HomeMy WebLinkAbout02-22-79
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COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
.. c:t -,L~-1?
RCC-33 (4-73)
RESIDENT DECEDENT
COUNTY OF
CUMBERLAND
IMPORTANT:
This return must be completed in detail and filed in duplicate, with all attached, with the Register of Wills of the
County where decedent resided; Return is due within nine months after date of death, unless an extension is granted
by the Secretary of Re~enue. (Section 703 of the Inheritance and Estate Tax Act of 1961.)
Late of
Cumberland
Pennsylvania
Cumberland
} AFFIDAVIT OF
EXECUTOR
~~N!(5XIK~
IN THE MATTER OF THE EST A TE OF
BURR B. BROOKS.
(STATE FULL NAME OF DECEDENT)
County
County of
},
State of
&l1\l~Xrx.t){rX
Caroline Z. Brooks
Executor
of the estate of the above-named decedent being duly sworn, depose
and say
Decedent died
May
10
, 19~{;;~leaVing a lost will, copy of which is hereto attached. }
( YEA R) !C
(MONTH)
Name and address of attorney or }
other outhorb::ed repres,entotive to whom
all correspondence should be moiled.
(DAY)
James R. Humer
1 W. High St., Carlisle, PA 17013
That as such Executrix deponent is familiar with the affairs of said estate and the property constituting
(EX ECU TO R-ADMINIST 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 following: -
NAME AND ADDRESS OF BANK OR OTHER INSTITUTION THIS SAFE DEPOSIT BOX RENTED RELATIONSHIP OF JOINT
IN WHICH DECEDENT RENTED A SAFE DEPOSIT BOX IN NAME OR NAMES OF HOLDERS TO DECEDENT
None
That the contents of said safe deposit box or boxes are itemized under Schedules N/ A of this return,
wi th the exception of the following, for the reasons hereinafter set forth:
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 pos ses sion, s tanding 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-
cedl~nt; 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
clai ms due and owing decedent at the time of death, and all promis sory note s 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 securjties 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 liabili ties
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 t'1ere is annexed to
said schedule, financial statements showing the assets and liabilities of said co-partnership or business.
A copy of the co-partnership agreement, (if oral, a statement setting forth the nature of the agreement)
together with a statemc,nt setting forth the character of the business, its location, and such other facts
pertaining to the business as may be pertinent to a fair and just appraisal of the decpdent's interest
therein must be submitted. It should also SGt forth in itemized form, together with the fair market value
thereof, any other property owned or bequeathed by the decedent at the time of death.
The Schedule C attached hereto and made part hereof sets forth a true answer to each inquiry
contained therein and in the case of transfers of property, real or personal, within two years of decedent's
death, in contemplation of decedent's death, or intended to take eft'ect 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 effect in j)ussession or enjoyment at or after death, there is also attached to the sclHHlule 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 pa~ses at decedent's death by
virtue of the exercise by decedent, either individually, or jointly with another, or any power of appoint-
ment vested in decedent, either individually or jointly, by the will, deed, or other instrwnent of another,
with a copy of the instrument 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' 5 death of all minors, annuitants and beneficiaries for life under decedent's Will. It also
contains a statement showing which of the beneficiaries named in the decedent's will, if any, died prior
to decedent, the dates of their death, their issue, and the relationship of such issue to the beneficiary.
That Schedule E attached hereto and made a part hereof sets 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 effecting the vesti ture of
real estate and the date of acquisition of personalty, plus the name, address and relationship, if any,
of CO-OWTlETS 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 fe(~s 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 nnpaid 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 cl aiming 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", "C", "E", and "F" as directed therein,
have been carried forward and properly registered in the Summary.
Subscribed and sworn to before me this ...If!d........
...........................11..
...........~
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8.? .....A.?p.~. 'f......P...~......~..,......R.,..P...,.. 2.......................................
(Street Number)
~.~ } i .....~.9..~.+..~n.g......~.p.r.!.ng.~.."."..P.A.....l..7..Q.O (......................
{-ly ,:". .; -,jO:l E:-: ;'C'. J';~ ";P' (City or Town and State)
NOTE: Bef~~~\i~ning ~}?i~4~~ft;~I\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 family corporations or an interest in any co-partnership or business, that the
data and statements re'1uireft 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.
day of~Pr.U..Clr..Y.,.................... 19...7...Q.....
