HomeMy WebLinkAbout11-27-78
;;..J-- ?f-~P.f?
R<::C-33 (4-73)
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
RESIDENT DECEDENT
COUNTY OF CUMEERLA>ID
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.)
Late of
NIDDLESEX TH"p., CT..JMBERJ...Ai,lJ):ounty
PENNSYLVANIA
} AFFIDAVIT OF
Ji~{)x R I.X
ADMINISTRA ThP..
IN THE MATTER OF THE EST A TE OF
HELTY H. SC1-n~ARTZBACP
(STATE FULL NAME OF DECEDENT)
County "f
C UHBE FJ....:.\ 1\11)
J 55:
State of
VIDLET E. HI.LDEBP~ND
Y7vv:.v:vy
...~-
Administra01rlx
of the estate of the above-named decedent being duly sworn, depose S
and say S
Decedent died
March
26
, 19~{t~~~~5bt~5{'~~~j{~~~~:.raChed.}
(YEAR) Intestate ... XXX
(MONTH)
Name and address of attorney or }
other authc,rized repres_entative to whom
all corresp,ondence should be moiled.
(DAY)
George B. Stuart
3 South Hanover Street, C.erlisle, ?a.
17013
That as such A()11)jn i stT(':trixdeponent 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.
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 fullowing: -
NAME AND ADDRESS OF BANK OR OTHER INSTITUTION THIS SAFE DEPOSIT BOX R EN TED REL A TIONSHIP OF JOINT
IN WHICH DECEDENT RENTED A S.,FE DEPOSIT BOX IN NAME OR NP."'ES OF HOLDERS TO DECEDENT
--
None
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 th is re turn,
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 t1-' 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 b~ statyte or agreement they are de~'ignated 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 he
less than the face value, it sets forth hriefly 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 or 1\.. .' (," death, bonds and accrued interest thereon to the date of decedent's
death and other investm J by the decedent at the time of death, with the market value there-
of at such time.
op"q;:>aJHJ-aAoqu Slc~ p"qaIdUlo;:> AIJadoJd uaaq S1Il! UAJUUlUllISII aln ul 1# UIlITIlo;:> 1uln upnJe.;:>
a)jllU1 os Iv opaq;:>u11 U aJB IIUU a 11lpaLPS 01 :;'iU! 1B IaJ aAoqB qdUJ:;'illJBd al{1 JapulI paJ lllL aJ Sl uaUla1 B1 S pUll lei1 Pop
al{1 lU41 'ssaulsnq .10 dll{sJaU1Jud-0;:> AUlI ul 1saJalul UB .10 SU011UJodJo;:> AI1UlBJ .10 asol;:> JO Sa!11JlI;:>as
'sall1JlI;:>as pa1 sl Iun puu aJlIJ aplll ;:>ul Sl aSSB aln aSB;:> Ul pUB 'lIauoNII pJOM al{1 .10 S I1B1 ap In 1M ul pal I lJ
aJB paxauwl salllpal{;:>S pUll '11AIIP1JJB aln 111 sa;:>lIds )juuIq IIU aJns a)jIlUl 11AuP1JJlI :1lulu~ls aJoJd\j ::qlOs:
(~'D1S puv umo,.L .LO /i,1~;))
.(10Z1...........-e(i"...~.dTS1.rj:i:?'j
(J.<JqULnN -:StJtJ.l4S)
..................................8. · CL .11
x~~vJ4~u~mPvl-/oJrf:>p:ji)
.._..........................l~jji}l..f.~~..
<:861 's- 1I;).IeH sa.:q::Ix2 UC1SSTllilllOJ AH
...~j~d .'al 81=1.I80...- ..;)3 Tqnd ,:\.I tEJON
r,~ .rr"./7--;[\ .;; ,..-,..'<?ij-2}'Y.
1'7-. \.! [/ ,J ....__,
..8[61..........ia({W:aAOi\l JO AUP ..
