HomeMy WebLinkAbout11-27-78
RC(C-SS {4-7~l
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS Q.
() \1 \<310
\\ ~' .
\'. COUNTY OF
~ 1__ '/ 'i' ~ 0 33 'L--
'*
RESIDENT DECEDENT
CUMBERT.ANn
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 Reuenue. (Section 703 of the Inheritance and Estate Tax Act of 1961.)
Lote of
CUMBERLAND
} AFFIDAVIT OF
EXECUTOR
~5OllWCHlK
County
IN THE MATTER OF THE ESTATE OF
SYLVIA Z. BRETZ A/K/A
SYLuln M R'RETZ
(Sl'"ATE FUL.L. NAME OF DECEDENTI
State of
PENNSYLVANIA
) as:
~WAVL~~ of the estate of the above-named decedent being duly sworn, depose S and say S
Decedent died June 11 , 19~{~..tate leaylng a la.t will, copy of which i. hereto attachOd.}
(MONTHI (DAY) (YEARI!X~
Namo and addre.. of attorney or } Horace' A_ ,Johnson. Myers. Myers. Flower & Johnson
other authorized repreumtative to whom
all ca"uflondonce .hould bo mailed. Third & Market Streets, Lemoyne, Pa. 1 704 3
CUMBERLAND
CLARK EDWARD BRETZ
Executor
County of
That as such Executor deponent is familiar with the affairs of said estate and the property constituting
(EXECUTO R-ADMINIST RA TORI
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 WHI CH DECEDENT RENTED A S.4FE DEPOSI T BOX IN NAME OR NAMES OF HOL.DERS 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 Scheau/e 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 Scheaule 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 pos ses sion, s tanding 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 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 wearing apparel, jewelry, silverware, pictures, books, works of art, household furnitute;'horse's';: carriages,
automobiles, boats, and any and all other personal chattels of whatsoever. kind '0( 'nature, '"left by decedent,
together with the fairly estimated market value thereof; all bonds and mortgages1i~ld 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 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-
of a t such time.
In the case of securities of close or famil y corporations, the values reported are as far as
pOBsible substantiated by fin~ncial 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 husiness.
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 Buch other facts
pertaining to the business as may be pertinent to a fair and jUBt 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 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 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 CORY
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, either individually or jointly, by the Will, deed, or other instrument of another,
with 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, 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 otherB, 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", "CO, "E", and "F" as directed therein,
have been carried forward and properly registered in the Summary.
_~:::_:':::;'d.':~fto==:::~;fJ/dL~i4=--
___\0. '__~.;;;...;:~ .----~~~~~;::------
'1.1 ::'OrnnW.;iOD Ezplte. Dee. 31, 1981 .dMech.ani.c.s.b.Ur..g.I....J?.a........l.7.Q.5.d5.d..ddddd.dd......
L...1J10yD&, Pc. CumberlQIld County (City or Town and Sto.te)
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.
ltC c... 44073) .
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
TRANSFER INHERITANCE TAX
RESIDENT DECI!DENT
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 ather, 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 located In the Common_alth of Penuylvanla .hould be
de.crlbed by lot ond block number, .treet ond .treet number, together with
o g.n.rol de.crlptlon of the property, with 0 r.f.r.nc. to tho r.cord af the
conveyonc. by which tho d.c.dent took title; If 0 farm .tot. numb.r of a.
crn; 01.0 .totem.nt of mortgoge .ncumbrance. upon eoch porc.1 ot death
of d.c.dent. To.e., a.....m.nu, occrued Int.,..t on mortgag.., .tc.,are
to b. lI.t.d on Schedul. "F" ond mu.t not be d.duct.d from thl. .ch.dul..
(1)
(2)
(31
DEPARTMENT
VALUA TION
CAUTION
(Do not writ.
In thl. .poco)
ASSESSED VALUE
FOR YEAR OF
DECEDENT'S
DEATH
ESTIMA TED
MARKET VALUE
Real Estate - Known as No. 103 North
21st Street, in the Borough of Camp
Hill, County of Cumberland and State
of Pennsylvania, in the name of the
decedent and James B. Bretz (James B.
Bretz died March 15, 1959) by Deed
dated August 3, 1946, recorded in Deed
Book E, Volume 13, Page 174.
Sale Price
33,000 .06 -8~, o~o. 00
W/!.'l.1el1 fl?(!e6vfl#
377V
,.. .-
------
1'1 ~ f ()
)
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.
