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HomeMy WebLinkAbout09-13-78 R C C:3.> ~ 4-7 3) COMMONWEAL TH OF PENNSYLVANIA DEPARTMENT OF REVENUE 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 Re1tenue. (Section 703 of the Inheritance and Estate Tax Act of 1961.) CUMBERLAND } AFFIDAVIT OF EXECUTOR ItBMlNtS'fib\:'feR ---('3 .- ]/ \.-' ~', Ll'1..) U IN THE MATTER OF THE ESTATE OF DOROTHY M. WETZEL lSTATE FULL NAME OF DECEDENT) Late of County \GO d . l - <) \ <.) '"\ State of PennslJlvania County of Northumberland }" Rhoda M. Bossler and Ethel E. Welker Executor ~Hl+~fQ~ of the estate of the abave-named decedent being duly sworn, depose and say Decedent died A:Jqust 13, 19~{testate leaving a last will, copy of which is hereto ottached. } (MONTH) lDAY) lYEAR) intestale Name and address of ottorney or } Mvro:l M. Moskowitz, Esquire other authorized representative to whom 17872 all carres.pondence should be mailed. 2 E. Independence Street, Shamokin, Pennsylvania That as such Executors deponent is familiar with the affairs of said estate and the property constituting ( EX E CU TO R-ADMIN I ST R A TO R) the assets thereof and their fair market value. That at the time of death there was no safe deposit box registered in decedent's individual name, or jointly with, or as agent or deputy of another, or in decedent's individual name, with right of access by another as agent or deputy, with the exception of the following: - NAME AND ADDRESS OF BANK OR OTHER INSTITUTION THIS SAFE DEPOSIT BOX RENTED RELATIONSHIP OF JOINT IN WHICH DECEDENT RENTED A SAFE DEPOSIT BOX INN AM E 0 R N AM ES 0 F HOLDERS TO DECEDENT N 0 N E. That the contents of said safe deposit box or boxes are itemized under Schedules N/A of this return, with the exception of the following, for the reasons hereinafter set forth: That Schedule A attached hereto and made part hereof sets forth fully and in detail all the real property in the Commonwealth of Pennsylvania of which decedent died having an interest therein. It also sets forth the mortgage encumbrances upon each parcel of real property at the date of death, giving the amount still due at death, name of mortgagee, date, rate of interest, and book and page of record thereof. It also sets forth in the columns provided therefore the assessed valuation of each of said parcels, the estimated market value thereof as of date of death of decedent. That Schedule B attached hereto and made part hereof sets forth fully and in detail all personal property wheresover situated owned by the decedent at the time of death; all moneys left by the decedent at the time of death, whether in decedent's immediate 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 decfdent'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 ~o 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 aU 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 tht: 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 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 lit th", time of death in any co-partnership or business, and in support of the value of such interest there 1s annexed to sa.id schedule, financial statements showing the assets and liabilities of said co-partnership or tms1ness. A copy of the co-partnership agreement, (if oral, a statement setting forth the nature of the agreement) together with a statement setting f'orth 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 rail' market value thereof', any other property owned or bequeathed by the decedent at the time of' death. The Schedule C attached hereto and made part hereof sets forth a true answer to each inquiry contained therein and in the case of' transfers of property, real or personal, within two years of decedent's death, in contemplation of decedent's death, or intended to take effect in possession or enJoyment at or after death, said schedule sets f'orth 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 transf'ers. In the case of transfers intended to take effect in possession or enjoyment at or after death, there is also attached