7? -; /; I
/-:-_ _I
srQl am aJoJaq Ol ll.IOMS puu paq~J;)sqns
oA.IUIlI\lInS al{1 Ul pa.ia1s1:1la.I A"[Jado.Id pUll pJBM.IOJ pal.I.IlI;:> uaaq aABl{
'ulaJal{1 pa1;:>aJ1P SB II.'III pUB '113:11 '11:)11 'IIUU 'IIVII saInpaq;:>s ul sUUlnIo;:> a1111.Ido.Iddu al{l JO SIB101 al{1 1'HIl
oln lMaJaq1 a;:>ulIp.Io;:>;:>u ul pasSaSSBa.I aq UlI;:> passassu XB1 JO 1LHlOWP. al{1
pn!1 plIB 'SI[B\ JO .Ia1s1:1lal( aln 01 pa~poda.I aq 111M aUlus al{1 1u41 'paMOIIB pUB :ilU1UllBI;:> 1unoUlu pa1p.U111sa
aln lJ.1lln ssaT Sl '14ap .10 uOlsSlU1U10;:> 'aaJ J\UU JO 1uaUlan1as ul P1Bd '\lllIn1;:>U 1unoUlU al{1 Jl 1Ul{'~ '1sanb
-aJ uodn SU011u~iqqo palU1111;:> PIllS JO Joo.Id lUasaJd 111M A.IB1;:>nplJ al{1 1Bl{1 paa.I:1lp. sl 11 o1\UB Jl 'SUO{1
-u~llqo .IoJ jJaZlpald IU.Ia1Bllo;:> JO 1ualUa1B1s B In1M .Ial{1a:.J01 : (1;:>V XBl a1u1s3: pUU a;:>uu11.Iaqul al{1 JO 1S9
uoq;:>as .18pun paMoIIU aSol{1 1da;:>xa) 41Bap s .1uapa;:>ap 01 .I01.Id pOl.Iad .IoJ alqua:1l.IBl{;:> pan.I;>;:>lI saxu1 :l{'pJap
JO aWll 1H p~UdUll pUB :aulMO slU1HI;> pUU s1qap :1uapa;>ap aln JO l{111ap al{1 JO a;>uanbasuo;> uT 'sa;:>TA.las snol:.J
-llaJ. PUH 'S.Id)j.IBlUaAU.I'ii .10 sau01sqlU01 'S1Sn.I1 IU1.Inq .IoJ papuadxa 1so;:> :P1Bd aq 01 .10 Pll1d suoTsslUlUlo;:>
<.; ,::.18 P1PllJ pun sadJ laSUllO;J :a1B1sa slln JO U011U.I'lS1UllUpH JO S1S0;:> :alqB;:>l [ddu a.Ial{M 'U011dlUGxa A[lU1l1J
:Plud sasuadxa IU.Iawy :1lU1pll[;:>Ul 'a1B1sa s.luapa;:>ap S141 JO Jl1Il{aq UO pUU .IOJ palUl111;:> SU011;)llpap pUll
s1qap l[H ITB'F'P Ul pUB )\IInJ 41.IOJ s1as Joa.Ial{ 1.IBd 11 aplllU pUll 01a.Ia4 pa4;:>1I1111 .:! a/npa,ps 1111U,
01uapaoap al{1 01 S.I2UMO-0;:> JO
',i:1l11 Jl 'dTllSU011B[a.I pUB SSa.Ippl' 'aUlBu al{1 snId 'A1[BUOS.Iad JO U0111s1nb;:>ll JO a'll1p al{1 pUB alu1Sa IBa.I
JO a.In111sa\ al{1 :1lull;:>aJJa S1uaM1.I1SUl JO p.Iooa.I JO a;>lIld pUll a111p al{1 snId 'S.Ial{10 PUH 1uapa;:>ap al{1 JO
alUBU al{1 Ul :1lUlpuB1S 'alql:1lmJ1Ul :il'U1Plll;:>Ul 'S.Ial{10 .10 .Ial{10ulI 411M Anulof 1uapaoap aln A:q pau.'.\o '[llUOS
-.lad puu pla.l 'A1.Iado.Ill lIB l{1J.oJ s1as Joa.Ial{ 1.I1-Id 1-1 apuUl pUll 01a.Ial{ pa4;:>U11u :3 a/npa<j_'S lll41
oA.IBl;:>lJauaq aq1 0'+ anssl Lpns JO dlL1SU011ll[aJ al{1 puu 'anssl .Ila41 'l{1uap .Ilal{1 JO sall1p aq,+ '1UclP,,-;;p Ol
.I01.Id palP 'AUlI Jl 'TIJM S ,1uapa;:>ap al{1 ul paUlBu sal.Illl;:>lJauaq al{1 JO l{;:>ll{M :llulMOl{S 1uaUla1u1stJ SUP>1UO;)
