HomeMy WebLinkAbout01-23-79
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R~C.33 1.1-7"3)
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
w ~ -\.,
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COUNTY OF
CUMBERLAND
RESIDEtH DECEDENT
IMPORTANT
Th.~ ';~';urn ;;'ust 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
b} the' Secretary of Reuenue. (Section 703 of the Inheritance and Estate Tax Act of 1961.)
_,FWIJ2J:,,-,-..J?J1R~fFLER
--- VillaTgeU~LfN13fosJ'~~Eif1T~, Upper
Late of Ji'ra,nkforJ1_ TowJ}ship. Cumb. County
Stok of u~.~~nsYlyania,
} AFFIDAVIT OF
RXBOUJrElR
ADMINISTRATOR
1:\ THE ~IATTER OF THE ESTATE OF
} 55:
County of .~_ Cumb,~~19-nL__
Admini"tf;:!O:
ISABELLA M. FREEMAN
:!ExeJ<~~
of ~he estate of the above.nomed decedent being duly sworn, depose S
and say S
Decedent d I ,~d
_J JJly
s
, 19~{~K~~~~OC<<~WX~~~~~ROC~X~~~~~X<<~}
(y EAR) intestate
(",~n r-.J 1'H)
(DAY)
Nom" cnd arlrl.e, c ,,' "'""',,p N }
other authr" ;1:cd ~epr"'~enl"'lfiVI' '0 .,~.h"rn
all corresp~>t',ienc'! ~~, !
Kramer & Kramer
One Irvine Row, Carlisle, Pennsylvania
17013
1'11<11," sue:. Admipistratrixdeponent is familiar with the affairs of said estate and the property constituting
x UTOI';:.ADMINISTRATOR)
(he aSSt'tc- tIH.:rC(J1 ,did theIr fair market value.
rh,,1 al the time of death there was no safe deposit box registered in decedent's individual name, or jointly with, or
a, agel1i fir de!'u ly of another, or in decedent's individual name, with right of access by another as agent or deputy, with the
exception or the foIIcJ\'" in!;: -
:-j AM
IN 'NH
---- ~. . --.-. .-
. ~-~ D AQL',F.'ESS OF BANK OR o TH E R IN5Tl TUTION THIS SAFE DEPOSIT BOX RENTED RELATIONSHIP OF JOINT
!(:H OECF.::.DLNT RENTED A SAFE DEPOSI T BOX IN N AM E 0 R N AM ES OF HOLDERS TO DECEDENT
..-."-
~~----
____.N...Jl..R.R-
-------------~--_.
__'_-0
Thai the contents of said safe deposit box or boxes are itemized under Schedules-----of this return,
wi th the exception of the following, for the reasons hereinafter set forth:
That Schedule A attached hereto and made part hereof sets forth fully and in detail all the real property
in thc 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
dcath, name of mortgagee, date, rate of interest, and book and page of record thereof. It also sets forth in the
colnmns provided thcrcfore the assessed valuation of each of said parcels, the estimated market value thereof
as o[ da te of death of decedent.
That Schedule B attached hereto and made part hereof sets forth fully and in detail all personal property
where ",ver s itua ted 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
giviog also separately the accrued interest thereon, if any, down to the last interest day prior 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
savin",. treasury certificates or notes and other evidence of indebtedness of the United States to the de-
cede:!!: all obligations, whether by statute or agreement they are designated as tax free, of the United States,
or all\' state, or political subdivision thereof, or of any foreign country, which are owned at the time of death;
...,. "'.<.I_JIIl/:; (l1'1J<lJ01 JL"'t;il)~ ",ijvervvart:, 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 de~edent"
togcthcr with the fairly estimated market value thereof; all bonds and mortgages held by decedent and of aU
claims duc and owing decedent at the time of death, and all promissory notes or other instruments in writing
for the pavment 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 Iban the face value, it sets forth briefly the reasons for such depreciation as to each item; all moneys
payable to the estate f'qJm life insurance policies carried by decedent; all annuity and endowment contracts
the proceeds of which 1ayable upon the death of the decedent; all and the corporate stocks and dividends
due thereon and unpaid as ". date of death, bonds and accrued interest thereon to the date of decedent's
death and other l!i ''',oen! ,'" Gwned by the decedent at the time of death, with the market value there.
of at such timc-,
h_I..:34~(4.73)
COMM<>>lWE~L TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
TRANSFER INHERITANCE TAX
R ESI DENT DECEOf:NT
SCHEDULE "A"
REAL PROPERTY
11&
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 ather, 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
described by lot and black number, .treet and .treet number, together with
o general descrlpt-ion of the property, with a reference to the record of the
conveyance by which the decedent took title; If 0 form .tote number of a-
cres; also statement 'of mortgage encumbranc.. upon each parcel at death
of decedent. Taxes, assessments, accrued Inter..t on mortgage., etc.,ar.
to be listed on Scheclule "F" and must not be deducted from this schedule.
