HomeMy WebLinkAbout10-12-78
RCC-33 (4-73)
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
*'
RESIDENT DECEDENT
COUNTY OF
CUMBERLAND
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 and Estate Tax Act of 1961.)
MARY E. SHEELEY
(STATE FULL NAME OF DECEDENT)
} AFFIDAVIT OF
EXECUTOR S
~
County
IN THE MATTER OF THE ESTATE OF
Late of
Cumberland
State of Pennsylvania
County of Cumberland
J os,
Administrator
Laurq E. Finkenbinder Starry and Jennie Dee Hocker,
of the estate of the above-named decedent being duly sworn, depose and soy
Executors
Decedent died
29
, 19~{testate leaving 0 lost will, copy of which is hereto attached. }
(YEAR) M~
January
IMONTH)
Name and address of attorney or }
other outhorized representative to whom
011 correspondence should Se mailed.
(DAY)
Tom H. Bietsch, Esq. (Bietsch & Morgenthal)
7 Irvine Row, Carlisle, Pa.
17013
That as such Executrices deponent is familiar with the affairs of said estate and the property constituting
(EX E CUTO R-ADMINIST RA TO RI
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 SAFE DEPOSIT BOX IN NAME OR NAMES OF HOLDERS TO DECEDENT
NONE
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
whercsovcr 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, Of 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 priflT 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 wt.:aring apparel, jewelry, silverware, pictures, books, works of art, household furniture, horses, carriages,
automobiles, boats, and any an'd all other personal chattels of whatsoever, kind or nature, left by decedent,
together with the fairly estimated market value thereof; all bonds and mortgages held by decedent and of all
claims due and owing decedent at the time of death, and all promissory notes or other instruments in writing
for the payment of money of which decedent died possessed, of whatsoever nature, with interest thereon, if
any, giving the face value and estimated fair market value thereof, and if such estimated fair market value be
less than the face value, it sets forth briefly the reasons for such depreciation as to each item; all moneys
payable to the estate from life insurance policies carried by decedent; all annuity and endowment contracts
the proceeds of which were payable upon the death of the decedent; all and the corporate stocks and dividends
due thereon and unpaid as of the date of death, bonds and accrued interest thereon to the date of decedent's
death and other investment securities own'ed by the decedent at the time of death, with the market value there-
of at such time.
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 of
death in any co-partnership or business, and in support or the value of such interest there is annexed to
said schedule, financial statements showing the assets and liabilities of' said co-partnership or 'ttusiness.
A copy of the co-partnership agreement, (if oral, a statement setting forth the nature of tile agreement)
together with a 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 and just appraisal of the decedent's interest
therein must be submitted. It should also set forth in itemized form, 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 transfers of property, real or personal, within two years of decedent's
death, in contemplation of decedent's death, or intended to take effect in possession or enjoyment at or
after death, said schedule sets forth the nature and value of such property, to whom transferred, the
relationship of the transferees to the decedent, the proportionate share received-by each transferee and
all other facts of a pertinent nature regarding said transfers. In the case of' transfers intended to
take effect in possession or enjoyment at or after death, there is also attached to the schedule a co~y
of the deed, trust agreement or other instrument creating the trust. Therl~ is also set forth in said
schedule a list of all property, real and personal, with its value, which passes at decedent's death by
virtue of the exercise by decedent, either individually, or jointly with another, or any power of appoint-
ment vested in decedent, either individually or jointly, by the will, deed, or other instrmnent of another,
with a copy of the instrument creating such power attached to the schedule.
That Schedule 0 attached hereto and made part hereo~ sets forth the names and addresses of all
persons beneficially interested in this estate at the time of decedent's death, the 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, and the relationship of such issue to the beneficiary.
That Schedule 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, including intangible, standing in the name
of the decedent and others, plus the date and place of record of instrmnents effecting the vestiture of
real estate and the date o~ acquisition of personalty, plus the name, address and relationship, if any,
of co-owners to the decedent.
That Sc/1edule 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 hlneral expenses paid;
family exemption, where applicable; costs o~ administration of this estate; counsel ~ees and fudiciary'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 ann nnpaid at time of
death; taxes accrued chargeable for period prior to decedent's death (except those allowed under Section
65101' the Inheritance and Estate Tax Act); together with a statement of collateral pledged for obliga-
tions, if any. It is 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 Register of Wills, and that
the amount of' tax assessed can be reassessed in accordance therewith.
That
have
the totals of the appropriate columns in Schedules "A", "B",
been carried ~orward and properly registered in the Summary.
"e" ,
"E", and "F" as directed therein,
Subscribed and sworn to before me this
~/:~ c,
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'....m...mm..I...':;,-:::..... . ... day of ,..:...>S.~;1!., "".L'l." 19.,]?.. "",m......m...'..mm....,.,m".m'..........m....m.......
