HomeMy WebLinkAbout05-04-78
.
j' RC.C~'3.; (4=-73) .~
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
RESIDENT DECEDENT
COUNTY OF
MAY 41S70
Cumberland
IMPORT ANT:
This return must be completed in detail and riled 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 Rc-v:cnue. (Section 703 of the Inheritance and Estate Tax A.ct of 1961,)
IN THE MATTER OF THE ESTATE OF
} AFFIDAVIT OF
EXECUTOR
~l!lll::
l
'~
Nellie A. Bousum
{STATE FULL NAME OF DECEDENT]
Late of
r.'1mhAj11 ~l"'I"
County
Stat. of Pennsyl vania
County of Cumberland
} 50:
Administrator
Harrx Fahnestock and Evelyn Fahnestock
, of tho esto.te of the above-named decedent being duly sworn, depose
Executor S
and SelY
DAP._ '?7.
(MONTH)
Name and address of attorney or }
other outhorh:ed representotive to whom
all correspondence should be moiled,
. .
.. .
[DAY)
, 19~ te~'o'e. leavl,ng 0 los, will, copy of which f. herelo ottoched..}
~RKlcM1i[ifsi{WC
Decedent died
J. Robert Staui'fer-Market Square Bldg.,
MAnhAnip.R~lrE, Penna. l70~~
That as such EYP."11t.{)~~ deponent i's familiar with the affairs of said estate ,and the'property consti"tuting
i EXECUTO R-ADMINISTRA TOR)
the assets thereof and their fair market value.
That at the time of death there w&s no safe deposit- box regis~ered in decedent',s individual name, or jointly with, or
as agent or. deputy of another, or in dec'edent's individual name, with right of access byanoth~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 SAFE DEPOSIT BOX IN NAME OR NAMES OF HOLDERS TO DECEDENT
NonA
That the contents of said safe deposit box or box~s are itemized under Schedules
with the exception'of the following, for the reasons hereinaf,ter 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 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 trust for any other person or persons
giving also separately the accrued interest thereon, if, any, down to the last interest day pri~"to decedent's
death in the case of savings banks, and to the date of decedent's death in all other case,s;' a},1 bOllds,postal
savings, treas~y cert~~i.~~t_es or notes and other evidence of indebtedness of the United Stat~s to the de-,_
cedent; all obligations, whether by. statute or agreement they are designated as tax free, of the' United States.,....\
or any state, or polftical subdivision th"ereof, or of any foreign country, which are owned at the time of d~llth~ i
all wearing apparel, jewelry, silverware, pictures, books, works of art, household furniture; horses,...;arria'8'esf: i
- ,. ^. '" . .... ~ '~', - ........:
automobiles, boats, and any and all other personal chattels of whatsoever, kind or nature,^...left by deceden:r;- .~.
......... v
together with the fairly,.estimated market value thereof; all bonds and mortgages held by decedent a'fid'o(:..all'
, ,........ . . ,- .-.
claims due and owing decedent at the time of death, and all 'promissory notes or other'instruments lh ~ritiitg
. ',....{w.~,..~
for the payment of money of which decedent died possessed" .of whats?ever 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 deprecia(ion. a.s to each. i~~m; a~l 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 decedept's
death and other investment securities owned by the decedent at the time of dea~h, with the-market value there-
of at such time. '~
/
In the case of securities of close or family 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 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, f'inancial statements showing the Assets and liabilities of said co-partnership or husiness.
A copy of the co-partnership agreement, (it oral, a statement setting forth the nature of tne agreement)
together with a statement setting forth the character of the business, its location, and such other facts
pertaining to the ~usiness as may be pertinent to a fair and just appraisal of the decedent1s 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 ease of transfers of property, real or personal, within two years of decedent' 8
death, in eontemplation of deeedentls 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 eo~y
of the deed, trust agreement or other instrument ereating the trust. TherA is also set forth in said
schedule a list of all property, real and personal, with its value, which pa6ses at decedentt, death by
virtue of the exltr.cise 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 instrument creating sueh power attached to the schedule.
That Sch~dule D 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 ot all minors, annuitants and beneficiaries for life under decedent's Will. It also
contains a statement showing whieh 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 E attached hereto and made a part hereof sets forth all property, real and per-
sonal, owned by the deeedent 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 decedent.
That SChedule F attaehed hereto and made a part hereof sets fbrth 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; eost expended for burial trusts, tombstones or gravemarkers, and reli-
gious services, in eonsequence of the death of the decedent; debts and elaims owing and unpaid at time of
death; taxes acerued ehargeable for period prior to decedent's death (exeept those allowed under Seetion
601 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 therewit~
That the totals of the appropriate columns in Schedules .A., .0., .e., .E., and .F- as directed therein,
have been carried forward and properly registered in the Summary.
