HomeMy WebLinkAbout06-01-79
RESIDENT DECEDENT
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
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RCC-33 (:,"73)
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 Re'ltenue. (Section 703 of the Inheritance and Estate Tax Act of 1961.)
IN THE MATTER OF THE ESTATE OF } AFFIDAVIT OF
A. Raymond Eppley EXECUTOR
(STATE FULL NAME OF DECEDENT)
West Pennsboro Twp., Cumberl and ADMINISTRATOR
County
Late af
State of Pennsylvania
County of Cumberland
Farmers Trust
~r
} ..,
Company
Executor
of the estate of the above-named decedent being duly sworn, depose S
and say S
Decedent died Sentember 1
(MONTH)
Name and address of allorne'y or }
other authorized repres,entative to whom
all correspondence should be mailed.
(DAY)
, 19712-1 testate leaving a last will, copy of which is hereto attaChed,,}
(YEAR) ~X
Henrv L. Stuart
3 South Hanover st., Carlisle, Pennsylvania 17013
That as such Executor deponent is familiar with the affairs of said estate and the property constituting
(EX ECUTO R-ADMINIST RA TO R)
the assets thereof and the"ir 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 RELATIONSHIP OF JOINT
IN WHICH DECEDENT RENTED A S_~FE DEPOSIT BOX HOLDERS TO DECEDENT
That the contents of said safe deposit box or boxes are itemized under Schedules B 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 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 whats oever, kind or nature, left by decedent,
together with the fairly estima ted 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 promis sory 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.
IT]. tl1€ :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 Qusiness.
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 ~eath.
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 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 pertinen~nature regarding said transfers. In the case of transfers intended to
take effect in possession or enjoyment at qr after death, there is also attached to the schedule a copy
of the deed, trust agreement or other instrument creating the trust. Ther~ is also ~et fOTth 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 joint-l,y wit.h',another, or any power of appoint-
ment ves.ted in decedent, either individually.or jointly, by the wil1, deed, ..or other instrument of another,
with a copy of the instrument creating such power attached t~. the schedule.
That Schedule 0 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, andthe 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 jo.intly with another ,or others, including intangible, standing in the name
of the decedent and others, plus the date arid place '~f record of instrlU1lents effecting the vestittire 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 Impaid 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.
Subscribed and sworn to before me this ..C:.RST........
-_:::~~ .... (f of ...mjU .. m .... mm_l_9_~~
DORCAS
CARLISLE 01\0. CUi\'1iiEriLA.ND COUNTY
MY COMMISSIQN EXPIRES AUG. 16, 1982 .......................................................................................................................................
"'em~~t! P~[If1S~lvania A$SOCialion of Notaries ) (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 column #1 in the "Summary" has been properly completed as above-directed.
and "F" as directed therein,
That the totals of the appropriate columns in Schedules "A", "B",
have been carried forward and properly registered in the Summary.
-
._.~......'- .,...;. _,..o,\,..~.__"....._" .".,....... '._ ,.
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COMMONWEAL TH'OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "Au
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 jn 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 Common_alth of Penn.ylvanla .hauld be
de.crlbed by lot and block number, .tre.t and .tre.t number. tog.th.r wi th
a general de.crlptlon of the property, with a r.ference to the record of the
conveyance by which the dec.dent took title; If a farm .tat. numb.r of a.
ere.; al.a statem.nt of mortgage .ncumbrance. upan each parcel at death
of d.ced.nt. Taxe., a.....m.nt.. accru.d Int.r..t on mortgag.., ete.,ar.
to be IIlt.d on Schedule "F" and mUlt not b. deducted from thll .ch.dule.
(1)
(2)
(3\
DEPARTMENT
VALUATION
CAUTION
(Do not write
In thl. .pace)
ASSESSED VALUE
FOR YEAR OF
DECEDENT'S
DEATH
ESTIMATED
MARKET VALUE
1. House and lot located at 72 West
Pomfret street, Carlisle, Penna.
2. House and lot loaated at ~3 East
Penn Street, Carlisle, Penna.
2,720.00
t'~
37,800.00
,.V
23,100.00
21,600.6(( .'
4,240.00
3. House and lot located at 17 North
East Street, Carlisle, Penna.
I
2,810.00
All values are actual sales prices.
Public sale held 12/16/78.
sy
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.
V'
"
82 500. 00 ~.2. 600. OD
RC(J':35
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 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 anyundistributed
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.
