HomeMy WebLinkAbout07-13-78
'7
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
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RC~~~ (4p731;
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RESIDENT DECEDENT
'JUL 131978
COUNTY OF
~A/;A/~
IMPORT ANT,
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'tenue. (Section 703 of the Inheritance Bnd Estate Tax Act of 1961.)
IN THE MATTER OF THE ESTATE OF
Charles H. Bishop A/K/A Charles
B1.sJjop Jr.
(STATE FULL NAME OF DECEDENT)
H.
} AFFIDAVIT OF
EXECUTOR
"'M'lllI1NI'i!"nl.l\:~
L(lte of
Cumberland
Counfy
State 01 Pennsylvania
J'"
Trust Orricer Dauphin Deposit
Bank & Trus t Company Executor
County 01 Cumberland
William S. Sanrord,
.Aata.iaiuw",-
of the estate of the above-named decedent being duly sworn, depose
and soy
Februa.ry
(MONTH)
Name and address of attorney or }
other authorized representative to whom
011 corres.pondence should be mailed.
3
(D'AY)
, 19~J ~elState leaving a last will,' ~opy of which Is hereto attaChed..}
(YEAR) ~~~)O
Decedent died
Mvers. Mvers. Flower and Johnson
3rd & Market Streets, Lemoyne, Pa.
17043
That as stich -Executor deponent is familiar with the affairs of said estate and the property constituting
(EXECUTa R.ADMIN ISTRA 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
IN WHICH DECEDENT RENTED A S.....FE DEPOSIT BOX
Dauphin Deposit Bk & Trust Co
3045 Market St
CamD Hill. Pa. 17011
THIS SAFE DEPOSIT BOX RENTED
IN NAME OR NAMES OF
Decedent
RELATIONSHIP OF JOINT
HOLDERS TO DECEDENT
That the contents of said safe deposit box or boxes are itemized under Schedules A&B of this return,
with 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 detai I all the real property
in ~he Commonwealth of Pennsylvania of which decedent died having an interest therein. It also sets forth the
mortgage encumbrances upori 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 Corth 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 mape 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,~wli:etlier~'in dece'denCs:.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 personsj;.i',,,,,
giving also separately the accrued inte;est thereon, if any, down to the last interest day prior to dec~d'e~:" ""
death in the case of saving's banks, and to the date of decedent's death in all other cases; all bon4s~~posta'l-
~.. .I' ~-":"lK
savings, treasur:y:'ce.rrificates or notes and other evidence of indebtedness of the United States ,10 the ~'e-
cedent; all obligations,:)whethef by .Sta.tuteLor'..agreement they are designated as tax free, of the'Uni_ted Stat~s,
or any state, or political subdivision thereof, or of any foreign country, which are owned at .the tim'e or-death;
all wearing apparel, jewelt:y;~ silverwa1e;'.pictures, books, works of art, household furniture, horses, '.carriag'ts"
automobiles, boats, and. any and all other personal chattels of whatsoever. kind or nature, left by decede~t,
together with the fairlY,.estimated market value thereof; all bonds and mortgages held by decedent a;d.:~f 'all.-
claims d~e and' owing decedent at the time of death, and all promissory notes or other"instru~ents 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 securities owned by the decedent at the time of dea~h, with the.market value there-
of at such time.
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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 or
death In any co-partnership or business, and in support of' the value of such interE!st there Is annexed to
said schedule, financial statements showing the assets and liabilities of' said co-partnership or D,uslness.
