HomeMy WebLinkAbout12-14-78
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COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
DEe 1 4 197B
COUNTY OF
RESIDENT DECEDENT
,
/'
CUMBERLAND
IMPDRT ANT,
This return must be completed in detail and riled in d~plicate, with all attached, with the Register of Wills of the
Co.u'nty 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.)
IN THE MATTER OF THE ESTATE OF
MARY E. SHAFFER
(STATE FULL NAME OF DECEDENT)
Late of
Cumberland
} AFFIDAVIT OF
EXECUlXm 'RIX
~
County
,
State of
Pennsylvania
Cumberland
J os,
.,
Cou~ty of
>Ulm_>lIZll<X
CATHERINE S. FOREMAN
of the estate of the above-named decedent being duJy sworn, dopas'oS
ExeCU1I)n..x
and say S
Decedent died
April
18
, 19~{te.tate leavlfig ~ last will, copy of which I. hereto attached..}
(YEARl ~ .
(MONTH]
, }
. '
Name and address of attorney or
ather authorized reprlluntative to whom
011 corres.pondence s}fould be mailed.
{DAY}
Charles H. Stone. Esquire
310 Bridge Street. New Cumberland, Penna. 17070
That as such Executrix deponent is familiar with the affairs of said estate and the property constituting
l EXE CUTO R.ADMIN ISTRA 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
fiN WHICH DECEDENT RENTED A S....FE DEPOSIT BOX IN NAME OR NAMES OF HOLDERS TO DECEDENT
CCNB Bank, N. A. M'R.rv 1'. ~n~ff'e~
331 Brid~e Street
New Cumberl and. Penna.
That the contents. of said safe deposit box or boxes are itemized under SchedulesA.B&E of this return,
with the exception.of the following, for the reasons hereinafter set forth:
That Schedule A ,attached herelo 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 herelo 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 prim 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.S.tate~ _t~ the :.de~
cedent; all obiigations, "whether _by statute or agreement they are designated as tax free, oi:'h~- United-States,
. -- . - ~ . ~ .... "".' ~
or any state, or political subdivision thereof, or of any foreign country, which are owned:' at.thc..time of death;
~1I wearing apparel, jewelry, silverware, pictures, books, works of art, household furnitJr~ horses, carriages,
automobiles, boats; and any and all other personal chattels of whatsoever. kind or natu~t, Jert 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 otherinstrum~nts"'in writing
for the payment of money of which decedent died possessed, of whatsoever nature, with interest thereon, if
any, giving the face value and estimated fair market value thereof, and if such estimated fair,market value be
less than the face value, it sets forth briefly the reasons for such depreciation as to each item; all moneys
payable to the estate from life insurance policies carried by decedent; all annuity and endowment contracts
the proceeds of which were payable upon the,death of the decedent; all and the corporate stocks and dividends
due thereon and unpaid as of the date of death, bonds and accrued interest thereon to the date of decedent;-s
death and other investment securities owned by the c)'{cedent at the time of death, with the.market value th.ere-
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 su~stantlated 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 1s annexed to
said schedule, financial statements showing the ass"ets and liabilities of said co-partnership or Quslness.
A copy of the c.o-partnership agreement, (if oral, a statement setting forth the nature of toe dgreement)
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 to the schedule a copy
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 instrument 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 natu~e 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 li~e under decedent's Wili. 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~^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 ~estiture 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;
. ,
family exemption, where applicable; costs of admin~stration 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 serv~ces, in consequence of the death of the decedent; debts a~d claim~ owing and lmpaid at time of
death; taxes accrued chargeable for period prior t~ 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 presen~ 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 nAn, nBn, nen, "En, and wFn as directed therein,
have been carried forward and properly registered in 'the SUmmary.
SUbSC~d sworn to before me this .................................
...................::..~.:,.;...... ,day O~f ..~ .
...~.J\.~.. 'Il :~~~.y .. .:,,~
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. ..., C"~..,..;-J,h." C',... ^ "....
...' ~'" .,~.."v.
NOTE: Before ,sig~ing affidavi t make sure all b~ank 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.
