HomeMy WebLinkAbout04-09-79
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COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
*
.
RESIDENT DECEDENT
COUNTY OF CUMBERLAND
IMPORTANT,
This return must be completed in det.ail and hied 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'\tenue. (Section 703 of the Inheritance and Estate Tax Act of 1961.)
IN THE MATTER OF .THE ESTATE OF
} AFFIDAVIT OF
EXECUTOR
ADMINISTRATOR
. HENRY J. LODEK
(STATE FULL NAME OF DECEDENT)
Late of
CUMBERLAND
PENNSYLVANIA
CUMBERLAND
J ."'
County
State of
County of
JANET A. RHINEHART
Executor
Administrator
of the estate of the obove6named decedent being duly swom, depose
. and ~ay
Decedent died
April 26
, 19~.ltes.trite leaving a last will, copy of which is hereto attached.,}
(YEAR) ~!MH)!:!HX .
(MONTH)
(DAY)
Nome and address of attorney or }
other authorized representative to whom
011 correspondence should be mailed.
James E. Reid, Jr.
P. O. Box 966, Harrisburg, Penna.
17108
That as such Adrninistratt~ponent is familiar with the affairs of said estate and the property constituting
(EX ECUTOR-ADMINISTRA TOR>
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, ~r 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 S..I,FE DEPOSIT BOX
THIS SAFE DEPOSIT BOX RENTED
IN NAME OR NAMES OF
RELATIONSHIP OF JOINT
HOLDERS TO DECEDENT
NON);:;
Th.at the contents ~f 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 fnlly 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 b90k and p~ge of record thereof. It also sets forth in the
columns provided therefore the assessed ,-,:aluation 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 ~he case of savings ba":ks, and to the date of decedent's death in all other cases; all bonds, postal
savings, treasury certificates or note5! and other evidence of. indebtedness of the United States. to the de..;
cedeot; all obligations, whether by statute or agreement they are designated as tax free, of the.Hnj~ed SJat.es,
or any state, o~ politic;1 subdivision thereof, or of any foreign country, which are owned a'-the time~f de~t~;
.all wearing apparel, jewelry, silverware, pictures, books, works of art, household furniture, horses, ca-rriages,.
automobiles, boats, and any and all other personal chattels of whatsoever, kind or nature, left"-::-:~y decede~t:,-
together with the fairly; estimated market value thereof; all bonds and mortgages held by dec~edent and.of ail
, / ., '
claims due and owing decedent at the time of death, and all promissory notes or other-instruments .in .~rhing
for the payment of money of w.hich decedent died possessed., of whatsoever nature, with interest thereon, if
any, giv.ing 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 o~ 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.
/ -
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. .
In the case of securities of' close or :family corporations, the values reported are as far as
possible substantiated by financial statements 01'- 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 1s annexed to
said schedule, financial statements showing the assets and liabilities of said co-partnership or ~usiness.
A copy of the co-partnership agreement, (if oral, a statement setting forth the nature of the agreement)
together with a statement 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 decedent's interest
therein must be submitted. It should also set 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 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 effect in possession or enjoyment at or after death, there is also attached ~o the schedule a cony
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 decedent, either individually or jointly, by the will, deed, or other instrument of another,
with a copy of the instrument creating such power attached to the schedule.
That SChedule 0 attached hereto and made part hereof sets 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, i~ any, died prior
to decedent, the dates of their death, their issue, and the relationship of such issue to the beneficiary.
That Sc~edule 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 vestiture 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;
f'amily exemption, where applicable; costs of administration of this estate; counsel fees and f'udiclary's
connnissions paid or to be paid; cost expended for burial trusts, tombstones or gravemarkers, and reli-
gious services, in consequence of the death of the decedent; debts and claims owing and unpaid at time of
death; taxes accrued chargeable for period prior to decedent's death (except those allowed under Section
651 of the Inheritance and Estate Tax Act); together with a statement of collateral pledged for obliga-
tions, if any. It is agreed that the fiduciary will present proof of said claimed obligations upon re-
quest, that if the amount actually paid in settlement of any ~ee, 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", "en, "E", and "F" as directed therein,
have been carried forward and properly registered in the Summary.
