HomeMy WebLinkAbout10-02-78
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COMMONWEAL TH OF PENNSYLVANIA OCT 2&\1
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
COUNTY OF CUMBERLAND
must be completed in detail and filed in duplicate, with all attached, with the Register of Wills of the
e decedent resided; Return is due within nine months after date of death, unless an extension is granted
tary of Re'otenue. (Section 703 of the Inheritance and Estate Tax Act of 1961,)
OF THE ESTATE OF } m,"",,,,
WELDON EXECUTOR
AME OF DECEDENT!
nd County ADMINISTRATOR
nia } ss,
nd
THOMAS p.?; DAWSON Executor
estate of the above-named decedent being duty sworn, depose S ond sClY S ,
30 19~{;"ot. leao;.., last wilt, copy of which is hereto attaChed.,},
.
I (ClAY) (YEAR) MXtMJ[ ..}'
yo, } Robert M. Frey. Esquire
o whom. 5 South Hanover Street, Carlisle, Pennsylvania 17013
iled.
cutor depo,nent is familiar with the affairs of said estate and the property constituting
UTa R-ADMINI ST RA TOR!
ir fair market value.
death there was no safe deposit box registered in decedent's individual name, or jointly with, or
her, or in decedent's individual name, with right of access by-another as agent or deputy, with the
: -
BANK OR OTHER INSTITUTION THIS SAFE DE:POSIT BOX RENTED RELATIONSHIP OF JOINT
ENTED A S."FE DEPOSIT BOX IN NAME OR NAMES OF HOLDERS TO DECEDENT
ts of said safe deposit box or boxes are itemized under Schedules of this return,
the following, for the reasons hereinafter set forth:
A attached hereto and made part hereof sets forth fully and in detail all the real property
of Pennsylvania of which decedent died having an interest therein. It also sets forth the
es upon each parcel of real property at the date of death, giving the amount still due at
gee, date, rate of interest, and book and page of record thereof.' It also sets forth in the
refore the assessed valuation of each of said parcels, the estimated market value thereof
decedent.
B attached hereto and made part hereof sets forth fully and in detail all personal property
wned by the decedent at the iime of death; all moneys left by the decedentatthe time of
-~-'~,_, \}.. .'v /' ...",
edent's immediate pas session, standing to decedent's credit in banks pf .,gep'osit, savi....ngs~
s, or other institutions, whether individually, or in trust for any othir~persQn:~d~~p~rstlis ~"'''''
~-_ - ..... '/f /.-.
Y the accrued interes t thereon, if any,. down to the last interest day"~ijJiio{ to decedent's..J-:
. ...... ~ ..-.;.-- ~ -
savings ,banks, .and to the date of decedent's death-. in all other cises;.all boiH!.s,--'p6Stal~ ~
tificat~s-< or not;s and other evidence of indebtedn~;s cJ' ih~ ~Uniie~~.tes- to l'f1_~d:e~i
~, wht}.ther ......by sta-tute or agreement they are designated as -tax free,~of..'"the-!Unit~d S't:tes,$ I
. ~ '. .. -~."',...~'.A~ .'
icaf subdivision thereof, or of any foreign country, which are owned al'th'e time::.of death-;~ t
jewe~ry, silver_ware, pictures, books, works of art, household furniture, h~orses, '.carriag~s, I
nd any and all other personal chattels of whatsoever, kind or nature, left by decedent,
lYi_estimated market value thereof; all bonds and mortgages held by decedent and. of all f('
decedent at the time of death, and all promissory notes or other-instruments in writing
oney of which decedent died possessed, of whatsoever nature, with interest thereon, if
value and estimated fair market value thereof, and if such estimated fair.market value be
alue, it sets forth briefly the reasons for such depreciation as to each item; all moneys
from life insurance policies carried by decedent; all annuity and endowment contracts
were payable upon the death of the decedent; all and the corporate stocks and dividends
id as of the date of death, bonds and accrued interes t thereon to the date of decedent's
tment securities owned by the decedent at the time of death, with the.market value there-
RCC-S3 (4-73)
RESIDENT DECEDENT
IMPORTANT,
This return
County wher
by the Secre
IN THE MATTER
GERTRUDE P.
