hs after date of death;. unless an extension is granted
d Estate Tax Act of 19.61.) .
OF
.Execut~
"ffifiX
Executrix
XXJllXlIlIr
onS and say S
~ a lost will, C~p'y of whic~ is ~~reto_l?tt~.Ched.,}
artson,_P.C.
Street~ "Carlisle, Pa.
17013
affairs of said estate and the property constituting
in decede,nt' s indi vidual name, or jointly wi th, or
t ,of access by another as agent or deputy, with the
DEPOSIT 8:ax RENTED
EaR NAMESOF
r . . L nn or
L.L nn
RELATIONSHIP OF JOINT
HOLDERS TO DECEDENT
Dau hter
ized under" Schedules E
rth:
of this return,
orih fuily and in detail alIthe real property
g an interest therein. It also sets forth the
" -
ate of d~ath, giving the amount still due at
of record ,thereof. It also sets forth in the
parcels, the estimate.d market value thereof
rth fully and in detail all personal property'
moneys left hy the decedent.t the time of
edent's credit in banks of deposit, savings
or in trus t for any other person or persons
I .." .....,.
to the last interest day 'prioT to .decedent's"-
death in all other cases; all bonds, postal
ebtedness of the United States 'to the de-
esignated as tax free, of the pilited States,
ntry, whi~h are owned at theli":le of death;
art, household furniture, horses, carriages,
atsoever, kind or nature, left by:decedent,
and ~ortgages held by decedent an-d of.all"
ssory notes' or other".instruments' i;.writing
, " " -
whatsoever nature, 'with interest the'reon, if
and if such estimated fair, market value be'
h .depreciation as to each item; all moneys
..1 .
dent; all an'noity a.od endowment contracts'
all and the corporate stocks and- dividends
d interest thereon to the date of decedent's
time of death, with the.market value there-
~
.
In the IJale of securities ot close or family corporations, the values reported are a8 far as
possible substantiated by financial statements of the corporations, showing the assets and liabilities
thereof 4S of the date of death. The schedule also seta 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 husiness.
A copy of the co-:partnership agreement, (if oral, a statement setting forth the nature of Uie agreement)
together with a stat8Jllent setting forth the eharacter 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 f'orm, together wi th the fair market value
thereof, any othe:r property owned or bequeathed by the decedent at the time of death.
The Sch.,du/~ 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' B
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 pOllsession or enjoyment at or after death, there is also attached :to the schedule a COllY
of the deed, trust agreement or other Instrum~~t ereatlng the trust. TherA is also set forth in said
schedule a list of all property, real and personal, with Its value, which pa~ses at decedent's death by
virtue of the exel'cise by decetlent, either individually, or Jointly with another, or any power of appoint-
ment vested in dectldent, either individually or jointly, by the will, deed, or other instrument of another,
with a copy of thtt instrument creating such power attached to the schedule.
That SCI).dule 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 statem.~nt 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 Scbedu/~ 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 vestiture of
real estate and the date of acquisition of' personalty, plus the name, address and relationship, if any,
of co-owners to the deceden t.
That SCI'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;
famdlyexemption, 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 ot' the decedent; debts and claims owing and lmpaid at time of
death; taxes aocrued chargeable for period prior to decedent's death (except those allowed under Section
651 of the Inheritance and Estate Tax Act); together with a statement of collateral pledged for obliga-
tions, if any. It is agreed that the fiduciary will present proof of' said claimed obligations upon re-
quest, that if the amount actually paid in settlement of any fee, commission or debt is less than the
estimated amount claiming and allowed, that the same will be reported to the Register of Wills, and that
the amount of tax asses8ed can be reassessed in aooordance therewit~
That the totals of' the appropriate columns in Schedules "A", "D-, .e., .E., and .F- as directed therein,
have been oarried forward and properly registered in the Summary.
Subseribed and sworn to before me this ..............."."'.........
",.........."........"'/30...
......"'.....~
..... day of ....~...
~~...~.
"''''..''' 19.7.f.
. ......:L.,..."......... ''''''''''''Ex'ecufrTx
....~l:i~....~c:I<.r!!g.!:1.!=..._~!=:t.:f;!.~.!=__...._...._....__
(StTeet. Numheti
Carlisle, Pa. 17013
................................................................................
