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RCC.33 (4.73)
CQMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECtiONS
RESIDENT DECEDENT
. COUNTY OF. CUMBERLAND
IMPORT ANT,
This return must be completed in detail and filed in duplicate, with all attachcd,..with the Register of Wills of the
County where decedent resided; Return is due withi':l nine months after d.atc of.death, unless an extension is granted
by the Secretary of R'cqenue. (Section 703 of the, Inheritance and Estate Tax Act of 1961.):
Late of
Cl.mIberland
Pennsylvania
,".J
EXECUTOR
IN THE MATTER OF THE ESTATE OF
AFFIDA VIT OF
ETHEL M. SIDESINGER
(STATE FULL NAME OF DECEDENT)
ADMINISTRATOR
County of
Cl.mIberland.
Dorothv F. Gleim. dam!hter
} '"
State of
~
~:JIOOW
of the estate of the aboveoname"d decedent being duly lOwor.", depose
,and say,
(MONTH)
Nome and address of attorney or }
other authorized repres.entotlve fa whom
011 correspondence should be mCiiled.
[DAY)
19~{testat~ le.avf~9 a last wil'l, co~y of'~hi~h is her~to atta'~hed.,}
(y EARl intestate
. ."
Decedent died
October
18
BietAch & Morgenthal (Tom H_ Hip-tAch)
7 Irvine Row. Carlisle; Pa. 17013!
That as such Daughter deponent is familiar with the affair$ of said estate and the property constituting
(EXECUTOR-ADMINISTRATOR) ..
the assets thereof and thcir fair market value.
That at the time of de'ath there was rlO saf'e deposit'b~x 'registe.r,ed i~ dece~ent's individual name, or jointly wi.th, or
as agent or .deputy of ano'ther, or in decedent's individua(name, with, right of.access by anoth~r.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 S.....FE DEPOSIT BOX IN NAME oR: NAMES OF HOLDERS TO DECEDENT
.
NONE . .
.. . .
.
That the contents of said safe deposit box or boxes are ite~ized under Schedules
with the exception'of the following, for the reasons hereinafter set forth.:
0[' this return,
That Schedule A attached .hereto and .m~de part hereof setsforth fully and 'in detail a.ll the real property
in the Commonwealth of Pennsylvania of which decedent died h-~ving an 'interest there-~~. It also sets f~)fth "the
mortgage encumbrances upon each parcel of real property at' thc_ dat~ of death, g~ving the amount still.due at
death,' nam-e' of mortgagee, date, rate. of inter<?st? and boo~ and page of reco'rd th.ereof. I~ ~lso 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 8 attached hereto and made part hereof se.ts fnrthfully anq In detail all persunal property
wheresover situated owned by the decedent at the. time of de.ath; all mon~ys left by the dece.dent a't .th~ time of,
. . ~,~.,,4."'''''.' .
death, whether in decedent's immediate possession, standing to decedent's credit in banks of deposit, saving~s~'''",.
banks, trust companies, or other institutions, whether individually, or in trust. for ~ny other .p~,l'k~~:~~t?'~~S~~,J;~~...
giving also separately the accrued interest thereon, if any, down to the last interest day p~icrrJ.,to~ecedentj~,..~~,
death in the case of savings banks, and to the date of decedent's death in all other casesiJ"al-l~b;mds, postal;". ~ ~
savings, treasur.y~ certificates.or notes and other eviden~e~- ~f indebtedness of the United tS'&t~t' to (h~ de..;:";- "" ~
. ~ ..... - ~. ""'- .. : ~i'?, ,.... ~ '<- ~
cedent; all obUgati,oQ,s, w.h~Hler by stat1.).t~ or agreement they are designated as tax free, of tpe Upg((d States,:- .~~..
_: .' '.1 oJ ,J'. :" f' ,,,,-.,,, , - J "',,1, '1'#)"" V--'-
or any state, or pori tical subdivision thereof, or of any foreign country, which are owned at th_eyt'ime "or..death';'~, i
all \vearing apparel,. jew~lry, silv~r.ware, pictures, books, works of art, household furniture, ho;;':sf c~~rri~g~s~ t: -~..."
