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HomeMy WebLinkAbout04-10-78 RCC-S3 (4-73) COMMONWEAL TH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS ,APR 1{) '(~"\ RESIDENT DECEDENT COUNTY OF r.TJMRFRT ANn 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..enue. (Section 703 of the Inheritance and Estate Tax Act of 1961.) IN THE MATTER OF THE ESTATE OF } AFFIDAVIT OF EXECUTOR ADMINISTRATOR 01iu,T Alf''l'''prl 'Rnr7 (STA E FULL NAME OF DECEDENT) Borough of Shippensburg Cumberland Late af County County of Cumberland } 55: State af Pf'nn<<ylvania ~~ I T'nnm,,<< T,. 1iloh~fwn of the estate of the above-named decedent being duly sworn, depose Executor and say Nn"rpmhPT (MONTH) Name and address of attorney or } other authorized repres-entotive to whom all correspondence should be mailed. (DAY) , 19~{~estate leaving a last will, copy of which is hereto attached..} (YEAR) Intestate Decedent died ?fi Mark & Weigle. Jerrv A. Weigle. Attorney 115 East King Street, Shippensburg, PA 17257 That as such F,xe""t-nr deponent is familiar with the affairs of said estate and the property constituting (EXECUTOR~X) 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 WHICH DECEDENT RENTED A S.~FE DEPOSIT 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 prilllT 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 subdivision 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 promis sory 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 interes t thereon to the date of decedent's death and other investment secm.lics owned by the decedent at the time of death, with the market value there- of at such time. RC C-S"4 (4..7 3) COICIMONWEAL TH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS TRANSFER INHERIT A~CE TAX RESIDENT DECEDENT SCHEDULE "A" REAL PROPERTY *' OLIVER ALFRED ROTZ 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 reol praperty located In the Cammanwealth af Pennsylvania 5hauld be described by lot and block number, street and street number, together with a general description of the property, with a reference to the record of the conveyance by which the decedent took title; If a farm state number of a- cres; also statement of mortgage encumbrances upon each parcel at death of decedent. Taxes, assessments, accrued Interest on mortgages, etc.,are ta be listed an Schedule "F" and must nat be deducted fram this schedule. (1) (2) (3) DEPARTMENT VALUA nON CAUTION (Do not writ. In this space) ASSESSED VALUE FOR YEAR OF DECEDENT'S DEATH ESTIMATED MARKET VALUE Real Karate, aituated at 346 Eaat Fort Street, Shippenaburg, PA 17257 - aold at public aa1. .$ ,II- A AI.(/tl""v 1" CJ ), /1 l,- L () (', $12,000.00,-1'12,000.00 WUr, t.~~J. 2..1.3 lJ J..I7() () 6, ~ p "" ~. L.,I ) ./"-' TOTAL $12,000.00 $ 12,000.00 Insert this total opposite "real prope.:y", Schedule "A" in the X X X X X "As Reported" column on the last page of this return. . 'RCC-35 RESIDENT DECEDENT SCHEDULE "B" PERSONAL PROPERTY '* COMMONWEALTH OF PENNSYLVANIA TI~SFER INHERITANCE TAX OLIVER ALFRED ROTZ INSTRUCTIONS: This Schedule must disclose aU tangible and intangible personal property owned individually b~' the decedent, at the time of his death. Property owned by the decedent jointly with another or others must be listed under Schedule "E". Intangible personal property, titled in 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 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 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 fUll y VALUE MARKET VALUE (Do not write in this space) 1. Apprai.ed value of household contents - sold /" at public sale $729.56 V $ 729.56 4.00 V / 2. Inaurance Refund 4.00 / 3. Id. IDaunIle. - laf.. 42.00 ,.,- 42.00 , Insert this total opposite "Personal Property", Schedule "B" in X X $775.56 $ the "As Reported" column on the last page of this return. 775.56 liCC -)S' COMMO\\'iEAJ.TIl OF PENNSYLVANIA THA'\SFFJi INIlElUTA\'CF TAX SCHEDlJLE; "c" TR \\1" [<1<:IlS I\ES I1lE'\T m:n:JlE\'T QT I'q(R !\J.FI?.E~ RQTZ (1.) Dirt decedent, within two years orrleath, milke a.n.y transfer of any material part of his estate, wJthout rec~~ivlng a valuahle and adequate consideration therefor? (Answer yes or' no) No (2) Did decedent, within two years of death, transfer propertv from himself to himself and another or others (inclurting 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 transrer No (b) State of decedent's heal th at time of making the transf'e,", (Note 1). (c) Cause of decedent's death. (Note I), (4) Did decedent, in his lif'etime, make any transfer of' property without receiving a valuable or adequate consideration therefor which was to take effect in possession or enjoyment at or af'ter his dp.ath? (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 decedent's death? (5) Did decedent in his lifetime make any transfer without receiving a valuable and adequate consideration therefor nnder which transferor expressly or impl iedly reserves for his liff! 