Loading...
HomeMy WebLinkAbout12-28-78 .. ... RCC-33 (4-73). . COMMONWEAL TH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS .. " " " RESIDENT DECEDENT COUNTY OF CUMBERLAND 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 Re'tenue. <Section 703 of the Inheritance and Estate Tax Act of 1961.) County of CARLISLE t PENNSYLVANIA CUMBERLAND CITMRRRT .AJIl) County } AFFIDAVIT OF EXECUTOR S ~ IN THE MATTER OF THE ESTATE OF D. ARTHUR CLOUSER (STATE FULL NAME OF DECEDENTI Lote of } 55: Stote of ~ of the estate of the above-named decedent being duly sworn, depose and say June 7 19~~Yin9 a loot will, copy of which io hereto attaChed..} (MONTH) (DAY) (YEAR) Home and oddre.. of attorney or} GeOrge B. Stuart other authorized repre, s.entative to whom all carrupondence should bemailed.3SouthHanoverStreettCar1is1e.Pa . 17013 DAVID B. CLOUSER and GEOFFREY L. CLOUSER Executor S Decedent died That as such Executors deponent is familiar with the affairs of said estate and the property constituting (EX ECUTO 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 following: - NAME AND ADDRESS OF BANK OR OTHER INSTITUTION THIS SAFE DEPOSIT BOX RENTED RELATIONSHIP OF JOINT IN WHICH DECEDENT RENTED A S..I,FE DEPOSIT BOX IN NAME OR NAMES OF HOLDERS TO DECEDENT NONR 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 Schedule A attached hereto and made part hereof sets forth fully and in detai I 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 mortgjlgee, date, rate of interest, and book and page of record thereof. It also sets forth in the COIUDUlS provided tK~refore 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 interest thereon, if any, down to the last interest day prior 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 in!iebtedness of the United States to the de- cedent; all obligations, :",hether 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 Df death; all wearing apparel, jl}welry, 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 dllcedent; all annuity and endowment, c_ontracts . ' I:: ' .. 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 lnterest 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 or securities or close or ramily corporations, the values reported are as rar as possible substantiated by rinancial statements or the corporations, showing the assets and liabilities thereor as or the date or death. The schedule also sets rorth the interest or decedent at the time or death in any co-partnership or business, and in support or the value or such interest there is annexed to said schedule, rtnancial statements showing the assets and liabilities or said co-partnership or l),usiness. A copy of the co-partnership agreement, (ir oral, a statement setting rorth the nature or tne agreement) together with a statement setting rorth the character or the business, its location, and such other racts pertaining to the business as may be pertinent to a rair and just appraisal of the decedent's interest therein must be submitted. It should also set rorth in itemized rorm, together with' the' rair ma~ke~ V'alue thereor, any other property owned or bequeathed by th~ decedent at the time or death. The Schedule C attached hereto and made part hereor sets rorth a true answer to each inquiry contained therein and in the case or transrers orproperty, real or personal, within two years o'r decedent's death, in contemplation or decedent's death, or intended to take errect in possession or enjoYment' at or arter death, said schedule sets forth the nature and value or such property, to whom transrerred, the relationship or the transferees to the (IEiceden-t; the propor'tionate share . received by each'tr'ansferee and all other facts of a pertinent ~ature regarding said transfers. In the case or transrers intended-to take effect in possession or enjoyment at or arter death,' there is also attached to the schedule a CORY of the deed, trust agreement or other instrument ~!