HomeMy WebLinkAbout07-10-78
RCC~~3 (4-73)
COMMONWEALTH OF PENNSYLVJUll 0 1975*, .
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
RESIDENT DECEDENT
COUNTY OF CUMBERLAND
IMPORTANT,
This return must be completed in detail and fUed 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'ltenue. (Section 703 of the Inheritance and Estate Tax Act of 1961.)
IN THE MATTER OF THE ESTATE OF
Late of
Cumberland
} AFFIDAVIT OF
EXECUTOR
~E*1ijKX
GRACE V. SHOVER
(STATE FULL NAME OF DECEDENTI
County
State of ppnn!=lyhr!=lnl!=1
} 55'
County of Cumbprl::Jnd
XXII!flI:liDlIl!ll!mf
Charlf's Lf'on Shovpr
of the estate of the above-named decedent being duly sworn, depose S
Executor
and srij
April 25.
(MONTH)
Name and address of attorney or }
other authorized representative to whom
all correspondence should be mailed.
( DAY)
, 19--11L{~utate leaving 0 last will, copy of which is hereto attached. }
(YEAR) Intestate
Decedent died
Robert M. Frev. Esquire
5 South Hanover street. Carlisle. Pennsylvania 17013
That as such Executor deponent is familiar with the affairs of said estate and the property constituting
I EX ECUTO R-ADMINI ST RA TO R)
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 S,-\FE DEPOSIT BOX IN NAME OR NAMES OF HOLDERS TO DECEDENT
Nonp.
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 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
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 b,usiness.
A copY' of' the co-partnership agreement, (if oral, a statement setting forth the nature of toe dgreement)
together with a statement setting forth the cparacter of the business, its location, and such other facts
pertaining to the 1)usiness as may be pertinent to a fair and just appraisal of the decedent's interest
therein must be submitted. It should also set forth 1n 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 transf'ers 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 eff'ect 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. 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 d~ce~e!lt, either individually or jointly, by tl}e will, deed, or other instrwnent 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-
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 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 instrtunents ef'f'ecting 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;
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 ann tmpaid 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", "e", "E", and "F" as directed therein,
have been carried forward and properly registered in the Summary.
~~~
m.............. ....7th day of. .... ..... July ..... 19..m.7..g. .. .mG.I:!.::!,:r.l~.~...L.e.QlJ,.s.b.Qy..er..........................................._...
(Ex"cutor-AdministratoT )
m~tf;{L~~/.Y ...m . ...B"P,#~.B.9.~A.7.(l.......
~~J] e4~uzt,;kz/uu .....Cadisl(:~~~::;;1;ania....l.7.0l3
C.,lisl., Cumberland ci7'pa. (City or Town and State)
NOTE: ~{;fgrp1riV1fgnEfRigesa~.ptJA~~fP make sure all blank spaces in the aff'idavit and schedules annexed are
filled. in with details or the word "None", anrl in case the assets include rare and unlisted securities,
securities of close or family corporlltions or an interest in any co-partnership or business, that the
data and statements requirerl under the paragraph above relating to Schedule "B" are attached. Also make
certain that colunm #1 in the "Sununary" has been properly completed as above-directed.
Subscribed and sworn to before me this
RCC-34 (4-73)
!=OMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
TRANSFER INHERITAi'lCE 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 volue 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 real property located In the Commonwealth of Pennsylvania shauld be (1) (2) (3)
described by lot and block number, street and street number, together wi th 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; lfa farm state number of a~ FOR YEAR OF ESTIMA TED CAUTION
cres; also statement of mortgage encumbrances upon each parcel at death DECEDENT'S MARKET VALUE (Do not writ.
of decedent. Taxes, assessments, accrued Interest on mortgages, etc.,are DEA TN In this space)
to be listed on Schedule "F" and must not be deducted from this schedule.
"NONE" NONE
Insert this total opposite "real prope,;,", Schedule "A" in the X X X X X
"As Reported" column on the last page of this return.
--
RCC-35
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 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 estatEt.
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, mortg&ges, 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 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)
Optional Account No. 8327~ Carlisle Building
and Loan Association
Accrued int~rest as of 4/25/78
3,248.46/
45. 3~ "r
3,248.46
45.39
Carlisle Building and Loan Association
Certificate No. 06-00-2849
Accrued interest as of 4/25/78
20,023. 2C ,.........20,023.20
420.06 V 420.06
Farmers Trust C"ompany Checking Account
No. 4-6508-9.-/
187.8E /'
187.85
Blue Cross Refund
9.3E ./
9.35
TOTAL
23,934.31
Insert this total opposite "Personal Property", Schedule "B" in
the "As Reported" column on the last page of' this return.
x X
$23,934.31
RCC-16
rl)MMO~WEALTII ilF PENNSYLVANI,\
T[{A\~FI':R Dil1!m[1'A~rE TAX
SCHEDULE "e"
TR.\}iSFEllS
w....