....(!.~.~1...1t:Y:::J.?1&cz.:!c.......__.
(E%ectLtor-~
144w..~~.!'...g<:>y.~.E!'-Q.r.:....R9.".(L_......................_........_.
(Street N'llmbl!1')
1l"'r:~~~y,.y~':lot.'.'l.,.....:L.7..Q}}........................
(City 0'1' Town and StlLte)
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RC C..34 ('4..731 \
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COMMONWEALTH OF PENNSYLVANIA
OEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
TRANSFER INHERITANCE TAX
RESIDENT DECEDENl'
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 cammon with another or other, should be identified
os to quantom of interest and the estimated value should be that of the decedent's interest only. (Property
held os joint tenants with right of surviarship or tenancy by entireties should be reported on Schedule "E.")
The reall property \ocated In the Commonwealth of Penhsylvanla should be
descrlhe,d by lot and block number, street and street numbar, together with
a general descrlptton of 'the pc-opert'!, with a reference to the record of the
conveyance hy which the decedent took title; If a form state numher of 0-
cres; 0110 statement of mortgage encumbrances upon each parcel Qt death
of decedent. Taxes, assessmen's, accrued Interest on mortgages, etc.,are.
to be listed on Schedule HF" and must not' be deducted from this schedude.
V
House and lot situate at 212 9th Street, New
Cumberland, Pennsylvania, recorded in Cumberland
County Deed Book "R," Volume 11, Page 222 and
"H," Volume 9, Page 524 sold to William Sheaffer
and Nancy Sheaffer, his wife
iYl.J. 9-~'70
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(1)
(2)
131
DEPARTMENT
VALUA TlON
CAUTION'
(00 not write
In thl. apace)
ASSESSED VALUE
FOR YEAR OF
DECEDENT'S
DEATH
ESTIMA TED
MARKET VALUE
V
27,500.001'" ~15"O,OU
I
,
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.
$27,500.00 d11500.CO
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'Rec -35
RESIDENT DECEDENT
SCHEDULE "B"
PERSONAL PROPERTY
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CO~~ONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
INSTRUCTIONS: This Schedule must disclose all tangible and intangible personal property owned individually
by, the decedent, at the time or his death. Property owned by the decedent jointly with another or others
must be listed under Schedule nEn. Intangible personal property, titled In the name or the decedent, but
payable at death to another or others, including but not limited to P.O.D. U. S. Savings Bonds and tenta-
ti'ire trust accounts, must be listed, despite the fact that they are not of the administered estate.
Tangible personal property should be listed first (e.g. jewelry, wearing apparel, household
goods, and fUrnishings, boOkS, paintings, automobiles, boats, etc.)
Intangible personal property, such as bonds, treasury certificates, cash on hand and in bank,
st~cks, mortgages, notes, together with accrued interest or rtividends, salaries or wages, insurance pay-
able to the estate or ~iduciary in said c~pacity, partnership interests, interest In any undistributed
estate of or income from any property held in trust under the will or agreement or another, even though
located outside of the State, at the time o~ death, should be listed in this schedule.
Item
NO.
ITEM
List and describe ~lly
UNIT ESTIMATED DEPARTMENT VALUATION
VALUE MARKIIT V ALOE (I)Q not write in
this space)
~ ~D'\ .'\5
209.95
2,894.70 a "8'\ '1.10
\
15.99 \!5.~9
40.00 "to.OO
200.00 ~OO. CO
18.70 \'4'.10
20.00 ~O.OO
29.00 0-"'.00
5 ,000.00, 6 000. DO
\
100.86 \DO. 'il..
1.
Proceeds of CCNB Bank, N. A. Checking Account No.
793-056",3/
2.
Proceeds of sale of personal effects held at
public auction
3.
UGI refund
4.
CCNB Christmas Club refund
5.
Property Tax Assistance Check
6.
Blue Cross refund check
7.
Claude Wolfe, Auctioneer, additional sale
proceeds
8.
New Cumberland Insurance Agency - insurance refun
9.
