HomeMy WebLinkAbout10-23-78
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COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE.
~UREAU OF COUNTY COLLECTIONS
RCC-33 (4-73)
RESIDENT DECEDENT
COUNTY OF CUMBERLAND
IMPDRT ANT,
This return must be completed in det~iI 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, unle'ss an extension is granted
by the Secretary of Revenue. (Section 703 of the Inheritance and Estate Tax Act of 1961.)
/
IN THE MATTER OF THE ESTATE OF
AFFIDAVIT OF
S. AGNES RAUDABAUGH
'(STATE,FULL NAME"OF DECEDENT)
Carltsle, Cumberland
EXECUTOR
Late of
County
State of
PENNSVLVANTA
CUMBERLAND
MARLIN L. SHOEMAKER. SR.
} 's<
County of
~
Executor
Decedent died
of the estate of the above-nomed decedent being duly sworn, depose S and say S
June 8,. 19~J testate leaving a last will, copy of which is hereto attaChed,,}
(MONTH) (DAY)' (YEAR) ~
Nome and oddr.ess of attorney or }
other authorized representative to whom .
011 correspondence should be moiled. -
Henry L. Stuart
3 South Hanover St.. Carlisle. Pa. 17013
That .as such Executor deponent is familiar with the affairs of said estate and the property constituting
(EXECUTO R-ADMINISTRA TOR)
the assets thereof and their fair market value.
That at t~e time of death there was no safe deposit box registered in decedent's individual name, or jointly with, or
as agent or deputy of an-other, 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
IN WHICH DECEDENT RENTED A S....FE DEPOSIT BO.X IN NAME OR NAMES OF HOLDERS TO DECEDENT
None
.
That the contents of said safe deposit box or boxes are itemized under Schedules
with the exception' of the following, for. the reasons hereinafter set forth:
of this return,
That ScheJule 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 ScheJule B attached hereto and made part hereof sets forth fully and in detail all personal property
wheresover situated owned by the decedent at the time of death;' all moneys left by the decedent at the time of
death, whether in decedent's immediate possession, standing to decedent's credit in banks of deposit, sayings
~anks, trust companies, or other institutions, whether individually; or in trust for any other person or persons
t giving also separately the accrued interest thereon. if any, down to the last interest day prior to decedent's
death in the case of savings banks, and to th~ date of deced~eiit's death ,~n all other cases; all bonds, postal
f ~p_~_M__.~_ _ ._M_ . ". .
savings, treasury certificates or notes and other eVidence of indebtedness of the United State~....to.,the,de-
cedent; all obligations, 'Y,~ether by~statut"e. o~. ~.greement they are designated as tax free, of th~.U~ite(i.~tates, \.
or any state, or political subdivision ther"eof, or of any foreign country, which are owned at the'",time'of-death;"
all wearing appar~l;\ jewetry, silverware,. piCture"s, books, works of art, household furniture, hOrs~s~"-;a;iagts, J'~
automobiles, bo~'t~, ~nd. any. a~d ail'~'ther"pe~~nal chattels of whatsoever. kind or.nature, l~it:by decedent;
together with the fairlYj' estimated market value thereof; all bonds and mortgages held by deced~nt and~of aU ..
". . "",
claims due and owing decedent at the time of death, and all promissory notes or other"instruments.in writing .~
. ,Jf .....,. ~ '" .... ~
for the payment of money of which decedent died possessed, of whatsoever nature, with interest th'ereon, if..
any, giving the face value and estimated fair market value thereof, and if such estimated fair.~~rklet::-vaiue be'~
less than the face value, it sets forth briefly the reasons for such depreciation as to each ite~~I~n-'tri'on~~ys
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-
or- at such time.
:
, . .fA'
/
In the case of 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 'b,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 business as may be pertinent to 'a fair and just appraisal of the decedent's interest
T ."
therein must be submitted. It should also set f'orth in itemized form, together with the fair-market value
thereof, any other property owned or bequeathed by the decedent at the time of death.
