HomeMy WebLinkAbout06-08-78
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Form RCC-33
COMMONWEALTH OF PENNSYL VANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
. COUNTY OF
.
RESIDENT DECEDENT
JUN 8 1978
.CIJMBERLAND..
IMPORTANT: This return must be completed in detail and, filed,.in duplicate, with .will attached, with, the
Register of' Wills of' the County where de,cedent resi,de:d;, Return..is.due within one year_,after
date of death, unless. an extension is granted hy the Secretary of Revenue~ (Section 703.of
the Inheritance and Estate Tax Act of ,~96:t.).
IN THE MATTER OF .THE ESTATE OF
...~:I;;_I::!~..:I3,..li.::r.,.OOD...................
(state full name of' decedent)
}AFFIDAVIT OF
. --. EXECUTOR
.\BlilllPlO'l!l:lIGR
ColDlty
Late of . .........<:::YJ:X1I?El;rlllnd.. ..............
I
State of . ..P!:'nn'lY1V!\n.i."
County of .CHt!'[Tt!lf.
...:.................................} .
......_....._..............._...~. : ,5S:.
..JAMES..B.....FLO.OD....
_tor
Administrator
of ' the 'estate of the aboveanamed decedent .being duly sworn, deposeS'
and. sayS"
Deeedent dJed .....P.!:'.c..!:'m.l:>.!:'T...
(Month)
Name and address of attorney or}
other authorized representative to
whom al~ correspondence should be
mailed.
J4,
(DllY)
, 19 77 ~ ,J testate leaVlnlil a lest w1l1, copy of which
(Yt'8r)l~ r'
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i!" ~~re'to attachesL -
. R h()lld.s;......~.i.Il()I1.....8.:......I:IEl.I1<l,.e..':.!!.h()t, ..4J.Q..N.Q':th....::rhi.r.cl...~.t':.!:'.!:'.t.,. ....P...Q.
Box 1146,Hardshurg,Pennsy;lvaniaJ7108"""""" ".."...."_"
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That as such ..,..~~.El.C;;.!J.t.Q.!:...................;. deponent is . familiar with the affairs .of.said estate and the property con-
. (Exl'C'lIWor-AllminiRtratur)
stituting the assets thereof and their rafr marke't value.
. - . "
That at the time'.of death there was no safe deposit bux 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 EOX , " IN NAME OR NAMES OF HOLDERS TO DECEDENT
. ..
None
. " ,
That the. contents or said. safe deposit box or boxes are ite~zed Under Schedules
return, with the exception'.of the- fOllowing, for, the r:easons hereinafter set forth:
of this
. That.Sc.hedufe.,A attached h~reto and JT.Iade part hereof sets :forth fully and in detail all the
real property in the Commonweal th or..Pennsylvania of which decedent ~ed having an interest therein~ r.t
also sets forth the mortgage encumbrances upon each parcel of real property at the date,of de~th, giving
the amount still 'due_ at death,. name of mortgagee, .date, rate of i~te.rest, and book and page of recor,d
thereof. It also sets :forth in the col:umns.provided therefore the ~ssessed 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 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.~~~st for
any other person or persons giving also separately the accrued interest thereon, if any, do~ to~the.last
. _' k \"\'" ~ ,_.
interest day prior to_~ec~dent's death in the case of savings banks, and to the date of ~ec~~ent's death.
,...~.....~~-.,.._~..,._~., ,- " -' ...~-";
in all other CaSeSj aIf bonds, postal savings, treasury certificates or notes and othe~'e~~den~e of.in~ ~
-........ -: E.'. T r -.:....-.. _...- a; .,
debtedness of the Uni"ted States to the decedent; all obligations, whether by statute or B:gr~emen.t :t~ey ~~ .
are designated as taxf~ee, of the United States, or any state, or political SUbdiVisi~~the~iof;: or::'of"..
. 'r, 1_ _ . . ... ......
any foreign country; which are ownerl. 'at ~he time of' deathj all wearing apparel, jewelry,~sj:l:ye1"..ware,,,,~ic- !'"