;,_ ._ .. t _' . -, ~' ... - , .,'/i, . ',"
automobiles, boats, and any and all other personal chattels of whatsoever. kind or nature, left by:"d'ec'edent:
together with the 'fairly; estimated market value thereof; all bonds and mortgages held by decedent and'of all
claims due and owing decedent at the time of ~eath, and ait'promissory notes or ot~e"-'instruf!le'nts in writing
for the payment of money of which decedent died possessed, or' whatsoever nature, with inte'iest thereon', if
any, giving the face v'alue and estimated fair market value thereof, and if suchestim'ated fa,j.r, market va.loe be
less than the face value, it sets forth briefly the reas~ns for. su.ch depreciatio~', as to e.ach,item; ail m<;>neys'
payable to the estate from life insurance policies carried by decedent.; all annuity and e~dowment contracts
'the proceeds of which were payable upon the death of the decedent; all and the corporate stocks and. dividends
due thereon and unpaid as of the date of death, bonds and accrued interes t thereon to the date of decedent's
death and other investment secmities owned by the decedent at the time of death, with the.market value there-
of a t such time.
'.
In the case of seourities of olose or family corporations, the values reported are as far as
possible substantiated by f'inanctal statements of the corporations, showing the assets and liabilities
thereof 88 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 f'orth the nature of Uie agreement)
together with a statement 81~ttlng 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 co~y
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 instrument of' another,
with a copy of the in8tr~nt creat{ng 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 min(tJ"s, annuitants and benef'iciaries 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 Schedule € 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 eo-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 consequenc:e 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 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 assessed can be reassessed in accordance therewith.
That the totals of the appropriate columns in Schedules -A-, "B., .C., "E", and "F" as directed therein,
have been carried forward and properly registered In the Summary.
Subscribed and sworn to before me this ..,....,............,..,..._...
1=..._.......,::0.]...~~". i.' day o~ \;_'~ fA)!JJ.Y' "~', ... 19...Z.7... .it.P::?.&1.ifit/l....!i..::.t..e...::~L,_..
~~,Q.:.:~c,u,. \-. \ (\o_~~~ ~/ '".... ...... .?Q?~Q-=1;n:.;....;,~~-:.-~....................__,__.
~ J.,~~;,Eb;;1 ~:,~;~~fy NO ~~:~~I :Up~~1 cllft.~.~~~~~~:;.r;;.~t..I.'.~~1.?.Q~~....
My Commission ExpireS January 27, 10)79 (City or Tow" "nd StaU)
NOTE: Bef'ore signing affidavit make sure all blank spaces in the arfidavit and schedules annexed are
ftlled in with details or the word "None., 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 WB" are attached. Also make
certain that column *1 in th,~ "SWlIDary. has been properly completed as above-directed.
Rcc~3414~73)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
TRANSFER INHERITANCE TAX
RESIDENT DECf:DENT
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 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 IOCGhtd In the Commonwealth of Pennsylvonla 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 a reference to the record of the ASSESSED VALUE VALUATION
conveyance by which "the decedent took title; If a farm state number of 0- FOR YEAR OF ESTIMA TED 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 IIFu and must not be d_educted from this schedule.
None NONE
."
,
.
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
'Rce ~35'
RESIDENT DECEDENT
SCHEDULE "B"
PERSONAL PROPERTY
.
CO~WONWEALTH 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 li~ted under Schedule "En. Intangible p~rsonal property, titled 1n the name of the decedent, but
payable at death to another or others, including but not limited to PIO.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, househo~d
goods, and furnishings, books, paintings, automobiles, boats, etc.)
Intangible personal property, such as bonds, treasury certificates, cash on haitd 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 ITEM UNIT ESTIMATED DEPARTMENT VALUATION
No. List and describe fully VALUE MARKE:r VALUE (Do not write in
this space)
$389.08 ./ /'
1. Camp Hill Nursing and Convalescent $389.08
Center refund.
.
Insert this total opposite "Personal Property", Schedul e "8" in X X .$389.08 $389.08
the "As Reported" column on the last page of this return.
RCC - 36
COMMONWEALTH OF PENNSYLVANIA
TRANS"~R INHERITANCE TAX
SCHEDULE "c"
TRANSFERS
*~
RESIDENT DECEDENT
(1) Did decedent, within two years of'death, make any transfer of,any material part of' his estate, without
receiving a valuable and adequate consideration 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) in joint ownership? (Answer yes or no) No..