- . ,
G
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 f'orth the nature and value or such property, to whom transferred, the
relationship of the transferees to the decedent, the ~proportionate sba're reeeiv:ed by each transferee and
all other facts of a pertinent nature regarding said transfers. In the case of transfers intende'd~ to'
take effect 1n possession or enjoyment at or after death, theTe is also attached to the schedule a co~y
. .
of the deed, trust agr~ement or other instrumen~ ~re~~ing 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.i""jointly 'with another, or any power of appoint-
ment vested in deced~nt, .eJther ,indivj,dual.ly or jointly, by the will, deed, 0.1' other instrument of another,
with a copy of the instrumertt~creating such power' attached to the schedule.
That Schedule 0 attached hereto and made part hereof sets forth the name~'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 ~or life under decedent's Will. It also
contains a statement showing which of the benericiaries 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 or record of instruments effecting the vestiture of
real estate and the date of acquisition of personalty, plus the name, address and relationship, if any,
of co-owners to the decedent.
That Schedule F attached hereto and made a part hereof sets forth fully and in detail all debts
and deductions claimed for and on behalf of this decedent's estate, including funeral expenses paid;
family exemption, where applicable; costs of administration of this estate; counsel fees and fudiciary's
commissions paid or to be paid; cost expended ~or burial trusts, tombstones or gravemarkers, and reli-
gious services, in consequence of the death of the decedent; debts and claims owing ann unpaid at time of
death; taxes accrued chargeable for period prior to decedent's death (except those allowed under Section
651 of the Inheritance and Estate Tax Act); together with a statement of collateral pledged for obliga-
tions, if any. It is agreed that the fiduciary will present proo~ of said claimed obligations upon re-
quest, that i~ 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 o~ 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", "e", "E", and "F" as directed therein,
have been carried forward and properly registered in the Summary.
uS'b"~- ,.d ';:;,,10 ~:~;
.....j(~7[i~~?.;.mm.m...
1~~..;,., ~,}11aJ,d,S;(9~.2-
NOTE: B~fore s~gning affidavit make sure all blank spaces in the affidavit and schedules annexed are
~illed in with details or the word "None", and in case the assets include rare and unlisted securities,
securiti,es of~clos; 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.
2f-<~(~:~;f~~~i~!.l,,",.,.~.:k.~............
.29.....Garden....Dr.i:u:e.............................m.............m..._..._._....
(Street NumbeT)
Clil:U!l1E:!J.1.'!:!L......1ZQ.l:3....p.m........
(City or Town and StlLte)
.4."
..:....."...,.; :;:.' ~., ~-".. .... .... ';' " ..
'.,..r.....:.:.:.-' ""_ ~__."...,.....~.,.._~,,--","'.
----.._--~- """
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'f~AJ~C'Fto31~_'~~_'-8Jjl.-.:. ':.'J?i ..
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT 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 os tenont .in common with onother or other, should be identified
as to quantum of interest and the estimated vallie 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 on Schedule "E.")
The real property located In the Commonwealth of Pennsylvania should be (1) (2) (3)
described by lot and block numbor, street and street number, together with DEPARTMENT
a general description Df the property, with a reference to the record of the ASSESSED VALUE VALUATION
conveyance by which the decedent took title; If a farm state number of a" FOR YEAR OF ESTIMA TED CAUTION
cres; also .tatement of mortgage encumbrances. upon each parcel at death DECEDENT'S MARKET VALUE (Do not writ.
of decedent. Taxe., as.enments, occrul!lId Interost on mortgage., etc.,ar. DEA TH In this spece)
to be ll.ted on Schedule "Fit and must not'ce d~ducted from this schl!lldule.
~Q-
NONE
-
.
~-vJL.
Inserllhis 10101 opposile "real properly", Schedule "A" in Ihe X X X X X
"As Reporled" column on Ihe losl page of Ihis relurn.
0.00
~- ~~. ,.
MEMO
Date
Oct. 24, 1971l M.
P.M.
H. Stuart.
From.
To
Subject :
Mr, Gleim '
S. Agnes Raudabaugh
Enclosed are the bank
statement accounts in the
above mentioned matter.
