HomeMy WebLinkAbout03-01-79
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FtCC-33 (4:~3)
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
* /\ '\.
V
"'2.,/
. ,
RESIDENT DECEDENT
COUNTY OF
CUMBERIAND
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'ttenue. (Section 703 of the Inheritance and Estate Tax Act of 1961.)
Lote of
Cumber land
Pennsylvania
Cumberland
Lucille
} AFFIDAVIT OF
~~
ADMINISTRATOR
IN THE MATTER OF THE ESTATE OF
NANCY L. NORRELL
(STATE FUL'L NAME OF DECEDENTI
County
State of
) so,
County of
Administrator
M. Bair
}I;X~iCXX
of the estate of the above-named decedent being duly sworn, depose
and soy
Decedent died
February 26
(MONTH)
Name and address of attorney or }
other authorlzed representative to whom
011 correspondence should be moiled.
(DAY]
, 19~{~~~~~~~~~~~~~~~~}
(YEAR) mtestate
Sylvia H. Rambo
27 w. Hiqh St., Carlisle, Pa.
That as such administratriXleponent is familiar with the affairs of said estate and the property constituting
(EXECUTa R.ADMINI ST RA TO R)
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 SAFE DEPOSIT BOX IN NAME OR NAMES OF HOLDERS TO DECEDENT
That the contents of said safe deposit box or boxes are itemized under Schedules
with the exception-of the following, for the reasons hereinafter set forth:
of this return,
That Schedule A attached hereto and made part hereof sets forth fully and in detail all the real property
in the Commonwealth of Pennsylvania of which decedent died having an interest therein. It also sets forth the
mortgage encumbrances upon each parcel of real property at the date of death, giving the amount still due at
death, name of mortgagee, date, rate of interest, and book and page of record thereof. It also sets forth in the
columns provided therefore the assessed valuation of each of said parcels, the estimated market value thereof
as of date of death of decedent.
That Schedule B attached hereto and made part hereof sets forth fully and in detail all personal property
wheresover situated owned by the decedent at the time of death; all moneys left by the decedent at the time of
death, whether in decedent's immediate possession, standing to decedent's credit in hanks 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
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 secm :li('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 family corporations, the values reported are as far as
possible substantiated by :financial statements o:f the corporations, showing the assets and liabilities
thereof as of the date of death. The schedule also sets forth the interest of decedent at the time of
death in an~y co-partnership or business, and in support of' the value of such interest there is annexed to
said schedllle, f'inancial statements showing the assets and liabilities of' said co-partnership or "b,llsiness.
A copy of the co-partnership agreement, (if oral, a statement setting forth the nature of' the agreement)
together with 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 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 transf'ers of property, real or personal, within two years of' decedent's
death, in contemplation of decedent's death, or intended to take efTect in possession or enjoyment at or
after death, said schedule sets f'orth the nature and value of' such propert~r, to whom transferred, the
relationship of the transferees to the decedent, the pro'[)ortionate share received by each transferee and
all other facts of a pertinent nature regarding said transfers. In the case of transfers intended to
take ef'fect 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. Therl'~ is also set forth in said
schedule a list of all property, real and personal, with its value, which passes at decedent's rleath by
virtue of' the exercise by decedent, either individually, or jointly with another, or anJ' power of appoint-
ment vested in decedent, either individually or jointly, by the will, deed, or other instrwnent 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 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 neath of all minors, annuitants and beneficiaries for life under decedent's Will. It also
contains a stat.ement showing which of the beneficiaries named in the decerlent'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 attacherl 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 anrl others, plus the date and place of record of instrmnents ef:fecting the vesUture of
real estate and the date of acquisition of' personalty, plus the name, address and relationsh.ip, if' any,
of co-owners to the decedent.
That Sc~edule F attached hereto and made a part hereof sets forth ~lly and in detail all debts
and deductiolJ" claimed for and on behalf of' this decedent's estate, inclucHng funeral expenses paid;
family exemption, where appl icable; costs of administration of this estate; counsel fees and f'udiciary'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 unpain at time of
death; taxes accrued chargeable f'or period prior to decedent's death (except those allowed under Section
651 of the Inheritance tind Estate Tax Act); together with a statement of collateral pledg;e(l ror 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 tinct allowed, that the same will be reported to the Register of' Wills, and that
the amount of' tax assessed cnn be reassessed in accordance therewith.
