HomeMy WebLinkAbout03-09-78
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Rce-ss (4-7.3)
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COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
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RESIDENT DECEDENT
COUNTY OF CUMBERLAND
IMPDRTANT,
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'lenue. (Section 703 of the Inheritance and Estate Tax Act of 1961.)
IN THE MATTER OF THE ESTATE OF
Benjamin S. Peters. Sr.
(STATE FULL NAME OF DECEDENT)
Late of
l'nmhprlrlnn
} AFFIDAVIT OF
~1l!lXIlaIl
surviving co-tenant
County ~lf~jl~~
State of Ppnnsylvanja
J SOl
County of Cumberland
Rpnj;:::lm;n q, Pp.h::::.r~. ,Tr ~l1rvivinq ~o-t:p:nant
KdoIOJtKOlCC!~ of the ..tot. of the obov.-nomed decedent being duly .worn, depo.. 5 and lIay S
not probated }
LTunp 24 19....1L..J te.tClte IllGvlng CI lal' will, ~~~>>Xii~X~.
IMONTH) (DAY) (YEAR) ~DlfJ(
Name Clnd addre.. of aHarney or } .Tnmp~ K Arno 1 n. Esq..
other authorized reprelentotive to whom
ClII carrlll.pondence should be moiled. P. O. Box 737, Camp Hill, PA
~_IlOD{
Decedent died
2109 Market Street
17011
That as such co-tenant deponent is familiar with the affairs of said estate and the property constituting
(EXECU TO R.ADMIN 1ST RA TOR)
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
IN WHICH DECEDENT RENTED A SAFE DEPOSIT BOX
rrNR R~nkr N A , r~m
21st & Market Sts.
THIS SAFE DEPOSIT BOX RENTED
IN NAME OR NAMES OF
Ben'amin S. Peters Sr.
Peters
REL.ATIONSHIP OF JOINT
HOL.DERS TO DECEDENT
Son
That the contents of said safe deposit box or boxes are itemized under Schedules E
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 priIDT 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 securities owned by the decedent at the time of death, with the market value there-
of at such time.
$-71'-016
-----
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,
, '
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 8.5 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 "business.
A copy of' the co-partnership agreement, (if oral} a statement setting forth the nature of the a~reement)
together with a statement setting f'orth the character of the business, its location, and such other facts
pertaining to the business as may be pertinent to a ~air and just appraisal or the decedent's interest
therein must be submitted. It should also set ~orth in itemized form, together with the ~air market value
thereo~, any other propert;r owned or bequeathed by the decedent at the time of death.
The 5c~edule C attached hereto and made part hereof sets forth a true answer to each inquiry
contained therein and in the case o~ trans~ers orproperty, real or personal, within two years of' decedene s
death, in contemplation of' decedent's death, or intended to take eff'ect in possession or enjoyment at or
af'ter death, said schedule sets forth the nature and value of' such property, to whom tra~sf'erred, the
relationship of the transferees to the decedent, the proportionate share received by each transf'eree and
all other f'acts of' a pertinent nature regarding said transfers. In the case o~ transf'ers intended to
take effect in possession or enjoyment at or af'ter death, there is also attached to the schernlle a copy
of' the deed, trust agreement or other instrument creating the trust. Ther\~ is also set forth in said
schedule a list of all property, real and personal, with its value, which passes at decedent's death by
virtue of the exercise by decedent, either individually, or jointly with another, or any power of appoint-
ment vested in decedent, either individually or jointly, by the will, deed, or other instrument of another,
with a copy of the instrument creating such power attached to the schedule.
That Schedule D attached hereto and made part hereof sets forth the names and addresses of all
persons beneficially interested in this estate at the time or deced~nt's death, the nature or 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, if any, died prior
to decedent, the dates of' their death, their issue, and the relationship of such issue to the benericiary.
That S~~edule 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, includ:J.ng intangible, standing tn the name
of the decedent and others, plus the date and place of record of instruments effecting the yestiture of
real estate and the date of acquisition of' personalty, plus the name, address and relationship, if any,
of co-owners to the pecedent.