Estate
\
Ene. - bank statements
.,
\
C 100 W Hector St. Conshohocken, Pa.
FORM 52 Samson Paper o. -. ,
g and Loan Association
I . THE OLDEST IN THE COUNTY
ET. CARLISLE. PENNA. 17013
~on. 243-2915
~
.Octooer 6, 1978
19nes Raudabaugh has been closed
10 date of death (June 8, 1978) were
value of $1.023.13.~
ation you needed.
I
o you.
I
,
Sincerely, ~
~. VL flee <L
~~lsie laRocca
~/saVingS dept. manager
-
~lUll~
~'S1\'\
f'<. _'
,
Commonwealth J~
National Bank ~
July 13, 1978
Henry L. Stuart
1~3 S. Hanover Street
Carlisle, Pa.
Re: Estate of.S. Agnes Raudabaugh
Dear Mr. Stuart:
In reply to your letter dated June 14, 1978 on the above estate,
the following accounts are listed below as of June 8, 1978.
. Checking ACCOU~1182-1068~7~9~
$2,467.24 Opened ~ 9~24-73
Statement Savings - #18~0014868~4 ~
$11,385.21 Accrued Interest ~ $12.48
Opened~. 4-27~76
Both of the above accountsare.in the~name of S. Agnes Raudabaugh.
If you have any questions, please feel. free. to contact us.
Very truly yours,
~c1/JL,
Robert Talalai
Assistant Vice President
and Credit Officer
RT/cg
The Commonwealth National "Bank, 10 South Market Square. Harrisburg, Pa. 17108 (717) 564-9500
,",'A,. .
RCC -35
RESIDENT DECEDENT
SCHEDULE "B"
PERSONAL PROPERTY
'*
COMMONWEALTH OF PENNSYLVANIA
TRANSFER.INHERITANCE TAX
INSTRUCTIONS: This Schedule must disclose all tangible andlntanglble 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 "E". 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-
tive trust accounts, must be listed, despite the fact that they are not or the administered estate.
Tangible personal property should be listed first (e.g. jewelry, wearing appar~l, household
goods, and furnishings, books, paintings, automobiles, boats, etc.)
Intangible personal property, such as bonds, treasury certificates, cash on hand and in bank,
stockS, mortgages, notes, together with accrued interest or dividends, salaries or wages, insurance pay-
able to the estate or fiduciary in said capacity, partnership interests, interest in anyundlstributed
estate of 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
No.
ITEM
List and describe fully
UNIT
VALUE
ESTUrATED
MARKEr VALUE
DEPARTMENT VALUATION
(Do not write in
this space)
Commonwealth National Bank
Checking Acc't 1tl82-106887-9 ~
Statement Savings #18-0014868-4 ~
Carlisle Bldg. & Loan - Certif. of Deposi
2,467.2l V"" ~t.1 {,1. :J.. f
l1,397.6c /Il/j'77, t,f(
l,023.p3 v--6 ()'Y3.. 13.
Spahr's Auction House - Sale of Householi
goods
2,851.6 hJ ?)/, 65
/~ 73~, 7/
Insert this total opposite npersonal Property", Schedule "Bft in
the "As Reported" column on the last page of this return.
x X
17,739.7
:-14. _
Rec - 36
COMMClXW"EALTI! ClF PENNSYLVANIA
TM:\SFER I:\HEIUTA:\CE TAX
SCHEDULE tlen
TJUNSI''EIlS
HESIDEXT DECEDENT
(1) Did rlecedent~ within two years of de 11th, make any transf'er of' any material part of' his estate, without
. receiving a valuable and adequate considerat.ion therefor? (Answer yes or no) No
(2) Did rlecedent, within two years of death, transfer properLY from himself to himself' and another or
others (including a spouse) in joint ownership? (Answer yes or no) l\Tn
(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 time of' making the transfer. (Note 1).
(c) Cause of' decedent's 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 eff'ect in possession or enjoyment at or af'ter his dp.ath?
(Answer yes or no) No ~
(a) Was there any possibility that the property transferred might return to transf'erer or his
estate or be .sub.1ect to his power of disposition? (Answer yes or no)
(b) What was the transferee's age at time of decedent's death?