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 incomp- therefrom? (Answer yes or no) (G) If the answer to (5) (b) above is in the affirmative, state whether the right was reserved in decedent alone or others No (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 benef'lcial enjoyment of which was subject to change, because of 11 reserverl power to al ter, amend, or revoke, or which C011ld revert t.o ctecedent lmder terms of transfer or by operation of law? (Answer yes or no) No (9) If the answer to (8) above i.....; in the affirmative, was the power to a1 ter, amend, or revoke the inter- est of the beneficiary reserved in the tiecedent alone or the decedent ann others? (Answer yes or no) No NOTE 1: The answers to these questions should be supported by affidavit by the attending ph~'sician as well as a copy of the death certif'icate. 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 "'horn transferred, with relationship of transferees to oecedent, if any. Submit copy of any trust rleed or instrument, if trans- fers are claimed to be non-taxable, also submit detailerl. statement of facts on whlch sald claim is based. NOTE 3: List applicable property below in manner in which provided in Schedules A, B, or E. ITEM DESCRIPTION MARlillT VALUE (Es tima ted) DEPT, VALUATTO:>I (Dept. Only) None NONE Insert this total opposite "Trans:fers", Schedule "e" in the "As Reported" column on the last page of' this return. llCC-37' (12-63) l'OMMONWEA1.TH OF PENNSYYLANIA TRANSFER INHERITANCE TAX RESIDENT DECEDENT SCHEDULE "D" BE!\EFICIARIES OLIVER ALFRED ROTZ ( 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 BIRTH I:homas Ro.binson NGfffE W '/.eS BoLE f3 ElvEF Ie I.M~ y_ 322 F."At- Fort- S"~aa" S} . PA 177"7 . Deponent further says that all the above-named beneficiaries are living at this time except below: NAME DATE OF DEATH RESIDENCE RC C'-38 RESIDENT DECEDENT SCHEDULE "E" JOINTLY OWNED PROPERTY CQMMO!'iWFALTH OF PENNSYLVANIA Tl\i\t\'SITH Tt\'HEHITAt\'CE TAX OLIVER ALFRED ROTZ I1iSTRrCTIO!'iS: This schedule must disclose all property, real and personal, owned by the decedent jointly wi th 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 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 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 1 Unit percentage Estate DEPARTMENT VALUATION Address and Relationship of Co-Owners, and Place Value Share Valuation CAUTION-Do not Write of Record of Instrument, where Real Estate. l In This Space. Y'. :;() Y' :S x'~:;( ~ ~ >x l\, Value of Value of ~ ~:) Y' J< P'\. Y':) S58 ) 3>2'; >Q>:>:"> /><":">)< X ;;/'. ~ x:: I)) ~ Y' (<" En ti re Decedent's >> Y';'> ) ) X~ 0:> x;) Y):> x.. 0< " Property Interest y 0, NONE NONE I I I I I I I I I I I I I I I I I I I I I I I Insert this total opposite "Jointly Owned Property", Schedule "En in the "As Reported" column on the last page of this return. NONE '* Rce-St (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 OF APPRAISEMENT ThOma6 L. Robwolt 322 E46t FolLt S.tJz.ee.t C:~jpp"vll.nIlJrg, Pa 17'157 (Executor or Admini stratar) In Re: Estate of o.uVeJ!. A. Rotz CumbeJli.a.n.d County - File Na. 21-78-0040 Dear Mtt. Robwolt, You are hereby notified that the OM.gh1.al appraisement in the estate of O.uveJ!. A. Rotz has been filed in the affice of the Register of Wills of ('lImnMPnVld Cauntyon Mall 25, ,19---.Zfl, Said appraisement reflects the following valuations: Real Estate $ 12,000.00 Personal Property 775.56 Transfers NOlte Jointly Owned NOlte Total $ 12,775.56 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, inc I usive; and twelve months when death occurred prior to December 22, 1965) from date of death, interest at the rate af 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. Signed ~-- /{, ~~A-'" May 25. 1978 Date Title CHIEF APPRA ISER '" --,.,. Note: This is not a bill. RC C-2 (2-64) DEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS HARRISBURG, PENNA, 17127 COMMONWEALTH OF PENNSYLVANIA RESIDENT INHERITANCE TAX APPRAISEMENT DATE Maw 25. 1978 COUNTY Cumb~d FILE NO. 21-78-0040 Whereas, OUVM A. Ro:tz late of BoltOuah 01. SfUt:Jt:Jelt6bUILQ in the County of Cumb~d Commonwealth of Pennsylvania, having died on the 26:th day of No ve.mb(>.Jr. 19J~_. seized and possessed of an estate subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania; Therefore, I, 1M K. Gleim . 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 Commonwealth hereby expressly reserves the right to appraise and assess transfer inheritance taxes at the lawful collateral rate on any such future interest. Unit Appraisement Description of Asset Values Made for Inheritance Tax Purposes Re.al PII.Ot:JeJ!..tU $ 12,000 00 Pe.JL6oltal PII.OIJeJ!..tu 775 56 Jo~ Held PlI.opeJ!..tq NOlte. Tll.aIt6l. e.JL6 NOlte. TOTAL ASSETS $ 12.775 56 Having been duly sworn according to law, I do hereby certify that the above appraisement is made in con- formity with law on this 25i"h day of t.., ~(J ~~ 19--.ZL. ('; ~ J(../; ___ Appraiser (l'fumber and Sthet) H ClJr.Jr..M, b U/tQ (Poot 0ftI..) , Penna.