HomeMy WebLinkAbout09-18-78
, .
'"
/
RCC-33,(4.73)
COMMONWEAL 'fH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
'*
SEP j X lq19
COUNTY OF CUMBERIAND
RESIDENT DECEDENT
IMPDRT ANT,
This return must be completed in detail and filed in duplicate, with all attached, with the Register of Wills of the
County where decedent resided; Return is due within nine months after date of death, unless an extension is granted
by the Secretary of Re'Otenue. (Section 703 of the Inheritance and Estate Tax Act of 1961.)
IN THE MATTER OF THE ESTATE OF
John Jacoby
(STATE FULL NAME OF DECEDENT)
} AFFIDAVIT OF
EXECUTOR S
~X
County
Late of
Carlisle
Pennsylvania
} ."'
State of
County of Cumber land
Mildred Pauline
_K<KIlfX
of the estate of the above.named decedent being duly sworn, depose
Jacoby, Robert Blaine Jacoby, Richard J. Jacob"Executors
and soy
Decedent died
February 13
(MONTH)
Name and address of attorney or }
other authorized repres-entotive HI whom
all correspondence should be mailed.
(DAY)
, 19~J testate leaving a lost will, copy of which is hereto attached. }
(y EAR) lJaXlm(fC
Sylvia H. Rambo
P.O. Box 261, 27 W. High St., Carlisle, Pa.
17013
That as such executors deponent is familiar with the affairs of said estate and the property constituting
(EXECUTO R-ADM1NISTRA TO RI
the assets thereof and their fair market value.
That at the time of death there was no safe deposit box registered in decedent's individual name, or jointly with, or
as agent or deputy of another, or in decedent's individual name, with right of access by another as agent or deputy, with the
exception of the following: -
NAME AND ADDRESS OF BANK OR O'THER INSTITUTION THIS SAFE DEPOSIT BOX RENTED RELATIONSHIP OF JOINT
IN WHICH DECEDENT RENTED A SAFE DEPOSIT BOX IN NAME OR NAMES OF HOLDERS TO DECEDENT
Farmers National Bank, John Jacobv and Father-Dauahte
Newville, Pa. Mildred Jacobv
r
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
- d.~~tlt,_ whether in dl~ce~~!!t:.:._s__imm_edi_~~e___~ossession, 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 ac_cruen 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 seeur ~i~'s 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 f'amily corporations, the values reported are as far as
possible substantiated by f'inancial statements of the corporations, showing the assets and liabilities
thereof as of the date of death. The schedule also sets forth the interest of' rlecedent at the time of'
death in any co-partnerstlip or business, and in support of' the value of such interest t:!1ere 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 the agreement)
together wi th a statement setting forth the character of the business, its location, and such other f'acts
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 1n 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' transf'ers o-fproperty, real or personal, within two years of decedent's
death, in contemplation of' decedent's death, or intended to take eff'ect in possession or enjoyment at or
af'ter neath, said schedule sets :forth the nature and value of' such property, to whom transferred, the
relationship of' the.transf'erees to the decedent, the proportionate share received by each transferee and
all other f'acts of' a pertinent nature regarding said trans-fers. In the case o-r transf'ers intended to
take ef'f'ect in possession or enjoyment at or af'ter death, there 1s also attached to the schedule a copy
of' the deed, trust agr~ement or other instrument creating the trust. Therf~ is also set f'orth in said
schedule a list of all property, real and personal, with its value, which pa~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 ill decedent, either individually or jointly, by the will, deed, or other instrument of' another,
with a copy~of the instrument cr~ating such p6wer attached to the sche'dule.
That Schedule D attached hereto and made part hereof' sets forth the names anti addresses of' all
persons benef'icially 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' a]l minors, annuitants and benef'iciaries f'or life under decedent's Will. It also
contains a statement showing which of' the benef'iciaries 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 ani! others, plus the date and place of' record o-f instrwnents ef'fecting the vesti ture of
real estate awl the date of acquisition of' personalty, plus the name, address and' relationship, if' any,
of co-owners to the decedent.
