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HomeMy WebLinkAbout03-14-79 (2) - . IilCC-SS (4!73) COMMONWEAL TH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS .3-/9--77 .x.l- '1 JY -{)3 &,.3 */O~/1.z -5- COUNTY OF cumberland IMPORTANT: RESIDENT DECEDENT 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 IN THE MATTER OF THE ESTATE OF } AFFIDAVIT OF ELIZABETH S. DOWNES xw (STATE FULL NAME OF'DECEDENT) - ~ Middlesex Twp. ,Cumberland ADMINISTRATqtVRIX County State of } 55: r.ITMBERLA.1\fD . SARA K. THUMMA and sayS PENNSYlVANIA County of I #/~.p( I of the estate of the above-named decedent being duly sworn, depose S Administratf>rJ r ix ) June 16 , 19 -1JLl:21 , (YEAR) 'lintestate Decedent died (DAY) (MONTH) Nome and address of attorney or } other authorized representative to whom 011 corres.pondence should be moiled. George B. Stuart 3 South Hanover St., Carlisle, Pa. 17013 That as such Administratrix deponent is familiar with the affairs of said estate and the property constituting (EX ECU TO R-ADMINIST 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 IN WHICH DECEDENT RENTED A SAFE DEPOSIT BOX THIS SAFE DEPOSIT BOX RENTED IN NAME OR NAMES OF RELATIONSHIP OF JOINT 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 pos session, 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 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, Vl,;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 of death; all wearing apparel, jewelry, silverware, pictures, books, works of art, household furn.iture, 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. i' , In the case of securities of close or family corporations, the values reported are as far as Possible substantiated by financial statements of the corporations, Showing the assets and liabilities thereof as of the date of death. The schedule also sets forth the interest of decedent at the time of death in any co-partnership or business, and in support of the value of such interest there is annexed to said schedule, financial statements showing the assets and liabilities of said co-partnerShip or husiness. A copy of the co-partnership agreement, (if oral, a statement setting forth the nature of the 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 aJlpraisal of, the. dec~d.ent' 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 be9ueathed 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 ~:t:ter death, said schedule sets forth the nature and value of' such property, to wJ:1om, transferred, the rel~tionship 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 inte~ded to take effect in ros~ession or en).oyment .at or after.death, there is also.attached to the schedule a cony of the deed, trust agrp-ement 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 pa~ses at decedent's death by virtue of the exercise by decedent, either indiVidually, or jointly With another, or any power of appoint- ment vested in decedent,ei ther, individually or jointly, by the will, deed, or other instrwnent of another, with a copy of the fnstrwnent creating such pbwer' atta~hed 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 instrwnents effecting th? 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 anrt unpairt 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. Subscribed and sworn to before me this ................................. .................................../d.t4...... day of ....M.a...r..c.h................................. 19.....7...9.. ~<<4tN5l:8~~~~ ............mm' My Commission Expires March 5, 1982 .~~~~._-"'-, ...~.!?!.....$..P~.~....Rq.!!......................................................................... (Street Number) . ......G.~r..l.i..~.lg.~.....p.a.."