HomeMy WebLinkAbout06-29-78
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
'*
. RCC-33 (4-73)
RESIDENT DECEDENT
JUN 29 If.llfl.
COUNTY d~ 'tumberland
IMPORTANT:
This return must be completed in detail and filed in duplicate, with all attached, with the Register of Wills of the
County where decedent resided; Return is due within nine months after date of death. unless an extension is granted
by the Secretary of Re'ltenue. (Section 703 of the Inheritance and Estate Tax Act of 1961.)
--~~-'~
-
,..J
EXECUTOR
I~ THE MATTER OF THE ESTATE OF
AFFlDA VIT OF
u_E;Ye),jT1LJ. Lackey
(':T.".TE-: FULL NAME Ci",' DECEDENTi
Late of
Cumberland
ADMINISTRATOR
StatF' of ----Eennsyl'lrania--
County of ~umherl ~l'ln
)..
Farmers Trust Company Executor
~--~-------~f;h:-~state- of the above-named decedent being duly sworn, depose ond say
Decedent died __~_?_~~~.~ 22 , 19 78_1 testate leaving a last will, copy of which is hereto attached. }
''v'C~TH) (DAY) (YEAR) \)L,~)H{
Natlle (wd addre~"; 01 !'~tV1EY 'jr }
other authClri7<!d ter'l,..-...cnl:J."tl' '() whom
all correspor,dence ~1',1.
James R. Humer, Esq.
1 West High street, Carlisle, Penna. 17013
That as SlH_:h_~_?Secu_!:..?r deponent is familiar with the affairs of said estate and the property constituting
,;: Y E':CU fa R- ADMIN I ST RA TO R)
the assets Ibereo! and Iheir fair market value.
That al the lime of death there was no safe deposit box registered in decedent's individual name, or jointly with, or
as agent 01 deputy of another, or in decedent's individual name, with right of access by another as agent or deputy, with the
exception of lht: foJlowing:
NONE
['lESS or: BANK OR OTHER INSTITUTION THIS SAFE DEPOSIT BOX R EN T ED RELATIONSHIP OFJOINT
[,OFNT RENTED A S_-\FE DEPOSI T BOX IN NAME OR NAMES OF HOLDERS TO DECEDENT
-. --
-,--_.-
--.,,--.----
--
~<AME AND ADD
IN WHI CH DEe
ThaI the LOnTents of said safe deposit box or boxes are itemized under Schedules N/ A of this return,
with the exception of the fo 11 ()\\-'ing , for the reasons hereinafter set forth:
That Schedule A attached hereto and made part hereof sets forth fully and in detail all the real property
In the Commonwealth uf 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
whcrcsover siluated owned by the decedent at the time of death; all moneys left by the decedent at the time of
death, \vhether in decedent's immediate possession, standing to decedent's credit in banks of deposit, savings
banks, trust companil~s, 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 primf 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-
ceJ,~r.t: 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;
,,:: "',,-1<1)115 <-lPP,.lI'l:;. .iv,vCII)', ~iivcl'wurt;, 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 \vith the fairly estimated market value thereof; all bonds and mortgages held by decedent and of all
claims due and O\ving decedent at the time of death, and all promissory notes or other instruments in writing
for the pa:yment 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 rrom life insurance policies carried by decedent; all annuity and endowment contracts
the proceed~ or which 'layable upon the death of the decedent; all and the corporate stocks and dividends
due thereon and :lnpai,j ';~" " date of death. bnnds and accrued interest thereon to the date of decedent's
death and olher In' "";CI\I owned by the decedent at the time of death, with the market value there-
of at such lil1ll'.
In the case of securities of close or family corporations, the values reported are as far as
possible substantiated by financial statements of the corporations, showing the assets and liabilities
thereof as of the date of death. The schedule also sets forth the interest of decedent at the time of
death in any co-partnership or business, and in support of the value of such interest there is annexed to
said schedule, financial statements showing the assets and liabilities of said co-partnership or husiness.