A copy of the co-partnership agreement, (if oral, 8 statement setting forth the nature of the agreement)
together with 8 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 af).d just__ft.Pprllisa.l'.of,the deeedent's inte..I"~8t,
therein must be submitted. It should also set forth in itemized f'orm, 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 case of' transf'ers of property, real or personal, within twO' years' '01' dec-edent' 8
death, in contemplation of' decedent's death" or intended to take effect in possession or enjoyment at or
after deat~, ~aid sche~ule sets f'orth the nature and value of' s~ch propert)-", to whom t'r8nsl"erred, the
relationship oT the transferees to the decedent; the proportionat~ share r~celved ~y ea~h transferee ind'
all other facts of a pertinent nature regarding said transfers. In the case of transfers intenltea-t'<f'-=-
take effect in possession or enjoyment at or after death, there is also attached ~o the schedule a co~y
of the deed, trust agreement or other instrument creating the trust. Ther~ is also set f'orth in said
schedule a list of all property, real and personal, with its value, which passes ut decedent's death by
virtue of the exercise by decedent, either tndividually, or ~olnt1-y wi~h .another, or an~" power of appoint-
ment vestedindecedmlt, e~t.het indiyidually ,or jpil"!tly, by thE! will, c:teed, or_other instrument of another,
with a copy of the lnstrument creating such power attached to the schedule.
That Schedule 0 attached hereto and made part hereof sets forth the name~ am addresses of all
persons beneficially interested in this estate at the time of decedent's death, thH 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 life under decedent's Will. It also
contains a statement showing which of the beneficiaries named in the decedent's will, if any, died prior
to decedent, the dates of their death, their issue, 8J1d the relationship of such issue to the beneficiary.
That S.:hedule 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, includi~g intangible, standing in the name
of the decedent and others, plus the date'and place of record of instruments efrecting the vestitute of
real estate and the date of acquisition of personalty, plus the name, address and rel~tio~Shi~; i~ any,'
of co-owners to the decedent. \
That Schedule F attached hereto and made a part hereof sets forth fully and in detail all debts
and deductions claimed for and on behalf of' this decedent's estate, including Olneral expenses paid;
family exemption, where applicable; eosts of administration of this estate; counsel fees and f\Jdieiary'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 1mpaid at time of
death; taxes ace rued chargeable for period prior to decedent's death (except those allowed under Section
651 of the Inheritance and Estate Tax Act); together with a statement of collateral pledged for obliga-
tions, if any. It 1s 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 Regist:.er 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", "B", "e", "E", and "F" as directed therein,
have been carried forward and properly registered in the Summary.
Dauphin Deposit Bk . Trust Co.
Subseribed and sworn to before me this ../Jp.:...........
tft~~-----
301 Market Street
................................(sv:~..N~i&;;r...............................---.
M1/~ry Public. CarIl".. Cumbo/land ... Lelll~.y.~~..........~.....~..?...~............m....
y I 0....0_ . "" -;/.d-. I ..,; (City or Toum elM St4te)
NOTE: Before signing affidavit make ~utl tll blank spaces in the affidavit and schedules annexed are
filled in with details or the word "None", and in case the assets inelude 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 1n the "SUJII11ary" has been properly completed as above-direct.ed.
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RC C"34 t4-73) l'
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 tenant ,in cammon with another or ather, should be identified
as to quantum of interest and the estimoted value should be that of the decedent's interest only. (Property
held os joint tenants with ri'ght of surviorship or tenancy by entireties should be reported on Schedule "E. ")
1/2 interest in
2100 Chestnut street, Camp Hill, Penna.
By decree awarding Real Estate dated MaYI
10, 1977. sold $44,500.00 /~
'0 of.. A/ 1r' PR IAI(J..Ll? ~ S 3 () 't'l; (CI). ;iJ
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(1) (2) (3)
DEPARTMENT
ASSESSED VALUE VALUA TION
FOR YEAR OF ESTIMA TED CAUTION
DECEDENT'S MARKET VALUE (Do not write
DEATH In thl. space)
-
-
7530 $22,250.06 '2.'2.--,'"2~.OO
The real property located In the Commonwealth of Pennsylvonla .hould be
descrIbed by '-at and block numbor, stre'e. and street number, together with
CI general description of the property, w:lth 0 reference to the record of the
conveyance by which the decedent took tltlo; If a farm state number of o~
eru; alia statement of martgag-. encumbrance. upon each parcel at death
of decedent. Taxes, auessments, accruedlntere,t on mortgage., etc.,are
to be listed on Schedule "F" and must not'!:I8 d~ducted from this schedule.
Insert this total opposite "real property", Schedule "A" in the X X X X X
"As Reported" column on the lost page of this return.
