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RCC.33 (4-73)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
IMPORTANT,
COUNTY OF CUMBERLAND
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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 ~eath, unless an extension is granted
by the Secretary of Re'ienue. (Section 703 of the Inheritance and Estate Tax Ait of 1961.)
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RESIDENT DECEDENT
IN THE MATTER OF THE ESTATE OF
".J
""PlIl~I~
AFFIDAVIT OF
ELLA M. MILLER
{STATE FULL NAME OF DECEDENTl
EXECUTOR
Late of
Cumberland
State of
Pennsylvania
Cumberland
} 55,
County of
CHARLES J. EUSEY
Executor
~
of the estate of the above-nomed decedent being duly sworn, depasel and s~yl :
April 25 7~ I }
. 19 testate leaving a lost wlll, copy of which is hereto attached.
lMONTHl [DAY) (YEAR) intestate I
Nome and address of attorney or } CHARLES J. EUSEY
other authorized representative to who~ 720 Museum Pa. 19611 I
all correspondence should be moiled. Rd., Reading,
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of said estate and the property constituting
Decedent died
That as such executor deponent is familiar with the affairs
I EXECUTO R.AOMINISTRA 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
IN WHICH DECEDENT RENTED A S....FE DEPOSIT BOX
,
THIS SAFE DEPOSIT BOX RENTED
IN NAME OR NAMES OFI
RELATIONSHIP OF JOINT
HOLDERS TO DECEDENT
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under scledules
That Scheclule A attached hereto and made part hereof sets forth fully and in detail all the real property
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in the Commonwealth of Pennsylvania of which decedent died having an interest therein. It also sets forth the
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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 thetei;lf. It also sets forth in the
columns provided therefore the assessed valuation of each of said parcels, the, eJtimated market ~alue thereof
as of date of death of decedent. . . I
That Scheclule 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 JJy 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 ~'~~pers'ons
giving also separately the accrued interest thereon. if any. down to the last interest day P!.i~,.io .(I~c;d~tfl':s,~.
death in the case of- savings banks; and to the date of decedent's death in all dther case~~ ;f1"6_~rtds, postVa.f;:'/
I ....,.' __
savings, treasury certificate-s or. notes and other evidence of indebtedness of the Uniteil Sta-t~s to the de- ,.
cedent; all obligations, whether by statute or agreement they are designated as tJx free, 01' .the United. States. ....;.
or any state, or politic~l subdivision thereof, or of any foreign country, which ar~ owned ~t1he_ t~me of death;
all wearing apparel. jewelry, silverware, pictures. books. works of art, household furniture.~hor-ses-, carriages.
automobiles. boats, and any, and all other personal chattels of whatsoever. kind or nature,-1e~t by decedent,
together with the fairly,_ estimated market value thereof; all bonds and mortgages held by decedeilt 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 natJre, with intere~t thereon, if
any. giving the face value and estImated. fair market value thereof, and if such e~timated fair,market value be
less than the face value, it sets forth briefly the reasons for such depreciationl as to ea~h item; all moneys
payable to the estate from life insurance policies carried by decedent; all annuity and endow!,"ent contracts
the proceeds of which were payable upon the death of the decedent; all and the cdrporate stocks and dividends
due thereon and unpaid as of the date of death. bonds and accrued interest therJon to the date of decedent's
death and other investment securities ow~ed by the decedent at the time of death'l with the.market value there-
of at such time.
with
That the contents. of s.sid safe deposit box or boxes are itemized
the exception'of the following, fo~ the_. reasons hereinafter set forth:
of this return,
. .
In the case o~ securities of close or family corporations, the values reported are as far as
possible substantiated by financial statements of the corporations, showing the assets and liabilities
thereof as of the date of death. The.schedule also sets forth the interest of decedent at the time of
death in any co-partnership or business, and in support of the value of such interest there is annexed to
said schedule, financial statements showing the assets and liabilities of" said co-partnership or husiness.
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 tftke ef'fect 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 to the schedule a cORY
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 passes 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, if any, died prior
to decedent, the dates of their death, their issue, and the relationship of such issue to the beneficiary.
That S~hedule 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 deceden t.
