HomeMy WebLinkAbout04-26-78
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, APR ~ 6 1978
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
Rcc..a3 (443)
RESIDENT DECEDENT
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'otenue. (Section 703 of the Inheritance and Estate Tax Act of 1961.)
Late of
Cumberland
} AFFIDAVIT OF
mlM~NRC
ADMINISTRATOR
C.T.A.
IN THE MATTER OF THE ESTATE OF
MICHAEL C. SEMAN AlK/A MICHAEL C. SEMYAN
(STATE FUl.l. NA.ME OF DECEDENTl
County
State of
Pennsylvania
) 55,
Cumberland
Cecilia J. Semyan
Administrator C T .A. . . ~. .. ,
. . of the estate of the abave.named dec:edent being duly sworn, depose S
County of
~
and sayS
Decedent died January
(MONTH)
Name and address of attorney or }
other authorized representative to whom
all c:orrespondenc:e should be mailed.
2
, 19~{testate leaving a last will, c:opy of which is hereto attached..}
lYEAR) ~*'~
(DAYl
Snelbaker, McCa.leb & Elicker
~~ West Main Street, Mechanicsbur~. Pennsvlvania
That as such Administrator C d~ent is familiar with the affairs of said estate and the property constituting
(EXECU TOR~ADMINI ST RA. TOR)
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 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 REl.ATIONSHIP OF JOINT
IN WHICH DECEDENT RENTED A S.J,FE DEPOSIT BOX IN NAME OR NAMES OF HOLDERS TO DECEDENT
r.r.NR RANK N A Decedent and Debra Granddaughter
Windsor Park Office Mihalich TIon,,1-u
5288 Simpson Ferrv Road
Mechanicsburl!:. Pennsylvania
That the contents of said safe deposit box or boxes are itemized under Schedules B
with the exception>of the following, for the reasons hereinafter set forth:
of this return, .
That Schedule A attached hereto and made part hereof sets forth fu'lly 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 person~},'p.r?~~rfY . .:,,' ......
wheresover situated owned by the decedent at the time of death; all moneys left by the decedent ar'th~~tlm~:6r:""'.... ...:y.,.
.death, whether in decedent's immediate possession, standing to decedent's credit in banks of dep.tsit~..s.a~i-rii~~~~~.,~'
banks, trust companies, or other instituti~ns, -whether individually, or in trust for any other pers'bn:"0;4iersons ~:'i.:? ~
. ~ ,""-. ~ - ~" - '" ~...
giving also separately the accrued interest thereon, if any, down to the last interest day prior:to_decedent'sl c; ::;:.::
death in the case of savings banks, and to the date of decedent's death in all other cases; all~b~d-~'" postal v/.'";'t j
savings, t.teasury certincates -or notes -and other evidence of indebtedness of the United States t6,~;h12d.e.,,:-::.-~....c~'C~l
, " ,-;.",~. ...,." ~,
cedent; all obligations, whether by statute or agreement they are designated as tax free, of the United 81ates-:;-:',\ \~..,
or any state, 'Or political subdi'Vision thereof, or of any foreign country, which are owned at the time ~f'tl~~.th;,~""."~~-
all wearing apparel, jewelry,. si~ver~.are,- p!ctures, books, works of art, household furniture, horses, carriages,
automobiles, boats, and any and all other personal chattels of whatsoever, kind or nature, left by decedent,
together with the fairly;estimated market value thereof; all bonds and mortgages held by decedent and'of all
claims due and owing decedent at ~he 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; all 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 of death, bonds and accrued interest thereon to the date of decedent's
death and other investment secur;ties owned by the decedent at the time of death, with the.market value there~
of at such time.
"1.- \ _'I B - 0 0 .... "1
\0 - \'3:;-1
.
.
...
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, 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 toe agreement)
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 f'orth in itemized form, together with the fair market value
thereof, an)' other propert;y owned or bequeathed by the decedent at the time of death.
The Scnedule C attached hereto and mad~ 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 erf'ect in possession or enjoyment at or
after death, said schedule sets forth the nature and value of such property, to whom transf'erred, 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 decedent1s death by
virtue of the exercise by decedent, either individually, or jointly with another, or any power of appoint-
ment vested in decedent, ei ther individually or jointly, by the will, deed, or other instrument of another,
with a copy of the instrument creating such power attached to the schedule.
That Scnedule 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 of all minors, annuitants and beneficiaries for lire under decedent' s Will. It also
contains a statement showing which of' the beneficiaries n8Dled 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 S~nedule 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 ef'fecting 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 Scnedule F attached hereto and made a part hereof' sets forth fully and in detail all debts
and deduction~ 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 fUdiclary's
commissions paid or to be paid; 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 for period prior to decedent'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 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", liB", lIell, "E", and "F" as directed therein,
~ave been.carrled forward and properly registered in the Summary.
- ~ ~
............._/..f. ..
.............c?~~
.. day of. .... .~..m.m 19.....?.~
.<f:.~..m._m.
e~:E.....:...................L~.... ._.......~_._-
( dmi. .T.A.
