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Home My WebLink About02-22-79 a2. - -V._ - 77 RCC-33 (4~73) ~ COMMONWEAL TH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS * RESIDENT DECEDENT COUNTY OF CUMBERLAND IMPDRTANT, 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'otenue. (Section 703 of the Inheritance and Estate Tax Act of 1961.) IN THE MATTER OF THE ESTATE OF } AFFIDAVIT OF EXECUTOR ~jlM~~~~ SOPHIA SUSAN BERTRAM (STATE FULL NAME OF DECEDENT) Lat. of CUMBERLAND County State of PENNSYLVANIA } .., County of CUMBERLAND KENNETH E. BERTRAM Executor H1lroiDtMN~K of the estate of the above~named decedent being duly sworn, depose S and say S : (DAY) 19--"LH...{~estotll leaving a last will, copy of which is hereto attaChed.} (YEAR) '!M:9f)f!)f Decedent died Jan uarv (MONTH) Nome and address of attorney or } other authorized representative to whom all corres-pondence should be mailed. 31 ",hnm.::lC:: T MYCiorc::, MYCiorc::. Myoros:, FloT.7fi7r i. John~on 301 Market Street, Lemoyne, Pennsylvania 17043 That as such Executor deponent is familiar with the affairs of said estate and the property constituting I EXECUTO R-ADMINI ST RA TOR) 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 S...FE DEPOSIT BOX IN NAME OR NAMES OF HOLDERS TO DECEDENT N;}oo That the contents of said safe deposit box or boxes are itemized under Schedules wi th 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 pricor 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 othcr evidence of indebtedness of the United States to the de- cedent; all obligations, whether by statute or agreement they arc designated as tax free, of the United States, or anv 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 sccur:tics O\vned 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 b;y 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 t~ere 1s annexed to said schedule, fimlncial statements showing the assets and liabilities of said co-partnership or 1msiness. A copy of the co-partnership agreement, (if oral, a statement setting forth the nature of the agreement) together with a statement setting f'orth the character of the business, its location, and sllch other f'acts pertaining to the business as may be 'Pertinent to a fair and just appraisal of the decedent's interest therein mlL,,;t be submitted. It should also se:t 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 decedentt s death, in contemplation of decedent's death, or intended to take ef'f'ect 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 eff'ect in possession or enjo,yment at or after death, there is also attacheri to the schedule a cony of the deed, trust agreement or other instrument creating the trust. Therl~ is also set f'orth in said schedule 11 list of all property, real and personal, with its value, which pa~ses at decedent's death by virtue of the exercise b;y decedent, either individually, or jointly with another, or any power of' apvoint- 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 ann addresses of all persons benef'iciully 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 tbe time of decedent's death of all minors, annuitants and beneficiaries for life under rlecedent's Will. It also contains a statf~ment showing which of the beneficiaries named in the decedent's will, if any, died prior to dt~cedent, the dates of their death, their issue, and the relationship of such issue to the benef'iciary. 