$33,000.00 3~ D()D.OD
I
'RCC-35'
RESIDENT DECEDENT
SCHEDULE "B"
PERSONAL PROPERTY
'*
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 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 anyundistributed
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
MARKEr VALUE
DEPARTMENT VALUATION
(Do not write in
this space)
1.
Dauphin Deposit Bank and Trust Company
Checking Account No. 17-67-598-7
Date of death balance
1,638.58 /l)u~r. 58
2.
The Harris Savings Association
Optional Passbook Savings No. 36629 v
Date of death balance, pIus interest
2,943.09~V~lql.\?>. 09
3.
Dauphin Deposit Bank & Trust Company
Certificate of Deposit No. 1002
Certificate of Deposit No. 1066
Certificate of Deposit No. 1037
6,103.54 V-(", 10.:5.5'"
7 , 043. 831~~1 0 "4t>. t!l
7,068.58k "1,Ollf,5W
4.
Miscellaneous personal property
Sold
46.10 //
5.11,..~'
30.701/~
4.{(". It)
6.1/
5 .
Refund - Bell Telephone Company
6.
Blue Cross - Blue Shield refunds
30. "0
7.
Continental Life Insurance Company
Policy No. 341021 - payable to Estate
1,291.42,/' ',~C'.l/.If~
190.86vV- IClto.8'b
8.
Tax adjustments at settlement
Insert this total opposite "Personal Property", Schedule "a" in
the "As Reported" column on the last page or this return.
x X
26,361.81
..<lp,3c,,1. g \
RCC-)6
COMMO:\I'\'l:ALTIl OF PE:\N~YLVANrA
THA.'\SFFH. rC\'HEIUTANrF TAX
SCHEDULE "c"
TRANSFEIlS
rtESIDENT DECFIWI\'T
(1) Dirl rlecedent, within two years ofrleath, make any transfer of any material part of his estate, without
receiving a valuable and adequate consirleration therefor? (Answer yes or no) No
(2) Did decedent, within t.wo years of rleath, transfer property from himself to himself and another or
others (including a spouse) in joint ownership? (Answer yes or no) 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 rlecerlent' s heal th at time of making the transfer. (Note 1).
(c) Cause of decedent's denth. (Note 1).
(4) Did decedent, in his lifetime, make any transfer of property without receiving a valuable or adequate
consirleration therefor which was to t.ake effect in possession or enjoyment at or after his df>ath?
(Answer yes or no) No
(a) Was there any possibility that the property transferred might return to transferer or his
estate or be subject to his power of disposition? (Answer yes or no) ~lo
(0) 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 en,l before his death:
(a) The possession or enjoyment of or the right to income from th,' property transferred?
(Answer yes or no) No
(b) The right to designate the persons who shall possess cr enjoy the property transferrerl 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 reserverl 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) No
(8) Dirl rlecedent, 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 c0111d revert to decedent under terms
of transfer 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 beneficia~~ reserverl in the decedent alone or the decedent and others?
(Answer yes or no) NO
NOTE 1: The answers to these questions should be supported. by affidavit by the attending physician as
well as a copy of the death cer'tificate.
NOTE 2: If answer to any of the above questions is yes, set forth below a description of the property
transferrerl, it's fair market value at rlate of death, dates of transfers and to whom transferred, with
relationship of transferees to rlecerlent, if any. Submi t copy of any trust deed or instrument, if trans-
fers are claimerl to be non-taxable, also sublnit rletailerl statement of facts on which said claim is based.
NOTE 3: List applicable property below in manner in which provided in Schedules A, n, or E.
ITEM
DESCRIPTION
MARKET VALUE
(Es tima ted)
DEPT. VALUATION
(Dept. Only)
NONE
~\ lmJ...J
Insert this total opposite "Transfers", Schedule "C" in the
"As Reported" column on the last page of this return.
tJ6'Y\.L
RCC- 37 '12-63)
CO~IMO:llWEALTll OF I'E;I;;I;SYYLANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "D"
BENEFICIARIES
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
Clark Edward Bretz Son Yes Adult One-Third Residue
3845 Sullivan Street
Mechanicsburg, Pa. 17055 .
Natalie J. Titler Daughter Yes Adult One-Third Res idue
?.443 Duke Street
H."l""; -.. :0 Pa 17104
.. .1.1 Walters Dauohter Yes Adult One-third Residue
R.D.#4, Silver Spring Rd.
Mechanicsburg, Pa. 17055
/
.
\
h
Deponent fUrther says that all the above-named beneficiaries are livin~ at this time except below:
NAME
DATE OF DEATH
RESIDENCE
(Executor-Administrator
must complete "As
Reported" column #1.)