, . /"...~...- ....
tures, books, works of art, household furniture, horses, carriages, automobiles, boats, ..and~'8;.ny and a~l....
"../ - .........
other personal c~attels of whatsoever kind or nature, left bydeced~nt, together with the fafr.vttes~mal:~:
market value thereofj all bonds and. mortgages held by decedent and of all claims du~ and oWin.gl~d.~c.~dent
d t the time. of' rie:ath, and all promissory notes or other instrtunents .1n wri ti~g for the p8;YJ1;lent of ~oney
of which decedent (lied possessed, of whatsoever nature, wi th intere~t the:reon, ir.. an.y, .g~ving the. face
value and estimaterl.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 ite~j :a.1] money; payable
to the estate f'rom life insurance polici'es carried by decedent; _all annuity and endowment contracts the
proceeds of' which were payable upon the death of the decedent; and all the corporate stocks and dividends
due thereon and unpaid as of' the date of' de.ath, bonds and accrued interest thereon to the date of dece-
dent's death and other investmeDt securities owned by the decedent at the time of death, with the market
value thereof at such time~
"
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In the case of securities of close or fandl y corporations, the values reported are as far as
possible substantiated by financial statements of the corporations, showing the assets and liabilities
thereof as of the date of death. The schedule also s'~ts f'orth 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, flnancla.l statements showing the assets and liabilities of said co-partnership or business.
A copy of thE" co-partnership agreement, (if oral, a statement setting forth the nature of the agreement)
together with a statement setUng Carth 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 f'orrnt 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 ofpropert~r, real or personal, within two years of decedent's
deatht in contemplation of decedentfs death, or intended to t~ke effect 1n possession or enjoyment at or
after deatht 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 transf'eree and
all other f'acts of a pertinent nature regarding said transf'ers. In the case of transfers intended to
take eff'ect in possession or enjoyment at or after dentht there is also attached to the schedule a CORY
of' the deed, trust agreement or other instrument crentlng the trust. Therp. 1s also set forth in said
schedule a list of all propertYt real and personal, w:lth its value, which passes at decedent's death by
virtue of the exercise by decedent, either individuall~r, or jointly with another, or any power of' appoint-
ment vested in decedent, ei ther individually or Jointly, by the willt deed, or other instrument of' another,
with a copy of the instrument creating such power atta.:hed 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 deatht the nature of their res-
pective interests, their relationship, if any, to th'~ decedent, together with the ages at the time of
decedent's death of all minors, annuitants and benef:Lciaries for life under rlecedent's Will. It also
contains a statement showing which of the beneficiaries named in the decerlent's will, if any, died prior
to decedent, the dates of their deatht their issue, and. the relationship of such issue to the beneficiary.
That Schedule E attached hereto and made a ~;.art hereof sets forth all propertYt real and per-
sonal, owned by the decedent Jointly with another or others, including intangiblet standing 1n the n&me
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 dec&dent.
That Schedule F attached hereto and made a part hereof 8&tS forth fully and in detail all debts
and deductions claimed f'or and on behalf of this de(~edent's estate, including funeral expenses paid;
family exemption, where applicable; costs of' admlnist1'atlon of' this estate; counsel fees and fudlclary's
c017llJisslons paid or to be paid; cost expended for bUl'ial trustst tombstones or gravemarkers, and reli-
gious services, in consequence of the death of the decedent; debts and claims owing anrt 1mpaid at time of
death; taxes accrued chargeable for period prior to ducedent's death (except those allowed under Section
65101' the Inheritance and Estate Tax Act); together with a statement of collateral pledged for obliga-
tions, if any. It is agreed that the fiduciary w111 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 8JIIOunt 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 accore.Mce therewith.
That the totals of the appropriate columns in Schedules ftA", "B", "e", "E", and "F" as directed therein,
have been carried forward and properly registered in t.he Summary.
I
........_.I..~.. ..... day of~..
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....... ....SHlR[EY.. .Blrri::R~
Notary PIJ~:L, Tredyffrin Twp.. Chester Co.
