HomeMy WebLinkAbout03-06-79 (3)
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RCC-33 (4-73)
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COMMONWEALTH 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 residedj Return is due within nine months after date of death, unless an extension is granted
by the Secretary of Re~enue. (Section 703 of the Inheritance and Estate Tax Act of 1961.)
IN THE MATTER OF THE ESTATE OF
John T. Greek
(STATE FULL NAME OF DECEDENT)
Late of
Cumberland
} A FFIDAVI! OF
rlX
EXECUTIIR
~
County
State of
Pennsylvania
Cumberland
} os,
County of
Administrator
Jane E. Graffam
Executffifix
of the ..tot. of the abov..named decedent being duly sworn, depo..S
and sa,.5
JulY
(MONTH)
Name and address of attorney or }
other authorized repres,entotive to whom
all correspondence should be moiled.
Decedent died
26
19--ZL-{teltate leaving a la.t will, copy of which i. hereto attached. }
(YEAR) ~
(DAY)
James D. Bo\,ar
23 West Main Street, Shiremanstown, PA 17011
That as such Executrix deponent is familiar with the affairs of said estate and the property constituting
I EX ECU TO R.ADMINISTRA TO RJ
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
TN WHICH DECEDENT RENTED A S....FE 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
wheresover situated owned by the decedent at the time of death; all moneys left by the decedent at the time of
death, whether in decedent's immediate possession, standing to decedent's credit in banks of deposit, savings
banks, trust companies, or other institutions, whether individually, or in trust for any other person or persons
giving also separately the accrued interest thereon, if any, down to the last interest day prim to decedent's
death in the case of savings banks, and to the date of decedent's death in all other cases; all bonds, postal
savings, treasury certificates or notes and other evidence of indebtedness of the United States to the de-
cedent; all obligations, whether by statute or agreement they are designated as tax free, of the United States,
or any state, or political subdivision thereof, or of any foreign country, which are owned at the time of death;
all wearing apparel, jewelry, silverware, pictures, books, works of art, household furniture, horses, carriages,
automobiles, boats, and any and all other personal chattels of whatsoever, kind or nature, left by decedent,
together with the fairly estimated market value thereof; all bonds and mortgages held by decedent and of all
claims due and owing decedent at the time of death, and all 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 owned 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 substantiateci. by financial statements o_f 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 D,usiness.
A cOj)y of the co-partnership ag'reement, (if oral, a statement setting forth the nature of tne agreement)
together with a statement setting forth the cnaracter of the business, its location, and such other facts
pertaining to the business as may be pertinent to a f'a1r and just appraisal of the decedent's interest
therein must be submitted. It should also set f'orth 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 transf~rred, 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 cOAY
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 paf,:ses 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 instrument of' another,
with a copy of the instrument creating such power attached to the schedule.
That Schedule D attached hereto and made part hereof 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 lire 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 S~~edule 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 instruments effecting the vestiture of
real estate and the date of acquisition of personalty, plus the name, address and relationship, if any,
of co-owners to the decedent.
That Scf1edule F attached hereto and made a part hereof sets f'orth fully and in detail all debts
and deductions claimed for and on behalf of' this decedent's estate, including funeral expenses paid;
family exemption, where applicable; costs of administration of this estate; counsel fees and hldiciary'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 nnpaid at time of
death; taxes accrued 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 Cdllateral 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 the totals of the appropriate columns in Scherlules "A", "B", "en, "E", and "F" as directed therein,
have been carried forward and properly registered in the Summary.
Subscribed and sworn to before me this
;;~^-
.....2... .
..~.
/!hAC,L
...... day of ...............
Ctl0fd&/
..19]Q
.........j)fE;;~eof~d~~~~yj~e.IL..-Graffam
.5Q\LCQ.\;,k.1.i.n..S_tr.~~t...._.._----_...._.
(Street Number)
~<:!1:::u:ic=.~1:l11.r.g,~}\p 05 5
(City or Town and State)
JOAN f.A.RNOlD. Notary publla
Shiremanstov,.-n, Cumberland Co., Pi!:
My Commission Expires Sept. 6,1982
NOTE: Before signing affidavit make sure all blank spaces in the a~~idavit and schedules annexed are
f'illed in with details or the worrl "None", anct in case the assets inclu~e rare and unlisted securities,
securities of close or family corporations or an interest_in any co-partnership or business, that the
data ami statements requirerf unrler the paragraph above relating to Schedule "B" are attached. Also make
certain that - column #i.- in the "Slmunary" has been properl'ycompleted as above-directed.