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Subscribed and sworn to before me this ...
"'7"'\lt-"J day of M
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NOTE: Before\slgning affidavit make sure all blank spaces in the affidavit and schedules annexed are
filled in with details or the word "None", 3.nct 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 requirerl under the paragraph above relating to Schedule "B" are attached. Also make
certain that column #1 in the "Summary" has been properly completed 6.S above-directed.
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RCC-3'J1. [4,,;13)
.eOM/lONWE,.I.l:TH"OF I>ENNSYLVANIA
DERARTMENT 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 tenonts with right of surviorship or tenancy by entireties should be reported on Schedule "E.")
The ,eal property located In the Commonwealth of Pennsylvania should be
described by lot and block number, street and street number, together with
a general descriptio" of the property, with Co reference '0 ,he record of the
conveyance by which the decedent took title; If a farm state number of a-
cres; also statement of mortgage encumbrances upan each parcel at death
of decedent. Taxes, assessments, occrued Interest on mortgages, etc.,are
to be listed on Schedule llF" and must not he d.educted from this schedule.
(1)
ASSESSED VALUE
FOR YEAR OF
DECEDENT'S
DEATN
NONE
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.
(2)
(31
DEPARTMENT
VALUA TION
CAUTION
(Do not write
In thl. spoce)
ESTIMA TED
MARKET YALUE
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RCC'-35
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COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "B"
PERSONAL PROPERTY
INSTRUCTIONS: This Schedule must disclose all tangible and intangible personal property owned individually
by the decedent, at the time o~ his death. Property owned by the decedent jointly with another or others
must be listed under Schedule "En. Intangible personal property, titled 1n 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 acconnts, 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 riduciary in said capacity, partnership interests, interest in any undistributed
estate or or income rrom any property held in trust under the will or agreement or another, even though
located outside of the State, at the time or death, should be listed in this schedule.
Item
No.
ITEM
List and describe fully
UNIT
VALUE
DEPARTMENT V ALUATIO N
(Do not write in
this space)
ESTIMATED
MAI\KIIT VALUE
Dauphin Deposit Bank & Trust Co.
Savings Account No. 1685068
\ )~<e,;,.to
1,263.03
Dauphin Deposit Bank & Trust Co.
Checking Account
3.37
1971 Barrington Trailer
12' x 60' including furnishings
4,000.00
Insert this total opposite "Personal Property", Schedule "B" in
the "As Reported" column on the last page of this return.
Ci,266.~
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
HARRISBURG
17127
RC ~43 (6-74)
NOTE: TO BE SUBMITTED IN TRIPLICATE
REPORTING FINANCIAL INS1'ITUTION
ADDRESS
Daupll4& DepeDit 'P~"1k 8< 'l'ftat
$528 Carl1ele Pike
M..nh..ni"....'rg. p.>. '70~$
INHERITANCE TAX DIVISION
GIl.
Pennsylvania Department af Revenue
Bureau 01 County Collections
G.'ble Building, 3rd, Floor
411 S. Second Street
Harrisburg, Pennsylv.ni. 17127
ZIP CODE
170SS
Pursuanlta Section 742, Pennsylvania Inheritance and Estate Tax Act of 1961, we
herewith submit the following report:
ACCOUNT NO. OF JOINT, TRUST OR
INVESTMENT DEPOSIT 1.6-85663
NAMES ON ACCOUNT OR
INVESTMENT
1t-t7 J, Wilt Dr Ed1tb V lMM. (d61l11 &-.G6-14)
DATE OF DEATH
April 26,1<118
DECREASED JOINT DEPOSITOR, TRUSTEE
OR INVESTOR Henri J. LodOk
ADDRESS 6~~n <>>~lble P-1k4t
>>ecbeJl1 <ls"'?g. Pll..