(STATE FULL N
Late of
Cumberla
Pennsyl va
Cumberla
State of
County of
~i:Q{
of the
Decedent died
May
(MONTH
Name and address of attarne
other authorized r~-presentative t
011 correspondence should be ma
That as such Exe
(EXEC
the as sets thereof and the
That at the time of
as agent or deputy of anot
exception of the"following
NAME AND ADDRESS OF
IN WHICH DECEDENT R
N()~
That the conten
wi th the exception- of
That ScheJu/e
in the Commonwealth
mortgage encumbranc
death, name of mortga
columns provided the
as of date of death of
That ScheJule
wheresover situated 0
death, whether in dec
banks, trus t compani e
giving also separatel
death in the case~of
savings, treasury eer
cedent; all obligatiQ,I)
or any state, or polit
all wearing app_ar~l..t
. '- ,,"\
automobiles, boa is, a
together with the fair
claims due and owing
for the payment of m
any, giving the face
less than the face v
payable to the estate
the proceeds of which
due thereon and unpa
death and other inves
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 sUQstantlated by finaneial 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 state~ents showing the assets and liabilities of said co-partnership or huslness.
A copy of tne co-partnership agreement, (if oral, a statement setting forth the natur~ of tne agreement)
together with a statement setting forth the character of the bUSiness, its location, and such other facts
pertaining to the ousiness 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 1n the case of transfers of property, real or personal, within two years of decedent' 5
death, in contemplation of decedent's death, or intended to take effect in possessiQn 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 co~y
of the deed, trust agreement or other instrum~nt .p.reating the trust. TheN~ 1s also set forth in said
schedule a list of all property, real and personal, with its value, which pa~ses at decedentts death by
virtue of the exercise by c;lecedent, either indivtdually, or jointly. With-another, or any power of appoint-
ment veste.dindec!de_n.!-~. eithe.r individually or jo~ntJY; bytJ::te !ill"d~ed, 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 decedentts Will. It also
contains a statement showing which of the beneficiaries named in the decedentts will, if any, died prior
to decedent, the dates of their death, their issue, and the relationship of such issue to the beneficiary.
That Schedule E attached hereto and made a part hereof sets. forth all property, real and per-
sonal, owned by the decedent jointly with another or others, .including intangible, standing in the name
of the decedent and others, plus the date and place of record of instruments effecting the 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 decedentts estate, including funeral expenses paid;
family exemption, where applicable; costs of adrnini;tration of this estate; counsel fees and fudiciaryts
~. ..
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 decedentts death (except those allo~ed 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 witl present proof of said claimed obligations upon re-
quest, that if th~ amount actually paid in settlement of any fee, commission or de'?t 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 ftAft, "B", ~C", "Eft, and "F" as directed therein,
have been carried forward and properly registered in the Summary.
..^ ..,:;~.....~ -- I.....I!'.. ....'"
...~ ".;:.;- ~ &
lti#s"~db~'d iiiYci;,s;6d, to before me this,,,.....,,..... (1zC'.5Yr7~ .0( . ,,~" ~
;- ~ ~ ~ ~ :... ~ (/'--''''''-. - ........
.d. ..~...:..';...~d. 29tB. ;Day ~f September .d 19.7.R..T.h9ma.!>,A..,..,Da:w..so.n...,...".".".....,...."."'.,..,..,_.,
~~u:~ .....J.~7~:.i(i~~:;;;;:~..............,...._,.,-"._.__..
DfBORAH J. ~'I~;~PHER. Notary Public .
Car/ISle. ,umber/and Co" Pa...~~c:>J~,..P..~.r.!!H,Yly@j,.!1,,,,,,.l7..Q;l~.,,
My Commission Expires Sept. 5,1981 (City or Tow" 'and State)
NOTE: Berore signing affidavit make sure all blank spaces in the affidavit and schedules annexed are
filled.in with details or the word "Non~", 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 nB" are attached. Also make
certain that coiumn #1 1n the nSummary" has been properly completed as above-directed.
1
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RCC~34 14-731
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
TRANSFER INHERITANCE TAX
RESIDENT DECEOEN"{
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 ather, should be identified
as to quantum of interestand the estimated value should be that of the decedent's interest only. (Property
held as joint tenants 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, street and street number, together with
a general description of the property, with a reference to the record of the
conveyance by which the decedent took title; If a form state number of 0-
cres; also statement of mortgage encumbrances upon"each parcel at death
of decedent. Taxes, assessments, accrued Interest on mortgages, etc.,ote
to be listed on Schedule llF" and must not be d~ducted from this schedule.
(1)
(2)
(3\
DEPARTMENT
VALUA TlaN
CAUTION
(Do not write
In this space)
ASSESSED VALUE
FOR YEAR OF
DECEDENT'S
DEATH
ESTIMA TED
MARKET VALUE
House and lot of ground at 30 Columbia Road,
Enola, East Pennsboro Township, Cumberland
County, Pennsylvania, described in Cumberland
County Deed Book "R", Volume 12, Page 384.