RC C-34 ~ 4-73)
COMMONWEALTH OF PENNSYLVANIA
OEPARTMENT 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 common with another or other, should be identified
os 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 Commotlwealth of Penn.ylvanla .hould be
described by lot and block number, .treet 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 .tate number of a-
cres; also statement of mortgage encumbrance. upon each parcel at death
of decedent. Taxe., a..e.sments, accrued Intere.t on mortgage., etc.,are
to be listed on Schedule "Fu and must not h. deducted from this schedule.
(1)
(2)
(3)
DEPARTMENT
VALUATION
CAUTION
(Do not write
In this .pace)
ASSESSED VALUE
FOR YEAR OF
DECEDENT'S
DEATH
ESTlMA TED
MARKET VALUE
ALL that certain piece or parcel of land situate in
the Borough of Camp Hill, Cumberland County,
Pennsylvania, bounded and described as follows,
to wit:
$12,360.00
$23,000.00~~
BEGINNING at a point on the south side of Green
Street, which point is the division line betweert
Lots Nos. 28 and 29 on the hereinafter mentioned
plan; thence along the division line of said lots,
towards Trindle Road, southwardly, one hundred fifty
(150.0) feet, more or less, to the line of land
conveyed to Roy M. Sheeley and wife to George R.
Davey and Vera H. Davey, his wife, by their deed
dated April 24, 1923, and recorded in the Cumberland
County Recorder of Deeds Office in Deed Book "Q",
Vol. 9, Page 489; thence eastwardly, along the line
of said land, fifty (50.0) feet to a point; thence
northwardly, along other land of the said Roy M.
Sheeley, by a line parallel with the division line
between Lots Nos. 28 and 29, aforesaid, one hundred
fifty (150.0) feet, more or less, to the south side
of Green Street; thence westwardly, along the south
side of Green Street, fifty (50.0) feet to the place
of BEGINNING.
BEING a PART of Lot No. 28 on a Plan of Lots known
as PLAN NO. 2 of the Rupp Tract, which plan is
recorded in the Cumberland County Recorder of Deeds
Office in PLAN BOCK 1, PAGE 14.
BEING the same premises which Mary Greek by her deed
dated December 1, 1955, and recorded in the Cumber-
land County Recorder of Deeds Office in Deed Book
''W'', Vol. 16, Page 30, granted and conveyed unto
Mary M. Greek and John T. Greek, her husband.
The real property was sold at private sale on
December 1, 1978, resulting in a gross proceed
of $23,000.00.
.-, "'2
t::-~) I OC\(1 ,L~O
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.
.. Rec -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 or 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 or 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 ract that they are not or the administered estat~
Tangible personal property should be listed rirst (e.g. jewelry, wearing apparel, household
goods, and fUrnishings, books, paintings, automobiles, boats, etc.)
Intangible personal property, such as bonds, treasury certiricates, cash on hand and in bank,
stocks, mortg~ges, 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 anyundlstrlbuted
estate or or income rrom any property held in trust under the will or agreement or another, even though
located outside or the State, at the time or death, should be listed in this schedule.
ITEM
List and describe fUlly
UNIT
VALUE
ESTIMATED
MARKET VALUE
DEPARTMENT VALUATION
(Do not write in
this space)
Household and personal effects
(See attached appraisal)
$
523.25, ~
State Capital Savings, Harrisburg, Pennsylvania
Certificate of Deposit No. 002-20-08462
Date Opened: July 2, 1975
Date of Death Balance: $10,000.00
Accrued Interest 52.21
Additional Interest 54.60
Total $10,106.81
10,106.81J/
State Capital Savings, Harrisburg, Pennsylvania
Savings Account No. 002-00-07695
Date Opened: January 8, 1977
Date of Death Balance: $4,783.94
Accrued Interest 17.74
Additional Interest 17.97
Total $4,819.65
/
4,819.65"
CCNB Bank, N.A., New Cwnberland, Pennsylvania
Certificate of Deposit No. 11465
Date of Death Balance: $16,000.00
Accrued Interest 112.79
Additional Interest 290.02
$16,402.81
//
16,402.81
CCNB Bank, N.A., New Cumberland, Pennsylvania
Trust Fund Check No. 003420 as Guardian of
the Estate of John T. Greek, an Incompetent
V
1,018.96
35.00 V
Medicare Refund
Mechanicsburg Insurance Service - Refund for
cancelled policies
105.00'V--
,V
Nationwide Mutual Fire Insurance Company -
Refund for cancelled policies
40.00
33,051. 48
~..,-'J,OSl.LjQ,
Insert this total opposite "Personal Property", Schedule "B" in X X
the "As Reported" column on the last page or this return.