(5) Did decedent in his lif'etime make an,Y transfer without receiving a valuable and adequate consideration
theref'or under .....hich transf'eror expressly or impliedly reserves for his life or any period whIch does
not in {'act end before his death:
(ft) The possession or enjoyment of or the right to income from th~' property transferred?
(Answer yes or no) No
(I)) The right to designate the persons who shall possess cr enjoy the property transferred or
income theref'rom? (Answer yes or no) No
(6) If the answer to (5) (b) above is in the aff'irmative, state whether the right was reserved in decedent
alone or others
(7) Did decedent in his lifetime make a transf'er; the consideration for which was transfereel s promise to
pay income to or for the benefj,t of care of transferor? (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 reserveri power to alter, amend, or revoke, or which cOllld revert t.o decedent under terms
of transfer or by operation of law? (Answer yes or no) No 1l;
(9) If' the answer to (8) above is in the affirmative, was the power to alter, amend, or revoke the inter-
est of the benef'iciary reserved in the decedent alone or the decedent and others?
(Answer- yes or no)
NOTE 1: The answers to these questions should be supporter! by af'fidavit by the attending llhJ'sician as
well as a copy of' the death certificate.
NOTE 2: If answer to any of' the above quest1,ons is yes, set forth below a description of' the property
transferred, it's fair market value at rlate of' death, dates of' transfers and to ",horn trltnsf'errefl, with
relationship of tra~sferees 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
MAlUmT VALUE
(Es tima ted)
DEPT. VALUATION
(Dept. Only)
None
Insert this total opposite "Transfers", Schedule "C" in the
"As Reported" colunm on the last page of' this return.
0.00
'" ~. ~ . .
.
,
RCC-37 (12-63)
CO~IMO:-l\\"EALTH OF PEN:\SYYL\NIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEOULE "0"
-
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
have an interest, vested, continge~t or other are involved, set STATE YES IN ESTATE
" wise, iti estate) forth this fact.) OR NO BIRTH
A,,,..h.. 1> . 1!J. 'Roi1ino Niece Yes One-eleventh
C~~i~n~ Rn"d "'~~1'i "le~_Pa:
. . . d. - .
Children of Lvnnette Wise,
a deceased niece:
.. .
..Jonn ~. ~.L"t:, "'7
116 IiI .
I I __"..~ 129412 r
Charleston. S. Carolina
,
-
Glenn W. Wise Yes One- twenty-second
5741 Union Deposit Road 1..'
Harr~Sl>urg, I:'a.
~
Thelma G. Marrow, 227 E. Niece Yes One-eleventh
!'lorCh sc., Lar , ra.
Varie G. Wa<:>ner 2909 Dick- Niece Yes One-eleventh
inson Ave., Camp Hi 11 , Pa.
Glenn R. Shoemaker, 131 I St. Nephew Yes One-eleventh
Carlisle, Pa.
.Mar1in L. Shoemaker, Sr., Nephew Yes One-eleventh
29 Garden Dr., Carlisle ,P~ . ,
Mar" P. Shoemaker. R.D.ln, Niece Yes One-eleventh
:Box 409, Car1is1e,Pa.
Jean A. Davis, 102 Lancastel Niece 'les ~ One-eleventh
Blvd., Mecnan~csDurg, ra.
Harold M.Shoemaker, 2124 BOIS Nephew Yes On.e-elarenth -
:
-St., Harr~sburg, 1'a. J./J.V; -
Thelma I. Frank. 407 Ritter IfUece'; Yes J One-eleventh
Rd., Wedgewood Hills, i .
HarriSburg, pa. 111U~
.
'Katherine E. Stambaugh, 270/ Niece Yes - One-eleventh
Rudy Road, Harr~sburg, pa
J./J.V" -
Deponent further says that all the above-named benericiar1es are living at this time except below:
......- NAME DATE OF DEATH RESIDENCE
None
.
,
! <0' .....
8 --:
E..f ~
"'<ii~ c
.2 BE
.- C) ='
E-'O
"Co."
