HomeMy WebLinkAbout12-14-78
RCC-33 (4-73)
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COMMONWEAL TH OF PENNSYLVANIAn r f" fJ
DEPARTMENT OF REVENUE \'
BUREAU OF COUNTY COLLECTIONS
,.
RESIDENT DECEDENT
alC; ~- y
COUNTY OF
Cumberl;:md
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~enue. (Section 703 of the Inheritance and Estate Tax Act of 1961.)
IN THE MATTER OF THE EST A TE OF
M. Lawrence Sadler
(STATE FULL NAME OF DECEDENT)
} AFFIDAVIT OF
EXECUTOR
C )1.- art. _ _~JII(
ounty
State of
Late of Cumber land
PennsYlvania
County of
Cumber];::)nd
} ..,
~
of the estate of the above-named decedent being duly sworn, deposeS
N. Jane Slonaker
Executl5rix
June
(MONTH)
Name and address of attorney or }
other authorized repres.entative to whom
all correspondence should be mailed.
and sayS
Decedent died
16
, 1911L-{~estate leaving a last will, copy of which is hereto attaChed,,}
(y EAR) ,ntestate
(DAY)
J. Robert Stauffer, Esquire
Market Square Building,Mechanicsburg, Penna., 17055
That as such Executrix deponent is familiar with the affairs of said estate and the property constituting
(EX ECU TO R-ADMINI ST 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
The First Bank and
of Mechanicsburg
THIS SAFE DEPOSIT BOX RENTED
IN NAME OR NAMES OF
RELATIONSHIP OF JOINT
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 fuIly 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 pril!lr to decedent's
death in the case of savings banks, and to the date of decedent's death in all other cases; all bonds, postal
savings, treasury certificates or notes and other evidence of indebtedness of the United States to the de-
cedent; all obligations, whether by statute or agreement they are designated as tax free, of the United States,
or any state, or political subdivision thereof, or of any foreign country, which are owned at the time of death;
all wearing apparel, jewelry, silverware, pictures, books, works of art, household furniture, horses, carriages,
automobiles, boats, and any and all other personal chattels of whats oever, kind or nature, left by decedent,
together with the fairly estimated market value thereof; all bonds and mortgages held by decedent and of all
claims due and owing decedent at the time of death, and all promissory notes or other instruments in writing
for the payment of money of which decedent died possessed, of whatsoever nature, with interest thereon, if
any, giving the face value and estimated fair market value thereof, and if such estimated fair-market value be
less than the face value, it sets forth briefly the reasons for such depreciation as to each item; all moneys
payable to the estate from life insurance policies carried by decedent; all annuity and endowment contracts
the proceeds of which were payable upon the death of the decedent; all and the corporate stocks and dividends
due thereon and unpaid as of the date of death, bonds and accrued interes t thereon to the date of decedent's
death and other investment securities owned by the decedent at the time of death, with the market value there-
of at such time.
In the case 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 liabili ties
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 "tl,usiness.
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 l;lUSiness as may be pertinent to a fair and just appraisal of the decedent's interest
therein must be submitted. It should also set forth in itemized form, together with the fair market value
thereof, any other property owned or bequeathed by the decedent at the time of death.
The Schedule C attached hereto and made part hereof sets forth a true answer to each inquiry
contained therein and in the case of transfers of property, real or personal, within two 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 cony
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 pa8ses 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 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", "en, "E", and "F" as directed therein,
have been carried forward and properly registered in the Summary.
Subscribed and sworn to before me this ,......,.........................
,A
m......lL=. ~d.Y of D~G.:;e.r... m.;........... 19.71L. ,'L1e
................~.. . .' ...... ...~~.n".~l<I!..PJD
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';'i{C;. CL~') .. )V.",
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C,:...; ',',...S \lEG. '2.9. 1979
i-A't CU t~d~i r~. . ; I"~ ,~ \:-
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.
'71L~~.mm._.._"
.........2.Qlf.~.w.~..9..t......Main....S.:t.re.e.t.........................................
(Street Number)
. .M~..g..h9..n.tg..9..p..Y.:r.g.".....p..e.nna......,... ..17.0.5.5..........
(City or Town a.nd Sta.te)
RCc.U (4-73)
COMMONWEAL.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 in common with another or other, should be identified
as to quantum of interest and the estimated value should be that of the decedent's interest only. (Property
held as joint tenants with right of surviorship or tenancy by entireties should be reported on Schedule "E. ")
Th. real property located In the Commonw.alth of Pennsylvania should b.
de.crlbed by lot and block numb.r, .tre.t and .tr..t number. together with
a g.n.ral dncrlptlon of the property, with a r.fer.nc. to the record of the
conv.yance by which the decedent took tltl.; If a farm stat. number of a.
ere.; 01.0 .tatem.nt of mortgage encumbrance. upon each pare. I at d.ath
of d.cedent. Tax... a.....m.nt.. accrued Int.r..t on mortgage., etc.,are
to be lI,t.d on Schedule "F" and mu.t not be d.ducted from thl. .chedule.