(1)
(2)
(3)
DEPARTMENT
VALUATION
CAUTION
(00 not write
In thl. spoce)
ASSESSED VALUE
FOR YEAR OF
DECEDENT'S
DEA TH
ESTIMA TED
MARKET VALUE
1. ALL that certain tract of land with
improvements thereon erected situate in
South Middleton Township, Cumberland County,
Pennsylvania, being known as Lots No. 36,
37 and 38 in Block "H" of the Plan of Lots
of Fairfield recorded in the Office of the
Recorder of Deeds in and for Cumberland
County, Pennsylvania, in Plan Book 2, Page
80. Containing 75 feet, more or less, in
front on York Road and extending in even
width a distance of 300 feet, more or less.
Being improved with a block and frame 1 1/2
story home and detached two car garage and
being known and numbered as 363 and 365
York Road, Carlisle, Pa. See Deed Book "Q",
Volume 15, Page 319. Actual sale price
C/-?
( ~) (1'./ ___ ./
~/k
$24,500.00 Jf;StJD. DO
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.
$24,500.00
.;)"/. 5 at). OD
J
.RC:C -35
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "B"
PERSONAL PROPERTY
Item
No.
1.
2.
3 .
4 .
5.
6 .
7 .
8.
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 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 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 in this schedule.
ITEM
List and describe fully
UNIT
VALUE
DEPARTMENT VALUATION
(Do not write in
this space)
ESTIMATED
MARKET VALUE
Well Driller, scrap value only, actual
sale price
v/
200.00' c;;<t){).OD
75.00 J/ ~ 1)0
Well Driller, scrap value only, actual
sale price
I
30/40 Model 1894 Krag Springfield calterfd)
See attached appraisal of Samuel B.
Hertzler
150.00..
/5().O"
12 gauge Model 158 H & R single shot
shotgun. See attached appraisal of
Samuel B. Hertzler
40.00....
~~. 0(.)
12 gauge Eclipse double barrell shotgun,
outside hammers. See attached appraisal
of Samuel B. Hertzler
50.00./
.5().OCJ
.22 Gal. LR Model 52 Winchester Target
Rifle. See attached appraisal of
Samuel B. Hertzler
250.00/ ...:1,50. DO
.22 Gal. H & R Sportsman Pistol. See
attached appraisal of Samuel B. Hertzler
75.00..... / 7.50tJ
1,500.00.... ;;.stJtJ. ()O
'/
1974 GMG pickup truck.
Actual sale pricE
Insert this total opposite "Personal Property", Schedule "B" in
the "As Reported" column on the last page of this return.
x X
~ ..3 "i (). I) ()
2,340.00
APPRAISAL
I, the undersigned, personally inspected the weapons
listed below on December 13, 1978, which are the property of
the Estate of Floyd L. Shreffler, and based upon my knowledge
and experience buying and selling weapons for a period in
excess of 10 years, their current fair market value is as set
forth below:
30/40 Model 1894 Krag Springf'ield (altered)
12 gauge Model 158 H & R single shot shotgun
$ 150.00
40.00
12 gauge Eclipse double barrell shotgun,
outside hammers
50.00
.22 Cal. l.R Mode.! ')2 Wirlchestcr' 'Parget HLfIe
250.00
.22 Cal. H & H Sportsman pistol
75.00
,~~.. ...Qh~'~~~
c amuel B. ertz er . ·
December 14, 1978
RCC-36
COMMONWEALTH OF PENNSYLVANIA
TRANS}~R INHERITANCE TAX
SCHEDULE "c"
TRANSFEIlS
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)----1!~
(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
no t in fact end before his death:
(a) The possession or enjoyment of or the right to income from th~ 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) no
(8) Did decedent, at any time, transfer property, the beneficial enjoyment of which was subject to change,
because of a reserverl 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)
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)
NnuJ
NON E
-0-
Insert this total opposite "Transfers", Schedule "CO in the
"As Reported" column on the last page of this return.
