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HomeMy WebLinkAbout11-16-78 RESIDENT DECEDENT COMMONWEAL TH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS 0~ COUNTY OF .7;: ;;7 '') (7 .;Jx- / R CC-33 (4-73) \~ CUMBERLAND IMPORTANT: 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.) Late of Cumber1 and Pennsylvania } AFFIDAVIT OF EXECUTOR ~~~ IN THE MATTER OF THE ESTATE OF BESSE W. PEARCE (STATE FULL NAME OF DECEDENT) Caunty County of Cumber1 and Geraldine E. Davis of the estate of the above-named decedent being duly sworn, depose S } 55: State of WlOO(mx Executor and say S Decedent died June 19. (MONTH) Name and addres& of attorney or } other authorized representative t~ whom all correspondence should L'9 me.lled. (DAY) , 19-1L{te.tote loov;ng a loot will, copy of which i. hereto ottached._} (YEAR) iM~j( Jon F. LaFaver 317 Third St., New Cumberland, Pa. 17070 That as such Executri X deponent is familiar with the affairs of said estate and the property constituting ( EXECU TO R"ADM1NIST RA TO R) the assets thereof and their fair market value. That at the time of death there was no safe deposit box registered in decedent's individual name, or jointly with, or as agent or deputy of another, or in decedent's individual name, with right of access by another as agent or deputy, with the exception of the following: - NAME AND ADDRESS OF BANK OR OTHER INSTITUTION THIS SAFE DEPOSIT BOX RENTED RELATIONSHIP OF JOINT IN WHICH DECEDENT RENTED A SAFE DEPOSIT BOX IN NAME OR NAMES OF HOLDERS TO DECEDENT . 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 wheresever 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 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 w~a.illg apparel, jewelry, silverware, pictures; books, works of art, household furniture, horses, carriages, automobiles, boa ts, and any and all other personal chattels of whatsoever, kind or nature, left by decedent, together with the fairfy 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 wer 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 see1 ities owned by the decedent at the time of death, with the-market value there- of at such time. In the case of securities of close or family corporations, the values reported are as 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 anpexed to said schedule, financial statements showing the assets and liabilities of said co-partnership or !:lusiness. A copy of the co-partnership agreement, (if oral, a statement setting forth the nature of tne agreement) to~ther 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 mllst be submitted. It should also set forth in itemized form, together with the fair market value thereof, any other property owned or bequeathed by the decedent at the time of death. The Schedule C attached hereto and made part hereof sets forth a true answer to each inquiry contained therein and in the case of transfers of property, real or personal, within two years of decedent's death, in contemplation of deoedent's death,\or intended to take effeot 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 deoedent, 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 effeot in possession or enjoyment at or after death, there is also attached to the sohedule a oony of the deed, trust agreement or other instrument oreating the trust. Ther~ is also set forth in said sohedule a list of all property, real and personal, with its value, which passes at decedent's death by virtue of the exeroise by decedent, either individually, orjointly with another, or any power of appoint- ment vested in decedent, either individually or jointly, by the will, deed, or other instrument of another, wi th a copy of the instrument creating such power attached to the schedule. That Schedule D attached hereto and made part hereof sets forth the names and addresses of all persons beneficially interested in this estate at the time of decedent's death, the nature of their res- pective interests, their relationship, if any, to the decedent, together with the ages at the time of decedent's death 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, andthe 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 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 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 "A", "B", "C", "E", and "F" as directed therein, have been carried forward and properly registered in the Summary. NOTARY PUBLIC My Commission E~D;;'es SZDt.. 20. 