That Sc~edule F attached hereto and made a part hereof sets forth fully and in rletall all debts
and deductiow' claimed Jor and on behalf' of' this decedent's estate, including funeral expenses paid;
f'amily exemption, where appl icable; costs of administration of this estate; counsel f'ees and f'udiciary's
commissions paid or to be paid; cost expended f'or burial trusts, tombstones or gravemarkers, and reli-
gious services, in consequence of' the death of the decedent; debts and claims owing ani! nnpaid at time of'
death; taxes accrued char~eable f'or 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 assesse{l can be reassessed in accordance therewith.
That
have
the totals of the appropriate colurrms in Scherlules "A", "B", "e",
been carried f'orward and properly registered in the
"E", and "F" as directed therein,
~
Subscribed and sworn to before me this ..\'\:~..
Summ~ . Jr-4
V?~/7pJtJ&A"/k71; t^~ v 6
~---
~~~~~19?~:.
SOUTHM,1Pi"ON T'_I[;~,:::':-j!? FRANKLIN CO.
MY COMMI::;Slu~J L\PI!1ES AUG. 10, 1981
(St'reet Number)
(City or Tow" and State)
NOTE: Bef'ore signing af'fidavi t make sure all blank spaces in the af'-fidavit and schedules annexed are
filled in with details or the word "None", and in case the assets include rare and unlisted securities,
securities of' close or family corporations or an interest in any co-partnership or business, that the
data anrl statements requirect under the paragraph above relating to Schedule "B" are attached. Also make
certain that column #1 in the "Summary" has been properly completei! as above-directed.
RC <;:-34 (4_731
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 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 an 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, with a reference to the record of the ASSESSED VALUE VALUATION
conveyance by which the decedent took title; If a farm .tate number of a_ FaR VEAR OF ESTIMATED CAUTION
cres; also statement of mortgage encumbrance. upon each parcel at death DECEDENT'S MARKET VALUE (Do not writ.
of decedent. Taxes, assessments, accrued Interest on mortgages, etc.,are DEATH In this space)
to be listed on Schedule uF" and must not b. deducted from this schedule.
NONE l'-J O"~
nsert this total opposite "real property", Schedule "A" in the X X X X X
'As Reported" column an the last page of this return.
RCC -35
RESIDENT DECEDENT
SCHEDULE "B"
PERSONAL PROPERTY
~~..~.'
,~'\
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
INSTRUCTIONS: This Schedule must disclose all tangible and intangible personal property owned individually
by the decedent, at the time of his death. Property owned by the decedent jointly with another or others
must be listed under Schedule "E". Intangible personal property, titled in the name of the decedent, but
payable at death to another or others, including but not limited to P.O.D. U. S. Savings Bonds and tenta-
tive trust accounts, must be listed, despite the fact that they are not of 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 certif'icates, cash on hand and in bank,
stocks, mortgages, notes, together with accrued interest or dividends, salaries or wages, insurance pay-
able to the estate or f'iduciary in said capacity, partnership interests, interest in anyundistributed
estate of' or income f'rom any property held in trust under the will or agreement of' another, even though
located outside of' the State, at the time of' death, should be listed in this schedule.
Item
No.
ITEM
List and describe fully
UNIT
VALUE
ESTIMATED
MARKET VALUE
DEPARTMENT VALUATION
(Do no t wri te in
this space)
C- ,c c'
.,
1
2
Cash
South Bend closed face pocket watch
(not operable)
Carlisle Building & Loan Savings Account
No. 1346"
The Farmers National Bank of Newville -
Checking Acct. No. 03130983 ~.
Cumberland Valley Coop, Inc. - Certificat
No. 1976 - one share, common
Cumberland Valley Coop., Inc. - Certifica e
No. 1580 - 3 shares preferred
SOC"i:::a1 ~A""I1:rit.y Dca.Lh .tSenerl.t
5.00.
1.00.
~ l :~) .....')
3
,','
6,176.89
l.) \ .. 'I Y, .<; z.-
4
3,561. 92..~'
SC"\- L_.
',. -
5
10.00
~ (~_:: . c~ '...-
6
7
30.00.
~~~ nn
'2",,~), <.: v
Total -
~--
<t~~~ 0 3 9~_~J
c~ ,'-1 S l, . L{ L(
Insert this total opposite "Personal Property", Schedule "B" in X X
the "As Reported" colllITUl on the last page of' thts return.