That SChedule F attached hereto and made a part hereof sets forth fully and in detail all debts
and deductions claimed for and on behalf of this decedent's estate, including funeral expenses paid;
family exemption, where applicable; costs of administration of this estate; counsel fees and 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 Impaid at time of
death; taxes accrued chargeable for period prior to decedent's death (except those allowed under Section
651 of the Inheritance and Estate Tax Act); together with a statement of collateral pledged for obliga-
tions, if any. It is agreed that the fiduciary will present proof of said claimed obligations upon re-
quest, that if the amount actually paid in settlement of any fee, commission or debt is less than the
estimated amount claiming and allowed, that the same will be reported to the Register of Wills, and that
the amount of tax assessed can be reassessed in accordance therewith.
That the totals of the appropriate columns in Schedules "A", "B", "en, "E", and "F" as directed therein,
have been carried forward and properly registered in the Summary.
Subscrilied an.:;i's%m to before me this ",~.~.!:E:,.""".".",
-< ~w"'~ ..........."~.,:..
i......:.:t~tf"~.....",l~....!~,,.,.,',
- ~'1\. NOTARY PUBLIC
My Commission~Expires July 19, 1980
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,.,,,"??'Q__tl.~.s..."'.w.n_JJ,Q,;g!..........__......,,,,....,,,,_..._..._.._.-
(Street Numbl!1')
_1.<.':.":~,~~~L!.":.:.~~~~~
(City or Town and State)
NOTE: Before signing affidavit 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 required 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.
. .
Real property in Pennsylvania, with statement of mortgage encumbrances upJn each parcel at death of dece-
dent. Property held by the decedent as tenant jn common with another or othfr, should be identified
as to quantum of interest and the estimated value should be that of the deced,ent's interest only. (Property
held as joint tenants with right of surviorship or tenancy by entireties shouldl be reported an Schedule "E.")
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(1) (2) (31
DEPARTMENT
VALUA TION
CAUTION
(Do not WI It.
In this apace)
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RCC-34 (4-73)/
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
TRANSFER INHERITANCE TAX
RESIDENT DECEDEN1'
SCHEDULE "A"
REAL PROPERTY
The teol property located In the Commonwealth of Penflsylvanla should be
descrIbed by lot and block number, street and s'ree' numher, together with
(I general description of the property, with a reference to the record of the
conveyance by which the decedent took tltlo; If (I form state number of a..
eres; also statemefl' of mortgage encumbrances upon each parcel at death
of decedent. Taxes, a..essments, accrued Interest on mortgages, .fc.,are
to be listed on Schedule "Fit and must not be d.educted from this schedule.
ASSESSED VALUE
FOR YEAR OF
DECEDENT'S
DEA TN
NONE
Insert this total opposite "real property", Schedule "A" in the X X X X X
"As Reported" column on the lost page of this return.
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ESTIMATED
MARKET VALUE
INSTRUCTIONS: This Schedule must disclose all tangible and intangible personal property owned individually
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by the decedent, at the time of his death. Property owned by the decedent jointly with another or others
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must be listed under Schedule ftEn. 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. uJ S. Savings Bonds and tenta-
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tive trust accounts, must be l,isted, despite the f'act that they are not of tne administered estate.
Tangible personal property should be listed first (e. g. jewelry,1 wearing apparel, househo.ld
goods, and furnishings, books, paintings, automobiles, boats, etc.) _ I
Intangible personal property, such as bonds, treasury certificates, cash on hand and in bank,
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stocks, mortgages, notes, together with accrued interest or dividends, salar~e~ or wages, insuranc: pay-
able to the estate or fiduciary in said capacity, partnership interests, interest in any undis tributed
,
estate of' or income 'from any property held in trust under the will or agreement of another, even though
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located outside of the State, at the time of death, should be listed 1n this schedule.
,
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ESTIMATED
,
llAIIXEr VALUE
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RCC -35 '
CO~~IONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "Bn
PERSONAL PROPERTY
Item
No.
ITEM
List and describe fUlly
UNIT
VALuE
1. Furniture stored at the home of William Alspaugh,
~. ~ 36- I Street, Carlisle, Pennsylvania--
,chest of drawers - $30.00; desk-$40.00; and
cloth covered chair $15.00.
85.00
2.
Life Insurance Policy payable to the Estate with
The Prudential Insurance Company of America,
Policy no. 61679538
1,lBL16
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27,7t.56
235.20
3.
Trust Account with Farmer's Trust Company,
Carlisle, Pennsylvania.
4.
Medicare Payment.