M)' CO~isSiorrtxp;rBS April 2. 1979
.... 19..?.?....
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....'<fU...:w..1',r..:rl9..t.:.B..Q"'.c;L.....,........... __ .,
(St'I'eet Numb",,) .. - .--...
.. .Mllly.".J:n.,!'l'..!'t.'.s.Y~:V:ll!':~Il1.9.3 55
(City or r"",,,, llnd Sto.te) .....................
Subscribed and sworn to before me this
NOTE: ,Befor"'e signing aff"1davit make sure all blank spaces in tl1e affidavit and schedules annexed are
filled in with details or the WONt "None", anti in case the assets include rare ano unlisteo securities,
securi ties of close or f'amlly corporations or Iln inr;erest 1n llny 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 completerl as above-directed.
RC C-~.~ (4_73\
COMt.'ONWE"'L TH OF .PENNSYLVANIA
. DEPARTMENT OF flEVENUE
'BUREAU OF COUNTY COLLECTIONS
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "A"
REAL PROPERTY
*
Real property in Pennsylvania, with statement of mortgage encumbrances upon each parcel at death of dece-
dent. Property held by the deceden' as 'enan' ,in cammon with another 01 ather, should be identified
as to quantum of interest and the estimated value should be that of the decedent's interest only. (Property
held as joint tenants with right of surviorship or tenancy by entireties should be reported on Schedule "E.")
The real property located In the Commonwealth of Pennsylvania should be (1) (2) (3\
described by lot and block number, street and street number, together wi th DEPA RTMENT
, o general description of the property, with a reference to the record of the ASSESSED VALUE VALUA TION
conveyance by which the decedent took title; If a farm state number of a. FOR YEAR OF ESTIMA TED CAUTION
I cres; also statement of mortgage encum\),ances upon each parcel at death DECEDENT'S MARKET VALUE (Do not write
of decedent. Taxes, assessments, accrued Inferest on mortgages, etc.,are DEATH In ,hi. space)
to be listed on Schedule OF" and must not be deducted from this schedule.
None ru-neJ
0.00
Insert this total opposite "real proper'y", Schedule" AU in the XXXXX -
"As Reported" column on the lost page of this return. 0
HCC<";.
IlESIIlE"iT DECr-:m:i\T
SCHEDULE "R"
PEHSO:-i,\L PHOPl::I\TY
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G(J)!\I((\\\'i':'\LTlI (1[0' i>I':i\i\~YL>i;\i\ u
T IL\~.(;~;l;;n INHEHITANCE TAX
I(\~THLCT[ONS: This Schedule Jllll~t disclose all UlOglble and Intrttlgibte persona.l property o;~nl'!-d 1ntlh"lrlually
b:y the decedent.) nt the timp. of hts d'::"nth. Propertj" owned by the ttecedent jointly with another or others
must h~ listed willer Schedule "E". Intangible personR.l property, tltl~d in the na~ of the decedent, but
pa)"fihle at death to nnother or others, includIng: but not limlted to.P..O.D.. u. S. Savings B'Jnds and tenta-
ti,.'c trust accounts, must be listed, d~splte the fRet that they l'.re not of the ad:nlnistered estate..
Tangible personal property should be listed .first (e.g.. jewelry, wenr'ing apparel, household
goods, nnd furnlshLngs, books, paIntings, automobiles, boats, etc.)
Intangible personal property, such as bonds, treasury certifica.tes, cash on hand nod .In bank,
stocks, mortgages, notes, together with accru~d interest or dividends, salaries or wazes~ insurance pay-
able to the estate or :firtuclnry In said capacIty, partnership "interests:, interest in anyundlstrlbuted
estate of or income from any property held in trust under the will Oi agreem~nt or nnother~ eVen though
located outside or the State, at the time of death, should be listerl in this schedule.
Item
NO.
ITEll
List and describe fUlly
UNIT
VALUE
EST! MATED
MARKET VALliE
DEPART,IIE/iT VALUATl
(no no t write in
this space)
1. Cash
34.00
.J>y I}(),
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2. Checking Account #33-44-719-5 at Dauphin
Deposit Bank and Trust Company
\
657.56
d,S7.S6
3.
