HomeMy WebLinkAbout11-13-78
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. RCC..33 (4-73)
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COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
''\' r" ,r
RESIDENT DECEDENT
COUNTY OF CUMBERLAND
IMPORT ANT:
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
hy the Secretary of Re'otenue. (Section 703 of the Inheritance and Estate Tax Act of 1961.)
Late af
Cumberland
Pennsylvania
} AFFIDAVIT OF
~~
ADMINISTRATOR
IN THE MATTER OF THE ESTATE OF
WILLIAM C. COLEMAN
(STATE FULL NAME OF DECEDENT)
County
County of
Cllrnherland
} 55:
State af
Administrator
Suszanne C Coleman
of the estate of the above-named decedent being duly sworn, depose
~1t~
and say
Decedent died .Tune
(MONTHI
Name and address of attorney or }
other authorized repres.entative to whom
all corres.pondenc:e should -~ :0d.
26
(DAY)
, 19~J~iXiX~X~1riX,XP;C~~~:lIi"~~~~}
(YEAR) tlnt.state
Mark E. Garber, Jr.
28 S. Pitt St., Carlisle, PA 17013
That as such Admrx. deponent is familiar with the affairs of said estate and the property constituting
I ~~~~jl,CADMINISTRATOR)
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 ri ght 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 DECEDENT
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 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 interest thereon, if any, down to the last interest day prilllT 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;
al: ~"'"a';llg 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 wcr 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 see 'lies 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 bJlsiness.
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 corltemplation 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 co~y
of the deed, trust agreement or other instrument creating the trust. Ther.. is also set forth in said
schedule a list of all property, real and personal, with its value, which 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 instrument creating such power attached to the schedule.
That Schedule D attached hereto and made part hereof sets forth the names and addresses of all
persons beneficially interested in this estate at the time of decedent's death, the nature of their res-
pective interests, their relationship, if any, to the decedent, together with the ages at the time of
decedent's death of all minors, annuitants and beneficiaries for life under decedent's Will. It also
contains a statement showing which of the beneficiaries named in the decedent's will, if any, died prior
to decedent, the dates of their death, their issue, and the relationship of such issue to the beneficiary.
That Schedule E attached hereto and made a part hereof sets forth all property, real and per-
sonal, owned by the decedent jointly with another or others, including intangible, standing in the name
of the decedent and others, plus the date and place of record of instruments effecting the vestiture of
real estate and the date of acquisition of personalty, plus the name, address and relationship, if any,
of co-owners to the decedent.
That Schedule F attached hereto and made a part hereof sets forth fUlly and in detail all debts
and deductions claimed for and on behalf of this decedent's estate, including fUneral expenses paid;
family exemption, where applicable; costs of administration of this estate; counsel fees and fUdiciary's
commissions paid or to be paid; cost expended for burial trusts, tombstones or gravemarkers, and reli-
gious services, in consequence of the death of the decedent; debts and claims owing and 11l1paid 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", "CO, "E", and "F" as directed therein,
have been carried forward and properly registered in the Summary.
Subscribed and sworn to before me this ....j?."!!.:...........
................"................................... day of ........~........1928... ......"..................... ........ . .. .... ..........(!...:...~...~
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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.
..,....-. ,.. ",,-
, ENUE
_"oJ '-'r ,-,-,,,,,, Y COLLECTIONS
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
REAL PROPERTY
..,."," '.. .' ,
........~.....
Real property in Pennsylvania, with statement of mortgage encumbrances upon each parcel at death of dece-
dent. Where property held as joint tenant or tenancy by entireties, report an Schedule "E". Property held by
the decedent as tenant in common with another or others, should be identified as to quantum of interest and
the estimated value should be that of the decedent's interest only.
The real property located In the Cammonweolth af Pennsylvania should be (1) (2) (3\
described by lot and block number, street and street number, together wi th DEPARTMENT
Q general description of the property, with a reference to the record of the ASSESSED VALUE VALUA TION
canveyonce by which the decedent taak title; If a farm state number af a- FOR YEAR OF ESTIMA TED CAUTION
cras; 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, ete.,ore DEA TH In this space)
ta be listed an Schedule "F" and must not be deducted from this schedule.