'1 ~7 g
.....~.......C~..........
RC<:;,.34 \4-13)
COMMONWIEAL TH OF PENNSYLVANIA
DEPARTMIENT 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
os 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 liE.")
The real prClperty located In the Commonwealth of Pen.nsylvanla should be
described b:f lot and block number, street and street number, together wi th
a general dElscrlptlon 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, assE/ssments, accrued Interest on mortgages, etc.,are
to be listed on Schedule ifF" and must not be deducted from this schedule.
(I)
(2)
(3\
DEPARTMENT
VALUATION
CAUTION
(Do not wr Ita
In this spaca)
ASSESSED VALUE
FOR YEAR OF
DECEDENT'S
DEATH
ESTIMATED
MARKET VALUE
House and lot of ground being Lot No. 88
of Plan of Sec. B of White Rock Acres,
Monroe Township, Cumberland County, Pa.,
being improved with dwelling No. 88 Asper
Drive.
For chain of title see deed from Cleason
C. Cromer et ux to Burr B. Brooks dated
4/5/71 and recorded 4/8/71 ln Cumberland
County Deed Book 24 "A" 543
....-
11,460.00.... 45,840.00
Insert this totol opposite "real property", Schedule "A" in the X X X X X
"As Reported" column on the last page of this return.
45,840.00
I i .-
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S q c . ()0
RCC -:';(5
RESln~K~ DECEDENT
SCHEDULE "B"
PERSONAL PROPERTY
COMMONWE,\LTH OF PENNSYLVANIA
TRANS~i'ER 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 wi th 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 certiricates, 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 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
MARKET VALUE
DEPARTMENT VALUATION
(Do not write in
this space)
1
2
3
4
5
1975 Chev. Impapa 4-dr. Sdn, AT, AC
1974 VW Station Wagon, AT
Homemade trailer
304 Sh. Penn Central Company
Industrial Valley Bk. & Tr. Co., 6%
Sub. Debenture due 12/1/80,
Ctf. No. X072452 for 190.00
2 3125
1.--.
2500.00 ;:::
2000.00/
100.00 -/'
703.00.,........
190.
v
190.00~
Insert this total opposite "Personal Property", Schedule "B" in
the "As Repo rted" column on the las t page of this return.
x X
5493.60
s '-{ ,:\
G '-)
RCC.- 3b
COMMONWEALTH OF PENNSYLVANIA
TRANSFE1{ INHERITANCE TAX
SCHEDULE "c"
TRANSFEIlS
11ESIDE~T DECEDENT
(1) Did decedent, wi thin 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) No
(2) Did decedent, wi thin two years of death, transfer property from himsel f to himsel f and another or
others (inclwUng a spouse) in joint ownership? (Answer yes or no) No
(3) I f the answer to (1) or (2) above is in the affi rma ti ve state:
(a) Age of decedent at time of transfer N/ A
(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 subject to his power of disposition? (Answer yes or no) No
(b) What was the transferee's age at time of decedent's death? N / A
(5) Did decedent in his lifetime 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 fact end before his death:
(a) The possession or enjoyment of or the right to income from the property transferred?
(Answer yes or no) No
(b) The right to designate the persons who shall possess or enjoy the property transferred or
income therefrom? (Answer yes or no) No
(6) If the answer to (5) (b) above is in the affirmative, state whether the right was reserved in decedent
alone or others N I A
(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, transfer property, the beneficial enjoyment of which was subject to change,
because of a reserved power to alter, amend, or revoke, or which could 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) No
NOTE 1: The anSwers to these questions should be supported by affidavit by the attending physician as
well as a copy of the death cenificate.
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-
fers are claimed to be non-taxable, also submit detailed statement of facts on which said claim is based.
NOTE 3: List applicable property below in manner in which provided in Schedules A, B, or E.
ITEM
DESCRIPTION
MARKET VALUE
(Es tima ted)
DEPT. VALUATION
(Dept. Only)
None
Insert this total opposite "Transfers", Schedule "C" in the
"As Reported" column on the last page of this return.