;,. 1\
~ .f!!1M
ilES I1lF\T m:rEllENT
(1) Dirl decedent, within two years of death, make any transf'er of' any material part of' his estate, without
receiving 11 valuable /ind adequate consideration theref'or? (Answer yes or no) no
(2) Did decedent, wi thin two years of death, transfer propeny from himsel f to himsel f and another or
others (inclurting Ii spouse) in ,joint ownership? (Answer yes or no) no
(3) If the answer to (1) or (2) above is in the af'f'irmative state:
(a) Age of' decedent at time of transf'er n /:::t
(b) State of decedent I s 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 t.ransfer of' property without receiving Ii valuable or adequate
consideration theref'or which was to take ef'f'ect in possession or enjoyment at or af'ter his death?
(Answer yes or no) 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) no
(b) What was the transf'eree's age a t time of' decedent I s death? n I:::!
(5) Did decedent in his lif'etime make any transf'er without receiving a valuable and adequate consideration
therefor lmrler which transferor expressly or impliedly reserves f'or his lif'e 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 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 theref'rom? (Answer yes or no) no
un If' the answer to (5) (b) above is in the aff'irmative, state whether the right was reserved in decedent
alone or others n I:::!
(7) Did decedent in his lif'etime make a transt'er, the consideration t'or which was transt'eree's promise to
pay income to or f'or the benefit of care of' transferor? (Answer yes or no) no
(8) Did decedent, at any time, transf'er property, the beneficial enjoyment of' which was subject to change,
because of' a reservert power to al tel', amend, or revoke, or which cmlld revert to rtecedent under terms
of' transfer or by operation of' law? (Answer yes or no) no
(9) ,If' the answer to (8) above is in the affirmative, was the power to alter, amend, or revoke the inter-
est of the benef'iciary reservert in the decedent alone or the decedent and others?
(Answer yes or no) nn
NOTE 1: The answers to these questions should be supportect by affidavit by the attenlUng physician as
well as a copy of the death certificate.
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 transferees. to decedent, if any. Submit copy of any trust deed or instrument, if trans-
f'ers are claimed to be non-taxable, also submit detailed statement of f"acts 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 tima ted)
DEPT. VALUATION
(Dept. Only)
"NONE"
NONE
Insert this total opposite "TranSfers", Schedule "C" in the
"As Reported" coltrnm on the last page of this return.
RCC-37 (12-63)
COMMON\\EALTH OF I'E:';:';SYYLANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "D"
BENEFICIARIES
\
h
BENEFICIARIES AND ADDRESSES RELA TIONSIIIP SURVIVED
(If step-children or DATE INTEREST OF
State full names and addresses of all who illegitimate children DECEDENT OF BENEFICIAny
ave an interest, vested, contingent or other- are involved, set STATE YES IN EST ATF;
wise, in estate) forth this fact.) OR NO BIRTH
-- l---
CHARLES LEON SHOVER Son Yes --- 1/4 of Estate
!---'
R. D. #6 Box 478 ---
Carlisle, Pennsylvania 17013
i
LEONARD LEE SHOVER Son Yes 1/4 of Estate
,
R. D. #4 I
-l -----"--
lvania 17055 I
S r P nns ,
MechanlC bu g,
e
y
MARLIN MEL VERNE SHOVER
66 Fairfield Street
Carlisle Penns lvania 17013
~son
! .._--,,_.
,
I
t -I=- t=
1_ )TJ'!'?____L___ t_J/4 of Estate
BEA TRICE ANN SHEARE
--1----- ---i- --=--- --t----- --------
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I _~_____L.______._._ ! __ .._.____.__'""._.__________.__.
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YPR
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~-_----.--_~-__._~___ _.__m
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.---.,.-.---1"-~-,--~____.___.__.__
,
,
Carlisle. Pennsylvania 17013 I
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-------.._----~.._-_._-~----_._- ----~-_.--.._- --.--- _...~._--_..- --'- -
JJ~I'onent f'urther says that all the above-named LeIWnciaries a.re lIving at this time except. below:
--'--' .._~-----,- ------_.__._---_._------~--- - --.------.-.--------- --------. - -----------------.