$22,250.00 "2.-'2.",2.<;0.00
RCC -35
RESIDENT DECEDENT
SCHEDULE "B"
PERSONAL PROPERTY
.
CO~~IONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
INSTRUCTION~: 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 ffEn. Intangible personal property, titled 1n the name of the decedent, but
payable at death to another or others, including but not limited to PwO.D. U. S. Savings Bonds and tenta-
tive trust acconnts, must be listed, despite the fact that they are not of the administered estate.
Tangible personal property should be listed first (ewg. j~welry, 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 rlividends, salaries or wages, insurance pay-
able to the estate or rirluciary in said capacity, partnership interests, interest in anyundistributed
estate or 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
VALUE
ESTIMATEJJ
MARKET VALUE
DEPARTMENT VALUATION
(Do not write in
this space)
1.
Jew1ery & Househ~ld Goods
Per appraisals less Grandrather Clock
$39U.00. See note below:.
$1.436.00
\" L\.31....c=
6.
Cash
428.45
"- , 300.00
*
2.
1971 Buick Sedan La Sabra
1,300.00
3.
Dauphin Deposit Bk & Trust Co.
Checking Acct. 15 60 552 3
7,545.59
'1... <;4>.S. '0'1.
-'\ ) -"2-"1- \3 .4. S
4.
123 shrs AT&T Comm
59 337
7,298.45
5.
514 shrs Dauphin Deposit Bk & Trust Co
Comm 31
15.934.00
7.
Commonwealth or Penna. Retirement Board
6,892.31
l..S \ ct ~<-l. 0-0
LlL.-B.llS
(." ) B'i. '2..;' \
*
Note Item 1. Grandfather clock encluded in appraisal was bequ athed
by the will of Isabella Oberly Bishop to Cha.les H. Bishop Jr.., or
t J Oberl Bo.' sh p.- Copy of w 111.
life with remainder interest 0 oann
of Isabelle Ober'ly Bishop is ~ttached.
Insert this total opposite "Personal Property", Schedule "B" in
the "As Reported" colUJlD1 on the last page of thl's return.
x X $40,834.80
LIe, '2>~'-f-Q"
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COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
SCHEDULE "c"
TRANSFERS
*~
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 properLY 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 1s 1n the affirmative state:
(a) Age of decedent at time or transfer
(b) State of decedent's health at time of making the transfer. (Note 1).
(c) 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 there~or which was to take ef~ect in possession or enjoyment at or after his death?" '
(Answer yes or no) _..nSL.- "
(a) Was there any possibility that the property transferred might return to transferer or h1s
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 li~etime 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 o~ 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 1n decedent
alone or others
(7) Did decedent in his life,time 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)
(8) Did decedent, at any time, transfer property, the beneficial enjoyment of which was subject to change,
because of a reserved po'wer to alter, amend, or revoke, or which could revert to decedent under terms
of transfer or by operation of law? (Answer yes or 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 a.nswer 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.
ITE\1
DESCRIPT ION
MARKET VALUE
(Es tlma ted)
DEPT. VALUATION
(Dept. Only)
None
N \f"YJ-
"Insert this total opposite "Trans:fers", Schedule "e" in the
"As Reported" column on the last -page of this return.
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Rcq-37 (12-63)
COM~lON\\'EALTH OF PENNSYYLANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "0"
BENEFICIARIES
'lJo . Jr.
~
<" >
i '.' . ; l~; f t ,. 1~ RELATIONSHIP
BENEFICIARIES AND ADDRESSES (If step-children or SURVIVED DATE INTEREST OF
.State full names and addresses of al] 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
If,t",,, w"..,,-t .. r.,.~ ".." M;nnp 1iln..";~i,, R.."".."i-
2140 Pinto Road ...." ~...........
Warrington, Penna. 18976 .
,
David Austin , Grandson yes minor Speciric Be"uest
75 Meadow Glen Drive
Dover, ve~aware ~"u~
Louise C. Barker None yes or age $10,000.00
2120 Market st
.
