HomeMy WebLinkAbout10-19-78
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R-li'C..33 (4-73)
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COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
*
Pl: ('.'7" -
(.,' I,. ,:
RESIDENT DECEDENT
COUNTY OF
CumbF>rlnnn
IMPORT 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 d 1961.)
IN THE MATTER OF THE ESTATE OF
Late of
Cumberlnnd
} AFFIDAVIT OF
EXECUTOR
ADMINISTRATOR
County
H~l&::lon R Mrlr,..h
(STATE FULL NAME OF DECEDENT)
State of ppnnRyl ":=in; ~
J'"
County of CllmhArl.-=lnn
~
Mrlrlin R M;;:arro'h ;;:ann 'Rt=lou~rly R ,qt-ino
of the estate of the above-named decedent being duly sworn, depose
Executor S
and soy
Decedent died 'J:i'onrl1 ;:ary 1 h
(MONTH)
Name and address of attorney or }
other authorized representative to whom
all correspondence should be mailed.
(DAY)
, 19...28-{~estate leaving 0 last will, copy of which is hereto attached.}
(YEAR) Intestate
Bietsch & Morgenthnl (Torn H. BiF>tsch)
7 Tr";n~ Rnw, C~rl;!=jlp, ppnnRyl,,~n;~
That as such 'RXeC"1l+-0r~ deponent is Familiar with the aFFairs of said estate and the property constituting
(EXECUTO R~ADMINIST RA TO RJ
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
NON!':
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 banks of deposit, savings
banks, trust companies, or other institutions, whether individually, or in trust for any other person or persons
giving also separately the accrued interest thereon, if any, down to the last interest day prior to decedent's
death in the case of savings banks, and to the date of decedent's death in all other cases; all bonds, postal
savings, treasury certificates or notes and other evidence of indebtedness of the United States to th~ de-
cedent; all obligations, whether by statute or agreement they are designated as tax free, of the United States,
or any state, or political subdivisi~n 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 securilics 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 substantiate(l by t'inancial statements of the corporations, showing the assets and 11ab1li ties
thereof as of' the date of death. The schedule also sets f'orth the interest of' decedent at the time of'
defl.th 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 business.
A copy of the co-partnership agreement, (if oral, a statement setting forth the nature of the agreement)
together with Ii statement setting forth the cllaracter 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 mllst be submitted. It should also set forth in itemized f'orm, together with the f'air market value
thereof', any other proper,t:y 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
af'ter death, said schedule sets forth the nature and value of' such propert~,., to whom transferred, the
relationship of the transferees to the decerlent, the proportionate share received by each transferee and
all other f'acts of a pertinent nature regarding said transf'ers. In the case of transf'ers intended to
take ef'f'ect in possession or enjoyment at or af'ter death, there is also attached to tIle 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 /ill 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 in decedent, either individually or jointly, by the will, deed, or other instrument of' another,
with a copy of the Instrmnent 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-
pe cti ve in teres ts, the i r reI a t ionship, i r any, to the deceden t, togetller with the a.f!;es at the time of
decedent's death of all minors, annuitants anel benef'iciaries f'or life uneler decedent's Will. It also
contains a statement showing which of' the beneficiaries named in the decedent's will, it' any, died prior
to decedent, the dates of tlwir 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 antl others, plus the date and place of record of instrrnnents ef'f'ecting the vestiture of'
real estate awl the date of' acquisition of' personalty, plus the name, address and relationshtp, if' any,
of co-owners to the decedent.
That Schedule F attached hereto and made a part hereof sets f'orth fully and in detail all debts
and deductions claimed lor and on behalf' of this decedent's estate, inclurt.ing funeral exp8nses paid;
f'amily exemption, where appJ icable; costs of' administration of this estate; counsel f'ees anil fudiciary' s
conunissions paid or to be pa:idj 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 and unpaiti at time of'
death; taxes accrued chargeahle :for period prior to decedent's death (except those allowerl under Section
651 of' the Inheritance and Estate Tax Act) j 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 fee, commission or debt is less than the
estimated amount claiming and allowed, that the same will be reported to the Register of' Wills, and that
the amount of' tax assessed can be reassessed in accordance therewith.