That Schedule 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 anrl furliciary's
commissions paid or to be paid; cost expended for burial trusts, tombstones or gravemarkers, and reli-
gious services, 1n consequence of the death of the decedent; debts and claims owing and llnpain 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 pledgert 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 Scherlules "A", "B", "en, "E", and "F" as directed therein,
have been carried forward and properly registered in the Summary.
.:= ~d ':~m'" b<f,:~"M' . ".la. i~~sa1P-----
.)~;LO~ ........ 3025~=~=r;;;:,.."".."",",
:M~~~~~~' ~~::;~~D ~~,U~;;B GOlIllPHJJ,J,J'S1IJJ}py;LV<;l,J};i,<;l, "...
Member,penRSylvanlaAsloClaliOAolNOtalllS (City or Town and State)
NOTE: Before signing affidavit make sure all blank spaces in the affidavit and schedules annexed are
f'illed in with details or the worn "None", and in case the assets include rare and unlisted securities,
securi tles o~ close or family corporations or an interest in any co-partnership or business, that the
data and statements requirerl under the para~raph above relating to Schedule "B" are attached. Also make
certain that colurrm #1 in the "Sununary" has been properly completed as above-directed.
RC C-34 (4-73)
COMMpNWEAL.TH OF PENNSYLVANIA
OEP).RTMENT 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 cammon 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 on Schedule "E.")
The reol 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 0 farm state number of 0- FOR YEAR OF ESTIMA TED CAUTION
cres; also statement of mortgage encumbrances upon each parcel at death DECEDENT'S MARKET VALUE (Do not write
of decedent. Taxes, assessments, accrued Interest on mortgages, etc.,are DEA TH In this space)
to be listed on Schedule <IF" and must not b. deducted from this schedule.
NONE No llG
nsert this total opposite "real property", Schedule "A" in the X X X X X
'As Reported" column an the last poge of this return.
-
N(('{D,
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, '
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 118ted under Schedule "En. Intangible personal property, titled in the name or the decedent, but
payable at death to another or others, including but not limited to P.D.D. U. S. Savings Bonds and tenta-
tive trust accormts, 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 certiricates, 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 anyundlstributed
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. Lis t and describe fully VALUE MARKET VALUE (Do no t wri te 1n
this space)
N G'Y'vL
NONE
I i
I
I
i
I
Insert this total opposite "Personal Property", Schedule "B" in X X 1\1 O'i'J
the "As Reported" column on the last page of this return.
RCC.- ?S
CL1MMn\\>VEI\LTll 1)]0' }'l<'\'\:"';YL\:\\T
Tt{AN~Ff'i1 [N!W!i [TA~n: '1'.\\
~:(':'TTH LF "('''
'1'1:\\,', 'lil(S
ImSl!W\'I' 1l,:CI"IW\T
(1) Dirt rte~~f~(h:'nt. .....ithin two )Pd.rs ofdp qL, m,tld' (fl'\' I rHlsf"pr of' <lIlY ma1pr1<t1 p<lrt or Ids estate, ?Iithout
reCeiV1Tlg It vallwblp ,tTlrt ddeqwttp ("Hlsidpr It ion I hf'rl'f'or? L\n""wer yes or no) no
(:J) Did decedpnt., wit.ldn two Y('I!J'S of d(~IlLlil j,l"lllsf'pr !'T'O\)('I'T,y from himself. to himsplf' and another or
nthers (including i\ spouse) in Joint nWfh'"rsh:ip:- (Answer yes or no)no
(3) If' the answ;~r to (1) OJ' (:2) above is in the aiTirmativ0 state:
(Ill Age of decnrtent. iLt time of' Lran~;fer _____
(b) St;tte f)f rlecectent's health at tim0 or lllaki.n,l2; the transfer. (Note 1).
(e) Cause or decedent's dt'IIU:. (~oLe 1).
(4) Did dpce(h'nt" in Jlis lifetime, make ;'llY trllnsl\~r of pl'op('rty Wit/lout receiving a valuahle or adequate
consideration t.l:1fll'ef'or which was to t tke effect in possPssion or enjoyment at or after his death?