{\.\ 0 n (..
None
Insert this total opposite "real property", Schedule "A" in the X X X X X
"As Reported" columt'l on the last page of this return.
1\1 0 t\t
. Rec -36
'*
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "B"
PERSONAL PROPERTY
INSTRUCTIONS: This Schedule must disclose all tangible and intangible personal property owned individually
by the decedent, at the time of his deatfu 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 estat$
Tangible personal property should be listed first (e.g. jewelry, wearing apparel, household
goods, and furnishings, books, paintings, automobiles, boats, etc.)
Intangible personal property, sueh as bonds, treasury certificates, cash on hand and in bank,
stocks, mortg~es, notes, together with accrued interest or dividends, salaries or wages, insurance pay-
able to the estate or fiduciary in said capacity, partnership interests, interest in any undistributed
estate of or income from any property held in trust under the will or agreement of another, even though
located outside of the State, at the time of death, should be listed in this schedule.
Item
NO.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
ITEM
List and describe fully
UNIT ESTIMATED
VALUE ~ VALUE
1973 Chevrolet Nova 2-door Sedan
Checking Account #7-0562-4
Savings Account .fF7038t39~-
CCNB Bank, N.A., Carlisle, PA
Interest on above accrued to 6/26/68
savi~~fm~r~o~PSs~lC6~~5CR;~sle, PA
Accrued interest on above to Sept 2, 1978
Savings Account #18-0007306-4 ~
Commonwealth National Bank, Carlisle, PA
Interest on above accrued to 6-30-78
Savings Account #18-0010597-3 ~
Commonwealth National Bank, Carlisle, PA
Accrued interest on above to Sept. 8, 1978
795.0C ./
1120.4: /
/"
6613.0~'/
87.03V
4156.6E V
51. 2:"/
3088.7C/
26.9:/
12,978.H v/
316.2- /
Total
$ 29,233.4
Insert this total opposite "Personal Property", Schedule "B" in
the "As Reported" column on the last page of this return.
x X
"q, d.53. ~q
DEPARTMENT VALUATION
(Do not write in
this space)
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RCC-'3D
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
SCHEDULE "c"
TRANSFERS
RESIDENT DECEDENT
(1) Did decedent, within two years of'death, make any transf'er of' any material part,Qf' his estate, without
receiving a valuable and adequate consideration theref'or? (Answer yes or no) ~O
(2) Did decedent, within two years of' death, transf'er property f'rom 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 af'f'irmative state:
(a) Age of' decedent at time of' transf'er
(b) State of' decedent's heal th at time of' making the transf'er. (Note 1).
(c) Cause of' decedent's death. (Note 1).
(4) Did decedent, in his lif'etime, make any transf'er of' property without receiving a valuable or adequate
consideration theref'or which was to take ef'f'ect in possession or enjoyment at or af'ter his death?
(Answer yes or no) No
(a) Was there any possibility that the property transf'erred might return to transferer or his
estate or be subject to his power of disposition? (Answer yes or no)
(b) What was the transf'eree'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 f'or 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 transf'erred?
(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 f'or 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 benef'iciary 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 f'orth 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' transf'erees 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 f'acts on which said claim is based.
NOTE 3: List applicable property below in manner in which provided in Schedules A, B, or E.
ITEM
DESCRIPTION
MARKET VALUE
(Es tima tel!)
DEPT. VALUATION
(Dept. Only)
N Of'\(..
Insert this total opposite "Transf'ers", Schedule "CO in the
"As Reported" column on the last page of this return.
~ Cr'\~
,
RCC-37' (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 tull names and addresses of all who illegitimate children DECEDENT OF BENEFICIARY
aye an interest, vested, contingent or other are involved, set STATE YES IN ESTATE
wise, in estate) forth this fact.) OR NO BIRTH
Suszanne Coleman Daul?hter Yes Entire 1<'",1-,,1-.,
1200 Svcamore Street
Washington, PA 15301
.
-
,
(
h
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 #1.)
Will
Administration
~ No.
