HomeMy WebLinkAbout02-23-78
R<;:C-33/4-7_1)
p'cq ? _,
COMMONWEAL TH OF PENNSYLVANIA.
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
1r'
-r~taLt_
..
RESlfJENT DECEDENT
IMPORTANT:
COUNTY OF CUMBERLAND
---~--""--
.-----. '-"-"--""-"-"- .-
This rcturn must be completed in detail and filed in duplicate, with all attached, with the Register of Wills of the
County \....here decedent resided; Return is due within nine months after date of death, unless an extension is granted
by the Secretary of Re'l.enue. (Section 703 of the Inheritance and. Estate Tax Act of 1961.)
I" 1111~ MAlTER OF THE ESTATE OF } AFFIDAVIT OF
..c.AJtlE~INEL_MINER ~
';T' rE FJLL NAME OF DECEDENT) t'....__
.u..c.umbe!'l.anc!... ~~~Ltnty AXl\IIlNI6lf1OOOO1l.
Late of
State of ___.-------Epnnc:y.l \Irln; rt
County of -_~.umherlaruL_
} s",
,l<!IIj(>)4Xl'(~)(O< -.
--- ___._._Rohprt r; Minpr surviving joint tpnant
of the estate of the above-named d~cedent being duty sworn, depose S
and say 5
xh'if:i<'leX
Decedent dkd _.___lany.grr
'.MC"-JTHI
28.
(DAY)
, 19--ZB-{~estote teoving a last will, copy of which is hereto attached. }
(YEAR) Intestate
Name and adclre,;:'c:.f alte-me)' or J
other authorized represcr.tativ,; '0 whom
011 correspondente .~ho d.: _,:,
Survivi JOlnt
Tenant
Jon F. LaFaver, Esquire
317 Third St.. New Cumberland.
Pa
17070
That as such
deponent is Familiar with the affairs of said estate and the property constituting
""_ x E- cu TO R.ADMINIST RA TO RJ
the assets thrrenl 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 agen1 or deputy or another, or in decedent's individual name, with right of access by another as agent or deputy, with the
exceptioll of the follO\\ ing:
NAMF::
'NW
-.-.-----------
---------.-...
AND AD['RE_SS Of~ BANK OR OTHER INSTITUTION THIS SAFE DEPOSIT BOX RENTED RELATIONSHIP OFJOINT
HI CH DECE'::OENT R EN TED A S...FE DEPOSIT BOX IN N AM E 0 R NAMES OF HOLDERS TO DECEDENT
.
~--------
.....---------.---...-
- --
That the contents of said safe deposit box or boxes are itemized under Schedules
with the '!exccption--of the following, for the reasons hereinafter set forth:
of this return,
Thl:!;l Schedule A attached hereto and made part hereof sets forth fully and in detail all the real property
in the CO~lmonweaJth 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
whcrc-"cvcr 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 pas session, 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 prior to decedent's
death in the case of savings banks, and to the date of decedent's death in all other cases; all bonds, postal
s<lvings, 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;
.:,:l ....;'..1116 di'I'U'':;. Jt:'.\thy, ~iiverware, 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 mving 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 fac\.: valuc 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 eslate from life insurance policies carried by decedent; all annuity and endowment contracts
the proceeds of \vhich \V{;< '1ayablc upon the death of the decedent; all and the corporate stocks and dividends
due thereon and llllpa id as Ti' tf,. date of death, bonds and accrued interest thereon to the date of decedent's
death and other IL\c<;l:ncnt 'ic~ owned by the decedent at the time of death, with the--market value there-
of at such lime.
/
;Z (-'(8-) 03
((J-(~3"9
--
In the case of securities of close or ramily corporations, the values reported are as rar 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 of the value of such interest there is annexed to
said schedule, financial statements showing the assets and liabilities of said co-partnership or b.usiness.
A copy of the co-partnership agreement, (if oral, a statement setting forth the nature of tIle a.greement)
together with a statement setting forth the character of the business, its location, and such other facts
pertaining to the ousiness 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 copy
of the deed, trust agreement or other instrument creating the trust. Thert~ 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 instrument of another,
with a copy of the instrument creating such power attached to the schedule.