COUNTY Cmab,,"laM
ZIP CODE l\'lO"!>
SURVIVING DEPOSITOR,
BENEFICIARY OR INVESTOR
Nane
ADDRESS
RELATIONSHIP TO DECEDENT
DATE DEPOSIT OR INVESTMENT
WAS ESTABLISHED
Hay 12,lf7A
BALANCE, INCLUDING INTEREST
DUE,AT DATE OF DEATH $ 1.Ze).62
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-SIGNATURe~
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/' RCC~ 36
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
*~
HESIDENT DECEDENT
SCHEDULE "c"
TRANSFERS
(1) Did decedent, within two years of de nth, make any transfer of any material part of his estate, without
receiving Ii valuable and adequate consideration therefor? (Answer yes or no) no
(2) Did decedent, within two years of death, transfer property from himself to himself and another or
others (including a spouse) in joint ownership? (Answer yes or no) no
(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' 5 heal th at time of making the trans:fer. (Note 1).
(e) Cause of' decedent' 5 death. (Note 1).
(4) Did decedent, in his lifetime, make any transfer of property without receiving a valuable or adequate
consideration therefor which was to take effect in possession or 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)
(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 possess!on 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
(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) nil
(8) Did decedent, at any time, transfer property, the beneficial enjoyment of which was subject to change,
because of a reserved power to al tel', amend, or revoke, or which conld 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 0 I' 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 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-
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.
no
ITEM
MARKET VALUE
(Es Urns tell)
DEPT. VALUATION
(Dept. Only)
DESCRIPTION
NONE
Insert this total opposite "Transfers", Schedule "C" in the
"As Reported" colunm on the last page of this return.
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DEED OF GIFT
KNOW ALL MEN BY THESS PRESENTS, THAT I, EMMA MARIE REEVES,
a/k/a MARIA EMMA REEVES, of 701 Winton Street, Philadelphia,
Pennsylvania 19148, named as beneficiary of the residuary
estate of my late uncle, HENRY J. LODEK, who died testate,
on April 26, 1978, and whose estate is being administrated
---
- ..---
in accordance with law in the Courts of the County of
Cumberland, Carlisle, Pennsylvania, and who also being named
as beneficiary of Prudential Life Insurance Company of
America Policy No. M6347.823 and POlicy No. 540.606886, on
the life of said Henry J. Lodek, do hereby transfer and give
unto Janet A. Rhinehart of 6820 Carlisle Pike, Mechanicsburg,
Pennsylvania, all of the assets of said estate bequeathed to
me pursuant to the Will of the late Henry J. Lodek, and the
proceeds of said life insurance policies set forth hereinabove,
in consideration of the advances of sums of money by Janet
A. Rhinehart to pay expenses and bills of the estate and in
~ further ~ consideration ~o.f the care which she gave to my
uncle, the late Henry J. Lodek, during his lifetime.
WITNESS:
~ )M_A'~.~ (SEAL)
Emma Mari: ~e~s,
a/k/a Maria Emma Reeves
Sworn.to and subscribed
before me this 20th day of
MaY
My
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NOtary,Pv~lic.~ P~~Phl~rftnidelphia (A
Wl!.rm~~;~. iliilAo)8
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RC'C-37 (12-63)
COMMONWEALTH OF PENNSYYLANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "D"
BENEFICIARIES
BENEFICIARIES AND ADDRESSES RELATIONSHIP SURVIVED
(If step.children or DATE INTEREST OF
State full nameS and addresses of all who illegitimate children DECEDENT OF BENEFICIARY
ave an interest, vested, contingent or other are involved, set STATE YES IN ESTATE
wise, in estate) forth this fact.) OR NO BIRTH
EMMA MARIE REEVES,
ajk/a MARIA EMMA REEVES NIECE Yes of age Deeaea DY Deed oT
Gift to Janet A.
Rhinehart, a copy
of which is attache
hereto.
I
.
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.
