HomeMy WebLinkAbout03-08-78
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RCC-33 f4-73}
MAR n
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
" 'rI".I!taaLt_
1'.
RESIDENT DECEDENT
COUNTY OF
CUMBERLAND
IMPORTANT
Thi:;; return must be completed in detail and filed in duplicate, with all attached, with the Register of Wills of the
{'ounty "'here decedent resided; Return is due within nine months after date of death, unless an extension is granted
h:o tile Secretary of Re'.tenue. (Section 703 of the Inheritance and Estate Tax Act of 1961.)
--.--.-
--
IN TIlE MA TTER OF TH E EST A TE OF
Late of ~_
_Cl!mb~rLal1~___
_~nn~lvani a
j:lJJllb~lal1~L
H __ _(]E!Ql]lE!
,.....1
1lOaK00JrI(QlJl(
Surviving Joint
~~
Tenant
AFFlDA VIT OF
LOUISE BRIXIUS
---- ..r:T-~_TE-~"L NAME OF DECEDENT)
State cf
} os,
County of
,x<l<olIl~IlXP<'X
B. Brixius
Survivinq Joint Tenant
X:Xml<<<X
of tile estate of the above-named decedent being duly sworn, depose S
and sayS
DeCI.~d('11j ,)it'(I.___.P~~_~mQ~r 19L.....
'/ONTH)
Name find oddre<;~ nf,t~:~,,,(!y <-'r }
other auth{"". ized r(!f:cf;~;~nl"1 ,",I,.' ~o ".,ham '
nil c:orres,po"'4encc "~I"~
(DAY)
, 1911-{~cstate leaving a last will, copy of which is hereto attached. }
(YEAR) Intestote
Jon F. LaFaver, Esquire
317 Third St., New Cumberland, Pa. 17070
"("hat a,; "uL~h ___________~dep()nent is familiar with the affairs of said estate and the property constituting
':x co.'~ U TO R-A 11MIN 1ST RA TO R)
the assch (hnen: ,I ill! their l'air market value.
Thai at the tillle of death there was no safe deposit box registered in decedent's individual name, or jointly with, or
as ag.ent or deputy of another, or in decedent's individual name, ,vith right of access by another as agent or deputy, with the
exceptiol1 of [he f()ll()wing: ~
NflMF ,,~,u A'lj,Rf':~-iS OF l"
IN WHICH DE::CEDI:~NT RE
A"JK OR OTHER INSTITUTION THIS SAFE DEPOSIT BOX RENTED RELATIONSHIP OF JOINT
NTED A S-\FE 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 COOlJnonwcaith 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.
'.
ThaI Schedule B attached hereto and made part hereof sets forth fully and in detail all personal property
whcrc~o\"er situated own,:,:d 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
hanks, trust lompanies, or other institutions, whether individually, or in trust for any other person or persons
giVing <tlso separately the accrued interest thereon, if any, down to the last interest day priOT 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 indebted!1ess of the United States to the de-
cedent; all obligations, \vhether 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;
<L:: "'--<""'b ,tl'p",~j IV'\C;I), ~ilverware, ridures, books, works of art, household furniture, horses, carriages,
autoll1ooiles, hoats, 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 an.d owing decedent at the time of death, and all promissory notes or other instruments in writing
for the paymcnt of moncy of which decedent died possessed, of whatsoever nature, with interest thereon, if
any. gi,,"ing the face valuc and estimated fair market value thereof, and if such estimated fair.market value be
less than the f;lce value, it scts forth brierly the reasons for such depreciation as to each item; all moneys
payable to the estate froOl life insurance policies carried by decedent; all annuity and endowment contracts
the proceeds oj" whic+ " layablc upon the death of the decedent; all and the corporate stocks and dividends
due thereon ,1nd unpaid ~I:' f' clute flf death, bonds and accrued interest thereon to the date of decedent's
death and other I',:" 1:: '"'~; owned by the decedent at the time of death, with the -market value there-
of at such 11m':.
a (-- ? f-- i~3
(0...1 ifG --3,
l- ~
1-,,'
---
'.
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 the 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 f'orm, together with the fair market value
thereof, any other property owned or bequeathed by the decedent at the time of death.
The Schedule C attached hereto and made part hereof sets forth a true answer to each inquiry
contained therein and in the case of transfers of property, real or personal, within two years of 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 copy
of the deed, trust agreement or other instrument creating the trust. Therf~ is also set forth 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 in decedent, either individually or jointly, by the will, deed, or other instrlUllent of another,
wi th 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 beneficiaries for life under decedent's Will. It also
contains a statement showing which of the beneficiaries named in the decedent's will, ir any, died prior
to decedent, the dates of their death, their issue, and the relationship of such issue to the beneficiary.