Proceeds on Life Insurance Policy #OT-7320005 0
Colonial Penn Life Insurance Co. payable to
Estate of the Insured, Irene B. Flood, as alter-
nate beneficiary
· /.I}/JO, tJ()
1,000.00 V
Savings A. ccounts at;rhe Harris Savings Associati'
Acct. #5-74757:vPrincipal ' $3,048.57
- Accrued interest 13.'i'S' ~)
,. /'
Acct. #5-74758: Principal $;198.55
Accrued interest 'il',,",9/~,
6. One-half of a Savings Certificate issued by ~
Harris Savings Association #5-06-057795 in the
joint names of Decedent and Myrtle E. Brown,
deceased':':
4.
5;
J(J6.l:J
501. 25
SlJ t, J".3
Principal
Accrued interest
$6,000.00
15. 19
!
6,015.1
"
7. Proceeds On Life Insurance Policy #126-449-868
of Metropolitan Life Insurance Company payable 0
Estate of the Insured, Irene B. Flood, as alterna e
b~neficiary
9.
Proceeds to COver burial of Decedent under Coloni I
Penn Insurance Co. Policy #76-100-412
1,290.80' Z .;J9~. fo
l Y ,
, h~.53-
8. Award from Colonial Penn Insurance Co. On Sur-
vival Action brought by Executor of the Es tate
10. One-half of refunded premium on cancellation of a
policy of renters' insurance ordered by Deceden
and Myrtle E. Brown, deceased':'
11. One-half the estimated value of furnishings in apal t-
ment shared with Myrtle E.' Brown, deceased':'
12. Refunded pre-paid premium from Colonial Penn
Insurance Co.
Total Personal Property, . . . . . . . . . . . . .
:' Myrtle E. Brown, sister of the Decedent,died si ul-
taneousl 'with Decedent on 12 14 77 ,
$
Insert tll.ls total opposite "Personal Propert)''', Schedule "art In X X
the "As nf~poT'ted" column on t~e l~st page of' this return.
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'RCC~ 36
COMMOt\WEA.LTH OF PEt\NSYLVA.NIA
TMNSFEH INHEIUTANCE TAX
SCHEDULE IIC"
TFL\NSFETlS
I
(1) Did decedent, within two years ofdeoth, make any transfer of any material paL of his estate, without
receiving a valuable and adequate consideration therefor? (Answer yes or no)1 No
(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) No j
(3) If' the answer to (1) or (2) above is in the af'f'irmative state:
(a) Age of decedent at time of transfer N / A
(b) State of decedent's heal th at time of making the transfer. (Note ).
(c) Cause of decedent's death. (Note 1). I
(4) Did decedent, in his lifetime, make any transfe.r of property without receivi~g a valuable or adequate
consideration therefor which was to take ef'fect in possession or enjoyment atJ or after his death?
(Answer yes or no) No l
(a) Was there any possibility that the property transferred might re urn to transferer or his
estate or be subject to his power of disposition? (Answer yes or no) N I A
(b) What was the transferee's age at time of decedent's death? N I A L
(5) Did decedent in his lifetime make any transfer without receiving a valuable a*d adequate consideration
therefor under which transferor expressly or impliedly reserves for his life br any period which does
not in fact end l)efore his death: I
(a) The possession or enjoyment of or the right to income from the property transferred?
(Answer yes or no) No l
(0) The right to designate the persons who shall possess or enjoy the property transferred or
income therefrom? (Answer yes or no) N n
(6) If the answer to (5) (b) above is in the affirmative, state whether the right as reserved in decedent
alone or others .NJA .. I
(7) Did decedent in his lifetime make a transfer, the consideration for which wasl transferee's promise to
pay income to or for the benefit of care of transf'eror? (Answer yes or no) No
(8) Did decedent, at any time, transfer property, the beneficial enjoyment o~ whibh was subject to change,
because of a reserved power to al ter, amend, or revoke, or which cOllld revertl to decedent rmder terms
of transfer or by operation of' law? (Answer yes or no) No
(9) If the answer to. (8) above is in the affirm<ttive, was the power to alter, amend, or revoke the inter-
est of the beneficiary reserved in the decedent alone or the decedent and oth rs?
