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Home My WebLink About11-13-78 RCC-33 (.-73) COMMONWEALTH OF PENNSYLVANIA * DEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIO~~.\~ '1 ~~l~)' RESIDENT DECEDENT } .J....... :COUNTY .OF ,CUMBERLAND " :. ! I ~ .~ I ., . '.; , "1 . ; I' . '1',' IMPORTANT: : ' This retUrn must be completed indetaU and filed induplicate{ with ell attached, ,wilh'the Register orWills.'(}f'the .COWlty lWhere deced~nt reside4;!,R.etum;tS' :due,wtthin ninC'/01onth$l'aftel""e-.of.~~~~....."'tens'ion-is.sranted; " by the S~~re,tl\r~ o( ~~'\tenue. (~~fV~11~3i ~f t~,e.1n.herita~ce a"",.I?~ta~~ Ta~ ~~~pf ~"96J.) '0,\ I' , .' .' j I ~ _: . 'I.t~. I : " ~ : . I. if'''; , " ~,: ,', :', ":.'" ." . ! ~ . IN THE MATTER'OF.~HEiESTAT~,O~I':i';' ,r,.,',: i, "'} AFFIDAVIT tiF ',I "." THELMA B. WORKMAN ," , ' EXECUTOR ", " j (STATE FUL.L. NAME OF DECEDENT) j'\' .'.~. ~."'c ';.. ~ (, :.~ . .", '('; If\ I It',. !~'l-J Late of New Cumber land, Cumber 1 andcounty XBXDIl16XJCJaOR .~ -'1 ',' .-', ' . 0\ ,', .' ~t.1.~ ":i...~,.:-..t':!'~-:,! <':,,;; ~I!'fr :,_J ~'!:,,;'f IJI;' :':~,:. "tY~:f' . ::::~:::i~, ' ", :\ ~~;, If '::~' f:" ",', '''',,','' ~,:~" .-< i ':"f':::" ", ,,'~ ;.",'; ____ ,""" ,.. ",', i J_ '.... ,\!'I..', !" "'\';':: ~:,l.t ,i;'r,',r ,'1~;,' ,rl:~"'i:~,'~ .' .... '. ,'.' :Th'~"'VerYf.ReVerend~Thomas,.A.,',Le:itch ".,:;"<'I-.','(~":, .... aaM.~~nltX, '. : of the e.tate of the above-named decedent!king tllily.wom~ ,tJepon c.': ~a,", say. 'j ji '.')'1 "d ." Co, -:: <) f' . . 1. , : '. , '.~~~~utor ~ j 'I: ~ y,'! ..;) 9~ ~~~, ' ..~ ~~I~;~ Io':;w; II. ~r;~ ~,~~,;,fh i. '~;,;.~ .t~.h~d: ) .\'.., ..', ,":~.l." ~., :,':',' ,'.1.,;.!'-j,_."};~1! ~~', 'r"',: l i'- .. -': ::1 ~ . ' f , ! if.;';' L, _so ~ ;. i. . F..D. "Box-, 99, Harrisb~:rq~:PA. Richard. .Le Placey, ,.:Esqui.re;' n~f'", 'OJ', . 'J; 1: ~.' ,'. ~_, ~~ ~. ;~ ',' f' <I ~ '-:;J r"; I ~ ' , . 171()8- . 'r.... . That as such Executor. deponent is familiar with the\ affaifsoC~ai4,e~tate an(l-the..property constituting .,..; :'I~E:~~..CU,T;qR-ADMINISTR~TO~),., I ',,' , ',' :".::' ,!' tJ';'''-,;';':I'-.j. ,'!,i,',J": the assels thereof and their fair market .value. ' " '_'.' ., .....~:..., ...,: '., ~'~::..; ~~;',J.~j- ~,~"fl~.. ; That at the time of death there. was no safe depQsit;box registered ip,de;ced~nt',~An.~,i,:~dul!-t n~~e,~or jointly with, or as agent Of deputy of. another, or in decedent's individual name, with right ofacc.es~.by:an-Qtller,,~s ~ge~~or 4eputy, with the exception 'of the following: - ,,' ." ,', f ,. !: '1 i" .. NAME ",NDADDRESS OF..8ANK OR o HI J;;RINST,I :rU.T!QN T~IS SA F:~ PE,PPi~1 :T BO ~ .~EN1:ED. RE.LAT!PNSHIP OF JOINT , .. IN WHICH DECEDENT RENTED A S.4FE DEPOSI T BO X IN NAME OR NAMES OF HOL.DERS' TO DECEDENT " . ;, . " .. .' I NONE , '. .1; , . I .' " ; ;. ~.. ' . - ~; . . : " ,. " ., n .' ;. 1 . .. : "'-. , , .. That ;h~ contents of ~aid safe ,_:d~p~,;i't, ~ox 'o'r, b.~~es are ite~i~e~, urid,er: Sci{~d~ies ;.. " '~f thi~ }retu'ni~ . . ,-'. l,.. ~ I " ~ j . '" 1 'J " ':. ' '. . " ;. ; .. . j . 'l t I . _ . . '; ! with the exception'of the following, fOf.the.~e.~sops ~ere}naft.er Selr?,rt~:""",:,' :J.:; :..', ',.' '.. . .'. ,> " .,.:) I:. . 1;'-:,' ,... ~,: ';.". ,J;:j.-,f,",j' ''-:' ''':-:':t .r'. ",.,':', .,:.~ ..-...... That ScheJul.. A attached hereto. aoo ~ade .part hereof sets fQrtbfuliy and in' detail 'all the ['eal property , ., "" . ,I ' . . ,'1 .fr'" ~'f,.: ;'" '. '<~' :;'.- :,","t ;'-'!