HomeMy WebLinkAbout08-28-78
.
~CC.:93 (4-73)
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COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
RESIDENT DECEDENT
AUG 2.~ 1978
'COUNTY OF- Cumberland
IMP.ORT ANT,
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'itenue. (Section 703 of the Inheritance and Estate Tax Act of 1961.)
Late of
Cumberland
Pennsylvania
} AFFIDAVIT OF
EXECUTOR
J\\.ji,!MWmR~
IN THE MATTER OF THE ESTATE OF
Robert S. Clark
(STATE FULL NAME OF DECEDENT)
County
County of
r.'lmhA~1 ~Yln
John Baker
} .s,
State of
Executor
~!ll!lQKX
of the estate of the obove-named decedent being duly sworn, depose S
and -say S
June 1,
(MONTH)
Nome and address of attorney or }
other authorized representative to whom
all correspondence should be moiled.
(DAyl
, l~~{testate leaving 0 lost will, copy of which Is hereto ottached..}
\ YEAR) ialaUtOCX
Decedent died
J. Robert Staurrer-Market'Square Bldg.,
Mechanicsburg. Penna. 170~~
That as such Execllt.OT' deponent is familiar with the affairs of said estate and the property constituting
(EX ECUTO R~ADM1N1STRA 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
The First ank and Trus
Mechanicsburg. Pa.,
S Me
THIS SAFE DEPOSIT BOX RENTED
IN NAME OR NAMES OF
Robert S. Clark
RELATIONSHIP OF JOINT
HOLDERS TO DECEDENT
That the contents of said safe deposit box or boxes are itemized under Schedules A
with the exception'of the following, for the reasons hereinafter set forth:
of this return,
That Scheclule 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 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 ~oneys 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 persol'!. or p~_.rSons
giving also separately the accrued interest thereon, if any, down to the last interest day prioT io_ decedent's
death in the case of savings banks, and to the date of dececlent's death in all other cases; all bond,s, p~stal " .
, + J. eO,
savings, treasury certificates or notes and other evidence of indebtedness of the United States~to the de:i~ "-:;.~"
.... ~ ........ -; ~
cedent; all obligations" ~hether by statute or- agreement they are designated as tax free, of the United SUitesh : ~ ~
.. ... " -, _"," .... ~ _ ' ..;;r ...._
or any state, or political ,subdivision thereof, or of any foreign country, which are owned at the tillle of death;""', ~,... ~
all wearing apparel, jewelry, sily,erware, pictures, books, works of art, household furniture, hors'es.""~arriage,~~.~.oi
auto'mobilles, 'b~ats, ~ni. an'y~;n'd~all other' personal chattels of whatsoever, kind or nature, left~~y dec;~~r:a-_;,_~-/'
together with the fairlYi,estimated market value thereof; all bonds and mortgages -held by decederit-,\i'n4,of _ail
'4~
claims due and owing decedent at the time of death, and all promissory notes or other'instruments in writing
for the payment of money of which decedent died possessed, of whatsoever nature, with interest thereon, if
any, giving the face value and estimated fair market value thereof, and if such estimated fair, market value be
less than the Jace 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 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 rar 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 1s annexed to
said schedule, financial statements showing the assets and liabilities of said co-partnership or 1l,usiness.
A copy of the co-partnership agreement, (if oral, a statement setting forth the nature of tne agreement)
together with a statement setting forth the character of the business, its location, and such other facts
pertaining to the ~usiness 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 1n possession or enjoyment at or after death, there is also attached to the schedule a copy
of the deed, trust agreement or other instrument cr.eating the trust. Ther'~ is als6 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 ~ercise by decedent; either individually, or jointly wi th 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 nature of their res-
pective interests, their relationship, if any, to the decedent, together with the ages at the time of
decedent's death o~ 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, Wld 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 erfecting the vestiture of
real estate and the date of acquisition of personalty, plus the narne, address and'r~lati6n~hip, 1~ 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 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 unpaid at time o~
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 nAn, nB~, "en, ~E~, and "Fn as directed therein,
have been carried forward and properly registered in the Summary.
Subscribed and sworn to before me this .................................
t... .........................cE..~.............._.......__...
. (ExeC1/.tor-~>
L.South....Walnut__..S..t..__..............................._._.
(St:reet Numb",">
J1"1g1:Hm;!,g~p.lJ,:r.gJ..:E'."1DD..!l",.J,7Q55.......