A copy of the co-partnership agreement, (if oral, a statement setting forth the nature of toe agreement)
together with a statement setting forth the character of the business, its location, and such other facts
pertaining to the business as may be pertinent to a fair and just appraisal of the decedent's interest
therein must be submitted. It should also set forth in itemized form, together wi th 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 transf'eree 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 cony
of the deed, trust agreement or other instrument creating the trust. Therl" is also set forth in said
schedule a list of all property, real and personal, with its value, which passes at decedent's death by
virtue of the exercise by decedent, either individually; or jointly with another, or any power of' appoint-
ment vested in decedent, either individually or jointly, by the w,ill, 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 benef'iciaries ror 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 decedent.
That Scf>edule 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 or administration of this estate; counsel f'ees and hldiclary'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 lmpaid at time of
death; taxes accrued chargeable for period prior to decedent's death (except those allowed under Section
651 of the Inh.:eritance and Estate Tax Act); together with a statement of' collateral pledged f'or obliga-
tions, if any. It is agreed that the f'iduciary will present proof' of' said claimed obligations upon re-
quest, that if the amount actually paid in settlement of any f'ee, 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 Schedules "A", "B", "e", "E", ,and "F" as directed therein,
have been carried forward and properly registered in the Summary.
Subscribed and sworn to b
re me this
c2:,,'z.tl.
......... 19...2...8"
.~m
~ ..... ")
7 I
FarmerSm T.r.us.t....Go any m. ...................
1 westS1Yfiek!:1"g'~f?' et7013
CarL1S e, t:lenna. 1
(City or Town and State)
NOTE: Bef'ore signing af'f'idavit make sure all blank spaces in t}1e aff'idavit and schedules annexed are
f'illed in with details or the word "None", and in case the assets include rare and unlisted securities,
securities of' close or family corporations or an interest in any co-partnership or business, that the
data and statements required under the paragraph above relating to Schedule "B" are attached. Also make
certain that column #1 in the "Summary" has been properly completed as above-directed.
oj
day of.
~rlffi;lll~~~:A-t~
n Expires July 14. 1981
CumH,11lld eo..ty
RC t-34 (4-73)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "A"
REAL PROPERTY
*'
Real property in Pennsylvania, with statement 01 mortgage encumbrances upon each parcel at death 01 dece-
dent. Property held by the decedent os tenant in common with another or other, should be identilied
os to quantum 01 interest and the estimated value should be that 01 the decedent's interest only. (Property
held os joint tenants with right 01 surviorship or tenancy by entireties should be reported on Schedule "E.")
The real property located In the Commonwealth of Pennsylvania should be
described by lot and block number, street and street number, together with
a general description of the property, with a reference to the record of the
conveyance by which the decedent took title; if a farm state number of a.
cres; also statement of mortgage encumbrances upon each parcel at death
of decedent. Taxes, assessments, accrued Interest an mortgages, etc.,are
to be listed an Schedule HF" and must not b. deducted from this schedule.
(1)
(2)
(3)
DEPARTMENT
VALUATION
CAUTION
(Do not write
In this .pace)
ASSESSED VALUE
FOR YEAR OF
DECEDENT'S
DEATH
ESTIMATED
MARKET VALUE
SEE SCHEDULE "E"
7Z.Qrl.U
NONE
Insert this total opposite "real prope,iy", Schedule "A" in the X X X X X
"As Reported" column on the lost page 01 this return.
'72c}t.('
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4
RCC -35
'*
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "B"
PERSONAL PROPERTY
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 1n 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 accormts, must be listed, despite the f'act that they are not of' the administered estate:.
Tangible personal property should be listed f'irst (e.g. jewelry, wearing apparel, household
goods, and furnishings, books, paintings, automobiles, boats, etc.)
Intangible personal property, such as bonds, treasury certiricates, cash on hand and 1n bank,
stocks, mortgages, notes, together with accrued interest or diVidends, salaries or wages, insurance pay-
able to the estate or riduciary in said capacity, partnership interests, interest in anyundistributed
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 1n this schedule.