(A.nswer yrs or no) nn
(u) ~\as there any possibility th;tL the propert:).' transferred might return to transf'erer or his
estatJ' or be sub,ject to his pow\'r or disposition? (i\nswer yes or no)
(b) Whnt was ttw transferee's agp at t.ime of (j1:'(~pdpnt' S dpath? ~
(5) Did decedent in hlslif'etime make liny transf'er without receiving a valuable and adequate consideration
Uwrefor Imder whieb transferor expressly or implipdly reserves for his lif'e or any period which does
not in fi\f:t end hcfore his death:
(a) TlIP possession or enjoyment of' 01' the f'ig;ht to Income f'rom Uu.:' property transferred?
(Answpr yes or no) ---no..---_
(ll) The right to rlesignatt; the persons who shall possess or enjoy the property transferred or
-ifH~ome therefrom'? (Answer yes or no) no
(0) If' th., answer to (5) (t>) above is in the affirmat-ive, state whether the right was reserved in decedent
alone or others ~_~___,_,___._____~_____
(7) Did necerlent in his lit'etime makp It transfer, the eonsirIeration for which was transf'eree's promise to
pay income to or f'or the henefit of earp of transferor? (Answer yes or no) 'nn
(8) Did deeedent, I'lt any time, transf'er propert.y, the lwnef'icial en,jn;}'men.t of wtdeh was subject to change,
because of a reserved power to al tel', amend, or revoke~ or whlc}l cOllld revert to decedent under terms
of' transfer or by OI)l~ration oi I aw? (Answer j'f's or no) --.no..._____~__
(9) If the answer to (1:1) ahove is in the 11ffirmative, was the power to I-tltt~r, amend, or revoke the inter-
est of the beneficiary reservc(l in the decedent alone or th!' decedent and others?
(Answer yes or no)
NOTE 1: The answers to these questions should bp sllpported by af'f.idavit hy the atteTldin~ physieiun as
well as a copy of the death ceI"ti.ficatt~.
NOTE 2: If answer to any of the above qllest:ions .is y~~s, set 1'orth below 11 description of t.he property
transf'erred, it's fair market vallie at date of death, dates of' transfers and to whom transferred, with
relationship or trnnsferees to decedent, if any. Sllbmit copy of an,Y trust ']eed or instrument, if trans-
fers are claime(! to be non-taxable, also submit (tetailed statement of facts on which said claim is based.
I\OTE:3: List applicable property helow in manTleI' in which provided in Scherlules A, B, or E.
['L<:\\
DESCRIPTION
MARKET VALliE
(Es tima ted)
DEPT. VALlJATION
(Dept. Only)
NONE
tJfi,(~
Insert this total opposite "Transf'ers", Schedule "e" in the
"As Reported" cO]UlTnl on the last page of' this return.
t\16X\.R.
RCC-37 (12-63)
COMMONWEALTH OF PENNSYYLANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "D"
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
"~-~"m;n co T.
3025 Columbia Avenue
Camp Hill, PA Son yes 100%
\
h
Deponent fUrther says that all the above-named beneficiaries 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)
(2)
(As Determined)
Gross Taxable Estate
$
$
$.
$
$
$
$
$
$
$
$
$
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COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "E"
JOINTLY OWNED PROPERTY
INSTRUCTIONS: This sehf'dule must disclose all property, real and personal, owned by the decedent jointly
with (mother lJr others, inelwling intangibles, standing in the name of' the decedent and others. List
real estate first., as entireties, or joint tenants, giving brief' description, as indicated tmder Schedule
"A", plus the date anrl place of' record of instrument eff'ecting vestitul'c, 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 unit percentage Estate
Address and. Relationship of' Co-Owners, and Place Value Share Valuation
of' Record of Instrument, where Real Estate.
DEPARTMENT VALUATION
CAUTION-Do not Write
In This Space.
