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Home My WebLink About06-26-78 0--"- A/- 7f-,(~ J RCC-S3 (4w7S1 /~ RESIDENT DECEDENT JUh ~ 6 197 , COUNTY OF CUMBERLAND . " COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS , . 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 residedj Return is due within nine months after date of death, unless an extension is granted by the Secretary of Re'itenue. (Section 703 of the Inheritance and Estate Tax Act of 1961,) IN THE MATTER OF THE ESTATE OF } AFFIDAVIT OF EXECUTOR ~MJ( Countr-...: Helen Aliene Cohick (STATE FULL NAME OF DECEDENT) Late of Cumberland Stot. of Pennsylvania County of Cumberland } ."' t Administrator Fredda Cohick Zeiter ExecutJ/lIX of the estate of the above-nomed decedent being duly s~orn, deposeS' ond sayS- Decedent died 29 , 19-Z.L{testote leaving a lost will, copy of which i,~(hereto ottached.,} . (YEAR) ~OUl' . January (MONTHl Nome ond oddress of attorney or } other authori:r.ed representative to whom 011 corres.pondence should be moiled. (DAY) Snelbaker, McCaleb & Elicker 44 West Main Street, Mf'"hani""hlll'~, PA 170SS That as such Executrix deponent is familiar with the affairs of said estate and the property constituting (EXECUTO R-AOMINISTRA 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 RENTEO RELATIONSHIP OF JOINT IN WHICH DECEDENT RENTED A S.,,-FE DEPOSIT BOX IN NAME OR NAMES OF HOLDERS TO DECEDENT CCNB Bank, N.A. Decedent or 1104 Carlisle Road l'redda r 7."it"'" Camp Hill. PA 17011 That the contents of said safe deposit .box or boxes are itemized under Schedules . 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 detail all the rea.! 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, tate 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 persona'I)"operty,'" ~ ,',,-~ ...--- .,-- ..;. wheresover situated owned by the decedent at the time of death; all moneys left by the decedent at the t!me of.?:. ~ .death, whether in decedent's immediate poss.ession, standing to decedent's credit in banks of deposit~;;savings ':;'-, ~ . >"- - , ~..- banks, trust companies, <.>r other institutions, whether individually, or in trust for any other person or perS:ons- :-: _.... 'wi __. _. giving also separately the accrued interest thereon, if any, down to the last interest day prior to decedent's .;:;........... ." ."./ ....... death in..the case of savin.gs.:banks, and to the date of decedent's death in all other cases; all b6~ds,'<"'postaI-..... (;' "~. - .- ..~~ savings, treasury certificates or notes and other evidence of indebtedness of the United States to .-tlie..de:: cedent; all obligations, 'Y.~ether by stat~te. or agre~ment they are designated as tax free, of the United State~~, or any state, or political subdivision thereof, or of any foreign country, which are owned at .the time of death; all wearing apparel,. jewelry, silver~are, 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 co.ntracts the proceeds of which were payable upon the death ~f the decedent; all and the corporate stocks and dividends due thereon and unpaid as of the d~te of death, bonds and accrued interest the~eon to the date of decedent's death and other investment securities owned by the decedent at the time of death, with the market value there- of at such time. ~ . In the ca"e of ~eCUrit1eS of close or famlly corporations, the values reported are as far as possible substantial:erl by iflnanclal statements of the corporations, showing the assets and liabilities thereof as of the dllte of !death. The schedule also sets forth the interest of decedent at the time or death in any co-partnershlt or business, and in support of the value of such interest there Is annexed to said schedule, financial s:tatements showing the assets and. liabilities of said co-partnership or huslness. A copy of the co-pal'tnerslilp agreement, (if oral, a statement setting forth