< .:.. ,": ""~,~" -: in the Commonwealth o{Penosylvania .of\V4icn decedent died having. allin.t~r~,st, ~~e,r~l~. it. al~o se~s forth t~e mortgage encumbrances upon each parcel of real property at the dat~ pfAeath",~ivi~g, t~e >~mQ?nt ,still d~e at, death, name of 'mortgag~.ey.date, rate,.of intere~t ~nd book and pa~e. o{ ,re.co~4 ,~~~f~.9f.i ,1,t ~lso ,Siets. ~6rth in the., columns provided therefore the, a ss~ssed valD:3tion of each of sflid par.ce.ls.,tl,1~ "st,i.tnat~~.~arket ,value th;er.eof . , ' , , ' ,.,.. . . ' , , ; , , as of date of death of decedent. "..; "lo;!~ '<,.t. ,. !! .' '~:": '~,": ',':' !i""':';;;." , That Schedule Battached hereto'and'madepart hereof ,set~ Jorth. fully andjip:.~~~aP aAI, per,sonal p~operty wheresover situated owned by the decedent-.:at'.the:time of. death~,aU:m()n<?}'~left'PY1,Jhe<:4~cC!~C!n~._a~,the ,time, of. death, whether in decedent's immediate 1'Os session, standing to decedent's credit in banks of deposit, savings banks, trust companies, or other institutions, whether individually, ori,n trust fot ~ny other person Qr persons giving also separately the accrued interest thereon, if any. down to th~ia~~t;irit~~~s{ diy'::p~loVi(~': d(lcea~rte s' death in the case of savings banks, and to the date of decedent's death in all other ~a.se~; all bonds, postal savings, treasury certificates or notes and other evidence of indebtedness of the United States to the de- cedent; all obligatiun,s, whether by statute or agreement they are designated as tax free, of the United States, or any state, or politicol 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, to~elher with ihe fairly estima tcdmarket value thereof; all, bonds and mortgages held by decedent and of all , ., , , .' .- ,: f'i ..... .,.' . "j' '. rf' "1_' .~.. . ,-"': :~. t "I "\C~'i'~'l'~'~' ". _"" -;;.: . claims due and owing decedent at the, ti!T'eof death, and all promissory 'notes' or oiher"irisiniments in w'riting for the pal'ment or"O\nllcy of which d~ce~e~i died ,p~ssessed, ofwh~tsoeve'r' ~'atUre;., ~ith intere;st th~reon,'if any, giving the face vlllue and estimated 'fair' ma~ket value thereof, ~nd 'i( such e'stimated'tair:ma~ket v'alue be I (;,' - , '. t'. - ,; .. ;' -' . -. " , . , -" '" ,~ .,- . p. " ,',- t i less than the face vulue, it sets forth briefly the, reasons fo'r such depreciation as to each' i'ie~; ail'moneys , : . . , , .. ,; ., ", " . .. , ! . I ' ' ~ payable to the cstah- from life in!i\urance policies carried by decedent; all annuity arid endo~~ent contracts the proceeds of whit'h w,,'re rayahle upon the death of the decedent; all and the corporate stocks and dividends due thereon and unpnid ItS or Iht' date (If (kalh, bonds and accrued interest thereon to the date of decedent's death and other iI1\T~lli"'I' 'l'l'lll'ilics O\\fH;d hy the dccec.kllt at the time of death, with the market value there- of a t such time. In the case of securities of close or famll~' corporations, the values reported are as far as pos~lble substantiated by financial statements of the corporations, showing the assets and liabilities th~reof ftS of the dftte of deAth. The schedule also sets forth the interest of decedent at the time of deat.h In an~r co-partnership or business, and in support or the value of such interest there 1s annexed to said schf'dule, financial statements showing the assets and liabilities of said co-partnership or huslness. -' C'opy of thp co-partnership agreement, (if oral, a statement