(City or Tow.. aM StAte)
..5!:t..Q
r,<,-.:-tory Public
CorL::.a... C ". '-" PA
My Commission Expi!"C'S Feb. 27, 191J2-
NOTE: Before signing affidavit make sure all blank spaces in the aff'idavit and schedules annexed are
filled in with details or the word .None., and in case the assets include rare and unlisted securities,
securities of cl,)se 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 "B. are attached. Also make
certain that column #1 in the .Summary. has been properly completed as above-directed.
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RC ~~34 ("4..' 3)
-cOMMON<WEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT-
SCHEDULE "A"
RE,AL 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 jn common with another or other, should be identified
as to quantum of interesfand the estimoted value-should be that of the decedent's interest only. (Property
held as joint tenants with ri-ght of surviorship or tenancy by entireties should be reported on Schedule "E.")
The real property located In the Commonwealth of Pennsylvania shauld be (1) (2) (3)
descrlbed by lot and block number, street and street number, together with DEPARTMENT
a general description of the property, with 0 reference to' flle record of the ASSESSED VALUE VALUATION
conveyance by which the decedent took title; If a farm state number of a~ FOR YEAR OF ESTIMA TED CAUTION
cres; also statement of mortgage encumbrances upon eoch patcel at death DECEDENT'S MARKET VALUE (Do not write
of decedent. Taxes, assessments, accrued Interest on mortgages, ete.,ore DEATH In this space)
to be listed on Schedule uFIt Clnd must not be deducted from this schedule.
NONE NONE N \0"-L
,
Insert this total opposite "real property", Schedule "A" in the X X X X X
"As Reported" column on the last page of this return.
NONE
Rec -35
.
RESIDENT DECEDENT
SCHEDULE "B"
PERSONAL PROPERTY
'*
COMMONWEALTH 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 118ted under Schedule "En. 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-
'tlve trust accounts, must be listed, despite the faot that they are not of the administered estate.
Tangible personal property should be listed first (e.g. jewelry, wearing app~rel, household
goods, and 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 any undistributed
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
ESTI MATED
IlAl\KEf V AWE
DEPARTMENT VALUATION
(00 not write in
this space)
1
. .......---
Checking Account No. 4-2569-6,
Farmers Trust Company, registered in
name of decedent
Balance as of date of death
$1,422.67...~ \~Ll2L-.!c"1
2 Continental Casualty Insurance Company:
Payment of claim for hospitalization
commencing 9/13/77
5. Reimbursements from Medicare for medical
payments to Dr. H. P. Lenton
184.001".... \ ~LI."oo
89.l4",r '6Q,lL\.
404.001./ 40Ll.oo
149.00,,1/ lLl'1.,t) 0
3. Aetna Insurance Company: Reimbursement
for drugs and medicines
4. Continental Casualty Insurance Company:
Payment of claim for hospitalization
commencing 11/29/77
Insert this tota.l opposite "Personal p~'-operty", Schedule "B" in
the "As Rellorted" colunm on the last page of' this return.
x X
.
$2,248.81
'2.. \'2...4.1(" e,l
, ~..,
FARMERS TRUST COMPANY
CAALISLE, PENNSYLVA~IA
Date January 9, 1978
William F. Martson, Attorney
10 East Hiqh Street
_C.arlisl e.---1'P 17013
Re: Estate of Cl i fford C. Lynn
Date of Death December 20, 1977
Dear
Mr. Martson
In answer to your request concerning accounts owned, either . separately or jointly,. by.
the above referenced decedent and the balance in .each account as of the date of
death,we have checked our records and.are submitting the . following informationjn
duplicate. We suggest that you file one of these letters attached to the Fennsylvania Inven.
tory forms (RCC) to substantiate. the. balance you report..
. No.ie that we have shown the correct registration for each
the date of death, if any, .is Ji,tedasa separate figure.
account. Also, interest accrued to
Checking
/'
account #4-2569-6 Balance
$1,422.67 ,.,----
as. of 12/20/77
Very truly yours,
~t~ {LJ. tkc~
Rosalie W. Asch
Executive Secretary
RCC=36
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COMMONWEALTH OF PENNSYLVANIA
TRANSrlER INHERITANCE TAX
SCHEDULE "c"
TRANSFERS
RESIDENT DECEDENT
(1) Did decedent, within two years.ofdeath, make any transfer of any material part or his estate, without
receiving a valuable and adequate considerat19n therefor? (Answer yes or no) NO '
(2) Did decedent, within two years of death, transfer property from himself to himself and another or
others (including a spouse) 1n 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 time of transfer
(b) State of decedent I s heal th at time. of making the transf'er4 (Note 1) 11
(c) Cause of decedent's death. (Note 1).