the nature of the agreement) together with a statement ,setting forth the cha~acter of the business, its location, and such other facts pertaining to the business as may be pertinent to a fair and just appraisal oC the decedent's interest therein must be submttted. It should also set Corth in itemized form, together with the fair market value thereoC, any other property owned or bequeathed by the decedent at the time of death. The SChedule C 4ttached hereto and made part hereof sets forth a true answer to each inquiry contained therein ar:d in th~ case of transCers of property, real or personal, within two years of' decedent's death, in contemplat.1on o~ decedent's death, or ,intended to take effect in possession or enjoyment at or aCter death, said s~hedulf sets forth the nature and value of such property, to whom transferred, the relationship of the transrrrees to the decedent, the proportionate share received by each transferee and all other facts of ~ pert nent nature regarding said transfers. In the case of transfers intended to take effect in POss~!ssion or enjoyment at or after death, there is also attached to the schedule a COllY of the deed, trust ~greem nt or other instrument creating the trust. Ther~ is also set forth in said schedule a list of nIl pr perty, real and personal, with its value, which pa~ses at decedent's death by virtue of the exercise by ecedent, either individually, or jointly with another, or any power of appoint- ment vested in de<:edent, ei her individually or jointly, by the will, deed, or other instrument of another, with a copy of the instrum nt creating such power attached to the schedule. That Schec'ule D persons beneficiallr inte pective interests, their decedent's death of all m contains a statement show to decedent, the dates of ttached hereto and made part hereof sets forth the names and addresses of all sted in this estate at the time of decedent's death, the nature of their res- elationship, if any, to the decedent, together with the ages at the time of nors, annuitants and beneficiaries for lire under decedent1s Will. It also g which of the beneficiaries named in the decedentl s Will, if any, died prior heir death, their issue, and the relationship of such issue to the beneficiary. That S.:/1edule E attached hereto and made a part hereof sets forth all property, real and per- sonal, owned by the deced nt jointly with another or others, including intangible, standing in the name of the decedent and other, plus the date and place of record of instruments effecting the vestiture of real estate and the date f acquisition of personalty, plus the name, address and relationship, if any, of co-owners to the deced nt. That Sc/1ec'ule F ttached hereto and made a part hereof sets forth fully and in detail all debts and deduction~ claimed 1" r and on behalf of this decedent's estate, including fUneral expenses paid; family exemption, where a plicable; costs of administration of this estate; counsel fees and fudiciary's commissions paid or to be paid; cost expended for burial trusts, tombstones or gravemarkers, and reli- gious services, in eonseq ence of the death of the decedent; debts and claims owing anrl lmpatd at time of death; taxes accrued char eable for period prior to decedent's death (except those allowed under Section 651 of the Inheritance an Estate Tax Act); together with a statement of collateral pledged for oblig&- tions, if any. It is agr ed that the fiduciary will present proof of said claimed obligations upon re- quest, that if the amoun 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 assesse1 can be reassessed in accordance therewith. That the totals of the aPtropriate columns in Schedules wAw, "B", .e., WE", and "F. as directed theretn, have been carried forward and properly registered in the Sunnary. CATHARINE E. lOUSUM, MECHAi'ICS3Ur,G OROUGH cu',m :RLAND C UIHY "'y (VlVIJIIS~;(J!' fn'IRF FEB. 27 1982 NOTE: Before signing at' idavii make sure all blank spaces in the affidavit and schedules annexed Are filled in with dete.iIs 0 the word "None", and in case the assets include rare and unlisted securities, securi ties of closl~ or l' roily corporations or an interest in any co-partnership or business, that the data and statements requi ed 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. m' 19,Z~ ~~~,......