HomeMy WebLinkAbout03-15-79 (4)
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COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
*'
RESIDENT DECEDENT
SUPPLEMENTAL
COUNTY OF
CUMBERLAND
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'otenue. (Section 703 of the Inheritance and Estate Tax Act of 1961.)
IN THE MATTER OF THE ESTATE OF
Annie M. Long AlK/A Anna M. Long
(STATE FULL NAME OF DECEDENT)
Late of
Cumberland
} AFFIDAVIT OF
EXECUTOR
Coun.y ADMINISTRATOR
State of
Pennsylvania
} so,
County of
~~
David E. Long
of the e.tate of the above-named decedent being duly sworn, depo.eS
Executor
and sayS
Decedent died
January
30
, 19~J testate leaving a last will, copy of which I. hereto attached. }
(YEA.R) ~M~
(MONTH)
Nome and address of attorney or }
other authorized representative 10 whom
all corres.pondence should be moiled.
(DAY)
Snelbaker, McCaleb & Elicker
44 West Main Street, Mechanicsburg, Pennsylvania 17055
That as such Executor deponent is familiar with the affairs of said estate and the property constituting
(EX ECUTO R~ADMINI ST RA TO RI
the assets thereof and their fair market value.
That at the time of death there was no safe deposit box registered in decedent's individual name, or jointly with, or
as agent or deputy of another, or in decedent's individual name, with right of access by another as agent or deputy, with the
exception of the following: -
NAME A.ND 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 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 prim to decedent's
death in the case of savings banks, and to the date of decedent's death in all other cases; all bonds, postal
savings, treasury certificates or notes and other evidence of indebtedness of the United States to the de-
cedent; all obligations, whether by statute or agreement they are designated as tax free, of the United States,
or any state, or political subdivision thereof, or of any foreign country, which are owned at the time of death;
all wearing apparel, jewelry, silverware, pictures, books, works of art, household furniture, horses, carriages,
automobiles, boats, and any and all other personal chattels of whatsoever. kind or nature, left by decedent,
together with the fairly estimated market value thereof; all bonds and mortgages held by decedent and of all
claims due and owing decedent at the time of death, and all promissory notes or other instruments in writing
for the payment of money of which decedent died possessed, of whatsoever nature, with interest thereon, if
any, giving the face value and estimated fair market value thereof, and if such estimated fair-market value be
less than the face value, it sets forth briefly the reasons for such depreciation as to each item; all moneys
payable to the estate from life insurance policies carried by decedent; all annuity and endowment contracts
the proceeds of which were payable upon the death of the decedent; all and the corporate stocks and dividends
due thereon and unpaid as of the date of death, bonds and accrued interest thereon to the date of decedent's
death and other investment securities 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
rqssip1.e _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 llusiness.
A C6py of the co-partnership -agreement, (if oral, a statement setting forth the nature of' the agreement)
together with a statement setting f'orth the character of the business, its location, and such other f'acts
pertatntng 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 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 f'orth the nature and value of such property, to whom transferred, the
relationship of the transf'erees to the decedent, the proportionate share received by each transferee and
all other facts of a pertinent nature regarding said transf'ers. 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 CORY
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 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 instrument creating such power attached to the schedule.
That Schedule 0 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, if any, died prior
to decedent, the dates of their death, their issue, and the relationship of such issue to the beneficiary.
That Schedule E attached hereto and made a part hereof sets f'orth all property, real and per-
sonal, owned by the decedent jointly with another or others, including intangible, standing in the name
of the decedent and others, plus the date and place of' record of' instruments effecting the ~estiture 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 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;
f'amilyexemption, where applicable; costs of administration of this estate; counsel fees and ~ldiciary'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 ami 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 Summary.
../5!~.
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......~qff(&~~..
. day of~<md
..~/~..
1979.
X)~
Subscribed and sworn to before me this
CATHAr;UJE E. GCUSUIJ, NOrMY PUBLIC
MECHA::1CS3L:i~G BOROUGH
CUMBERLAND COlJNrV
uy ('nMMI~~I'l" FXP',')[" Frl1 n. 19R2
NOTE: Bef'ore signing affidavit make sure all blank spaces in the af'f'idavit and schenules annexed are
filled in with details or the wor~ "None", ano in case the assets include rare and unlisted. securities,
securi ties of close or f'amily corporations or an interest in any co-partnershiv or business, thllt the
data anrl statements requirerl under the paragraph above relating to Schedule "il" are attached. Also make
certain that column #1 in the "Smmnary" has been properly completed as above-directed.
(Executor
R. D.1,1l".'.'o:I}':'::::!L.................
(Street Numb",,)
i'leVJpor:t,f'':'I1I1"y.l.\'a.!1~a. 1707 L,...
(City en" Town and State)
RCC-304 (4-73) -
COMMONWE"AL TH OF PENNSYLVANIA
DE~ARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "AIf
REAL PROPERTY
SUPPLEMENTAL
*'
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 surviorship or tenancy by entireties should be reported on Schedule "E.")