(Answer yes or no) 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 desc iption 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 ~r instrument, i~ trans-
f'ers are claimed to be non-taxable, also submit detailed statement of' facts on Wh}ch said claim is based.
NOTE 3: List applicable property below in manner in which provided in Schedules t, B, or E.
RESIDENT DECEDENT
ITEM DESCRIPT ION MAlUillT VALUE DEPT. VALUATION
(Es tima ted) (Dept. Only)
N/A ~
,
.
Insert this total opposite "Transfers", Schedule "e" in the 0.00
"As Reported" column on the last page of this return.
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LASTWlt,L AND TESTAM~'. ; ,
OF
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!!UfNEB;' FLOOD
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I, IRENE B, FLOOD, of Harrisburg, Dau hinCoutlty, Penn.-
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... .
sylvani:>', being of sO..md and displ)!Iing mind and memory, do make, publish
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and declare thi& my Last 'NtH and TeGtament, hereby revoking aU WillG and
"." ': ;,.' " . ';' '.~'. '. >, '.- :' ; .~
Codlcib by me at any time made.
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ITEM !: .; I direct that all'inhal'ltallce and estate taxelil
..,=1.. d_ by ,.a..' of my' d.a"'.wh'''''T.~h .....!y "" ..,.hi. hy
my Estate ~r by!!,nyrecipleni:'of anypropel"ty; !lhaUbe pa~d'bymy.Executor out
.f th. pTop.." pa."', =dOT' tb"Wnl.'wbk' t. Dot ...,+al1Y "vl..d ., ,
bequen::hed, as an expeJ:h'le andco!lt of.admlni.strationof m~(EtiltateJ.My Executor
shalt have no outyor obligation'toobtal.nreimbu1"lllementfo any'such.tax paid
even though on proceed:). of h'l8U1"anCe or other." propertynotpas3ing' under thilJ
Will.
.
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ITEM ll:' \ ". .. Ii I predecease my altlterr',""MYR TLE E. BROWN,
er Harrisburg, Pennsylvania;!'I give, de'"beand beq~eath't her all of my propet'ty,
".1, p....on., .nd mb.d. If my .Iot.. p..dn...... m., +aka oald d.vI.. and
bequeat to my son, JA}"~ES B..~LOO~',.n~w ~~Ch~rlotta, iNI~rt,hGarOli~~, or, if
he aho predeceaoea me, to bia illflUe", pe.r, stirpes, li~ing "at the time of my dea~h.
ITEM ill: In the eettlementof my Estate, my E:;<ec1.1tor
. , . .' ." \.,. .. ., .,,,.
"hall pOOlJe"l;, among oth"'t'!l, the following power" for the'l:le"t interest of the
,
beneficiari<ll'l :
. (a)
To
".n .~1h~' al publl. .T p".'r~ '~'. ~~d..
Irene 13. ,Flood
{SE.A.L
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upond'Juch te~rn.5 and condi::ions an my E}~ecut?r may.
,deem advanta3aOUli to my Estat'l.l, any or all real or
,personal estate or interest ther",in owned by me sev- '
Grally or in conj=ction with other persona or acquired
t-.... . '_ . .., " _
after my death by my Executor and to c~n!1urri'mat';; fiI;!.ld
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sale or salcHI 'by sufficient deeds or other instruments
,'....
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'. --,,~. . '. ..: " ., ". -.' : : -'''' . ,- ,
to the purcha<Jar or purchasers, con:veying a fee'llimpi",
,."
titI0, , free and char of all truet and vAthout'obli:g~tio~
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or liability of the pUl'crn..aer or pl,tt'ch.ua'r'o t(,ae'e to 'the'
''of
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'appUcation of the p;.lrchase money or to make inquiry
into the vaUdlty of said, aala or sales; also, to make.