~/ THAT CERTAIN House and Lot of Ground
situate in the Village of New Kingstown,
Township of Silver Spring, County of Cumber-
land and State of Pennsylvania, bounded and
described as follows, to wit:
(1)
(2)
(3)
DEPARTMENT
VALUATION
CAUTION
(Do not write
In thl. .pace)
ASSESSED VALUE
FOR YEAR OF
DECEDENT'S
DEATH
ESTIMA TED
MARKET VALUE
On the North by the Carlisle and Harrisburg
Turnpike, on the East by lands formerly of
John Mason Thrush, now or late of David Reed
on the South by an alley, and on the West by
lands formerly of the Messiah Church, now or
late of William Kapp, containing 40.0 feet
in width in front on said Turnpike Road,
and 34.0 feet in width in the rear along saie
alley, and a depth of 188.0 feet, be the
same more or less, and having thereon
erected a frame dwelling house.
Being the same premises which Merian Slonake~
Administratrix of the Estate of Minnie C.
Sadler, by her Deed dated December 1, 1960
and recorded in the Cumberland County
Recorderts Office in Deed Book uBn, Volume
20, Page 818, granted unto M. Lawrence i
Sadler. I
Appraised by Lester G. Connor, Professional
Real Estate Broker and Appraiser, of 2159
Market Street, Camp Hill, Penna., at
$6,000.00. A copy of said appraisal is
submitted herewith. $ 6,000.00
RT ~ y g) ff/ }ltAI'" ~r.
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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.
lJ,IOOD. Do
RCC -~5 '
'*
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "B"
PERSONAL PROPERTY
INSTRUCTIONS: This Schedule must disclose all tangible and intangible personal property owned individually
by the decedent, at the time of 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 of 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 fact that they are not of the administered estate.
Tangible personal property should be listed first (e.g. jewelry, wearing apparel, household
goods, and fUrnishings, books, paintings, automobiles, boats, etc.)
Intangible personal property, such as bonds, treasury certificates, 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 f'iduciary in said capacity, partnership interests, interest in any undistributed
estate of or income from any property held in trust under the will or agreement of another, even though
located outside of the State, at the time of death, should be listed in this schedule.
Item
No.
ITEM
List and describe fUlly
UNIT ESTIMATED DEPARTMENT VALUATION
VALUE MARKEl' VALUE (Do not write in
this space)
(1) $25.00 denomination, Series E, U. S.
Savings Bonds as follows:
Q1805437760E - dated Jan. 1960 /
Q1817561735E - dated Feb. 1960/
Q1822244329E - dated March 1960~
Q18BS793884E - dated April 1960/
Q1829820982E - dated May 1960 ~..
Q1838191420E - dated June 1960 v
Q1842405512E - dated July 1960~
Q184832196SE - dated Aug. 1960v'
Q1848668326E - dated Sept. 1960/
Q1852878718E - dated Oct. 1960~/
Q18S7367691E - dated Nov. 1960v
Q1861343359E - dated Dec. 1960 ~
Q1870525782E - dated Jan. 1961/
Q1871126653E - dated Feb. 1961/
Q1880904$18E - dated March 1961/
Ql885397805E - dated April 1961/
Q1889077811E - dated May 1961~
Q1895626715E - dated June 1961/
Q1896101346E - dated July 1961v
Q1903854711E - dated Aug. 1961//
Q1904840025E - dated Sept. 1961~
Q1909587019E - dated Oct. 1961~
Q1914447475E - dated Nov. 1961//
Q1918454582E - dated Dec. 1961~
Q1228655182E - dated Jan. 1962/
Q1232691371E - dated Feb. 1962 v
Q1937463674E - dated April 1962/
Q1941210162E - dated May 1962~
Q19457S0657E - dated June 1962 v
Q1952412757E - dated July 1962/
Q1956442781E - datedAug. 1962 /
Q1968091391E - dated Sept. 1962v
Q1968119642E - dated Oct. 1962/
Q1972290639E - dated Nov. 1962/
Q1983786423E - dated Dec. 1962~
Q1987851759E - dated Jan. 1963/
Q1987871419E - dated Feb. 1963'/
Q1990786933E - dated March 1963/