----
-
RCC..42. (4-017) BANK NO.
COMMONWEALTH OF PENNSYLVANIA f1 r .- ". .,
~tr4' {J ,';'"
OEPARTMENT OF REVENUE
DATE FILED
NOTICE OF DECEDENT ACCOUNT STATUS 9-20-78
Submit in truplicate within IU days alter knowledge of STATUS OF AC5~~~O: (JOINT, TRUST, OR INVESTMENT
the death.
:IlJQ;~ 1-8-77
RETURN COMPL ETED NAMES ON ACCOUNT SOCIAL SECURITY NUMBER(sI
FORMS TO LOCAL COUNTY John '1'. Greek 172-01-9045
INHERITANCE TAX OFFICE or
Donald '1'. Graffam
- SURVIVING DEPOSITOR (Beneficiary) INFORMATION OECEOENT INFORMAlluN
NAME RELATIONSHIP NAME DATE OF DEATH
TO DECEDENT. 11-~.7l
Donald '1'. Grdf_ unrela1;ed John '1'. Greek
,6,DDRESS (~~ ADDRESS
509 COcklin S1;ree1;
Unknown CITY COUNTY I _ft"
Mechanicllburg ZIP 1"1\555
BANK/INSTITUTION ADDRESS BALANCE OF ACCOUNT AT 000 $ 4. 7lli.94
51;a1;e Capi1;al Savings INTEREST ACCRUED AND COLLECTIBLE AT 000 $ 17.47
" Loan Assoc. TOTAL 002-00-07695 $ . .~
108-114 Korth 2nd S1;ree1; BANK AUTliORIZATlON
P.O. Box 1861 I HEREBY CERTIFY THAT THE INFORMATION CONTAINED HEREIN IS A
Harrisburg, Pa. 17105 CORRECT REPRESENTATION OF INFORMATION IN OUR FILES IN ACCORD
WITH SECTION '/42 PI 6: E TAX ACT OF 1961.
SIGNA'(::E 0 FF,INAN CIAL~N.VE~TIGA TO R DATE
" ,{__r"t/;-L-i"'-' /;;,J//C.,,-'C:-5[)(L ,,_,:_c ~ ~_-c::Y ~-_ -;"J!
-
:UO pa.llnba.l I! ~oda.l oN
'(pappD . IID~dw3) .. '(O\J:$)
"DIIDP pa'pun~ aa'~I p..,xa IDU .aDp ~IDap fa aW!I aql
10 1!lodap 8'11 ua'lM IUnO:l:lo '1:lns 01 p.l06a.l U! p..I!nbN a<l
lIolt' UO!IO:)!J!IOU ON eIUnO:l:lO alfl C).lI.lOA!A.lnS.lO .I0AlAIn,
a'll 10 ".'ppD pUD aWDU a~I pUD UOII",IISUI IDI'UDUll
a~I ~II'" ~IDap 10 alDp a~I ID lIso<lap UO '0 palsaAUI IuaOWD
altl 'IUliWISaAU! .10 1110d.p IIR.l1 .10 lutol aql JO UO!108~ altl
JO alOp altl 'uoS.lad palD8:l8p 8lf1 JO _WOU -It I 6U!A!6 Joa.laltl
anuauN 10 luaW"D<laa aql .If!lOU OJ ~IDap a~I 10 a6pal"'ou~
'aijD dDp (01) ual ulqll'" uO!lnlllsul ID!>UDUil a'll 10 ~np
-It I 8q lIolts I! 'alP 1I0ltl luewit_AU! ..0 Hlodap al.{i Oi s.!....Dd
-It I JO euo pUD 1"8l.f40 .10 .I8ltlOUD "oJ IIR.l1 VI SUOI.l8d .10 uos.lea
o JO _wov 8't1 U! .10 -HM pu~ pUoqSRq UO'l1 ..atllo SUOSJ8d ~uow
.10 OMi JO sawou a~ U! O!UDAIASuuad U! P.iO:101 uOHnHUU!