Value of' Value of'
Entire Decedent's
Property Interest
ALL ASSETS HELD JOINTLY BY DECEDENT AN
l/House & lots at 3025 Columbia Ave, Canp
Hill, Pa., acquired !?y deed dated 2/28/68 in
22 "R" 442. iU,,,. 5 71',;-
a.3 I ""0
2. Olecking acct. 689-584-1 ~CCNB Bank, N.
balance at death was $569.99, but included
$240 which son deposited on 6/23/77 from oon' s
paycheck (proof attached)
3. Savings acct. 002-101041-8 in ~Bank,
N .A.; balance at death was $5,067.84, but
san made all deposits totalling $7,221.11
from pay checks Such acct. was opened
6/5/75. (proof attached)
4.hs. Series "E" $1,000 Bond .M201-751-283E
purchased 2/76 with funds drawn from Item 3
above, all funds having been provided by son
(proof attached)
5. CCNB Bank, N.A., certificates of deposit,
as follows:
(1)vii08287 issued 3/11/74
(2)~07688 issued 10/7/74
(3)~~11416 issued 4/4/75
(4)~jil1440 issued 6/3/75
(5)1'#111729 issued 7/2/75, purchased with
proceeds of matured CD #105242 issued
6/'Jy9/73 .
(6)~115526 issued 11/22/76, purchased
with proceeds of matured CD #108461
issued 5/22/74
SON
BENJAMI
S. PET RS, JR.
50%
12,000.00 9..~1 (! Od,fj (/
50%
,~~Y'~1
'.165.00, S t'f/! '1
50%
50%
(/)?! .91/
50%
50%
50%
50%
1,251. 00
603.56
587.77
1,136.44
,5'"ol.f1't
) ll-07,/'
. /7b,SJ
bz... '17
50%
I)D7~1t>)
1,226.97
14S::d4
50%
,
.
TOTAL
Insert this total opposite Il,Jointly Owned Property", Schedule "E"
in the "As Heported" COllllTnI on the last page of this return.
tl>
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*
RCC.S! (6-73)
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
HARRISBURG
17127
IN YOUR REF'LY PLEASE
REFER TO
NOTICE OF FILING OF APPRAISEMENT
Benjamin S. Peters, Jr.
3025 Columbia Avenue
Camo Hill. IA 17011
(Executor or Administrator)
Inherifance Tax Division
In Re: Estate of
Beniamin S. Peters. Sr.
Cumberland
County - Fi Ie No.
21-78-0130
Dear Mr. Peters:
You ore hereby notified that the Original
appraisement in the estate of BeniAmin S. Peters. Sr.
has been filed in the office of the Register of Wills of Cllmb..rlanrl
County on May 25 ,19 78, Said appraisement reflects the following
valuations:
Reol Estate
Personal Property
Transfers
Jointly Owned
Total
None
None
None
24.555.87
$24,555.87
As to such tax that is paid within three months from dote of death, 0 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 dote of death,
interest at the rote 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 os provided by Section 1001 of the Inheritance and
Estate Tax Act of 1961, 72 P. S. 2485-1001, P. L. 3~.
Dote May 25, 1978 Signed ~ d l<. )J~ _
Title Chief Apprais..r
I..-
Note: This is not 0 bill.
RCC-2 (2-64)
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
HARRISBURG, PENNA, 17127
COMMONWEALTH OF PENNSYLVANIA
RESIDENT INHERITANCE TAX
APPRAISEMENT
DATE
May 25, 1978
COUNTY
Cumberland
FILE NO.
21-78-0130
Whereas, Benjamin S. Peters,SR. late of Borough of Camp Hill
in the County of Cumberland Commonwealth of Pennsylvania, having died on
the 24th day of June 19~, seized and possessed of an estate
subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania;
Th f I Ira K. Gleim . d I . t d d' t I
ere ore, , , an appraIser u y appom e accor mg 0 aw,
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 appra1se and assess transfer
inheritance taxes at the lawful collateral rate on any such future Interest.
Delcrlptlon of Allet
Unit
Vah.lel
Appraisement
Made for Inheritance
Tax Purposes
Real Eroperty
Eersonal Eroperty
$
None
Transfers
None
Joint-Held Froperty
None
24,555 87
TOTAL ASSETS
$24,555 87
Having been duly swo.rn accordin~ to law, I do hereby certify that the above appraisfli1ent
formity with law on this 2 th day of ~ d 'lJ~/
( ;<, Yo _
is made in 9W'-
19_.
Appraiser
{l'f\Imbt!r and Stneu
Harrisburg P
, enna.
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