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HomeMy WebLinkAbout10-30-78 COMMONWEAL TH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS *' RCC-33 14-73) RESIDENT DECEDENT 'C1 ~ (" \:71tOUNTY OFumberland 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 Rellenue. (Section 703 of the Inheritance and Estate Tax Act of 1961.) Late af Cumberland } AFFIDAV1T OF EXECUTOR ~ IN THE MATTER OF THE ESTATE OF H"l"n M R"nt'ln"" (STATE FULL. NAME OF DECEDENT) Caunty State af Pennsylvania } 51: Caunty af Cumberland Edward S. Sandnes Executor ~HllWit{x of the estate of the obove..nomed decedent being duly sworn, depos~ and .oy S Decedent dieJktober 16 (MONTH) (DAY) Name and addre.s of attorney or } other authorized repres,entative to whom all correspondence should be moiled. 19~{testate leaving a lost will, copy of which I. hereto attache~. } ( YEA R) ilUiJaKIi Stone, Sajer & Stewart 310 Bridge St., New Cumberland, Pa. 17070 That as such Executor deponent is familiar with the affairs of said estate and the property constituting (EX ECUTO R-ADMINIST RA TO R) 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 RELATIONSHIP OF JOINT IN WHl CH DECEDENT RENTED A S....FE DEPOSI T BOX IN NAME OR NAMES OF HOLDERS TO DECEDENT That the contents of said safe deposit box or boxes are itemized under Schedules 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 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 priIDr to decedent's death in the case of savings banks, and to the date of decedent's death in all other cases; all bonds, postal savings, treasury certificates or notes and other evidence of indebtedness of the United States 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 political subdiv'ision thereof, or of any foreign country, which are owned at the time of death; all wearing apparel, jewelry, silverware, pictures, 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 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; 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 seCUfll;CS owned by the decedent at the time of death, with the market value there- of at such time. RC C~34 (4..73) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT 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 tenantjn 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) (31 described by lot and black 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 a. FOR YEAR OF ESTlMA TED CAUTION cres; also statement of mortgage encumbrances upon each parcel at d.ath DECEDENT'S MARKET VALUE (Do not write of decedent. Taxes, assessments, accrued Int.r..t on mortgage., .tc.,ar. DEATH In this spac.) to be listed on Schedule uF" and must not b. deducted from this schedule. 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. RCC- 36 COMMONWEALTH OF PENNSYLVANIA TRANS}~R INHERITANCE TAX SCHEDULE "c" TRANSFEfiS 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 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 no)~O______ (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 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 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 for the benefit of care of transferor? (Answer yes or no) }!s (8) Did decedent, at any time, transfer property, the beneficial enjoyment of which was subject to change, because of a reserved power to al ter, amend, o.r 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) No NOTE 1: The anSwers to these questions should be supported by affidavit by the attending physician as well as a copy of the death certificate. NOTE 2: If answer to any of the above questions is yes, set forth below a 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) Insert this total opposite "Transfers", Schedule "CO in the "As Reported" column on the last page of this return. RCC-37 (12-63) COMMONWEALTH OF PENNSYYLANIA TR:4.NSFER INHERITANCE TAX RESIDENT DECEDENT SCHEDULE "0" BEl\'EFICIARIES BENEFICIARIES AND ADDRESSES RELATIONSHIP i SURVIVED (If step-children or , 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 Edward S. Sandnes husband yes adult entire estate 322 Blacksmith Rd. -- Camp Hill. Pa. I --~ ..- r - I I , -----+- _.~--,.-- I ! I I -----.------- I -- .- -. - I I - .'.-...-.- _'.._n_ I .,.._- .-.---,. i I r I --_.-- j i -..- .- ! ----. l h Deponent further says that all the above-named beneficiaries are living at this time except below: NAME DATE OF DEATH RESIDENCE - RCC-3B RESIDENT DECEDENT SCHEDULE "E" JOINTL Y OWNED PROPERTY COMMONWEALTH OF PENNSYLVANIA TRANSFER INHERITANCE TAX INSTRUCTIONS: This schertule must disclose aU property, real and personal, owned by the decedent jointly with another or others, including intangibles, standing in the name of the decedent and others. List real estate first, as entireties, or joint tenants, giving brief description, as indicated under Schedule "A", plus the date and place of record of instrlllnent eff'ecting vestiture, but do not include entireties or out of state real estate value in estate valuation column. Personal property should be listed as in Schedule "B", plus date of acquisition, and the name, address and relationship (if any) of co-owners to the decedent. Description of Property, Date of Acquisition, Name Address and Relationship of Co-Owners, and Place of Record of Instrument, where Real Estate. Unit Value percen tage Sh are ES ta te Valuation DEPARTMENT VALUATION CAUTION-Do not Write In This Space. Value of Value of Entire Decedent's property Interest ~s ~ ~ ~ )< >? ~ )<:;: > x,. )< )< 59< 'x :;><> X :x Ax,. >>~ ? \t v ?)