HomeMy WebLinkAbout07-24-78
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RCc..33 (4~73)
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
RESIDENT DECEDENT
JUt 2;1 1978
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'ienue. (Section 703 of the Inheritance and Estate Tax Act of 1961.)
} AFFIDAVIT OF .
EXECUTOR
"'BMtNIS'I'It1\'f8It
IN THE MATTER OF THE ESTATE OF
Stephen B. Shover
iSTATE FULL NAME OF' DECEDENT}
Cumberland
Late of
County
State of
Pennsylvania
<
C Cumberland
ounty of
} s",
Administrator
CCNR RAnk, N A
of the estate of the above-named deceden' being duly sworn, deposoS
Executor
and 50y S
Decedent died
December
14
19~{testQ'e leavinq 0 lost will, copy of which is hereto attaChed.,}
(YEAR) intestate '
(MONTH)
(DAY)
Na~e and address of attorney or } Charles H. Stone, Esq.
other authari~ed representative to whom 310 Bridge St., New Cumberland, Fa.
all ccrres.p<>ndence should be moiled.
That as such Executor deponent is familiar with the affairs of said estate and the property constituting
(EXECU TO R-ADMINISTRATO RJ
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 individuaJ 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 RENTEO RELATIONSHIP OF JOINT
IN WHICH DECEDENT RENTEO A S,-l,FE DEPOSIT BOX IN NAME OR NAMES OF HOLDERS TO DECEDENT
CCNB Bank, N.A. S.B. Shover and Wife
Enolar p.q Shover
"'.
That the contents of said safe deposit box or boxes are itemized under Schedules
with the exception:o[ the foJJowing, for the reasons hereinafter set forth:
of this return,
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 forth the
mortgage encumbrances upon each parcel 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 assessed 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 herenf sets forth fully and in detail all personal property
wberesover 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 ~'ccrued 'in teres t thereon, if any, down to the last interest day prioT to decedent' s
death in the case of savings banks, and to the date of decedent's death in all other cases; ai1,bonds~ postal
, ....... -- ", ...
savings, treasury certificates or notes and other evidence of indebtedness of the Unite'd" States -t~ __the'":de-
cedeht; all obligations, whether by statute or agreement they are designated as tax fre(, ~'f~tI1~ United"St~te\,
or any state, or political subdivision thereof, or of any foreign country, which are owned' at~the time of d-eath;
all wearing apparel, jewelry, silverware, pictures, books, works of art, household furnitur~, tWrses, carriages,
automobiles, boats, and any and all other personal chattels of whatsoever. kind or naiute.,~I:fC'-by_ d(;c~derit,
v. . ,,"' ,
together with the fairly"estimated market value thereof; all bonds and mortgages held by -dece.dent' and'oT all
J ...... ,.
claims due and owing decedent at the time of death, and all promissory notes or other'instruments'in writing
for the payment of money of which decedent died possessed, of whatsoever nature, with interest' thereon, if
any. giving the face value and estimated fair market value thereof, and if such estimated fair-market value be
less than the face value, it sets forth briefly the reasons for such depreciation as to each item; aU 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 o~ 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.
;
In the case of sf~curltles of close or family corporations, the values reported are as far as
rossible substantiated by 1~lnancial 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, financial statements showing the assets and liabilities of said co-partnership or huslness.
A copy of the co-partnership agreement, (if oral, a statement setting forth the nature of the dgreement)
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 transrers of property, real or personal, wi thin 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 trftllsferred, the
relationship of the transfet'ees to the decedent, the pro~rtionate share received by each transferee and
all other facts of a pertinent nature regarding said transf'ers. In the case of' transfers intended to
take ef'f'ect in possession or enjoyment at or af'ter death, there is also attached to the schedule a co~y
of the deed, trust agreement or other instrument creating the trust. Therl~ is also set f'orth 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 exercise by decedent, either individually, or jointly wi th another, or ftlly power of' appoint-
ment vested In decedent, either individually or jointly, by the will, deed, or other instrument of another,
wi th a copy of' the instrument creating such power attached to the schedule.