~ating the trust. Ther.. is also set forth in said schedule a Itst of all property, real and personal, with its value, which pa~ses at decedent's death by virtue or the exercise by decedent, either individually, orjolntlywith another, or any power of appoint- ment vested il)dec~d,ent, ~ither. i~d:J,vidually o,rjointly, ,by the Will, deed, or other instrwnent or another, with a copy of the instrwnent creating su6h power attached to the schedule. That Schedule D attached hereto and made part hereof sets forth the names arid 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 or all minors, annuitants and benericiaries ror life under decedent's Will. It also contains a statement showing which or the benericiaries named in the decedent's will, ir any, died prior to decedent, the dates or their death, their issue, and the relationship of such issue to the beneficiary. That Schedule E attached hereto and made a part hereor sets rorth all property, real and per- sonal, owned by the decedent jointly with another or others, including intangible, standing in the name or the decedent and others, plus the date and place or record of instrwnents erfecting the vestiture of real estate and the date or acquisition of personalty, plus the name, address and relationship, if any, or co-owners to the decedent. That Schedule F attached hereto and made a part hereor sets rorth rully and in detail all debts and deductions claimed for and on behalf or this decedent's estate, including runeral expenses paid; ramilyexemption, where applicable; costs or administration or this estate; counsel rees and ~Idiciary's commissions paid or to be paid; cost expended ror burial trusts, tombstones or gravemarkers, and reli- gious services, in consequence of the death of the decedent; debts and claims owing and Imp aid at time of death; taxes accrued chargeable ror period prior to decedent's death (except those allowed under Section 651 of the Inheritance and Estate Tax Act); together with a statement or collateral pledged ror obliga- tic;ns, if any. It is agreed that the fiduciary will present proor of said claimed obligations upon re- quest, that ir the amount actually paid in settlement or any ree, 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 or 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 rorward and properly registered in the Summary. Geoffrey L. Clouser {/ y.-/..; Subscribed and sworn to before me this .....2......................... ......................Jr.4f.~:J~ day of .Lt.~(~~~'f!.~..... 19....?Jt. t:... . ,~ I; ~..-.-cI .....J!. ... . :(j:::;;;::::~.'::":...... My Cornm. expires (E 13.......g~~~........!..... ......!:..~.J.g.~.;!;:JJ~J.~.t......p.51,....1.z..Q 13 . (StTe~ Number) - 144 Broadview Ave.~ Warrenton,Va. 2218l .........................................................................,.................."......................................... (City or Town and State) NOTE: Before signing affidavit make sure all blank spaces in the affidavit and schedules annexed are rilled in with details or the word "None", and in case the assets include rare and unlisted securities, securities or close or family corporations or an interest in any co-partnership or business, that the data and statements required under the paragraph above relating to Schedule "B" are attached. Also make certain that column #1 in the "Summary" has been properly completed as above-directed. David B. Clouser, Subscribed and sworn to before me this 14th day of Degember, 78. ) ., ~ 9/23/79 DBC GLC y My Commission 1982 "c... c.34 (4-13) CqMM(lI.U",Q,-,~,Y;t;"" DEPARTMENT OF UVENUE BUREAU OF COUNTY COLLECTIONS TRANSFER INHERITANCE TAX RESIDENT DECeDENT SCHEDULE leAn REAL PROPERTY '" Real property in Pennsylvania, with statement of martgage encumbrances upan each parcel at death of dece- dent. Property held by the decedent as tenant in common withano1her or other, should be identified as to quantum of interest and the estimated value should be thot df 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 reol properi)'located In the Commonwealth of Pennsylvania should be described by lot and 'block number, street and street number, together wi th o generol descrfptl"" of the property, with 0 reference to the record of the conveyance by which the decedent took title; If 0 form state number of a- cres; 0150 statement of mortgage encumbrances upon each parcel at death of decedent. Taxe., ass.ssments, accrued Inter..t on mortgage., etc.,ar. to be listed on Schedule "F" and must not b. deducted from this schedul.. {I) ASSESSED VALUE FOR YEAR OF DECEDEHT'S DEATH Real property situate in Carlisle, Cumberland County, Pennsylvania, known as and numbered 114 West Willow Street ~ tJ" 0, 16,240.00 . Insert this total opposite "real property", Schedule "A" in the X X X X X "As Reported" column on the last page of thi s return. (2) (3\ DEPARTMEHT VALUATIOH CAUTIOH (Do not writ. In this opoce) ESTIMATED MARKET VALUE v 40,OOO.