"'CT' r~., .".. 'cmq,?/~,~) ~......... .., BOX~~;:~;.:~:~,'~=>.'..m_....'m..'
~~NICE E. HERTZLER, NOTARY PUBLIC (Street Number)
cumberland County Carlisle, Pa'C:::Clf:J,j,l!!),t;l",J:>i:l.,....,lZQl::L
My commission Expires January 27,1979 (City M' Town and State)
NOTE: Bef'ore signing aff'idavit make sure all blank spaces in the af'fidavit and schedules annexed are
filled in with details or the word "None", and in case the assets include 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 in the "Summary" has been properly completed as above-directed.
-I'M ~~~{, jJ;R- I/~t-<
. D. 2, Box 125 (
, Newville, Pa. 17241
. RC C.34 (4.73)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
TRANSFER INHERITANCE TAX
RESIDENT DECEDEN"(
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 other, should be identified
as to quantum of interest and the estimated value should be that of the decedent's interest only. (Property
held as joint tenants with right of surviorship or tenancy by entireties should be reported on Schedule "E.")
The real property located In the Commonwealth of Pennsylvania should be
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
to be listed on Schedule uF" and must not be deducted from this schedule.
(1)
(2)
(3)
DEPARTMENT
VALUATION
CAUTION
(Do not write
In this space)
ASSESSED VALUE
FOR YEAR OF
DECEDENT'S
DEA TH
ESTIMA TED
MARKET VALUE
1.
Farm of 60 Acres, more or less,
situate in Upper Mifflin Township,
Cumberland County, Pennsylvania.
For source of title see Deed dated
March 20, 1927, and recorded in the
Office of the Recorder of Deeds for
Cumberland County in Deed Book "r",
Vol. 11, Page 338. //< $9,180.00
$60,000.00 "vt,,;, ,1)), I"
'"J "
'11 ~:l ,(1 ~
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b {II OU ,v
Insert this total opposite "real prope.l,", Schedule "A" in the X X X X X
"As Reported" column on the last page of this return.
$60,000.00
---
RCC -35
J\ESIDLa DECEDENT
SCHEDULE liB"
PERSONAL PROPERTY
~."..'
,~'\
CO~WONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
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.Q.D. U. s. Savin~s Bonds and tenta-
tive trust accounts, must be listed, despite the f'act that they are not of' the administered estate.
Tangible personal property should be listed f'irst (e.g. jewelry, wearing apparel, household
goods, and :furnishings, hooks, paintings, automobiles, boats, etc.)
Intangible personal property, such as bonds, treasury certif'icates, 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 t'iduciary in said capacity, partnership interests, interest in anyundistributed
estate of' or income f'rom 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
ESTIMATED
MARKET VALUE
DEPARTMENT VALUATION
(Do not write in
this space)
1.
Cash.
$
41. 20 ~
, ,. "/
"11,'" "
2.
Checking Account No. 084-888-3-20. l~e
First National Bank. Newville, Pa.
/'/ .
Savings Account No. 19. The F1rst
National Bank. Newville. Pa.
182.78
1
, .
i'.'" , ~)
4.
Refund. Adams Electric.
5.00
r-~ 1, r: k
I" , . "'
, , .
, . .;
F'" 1 "
.- .
.., ~
. ..
.
3.
7,011.56 c
A.
Accrued Interest on Item 3.
27.83
5.
Pennsylvania Real Estate Tax refund.
200.00
1) i i~f, }7
Ins er t this to tal oPPos! te "Personal Proper ty", Schedul e "8" in
the "As Reported" column on the last page of' this return.
x X $ 7 , 468 . 37
RCC- 36
COMMOXWEALTH OF PENNSYLVAliIA
TRAXSFER INHERITA:'-iCE TAX
SCHEDULE "c"
TRANSFEllS
*
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 1s in the affirmative state:
(n) Age of' decedent at time of transfer N/A
(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)---1i~
(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) ~o
(b) What was the transferee's age at time of decedent's death? bl/1\
(5) Did decedent in his lifetime make any transfer without receiving a valuable and adequate consideration
therefor under which transferor expressly or impliedly reserves for his life or any period which does
not in fact end bef'ore his death:
(a) The possession or enjoyment of or the right to income from the property transferred?
(Answer yes or no) blo
(b) The right to designate the persons who shall possess or enjoy the property transf'erred 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 N/A
(7) Did decedent in his lifetime make a transfer, the consideration f'or which was transferee's promise to
pay income to or for the benefit of care of' transf'eror? (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 al tel', amend, or revoke, or which could revert to decedent nnder terms
of' transfer or by operation of' law? (Answer yes or no) No
(9) If' the answer to (8) above is in the af'f'irmative, was the power to alter, amend, or revoke the inter-
est of' the benef'iciary reserved in the decedent alone or the decedent and others?
(Answer yes or no) No
NOTE 1: The answers to these questions should be supported by affidavit by the attending physician as
well as a copy of the death certif'1cate.