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 amI others, plus the date and place of record of instruments ef'fecting the vest! ture of' real estate and the date of acquisition of personalty, plus the name, address ann relatlonship, if any, of co-owners to the decedent. That Schedule F attached hereto and made a part hereof sets forth fully and in detail all debts and deductions claimed f'or and on behalf' of this decedent's estate, including :f'uneral expenses paid; family exemption, where appl icable; costs of administration of this estate; counsel fees and f'udiciary's conunissions pald 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. at time of death; taxes accrued chargeahle ror 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 pledgert for obliga- tions, if any. It is agreed that the f'iduciary will present proof of said claimed obligations upon re- quest, that if' the Ilmount actually paid in settlement of any fee, commission or debt is less than the estimated amount claiming ann allowed, that the same will be reported to the Register of' Wills, and that the amount of' tax assessed can be reassessen in accordance therewith. That the totals of' the appropriate columns in Schedules "A", "B", "en, "E", and "F" as dlrected therein, have been carried f'orwarrl and properly registered in the Summary. Subscribed and,sworn to befor,e me this " / day of 19.....<.. ~'-/c- ~4Uc:;.X"'.L.:,... . c.C. ... ,..<!'."~.. . (E:reClLtor-~~' -'ft) Kenneth E. B rtram .....m....................o'..........................................'...............-........".... (Street N 'Umber) 1808 Bridge St., New .............................................. (City O'J" Town and State) ~7 . ',"n" " " -;,;:'1U C', r, \\; :Qn:';~j"s::cl~ Ex::ires C:::i. 25, 1982 r'"' 0' -:~, ~k:~',- ,";!.:!;G cumberland, pa;170.70 NOTE: Before signing af'f'idavit make sure all blank spaces in the af'fidavit and schedules annexed are filled in with details or the worrl "None", and. in case the assets include rare and unlisted. securities, securities of close or f"amily corporations or an interest in any co-partnership or business, that the data and statements requi red under the paragraph above relating to Schedule "B" are attached. Also make certain that column #1 in the "Sunnnary" has been properly completed as above-directerl. RC C-34 14_731 , . -" . COMMONWEAL TH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS TRANSFER INHERITANCE TAX . RESIDENT DECEDENT SCHEDULE "A" REAL PROPERTY *' Real property in Pennsylvania, with statement of mortgage encumbrances upon each parcel at death of dece- dent. Property held by the decedent os 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 os 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 (1) (2) (3) described by Jot and block number, .treet and .treet number, together with DEPARTMENT a general description of the property, with a reference to the record of the ASSESSED VALUE V A LUA TION conveyance by which the decedent took title; If a farm .tat. numb.r of 0- FOR YEAR OF ESTIMA TED CAUTION ere.; 01.0 statement of mortgage encumbrances upon each parcel at death DECEDENT'S MARKET VALUE (Do not writ. of decedent. Taxes, o.s..sment., accrued Inter..t an mortgages, etc., are DEA TH In thl. .pace) to be lI.ted on Schedule uF" and must not b. deducted from this schedule. None - , Insert this total opposite "real property", Schedule "A" In the X X X X X "As Reported" column on the lost page of this return. None NCf\--lI_ P'C2-~,::; PAGE 1 COMMONWEALTH OF PE'INSYLVANLI TltANSFER INHEflIT:\NCE TAX IlFSInENT DECEDENT SCHEDULE n 1:3" PERSONAL PftOPERTY ...