That Sc~edule E attached hereto and made a part hereof sets f'orth all property, real and per-
sonal, owned by the decedent jointly with another or others, including intangible, standin~ 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 Sc~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 of administration of this estate; counsel fees and hldiciary'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 unpaid at time of'
death; taxes accrued chargeable for 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 assessed can 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 carried forward and properly registered in the Sununary.
. 1921:.
,
/ ;' I, )
....>~tttt;,:;;tt~~=d;;;~w~ir:..'..'.~............_..
./ 2 Wi 11 i am. Xll.nlJ.pr.1.y.Il....m....._..........
(Street Number)
Camp...~i.1..1...mP~.m~?9~..1.....
(City or Town and State)
,;i;,Cr: ."~- ~i:lt:'t. 20. l:
j.. ~;"..erlanGI . 3. (,crnt~r:and Co.
NOTE: Before signing af"f'idavit make sure all blank spaces in the affidavit a.nd schedules annexed are
filled in with details or the word "None", and in case the assets include rare and unlisterl 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.
.
RCC-34l4~73)
COMMONWEALTH OF PENNSYLVANIA
OEPARTMENT 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 (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 VALUA nON
conveyance by which the decedent took title; If a farm .tat. number of a~ FOR YEAR OF ESTIMA TED
eres; olso statement of mortgage encumbrances upon each parcel at death CAUTION
of decedent. Taxes, assessments, accrued Interest on mortgages, .tc.,ar. DECEDENT'S MARKET VALUE (Do not writ.
to be listed on SchedulellF" and must not b. deducted from this schedule. DEl. TH In this space)
NONE 00.00 N (l'VlL
Insert this totDI opposite "real property", Schedule "A" in the X X X X X
"As Reported" column on the lost pDge of this return.
00.00
~~
"
RCC -35
RESIDENT DECEDENT
SCHEDULE "B"
PERSONAL PROPERTY
'*
C01lMON~EALTH 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 118ted 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 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 of the State, at the time of death, should be listed in this schedule.
Item ITEM UNIT ESTIMATED DEPARTMENT VALUATION
No. List and describe fully VALUE MARKET VALUE (00 not write in
this space)
NONE 00.00 N &'{tL
I
I
I
I
Insert this total opposite "Personal Proper ty" , Schedule "B" in X X \'J6'lCl
the "As Reported" column on the last page of this return. 00.00
RCC-36
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHEIUTA);CE TAX
SCHEDULE "C"
TRA);SFETlS
.
RESIDE);T DECEDENT
(1) Did decedent, within two years of'dell.th, make any transfer of' any material part of his estate, without
receiving a valuable and adequate consideration therefor? (Answer yes or no)
(2) Did decedent, within two years of death, transf'er property from himself to himself and another or
others (inCluding a spouse) 1n joint ownership? (Answer yes or no)
(3) If the answer to (1) or (2) above 1s in the affirmative state:
(a) Age of decedent at time of transfer
(b) State of decedentt s heal th at time of making the transt'er. (Note 1).
(e) Cause of decedent's death. (Note 1).
(4) Did decedent, in his lifetime, make any transf'er of property without receiving a valuable or adequate
consideration there~or which was to take ef'~ect in possession or enjoyment at or a~ter his death?
(Answer yes or no)__
(a) Was there any pOSSibility that the property transf'erred might return to transf'erer or his
estate or be subject to his power of' disposition? (Answer yes or no)
(b) What was the transferee1s age at time of' decedent's death?
(5) Did decedent in his lif'etime make any transf'er without receiving a valuable and adequate consideration
therefor nnder which transferor expressly or impliedly reserves for his life or any period which does
not in f'act end bef'ore his death:
(a) The possession or enjoyment of' or the right to income f'rom th~ property transf'erred?
(Answer yes or no)
(b) The right to designate the persons who shall possess or enjoy the property transferred or
income therefrom? (Answer yes or no)
(6) If the answer to (5) (b) above is in the aff'irmative, state whether the right was reserved in decedent
alone or others
(7) Did decedent in his lif'etime make a transf'er, the consideration for which was transferee's promise to
pay income to or for the benef'it 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 of a reserveci power to al tel', amend, or revoke, or which C01\ld revert to decedent under terms
of' transf'er or by operation of' law? (Answer yes or no)
(9) If the answer to (8) above is in the af'firmative, was the power to alter, amend, or revoke the inter-
est of' the benef'iciary reserved in the decedent alone or the decedent and others?
