HomeMy WebLinkAbout06-21-79 (3)
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RC'C-33 (4-73)
COMMONWEAL TH OF PENNSYL Y ANI A
DEPARTMENT OF REYENUE
BUREAU OF COUNTY COLLECTIONS
*
RESIDENT DECEDENT
COUNTY OF
CUMBERLAND
IMPORTANT:
This return must be completed in detail and filed in duplicate, with all attached, with the Register of Wills of the
County where decedent resided; Return is due within nine months after date of death, unless an extension is granted
by the Secretary of Re'ltenue. (Section 703 of the Inheritance and Estate Tax Act of 1961.)
La te of
CUMBERLAND
PENNSYLVANIA
} AFFIDAVIT OF
EXECUT~ IX
County ~**~
IN THE MATTER OF THE ESTATE OF
RORRR'T' 'R QTTTN
(STATE FULL NAME OF DECEDENT)
County of
CUMBE RLAND
FLORENCE P. QUIN
}.,
State of
Execut~ix
~
of the estate of the obove-nomed decedent being duly sworn, depose S and soy S
Decedent died
1,
(DAY)
, 19-1L{~estote leaving 0 losl will, copy of which is hereto attached. }
(YEAR) 'X~~~
July
(MONTH)
Nome ond address of attorney or }
other authorized repres.entative to whom
o II correspondence should be mo i led.
Thn~~~ T Myers, MYERS, MYERS, FLOweR & JOHNSON
P. O. Box 125, Lemoyne, Pennsylvania 17043
That as such Executrix deponent is familiar with the affairs of said estate and the property constituting
(EX ECUTO R-ADMIN I 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 fullowing: -
NAME AND ADDRESS OF BANK OR OTHER INSTITUTION
IN WHICH DECEDENT RENTED A SAFE DEPOSIT BOX
Daup In Deposlt Ban & Trust Co.
Lemoyne, Pennsy1vanla 17043
RELATIONSHIP OF JOINT
HOLDERS TO DECEDENT
e
Thai 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 possession, standing to decedent's credit in banks of deposit, savings
banks, trust companies, or other institutions, whether individually, or in trust for any other person or persons
giving also separately the accrued interes t thereon, if any, down to the last interest day pri(lJT 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, househoIafutniture, horses, carriages,
automobiles, boats, and any and all other personal chattels of whatsoever, kind""or' "'ftature;, left ,by decedent,
together with the fairly estimated market value thereof; all bonds and mortgag'U lt6'ra"~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 ;\;1 k (If death, bonds and accrued in teres t thereon to the date of decedent's
death and other inve stme.q '", :.., ' '\' -- :,,~d hy 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 state~ents 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 l)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
pertuini ng to the business as may be pertinent to a fair and just appraisal of the decedent's interest
therein niust 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 conte~lation 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. Ther,~ is also set forth in said
schedule Ii 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, or jointly 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 instrmnent 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 "esti ture 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 ~lneral expenses paid:
family exe~tion, where applicable; costs of administration of this estate; counsel fees and fudiciary's
connnissions 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 t~on 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 .................................
.)......
~),/", /- . .... . '\
......................!...~..~1.. ...... day of ......~~.........................19..J..1... ~~~~~~.::~:::<.._..
mmm&_""m~~ . ... ... .mmm F~~,,~gi;~~~l"e,,~1::E~"mmm_
M ~~~:'Dec. 21, 1981 ........G.i:l.ffiP....JLi.Jl.l......p..?t.......l.7...9Jl................................
L:IJI07M, Pa. CU!8berl." Cou' (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 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.
RC C-34 (4-73)
COMMOMH'At.TH OF PENtoiSYLVANIA
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 Commonwealth of Pennsylvania should be (1 ) (2) (3)
described by lot and block number, street and street number, together wi th DEPARTMENT
a general description of the property, with a reference to the record of the ASSESSED VALUE VALUATION
conveyance by which the decedent took title; If a form state number of a- FOR YEAR OF ESTIMA TED CAUTION
cres; also statement of mortgage encumbrances upon each parcel at death DECEDENT'S MARKET VALUE (Do not write
of decedent. Taxes, assessments, accrued Interest on mortgages, etc.,are DEATH In this space)
to be listed on Schedule "F" and must not b. deducted from this schedule.
NONE
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.
71.. ~/U_)
Ree -(55
RESIDENT DECEDENT
SCHEDULE "B"
PERSONAL PROPERTY
CO~WONWEALTH OF PENNSYLVANIA
T~\NSFER 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 Dlrnishings, books, paintings, automobiles, boats, etc.)