Subscribed and sworn to before me this "."........"."...............
--------/.,%~dBl~=---------..l..--I~-
..........~.. ... .......... ..........i. ;;C!,..:.... ,,1Yc"".~~.t"~'..f'"bLiC
~ ;,""..".'_'.~~.,ti~j
, , , -.-,;','1'1
.:', '-_ .'.r.;.~ [i~;~. 23, 1919
~
f ()~
...............~........................................._...................._-----
......{iii~tOr- ]t.......a-..M1f)
......9..Q9.....Y:i.(3.::J.~....lrJ.!ls.!..~......B..2!:\.~.............
(Street Number)
.mm ..I~IE1.c:J::lll,I}.~c:,,9.~1I.:E.J..f.'!J,..~..:lI()5.2m.......
(CittI or Town 4M Sta.te)
NOTE: Before signing affidavit make sure all blank spaces in the aCfidavit and schedules annexed are
filled 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 1n 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.
~
. RC C_34 ~4'" 3)
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
TRANSFER INHERITANCE TAX
RESIDENT DECED~NT
SCHEDULE "A"
REAL PROPERTY
.
Real property in Pennsylvania, with statement of mortgoge encumbronces upon each parcel at death of dece-
dent. Property held by the decedent os tenant in common with another or other, should be identified
os to quontum of interesfand 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 Pennsylvonla should be
described by lot and block number, street and street number, together with
a general description of the property, with 0 reference to the record of the
conveyance by which the decedent took title; If a farm state number of a.
eres; also statement of mortgage encumbrances upon each parcel at death
of decedent. Taxes, assessments, accrued Interest on mortgages, ete.,are
'to he listed on Schedule uFIt and must not be d.educted from thls schedule.
(1)
(2)
(3\
DEPARTMENT
VALUATION
CAUTION
(Do not wrIte
In thl. .pace)
ASSESSED VALUE
FOR YEAR OF
DECEDENT'S
DEATN
ESTIMATED
MARKET VALUE
ALL THAT CERTAIN House and Lot of Ground
situate in the Borough of Mechanicsburg,
Cumberland County, Pennsylvania, bounded and
described as follows, to wit:
BEGINNING at a post on the building line of
West Locust Street at"corner of Lot now or
late of Nancy Bricker; thence by the building
line of said Locust Street, Westward 30 feet
to a point at corner of Lot now or formerly
of George F. Coble; thence by said Lot,
Southward 136.5 feet, more or less, to a
point at an alley; thence by said alley,
Eastward 30 feet, more or less, to a point at
corner of Lot now or late of Nancy Bricker,
aforesaid; thence by said Lot, Northward
133.7 feet, more or less, to a post on the
building line of said West Locust Street,
the place of BEGINNING.
HAVING thereon erected a two story frame
dwelling known and numbered as 15 We$t
Locust Street, Mechanicsburg, Pa.
Sold to Ray A. Brubaker and Maryann Brubaker,
his wife, for total consideration and selling
price of $18,500.00
R/l-T !3f\&-hP-l<kfl... Jb~l1
~
---
Il f) 1" p
I
18,500.00 ----U:SOO.OO
Insert this total opposite "reol property", Schedule "A" in the X X X X X
"As Reported" column on the last page of this return,
18,500,/00
18,500.00
/'
.
Rce ~35
RESIDENT DECEDENT
SCHEDULE "B"
PERSONAL PROPERTY
'*
COMMONWEALTH OF PENNSYLVANIA
T!WlSFER INHERITANCE TAX
INSTRUCTIONS, This Schedule must disclose an tangible end intangible personal property owned individue.Ily
by the decedent, at the time of his death. Property owned by the decedent jointly with another or others
must be listed under Schedule ftEft. Intangible personal property, titled In the name of the deoedent, but
payable at death to another or others, including but not limited to P.D.D. U. S. Savings Bonds and tent~
tive trust accounts, must be listed, despite the fact that they are not of the a(m~Jnistered estattli.
Tangible personal property should be listed first (e. g. jewelry, wearl~ "apparel, hougeho~d
goods, and furnishings, books, paintings, automobiles, boats, etc.)
Intangible personal property, such as bondS, treasury certificates, cash on hand and in bank,
stOCkS, mortg~ges, notes, together with accrued interest or dividends, salaries or wages, insurance pay-
able to the estate or fiduciary in said capacity, partnership interests, interest 1n anyundlstrlbuted
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 ESTIMATED DEPARTMENT VALUATION
VALUE MARKET VALUE .. (Do not write in
this space)
1
Proceeds of Checking Account No. 142-
108027-4 with The Commonwealth National
Bank, balance as of De~ember 27, 1977
(Date of Death)
119.52 yV
119.52
2
Proceeds from nublic sale of household
furnishings sold at Bricker's Auction
House, mexaco Road, Mechanicsburg, Pa.
