HomeMy WebLinkAbout10-30-78
RCC-72 9-(3,'=1'
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
APPLICATION FOR AND CONSENT
TO TRANSFER SECURITIES
REGISTERED IN THE NAME
OF A RESIDENT DECEDENT
APPLICATION (MUST BE FILED IN TRIPLICATE)
TO THE PENNSYLVANIA DEPARTMENT OF REVENUE:
Application is hereby made for consent to the transfer of the following securities of a Pennsylvania
Corp4~tion or a National Banking Association located in Pennsylvania: 9.5% preferred
Philadelphia Electric Co. common
DATE
(a) 92 (b) (c)
(NOTE: In describing securities E~nter in (a), ab Ole, either the number of shares of stock or the face amount of
registered bonds, in (b), the name of the issuing company and in (c) the class of stock or the stated interest rate
and maturity date of registered bonds.)
various dated
, and havin9-a TOTAL MARKET V AtUE OF $
(Date) Irene B. Hausman
as of the date of death of the decedent,
ISSUED ON
1,915.00
July 27, 1978
, on
(Name of Decedent)
(Date of death)
Cumberland, Pa.
who was late of
105 May Drive, Camp Hill,
(Street and Number)
(PrefdTtrtllli):e) l-lrs. Irene (<Bllntilausman (State)
(Common) John C. Hausman & Irene B. Hausman
The securities are registered as folllows:
(Name or names in which certificates are registered)
A D-MINISTRATOR)--
EXECUTOR )
John C. Hausman, 105 ~'1ay Driae, Camp Hill, Pa.
(Name) .:{&hns~. Slike, Esg.
NAME OF APPLICANT
2109 Market St., Camp Hill, Pa.
COUNTY FILE NUMBER-~ '~'7 .f-/J-?':;' ADDRESS OF APPLICANT
BUREAU FILE NUMBER SIGNATURE OF APPLICANT ;,Jrt:I.A,' f; ,;a/iL
NOTICE: IF YOU FAIL TO PROPERLY FILL IN ANY PORTION OF THIS APPLly{fioN, IT WILL NOT BE
CONSIDERED COMPLETE AND WILL BE RETURNED TO YOU FOR COMPLETION.
COMMONWEALTH OF PENNSYLVANIA - DEPARTMENT OF REVENUE.
CONSENT TO TRANSFER SECURITIES 6. 'I :2 - q (/_-
DATE C \~7t) I 'Jd
I hereby consent to the transfer of the above securities now registered in the name of the aforesaid
Decedent and waive the filing of a certificate certifying to the payment of the transfer inheritance tax to which
the property of said Decedent is made subject pursuant to the provisions of the Act of June 20, 1919, P.L. 521,
as amended and the Act of June 15, 1961, P.L. 373, as amended. This is also in accordance with the provisions
of the Act of April 9, 1929, P.L. 343.
This Consent to Transfer thE! herein described property operates only in reference to the estate of the
above-named Decedent.
Signed for the Secretary of Revenue
a;;:ffc:L.o.,tJ (2 CVY(I.tQ/\X}l~ t~, ,',
(Signature) \
E- ""l :-:_ /'.\J::sntt '
uF V'J;LL3
{Co'\Jn~y;v.iiH r
(Title)
RCC-72 19-681
"COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
APPUCA TION FOR AND CONSENT
TO TRANSFER SECURITIES
I REGISTERED IN THE NAME
j OF A RESIDENT DECEDENT
--------_.__._._._--~-----_._---,--
I
I
I
___.---1___~__.__
APPLICATION (MUST BE FILED IN TRIPLICATE)
TO THE PENNSYL VANIA DEPAf~TMENT OF REVENUE:
Application is hereby made for consent to the transfer of the following securities of a Pennsylvania
Corporation or a National Banking Association located in Pennsylvania:
DATE
10/4/78
(a) 100 (b) Pennsylvania Power & Light: C01l1.pany-;_Jc) common
(NOTE: In describing securities enter in (a), ab CNe, either the number 0 shares of stock or the face amount of
registered bonds, in (b), the name of the issuing company and in (c) the class of stock or the stated interest rate
and maturity date of registered bonds.)
ISSUED ON various , and having a TOTAL MARKET V AtUE OF $
(Date)
as of the date of death of the decedent, __Irene B~_Hausm~~___, on
(Name of Decedent)
2,125.00
July 27, 1978
(Date of death)
who was late of
105 May Drive,___~~~i~l~__ C~mber1and,
Pa.