setting forth the nature of die agreement) tOgE>thPT with a statement setting forth the character of the business, its location, and such other facts 'Pprtnining to the business as may be pertinent' to a fair and just appraisal of the decedent's interest therf'in must be ~ubmltted. It should also set forth in itemized form, together with the fair market value ther~of, any other property owned or bequeathed by the decedent at the time of death. T~e Sc~edule 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 t~ke effect in possession or enjoyment at or after death, said schedule sets forth the nature and value of such property, to whom transferred, the relationship of the transferees to the decedent, the proportionate share received by each transferee and all other facts of a pertinent nature regarding said transfers. In the case of transfers intended to take effect in possession or enjoyment at or after death, there is also attached to the schedule a CORY or the deed, trust agreement or other instrument creating the trust. Ther~ is also set rorth in said schedule a list or 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 ve~ted in decedent, ei ther individually or jointly, by the w111, deed, or other instrument of another, with a copy of the instr\~ent creating such power attached to the schedule. That Sc~edule 0 attached hereto and made part hereof sets forth the names and addresses or 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 benef"iciaries for life under decedent's Will. It also contains a statement showing which or the b~neficiaries named in the decedent's will, ir any, died prior to decedent, the dates of their death, their issue, and the relationship of such issue to the beneficiary.. That Sc~edule 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 anrl others, plus the date and place of record of instruments ef'f"ecting the "esti ture of real estate and the date of acquisi tion of personalty, plus the name, address and relationship, if any. of co-owners to the deceden t. That Schedule F attached hereto and made a part hereof" sets f"orth fully and in rlf:'t,ail all dehts and deductions claimed for and on behalf of this decedent's estate, including t~neral expenses paid: f"amlly exemption, where appl icable; costs or administration of this estate; counsel fees anrl f'udiciary's commi s5ions paid or to be paid; cost expended ror burial trusts, tombstones or gravemarkers, and reI j- gious services, in consequence of the death of the decedent; debts and claims owing and \mpairt at time of death; taxes accrued chargeable ror period prior to decedent's death (except those allowed under Section 651 of the InheritllnCp. aflll Estate Tax Act); together with a statement of collateral ]lled~e(l ror obliga- tions, if any. It is agreed that the fiduciary will present proof of said claimed obligations \1110n re- quest, that ir the amount actually paid in settlement or any f"ee, commission or debt 1s less than the estimated amount claiming and allowed, that the same will ~e 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 wAw, "B", "e., "E", and "FW as directed therein, havse bheen'becadrriedd forWllrdt. abndfJlroperlYthregistered in the sUIlIII1llry.. !/J. . ~'/ .....: U sen an sworn 0 e ore me is ................................. C/ ...................................g~. ..... day of ......... ~...... 19...1.8..... ............/...I:h!...?:................... .:................. ...1../.l..