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HomeMy WebLinkAbout09-28-78 , . RCC.55 (4-75) COMMONWEAL TH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS * RESIDENT DECEDENT COUNTY OF SE~T~JR~2~ND IMPORTANT: This return must be completed in detail and filed in duplicate, with all attached, with the Register of Wills of the Colmty where decedent resided; Return is due within nine months after date of death, unless an extension is granted by the Secretary of Re'tenue. (Section 703 of the Inheritance and Estate Tax Act of 1961.) SUZANNE B. FISH (STATE FULL NAME OF DECEDENT) } AFFIDAVIT OF EXECUTOR ADMINISTRATOR IN THE MATTER OF THE EST ATE OF Late of Cumberland County State of Pennsylvania County of Cumberland J II: Administrator S Eugene K. Albright and Reba I. Albri"ht of the .dot. of the above-named decedent being duly sworn, d.po~. ~ and .oy Decedent died Tllnp {MONTHI Name and add,..1& of attorney or } other authorized repr...en.totive to whom all corr...pondence should be mailed. 2R , 19.1lL.-{~nXtml!HllmdHXd!x~x.IJtG!!~IiX} (DAY) (YEAR) Int..tat. Robert M. Frey. Esauire 5 South Hanover Street. Carlisle. Penna. 17013 That as such Administrators deponent is familiar with the affairs of said estate and the property constituting {EXECUTO R-ADMINIST RA TO RI 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 THIS SAFE DEPOSIT BOX RENTED RELATIONSHIP OF JOINT IN WHICH DECEDENT RENTED A S.",FE DEPOSIT BOX IN NAME OR NAMES OF HOLDERS TO DECEDEN T None That the contents of said safe deposit box or boxes are itemized under Schedules with the exception' of the following, for the reasons hereinafter set forth: of this return, That Schee/ule 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 Sehee/ule B attached hereto and made part hereof sets forth fuUy and in detail all personal property wheresover situated owned by the decedent at the time of death; aU 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 interest thereon, if any, down to the last interest day prior to decedent's death in the case of savings banks, and to the date of decedent's death in aU 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 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 substanUated 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, financ1al statementB showing the assets and liabilities of said co-partnership or D,uB1ness. 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 tru~.a~wer 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 caBe of transfers intended to take effect in possession or enjoyment at or after death, there is also attached to the schedule a CORY of the deed, trust agreement or other instrument creating the trust. Therp. 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, eitherfndividually, or jointly wt-th another, or any power of appoint- ment vested in decedent, e_ither 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 0 attached hereto and made part hereof sets forth the names and addreSBes 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 ef"f"ecting 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 f"orth 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; c~unsel f"ees and fUdiciary's commissions paid or to be paid; cost expended f"or buriai trusts, tombstones'or gravemarkers, and reli- gious services, in consequence of" the death of the d~cedent; debts and claims owing and Imp aid 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 f"or obliga- tions, if" any. It is agreed that the f"iduciary 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", "CO, "E", and "F" as directed therein, have been carried forward and properly registered in the Summary. Subscribed and sworn to before me this ................................. ....................~6....th...... day of ~~..... 19..28.... ..~~J..CC;ZOPHE{}i~..... Carlillle. Cumberland Co., Pa. My Comm.i~l~nExplres Sept. 5. 1981 ~:~n~~~:l~:=~1U W' (Ezecutor-AdministTator) ~ .R.~..P..,...#..?..................................._...........................................................,........... (Street Number) ;e..~gl.~;r..Y.iU.~......p..g".........l7..3.Q.7................... ............. .............. (Cit1l or Town and Sta.te) NOTE: Before signing af"f"idavi t ma1j:e sure all blank spaces in the af"fidavi t 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) COMMONWEALTH 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.") The real property locat$d In the Commonwealth of Pellllsylvanla should be described by lot and black number. street and street number. together with a gelleral description of the property, with a reference to the record of the conveyance by whl ch the decedent took title; If a farm state number of a. cres; also statement of mortgage encumbrances upon each parcel at death of decedent. Tax.., assessments, accrued Inter..t on mortgage., etc.,Gr. to be listed an Schedule "F" and must not be deducted from this schedule. (1) (2) (3\ DEPARTMENT VALUATION CAUTION (Do not write In this space) ASSESSED VALUE FOR YEAR OF DECEDENT'S DEATH ESTIMA TED MARKET VALUE House and Lot of Ground at 138 Elm Street in Carlisle. First Ward. Cumberland County. Pennsylvania. being purchased on an Installment Sales Contract. 