Intangible personal property, such as bonds, treasury certificates, cash on hand and in bank,
stocks, nmrtgages, 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 anyundistributed
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
MARKEl' VALUE
DEPARTMENT VALUATION
(Do not write in
this space)
1. Automobiles:
1967 Buick Sedan
1971 Oldsmobile Sedan - Sale Price
1958 Volvo (Junk)
2. Stock:
Arizona Public Service - 95 shares
@ 19.96875 p/sh.
Northwest Energy Company - 18.4 shares
@ 42. 90625 P / sh (Voting Trust Certificate)
Sun Oil Co. (2.25 Conv. Preferred)
50 shares @ 42.90625 p/sh
The Southern Company - 100 shares
@ 16.1875 p/sh
Union Oil Company of California
50 shares @ 47.7500 p/sh
-~
1,897.0Y;"
3. Commonwealth of Pennsylvania:
Accrued salary
Accumulated leave
625.6
4. Northwestern Mutual Life Insurance
Company of Milwaukee
Robert E. Quin owner of policies
on the life of Elmer G. Quin -
Policy No. 1,737,076A
Policy No. 2,068,873
5. Dividend - Union Oil Company of Calif.
2,950.53
4,788.45
27.50
Insert this total opposite "Personal Property", Schedule "B" in
the "As Reported" column on the last page of this return.
x X
17,619.40
\ -, 1 1.0 L q. 40
R'CC- 36
COMMO:\W"EALTH OF PENN~YLVANIA
T1-tA\~FFR I:\HF:l1.ITA:\CE TAX
SCHEDULE "c"
TRANSFEIlS
IlliS IDE:\T DECEDE\'T
(1) Did decedent, within two years of death, make any transfer of any material part of his estate, without
receiving a valuable and adequate consideration therefor? (Answer yes or no) No -
(2) Did decedent, within two years of death, transfer property from himself to himself and another or
others (including a spouse) in joint ownership? (Answer yes or no) l\Tn
(3) If the answer to (1) or (2) above is in the affirmative state:
(a) Age o~ 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) 1\Tn
(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 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) No
(6) If the answer to (5) (b) above is in the affirmative, state whether the right was reserved in decedent
alone or others
(7) Did decedent in his lifetime make a transfer, the consideration for which was transferee's promise to
pay income to or for the benefit of care of transferor? (Answer yes or no) No
(8) Did decedent, at any time, transfer property, the beneficial enjoyment of which was subject to change,
because of a reserved power to al tel', 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 VALUE
(Es tima ted)
DEPT. VALUATION
(Dept. Only)
NONE
~o
Insert this total opposite "Transfers", Schedule "e" in the
"As Reported" column on the last page of this return.
REV-453 (8-18)
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "0"
BENEFICIARIES
BENEFICIARIES AND ADDRESSES RELATIONSHIP
(State full names and addresses of all who (If step-children or SURVIVED DATE INTEREST OF
have an interest, vested, contingent or other- illegitimate children DECEDENT OF BENEFICIARY
wise, in estate) are involved, set ST ATE YES BIRTH IN ESTATE
forth this fact.) OR NO
Florence P. Quin Wife Yes Adult Entire Residue
36 Colqate Drive
Camp Hill, Pa. 17011
Deponent further says that all the above-named beneficiaries are I iving at thi s time except below:
NAME
DATE OF DEATH
RESIDENCE
(Sch. "A") $
(Sch. "8") $
(Sch, "C' ') $
$
$
$
(1)
(As Reported)
-0-
17,619.40
-0-
(2)
(As Determined)
...
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o '"
...... Cl)
= '" ....
U = ...
Cl) e g,
;< Cl)
e ez::
SUMMAR Y
Gross Taxable Estate
17.619 40
$
$
$
$
$
$
Real Property
Personal Property
Transfers
s::
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ORe <;:-38
RESIDENT DECEDENT
SCHEDULE" E"
JOINTLY OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERIT ANCE 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
percentage
Share
Estate
Valuation
DEPARTMENT VALUATION
CAUTION-Do not Write
In This Space.
Value of' Value of
Entire Decedent's
Property Interest
NONE - "except property owned
as tenant by the entireties
with surviving wife".
Insert this total opposite "Jointly Owned Property", Schedule "E"
in the "As Reported" column on the last page of this return.
NONE
~(S~
"
REV-5IB (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
Florence P. Quin
36 Colgate Drive
Camp Hill, PA 17011
(Executor or Administrator)
In Re: Estate of Robert E. Quin
Cumberland
County - File No. 21-78-0368
Dear Ms. Quin:
You are hereby notified that the original
appraisement in the estate of Robert E. Quin
has been filed in the office of the Register of Wills of Cumberland
County on August 12 ,19L2.... Said appraisement reflects the following valuations:
Real Estate
Personal Property
Transfers
Jointly Owned
Total
none
$ 17, 619.40
none
none
17,619.40
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
August 21, 1979
Signed
~~~/(/L- ~~
Title Administrati.ve Offi.cer
NOTE: This is not a bill.