~. .''';.. 1\ .~"' '>l)' ,;J I;';:STRUCTIONS: This Schedule must disclose all tangible and intangible personal property owned indivIdually hy the decedent, at the time of' his death. Property owned hy the decedent jointly with another or others must be listed under Schedule "E". Intangible person~1.1 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 ract that they are not of the administer'ert estlite. Tangib 1 e personal proper ty shoul(l be ) is ted IiI's t (e. g. jewel ry, wearing apparel, househol d goods, and f'urnishings, hooks, paintings, automobiles, boats, etc.) Intangihle 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- abIe to the estate or f'iciuciary 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. ITEM List and describe fully UNIT VAWE 1. Stocks 1960 shs. Eastman Kodak Co. common @ 45.9375 p/sh 2. 53 shs. Sun Oil Co. 2.25 cu. conv. pfd. @ 40.1875 p/sh 100 shs. Husky Oil Ltd. @ 24.0625 p/sh 20 shs. Nat'l Distillers & Chern. Corp. Common @ 21.25 p/sh 30 shs. Gen. Tel. & Electronics Corp. Common @ 28.5625 p/sh 30 shs. Amicor @ 2.8125 p/sh 31 shs. Boise Cascade Corp. Com. @ 22.8125 p/sh 328 shs. Michigan Gas Utility Common A 14.00 p/sh 126 shs. UAL Corp. , @ 20.8750 p/sh Gas Producing Ser. A 30 shs. Coastal States Co. $1.19 Cum. Conv. Pfd. @ 18.1250 p/sh 28 shs. Hewlett-Packard Co. Common @ 66.6875 p/sh 80 shs. American Cyanamid Co. Common @ 24.75 p/sh 105 shs. Sonesta Int'l Hotels Corp. @ 7.25 p/sh 100 shs. Great Lakes Oil & Chern. Co. Common @ 30.75 p/sh I 500 I @ shs. Goldfield Corp. Common .9063 p/sh 21 shs. Image Systems Ind. S.E.C. 40 shs. Photon, Inc. 100 shs. Flamingo Air Service, Inc. (See Paae 2) (nsert this total opposite "Personal Propertyll, Schedule liB" in the "i\s Heported" column on the last page of' thi's return. x X ESTIMATED MARKEr VALUE DEPARTMENT VALUATION (Do not write in this space) , 90,037.50.,......1-- ~ 2,129.94../1-- v , 2 ,406 . 25 /'1 - 425.00~ , I \856.8~ - , /--- 84.38..- . ./ '707.19/ ,i I 4',592.00'[ 542.7~1 I .S43.7s1-' I "1,867.25~ 'l,980 001-- "-761.251 I - 3,075.001 , 15.---Y 4::~~ -0- /" ~ -0- I p'cc -3fi PAGE 2 '. ~ A~. . '~~" . t\' I'~ COMMONWEALTH OF PENNSYLVANB '['ItANSFER INHEl\TT:\NCF: TAX IWSITJENT DECEDENT SCHEDULE liB" PEItSIlNAL PIlOPERTY I:\STRUCTIONS: This Schedule must disclose all tangible and inta.ngible 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 undel' Schedule TIE". Intangible person~ll property, titled in the name of" tbe deced(~nt, but payahle at death to another or others, including but not limited to P.O.D. U. S. Savings Bonds and tenta- t ive trust accormts, must be listed, despite the fact that they flre not of the administered estate. Tangible personal property shauIn be listert i'irst (e.g. jewelry, wearing apparel, household goods, and furnishings, hooks, paintings, automobiles, hoats, etc.) Intangible personal property, such as bonds, treasury certi:ficates, 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 f'irtuclary 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 o:f the State, at the time of' death, should be listed in this schedule. --C'o Item No, I'fEM Lis t and describe fully UNIT VALUE ESTHlATED MARKEr VALUE DEPARTMENT VALUATION (Do not wri te in this space) Values shown as Item #2 (Page 1 of Schedu e B) were assets of decedent's late husband Adam E. Bertram which was