OS[B 11 ollHI s,1uapaoap .Iaputl aJl1 .loJ sal.IlIl;:>lJauaq pUll S1ull11nuulI 'S.IOU1Ul 1[11 JO l{'luap s, Ihlpaaap
JO amp al{1 111 sa:il'u al{'l 411M .Ial!1a:a01 '1uapa;:>ap aln 01 'AUll Jl 'dll{SuOl111Ia.I .Ila41 'S1Sa.I31Uj ,,:'n;)cHl
-saJ. .Ilal{1 JO a.In1uu aq1 'l{1Bap s,luapaoap JO aUll1 aq1 1B a1111sa Sll{1 ul pa1Sa.Ia1Ul AIIlIlaJJauJq suos.Iad
liB JO sassa.Ippu pUB saUlBU al{1 l{1.IOJ S1as Joa.Ial{ 1.IlId apllUl pUll 01a.Ial{ pal{;:>1I1111 G a/npa<jJS~ 1l1l{,1
oalnpaqas al{1 O'l pal{;:>u11u .IaMOU l{;:>ns :il'ul111a.I;:> 1UaUIT1.I1suJ al{1 .IO Adoa H lnp\
'.Ial{'10uu JO 1UaUlll.I1sul .Ial{10 .10 'paap '111M a41 Aq 'A[1Ul0f .10 AII1InplAlpul .laIn la 'luapaaap uJ p,qS,'A 1uaUl
-'luloddB JO .IaMOU .~U1-I .10 '.Ial{10ull l{11M ,\[1u'{or.IO 'A[lunplAlpul .Ia411a '1uapa;:>ap Aq aSl;:>.Iaxa a'n ]>. "lll.q.\
All l{lBap s,luapa;:>ap 1B SBS3lld l{;:>ll{M 'anIBA s1T l{11M 'IllUOs.Iad pUll Illa.I 'A1.Iado.Id lIB JO 1s1l B J[I~pal{;:>S
PlUS ul l{1.IOJ 1as oSIll sl ~.Iaql 01Sn.I1 al{1 :aul111a.I;> 1Uawn.I1Sul .Iall10 .10 1UaUlaa.I:il'1I 1Sn.I1 'paap al{1 JO
.\110;) H a[npal{;:>s a41 01 palpu11u OS[U sl a.Ial{1 'l{1Bap .Ia1Jll .10 11-1 1uaurAOrua .10 uOlssassod Ull;)d.}.", a){1-I1
<n papualul s.IaJsull.I1 .Jo aSB;:> al{1 uI oS.IaJsu1-I.I1 PlUS :aulp.Iu:il'a.I a.In111U 1UaUl1.Iad U JO S1;)1IJ .laqlo liB
puu aa.IaJsUB.I1 L{;:>Ba Aq paAla;>a.I a.IB4S ,!1uuop.IOdO.Id aL[1 '1uapa;:>ap al{1 01 saa.IaJsuB.I1 al{1 JO dT1[SuOJ'l1Jla.I
al{1 'pa.I.IaJsU1I.I1 U10l{M 0'1 'A1.Iado.Id l{ans JO anIBA pUll a.In1llU al{1 In.IOJ slas aInpal{;:>S Pl11S "[1 pal: Jal.Jll
.10 1u 1uaurAOrua .10 uOlssassod III 1;:>aJJa a)jlq 01 papua'lul .10 'L{1llap S ,1uapa;>ap JO u011uldUlBPlO:) LI1 'I['!llclp
S .~uapa;:>ap JO S.IBaA OM1 u1411M 'pmos.Iad .10 [Ba.I 'A1.Iado.IdJo s.IaJsuB.I1 JO aSll;:> a41 ul puu u1clJ..Hjl p...nljlquO;)
A.Ilnbul l{;:>1Ia 01 .IaMSUB an.I1 u l{1.IOJ s1as Joa.Ial{ 1.Illd apuUl pUB 01a.Ial{ pa4;:>u11U :J a/nfJa<jJ') aliI
olnuap JO aUl11 al{1 1B 1uapa;)ap al{1 J\q pa41llanbaq .10 pauMo .\1.Iado.Id J.al{lo .'''.lh '.:".Id'{+
anIBA la)jJBW .I1BJ al{1 411M .Ial{1a:iJ'01 'Ul.IOJ pazlUla11 ul l{1.IOJ 1as OS[lI Plnol{s 11 oPcq11U1Qns ,'qis'.' "~,Udln
lSa.Ia'p11 S ,1uapa;:>ap aq1 JO IllS1ll.Iddu 1snr pUll .I1BJ 11 01 1uaul1.Iad aq AlIW S1I ssauJsnq BIn In ':i; 't: t,)d
S1auJ Jal{10 l{;:>ns pUll 'U011ll;:>01 s11 'ssaulsnq al{1 JO .Ia1;:>lI.Ill4;:> al{1 l{1JOJ :aul11as 1uawa1u1s 11 Lll[Y J.041ujol