-- - - -- ~
-T ~--
NAME DATE OF DEATH HESIDENC!<;
--
, --.-- ..---.-----..--.-- ---
---
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SUMMARY
. ..(Sch. "A")
. ... .............. ...(Sch. "B")
....(SCh...C..)
Real Property
Personal Property
Transfers
Gross Taxable Estate.
(1 )
(As Reported)
$ -0-
$. ....~.:3,9.:34;.:n
$.. ......."Q"..
$..
$
$...2:3,fl:34,31
(2)
(As Determined)
$
$23,934.31
$
$
$
$ 23,934.31
0-
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RCC-38
RESIDENT DECEDENT
SCHEDULE "E"
JOINTLY OWNED PROPERTY
-
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
INSTRUCTIONS: This schedule must disclose all property, real and personal, owner! by the decedent jointly
wi th another or others, including intangibles, sta.nding in the name of' the decedent and others. List
real estate first, as entireties, or joint tenants, giving brief' description, as indicated tUlrler Schedule
"A", plus the date and place of' record of' instrument ef'f'ecting vestiture, but do not include entireties
or out of state real estate value in estate valuation column. Personal property should be listed as 1n
Schedule "B", plus date of' acquisition, and the name, address anti relationship (if' any) of' co-owners to
the decedent.
Description of' Property, Date of' Acquisition, Name Unit percentage
Address and Relationship of' Co-Owners, and Place Value Share
of' Record of' Instrument, where Real Estate.
Estate
Valuation
>0
~
O<>xs.
X:X:0<
o<;/<
<0(0
xx
'>> tx> ~ ;.x
;XX o<>;.x ex i50 bXX gg ;/<
0<>
~~
DEPARTMENT VALUATION
CAUTION-Do not Write
In This Space.
Value of' Value of
Entire Decedent's
Property Interest
"NONE"
!<<JNE
I
Insert this total opposite "Jointly Owned Property", Schedule "E"
in the" As Reported" colUIYDl on the last page of' this return.
-----
RCC-81 (6-73)
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
HARRISBURG
17127
IN YOUR REPL Y PLEASE
REFER TO
Inheritance Tax Division
NOTICE OF FILING or APPRAISEMENT
Charles Leon Shover, Executor
(Executor or Administrator)
In Re: Estate af Grace V. Shover
Cumberland
County - Fi Ie No. 21-78-0237
Dear Mr. Shover:
You ore hereby notified that the original
appraisement in the estate of Grace V. Shover
has been filed in the office of the Register of Wills of Cumberland
County on September 7 ,1978 , Said appraisement reflects the following
valuations:
-0-
$23,934.31
-0-
-0-
$23,934.31
Real Estate
Personal Property
T ranslers
Jointly Owned
Total
As to such tax that is paid within three months Irom dote 01 death, 0 five (5%)
percent discount is allowable. As to any tax that remains unpaid alter nine (9) months
(filteen 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 obiect thereto within
sixty days alter receipt of said notice os provided by Section 1001 01 the Inheritance and
Estate Tax Act of 1961, 72 P. S. 2485-1001, P. L. 373.
Dote September 7, 1978
Signed
. i.' .
...._----_.~-~
Title Chief Appraiser,
~
Note: This is not a bi II.
RC0>-2 !2-64)
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
HARRISBURG, PENNA, 11121
COMMONWEALTH OF PENNSYLVANIA
RESIDENT INHERITANCE TAX
APPRAISEMENT
DATE
September 7. 1978
COUNTY
Perry
FILE NO.
21-78-0237
Whereas,
in the County of Cumberland Commonwealth of Pennsylvania, having died on
the 25th day of April 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:
Grace V. Shover
late of East Pennsboro Township
In the event that any future interest in this estate is transferred in possession or enjoyment to collateral heirs of the de-cedent after
t.he expiration of any estate for Ufe 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 Appraisement
Descrlptlon of Auet Values Made for Inheritance
Talt Purpo,es
REAL ESTATE !-PNE $ -0-
-
PERSONAL PROPERTY $23.934.31 23-934 31
TRANSFERS !-PNE -0-
JOINT-HELD PROPERTY !-PNE -0-
TOTAL ESTATE $23.934.31 ~;23 - 934 31
Having been duly swo.rn according to law, I do hereby certify that the above appraisement
formity with Jaw on this 7th day of September
.,-
/\
is made in ,gn-
19__
) I,
Apprailer
(Ifumber an4 ~net)
HarriSburg
{PM Oftl:eel
, Penna.
------------
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