-
RCC - 36
COMMO:\WEALTH OF PENNSYLVANIA
TRANSFr:R INHl'HITANCE TAX
SCHEDULE lie"
T )UN S FEI\S
+~
~
I\ES IDE:\T nECi<:nENT
(1) Did decedent, within two years ofdeuth, make any transf'er of' any material part of his estate, without
receiving 11 valuable and adequate consideration therefor? (Answer yes or no) yes
(2) Did decedent, wi thin two years of death, transfer propeny from himself to himself and another or
others (including Ii spouse) in joint ownership? (Answer yes or no) ves
(3) If' the answer to (1) or (2) above is in the affirmative state:
(a) Age of decedent at time of transfer 90
(b) State of decedent's health at time of' making the transfer. (Note 1).
(c) Cause of' decedent's death. (Note 1).
(4) Did decedent, in his lifetime, make any transfer of property without receiving a
consideration therefor which was to take errect in possession or enjoyment at or
(Answer yes or no)
(a) Was there any possibility that the property transrerred might return to transrerer or his
estate or be subject to his power or disposition? (Answer yes or no)
(b) What was the transreree's age at time or decedent's death?
(5) Did decedent in his liretime make any transrer without receiving a valuable and adequate consideration
thereror unrler which transf'eror expressly or impliedly reserves ror his lif'e or any period which does
not in ract end berore his death:
(a) The possession or enjoyment or or the right to income f'rom th~ property transrerred?
(Answer yes or no)
(b) The right to designate the persons who shall possess or enjoy the property transrerred or
income therefrom? (Answer yes or no)
(6) rr 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 liretime make a transt"er, the consideration for which was transferee's promise to
pay income to or ror the benerit of care of transferor? (Answer yes or no)
(8) Did decedent, at any time, transf'er property, the beneficial enjoyment of' which was subject to change,
because or a reserved power to al tel', amend, or revoke, or which could revert to decedent under terms
or transrer or by operation of' law? (Answer yes or no)
(9) rr the answer to (8) above is in the at"firmative, was the power to alter, amend, or revoke the inter-
est or the benericiary reserved in the decedent alone or the decedent and others?
(Answer yes or no)
NOTE 1: The answers to these questions should be supporter! by affidavit by the attenciing physician as
well as a copy of the death cer-tiricate.
NOTE 2: If' answer to any or the above questions is yes, set rorth below a description of' the property
transf'erred, it's rair market value at date or death, dates or transfers and to whom transrerred, with
relationship or transrerees to rlecerlent, ir any. Submit copy or any trust deed or instrument, ir trans-
rers are claimed to be non-taxable, also submit detailed statement of racts on which said claim is based.
NOTE 3: List applicable property below in manner in which provided in Schedules A, B, or E.
(See attached
documents)
valuable or adequate
arter his death?
ITEM
DESCRIPT ION
MARKET VALUE
(Es tima ted)
DEPT. VAI.UATION
(Dept. Only)
1
CD #AR3993 ~ Farmers National Bank of
Newville - Dated 11/19/76 in names of
John or Robert Jacoby
1,015.00 '
\ \ CJ \
C' \.. ~
2
CD #AR3994 - Farmers National Bank of
Newville - dated 11/19/76, in names of
John or Richard Jacoby
1,015.00
\
\
:---'
Total
2,030.0(
-:', C,:~(\.C\O
Insert this total opposite "Trans~ers", Schedule "e" in the
"As Reported" column on the last page of this return.
taLt
~-\
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
HARRISBURG
17127
RCC-43 (4-71)
NOTE: TO BE SUBMITTED IN TRIPLICATE
REPORTING FINANCIAL INSTITUTION
ADDRESS
Pennsylvania Department of Revenue
Bureau of County Collections
Gable Building, 3rd, Floor
411 S. Second Street
Harrisburg, Pennsylvania 17127
Carlisle Building & Loan
17 W. High Street
Garl1s1e, I"a.
ZIP CODE 17013
-=<-/- 7P- {lIt t.