Item
No.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
ITEM
List and describe fUlly
UNIT
VALUE
ESTIlIATED
llARKEr VALUE
Cash
Checking Account #7-1631-6
Farmers Trust Company
Savings Account #077-117075-0
CCNE Bank, N.A.
South Middleton School District
Wages dated 1-20-78
South Middleton School District
Wages dated 2-3-78
Educators Mutual Insurance Company
Disability Benefits
Refunds, Capital Blue Cross
Refund of Premium, Mutual of Omaha
Refund of Premium, Penna. Life Ins. Co.
Refund, 1977 Federal Income Tax
297.92 ,,//
286.36 /.-..---
179.06../
312.86.../
482.82 v /
/'
41 5 . 00 "
914.97 \ /
123.75 v
25.65 ,t;-
774.00 \
DEPARTMENT VALUATION
(Do not write in
this space)
..3? q? 'J 2.
~J?(. .3(,
/7:/ tiC
.3;.;<
//5;;;
2t.
s: /)
(" ..-><L
.AI /,!.J_C /' C
'1/ 'I '/ ?
/ Si.S' 7:J-
~.....')-':t.,,-:j'-
77,,/.((,
Insert this total opposite "Personal Property", Schedule "8" in
the "As Reported" column on the last page or this return.
x X
;J,OI".5~ ~rf''/~. 3'/
,
-
RC8- %
C"MMO\WFAI.TII II!-' I'L'\\SYLVANI A
T>{A\SfVI\ l\i:'mITA\'CF TAX
SCImnL;I-,E 'f C"
'I'll \N<':':FJ<:nS
~,\.,
IJ 'f,,,"';i l\
' ",l-f'j,.,.,.
I.,' \,,,'..,J:.r,,,.
",~J~
9,....,~....~"~,<.;
ilES IIll':\:T DECFDF\T
(1) Did decedent, within two years of'death, make allY transfer of Ilny material part of' his estate, vdthout
reeplving il valuable ap.rt adequate consideration thf:'refQr? (Answer yes or no) NO
(2) Did dpcedent, within two years of' deuth, transfer properlY from j,imself' to himself' and another 0,'
(,thers (tllclllding a spouse) in joint ownership? (l\nswer yes or no)--N..O__
(~l) It' the answer to (1) or (:J) above is in the l:If'firlllfit,ive state:
(a) Age of' decedent at time of transf'er
(b) State of decedent's health at time of making the transf'er. (Note 1).
(c) Cause of decedent's death. (~ote 1) 4
(4) Did decedent, in hi:> lifetime, make any transfer of property without receivinp; a valuable or adequate
consideration therefor which was to take ef'f'ect in possession or enjoyment at or af'ter lds np.ath?
(Answer yes or no)~_
(11) \ViIS there any possibillty that the property transferred might return to transf'erer or his
estate or be subject to his power of' (Ji.sposition? (Answer yes or no)
(b) What was the transf'eree's age at time of decedent's death?
U'>) Did decedent in his lifeUme makJ:' any transf'er without receiving a valuable amI adequate conslderation
therefor tmder which transferor expressly or implledly reserves I'or his lif'e or any perioo which does
not in fact end lJefore his death:
(n) 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 cr enjoy the property transi'erred or
inCOffi'" therrd'rom? (Answer yes or no) NO~
(n) 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 1 if'etime make a transf'er, the consideration lor whlch was transferee's promise to
pay income to or for the lIenen t of' care of' tl~ansferor? (Answer yes or no) NO
(8) Did decedent, at any time, trllnsf'er- property, the benef'icial enjoyment of' which was subject to change,
because of' a rp.served power to aI tel', amend, or revoke, or which c0111d revert to .-'Ieeelient under terms
of' transf'er or by operation of' law? (l\nswer yes or no) NO
(9) If' the answer t.o (H) above is in the af'ftrmative, was the power to alter, amend, or revoke the inter-
est of' the belwficiary rescrverI in t:he decedent alone or the decedent and others?