. lOlL Lane.as. _..B.o.ul.e.v. .................
( Street Number)
~li!IOl:J:"l.I1.:i.IO.!'.:!:l.L.lF.g......P.A.....J.].Q?? m........
(City or Town 11M S_)
..-Subse.ribe<EAna sworn to before me this
CATH-\~I~::: E. G-~USU~,~, r:orr\RY PUBLIC
f"ECfil" iCS3URG BORO'JGH
CU~,:BiRlAND COUNTY
"' rnMMISSlnN EXPIRES FEa 27 1982
NOTE: Before signing affIaavtt make sure all blank spaces in the affidavit and schedules annexed are
filled in with details or the worrl "None", anrl 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 "B" are attached. Also make
certain that column #1 in the "Summary" has been properly completed as above-directed.
Rcc-34:;:14-73)
COMMONW~AL TH OF PENNSYLVANIA
DEJi'AilTMENT OF REVENUE
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 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 real property located In the Commonwealth of Pennsylvania should be (1) (2) (3)
described by lot and bloc.k number, street and sireet number, together with - DEPARTMENT
o general description of the property, with a reference to the record of the ASSESSED VALUE VALUA TION
conveyonee by which the decedent took title; If a farm state number of a. FOR 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, ete.,are DEATH In thl. spaco)
to be Ilsted on Schedule uFJt and must not" be deducted from this schedule.
NONE NONE
,
Insert this totol opposite "reol property", Schedule "A" in the X X X X X
"As Reported" column on the .Iost poge of this return.
NONE
Rce -~:;
~'.
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "B"
PERSONAL PROPERTY
'*
INSTRUCTIONS: This Schedule must disclose aU 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 11&ted under Schedule nE". Intangible pe:rsonal property, titled 1n the name of the decedent, but
payable at death to another or others, including but not limited to P.O.D. U. S. Savings Bonds and tenta-
tive trust accounts, must be listed, despite the fact that they are not of the administered estate.
Tangible pers~nal 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 hand and 1n 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 anyundistributed
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 1n this schedule~
Item
No.
ITEM
List and describe fully
UNIT
VALUE
ESTIMATED
MARKET VALUE
DEPARTIlENT VALUATION
(Do not write in
this space)
1.
Checking Account No. 150-0865-9, CCNB Bank,
N.A.
/
$3,260.94- V'
.3,,}W. 9:45.
2.
Pension check dated December 30, 1977,
Crucible, Inc.
./
34-6.94- V
346.94
3.
Death benefit: Colt Industries Crucible, Inc.
".
1,4-00.00 V
,.
4-.66 v'
1,400.00
4.66
4-.
Refund on safe deposit box, CCNB Bank, N.A.
.
Insert this total opposite "Personal Property", Schedule "Bn in
the "As Reported" column on the last page of this return.
.
X X $5,012.54-
$
5,012.54
RCC_C'36
~
COMMONWEI'.LTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
SCHEDULE "c"
TRANSFERS
.....
. . ""'. i\
.1>', . .
RESIDE,T DECEDENT
(1) Did decedent, within two years of death, make any transfer of any material.part.n.f his estate, without
receiving a valuable and adequate consideration therefor? (Answer yes or no) NO
(2) Did decedent, within two yesrs of desth, trsnsfer property from himself to himself snd snother or
others (inclmUng 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
(b) State of decedent's health 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 no) 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)
(b) What was the. transferee's age at time of de~edent'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 fn.ct 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 af'firmative, state whether the right was reserved i~ decedent
alone or others
(7) Did decedent in his lifetime make a transfer, the consideration for which was transfereels 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 rlecedent 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 al tel', amend, or revoke the inter-
est of the beneficiary reserved in the decedent alone or the decedent and others?
(Answer yes or no)
NOTE 1: The answers to these questions should be supporterl 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 Urns ted)
DEPT. VALUATION
(Dept. Only)
NONE
NOne.
Insert this total opposite "Transfers", Schedule "e" in the
"As Reported" colunm on the last page of this return.
None.
RCC-3? (12-63)
COM~U)NWEALTH OF PENNSYYLANIA
TRAN"SFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "D"
*~
.,.
BENEFiCIARIES' -
-..
.......-...
":.,
(
h
BENEFICIARIES AND ADDRESSES .RELA TIONSHIP SURVIVED DATE
(If step-children or 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 BIRTH
Michael James Semyan Son Yes Entire residu'e
108 Lancaster Boulevard "
Mechanicsburg; PA . , " .. ~. . - '.'
. - .
.
"
,
J ,
,
Deponent further says that all the above-named beneficiaries are living at this time except below:
NAME
DATE OF DEATH
RESIDENCE
'".
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o .
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b. "
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SUMMARY
....(Sch. "A")
.....(Sch. .B")
...(Sch. .C")
Real Property .
Personal Property
Transfers
Gross Taxable Estate
(2)
(As Determined)
(1 )
(As Reported)
$...