Q1999815047E - dated April 1963./
Q2001866575E - dated May 1963'/
Q2004522700E - dated June 1963/
Q2011865122E - dated July 1963./
Q2020120754E - dated Aug. 1963/
Q20201+40078E - dated Sept. 1963/
Q2027415480E - dated Oct. 1963,/
Q2029055712E - dated Nov. 1963/
Q2038624478E - dated Dec. 1963/
44.00
44.00
44.39
43.10
43.10
43 .18 ~
43.18
43.18
43.57
41.77
41.77
41.87
41.87
41.87
42.23
40.90
40.90
41.00
41.00
41.00
42.00
40.79
40.79
40.89 '
40.89X
40.89 IY
39.8<t ~
39.89,
39.99
39.99
39.99
40.18
39.01
39. en
39.16
39.16
39.16
39.26
38.11
38.11
38.40
38.40
38.40
38.49
37.37
37.37
37.60
~4.00
L.tJ4. 00
J.t J.I. .3 'I
1i~.IO
"fa. it>
4~.1~
Jj~.lt
Ji3.1 CZ
'i1.51
Lt,.11
LU.l1
'il. <n
...,. t'1
41.rJ
&.t;)" .'?>
Lt~. tto
'fo.1o
41.00
"'t1.OO
41.0b
~).,Ob
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31.01
",.01
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3$? i I
:32.'.H)
3Z- . ~ 0
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.31. ?J7
!J7. 37
31.1o b
1'-
. RCC -35
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
RESIDEKT DECEDENT
SCHEDULE "B"
PERSONAL PROPERTY
INSTRUCTIONS: This Schedule must disclose all tangible and intangible personal property owned individually
by the decedent, at the time of 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 of 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 fact that they are not of the administered estate.
Tangible personal property should be listed first (e.g. jewelry, wearing apparel, household
goods, and furnishings, books, paintings, automobiles, boats, etc.)
Intangible personal property, such as bonds, treasury certificates, 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 from any property held in trust under the will or agreement of another, even though
located outside of the State, at the time of death, should be listed in this schedule.
Item
No.
ITEM
List and describe fully
UNIT ESTIMATED DEPARTMENT VALUATION
VALUE MARKEl' VALUE (Do not write in .
this space)
$25.00 denomination Series E, U. S. Savin s
Bonds - Continued -
Q2042053172E - dated Jan. 1964 v
Q2042068737E - dated Feb. 1964~
Q2049953073E - dated March 1964v
Q2055010882E - dated April 1964/
Q2055038925E dated May 1964 ~.
Q2062325144E - dated June ~964 /'
Q206760526iE - dated July 1964../
Q2076147732E - dated Aug. 1964/~
Q2078834779E - dated Sept. 1964 .
Q2083702115E - dated Oct. 1964/
Q2088866220E - dated Nov. 1964 v
Q2093564310E - dated Dec. 1964 ~
Q2105133351 E - dated Jan. 1965~
Q2107918075E - dated Feb. 1965/
Q2107949772E - dated March 1965/
Q2118561166E - dated April 1965/
Q2119594614E - dated May 1965/
Q2129553928E - dated June 1965/
Q2135330901E - dated July 1965/
Q2140542499E - dated Aug. 1965/'
Q2146159839E - dated Sept. 196~
Q2150639904E - dated Oct. 1965 .
Q2156252686E - dated Nov. 1965/
Q2161983166E - dated Dec. 1965/
Q2168790810E - dated Jan 1966~~
Q2172672467E - dated Feb. 1966
Q2176489606E - dated March 1966"'-
Q2176715988E - dated April 1966~
Q2184954917E - dated May 1966/
Q2185239737E.- dated June 1966~
Q2190672608E - dated July 1966~
Q2202564807E - datedAug. 1966~
Q2206326300 E - dated Sept. 1966~
Q2206751407E - dated Oct. 1966~
Q2211883990E - dated Nov. 1966~
Q2236003158E - dated Dec. 1966
Q2239738316E - dated Jan. 1967..,/'
Q2245883203E - dated Feb. 1967 l/
Q2251139751E - dated March 1967~
Q225703873580E - dated April 1967v'
Q2257164673E - dated May 1967vr
Q2272075558E - dated Oct. 1967~
Q2281818315E - dated Nov. 1967 ~
Q2292756~5~E - dated Dec. 1967~
Q2292777040E - dated Jan. 1968""'"
Q2318677738E - dated Feb. 1968~.
Q2343708576E - dated March 1968~
25.00
37.60
37.60
37.70
36.59
36.59
36.84
36.84
36.84
36.93
35.85
35.85
36.07
36.07
36.07
36.16
35.11
35.11
35.31
35.31
35.31
ja:~g
34.36
35.51
34.47
34.47
34.47
34
34.