ID!:lUDU!J D U! p8lti_AU!..o p81}tiodap S! Aauow ual.{M..
'~IIDnpIAlpUI Iuapa,ap a'll ~q Pla~ Iluno>>y (E
OO'O\J:$ ,apun a'UD\Dq D ~1I'" 'IunO>>D IUlor IZ
"IunO>>D all'" pUD puoqsnH (I
'.all'Dd P'I'll pUD
all'" puo pUDq.n~ ~q Pla~ 'Iuno>>y (S
'~I'ol os pUD
'SIUnO:l:lD ."D'tS 'Hsod8p JO S.IO:l!U....:l
so It:lRS '1IUnO:l:lO IU.WIS8AU! IU!Or (t
sluno>>y Isn'l (E
sluno>>y 6u1~'aq:> IUIor (~
slunO:):lY S6U!ADS IU!Or (L
'1961::10 l:>Y XYl31Y1S3 aHY
3:>HYlIN3HHI 3Hl :10 ~'l HOI1:>3S
:uo p_..!nb... S! ....od... Y
"
The following is an appraisal of the Estate of John T. Greek, Incompetent,
property located at 3421 Green Street, Camp Hill, Pa.:
Kitchen
5 Piece Maple Dinette Set
Kitchen Clock
Frigidaire Refrigerator (Old)
Metal Cabinet
Miscellaneous Utility Dishes
Miscellaneous Cookware
Back Bedroom
2 Piece Cherry Bedroom Suite
Straight Chair
Book Shelf
Assorted Bed Clothes
Wall Lamp
Baby Ben Clock
$ 45.00
1.00
12.00
5.00
10.00
2.00
5.00
12.00
24.00
4.00
1.50
7.50
1.00
3.00
4.00
125.00
7.00
3.50
5.00
2.50
1.50
Front Bedroom
Single Bed, Spring & Mattress
Chest of Drawers
Cedar Chest
Dresser Set
Metal Security Box
G.E. Electric Sweeper (Tank)
Cane
Miscellaneous Christmas Goods
Oval Picture
Basement
Worthless Junk (Wet)
Living Room
Sofa
Large Rectangular Mirror
What Not Shelf
Table Light
Square End Table
End Table With Glass
Morris Chair, Antique
Straight Chair (Cane Seat)
Straight Chair, Windsor Type
Telephone Stand
Television Table
Knickknack Shelf
Sony Portable Colored T.V. (Needs Repairs)
Ladder Back Chair
Floor Light
Rocking Chair
Drop Leaf Table
Foot Stool
Assorted Books
Miscellaneous ~nickknacks
25.00
12.00
7.00
3.00
1.50
6.00
;;.00
15.00
8.00
3.00
3.50
2.50
75.00
16.00
1.50
10.00
15.00
2.00
3.00
2.00
----
Appraisal of the Estate of John T. Greek, Incompetent, property located at
3421 Green Street, Camp Hill, Pa. Continued:
Garage
2 - Hand Lawn Mowers @ $1.50 each
Hose
Assorted Garden Tools
Plastic Trash Can
Wood Ladder (Old)
Drop Leaf Table
Fishing Nets
$ 3.00
1.00
10.00
1.00
3.00
1.00
.75
$523.25
This appraisal is true and
Auctioneer and Appraiser with thi
')
correct to the best of my knowledge as an
five years experience.
{o..(l e V)cr(
Claude C. Wol
(/
September 20, 1978
James D. Bogar
Attorney at Law
23 West Main Street
Shiremanstown, Pa. 17011
RE: Estate of John T. Greek
D.O.D- 7-26-78
Dear Mr. Bogar:
In response to your request, we show the following
account information for the above named decedent:
# 002- 20- 08462 BALANCE AS OF DATE
OF DEATH $ 10,000.00
Est. of John T. Greel<.ACCRUED INTEREST 52.21
c/o DATE OF DEATH VALUE $ 10,052.21
Jane E. Graffam DATE ORIGINALLY OPENED '-2-'~
# 002- 00- 07695 BALANCE AS OF DATE
OF DEATH $ 4,783.94
1111 ACCRUED INTEREST 17 .47
DATE OF DEATH VALUE $ 4,801.41
DATE ORIGINALLY OPENED 1-Cl-",
#- ---
BALANCE AS OF DATE
OF DEATH $
ACCRUED INTEREST
DATE OF DEATH VALUE $
DATE ORIGINALLY OPENED
#_-
BALANCE AS OF DATE
OF DEATH $
ACCRUED INTEREST
DATE OF DEATH VALUE $
DATE ORIGINALLY OPENED
If you have any further questions, please feel free
to contact this office.