(1f( ~o,OOO.OO 40,000.00 Yo.OOD,DO RESIDENT DECEDENT SCHEDULE "B" PERSONAL PROPERTY ~~..~,'~ ,~"\ Rec -3S 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 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 ract that they are not or the administered estate. Tangible personal property should be listed rirst (e.g. jewelry, wearing apparel, household goodS, and rurnishings, books, paintings, automobiles, boats, etc.) Intangible personal property, such as bonds, treasury certiricates, 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 any undistributed 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 or death, should be listed in this schedule. Item NO. ITEM List and describe rully UNIT VALUE ESTIMATED MARKET VALUE DEPARTMENT VALUATION (Do not write in this space) 2. Checking Account No. 4-0755-0, F~rmers Trust Co. Certificate of Deposit No. 14626~ Accrued interest Certificate of Deposit No. 14627 ~ Accrued interest 1. Fidelity Mutual ~ospita1 Insurance benefi s I) 13'+, l#/P ?,'a,q,15 ~.5i ~ ~~.3.3 ~. ct1 3. 4. 1978 Buick Regal automobile - sales price 5. Household furnishings and items, etc. 6. Medicare benefits 1o\-11.Qo 7. Blue Shield benefits Cl.50 8. .soo.OO Insert this total opposite "Personal Property", Schedule "B" in the "As Reported" column on the last page or this return. x X 50,817.6 50~n.~6 I COMMONWEALTH OF PENNSYLVANIA TRANS}~R INHERITANCE TAX SCHEDULE "c" TRANSFERS '* Rcc"36 RESIDENT DECEDENT (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, within two years of death, transfer property from hi~ttf to himself and another or others (including a spouse) in joint ownership? (Answer yes or no) (3) If the answer to (1) or (2) above is in the affirmative state: (a) Age of decedent at time of transfer (b) State of decedent's health 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 effect in possession or enjoyment at or after his death? (Answer yes or 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) (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 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) NU (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 t~~feree's promise to pay income to or for the benefit of care of transferor? (Answer yes or no) NU (8) Did decedent, at any time, transfer property, the beneficial enjoyment of which was subject to change, because of a reserved power to alter, amend, or revoke, or which c011ld 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 !~erved in the decedent alone or the decedent and others? (Answer yes or no) DR. 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 (Estimated) DEPT. VALUATION (Dept. Only) NONE NonL Insert this total opposite "Transfers", Schedule "CO in the "As Reported" column on the last page of this return. 0.00 N. D'fl.L '. RCC-3~ (l~-63)' COMMONWEALTH OF PENNSYYLANIA TRANSFER INHERITANCE TAX RESIDENT DECEDENT SCHEDULE "D" BENEFICIARIES , BENEFICIARIES AND ADDRESSES RELATIONSHIP SURVIVED DATE (If step.children or 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 nSlvi~ u r1~....""... ~nn $2,000.00 bequest, . ~..'" rurn~cure oequest: liC 132 Glendale St.. Carlisle, Pa. 17013 --rrr OJ: res ~oue Geoffrey L. Clouser, ~nn V&:lQ 1/? nr "'&:l"~ -'1110 144 Bros.Qv~ Ave.. WarrentlXi", Va. 22186 ...-. - : .- - -- I Deponent fUrther says that all the above-named beneficiaries are living at this time except below: NAME DATE OF DEATH RESIDENCE NONE . """""""""""" ,,- >- '" u ~~ 8"t-o ...