< ~ x<> :?<> ~ V?)< 'x'x NONE ~(i /7ZfY ''--. Insert this total opposite "Jointly Owned Property", Schedule "E" in the dAs Reported" column on the last page o~ this return. ~ RCC-3g (!l-OB) COMMONWEAL TH OF PENNSYLVANIA TRANSFER INHERITANCE TAX RESIDENT DECEDENT SUMMARY Estate of SANDNES (Last Name) Helen (First Name) M. (Initial) DATE OP DEATH 10/16/78 PILE NO. 21-78-0035 REPORT OP INHERITANCE TAX APPRAISER I, the undersigned duly appointed Inheritance Tax Appraiser in and for the County of r."mh<lT'lO'lnrl 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 "E". Dated: Januarv 25, 1979 iU"'-'tio f). nt jp ~ H,L) INHERITA E TAX APPRAISER REPORT OP THE REGISTER OP WILLS I, the undersigned duly elected Register of Wills in and for Cumberland County, Pennsylvania, do respect- fully report that I 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 "P", which greater or lesser amount represents the sum allowed as a deduction. Dated: REGISTER OF WILLS INVENTORY Real Property (Schedule A) Personal Property (Schedule B) Transfers (Schedule C) Join t - Held Property (Schedule E) TOTAL GROSS ASSETS Less Debts and Deductions (SCHEDULE F) CLEAR VALUE OP ESTATE 3 673 42 Valuation of life estates or annui ti e s . . . . . . . . . . . . . . . . . . . $ ESTATE TAX ASSESSMENTS $ t= t= t= POR USE OP REGISTER ONLY Tax on $ Tax on $ Tax on $ Tax on $ Tax on $ Exemptions Total Estate TOTAL TAX Less tax previously paid BALANCE Less 5% of tax if paid within 3 mon th s after dea th BALANCE OF INHERITANCE TAX DUE Add interest at rate of 6% from to AMOUNT OP ESTATE TAX ASSESSED $ Es ta te tax paid $ BALANCE DUE Add interest at rate of 6% from to COMPUTATION OP TAX 2% 6% 5% 10% 15% * $ $ $ $ $ (*) As evidenced by Charitable Exemption Certificates issued by the Secretary of Revenue. $ $ $ t= $ $ c $ C L t= $ $ TOTAL TAX BALANCE $ PAID $ FOR USE OF REGISTER ONLY ADJUSTMENTS NOTE: Where subsequent adjustments are made to the above cumputation of tax by the Register of Wills, for proper reason, same should be noted below, with short explanation. .. R E V-S IB (B-7B) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF FIELD OPERATIONS P.O. BOX 2970 HARRISBURG 17105 IN YOUR REPLY PLEASE REFER TO Inheritance Tax Division NOTICE OF FILING OF APPRAISEMENT Edward S. Sandnes (Executor or Administrator) In Re: Estate af Helen M. Sandnes Cumberland County - File No. 21-78-0035 Dear Mr. Sandnes: You are hereby notified that the orioinal appraisement in the estate of Helen M. Sandnes has been filed in the office of the Register of Wills of Cumberland County on .lRnuRry ?"i ,1979, Said appraisement reflects the following valuatians: Real Estate Personal Property Transfers Jointly Owned _ Total None st11,303.65 rJone r~one $11,303.65 As to such tax that is paid within three months from date of death, a five (5%) percent discount is allowable. As to any tax that remains unpaid after nine (9) months (fifteen months when death occurred from December 22, 1965 to June 16, 1971, i nc I usive; and twelve months when death occurred prior to December 22, 1965) from date of death, interest at the rate of six (6%) percent per annum is charged. Any party in interest who is aggrieved by this notice may object thereto within sixty days after receipt of said notice as provided by Section 1001 of the Inheritance and Estate Tax Act of 1961, 72 P. S. 2485-1001, P. L. 373. Date Januarv 25, 1979 Signed J/~~~d r t?(:~.4. oJ< d) Title Chief Appraiser ]~ Note: This is not a bill. R C C-2 (2-64) DEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS HARRISBURG, PENNA, 17127 COMMONWEALTH OF PENNSYLVANIA RESIDENT INHERITANCE TAX APPRAISEMENT DATE .1RnlIRl'\1 ?"i r 1979 COUIIo"TY Cumberland FILE NO. 21-78-0035 Whereas. Helen M. Sandnes late of Lower Allen Township in the County of Cumbii/rlOil'1d Commonwealth of Pennsylvania, having died on the 16thdayof October 19 77 , seized and possessed of an estate subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania; Therefore, I, Gloria J. Richard , an appraiser duly appointed according to law, having been designated to make a fair and conscionable appraisement of the said estate, and to assess and fix the cash value of all annuities and life estates growing out of said estate, hereby file the following appraisement: In the event that any future interest in this estate is transferred in possession or enjoyment to collateral heirs of the decedent after the expiration of any estate for llfe or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer inheritance taxes at the lawful collateral rate on any such future interest. Una Apprai$ement Description of Asset VAlues Made for Inheritance Tax Purpose, R"",l Fstate None $ -0- .---- ------t pp.l'snnRl PI'ODBrtv :Jli11.303.65 11,303 ~ Transfers None -0- Joint Propertv None -0- Tnt",l F",t"tp ,'i!;11.1n1.F.'i :~11 303 Jj5 - - Having been duly sworn according to law, I do hereby certify that the above appraisement is made in con- formity with Jaw on this 25th day of JRnURl'l/ 19~. ~LV1.J-;f 1If.'edoJu/ / / Appraiser 1846 3rookwDod St. (N\lmber and Strtet) H~T"T"i c::hrlT''] (Pod 0ftI..) - , Penna.