The real property located In the Commonwealth of Pennsylvania should b.
described by Jot and block number, street and street number, together with
a general description of the property, with a ref.rence ta the record of the
conveyance by which the decedent took title; If a farm state number of a.
cres; also statement of mortgage encumbrance. upon each parcel at death
of decedent. Taxes, assessment., accrued Int.re.t on mortgages, etc.,are
to be listed on Schedule uF" and must not b. deducted from this schedule.
(1)
(2)
(3)
DEPARTMENT
VALUATION
CAUTION
(Do not writ.
In this space)
ASSESSED VALUE
FOR YEAR OF
DECEDENT1S
OEATH
ESTIMA TED
MARKET VALUE
2.
Two (2) cemetery lots, No. 46C-3 and 4,
situated in Blue Ridge Memorial Gardens,
Harrisburg, Dauphin County, Pennsylvania
$120.0V
Insert th,s total opposite "real property", Schedule "A" in the X X X X X
"As Reported" column on the last page of this return.
/
$120.00
\'20,U:'
-------
REV"4el (B-78)
RESIDENT DECEDENT
SUPPLEMENTAL
SCHEDULE "B"
PERSONAL PROPERTY
*'
COMMONWEAL TH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
INSTRUCTIONS: This Schedule must disclose all tangible and intangible personal property owned individually by the
decedent, at the time of his death. Property owned by the decedent jointly with another or others must be listed
under Schedule liEu. 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 tentative 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 gouds, 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 payable to the estate or
fiduciary in said 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.
I1EM
List and describe fully
UNIT
VALUE
ESTIMA TED ,
MARKET I'
VALUE
DEPARTMENT
VALUATION
(Do not write in
this space)
8.
Refund of Mortgage Escrow Account: Cumberland
Valley Savings and Loan Association
I
Major medical benefits: Capital Blue Cross
$4-4-2.2V
1,74-7.6~
9.
10.
Return premium: Ohio Casualty Insurance
Company
10.Olf/
...
2,589.0Ck
11.
Household contents, appraised value
Insert this total opposite "Personal Property", Schedule URn in
the It As Reported" column on the las t page of this return.
xx
$4-,788.93
'-\,-IS\?' 43
-----
REV.S18 (8~7Fl)
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF FIELD OPERATIONS
P.O. BOX 2970
HARRISBURG
17105
IN YOUR PEPLY PLEAS!_:_
REFER TO
Inheritance Tox Divisicn
NonCE .OF FiliNG OF APPRAISEMENT
Dav~d E. Long
R. D. #1, Box 134-B
. _. ~.e""Por_t!P~_..17074
(Executor or Administrator)
In Re: Estate otArn!iE!_!"!.__~.1U'kla Anna M. Long
___CUlllJ>~r1:~~__ County - File No.
21-78-0144
Dear Mr. Long:
You ore hereby notilied that tho Supplemental
appraisement in the estate oL_.~ie M.. Long a/k/a Anna M. Long
has been liled in the office at th~ Register 01 Wills 01__.Qumber1and
County on _____Al;1ri.l.__~__._, -19--'29_, Said appraisement rellects the lollowing
valuations:
Real Estate 1;:>0.00
Personal Prop~rty~~88.q?
T ronsters None
Jointly Owned _ None
Totol __.....1!f~8.93
As to such tax that is pujd within three months from date 01 death, a live (5%)
percent discount is allo'Noble. As 10 any tax that remains unpaid alter 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) Irom date 01 death,
interest at the rate at six (6%) percent per annum is charged.
Any party in interest who is aggrieved by this notice may object thereto within
sixty days alter receipt 01 said notic~ os provided by Section 1001 01 the Inheritance and
Estate Tax Act at 1961, 72 P, S. 2485-1001, P. L.373.
Dote __~__;\.pz:i.1_4L1_97.9_____ Signed_
Title ____.._ Anm;nia+T'::I+;v~ OffiC'er
1
I
" -_.-
Note: This is not 0 bill.
----
REV.4iii71'8-78}
DEPARTMENT OF REVENUE
BUREAU OF FIELD OPERATIONS
P.O. BOX 2970
HARRISBURG, PENNA. 17105
SUPPLEMENTAL
COMMONWEALTH OF PENNSYLVANIA
RESIDENT INHERITANCE TAX
APPRAISEMENT
[JAiL
April 4, 1979
COUNTY
FilE rJO.
Cumberland
~78-0144
Whereas, Annie M. Long a/kla Anna M. Long late of Hampden Township
in the County of Cumberland Commonwealth of Pennsylvania, having died on
the 30th day of January 19 ~, seized and possessed of an estate
subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania;
Therefore, I, LAO 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 ail 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 Made for Inheritance
Tax Purposes
R~~l $ 120 00
Personal Pronertv 4.?88 q,
Transfers None
.Tn;n~_H~ld Prnnertv None
TOTAL ASSETS $4,908 93
. Have been duly sworn a<;cording to law, I do hereby certify that the above apprai:'ement is made in conformity
With the law on thiS 4th day of ...... Apt',l . .,).. 19 ~.
\. j
....._-,~
Appraiser
Harrisburg
(Number and Street)
(Post Office)
, Penna.
--------
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