HomeMy WebLinkAbout11-29-78 (3)
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RCC-33 (~73!
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
'*
RESIDENT DECEDENT
COUNTY OF
C". T}MB.EPLAND
IMPORT 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 Reltenue. (Section 703 of the Inheritance and Estate Tax Act of 1961.)
IN THE MATTER OF THE ESTATE OF
J AFFIDAVIT OF
(?"M"~ APJ(/.(f/f ~T,e/y
{STATE FULL NAME OF DECEDENT!
Cumber1a ~
North Middleton Twp., I Counly
/
STELLA M. HOLLY
Lole of
Slole of
PF.NN~.VANTA
} 51:
Execu~yix
Decedent died
CUMBERLAND
Mabel H. Wentz
of the estate of the above-named decedent being duly .worn, depa.. S and say S
Jll"03 10 19....1..8.-1 tooloto leaving 0 loot will, copy of which io horoto ottOChOd.,}
(MONTH! {DAY! (YEAR! ~
Nome and oddros. of attarnoy or} Henry L. Stuart
other authorized repres.entative to whom
all CO"OSi'ondonce .hauld b. mail.d. 3 South Hanover Street. Carlisle. Pa. 17013
Counly of
~
That as such Executrix deponent is familiar with the affairs of said estate and the property constituting
{EXECUTO R-ADMINIST RA TOR!
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 follow ing: -
NAME AND ADDRESS OF BANK OR OTHER INSTITUTION THIS SAFE DEPOSIT BOX RENTED RELATIONSHIP OF JOINT
IN WHICH DECEDENT RENTED A S.",FE DEPOSIT BOX IN NAME OR NAMES OF HOLDERS TO DECEDENT
None
That the contents of said safe deposit box or boxes are itemized under Schedules
wi th the exception- of the following, for the reasons hereinafter set forth:
of this return,
That Schedule 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 Schedule 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, savings
banks, trust companies, or other institutions, whether individually, or in trust for any other person or persons
giving also separately the accrued interes t 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 States to the de-
cedent; all obligations, whether by statute or agreement they are designated as tax free, of the United States,
or any state, or political subdivision thereof, or of any foreign country, which are owned at the time of death;
all wearing apparel, jewelry, silverware, pictures, books, works of art, household furniture, horses, carriages,
automobiles, boats, and any and all other personal chattels of whatsoever. kind or nature, left 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 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 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 interes t 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 ot securities of close or family corporations, the values reported are as far as
ross~ble substantiated by ftnll.llcj.al stl!-tements Qf. 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, fihancialstatements showing the assets and liabilities of said co-partnership or Qusiness.
A .copy of the co-partnership 'agreement, (if oral, a statement setting forth the nature of Hie agreement)
together with a statement setting forth the character of the business, its location, and such other facts
pertaining to the business as may be pertinent to a fair and just appraisal of the decedent's interest
therein must be submitted. It should also set forth in itemized form, together with the fair market value
thereof, any other property owned or bequeathed by the decedent at the time of death.
The SChedule C attached hereto and made part hereof sets forth a true answer to each inquiry
contained therein and in the case of transfers of property , real or personal, within two y~ars 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 COllY
of the deed, trust agreement or other instrument creating the trust. Ther,~ is also set forth in said
schedule a list of all property, real and personal, with its value, which passes at decedent's death by
virtue of the exercise by decedent, either individually, orJointly with another, or any power of appoint-
ment vested in decedent, eithe.r individually or jointly, by the will, deed, or other instrument of another,
with a copy of th~ 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 of all minors, annuitants and beneficiaries for life under decedent's Will. It also
contains a statement showing which of the beneficiaries named in the decedent's will, if any, died prior
to decedent, the dates of their death, their issue, and the relationship of such issue to the beneficiary.