in administrati<n at the time of the decedent's death. They are shown at their values at the date of Sophia Susan Bertram's death. The value of her interest in the Estate of Adam E. Bertram is reduced by the following costs unpaid at the date of death of Sophia Susan Bertram: Value of Decedent's interest Adam E. Bertram Estate - - - Less Costs: Joseph Kaufman, Rochester, N.Y. - Attorney Fee & Disbursements Internal Revenue Service Estate Tax Ieficiency State of New York - Estate Tax Ieficiency Sophia Bertram - Commission due in $20,424.79 - $6,453.00 343.06 100.00 (87.56 + Int. 972.97 Reserve for costs of filing, appointment of substitute fiduciary & iscellaneous - 250.00 I I I I '12,305. 76~ I I i 21,562.804 Total Costs 8,119.03 Net value of Adam E. Bertram Estate - 3. Community Savings Bank - Account No. 302-25041 in the name of the decedent. Date of death balance - I i ....~ x ; 1t23.906.06i, ('23 ct06.QIo i nser t this total opposi te "Personal Property", Schedule fiB" in the "As ReportedTl colulTU1 on the last page of' this return. - RCC-36 COMMO\WEALTII OF I'I'N\SYLVA\IA TRA\SFEIl I:'iHEl\!TANCE TAX SCHEDULE "e" TR"~SF'EJtS I1ES IllE\T DECFIlI'\T (1) Did decedent, within two years ofdeutll, make an,Y transf'er of' any material part of' his estate, without receiving tl valuable and 'idequate consideration therefor? (Answer yes or no) Y-cc (::n Did decedent, within two years of' death, transf'er properr,y f'rom himself' to himself' and another or others (including a SPOUS'i:l) in joint ownership? (Answer yes or no) Yes (a) If' the answer to (1) or {,3) above is in the af'f'irmative state: (a) Ag;e of' decedent at time 01 transfer 79 (b) State of decedent's heal th at time of' ffi1l..king the transf'er. (Note 1). (c) Cause of' decedent's death. (Note 1). (4) Did decedent, in his lj,f'etime, make any transf'er of' property without receiving a valuable or adequate consideration theref'or which was to take ef'f'ect in possession or enjoyment at or af'ter his death? (Answer yes or no) ~ (a) Was there any possibility that the property transf'erred might return to transf'erer or his estate or be ~:mb.1ect to his power of' disposition? (Answer yes or no) No (b) What was the transf'eree's age at time of' decedent's death? (5) Did decedent in his IU'etime make any transf'er without receiving a valuable and adequate consideration therefor under which transf'eror expressly or impliedly reserves for his lif'e or any period which does not in fnet end bef'on~ his death: (a) The possession or enjoyment of' or the right to income f'rom tlH' property transf'erred? (Answer yes or no) No (b) The ri~ht to desi.gnate the persons who shall possess or enjoy the property transf'erred or income therefrom? (Answer yes or no) No (fi) If' the answer to (5) (b) a'bove 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 transf'er, the consideration for which was transferee' 5 promise to pay income to or for the benef':lt of' care of' transf'eror? (Answer yes or no) No (8) Dirl decedent, at any time, transfer property, the benef'icial enjoyment of' which was subject to change, because of Ii reserved power to al tel', amend, or revoke, or which COllld revert to decedent rmder terms of' transfer or by operation of' law? (A.nswer yes or no) No (9) If' the answer to (8) alJove is in the aff'irmative, was the power to aI tel', amend, or revoke the inter- est of' the benef'icinry reserved in the rlecertent alone or the decedent and others'? (Answer