HomeMy WebLinkAbout02-05-79
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RCC-33 (4-73)
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
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RESIDENT DECEDENT
COUNTY OF CUMBERLAND
IMPORTANT:
This return must be completed in detail and filed in duplicate, with aU 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'.tenue. (Section 703 of the Inheritance and Estate Tax Act of 1961.)
IN THE MATTER OF THE ESTATE OF
J. Leonard Hertzler, A/K/A
.Jam~s L Hertzler
STATE FULL NAME OF DECEDENT)
} AFFIDAVIT OF
EXECUTOR
Cumber landCounty Arp~I'/~fsirj..tfrlJftl
,
Late of ITpppr Allen Twp
State of Pennsylvania
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r.l1mberland
James N. Hertzler,
=:Admi:Jti!l:lf6te= of the estate af the above-named decedent being duly sworn, depose S
County of
Executor
and say
Decedent died May 8, 1978
(MONTH)
Name and address of attorney or }
other authorized representative to whom
all correspondence should be mailed.
(DAY)
, 19_1 testate leaving a last will, copy of which is hereto attached. }
(YEAR) ~MtiflU!l
Wi11iRm T. Sl1ndClY
39 West MR:in Sf": MprhRr)i('sbl1rg, Pa
17055
That as SUCIL Executor deponent is familiar with the affairs of said estate and the property constituting
(EX ECU TO R-ADMINI ST R A TO R)
the assets thereof and their fair market value.
Tha tat the time of dea th there was no safe deposi t box re gis tered in decedent's individual name, or jointly wi th, 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
THIS SAFE DEPOSIT BOX RENTED
IN NAME OR NAMES OF
RELATIONSHIP OF JOINT
HOLDERS TO DECEDENT
The First Bank &~
of Hcchanicsburg,
That the contents of said safe deposit box or boxes are itemized under Schedules B of this return,
with the exception-of the following, for the reasons hereinafter set forth: See: No Value Items
That Schedule A attached hereto and made part hereof sets forth fully and in detai I 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
gi ving al so separately the accrued in teres i thereon, if any, down to the las t interes t day prim to decedent's
death in the case of savings banks, and to thl' 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 mcrtgages 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 linarket value there-
of at such time.
"CC-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 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 wi th DEPARTMENT
a general description of the praperty, with a reference to the record of the ASSESSED VALUE VALUATION
conveyance by which the decedent took title; If a farm state number of a- FOR YEAR OF ESTIMATED 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 DEATH In th Is space)
to be listed (In Schedule "F" and must not be deducted from this schedule.
NONE NONE fJone
/
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.
NONE
RCC -25
COMMONWEALTH OF PENNSYLVANIA
TRANSB~R INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "B"
PERSONAL PROPERTY
Item
No.
6.
7 .
8.
9.
10.
11.
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 li~ted 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
List and describe fully
UNIT ESTIMATED
VALUE MARKEr VALUE
DEPARTMENT VALUATION
(Do not write in
this space)
1.
6,[;33.75
1 '1 .97
2.
Savings Acct. #501-426-1 in The First Ban
& Trust Co., of Mechanicsburg, Pa. ~r ~....
Balance on date of death
Accrued interest 4/1/78 to 5/8 78
Certificate of Deposit #3904 issued in-na e
of Mary E. Hertzler (died Dec. 3, 1977) o~'
J. Leonard Hertzler by The First Bank & T ust I
Co., of Mechanicsburg, Pa., on Oct. 30, 1 74 I
in face amount of $4000.00 for term of 12 mos. I
with interest at 5-1/2% payable annually i
Face value I
Accrued interest 10/31/77 to 5/8/78 I
Checking Acct. #130-406-2 in The First k A4
& Trus t Co., of Mechanicsburg, P a. 2- _ \~ :;.>',1 /'
Balance on date of death J ~I
Return Premium--Nationwide Mutual Ins. Co.-- .
Comprehensive Family Liability Policy 58B 132931
Return Premium--Nationwide Mutual Ins. Co.-- I
Mobile Homeowners Policy 58 MH 007165
1967 Oldsmobile sedan at sale price
1969 Fawn Mobile Home at sale price
Household goods & furniture at sale
Premium Refund - Capital Blue Cross
Refund for overpayment - Harrisburg
40.00
--I. '\
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$ 6,633.75
11. 97'
, ?