1978 Ne'lI Cumberland, Pc. Cumberland Co. NOTE: Before signing affidavit make sure all blank spaces in the affidavit and schedules annexed are filled in with details or the word "None", and in case the assets include rare and unlisted securities, securities of close or family corporations or an interest 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. . /.-"/ Ii h18 ..L.q...:................. .,~~.....~:..&~........._'". (Ea:ecutor-AdminiBtratcw) C~ ....21S....So.uth...Riy..er.....S.tr.e.e.t..................................._.__._... (Street Number) ,...War.mlE~.b~.'F~;Il~~t~::;Ja,..17043..".......... Subscribed and sworn to be ore ............"'JA.:...w....4,...~ day ~f '.. ........!~tt2b,lp.. PH w w,.. .....w..,......... 19......1.8.. RC C-34 (4-73) COMMC>>l WE AI". TH 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 as tenant jn common with another or other, should be identified as to quantum of interest and the estimated value should be that of 1he decedent's interest only. (Property held as joint tenants with right of surviorship or tenancy by entireties should be reported on Schedule "E.") The r.al property locoted In the Common_olth of Pe""lylva"la ahould be (1) (2) (3\ ducrlbed by lot ond block "umber, atre.t a"d atreet "umber, together with DEPARTMENT a ge"eral deacrlptlon of the property, with 0 ref.rence to the record of the ASSESSED VALUE VALUATION conveyance by which the decede"t took title; If a farm atate number of 0- FOR YEAR OF ESTIMATED CAUTION cr.a; alao atatement of mortgage encumbrancea upon each parcel at death DECEDENT'S MARKET VALUE (Do not write of decedent. Tax.., a.....m.nts, accrued Inter..t on mortgag.., ete.,ar. DEATH In thla apace) to be lIated an Schedule "F" and muat not be d.educted from thla achedule. NONE 00.00 NcnfL,. . 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. 00.00 Nt>\",)L RCC-35 RESIDENT DECEDENT SCHEDULE liB" PERSONAL PROPERTY '* CbMMONWEALTH 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 fUrnishings, 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 riduciary 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 fUlly UNIT VALUE ESTIMATED MARKET V AWE DEPARTMENT VALUATION (Do not write in this space) 1. / Account No. 1974 at Mon-oc Public Employees Federal Credit Union 2. 4.195 shares Keystone Custodian Funds, Inc. S3 ..--- Certificate Account No. 4 06 056438 at Harris Savings Association 8.58 164.36 35.99 \!c~.al. O~.C\ C{ 3. 4. Checking Account No. N. A. Certificate of Deposit No. 13923~CCNB Bank, N. A. Balance $6,000 plus accrued interest of 31.41 Certificate of Deposit No. 13918~ CCNB Bank N. A. Balance $10,000 plus accrued interest of $ 32 . 22 ~ Savings Account No. 003 703929 4 at CCNB Bank, N. A. Balance $4,715.09 plus accrued interest of $56.66 ~. 682 396 7 at CCNB Bank, 5.017.18 !st)\;.\tl } 5,382.06 5 -af~.O~ \ 5. 6,031.41 l.. 031.1..\\ I 6. 10,032.22 \ Dl D a~. d.~ 7. 4,771. 75 '+, .,; I. 1 S; Insert this total opposite "Personal Property", Schedule "B" in the "As Reported" column on the last page or this return. x X 31,434.97 .3\, '+3"+. q1 &r~ r:n!J~~=1(J1fI U Y li ". ...11 LJ "J ~~ ~u~~ic Em~!ol[ees . ~~<:::zial (re(lit Union Post Office Box 1172. 1372 Route 9 Toms River, New Jersey 08753 Jon F. La Faver 317 Third Street New Cumberland, Pennsylvania 17070 July 10,1978 Re:Besse w. ~earce Deceased Account No.1974~ Dear Mr. La Faver, We will require a death certificate and the date last regularly worked at occupation, date of retirement,next of kin and a tax waiver for $164.36~lance at time of death). We have filed for Cuna Insurance in the amount of $25.43. If accepted we will require a tax waiver for that amount. If I can be of any further assistance, please feel free to call. Very truly yours, . ' r:q;C&----, /2J_J.:J~~. Kathleen De Turo Assistant General Manager ..,Ad...lfll.'..'U.I'I.lI<lUII.'..IIlI.fllo"".""..lttn.... REPLY TO: " POST OFFICE BOXH72. TOMS RIVER, N.J.087S3- (201) 341-3550 o POST OFFICE BOX 558 .ASBURY PARK, N.J. 07712. (201) 775-4545 D POMONPLAZA,S9STATE H'WAYJ6. PORT MONMOUTH. N,J.onS8, (201) 767.1311 i~ ~-~"i'"'I.r.A.