yes or no) ~ NOTE 1: The answers to these questions should be supported by af'f'idavit by the attending physician as well as a copy of' the death certificate. ;./OTE 2: If' answer to any of the above questions is yes, set f'orth below a description of the property transf'errert, ie s f'air market value at date of rleath, dates of transf'ers and to whom transf'erred, with relationship of' transf'erees to rlecedent, if' any. Submit copy of' any trust deed or instrument, if trans- f'ers are claimed to be non-taxable, also submit detailed statement of' facts on which saId claim is based. !\OTE 3: List appl i.cable property below in manner in which provided in Sche(tules A, B, or E. ITE11 DESCRIPTION MAlUillT VALUE (Es tima ted) DEPT. VALUATION (Dept. Only) 1. In Novenrer 1976 on the advice of counsel in =sideration of the ArrendnEnt to the Internal Ievenue Code to becare effective December 31, 1976, Mrs. Bertram made a gift to her son of $33,000.00 and to each of her three (3) grand- children of $3,000.00, it being her intention to take advantage of the Gift Tax Exemption which v.ould expire December 31, 1976 and to rrake available to her son and grandchildren sorre funds resulting from the Estate of her recently deceased husband, Adam E. Bertram. Mrs. Bertram had left her forrrer hare in lbchester, New York and established a horre with her son in New Cumberland, Pennsylvania. Her nntivation for the gifts was in no way associated with her own death and conterrqJlation thereof, and she had at the tine no reason to consider death as being :i.rrminent being in reasonably good health for a person of her age, as evidenced by the Affidavit of Dr. G3.ither attached. 2. CCNB Bank, N.A., checking a=unt No. (See chedule "E") 003-000108-5 in the narre of the decedent/or K. E. Bertram as of November 4,1976. Date of death balance - $10,408.80 Decedent, for her convenience, established a join son, Kenneth E. Bertram, for the ptlIpOse of enabl' expenses and her business affairs, she being _ake recent death of her husband and the closing of he to pay the e}<j:lenses of the decedent during the sh , . t with her care of her shock at the ount was used r residence Insert this total opposite "T:ransf'ers", Schedule "C" in the "As Reported" colUJTU1 on the last page of this return. in conterrqJlation of death at the tine. See Affidavit of Dr. G3.ither. N tJ>---SL - COMMONWEALTH OF PENNSYLVANIA SS. COUNTY OF CUMBERLAND HERBERT GAITHER, M.D., being duly sworn according to law, deposes and says that he is a Doctor of medicine conducting general practice at 1517 Cedar Cliff Drive, Camp Hill, Pennsyl- vania; that he examined and treated Sophia S. Bertram from shortly following her arrival in Pennsylvania near the end of 1976 until the time of her death in January 1978; that in December of 1976 Mrs. Bertram was not suffering from any disease which carried with it the expectation of imminent death and was not, insofar as affiant is able to report, in contemplation thereof; that her death in January of 1978 was a result of a cerebral infarction having its onset some 16 days prior to January 31, 1978. 4;!~(/;1'? Sworn and subscribed before me a Notary Public this 12 :Hhay of F-'-C~'-~.4~''6' 1979. &" " ,l ,,_.__ ~'- >~.:. ~ Notary Plibl:li-c ,-' NOTARY PUBUC My Commi.oI01l topi'" Doc, 21, 1981 Lo",,_, Pel, Cumbe:rI<1nd County I . RCC- 37 . (12-63) 'CmlMO~\\'EALTll OF PE1>:-;,YYI A'II.-\ TRANSFE!; INIIE!;ITA!,;CE TAX R~:SIDENT DEl'EDENT SCHEDULE "I)" BEi'\EFICIAHlI'~S 1."