4,000.0
116.11
4.
62.00
4, rJOO . OLl
115.11
3.
1,:;3:;.35
22.20
5.
62.0
500.00
5,000.00
68.45-
65.45
40.00
500.00
5,000.00
:;e,.!+5
5.45
price,
HOspi
al
Household goods) furniture
Bed
Lawn mower
Rocker
TV (black & white)
Radio
Toaster
Toaster oven
Wrist watch
Iron
at appraisal:
$ 20.00
5.00
25.00
20.00
15.00
5.00
5.00
10.00
2.00
107.00
'107.00
107.00
Insert this total opposite "Personal Property", Schedule "B" in
the" As Reported" colW1ll1 on the last page of this return.
x X $ 18,263.28
~~18,2lJ3.23
Rec - 36
COMMO\WEALTIl OF PENN~YLnNIA
TH.ANSFFR INHEIUTANCF TAX
SCHEDULE "e"
TR\\T"T'EHS
HESIDF:XT DECEDEXT
(1) Dhi decedent, within two years ofdeatll, make any tr'IUlsfer of any material part of his estate, without
receiving a valuable and 'idequate con~;ideration therefor? (Answer yes or no) No
(2) Did decedent, within two years of d.?ath, transfer property from himself to himself and another or
others (including a spouse) in joint ownership? (Answer yes or no) No
(3) If the answer to (1) or (2) above is :in the affirmativ'? state:
(a) Age of decedent at time of transfer
(b) State of decedent's health at time of making the transfer. (Note 1).
(c) Cause of decedent's 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 enjoyment at or after his death?
(Answer yes or no) No
(a) Was there any possibility that the property transferred might return to transferer or his
estate or be E:ubject 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 lifetime make any transfer without receiving a valuable and adequate consideration
therefor under which transferor expressly or impl iedly reserves for his 1 ife or any period which does
not in fact end before hi,; death:
(a) The possession or enjoyment of or the right to income from th(' property transferred?
(Answer yes or no) No
(b) The right to designate the persons who shall possess or enjoy the property transferre,l or
income therefrom? (Answer yes or no) No
If;) If the answer to (5) (b) aDove is in the affirmative, state whether the right was reserved in rlecedent
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 transferor? (Answer yes or no) No
(8) Did decedent, at any time, trans!'er property, the beneficial enjoyment of which was subject to change,
because of a reserved power to alter, amend. or revoke, or which cOllld revert to decedent 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 beneficiary reserved in the decedent alone or the decedent and others?
(Answer yes or no)
NOTE 1: The answers to these questions shoul d be supported by affidavi t hy tlle atteTllting physi cian as
IFdl as a copy of the death certificate.
:,OTE 2: If answer to any of the above questions is yes, set forth below a description of the property
trn.nsferred, it's fair market value at date of death, dates of transfers and to whom trflnsferred, with
relationship of trflnsferees to decedent, 1.1' any. Submit copy of any trust deed or instrument, if trans-
f2rs aI'" claimed to be non-taxable, also subm1.t detailed statement of facts on which sald claim 1.s based.
NOTE 3: List applicable property below in manner in which provided in Schedules A, il, or E.
ITEM
DESCRIPTION
MAIUmT VALUE
(Es tima ted)
DEPT. V,\UJATION
(Dept. Only)
I
None
None
fdone
Insert this total opposite "T:ransfers", Sehedule "C" in the
"As Reported" column on the l,'ist pag,e of this return.
None
RCC-37 (12-63)
COM~tONWEALTH OF PENNSYYLANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCBEDt'LE "D"
BEI'\EFICIARIES
TIONSHIP ! SURVIVED i
-children or r DATE INTEREST OF
ate children DECEDENT I OF BENEFICIARY
volved, set ST A TE YES I IN ESTATE
this fact. ) OR NO I BIRTH
~h~_~~__+~~~~, 1932 One-fourth
-- ; --~ --
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-----_..__._~,---
-----.--..-...-----------
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i Yes Apr. 11. 193i One-fourth
.---+-
---...------...----.------.--
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B~NEFICIARIES AND ADDRESSES (If step
(Frate tull names and addresses of all who i illegitim
have an interest, vested, contingent or other-! are in
wise, in estate) i forth
r-
I Dau
-+-----
Mp~h"Ilicsbllrg. Pa. '1705~
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-4--
I Son
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Emma Jane Thornton
612 Wingert Drive
JRrneR N Hertzler
Route 1 , Box 63
__~inzer, Fa. 17535
_Edna M. Litwiller
I
Da1.lght~!"_____~ Yes
~ar.19,193{
i
One-fourth
------Parnell, Iowa 52325 I ------------------
--------1-------------- --------- -~- -------_ _ _________
__+---'s.Q..I1___ _
___ Wpst T,ihert:y, Ohio 41157
Don::lln F.