Sincerely,
,
ii'''-'
,/. rll! 1'7(-:~..r
,,'. ./ !
Donna Magdinec (Miss)
FW~~~'M~~E<:X~Mi<)
Savings Investment Servicer
I
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FEM
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'.........-~;;;........ "',." ;..,r:~."..? -.J "'. .1 l",..~;p,,) MAIN OFFICE 331 BRIDGE STREET NEW CUMBERLAND, PENNSYLVANIA 17070 17171 774~7000
CCNBBANK.N.A.
Date
September 18, 1978
TO: James D. Bogar
23 West Main Street
Shir~manstown, PA 17011
RE:
Estate of John T. Greek
Name of Decedent
The following is a complete record of the above decedent's accounts
as of
July 26, 1978
Date of Death
lCCOunt No.
Type of Account
Balance on Date of Death
Principal Accrued Int.
Names on Account
(All Owners)
Date of Creatio:
of Joint
Ownership
n465
Cert. of Dep.
$16,000.00
$25.77
John T. Greek
..;
.
R. S.
,/Jt0-L. _
'.J~::I' 0,//1,. '
, )1", ' ~//
Stenhens;;: /,' !.' //c.:'
Authoriz~~'Slgnature
y
.
-
Rec - %
CllMMO:\'>'iEALTII OF PENNSYLVANIA
TI!A:\~Ff:il I:\HEHlTANCE TAX
SCHEDULE lie"
TR\NSF'EHS
'*",
, 'If t\
(.\!' ",
I1ESIm:,T fll':CEllENT
(1) Did decedent, within two years of'death, make any transf'er of' any material part~9f' his estate, without
receiving a valuable and adequa,te consideration theref'or? (Answer yes or no) NO
(:;) Did decedent, within two years of' death, transf'er propen,y f'rom himself to himself' and another or
others (1nclwUng a spouse) in joint ownership? (Answer yes or no) No
(:i) If' the answer to (1) or (2) above is in the af'f'irmative state:
(a) Age of' decedent at time of' transf'er
(b) State of' decedent's health at time of' making the transfer. (Note 1).
(c) Cause of decedent's death. (Note 1).
(4) Did rlecedent, in his lifetime, make any transfer of property without receiving a valuable or adequate
consideration therefor which was to take ef'f'ect in possession or enjoyment at or af'ter his death?
(Answer yes or no) No
(a) Was there any possibility that the property transferred might return to transf'erer or his
estate or be subJect to his power of' disposition? (Answer yes or no) No
(b) What was the transf'eree's age at time of' decedent's death? No
(5) Did decedent in his lifetime make any transf'er without receiving a valuable and adequate consideration
theref'or lmrler which transf'eror expressly or impliedly reserves f'or his lire or any period which does
not in f'act end bef'ore his death:
(a) The possession or enjoyment of or the right to income f'rom 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 is in the affirmative, state whether the right was reserved in decedent
alone or others
(7) Did decedent in his lif'etime make a transfer, the consideration f'or which was transferee's promise to
pay income to or f'or the benefit of' care of transferor? (Answer yes or no) No
(8) Did rlecedent, 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 cOHld 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 0,1 ter, amend, or revoke the inter-
est of the beneficiary reserved in the decedent alone or the decedent and others?
(Answer yes or no) No
NOTE 1: The answers to these questions should be supporterl by aff'idavit by the attending physician as
well as a copy of the death ceni f'icate.
NOTE 2: If' answer to any of the above questions is yes, set f'orth 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 transf'erees 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
DESCRIPT ION
MARKET VALliE
(Es tima ted)
DEPT. VM.UATION
(Dept. Only)
None
N~~
Insert this total oppos 1 te "Transf'ers", Schedule "C" in the
"As Reported" column on the last page of this return.