(Street and Number)
(Post Office) (County) (State)
MrS. Irene B. Hausman (75 shares)
John C. Hausman and Irene B. Hausman (25 aha.)
(Name or names in wh ich certificates ore registered)
The securities are registered as fo,llows:
AJ;>M I tll S+RA+QR)
EXECUTOR )
John C. Hausman, 105 ~~y Driv~,
(Nclme)
Camp Hill, Pa.
(Address)
NAME OF APPLICANT _____~o~_ E. Slik~Esquire
COUNTY FILE NUMBER ~/-7f-lf71 ADDRESS OF APPLICANT 2109 ~1arket St., Camp Hill, Pa,
BUREAU FILE NUMBER SIGNA TURE OF APPLICANT __\ u_~ t:) -4'~'L('
NOTICE: IF YOU FAIL TO PROPERLY FILL IN ANY PORTION OF THIS APPLI iON, IT WILL NOT BE
/
CONSIDERED COMPLETIE AND WILL BE RETURNED TO YOU FOR C PLETION.
COMMONWEALTH OF PENNSYLVANIA - DEPARTMENT OF REVENUE
CONSENT TO TRANSFER SECURITIES .It, .'/...... l lV""
----- DATE !.;:! (A:, <) 11__ _ 9 ?.iJ
I hereby consent to the transfer of the above securities now registered in the name of the aforesaid
Decedent and waive the fi ling of a certificate certifying to the payment of the transfer inheritance tax to which
the property of said Decedent is mode subject pursuant to the provisions of the Act of June 20, 1919, P.L. 521,
os amended and the Act of June 15, 1961, P.L. 373, os amended. This is also in accordance with the provisions
of the Act of April 9, 1929, P.L. 343.
This Consent to Transfer the herein described property operates only in reference to the estate of the
above-named Decedent.
Signed for the Secretary of Revenue
~~I~'''~~~
"iF WiL.LS
) (;Jj,JI'I'
(Tit!e) (County)
,
.
"1 / '7 r;.
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RCC-33 (4-73)
. ' .
COMMONWEAL TH OF PENNSYLVANIA
DEP AR TMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
,.
RESIDENT DECEDENT
OCT 3 ~J~'~y OF
C Drffi ERLAND
IMPORTANT:
This return must be completed in detail and filed in duplicate, with all attached, with the Register of Wills of the
County where decedent resided; Return is due within nine months after date of death, unless an extension is granted
by the Secretary of Re~t:nue. (Section 703 of the Inheritance and Estate Tax Act of 1961.)
IRENE B. HAUSMAN
} AFFIDAVIT OF
EXECUTOR
County ~~WX~R
IN THE MATTER OF THE ESTATE OF
(STATE FULL NAME OF DECEDENT)
Late af
Cumberland
Pennsylvania
Cumberland
},
State of
County of
Aj{~
John C. Hausman
Executor
of the estate of the above-named decedent being duly sworn, depose
and say
(MONTH)
Name and address of attorney or }
other authorized repres,entative to whom '
a II correspondence shou Id be me i led.
(DAY)
, 19~{~estate leaving a last will, copy of which is hereto attached. }
(YEAR) ~~
Decedent died
July 27,
John E. Slike, Esq., Arnold, Slike & Bayley
P. O. Box 737, 2109 Market St., Camp Hill, Pa.
That as such executor deponent is familiar with the affairs of said estate and the property constituting
(EX E CU TO R-ADMIN II 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 f"llowing: -
NAME AND ADDRESS OF BANK OR OTHER INSTITUTION
IN WHICH DECEDENT RENTED A SAFE DEPOSIT BOX
CCNB Bank, N.A.
21RT and Market St~
Camp Hill. PA 17011
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:
B
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, trus t companies, or other ins titutions, whether individually, or in trus t for any other pers on or persons
gi ving also separately the accrued interes t thereon, if any, down to the las t interes t day prior to decedent's
death in the case of savings banks, and to the date of decedent's death in all other cases; all bonds, postal
savings, treasury certificates or notes and other evidence of indebtedness of the United States to the de-
cedent; all obligations, whether by statute or agreement they are designated as tax free, of the United States,
or any state, or political subdivision thereof, or of any foreign country, which are owned at the time of death;
all wearing apparel, jewelry, silverware, pictures, books, works of art, 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 dale' (If death, bonds and accrued interest thereon to the date of decedent's
death and other investment ,,,CUi i( '".\n.,J 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
possibl e substantiated by financial statements of the corporations, showing the assets and liabili ties
thereof as of the date of death. The schedule also sets forth the interest of necedent 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 tmsiness.