~..~. ... .------ (Ezecutor-AlllJ~ .....!....c::.ilP!J.~.!.~Ulyg!!gg..............................-...__. (Street Number) .ll,E!i:ld.:i.~.,....r.~.....!~~g~........... .... ...m......... (Citv or Toum 11M StIIte) Subscribed and sworn before me this m..............d2...:::! J2d-v.....-c: .. ,j .--~_. -,.- .... ... - .-.~ - ~ ...~.~-~ RCCR'3f (4-73) . COMMONWEALTH OF PENNSYLVAHIA DEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS TRANSFER INHERITANCE TAX RESIDENT DECEDENT- SCHEDULE "A" REAL PROPERTY * Real property in Pennsylvonio, 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 estimated valuesh'ould 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 10t and block number, street and street number, together with a general description of the property, with a reference to the record of the conveyanee by wh(c\o. t\1e decedent toc-k title; H Q form 5tote number of a- cres; also statement of mortgage encumbrances upon' each parcel at death of decedent. Taxes, assessments, accrued In,erest on mortgages, ~tc..are to be listed on Schedule uF" and must not' be d_educted from this schedule. l,~l that certain piece or parcel of land situate in LOwer Allen Township, Cumberland County, Pennsylvania, having thereon erected a two story dwelling house, more particularll described in Cumberland County Deed Book "A", Volume 22, Page 890. ::z.'J-~ A-LJ..M,eJP.t2t: wfT'1 (1) (2) (3\ DEPARTMENT VALuA TION CAUTION (Do not write In this space) ASSESSED VALuE FOR YEAR OF DECEDENT'S DEATH ESTIMA TED MARKET VALUE PRI el;;,r] (}A'1'1-0'/ j(,u1....L~, /0 C- ') D Lh#& /2 I () -117Z'~ '1_ ---- ?J'i.i? 1 ) Sale Price $62,000.00 '.2"OltD.Od..V 62,000.00 Insert this total opposite "real property", Schedule "A" in the X X X X X "As Reported" column an the last page 01 thi.s return, ~:?/ d7JV, 0lJ " RCC-35 . COMMONWEALTH OF PENNSYLVANIA TRANSFER INHERITANCE TAX RESIDENT DECEDENT SCHEDULE "B" PERSONAL PROPERTY 2.. 30 Shares, Common Stock, Trans World Airlines,.,. Inc. issued to J. Scott Cohick (predeceased spouse) and H. Aliene Cohick (decedent herein) 1.~06 5 Item No. 1. 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 11&ted under Schedule "En. Intangible personal property, titled in the name of the decedent, but payable at death to another or others, including but not limited to P.D.D. U. S. Savings Bonds and tenta- tive trust accounts, must be listed, despite the fact that they are not of the a~i'.llstered estate. Tangible personal 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 riduciary in said capacity, partnership interests, interest in any undis tributed es~ate 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 UN IT ESTI MATED VALUE MARKEr VALUE DEPARTMENT VALUATION (Do not write 1n this space) 3~ Shares, Capital Stock, American Telephone and Telegraph Company 7.218 5 $ 1,9~5.~~ 1,945.44 3~2;19 342.19 3. Single Payment Savings Certificate No. W 92~2, Class VII, Account No. 002-20-092~2, State Capital Savings and Loan Association, issued to J. Scott Cohick (predeceased spouse) or H. Aliene Cohick (decedent herein). Balance on date of death Accrued interest / 1,736.20 1,736.20/ 9.1~ 9.14 /' 5,433.58 5,~33.58 ~,OOO.OOI""""" 4,000.00 1~0.00 ........- 140.00 100.00,......- 100.00 1,860.00 1,860.00 ~. Checking Account No. 161-58~-8, CCNB Bank, N.A Balance on date of death 5. .c- Ford ~-door LTD hardtop, 1976 model, sale price 6. First National City Bank Travelers Checks (7) $20.00 checks (2) $50.00 checks 7. Household furniture, appraised value 8. 