~ I :l '" c... - . RESIDENT DECEDENT SCHEDULE "E" JOINTLY OWNED PROPERTY . RCC~3"~ COMMONWEALTH OF PENNSYLVANIA TRANSFER INHERITANCE TAX INSTRUCTIONS: This schedule nrnst disclose all property, real and personal, owned by the decedent 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 instrlooent 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 and relationship (if any) of co-owners to the decedent. Description of Property, Date of Acquisition, Name unit percentage Estate DEPARTMENT VALUATION Address and Relationship of Co-Owners, and Place Value Share Valuation CAUTION-Do not Write of Record of Instrument, where Real Estate. In This Space. ;. J ^ xX> J<~ ~ ~ ><>> Value of Value of > ;.> ~ Entire Decedent's '" ><.. .)5 ><,. :.x. property Interest ;. >( NONE t\l'D nt.. Insert this total opposite "Jointly Owned Property", Schedule "E" NOnL in the "As Reported" colunm on the last page of this return. 0.00 R E V-S \8 18-781 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF FIELD OPERATIONS P.O. BOX 2970 HARRISBURG 17105 IN YOUR REPLY PLEASE REFER TO .. Inheritance Tax Division NOTICE OF FILING OF APPRAISEMENT David B. Clouser Geoffrey L. Clouser 132 Glendale Street 144 Broadview Avenue Carlisle. FA 17013 Warrenton. Va. 22186 (Executor or Admini strator) In Re: Estate of Cumberland D. Arthur Clouser County - Fi Ie No. n,-78-032l Dear Mr. Clouser: You are hereby noti fied that the original appraisement in the estate of D. Arthur Clouser has been filed in the office of the Register of Wills of Cumberland County on February 22 , 19--'!2, Said appraisement reflects the following valuations: Real Estate Personal Property Transfers Jointly Owned Total 40,000.00 50,817.65 None None $90,817.65 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 object 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 r P. .tD373. . . . . ".0 -;-- t=''->--..-CLs>~~~ Date February 22. 1979 Signed 0 "'-<.::.> U Title Administrative Officer 1:--------- Note: This is not a bill. REV-4S7 ~8.78) . DEPARTMENT OF REVENUE BUREAU OF FIELD OPERATIONS P.O. BOX 2970 HARRISBURG, PENNA. 17105 COMMONWEALTH OF PENNSYLVANIA RESIDENT INHERITANCE TAX APPRAISEMENT DATE February 22, 1979 Cumberland 21-78-0321 COUNTY FILE NO. Whereas, D. Arthur Clouser late of Carlisle in the County of Cumberland Commonwealth of Pennsylvania, having died on the 7t"h day of June 19 ~, seized and possessed of an estate subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania; Therefore, I, Leo Fulginiti ,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 life or for years, the commonwealth hereby expressly reserves the right to appraise and assess transfer inheritance taxes at the lawful collateral rate on any such future Interest DESCRIPTION OF ASSET UNIT APpraIsement VALUES Made for Inheritance Tax Purposes Real Property $ 40.000 00 Personal Property 50.817 65 Joint-Held Pronertv None Transfers u___ TOTAL ASSETS 90.817 fit; / Have been duly sworn according to law, I do hereby certify that the above appraisement is made in conformity with the law on this 22nd day of' d) ._ ~ . pebrua~y , 1979_ . C ^, ~.C',..~~ o Appraiser (Number and Street) Harrisburg (Post Office) . Penna. i< {-.. '?~- 3~ I ....... ................<;:~!;!:J:~~~.................. County RESIDENT INHERITANCE TAX APPRAISEMENT ......................................................................... Estate of D. ARTHUR CLOUSER Deceased. Late of Carlisle ......................................................................... Date of Death, ........:!.~~..?t..!??~................. Appraisement Docket Vo1., ........10.................6% Page,.............~~.?........... No. .......?................ ......................................................................... Filed in Register's Office, .......y~.y...... 19.?? Amount of tax due, $..:.................................... . DEPARTMENT OF REVENUE Received, ......... ........... ..... ................... ............. ......................................................................... Examined and Approved, ................................. Wrote about Appraisement, ............................. ......................................................................... Appeal from Appraisement, ............................. ......................................................................... Entered and charged, .......................................