(Answer yes or no)
~OTE1: The answers to these questions should he supporterl by af'f'idavit hy the attendjng physician as
well as a copy at the death eerttficate.
NOTE 2: If answer to any of' the above questions is yes, set f'orth below a descriptton of' the property
transf'errerl, it's r:dr market vltlllc at date of' death, dates of transfers and to ""horn tr~'tnsferreri, with
relationship of' transf'erees to decedent, if' any. Submit copy of' any trllst 'h____ecI or instrument, if' trans-
f'ers are cla.imerl to be non-taxable, also submit detailert statement of' f'acts on which sl-dd claim is based.
~OTE :3: List apjll icable prollerty helow in manner in whi.ch provirled in Scheoules A, H, or E.
ITE;!
DESCltIl'TION
.\LtRKET VAI,UE
O~s Uma ted)
DEPT. ViU-,UAT:':ON
(Dept. Only)
NONE
-".,
),_. (/"}-l-(.
Insert this tntrtl opposi.te "Transfers", Schedule "C" in the
"As Reported" CnlllnID on the last p'tg;e of' this return.
rL41,U
---
.
RCC-37 (12-63)
COMMONWEALTH OF PENNSYYLANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "D"
BE!\:EFICIARIES
BENEFICIARIES AND ADDRESSES RELATIONSHIP SURVIVED
(If step-children or DATE INTEREST OF
State full names and addresses of all who illegitimate children DECEDENT OF BENEFICIARY
ave an interest, vested, contingent or other~ are involved, set STATE YES IN ESTATE
wise in estate) forth this fact.) OR NO BIRTH
Rebecca J. Lackev Sister Yep, ;:>1 'i0%
'i>;J; C'''~~i+ n",i""
(""",1 i ",1 a 17m '"
Clvde A. Lackev VA'" f"\ua~ ::>1 J;no,(
53'5 Summit Drive
Carlisle Penna. 1701'"
.
Deronent further says that all the above-named beneficiaries are living at this time except below:
NAME
DATE OF DEATH
RESIDENCE
------
~
o .
-~-
E<""
tj: r::
'a 4) s
's 't ..:
"00..8
<: E.
~ 8::-0
o ~
;j'tit:
~ ~ 0
~sg.
~ 0::
SUMMARY
......(Sch. "A")
.... ..... .....(Sch. "B")
........(SCh. "C")
Real Property
Personal Property
Transfers
Gross Taxable Estate
(1)
(As Reported)
$..
$3,$12.39
$
$
$"H
$3,8.12.39
(2)
(As Determined)
$
$
$
$
$
$
to- '0
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0 ?i :I: '" ..-. ":>' ro Q) c: ~
0 f-< Q)
Z f-< '" ,!:1...-1 ~ ~
~ ~ I'l bOH - ...
~ >. ~Q) 0
0 ...-I ~~ U ..:: llIi
c: IX: Q) .:; 0
0 ~ ~ =-
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's ...., .1:i :: E
0:::"'0 " 15 0
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RCC:36
RESIDENT DECEDENT
SCHEDULE "E"
JOINTL Y OWNED PROPERTY
'*
COMMONWEAL TH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
INSTRUCTIONS: Tllis scherlule must disclose all property, real and personal, ownerl by the rlecedent jointly
wi th another or others, including intangibles, standing in the name of' the decedent and others. List
real estate first, as entireties, or joint tenants, giving brief' description, as indicated lIDder Schedule
"A", plus the date and place of record of' instrument ef'fecting vesti ture, but do not include entireties
or out of state real estate value in estate valuation column. Personal property should be listed as 1n
Schedule "B", plus date of' acquisition, and the name, address and relationship (if any) of co-owners to
the decedent.
Description of Property, Date of' Acquisition, Name
Address and Relationship of' Co-Owners, and Place
of Record of Instrument, where Real Estate.
Q<.
unit
Value
percen tage
Share
Estate
Valuation
(:<
rx
<X
~~
DEPARTMENT VALUATION
CAUTION-Do not Write
In This Space.