9. " }. (~) $1,000.00 United States Treasury Notes, Series B~1980, dated August 15, 197~, Nos. 599, 600, 601 and 602 issued to H. Aliene Cohick (decedent herein) or J. Scott Cohick (predeceased spouse) due August 15, 1980 Interest payable February 15 and August IS, 103.8 Accrued interest from August 15, 1977 to January. 29, 1978 /" (76) $50.00 United States Savings Bonds, Series "E", Registered to J. Scott Cohick (predeceased spouse) or H. Aliene Cohick (decedent herein) : Date of Issue Date Serial No. Death Vaiue May 1968 L 738291668E $ 61. 58 /:..- April 1968 L 736~66680E 61.58 ~~ March 1968 L 7 27 277~22E 61. 58 .......... February 1968 L 725339~37E 61.58 January 1968 L 725336~6~E 63.~2 December 1967 L 722217629E 63.~2 November 1967 L71721~~81E 62.80 ~ October 1967 L717211003E 62.80 / September 1967 L 717188153E 62.80 August 1967 L 717185538E 62.80 ~ 4,152.00 164.71 Insert this total opposite npersonal Property", Schedule ftBft 1n the "As Reported" column on the last page of this return. .. x X $26,786.14 CONTINUED ON PAGE 2 Rec -35 PAGE 2 SCHEDULE "B" PERSONAL PROPERTY . .... COMMONWEALTH OF PENNSYLVANIA TRANSFER INHERITANCE TAX RESIDENT DECEDENT 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 ftE". 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 or the a~l-:als.tered estate. Tangible personal 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, mo"rtgages, 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 No. Issue Date July 1967 June 1967 May 1967 April 1967 March 1967 February 1967 January 1967 December 1966 November 1966 October 1966 September ,1966 July 1965 June 1955 May 1965 April 1955 March 1955 February 1965 January 1955 December 1955 November 1955, October 1965 September 1955 August 1965 July 1955 June 1965 ay 1955 pril 1955 arch 1955 ebruary 1955 anuary 19'55 ecember 1964- ovember 1954- ctober 1954- eptember 1954- ugust 1954- uly 1964- une 1964- ay 1954- pril 1964- arch 1964- ebruary 1954- anuary 1964- ecember1963 ovember'1963 ctober 1953 eptember 1953 ugust 1953 uly 1953 une 1963 ITEM List and describe fully UNIT ESTIMATED VALUE MARKEr VALUE DEPARTMENT VALUATION (Do not write in this space) Serial No. L 7094-4-7113E L 707814-251E L 70781o597E L 7051873o1E L 7ooo79293E L 7ooo7531oE L 693554-528E L 69355374-6E L693550352E L69154-5915E L685539213E L585233775E L5824-66955E L5824-63907E L579363315E L57335984-8E L5733574-4-7E L67069373oE L67 06904-7 5E L65814-804-lE L667904-111E '; L6650384-67E L66304-1716E L658294-204-E L6574-82339E L654-115296E L650657792E L65064-4-187E L64-9728775E L64-8935187E L64-2696367E L64-4-86324-9E L64-o3784-97E L5374-70574-E L6374-56555E L635513830E L53537 517 6E L63055674-8E L63051o259E L6:304-98o24-E L6254-51736t L623518989E L6217994-11E L617791106E L617779997E L616395625E L515126074-E L614-386324-E L510761139E Date of Death Value $ 64-:.'70 54-.70 64-.12 64-.12 64-.12 64-.12 66.04- 66.04- 65.50 65.50./ 65.50,/ 67.4-8 V 67.4-8 v 66.94- ,/ 66.94-./ 66.94-/ 56.94-/ r 68.94-,V" 58.94- v" 56.72 68.72 68.72 58.56 58.56 68.55 68.16 70.22 7o.22v 70.04- 70.04- 70.04- 69.62 V 71. 70 71.70 71. 52 71.52 71.52 71. 06 73.18 73.18 73.02 v''- 73.02 V;- 73.02 r 72.55 v,/ 74-.74- v 74-.74- 74-.56 74-.56 74-.56 Insert this total opposite "Personal Property", Schedule "B" 1n X X the "As Reported" colunm on the last page of' this return. CONTINUED ON PAGE 3 " RCC -35 COMMONWEALTH OF PENNSYLVANIA TRANSFER INHERITANCE TAX PAGE 3 SCHEDULE "B" PERSONAL PROPERTY . RESIDENT DECEDENT 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 nE". Intangible p~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 adm1.nlstered 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 fully VALUE MARKEr VALUE (Do not write in this space) Date of Issue Date Serial No. Death Value May 1963 L606566052E 74.00 V' May 1963 Lo06566051E 74.00 v'" March 1963 L603371953E 76.22 February 1963 L599984886E' 76.04 January 1963 L596844717E 76.04 V ... January 1962 L578212103E 79.40 February 1962 L578564624E 79.40 March 1962 L580447069E 79.78 April 1962 L582527940E 79. 