A C'ol'Y of the" co-partnership agreement, (if oral, a statement setting forth the nature of the iigreement)
togenw>' ",ith a statement setting forth the character of the business, its location, and such other facts
i'er.tl. ni l'g 10 the business as may be pertinent to a fair and just appraisal of the decedent's interest
then>i>l 11I\1-;t be submitted. It should also set forth in itemized form, together with the fair market value
there!);', Ilny other property owned or bequeathed by the decedent at the time of death.
The Sc/1edu/e C attached hereto and made part hereof sets forth a true answer to each inquiry
contfdned th.>rein ann 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 tlJ.ke effect in possession or enjoyment at or
after death, sain schedule sets forth the nature ann 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 regarning said transfers. In the case of transfers intended to
take (~ffect in possession or enjoyment at or after neath, there is also attachen to the schedule a copy
of the deed, trust agreement or other instrument creating the trust. Ther.~ is also set forth in sain
schenule a list of all property, real and personal, with its value, which passes at decedent's death by
virtue of t.he exercise by decedent, either individually, or jointly wi th another, or any power of appoint-
ment vested in decedent, either individually or jointly, by the will, deed, or other instrument of another,
wit.h a copy of the instrument creating such power attached to the schedule.
That Sc/1edu/e D attached hereto and made part hereof sets forth the names and addresses of all
persons ~Jeneficially interested in this estate at the time of decedent's neath, the nature of their res-
pective interests, their relationship, if any, to the necedent, together with the ages at the time of
decedent's death of all minors, annuitants ann beneficiaries for life unner necedent's Will. It also
contains It statement showing which of the beneficiaries named in the decenent's will, if any, died prior
t.o deeedent, the dates of their death, their issue, ann the relationsllip of sucll issue to the beneficiary.
That. Sc/1edu/e E at.taclled hereto and mane a part hereof sets forth all property, real ann per-
sonal, owned by the decedent jointly with another or others, including intangible, st.anding in tile name
of the decedent and others, plus the date and place of record of instrlooents effecting the vestiture of
real estate and the date of acquisition of personal ty, plus the name, address and relationship, if any,
of co-owners to the decedent.
That Sc/1edu/e F attached hereto and made a part hereof sets fortll fully and in detail all ,lebts
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 fildiciary'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 unpaid at time of
death; taxes accrued chargeable for period prior to decedent's death (except those allowed under Section
651 of the Inheritance and Estate Tax Act); together with a statement of collateral pledged for obliga-
tions, if any. It is agreed that the fiduciary will present proof of said claimed obligations 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 tile Register of Wi] Is, and that
the amount of tax assessed can be reassessed in accordance therewith.
That the totals of the appropriate columns in Schenules "A", "B", "C", "E", and "F" as directed therein,
have been carried forward and properly registe~ed in the Summary.
Subscribed and sworn to before me this ...............................
.>tt::: . i),~ter. 197..8.
T(1,. /k(..'\;'", No"'" :-
Mv. Comm,s,iOR ExpIres July I.
1.J~1 PA Cumberland County
(amp J1~.
..........~;lJ~~~,""'..........._.__...
..2..~..~l.l...f.x:.gJ1Y.;;.1;j,..n.....RQ.g.d.I.....AP.t...".......#.J...3.0
(Street Number)
Southfield, Michigan 48034
........................................................................
(City or Town and State)
NOTE: Before signing affidavit make sure all blank spaces in the affidavit and sclledules annexed are
1'1 lIed in wi th details or the word "None", and in case the assets include rare awl unlisted securities,
securities of close or family corporations or an interest in any co-partnership or business, that the
data ann statements required under tile paragraph above relating to Scherlule "B" are attached. i\lso make
cerUtin that. column #1 in the "Summary" has been properly completed as above-directen.
,.. 1(",
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 elf surviorship or tenancy by entireties should be reported on Schedule "E.")
The real property located In the Commonwealth of Pennsylvania should be (1) (2) (3)
described by lot and block number, street and street number, together wi th DEPARTMENT
a general description of the property, with a reference to the record of the ASSESSED VALUE VALUATION
conveyance by which the decedent took title; If a farm .tate number of a. FOR YEAR OF ESTIMATED CAUTION
ere.; 01.0 .tatement of mortgage encumbrance. upon each parcel at death DECEDENT'S MARKET VALUE (Do not write
of decedent. Taxe.. a....sment.. accrued Intere.t on mortgage.. etc.,are DEATH In thl. .pace)
to be ll.ted on Schedule "F" and must not be deducted from this schedule.