......1.70.l.3.............................................. (City or Town and State) 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 re~lirert 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. ".,; coot. (.., 1Ir) CO'M~ALTHOF.""'.LVA.;:'. DEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS TRANSFER INHERITANCE TAX RESIDENT DECEDENT SCHEDULE "Au REAL PROPERTY #1& Real property in Pennsylvania, with statement of mortgage encumbrances upon each parcel at,death of dece- dent. Property held by the decedent as tenant in common with vnofher or other, should be identified as to quantum of interest and the estimated value should be that 01 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 Commonwealth of Pennsylvania should be described by lot and block number, street and street number, together with a general description ~f the property, with a reference to the record of the conveyance by whiCh the decedent took title; If a farm state number of a- cres; also statement 'of mortgage encumbrances upon each parcel at death of decedent. Taxes, assessments, accrued Interest on mortgages, etc.,are to be listed on Schedule "F" and must not be deducted from this schedule. (1) (2) (3) DEPARTMENT VALUATION CAUTION (Do not write In this space) ASSESSED VALUE "OR YEAR OF DECEDENT'S DEATH ESTIMA TED MARKET VALUE All that certain property situate in Dickinson Township, Cumberland County, Pa., containing 86 acres, more or less, with limited right of way for ingress and egress. Assessment $7,490.0~ 29,960.00 80,000.00.../ ~~.:;... .. (.-~... \.. ....---/-- .../.~. U~- \S \J 0-9- ' ~ 0' G.-~ 'O~- - Q"J' B ('1 \ 00 c 'v) 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. 80,000.00 Rec -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 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 of or income rrom any property held in trust under the will or agreement or another, even though located outside of the State, at the time or death, should be listed in this schedule. Item ITEM UNIT ESTIMATED DEPARTMENT VALUATION NO. List and describe rully VALUE MARKEl' VALUE (Do not write in this space) NONE NQ~ Insert this total opposite "Personal Property", Schedule "B" in X X the "As Reported" column on the last page or this return. 0.00 RCC-36 COMMONWEALTH OF PENNSYLVANIA TRANS}~R INHERITANCE TAX SCHEDULE "c" TR.<\.NSFERS '* RESIDENT DECEDENT (1) Did decedent, within two years of death, make any transfer of any material part 9.f his estate, without receiving a valuable and adequate consideration therefor? (Answer yes or no) Nu (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) 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) 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 fr9m the property transferred? (Answer yes or no) NO (b) The right to designate the persons who sha~ possess or enjoy the property transferred or income therefrom? (Answer yes or no) 0 (6) If the answer to (5) (b) above is in t.h~ _affirmative, state whether the right was reserved in decedent alone or others (7) Did decedent in his lifetime make ~ransfer, 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) Did decedent, at any time, transfer property, the beneficial enjoyment of which was subject to change, because of II. reserved power to alter, amend, or revoke, or which could 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 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 (Es tima ted) DEPT. VALUATION (Dept. Only) NONE N f"\.