Value of Value of'
Entire Decedene s
Property Interest
(
:X>~ xx::x <X 9<
3ix ><x;sg~0
:X> ;00 ;.x
%~
House and Lot located at 535
Summit Drive, Carlisle,
Penna. 17013
Owned jointly with decedent's
brother, Clyde A. Lackey and
sister, Rebecca J. Lackey--See
attached appraisal .
1968 Chevrolet Nova owned jointly
with decedent's brother, Clyde
A. Lackey
Household account #4-2329-7 (chec~-
ing), Farmers Trust Company
Household furnishings
xx
(:<
:)0
1 .
2.
33.333% 14,000.0lr:~r;':"
I
/~ U((,(
3.
4.
50%
33.333%
33.333%
275.ob,/' !:Jo.oc,
87.9~~
1 ,ooo.ob' 3,000,00
.c,lFf cO
s? '71.
I OC'{i 00
/
Insert this total opposite "Jointly Owned Property", Schedule "E"
in the" As Reported" column on the last page of' this return.
h"i "lh?q
/I
/Sdb:J.
12
--
*
RCC-BI (6-73)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
HARRISBURG
17127
IN YOUR REPLY PLEASE
REFER TO
Inheritance Tax Division
NOTICE OF FILING or APPRAISEMENT
Farmers Trust Company
One West High Street
Carlisle, FA 17Q13
(Executor or Administrator)
In Re: Estate af
Evelyn J. Lackey
Cumberland Caunty - File No.
2l~78-01l2
Dear Mr. Caverly:
You ore hereby notified thot the Original
appraisement in the estate of Evelyn J. Lackey
has been filed in the office of the Register of Wills of Cumberland
County on 21 August, 19 78, Said appraisement reflects the following
valuations:
Real Estate
Personal Property
Transfers
Jointly Owned
Tatal
None
3.812.39
None
,15.362.92
$19.175.31
As to such tax that is paid within three months from date of death, a five (5%)
percent discount is allawable. As to any tax that remains unpaid after nine (9) manths
(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 natice may object thereto within
sixty days after receipt of said notice as pravided by Section 1001 of the Inheritance and
Estate Tox Act of 1961, 72 P. S. 2485-1001, P. L. 373.
Dote August 21, 1978 Signed' : ,( /< _~(LL
Title _
Chief Appraiser
Q
- _.____---.-.--.-n__.
Note:
This is not 0 bill.
RCC-2 (2-641
D!i.PARTMl!ONT OF REVENUE
BUREAU OF COUNTV COLLECTIONS
HARRISBURG, PENNA, 17127
COMMONWEALTH OF PENNSYLVANIA
RESIDENT INHERITANCE TAX
APPRAISEMENT
DATE
August 21, 1978
Cumberland
COUNTY
FILE NO.
21-78-0112
Whereas, Evelyn J. Lackev late of Borough of Carlisle
in the County of Cumberland Commonwealth of Pennsylvania, having died on
the 22nd day of Januarv 19~, seized and possessed of an estate
subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania;
Therefore, I, IrR K. (;I,,;m . an appraiser duly appointed according to law,
having been designated to make a fair and conscionable appraisement of the said estate, and to assess and fix
the cash value of all annuities and life estates growing out of said estate, hereby file the following appraisement:
In the event that any future interest in this estate is transferred in possession or enjoyment to collateral heirs of the decedent after
the expiration of any estate for life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer
inheritance taxes at the lawful collateral rate on any such future interest.
Unit Appraisement
Description of Anot Value. Made for Inheritance
Ta:w; Purpo,el
Real Pronertv $ None
Personal Propertv 3 812 11Q
Joint-Held Property 15,362 92
'transfers None
TOTAL ASSETS $19 175 31
.
Having been duly swo.rn according to law, I do hereby certify that the above appraisement
formity with law on this 71 "t day of A"g"~"
,
/
is made in con-
19-28..
,///
ApprailJef
(Ifumbfto and Stnet)
Hartisburl: , Penna.
(Pod 0ftI")
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