Camp Hill. Pa. 17011
T..". +h 1'1; ~hnn W"...<:+ ,no ...ter yes nf' .aA 1/2 Re,''',
2140 Pinto Road
11arrington. Penna. 18976
Toann Bi"hon Au"tin DaulZhter yes or aee 1/2 Residue
75 Meadow Glen Drive
vover. ~'7"J.
,
h
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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SUMMARY
...(Sch. "AN)
............................................... .........(SCh. "B")
....(SCh. "C")
Real Property
Personal Property
Transfers
Gross Taxable Estate.
(2)
(As Determined)
(1 )
(As Reported)
$?2,2,50.00.
$.40,S}4.S0
$
$
$. .
63,OS4.80
$.
$
$
$
$
$
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RC.C-38
RESIDENT DECEDENT
SCHEDULE "E"
JOINTLY OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
INSTRUCTIONS: This scherlule must disclose all property, real ann persona], 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
"..\", 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 "BIf, lllus date at' acquisition, llnd the name, address and relationship (if any) of co-owners to
the deceden t.
Description of Property, Date of Acquisitio.n, Name Unit percentage Estate DEPARTliENT VALUATION
Address and Relationship o~ ,Co-Ownersj and PI ace Value Share Valuation CAUTION-Do not Write
of Recorn of' Instrument, where Real Estate. In This SpRee.
<x Value of Value of
~55 X X>< ~ )< 55 X>< :><>0< )< % :?<: )< :x z: Entire Deceden t t S
X :)< ~% 55X&% )<
v< >0< :x Property Interest
None
.
Insert this total opposite "Jointly Owned Property", Schedule "E"
in the "As Reported" column on the last page o~ this return.
N~.
- . . .
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R c c.slf (&.77)
.
County, Number and Name. SUMMARY
File Number 21-78-64
Date 01 Death ~9" J. '97R.
File Date COMMONWEAL TH OF PENNSYL VANIA
Estate Name Bishop, Charles H. Jr. TRANSFER INHERITANCE TAX
(LAST NAME) (FIRST NAMEI (INITIAL.)
RESIOENT DECEDENT
REPORT OF INHERITANCE TAX APPRAISER
I, the undenigned duly appointed Inheritance Tax Appraiser in and lor the County 01 ,
Pennsylvania, do respectlully report .that I have oppraised the real and personal property as reported in the loregoing return at
the values set forth opposite each item in the last column to the right in Schedules itA", 11-8'., "CU, and liE".
Dated: tf- 13 - 7'i 1:..2L P-. /(, }f jJ()<-~
INHERITANCE TAX APPRAISER
REPORT OF THE REGISTER OF WILLS
I, the undersigned duly elected Register al Wills in and lor County, Penn5ylvania, do respect-
fully report that f have allowed deducfion~ in the amounts claimed by deponent, ~xcept os to those items where a greater or
lesser amount is 5et forth in the last column to the right in Schedule "fu, which greater or lesser amount represents the sum
allowed as a deduction.
Dated:
REGISTER OF WILLS
INVENTORY VALUE AS REPORTED VALUE AS APPRAISED CODE VALUE AS REAPPRAISED CODE
Rea I Property (SchedlJ Ie A) $ 22 250 00 $ !JIl '1.1; dtJ 004+ 00+
Personal Property (Schedu{e B) 40 834 80 '.JJ;; .1", Ji'/J 10+ 10+
Joint-Held Property (Schedule E) T -r;;;;; , 20+
Tran$fers (Schedu\eC) '",,,v . 30+
TOTAL GROSS ASSETS 63 084 80 ;;,;, ./>~;, 90
Less Debts and Deductions , 40.
(SCHEDULE F) ,
CLEAR VALUE OF ESTATE
Valuation of life estates or .2...- PRINCIPL.E FACTOR VAL.UE ~
annuities.................... ._ $ .t= 1= r
-
ESTATE TAX ASSESSMENTS -$
FOR USE OF REGISTER ONL.Y ~ COMPUTATION OF TAX
Tax on $ 2% $
Tax on S 6% $
Tax on $ S% $
Tax on $ 10% $
TaX" on $ 15% $
Exemptions . (') As evidenced by Charltabfe
Total Estate Exemption Certificates issued
TOTAL TAX $ by the Secretary of Revenue.