(4) Did decedent, 1n his lifetime, make any transfer of property without receiving a valuable or wdequate
consideration therefor which was to take effect 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?
(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 ef.ld 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 designate the persons who shall possess or enjoy the property transferred or
income therefrom? (Answer yes or no) NO .
(6) If the ~nswer 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 transfereets proonise to
pay income to or for the benefit of ca.re of transferor? (Answer yes or no) NO
(B) Did decedent, at any time, transfer property, the beneficial enjoyment of which was subject to change,
because of a reserved power to al ter, amend, or revoke, or which could 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 Intel'-
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 s~ld claim 1s based.
NOTE 3: List applicable property below in manner in which provided 1n Schedules A, B, or E.
ITEM
DESCRIPT ION
MARKET VALUE
(E. tima ted)
DEPT. VALUATION
(Dept, Only)
NONE
N <JY-..-L.
NONE
Insert this total opposite wTransfers", Schedule "C" in the
"As Reported" column on the last page of this return.
NONE
RCC-31 (12-63)
,
COMMON\\'EALTH OF PENNSYYLANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "0"
BENEFICIARIES
BENEFICIARIES AND ADDRESSES RELATIONSHIP SURVIVED
(If step,children or DATE INTEREST OF
(State full names and addresses of all WIlD illegitimnte children DECEDENT OF BENEFICIARY
have an interest, vested, contingent or other are involved, set STATE YES IN ESTATE
wise, in estate) forth this facL) OR NO BIRTH
Hazel L. Lvnn Daughter YES Entire residue per
262 McKnight Street Item. 1 of said Will
Carlisle Pa. 17013
,
-
.
-
NAME
DATE OF DEATH
RESIDENCE
Deponent further Sl:lYs that all the above-named beneficiaries are living at this time except below:
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SUMMARY
.....(SCh. "A")
... ..(Sch. "8")
....(SCh...C..)
Real Properly
Personal Property
Transfers
Gross Taxable Estate .
(1 )
(As Reported)
$
$.
$
$.
$ d.
$
(2)
(As Determined)
$
$
$
$
$
$
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February 9, 1978
william F. Martson
lIeriderson Block
Ten East High street
Carlisle, pa 17013
RE: Clifford C
Lynn .Estate
In response to your request, we show the following
account infor~mation for the above named decedent:
, , ~
#~-2frO~SS3 B~ANCE AS OF DATE
, OF ,DEATH
ACCRUED INTEREST
DATE OF DEATH VALUE '$
DATE ORIGINALLY OPENED,
, ,~
20,000,00
79,32.....- '
20.079 32
2-28-77
Cj ,
'~ .
~',~,
(~ "-'-<."'-'7 ~:2
l.) <'~_Q..c.. ,I"?),!
'1 C,;t: ~"--~ #_ _
I'--<.~~)'r--~
$
BALANCE AS OF DATE
OF DEATH
ACCRUED INTEREST
DATE OF DEATH VALUE $
DATE ORIGINALLY OPENED
$
#~-
BALANCE AS OF DATE
OF DEA,TH$
ACCRUED INTEREST ,"
DATE OF DEATH VALUE $
DATE ORIGINALLY OPENED
BALANCE AS OF DATE
,OF DEATH $
ACCRUED INTEREST
DATE ,OF DEATH VALUE $
DATE ORIGINALLY OPENED
#_-
If you have any further questions, please feel' free
to contact this office.
FEM
'Sincerely,
"1 /1'
/.? 1=" 'l;, .< ,'-;' J----.J:: /... /l//.-' _.- '-.
D~nna l':aad;~~~' ['- ", <.:
Fe'lice'''E;''Maurer--(Mrs. )
Savings Investment Servicer
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, CUMBERL4ND
lI4llEY ~1N(75
AND LOAN ASSOCIf\TION
16 West High Street, Carlisle. Pennsylvania 17013 249-2525
March 17, 1978
Law Offices
William F. Martson, P.C.