=""=-1-]., ~ - -. ,~ 1808 Bridae St. New Cumberland, Pa. 17070 RELA TIONSIIIP . (If step-children or I SBRYIVED illegitimate children! o.";..cf~l!ENI are involved, set : S I ATE YE.... forth thIs faClJ~/{ _ NO Son _-pes , BENEFICIARIES AND ADDRESSES State full names and addresses of all who have an interest, vested, contingent or other~ wise. in estate) ! i n'II'E I OF I HI [{TH r- ~dUl t INTEREST OF BENEFICIARY IN ESTATE Entire Residue L I , I - - I r +- - I , Deponent further says that all tile above-named beneficiaries are living at this time except below: - NAME DATE OF DEATH RESIDENCE ----- 15 '-: -~- e<"" t:i ': ~ '2 <1) S ....'a) ::l ';0.0 ~ E t.I ~ 8::0 o ~ .................. ::l <.r. ~ U ;::l 0 ~ E ~ f'O 0: Real Property I>ersonal Property Transfers SUMMARY . (Sch. "A") (Sch. "8") (Sch."C") (1 ) (As Reported) $ -0- $ :123,906.06 $.. ."0.,, $ $ $.. 123,906.06 (2 ) (As Determined) Gross Taxable Estate $ $ $ S $ $ 'CJ s:: III s:: .--l 0 ~ 00 b <lJ s:: M Z "" ~ .c: "" ~ l;i r. Q - - ::: < III -< <lJ '" =: ~ ..., ~ ~ E-< Z 'CJ '0 ~ s:: P- o.. 0 ~ s:: '" ... III P- ..:: '" -< '" r. ~ ~ J: r.' ~ :I: '" -< ~ .c: <lJ Z ~ ~ 00 0 0 b 0; Z b if> tr> ~ P- < <lJ - +> s:: ~ r.,00U1S:: ~ P 0 0 i- ::;:: ~ <lJ 0 U1 ~ t) ..c =: <lJ+>p.. " ~ 0 ~ 0 ':>.<lJ 0 .0: ~ ... H::;::~ :c r.. '0 0 0 .c' a s ~ 0 E ..-. U1 Q) S ~ 0 <lJ.--l S ?'t - 0 .c: :>'0 <lJ '" :;::: ..r: ..l U U E-<::;::M...:! r~ c C:-::l~, RESIDENT DECEDENT SCHEDULE "E" JOINTLY OWNED PROPERTY COMMONWEALTH OF PENNSYLVANIA TRANSFER INHERITANCE TAX INSTRUCTIONS: This schedule must disclose all propert;y, real and personal, owned by the necedent Jointly wi tl1 1-mother or others, including intangibles, standing in the name of' the decedent and others. List rE'tll estate first. as entireties, or ,joint tenants, giving brief' description, as indicated lmder Schedule "A", plus the date and place of record of' instrument ef'recting vestituJ'e, but do not include entireties or nut of state rea] estate value in estate valuatIon column. Personal property should be listed as in Schedule "H", plus date of acquisition, and the name, address anti relationship (if' any) of' co-owners to the !lecedent. Description of Property, Date of' Acquisition, Name Address and Helationstdp of Co-Owners, and Place of' Record of Instrmnent, where Heal Estate. ~ """,:;:^ X ~:Q<>:Q<>&:SO<: 0 ~ X> ~ Sf> 2'< X> 0< 'XC ~)< '$ X> 0 unit percentage Estate DEPARTMENT VALUATION Value Share Valuation CAUTION-Do not Write In This Space. Y.> )< <>0';0<: :x :x ;& ~ Value or Value or 3832> Entire Deceden tIs 38 ~ X> 2'< X> Property Interest CXNB Bank, N. A. checking Account No. 003-000108-5 in the name of the decedent or Kenneth E. Bertram as of November 4, 1976. Date of Death Balance - $10,408.80 I /- rme-half ,5.204. 4Ql Insert this total opposite ",Jointly Owned Property", ScilellUle "1<." in the "As Heported" column on the last pag(~ of this return. .".c- ~~2o~Jil':_ J '5,'204.LjO ;- -- CC:~EI CCNB BANK. N.A. MAIN OFFICE 331 BRIDGE STREET NEW CUMBERLAND, PENNSYLVANIA 17070 17171774-7000 December 7, 1978 Myers, Myers, Flower & JOhnson Third & Market Streets P.O. Box 125 Lemoyne, Pennsylvania 17043 ATTN: Thomas I. Myers Dear Atty. Myers: Reference to your letter of December 5, 1978, regarding checking account number 003-000108-5, in the names of Sophia Bertram or K. E. Bertram DDS. The account was opened on November 4, 1976 and the balance as of January 31, 1978 (DaD) was $408.80. Our records indicate a $10,000.00 withdrawal on January 23, 1978 by Dr. Bertram. If you have any questions, please contact us. Very truly yours, A9:fI/lA-1A'~(!