HomeMy WebLinkAbout09-11-78
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COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
.
SEP 11197
COUNTY OF Cumberland 8
RCC-33 (4-73)
RESIDENT DECEDENT
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'ltenue. (Section 703 of the Inheritance and Estate Tax Act of 1961.)
Late af
Cumberland
Pennsylvania
Cumberland
} AFFIDAVIT OF
EXECUTOR
~~
IN THE MATTER OF THE ESTATE OF
Mary G. McClure
(STATE FULL NAME OF DECEDENT)
County
State af
}.,
County of
Clifton McClure
AD~.1I@1P.KX of the estate of the above-named decedent being duly sworn, depose
Executor
and say
(MONTH)
Name and address of attorney or }
ather authorized repres"ntotlve 10 whom
all corresflondence should be moiled.
(DAY)
, 19-1L{'estate leaving a last will, copy of which is hereto attached..}
(YEAR) ~x
Decedent died
June IS.
J. Robert Stauffer-Market Square Bldg..
Mechanicsburg. Penna. 17055
That as such Exe cutor deponent is familiar with the affairs of said estate and the property constituting
(EX ECUTO 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
I.
That the contents of said safe deposit box or boxes are itemized under Schedules N/A of this return,
wi th the exception. of the following, for the reasons hereinafter set forth:
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 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 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, 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 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 promis sory note s 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 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 annexed to
said schedule, financial statements showing the assets and liabilities of said co-partnership or 1:>,usiness.
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 such other facts
pertaining to the business 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 copy
of the deed, trust agreement or other instrument creating the trust. There 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, e~ther individually, orjoiptly 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 creatlng 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", "C", "E", and "F" as directed therein,
have been carried forward and properly registered in the Summary.
Subscribed and sworn to before me this ...u....uuUu..u.u.........
..,1t!' ...- day Of~~ 19.7.8~~---.
.-..)&~,.. ./~(~iP:'\"~ii,~i1;~~..-_. ..........1.9...)!;aff;..r;;-s~;:J;~iRc>ad-.._._-_.
Mi:.GH/I.NiC::;BlJRG BOROUGH
cu M B Ef: LAN D GOU NTY ..u... ...:E?9w.m!?X!.~.4..a.1..!?.u'..u..p..ennau"...ul.7.0.o.8u....uu.....
MY COMMlSSiVNfXPIRES.IJEC. 29, 1979 (City 0'1' 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 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.
, .
,,,,,,,,,,,',..~,., I
RC C:-S4 (....731
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "Au
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.")
The real property located In the Common_alth of Pennsylvania .hould b.
d..crlb.d by lQ,t and block numb.r. .tr..t and .tre.t numb.r. tog.th.r with
a gen.ral de.crlptlon of the prop.rty. with a r.f.r.nc. to the record of the
conveyance by which the dec.dent took title; If a farm .tat. number of a.
cr..; al.o .tat.m.nt of mortgage .ncumbrance. upon .ach parc.1 at death
of d.c.d.nt. Tax... a.....m.nt.. accrued Int.r..t on mortgag... .tc..are
to b. lI.t.d on Sch.dul. "F" and mu.t not be d.duct.d from thl. .chedule.
(1 )
(2)
(3\
DEPARTMENT
VALUATION
CAUTION
(Do not write
In thl. .pace)
ASSESSED VALUE
FOR YEAR OF
DECEDENT'S
DEATH
ESTIMA TED
MARKET VALUE
ALL THAT CERTAIN tract or mountain land
situate in the Township of Monroe, County of
Cumberland and State of Pennsylvania,
bounded and described as follows, to wit:
BEGINNING at stones; thence North 4-3/4 degr3es
West, 2689.50 feet along land now or formerl~
or Jacob M. Hertzler to a stone; thence by
land rormerly of Michael Brandt, now or
formerly of Graybill, North 84~ degrees East
53.00 feet to a point; thence along other
lands now or formerly of George E. Westhafer being
the remaining portion of the tract of which
the parcel now conveyed was a portion, in a
southerly directton to stones, the place of
BEGINNING.