Less tax previously paid $ E=.. .
BALANCE $
Less 5% of tax if paid within
3 months Gher cJeoth $
BALANCE OF INHERITANCE TAX DUE ~ I
Add interest at rate of 6% from
to $
AMOUNT OF ESTATE TAX ASSESSED $ t=
Estate tax paid $ I
BALANCE DUE S
Add interest at rate of 6% from
to $
TOTAL TAX BALANCE $
PAID $
Supplemental Codes: (FOR USE IN HARRISBURG ONL Y)
48-Adjustment 6O-Lile Estate 93C-Charity 96-Success ive
49+Adjustment 92+Remainder Appraisal 94-.Remainder Residue Lile Estate
56-Annuity 93-Remainder Deduction
FOR USE OF REGISTER ONL Y ADJUSTMENTS ,
NOTE: Where subsetent adjustments are made tQ the above computation of tax by the ,Register of Wills, for proper reason,
"Qme should e note below, with short explanation.
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Rcc-a1 (6-73)
COMMONWEAL TH OF PENNSYL VANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
HARRISBURG
17127
IN YQUR REPLY PLEASE
REFER TO
Inheritance Tax Division
NOTICE OF FILING or APPRAISEMENT
~uphtl'l l)a.\7olllt
301 Un'Ml: Street
~uvnu. &~po~. )
.. xectltor~or Aomlnlstrator
In Re: Estate of
r:a~"!!P.l"""'nfJ
Gl=i..e\ll Ii. ilisltvp
County - File No. ~1-"/iI,-O"~~
Dear
You ore hereby notified thot the t-".j ...,tt....,
approisement in the estate of C\)"'t:'l"n it. ltflith'lJ>
has been filed inthe office of the Register of Wills of t'!r",lti>l<l....1t
County on USetll:e:::l:lot' , 19 18 . Said appraisement reflects the following
valuations:
.
f
Real Estate
Personal Property
T ronsfers
Jointly Owned
Total
l2.2JlO.ntl
40.g1~.tO
'itcne
Nane
iB.OM.nO
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 dote 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 days after receipt of said notice os provided by Section 1001 of the Inheritance and
Estate Tax Act of 1961, 72 P. S. 2485-1001, P. L. 373.
Dote U Sl.!~t~llf" 18 Signed 2t-1"""--- k. jIf~
Cllt.af .l\Pflf:'.~.ielrt'
Title
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Note: This is not 0 bill.
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R c.c-a (2tt641
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DEPARTMENT OF REVENUE
BUREAU OF COUNTY COll ECTlONS
HARRISBURG, PENNA, 17127
COUNTY (' ~
FILE NO. '2..- t -( \3 - 00'" u..
Whereas, C~'l-\-- C2,~ late of C'~ \~
in the County of (' ~ Commonwealth of Pennsylvania, having died on
the '2:, ~SL day of ~ 19::I.B., seized and possessed of an estate
subject to Inheritance Tax under the laws of the_Commonwealth of Pennsylvania;
Therefore, T, \ R 0-- C ~ 0 0 . " . 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
tbe cash value of all annuities and life estates growing out of said estate, hereby file the following appraisement:
COMMONWEALTH OF PENNSYLVANIA
RESIDENT INHERITANCE TAX
APPRAISEMENT
DATE
In the event that any future interest in this estate is transferred in possession or enjoyment to collateral heirs of the decedent after
t.he expiration of any estate for life Or for years, the Commonwealth hereby ekpressly reserves the right to appraIse and assess transfer
Inheritance taxes at the lawful collateral rate on any such future interest.
Olllerlllt/on of Auet
Unll
Valuel
Appnhement
Made for lntlluitance
Tax Purpoles
$2.'- l.-S 00
l{o B3 80
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N~,
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63 DBL{ B~
Having been duly SWOl'll' accordi!lg" to law, T do hereby ce tify that the above appraisement is made in con-
formity with law on this \ ~ -\::::Y- day of ~, 19L'3.
Appraiser
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