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HomeMy WebLinkAbout06-22-78 COMMONWEAL TH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS * JUN 221919 COUNTY OF CUMBERLAND RC C-33 r4~73) RESIDEtH DECEDENT IMPORTANT, Thi~ return must be completed in detail and filed in duplicate, with all attached, with the Register of Wills of the County whme decedent resided; Return is due within nine months after date of death, unless an extension is granted hy the Secretary of Re-.tenue. (Section 703 of the Inheritance and Estate Tax Act of 1961.) } AFFIDAVIT OF 1j(:j(1XWlO(1l(~ ADMINISTRATOR I" THE MATTER OF THE ESTATE OF AGNES B. SHIPE ("T,~TE FULL NAME OF DECEDENT) Late of (;JJmberli!ruL County Stole ,,!_ _____1'eIlJlS.Ylyani a County of _~JlIIIher1 and __.JQn_J____ LaFaver ) ."' Administr::tor of the estate of the obove-nomed decedent being duly sworn, depose S X:J1fJl.~9'< end soy 5 iMor,ITH) NOI11': and oddrc~:; of r,tk,~[1ey N } other outhO';Il"d repre'cflrOf;ve :0 whom all correspoftdenc€ sh" "I,_~. _ (DAY) , 19~{~~tX~)(~~XJW(~1IIs:X~~lI:ll(l.4I<"JQ(;j;~.} (YEAR) Intestate Jon F. LaFaver Dl'ceJcnt dIed Feb. 14. 317 Third St., New Cumberland, Pa. 17070 That a~ sl~ch _ _~!\~~!rlj_~tr<!..t..9~deponent is familiar with the affairs of said estate and the property constituting ,: E ':UTO R-AOMINI ST RA TO R) the asset...; thereor ,\l1d their fair market value. That at the timc of death there was no safc deposit box registered in decedent's individual name, or jointly with, or as agent 01 deputy Ill' another, or in decedent's individual name, with right of access by another as agent or deputy, with the cxception of the following: NAME "'ND AD IN WHICH DE' DRESS 0 F' BANK OR OTHER INSTITUTION THIS SAFE DEPOSIT BOX RENTED RELATIONSHIP OFJOINT CEDENT RENTED A S.~FE DEPOSI T BOX IN NAME OR NAMES OF HOLDERS TO DECEDENT -- .--- ----. ---~._-,. - That the contcnts 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 Pcnnsylvania 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 dale of death of decedent. That Schedule B attached hereto and made part hereof sets forth fully and in detail all personal property \\hcrc,>cver situated o\vned by the decedent at the time of death; all moneys left by the decedent at the time of death. vt'!lCthlT in decedent's immt:diate possession, standing to decedent's credit in banks of deposit, savings hanks, 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 ~avjJ1gs, treasury certificates or notes and other evidence of indebtedness of the United States to the de- I.::cdcnt: all ohligations, 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; to:: "'-'";H~ ,~!,p<,,\;L jcweilY, :-,ilvcrware, pictures, books, works of art, household furniture, horses, carriages, automohilcs, boats, and any and all other personal chattcls 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 ~alue 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 estalt' fro111 life insurance policies carried by decedent; all annuity and endowment contracts the proceeds Ill' which 'V'.~~ ;1ayable upon the death of the decedent; all and the corporate stocks and dividends due thereon and unpaid as of tJ,!. dale of death, bonds and accrued interest thereon to the date of decedent's death and other 11l"!"sl:ncnl ";~1 :~ Ct, o\vned by the decedent at the time of death, with the ,market value there- or at such tilll~'. In the case of secUl"ities 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, f'inancial statements showing the assets and liabilities of' said co-partnership or 'b,usiness. A copy of the co-partnership agreement, (if oral, a statement setting f'orth the nature of tne agreement) together with a statement setting forth the character of the business, its location, and such other facts pertaining to the bustness as may be pertinent to a fair and just appraisal of the decedent's interest therein mlLst be submttted. It should also set forth in itemized form, together wi th the fair market value thereof, any other propert:r owned or bequeathed by the decedent at the time of dea.th. 