- '7~(,-vL
NONE
!
!
.',
--v&d~
./ '
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.
. RCC -3e;
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
RESInE~T DECEDENT
SCHEDULE "B"
PERSONAL PROPERTY
INSTRUCTIONS: This Schedule must disclose all tangible and intangible personal property owned individually
by the decedent, at the time o~ 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 o~ 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 ~act that they are not o~ the administered estate.
Tangible personal property should be listed ~irst (e.g. jewelry, wearing apparel, household
goods, and furnishings, books, paintings, automobiles, boats, etc.)
Intangible personal property, such as bonds, treasury certi~icates, 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 f'iduciary in said capacity, partnership interests, interest in anyundistributed
estate of' or income ~rom any property held in trust under the will or agreement o~ another, even though
located outside of' the State, at the time o~ death, should be listed in this schedule.
Item
No.
ITEM
List and describe fully
UNIT
VALUE
Common stock, unless otherwise indicated, in
the following companies:
1.
2.
3.
4.
5.
6.
7.
12.
13.
14.
15.
75 shs. P.P.&L.
100 shs. Gulf Oil Corporation
37 shs. United States Steel Corp.
50 shs. Public Service Electric & Gas Company
20 shs. Philadelphia Electric Co., 9/5% pfd.
109 shs. Madison Fund, Inc. ~
10 shs. Pennroad Corp; now merged with Madison
Fund
25 shs. American Tobacco Co.
100 shs. Delaware Fund, Inc.
10 shs. Niagara Mohawk Power Co., 7.72% pfd.
Dauphin Deposit Statement Savings account
14-6-0001-3
Dauphin Deposit Bank and Trust Co., C.D. #17598
Cumberland Valley Savings & Loan C.D. 6691938.
Cumberland Valley Savings & Loan C.D. 6691944,
First Federal Savings & Loan savings account
2-6473
14-l/E
49-1/4
1,1.95
79
.c.
2l-l/~
. /23-3/8
28-l/~
23-1/8
95-3/~
14-1/8
8.
9.
10.
11.
Ins er t this to tal opposi te "Personal Proper ty", Schedul e "B" in
the "As Reported" column on the last page o~ this return.
x X
ESTIMATED
MARKET VALUE
DEPARTMENT VALUATION
(Do not write in
this space)
!)., "
141.25
1,231. 25 .
1,195.00 t '
790.00 ,
22,741.74
31,553.23 I-
4,019.28
20,111. 26
.-
/ ~ - 9'), 75
,t 3 /;1-, -SO,.-
10 '1~' 1-'),-
1/ .,-t.. ').-)
1/'/'-' t1~
/")-/1. /'/,
I '39, J(
/'
I 1- }I. J- 5
. ,'/1-0,..,oD
;riO' ()O
) 1-I7i/1 II
J/ ~-5:3.. ?-}
~ 01 J'. U
!}-~ III . -r-6
" /
/ ~ 6c/d, 7d
J
1,593.75 I,
2,337.50
1,045.25
1,156.25 .. ;-
1,915.00 v
1,539.63 ,!
14,640.78
/"
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106,011.17
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itES 1]11-:\'1' IW(TIW\'1'
(1) Did decedent, within tl'O years ot'death, m,ike ,illY tl'dnst'pr of ,iny material part of hi.., "state, without
receiving a valuable and adequate ('onsid'>r,lti(lll tllp:'pfor? C\nswer yes or no)_~~__
(2) Did decedent, wi thin two ye'ars of d(~ath, trdo",fer' ]lrOperLY from ltimsel r to himself and another oc
(,thers (including a spouse) in Joint ownership? (Answer yes or no)~__
(a) If the answer to (1) or (2) above is in the at'firmative state:
(a) Age of decedent at time of transfer
(b) State of decedent's tWill th at time of making the transfer. (Note 1).
(c) Cause of decedent's de'ith. (t'\ote 1).
(4) Did decedent, in hL, lifetime, make any transfer of property without receiving a valuable or adequate
cons idera tion therefo I' which was to take effec tin possess i on or enJ oymert at 0 r after hi s df'ath?
(Answer yes or no) No
(a) \\as 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)
(lJ) What was the transferee's age at time of decedent's death?
(5) Did decedent in hts lifetime make any transfer without receiving a valuable amI adefjuate consideration
therefor Imcter which transferor expressly or impltedly reserves for his life or any period which does
not in filet end before hIs death:
(a) The possession or eEjoyment of or the right to Income from the property transferred?