That the totals of the appropriate columns in Schedules "A", "B", "en, "E", and "F" as directed therein,
have been carripd f'orward and properly registered in the Summary.
Subscribed and sworn to before me this
..;);"')~ b
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~ ;,','MJA l. sr.::C:::::j'!':t, t~OTA.7l.Y PUBLIC
.~iei~~m............._..
.J.:I.Qf~9gj::.i1t,".....m...m.m......_......'-'"
(Street Number)
...~l:1:i~e!1:\?,g~j::9~,.J)A..
(City M Town aM Sto.te)
NOTE: Before signing aff'idavit make sure all blank spaces in the affidavit and schedules annexed are
f'illed in with details or the word "None", and in case the assets include rare anrl unlisted securities,
securi ties of close or family corporations or an interest in any co-partnership or business, that the
data and statements require(l 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.
19...7...~L
L,. IHA~'PTC'! -~-, U..:jHIP, rTIANKLlN CO.
j'.ill' COMMI::;SJUN ExpmE.S AUQ.. 1CJ~ 1961,
RC<!-34 (4.73i
COIi4MONWEAL 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 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 stat. number of a_ FaR YEAR OF ESTIMA TED CAUTION
ere.; also statement of mortgage encumbrances upon each parcet at death
of decedent. Taxes, ossessments, occrued Interest on mortgages, etc.,ore DECEDENT'S MARKET VALUE (Do not writ.
to be listed on Schedule uF" and must not be deducted from this schedule. DEATH In this apoce)
NONE
Insert this total apposite "real property", Schedule "A" in the X X X X X
"As Reported" column on the last page of this return.
.00
N 0'-"-
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"HCC -35'
SCHEDULE "B"
,PERSONAL PROPERTY
~. ~.~
'~'
COMMONm,ALTH OF PENNSYLVANIA
TRANSB~R INHERITANCE TAX
RESIIJE;;'f DECEDENT
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. Savi.ngs Bonds and tenta-
tive trust accounts, 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 f'urnishings, 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 not write in
this space)
Social Security Payment
~-1:"-!-~ tJc
(v 0.~
checking
255.00
Farmers Trust Company,
account #8-1317-6
~
421.2
Keystone Insurance Company - no-fault
wage payment
United Telephone Company - refund
10.14
T.V. Cable - refund
10.54
Perfect School Plan Subscription - refun
19.53
Sears Roebuck
refund
/'
80.30
Sears Roebuck - refund
36.57
Ins er t this to tal Oppos! te "Personal Proper ty", Schedul e "B" in
the "As Reported" column on the last page of this returne
x X
$1,055.88
q LIt S
'1J.].7 I
-----
. BCC-1i.
CO\1Mn\'A'EAT,lll l!F 11't.:'\\SYlj'V/\NIA
Ti{A\~I.,:,'H I\l;l"]lfTl~,X(,),' TAX
SCl!r-:nfiLE ~!(.IT
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!\ESIDF\T ])]'TFDI"\'T
(1) Did de:-edeTlt, within two years ot'death, IIInke any tl'nnsf'~.r uf' any ma.tJ?rial part of his estatt', W:itllOllt
reCpiV1TlP; il valuable ill~d ade(lW:ltc considerntton tlH't'I~r(Jr? (AJIswer yes OJ' no)-y-es_._
(:.n Did opcedent, witl1Jn two years of' deaLh, trttnsf'ei' pl'opere.1i f,'om himself' to himself and another or
nthers (including; a spouse) in joint owner'ship? (An~wpr yes or no) yeS
(3) If thp answer t.o (1) or (2) Ftbove is "in the at'ftrIrlHtive state:
(a) Age of' decedent at tilTle qf transfer ~_O
(b) State of decedent's h.~alth at; time (Jf making the transfer. (Note 1).