Hert:~d er
; Yes
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lo~one-fourth
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D"'ponent f'urther says that 311 the above-named beneficiaries are living at this time except below:
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--~--_...--_..~~-_._--.,._------_.._......-., .
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!'lAME
DATE OF DEATH
RESIDENCE
None
----+-
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-----.,-.----.-,' -_.~.._.- ...J--____~______.__. .____.__.._.._.__.J.,_________....._.____~__..___
"
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Real Property
Personal Property
Transfers
SUMMARY
(Sch. "A")
. .(Sch. "B")
...(Sch. "e")
( 1 )
(As Reported)
$ -0-
$18,263.28
$.,.,.0,.,.
$ -0-
$
$18,263.28
(2 )
(As Determined!
-0-
$
$ 18,263.28
$ ,.,.0-
S -0-
$
$
18,263.28
Gross Taxable Estate
t- '>::l I
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f-< ~ f-< (-< U ill C = Q
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(-< <.0.. ;... ~
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1\ (-< ~
.';:: -< <.0.. .c' E
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,. ...... 0
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RRSIDENT DECEDENT
SCHEDULE "E"
JOINTLY OWNED PROPERTY
RCC-;38
CQMMONWE/\LTH OF PENNSYLVANIA
Tni\NSF1~n INHERITANCE TAX
IJ'iSTRt'CTIOSS: This schedule must disclose all property, real and 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 vestiture, 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 DEPARTMENT VALUATION
Address and Relationship of Co-Owners, and Place Value Share Valuation CAUTION-Do not Write
of Record of Instrument, where Real Estate. ! - In This Space.
Value of Value of
Entire Deceden t' s
property Interest
None None i\Jone
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Insert this total opposite "Jointly Owned Property", Schedule "E"
in the "As Reported" column on the last page of this return.
RCC-39 (8-77)
County, Number and Name
File Number
Date of Death
Estate Name Hertzler
(LAST NAME)
21 Cumberland
21-78-0250
5-8-78
J. Leonard
(FIRST NAME) (INITIAL)
SUMMARY
COMMONWEAL TH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
REPORT OF INHERIT ANCE TAX APPRAISER
I, the undenigned duly appointed Inheritance Tax Appraiser in and for the County of Cumberland
Pennsylvania, do respectfully report that I have appraised the real and personal property as reported in the foregoing return at
the values set forth opposite each item in the last column to the right in Schedul es "A", "B", "C", and" E".
Dated: F phT'urlrv 28, 1979
~ "*4 ~ 1)
"JuIJ;: LeJt~l .'-{ II ."
INHERITANC AxtPRAISER
REPORT OF THE REGISTER OF WILLS
I, the undersigned duly elected Register of Wills in and for County, Pennsylvania, do respect-
fully report that I have allowed deductions in the amounts claimed by deponent, except as to those items where a greater or
lesser amount is set forth in the last column to the right in Schedule "F", which greater or lesser amount represents the sum
allowed as a deduction.
Dated:
REGISTER OF WILLS
ADJUSTMENTS
INVENTORY VALUE AS APPRAISED ~ODE (HARRISBURG USE ONL YI REMAINDER APPRAISEMENT CODE
Real Property (Schedule AI $ -0 00+ 92+
Personal Property (Schedule B) 18 263 28 10+
Joint-Held Property (Schedule E) -0- 20+
Transfers (Schedule CI -0- 30+
TOTAL GROSS ASSETS Ji18 263 28
Less Debts and Deductions 40- 93-
(SCHEDULE FI
CLEAR VALUE OF ESTATE
Valuation of life estates or
~
PRINCIPL.E
FACTOR
VAL.UE
CODE
annuities....................._ $
E
t=
ESTATE TAX ASSESSMENTS _ $
FOR USE OF REGISTER ONL.Y
Tax on $
Tax on $
Tax on $
Tax on $
T ax on $
Exemptions
T ota I Es tate
CODE
COMPUTATION OF TAX
$
$
$
$
$
2%
6%
15%
*
TOTAL TAX
$
(*) As evidenced by Charitable
Exemption Certificates issued
by the Secretary of Revenue.