to the schedule a copy of the deed, trust agreement or other instrument creating the trust. There is also set forth in said schedule a list of' all property, real and personal, with its value, which pa~ses at decedent's death by virtue of the exercise by decedent, ei ther individu~lly, or jointly wi th another, or any power of appoint- ment vested in decedent, either individually or jointly, by the will, deed, or other instrwl1ent of' another, with a copy of' the instrument c'reating such \power attached to the schedule. That Schedule D attached hereto and made part hereof sets f'orth 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, Lheir 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 Scredule 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 vesti 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 funeral expenses paid; family exemption, where applicable; costs of administration of this estate; counsel fees and f'udiciary'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 Impnid 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 cl aiming 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", "e", "E", and "F" as directed therein, have been carried forward and properly registered in the Summary. Sllbs~ribed and sworn to before me this ................................. 2fM~:~?Ja::!t;::d.......19_?_: I' / ,/0. I .<:: / C.'! C; / ~-O!- A .I .../i.~.'/P~.....f};Z....~~................................_... (Executor-Administrator) ....?Jp......~.LJ.k.l:!....f..tQlg;r......................................................................... (Street Number) Shamokin , PA 17872 .....................................".................................................... (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 collmID #1 in the "Summary" has been properly completed as above-directed. ,,' _"''',I' ~lt RC C-34 ('4;73) . COMMONW'EAL TH OF PENNSYLVANIA De:PARTMENT 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 located In the Commonwealth of Pennsylvania should be described by lot and block number, street and street number, together wi th a general description of the property, with a reference to the record of the conveyance by which the decedent took title; If a farm state number of a- cres; also statement of mortgage encumbrances upon each parcel at death of decedent. Taxes, assessments, occrued Interest on mortgages, etc.,are to be listed on 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 1. Real Estate municipally numbered 3012 Harvarc Avenue, Camp Hill, Cumberland Co~nty, Pennsyl- vania as more particularly described in the deed recorded in the office for the Recording of DeedE in and for Cum~erland County, Pennsylvania in Deed Book 0, Volume 13 page 172. Sold 9/27.78 5,440.00 I: 40,000.00 t...---- YD/)DO. (,) 0 TOTAL 40,000.00 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. 4~ aoe, 00 COMMONWEAL TH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS HARRISBURG 17127 CAMP BILL OFFICB l1I&\I8t 21 t 1971 RCC-43 (4-71) NOTE: TO BE SUBMITTED IN TRIPLICATE REPORTING FINANCIAL INSTITUTION ADDRESS Daufihln DeI.Qsit. Baru~ &: Trust Co. )045 Market, St.. Camp Ul11, Pa. ZIP CODE ~'rolJ. Pennsylvania Department of Revenue Bureau of County Collections Gable Building, 3rd, Floor 411 S. Second Street Harrisburg, Pennsylvania 17127 Pursuant to Section 742, Pennsylvania Inheritance and Estate Tax Act of 1961, we herewith submit the following report: ACCOUNT NO. OF JOINT, TRUST OR INVESTMENT DEPOSIT 14-21)81 NAMES ON ACCOUNT OR INVESTMENT DDrot.h1 H. ,.-tael DATE OF DEATH 8-14-78 DECEASED JOINT DEPOSITOR, TRUSTEE OR INVESTOR Q>>rotbl M. .-tael ADDRESS 3014 Harvard A'ge. Camp m,ll, r>a. COUNTY ZIP CODE Cumberland 17011 SURVIVING DEPOSITOR,. BENEFICIARY OR INVESTOR MoM ADDRESS RELATIONSHIP TO DECEDENT Heme DATE DEPOSIT OR INVESTMENT WAS ESTABLISHED 3-17-71 BALANCE, INCLUDING INTEREST DUE, AT DATE OF DEATH $ 9,129.90 ~dA/.A!!!t . Signature (..