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 transferee and all other facts of a pertinent nature regarding said transfers. In the case of transfers intended to take ef'f'ect in possession or enjoyment at or af'ter rleath, there is also attached to the schedule a COllY 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 pa8ses at decedent's rleath 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 rorth the names and addresses of' all persons beneficially interested in this estate at the time of decedentts death, the nature of their res- pective interests, their relationship, if' any, to the decedent, together with the ages at the tlme of' decedentts death of' all minors, annuitants and beneficiaries f'or lire unrler 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 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 and others, plus the date and place of record of instruments ef'fecting the vestiture of real estate and the date of acquisition of' personalty, plus the name, address and relationshlp, 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 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 fudiciary'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 have the totals of the appropriate columns in Scherlules "A", "B", been carried forward and properly registered in the Summary. vd "e" , "E", and "F" as directed therein, Subscribed and sworn to before me th' S;Jdl~~h:~e- In ..19..?? ~W,\q PUBLIC ~L::k ~ r ~ on s Sopt 20. 3 U New CUffi~ei;: ,-. Cumberland Cu. ......._!t't)t~_______ (Executor-Administrator) ..Ihird..S.t............................. (Street Number) NE!\'i....~ulTI~E!T.l..Cl.n..d..pa.:,....1]9?9. (City or Town and State) NOTE: Before signing af'fidavit make sure all blank spaces in the affidavit and schedules annexed are filled in with details or the word "None", and in case the assets include rare and unlisted securities, securities of close or raml1y 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. R~ C~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 surviarship or tenancy by entireties should be reported an Schedule "E.") The real property located In the Commonwealth of Pennsylvania should be described by lot and block number, street 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 a farm state number of a- cres; also statement of mortgage encumbrances upon each parcel at death of decedent. Taxes, assessments, accrued Intere.t on mortgages, etc.,ore to be I isted on Schedule II F" and must not b. deducted from this schedule. (1) (2) (3) aEPARTMENT VALUATION CAUTION (Do not write In tnis space) ASSESSED VALUE FOR YEAR OF DECEDENT'S DEATH ESTIMA TED MARKET VALUE 1. Real estate situate in the Borough of New Cumberland, Cumberland County, Pennsylvania, being known as 304 11th Street, New Cumberland, Pennsyl van i a (See Deed Book "Y", Vo 1 ume 11, Page 123) SOLD FOR ,-;~("~' ;,. ",; n .F io/l.,.~;(," 'r "\, 28,500.00.... -p,:ZI;.roo.{)() 12 ~ ' IJ 0 ,.dl. 3 Ii "' I' / ~/ . , (,~ ,~....' ", Insert this total opposite "real property", Schedule "A" .n the X X X X X "As Reported" column on the last page of this return. 28,500.00 1/01-/1..:'-00,00 / ~,>.