Less tax previously paid
BA LANCE
Less 5% of tax if paid within
3 months after death
$
$
t=
$
BALANCE OF INHERITANCE TAX DUE
Add interest at rate of 6% from
to
AMOUNT OF ESTATE TAX ASSESSED
Estate tax paid
$
$
BALANCE DUE
Add interest elt rate of 6% from
to
c
$
$
$
$
TOTAL TAX BALANCE $
PAID $
Supplemental Codes: (FOR USE IN HARRISBURG ONL Y)
48-Adj ustment
49+Adjustment
56-Annuity
6O-Life Estate
92+Remainder Appraisal
93- Rema inder Dedu cti on
93C-Charity
94-Remainder Residue
96-Success i ve
Li fe Estate
FOR USE OF REGISTER ONLY ADJUSTMENTS
NOTE: Where subsequent adjustments are made to the above computation of tax by the Register of Wills, for proper reason,
same should be noted below, with short explanation.
*
R E V-5IS (S-78)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF FIELD OPERATIONS
P.O. BOX 2970
HARRISBURG
17105
IN YOUR REPLY PLEASE
REFER TO
Inheritance Tax Division
NOTICE OF FILING OF APPRAISEMENT
James N. Hertzler
(Executor or Administrator)
In Re: ESTate of~_.LaQllilrd i:ertzler
___Cumberland County - File No. 21-78-0250
Dear [V':r. 'i8rtzler:
You are hereby notified that the original
appraisement in the estate of__ J. Leonard Hertzler
has been fjled in the office of the Register of Wills of r:11ri1:..,Rl"l <'1nrl
County on February 28 , 1912., Said appraisement reflects the following
valuations:
Reol Estate____ Ilone
Personal Property ,,~18,263.2B
Transfers__ 0Jone
Jointly Owned ;'Jon8
Total .,;18,263.28
As to such tax that is paid within three months from date 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;
ond twelve months when deoth occurred prior to December 22, 1965) from date of death,
interest at the rate of ~ix (6%) percent per annum is charged.
Any party in interest who is aggrieved by this notice may object thereto within
sixty days offer receipt of said notice as provided by Section 1001 of the Inheritance and
Estate Tax Act of 1961, 72 P. S. 2485-1 DOl, P. L. 373.
Date _-1C-_a..hr.~2':l-1-_-19-29____ Si gned --// J/I'H /~ 9- ~'-"Ad /f LI'/____
Title Chief _Inileri tanc8 Tax ..poraiser
~ -----....-.,.'0..,.
Note: This is not 0 bill.
REV-457 (8-78)
DEPARTMENT OF REVENUE
BUREAU OF FIELD OPERATIONS
P.O. BOX 2970
HARRISBURG, PENNA. 17105
COMMONWEALTH OF PENNSYLVANIA
RESIDENT INHERITANCE TAX
APPRAISEMENT
DAit: -..E8bruary 28. 1979
COUNTY Cumberland
FILE NO. ,-1-78-02~IL_
Whereas, J. Leonard Hertzler late of Upper Allen Townshio
in the County of Cumberland Commonwealth of Pennsylvania, having died on
the Bt h day of Mav 19 2!.i., seized and possessed of an estate
subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania;
Therefore, I, Gloria J. Richard , an appraiser duly appointed according to lavl,
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.
DESCRIPTION OF ASSET UNIT Appraisement
VALUES Made ;"or inheritance
Tax Pu r poses
$
RI3al Estate [Jone -0-
PI3rsonal Prooertv 1118.263.28 18 26 28
Transfers None -0-
Joint ProDertv i'Jone -0-
Total Estate :,h 18.263.28 1;18 ?G 2R
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Have been duly sworn according to law, I do hereby certify that the above appraisement is made in conformity
with the law on this 28th day of FRbrucuy 19 23-.
/JIJ ' . f Jt), 1: .1 I
.....w~~ -'T al m I" If d )uY ./
. Appraiser
1B'6 Brookwood St.
(Number and Street)
I !arrj R hllT'n.., 171 ?7 Pe
, nna.
(Post Office)