-. r1 \' 1'''-..,~!7-'l ___ i, " 'l' Ar.. Cod. 717/236.4041 The H A.. fP1 R m $ Savings Association 205 PINE STREET. HARRISBURG. PENNSYLVANIA 17106 OFFiCES DOWNTaNN . COLONIAL PARK' CAMP HILL . LEBANON' UNION DEPOSIT CAPITAL CITY' NEW CUMBERLAND. July 13, 1978 Jon F. LaFaver 317 Third Street New Cumberland, Pa. 17070 Besse W. Pearce, Deceased Dear Mr. LaFaver: Ms. Pearce held only one account with our association at the time of her death. This account was an certificate account, 4-06-056438, which was established February 9, 1976. This account was receiving the interest in check form every month. The balance in the account was $5,000.00 with interest due in the amount of $17.18. This brings the~- account balance as of June 19, 1978, to $5,017.18.~ If you have any further questions, please feel free to contact me in the Savings Department at 236-4041. Very truly yours, '))f~" .J_.(~ E.~J)/;.'-) (Mrs.) Sandra E. Myers Savings Counselor SEM:sem ~ J.I,+g. "'" g"""",. g. .'puJAt ~ g...l886 "I !fS~l~j -:; ,. " '. ~~r"'" nr=; ~"~LJ~'J L~ MAIN OFFICE 331 BRIDGE STREET NEW CUMBERLAND PENNSYLVANIA 17070 (7171238-0841 CCNS BANK. NoA. DATE JULY 12,1978 Law Offioes JON F LAFAVER 317 THIRD STREEr NEW CUMBERLAND, PA. 17070 RE ::.. BESSIE W. PEARCE GENTLEMEN: The fOllowing is a list of accounts that we have in our bank. TYPE OF ACCT. ACCOUNT NO. OPEN DATE DUE DATE BALANCE ACeR. INT., -- CERTIFICATE OF 1322~ V 3/24/76 .3/2L/80 $6000.00 /$.31.ll ~ DEPOSIT 1.3918 '/ CERTIFICATE OF 2/3/76 2/3/80 $10,000.00 $32.22 DEPOSIT SAVINGSifGP 003-703929-4 1/28/74 $471S.09~$S6.66 ~ NAMES ON THE ABOVE ACCOUNT GERALDINE E.DAVIS FOR BESSE W. PEARCE If we can be of further assistance, do not hesitate to write. Very truly yours, ,.. ,_ /' '2-..., t:f~--?6... hi O-'l-"~ ", /. , Dorothy Morrette Savings Department Head. , ,-, ,. " CCNB MAIN OFFICE 331 BRIDGE STREET NEW CUMBERLAND PENNSYLVANIA 17070 (717) 238-0841 CCNS BANK. NoA. July 7) 1978 Law Offices Jon F. LaFaver 317 Third Street New Cumberland) PA. 17070 RE: Bessie W. Pearce Gentlemen: Reference to your letter of July 5) 1978) concerning accounts of Bessie W. Pearce) Deceased) we have located one . checking account. The account number is 682-396-7~ed on August 4) 1972) in the name of Bessie W. Pearce Conly). The balance as of June 19) 1978 (date of death) was $5,382.06. ~ If you have any further questions) please contact us. Very truly yourJ/ )(fll/~~ D.E. Machemer, Manager Bookkeeping Department DEM: sd .-: ,., RCC-36 COMMONWEALTH OF PENNSYLVANIA TRANSFER INHERITANCE TAX SCHEDULE "c" TRANSFERS '* RESIDEST 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) (2) Did decedent, within two years of death, transfer property from himself 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 th~ property transferred? (Answer yes or no) (b) The right to designate the persons who shall possess or enjoy the property transferred or income therefrom? (Answer yes or 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) (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 could revert to decedent under terl1lS of transfer or by operation of law? (Answer yes or 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) 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 00.00 N6NJ Insert this total opposite "Transfers", Schedule "C" in the "As Reported" column on the last page of this return. 00.00 N El'(U.. R.CC-37 (1~-63) COMl\iONWEALTI! OF PENNSYYLANIA TRANSFER INHERITANCE TAX RESIDENT DECEDENT SCHEDULE "D" BENEFICIARIES \ h BENEFICIARIES AND ADDRESSES RELATIONSHIP SURVIVED (If step-children or DATE INTEREST OF State full names and addresses of all who illegitimate children DECEDENT OF BENEFICIARY aYe an interest, vested, contingent or other are involved, set STATE YES IN ESTATE wise, in estate) forth this fact.) OR NO BIRTH Mrs. Helen Buchanan 202 North B1 vd. Be1mar. New Jerse_y 07719 none yes adult $1,000 Rnnnie Tomlinson M~nc:nn QOl Wash;"n+^" . Wall. New Jersev 07719 none yes adult $1 ,000 Geraldine E. Davis ?ll\ t'^........ IH vpr ".. .... Wnrm" _ L ... ., ,,,,,"; l> niece yes adult Entire Residue - --- -_.