That Schedule 0 attached hereto ftlld made part hereof' sets forth the names and addresses of all
persons beneficially intere~ted 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 Scnedule 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 Schedule 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;
f'amilyexemption, where applicable; costs of administration of this estate; counsel fees and fUdiciary's
commissions paid or to be p.~id; 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 unpaid at time of
death; taxes accrued chargeable f'or 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 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 f'ee, commission or debt is less than the
estimated amount claiming and allowed, that the same w111 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 Schedules .A., IIBII, .C., IIEII, and IIFII as directed therein,
have been carried forward and properly registered in the Summary.
Subscribed and sworn to before me this ................................
______-lS"\E) "",of 'A:X-~-- ,.lll
...........2s;n.~.. .~.. .. -~ .... ........
.... ~ ~
I
.........~~F..................__..._--
21....s-t....&....Ma".kat....St..~_.....................................-.........._..__..
(Street Number)
..C""'p...~:I),J,P.a....l1Q1L._..... . ..................
(City or Toum 4M Sta.te)
NOTE: Before signing affidavit make sure all blank spaces in the af'f'ldavit and schedules annexed are
filled in with details or tIle word IINone., 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 para~raph above relating to Schedule IIBII are attached. Also make
certain that column #1 In the IISummary. has been properly completed as above-directed.
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.....~t C..3~ (,,4-731 :-
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
TRANSFER INHERITANCE TAX
RESIDENT DECEDEN'r
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 decedent as tenant .in common 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 on Schedule "E.")
The rGal property located In the Commonwealth of Pennsylvania should be (1) (2) (31
described by lot and block number, street and street number, together with DEPARTMENT
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. FaR YEAR OF ESTIMATED CAUTION
cres; also statement of mortgage encumbrances upon each parcel at death DECEDENT'S MARKET VALUE (Do not write
of decedent. Taxes, assessments, accrued Interest on mortgages, etc.,are DEATH In this space)
to be listed on Schedule uF" and must not be d_educted from this schedule.
None
I
,
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.
o
Rec -35
RESIDENT DECEDENT
SCHEDULE "B"
PERSONAL PROPERTY
*~
CO~~ION~.~TH 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 listed 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.a.D. U. S. Savings Bonds and tenta-
tive trust accounts, must be listed, despite the fact that they are not of the administered estate.
Tangible personal property should be listed first (e.g. jewelry, wearing apparel, household
goods, 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 rlividends, 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
ESTIMATED
MARKEr VALUE
DEPARTMENT VALUATION
(Do not write in
this space)
1.
1963 Chevrolet Sedan (poor condition), proceeds
sale of
JOO.OO
. ---..... \ C}o . '~O
$100.00 _ u
2.
Cash distribution from CCNB Bank, N.A. Trustee
under Revocable Investment Trust dated
July 19, 1977 $ 8,462. 1
",1../
$78,462.51 ""1 '2>..., Lllo""2-. '5 \
Insert this total opposite npersonal Propertyn, Schedule nB" in
the "As Reported" column on the last page of this return.
x X
$78,562.51
I '8" S [,,;1... S \
,...............,.1io!_...~ ",. ...-
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.
, RCC-36
:;.r :\.""
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
SCHEDULE "c"
T Rie!' S FERS
*'
RESIDENT DECEDENT
"
(1) Did decedent, within two years of death, make any transfer of any material part of hi~ estate, without
receiving a valuable and adequate consideration theref'or? (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) in joint ownership? (Answer yes or no) ~e
(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).
(c) 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 therefor which was to take effect in possession or enjoyment at or after his death?
(Answer yes or nQ)~_
(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 o~ any period which does
not in fact end bef'ol"'e his death:
(a) The possession or enjoyment of or the right to income from the property transCerred?
(Answer yes or no) n0.