Hender.son Block
Ten East High St.
Carlisle, PA 17013
I
,
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RE: Estate of Clifford C. Lynn
Date of Death - December 20, 1977
Accounts .#6686513 & #137827 .
Gentlemen:
Please find below the balances and accru~d.interest onCert. #6686513 and
Savings #137827 as of December 20, 1977. Both accounts are joint accounts
in the names of Clifford C. Lynn, Hazel L. Lynn.
/
#137827
'.. .'~
Balance ----~~--c-~-~---$2;000.Oa
Accrued Interest ------- 353.87/
#6686513
Balance -m--~--h-h-$20,ciOO:00 v"
Accrued Interest n__~_ 82.35/'
Total ~---"-----$20,082.35
Total --~--~-----$2,353.81
In need of additional information,' please conta.ct this office..
'Very truly yours,
n. .
,')~JkW-J1IuSf
Richard L. Kuntz .
Bookkeeping Dept;
RCC-~8
RESIDENT DECEDENT
SCHEDULE "E"
JOINTLY OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
INSTRUCTIONS: Tllis schectule must disclose all property, real and personal, owned by the decedent jointly
With anot.her or others, including intangibles,. standing in the name of the decedent and others. List
real es ta te fi rs t, as en ti re ties, or j oint tenants, giving brief description, as indica ted under Schedule
"A", plus the da.te and place of record of instrlunent ef'fecting vestlture, but do not include entireties
or out of state real estate value in estate valuation column. Personal property should be listed as in
Schedule "Bit, plus elate of acquisition, and the name, address and relationship (if any) of co-owners to
the decedent.
Description of Property, Date of Acquisition, Name unit percentage Estate DEPART!lENT VALUATION
Address and Relationship of Co-Owners, and PI ace Value Share Valuation CAUTION-Do not Write
of Record of Instrument, where Real Estate. In This Space.
g .;v :x Value of Value of
XX X << XX 0<: :50 ex': Deceden t t S
X << X 0<: X X 'Y Entire
:&< X>< X>< X>< X X>< X>< X Property Interest
l. $20,000.00 Single Payment
Savings Certificate No. W5553,
State Capital Savings and Loan
Association, 7-1/2%, issued
February 22, 1974, to
Clifford C. Lynn and Hazel L.
Lynn, his daughter, Joint Tenant
with Right of Survivorship and
not as Tenants in Common and
not as Tenants by the Entirety. /'
Balance at date of dea th:
$20,000.00 ......- 1/2 $10,000.00 (0)000.0 \)
/
Accrued interest to date ~ 3q,~ "
of death: 79.32 .- 1/2 39.66
-
2. $20,000.00 ~ificate of Deposi
No. 6686513, Cumberland Valley
Savings and Loan Association,
4-year certificate, 7-1/2%,
issued September 30, 1974 to ,
Clifford C. Lynn or Hazel L.
Lynn.
Balance at date of death: ,,/ i-o) () 00 ,0 0
$20,000.00.... t2 $10,000.00
Accrued Interest at date / /' L\.t.c9
of death: )2.351 1/2 4l~18
3. Savings Account No. 137827,
Cumberland Valley Savings and
Loan Association, registered in
names of Clifford C. Lynn or
Hazel L. Lynn, daughter.
(Account was opened Oct.14, 1960
Balance at date of death: ,r ,. ,,-- l,ooo,ou
$ 2,000.00.. 1/2 $ 1,000.00
Accrued Interest at date 353.87," /' n\., .'1. <-{
of death: 1/2 176.94
Insert this total opposite "Jointly Owned Pl"o-perty", Schedule "Eft
in the "As Reported" column on the last page of' this return.$21,257..78
'2.1,2S. ,If!
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.
~C 0039 (~77)
.
County, Number and Na"!r . Cumberland SUMMARY
File Number 1- 711-1
Date af Death December 2U, l~/I
File Date LYNN GL U'l"ORD COMMONWEAL TH OF PENNSYLVANIA
Estate Name C. TRANSFER INHERITANCE TAX
(L.AST NAME) (FIRST NAMEI (INITIAL.)
RESIDENT DECEDENT.