1978 Assessment: $ 2, 97 O. 00 tJ I<.. Full Value: $19.500.00 11, 880. 00 19,500. 00 V~,500.00 Insert this total opposite "real prope'iy", Schedule "A" in the X X X X X "As Reported" column on the last page of this return. $19,500.00 .,. FARMERS TRUST COMPANY CARLISLE, PENNSYLVANIA Date Re: Estate of Date of Death Dear In answer to your request concerning accounts owned, either separately or jointly, by the above referenced decedent and the balance in each account as of the date of death, we have checked our records and are submitting the following information in duplicate. We suggest that you file one of these letters attached to the Pennsylvania Inven- tory forms (RCC) to substantiate the balance you report. Note that we have shown the correct registration for each account. Also, interest accrued to the date of death, if any, is listed as a separate figure. Very truly yours, '1 .... ROBERT M. FREY ATTORNEY-AT-LAW ;;. ,. tL; [!:_!iUU OF COliN T '~GLL E CnONS 5 SaUTH HANDVER 8TREET CARLISLE, PA. 17D13 PHONE,243-!!IB3B Ocr II "19 AM '78 October 10. 1978 Cumberland County Inheritance Tax Office 411 South Second Street Harrisburg. Pennsylvania 17127 Attention: Mr. Ira Gleim Re: Estate of Suzanne B. Fish File No. 21-78-405 Dear Mr. Gleim: Pursuant to your recent telephone request. I am pleased to enclose corrected statement from Farmers Trust Company showing balances in two accounts at Farmers Trust Company maintained by Suzanne B. Fish as of her date of death on June 28. 1978. These balances correspond with the information previously forwarded to you on the Pennsylvania Inheritance Tax Return. I trust you will now be in a position to complete your file on this Estate and file your official appraisal. Thank you for your continued attention to this matter and should you require anything additional please advise. Sincerely yours. ~A. ^\ Robert M. Frey RMF I djc enclosure RCC - 36 COMMONWEALTH OF PENNSYLVANIA TRANSFFH INHERITANCE TAX SCHEDULE "c" TRANSFERS RESIDEXT DECEDENT (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) ~n (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 N I A (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) Ne (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? ~ I A (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 reBerved in decedent alone or others ~/l\ (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) ~n (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 cO'lld 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 None Insert this total opposite "Transfers", Schedule "C" in the "As Reported" column on the last page of this return. '- , . RCC':3? (12-63) COMMONWEALTH OF PENNSYYLANIA TRANSFER INHERITANCE TAX RESIDENT DECEDENT SCHEDULE "D" BENEFICIARIES BENEFICIARIES AND ADDRESSES RELATIONSHIP SURVIVED (If step-children or DATE INTEREST OF State full nameS and addresses of ll.ll 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 Andrew D. Fish Son Yes 1/3 of Estate R. D.'#2 Bie'lerville. Penna. 17307 . . Theodore L. Fetters Son Yes 1 / 3 of Estate R. D. #2 Bi~lerville Penna. 17307 Clark Lincoln Fetters Son Yes 1/3 of Estate R.D.#2 Biglerville. Penna. 17307 Deponent fUrther says that all the above-named beneficiaries are living at this time except below: NAME DATE OF DEATH RESIDENCE (Executor-Administrator must complete "As Reported" column "I.) Will Administration ~ No. Year .... IS THE ~IATTER OF THE APPRAISEMENT OF THE ESTATE OF SUZANNE B. FISH Deceased Late of .. th.~BoX'Qllgb.oLC~:r'lisle. County of Cll:mb~rland Commonwealth of Pennsylvania REPORT AND APPRAISAL () ... o '" '" >-i 'tl !:l:l ; ~ ~ S! 0 ;' ::s 'tl :1 e. a ~'i .g ~ ~ .... '< en c: ::: ::: > !:l:l www>< F" F" F" Ci ~ ~ ~ -&!l~-EI>~~~ >-i ~ ~ !r l'<l '" ... II> ... "' :t>:l '0 .. :t>:l 'CO ,t>:l :. '''''' :c.:l :1-'-; :~~ :, :..;. (J1!:l:l~ :ob:l 0"'.... ,. 1>:1 o";l~ .. :" ~ il>-:o~ ~ :oc.. ~ ."" -0 -GI>.""........ :N :0 :.. :N :00 :N .. :~ :\.>> :J-l- \0)- ~ or. .OJ .~ \:) N 0 ~~ .. ". rt tv .t-- o"'~ \.