~..~~.................~......._.. (E%ecutor-Administrator ) ...................................C~6fAR ... .................................... Ms,g.x:.'-......TbQIDg.~.....~.~......L.e.i..t.G.b......................._..._.._- L 1980 1212 BrlStree-pt SN'PrmebeerJ My Commission Expires DEcem r g, . .lag 1:. 't ....butO. PA Dauphin (..nty N.ew.....CWUberl.ana..,......PA........l.7..Q.70........................ (City or Town and State) NOT1~: Before s1gnfnp; Ilffjdllvl t make sure all blank spaces in the affidavit and schedule~ annexed are f'il1t.cJ 1n with detlll1H or the word "None", anrl in case the assets include rare anrl unllsterl securities. secur j ties of close or fllmll y corporations or an interes t in any co-partnership or bus iness, that the t!utu nnt! st___te~ntH rl>fJuf reel unrler the paragraph above relating to Schedule "B" are attached. A.1so makf:' cprtll1n that column #1 in the "Rul1I1lary" has been properly completerl as ___bove-directed. i 1 i 1 I j j 1 ""I.<c, :lU(.~~~,,,",,,.1l.,t.,'..) KA.'L.,..."","", ''',ii'' *'.. ~(,,::r - RC: C-U (...,'S) COMM~WEAt TH OF PEN~SYLVANIA DEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS TRANSFER INHERITANCE TAX RESIDENT DECEDENT SCHEDULE "Au ,R~J:('(~ff~p'ERTY . 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 ioint tenants with right of surviorship or tenancy by entireties should be reported on Schedule "E.") Th. real property located In the Commonwealth of Pennsylvania .hould be described by lot and block number, street and street number, together with a general description of the property, with a reference to the record of the conveyance by which the decedent took t'tle; If a farm .tate number af a- cres; 0150 statement of mortgage encumbrance. upon each parcel at death of decedent. Taxe., asse..ments, accrued Intere.t on mortgage., etc.,are ta be listed on Schedule "Fit and must not be deducted from thl. schedule. (1) (2) (3\ DEPARTME VALUA TIC CAUTIOI (Do not wrl In this _pac ASSESSED VALUE FOR YEAR OF DECEDENT'S DEATH ESTIMA TED MARKET VALUE NONE 0.00 NbnL Insert this total opposite "real property", Schedule "A" in the X X X X X "As Reported" column on the lost page of this return. 0.00 1\lOt"-\.t.. .' Cr\ . R \"'#-35 RESIDENT DECEDENT SCHEDULE "B" PERSONAL PROPERTY * COMMONWEALTH OF PENNSYLVANIA TRANSJt"ER 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 wi th another or others must be listed under SchedUle WEft. 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 ~nterests, 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 MARKEr VALUE DEPARTMENT VALUATl (Do not write il this space) 1. Optional passbook account, Harris Savings Association, No. 7-75036. Date of death balance - $45.00 plus interest accrued - $.67 = $45.67 (see bank letter attached) $ 45.67 '-\6.~1 2. Christmas Club account, Harris Savings Association, No. 7-18003343. Balance at date of death - $30.00 plus interest accrued - $.45 = $30.45 (see bank letter attached) 30.45 ." aO, A..\S 3. Savings account, CCNB Bank. N.A., No. 001-100418-1, date of death balance - $42.50 plus interest accrued - $.07 = $42.07 (see bank letter attached) 42.57 Lt~.S' 4. Christmas Club account, CCNB Bank, N.A., No. 05001613 54.00 ~.Ob 5. Survivor action against Gary D. Null, Aetna Life & Casualty Co. 8,629.50 ~)lt)..9.S0 6. Aetna Life & Casualty Co. - No-fault benefit toward funeral bill 1,500.00 \,SOO.DO 7. Sale of personal property - appraised at value for which sold at auction 1,658.00 'I ~Sl. DC'" . Insert this total opposite .Personal Property., Schedule -Bft in the .As Reported- column on the last page of this return. - - .