That the totals of the appropriate columns in Scherlules "A", "B", "e", "E", and "F" as directed therein,
have been carried forward and properly registered in the Summary.
Subscribed and sworn to before me this
I;{ -c'l.,
. . day of .
'C"'""'"
!
Oc.tober
I~~
.... 19.....7.8
..};J1t:i7i~~ckJ~..............
R.D.5{S:"~~N;~~;;;:rm
Carlisl.e........Pennsylv.ania.....
(City 0'1" Tow" and State)
Sd?-~~
.. !"RTZL:-:R, NOTARY PU8L1C
'21:-i!$I~, Pa.
:-, ;<'1if'~y~ 1:'n'.!T(','? i, "';tq
J i\ r.~ i
'.,'\.;
!1
): ~ ", !",/
:'/\,
NOTE: Bef'ore signing aflidavit make sure all blank spaces in the af'fidavit and schedules annexed are
jilled in with details or the worrl "None", anrl in case the assets include rare ami unlisted securities,
securities of' close or ramily corporations or an interest in any co-partnership or business, that the
data and statements requiretl unrler the paragraph above relating to Schedule "B" are attached. Also make
certain that column #1 in t.he "Sununary" has been properly completed as above-directed.
,.4,UL'~1 c: ff~
. Exee!utor
716 Sherwood Drive
Carlisle, Pennsylvania
.
RCC..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 of mortgage encumbrances upon each parcel at death of dece-
dent. Property held by the decedent as tenant.in common with another or other, 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 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, .tre.t 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 0 form .tat. number of 0-
cr.s; also .tatement of mortgage encumbrance. upon each parcel at death
of decedent. Tax.., a..e..ment., accrued 'nt.r..t on mortgage., etc.,ar.
to b. lI,ted on Schedul. IIF" and must not b. deducted from this sched",'..
(1)
(2)
(3)
DEPARTMENT
V AlUA TICN
CAUTION
(Do not writ.
In this space)
ASSESSED VAlUE
FOR YEAR OF
DECEDENT'S
DEATH
ESTIMA TED
MARKET VALUE
Dwelling house and garage on the Southern
side of the Pine Road in Dickinson Township
Cumberland County, Pennsylvania.
tIC
$2,080.00
$30,000.00
~a()O,()o
C30, 000- 00
Insert this total opposite "real property", Schedule "A" in the X X X X X
"As Reported" column on the last page of this return.
$30,000.00
-
RCC-35
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
,,~. ;~
~
REsrn:=,d DECEDENT
SCHEDULE liB"
PERSONAL PROPERTY
I NSTROCTIONS: 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 f'act that they are not of' the administered estate.
Tangible personal property should be listed first (e.g. jewelry, wearing apparel, household
goods, /lnd furnishings, books, paintings, automObiles, boats, etc.)
Intangible personal property, such as bonds, treasury certificates, 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 fiduciary 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 01 the State, at the time of death, should be listed in this schedule.
UNIT ESTIMATED DEPARTMENT VALUATION
VALUE MARKEr VALUE (Do no t wri te in
this space)
$36.00, / ')" a6'
II -,,]. '7 'I
1,133.79,
, ( ()O
8.00. .
Item
No.
ITEM
List and describe fully
1.
Cash.
v
2. Checking account No. 757-2288-4, Cumber-
land County National Bank and Trust Co.,
Mount Holly Springs, Pennsylvania.
3.
Christmas Club Account No. 6997, Cumber-
land County National Bank and Trust Co.,
Mount Holly Springs, Pennsylvania.
4.
Account No. 138968,' Cumberland Valley
Savings and Loan Association, Carlisle,
Pennsylvania.
J" p1'I,OI
10,691.01 ,'/v/
5.
a. Accrued interest on item 4.