.. .}.. . ,-...
RCC-39 (8-77)
'Cou:ty, Number and Name
File Number
CUMBERLAND
L
II
! ~
j:
"I
'II
II
ii
i[
I,
REPORT OF INHERITANCE TAX APPRAISER
21--78-368
SUMMARY
'~
Date of Death
July 1, 1978
(FIRST NAME)
E.
(INITIAL)
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
Estate Name
QUIN
(LAST NAME)
ROBERT
I, the undersigned duly appointed Inheritance Tax Appraiser in and for the County of Cum.be1;'land
Pennsylvania, do respectfully report that I have appraised the real and personal property as reported in the foregoing return at
the values set forth opposite each item in the last column to the right in Schedules "A", "B", "C", and "E".
Dated:
August 21, 1979
~/1/lfivcL ~-R
-
INHERITANCE TAX APPRAISER
REPORT OF THE REGISTER OF WILLS
I, the undersigned duly elected Register of Wills in and for County, Pennsylvania, do respect-
fully report that I have allowed deductions in the amounts claimed by deponent, except as to those items where a greater or
lesser amount is set forth in the last column to the right in Schedule "F", which greater or lesser amount represents the sum
allowed as a deduction.
Dated: -
REGISTER OF WILLS
17
ADJUSTMENTS
ODE (HARRISBURG USE ONLY)
REMAINDER APPRAISEMENT CODE
INVENTORY
Real Property (Schedule Al
Personal Property (Schedule B)
Joint-Held Property ISchedule EI
Transfers ISchedule CI
TOTAL GROSS ASSETS
Less Debts and Deductions
ISCHEDULE Fl
CLEAR VALUE OF ESTATE
VALUE AS APPRAISED
$
92+
40-
93-
Valuation of life estates or
~
PRINCIPLE
FACTOR
VALUE
CODE
I
annuities....................._ $
t
t=
ESTATE TAX ASSESSMENTS _ $
FOR USE OF REGISTER ONLY
Tax on $
Tax on $
Tax on $
Tax on $
Tax on $
Exemptions
Total Estate
CODE
COMPUTATION OF TAX
2%
6%
15%
$
$
$
$
$
*
TOTAL TAX
$
(*) As evidenced by Charitoble
Exemption Certificates issued
by the Secretary of Revenue.
Less tax previously paid
BALANCE
Less 5% of tax if poid within
3 months after death
$
$
$
l=
BALANCE OF INHERITANCE TAX DUE
Add interest ot rate of 6% from
to
AMOUNT OF ESTATE TAX ASSESSED
Estate tax paid
$
$
$
$
l=
BALANCE DUE
Add interest ot rate of 6% from
to
$
$
TOTAL TAX BALANCE $
PAID $
Supplemental Codes: (FOR USE IN HARRISBURG ONL Y)
48-Adj ustment
49+Adjustment
56-Annuity
6O-Life E",tat..
9 2+Rema inder Apprai sal
93-Remainder Deduction
93C-Chority
94-Remainder Residue
96-Success i va
life Estate
FOR USE OF REGISTER ONLY ADJUSTMENTS
. _ ~_,___,_~.,_,,~ _._.._....._~N.._.___
NOTE: Where subsequenj odjustmenls ?re made to the above computation of tax by the Register of Wills, for proper reason,
some shou!.' be ""'i,.,d below, with ,hort explanation.
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REV-457 (8-781'
DEPARTMENT OF REVENUE
BUREAU OF FIELD OPERATIONS
P.O. BOX 2970
HARRISBURG. PENNA. 17105
COMMONWEALTH OF PENNSYLVANIA
RESIDENT Il\IHERITANCE TAX
APPRAISEMENT
DATE
COUNTY
FILE NO.
August 21, 1979
Cumberland
21-78-0368
Whereas, Robert E. Quin late of Lower Allen Township
in the County of Cumberland Commonwealth of Pennsylvania, having died on
the 1st day of Julv 19 .li., seized and possessed of an estate
subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania;
Therefore, I, Sandra L. Stone I an appraiser duly appointed according to law.
having been designated to make a fair and conscionable appraisement of the said estate, and to assess dnd 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 inheritancA taxes at the lawful collateral
rate on any such future interest.
DESCRIPTION OF ASSET UNIT Appraisement
\l ALUES Mode for Inheritance
, Tax Purposes
Real Estate $
none
Personal Property 17.619 40
Transfers none
Jointly Owned none
Total Asse s 17.619 40
\
Have been duly sw~ln according to law, I do hereby certify that the above appraisement is made in conformity
with the law on this st day of ~st 1972...- .
-t/'..A..... ~ v _
Appraiser
Harrisburg
(Number and Street)
(Post Office)
, Penna.
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