Sale Sheets submitted herewith.
3 Household furnishings not sold at public
sale above and taken by decedent's
legatees in kind at valuation placed
thereon by "Chuck Bricker" Auctioneer,
who conducted public sale noted above
,
as follows:
./'
1898.60.....
1,898.60
Secretary Desk
Kitchen Cabinet
Rocker
Upright Freezer
Porch Swing
Set of Dishes
Set of Bedding
Air Conditioner
Coal Stove
75.00,...--
)0.00 "'v-
20.00."/
80.00.....---
5.00 ",---
10100 ~::::.-
25.00 ...
---
40.00'" .......
40.00 ...
75.00
30.00
20.00
80.00
5.00
10.00
25.00
40.00
40.00
4 Gas Stove and Refrigerator located in
decedent's residence and sold directl~
to Ray A. Brubaker and Maryann "J
Brubaker, his wife, purchasers of
decedent's real estate, as follows:
Gas Stove
Refrigerator
v-
80.00 """'v
)0.00 .....
80.00
30.00
.
Insert this total opposite "Personal Property", Schedule "B" 1n
the nAs Reported" column on the last page of this return.
x X
2453.12
2,453.12
,~
RCC-36
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
SCHEDULE "Cn
TRANSFEllS
.
RESIDENT DECEDENT
(1) Did decedent, within two years of'denth, make any transfer of any mater1al 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 is In the affirmative state:
(n) Age of decedent at time of transfer 1\Tf"IrJp.
(b) State of decedent's health at time of making the transfer. (Note 1).
(e) Cause of' decedent' 5 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)_....Na...-
(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? None
(5) Did decedent in his lifetime make any transf'er 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 f'act end 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 answer 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 transferee's promise to
pay income to or 1'0 r 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 aff'irmative, was the power to alter, amend, or revoke the inter-
est of the beneficiary reserved 1n the decedent alone or the decedent and others?
(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 cer1;ificate.
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
(Estimated)
DEPT. VALUATION
(Dept. Only)
None
None
None
Insert this total opposite "Transfers", Schedule "e" in the
"As Reported" column on the last page of this return.
None
RCC-37 (12-63)
COMMONWEALTH OF n:NNSYYLANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "0"
BENEFICIARIES
\
h
-
..:. . _. t RELATIONSHIP
BENEFICIARIES AND ADDRESSES (If step-children or SURVIVED DATE INTEREST OF
.State full names and addresseS of all who 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
T ""',.r,A'" " Bousum Son Yes One-sixth of Estate
206 West Harris burl>" St. ' :
Harrisburg, Pa.
Mildred M. GreeQ'or Daughter Yes One-sixth of Estate
-
Ridgewood Acres - R. D. 6
Cambridge, Ohio 43725
Kathryn H. lo/imberly Dau"hter, Yes One-sixth of Estate
'"
1<; ',-lest Locust St.
M""y",,,{ csbu"''' l70~~ ,
Pa.
Evelvn Fahnestock Daughter Yes One-sixth of Estate
QOQ West Trindle Road
Mechanicsburg, Pa. 17055
Clarence Bousum Son Yes One-sixth of Estate
lonn N"n1 ^~"^lm " ~
'04 rt-onmoC'n i>~ 1 ~.,nC
Charles M. Bousum. Jr. Son No One-sixth of Estate
Survived bv two children. t wit: Richa d M. Bou urn and Ma ie E. Bousum
R{f>ha,.,d M Bousum Grandson Yes One-twelfth of Estat
'>.1n r.h"1,,t- n,.,4""
r1i llersville Pa. 21108
Marie E. Bousum GranddaughteJ Yes One-twelfth of Estat
707 Hanover Court
Apt. D20l
Carlisle, Pa. 17013
. .
-.
,
.t
e
e
Deponent further says that all the above-named bene~iciarles are living at this time except below:
NAME
DATE OF DEATH
RESIDENCE
en t
thei
wi t: R. chard M
father's share
S. York St. Mechanicsbur
Bousurn and Marie E. Bousum
at one-twelfth share each for
Pa.
Charles M. Bousum
S i ed b two
listed above as
on
...
o .
-.,-
"<"'
b. c
.g... e
....... ='
e"-
.,,'all
< e.
.:oS;,
o "
'$t;t::
~ " 0
r:leg.