- . . TITLE Han7 D. Reel, Jr., ce wealdent RC~ -35 COMMONWEALTH OF PENNSYLVANIA TRANSFER INHERITANCE TAX '* RESIDENT DECEDENT SCHEDULE "B" PERSONAL PROPERTY Item No. 1 . INSTRUCTIONS: This Schedule must disclose all tangible and intangible personal property owned individually by the decedent, at the time of his death. Property owned by the decedent jointly with another or others must be listed under Schedule "E". Intangible personal property, titled in the name of the decedent, but payable at death to another or others, including but not limited to P.O.D. U. S. Savings Bonds and tenta- tive trust accounts, must be listed, despite the fact that they are not of the administered estate. Tangible personal property should be listed first (e.g. jewelry, wearing apparel, household goods, and fUrnishings, books, paintings, automobiles, boats, etc.) Intangible personal property, such as bonds, treasury certificates, cash on hand and in bank, stocks, mortgages, notes, together with accrued interest or dividends, salaries or wages, insurance pay- able to the estate or fiduciary in said capacity, partnership interests, interest in any undis tributed estate of or income from any property held in trust under the will or agreement of another, even though located outside of the State, at the time of death, should be listed in this schedule. ITEM List and describe fUlly UNIT ESTIMATED VALUE MARKEl' VALUE DEPARTMENT VALUATION (Do not write in this space) V' Chec~ing Account No. 112-952513-3 in the Commonwealth National Bank, Harrisburg, PA M) ? Y'~, II'), "gt.~48.15) ~~l T8~. I ~ 2. Seve~ty-Eight (78) - $25.00 United States Ser"es E Bonds asshow:, on Exhibit "A" attached here- to and made a part hereof 2,328.13 ~ a-.1. \3 , 300.00 3eo.00 345.60 a~5. ~ 0 345.40 3~S.~b 948.64 ~~~.CD~ 948.64 qyt.(plf 3. Six (6) - $50.00 First National City Bank Travelers checks 4. U.S. Treasury check 46,861,011 dated 8/3/78 - Social Security 5. U.S. Treasury check 50,216,086 dated 7/3/78 S'Jcial Security 6. Commonwealth of Pennsylvania, check 214802 dated 6/30/78 7. C mmonwealth of Pennsylvania, check 226043 dated 7/31/78 $10,000.00 certificate of Deposit No. 2912~ dated 11/14/75 at 7.250% in the Commonwealth National Bank, Principal and Interest to date of death /' Savings Deposit certificate No. 4-47147 in th Harris Savings Association, Harrisburg, PA Principal iand interest to date of death 8. 9. 10. 11. t 12. /()) r63.~ () "::---' lP,659.15 tD 5lP3. DO \ J) or~ .J".3 .1, O?g. 12) l ) C \~. 5 3 Savings Account No. 14-21381 in the Dauphin Deposit Trust Co., Harrisburg, PA., Principal and interest to date of death /' Golden opportunity Passbook No. 705225-8 in the Cumberland County Natio:'al Bank and Trust Co~pany, Camp Hill, PA. Principal and In- terest to date of death Cf) J ~ CJ'.tJ1-- 9,167. 28~ ,-,-- q) \~q. O~ 3,466.46 3, Lt~lD. l.\o l., $1,000.00 Growth certificate in the Cumberlan County National Bank and Trust Co., No. 2681 G. Principal end interest to date of death \) "t~ID. 44- 1,466.44 (cont'd on next sheet) Insert this total opposite "Personal Property", Schedule "B" in X X the "As Reported" column on the last page of this return. 7l, ~ C\ \. 5~ R~C -35 '* COMMONWEALTH OF PENNSYLVANIA TRANSFER INHERITANCE TAX RESIDENT DECEDENT SCHEDULE "B" PERSONAL PROPERTY Item No. 13. 14. 15. 16. 17. 18. INSTRUCTIONS: This Schedule must disclose all tangible and intangible personal property owned individually by the decedent, at the time or 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 or 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 ract that they are not or the administered estate. Tangible personal property should be listed rirst (e.g. jewelry, wearing apparel, household goods, and rurnishings, books, paintings, automobiles, boats, etc.) Intangible personal property, such as bonds, treasury certiricates, cash on hand and in bank, stocks, mortgages, notes, together with accrued interest or dividends, salaries or wages, insurance pay- able to the estate or fiduciary in said capacity, partnership interests, interest in anyundistributed estate or or income rrom any property held in trust under the will or agreement or another, even though located