-A.. Insert this total opposite "Transfers", Schedule "C" in the "As Reported" column on the last page of this return. o .00 RdC-37 (12-63) COMMONWEAL TH 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 pf all who illegitimate children DECEDENT OF BENEFICIARY aye an interest, vested, continge~t or ~ther are involved, set STATE YES IN ESTATE wise, in estate) forth Uris fact.) OR NO BIRTH Carl N. Downes R n _ Ii_ ~nn Vt:J,Q , II. _1-___ Carlisle, Pa. 17013 . Frances Brantner R_ n_ 2 , +-0... VOC!> , II. . ". GetT - - p,q , ......... .. - - 'J Flora A. Fraker.. R. D. 1. Dau~hter Vt:J,Q 1/!J.. . . Boiling Springs, Pa. 17007 Sara K. Thumma , 3121 Sprina Daughter Yes 1/4 Qh~.,..o Rd. , Carlisle, Pa. 17013 Deponent fUrther says that all the above-named beneficiaries are living at this time except below: NAME DATE OF DEATH RESIDENCE o E SUMMARY Real Property ................... ... .................................................... (Sch. "A") Personal Property .. ........................ ........... ............................. (Sch. "B") Transfers .................... ....... .............. ... ... .......... ....... .................. (Sch. "C"). J.Q.ip.tl.y..Qw.P...~.<i...r.+.~P~r.q (Sch. liE' ) . ,.......................................................,' .... o . ....."'.... ~<"k t:: d '2 41 8 's Q) .z "Oc.8 < 8. ':'8~ "S...,aQJ ::loot: u ;:l 0 ~ 8 ~ ~ ~ ..............~...........................,...........,....... Gross Taxable Estate ............ ( 1) (As Reported) $ J~9 .,.9()O ,,()() . $...... ....... ....~. ~~~... $................O.O.(L.. . $.....2..'..1.~~.~~ . $...................................... $... .~.? .~.1..3..9.....3.~.... (2) (As Determined) $. $. $. $ $.. $. cO ...... ~ r-I a Q) ('1"')>- \0 ('I"') I 00 r--. I r-I N c5 Z ~ ~ ---.-. c o :c:: ~ l:l Vl 'c == '5 .~ "'0 ~..r: f-o Z ~ ~ ~ CJ) - < c:I::: ~ ~ < ~ :t t-< ~ o c:I::: ~ ~ < - ,.. ."0 .41 :Ul :<U ,41 :u ell 41 ~Q ~. t::l: ~ o w := ~ ... t-< ~ ..r: o t-< CJ) ~ .: 00: ::z::: E-\: ~: ~. ~. H: H ~: .... o <li .... ~ ..J fit H ::t: CO Z ~ E-i ~ ri:l CO f;i.:l ~ l;l al H ~ t::l z: ~. I (1l '2 (1l ~ :... Vl c C <li ~ ~ ~ fI} - ~ l:llI: A. A. ~ Q ~ !- l:llI: o A. ~ " .... o l:' :: oJ o U .... o ..c .:: ~ <li ::: c o E ,.. :: o U , .... ,,1 RCC-38 RESIDENT DECEDENT SCHEDULE" E" JOINTLY OWNED PROPERTY COMMONWEALTH OF PENNSYLVANIA TRANSFER INHERITANCE TAX INSTRUCTIONS: This scheoule must disclose all property, real and personal, owned by the decedent jointly wi th 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 lmder Schedule "A", plus the date and place of record of instrument effecting vesti ture, 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 percentage Estate Value Share Valuation . I DEPARTMENT VALUATION CAUTION-Do not Write In This Space. Value of Value of Entire Decedent's Property Interest ^ ^ 1. Checking Acct. No. 722 7049 9, CCNB Ba uk NA co-owner, Sara K. Thumma (daughtl r) opened April 1974 4,278.72 , 1/2 = 2,139.36 50% / 2,139.36 Insert this total opposite "Jointly Owned Property", Schedule "E" in the" As Reported" colUllD1 on the last page of this return. 2,139.36 'Lll3<{.3G ~.. ~. , COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE HARRISBURG RC C-43 (4-69) NOTE: TO BE SUBMITTED IN TRIPLICATE Pennsylvania Deportment of Revenue Bureau of County Collections 26 S. 4th Street Harrisburg, Pennsylvania Dear Sir: Pursuant to Section 742, Pennsylvania Inheritance and Estate Tax Act of 1961, we herewith submit the following report: NAME OF REPORTING FINANCIAL INSTITUTION ccrm Bar...k, lLA. ADDRESS 331 Bridge f~treet, !iew CU!!I.ber1and.?A 17070 ACCOUNT NO. OF JOINT, TRUST OR INVESTMENT DEPOSIT Check.ine A.cct. #722-7049-9 NAMES ON ACCOUNT OR INVESTMENT ::':lizabeth S. Downes with Sara L '::'h1.11!'lnla DECEASED JOINT DEPOSITOR,_ '" TRUSTEE OR INVESTOR l:..lizabeth .::.. Downes ADDRESS AND COUNTY R. D. 112, Box 165", Carlisle. PA 17013 County - Cumberland DA TE OF DEATH June 16" 1978 SURVIVING DEPOSITOR, BENEFICIARY