(Answer yes or no) No
(h) The right to designate the persons who shall possess cr enjoy the property transferrell or
income therefrom? (Answer yes or no) No
(G) If the answer to (5) (b) above is in the affirmative, state whether the right was reserved in decedent
alone (lr others
(7) Did decedent in hIs lifetime make a transfer, the consideratIon for whIch was transferee's promise to
pay tncome to or for the benefi t of care of tl'ansferor? (Answer yes or norO
(8) Did ctecedent, Ilt any tIme, transfer property, the beneficial enjoyment of whIch was subject to change,
because of a reserved ]lower to al ter, amend, or revoke, or which cOllld revert to <iecedent under terms
of transfer or by operation of law? (Answer yes or no) ~
(9) If the answer to (8) above i3 in the affirmative, was the power 1<) al tel', amend, or revoke the Inter-
est of the bepeficiary reserved in the decedent alone or the decedent and others?
(Answer yes or no)
~OTE1: The answers to these questions should be supporterl by affidllvit 11y the IlttewUng physician as
well as a copy of the death certificate.
"OTE 2: If answer to any of the above llucstions is yes, set forth below a description of the property
transferred, it's faIr market value at date of death, dates of transfers awl to ~'hom transferred, with
rellltionship of transferees to decedent, if any. Submit copy of any trust <ieed or instrument, if trans-
fers are claimed to be non-taxable, also slilimit detaIled statement of facts on which said claim is based.
\OTE 3: List ~)plIcable property below in manner in which provider! in Schedules A, D, or E.
ITEM
UESCIUPT ION
~L\RKET VAI,UE
(Estima ted)
DEPT. VALUATm:-l
(Dept. Only)
N Ot\~
Insert this toUt! opposIte "Transfers", Schedule "e" in the
"As Repor ted" eo lllmn on the 1 as t pilge of this return.
~Ot'l.L
..
RCC-J7' (12-6J)
l'O:\ll\IO~\\.tALTI! OF PEX;\"~YYL\NL\
TRANSFER INHERITA;-';L'E TAX
RESIDENT DECEDENT
SCHEDULE "D'
k~:'~1
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T~ ~'''',~1.1r/,<. . ".'t
el,).."J,;.-" ,
,-,:~<;\i'~"": ,/~'~., ,,~::>)'.~I
BE:'\EFJCIAHIES
!tELA TIONS1IIP i c," , I
, B~NrFICIARIES AND ADDRESSES (If step-children or: "l!!~XI~P) I DATE ~
\:state tud names ana addresses of all Wh,O illl'gl'tima,te r,t ',ildren I ~!El;:-,~!)";~:r. I OF
have an intf're~t, vested, cont ingent or other- 31''' ,nvolved, set S fA II, ,\ E::> I
wise, in clstnte) ! forth this f3Ct.) on NO , BIRTH
~-------+-- .---- ----
John C. Hausman i Husband 'I' Yes I Entire estate except
28311 Franklin Road j' -l- I r-for $50
Southfield, >liehigan . i L-~
John C. Hausman, Jr. j Son _Yes ! r---~------
920 Sandhurst Road _+ : i _~
Bloomfield Hills, Michigan -J I
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INTEREST OF
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IN f:ST\TE
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Deponent further says that all the above-named beneficiaries are living at this time exce'Pt below:
- ----------------- - ~------ ,-
NAME DATE OF DEATH RESIDENCE
-
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3
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.~ ;." e
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SlJ~fMARY
(Sch. "A")
. (Sch. "B")
(Sch. "e")
Heal Property
Personal Property
Transfers
Gross Taxable Estate
( 1 )
(As Heported)
(2 )
(As ))dl'rlllillcd)
$
$
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R C C-38
CO~MONWEAL TH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE" En
JOINTLY OWNED PROPERTY
INSTRUCTIONS: This scheoule 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 oescripUon, as indicated lmder Schedule
"A", plus the date and place of record of instrument effecting vesti ture, but do not include entireties
or out of state real estate value in estate valuation column. Personal property should be listed as in
Schedule "8", 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
Estate
Valuation
percentage
Share
ALL JOINT PROPERTY HELD AS TENANTS
BY THE ENTIRETIES
Insert this total opposite "Jointly Owned Property", Schedule "E"
in the "As Reported" column on the last page of this return.
DEPARTMENT VALUATION
CAUTION-Do not Write
In This Space.
Value of Value of
Entire Decedent's
Property Interest
NC!"'\t
~ON.