(3) If the answer to (1) or (2) above 15 in the affirmative state:
(8.) Age of decedent at time of transfer
(b) State of decedent' 5 heal th at time of making the transt"er. (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 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) Nn_
(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 end before his death:
(a) The possession or enjoyment of or the right to income from tht' 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 answer to (5) (b) above is in the affirmative, state whether the right was reserved in decedent
alone or others N/A
(7) Did decedent in his lifetime make a transfer, the consideration for which was transferee's promise to
pay income to or for the benefit of care of transferor? (Answer yes or no) No.
(8) Did decedent, at any time, transfer property, the beneficial enjoyment of which was subject to change,
because of a reserved power to alter, amend, or revoke, or which 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 inter-
est of the beneficiary reserved in the decedent alone or the decedent and others?
(Answer yes or no) N1A.
NOTE 1: The anSwers to these questions should be supported by affidavit by the attending physician as
well as a copy of the death certificate.
NOTE 2: If answer to any of the above questions is yes, set forth below a description of the property
transferred, it's fair market value at date of death, dates of transfers and to whom transferred, with
relationship of transferees to decedent, if any. Submit copy of any trust deed or instrument, if trans-
fers are claimed to be non-taxable, also submit detailed statement of facts on Which said claim is based.
NOTE 3: List applicable property below in manner in which provided in Schedules A, B, or E.
ITEM
DESCRIPTION
MARKET VALUE
(Es tima ted)
DEPT. VALUATION
(Dept. Only)
None
NONE
Insert this total opposite ftTransfersft, Schedule "eft in the
"As Reportedft colunm on t.he last -page of' this return.
None
"
'RCC-37 (12-6)\
COMMONWEALTH 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 who illegitimate children DECEDENT OF BENEFICIARY
aye an intere~t. vested.. co~tingent or other are involved. set STATE YES IN ESTATE
~ wise, in estate) forth this fact,) OR NO BIRTH
- ,
DorothvF. : Gleim
202 Chestnut Street t'.' - '.\ .. ,
. . ..
Mt. Hollv . SDrinl'!s,. Pa. .' Daul'!hter Yes . .- Entire Estate
. ...
.
,
-
.
,
.
.
Deponent further says that all the above-named beneficiaries are living at this time except below:
NAME
DATE OF DEATH
RESIDENCE
"
~ "":'
~<..
.. ..
..
~ - ~
..-
.- ..
.s Q:) =
Ea,o
"'au
"!= ",
~Col'E
~~t:
~~8.
r;1a&j
SUMMARY
...(Sch. "A")
..(Sch. "B")
...(Sch. "C")
J.~.l1,~...'~.~.".J
Real Property .................................
Personal Property ............................,..... ................ .
Transfers ........... ............................ ....................
'! ()~nt;~ Y. ..~43<i. .I?r.()~:r:::t,y
Gross Taxable Estate
(I)
(As Reported)
$ ...N()n~
$3!3!:l ~..()?..
$.....~(ml;!.
$..?:3...1..4:Ei..41..
$.................
.... $2.:3...S~.5..A~...
(2)
(As Determined)
$None
$ ... ...]89.08
$None..
$ 23, 146.41
$.....
$23,535.49
.-
~ J
z
lil til ... ..l
.. ~ ..
>< til a:~ <
'"
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... <
~ r<l
~. " llII
fo. 'S ..
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0 ~ ::I: .. -< Q = ~
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--- 0 . 0 llII
~ -=
= II: - 0
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b 0 =
.~ -< ~ .c. 0
= ::::; Tzl 0 E
= 'E .. E E
- 15
.- ." j 0
::;.-r. u u
RCC-3B
RESIDENT DECEDENT
SCHEDULE "E"
JOINTLY OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
INSTRUCTIONS: This schedule must disclose all property, real and personal, owned by the rlecedent jointly
wi th 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 elate and place of record of instrwnent eff'ecting vest! tu~e, 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 decerlent.
Description of Property, Date of' AcquisitiQn, Name unit percentage Estate
Address and Relationship of Co-Owners, and Place Value Share Valuation
of Record of Instrument, where Real Estate.
DEPARTMENT VALUATION
CAUTION-Do not Write
In This Space.