outside or the State, at the time or death, should be listed in this schedule. ITEM List and describe rully UNIT VALUE DEPARTMENT VALUATION (Do not write in this space) ESTIMATED MARKEl' VALUE (cont'd) $2,000.00 certificate No. 16-3271 at ~h% in the First Federal Savings and Loan Association of Harrisburg, PA. Principal and interest to date of death. ,/'" $2,000.00 certificate of Deposit No. 112634 and $14,gpO.00 certificate of Deposit No. 112635,a/EJoth dated August 20, ,1974 and both Account Nos. 09-112634 at ~h% interest in Harris Savings Association, Camp Hill, PA. Principal and interest to date of death ~t;41.~? Z.654 19", '-'-.-. . .jl~"il.\'n '''~J 0 ~ ,ti.f! .22,227.09 .....- ~~\ D~'i. ~ 1 Two Hundred (200) shares of Captain Inter- national Industries Ltd., certificate No. 45699 dated 9/2/70 (worthless) -0- .,.,.,./ 0.00 1973 American Motors Automobile, Title A246021o2, 1.0. No. A3A857Z221455 Sold ~ 1,490.00 v \,)~C\~.oo Household contents - Sold at Auction on 9/23/78 ./ 1,206.80 II'" \I.O~. BO Refund from Alcoh - ck. no. 12929 dated 10/2/78 286. 00 ~ ~ 8t-. 00 TOTAL (~:i~i~ Insert this total opposite "Personal Property", Schedule "B" in the "As Reported" column on the last page or this return. x X - ... . - ...... .. , .' '.' ,.... " ~. .. , ., .... ''''C'', " RCC- 36 . COMMONWEALTH OF PENNSYLVANIA' T~~SFER INHERITANCE TAX SCHEDULE "C" TRANSFERS '* RESIDENT DECEDENT (1) Did decedent, within two years of'death, make any transf'er of' any material part of' his estate, without receiving a valuable and adequate consideration theretor? (inswer yes or no). NO (2) Did decedent, within two years of' death, transfer proper~y f'rom h~a8lf' to himself' and another or others (including a spouse) in Joint ownership? (Answer yes or no) r.PlP (3) If' the answer to (1) or (2) above is in the af'f'iraative state: (a) Age of' decedent at tiae of' transf'er N/A (b) State of decedent's heal th at ti_ of' ilaking the transf'er. (Note 1). (c) Cause of' decedent's death. (Note 1). . (4) Did decedent, in his lif'etime, make any trans1"er of' property without receiving a valuable or adequate consideration thereto.r which was to take ef'f'eet in possession or enjo)'ll8nt at or af'ter his death? (Answer yes or no) NIJ (a) Was there any possibility that the property tranat'erred tight ..eturn to transt'erer or his estate or be subject to hill power of' disposition? (Answer yes or no) Ml (b) What was the.transf'eree's age at t1ae of' decedent's death? N/A (5) Did decedent in his lif'eti_ make any transf'er without receiving a valuable andadeqQ!ate oonsideration theref'or 1D1der which transf'eror expressly or illlplledly reserves f'o.. his lif'e or any period which does not in f'act end bef'ore his death: (a) The possession or enJ<tWnt of' or the right to inco.. f'rom the property transf'erred? (Answer yes or no) (b) The right to designate the persons who shall possess or enjoy the property transf'erred or . income theref'roa? (Answer yes or no) NO (6) If' the answer to (5) (b) above is in the af'f'i....t&V'.. state whether the right was reserved in decedent alone or others.. I'" (7) Did decedent in h~s lif'eti_ make a transf'er, the oonsideration tor which was transf'eree's promise to pay income to or tor the benefit of' care of' transf'eror? (Answer yes or 00) NO (8) Did decedent, at any tiDl8, transf'er property, the beneficial enJoyaent of' which was subject to change, because of' a reserved power to alter, ..mi, or revoke, or _1Ifbich could revert to decedent 1D1der te... of' transf'... or by operation of' law? (Answer yes or no) NO (9) If' the SllBWer to (8) above is in the arf'iraative, 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) NO NOTE 1: The answers to these questions should be sUpported by af'f'idavit by the attending physician as well as a copy of' the death certificate. NOm 2: If' answer to any of' the above questions is yes, set f'orth below a description of' the prope..ty .transf'e....ed,. it's f'air ....ket value at date of' death, dates of' transf'ers ami to whom transf'erred, with relationship of' transf'erees to decedent, if' any. Subait copy of' any trust deed or instrument, if' trans- f'ers are clai.ed to be non-taxable, also sub.it detailed state.ent of' f'acts on which saidclai. is based. NOTE 3: List applicable property below in _nner in which provided in Schedules A, B, or E. ITEM DESCRIPTION IWIIDr.r V ALtJE (Ea tiJRa ted) DEPT. VALUATION (Dept. Only) NONE - 0 - NoC\.L Insert this total opposite -Transf'ers-, Schedule -C- in the -As Reported- oolUlm on the last page of' this return. t\\6'1\L "..