(City en- Town and State)
...........;;qf.~...~...~..... day of ...~. . . . aL 19...1.!;L
.... .~.
. :;');;, . --I.' ' ar'ft.r
....~:~{~(a~A.??,GM~~..~iS. ~~~r:cfu~ji~~~~~~~:UBLlC
~ ...... ,,;'-t CUMBERLC\ND COUNTY
. ,
liT tDMMISSION EXPIRES DEC. 29, 1979
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 1n 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 ~Summaryn has been properly completed as above-directed.
.".'
,
.' .
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,
..I~C C..S4 {"4.07::1},
COMMONWEAL TH OF PENNSYLVANIA
OEPARTMENT 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 cammon with another or other, should be identified
asta quantum of interest and the estimated value should be that of the decedent's interest only. (Property
held as joint tenanls with right of surviarship or tenancy by entireties should be reported an Schedule "E.")
The real property located In the Commonwealth of Pennsylvania should be
described by lot and block number, .treet and street number, together with
a general description of ,he propeny, 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 a' doath
of decedent. Taxe., oue.sm.nts, accrued Interest on mortgages, etc.,are
to be listed on Schedule uFu and must not' be d_educted from this schedule.
'1(LL THAT CERTAIN House and Lot of Ground
situate in the-Township of Upper Allen,
County of Cumberland and State of Pennsylvan a,
bounded and described as follows:
BEGINNING at a point on the southern line of
Big Horn Avenue at the Western line of Lot N . 67
as shown on the hereinafter mentioned Plan
of Lots; thence by said Western line of Lot No. 67,
South 05 degrees 07 minutes East, 155.0 feet
to a point; thence along land now or late of the Mt.
Allen Corporation, South 84 degrees 53 minut s West,
80.0 feet to a point on the Eastern line of Lot No. 69
on said Plan; thence along said line North 0# degrees
07 minutes West, 155.0 feet to a point on the Southern
line of Big Horn Avenue; thence along the
Southern line of Big Horn Avenue, North 84
degrees 53 minutes East, 80.0 feet to a point, the
place of BEGINNING.
BEING Lot No. 68, Plan of Section I, Mt.
Allen Heights, said Plan being recorded in
the Cumberland County Recorder's Office in
Plan Book 18, Pages 14 and 15. - .'
HAVIN~ thereon erected a single family
dwelling numbered 9 Big Horn Ave.,
Mechanicsburg, Pa.
(1)
(2)
/3l
DEPARTMENT
VALUA TION
CAUTION
(Do not write
In thl. apace)
ASSESSED VALUE
FDR YEAR OF
DECEDENT'S
DEATH
ESTIMA TED
MARKET VALUE
Appraised by Lester G. Conner, Real Estate
Broker and Appraiser or 2159 Market Street,
Camp Hill, Pennsylvania at $38,500.00.
Appraisal is submitted herewith.
38,500.00
/fe 5fJO.OO
26l.1t.i~ 8 iP t:13 11
/..A.N~ ~
~'11()
-~
J~ll'
Insert th,s total opposIte "real properly", Schedule "AU in the X X X X X
"As Reported" column on the last page of this return.
38,500.00 "1J; ~OO. ~
.'
RCC-35
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 of his death. Property owned by the decedent jointly with another or others
must be listed under Schedule "En. 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 certU'icates, cash on hand and 1n 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 1n anyund1str1buted
estate or or income rrom any property held in trust under the will or agreement or another, even though
located outside or the State, at the time of death, should be listed in this schedule.
Item
NO.
ITEM
List and describe fully
UNIT ESTIMATED
VALUE MARKET VALUE
1
Pay Check from The Patriot-News Co.,
dated May 31, 1978. Copy of Check
submitted herewith.
Pay Oheck from The Patriot-News 00.,
dated June 7, 1978. Oopy of Oheck
submitted herewith.
Proceeds of Checking Account No. 22-89-
509~4) with Dauphin Deposit Bank and ~
Trust.Oompany. Balance as of 6/1/78.~
Proceeds of Savings Account No. 149142
with Oumberland Valley Savings and Loan
Association, Oarlisle, Pa. Balance as
of 6/1/78.
Household furnishings of decedent located
at his residence at 9 Big Horn Ave.,
Mechanicsburg, Pa., appraised by Ohuck
Bricker, Auctioneer and dealer in used
furniture, Texaco Road, Mechanicsburg, Pa
1970 (dismante1ed) Volkswagen, appraised
by Robert Kennedy of Bob & Steve Kennedy'
Arco, Bowmansdale, Pa., vehicle is
completely torn down and in poor conditio .