>> o~. ::l '"' c.. R C C-38 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 decedent jointly wi th anot.her 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 under 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 Estate Share Valuation '^ DEPARTMENT VALUATION CAUTION-Do not Write In This Space. Value of Value of Entire Decedent's property Interest ,., '^va v-.t;: '^ None None Insert this total opposite "Jointly Owned Property", Schedule "E" in the "As Reported" column on the last pkge of this return. RCC.39 (8-77) 21 Cumberland 21-78-0405 7-18-78 SUMMARY County, Number and Name File Number Date of Death Estate NameFish (LAST NAME) Suzanne (FIRST NAME) B. (INITIAL) COMMONWEALTH OF PENNSYLVANIA TRANSFER INHERITANCE TAX RESIDENT DECEDENT REPORT OF INHERIT ANCE TAX APPRAISER I, the undersigned duly appointed Inheritance Tax Appraiser in and for the County of Cumberland 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 liE". Dated: January 11. 1979 '-~-Q -~-__ C":';. r ~. ~.{'--' c:::::;J - '--' ,. ..J....,.;:<~-'--, .-' INHERITANCE TAX APPRQR REPORT OF THE REGISTER OF WILLS I, the undersigned duly elected Register of Wills in and for County, Pennsylvania, do respect- fully repart 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: REG1STER OF WILLS CODE ADJUSTMENTS INVENTORY VALUE AS APPRAISED (HARRISBURG USE ONLYI REMAINDER APPRAISEMENT CODE Real Property (Schedule AI $ 19.500 00 00+ 92+ Personal Property (Schedule 81 782 43 10+ Joint-Held Property (Schedule E) -0- 20+ Transfers (Schedule CI -0- 30+ TOTAL GROSS ASSETS $20.282 43 Less Debts and Deductions 4().. 93- (SCHEDULE F) CLEAR VALUE OF ESTATE Valuation of life estates or .:L- PRINCIPL.E FACTOR VAL.UE l= I~ annuities....................._ $ 1== ESTATE TAX ASSESSMENTS _ $ .....-..-. FOR USE OF REGISTER ONL.Y ~ COMPUTATION OF TAX Tox an $ Tax on $ Tax on $ Tax on $ Tax on $ Exemptions Total Estate $ $ $ $ $ . 2% 6% 15% * TOTAL TAX $ (*) As evidenced by Charitable Exemption Certificates issued by the Secretary of Revenue. Less tax previously paid BA LANCE Less S% of tax if paid within 3 months after death $ $ $ t= BALANCE OF INHERITANCE TAX DUE Add Interest ot rate of 6% from to AMOUNT OF ESTATE TAX ASSESSED Estate tax paid $ $ c $ $ BALANCE DUE $ Add interest at rate of 6% from to $ TOTAL TAX BALANCE $ PAID $ Supplemental Codes: (FOR USE IN HARRISBURG ONL Y) 48-Adjustment 49+Adjustment 56-Annuity 6O-Life Elitate 92+Remainder Appraisal 93-Remainder Deduction 93C-Charity 94-Remainder Reliidue 96-Suceen i ve Life Estate FOR USE OF REGISTER ONLY ADJUSTMENTS NOTE: Where subsequent adjustments are made to the above computation of tax by the Register of Wills, for proper reason same should be noted below, with short explanation. ' Will ) Administration No. Year IN THE MATTER OF THE APPRAISEMENT OF THE ESTATE OF . Suzanne B. Fish Deceased Late of Carlisle County of Cumberland Commonwealth of Pennsylvania REPORT AND APPRAISAL . * REV-518 18-78) 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 Eugene K. Albright & Reba 1. Albright (Executor or Admini strator) In Re: Estate of Suzanne B. Fish Cumberland County - Fi Ie No. 21-78-0405 Dear Mr. Albright & Mrs. Albright: You ore herehy notified that the original appraisement in the estate of Suzanne B. Fish has been fi led in the office of the Register of Wi lis of Cumberland County on January 11 , 19~, Said appraisement reflects the following valuations: Real Estate Personal Property Transfers Jointly Owned Total $19.500.00 782.43 -0- -0- ~20.282.43 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 rote 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 af 1961, 72 P. S. 2485-1001, P. ~. B . ~:' Date January 11. 1979 Signed ~^-'.. . Title Administrative Officer t~ Note: This is not a bill. ~ -- RC C-~ (2-641 DEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS HARRISBURG, PENNA, 17127 COMMONWEALTH OF PENNSYLVANIA RESIDENT INHERITANCE TAX APPRAISEMENT DATE January 11, 1979 COUNTY Cumberland FILE NO. 21-78-0405 Suzanne B. Fish late of Carlisle Whereas, in the County of Cumberland Commonwealth of Pennsylvania, having died on the 18th day of July 19~, seized and possessed of an estate subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania; Therefore, I, Leo Fulginiti . 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. Unll Appraisement Description of Allel V.luel Made for Inheritance Tax Purposes Real Estate $19, SOO .00 $ 19,500 00 Personal ProDertv 782.43 782 43 Transfers -0- -0- Joint Property -0- -0- Total Estate $20,282.43 $20,282 43 . Having been duly sworn according to law, I do hereby certify that the above appraisement is made in COD- formity with law on this 11 th day of January '^ ,-, r- "19~. J r, .. .._,I..,-~.,....~ Oppraiaer ~ -':,-,C\'.-~ '.,.".-." ,~ (Il\unber &l}d se-l) Harrlsburg (Paot 0ftI..1 , Penna. ~ I~ 1!', 'f ~ g- Cumberland County RESIDENT INHERITANCE TAX APPRAISEMENT Estate of Suzanne B. Fish Deceased. Late of Carlisle Date of Death, 7-18-78 Appraisement Docket Vol., 10 Page, 177 No. 2 6% Filed in Register's Office, Amount of tar dlle, $ 1-11 19 79 DEPARTMENT OF REVENUE Received, Examined and Approved, Wrote abQ,l/t Appraisement, Appeal fl'om Appraisement, Entered and charged,