<< XX
X
y Y'x (Y' X
<< :&: 3& X
:9;: X
:88 X
~xx:~~)O<)O<
Value of
Entire
Property
Value of
Decedent's
Interest
X X X
~ :xx )0< X
"'^
1. Savings Account No. 18-0010438-0,
Commonwealth National Bank, Carlisle,
Pa. registered in the name of decedetl t
and Dorothy F. Gleim, her su rviving
daughter, as joint tenants with the
right of survivorship; and havi~_ a
principal balance of $20,89~.02 with
accrued interest of $56.75vfor a
total of $20,952.77.
~. Savings Certificate No. 6686274,
Cumberland Valley Savings And Loan
Association, Carlisle, Pa., regis-
tered in the name of decedent and
Dorothy F. Gleim, her surviving
daughter, as joint tenants with the
right of survivorship, and having
a principal balance of $20,000.00 ~
with accrued interest of $392.93,~
for a total of $20,392.93. "
-
3\. Checking Account No. 781-6896-0""'-
CCNB BANK, N.A., Mount Holly Springs
Pa.., registered in the name of de-
cedent and Dorothy F. Gleim, her
surviving daughter, as joint tenants
with the right of survivorship, and
having a balance of $4,947.08.~
50'7,
lO,476.fl-0 /
$10,476.40
(
./
50'70
10,196.~7 ~.
$10,196.47
50'7d
/
2,473.54
2,473.54
TOTAL
23,146.4~
Insert this total opposite "Jointly Owned Property", Schedule ftE"
in the" As Reported" column on the last page of this return.
$23,146.41
RCC-Bl (6-73)
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
HAR RISBU RG
17127
IN YOUR REPLY PLEASE
REFER TO
Inheritance Tax Division
NOTICE OF FILING or APPRAISEMENT
Dorothy S. Gleim
202 Chestnut Street
Mt. HollV Springs, PRo 17065
(Executor or Administrator)
In Re: Estate of Fth"l M. Sin"Ri nger
Cumberland County - File No.
21-78-0023
Dear Mrs. Gleim:
You are hereby notified thot the erigin21
appraisement in the estate of Ethel r~. Sid8s1nger
has been filed in the office af the Register of Wills of r:llmh"T'l ",nn
County on M"'rr.h ?O ,1928-, Said appraisement reflects the following
valuations:
Real Estate
Personal Property
T ronsfers
Jointly Owned
Total
f\lnnp.
it 3R9.nR
None
~23,146.41
~23.535.49
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 twelve 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 wha is aggrieved by this notice may obiect 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. 373.
Date M"'rr.h 20, 1978 Signed ~ A - Jr(, ~
Ti~e Chief ApprRisRr
~~.
Note: This is not a bill.
\
~
RCC-2 (2-64)
, March 20 1978
COMMONWEALTH OF PENNSYLVANIA DATE
DEPARTMENT OF REVENUE RESIDENT INHERITANCE TAX ......-.... " -'
BUREAU OF COUNTY COLLECTIONS COUNTY
HARRISBURG, PENNA, 17127 APPRAISEMENT FILE NO. '>1_7A_nn'>,
Whereas, Ethp.l M. Sidesinr;ler late of Camp Hill
in the County of r.llmhj:l,.l Rnrl Commonwealth of Pennsylvania, having died on
, October 1977 , seized and possessed of an estat.e
the 1f\th day of
subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania;
Therefore, I, TT':::l fl. r:l",i m . 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 CommonW'ealth hereby expressly reserves the right to appraise and assess transfer
inheritance taxes at the lawful collateral rate on any such future Interest,
Unit Apllrailement
Oelcrllltlon of Allet Values Made for Inheritance
1811. Purposel
REAL PROPFRTY NONE $ NmlE
,
PERSONAL PROPERTY . ~ 389.08 389 08
. NONE
TRANSFERS NONE
JOINT-HELD PROPERTY $23.146.41 23,14E 41
TOTAL ESTATE Sl23 535.49 $23,53' 49
- -- - - . .- ... --------
-
.----
-
. -
.
, -
- - .
"--.
Having been duly sworn according to law, I do hereby certify that the above appraisement. Is made in con.
formlty with law on this 70th day of M"T'r.h ~ )f.. .-J.i~ 19...1fL. .
Apprat8l!r
(mJmbef and Stnet)
. Harrisburo Penna.
.
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