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~nsert this total opposite .Personal Property., Schedule .Bn in
Jhe ftAs Reportedft column on the ~ast page of this return.
x X 29,1195,92
1/
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DEPARTMENT VALUATION
(Do not write 1n
this space)
v
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V 23'.':>.'-0
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RCC-36
CL1MMOXWEAIlfll OF I'ENNSYLVANI A
Tf\ANSFEI\ INHEI\ITANCE TAX
SCHEDlILE "c"
TJH:;~FEnS
ITEM
DESCRIPTION
,
MARKET jVALUE
(Es Uma ted)
,
Insert thls total oppo~lte "Transfers", Schedule "e" 1n the
"As Reported" column o.it/"the 1 fiS t 'page of' this return.
.
DEPT. VALDATION
(Dept. Only)
N~
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I RCC-37 (i2-63)
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l'OMMONWEALTII OF PENNSYYLANIA
irRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "0"
BENEFICIARIES
I RELA TraNSHIP I
I BENEFICIARIES AND ADDRESSES (If slep-children or SURVIVED DATE INTEREST OF
'State full names and addresses of all who illegitimate children DECEDENT OF I BENEFICIARY
I , ' t h STATE YES
aye an Interest, vested, contlngen or ot er are involved, set IN ESTATE
I wise. in estate) forth this fact.) OR NO BIRTH
,
Juline W. 'Alspaugh , I
wife of nephew yes 7-24-31 Five percent of residue
I 36 H. Street 1
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I Carlisle, Pa. 17013 I
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I 2-2-01\
dna Alspaugh sister no Ten percent of residue
I 125 E. Luther Street I
l Carlisle, Pa. 17013 " I
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"IT" _, _ ~o"onrh' ,~"" 'er yes I Ten percent of residue
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hurch
110 Belvedere Street \
I ~arli~le Pa. 17011 I
\
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I of Seventh- I Remainder of residue
eneral Conference yes
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ay vent~sts
I 6840 Easte~n Avenue N.W. I
I Washington, D. C. 20012 I
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nbponent further says that all the above-named beneficiaries are living at this time except below:
,
NAME
DATE OF DEATH
RESIDENCE
EdJa Als au h
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Lo1 ther
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S t. Carlisle
Pa. 17 13
25 E.
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SUMMARY
..... ............................. .....(Sch. "A")
... ...... ...........(Sch. "B")
.. ........ .... ............... ...........(SCh. "C")
Real Property
Personal Property
Transfers
Gross Taxable Estate ....
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(1)
(As Ra8:'l1Bd)
$..
$. ..29,).9~,92
00.00
$....
$..
$.. .
$.. 29,195.92
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(2)
(As Determined)
$
$.
$.
$
$.
$
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INSTRUCTIONS: This schedule must disclose all property, real and personal, owned by the decedent jointly
wi th another or others, including intangibles, sta.nding in the name of' thb decedent and others. List
real es ta te fi rst, as en tire ties, or joint tenants, giving brief descriPtion,1 as indica ted nncier Schedule
"An, plus the date and place of record of instrument ef'fecting vestiture, but do not include entireties
or out of state real estate value in estate valuation column. Personal proberty should be listed as 1n
I
Schedule "Bn, plus date of acquisition, and the name, address and relationship (if' any) of' co-owners to
the deceden t. I
Description of Property, Date of Acquisition, Name un! t percentage Est'ate
Address and Relationship of Co-Owners, and Place Value Share ValuJtion
of Record of Instrument where Real Estate. I
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RCC-3B
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "E"
JOINTLY OWNED PROPERTY
NONE
Insert this total o~posite "Jointly Owned Property", Schedule "E"
in the" As Reported" colunm on the last page of this return.
DEPARTI.tENT VALUATION
CAUTION-Do not Write
In This Space.
Value of Value of
Entire Decedent's
~r~perty Interest
N~
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I RCC-" '''68)
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'Estate of MILLER
I (Last Name)
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SUMMARY
{j ~. ... '
(Initial)
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DATE OF DEATH 4+25-78
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FILE NO. 21-78-279
ELLA
(First Name)
M
. REPORT OF INHERITANCE TAX APPRAISER I
I, the undersigned duly appointed Inheritance Tax Appraiser in and for the County of .