None
N (j-v--,,-_
RCC-37 (12-63)
COMMONWEALTH OF PENl"SYYLANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "D"
BEr\EFICIARlES
\
h
BENEFICIARIES AND ADDRESSES RELA TIONSHIP! r i
(If step-children or ! SUR" IVED I DATE INTEREST OF
State full names and addresses of all who illegitimate children I DECEDENT OF BENEFICIARY
aye an interest. vested, contingent or other- are involved, set I STATE YES BIRTH IN ESTATE
wise. in estate) forth this fact.) OR NO
Caroline Z. Brooks Wife Yes 3/14/30 Entire Estate
88 Asner Drive. R.D.2
I
Boiling Springs. FA 17007
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Deponent further says that all the above-named beneficiaries are living at this time except below:
-----
NAME DATE OF DEATH RESIDENCE
NOne
---~
----
I '0'__.'.._-----
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, owned by the (lecedent jointly
wi th another or others, including intangibles, standing in the name of' the decedent and others. List
real estate f'irst. liS entireties, or joint tenants, giving brief' description, as indicated Imder Schedule
"A", plus the date lind 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 in
Schedule "B", plus date of' acquisition, and the name, address and relationship (if any) of' co-owners to
the dece,ient.
Description of Property, Date of' Acquis ition, Name Unit percentage Es tate DEPARTMENT VALUATION
Address and Relationship of Co-Owners, and Place Value Sh are Val u ation CAUTION-Do not Write
of' Recore! of Instrument, where Real Es tate. In This Space.
iii Value of Value of
Entire Deceden t's
Property Interest
Burr B. Brooks and Caroline Z. Brookb as enants bIT th e en ireties
Dauphin Deposit Bank, Ck. Ac ct. N/ A
Dauphin Deposit Bank,Sav. Ac ct. N/ A
N U'v~'
Insert this to tal opposite ",Jointly Owned Property", Schedule "E"
in the "As Re JOrted" column on the last page of this return.
R E V-S 18 (8-781
COMMONWEAL TH 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
Caroline Z. Brooks
88 Asper Drive, R. D. 2
Boiling Springs, FA 17007
(Executor or Administrator)
In Re: Estate of Burr B. Brooks, Sr.
Cumberland
County - File No. 21-78-0262
Dear Mrs. Brooks:
You are hereby notified that the OriginAl
appraisement in the estate of Burr B. Brooks, Sr.
has been filed in the office of the Register of Wi lis of Cumberland
County on May 9 , 19.22., Said appraisement reflects the following
valuations:
Real Estate
Personal Property
Transfers
Jointly Owned
Total
4'5,840.00
5.493.00
None
None
$51,333.00
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;
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. 37~.("~;
Dote
May 9, 1979
Signed
Title
Administrative Officer
--_._----,_._-~-
Note: This is not a bi II.
F!U~ ,'In,
Ma~ 9, ~279 ~~_~...
Cumberland
21-78-0262
REV-457 (8-78)
DEPARTMENT OF REVENUE
BUREAU OF FIELD OPERATIONS
P.O, BOX 2970
HARRISBURG, PENNA. 17105
COMMONWEALTH OF PENNSYLVANiA
RESIDENT INHERITAf\ICE TAX
APPRAISEMENT
DATE
COUNTY
Whereas, Burr B. Brooks. Sr. late of Monroe Townshi~ ,__
in the County of Cumberland ~_ Commonwealth of Penmybania. -;\c,d en
the _ lOth day of May 19 ...za, seized and possessed of i".,'l e5': t<,
subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania;
Therefore, I, Leo Fulg:initi ,an appraiser duly apoointed to
having been designated to make a fair and conscionable appraisement of the said estate, and to a<:..ssss d[k~ t); ~(l;~ C;1'
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 r1eirs of U'll) de.ced2nt afL.';r U~,:: '::;<oj(Jtion
of any estate for life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer inher:tance taxes at ttle '3'.;vL,1 ]'_eCoi
rate on any such future interest.
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for !n;lerit3rl.U
Puror_sE--S
Ff1()l1lAT. A~RF.Ff1~
-I UNIT I
I VALUES.
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DESCRIPTION OF ASSET
Real Pr,opertv
Personal Property
Transfers
Joint-Held Property
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Hav,e been duly sworn according to law, I do hereby ge~tify that the above appraisement is made in conformity
wi th the law on this 9th day of . "< ,'" '> - May. 1 S ..:a...,
P-ppnl:;sf
(Number and Street)
Harrisburg
Penna.
(Post Office)