_ 0::
Real Property
Personal Property
Transfers
SUMMARY
(Sch. "A")
................................. ............. .........(SCh. "8")
............ ................ ........(SCh. "C")
JoinU)'..owne<j J'~O'pe!'tyJ:3<:h. ..uE.")
Gross Taxable Estate
(1)
(As Reported)
. 18.500.00
.. .2,4$3.12
0.00
0.')0
$
$...
$..
$.
$....
$ ..20,953.12
(2)
(As Determined)
$
$
$
$
$
$
,...
z J
a tIl
- " ..I
~ '" "
tIl ~ <
C/) <II
-
- <
~ .. IlC
"" lo. tlO' 'S llo
"" 0 ~ '0 .. llo
~ -< '" '<" ;:i c ..:: <
:: tIl ~ ;..
tIl i- ,... en .0 ct1 ~ Q
< I]J H c
.; ~ :t ... ::-.J " H " ~
0 ,... "
Z ,... C/) 0 "" <lJ ""
lo. tIl P"1 C .0 ~ i-
~ 0 Qj f, 0
. ~ ~ ..c: IlC
" p:; ~ " <5 - 0
0 -;; llo
:c tIl Q) .. ~
.. ~ P'1 H ~ ~
b .... IlC
H 0 C
~ -< H 0
'S ~ ;:.
>-1 0 E
= 'E ..-. f<l .. = E
;;;'0 - - <5
.< j 0
~< 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, ownerl by the rtecedent 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 Imeter Schedule
"A", plus the date and place of record of instrument effecting vestiture, but do not include entireties
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 decerlent.
XX>o-
X
Description of Property, Date of Acquisition, Name
Address and Relationship of Co-Owners, and Place
of Record of Instrument, where Real Estate.
5<> XX X X> :so <X :so (X
XX XX XX X5(60
)< >>:x
X X>
X>~
unit percentage Estate DEPARTMENT VALUATION
Value Share Valuation CAUTION-Do not Write
In This Space.
XX <> ~X5(~ Value of' Value of'
>> 0< Entire Deceden t t S
Y'> 0< <X XX property Interest
None None.
None
Insert this total opposite ~Jointly O~ned Property~, Schedule ffEff
in the" As Reported" colunm on the last page 01' this return. None
. ",
RCC-Bl 16-73)
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
HaJVuf Fahnu.tock
909 We6.t T~ndee Road
Mecho.n.i.C6buJt.g, Pa. 17055
(Executor or Administrator)
;
In Re: Estate of
Ne.tUe A. Bou.6wn
Cumb eJli.and
County - File Na.?1-78-nn?;
Dear
.
MIL. Fahnu.tock,
You are hereby notified that the OJtJ.fJiJ11li
appraise~ent in the estate of Ne.tUe A. Bou.6wn
has been filed in the office of the Register of Wills of CwnbMl.nad
County an Jul.LI 3. ,19-11..', Said appraisement reflects the fallowing
valuations:
Real Estate
Personal Property
Transfers
Jointly Owned
Total
18.500.00
2,453.12
None
None
$20,953.12
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, inclu.sive;
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 who is aggrieved by this notice may abject 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.
2lAtZ- _ j(. JJ~~
Jul.LI 3. 1978
Si gned
Date
Title CHIEF APPRAISER
.t!-
---......
Nate: This is not a bi II.
RCC-212-64)
, lulu 3. 1978
. .. " COMMONWEALTH OF PENNSYLVANIA DATE
DEPARTMENT OF REVENUE RESIDENT INHERITANCE TAX COUNTY Cwnbetzland
BUREAU OF COUNTY COLLECTIONS
HARRISBURG, PENNA, 17127 APPRAISEMENT FILE NO. 21-78-0025
Whereas, NetUe A. BoU6um late of MecJta.n,{,co bWtg
in the County of Cumbetzland Commonwealth of Pennsylvania, having died on
the 27:th day of Vec.embeJt 19-1L, seized and possessed of an estate
subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania;
Therefore, I, .1Jrn r Gfoim . 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 1s transferred In possession or enjoyment to collateral heirs of the decedent 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 lnter~st.
Unit Appraisement
Descrlpllon of Anot Values Mada for Inheritance
Tax Purposes
REal PlWveM:u $ 18,500 00
n. .. 2 453 12
'. !o.w: .lfe&d PltOpeM:u Non(
r"n",^ '0"10. Non(
TOTAL ASSETS $ 20.95 12
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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 3Jr.d . day of 1 ulu ~ .-hi J1,. . 19-.Z!..
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Appraiser
(""mbc!r and Strttt)
Hll/l.IlM, b Wtq , Penna.
(POIt 0ftlC!e)
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