~----:=-~-::=.:..--:-==-._- X X 1 $11,960019] \\,q\oO.\~ .' The H A. R R I S Savings Association 205 PINE STREET. HARRISBURG. PENNSYLVANIA 17105 DFFJCES Area Code 717/236.4041 DOWNTaNN. COLONIAL PARK. CAMP HILL. LEBANON. UNION DEPOSIT CAPITAL CITY. NEW CUMBERLAND June 27, 1978 PLACEY & WRIGHT Richard L. Placey 232 North Second Street P. O. Box 99 Harrisburg, Pa. 17108 Dear ,,11-. P1acey: At the time of Ms. Workman's death, she held two types of accounts with our association. The first is an Optional passbook account, 7-75036, and is held in her name alone. The second, is an Christmas Club account 7-18003343 also in her name alone." The balance in Optional 7-75036 was 145.00. The interest which accred to the day of her death,' June 11, 1978, was 1.67. The total balance in the account on June 11, 1978 was 145.67. The balance in Christmas Club 7-18003343 was 130.00. The interest which accrued to the day of death was 1.45. The total balance in the account on June 11, 1978 was 130.45. Both of these accounts were established December 1, 1977. If you have aI1Y further questions, please feel free to contact me in the Savings Department at 236-4041. Very truly yours, /i ' / / ~ ,......""'// -. ~...J__ . _.:"':"'____ ~ v..' /,,-/.~., ~..1 -- r" .~..,... ........._._.'. ----.,.-- . i ~. ~.......'\.,;..-...... l ~~.I (Mrs.) Sandra E. Myers Savings Counselor SEM:sem ~1JMIt~~ ~~ 1!~"1 .. (L;(C~~ l~.1 ~,~ {f ,;..u 0 . ----- MAIN OFFICE 331 BRIDGE STREET NEW CUMBERLAND PENNSYLVANIA 17070 (717) 238-0841 CCNB BANK. N.A. DATE June 29,1978 LAW OFFleFS FLA GET & WRIGHT 232 R:>RTH SECOND STREET HARRISBJRG,PA 17108 RE: ESTATE OF THEtMA B WORKMAN GENTLEMEN: The following is a list of accounts that we have in our bank. TYPE OF ACCT. ACCOUNT NO. OPEN DATE DUE DATE BALANCE ACCR. INT. SAVINGS 001-100418-1 3/3/76 $42.,0 $.07 NAMES ON THE ABOVE ACCOUNT THELMA B WORKMAN If we can be of further assistance, do not hesitate to write. Ve~. ~Tuly ycu~s, ~ /;' '")... .-.4 / i.-;~"" h':-~-'C<- Dorothy Morrette Savings Department Head ~CC:"3&' r(lMMn~WEALTII OF PENNSYLVANIA TRA~SFFH IXHF.IUTA~rF TAX SCHEDULE "e" T RA.N SFEns . I\ESlnE~T m.TEHENT (1) Did decedent, wi thin 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, wi t.hin two years of death, transfer property from himsel f to himsel f and another or others (1ncl ud! ng 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 wi.thout 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 Wlder which transferor expressly or impliedly reserves for his life or any period which does not in fact end before his death: No (a) The possession or enjoyment of or the right to income from the property transferred? (Answer yes or no) (b) The right to designate the persons who shall possess or enjoy the property transferred or income therefrom? (Answer yes or 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 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 tr~nsferred, 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 & ITEM DESCRIPTION MARKET VALUE (Es tima ted) DEPT. VALUATION (Dept. Only) NONE 0.00 I\l 0 f\.(., I nc;~rt lh t s t.ot.111 ()ll(lo~ j te "TrllIlHfers", Schedule "C" in the "As ~~f'ur t,~d" ~rJ) limn on the ] IlM t. page of this return. 