pUaWad.I:;';" al{1 JO a.Itquu al{1 l{lJOJ :iJ'ul11as 1uawa1u1s 11 '[U.IO Jl) '1UaUlaa.I:il'1I dlqSJ.aU1.IBd-0;:> aql " ,.to.) \'
.ssaufsn<.[ .10 dll{S.Iau1.Illd-0;:> prBS JO sal'11Ilq1l11 pUll s1assu aq1 :1lulMOl{S s1uaUla1u1s Il1Jau1Iuu 'aplp,lIj;)S PftlS
(11 paxauuB sl a.Ial{1 1Sa.Ia'lul 4;:>llS JO anll1A al{1 JO 1.Ioddns ul puu 'ssaulsnq .10 dll{SJau1.IBd-oa ,\U1/ U~ l{H,ap
JO aUll'l al!1 1ll 1uapa;:>ap JO lsa.Ia1ul all1 l{1.IoJ s'las oSlu alnpa4;:>s al{l 041Bap JO a1up aql JO Sl! JoaJ.Cll{~
saql11qllJI PUlI S1aSSll al{l :l5ulMOl{S 'SU01111.Iorl.Ioa a41 JO s1uaUla1u1s 11Il;:>uuulJ ,\q pa1HlluBlsqns B[llTssod
SlI .IB.J SB a.IU pa1.Ioda.I sanlBA a41 'SU011U.IodJo;) ,\[lU1l1J .10 asoI;:> JO saT11.Inaas JO aSlI;> al{l III
"'0:: C-34 (4.73)
COMMONWEALTH OF ~toritS!YLVA.A
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE IIAn
REAL PROPERTY
.
Real property in Pennsylvania, with statement of mortgage encumhtances 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 Comm"nwealth of Pennsylvania should be (1 ) (2) (3)
described by le.t 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; If a 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 write
of decedent. Taxes, assessments, accrued Interest on mortgages, etc.,are
to be listed on Schedule "F" and must not be deducted from this schedule. DEATH in this spoce)
None
lIe HE
Insert this total opposite "real property", Schedule" A" in the X X X X X
"As Reported" column on the last page of this return.
~:J 0 '.le
PCC -3.~
ItESITlE,'iT DECEDENT
SCHEDULE "13"
PERSON AL PROPEJ1TY
CO^,ThION'I!K\LTH OF PENNSYLVANIA
THANSn;:n INHERITANCE TAX
I NSTRUCTIONS: This Schedule must disclose all tangible and intangible personal property owned individually
hy 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 !lame 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 arlministered estate.
Tangible personal property should be listed f'irst (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
es tate of' or income from any property held in trus t 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 ESTIMA,TED DEPARTMENT VALUATION
List and describe fully VALUE MARKET VALUE (Do not write in
No. thts space)
-
1. CCNB Bank, N.A. c'lecki ng account
(lumber 0760011973 ',/ 2)880.92..- .- 2,880.92
2. 188 S'lares Adams Express stock 11 3/1 ? 11.... ~O . 2,138.50
._)..0.)\ '
~ 100 s:'ares American Motors stock 4 1/1~ 406.25 406.25
~; .