Pursuant to Section 742, Pennsylvania Inheritance and Estate Tax Act
of 1961, we herewith submit the following report:
ACCOUNT NO. OF JOINT, TRUST OR
INVESTMENT DEPOSIT 01-000-380
NAMES ON ACCOUNT OR
INVESTMENT John Jacoby or Richard J. Jacoby
DATE OF DEATH February 13, 1978
DECEASED JOINT DEPOSITOR, TRUSTEE
OR INVESTOR John Jacobv
ADDRESS 150 C Street, Carlisle, Pa. COUNTY Cumberland
ZIP CODE 17013
SURVIVING DEPOSITOR,
BENEFICIARY OR INVESTOR
Richard J. Jacoby
ADDRESS
unknown
RELATIONSHIP TO DECEDENT "to the best of our knowledqe this is his son"
DATE DEPOSIT OR INVESTMENT
WAS ESTABLISHED 12/30/75
BALANCE, INCLUDING INTEREST
DUE, AT DATE OF DEATH $ 10,000.00 + 71.92 interest
fJq~"t ~A~~:1
Signa ure
;.),Jl.v.
TITLE
RCC-38
RESIDENT DECEDENT
SCHEDULE" En
JOINTLY OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
INSTRUCTIONS: This schedule must di,sclose all property, real and personal, owned by the decedent jointly
with another or others, including intangibles, standing in the name of the decedent and others. List
real estate first, as entireties, or joint tenants, giving brief description, as indicated lmder Schedule
"A", plus the date and place of record of instrument 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 "B", plus date of acquisition, and the name, address anrl relationship (if any) of co-owners to
the decedent.
Description of' Property, Date of Acquisition, Name unit percentage Estate DEPARTllENT VALUATION
Address and Relationship of Co-Owners, and PI ace Value Share Valuation CAUTION-Do not Write
of Record of' Instrument, where Real Estate. In This Space.
Mex ~~;XX 'V;~~ ?<; :x> M Value or Value or
ex :X ?<: :x> ex ?<;ex ?SO I!.ntire Decedent's
:x> :x> ;OX ;X ex ex :x>;X
6: ;X; Property Interest
1., ACD#380 - Carlisle Building &
Loan - dated 12/30/71, in names 0
John or Rich~d Jacoby - $10,000
CD#109965 '::. Cumberland County'
National Bank - dated 1/7/75,
in names of John or Mildred
Jacoby - $8,000- did value $10,0 1.04
CD#AR1736 - Farmers National Ba k
of Newville - dated 11/2/71, in
names of John or Robert Jacoby
$10,150.00
4.: CD#AR3422:-
of Newville -
names of John
$1,020.00
CD#AR3254'-
of Newville -
names of John
$1,035.00'
CD#AR1737'-
of Newville -
names of John
$2,030.00 c---/
CD#AR3603' ;.;;"
of Newville -
names of John
$-1,060.00 'J
8.v' CD#AR3992 '-
of Newville -
names of John
$1,005.00-
Cumberland Valley Coop., Inc.,
Certificate No. 1902 - 2 shares
preferred issued 8/14/75, in
names of John & Robert Jacoby - $ 0
10. Interest on above CD#380 - $73.59
1/2
5,000.CO
'..j "
S. O.>'lc ,t2p
2.
"
1/2
/
5,025.52
S\02.S S-z.
3. ,
1/2
5, 075.1 0
S;ulS 00
Farmers National Ba k
dated 10/3/75, in
or Robert Jacoby
---
1/2
510. C 0
'-;lO,00
5.
Farmers National Ba k
dated 6/20/75, in
or Richard Jacoby
1/2
...-'
.
517.~0
Sl,SL
6.
Farmers National Ba k
dated 11/2/71, in
or Mildred Jacoby
1/2
" '
1,015.CO
l,OlS.OC
7.,.
Farmers National Ba k
dated 2/16/76, in
or Mildred Jacoby
1/2
,
530.CO
::; ~~ 0 .Ct
Farmers National Ba k
dated 1/6/75, in
or Mildred Jacoby
1/2
502. 0
c;o L.~U
9.
/
1/2
1/2
10.1 0
36. 0'
l0. u C
36 90
NOTE - See Schedule C for other
jointly owned property transferred
within two years of death
TOTAL
f-.--=-:----" ,
(p18.222.S2/
i 'D ,-2.. c:ll.\ L..
,
Insert this total opposite "Jointly Owned Property", Schedule "E"
in the "As Reported" column on the last page oC this return.
lj.CC-37' (12-63)
COMMON\\'EAl.TIl OF PEN:"ISYYl.ANIA
TRANSFER INIIERITA:"ICE TAX
RESIDENT DECEDENT
SCHEDULE "D"
*1li1J"tM* 1\
. . .