That 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 ScheduleF 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 of
death; taxes accrued chargeable for period prior to decedent' s death (except those allowed under Section
651 of the Inheritance and Estate Tax Act); together with a statement of collateral pledged for obliga-
tions, if any. It is agreed that the fiduciary will present proof of said claimed obligations upon re-
quest, that if the amount actually paid in settlement of any fee, commission or debt is less than the
estimated amount claiming and aliowed, that the same will be reported to the Register of Wills, and that
the amount of tax assessed can be reassessed in accordance therewith.
That the totals of the appropriate columns in Schedules "A", "B", "CO, "E", and "F" as directed therein,
have been carried forward.and properly registered in the Summary.
SU. bse. t~d. . and sworn to be~ore me this .................................
/~ .. /.. I. /i }/ I,[~ _
....~ll...............;.u.........p...........~..~~~..:.~~:mb.e.r................. 19.1.8...... .......-/-/....1E~J#ift#{ifi>......~......._..
~~................~............~......A................ ...lO'35TRINDLE....ROAD........................................................._..
K~~~~)Y1~. 5; 19 \?~~~~~~;f-'di~--
N~E: Before signing affidavit make sure all blank spaces in the affidavit and schedules annexed are
filled in with details or the word "None", and in case the assets include rare and unlisted securities,
securities of. close or family corporations or an interest in any co-partnership or business, that the
data and s~atements ~equired under the paragraph above relating to Schedule "B" are attached. Also make
certain that column #1 in the "Summaryn has bee~ properly completed ~s above-directed.
.
, ~.. '"....,,,..
lie c;.w ("7a!
COMMONWEAL. TH OF PENNSYL.VANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COL.L.ECTIONS
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE CIA"
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 jn common with another or other, should be identified
as to quantum of interest and the estimated value should be that of the decedent's interest only. (Property
held as joint tenants with right of surviorship or tenancy by entireties should be reported on Schedule "E.")
The real property localed In the Commollwealth of P."hl"lvanla Ihauld b. (1) (2) (3)
de.crlb.d by lot and block number, .tr..t and .tr..t number, tog.lh.r with DEPARTMENT
a g.n.ral d..crlptla" of Ihe properly. with a refere"c. to Ih. r.cord of Ihe ASSESSED VAL.UE VALUA TlON
conveyance by which the decedent took 1111.; If a farm .Iale numb.r of a. FOR YEAR OF ESTIMATED CAUTION
cre.; 01.0 .Iatem.nt of marlgage encumbrance. upon each parcel at d.alh DECEDENT'S MARKET VALUE (Do nol write
of deced.nt. Tax.., a.....m.nt.. accrued Inl.r..t on mortgage., etc..ar. DEATH In thl. .pace)
10 be 11.led on Schedul. "F" and mu.t nal be deducted from Ihl. .ch.dul..
None
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.
0.00
N~
RESIDENT DECEDENT
SCHEDULE "B"
PERSONAL PROPERTY
Rec -35
COMMONWEALTH OF PENNSYLVANIA
TRANSFER 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 ~act that they are not o~ the administered estate.
Tangible personal property should be listed ~irst (e.g. jewelry, wearing apparel, household
goods, and fUrnishings, books, paintings, automobiles, boats, etc.)
Intangible personal property, such as bonds, treasury certi~icates, 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 riduciary in said capacity, partnership interests, interest in anyundistributed
estate o~ or income ~rom any property held in trust under the will or agreement o~ another, even though
located outside o~ the State, at the time o~ death, should be listed in this schedule.
Item ITEM UNIT ESTIMATED DEPARTMENT VALUATION
No. List and describe fUll y VALUE MARKET VALUE (Do not write in
this space)
1. CCN! Checking Acc't #409-388-6 11,376.30 \. \.,3\\o.so
2. BANKERS LIFE INSURANCE proceeds 3,150.43 5, \so .43
.
.