0.00 N~ ... w .. LAST WILL k~D TESTAMENT OF THELMA B. WOR.l(MAN I, THElJt1A B. WORKMAN, of New Cumberland, Cumberland County, Pennsylvania, do declare this to be my Last Will and Testament and revoke any Will previously made by me. ITEM I. I direct that all of my just debts and funeral expenses, including my gravemarker, if any, . shall he paid from my residuary estate as soon as practicable after my decease, as a part of the administrative expenses of my estate. ITEM II. I give and devise all of my estate of every nature and wherever situate unto ST. THERESA'S RO~urn CATHOLIC CHURCH, New Cumberland, Pennsylvania. ITEM III. I appoint THE VERY REVEREND THOI1AS A. LEITCH, Pastor of St. Theresa's Roman Catholic Church, ~s Executor of this my Last Will and Testament. Should he not be serving as Pastor at the time of my death, I then appoint his successor in office as Executor of this my Last Will. ITEM IV. In addition to the powers given to my Executor by operation of law, the following powers are herein given to him to be exercised by him at his sole discretion: A. To retain property received by him and to invest in all forms of property without restriction as to investments; B. To operate any business, corporation, partnership, . or enter into any recapitalization, merger, reorganization or voting trust plan and to delegate authority with respect thereto and to deposit investments under agreements and pay assessments and to exercise all rights of an investor; C. To hold investments in the name of a nominee or to compro~ise controversies with respect to any assets held by him; J~~ tf2.lhJ~/l1'L .. ... D. To exchange or sell for cash, property or credit, publicly or privately, or to lease for any term without liability to see to the application of the consideration and to give options for such purposes without obligation to repudiate them in the favor of a higher offer and to mortgage any assets held by him; E. To make distributions in cash or kind or partly in .each at the valuations fixed by each and the right to borrow money, including the right to borrow from himself as Executor; F. To exercise and dispose of warrants and to loan to and buy property from my estate. IN WITNESS WHEREOF, I have hereunto set my hand and seal this:l5z,f day of ~II el) , 1978. \~f3, ~ Thelma B. Workman The preceding instrument, consisting of this and one (1) other typewritten page, identified by the signature of the testatrix, was on the day and date thereof signed, published and declared by Thelma B. Workman~ the testatrix therein named, as and for qer last Will in the presence of us, who at her request, in her prese e ~i fthe presence of each other have subscribed,our names s w tne s hereto. , . ,. . :)3.). /l}.;),..c1 L1; U//)/J~7 (/? /)7/, YJ7j/{~,-- ~~ Jd)'YI.~!d- ~.rf~, p~ {~uJ }~~/~. 171 ( if,. 23~ /1.) ~~../l ) i, 16-4/1.:': ~ f, ~ I /,4- ~ '-'1;, <4 ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA: S5: COUNTY OF DAUPHIN : I, THELMA B. WORKMAN , testatrix whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my last Will, that I signed it willingly, and that I signed it as my free and voluntary act for the purposes therein expressed. ~e{j; ~/.Vt- Sworn or affirmed to and acknowled~edb~fore me, by I THELMA B. WORKMAN testatrix, thisd~ day of &~, 19 78 . , (Jet,,? c--P (J... ~Qf~/t4'-L~__- Notary Publi~ My Commission Expires: NOT 'I~Y PUgUe Mv Com:n:!~;cn lxpiru Dr" ... Ktrri~blUg PA _.r.._" 6. J9S0 " - Q~"',lhlR C..,nl~ AFFIDAVIT COl~ONWEALTH OF. PENNSYLVANIA: 5S: COUNTY OF DAUPHIN : We', J$;. t. (jk~, Yl? .