- - ,- -~ Deponent fUrther says that all the above-named bene~iciaries are living at this time except below: NAME DATE OF DEATH RESIDENCE (Executor-Administrator must complete "As Will ~ Reported" column #1.) Administration No. Year ............ 0 ..., "C :Xl .... .... (I) (I) 0 ll> .... e:. P.J THE <Il Cl '" <Il '" 0 [ Cl "C :\IATIER OF THE APPRAISEMENT ..., e:. .... e; 0 '0 ll> ~ (I) c- .... OF THE ;r 0 ~ '0 t<1 (I) .... ESTATE OF <Il ~ ..... ll> ..... (I) BESSE W. PEARCE Deceased Late of Ea,st Penns~<:)r.<:). T9WIl!td P. ., Cumberl and t'-l County of c:: a: a: Commonwealth of Pennsylvania > :Xl W t'-l t'-l >< 0 0 ?"' ?"' ?"' REPORT AND APPRAISAL g ~ ~ -GI> -GI> '* ..... ..... ..... w w > ..... .... ;. .. <Il ~ .... :Xl~ (...) ~ ~ (I).... . . 'g~ ~ \0 .... "'-J " ..... (I) c.. ~~.yj~~0 > '" tl ~~ Itl'<> 3~ 5' It c.. I. . . RCC,38 > RESIDENT DECEDENT SCHEDULE "E" JOINTLY OWNED PROPERTY '* COMMONWEAL TH 0 F PENNSYLVANIA TRANSFER INHERITANCE TAX INSTRUCTIONS: This schedule must disclose all property, real and personal, owned by the decedent jointly wi ih another 01' 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 ,mder 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 "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 Es tate DEPARTMENT VALUATION Address and Relationship of Co-Owners, and Place Value Share Val uation CAUTION-Do not Write of Record of Instrument, where Real Estate. In This Space. '> Value of Value of ^" En t1 re Decedent's ^" Property Interest NONE 00 .00 N~ Insert this total opposite "Jointly Owned Property", Schedule "E" 1\\ maJ in the "As Reported" column on the last page of this return. 00. 00 - REv-sts (S-7B' COMMONWEAL TH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF FIELD OPERATIONS P.O. BOX 2970 HARRISBURG 17105 IN YOUR REPL.Y PL.EASE REFER TO Inheritance Tax Division NOTICE OF FILING OF APPRAISEMENT Geraldine E. Davis 215 S. River St. WQr-ml9YBs~rg- p~ (Executor or Admini stratar) In Re: Estate of Besse W. Pearse Cnmherland County - Fi Ie No. 21-78 329 Dear You are hereby notified that the O...i gin'" appraisement in the estate of Rp<lA..' TN P",,,...,.., has been filed in the office of the Register of WHls of r."mh""'lauQ County on 20 February , 19-12., Said appraisement reflects the following valuations: Real Estate Personal Property Transfers Jointly Owned Total None 31.434.97 None None $31.434.97 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, P. L. ~~,' ~. C\, CL,. ~~y_.:,J.~ Date '0 'F..br'lary 1979 Signed CJ C2\=> \. ,-. ,;>) Title AdminiS1:ra1:ivp Officer L-~-~..,. Note: This is not a bill. REV-457 (8-78) DEPARTMENT OF REVENUE BUREAU OF FIELD OPERATIONS P.O. BOX 2970 HARRISBURG, PENNA. 17105 COMMONWEALTH OF PENNSYLVANIA RESIDENT INHERITANCE TAX APPRAISEMENT DATE COUNTY FILE NO. 20 i'sQl'1iary 1979 Cumberland 21-78-329 Whereas, "Rocooo tJ' 'Po~,.......o late of 'If' 'D.o.""',l"Io.l..I"\""'" in the County of Cumberland Commonwealth of Pennsylvania, having died on the 19th day of June 19 I!L., 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 $ 1)~~1 1>~.._..~ None Personal Prooerty 11 .414 !Q7 T....""" f'......" None .Tni"..1.. ~ " None Tn.. ,,1 $31.434 97 - Have been duly sworn according to law, I do hereby €.~tify that the above appraisement is made in conformity with the law on this 20th day of d C,~.;b~~():. 'P, _~)~ 19 l!L-_ '--) Appraiser Harrisburg (Number and Street) (Post Office) . Penna. 4' F '7 ~- 3.a'l ...~:#~.::..~:.~............... County RESI DENT INHERITANCE TAX APPRAISEMENT Estate of ) , \...J e...o<x. . lA) Pk2-'-i?J~ Deceased. Late of 'r.:. ,'212..--v__,,__..-eXn::-'-D ......................................................................... Date of Death 0 L - \ '\ -, '0 , ................................................. Appraisement Docket Vol., ........Lq.............. Page,......\.~.~............. No. ....:1.....J:?~ J Filed in Register's Office, ..?:-..-:.?:-.~..... 19::~ Amount of tax due $ . , ....................................... DEPARTMENT OF REVENUE Received, .................... ........................ ..... .... .... Examined and Approved,................................. Wrote about Appraisement, ............................. Appeal from Appraisement, ............................. En tered and charged, ...... .................................