I
I
I
I
I
I
I
._~-
lnser t tbis total opposi te "Personal Property", Schedule ~B" in
the "As Reported" column on the last page of this return.
x X
5,42.5.67
$5,if2S.67
RCC-1S
Cl )\l\\t)\iVEI\ L~I1 (W 1'L:',''i~Y L\-i\\i I!\
T)lA\~:":ii\. T'i1:~':l\.IT!)\'CF TAX
SCHF~DULE "e"
Tit \Nc;n:ns
~~
~..~. A
I,',-:,~,:,,;, ~y
/j 'L~!X~'\
,~>ll:~~(SJ
\" .:-T'{i4iY ~/\L.
i,Esrm:\T j)iTFIlF\T
(1) Did decedent, within two years ofdeattl, make any transfer of any mat.erial part of his estate. WiUilHlt
receiving a valuable ar.d adequate consideration the~>(~ror? (,\nswer yes or' Do)__NO__
(:2) Did decedent, within (wo years of death, tl'd.nsfer property from himself to himself and an'lther' 01'
(;thers (illClllliing; a spouse) in joint ownership? (Answer yes or no)---I:lu._._._
(3) If' the answer to (1) or (2) above is in the affirmative state:
(a) Age of decedent at time of transfer
(b) State of decedent's he/ilth at time of making the transfer. (Note 1).
(c) Cause of decedent's death. ("Iote 1).
(4) Did decedent, in hLi lifetime, make any transfer of property without receiving 'i valuable or adequate
consideration thf'ref~f which was to take effect in possession or enjoymert at or after his death?
(Answer yes or no) ..0
(a) Was there any i)Ossihility that the property transferred might return to transferer or his
f'st.ate or be subject to his power of disposition? (Answer yes or no)
(ll) What. was the transferee's age at time of decedent's death?
(5) Did decedent in his lifetime make any transfer Wit/lout receiving a valuable and adequate consideration
therefor uncleI' which transferor exprf)ssly or impliedly reserves for his life or any pf~riod which does
not in fact end before his deat.h:
(a) The possession or ero,joyment.of or the right to income from the property transferred?
(Answer yes or no) L'iO
(h) The right to designate the persons who sh<>;.l1 possess cr enjoy the property transferre,] or
income therefrom? (Answer yes or no) i.;rO
(G) If the answer to (5) (b) above is in the affirmative, state whether the right was reserved in decedent
alone lJr others
(7) Did decedent. in his lifetime make a transfer, the consideration for which was".p'ansferee's promise t.o
pay income tOOl' for the benefit of care of traEsferor? (Answer yes or no)..jO
(8) Did decedent, at any time, transfer property, the beneficial enjoyment of which was subject to change,
because of it reserverl power to al tel', amend, or revoke, or which cOllld revert. to rlecedent undf~r terms
of transfer or by operation of law? (Answer yes or no) N:J
(9) If the answer to (8) above i3 in the affirmative, was the power tlJ alter, amend, or revoke the inter-
est of the bel'efi ciary reserved in the decedent alone or the decedent and ot.hers?
(Answer yes or no) ----
NOTE1: The answers t.o these questions should be supporterl by affidavi t hy the attewU ng physician as
well as a copy of the death certi f'i.cate.
~OTE :!: If answer to any of the above questions is yes, set forth below a rlescription of the property
transferrect, it's fair market value at date of deat.h, dates of transfers alld t.o Y'hom transferred. with
relationship of transferees to rlecedent, if any. Submit. copy of any trust deed or instrument., if trans--
fers are claimed to be non-taxable, also submit detailed statement of facts on which said claim is based.
~OTE :1: List applicable property below in manner in which provide'] in Schedules A, B. or E.
ITEM
L'ESCIUPTION
MAIUillT VALUE
(Es tima ted)
DEPT. VALLAT~O:-i
(Dept. Only)
l~r Oi~IE
NCNE
Insert this toVtl opposite "Transfers", Schedule "C" in the
"As Reported" colllrrm on the lllst p'ige of this return.