Ci
....
o
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Year
IS THE
MA TIER OF THE APPRAISEMENT
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OF THE
ESTATE OF
Deceased
Late of .
County of
Commonwealth of Pennsylvania
REPORT AND APPRAISAL
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neG-38
RESIDENT DECEDENT
SCHEDULE "E"
JOINTLY OWNED PROPERTY
CQMMONWEi\LTH OF PENNSYLVANIA
TRANSF1':1t fNHEllI TANeE TAX
INSTRVCTIONS: This schedule must disclose all property, real and personal, owned by the decedent jointly
wi th another or others, including intangibles, standing in the name of' the decedent and others. List
real estate first, as entireties, or joint tenants, giving brief' description, as indicated under Schedule
"A", plus the date and place of' record of' instrument ef'f'ecting 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 Acquisi tion, Name I Uni t percentage Estate DEPARTMENT VALUATION
Address and Relationship of' Co-Owners, and Place Value Share Valuation CAUTION-Do not Write
of' Record of' Instrument, where Real Estate. ! In This Space.
\/' "'- Value of' Value of'
"'- ^ (',. '.)v Entire Decedent's
Property Interest
None NCl
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I
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I
I I
I I
I I
I
Insert this total opposite "Jointly Owned Property", Schedule "En N onQ.
in the "As Reported" column on the last page of' this return.
n.L
-
REV-~t8 IB-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
, Ms. Suszanne C. Coleman
,427 First Street
Carliillil> PA
(Executor or Administrator)
In Re: Estate of
William C. Ce1emaa
Cnmherland
County - File No. U-78-0UO
Dear
You are hereby notiHed that the OM gin'"
appraisement in the estate of Willi"m r.. Co't>man
has been filed in the office of the Register of Wills of r.nmh~~ht1d
County on 13 Februarv , 19--12., Said appraisement reflects the following
valuations:
Real Estate
Personal Property
Transfers
Jointly Owned
Total
None
29,233.49
None
None
$29.233.49
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 '3 Pebruary 1979 Signed L-e...o F\~~
Title Administrat:ivp Offir>t>r
y
Note: This is not a bill.
,
..
REV'-457 (11-78)
DEPARTMENT OF REVENUE
BUREAU OF FIELD OPERATIONS
P.O. BOX 2970
HARRISBURG, PENNA, 17105
COMMONWEALTH OF PENNSYL VAN IA
RESIDENT INHERITANCE TAX
APPRAISEMENT
DATE 13 February 1979
COUNTY ~l1mhpr'tlnr1
FILENO. 21-78-0410
Whereas, William C. Coleman late of Carlisle
in the County of Cumberland Commonwealth of Pennsylvania, having died on
the 26th day of June 19l!L, seized and possessed of an estate
subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania;
Therefore, I, Leo Fu1l!:initi ,an appraiser duly appoin-ted 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 annuiti~ and life estates growing out of said estate, hereby file the following appraisement:
In the event that any future interest In this estate 15 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 Mad:-ftr~~~ee~;t~~ce
VALUES
Tax Purposes
Real Estate $
None
Personal Property 29.233 49
T1"ansfers None
Jointlv Owned None
Tnt-",' $29,233 49
Have been duly sworn according to law, I do hereby certify that the above appraisement is made in conformity
with the law on this , ''If-h day of' 1i'Oh~~:) . 19 .2.!L-.
\ l="'( ~~
Appraiser
(Number and Street)
Harrisburg
(Post Office)
, Penna.
~ I -1 p. ..)1/ ()
..~................... County
RESIDENT INHERITANCE TAX APPRAISEMENT
_ Estate of
.......W.~....L.~..~
Deceased.
Late of
Date of Death, .......Q...~....::::-.2:.~...;:J-..\?
Appraisement Docket Vol., ....l..9..................
Page,.....l.~.~............. No. .6.....................
Filed in Register's Office, .2.::-;.\3...... 19:J.~
Amount of tax due, $..:....................................
DEPARTMENT OF REVENUE
Received, .... ................ .... .................... ..... ........
Examined and Approved, .................................
Wrote about Appraisement, .............................
Appeal from Appraisement, .............................
Entered and charged, .......................................
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