1978 Assessment: $3,010.00 01-1...
Sold September 15, 1978 - $18,000.00
'3, tJllJ,,? ~J
If/ (1 AJrZ P.uA/ /+L-J, L., 7
-- 'II"'"''
17P
i,2t040;'OO
18,000. 00 ~ 000. of)
,
Insert this total apposite "real property", Schedule "A" in the X X X X X
"As Reported" column an the last page of this return.
..c,
Rec -35
RESIDENT DECEDENT
SCHEDULE "B"
PERSONAL PROPERTY
*
COMMONWEALTH OF PENNSYLVANIA
T~SFER INHERITANCE TAX
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 "E". Intangible personal property, titled in the name o~ 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 ract that they are not or the administered estatEt.
Tangible personal property should be listed rirst (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,
stocks, mortg~ges, notes, together with accrued interest or dividends, salaries or wages, insurance pay-
able to the estate or fiduciary in said capacity, partnership interests, interest in any undistributed
estate or or income from any property held in trust under the will or agreement of another, even though
located outside of the State, at the time of death, should be listed in this schedule.
Item ITEM UNIT ESTIlIATED DEPARTMENT VALUATION
No. List and describe fully VALUE MARKEr VALUE (Do not write in
this space)
Dauphin Deposit Bank and Trust Company Sfll.J,J1' j 9'1, 'II
Checking Account No. 27-62-452-8 ~76. .9
Cumberland County Nursing Home ~ "J 7'-~.k
Balance in Patient's Account 1,376.26
.
,
Insert this tQtal opposite "Personal Property", Schedule "B" in X X 1,752.69 /770,/'7
the "As Reported" colwrm on the last page of this return.
,
RCC - 36
COMMONWEALTH OF PENNSYLVANIA
TRANSFEH INHERITANCE TAX
SCHEDULE "c"
TRANSFERS
~~
~
HESIDENT TlECEDENT
(1) Dirt decedent, .....ithin two years afdenth, make any transfer of any material part of his estate, without
receiving a valuable and adequate consideration therefor? (Answer yes or no) ~o
(2) Did decedent, within two years of death, transfer property from himself to .himself and another or
o-thers (inclurling a spouse) in joint ownership? (Answer yes or no) No
(3) If the answer to (1) or (2) above is in the a:ffirmative state:
(n) Age of decedent at ti~e of transfer n I ~
(b) State of decedent's health 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 death?
(Answer yes or no) No
(a) Was there any possibility that the property transferred might return to transferer or his
estate or be subject to his power of disposition? (Answer yes or no) No
(b) What was the transferee's age at time of decedentt s death? nl a
(5) Did decedent in his lifetime make any transfer without receiving a valuable and adequate consideration
therefor under which transferor expressly or impliedly reserves for his life or any period which does
not in fact end before his death:
(a) The possession or enjoyment of or the right to income from the property transferred?
(Answer yes or no) No
(b) The right to designate the persons _who shall possess or enjoy the property transferred or
income therefrom? (Answer yes or. no) No
(n) If the answer to (5) (b) above is in the affirmative, state whether the right was reserved in decedent
alone or others nl a
(7) Did decedent in his lifetime make a transfer, the consideration fo'r which was transferee's promise to
pay income to or for the benefit of care of transferor? (Answer yes or no) No
(8) Did decedent, at any time, transfer property, the beneficial enjoyment of which was subject to change,
because of a reserve(t power to al ter, amend, or revoke, or which could revert to decedent under terms
of transfer or"by operation of law? (Answer yes or no) No .
(9) If the answer to (8) above is in the affirmative, was the power to alter, amend, or revoke the inter-
est of the beneficiary reserved in the decedent alone or the decedent and others?
(Answer yes or no) No
NOTE 1: The answers to these questions should be supported by affidavit by the attending physician as
well as a copy of the death 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.
ITEM
DESCRIPTION
MARKET VALUE
(Es tima ted)
DEPT. VALUATION
(Dept. Only)
None
NONEI
Insert this total opposite "TranSfers", Schedule "e" in the
II As Re:ported" colwnn on the last- page of this return.
NONE
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RCC-38
RESIDENT DECEDENT
SCHEDULE "E"
JOINTLY OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
INSTRUCTIONS: This schedule must d.isclose all property, real and personal, owned by the decedent jointly
wi t,h another or" others, including Intangl,?les, 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
"Aft, 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 "Bn, ll1us date of acquisition, and the name, address and relationship (if any) of cO-OWners to
the decedent.