R9C-37 (12-63)
COM~lO~\\"EAl.Tll OF PE~NSYYLA~IA
THANSFER INllEHITA~CE TAX
RESIDENT DECEDENT
SCHEDULE "D"
BENEFICIARIES
h
BENEFICIARIES AND ADDRESSES RELA TIONSIIIP I '
(If step-children or I S~RVIVED DA'1'R INTEREST OF
(State full names and addresses of all who illegitimate children I DECEDENT OF BENEFICIAHY
ave an interest, vested. contingent or other- arc involved, set STATE YES BIRTH IN ESTATE
wise. in estate) forth this fact.) I On. NO
Ravmond A, Hinke None Yes Adult Specific Bequest per Wil
3419 Green Street I
-
Camp Hill, Pennsylvania 17011
Randal Davev Nenhew Yes Adult Specific Bequest per Wil
2412 Southeast Ninth Street
Pompano Beach, Florida 33062
---.
William P. Kephart Jr. Nenhew Yes Adult Specific Bequest per _Wil
3622 North Second Street
n~r I --
Harrisburg, Pennsylvania 17110
---t---- -
I
I -
Rosemary Cunningham Niece Yes Adul t Specific Bequest per Wil
-~-- - --
200 West 70th Street, Apt. 3L ~I
I -
New York New York 10023 I
Caroline Cunningham Niece T Yes Adult Specific Be'lue s t per~l1
I
301 West 22nd Street. Apt. 25 !
! ... --_._--
Np,^, Ynrk- New York 10011 !
!
,
-~-
-, 0mnin"ham Weiser Niece Yes Adult Specific Bequest per Will
! _______u__ -
33 East Locust Street
- --
Mechanicsbur" Pennsylvania 170S:
--
----
_bnp F None Yes Adult Specific Bequest per Will
509 Cocklin Street
Mprhanicsbun! PennsYlvania 1705
John R. Davey None Yes Adult 22% of Residuary Estate
dnQ 1<1 h Lane
Camp Hill, Pennsylvania 17011
1
1
1
1
Deponent further says that ull the above-named beneficiaries are living at this time except below:
NAME DATE OF DEATH RESIDENCE
---
I --,-. ...
~ "
.BrJl-
e<'lt:
Uj: s:::
"2 ~ 8
.- aJ ::l
E-o
"C 0. ~
"" ~,
~~"C
2.....2
~ ~ ~
~ ~ 0
~ E fr
f:J or:
SUMMARY
. .(Sch. "A")
.... (Sch. "B")
... (Sch."C")
Real Property
Personal Property
Transfers
Gross Taxable Estate
(1 )
(As Reported)
$
$..
$..
$
$
$..
(2)
(As Determined)
$
$
$
$
$
$
06
t"-
O> f...
..... Z "C
'" .....
~ W ~ ......
'" " ..l
OJ - '" ....;
>< "'" ~ :r: ...:
w '" 'IJ
00 <fJ Q ~ -
0\ - ~ ...:
, ..: P-1 '" =:
00 <:<: '" ~ u '8 =-
t"- "" 0 '" =-
, '" "" '" lC). ~ 2: ...:
..... ~ ..: :I: W 0 ] ~,
~
N W .... [-< E-< ~ S Q
0 ~ :I: '" ..: rl :;; Z
[-< 0 [-< ~ is H "" <
Z <fJ (!J
'" W H ~ ~ I-
~ ...,. 0 0
0 =:
<=Q 2 0
~ (!J '" =-
w .<::. OJ loW
!: +-' ~ ~ =:
0 ~
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0 E
.... 1: E E
~ '" is 0
..l U U
RCC-37 (12-63)
COMMON\\'EAI.TH OF PENNSYYLANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "Dn
BEl\iEFICIARlES
\
h
BENEFICIARIES AND ADDRESSES RELATIONSHIP I SURVIVED
(If step-children or D'\TE INTEREST OF
State full names and addresses of all who , DECEDENT
illegitimate children I OF BENEFICIARY
aye an interest, vested, contingent or other are involved, set, STATE YES IN ESTATE
wise, in estate) forth this fact.) i OR NO BIRTH
Marv Kephart None Yes Adu1 t 34% of Residuary Estate
c/o Kath01een Kephart
3300 Union Deposit Rd. Apt. E- 30i
Harrisburg, PelU1sy1vania 17109
-
,
M Stees Sister Yes Adu1 t 22% of Residuary Estate
3300 Union Deposit Rd., Apt. E-3J ,
.,
Harrisburg, PelU1sy1vania 17109
m_
I ,--.--
,T::mp. E. Graffam None Yes I Adult 22% of Residuary Estate
_.---. -- --- ~-
---r
=
c;nQ rnrkl in Srrpet ,
- '.'--- I ..------
Mf>chani csbur~ . PelU1sv1vania 17055 i I
i
-~--_._-- I ---.".-....