~.. D.E. Machemer, Manager Bookkeeping Department DEM: sd RGC-39 {B-77r . . County, Number ond Name Cumberland File Number No. 21-78-107 SUMMARY Date of Death .Trlnlli'lry 11 Estate Name BERTRAM (LAST NAME) 1'l7R SOPHIA (FIRST NAME) COMMONWEAL TH OF PENNSYLVANIA TRANSFER INHERITANCE TAX RESIDENT DECEDENT snSAN (INITIAL) REPORT OF INHERIT ANCE TAX APPRAISER I, the under$igned duly appointed Inheritance Tax Appraiser in and for the County of Pennsylvania, do respectfully report that r hove 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", US", "C", and HE". Dated: INHERITANCE TAX APPRAISER REPORT OF THE REGISTER OF WILLS I, the undersigned duly elected Register of Wills in and for County, Pennsylvania, 'do respect- fully report thot 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 IIF", which greater or lesser amount represents the sum allowed as a deduction. Dated: REGISTER OF WILLS CODE ADJUSTMENTS INVENTORY VALUE AS APPRAISED (HARRISBURG USE ONL VI REMAINDER APPRAISEMENT CODE Real Property (Schedule Al $ -0- OD+ 92+ Personal Property (Schedule B) 1 ?~- QOh 06 1D+ Joint-Held Property (Schedule EI <; 2"A 40 2D+ Transfers (Schedule CI -0- 3D+ TOTAL G ROSS ASSET'S 129.110 46 less Debts and Deductions 40- 93- (SCHEDULE F) CLEAR VALUE OF ESTATE Valuation of life estates or ~ PRINCIPLE FACTOR VALUE Ilnnuities....................._ $ l= CODE r- I ~ ,STATE TAX ASSESSMENTS _ $ FOR USE OF REGISTER ONLY Tax on $ Tax on $ Tax on $ Tax on $ Tax on $ Exemptions Total Estate ~ COMPUTATION OF TAX $ $ $ $ $ 2% 6% 15% . (*) As evidenced b" Charitable Exemption Certificates issued by the Secretary af Revenue. TOTAL TAX $ Less tax previously paid BA LANCE Less 5% of tax if paid within 3 months after death $ $ t= $ BALANCE OF INHERITANCE TAX DUE o\dd interest at rate of 6% from to "MOUNT OF ESTATE TAX ASSESSED Estate tox paid $ BALANCE DUE A.dd interest at rate of 6% from to ,= $ $ $ $ $ TOTAL TAX BALANCE $ PAID $ Supplementdl Cddes: (FOR USE IN HARRISBURG ONL Y) 48-Adj ustment 49+Adjustment 56-Annuily 6O-Life Estate 92+Remainder Appraisal 93-Remainder Deduction 93C-Charity 94-Remainder Residue 96-Success i ve life Estate FOR USE OF REGISTER ONLY ADJUSTMENTS NOTE: Where subsequent adjustments ?re made to the above computation of tax by the Register of Wills, for proper reason, same should be noted below, with short explanation. ----- <=: ,... ...l 0 Z "0 ...: Ul ~ u 00 <=: M ~ . - .<:: "" '" ::;' . ...: Q) u 0 0 ;>< ~ u =0: I""J r- OO u c.. - :E: Q ...... ...: ~ c.. '" =0: " ...: III c.. ~ E-< '0 "E Q ~ 'M c.. ~ <=: " Q) <=: 0 > Z "' ...: "' [ii III - ...: :;; III = = ~ a:I ...... ;., 0 :> "" ~ "" ,... '" ,... ...... ~ " ...... 0 i'!; ::I: "'" ...: ;ij Q) " =0: Ul~ I ~ Z ,... 0 ,... ~ OJ 0 ~ Ul ~ 00 Ul c.. c.. Q) -If) <=: 0 ~ ::> '- ~ ~UlN <=: ~ Ul U 0 =0: :E: ~...... Q) =0: ..c::: Q) P< .S ~ .0: ~ .~X - ~ ,... H '" H:E:O '" ,... OJ a:I Q) ~ ::I: '- ~ ~ ...: '" P< 0 " Ul - <=: ::;' '- III Ul .~ "E 0 0 ;., ~ ~ s~oo ::{s Ul Q) " ~ = e o Q) S .~." '" 0 0 .<:: ~ . Q) ~...: ...l U U E-<:E:P<...:l L. . 