33.7
33.74
33.74
33.74
33.74
34.02
33.02
33.02
33.02
33.02
33.02
32.35
32.35
32.67
31.71
31.71
31.71
31.(,0
31.l.P 0
.31. 10
3to.S'f
jt,.5''\
3(,.g~
3t-i4
3iAi93
31,.gs
35.
!S&'. IS
.31,.01
~()'
3(,. 01
310.1("
3S.1l
35.11
.35.31
~.31
:;~.31
3S.40
3't. ,<<-
~.~t.
~..sl
3'\-. ",
~.'11
3't. "'1
7 ... ., ~4A1
- nit ~. *1
3't. "'\ ~L
33 :-h
3.3.1lf
.33.1"1-
.33.1[
.lil
3~.
33.~
33. O~
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S30~
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$), as'
3~.t.1
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. RCC-35'
'*
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "B"
PERSONAL PROPERTY
INSTRUCTIONS: This Schedule must disclose all tangible and intangible personal property owned individually
by the decedent, at the time of 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 of 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 fact that they are not of the administered estate.
Tangible personal property should be listed first (e.g. jewelry, wearing apparel, household
goods, and furnishings, books, paintings, automobiles, boats, etc.)
Intangible personal property, such as bonds, treasury certificates, 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 from any property held in trust under the will or agreement of another, even though
located outside of the State, at the time of death, should be listed in this schedule.
Item
No.
ITEM
List and describe fully
UNIT ESTIMATED
VALUE MARKEl' VALUE
DEPARTMENT VALUATION
(Do not write in
this space)
$25.00 denomination Series E, U. S. Saving
Bonds - Continued -
2
Q2343927625E - dated April 1968~
Q2349483723E - dated May 1968 v
Q2355257923E - dated June 1968 v
Q2363977519E - dated July 1968 v
Q2364014168E - dated A ug. 1968 v
Q2370885472E - dated Sept. 1968~
Q2377k64662E - dated Oct. 1968/
Q2384007214E - dated Nov. 1968~
Q2384131114E - dated Dec. 1968./.. ,"
Q2390847773E - dated Jan. 1969!of'.J /
Q2397480846E - dated Feb. 1969'/ ') l,'-"
Q2404242436E - dated March 1969/Lt1-1-\.
Q2411617796E - dated April 1969/
Q2418087014E - dated May 1969/
Q2428657265E - dated June 1969v
Q2455579296E - dated July 1969~
Q2455591291E.- dated Aug. 1969 ~
Q2410003405E - dated Sept. 196~
Q2473066357E - dated Oct. 1969 .
Q2474047962E - dated Nov. 1969~
Q2474097358E - dated Dec. 1969~
Q2481288405E - dated Jan. 1970
Proceeds of~cking Account No.
150-239-2r'with The First Bank and Trust
Company of Mechanicsburg, Pa.; balance
as of June 16, 1978
Proceeds o~avings Account No.
502-659-6, with The First Bank and Trust
Company of Mechanicsburg, Pa.; balance
as of June 16, 1978
Proceeds of public sale of household
furnishings conducted by Frank Potteiger
Auctioneer
-~
31.71
31.71
32.01
31.08
31.08
31.08
31.08
31.08
31.43
30.51
30.51
30.51
30.51
30.51
30.77
30.77
30.77
29.87
29.87
29.87
30.03
30.03
3
4
Insert this total opposite "Personal Property", Schedule "B" in
the "As Reported" column on the last page of this return.
x X
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SCHEDULE "B" - PAGE 3
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30.51
30.5(
30.51
30.11
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R.CC- ,'6
COMMO\V\fEALTIl OF PE~NSYLVANI A.
TRAN~FF}~ INIrF!UTANCF TAX
SCHEDULE "e"
Tll\NSFEllS
llESIDENT DECFlm)iT
(1) Did decedent, wi thin two years ot'death, make any transfer of any material part of his estate, without
receiving a valuable ar..d adequate cons.ideration therefor? (Answer yes or no) No
(2) Did decedent, within two years of death, transfer property from himself to himself and another oc
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 transt'er
(b) State of decedent's heal th at time of making the transfer. (Note 1).
(c) Cause of decedent's death. (Note 1).