~... , "..~
BEt\EFICIARIES
(
h
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
aye an interest, vested, contingent or other- are involved, set STATE YES IN ESTATE
wise, in estate) forth this facL) OR NO BIRTH
Mildred Pauline Jacoby
150 C Street
Carlisle, PA 17013 Daughter yes 10/11/15 one-third
Robert Blaine Jacoby
R.D.4, Newville, Pa. 17241 Son yes 5/5/22 on-third
Richard J. Jacoby
529 w. Louther Street
Carlisle, PA 17013 son yes 2/28/27 one-third
Deponent fUrther says that all the above-named bene~lciarles are living at this time except below:
NAME
DATE OF DEATH
RESIDENCE
~ '"'
StIl...-l
~<~
'tj: d
"8 ell E
"s t: .:
"t:Io.o
<<: E_~
~ 8 ~
.8_~
~ ~ ~
~ ~ 0
~E~
[:! 0:
SUMMARY
......... (Sch. "A")
..........(Sch. "B")
.......(SCh...C..)
. .Scllec1u.1e...E
Real Property
Personal Property
Transfers
Gross Taxable Estate
(1 )
(As Reported)
None
$
$
$
$
$..
$ .... ;30,292.13
....10,()39.81
..:2,030.00
..18,222.32
(2)
(As Determined)
$
$
$
$
$.
$
co:
r"<
l- '"
Z "
~ r.l ~
.. ...
" .... "
;... ..... ~ .(
r.l "
0 ell
CJl -
- .(
\D <<: '" IIC
.-l ~ ~ ~ ."
.-l p.. '8 llo
0 '" llo
I p.. 0 ~
'" <<: '" .(
.-l ~ :I: r.l 0 (I) III :..
N r.l ... l- I!:i .-l .-l ~ Q
S
,; ~ :I:: '" ;:: UJ I-l ;:; ~
l- 0 ..-{ (I)
Z CJl fa .-l ~. p..
~ r.l I-l ~ ...
~ 0
0 g III ij IIC
I ~ 0 0' 0
r.l '" llo
" ...
f: ~ :. IIC
0 ~
"
~! <<: ~ ,C- o
;::;: 0 E
" S E
- 0
'" 0
....l U U
RCC-39 (8-77)
File Number
Number and Name L \ - L01'A f'-"<-P..... Lf-'\N0
"2\- 1'0 '0\\10
(:';-2- - \?~ -I '2>
..)~
SUMMARY
County,
Date of Death
Estate Name ~c~
(LAST NAME)
COMMONWEAL TH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
(FIRST NAME)
(INITIAL)
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 flAil, liB", IIC", and liE".
Dated:
\0-10 -'18
~ k. };~
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 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 'IF", which greater or lesser amount represents the sum
allowed as a deduction.
Dated:
REGISTER OF WILLS
ADJUSTMENTS
INVENTORY VALUE AS APPRAISED ODE (HARRISBURG USE ONL VI REMAINDER APPRAISEMENT CODE
Real Property (Schedule A) $ 00+ NO\'<\~ 1 92+
Personal Property (Schedule B) 10+ c, .Slo 144
Joint-Held Property (Schedule E) 20+ I~ :;'51 '-1'2:-..
-.
Transfers (Schedule C) 30+ ) b')O tJ 0,
TOTAL GROSS ASSETS '30 o'-iC: -~ 6
Less Debts and Deductions 40- 93-
(SCHEDULE F)
CLEAR VALUE OF ESTATE
Valuation of life estates or
~
PRINCIPL.E
FACTOR
t=
VAL.UE
I~
onnuitJes....................._ $
1=
ESTATE 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 by Charitable
Exemption Certificates issued
by the Secretary of Revenue.
TOTAL TAX
$
Less tax previously paid
BALANCE
Less 5% of tax if paid within
3 months after death
$
$
1=
$
BALANCE OF INHERITANCE TAX DUE
Add interest at rote of 6% from
to
AMOUNT OF ESTATE TAX ASSESSED
Estate tax paid
$
~
$
BALANCE DUE
Add interest at rote of 6% from
to
c
$
$
$
$
TOTAL TAX BALANCE $
PAID $
Supplemental Codes: (FOR USE IN HARRISBURG ONL Y)
48-Adjustment
49+Adju5tment
56-Annuity
6O-Life Estate
92+Remainder Appraisal
93-Rema inder Oedu ction
93C-Charity
94-Remainder Re5idue
96-Success i ve
Life Estate
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 5hould be noted below, with short explanation.