That Schedule 0 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 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 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 deceden t.
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 funeral expenses paid;
family exemption, where applicable; costs of admini~tration 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. unpaid a.t 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' 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 forward and properly registered in the Summary.
"en,
"E", and "F" as directed therein,
",,,"'OOd"",, ':," rd'
~,'0T;'VW PUBLIC
, Sept. 20. 19 "
L~"]":~ l rand Co.
'/~' Cc:';::'~::,~:C(;
;-:;w CUI"..:Crc2::C ''''
.......19......]8
7 ~e~t Majl).~t.r.:~.;tato+)
(Street Number)
..r~ech~nic:sb.~.~9.,.~.E!.~.~sX1v.~~i.~... 17055
(City or Town and State)
NOTE: Berore signing aff'idavit make sure all blank spaces in tl1e affidavit 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 cohoon #1 in the "Summary" has been properly completed as above-directed.
RCC_34 (4-73)
COMMONWEAj.. TH 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 ather, should be identified
as to quantum of interest and the estimated value should be that of the decedent's interest only. (Property
held as joint tenants with right of surviarship or tenancy by entireties should be reported on Schedule "E.")
The real property located In the Commonwealth of Pennsylvania should be (1) (2) (3)
described by lot and block number, street and street number, together with DEPARTMENT
a general description of the property, witt. a reference to the record of the ASSESSED VALUE VALUA TlON
conveyance by which the decedent took title; If a farm .tate number of a- FaR YEAR OF ESTIMA TED
cres; also statement of mortgage encumbrances upon each parcel at death CAUTION
of decedent. Taxes, assessments, accrued Intere.t on mortgage., etc.,are DECEDENT'S MARKET VALUE (Do not writ.
to be listed on Schedule uF" and must not b. deducted from this schedule. DEATH In this spoce)
NONE 00.00 None
Insert this total opposite "real property", Schedule "A" in the X X X X X
"As Reported" column on the last poge of this return.
00.00
None
pCe -35
RESIDENT DECEDENT
SCHEDULE liB"
PERSONAL PROPERTY
.
COMMONWEALTH OF PENNSYLVANIA
T~\NSFER INHERITANCE TAX
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 li8ted 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 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 certiricates, 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 riduciary 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 or death, should be listed in this schedule.
ITEM UNIT ESTIMATED DEPARTMENT VALUATION
Item VALUE MARKEr VALUE (Do not write in
No. List and describe fully this space)
NONE 00.00 None
I
I
Insert this total opposite "Personal Property", Schedule "B" in X X 00.00 None
the "As Reported" colwnn on the last page or this return.
RCC- 36
COMMOXWEALTH OF PE~NSYLVANIA.
TRANSFER I~HERITANCE TAX
SCHEDULE "c"
TRANSFERS
....
' .
t
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)
(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)
(3) If the answer to (1) or (2) above 1s 1n the affirmative state:
(a) Age of decedent at time of transfer
(b) State of decedent's heal th at time of making the transf'er. (Note 1).
(c) Cause of decedent's death. (Note 1).
(4) Did decedent, in his I1f'etime, 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)__
(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)
(b) What was the transferee's age at time of decedent's death?
(5) Did decedent in his lif'etime make any transfer without receiving a valuable and adequate consideration
theref'or under which transf'eror 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 th~ property transferred?
(Answer :yes or no)
(b) The right to designate the persons who shall possess or enjoy the property transferred or
income theref'rom? (Answer yes or no)
(6) If' the answer to (5) (b) above is in the af'f'irmative, state whether the right was reserved in decedent
alone or others
(7) Did decedent in his lifetime make a transfer, the consideration for which was transferee's promise to
pay income to or for the benefit of care of transferor? (Answer yes or no)
(8) Did decedent, at any time, transfer property, the beneficial enjoyment of which was subject to change,
because of Ii reserved power to al ter, amend, or revoke, or which could revert to rlecedent 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 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 transrerred, with
relationship o~ trans~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
DESCRIPTION
MARKET VALUE
(Estimated)
DEPT. VALUATION
(Dept. Only)
NONE
00.00
None
Insert this total opposite "Transf'ers", Schedule "e" in the
"As Reported" column on the last page of this return.