../.
e " " " "
Ins rt this total opposite Personal Property, Schedule B in
the "As Reported" column on the last page o~ this return.
x X
14',526'.73 \.L..\. '\ s L..-\..... '3
RCC-%
Cl)MMO'iWEALTH OF I'EXNSYLVANIA
TAA'i~FFR INREH.ITANCF TAX
SCHEDULE "c"
TH.\NSI'1mS
HESIDE'iT DECJo:nFXT
(1) Did decedent, within two years of death, make any transfer of any material part of his estate, without
receiving a valuable and adequate consideration therefor? (Answer yes or no) No
(2) Did decedent, wi thin two years of death, transfer property from himself to himsel f and another or
others (including a spouse) in joint ownership? (Answer yes or no) Ne
(3) If the answer to (1) or (2) above is in the affirmative state:
(a) Age of decedent at time of transfer
(11) 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 the~,for which was to take effect in possession or enjoyment at or after his death?
(Answer yes or nof!O
(a) Was there any possibility that the property transferred might return t~lransferer or his
estate or be subject 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 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 th,' property transferred?
(Answer yes or no) Nfl
(b) The right to designate the persons who shall possess or enjoy the property transferred or
income therefrom? (Answer yes or no) No
(6) If the answer to (5) (b) above is in the affirmative, state whether the right was reserved in decedent
alone or others
(7) Did decedent in his lifetime make a transfer, the consideration for which was transferee's promise to
pay income to or for the benefit of care of transferor? (Answer yes or no) Nfl
(8) Did decedent, at any time, transfer property, the beneficial enjoyment of which was subject to change,
because of a reserverl power to alter, amend, or revoke, or which conld revert to decedent under terms
of tran,;fer 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 bepeficiary reserved in the decedent alone or the decedent and others?
(Answer yes or no) ---
NOTE1: 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 >"hom transferred, with
relationship of transferees to decedent, if any. Submit copy of any trust oeed 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 provideo in Schedllles A, fl, or E.
ITEM
DESCRIPTION
MARKET VALUE
(Es Uma ted)
DEPT. VALUATION
(Dept. Only)
None
Insert this total opposite "Transfers", Schedule "CO in the
"As Reported" column on the last page of this return.
0.00
t--J ~
RCC-37 (12-63)
CmlllIlO:'IlWEALTII OF I'EN~SYYLANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "D"
BENEFICIARIES
RELATIONSHIP I
BENEFICIARIES AND ADDRESSES (If step-children or SURVIVED DATE INTEREST OF
State full names and addresses of all who illegitimate children I DECEI?ENT OF BENEFICIARY
a.e an interest, vested, contingent or other are involved, set STATE YES BIRTH IN ESTATE
wise, in estate) forth this fact.) OR NO
Bertha Hollev. Claremont FarD I. Mother Yes Entire Estate
R. D. #1, Carlisle, Pa.
,
Deponent fUrther says that all the above-named bene~iciaries are living at this time except below:
NAME DATE OF DEATH RESIDENCE
None
"
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Real Property ....
Personal Property
Transfers ...............
SUMMARY
.......... ..........(Sch. "A")
..................( Sch. "B")
..............................(SCh. "C")
.................................n.....".................... ......................................
Gross Taxable Estate ..............
( 1)
(As Reported)
$ 0.00
V..52.6.~73.
$...................
$.........
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(2)
(As Determined)
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RC C-3B
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE" E"
JOINTLY OWNED PROPERTY
INSTRUCTIONS: This scherlule must disclose all property, real and personal, ownen by the rlecedent jointly
with another 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 under Schedule
"A", plus the date and place of record of instrwnent 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 "B", plus date of acquisition, and the name, address ann relationship (if any) of co-owners to
the decerlent.
Description of Property, Date of Acquisition, Name
Address ann Relationship of Co-Owners, and Place
of Record of Instrwnent, where Real Estate.
x"
Unit
Value
~ VV'
~ J<.J'..,
^"
v
).>~
V'
CCNB Savings Acc't #076-117270-9 in
the name of Stella M. Holley and Mabe~ H.
Wentz, which was created February 27, 19s.
10,323.19
Accrued interest 82.73
10,405.92
I
percentage
Share
Estate
Valuation
v
Y.'