(e) Cause or decedent's dp:tth. (Note 1). killed in fire
(4) Did decerh-'nt, in hL,;; liretime, make any transfer of lU'OllPrty ....ithout receiving a va111uble or adequate
consit1eratioll theref'or which was to take effect in possession or enjoymer-t at or af'ter .his death?
(Answer yes or no)---y"~
(a) WllS there any jJossibiUt:V thut the property transferred might return to transf'erer Or his
estat.e or be subject to his flower of' disposition? (Answer yes or no) yes
(b) What was the transf"eree's age at time of decedent's death?
(;')) Did dece(lent in his 1 i f'etime make any transfer withont receiving a valuable and ade(l11ilte consideration
therefor lm(ler which transferor expressly or impliedly reserves f'or his lif'e or any lleriod which does
not in fltf:~t end hlO'f'ore his death:
(a) The posscssjon or er.joyment of or the ri~ht to income from th\'.' property transf'erred?
(Answer yes or no)
(b) Thf' right to designate the persons who shall possess cr enjoy the property transferred or
income therefrolll? (Answer yes or no)
(fj) If the answer to (fI) (b) above is .in the affirmative, state whether the right was reserved in decedent
alone f)r others ~_~,~..___ __.__~_~___
(7) Did decedent in Ids lifetime make a transfer, the consideration f'or wtdch was transferee's promise to
pay income to or for the benefit of cure or tl'aFsf'eror? (Answer yes or no)
(8) Did dceefh'tlt, at any time, traw,;1'f:>r property! the hfmef'ici.al enjoyment of' whieh was subject to change,
because of a reserved power to alter, amend, or revoke, or which could revert to deccf1ent under terms
of' transfer or by operation of' law? (Answer yes or no)
(fJ) If' the answer to (H) ll!Jove 1.5 in the af'firmative, was the power tf) alter, amend, or revoke the tnter-
(',st of the beI'ef'iciary r'eserved in the decedent alone or the decedent Ilnd others?
(Answer yes or no)
~OTE 1: The (mswers to these 11uestions should be slIPporte(l by affidavit hy the attendjng physician as
well as a copy of' the death certificate.
l\OTE 2: If answer to any of' thc above lluest.ions is yes, set forth below a description of the property
transf'errefl, it's f'air market valnc at date of (leath, (1<1te5 of transfers and to ,,"'horn transferred, with
relationship of' transf'erees to decedent, if an,Y. Submit copy of any trust deerl or instrument, if' trans-
f'ers are claimed to be non-taxable, also submit detailerl statement of' facts on which said t:'laim is based.
NOTE ;}: List ap"j11icllhle property below in manner ln which provided in Schedules A, B, or E.
-~.-
ITEM
]H~SCRIPTION
M,AromT VIU,UE
(Estimated)
DEPT. V,U,UAT~O;.j
(Dept. Only)
Farmers Trust Company - Savings Account
#1-30334-0, joint with Lucille M.
Bair (2/14/77) $10,113.27
Interest on same
Insert this totrtl opposite "Transf'ers", Schedule "e" in the
"As H.eportf~d" CollUml on the last page of Uds return.
$10,150.84
\0,l')O '0'-1
ROC-3? "(12-63)
COMMONWEALTH OF PENNSYYLANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "D"
.'.,
,I~ 1\
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BE!\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
ave an interest, vested, contingent or other. are involved, set STATE YES IN ESTATE
wise. in estate) forth this fact.) OR NO BI RTH
Anaela K. Norrell dauqhter ves 8/19/67 one-half
p",,",,"., Nor,,"Qll ,Tr son ves 11/16/73 one-half
Deponent fUrther says that all the above-named bene~lclarles are living at this time except below:
NAME
DATE OF DEATH
RESIDENCE
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Real Property
Personal Property
Transfers
SUMMARY
.(Sch. "A")
.............. ...(Sch. "B")
. ....(SCh."C..)
(1 )
(As Reported)
$ ,00
$ ... .1.055.88
$ .10,150,84
$
$"H
$.. .11,206.72
(2)
(As Determined)
Gross Taxable Estate
$
$
$
$
$
$
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.RCC-38 .