(b) The right to designate the persons who shall possess or enjoy the property transCerred or
income therefrom? (Answer yes or no) n0
(6) If the answer to (5) (b) above is 1n the affirmative, state whether the .right was reserved in decedent
alone or others
(7) Did decedent in his lifetime make a transf'er, the consideration for which was transferee's promise to
pay income to or for the benef'it 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 al tel', 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, ame~d, or revoke the inter-
est of the beneficiary reserved in the decedent alone or the decedent and others?
(Answer yes or no) nli'l
NOTE 1: The answers to these questions should be supported by affidavit by the attending physician as
well as a copy of the death ceI"tiftcate.
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.
ITEM
DESCRIPT ION
M>\RKET VALUE
(Es tima ted)
DEPT. VALUATION
(Dept. Only)
Neme
N II'-L
Insert this total opposite ftTransfers", Schedule "en in the
"As Reported" column on the last -page of' this return.
0.
RCC-37. (12-63)
COMMONWEALTH OF PENNSYYLANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "0"
IJ~." i;t~ 1\
~
BENEFICIARI.ES
l
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
1- Elverda E. Shover Wife Yes Legal Automobile,
146 S. Enola Drive household and
Enola Pa. Ipersonal effects
2. ('('MR Ronlr M' Trustee Yes N/A tiV4 .. . '1. . rr
'1'~..~ha n_ ., ~ ,
nf' 1'rna> . .
September 15, 1972
,
Deponent further says thut all the above-named beneficiaries are living at this time except below:
NAME
DATE OF DEATH
RESIDENCE
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SUMMARY
(Sch. "A")
.............. .......(Sch. "B")
. ...(Sch. "C")
Real Property
Personal Property
Transfers
Gross Taxable Estate
(I)
(As Reported)
$.. ..0
$ ...78...5/iZ..51
$ . ...... .... 0
$.
$...
$ .... 78,5~2. 51
(2)
(As Determined)
$
$
$
$
$
$
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W Q '"
ell -
- 0(
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--- 0 0 IIIi
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RCC-38
RESIDENT DECEDENT
SCHEDULE" En
JOINTLY OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
INSTRUCTIONS: This schectule must disclose all property, real and personal, owned by the rlecedent Jointly
wit.h anot.her 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 Imder Schedule
"A", plus the date and place of record of instrument effecting vestiture, but ria not include enUreties
or out of state real estate value in estate valuation column. Personal property should be listed as 1n
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 Acquisi tion, Name unit pe rcen t age Estate DEPART/.IENT VALUATION
Address and Relationship of Co-Owners, and PI ace Value Share Valuation CAUTION-Do not Write
of Record of Instrument, where Real Es ta te. / In This Space.
~ & 'h ~38: >>~~ ~:;, ~ ~ 'h~:X ~ ~ X> >0<: >0<: Value of Value of
VY ~>>>> Entire Decedent' 5
?'x'Si :xx: ~x 'h :y <<<< property Interest
All other real and personal property was
held jointly with wife for over three
years and is not subject to Pennsylvania
State Inheritance Tax
Insert this total opposite "Jointly Owned Property", Schedule "E"
in the nAs Reported" column on the last page of this return.
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.
RCC~39 (5-1581
COMMONWEAL TH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX SUMMARY
RESIOENT OECEDENT
.
Estate of DATE OF DEATH FILE NO.
(Last Name) (First Name) (Initial) -.
REPORT OF INHERITANCE TAX APPRAISER
I, the undersigned duly appointed Inheritance Tax Appraiser in and for the County of ,
Pennsylvania, do respectfully report that I have appraised the real and personal property as reported in the foregoing return at
the values set forth opposite each item in the last column to the right in Schedules "A", "B", "C", and "Eu.
Dated: 6j 1.3 77 L~ )(, Jd~
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 r have allowed deductions 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" I which greater or lesser amount represents the sum
allowed as a deduction.