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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
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Real Property
Personal Property
Transfers
SUMMARY
.......(Sch. "A")
.. ..................... ........................(Sch. "B")
....................(Sch. "C")
Gross Taxable Estate.
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(As Reported)
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(2)
(As Determioed)
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-COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "E"
JOINTLY OWNED PROPERTY
"-.
INSTRUCTIONS: TIl.ts schenule must disclose all property, real and personal, owned by the necedent Jointly
wit.h 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 der:edent.
Description of Property, Date of Acquisition, Name
Address and Relationship of Co-Owners, and Place
of Record of Instrwnent. where Real Estate.
Unit
Value
percentage
Share
Estate
Valuation
DEPARTMENT VALUATION
CAUTION-Do not Write
In This Space.
Value of Value of
Entire Decedent's
property Interest
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xX
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NONE
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Insert this total opposite "Jointly Owned Property", Schedule "Elf
in the "As Reported" column on the last page o~ this return.
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF FIELD OPERATIONS
P.O. BOX ~70
HARRISBU RG
17105
IN YOUR REPL Y F'L,EASE
REFER TO
REV..S1a (B"7B)
Inheritance Tox Division
NOTICE OF FILING pF APPRAISEMENT
Janet A. Rh~nehart
6820 Carlisle Pike
Mechanicsburg, PA 17055
(Executor or Administrator)
In Re: Estate of
Henry J. Lodek
Cumberland
County - File No. 21-78-0275
Dear Mrs. Rhinehart:
You are hereby notified that the original
appraisement in the estate af Henry J. Lodek
has been filed in the .office of the Register of Wi lis of Cumberland
County an Apnl 9 , 1922-, Said appraisement reflects the following
valuotions:
Real Estate
Personal Property
Transfers
Jointly Owned
Total
None
5,286.99
None
None
$5,286.99
As to such tax that is paid within three months from date of death, a five (5%)
percent discount is allowable. As to ony 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 deoth accurred prior to December 22, 1965) from date of death,
interest ot the rate of six (6%) percent per annum is chorged.
Any party in interest who is aggrieved by this notice moy 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.
'--<\ \'c ".
Date April 9,1979 Signed r-J.Q.:z:::, \~~
Title Administrative Officer
Note: This is not a bill.
c.
R~V-457 (S-7S)
DEPARTMENT OF REVENUE
BUREAU OF FIELD OPERATIONS
P.O. BOX 2970
HARRISBURG. PENNA. 17105
DATE
COUNTY
FILE NO.
Abril 9. 1979
Cumberland
21-78-0275
COMMONWEALTH OF PENNSYLVANIA
RESIDENT INHERITANCE TAX
APPRAISEMENT
Whereas, Henry J. Lodek late of Hampden Township
in the County of Cumberland Commonwealth of Pennsylvania, having died on
the 26th day of April 19 2!!..., seized and possessed of an estate
subjeCt to Inheritance Tax under the laws of the Commonwealth of Pennsylvania;
Therefore, I, Leo Fulginiti ,an appraiser duly appointed according to law,
having been designated to make a fair and conscionable appraisement of the said estate, and to assess and.fix the cash
value of all annuities and life estates growing out of said estate, hereby file the following appraisement:
In the event that any future Interest In this estate is transferred in possession or enjoyment to collateral heirs of the decedent after the expiration
of any estate for life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance taxes at the lawful collateral
rate on any such future interest.
DESCRIPTION OF ASSET
UNIT
VALUES
AppraIsement
Made for Inheritance
Tax Purposes
Real Pro crt
$
None
Personal Pro erty
5.286 99
Transfers
None
Joint-Held
None
TOTAL ASSETS
5,286 99
Have been duly sworn accordio~ to law, I do hereby cectify that the above app;aisemen.t is made in conformity
with the law on this . ~ Ii day of ~ r--" ^ kpn 1 19 .:J!L.
ri-Q;;::-, \. ~\(--s~
U Appraiser
(Number and Street)
Harrisburg
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