, , i
1 I - .--..----
I I - ---.
i
I
.---------
!
..... -----...--.
i
:
i "_'_-0
!
I -~--'-"- ._..
--.--..-..--,.
! ,
I
_.~----_.
,
-.-'--..
n.
Deponent further says that all the above-named beneficiaries are living at this time except below:
- --
NAME DATE OF DEATH RESIDENCE
-
Morv August 20 1978 c/O Katho1een Kephart
"00 Union Deposit Road Apt. E- 307
Harrisbura. PelU1sv1vania 17109 -..--,---
-----_.._-------.------
----
~ --,
.8 -
E<*
t:j: ~
.2 Cll E
._..... ::l
.E ~"O
- a ~
<;: 0"
StJ""g
'5t:it:
~ " 0
~Eg.
~ 0:
Real Property
Personal Property
Transfers
SUMMARY
(Sch. "A")
(Sch. "B")
.. (Sch. "C")
(1 )
(As Reported)
$ 23,000,00
$33,051,48
$I'JoI)e
$.
$
$S6,O~1,48
(2)
(As Determined)
$
$
$
$
$
$
Gross Taxable Estate
00
"-
do
..., b
Z '0 r-<
"
~ ~ ~ .-l
oj - " .,-l ..l
"' "
;... ~ ~ ::r: <
~ " '"
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00 - <
0> -< '" CIi
, ~ "" ~ l) '2 l>o
00 ~ 0 ~ '" l>o
N OJ ~ OJ ~ 4-; ..:: <
, :I: -< :I: ~ 0 "d ;..
r-< .... ~ .... f-< '-" g ~ Q
N ..c:: S
0 ~ :r: ,.. .-: bll r-< 0) Z
f-< 0 f-< E-< ::l H <
Z '" 0 <Il ~
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~ 0 0
0 <=Q ~ CIi
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-B "' ...
f-< ~ ~ CIi
f-< 0 c
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0 2
--. -'" :: E
~ '" 0 0
..l U U
RCC-38
RESIDENT DECEDENT
SCHEDULE "En
JOINTL Y OWNED PROPERTY
COMMONWEAL TH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
INSTRUCTIONS: Tllis scherlule must disclose all property, real and personal, ownerl by the rleceilent jointly
with Rno the r or (l the rs, inc 1 uding in tangi hIes, s tanding in the name 0 f the deceden t and othe rs. Lis t
real estate first. as entireties, or joint tenants, giving hrief' description, as indicated lmder Schedule
"A", plus the date and place of' record of instrmnent 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 fiB", plus date of acquisition, /Lnd the name, address and relationship (if any) of co-owners to
the deceden t.
Description of Property, Date of Acquisition, Name unit percentage Estate DEI' ARTMENT VALUATION
Address and Relationship of Co-Owners, and PI ace Value Share Valuation CAUTION-Do not Write
of Reeorrl of Instrument, where Real Estate. In Thts Space.
;( )0 xx. ~ :xx X:X: ;&: ~ 5?' :x Y:X Value of' Value of'
xx: ::x 0< [)< <x> )(> X: Deceden tIs
~ :so ~ ::x y Entire
6< %> Xx 9 Xx )(> IV\, )(> :xx ;X )(> :xx )(> :x Property Interest
None
Insert this total opposite ".Jointly Owned Property", Schedule "E" N lY'-"--
in the "As Reported" column on the last page of this return.
Ace-a; (15-58)
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SUMMARY
Estate of Greek
(Last Name)
JaM
(First Name)
T.
(Initial)
DATE OF DEATH 7/26/78
FILE NO.21-78-98
REPORT OF INHERITANCE TAX APPRAISER
I, the undersigned duly appointed Inheritance Tax Appraiser in and for the County of
Pennsylvania, do respectfully report that I have appraised the real and personal property as reported in the foregoing return at
the values set forth opposite each item in the last column to the right in Schedules "A", uB", He", and "E".
Dated:
INHERITANCE TAX AFFRAISER
REPORT OF THE REGISTER OF WILLS
I, the undersigned duly elected Register of Wills in and for County, Pennsylvania, do respect-
fully report that I have allowed deductions in the amounts claimed by deponent, except as to those items where a greater or
lesser amount is set forth in the last column to the right in Schedule "P", which greater or lesser amount represents the sum
allowed as a deduction.