~<t:~~aJ- ~ ~~"""'I"-' -~ 11; the witnesses whose names are signed tot he attached or foregoing 1nstrument, being duly qualifie( according to law, do depose and say that we were present and saw testatrix sign and execute the instrument as her last Will; that she signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the testatrix signed the will as her witnesses;, and that to the best of our knowledge the'testatrix was at that time 18 or more years of age, f so/ ~nd and under no constraint or undue influence. . . .~ VIi ~-l~ 'fGdvdu.J ec.-t6~ )fL1~L~ tl'rtlf'h , {. iJ JA_ S~orn to and subscribed before me this.;)Vay of I'M ~~<JC19~. r, J 1",-"" (, to :? ' _ J /.' /:' ',-';.. . Notary Public My Co~~ission Expires: NC)i:,~y E:?UC "~'1 (orr.~:!:."n h;l;1' > r -" - '.. ' .. 't) .:."js!lur;. PA .... "r" . ',: .-.( ; > -. &...~..: r: .. ~ ,. ~ t -- RCC - 37 (12-6 3) .... ~ COMMONWEALTH OF PENNSYYLANIA TRANSFER INHERITANCE TAX RESIDENT DECEDENT SCHEDULE "0" BENEFICIARI ES BENEFICIARIES, AND ADDRESSES RELATIONSHIP SURVIVED DATE (If step-children. OF INTEREST OF State full names and addr.ess.es 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 ~ s.... -. 's r~""hnl ; .. . N' In. N'/n. lJ/n H:n....; ,...~ . Church - 1212 Bridge Street New Cumberl.and. PA 17070 - - ( h Deponent further says that all the above-named bene~iciaries are living at this time except below: NAME DATE OF DEATH RESIDENCE - . RC C-38 , .. RESIDENT DECEDENT SCHEDULE HE" JOINTLY OWNED PROPERTY - COMMONWEALTH OF PENNSYLVANIA TRANSFER INHERITANCE TAX INSTRUCTIONS: This schedule must disclose all property, real and personal, owned by the decedent Jointly with another or others, including intangibles, standing in the name of the deeedent and others. List real estate first. as entireties, or Joint tenants, giving brief description, as indieated tmder Schedule "A", plus the date and place of record of instrument errecting vestiture, but do not include entireties or out of st~te real estate value in estate valuation column. Personal property should be listed as in Schedule "B", plus date of aequisition, 'and the name, address and relationship (if any) of co-owners to the de~~.ient. Description or 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 or Value of Entire Decedent's Property Interest NONE N6Y\L Insert thl" lutnl ol'posl h~ "Jointly Owned Propert).., Schedule "E" 1n the · APi I\.~tlnrh~d" COhl~l on the last page of th1 s return. 0.00 *' REV-SI8 (8-78) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF FI ELD OPERATIONS P.o. BOX 2970 HARRISBURG 17105 IN YOUR REPLY Pl.EASE REFER TO Inheritance Tax Division NOTICE OF FILING OF APPRAISEMENT Reverend Thomas A. Leitch 1212 Bridge St. N. CI-+ eE'land , FA (Executor or Administrator) In Re: Estate of Cumherland Thelma B. UerlaBaft County - File No. 211""72 0378 Dear You ore hereby notifi ed that the Ori gi nA 1 appraisement in the estate of ThelmA B.. WOl"lmUln has been fi led in the office of the Register of Wi lis of r..mherlaud. County on 5 F9br1]ary , 19~, Said appraisement reflects the following valuations: Real Estate Personal Property Transfers Jointly Owned Toto I Nnng 11 J QI\O. 19 Nnn~ Nonp- Sll,960.1Q As to such tax that is paid within three months from dote of death, 0 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 obiect 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 ---5.; . Fph'rI1Ary 1979 Signed Title Administl"Ativp OTti<,er t.' ~ Note: This is nota bill. .... ~ REV-457 (8-78) DEPARTMENT OF REVENUE BUREAU OF FIELD OPERATIONS P.O. BOX 2970 HARRISBURG, PENNA. 