~ -?,~, RESIDENT DECEDENT SCHEDULE liB!! PERSONAL PROPERTY '* COI~IONWEALTH 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 "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 rlividends, salaries or wages, insurance pay- able to the estate or firtuciary in sairl 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 f'ully UNIT VALUE ESTHlATEIl MARKEl' VALUE DEPARTMENT VALUATION (Do not write in this space) 1. U. S.SEries "E" Bond dated Feb., 1943 in the face amount of $50 ~ No. L30711136E 3. Property Tax Rebate 141. 38 1...",,/ If/ 3.v 241.20 / :1..1-/. .2-0 / 200.00 .,/ 5tC'c, DO 2. Miscellaneous household furniture and equipment I I I I I Inser t this total opposi te "Personal Property", Schedule "B" in the "As Reportedll column on the last page of this return. x X 582.58 S- 3:l, 6-8 RCC-36 COMMOll"WEALTH OF PElI"NSYLVANIA TRAlI"SFER INHERITANCE TAX SCHEDULE "c" TRANSFERS *~ RESIDElI"T DECEDENT (1) Did decedent, within two years of death, 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, transfer property from himself to himself and another or others (including a spouse) in 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 decedent' 5 heal th at time of making the transf'er. (Note 1). (c) Cause of decedent' 5 death. (Note 1). (4) Did decedent, in his lifetime, make any transfer. of property without receiving a valuable or adequate consideration therefor which was to take effect in possession or enj0yment at or after his death? (Answer yes or no) (a) Was there any possibility that the property transferred might return to transferer or his estate or be subject to his power of disposition? (Answer yes or no). (b) What was the transferee's age at time of decedent's death? (5) Did decedent in his lif'etime 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 f'act end before his death: (a) The posseSSion or enjoyment of or the right to income from tht, 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 affirmative, state whether the right was reserved in decedent alone or others (7) Did decedent in his lifetime make a transfer, the consideration for which was transferee's promise to pay income to or for the benefit of care of transf'eror? (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 reserved power to al tel', amend, or revoke, or which could 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 affirmative, was the power to al ter, amend, or revoke the inter- est of the beneficiary 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 affidavi t by the attenrling physician as well as a copy of the death ceJ"tificate. NOTE 2: If answer to any of the above questions is yes, set f'orth below a d;scription of the property transferred, it's f'air market value at date of' death, dates of transf'ers and to whom transf'erred, with relationship of transferees 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 f'acts on which sajd claim is based. NOTE 3: List applicable property below in manner in which provided in Sc:hedules A, B, or E. ITEM llESCRIPTION MARKET V ALUIl (Es tima ted) DF.PT. VALUATION (Dept. Only) NONE 00.00 N tYI<.L/ Insert this total opposite "Transfers", Schedule "e" in the "As Reported" colunm on the last page of this return. 00.00 RCC-37 (12-63) (,O~lMONWEALTH or' PENNSYYLANIA TRANSFER INHERITANCE TAX RESIDENT DECEDENT SCHEDULE ''IY' v:!<.. ~~~ ""II IJ .~7jI. ,\ ,~t.~: i;..r;<~:i~.i!' BEr\EFIC!\HIES - BENEFICIARIES AND ADDRESSES RELATIONSHIP I SURVIVED (If step-children or DATE INTEREST OF State full names and addresses of all who illegitimate children I DECEDI,NT OF BENEFICIARY aye an interest, vested. contingent or otherM are involved, set STATE YLS l'I ESTATE wise, in estate) forth this fact.) ! OR NO BIRTH ~hine I 1 nl ~ ~'hAn"ta St. A 11 entown. Pa. 18103 . ves adult 1/5 of Residue r ".