~ " '-" .,." .,.,... "t'. I :~ ., ,... .,'" , . J, "cz '''.'''' , : ,Rcc..i7 (12~63) t'OMMONWEALTIl OF PENNSYYLANIA TRANSFER INHERITANCE TAX RESIDENT DECEDENT .,...-..,.., ....,..,_..""..,.--""'.,..... "'.f..':l',. SCHEDULE "0" BENEFICIARIES , BENEFICIARIES AND ADDRESSES ,State .full names and addresses of all .ho have an interest. vested. contingent or other wise. in estate) Rhoda M. Bossler 31D luke Fidler Shl!llllDkin-.. PA 178"2, RELATIONSHIP (If ste~hiIdren or 'illegiti~.te children . are involved. ~t forth this fact.) Sister SURVIVED DECEDENT STATE YES OR NO Ves DATE' OF BIRTH . 8/10/1916 INTEREST OF . BENEFICIARY IN ESTATE one-half ()i) , , .' E<thel E~ WElker 310 luke Fidler -. . - PA 17872 Sister Ves 7/4/1909 one-half ()i) ,j . '. , ~ . n .' 0 , n , : ! .'~ ...\ -. Deponent further says t~at all the above-naaed beneficiaries "re 11villg,at this tiae except below: NAME DATE OF DEATH RESIDENCE . N nN E "" " '~. << ... . ~. j':. I. , ./' .. ';. ,:: A'!l. *i'" '0' '.- '.'IIi" l:',?'" ":;-'7:\\ t ' ; (:'1 ~ t Jr, ... ,S<.... l'lI 'II: ... ~~~ .- .... :s e ClI_ 'OQ.o <e" ':'3~ ~~~ " ~ 0.. '.. 41 e Q,'\ ..:':' .' g ~ (1) (As Reported) .........."............................. (2) (As Detcrmin<.-.()) ,,-. ., .....*'....................... $ $:.:,.,,/.:,...... .............................. ... $..,.:.......................... 'J.....'.f. ~:. .>i pL. . ;:-1 $.:'.. 1. ! Gross Taxable Estate ..................... ..........................". '...:................. ...... .~.;. "I ...... ',. . , . '-u 'IP n,.t:'i~l.'.'...;i JL 'I S j f?~": .3 .reo -; '1 i t -, ., ~ ..;.) Z ~ (.J:l ...:I . ~ N ~ ~ idJ '<111: . fif':-&; (.J:l fI) LaJ !:4 t' V) - ~ N .e ..~ r. ....: ~ II ..co .~. ~ l .. N j:l.oj 0 .. .... m .. ~ .i: ~ .... 0 . ~ < .~ W .: .;... ... ~ ::a c .lD I-< ~ ~ -J C(: OIl Cl ~ m C (.J:l -J -J: c "C C 0 ~ :I: '" < ~ .... . ffi :.. .e .,~ UJ'E 1IJ 0 E-o' i~~,,, z E-o V) ::I:, ::J: ~ 1.1. (.J:l. b ~: ....--. ~ i 0 m .. ---- 0 "C C a:::: . c ! C t;]i .oj :IE: to: .... 0 = t.3 ~ .... .::,L, :c (.J:l Q./ ~ Z 0 ~ I: ..... .~ 0'. e b 0 c a:::LaJ m ell < ~ :G' ~. > ..t: ... :IE: N CO c - 's ".. 2 5 E - - .- ~ "t:l :r O' 0 < U U E"'.~H " ., n. ; '1 ~ . ~j '" '" - .. , p" ~ -. ',', ,",_'." ,".,'''.",'''__'' ""'''','''"",,.'' Y', "'!- ~'7 r J!l'C,= ' ~, .~.,~;/ Y , .. . .. . RCC~" RESIDENT DECEDENT SCHEDULE "2" JOINTLY OWN'" PROPERTY '* COMMONWEALTH Of PENNSYLVANIA TRANSfER INHEIUT ANCE TAX INSTRUCTIONS: This schedule .at disclose all property, real Uld personal, owned by the deoeclent Jointly wt th another or others' including intangibles, standing in the n... of the decedent Uld others. List real estate first, as entireties, or joint tA,nants, giving brieI' .scription, as indicated Ulder Schedule -.1-, plus the date and place of record of instrUlll8nt ettecting v..titure, but do not include entireties or out of state real ..tate value in estate valuation colUlllll. Personal property should be listed as in Schedule -8-, plus date of acquisition, and the name, address and relationship (if any) at co-owners to the decedent. Description of' Property, Dl!I.te of Acquisit1Qn, Name Address and Relationship of Co-Owners, and Place of Reco", of InstJ'UMflt where Aeal Estate. unit Value percentage Share Estate Valuation DEPARtMENT VALUATION CAlJTIOI-Do not Write In This SDace. Value 01' Value at Entire Decedent's property Interest ;is iii . Nb~ NON E - 0 - ~ " Insert this total oppolll~te -Jointly Owned Property", Schedule .Ew in the WAs ReportedW colUlllt on the last page at this retum. N~ / '" , '~. '