BEING the same premises which Ivan W. Fritz
and Selanda B. Fritz, his wife, by their
Deed dated July 19, 1965 and recorded in the
Cumberland County Recorder's Office in Deed
Book "Q", Volume 21, Page 1122, granted and
conveyed unto Mary G. McClure.
Sold to Arlene A. Eppley for $1500.00.......
3.-' C'OC,,c1{.
L15~,~.~9) "3 \ O()(),o~
rv u 1f1.. J V .
LPr-A/b
Ji! 0
370
'qTO
/ "t
I , t:J
"l ,''-t
y(...
)
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.
(15?O~~~ ~ I OOO,u~
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 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 undis tributed
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
VALUE
ESTIMATED
MARKET VALUE
DEPARTMENT VALUATION
(Do not write in
this space)
1
Proceeds or Checking Account No. l12-v
612085-4 with The Commonwealth National
Bank. Balance as or June 15, 1978.
1,429.40 t"/ \, '-l LA. L{ 0
2
Proceeds of Evergreen Pass~ook Savings
Account No. 14-00ll7l2-l~ith The
Commonwealth National Bank. Balance as
of June 15, 1978.
Interest accrued to 6/15/78
/
7,397.86...- ,,/'
85.20
1,'34.l,8b
8 S . L.-O
Insert this total opposite "Personal Property", Schedule "B" in
the "As Reported" column on the last page of this return.
x X
8,912.46
gctl2-.4b
)
RCC-36
COMMONWEALTH OF' PENNSYLVANIA
TRANS~~R INHERITANCE TAX
SCHEDULE "c"
TRANSFERS
~-
~
RESIDENT DECEDENT
(1) Did decedent, within two years of death, make any transfer of any material part .<If his estate, without
receiving a valuable and adequate consideration therefor? (Answer yes or no) ~o
(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 NnnA
(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 tr~nsferer or his
estate or be subject to his power of disposition? (Answer yes or no) ~o
(b) What was the transferee's age at time of decedent's death? None
(5) Did decedent in his lifetime make any transfer without receiving a valuable and adequate consideration
therefor under which transferor expressly or impliedly reserves for his life or any period which does
not in fact end before his death:
(a) The possession or enjoyment of or the right to income from the property transferred?
(Answer yes or no) No
(b) The right to designate the persons who shall possess or enjoy the property transferred or
income therefrom? (Answer yes or no) Nn
(6) If the answer to (5) (b) above is in the affirmative, state whether the right was reserved in decedent
alone or others None
(7) Did decedent in his lifetime make a transfer, the consideration for which was trmsferee's promise to
pay income to or for the benefit of care of transferor? (Answer yes or no) 0
(8) Did decedent, at any time, transfer property, the beneficial enjoyment of which was subject to change,
because of a reserverl 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) 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 V AWE
(Es tima ted)
DEPT. VALUATION
(Dept. Only)
None
None
N~
Insert this total opposite "Transfers", Schedule "C" in the
"As Reported" column on the last page of this return.
None
RCC-37 (12-63)
Cmfl\lO~WEALTH OF PEN:'\SYYLANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "D"
BENEFICIAHIES
\
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 \
ave an interest, vested, contingent or other are involved, set STATE YES IN ESTATE
wise, in estate) forth this fact.) OR NO BIRTH
Clifton G. McClure Husband Yes Entire Estate
19 East Lisburn Road
Bowmansdale, Pa. 17008
Deponent fUrther says that all the above-named beneficiaries are living at this time except below:
NAME
DATE OF DEATij
RESIDENCE
. . .
R C C-3B
RESIDENT DECEDENT
SCHEDULE" E"
JOINTLY OWNED PROPERTY
'*
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
INSTRUCTIONS: This schedule must disclose all property, real and personal, owned by the rlecedent 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 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
percentage
Share
Estate
Valuation
DEPARTMENT VALUATION
CAUTION-Do not Write
In This Space.
Value of Value of
Entire Decedent's
property Interest
~
.x
All other property of the decedent
was owned jointly by her and her
husband Clifton G. McClure, who
survives the decedent and who makes
this return as Executor and surviving
Tenant by the Entireties of
decedent's estate....................