7B........' May 1962 L582906802E 77 .46 June 1962 L584934557E 77 .64 ~ July 1962 L588256506E 77.64 V August 1962 L588774103E 77 .64 V' September 1962 L590693286E 78.02 "" November 1962 L593912869E 75.76 December ,1962 L596770172E 76.04 /' December 1962 L596770l73E 76.04 Total date of death value $5,328.66 5,328.66 ~" '-;':' ._-."~ 10. Net proceeds from public sale of household contents 1,426.20 1,426.20 11. Medicare payment: Pennsylvania Blue Shield 118.00 118.00 12. Medical benefits: Blue Shield 65 Special 24.50 24.50 13. Refund: West Shore TV Cable Company 5.52 5.52 Insert this total opposite "Personal Property", Schedule "Bft in the nAs Reported" column on the last page of this return. x X $26,786.14 l RCC - 36 COMMONWEALTH OF PENNSYLVANIA TRANSFER INHERITANCE TAX SCHEDULE "c" TRANSFERS *.,. ..... . '. w. 1\ RESIDENT DECEDENT (1) Diet deCHdent, 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' 5 heal th at time of making the transfer. (Note 1). (c) Cause of decedent' 5 death. (Note 1). (4) Did deCHdent, .tn his lifetime, make any transfer of property without receiving a valuable or adequate conside.'ation theret:or which was to take effect in- possession or enjoyment at or after his death? (Answer yes or no)~~ (a) Was there any posslbil'ity that the property transf'erred might return to transf'erer 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 decE!dent 1n his lifetime make any transf'er without receiving a valuable and adequate consideration therefor nnder which transf'eror expressly or impliedly reserves f'or his lU'e or any period which does not in fact end before his death: (a) The possession or enjo~ent 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 1s in the affirmative, state whether the right was reserved in decedent alone OJ' others (7) Did decE!dent in his I if'et:1.me make a transfer, the consideration for which was transfereet s promise to pay income to or for the benefit of care of transferor? (Answer yes or no) No (8) Did decE!dent, at any time, transfer property, the benef'icial enjoyment of' which was subject to change, because of a reservecl 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 transf'erred, it's fair market value at date of death, dates of transfers and to whom transferred, with relationsh~) of transferees to decedent, if any. Submit copy of any trust deed or instrument, if trans- fers are clllimed 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. I TEl! DESCRIPT ION MARKET VALUE (Es tlma 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-37 (12-63) COMMONWEALTH OF PENNSYYLANIA TRANSFER'INHERITANCE TAX RESIDENT DECEDENT SCHEDULE "D" BENEFICIARIES ( 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 Fredda Cohick Zeiter DAUGHTER Yes Entire REsidue 1 Carlisle Avenue Reading, PA 19609 , , - Deponent further says that all the above-named beneficiaries are living at this time except below: NAME DATE OF DEATH RESIDENCE " . ... o . cutll~ ...-< Vi ': c '2 ~ E ._ ... :s ~"- ,,- 0 ." c." -< E. . o. 8u"g - -- " ~ ... " " 0 ~ E fr eg ~ SUMMARY .(Sch. "A") ......(SCh. "8") . ....(SCh. .e") Real Propert:. I Personal property...... Transfers 1 Gross Taxable Esta ,.. ] Z ... W '" .. ..l '" - .. ;.. "" .~ -< W Q '" 'Jl - - -< -< " llIi p:; ~ 'S a. "" 0 " a. "" 2: '" -< '" W -< ~ :I: :.. W ... ,.. .. Q c: c:i ?i .,. .. -< c: ~ - 0 ,.. ~ Z ,.. 'Jl ~ W ~ ,.. -"- 0 0 :; llIi c: p:; 0 0 a. :c w ;; ~ " I: ~ " Cl: J: 0 c: .. -< ~ 0 'S 0 l:' E - 'E --. '" :: E - - i5 .