-.. 7715 Farmda1e Ayenue I-h....ich....n Pa. 17112 Daunhter yes , adult 1/5 of Residue Winifred Sturn lnH; 1.lh,n"b St A 11 entown. Pa. 18103 Dauqhter yes adult 1/5 of Residue Th"..esA MII..nhv 8133 Murray Point Road Baltimore, Maryland 21222 Daughter yes adult 1/5 of Residue ". Fllrh~ i ~n~ l"h'lrnt Sallarp Baltimore Maryland 21221 Dauahter yes adult 1/5 of Residue - I ( h Deponent further says that all the above-named beneficiaries are living at this time except below: - NAME DATE OF DEATH RESIDENCE ._-~ ~ SUMMARY (1 ) (2) o . (As Reported) (As Determined) MtIl~ ~-<: Real Property .. (Sch. "A") $ 28,500.00 $ 28,500.00 e;;::. ~ '2 dl E Personal Property (Sch. "B") $ ?82,58 $ 582.58 .s v": "00.8 Transfers . (Sch. "C") $ $ -<: s. ~ e ~ Jointly-held... ..... .3.650.52 ..3.....,~ $ $ ~,656.52 ~ ~ ~ ~ ~ 0 ~ E go $ $ f'!. <>: Gross Taxable Estate $.. .32,739.10 $32,739.10 l- Z "'" ~ ~ til ~ " " Q) - ..l .... ~ ;... ~ <( til ~ <JJ Q '" - - <<: l.LI <( ~ " CI: ~ 0.. "C '" ~ 0 ...... c " C. ~ :c '" ..:: c. '" <<: '" V1 ~ "C <( II: II: til :>. ... til ... I-< .. c '" . QJ '" ;:: Q 0 ~ :r: "- <<: '" ..0 ~ Z 0 I-< g .. " Z I-< Vi V1 QJ ~ < ~ til l.LI c...> ..0 - i- ~ 0 z E 0 <!l :;: ::l ~ CI: " ~ -0: QJ c...> 0 0 z :c til c. " '" " I-< - - .P I-< c ~ CI: '" <<: '" - i:. c c E E ..-. 5 1< ~ ;?"'C " 15 ::::~ ..l U 0 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE HARRISBURG I'<CC>43 14~C(li NOTE: TO BE SUBMITTED IN TRIPLICATE Pennsylvania Deportment of Revenue Bureau of County Collections 26 S. 4th Street Harrisburg, Pennsylvania J.;-1f-o/lft Dear Sir: Pursuant to Section 742, Pennsylvania Inheritance and Estate Tax Act of 1961, we herewith submit the following report: NAME OF REPORTING FINANCIAL INSTITUTION CC~.13 p',:tnk il.A. ADDRESS 351 llriJ,ge Street, ~[ew Cu.~.berla"d ?A 170'[0 ACCOUNT NO. OF JOINT, TRUST OR INVESTMENT DEPOSIT Savings ACC01U:t i'OOl, ')55763..4 NAMES ON ACCOUNT OR INVESTMENT c\i;nes 13. 8'11}>6 witll ~!ary :;. r;haft'er DECEASED JOINT DEPOSITOR, TRUSTEE OR INVESTOR Agnes :So Shipe ADDRESS AND COUNTY 304 11th Street. New Cumberlll.ud, T'A 17070 ,~oullty Cumberland DA TE OF DEATH February ],1" 1978 SURVIVING DEPOSITOR, BENEFICIARY OR INVESTOR ~~ary E. Cha.ffer ADDRESS enk...'1o\t!: RELATIONSHIP TO DECEDENT DATE DEPOSIT OR INVESTMENT WAS ESTABLISHED BALANCE, INCLUDING INTEREST DUE, AT DATE OF DEATH $ Unknown June 1 'e, 1971 :3,,611).50 " ~ ,-' ....;;U/-.'-, ;' 'De;posit Operations R. ~. ",l;~CYJ;;., /'", Coordinator ......---:;. .~:--,~"" J./'-'r-- Si gnalure ! TITLE ----- RCC.38 RESIDENT DECEDENT SCHEDULE "En JOINTLY OWNED PROPERTY CQMMONWEAL TH OF PENNSYLVANIA TRANSFER INHERITANCE TAX I~STRVCTIONS: This schedule must disclose all property, real anrl personal, owned by the decedent jointly with another or others, including intangibles, standing in the name of' the decedent and others. List real estate first, as entireties, or joint tenants, giving brief description, as indicated under Schedule "A", plus the date and place of record of instrument effecting vestlture, but do not include entireties or out of state real estate value in estate valuation colunm. 