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: ",executa, , acknow10dlJ~anddeliver any and all deede,
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',:assignments" options or, other writin);i!l which may 1;Ie, .'
. '-. . . - . - .' . ',_1..-.<- - ',;';'.-_..;.,:-,
:', ~ necess..ry or, desirable in carrying out any of the powers
. . ' '
conferred upon my Executor in this paragraph ore1ee-
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where in my Will.
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(h) To pay all coSt3, taxe~. ,21cpenllea and
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'charges in connectlo'll with the administration of 'my"""
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'E state.
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(c) ,To dbtr.1bute my E...tat~h~ kind or in,money.,
. I,. " . .. ~ ,', 't -)_"":,.
(dj To dQ an other acts' i~ th~ j~dgn1ent olm.j' ,
E:cecutor necessary or deairable for th~ proper and ad"lan-
tageo..UI xr"M'lagorn,"-llt, iXl'l/'eatment .mo distrlbution of my
Estate.'
ITEM XV:
-,---
Any person who shaH h~ve died at the same time
(SEAL)
Page 'l. o~ :; page(l.
Iren" B. Flood
. .
:~;d'~.
as Tegtatrix,or in a conlmon dfsafltel'with her, or under such circumstances
that it ia difficult or impossible to determine who died first, . Bhdl be deemed
to have predeceased her.
ITEM V: .
. . .
I hereby nominate, constitute and app.:,Gtroy
. .
sister,. MYR TLE .E.. BROWN. to be my EX'3cutrix (herein re-ferred'to'aa'nExe.
cutor"). In the event of the death. resignation, 'reful!Ial' or 'iziabtiity' of' mY'~ll.id
sister to act as my Executa:" I nominate, constitute ;~nd appoint my son,
JAMES B. FLOOD, as my EX9cutor.
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My Executor specifically is relieved from .
. _ '_ . : ~ " >,'," ':.,_";"_. .:'; . ',"} :', f", '_:, :.c'":''' ":. '-
the duty or obligation of filinS a.ny bond or other security.
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'. . ".. ;;,IN WITNESS WHEREOF, I have eei: my hand and seal to' this
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my :Last.Will and Testament; cOl!l.Bistlng of thh and the preceding two (Z)pages.
. ". . .... ~ ~- < . '~'.,.,
a.tth~ endo! each'page o!which Ihav~ a190' 'get my hand and seal rfir gr~ater" .,.
. s ecuritv and better identification; thi9-o, 7 ,/... , 'dayo!'{;l:t...
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1967.
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(SEAL)
Pa.ge 3 of 3 page3.
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Irene B. Flood
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We, the =der:ligned, hereby certify that the! foregoing, W:ill wall ..; .,'.'
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3igned, se::>.led, published and d~c1ared by the above-named Testatrb: as andJ~or..,
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.her I,a-at Will and Testament, in the pre3lOnce of us, who, at.har request.:l.l1d Ul. ..,
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her pregence and in the preti"nce of each other, have herenD.to z~t our hand.. and.,'''__
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eea.1e the day and year abov~ writblm, and we certify that at t..'le time of the exe.
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cution th~rco!, th<l 'cHlid Tel1ltatrbt we:! of son..'ld and diapoaing rnhld and memot'y.
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Residing at:
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Rel1iding at:
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SCHEDULE "0"
BENEFICIARIES
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. , . , RELATIONSHIP -,--
BENEFICiARIES AND ADDRESSES (If step-children or SURVIVED DATE INTEREST OF
State full names and ,addresses' of all whp illegitimate children DECEDENT OF BENEFICIARY
aye an interest. vested. contingent or other are involved, set STATE YES IN ESTATE
wise, in estate) forth this fact) OR NO BIRTH
James B. Flood Son Yes (A dult) . Entire Es ta te
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Deponent further says that all the above-named beneficiaries are ~iving at this time except below:
NAME
DATE OF DEATH
RESIDENCE
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SUMMARY
(Sch. "A")
. (Sch. "B")
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Real Property
Personal Property
Transfers
Gross Taxable Estate
(1 )
(As Reported)
$ 0.00
$ ......13,857.88
$... .. 0.00
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(As Determined)
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gCC-3B'
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COMMONWEALTH 0" PENNSYLVANIA
rI1ANSF1<:R INHERITANCE TAX
RI<:SIDENT DECEDENT
SCHEDULE "E."