None
RCC-J7 (12-E~)
COW\IO~\n~ALTH OF :rE?,~~:'-.YVL\:-';IA
TRANSFER I",^HEHITA",^CE TAX
RESIDENT DFl'EDE~T
SCHEDULE "D"
. ~. "':': ,,,,
~. :H't.,.,,*
;(',~>:~.:~-:),-
I).'~,:,\ ",1,~.ti
lJ.. ::>-;t;(,:', ..'<."~> 1\ '.t
.' .
m:;\EFICIAHIES
T --'~---"--"-----
I RELA TIONSHlP
BENEFICIARIES AND ADDRESSES (If step-chIldren or I SlJRVIVED
\State f.ull nG1'1.,es and addre.ss.... e"., of 11.11 who ilif'gitimate chjdrcn I' DECl;IJ:t:~~T i
. <cr. \TF YES I
have an Intc"C'C't, vested, cent ;ng0nt or ot.her"i arc involved, set ." I" 'd
wi se, l.n estat.p) J forth tkis fact.) OR NO
i
R.D.8 I Sister Yes
I
I Brotb.er J Yes ~
~- ! I
~ i ...~
I i I
ISis ter IYes I
, ..---+-= I
i i
I .-------! I
I I I
I -t- -I
------t.-- I
Nephe~" ! Yes _\
-+- I
~ i
k I
I Yes I
I f-
I I
_+ I ~
-l I . -1-_____ ... . ... ...
I ; I
! I +--------
-+----1--+------------
r- .
D.\TE
OF
BIHTH
---.-t----------- m__....__.... ------
l 0 I _.r: 1 t~
! L~ .L OC...r_~___________
INTF:HESr nF
nrr\lEF)\:JAHY
r~ YSTY~E:
Violet F. Hildebrand,
CexIis lE~, Pa.
~---_._-------
I
I One-fourt'-c
I w --,-----,---------------~___
!
Ammon E. Sc;,r,7artzbac:l
Sr. 26, Rt. 1, Box 473
I-=~=-----------------
I
.-t------------
lOne-fourth
--+--.-.------.---.------
I
--~._----_.._------
L
I
I
I
.---1------------.---
I
-.1----------------.-..
! II i '-.t-'h
I ",ne-e_g:L.~
I -.---------.---
i
-------t-.--- -----.--------. .----
I
~--~----_._----_._-"------
I
i
+----.-----..---.--.----.
i One-eigcltb
I - ..-------.----..-----
I
~
Ne~.qberry ,_ Fla.
32669
Ivl i 1 e
R. Schy;mrtzbacn
The Brandywine, Apt. 834
4.54'5- Connect 1.cutAve.
Washington, D. C.
20008
Lloyd L.. Lyter,
ParaCUSE? Bpy :?C'lrk, 37".Jo St.
llr,de<ltotl, Fl,. - - . -I +
Harvey W. Lyter I Pephew
92) S. .l Ith St.
-I .." p , ." AI:) --j
h;;1rrJ,~u1.1rg, ...8.--:r:1.1.\..I~ I
I
I
!
I
I
I
I
I
1=
I
, I
I
- I
I
I .-
I
! i
--~--
I I
I I
i
I -r
--- , I
=1=~~=~~=~
L-
I I
-t---t
t-
1-
..--J
Deponent further says that all the above-named beneficiaries are living at this time excellt below:
NAME
DATE OF DEATH
RESIDENCE
Hen
e
.- --
_._--- ---
n n t""" :;.. ~
g .- ~
.- ..... .-
.- '1l '/ .-
.- ,..,. 0 .-
c '~ ....., ~ ;...
'./'.
:=:I :::J 0 -. -J ,..,.
... ...,
.-: ....., ~ -J '"
~ v :s:: 1-3 M .....
"o::l .-
0 ,..,. H ~ ::;:l
::z:l .- (') '.:;:J 0
0 $ tj i'"~,-1
~ ,~ 'T'J ~
....., ~ M
;-..:1;
~ "j t:;d tTj VJ -J /:
'2 CS \:r! .en (lj -J 0 - :2 ?
::; ;;d tTl (') ;... 'r1 -
0 -J .., M .., ''-'
V> ~ ~ .....