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 DEPARTMENT VALUATION Address and Relationship of Co-Owners, and Place Value Share Valuation CAUTION-Do not Write of Recorct of Instrument, where Real Estate. In This Space. )6 6< 60 ~ ~ X)y 3< X>; 6< 60 Value of' Value of' ~ 6< ~ ~ ~ 3< XX & gg hntire Decedent's :<< 2 >9> D6 ><X y IV :)< Property Interest ,/' l. Savings Account No. 001 055768 4 at I GGNB Bank, N. A. in the joint names ! of Agnes B. Shipe or Mary E. Sha ffer ! i , ! o ened June 18 197 , p , 1/ Total Balance $3,610.50 1/2 included /' 2. Savings Account No. 001 003225 8 at GGNB Bank, N. A. in the joint names of Agnes B. Shipe or Winifred Sturn opened February 28, 1964/ Total Balance $3,702.54~/2 included , 1,805.25 /' $1,805.25 I : Il,85l.27.}/ $1,851. 27 Insert this total opposite ",Jointly Owned Property", Schedule "E" in the "As Reported" column on the last pagl'! of this return. 3,656e52 $3,656.52 ------- CCCC~[E3 MAIN OFFICE 331 BRIOGE STREET NEW CUMBERLAND PENNSYLVANIA 17070 17171 23B-OB41 CCNS BANK. N.A. June 14, 1978 Mr. Jon LaFaver 317 Third Street New Cumberland, Pa. 17070 Dear Mr. LaFaver: Here is following information regarding the deceased Savings Account- #001-055768-4 Name- Agnes B. Shipe OR Mary E. Shaffer Opening Date- June 18, 1971 Balance- $3,610.50 ~ Savings Account- #oOl-003225-8~' Name- Agnes B. Shipe OR Winifred Sturn Opening Date- Februar)" 28, 1964 Balance- $3,702.54v' Agnes V- B. Shipe. We trust this information is satisfactory. If you have any further questions please feel free to contact us. SinCerely,. /l ~,,~ X ;h?uL--G (Mrs.) Candas L. Snell Assistant Manager CLS :slb - . 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 Jon F. LaFaver, Administrator (Executor or Administrator) In Re: Estate of Agnes B. Shipe Cumberland County - Fi Ie No. 21-78-0146 Dear Mr. LaFaver: You are hereby notified that the original appraisement in the estate of Agnes B. Shipe has been filed in theJlfpce '1 the Re9~ster of Wills of Cumberland County an u y 1 ,19_, Said appraisement reflects the fallowing valuations: Real Estate Personol Property Transfers Jointly Owned Total $28,500.00 582.58 -0- 3,656.52 $32,739.10 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 July 13,1978 Signed ~ ;'L~ Title Chief AppraJser l-----~- Note: This is not a bill. RC C-2 (2-64) DEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS HARRISBURG, PENNA, 17127 COMMONWEALTH OF PENNSYLVANIA RESIDENT INHERITANCE TAX APPRAISEMENT DATE July 13, 1978 COUNTY Cumberland FILE NO. 21-78-0146 Whereas, Agnes B. Shipe Cumberland late of New Cumberland in the County of Commonwealth of Pennsylvania, having died on the 14th day of February 19~, 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 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. Unit Apprahement DucrlptJon of Aud Values Made for Inheritance Till. PUrpOleli REAL ESTATE $28,500.00 $ 28,500 00 r--I FERSONAL PROPERTY 582.58 582 58 JOINT-HELD PROPERTY 3,656.52 3,656 52 TRANSFERS -0- -0- TOTAL ESTATE $32,739.10 $32,739 10 - Having been duly sworn according to law, I do hereby certify that the above appraisement is formity with law on this 13th day of July ;~""-_ X. ..$ .&.. ~ , made i~g'on- . 19_. Apprailt'r (N'umber and Stnet) HarrisburQ (PG.t Oftleel , Penna. ~I ." '" ~ ... ~ ~ ?) ~ '" ;::J ~ " '" .... :z: ;;: I ~ c Q I"- >- '-' " 00 ~ :il =::: ;; ~ 0 I"- ... ;; '" "'"' '" '" '-.!J '" ~ .... Q "i ;e ;e ., "" CO ci '" '" ." J- i:l ~ I"- ~ " '" '" '" ~ - I <i ",' E- o .~ .~ ~ ., - :I: 0 ..j" " :z: ... l! --- ... 0 .... :;. ~ ... ~ ~ ~ .... (I] '" "" .... '" -;; ~ I a 'i :E '0:: '0:: " tJ -;; N - -.: -..l ~ .;; l ~ z 1:; o:l "" '" E- ." ;e ()<J ., Ll.l 0 :s t ~ ~ ; ~ " ... ~ Q t; " .::. ." ...:l '" ." .c r--. ~ 's, c.. " ~ - ..: f:l ~ "" ~ g ... - - "i i ~ " " <;- ~ " '" , " Cl:; .~ '" ;; I == ~ ~ co Q " <; "- -... z Q ;;; ..j" .S O! ';;; ~ ... .... Ll.l ~ .... ::t '0:: ~ 0 - '" " " ... "5 ~ " Ll.l 0 ",' ." Cl:; Z .;: s.. '" ~ ..;: " it: l') " "- " ~ Q '0:: "- 00 " III