Account No. 6685434:'Cumberland Valley
Savings and Loan Association, Carlisle,
Pennsylvania.
2, 500.00 I.
72.51,/
a. Accrued interest on item 5.
21.01
6.
Account No. 6689845, Cumberland Valley
Savings and Loan Association, Carlisle,
Pennsylvania.
2,000.00 ..
a. Accrued interest on item 6.
" '/
19.21
7. Personal property bequeathed to Audrey I
Shughart.
111.00 I
283.00 /
I
j/
112.00,
8. Personal property bequeathed to Barbara A.
Miller.
9. Personal property bequeathed to Beverly E.
Stine.
10. Personal property bequeathed to Marlin E.
March.
123.00
, .
11. Remainder of household furniture and
furnishings.
1,518.20.//
12. 1972 Chevrolet Coupe.
1,500.00
13. CSF Annuity.
268.81
/
14. Medicare reimbursement.
48.00
/
(CONTINUED ON ATTACHED SHEET)
Insert this total opposite "Personal Property", Schedule "B" in X X
the "As Reported" colunm on the last page of this return.
.......
'J7-rl
~ / )'(}O, 0 0
/
?-/O/
P..600.00
/
19,1./ I
/11. dO
?-f J 06
If")..,OO
/?-.J.O(/
I <) / y. ?-O
1')-00, () 0
,7bf;.g-1
l-Id'.od
RCC-'
oJ 6 ;7 v,-_
15 ?~.
2100'-~
::>0 11 O~_
.85 .10__
5 1
. 1 'r
RESIDES' DECEDENT
SCHEDULE "B"
PERSONAL PROPERTY
'*
cmt..
TRANSFF;lt
INSTRUCTIONS: This Schedule m....' l1sclose all tangible and intangible personal property owned individu<;Llly
by the decedent, at the time of his death. Property owned by the decedent jointly with another or others
must be listed under Schedule "En. Intangible personal property, titled 1n 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, a.utomobiles, boats, etc.)
Intangible personal property, such as bonds, treasury certificates, 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 fiduciary in sa.id 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 of the State, at the time of death, should be listed in this schedule.
Item
No.
ITEM
List and describe fUlly
UNIT
VALUE
ESTIMATED
MARKEl' VALUE
DEPARTMENT VALUATION
(Do not write in
this space)
16.
Refund, United Telephone Company of
Pennsylvania.
4.50
"3 }b. 71
t-J, )0
j t.f () (j
15.
Blue Cross-Blue Shield reimbursement.
336.77
17.
Refund, Commonwealth of pennsylvania,
Drivers License registration fee.
24.00 .
18.
Commonwealth of Pennsylvania realty tax
refund.
/
44.10.
'.;t-I, / ()
20,854.91
J-3r J)' / I
Insert this total opposite "Personal Property", Schedule "B" in
the "As Reported" column on the last page of this return.
x X
RCC- "1b
COMMO,WEALTJI OF PENN~YLVANI ~
TH..A\~FFH INI-1E1UTANCE TAX
SCHEDULE "e"
TJ{'\'i~FEl\S
*~
HESTIJE'T DECEIJENT
(1) Did decedent, within two years of'death, make any transf'er of any material part of his estate, without
receiving 11 valuable and adequate consideration theref'or? (Answer yes or no) Nn
(2) Did decedent, within two years of death, transfer property from himself to himself and another or
others (inclwHng Ii spouse) in joint ownership? (Answer yes or no) Nn
(3) If' the answer to (1) or (2) above is in the af'f'irmative state:
(a.) Age of' decedent at time of' transfer N fA
(b) State of' decedent's heal th at time of' making the transf'er. (Note 1).
(e) Cause of decedent's death. (Note 1). -
(4) Did decedent, in his lifetime, make any transfer of property without receiving a valuable or adequate
consideration thereror which was to take errect in possession or enjoyment at or after his death?