(Answer yes or no)
NOTE 1: The answers to these questions should be supported by affidavit by the attending physician as
well as a copy of the death certificate.
NOTE 2: If' answer to any of the above questions is yes, set f'orth below a description of the property
transf'erred, it's fair market value at date of' death, dates of' transfers and to whom transferred, with
relationship of transferees to decedent, jf' 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
DESCRIPTION
MARKET VALUE
(Es tlma ted)
DEPT. VALUATION
(Dept. Only)
NONE
00.00
(\\ Me
Insert this total opposite "Transfers", Schedule "C" in the
"As Reported" colunm on the last pag;e of this return.
00.00
U<I'Nt.-
--
RCC-37 112-63)
COMMONWEAIml OF PENNSYYLANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "0"
BENEFICIARIES
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
Georne B. Bri xi us
Two William Penn Drive
Camo Hi 11 Pa. son ""< .<l"l<- Jointlv_h"l<l D~n
Deponent fUrther says that all the above-named beneficiaries are living at this time except below:
NAME
DATE OF DEATH
RESIDENCE
-
... .-,
soo-
~<*
u:;: s::
"2 ~ E
..... ~ ~
.50.0
~ ~ u
~ Z::
~u~
~t)t:
u ~ 0
~ E fr
f':> 0::
SUMMARY
..(Sch. "A")
.....(Sch. "B")
. ...................(SCh. "e")
Real Property
Personal Property
Transfers
JDint~held.
Gross Taxable Estate ..
(1 )
(As Reported)
$..
$..
$.
$9,605.30
$.. .
$ .. ......... 9,605.30
(2)
(As Determined)
$
$
$
$
$
$
l- "C
Z "
... W ~ 0:
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RCC~38
RESIDENT DECEDENT
SCHEDULE "E"
JOINTLY OWNED PROPERTY
COMMONWEAL TH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
INSTRUCTIONS: This schedule must disclose all property, real awi personal, owned by the rlecerlent jointly
With anuther or others, including; intangibles, standing in the name of' the decedent and others. List
real pstate first, as entireties, or joint tenants, giving brief description, as indicated Ilnlier Schedule
"A", plus the date Hnrl place of record of' instrument ef':fecting vestiture, but rlo not include entireties
or out of' state rf:>al estate value in estate valuation column. Personal property Rhould be listed as in
Schedule liB", plus date of acquisition, and the name, address and relationship (if' any) of' co-owners to
the decedent.
X>OxY
;.xx :)0 ~
:)0 N
Description of' Property, Date of' Acquisition, Name
Address and Relationship of' Co-Owners, and Place
of' Recorrl of' Instrument, where Real Estate.
>0 6<Q yv ~ :"50
:x ;.xx '-'0 ~%
. .
Unit
Value
percentage Estate
Share Valuation
DEPARTMENT VALUATION
CAUTION-Do not Write
In This Space.
Value of' Value of'
Entire Decedent's
Property Interest
;00 ~ ':50< cV; :x
;.xx
N 0,>0;
xx :x
XX:$<:
2;8;:0
:<>< >Q<? '<'X' XX ex ;XX
~::>O<YY':5O<'-'0<X>
1. Account No. 002 0000701 at State
Capital Savings and Loan Association
in the joint names of Louise Brixius
or George Brixius. Account opened
August 10, 1974 in joint names of
Louise Brixius, Cyril Brixius and
George Brixius. Cyril Brixius pre"
deceased Louise Brixius, whereupon
the account became the property of
Louise Brixius (the present decedent)
and George Brixius. One-half of
balance is here included since the joint
tenancy was in effect for in excess of
three years prior to decede~t's death.
Total Balance $19,210.60 ~
9,605.30
q lPDS 30
)
Insert this total opposite 1I,Jointly Owned Property", Schedule "E"
in the "As Heported" colunm on the last page of' this return.
-t'
9 605.3 q loaf). ~D
'.
..-'.
Jon F. LaFaver
317 Third street
New Cumberland, Pa. 17070
February 28, 1978
RE: Louise Brjx.ius Estate
Louise Brixius or
Cyrj 1 Brixius or
George Brixius
In response to your request, lYe show the following
account information for .the above named dececient:
1/'/
4r~ 00- 00701 Bl\.LANCE AS OF DATE
OF DEATH
ACCRUED IwrEP~ST
DATE OF DEATH VALUE $
DATE ORIGINALLY OPENED
$
18,750 5J.