11Lctllt lIt11 ctttb W~lltctm~ttt I, SOPHIA SUSAN BERTRAM, formerly of Rochester, New York, now of New Cumberland, Cumberland County, Pennsylvania, make, publish and declare this to be my Last Will and Testament, revoking any and all former Wills by me at any time heretofore made. 1. I direct that my just debts and funeral expenses be paid by my Executor hereinafter named as soon as conveniently may be. 2. All the rest, residue and remainder of my estate of what- soever nature and wheresoever situate, I give, devise and bequeath unto my son, Kenneth E. Bertram. 3. I name, constitute and appoint my son, Kenneth E. Bertram, to be the Executor of this, my Will. IN WITNESS WHEREOF, I hereunto set my hand and seal, this ~ day of Ai ,)lK"""i", , 1976. /)( / " . J S. /).. ".c:tL-" ,U>Xc- /j({)0-~ Sop ia Susan Bertram (SEAL) Signed, sealed, published and declared by the above-named Testatrix, as and for her Last Will and Testament, in the pre- sence of us, who, at her request, in her presence and in the presence of each other, have hereunto subscribed our names as witnesses. 75 /-,i7c%y, 1 /IT /c;( -<tU&~'rrd {) r~L.<~ ----- * REV-51a (B..n) 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 Tex Division NOTICE OF FILING OF APPRAISEMENT Kenneth E. Bertram 1808 Bridge St. N. CUffiberland0 p~ (Executor or Administrator 17070 In Re: Estate of Sophia Susan Bertram Cumberland County - File No. ?1-7R-0107 Dear You are hereby notified that the_. Original oppraisement in the estate of Sophia Susan BeY'tram has been filed in the office of the Register of Wills of~mb\'rland ____ County on 28 March . 19--22., Soid approisement reflects the following va I uations: Reol Estote Personal Prnperty T ransfers_ Jointly Owned Total _____.__ Hnnc. l?~..Qnh flh }In,,p "s) ?nl~ u.n .J2.l2.9,llO.46 As to such tax that is paid within three months from date 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 naticp. as provided by Section 1001 of the Inheritance and Estate Tax Act of 1961, 72 P. S. 2485-1001, P. L. 373. Date ?A M~rQr 1979 Signed Title __Administr.;'ltive Officer Nate: This is not a bill. ----- REV-457 (8-78) DEPARTMENT OF REVENUE BUREAU OF FIELO OPERATIONS P.O. BOX 2970 HARRISBURG, PENNA. 17105 COMMONWEALTH OF PENNSYLVANIA RESIDENT INHERITANCE TAX APPRAISEMENT DA,-il;. COUNTY FilE NO. 28 f.!arch ] g7g Cumberland 21-78-0107 Whereas, ~()p'hi ~ C:11<:'::::l,.., PO"Y'l+............... late of N. Cumr1erJ ann in the County of Cumber Ian d Commonwealth of Pennsylvania, having died on the 31 s t day of J an u a rv 19 7JL, seized and possessed of an estate subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania; Therefore, I, Leo Pul gin i t i , 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 Appraisement VALUES Made for Inlleritance Tax Purposes PQ" T'"~ $ Personal Pronert" " Transfers u. Joi~~'" f1..~"-, , ~ n', ',n T"+~l .", ~--:r: Have been duly sworn according to law, I do hereby certify that the above appraisement is made in conformity with the law on this ~~tft day of M~~'~" . 19~, Appraiser Ha,..,,...i<::!'hlape (Number and Street) (Post Office) , Penna, >, ~ <:: :l o U l:'-- o '- [ ~ ~ r ~ ..ry e:. ~ .::l 4: "" "" :t ::> Ci.l I- Z '" ::;; '" CIl <( a: Q. Q. ~ X ~ I- '" U Z ~ I- a: '" J: Z I- Z '" o 0; '" a: 'Q '" ~ :s '" ",1 al ;;J '" : l;j : '" :0 ::.: ~ to< P<< ~ ,,:; :.:. <: "" ::>: CIl: <: ....: ;t;: ....: 0: en: al l"! 0- -< a:i w to< ~ ::) 2 w '" ;;t: ex! > r< C'I w ~ 0. ,: a: ~ ~ u.. ;. ~ ",- 0 'ti "": g l;j <Pi I- .... 't:: 2 0 ~ .-I: 0 ~ ",- W '" (1'); '" :l 2 ~ .-I '" '" g -'" '" I- ....:! ... Cl '" >: a: 0 ~ '" <( 'il '" ~ ~ ;;t os, .... "- ::1 '"5 <:: ;;t '" 0 w (.l; '" '" .-I 0:: ~ 0 '" ~ "S <:: < 0 :l '" 0 :z:: .... 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