RESIDENT DECEDENT
SCHEDULE" E"
JOINTL Y OWNED PROPERTY
*
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
INSTRUCTIONS: This scherlule must disclose all property, real and personal, owned by the decedent jointly
with ano ther or 0 the rs, locI uding in tang! bles, 5 tanding in the name of' the dcceden t and others. List
real estate f'irst, as entireties, or joint tenants, giving brier description, as indicated \UHler Schedule
"A", plus the date and place of record of instrtuTlent ef'f'ecting vestiture, 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.
Descriptlon of Property, Date of Acquisition, Name unit pe rcen tage Estate DEPARTMENT 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.
X>iS8 IV'. = X> Value or Value or
% 6OX'S< 0< % ;X :xx ?< y <>0 XX <)< 0< ~ Entire Decedent's
%X> y 3< y <X X>(y ~ Q<
Y ;X property Interest
See Schedule C
Insert this total opposite "Jointly Owned Property", Schedule "E"
in the" As Reported" column on the last page of' this return.
.00
N <f'-'--
-
REV-51!! (s..n)
COMMONWEAL TH OF PENNSYLV ANIA
DEPARTMENT OF REVENUE
BUREAU OF FIELD OPERATIONS
P.O. BOX ~970
HARRISBURG
17105
IN YOUR REPLY PL.EASE
REFER TO
Inheritance Tax Division
NOTICE OF FILiNG OF APPRAISEMENT
Lucille M. Bair
110 Front Street
Shiremanstown, PA 17091
(Executor or Administrator}
In Re: Estate of
Nancy L. Norrell
Cumberland
County - Fi Ie No.
;:>] -78-0117
Dear Ms. Bsir:
You are hereby notified that the Orirrinal
appraisement in the estate of Nancy L. Norrell
has been filed in the office of the Register of Wills af_ Cumberland
County on April 9 , 19 79 , Said appraisement reflects the following
va l uations:
Real Estate
Personal Property
Transfers
Jointly Owned
Total
None
927.75
10,150.84
None
$ll.Q28.59
As to such tox that is paid within three months from dale 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 deoth occurred prior to December 22, 1965) from date of death,
interest at the rate of six (6%) percent per annum is chorged.
Any party in interest who is aggrieved by this notice may object 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. p-3.
Date
April 9, 1979
Signed
Title_ Administrative Officer
I
""--
.~,..
Note: This is not a bi II.
REV-457 (8-78)
DEPARTMENT OF REVENUE
BUREAU OF FIELD OPERATIONS
P.O. BOX 2970
HARRISBURG, PENNA. 17105
COMMONWEALTH OF PENNSYLVANIA
RESIDENT INHERITANCE TAX
APPRAISEMENT
DATi:.
April 9. 1979
Cumberland
21-78-0117
COUNTY
FILE NO.
Whereas, Nancy L. Norrell late of South Middleton Township
in the County of ClImh..,., "nrl Commonwealth of Pennsylvania, having died on
the 26th day of February 19 78 ,seized and possessed of an estate
subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania;
Therefore, I, r",o Ful..initi ,an appraiser duly appointed according to law,
having been designated to make a fair and conscionable appraisement of the said estate, and to assess and fix the cash
value of all annuities and life estates growing out of said estate, hereby file the following appraisement:
In the event that any future Interest in this estate is transferred in possession or enjoyment to collateral heirs of the decedent after the expiration
of any estate for life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer inheritance taxes at the lawful collateral
rate on any such future interest
DESCRIPTION OF ASSET UNIT Appraisement
VALUES IVlade for Inheritance
Tax Purposes
Real Pronertv $ None
Personal Property 927 75
Transfers 10 ISO 84
Joint-Held Pronertv None
IDTAL ASSETS $11,078 59
I
. Have been duly sworn according to law, I do hereby ~~fy that the above apj,raisement is made in conformity
wIth the law on thIS 9th dayof. ~.:'J " ~r11~+_ 19 ZL..
Appraiser
Harrisburg
(Number and Street)
(Post Office)
, Penna.
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