~ '" J 0 :;;:~ U U (I) (As Reported) $ $. $. $ $. $ (2) (As Determined) $ $ $ $ $ $ . RCC~38 COMMONWEALTH OF PENNSYLVANIA TRANSFER INHERITANCE TAX RESIDENT DECEDENT SCHEDULE "E" JOINTLY OWNED PROPERTY INSTRUCT10NS: This schenule 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 brle~ description, as indicated under Schedule "An, 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 "8", V1us date of acquisition, and the nWme, address ano relationship (ir any) of co-owners to the decedent. Description ~r Property, Date of' Acquisi tion, Name Address and Relationship of Co-Owners, and Place of Recor'd of Instrument, where Real Estate. XX~><o.~ 0< !Y (X~ !Y 0( ')I unit Value percentage Sh are Sex> > OCx fS~~ 0: 0<:>0 1. Savings Account No. 001-017221-1, ~- CCNB Bank, N.A. in joint names of decedent or Fredda C. Zeiter as joint tenants with right of survivorship. _ Balance on date of death: $:',868.:'10./ Accrued interest: $20.63~rUlly taxabje ~ 2. 16:' Shares, Common Capital Stock, CCN Corporation in joint names of deceden< and Fredda C. Zeiter as joint tenants with right of survivorship. Fully ".,...-------' taxable p'2. 00 3. Account No. 119306548-0, TWA Club Credit Union, in joint names. of decedent and Fredda Cohick Zeiter as joint tenants with right of survivor~ ship. Balance on date of death: $25,650.%. Fully taxable TOTAL Inse~t this total opposite "Jointly Owned Property", Schedule "En in the "As Reported" colunm on the last page of this return. Estate Valuation ~ DEPARTMENT VALUATION CAUTION-Do not Write In This Space. Value of Value of' Entire Decedent's Property Interest 5,868.:'1~....-- 20.63 (...--'" ~ 1,980.0OJ . V :',6:'0.56 $ 3,:'19.70 $33,519.70 5,868.51 20.63 1,980.00 25,650.56 r , '. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS HARRISBURG 17127 IN YOUR REPLY PLEASE REFER TO RCC-81 (6-73) Inheritance Tax Division NOTICE OF FILING or APPRAISEMENT Fredda Cohick Zeiter One Carlisle Avenue Reading, FA 19609 (Executor or Adm ini strator) In Re: Estate af Helen A1iene Cohick Cumberland 21-78-0067 Caunty - Fi Ie Na. Dear Mrs. Zeiter: Yau are hereby natified that the Original appraisement in the estate of Helen Aliene Cohick has been filed in the office of the Register of Wills of Cumberland County on August 14 , 19 78, Soid oppraisement reflects the following valuations: Reol Estote Personal Property T ronsfers Jointly Owned Total 62,000.00 26,786.14 None 33,519.70 ~122,305.84 As to such tax thot is poid within three months from dote of death, a live (5%) percent discount is allowable. As to any tax thot remoins unpoid ofter nine (9) months (fifteen months when death occurred from December 22, 1965 to June 16, 1971, inclusive; ond twelve months when deoth occurred prior to December 22, 1965) from dote of death, interest at the rote of six (6%) percent per annum is chorged. Any party in interest who is oggrieved by this notice moy object thereto within sixty days after receipt of soid notice as provided by Section 1001 of the Inheritance ond ::::te Ta~u::~:f ~:~\:~:. S. 2485-10:il:n:~ L. ~~ k, hh~ Title Chief Appraiser L~ Note: This is not a bi II. RCC-2 (2.64) 14, 1978 COMMONWEALTH OF PENNSYLVANIA DATE August . DEPcARTMENT OF REVENUE RESIDENT INHERITANCE TAX COUNTY Cumberland BUREAU OF COUNTY COLLECTIONS HARRISBURG, PENNA, 17127 APPRAISEMENT FILE NO. 21-78-0067 Whereas, Helen A1iene Cohick late of Lower A11enc Township in the County of Cumberland Commonwealth of Pennsylvania, having died on the 29th day of January 19 78 , seized and possessed of an estatc subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania; Therefore, I, Ira 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 Ufe 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 Appraitement Dtlcrlptlon of Anet Valuel Made for Inheritance Tllx PurpOlet , Real Froperty $ 62,000 00 Fersona1 Froperty 26,786 l4c Transfers None Joint-Held I'roperty 33,519 70 TOTAL ASSETS $122,305 84 . - . . j , , . i . I . ^ , . . . . , . - . ~ . t . -- - . ,c . ,c : -~ . . .. , - ~ . . 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