Will
Administration
~ No.
C")
...
o
'"
'"
Year
P.oI THE
~IATTER OF THE APPRAISEMENT
>-l
~
x
~
cr
ir
t'!l
'"
....
~
....
(1)
OF THE
ESTATE OF
SYLVIA Z. BRETZ A/K/A
SYLVIA M. BRETZ
.. ........
Deceased
Late of. Haml?CleI1T~)\vl1~l1il?H
County of
Cumberland
Commonwealth of Pennsylvania
REPORT AND APPRAISAL
~ ~ ~
~ ~ E-
'" 0
lr ::I "I:l
~ e.. :3
"I:l'1il
... ...
.g ~
9l
....
'<
(J)
c:
~
~
>
~
(J) (J) (J) ><
() (l (l
?" ?" ?"
q ~ ~
-&& .~ <ih -0 -0 -0
Myers, Myers, Flower & Johnson
P. O. Box 125
Lemoyne, Pa. 17043
l..11
\0
.;
W
P"
!-'
.
Co
~
:IVW>
: 0"1 W '"
:1 :.. ;,. ~
o:wo~::
:I :O"Io-g~
:......0 :4-
:. it ('t
. OJ 0 c..
I-'O~
-0q,q,q,.;eq,
~
tl
~~
\'tt--:J
..,~
~.
::I
r:
c...
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
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 tmder 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
Address and Relationship of Co-Owners, and Place
of Record of Instrument, where Real Estate.
Unit
Value
percen tage
Share
Estate
Valuation
^'
v
('>
~
DEPARTMENT VALUATION
CAUTION-Do not Write
In This Space.
Value of Value of
Entire Decedent's
Property Interest
VV'
^"
NONE
WO'fll./
~
I
Insert this total opposite "Jointly Owned Property", Schedule "E"
in the "As Reported" column on the last page of this return.
M6YlU
-
REV-~IB (B-7B)
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
Clark Edward Bretz
3845 Sullivan Street
Me..hAn; csburit PA. 170,55
(Executor or Adm ini s tro tor)
In Re: Estate of Sylvia Z. Bretz a/k/a Sylvia M. Bretz
Cumberland County _ File No. 21-78-0332
Dear Mr. Bretz:
You are hereby notified that the original .
appraisement in the estate of Sylv1a Z. Bretz a/k/a Sylv1a M. Bretz
has been filed in the office of the Rtlister of Wills of Cumberland
County on January 19 ,19~, Said appraisement reflects the following
valuations:
Real Estate
Personal Property
Transfers
Jointly Owned
Total
33.000.00
26.361.81
None
None
159.361.81
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 an'num 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. ~3~ B .~
Date January 19. 1979 Signed d ~
Title Administrative Officer
L ---------.
Note: This is not a bill.
RC C.2 (2.64)
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
HARRISBURG, PENNA, 17127
COMMONWEALTH OF PENNSYLVANIA
RESIDENT INHERITANCE TAX
APPRAISEMENT
DATE
January 19, 1979
COUNTY
Cumberland
FILE NO.
21-78-0332
Whereas, Sylvia Z. Bretz a/k/a Sylvia M. Bretz late of Hampden Township
in the County of Cumberland Commonwealth of Pennsylvania, having died on
the 11th day of June 19 78 , 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 deeedent 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.
Unit Appraisement
Delorlptlon of Allot ValulIs Made for Inheritance
Tax Purposes
Real Property $ 33,000 00
Personal Property 26,361 81
Joint-Held Property None
Transfers None
TOTAL ASSETS 59,361 81
.
.
Having been duly sworn according to law, I do hereby certify that the above appraisement is made in con-
formity with law on this 19th day of d ~ : J:~ 19~.
_ ~-..., -=~, 0 _ _ -=:':-'
<C",,, ~
o Appraiter
(IIIImbor and Strw) . b
J:1lU'rJ.s urg P
, enna.
lPoot Oftl..l
R l....~ 'i'- 33.:2.,
Cumberland
County
RESIDENT INHERITANCE TAX APPRAISEMENT
Estate of
SYLva Z. BRETZ A/KIA
SYLVIA M. BRETZ.
Deceased.
Late of
Hampden Township
Date of Death, June 11. 1978
Appraisement Docket Vol., 10 6%
Page,
16q
No.
1
Filed in Register's Office,
Amount of tar dtte, $
1/19/1979
DEPARTMENT OF REVENUE
Received,
Examined and Approved,
Wrote abo.ut Appraisement,
Appeal f,.oltl Appraisement,
Entered and charged,