(Answer yes or no) 1\TI""I
(a) Was there any possibility that the property transferred might return to transrerer or his
estate or be subject to his power of disposition? (Answer yes or no) 1\T/~
(b) What was the transferee' 5 age at time of decedent's death? N fA. .
(5) Did decedent in his lifetime make any transfer without receiving a valuable and adequate consideration
therefor under which transferor expressly or impliedly reserves for his life or any period which does
not in :fact end before his death:
(a) The possession or enjoyment of or the right to income from thE.' property transf'erred?
(Answer yes or no) No
(b) The right to designate the persons who shall possess or enjoy the property transferred or
income therefrom? (Answer yes or no) ~O
(G) If' the answer to (5) (b) above is in the affirmative, state whether the right was reserved. in decedent
alone or others N/A
(7) Did decedent in his 11f'etime make a transfer, the consideration f'or which was transferee's promise to
pay income to or for the benefit of care of transferor? (Answer yes or no) ~O
(8) Did decedent, at any time, transfer property, the beneficial enjoyment of' which was subject to change,
because of' a reserverl power to al ter, amend, or revoke, or which conld revert to decedent under terms
of transf'er or by operation of law? (Answer yes or no) No
(9) If the answer to (8) above is in the af'firmative, was the power to a1 ter, amend, or revoke the inter-
est of the beneficiary reserved in the decedent alone or the decedent and. others?
(Answer yes or no) N fA
NOTE 1: The answers to these questions should be supported by affidavit by the attending physician as
well as a copy of the death ceM;ificate.
NOTE 2: If answer to any of the above questions is yes, set forth below a description of the property
transferred, it's fair market value at date of' death, dates of transfers and to whom transferred, with
relationship of' transf'erees to decedent, if' any. Submit copy of' any trust deed or instrument, if trans-
fers are claimed to be non-taxable, also submit detailed statement of facts on which said claim is based.
NOTE 3: List applicable property below in manner in which provided in Schedules A, B, or E.
ITEM
DESCRIPT ION
MARKET VALUE
(Es tlma ted)
DEPT. VALUATION
(Dept. Only)
NONE
r) _
/" 7--z./()<- *__
,/ "7- '- -0-0.... ~
Insert this total opposite "Transfers", Schedule "C" in the
"As Reported" column on the last page of' this return.
NONE
--
RCC-37 (12-63)
CmnlO~WL\LTlI OF PE;-';;-';,YYL\!IIIA
TRANSFER INlIEHITA!>:CE TAX
RESIDENT DEl'EDENT
SCHEDULE "D"
BEI'\EFICl.\HIES
RELATIONSHIP I
' BENEFICIARIES AND ADDRESSES < (If step-children or SUr:VIVED
~~tate tull names and addresses of all who illegitimate children I D~.CE~ENT
have an interest, vested, contingent or other- are involved, set S1ATL YES
wise, in estate) forth this facL) . OR NO
DATE
OF
BIRTH
INTEREST OF
BENEFICIARY
IN ESTATE
T ~~. _'- ,~
~ ~ c ~_u .,.,.,
ro~_,;~,~ o~
-"-" -~~
u~~
, , tu as
. ; ~~=-" ; n ,.,; l' &
onp-fourth remainder.
-, ~ u'"
"~Q "'=<1r_ ~---
dauol1ter
yes
i
Personal property as
. ' 'i n "';'1 ~nd
one-fourth remainder.
t
Ct=lrliRlp, Pn_
Beverlv E.
71<':
Stine
, nriu=
n~unhter
ves
Personal nropertv as
mentioned in will and
on=-fourth remainder.
~. -1; ~,= ~_
M~r' i ~ R M"r,-."
o n 0: ,,~~ 'l1A
("'~r'i~'= o~
snn
ves
Personal property as
mentioned in will and
~~-
;~rl=r
Deponent further says that all the above-named bene:ficiaries are living at this time except below:
NAME DATE OF DEATH RESIDENCE
"^"~
.
~
x ~ 'II-
. -
~ ~ ~
;::.30:
"0 Po 0
< E ~
. 0-
;U~
~ ~ ~
::s 'll l-.
o ~ 0
<:; E c.