None
N\)~
Insert this total opposite "Jointly Owned Property", Schedule "E"
in the "As Reported" colWlD1 on the last page of this return. None
RCC-81 16-73)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
HAR RISBU RG
17127
IN YOUR REPLY PLEASE
REFER TO
*
Inheritance Tax Division
NOTICE OF FILING or APPRAISEMENT
Clifton McClure
19 E. Lisburn Rd.
Bowman~dal~, P~nna.
(Executor or Adm ini strator)
In Re: Estate of
Mary G. MC'Col11rp
Cumberland
County - Fi Ie No.
2h-78-0367
Dear
You are hereby notified that the Original
appraisement in the estate of Mary G. McClure
has been filed in the office of the Register of Wills of Cumberland
County on 15 November , 19~, Said appraisement reflects the following
valuations:
Real Estate
Personal Property
Transfers
Jointly Owned
Total
3.000.00
8,912.46
None
None
11,912.46
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.
(k "1,
D 15 November 78 S' d c: )1 ~
ate Igne - \.. <" ,
Title
Chief Appraiser
" ,-----------
Note: This is not a bi II.
RC C-2 (2-6,V
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
HARRISBURG, PENNA, 17127
'DATE .\ \.- ~ S - 1 ~
COUNTY Cv.--~~
FILE NO. l.- l - l 6 - ()?J ~ '{
Whereas, ~ ~ G. (\r\ L ~ late of lJ ~ 6..1..!l......--. 'T '^(J .
in the County of C~ G..-..-1J Commonwealth of Pennsylvania, having died on
the \ ~ -\Jl- day of :l tJ---..Q If19, seized and possessed of an estate
subject to Inheritance Tax under the law)' of the Co~monwealth of Pennsylvania;
Therefore, I, l ~ ~ ~~ . 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:
COMMONWEALTH OF PENNSYLVANIA
RESIDENT INHERITANCE TAX
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 Allet
Unit
Values
Appraisement
Made for Inherllance
T ax Purposes
$
~
tL q(L.- l.{6
Having been duly sworn accrdin~ law, I do hereby ce~ that the above appraisement is made in con-
formity with law on this S day of ~~. j~<c.--, 19.2.9..
Appraloer
l~ ~ ~>>,ber and Sine!)
(~
, Penna.
Form RC C -10
OF"
Cumberland
COUNTY
oJ /- 7l-?er 7
STATEMENT OF DEBTS
AND DEDUCTIONS
DEDUCTIONS ALLOWED IN
OFFICE OF THE
REGISTER or WILLS
THE SUM OF ............ $
LATE OF
Upper Allen Township
June 15, 1978
AND AGENT OF THE COMMONW5ALTH
ESTATE OF
Mary G. McClure
DATE I No. 01'" I NAMIL OF PAYEE REMARKS AMOUNT
VOUCfoIr;"
Register of Hills Letters Testamentary 25 00
Myers Funeral Home Funeral Bill 2098 74
Rei2'ister of Wills Filin2 Appraisal 3 00
Howard Chhen, M. D. Nedical Bill 6 06
Baughman Memorials Lettering Monument 32 00
J. Robert Stauffer Attorney Fee 100 00
Register of tVills Filing Debts and Deductions 3 00
DATE OF FILING APPRAISEMENT
Nov. IS, 1978
OATS 01" DEATH
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF Cumberland
I, Clifton McClure
I
1..:
MY KNOWLEDGE AND BELIEF. THE FOREGOING IS A JUST AND TRU E srATEMENT OF DEBTS. FUNERAL EXPENSES AND EXPENSItS OF
ADMINISTRATION SUBMITTED TO THE EST....TE OF Mary G. l-'J:cClure DECEASED. A. DEDUCTIONS FOR
~~ t'r- ~
---- ~~ 711 t!
DAYOf'
HEREBY CERTIFY. THAT. TO THE BEIIT OF
INHERITANCE TAX PURPOSES.
SWORN AND SUBSCRIBED BEFORE ME THIS 19th
December 10 ~
~~ .J. ,.eA;/7S~.-?
/ NufM?Y PU8UC
\~! :'1m':'. .~:. ~t "'~c'~;.'~~'~:1~; IC"~I;~{
(L. S.l