$...
$..
$...
$...
$.....
$
$.
$
$
$ .
$
!-o J
z
~ til .. o.l
'" :::a " <
;>< til ! '"
en -
.... <
-< " Il&
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"" 0 " 110
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~ til ...
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til c
~ :I: ... -< c ~
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Z !-o en ""
I:. til ~ !-o
---- 0 0 Il&
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0 -;;
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== 's '" c E
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.~ "tl j 0 0
:::< U U
,
"RCC-38
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 decedent jointly
with 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 under Schedule
"Aft, plus the date and place of record of instrument effecting vestiture, but 00 not include entireties
or out of state real estate value in estate valuation column. Personal prcperty 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 Acquls1tiQn, Name unit percentage Estate DEPARTMENT VALUATION
Address and Relationship of Co-Owners, and Place Value Sh are Valuation CAUTION-Do not Write
of Record of Instrwnent, where Real Estate. In This Space.
~ "^ <<~ Xx" ><X <<<< '^ Value of Value of
0< << <<X ~ X>< X << I?~ I?%%~ Entire Decedent's
X X>< X ><X ~ X property Interest
()('
1. Savings Certificate No. ~203, Account
No. 2-9-50~203, First Federal
Savings and Loan Association, issued
6/4/72 to Michael C. Seman (decedent
herein) or Michael J. Semyan (son), ~
balance on date of death: $20,909.86
wi th accrued interest of $6. 85 ~.
One-half taxable
10,45~.9
./"
/'
10,454.93
3.43
Accrued interest
3.4
2.
Savings Account No. 015-704835-6,~
CCNB Bank, N.A., opened July 1975
in the joint names of Michael Seman
(decedent herein) or Debra Mihalich
(granddaughter), ~nce on date of
death: $11,857.82 wi~h accrued
interest of $9.99~ .
One-half taxable
5,928.9
/
/
5,928.91
5.00
Accrued interest
5.0
TOTAL
$ 16,392.2
$
16,392.2
Insert this total opposite "Jointly Owned Property", Schedule "E"
in the "As Reported" colWtDl on the last page of this return.
.
~
RCC-81 16-73)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
HARRISBURG
17127
IN YOUR REPLY PLEASE
REFER TO
Inheritanc:e Tax Division
NOTICE OF FILING or APPRAISEMENT
. Cecili.a. J. Seman
5288S~&on F~y Rd.
Mec.han..ic6 bU/l.g, Pa..
(Executor or Administrator)
In Re: Estate af
lU.c.ha.et C. Seman
Cwnbe/l.ta.nd Caunty - File Na. 21-78~0027
Dear M6. . Shnp&on,
You are hereby noti/ied that the 04i.a..tnal
appraisement in the estote af. M.<.cha.et C. Seman
hos been filed in the office af the Register of Wills of Cwnb"JrLmd
Cauntyon June 15. , 19~, Said appraisement reflects the following
voluations:
Reol Estate
Personal Property
Transfers
Jointly Owned
Total $
None
5,012.54
None
16.392.27
21.404.81
As to such tax that is paid within three months from date of death, a five (5%)
percent discount is ollowable. 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 rote of six (6%) percent per annum is charged.
Any party in interest who is aggrieved by this notice may object thereto within
sixty doys after receipt of soid notice os provided by Section 1001 of the Inheritance and
Estate Tax Act of 1961, 72.P. S. 2485.1001, P. L.~ .' ,
Dote June 15, 1978 Signed c: ,{{~ X. ~
Title
CHIEF APPRAISER
Note: This is not a bill.
RC C-2 12-64) 1978
COMMONWEALTH OF PENNSYLVANIA DATE June 15,
,
c DEPA'RTMENT OF REVENUE RESIDENT INHERITANCE TAX rumbvl!Ptmd
~uREAU OF COUNTY COLLECTIONS COUNTY
HARRISBURG, PENNA, 17127 APPRAISEMENT FILE NO. 21-78-0027
Whereas, M.i.c.ha.el C. S e.man late of Mec.hCl/u.C6 bUll.Q
in the County of CwnbeJLia.n.d Commonwealth of Pennsylvania, having died on
the 2nd day of Ja.nu.aJl.lJ 191L, seized and possessed of an estate
subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania;
Therefore, I, 1M. K. Gfvim . 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 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 colla.teral rate on any such future interest.
,
Unit A5151ral~ement
Delcrl51tlon of Auet Values Made for Inharltance
Tall. Pur5101eS
Real PJlO-."+;' $ NOne
PeM 0 rr.a.i PM 5 012 54
Jo).n;(; Held PliO 16 392 27
T ItM6 ~ eM None
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,
Having been duly sworn according to law, I do here by certify that the above appraisement is made in con-
formity with law on this 15tit day of ]~ ~' 19.2L.
~A.._ 1<. '/
Appraiser
(In.Imber and Stnet)
HaJrJri.6 buJr.g
(Poet OftIee)
. Penna.
,
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