First Federal Savings & Loan Associatio~~
Harrisburg Certificate No. 218-005470~
10.
; Accrued interest to date of death on above accoun
11. Bonds in the name of Mr. George Shaffer (pre-
deceased Mary E. S~affer) or Mrs. Mary Shaffer as
follows:
,
~b.Clil Q708230945E
~5.tlO Q339797504E
.t6-V'oQ7 4246526 7E
,9J5,uelQ555227959E
issued November
issued January
issued December
issued February
1945
1944
1945
1945
~3,'I.O('b7.05)
~ iI" 7jJf:Z;j5
~~I~'l,. 66.5";;)
~~,,(@--:1.D
lc3. ;) 0
t"g.3"\
1.~.lD~
\'l... 16
Insert this total opposite npersonal Property", Schedule "B" in
the "As ,Reported" column on the last page of this return.
x X ~8~0~
~ ..,011. Sf,.,
I
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Hec-36
COMMO~WEALTII OF PENNSYLVANIA.
TRA.N8FEIl niHElUTANCE TAX
SCHEDULE "c"
TRAN8F1mS
liES I1JE~T DECEDENT
(1) Did decedent, wlthin two years ofdeuth, make any transf'er of any materi.al ]Jart of' his estate, vdthout
receiving 11 valuable and adequate consideration therefor? (Answer yes 01' no) l\1n
(2) Did decedent, within two years of neath, transfer property from himself to himself and another or
others U.ncluding 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's heal th at ti.me of' making the transf'er. (Note 1).
(c) Cause of decedent's death. (Note 1).
(4) Did decedent, in his lif'etime, make any transfer of prol1ert;y without receiving a valuable or adequate
consideration therefor which was to take effect in TJossession or enjoyment at or after his df~ath?
, (Answer ~Tes or no) No
(a) Was there any possibiU.ty that the prop~rty transferred might return t.o transferer or his
estate or be subject to his power of' disposition? (Answer yes or no) No
(b) What was the transf'eree's age at time of decedent' 5 neath?
(5) ,Did decedent in his lifetime make any transfer without receiving a valuable and adequate consideration
:therefor Wlner which transferor expressly or. impliedly reserves for his life or any period which does
'not in f'act end berore his death:
(a) The posseSSion-or enjoyment of or the right to income f'rom the property transferred?
(Answer ~res or no) No
(b) Tl1e right to designate the persons who shall possess or enjoy the property transf'erred or
income theref'rom? (Answer yes or no) No
(0) :If the answer to (5) (b) above 1s in the affirmative, state whether the right was reserved in decedent
:alone Qr others
(7) Did decedent in his lif'etime make a transfer, the consideration for which was transferee's promise to
pay income to or :for the benen t of care of' transferor? (Answer yes or no) No
(8) Dirl 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 cOl\ld revert t.o rlecedent under terms
of transfer or by operation of' law? (Answer yes or no) No
(9) If the anSwer to (8) above i3 in the affirmative, was the power to alter, amend, or revoke the inter-
est of the beneficiary reserverl in the decedent alone or the decedent and others?
(Answer yes or no)
NOTE 1: The answers to these questions should. be supporterl by affidavit by the attending physician as
weli as 11 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
tra:hsf'erred, it's fair market vallie at date of death, dates of' transfers and to "'horn tritnsferred, with
relationship of transferees to decedent, if any. Submit copy of an~i trust deed or instrument, if trans-
ferS are claimerl to be non-taxable, also submi.t rletailed statement of facts on which said clai.m is based.
NOT~ 3: List applicable property below in manner in which provided in Schenules A, B, or E.
ITEM
DESCRIPTION
MARKET VALUE
(Es tima ted)
DEPT. Viu,UAT:mN
(Dept. Only)
NON E
NOr'lL
Inse:rt this tot:)..1 opposite "Transf~rs", Schedule "e" in the
"As ~eport~d" cQl1mlll on the la.st page of' this return.
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RCC-37 (;12-63)
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l'O~lMO:>l\\"EALTII OF PEi'!:\SYYL\NIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
.'