4GO 00,
19,210 bO
'-10-74
......--
#_-- -
BALANCE AS OF DATE
OF DEATH $
ACCRUED INTEREST
DA'I'E OF DEATH VALUE $
DATE ORIGINALLY OPENED
#- ---
BALANCE AS OF DA'l'E
OF DEATH $
ACCRUED INTEREST
DATE OF DEATH VF~UE $
DATE ORIGINALLY OPENED
#_---
BALANCE AS OF DATE
OF DEATH $
ACCRUED INTEREST
DATE OF DEATH VALUE $
DATE ORIGINALLY OPENED
If you have any further questions, please feel free
to contact this office.
Sincerely,
, "~
'/C!",., >L~'V/{<~5<Y-CL.,'~ <:.._
Donna ~jaga.i nec
-F.e.W.-o.e- -lh- .l>laur-B-r- -(.Mr s . )
Savings Investment Servicer
FEM
, I I I'"
\
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IlJlllllli',illl'"',,,,,,1 II.,III'IJ' '''11'1 I', , 1111
! 11111 IIIIII ',1'''1 '1'11"1 {"Iii, r . 11,11111 '111'1 I I " f I ,II
I ~ I I' Ii, '11 I' I I . I I I I I, II", I, '" I I '" I .. I I, '111, r I ,II
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*'
RCCw81 (5-73)
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
HARRISBURG
17127
IN YOUR REPL.Y PLEASE
REFER TO
/
Inheritance Tox Division
NOTICE OF FILING OF APPRAISEMENT
George B. Brixius
Two William Penn Drive
Camp Hill, I'A 17011
(Executor or Administrator)
In Re: Estate af
Louise Brixius
Cumberland
Caunty - Fi Ie Na.
21-78-0123
Dear Mr. Brixius:
Yau are hereby natified that the Original
appraisement in the estate of Louise Brixius
has been filed in the office of the Re~ister of Wills af Cumberland
County on May 18 , 19~, Said appraisement reflects the fallowing
va I uations:
Real Estate
Personal Property
Transfers
Jointly Owned
Total
None
None
None
9.605.30
$9,605.30
As ta such tax that is paid within three manths from date of death, a five (5%)
percent discount is allawable. As to any tax that remains unpaid after nine (9) months
(fifteen months when death accurred from December 22, 1965 ta June 16, 1971, inclusive;
and twelve months when death occurred prior to December 22, 1965) from date af death,
interest at the rate of six (6%) percent per annum is charged.
Any party in interest who is aggrieved by this notice may object thereto within
sixty days after receipt of said notice as provided by Section 1001 of the Inheritance and
Estate Tax Act of 1961, 72 P. S. 2485.1001, P. L. 373.
Date Mav 18. 1978 Signed &. a _ k. .fit A ~ _
Title Chief Appraiser
L
-----------
-------.
Nate: This is not a bill.
R C C-2 (2-64)
DEPAR.MENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
HARRISBURG, PENNA, 17127
COMMONWEALTH OF PENNSYLVANIA
RESIDENT INHERITANCE TAX
APPRAISEMENT
DATE
May 18, 1978
COUNTY
Cumberland
FILE NO.
21-78-0123
Whereas,
Louise Brixius
late of
Lower Allen Township
in the County of Cumberland Commonwealth of Pennsylvania, having died on
the 19th day of December 19R, seized and possessed of an estate
subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania;
Therefore, I, Ira K. Gleim . an appraiser duly appointed according to law,
having been designated to make a fair and conscionable appraisement of the said estate, and to assess and fix
the cash value of all annuities and life estates growing out of said estate, hereby file the following appraisement:
In the event that any future interest in this estate 1s transferred in possession or enjoyment to collateral heirs of the decedent after
the expiration of any estate for life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer
inheritance taxes at the lawful collateral rate on any such future interest.
Unit Apprai$ement
Ducr/ptlon of Allet Values Made for Inheritance
Till PurpOIe$
Real l'roperty $ None
'- -I
l:ersonal l:roperty None
Joint-Held l'roperty 9,605 30
Transfers None
TOTAL ASSETS $9,605 30
-
.-
Having been duly sworn according to law, I do hereby certify that the above
formity with law on this 18th day of ~
r'\ .....-..;..
appraisement is made iru:on-
May 19 711
J(. J,Lj""...._ ~ -.
Appraiser
(N\Jmber and Stl't'et)
Harrisburg, Penna.
(Poet OftIee)
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