>6<'X
o.c
Description of Property, Date of Acquisition, Name
Address and Relationship of Co-Owners, and Place
of Record of Instrument. where Real Estate.
:s<: :xy, ~ is& 0<: 0<: :><:
'Y 'X'X'X C>O< vf; :x: X>< :>< ~
Unit
Value
percentage
Share
Estate
Valua tion
~
~
rxxx
KX>
:><
Xo<X
:>< X
DEPARTMENT VALUATION
CAUTION-Do not Write
In This Space.
Value oT Value of
Entire Decedent's
property Interest
None
IJO N E
Insert this total opposite "Jointly Owned Property", Schedule ftE"
1n the" As Reported" column on the last page of this return.
iq ON t.\
~
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RCC-37' (12-63)
COMMONWEALTH OF PENNSYYLANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "0"
/j~, 1\,
.,~
BENEFICIARIES
, ,
"
. - - RELATIONSHIP
BENEFICIARIES AND ADDRESSES' (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 fact.) OR NO BIRTH
ThomasA; Dawson lrre-,';'hew Yes Entire Estate
1975 Randall Road ~ "0 ,
- ,," , .f.;
Enola. Pennsylvania 17025 . , - -.. . "...".. - .,~,"... . " ~ ~.,
.
,
, ,
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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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SUMMARY
Real Property ........... ..... .....(Sch. "A")
Personal Property.... ... ........... .................(Sch. "B")
Transfers ... ......... ...............(SCh. "C")
...................................._........... _ "' A.
Gross Taxable Estate.
(1)
(As Reported)
$...18.000.00
$....)..752,69 .
$.. -0-
$..
$.. .
$ ...1~.752,69 ~ .
..... - ~..
(2)
(As Determined)
$.
$
$
$
~$
$ ~
Pi
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RCC-81 (6-73)
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
HARRISBURG
17127
IN YOUR REPLY PLEASE
REFER TO
Inheritance Tax Division
, -
NOTICE OF FILING or APPRAISEMENT
thomasA" D~lSon
1975 Randall Rd.
BaCla, Penna.
(Executor or Adm ini strotor)
In Re: Estate of
Certrl1de P. UddOLl
l'!1tmh~,..1~h"
County - Fi Ie No. :21 7!l 9296
Dear
You ore hereby notified that the Original
appraisement in the estate of Gertrude P _ Haldan
has been filed inthe office of the Register of Wi lis of C_bedaad
County on 16 October ,191a.., Said appraisement reflects the fallowing
valuations:.
Real Estate
Personal Property
T mnsfers
Jointly Owned
Total
. ifl,non no
I,nn 1\7
Nnnp
None
19770.67
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,
interest at the rote of six (6%) percent per annum is charged.
Any party in interest wh'1 is aggrieved by this notice may obiect 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.
Dote 16 October 78 Signed ~~ k. ~~
- , .
:j
Chief Appraiser ,---, 12-
Title
~.
'.
Note: This is not a bill.
RCC-2 (2-64)
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
HARRISBURG, PENNA, 17127
COMMONWEALTH OF PENNSYLVANIA
RESIDENT INHERITANCE TAX
APPRAISEMENT
DATE
) 0 -l ~ '- ~ 'a
.
COUNTY(.l.~l~
FILE NO. L. \ -"\!3 - 0 L.l{ 10
Whereas, <b~ \? W ~ late of C/""'v"">-.-<.JL......
in the County of C'~, <L. Commonwealth of Pennsylvania, having died on
the ~("\-ti1.- day of IV\. ~ 19:L!?, seized and possessed of an estate
subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania;
Therefore, I, \ "--t<- C::, Q e.... - , 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 foIlowing 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 lite 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
DelcrJpllan 0' And Valuel Made for Inheritance
Tax Purpoles
?~ \? n ~. _--tA-. $ \,-1/0 "'1
\<-~ C?A. .~-+; lO, 000 00
\-"'" n n NON\S
-" A > '1In.. L\nOD en ..-~ NONE
--.J ~ '-'
~ ^ 0 1I^/l6.".. \ q, 770 t"oL
\(~.
.
Having been duly sworn a~rding to law, I do hereby cert~ ,~Ltlle above appraisement is made in con-
formity with law on this lo day of I ~':f. .. A 19.
"- J -""<.- Jr /::1
Apprai8l'f
~Ee~ , Penna.
(Post Oftie.)
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