00.00
None
-------
RCC-37 (12-63)
rO~"~IO"I\n';ALTIf OF I'ENNSYYLANIA
TRANSFER INHERITANCE TAX
RESIDENT DErEDENT
SCHEDULE "D"
BE1\:EFICIAHIES
I RELATIONSHIP !
BENEFICIARIES AND ADDRESSES (If stt~p-chiJdren or ! SUIlVIVED DA.'l'E INTEIlEST OF
State full names and addresses of all who illegitimate children I DECEDENT OF BENEFICIARY
ave an interest, vested, cont ingent or other- STATE YES IN ESTATE
are involved, set ! OIl NO IJIIlTH
wise, in estate) forth this facL)
Robert G. Miner
7/1 I.I~~~ M"in Street Survivina Joint Owner
Mo~h"nir<bllrn Pennsvlvania son yes adult n-F "11 ioi ntl v-hel d
I
. ---
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, ,
-------
,
- --
Depommt further says that all the above-named beneficiaries are living at this time except below:
" "
NAME DATE OF DEATH RESIDENCE
.---- -- u
Gross Taxable Estate
SUMMARY
..... (Sch. "A") $ .
.(Sch. "B") $
(Sch. "e") $..
(SCh'd"EH) $
$
$..
(1 )
(As Reported)
(2)
(As Ddermined)
~ -
o .
(;jrJl;:
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'a Cl,) S
'S Q) .:
"Oo..e
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o '"
- --
~ ~ ~
~ ~ 0
~E~
~ ..:
37,260.25
$
$
$
$
$
$
Real Property
Personal Property
Transfers
~ointlY~hE!lo...
37,260.25
...
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RCC>38
RESIDENT DECEDENT
SCHEDULE "E"
JOINTLY OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
INSTRllCTIONS: This schedule must disclose all property, real ann personal, ownerl by the (lecedent jointly
with another ur others, ineluding intangibles, standing in the name of' the decedent and others. List
real f'state first. us entireties, or joint tenants, giving brief' description, as indicated ImdeI' Schedule
"A", plus the date lind place of record of instrwnent ef'fecting vestiture, but do not include entireties
or out of state real estate value in estate valuation column. Personal property should be listed as in
Schedule "B", plus date of acquisi tion, and the name, address and relationship (if' any) of co-owners to
the decedent.
I .
Description of' Property, Date of' Acquisition, Name Unit percentage
Address and Relationship of Co-Owners, and Place Value Share
of Record of Instrwnent, where Real Estate.
60 AX. 'XX. ?9< :xx .?'VV' 66 <Xx 66 %>
&%~~~~~Y~~~~~~~~~0
. V'
1. Checklng Account No. 142 1087949 at
Commonwealth National Bank in the joint
names of Catherine E. Miner and Robert
G. Miner - opened 10/5/77
Entire amount included herei~
2. Savings Account No. 14 004 02 82 0 at
Commonwealth National Bank in the joint
names of Catherine E. Miner and Robert
G. Miner - opened 10/5/77
Entire amount included herein
Estate
Valuation
DEPARTMENT VALUATION
CAUTION-Do not Write
In This Space.
~~
Va--4te of'
En\lre
property
Value of'
Deceden tIs
Interest
553.6" /
553.63
- ~I '1
~ i . ,
/
6,647.14
3.
7805.284 shares of Affilia~und
(Account No. 97514370) at~ per share
in the jOint names of Catherine E. (..Q'?6
Miner and Robert G. Miner - Total Value
$54,285.75 1/2 value included herein
538.369 shares of Sentinel Group Fund
Inc. Common Stock Fund (Account No.
9802189) at ~per share in the joint 7,70
names of Catherine E. Miner and Robert
G. Miner - Total Value $5,833.23
1/2 value included herein
,~,)'l~"t,l~
/27~142~8z SLfI5/1,11
'-m-----.
27,259.96
4
') 1)"1;),1;;"
.~.
2..n6.6l L/) ILf{'4lf
2,072.72
Insert this total opposite "Jotntly Owned Property", Schedule "~,260.25 $36,533.45
in the "As R~ported" COltullIl on the lust page of this return.