---------
.... ....l
Z '" ~
~ ~ 0 Vl
f/' -
" :::0 " ~
" 0
;.... "-l Q 0::
Vl 0 c..
- 0
I ~ c..
0:: '" ~
c.. U;.. '" Q
c.. "
j 0 ..=: z
:= ~ ~ ~
~ :I: "-l ;.,
f-< := ... f~ en ....
"
0 i!: - '" ~ " 0::
Z .... 0 .... " 0
U;.. cr. c.. c..
I~ 0 UJ '- "-l
0 0::
~ -'"
"-l .:::
~ .... "
" ;- "
.:: '- ..
en < 0 "
'" L ., >. ~
~
- E 2 " '"
'"
::::"'0 e 0 0
:::~ ....l U U
R C C-2 (2-64)
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
HARRISBURG, PENNA, 17127
COMMONWEALTH OF PENNSYLVANIA
RESIDENT INHERITANCE TAX
APPRAISEMENT
DATE \ c - 0 ~~ ' I '0
(, 'C> L
COUNTY '- \) r,,'\ b '2 i< to. ~ D
FILE NO. 2.. \ '.. '1 '2,- a L l h
,,,'J ('>--'<~~) 0-c.~'-"J
in the County of C~,\.."-,,,,~.J.J-b~~ Commonwealth of Pennsylvania, having died on
the 0~ "'-eL day of \::-' J) ,()}'\A.~ 19'( '9 seized and possessed of an estate
subject to Inheritance Tlllf under the laws of the pommonwealth of Pennsylvania;
Therefore, I, \ /\..-c-- G~ , 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:
Whereas,
late of
(:_h_.i"'- ~~tl U
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
Oucrlptlon of Anet Made for Inheritance
Values TaxPurDoles
Q.fG.eJ- \' ~ $NONb:
~ ~'"'---t; --- ....
,
P~v-e.sc.. \? i"A -. ~ C{,LS", 44
T~~ 'J
'2,030 00
' ~ \ .') '1-,-, I ~, ) 2. s<(
.) C""-....::::tt.-L.,~ L.. t,'--f, . , \ L..
, ~ 'J
-~ '-
~Jl C\....;:L..~t:o 30. 04 S ~t,
"
/ ....
L~
~avi~g been duly ~worn accqrding to law, I do hereby certify, th t the above appraisement is made in con-
formity WIth law on this --12-\d!- day of C. ,. """- 19..::L!2.
Apprai8l.'r
\' \ (N\nnbeT ~d Stn~t 1
"ct:\../'v'\..~~
(Pm 0ftI~) -__J
, Penna.
1:'
C
\.)
0~
~c:)
!i
cJ
...
z
B
~
:i1
~
..
<
~
<
...
"'
'"
z
<
...
i!
"'
II:
Z
~
...
z
"'
'"
~
~
"'
~
-
Q
~
<)
II
~
/]
'"
.':
<0
'"
l
r)l
\
1
("10
---' --'
o
-'
~
-9
I
:J
-
Q
-
~
""
:50'
Ci
~ - --1-"
o t".:.J
~ ~
Ci ~.-'
~
- <0
: "t
<; "-
Ci "<:
~
L,]
c
~
~
<;
>-1
Q
<
~'
""
'"
'"
~I
""
~
.t5
o
..
... ...
~
o
<0
:E
<0
OS,
~
Q::
.;;
]
'"
., . . ..
'!;l'
.;;
~
~
Q
~
>-
~
~
o
E-
~
::'iIEi
~
~
Q
"i
"
0..
...
~
Q::
"
l:!
"
~
'"
'<:
"
~
~ !:
" ~
e .~
~ ~
'<: '<:
.",
"
..
11
"
o~
~
l.tl
-
<l
.c
"
~
<;
...
:::
"
..
!1
~
<0
.~
""
""
'<:
!1
"
~
1
""
'<:
"i
~
~
...
1
.",
~
...
~
"
l.tl