Pennsylvania, do respectfully report that I have appraised the real and personal property ~s 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:
0/-/'1, - 7~
~L k, .j~~
INHERITANCE TAX APPRAISER
I
REPORT OF THE REGISTER OF WILLS
I, the undersigned duly elected Register of Wills in and for Cumberland County, Pennsylvania, do respect-
fully report that I have allowed deductions in the amounts claimed by deponent, except as Ita 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. II
Dated:
REGistER OF WILLS
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VALUE AS APPRAISED
$ I
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INVENTORY
Real Property (Schedule A)
Personal Property (Schedule B)
Transfers (Schedule C)
Joint-Held Property (Schedule E)
TOTAL GROSS ASSETS
Less Debts and Deductions
(SCHEDULE Fl
VALUE AS REPORTED
$
29 195 92
2,665 15
26,530 77
CLEAR VALUE OF ESTATE
Valuation of life estates or
annuities. . . . . . . . . . . . . . . . . . . $
t=
t1
f
ESTATE TAX ASSESSMENTS $
FOR USE OF REGISTER ONLY
Tax on $
Tax on $
Tax on $
Tax on $
Tax on $
Exemptions
Total Estate
COMPUTATION OF TAX
2%
6%
5%
10%
15%
o
$
$
$
$
$
TOTAL TAX
$
Less tax previously paid
BALANCE
Less 5% of tax if paid within
3 months after death
t=
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C
$
$
$
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 at rate of 6% from
to
$
$
C
1-
1=
$
$
TOTAL TAX BALANCE $
PAID $
VALUE AS REAPPRAISED
$
t=
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(0) As evidenced by Charitable
Exemption Certificates issued
by the Secretary of Revenue.
FOR USE OF REGISTER ONLY ADJUSTMENTS !
NOTE: Where subsequent adjustments are made to the above computation of tax by the R~,gister of Wills, for proper reason,
same should be noted below, with short explanation.
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COMMONWEAL TH OF PENNSYLVANIA
OEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
HARRISBURG
17127
IN YOUR REPL Y PLEASE
REFER TO
RCC-BI (6-73)
Inheritance Tax Division
NOTICE OF FILING or APPRAISEMENT
Charles J. Eusey
720 Museuin Rd.
Reading, Penna.' 1961T
(Executor or Adm ini stratar)
In Re: Estate af
Ella M. Mill..r
Cumberland
I 21-78-0279
Caunty - File Na.
Oear
Yau are hereby natified that the Original
appraisement in the estate af Ella M! Miller
has been filed in the office of the Register of Wills of Cumberland
County on 13 September, 19~, Said approisement refl~cts the following
valuations:
Real Estate None
Personal Property 29,195.92
Transfers None
Jointly Owned None
Total 29,195.921
As to such tax thot is paid within three months from dote lof deoth, a five (5%)
percent discount is allowable. As to any tax that remains unpaid after nine (9) months
(fifteen manths when death occurred from December 22,1965 'to Ju~e 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 100111 of the Inheritance and
Estate Tax Act of 1961, 72 P. S. 2485-1001, P. L. 373.
13 September 78 S' Cl I 1/ (J, / '
Date .gned ~ _ D_, ,&~
Title Chief jppraiser
L,~'
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Note: This is not a bill.
RCC-2 (2-64)
'. -t . .'"
DATE 0 q-v ~~-l '8
COUNTY.~
FILE NO. ""2.l -t 8 - D'J- l <1.
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
HARRISBURG. PENNA. 17127
COMMONWEALTH OF PENNSYLVANIA
RESIDENT INHERITANCE TAX
APPRAISEMENT
Whereas, E ~ M. (V\..~ late of ~
in the County of C~ e & Commonwealt~ of Pennsylvania, having died on
the L C:;-\;:..L day of ~ 19~ :seized and possessed of an estate
subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania;
. Therefore, I, \ "'.At-.. C~ .S) o. . - J . an appraiser buly appointed according to law,
having been designated to make a fair and conscionable appraisement of the ~aid estate, and to assess and fix
the cash value of all annuities and life estates growing out of said estate, hereb~ file the following appraisement:
. I
In the event that any future mterest in this estate is transferred in possession or enjoyment to collateral heirs of the decedent after
t.he expiratIon of any estate for Ufe or for years, the. Commonwealth hereby expressly reserves the right to appraise and assess transfer
inheritance taxes at the lawful collateral rate on any such future Interest. I
DelcrlptJon 0' Allet
Unit
ValUlll
Apprlllsement
Made 'or Inheritance
Tax PurpOles
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$N
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Having been duly sworn a~rding to law, I do hereby ce
formity with law on this '"2, +J2- day' of
Ify that the abote appraisement is made in con-
19"19 .
.
Appraieer
~:~25
(Pori Met',)
, Penna.
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