Dated:
REGISTER OF WILLS
INVENTORY VALUE AS REPORTED VALUE AS APPRAISED VALUE AS REAPPRAISED
Real Property (Schedule A) $ $ $
Personal Property (Schedule B) 7" '''? 1<,
Transfers (Schedule C) "
Joint-Held Property (Schedule E) "
TOTAL GROSS ASSETS $ 7Q ,,~o I",
Less Debts and Deductions $ 13 122 0
(SCHEDULE FI
CLEAR VALUE OF ESTATE $ 65,440 11
Valuation of life estates or
annuities. . . . . . . . . . . . . . . . . . . $ t= .t= t=
ESTATE TAX ASSESSMENTS $
.
FOR USE OF REGISTER ONLY COMPUTATION OF TAX
Tax on $ 2% $
Tax on $ 6% $ .
Tax on $ 5% . $
~ax on $ 10% $
Tax on $ 15% $
Exemptions 0 (0) As evidenced by Charitable
Total Estate Exemption Certificates i'ssued
TOTAL TAX $ by the Secretary of Revehue,
Less tax previously paid $ t=
BALANCE $
Less 5% of tax if paid within
3 months after death $
BALANCE OF INHERITANCE TAX DUE $ t=
Add interest at rate of 6% from
to $
AMOUNT OF ESTATE TAX ASSESSED $ C
Estate tax paid $ 1-
BALANCE DUE $
Add interest at rate of 6% from t=
to $
TOTAL TAX BALANCE $
PAID $
FOR llSE OF REGISTER ONLY ADJUSTMENTS
NOTE: Where subsequent adjustments are made to the above computation of tax by the Register of Wills, for proper reason,
same should be noted below, with short explanation.
.
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Rcc-al (6~73)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
HARRISBURG
17127
IN YOUR REPLY PLEASE
REFER TO
Inheritance Tax Division
NOTICE OF FILING or APPRAISEMENT
C.C.N.B
.21st and Market Street'
r.~mp J:r;"1 ' . Pen.na
(Executor or Administr;tor)
In Re: Estate of
Stephen B. Shover
Cumberland
County - File No.
21-78'-0016
Dear
You are hereby notified thot the Original
oppraisement in the estote of Stephen B. Shover'
has been filed in the office of the Register of Wills of Cnmhprl"ncl
County on 13, SePtember, 1978 , Said opproisement reflects the following
valuotions:
Reol Estate
Personal Property
T ran siers
Jointly Owned
Total
None
78,562.51
None
None
78.562.51
As to such tax that is paid within three months from date of death, a live (S%)
percent discount is allowable. As to any tax that remains unpaid after nine (9) months
(IHteen months when death occurred from December 22,1965 to June 16,1971, inclusive;
and twelv~ months 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 19,61, 72 P. S. 2485-1001, P. L. 37~,
Date 13 September 78 Signed ~a J( }Ik~
Chief Appraiser
Title
l-
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-.
Note: This is not a bi II.
R C C-2 12-64)
.~ "'.
COMMONWEALTH OF PENNSYLVANIA
RESIDENT INHERITANCE TAX
APPRAISEMENT
DATE
....-n,
~
L..-1.. -'\\3-t:Jolto
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
HARRISBURG, PENNA, 17127
COUNTY
FILE NO,
Whereas, S '\-~ \6. S ~late of C' -"'--" 0, ..;.. 0 It
in the County of C', ~ ~ Commonwealth of Pennsylvania, having died on
the \ L\ -Le- day of D JZ-<'" ~ 19:::LJ. seized and possessed of an estate
subject to Inheritance Tax under the laws of the Comrp.onwealth of Pennsylvania;
Therefore, I, \ I"\.....V-. C":> J) (\ '. - . 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 a1l annuities and life estates growing out of said estate, hereby file the f01l0wing 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 life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer
inheritance taxes at the lawful collateral rate on any such future Interest.
Description of Allel
Unit
Value.
Appral.ement
Made for Inheritance
Talt Purpo.e.
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$ ~0-L
1<6 SIo"l.. 5 l
N~
N~
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Having been duly sworn acc;o~o law, I do hereby C~y that the above appraisement is made in con,
formitywithlawonthis \.. day of ~ kAA__~' 1911fl.
Appraiser
\:~t~tnet)
(Pad Ofti:~
, Penna,
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