'V:)<
v:>
^" >G
Insert this total opposite "Jointly Owned Property", Schedule "E"
in the" As Reported" colUl1U1 on the last page of this return.
DEPARTMENT VALUATION
CAUTION-Do not Write
In This Space.
Value of Value of
Entire Decedent's
Property Interest
\ 0)4 oS rn
LO\4oS.ct-;
-
RCC-8t (6-73)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
HARRISBU RG
17127
IN YOUR REPLY PLEASE
REFER TO
'*
Inheritance Tax Division
NOTICE OF FILING or APPRAISEMENT
Mabel H. Wentz
R.D.I.
Carlisle. Penaa.
(Executor or Administrator)
In Re: Estate of
Stella M. Holley
Cumberland
County - File No.
21-78-0316
Dear
You are hereby notified that the Original
appraisement in the estate of Stella M. Holley
has been filed in the office of the Register of Wills of Cumberland
County on 11-39 , 197~, Said appraisement reflects the following
valuations:
Real Estate
Personal Property
Transfers
Jointly Owned
Total
None
14,526.73
None
10,405.92
24,932.65
As to such tax that is paid within three months from date of death, 0 five (5%)
percent discount is allowable. As to any tax that remains unpaid after nine (9) months
(fifteen months when death occurred from December 22r 1965 to June 16, 1971, inclusive;
and twelve months when death occurred prior to December 22, 1965) from dote of death,
interest at the rote of six (6%) percent per annum is charged.
Any party in interest who is aggrieved by this notice may object th.ereto within
sixty days after receipt of said notice as provided by Section 1001 of the Inheritance and
Estate T ax Act of 1961, 72 P. S. 2485-1001, P. L. 373.
11-29-78 ~ V M
Date Signed ^ .. <
,
[.~-'''-
, -.
Title
Chief ....flflI'a1scr
Note: This is not a bi II.
.
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
HARRISBURG, PENNA, 17127
COMMONWEALTH OF PENNSYLVANIA
RESIDENT INHERITANCE TAX
APPRAISEMENT
DATE J ~ - '2 ct - I CO
COUNTY ( ..I. .~....-J ,JI..r....~
FILE NO. '"2- \ - [ B - 0 3l 6
late of _N ' (V\ ...JlJJ 0 0+ -Ir\o-
RC C.2 (2-641
Whereas,
in the County of Commonwealth of Pennsylvania, having died on
the \ day of 19 ( ~, seized and possessed of an estate
subject to Inheritance Tax under the laws of (2: ~m~wealth of Pennsylvania;
Therefore, I, \ ~ ('). _ 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 of any estate for Ufe or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer
Inheritance taxes at the lawful collateral rate on any such future Interest.
n
Unit Appraisement
Description of AII.t Values Made for Inheritance
Tax PurpolfI'
\:< () ~ 0 '? ~r - nro.-+:- $N~
V~ ~~ -~^~ \ L\. S l...lo 13
~../'\. A ) D V -J Nn-...L
.')~ ' . y ~ O~a -eA. ~,,~ ~tL LloS q:z..
.x ...
J I..J .-...J
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0rb.Q. ~ ?..L\, ~32- CoS
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.
.
Having been duly sworn a~i2f to law, I do hereby certif1-(yat the nabove appraisement is made in-f<gJ-
formity with Jaw on this day of ,~ . , 0 A A 19_.
f''k _ ....) -r.:f YII... ·
Approleor
th~~ , Penna.
(PIlot Oftl..,
III
.;(/-'9 ~ -3/Co
CUIlIber1and
Coullty
RESIDENT INHERITANCE TAX APPRAISEMENT
Estate of
Stella M. Rolley
Deceased.
Late of
N. Middleton
Date of Death,
06-10-78
10
Appraisement Docket Vol.,
Page,
167
No.2
6%
Filed in Register's Office,
Amount of tax dlle, $
11-29
1978
DEPARTMENT OF REVENUE
Received,
Examined and Approved,
Wrote abo.ut Appraisement,
Appeal f,.om Appraisement,
Entered and charged,
'.