-0-
N tfYlL.J
RCC-37 -(12-63)
COMMONWEALTH OF PENNSYYLANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "D"
BENEFICIARIES
BENEFICIARIES AND ADDRESSES RELATIONSHIP , SURVIVED DATE INTEREST OF
(If step-children or ,
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
Evelyn M. Shreffler Widow yes over 18 lli of e,d-:",tc"
121 South East Street ----
Carlisle Pennsvlvania 1701"l
Isabella M. Freeman Daughter yes over 18 1/6 of ~<-~..
Box 48
New Kin ~ rl"",n; '" '707') I
--
Doris M. Handshew f)"'11 ",ht-o.,.., "I"" 1 R 1 If. ,-,f' "'~<-~<-~
R. D. #4, Box 246 ,
i
--
Newville. Pennsylvania 1724 I
--------- _._.,-~---
; - --
Charlotte McNeelv Daughter ! yes nv"y> 18 1 If. nf' "'''+-'''+-e________
R. D. #10. Box i66 --- - "-.. --
Carlisle. Pennsvlvania l70n ------ --
.-.--..
Flovd L. Cox Son ves 'over 1 8 1 If) of O"t-Ol+:"
Box 61 I
"--,-.
l72i4 i
Gardners PennsYlvania I
I
! ----.-
. _.. _ _"'_'M_
-...
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h
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"
JOINTL Y OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
INSTRUCTIONS: This scherlule must disclose all property, real anrl personal, ownerl by the rlecedent jointly
with another or others, including intangibles, standing in the name of' the decedent and others. List
re"l estate first, as entireties, or joint tenants, giving brief description, as indicated lUlrler Schedule
"A", plus the date and place of record of' instrrunent 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 acquisi tion, and the name, address and relationship (if any) of co-owners to
the decedent.
~~
~~
Description of Property, Date of Acquisition, Name
Address anrl Relationship of Co-Owners, and Place
of Recorrl of Instrument, where Real Estate.
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6
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:x~
"x
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l'
:Xl'
Unit percentage Estate DEPARTMENT VALUATION
Value Share Valuation CAUTION-Do not Write
In This Space.
^" Value of Value of
~ :y ~l' ~ <><>0< >\ :> En t1 re Decedent's
l' x: ~l':X
^' Property Interest
Nmu
NON E
-0-
Insert this total opposite "Jointly Ownerl Property", Schedule "E"
in the" As Reported" coluJTU1 on the last page of this return. - 0-
A/,m~J
.
REV-5IB lB-78)
COMMONWEAL TH 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
Isabella M. Freeman
P.O. Box 48
New King;~t-on, PA
(Executor or Administrator)
In Re: Estate of
Floyd T. !'l}',.pfflp,.
Cumberland
County - File No. 21-78-001)4
Dear
You are hereby notified that the Original
appraisement in the estate of Floyd L. Shreffler
has been filed in the office of the Register of Wills of Cumberland
County on 15 February , 19-Z2, Said appraisement reflects the following
valuations:
Real Estate
Personal Property
Transfers
Jointly Owned
Total
24,500.00
2,340.00
None
Non",
$26,840 00
As to such tax that is paid within three months from date of death, 0 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 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. 2485-100.1, P. L.i:6'.:. _ ".
Date 1 I) Fp},,,",,,,,y /11'/ Signed a~ \?t_._Q c '- ......~
C)
Title Administrative Officer
Note: This is not a bill.
REV-457 (8-78)
DEPARTMENT OF REVENUE
BUREAU OF FIELD OPERATIONS
P.O. BOX 2970
HARRISBURG, PENNA. 17105
COMMONWEAL TH OF PENNSYLVANiA
RESIDENT INHERITANCE TAX
APPRAISEMENT
DAlE
1<; Fphrl1",ry
Cumberland
21-78-0054
1 q7Q
COUNTY
FILE NO.
Whereas, F1nyil T, Hhrpff1pr late of Tlpppr Allp" 'I'n..",,,,hip
in the County of Cumberland Commonwealth of Pennsylvania, having died on
the 5th day of July 19 ~, seized and possessed of an estate
subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania;
Therefore, I, Leo Fulginiti ,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.
DESCRIPTION OF ASSET UNIT Appraisement
VALUES Made for Inheritance
Tax Purposes
$
n. .1 ~ "/. ",nn nn
Personal Pronertv 2 140 00
Transfers None
Jointly Owned None
Total ~?" llb.n nn
Have been duly sworn according to law, I do hereby certify that the above appraisement is made in conformity
with the law on this 1 'it-h day of Fphrl1",ry ~ V . . ,,!9 _.l!l- .
.~ l.O",_~~ ,
o Appraiser
Harrisburg
(Number and Street)
(Post Office)
. Penna.