~ <:;
~ ~
Real Property
Personal Property
Transfers
Gross Taxable Estate
SUMMARY
(Sch. "A")
(Sch. "B")
(Sch. "C")
(I)
(As Reported)
$ 30,000.00
$20,854.91
$ ...None
$
$
$50,854.91
(2)
(As Ddt'rmilH'd )
$
$
$
$
$
$
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RCC-38
RESIDENT DECEDENT
SCHEDULE "E"
JOlNTL Y OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
INSTRUCTIONS: This schenule must disciose all property, real and personal, owned by the rlecedent jointly
with another or others, including intangibles, standing in the name of' the decedent and others. List
real estate first. itS entireties, or joint tenants, giving brief' description, as indicated lmder Schedule
"A", plus the date ann. place of' record of instrwnent 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 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' Recorrl of Instrument, where Real Estate.
(~ XX 0: ;00 XX :>0 :x>
;~~~:x X( ~~3S ~ ~~ :>o~~:>o %~~
unit
Value
percentage
Share
Estate
Valuation
:>0 :>0
DEI' ARTMENT
CAUTION-Do
In This
Value of'
l'.ntire
property
VALUATION
not Write
Space.
Value of'
Deceden t's
Interest
.r<YZ--C'''-C
NONE
NONE
/J-LO~
Insert this total opposite "Jointly Owned Property", Schedule "E"
in the "As Reported" coluHDl on the last page of' this return.
RCC-81 (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
Marline E. March
R.D. 1/5 Box 318
Carli~ler pp.nn~.
(Executor or Administrator)
In Re: Estate of
Hp.lpn M,qTl"h "R
Cumberland
County - Fi Ie No.
21-78-0118
Dear
You are hereby notified that the Original
appraisement in the estate of Helen E. March
has been filed in the office of the Register of Wills of Cumberland
County an 15 November ,19~, Said appraisement reflects the following
valuations:
Real Estate
Personal Property
Transfers
Jointly Owned
Total
30.000.00
20,855.11
None
None
50,855.11
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 notice as provided by Section 1001 of the Inheritance and
Estate Tax Act of 1961, 72 P. S. 2485-1001, P. L. 373.
Date 11-15-78 Signed ~-L.;!L-.X,-"""!t&<,,.
Title __
Chief. f.f'praiscr
t
.-.--------
Nate: This is not a bill.
------
. RCC-2 ';-64)
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
HARRISBURG, PENNA, 17127
DATE i \ - l S.[ 8
couNn.cA y."",J;.t^ ~
FILE NO. '2....l"':l 'd - ull '8
Whereas \~ ~ S l'Y'\ OJ'---c.12-- late ofD~-=4S~
in the count; of C '~~ Commonwealth of Pennsylvania, having died on
the \ lo-l::ii-- day of F~ 19.::lJ2. seized and possessed of an estate
subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania;
Therefore, I, \ ~'- G J) 0, - . 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:
COMMONWEALTH OF PENNSYLVANIA
RESIDENT INHERITANCE TAX
APPRAISEMENT
In the event that any future interest in this estate is transferred in possession or enjoyment to collateral heirs of the de-cedent after
the expiration of any estate for life or for years, the CommonwealUl hereby expressly reserves the right to appraise and assess transfer
Inheritance taxes at the lawful collateral rate on any such future Interest.
Unit Appraisement
Descrlptlon of Anet ValuOI Ma.de for Inheritance
Tax Purposes
K -e....,-L\.J /L-{ ^ ,~" $'3o,I\f'\[\ 00
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-- -
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Having been duly sworn ac~orging t9 law, I do hereby cert' y that the above appraisement is made in con-
formity with law on this \ S '~ day of O'-'~~ .! . 19.::U:L.
" "J; ~_ (..... '4__.
Appraiser
\'-- l ~,(l'fumbe"r ud ~reet)
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, Penna.
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