1972 Volkswagen Station Wagon (VW 412)
appraised by Lloyd Long Volkswagen, Inc.,
19 Harrisburg Pike, Carlisle, Pa.
dies Phdn 14 kt yellow ~~wedding band
an's Plain l4kt. yellow gold wedding ban
(Both rings appraised by William S.
Mumma, Mumma's Jewelry Storef 34 West
Main St.; Mechanicsburg, Pa.)
Personal guns of decedent appraised by
Cole's Sporting Goods and Oycle Oenter,
327 N. Hanover St., Oarlisle, Pa., an
itemized list of guns and appraisal is
submitted herewith.
600.00
219.23
2
682.90
3
261.58
4
1263.67
5
571. 00
6
100.00
7
8
995.00
15.00
15.00
9
Insert this total opposite "Personal Property", Schedule "B" in
the "As Reported" column on the last page of this return.
x X
4723.)8
DEPARTMENT VALUATION
(Do not write in
this space)
/'rj..9~,
p. 61. "r
I.J :;.. 6.3. ( 7
Igo.~t;
.,~~. d ~
I!'". () ()
1r;()7J
'd().d~
2.17 ~J; Jr
RCC-36
COMMO\WEALIlI OF PENNSYLVANIA
TRANSFFI\ INHE!\IIANCE TAX
SCHEDULE II G"
TJ~\NSFEJlS
I\ESIDENI DECEIlEIiT
(1) Dio rle~edent, within two years ofdeuth, make any transfer of any material part of tns estate, wjthout
receivlng a valuable and adequate considf>ration therefor? (Answer yes 01' no) No
(2) Did rtecerlent, wi thin two years of cleath, transfer property from himself' to himself and another or
others (incllllUng Ii 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 None
(b) State of' decedent' 5 heal th at time of making the transfer. (Note 1).
(c) 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 dp.ath?
(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 cUsposition? (Answer yes or no) No
(b) What was the transferee's age at time of decedent's death? NonA
(5) Did decedent in his lif'etime make any transfer without receiving a valuable and adequate consideration
therefor llilder which transferor expressl~y or impliedly reserves for his life or any period which does
not in fact end lJefore his death:
(n) The possession or enjoyment of or the right to income from the property transferred?
(Answer yes or no) Nn
(h) The right to designate the persons who shall possess cr enjoy the property transferred or
income there-rrom? (Answ"er yes or no) No
(0) If' the answer to (5) (b) above is in the affirmative, state whether the right was reserved in decedent
alone Qr others None
(7) Did decedent in his lif'etime make a transf'er, the consideration for which was transferee's promise to
pay income to or -ror the benefit of care of tl.ansferor? (Answer yes or no) No
(8) Did decedent, at any time, transf'er property, the benef'icial enjoyment of' which was subject to change,
because of' a reserven l)Ower to al ter, amend, or revoke, or which cOllld revert t.o decedent under terms
of "trans:fer or by operatlon 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 ben.eficiary reserverl 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 certificate.
NOTE 2: If' answer to any of the above questions is yes, set forth below a ~escription of the property
transferred, it's fair market value at elate of death, dates of transf'ers anel to ",'hom transferred, with
relationship of transf'erees 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
~~\RlmT VALlIE
(Estimated)
DEPT. VALUATION
(Dept. Only)
None
None
I
i
I
I
I
I
I
-:?7 ~.
Insert this totftl opposite If Transfers", Schedule "e" 1n the
"As Reported" column on the last page of this returne
None
RCC-37 (12-63)
COMMONII'EALTH OF PENNSYYLANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "D"
+- ..~
,
BENEFICIARIES
(
h
,
RELATIONSHIP -
. BENEFICIARIES AND AIllJRESSE'S (If step-children or SURVIVED 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) , O~ NO . BIRTH ."
Caryn Clark Daucrhter Yes Entire Estat.A
q Bia Horn Ave ,J' ,. .
"
Mechanicsbur>l:. Pa. l70~~
-
-
,.
.
.
.,
.
-
Deponent further says that all the above-named beneficiaries are living at this time except below:
NAME DATE OF DEATI;I RESIDENCE
.