JOINTLY OWNED PROPERTY
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HiSTRt'CTIOl'lS: This schedule nrust disclose all property, real and personal, owned by the rlecedent jointly
with another or others, including intangibles, standing in the name of the decedent and others. List
real estate first, as entireties, or joint tenants, giving brief description, as indicated tuIder Schedule
riA", plus the date and place of record of instrwnent ef'f'ecting vestiture, but do not include entireties
or out of state real. estate value in estate valuation column. Personal property should be listed as in
Schedule "B", plus date of acquisition, and the name, address and relationship (if any) of co-owners to
the decedent.
Description of' Property,. Date of' Acquisition, Name! un! t percentage Estate
Address and Relationship of' Co-Owners, and Place Value Share Valuation
of Record of' Instrument, where Real Estate. !
~ X> ~ yyggBS 88 ~ ~ 6<: rx 6& 8 ~$:X& ~~88
)() ">N'>N)(S( yy)(S( XX 0< ~ 00< rx 00< XX yy X? ~ '^'" ^>{',
See Schedule "B".
DEPARTMENT VALUATION
CAUTION-Do not Write
In This Space.
Value of' Value of
Entire Decedent' s
property Interest
All joint property was held with Myrtle E. E rown, who died imultane usly with de edent
on December 14, 1977.
Insert this total opposite "Jointly Owned Property", .Schedule .nE"
in the "As Reported" column on the last page of this return.
0.00
.
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RCC-81 (6.73)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
HARRI~BURG
17127
IN YOUR REf'L Y PLEASE
REFER TO
Inheritance Tax Division
NOTICE OF FILING or APPRAISEMENT
James 11. Flood
913 Warrior Road
Malvern. PA 19355
(Execufor or Administro1or)
In Re: Estate al
Irene B. Flood
Cumberland
County - File No.
21-78-0008
Dear Mr. Flood:
You are hereby notified that the Original
appraisement in the estate 01 Irene B. Flood
has been filed in the office 01 the R"-JIister 01 Wills 01 Cumberland .
County on July 31 , 19_, Said appraisement reflects the lollowing
valuations: ' .
Real Estate
Personal Property
T ranslers
Jointly Owned
Total
None
13,864.69
None
None
$13.864.69
As to such tax that is paid within three manths Irom date 01 death, a live (5%)
percent discount is allowable. As to any tax that remains unpaid after nine (9) months
(fifteen months when death occurred Irom December 22,1965 to June 16,1971, inclusive;
and twelve months when deoth occurred prior to December 22, 1965) horn date 01 death,
interest at the rate 01 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 01 said notice as provided by Section 1001 01 the Inheritance and
Estate Tax Act of 1961, 72 P. S. 2485-1001, P. L. 373.
~a
July 31, 1978
Signed
k,
Jvt~~
Date
Title
Chief Appraiser
Note: This is not a bill.
RC C-2 (2-64)
DEPAR'fM'ENT"OF REVENUE
BUREAU OF COUNTY COLLECTIONS
HARRISBURG, PENNA, 17127
COMMONWEALTH OF PENNSYLVANIA
RESIDENT INHERITANCE TAX
APPRAISEMENT
DATE
July 31, 1978
Cumberland
COUNTY
FILE NO,
21-78-0008
Whereas, Irene B. Flood late of East Pennsboro Township
in the County of Cumberland Commonwealth of Pennsylvania, having died on
the l4tti day of December 19~, 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 decedent 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.
Unll Appraisement
Oucrlpllon 0' Anal ValueI Made for Inheritance
Tu Purposes
Real Property $ None II
Personal Prooertv 13.864 69
Joint-Held Property None
Transfers None
TOTAL ASSETS $13,864 69
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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 31st day of ~ JUl~ ~, . 19~.
c: a _ N. r....ee~
Appraiser
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