-<: E.
~8:o
o u
"S~t:
" " 0
~ E ~
~ rc:
Heal Property
Persooal Property
Transfers
SUMMARY
. (Sch. "A")
................................. ..........(Sch. "B")
...(Sch. "e")
$
$..
$
$
$
$.17,,739.71. >
(1 )
(As Reported)
0.00
17.739.71
0.00
(2)
(As Dl'I"rmined)
Gross Taxable Estate.
$
$
$
$
$. ..,.
$
,
, ,
L
, .
( , . .\
(
, .
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~._--..."....- .-- ---
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Cl p::; ~ 1:1: , .
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.b I- 0 C
,~ .,-. ~ .c' 0 (
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RCC.38
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "E"
JOINTLY OWNED PROPERTY
.
..
INSTRUCTIONS: This schedule must disclose all property, real and personal, owned by the rlecedent jointly
wi t.h another OI' 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 \UHler Schedule
"A", plus the date and place of record of instrument effecting vestiture, but do not include entireties
or out of state real estate value in estate valuation column. Personal property should be listed as in
Schedule "Bit, plus date of acquisi tion, and the name, address and relationship (if any) of co-owners to
the decedent..
Descri{ltion of Property, Date of Acquisitiqn, Name
Address and Relationship of Co-Owners, and Place
of Record of Instrument~here Real Estate.
:x :.;0( xX: >0
8<>
Q;
'^ :x
None
.'
v
.
unit percentage Estate
Value Share Valuation
:;<;>>0 ;X;cx
8<>>9': ;0 ~
>0
X)
Insert this total opposite "Jointly Owned Property", Schedule "E"
in the It A.s Reported" column on the last 'Page of this return. 0 00
.
DEPARTMENT VALUATION
CAUTION-Do not Write
In This Space.
Value of'
Entire
property
Value of
Deceden tis
Interest
"7? ~L
~~c
.. I . .
Ii '
'.
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
Marlin L. Shoemaker Sr.
29 Garden Drive
f'n,...l-i ~1 e ~ - "P~npa
(Executor or Adm ini strator)
In Re: Estate of
Agnes. S. Raudabaugh
Cumberland
County - Fi Ie No.
2l~78~0298
Dear
You are hereby notified that the Original
appraisement in the estate of Agnes S.. Raudabaugh
has been filed in the office of the Register of Wills of Cumberland .
County on .. 15 November ,1c;i'~, Said appraisement reflects the fallowing
valuations:
Real Estate None
Personal Property
Transfers
Jointly Owned
Total
17,739.11
None
None
17.739. 11
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 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 ~_ J{, ~
Chief Appraiser
Title
~.
Note: This is not a bi II.
RC C-2 (~6~) .; '::' , \ " " L~-1.S
COMMONWEALTH OF PENNSYLVANIA DATE \ -
DEPARTMENT OF REVENUE RESIDENT INHERITANCE TAX COUNTY ~~
BUREAU OF COUNTY COLLECTIONS
HARRISBURG, PENNA, 17127 APPRAISEMENT FILE NO. --:J _l - 1 'B - <J"Z..'i '0
Whereas, ~ S. \.<-~ late of l.A...,. ~ .-"..h"
in the County of Cl~ O. .9 Commonwealth of Pennsylvania, having died on
the ~--tJL day of .:J ~ 19~, seized and possessed of an estate
subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania;
Therefore, I, \.~ G 1) D. . . an appraiser duly appointed according to law,
having been designated to make a fair and conscionable appraisement of the said estate, and to assess and fix
the cash value of all annuities and life estates growing out of said estate, hereby file the following appraisement:
In the event that any future interest In this estate is transferred in possession or enjoyment to collateral heirs of the decedent after
the expiration ot 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 Apprai'em~nt
Delcrlptlon of Alset Values Made for Inheritance
Tal( Purpo.es
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Having been duly sworn according to law, I do hereby certify ~~ement is made in con-
formity with law on this \ c:; day of " 0~~....!... 19~.
Appraiser
l~~~~ , Penna.
(Pod Oftlee)
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