3,-,533 '\"
I
Commonwealth A\\
National Bank ~
February 16, 1978
Mr. Jon F. LaFaver
Attorney-At-Law
317 Third Street
New Cumberland, Par 17070
Re. Catherine E. Miner
Checking Acct. #142-108794-9
Savings Acct. #14-0040282-0
Dear Mr. LaFaver,
In reply to your recent letter of inquiry, we wish to advise
the fOllowing,
,/'
Checking account #142-108794-9 was opened in the joint
names of Catherine E. Miner & Robert G. Miner, Son on
October 5, 1977. The balance in this account as of
date of death, January 28, 1978 was $553.63.
.,/
Savings account #14-0040282-0 was opened in the joint
names of Catherine E. Miner & Robert G. Miner, on on
October 5, 1977. The balance in this acco as of
date of death, January 2jv, 1978 was $6,62 .74. Accrued
interest was $25.40. ~
Very, tl;Ouly yours, /. /
/////. .
Ie ~.-cL, rj-/' I>::t/>C:,d'!-
I ~' l/. (
obert A. Talalai
Assistant Vice President
RAT/<imf
The Commonwealth National Bank, 10 South Market Square, Harrisburg, Pa. 17108 (717) 564-9500
RCC~81 (6-73)
COMMONWEALTH OF PENNSYL VANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
HARRISBURG
17127
IN YOUR REPL Y PLEASE
REFER TO
Inheritance Tax Division
NOTICE OF FILING or APPRAISEMENT
Robert G. Miner
74 West Main Street
Mechanicsburg, FA 17055
(Executor or Administrator)
In Re: Estate of
Catherine E. Miner
Cumberland
County - Fi Ie No.
21-78-0103
Dear Mr. Miner:
You are hereby notified that the . Original
appraisement in the estate of Catherine E. Miner
has been fi led in the af~ice of the Register of Wi lis of Cumberland
County an Apnl 20 ,19~, Said appraisement reflects the fallowing
valuations:
Real Estate
Personal Property
Transfers
Jointly Owned
Total
None
None
None
36,533.45
~533.45
As to such tax that is paid within three months from dote of death, a five (5%)
percent discount is allowable. As to any tax that remains unpaid after nine (9) months
(fifteen months when death occurred from December 22,1965 to June 16, 1971, inclusive;
and twelve months when death occurred prior to December 22, 1965) from date of death,
interest at the rate of six (6%) percent per annum is charged.
Any party in interest who is aggrieved by this notice may abject thereto within
sixty days after receipt of said notice as provided by Section 1001 of the Inheritance and
Estate Tax Act of 1961, 72 P. S. 2485-1001, P. L. 373.
Signed 2J.-~ If'",- ~-,---14~-'
April 20, 1978
Date
Title Chief Appra!'>-er_____~___
<,;._._-_.__.~-_.-
Nate: This is not a bill.
",,-,--, \':::-041
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
HARRISBURG, PENNA, 17127
COMMONWEALTH OF PENNSYLVANIA
RESIDENT INHERITANCE TAX
APPRAISEMENT
DATE
April 20, 1978
COUNTY
Cumberland
FILE NO.
21-78-0103
Whereas, Catherine E. Miner late of Borough of Mechanicsburg
Cumberland
in the County of Commonwealth of Pennsylvania, having died on
the 28th day of January 19~, seized and possessed of an estate
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 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 AoorHi~emant
Desorlptlon of Anet Valuel Made 10, Inharitance
r.. PurpOlal
Real Property $
None
___m_____.__ f---
Personal Property None ~
~-----
Joint-Held Property 36,533 45
Transfers None
--- f--- f--
---~._- -~----_..- ._-~
TOTAL ASSETS -- -- $36,533 45
--
--- _._.~
--
--
- -- --
-.-- . -_.~ -
--
--- -
- --
-
--
Having been duly sworn according to law, I do hereby certify that the above appraisemem,is made in con-
formity with Jaw on this 20th day of \.1 -:1 , Apn 1 19~.
~4 R. 61b~
Apprai8er
(N\!mber and StUet) H . b
arns urg P a
, enn.
(PDIt Me.)
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