11105 COMMONWEALTH OF PENNSYLVANIA RESIDENT INHERITANCE TAX APPRAISEM ENT DATE COUNTY FILE NO. 5 ....~"'.....O...}7 1 079 Cumberland 21-78-0378 Whereas, Thelma. B. Workman late of Borough of New Cumberland in the County of (,'V"b~...1 o...A Commonwealth of Pennsylvania, having died on the 11 t-h day of T"n~ 19 lfL, seized and possessed of an estate subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania; Therefore, I, :Laa :fwJ.siai 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 APpralsemenf VALUES Made for Inherltanc Tax Purposes 'Rp::II1 - $ None - l1 - 11.960 19 - ~ "T,..... "'" _Tnint-l v l'lLm~~ None Total $11.960 19 = 1------- .. I~~. - -- I L_ 1~_ I I I I I I I I .- C__I_._l _ 1 . _ _ _u~ _T~_~ r---c_~_-~~~l~.~-_ L___~___ [-- C___~_1L~_~~~ - J--=- L l_ _ [- 1 T~---~n-l~- 1 _ _ Ru ___ - ~ ~ [_--~ ~ [~~-----[- -- -_-r-~=---I .n _r_--_ -=c=J[___=-~~ -r_~~_ -C~-~-_ -~~--l-~ I ][_-~-l- L~[~-~-r-- -- -----l___-_~_lC---__r~- -- C_-_-_U-_=~-~-_--r-- r_~~~=_:- I~_ Have been duly sworn according to law, I do hereby certify that the above appraisement is made in conformity with the law on this Stlt day of :Jaln;uaI'l) 19 .lQ-. Appraiser (Number and Street) HRrriAhnrg (Post Office) , Penna. ~. a .... l Sf ~i s:::: z 0\ ::s w """f 8 ~ ~ w Ii (b w U) Q . : ;;: ~ ....: ~ t:r " ~: 'rf z ~ , : w ;.. ~ ": :> ~ c:r: I!IIf . ~ . ii w ~ll >< . : ~ cr ....... ....... ~ 1> -: 1> <3 u. "tl" ~ ~ w ~ il (b" 0 ~ ~ ~ ::s. t> (J ~ (b !;:: ~. I- 8 .!3 "tJ z ..... ..... C5 .t/) ~ fU ~ 2 ~ ~ ~ "' : ~ ....:J If (b" g; w ~ ~ a: 8 ..t/) .g ~ co:: ~ w Q ;!I ~ ~ "tS co:: co:: -u ..... cr :r '5" +-> t/) fa ..... ~ "tJ ~ &i -f: "& ot.;t <( :::s 1a fU &: ~ 0.. 11 0 ~ t- ~ ~ W "tJ .. ..0 "tJ Z +-> 0 ~ .S ~ ~ ~ w <e; t/) .S s:::: (b -.... :::s .~ ~ +-> (b (l) Q ~ ft 5. g ~ 0 0 ..... c;; <I> r2 ..... ~ (b ~ ~ w CS ~ ~ ::::: I:t: q:; t:r ~ ., " ... o . "'",- ~<- 0;;;= s: 'c ~ S .- ... =' SCU- oo1i8 < e_ .:.0. OuOO ...~~ ::s rn ... t='O a<Sg. bJ CU - =:: SUMMARY Real Property ............ ......... ........ ........................................ -- -.. (Sch. "A") Personal Property . ........ ........ .......... ........ ........ ........ ....... ..... ... (Sch. "B") Transfers .................. ......... ........ ............ .............................. ..... (Sch. "e") ..............~........ '.0..0.............. ......0......0......0..0. .0......0 .0.................... _.... ..........0......... Cross Taxable Estate ...... ............................. .................... ....... ...... ............ (1) (As Reported) $....... ....... ........ .0....0 0.... $....... .)..,:1:..1. .9..6.0...1 ~.... $................. _.....Q. !..9..9. .. .. $.. .. . .. .. .. .. .. .. . .. .. .. . . .. . . . . . . . . . $......... ............................. $..... ...++.1. ...~.~.o. .!.+ ~. (2) (As Determine- $............ $.. .............. .. $....................... . .. $ $............ - -.. $................ . t- :00 Z .CU ; ~ ~. ;2 .CO ~ ~ cu >c. ~ :t ~ r.n Q '0: fIJ - - < < s::: ~ 0 m: ~ " ~ ~ ~: r-I: 'S A. 0 ~ A. ~ H: '0: ~ w < 11.1 < :z: ... ~ -: 0): s::: ~. i-c ~ i= f-c ~: ~: ro "'l Q 0 ~ ::r: ~ ..,-: ~: r-I = Z 0 f-c H: c::i Z f-c r.n u: or ~ < ------ ~ ~ H: .0: ..... ... 0 ~: ~: a. 0 ~ ::r:: 0). ::s: ,.. ~ ~ ~ 8: z u ... 0 t.J - ~ ~ [.JJ ! ~ .... ;, 0 ,. " c < .... ~, 0 ~I 0 s: "'" Q,.l E ~ .... ... ~ 0 u ~ u