'~ -'-' M i :J:: r-...I
;... <" > :E: M :;.. M I
"o::l z: H :P 0 "j -..J
~ "i:!
"l:l :::J t:1 0 :;.0 'T'J CO
::z:l ~. ~ f'-'j :::0 I
;... r."l ;... N
-
- (,'1 t:l t~ VJ '.";1
'JJ ... <':> > M
~ .-4 ~
H () (") '/
r-' l'D '1l
''0 '" ,.,.. M ~
", - ....
l'D Z f....
0-
-1 'cO
'.I
())
I (l.Jfl!UJI.'l"( [ SV)
IZ)
91- 991'2:1$
... .. .....~....$
6ij.0i7L'9 S .... ..~. . . .
(il3jl \., oS)
. -0':' $ ("8" 'IPS) ...
L 9.'SG"?'~$ C.a" 'IPS)
-0- $ C.V" "lpS)
((l.lpod.}U SV) AUV~'\I\nS
(r)
;:JWIS3 d!qBXlJL SSG1:)
;:0 ~
~ :3 ~
C !:: n
'"1 v: ::::
,-,...... ,..,.
.'to ,-
~~~
. 5 >-
(') - ,-.,
c'E..5'
=- :?- ~.
5 r~: ~
91' 99t'<:1 S
$
6i?' Oit'L '9 S
$
L9-~Z?c ~ S
S
Ki.:r.-aGo.:td p<HJl10 L\F~U10f
S.l<3Jsmu.l
^118do1d IBUOS1"d
^l18dold Jl~.)}1
""
R C C-38
RESIDENT DECEDENT
SCHEDULE" E"
JOINTLY OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
INSTRUCTIONS: TIIis schenule 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 nescription, as indicated tmder 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 acquisi tion, and the name, address and relationship (if any) of co-owners to
the decedent.
Description of Property, Date of Acquisition, Name
Address and Relationship of Co-Owners, and Place
~R.eoc~ of !",tcum."t, wh.c. R.al E,tat..
Unit
Value
percentage
Share
Estate
Valuation
DEPARTMENT
CAUTION-Do
In This
Value of
Entire
Property
VALUATION
not Write
Space.
Value of
Decedent's
Interest
1.
RI~a 1 property conta i.ning approKimm 1y
1/4 Acre, ~aving a garage
thereon erected.
AcquireJ by Deed Book 23 I 19.
Situate in. }::Lddlesex TOtvnSIlip,
CumJ- e.rlp rid Cou.nty, pennsy1 va nia .
HeL" in 11aml~S of ~'lelty B. Schh7artzlach
and Judit~ E. Eckert(niece) as jOilt
#o!. . h'C . .. ,-
tenants ,.ntil r~g,ct 01.. surv~vorsnJ.p
(J / I~ FT. f.;' () /) /
021}, }20
j., t'N' 61-0 ~:. .:.: ~'/
r: 0""
....., ~ /0
//
J.
1,000.00 ~ ~CJf/. d tJ 1,000.00
,
.,t' ./
.;:,.
'"'
r., _
I'" "
!) .."
Dcuphin Deposit Bank and Trust Co. 1'//
checking account number 42-88-521- .
Joint cccount :in name of He1ty ~I.
SClwarL~b8.ch 8 nel Violet E. Fildebn nd. 100%
(s:;ster)
5,7LfO.l~C
5,740.49
In~ert this total opposite "Jointly Owned Property", Schedule "E"
in the "As Reported" colunID on the last page of this return. 6 74.0.L~)
:;;6, 74C .Lf9
RCC-39 (8-77)
21 Cumberlp.nd
21-78-0257
3-26-78
SUMMARY
County, Number and Name
Fi Ie Number
Date ()f Death
Estate Name
Schwartzbach
(LAST NAME)
deIty
(FIRST NAME)
H.
\INITIAL)
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
REPORT OF INHERIT ANCE TAX APPRAISER
I, the undersigned 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 Schedules "A", "B", "C", and "E".