SCHEDULE "0"
BENi::FICIARIES
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 facL) OR NO BIRTH
"'o.h6~{~~ S. Foreman Dauo:hter Yes Legal one-third of the residue
1/, I, T:lo~. Road
Hpr"hev Penna. 17033
Winifred G. Kumo Dauo:hter Yes Leo:al one-third of the residue
1101' Brandt Avenue
New Cumberland Penna.
Emma M. Millen! Dauo:hter Yes Legal one-third of the residue
505 Cherino:ton Rd.
T.1~~.~~'~"o nhin 41081
,
.
,
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h
Deponent' further says that all the above-named beneficiaries are living at this time except below:
NAME DATE OF DEATH RESIDENCE
I
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:s ~ ...
" :s 0
~ E fr
~ 0::
Real Property
Personal Property
Transfers
SUMMARY
. .....(Seh. "A")
...(Sch. "B")
... (Sch. "C")
(Sch."E")
.......................
.Jo.in.t1y.. .Owned..p;mperty....
Gross Taxable Estate.
(1)
(As Reported)
$2],~OO. O()
$ ..~,801.38
$. ....0..
$ .)',98.1,,16.
$.
$ ...38,282..54..
(2)
(As Determined)
$
$
$.
$
$.
$.
f- :'" '0
Z .", "
... w '0
oj ." ro ..l
'" ;;Z .", .-i
;.... '" ... 0(
W .'" Q} ell
'" :<=1 ~ -
- 0(
-<: oj
~ ~ '" CI:
~ u ""
0 '0: :s ""
~ ~ '" ..::
'" -<: '" <::, 0(
~ :I: W ~ ro' ;,.,
W ... f- .-i ~ Q
-<: ~ ... ~
<3 ~ :r: '" .... Z
0 f- Q} Qj
Z f- ::q 0: ,.Q ~ ..:
'" '" !j
~ W ,.Q - Ii
~ 0 <J 00 u' 0
" .<:
" ~ 0 .:::: 0
0 >i ... :s ""
:c W ~ o' " W
'" f- ~
.b "" - CI:
~ f- 0 "
'" <<: - ~, 0
0 E
'E ..... " S g
~'"C - <5
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
RCC-43(5-76)
NOTE: TO BE SUBMITTED IN TRIPLICATE
REPORTING FINANCIAL INSTITUTION
ADDRESS
FIRST FEDERAL S. & L. ASS'N. OF HBG.
234 N. Second St., P.o. Box 1111
Harriaburlt. 1'A
ZIP CODE 17108
~/- 7 1- 0 ,2 ! S-
Pursuant to Section 742, Pennsylvania Inheritance and Estate Tax Act of 1961, we
herewith submit the following report:
ACCOUNT NO. OF JOINT, TRUST OR
INVESTMENT DEPOSIT 1-19712
NAMES ON ACCOUNT OR
INVESTMENT MRS. GEOROEF. SHAFFFRor CATHERINE S. FOREI'iAN
DATE OF DEATH April 18, 1978
DECEASED JOINT DEPOSITOR, TRUSTEE
OR INVESTOR MRS. GroRGE F. SHAFFER
ADDRESS 312 9\Il St.
New Cumberland, PA
COUNTY
ZIP CODE 170?0
SURVIVING DEPOSITOR,
BENEFICIARY OR INVESTOR CATHERINE S. FOREMAN
.
ADDRESS
RELATIONSHIP TO DECEDENT
Daughter
DATE INVESTMENT WAS ESTABLISHED
:~TNHE~rc~i~:~~II~~~gooiITOR, February 16,1971
BALANCE, INCLUDING INTEREST nL.,
PAYABLE, AT DATE OF DEATH $ 3'7<>'.31
.
Savings Counselor
TITLE
.f" f ......,.
Rc..c-3,B .