Dated:
REGISTER OF Wll.l.S
INVENTORY
Real Property (Schedule A)
Personal Property (Schedule B)
Transfers (Schedule C)
Joint - Held Property (Schedule E)
TOTAL GROSS ASSETS
Less Debts and Deductions
(SCHEDUl.E FI
CLEAR VALUE OF ESTATE
VALUE AS REPORTED VALUE AS APPRAISED VALUE AS REAPPRAISED
$ $ $
one
one
56 051 48
15 194 77
40,856 71
Valuation of life estates or
annuities. . . . . . . . . . . . . . . . . . . $
t=
E
1==
ESTATE TAX ASSESSMENTS $
FOR USE OF REGISTER ONLY
Tax on $
Tax on $
Tax on $
Tax on $
Tax on $
Exemptions
Total Estate
$
$
$
$
$
2%
6%
5%
10%
15%
o
COMPUTATION OF TAX
TOTAL TAX
$
(0) As evidenced by Chari table
Exemption Certificates issued
by the Secretary of Revenue.
Less tax previously paid
BALANCE
Less 5% of tax if paid within
3 months after death
$
$
t=
$
BALANCE OF INHERITANCE TAX DUE
Add interest at rate of 6% from
to
AMOUNT OF ESTATE TAX ASSESSED $
Estate tax paid $
BALANCE DUE
Add interest at ra te of 6% from
to
$
,=
t=$
$
L
t=
$
TOTAL TAX BALANCE $
PAID $
FOR USE OF REGISTER ONLY ADJUSTMENTS
NOTE: Where subsequent adjustments are made to the above computation of tax by the Register of Wills, for proper reason,
same should be noted below, with short explanation.
<6 '0 ...l
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00 "" ~ c
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*'
REVwS18 (a.?ij)
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF FIELD OPERATIONS
P.O. BOX 2970
HARRISBURG
17105
IN YOUR REPL Y PL.EASE:
REFER TO
Inheritance Tax Divisiof'l
NOTICE OF FILING OF APPRAISEMENT
Jane E. Graffam
509 Cocklin St.
----- Msdumic8barg, PL'. 17Q55
(Executor or Administrator)
In Re: Estate of
.John ,.. GTPpk
Cwnberland
County - Fi Ie No.
21-78-98
Dear
You ore hereby notified that the Original
appraisement in the estote of John T. Greek
hos been filed in the office of the Register of Wills of___Cumberland
County on 3 April , 19--22, Said appraisement reflects the following
valuations:
Real Estate 23,000.00
Personol Prnperty 33.051.48
Tronsfers None
Jointly Owned _~ Non~_
Total __________~~_Jl~1.4_~
As to such tax that is paid within three months from date of deoth, 0 five (5%)
percent discount is allowable. As to any tax that remains unpaid after nine (9) months
(Ii fteen months when death occurred from December 22, 1965 to June 16, 1971, i nc I usi ve;
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 oy Section 1001 of the Inheritance und
Estate Tax Act of 1961, 72 P. S. 2485.1001, P. L. 373.
LeA,
3 April -1979
Si gned
f~~^~
C) ----~
Date
Title __;\~~l1istrat~_ive Officer ____
I
I
-."----.--.
Note: T!,is is not a bi II.
----
REV-","S7 (S!]S)
DEPARTMENT OF REVENUE
BUREAU OF FIElO OPERATIONS
P.O. BOX 2970
HARRISBURG, PENNA. 17105
COMMONWEALTH OF PENNSYl VANIA
RESIDENT INHERITANCE TAX
APPRAISEMENT
DAr~ 1 Ap~f' 1070
COUNTY Cnmhprl.qnd
FilE NO. 21-78-98
Whereas, John T. Greek late of Borough of Camp Hill
in the County of Cumberland Commonwealth of Pennsylvania, having died on
the ?/;t-h day of Tn1 ]' 19 .lIL., seized and possessed of an estate
subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania;
Therefore, I, Leo F1l1 "initi ,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 Apprarsement
VALUES lVIade for Inheritance
Tax Purposes
R",,1 $ 21.000 00
P. ", 33 051 48
Transfers lITnnp
.Tnint-1v . None
~~/; .0~1 48
Have been duly sworn according to law, I do hereby certify that the above appraisement is made in conformity
with the law on this 1rn day of tpri~ . 19 1.9.-.
\.~~~,
, )
"'"
Appraiser
Harrisburg
(Numbe( and Street)
(Post Office)
, Penna.
----
....
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