Dated:
December 4, 1978
("'~ , .~,. I/ l! i~".,
./. ''\ '- l/'.. ,/\ G ~,' '" {X',-1..9.1rL-l::-
INHERITANCE TAX APPRAISER
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
!cODE ADJUSTMENTS
INVENTORY V ALUE AS APPRAISED (HARRISBURG USE ONL YI REMAINDER APPRAISEMENT CODE
Real Property (Schedule AI $ -G- 00+ 92+
Personal Property (Schedule B) 5.425 67 10+
,Ioint-Held Property (Schedule EI b.740 49 20+
Transfers (Schedule C) -0- 30+
TOTAL GROSS ASSETS $12.166 16
Less Debts and Deductions 40- 93-
(SCHEDULE FI
CLEAR VALUE OF ESTATE
Valuation of life estates or
.:i..-
PRINCIPLE
FACTOR
VALUE
CODE
1-
t=
annuities............... ..... __ $
t=
ESTATE TAX ASSESSMENTS _ $
FOR USE OF REGISTER ONLY
Tax on $
Tax on $
Tax on $
Tax on $
Tax on $
Exemptions
T ota I Estate
CODE
COMPUTATION OF TAX
$
$
$
$
$
2%
6%
15%
*
TOTAL TAX
$
(*) As evidenced by Choritable
Exemption Certificates issued
by the Secretary of Revenue.
Less tax previously paid
BALANCE
Less 5% of tax if paid within
3 months after death
$
$
~
$
BALANCE OF INHERITANCE TAX DUE
Add interest at rote of 6% from
to
AMOUNT OF ESTATE TAX ASSESSED
Estate tax paid
$
$
c
$
$
BALANCE DUE
$
Add interest at rate of 6% from
tCI
$
TOT AL TAX BALANCE $
PAID $
Supplementdl Cddes: (FOR USE !N HARRISBURG ONl Y)
48-Adjushnent
49+Adjustment
56-Annuity
6O-Life Estate
92+Remainder Appraisal
93-Remainder Deduction
93C-Charity
94-Remainder Residue
96-Successive
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 Wiils, for proper reason,
SClme should be noted below, with short explanation.
R E V-SIS (a-7s1
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
Violet E. Hildebr~nd
(Executor or Administrator)
In Re: Estate of '1iel ty H. Sch\'wrtzoe..ch
CwnberLsnd
County - File No.21-78-0257
Dear Mrs. Hildebrand:
Yau are hereby notified that the original
appraisement in the estate of '(.vel ty H. SChvlA.rtzbC'.ch
has been filed in tge, office of the Re~ister of ~i"s of. Cumberland
County on Decem er 4 , 19~, Said appraisement reflects the fallowing
valuations:
Real Estate
Personal Property
Transfers
Jointly Owned
Total
-0-
$5,425.67
-0-
$6, /40.49
:]12,166.16
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 object 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 December 4, 1978
Signed
, ,
\' . l.: [
k' "-.'.f1
f i, I , \.',., ~ .1.;;,.
Title Caier Appreiscr
, .
..
Note: This is not a bi II.
R C C-2 (2-64)
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
HARRISBURG, PENNA, 17127
COMMONWEALTH OF PENNSYLVANIA
RESIDENT INHERITANCE TAX
APPRAISEMENT
DATE
December 4, 1978
COUNTY
Cumberland
FILE NO.
21-78-0.257
Whereas, Hel ty H. Schwartzba.ch late of Niddlesex Tcwnship
in the County of Cumberla.nd Commonwealth of Pennsylvania, having died on
the 26th day of l"farch 19 78, seized and possessed of an estate
subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania;
Therefore, I, Ira K. Gleim I 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 th.e 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 Appraisement
De.crlption of Anot Value. Made for Inheritance
Tax Purposes
Real Estate None $ -0-
-"--
Personal Property $5,425.67 5".25 b7
_ u
Transf,ers None -c-
Joint J2roperty $6,740.49 6,740 49
Total ]~st,~lte $12.166.16 $12,lb6 16
-
..-
Having been duly sworn according to law, I do hereby certify that the above appraisement is made in con-
formity with law on this 4 th day of D~c,"mber '~~.~ / (, i.~ ,.. 19-22-.
(j "". to,- /1 I ,. .1._ LA. 'd'
Appraiser
(IC\1m~.and Street)
Harn.Sburg
(Poet 0flI.,.1
, Penna.