RESIDENT DECEDENT
SCHEDULE "E"
JOINTL Y OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
INSTRUCTIONS: This schedule must disclose all property, real and personal, ownerl by the rlecedent jointly
wi th another or others, including intangibles, standing in the name of the decedent and others. List
real es ta te fi rs t, as en ti re ties, or j oint tenants, giving brief descriptlon, as indicated tmrler Schedule
"A", plus the date and place of' record of instrument effecting vesti-ture, but clo 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' an~") of co-owners to
the ,deceden t.
Description of Property, Date of Acquisitiqn, Name unit
Add~ess and Relationship of Co-Owners, and Place Value
of Record of Instrtunent, where Real Estate.
percentage
Share
Estate
Valuation
c
::x 0<::>0 X
<<::xo::xo :;<, 'Y
::xo::x
'Y%%:s<x::xo ~
::xo
:0<:
ex
<<<<~
<<:0<::8
DEPARTMENT VALUATION
CAUTION-Do not'Write
In This Space.
Value of Value of
Entire Decedent's
Property Interest
1.
First Federal Savings & Loan Association
o'f Harrisburg Savings Account II 1-9712"""-
in joint names of decedent and Catherine
S'. Foreman (daughter); made joint
February 16, 1971; date-of death
balance was $3,901.24 ( taxable on one-ha f
,/
interest on above $61.07; tax-
one-half
/'
1,950.62" 1)95"0.~;J..
/
30.54r/ 3O.5'f
2.
A:ccrued
able on
,
,.
Insert this total opposite "Jointly Owned Property", Schedule "E"
in the "As Reported" column on the last page of this return.
1,981.16
,
REv-sta (a"78)
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
Catherine S. Foreman
l44:W. Governor Rd.
Hershey. . PA
(Executor or Adm ini strator)
In Re: Estate of
MaryE. Shaffer
Cumberland
County - Fi Ie No. 21:"'78-0285
Dear
You are hereby notified that the Original
appraisement in the estate of Mary E. Shaffer
has been filed in the office of the Register of Wills of Cumberland
County on 28 February., 19 79', Said appraisement reflects the following
valuations:
Real Estate
Personal Property
Transfers
Jointly Owned
Total
$?7, ~nn nn
l!, 7'11 .~n
None
1,981.16
S38,272.72
As to sucry 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 deoth,
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 doys ofter receipt of said notice as provided by Section 1001 of the Inheritance and
Estate Tax. Act of 1961, 72 P. S. 2485.1001, P. Ld"373. C 0 :~~
.QA::::. \: '_k---c./
Date 28 February 1979 Signed.. ()
Title Administrative Officer
"
Note: This is not a bill.
REV-157. {8';7~
DEPARTMENT OF REVENUE
BUREAU OF FIELD OPERATIONS
P.O. BOX 2970 ..
HARRISBURG, PENNA. 17105
COMMONWEALTH OF PENNSYLVANIA
RESIDENT INHERITANCE TAX
APPRAISEMENT
DATE
COUNTY
FILE NO.
28 February 1979
Cinnberland
21-78-0285
Whereas, Mary E. Shaffer late of N. Cl1mh"rl;mn
in the County of Cumberland Commonwealth of Pennsylvania, having died on
the' 18th day of April 19 78 ,seized and possessed of an estate
subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania;
Therefore, I, T O~ ",,1 g; n; H , 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:
I n the event that any future interest In this estate is transferred in possession or enjoyment to collateral heirs of the decedent after the expiration
of any estate for life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer inheritance taxes at the lawful collateral
rate on any such future Interest.
DESCRIPTION OF ASSET UNIT Appraisement
VALUES Made for Inheritance
Tax Purposes
$ ?7 ,nn Inn
1>001
n. ., n. .. 8,791 56
Transfers . None
T~;n~l" 1.981 lIE;
To"'" !nlL ?7? 7?
,
.
.
.
-
Have been duly sworn according to law, I do hereby certify that the above appr.aiselll.ent is made in conformity
with the law on this ?R..h' day of l'1ot\-",,'"Y r-,." . · 19 12-.
r-'J-~--'--, . '_'-'c..c-/V"v-vu.....-
--.......J Appraiser
(Number and Street)
Harrisburg
(Post Office)
. Penna.
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