REPORT OF INHERIT ANCE T AX APPRAISER
I, the undersigned duly appointed Inheritance Tax Appraiser in and for. the Caunty 01 ,
Pennsylvania, do respectfully report that I have appraised the real and personal property as reported in the loregoing return at
the values set forth opposite each item in the last column to the right in Schedules "An, fiB", "e", and uEIf.
Dated:
INHERITANCE TAX APPRAISER
REPORT OF THE REGISTER OF WillS
I, the undersigned duly elected Register of Wills in and for County, Pennsylvania, do respect-
fully report that I have allowed dedu'ctions 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 "F", which greater or lesser amount represents the sum
allowed as a deduction.
Dated:
REGISTER OF WIL.LS
INVENTORY VALUE AS REPORTED VALUE AS APPRAISED CODE VALUE AS REAPPRAISED CODE
Real Property (Schedule A) $ None $ a04+- 00+
Personal Property (Sehedule B) 2 248. 181 10+ 10+
Jolnt..Held Property (Schedule E) 21,257 78 , '0+
T,an$(en (ScheduteC) ~ 30+
TOTAL GROSS ASSETS 59
Less Debt. and Deductions 40.
(SCHEDULE F)
,
CLEAR VALUE OF ESTATE
Valuation of life estates or .:L- PRINCIPL.E FACTOR VAL.UE I~
annuities.. .................. .... - $ t= E=
-
EST A TE TAX ASSESSMENTS -$
.,
FOR USE OF REGISTER ONL.Y ~ COMPUTATION OF TAX-
Tax on $ 2% $
Tax on $ 6% $ "
Tax on $ 5% $
Tax on $ 10% $
Tax on $ 15% $
Exemptions . (') As evl~enced by Charitoble
Total.Estate Exemption Certificates-issued
TOTAL TAX $ by the Secretory of Revenue.
Less tax previously paid $ E
BALANCE $
Less 5% at tax if paid within
3 months offer death $
BALANCE OF INHERITANCE TAX DUE r; I
Add interest at rate of 6% from
'0 $
AMOUMT Of ESTATE TAX ASSESSED $ C -C
Estate tax paid $ I
BALANCE DUE $
Add interest at rate of 6% from
to $ ,
TOTAL TAX BALANCE $
PAID $
Supplemental Codes: (FOR USE IN HARRISBURG ONl Y)
48-Adjustment 6O-lile Estate 93C-Charity 96-Successive
49+Adjustment 92+Remainder Appraisal 94-'RemCJ inder Residue life Estate
56-Annuity 9.3-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
some should e note below, with short explanation. '
RC C-2 (2-64)
, COMMONWEALTH OF PENNSYLVANIA DATE 5 Ma.u 78
." } .
DEPARTMENT OF REVENUE RESIDENT INHERITANCE TAX r.llmb~IfJl,,~d
BUREAU OF COUNTY COLL ECTIONS COUNTY
HARRISBURG, PENNA, 17127 APPRAISEMENT FILE NO. 21-78-0001
Whereas, CU6.6.Of1.d C. LYM late of CaJt.Uo.f.e
in the County of Cumb wand Commonwealth of Pennsylvania, having died on
the 20th day of VecembeJt 19~, seized and possessed of an estate
subject to Inheritance Tax under the Iliws of the Commonwealth of Pennsylvania;
Therefore, I, Thn &oim . 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 1n this estate is transferred In posseSSion or enjoyment to collateral heirs of the decedent after
the expiration of any estate {or life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer
inher1tance taxes at the lawful collateral ute on any such future interest.
Unil ADD(8j'8m~nl
Dert:rlptlon of And Value. Mllde for Inheritance
Tax Purpolel
Reh,O "'h~h'+" $ None
' -,-
pOIfAn~"P Plth~n'+" 2 248 81
T/Ul.n,6 'Olf A ...
J o,i.n..t;tU H e.f.d Pita ~n h +" 21,257 78
TOTAL ASSETS 23,506 59
,
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Having been duly sworn according to law, I do hereby certify that the above appraisement is made in con-
formity with law on this ;,..h day of ~ ...~~ ,r, ..li/o_ __ ' 1!1-L-.
A,ppraleer
(In:ImbC!r and b;.'et)
H oJzJU.& Mil. , Penna.
(Pod Offtee)
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