(4) Did decedent, in his lifetime, make any transfer of property without receiving a valuable or adequate
consideration 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) 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) No
(b) The right to designate the persons who shall possess cr enjoy the property transferred or
income therefrom? (Answer yes or no) No
(6) If the answer to (5) (b) above is in the affirmative, state whether the right was reserved in decedent
alone or others
(7) Did decedent in his lifetime make a transfer, the consideration for which was transferee's promise to
pay income to or 1'0 I' 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 a reserverl power to al tel', amend, or revoke, or which c01lld revert t.o decedent under terms
of trans fer or by operation of' 1 aw? (Answer yes or no) No
(9) If the answer to (8) above i3 in the aff'irmative, 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) No
NOTE 1: The answers to these questions should be supported by affidavit by the attenlUng physician as
well as a copy of' the death certificate.
NOTE 2: If answer to any of the above questions is yes, set forth below a description of the property
transferred, it's fair market value at date of death, dates of transfers and to ~'hom transferred, with
relationship of transferees to decedent, if any. Submit copy of any trust deed or instrument, if trans-
fers are claimed to be non-taxable, also slIDmit detailed statement of f'acts 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. VALUATlON
(Dept. Only)
NroL
None
Insert this total opposite "Transfers", Schedule "C" in the
"As Reported" column on the last page of this return.
~6l\.u
RCC-37 (12-63)
Cmll\lO~WEALTH OF PE;-,:'\SYYLANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "0"
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 I<=STATE
wise, in estate) forth this fact.) OR NO BI RTH
I
1\T .T!:lnp ~l nn!:lk-pl'" liT' v~~ Entire Estate
507 West Main Street
Mechanicsburg, Penna.
-
Deponent further says that all the above-named benef'iciaries are li.ving at this time except below:
NAME
DATE OF DEATH
RESIDENCE
None
....
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SUMMARY
( Sch. "A")
,. (Sch. "B")
.... (Sch. "C")
Heal Property
Personal Property
Transfers
.Jointly .owned. :flr.O,PElr't.Y\;3,Ql1 ~ ,"EU),.
Gross Taxable Estate
(1 )
(As Reported)
6.,000.00
, 3tt-,:I, 01.5 3
0.00
0.00
$
$
$
$
$..
$ ,1+0,101..5.3
(2 )
(As ])dl'nni'H'd)
$
$
$
$
$
$
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RC C-3.8 .
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE" E"
JOINTLY OWNED PROPERTY
'*
INSTRUCTIONS: This schedule 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 tmder 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
Value
Estate
Valuation
percentage
Share
None
Insert this total opposite "Jointly Owned Property", Schedule "E"
in the "As Reported" column on the last page of this return.
DEPARTMENT VALUATION
CAUTION-Do not Write
In This Space.
Value of Value of
Entire Decedent's
Property Interest
!I7trYlL
N{f1h
R E V-~ 18 (8-78)
COMMONWEAL TH 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
N. Jane Slonaker
507 W. Main St.
Mecbanic9hn-rg. 'PA
(Executor or Administrator)
In Re: Estate of
M Lawrepce Seo1PT
Cnmher1and
County - File No. 21,...78-0366
Dear
You are hereby notified that the Original
appraisement in the estate of M. Lawrence Sadler
has been filed in the office of the Register of Wi lis of Cumberland
County on 5 March , 19-12, Said appraisement reflects the following
va I uations:
Real Estate
Personal Property
Transfers
Jointly Owned
Total
$ 6,000.00
34~278,] 8
Nnnp
Nnnp
$40,278.18
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. ~~73. r-o. ..
" /) , ' --. n --1-'
(-J--~\::> \. \.J'-....-'...._--c~_,(~/-v--"-'~
Date 5 March 1979 Signed -- 0
Title Administrative Officer
Note: This is not a hi II.
REV-457 (S-7S)
DEPARTMENT OF REVENUE
BUREAU OF FIELD OPERATIONS
P.O. BOX 2970
HARRISBURG, PENNA. 17105
COMMONWEALTH OF PENNSYLVANIA
RESIDENT INHERITANCE TAX
APPRAISEM ENT
DATi:.
11 M~Tl'h lq7q
COUNTY Cumberland
FILENO. 21-78-366
Whereas, M. Lawrence Sadler late of Silver Sprini
in the County of Cumberland Commonwealth of Pennsylvania, having died on
the 16th 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 Fu1einiti , an appraiser duly appointed according to law,
having been designated to make a fair and conscionable apprilisement 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
R",..l F"t-..t-", $ F..nnn nn
~ ., ~ 34,278 18
Transfers None
Joint1v Owned None
'T'nt-..l 40,278 18
Have been duly sworn according to law, I do hereby certify that the above appraisement is made in conformity
with the law on this l1t"h day of '- () ~ .--. n.....,..~ ~_~_. 19 Z9--.
I . .. I ,
~ -
~..._....
Appraiser
(Number and Street)
Harrisburg
(Post Office)
. Penna.