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02 ~ S
..... C) ='
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o "
---
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~ <>:
SUMMARY
.. ...................(Sch. "A")
. ... ...(Sch. "B")
..................(SCh. "e")
Real Property
Personal Property
Transfers
J 0 int.ly.. .owned.. .Proper ty.. (.Sch. ...IIEU)..
Gross Taxable Estate .
(1)
(As Reported)
$... 38,.5.0.0..0.0
$ ..4,723.38
$....0..0.0
$ ....0..0.0
$
$....4-3,223.38..
(2)
(As Determined)
$.
$...
$
$
$
$ ..
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b f-. p::: 0 "
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RCC~3B
~
.
RESIDENT DECEDENT
SCHEDULE "E"
JOINTLY OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
INSTRUCTIONS: Tllis schedule must disclose all property, real and personal, ownerl by the decedent jointly
with anot.her 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 tmeter Schedule
"Art, plus the date and place of record of instrument effecting vest! ture, 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 decedent.
g
Description of Property, Date of Acquisition, Name
Address and Relationship of Co-Owners, and Place
of Record of Instrument, where Real Estate.
~~~ri8;g~6O(
"^
Unit
Value
pe rcen tage
Share
Estate
Valuation
>
~
)<
<>
9S~
DEPARTMENT VALUATION
CAUTION-Do not Write
In This Space.
Value of Value of
Entire Decedent's
Property Interest
)<
30)<
x.x'x>
)<
~
None
None
-:f~
-'
'h...~~
Insert
in the
this total opposite "Jointly Owned Property",
,
liAs Reported" coluITDl on the last page of this
Schedule "Ell
return.
None
",' '..
. ,
RCC-81 (6-73)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU"OF COUNTY COLLECTIONS
HARRISBURG
17127
IN YOUR REPL Y PLEASE
REFER TO
Inheritance Tax Division
NOTICE OF FILING or APPRAISEMENT
John Baker
101 S. Walnut St.
Mechanicsburg. Penna.
(Executor or Administrator)
In Re: Estate of
Robert S. Clark
Cumberland
County - Fi Ie No.
2 F-78-0294
Dear
You are hereby notified that the Original
appraisement in the estate of Robert S. Clark
has been filed in the office of the Register of Wills of Cumberland
County an 15 November , 19 78, Said appraisement reflects the fallowing
valuations:
Real Estate
Personol Property
T ronsfers
Jointly Owned
Total
38.500.00
4.723.38
None
None
43,223.38
As to such tax that is paid within three months from date of death, a five (5%)
percent discount is allowable. As to any tax that remains unpaid after nine (9) months
(fifteen months when death occurred from December 22,1965 to June 16,1971, inclusive;
and twelve months when death occurred prior to December 22, 1965) from date of death,
inter,e"st at the rate of six (6%) percent per annum is charged.
Any party in interest who is aggrieved by this notice may abject thereto within
sixty days after receipt of said notice as provided by Section 1001 of the Inheritance and
Estate Tax Act of 1961, 72 P. S. 2485-1001, P. L. 373.
Date' " 15 November 78 Signed &-, d _ 1<. ,Jj~.:-..
Title
Chief" Appraiser
I-
---.
Nate:
This is not a bill.
RCC-2 (2-64) \ l:\S:-IB
- . DATE
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE RESIDENT INHERITANCE TAX COUNT~
BUREAU OF COUNTY COLLECTIONS
HARRISBURG, PENNA, 11121 APPRAISEMENT FILE NO.
R~~, (O~ M e.-.J}... ,
Whereas, late of I> . -~g~
in the County of CA.> .._~O . &. Commonwealth of Pennsylvania, having died on
the o (c-, - 0 l -l '6 day of 0~ 19~, seized and possessed of an estate
subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania;
Therefore, I, ,~Cs,.J) o. '. , 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 tra.nsferred In possession or enjoyment to collateral heirs of the decedent after
the expiration of any estate for life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer
inheritance taxes at the lawful collateral rate on any such future interest.
Unit Appraisement
DescrIption of Anet Value. Made for InherItance
Tall Purpoles
K~VA />J) /' $3<a,<;OCl 00
~$Uvo-o~ ~ '" ^ ---r-- L.{ '1'23 3'3
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Having been duly sworn according to law, I do hereby certify ~t the above appraisement is made in con.
formity with law on this \ <S day of ~ 19 t 8.
^'h~.I_ J( H J" .
Appraiser
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.. ~ and Strtet) Penna.
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