OR INVESTOR Sara K. ':'11~ ADDRESS RELATIONSHIP TO DECEDENT Unl:nowu DATE DEPOSIT OR INVESTMENT WAS ESTABLISHED April, 1974 BALANCE, INCLUDING INTEREST L r DUE, AT DATE OF DEATH $,27J. 72 Unknown R. S. Deposit Operations Coordinator TITLE .Tamw.r;,r IS', I97~1 COMMONWEALTH OF PENNSYL V AN IA DEPARTMENT OF REVENUE HARRISBURG fEB 05 1979 RC C-43 (4-69) NOTE: TO BE SUBMITTED IN TRIPLICATE Pennsylvania Department of Revenue Bureau of County Collections 26 S. 4th Street Harrisburg, Pennsylvania Dear Sir: Pursuant to Section 742, Pennsylvania Inheritance and Estate Tax Act of 1961, we herewith submit the following report: NAME OF REPORTING FINANCIAL INSTITUTION ccnB Bank, fl./\.. ADDRESS 331 Bridge Street, lJew Cumberland, PA 17070 ACCOUNT NO. OF JOINT, TRUST OR INVESTMENT DEPOSIT Cert. of Deposit 1152-119682, f.152-119683 & #52-119684 NAMES ON ACCOUNT --, . _ C' OR INVESTMENT L1uabetn '-'. Downes or Sara K. ThUlDDla DECEASED JOINT DEPOSITOR, TRUSTEE OR INVESTOR Elizabeth S. Downes ADDRESS AND COUNTY R. D. )~!3. :Box 209; Carlisle 0 FA 17013 DATE OF DEATH JtU1e 1G, 1978 SURVIVING DEPOSITOR, BENEFICIARY OR INVESTOR Sara K. Thumma. County -. Cumberland ADDRESS Ul1knei.n:t /,/) . .- .....'--',-.;, - '"? RELATIONSHIP TO DECEDENT Unknown DATE DEPOSIT OR INVESTMENT WAS ESTABLISHED All three (3) on September 19, 1977 BALANCE, INCLUDING INTEREST DUE AT DATE OF DEATH $ JI~l three (3) at $1,046.39 each , Total: $3~139.1'r t< vi. ( Si gnature Deposit Operations -- ',;;, oordinator R. S. l3tephe ;/ TITLE January 19, 1979 REV-518 (3-79) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF FIELD OPERATIONS P. o. BOX 2970 HARRISBURG 17105 IN YOUR REPLY PLEASE REFER TO Investigation Division NOTICE OF FILING OF APPRAISEMENT Sara K. Thumma 3121 Spring Road Carlisle, PA 17013 (Executor or Administrator) In Re: Estate of Elizabeth S. Downes Cumberland County - File No. 21-?8-0'36'3 Dear Ms. Thumma: You are hereby notified that the Orb:inal appraisement in the estate of Elizabeth S. Downes has been filed in the office of the Register of Wills of Cumberland County on May 2lj . 19-29... Said appraisement reflects the following valuations: Real Estate Personal Property Transfers * Jointly Owned Total 80,000.00 None None 5.278.53 885.278.53 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. 373. Date May 25, 1979 Signed \ _ ~ ~ E="~~ Title Administrative O~icer *Joint-He1d Property in the amount of 15,278.53 includes Certificates of Deposit #52-119682, #52-119683 & #52-119684 at the CCNB Bank, N.A. in the names of the decedent or daughter. Accounts established 9/19/77. Balance at date of death NOTE: This IS not a bill. $3,139.17. (Taxable in full) 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 May 25, 1979 COUNTY Cumberland FILE NO. _21-78-0363 Whereas, Elizabeth S. Downes late of Middlesex Township in the County of l'!nmh",.,.l..nn Commonwealth of Pennsylvania, having died on the 16th 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, Len Fuliini ti , 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 Pu r poses R",..l - . $ Rl)()()() 1m Personal Pronertv None Transfers None *.T ^.; ....+ -Held Prnnertv 5,278 53: '1V\'1'IA T. ~Rc; ??8 c;~ *JDint-Held ..... ..... in the amount of 15.278.5-=5 includes Certificates of Deposit #52-119682, #52-119683 & #52-119684 at the CCNB Bank, N.A. in +.h". n..m.... nf' the decedent or da1H,.hter. Accounts established 9/19/77. R..l..n"e at date of death S~ l~q.l? (Taxable in full) f . Have been duly sworn according to law, I do hereby certify that the above appraisement is made in conformity with the law on this ?5th day of Mav 19 7.2...- . L ~ t=' v--D-x._~ ... . uUU Appraiser (Number and Street) Harrisburg (Post Office) , Penna.