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 racts 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
(Es tlma ted)
DEPT. VALUATION
(Dept. Only)
NONE
NONE
'-
Insert this total opposite "Transf'ers", 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"
~.. . ^f;lt. 1\
~
BENEFICIARIES
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
lave an interest, vested. contingent or other are involved, set STATE YES IN ESTATE
wise in estate) forth this fact.) OR NO BIRTH
David A. Sheeley Son Yes The farm of decedent
R. D. 2, Box 118A for the consideration
Newville Pa. 17241 ~~<';>~~u~~;.u~.;,,,,~~~o
Laura E. Finkenbinder Di'lunht",r Yes 1/3 of residue
Starry
Box 364, R. D. 1
Carlisle, Pa. 17013
Jennie Dee Hocker Daughter Yes 1/3 of residue
R. D. 2, Box 125
Newville. Pa. 17241
Deponent further says that all the above-named benef'iciaries are living at this time except below:
NAME DATE OF DEATH RESIDENCE
NONE
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SUMMARY
...(Sch. "A")
... ...(Sch. "B")
. ....... ........ .......(SCh. "C")
Real Property
Personal Property
Transfers
Gross Taxable Estate. .
(1 )
(As Reported)
$oC),C)OO.OO
$ ....1...4:6.8,37
$.. .. ....N:9.Il.EL
$
$..
$ 67,468.3} .
(2)
(As Determined)
$
$
$
$
$.
$
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RCC-38
RESIDENT DECEDENT
SCHEDULE "E"
JOINTLY OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
INSTRUCTIONS: This schedule must disclose all property, real and personal, owned by the decedent jointly
with another or others, including intangibles, standing in the name of' the decedent and others. List
reil.l estate first, as entireties, or joint tenants, giving brief description, as indicated under Schedule
"A", ph:..s the date and place of record of' instrwnent effecting vestiture, but do not include entireties
or out of state real estate value in estate valuation colunm. 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 dece(ient.
Description of Property, Date of Acquisition, Name
Address and Helationship of' Co-Owners, and Place
of Record of' Instrument, where Real Estate.
;~ VV< 'X VV< ~ 0&
;~~ ~ ~ co~~ 0 ~ ~~X%~ SS;S ~
unit
Value
percentage
Share
Estate
Valuation
DEPARTllENT VALUATION
CAUTION-Do not Write
In This Space.
00< ~ XX 0<
~
Value of'
Entire
Property
Value of
Deceden t' s
Interest
.r_ONE
NONE
NONE
Insert this total opposite "Jointly Owned Property", Schedule "E"
in the "As Heported" column on the last page of' this return.
.............
.
Rcc-a 1 (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 or APPRAISEMENT
Laura Finkenbinder Starry
Box 364
r.::Irliglp, Ppnn.:::a
(Executor or Administrator)
In Re: Estate of
M.Ary R !ShAt:ll&>y
Cumberland
County - Fi Ie No.
21-78-0086
Dear
You ore hereby notified that the Original
appraisement in the estate of Marv E. Sheeley
has been filed in the office of the Reqister of Wills of Cumberland
County on 12 October ,19~, Said appraisement reflects the following
valuations:
Real Estate
Personal Property
T ronsfers
Jointly Owned
Total
60.000.00
7.468.37
None
None
67,468.37
As to such tax that is paid within three months from dote 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 obiect 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. 37~l _ .. 77
Dote 12 O"tober 78 Signed C lLA. _ ~{~fi.jg~~_.__
Title.
Chief Appraiser
/ ..
L..'/
Note: This is not a bi II.
---
RC C-2 (2-64)
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
HARRISBURG, PENNA, 17127
COMMONWEALTH OF PENNSYLVANIA
RESIDENT INHERITANCE TAX
APPRAISEMENT
DATE I 0 - I '2-- I 8
COUNTyCu./vv\.L~
FILE NO. L-l -( '8- 00 6(,
Whereas, ~~. S~ late of N~
in the County of 0.. ~ . Commonwealth of Pennsylvania, having died on
the -;; C(-t:Q..... dayof'~ ~J 19'1'0, seized and possessed of an estate
subject to Inheritance Tax under the laws of the 9ommonwealth of Pennsylvania;
Therefore, I, \ ~"- G. 0 Q . - . 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 Auet Values Made for Inheritance
Tax Purposes
Q 0 A. ~ e "- -.GO ~-k $Ioe QuO (X)
?~'/>.J~ v,,~...:..~ ~- t---I
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\ cYtt~ ~ 101,469 31
-
Having been duly sworn al{CQ!ding to law, I do hereby certify that he bove appraisement is made in con.
formity with Jaw on this -1. L -tLL day of 19'1 '2> .
~4."'-r-.----
Appraiser
'h. (IfDmber and Stnet)
\ '\"~~
(Post OftIee)
, Penna.
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