---. :S .
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
ITEM
List and describe fUlly
UNIT ESTIMATED DEPARTMENT VALUATION
VALUE MARKEl' VALUE (Do not write in
this space)
Cash
Proceeds checking account #4-1126-4,
Farmers Trust Company
Proceeds savings account #9359, Carlisle
Building & Loan Association
Proceeds savings certificate #05-3813,
Carlisle Building & Lean Association
Proceeds money market ceTtificate #727-90 131
First Federal Savings & Loan
Balance savings account #136093, Cumberl
Valley Savings & Loan
-Interest on Item 6 to date of death
Balance certificate #6688182, Cumberland
Valley Savings & Loan
Interest on Item 8 to date of death
Balance certificate #6688108, Cumberland
Valley Savings & Loan
Interest on Item 10 to date~ death
Balance certificate #6689521, Cumberland
Valley Savings & Loan
Interest on Item 12 to date of death
Augu~t and September rent, 43 East Penn
August Social Security payment
August and September, Teachers Retirement,
Commonwealth of Pennsylvania, checks date
8/1/78 and 9/1/78
September CSA Annuity, dated 9/1/78
Refund, Pennsylvania Blue Shield
Premium refund, American Family Life In-
surance of Columbus
Balance account #5653-8, Federal Credit U ion
United States Series E Bonds:
1, $25 par January 1964
1, $25 par February 1963
1, $25 par December 1962
2, $25 par August 1969
2, $25 par December 1968
2, $25 par November 1968
2, $25 par May 1969
2, $25 par June 1969
3, $25 par July 1969
ote, Harvey Eppley
edicare refund
efund, Presbyterian Homes
ro rated Real Eaate Taxes, sale 72 West
Promfret Street
efund, PP&L
ro rated Real Estate Taxes, sale 43 East
Penn Street
a ancr Savin s Acct. 94-4, CCNE, N.A.
Insert this total opposite "Personal Property", Schedule "B" in X X
the "As Reported" column on the last page of this return.
37 . 60 /"
39.16
40. 34 .
61.54
62.86
62.16
61.02
61.5
.'" 92. 31
1,100.0
147.92
623.62
... 65.3
~j 8.72
1 J3,,244~.1~-
l33, ~ LIJ.\.' L\'
PAGE 2 CONTINUATION OF SCHEDULE "B"--PERSONAL PRePERTY
29. Premium refund, Motorist Mutual Insurance Co.
30. Pro rated Real Estate Taxes, sale 17 North East Street
~.
41 . 00 .,,-'
74.00
133,244.74
.
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------.
,
USE REVERSE SIDE FOR
RECONciLING YOUR ACCOUNT
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CHECKS AND OTHER CHARGES
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DEPOSITS AND OTHER
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Pt 4SE AOVISE us OF
ANY :"ANGE IN ADDRESS
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BALANCE" " I
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Please examine this statement at once, If no error IS reported in ten days the account will be considered conec t.
'''''''TIIlN Of ""'LS """iI'" '''''. ,.ti>t. ....... ,."", '''''"'. ".. "'''"''. SS..,., ""P. n,,,,.,. ,.".,._ , "P
STATEMENT <0 , _-:~
FARl\n<~RR rl'I~(JR'l' ('O'\IP^K~I~/
('AI-n,ISLE, I'EN:'\lSYL\'A:\'L\ 170la ~...
_:::'~~:jJ 1 ~ RAYMOND ~PPLnIL"~~ ~~::j D
tjO~ t:J5
PL.I~~rELD PA 170C1
7
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DATE
, .-..--.----..----
J.!.
,~~~'"""'~<'-=-_.-
,j."-
T" ..
'. ':- yr':ond Eppley
ACC'T No, 9359
,'. '1,\'f !>..TS
! WITHDRAWALS
~.--~~., :,~.~' -..--.... -. .~
MEMO
DATE
8ALANCE
"---
375.32
.:70
EP 1,78 C
o ~ '4 7 NB
SEPJ4,78 C
374P2 is!
375.32 2B
.00 26
4)) i'
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CLOSEO OU"[
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--..".----..,,-.---- .'!.~ ""--slvlNQS . PASS BOOK
CARLISL:E'I3UILDING AND LOAN ASSOCIATION
. , CARLISLE, PENNA,
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DU 1.(;11 I-fERE BHORE DU"J~;'ll~G
CARLISLE BUILDING. LOAN ASSOCIATION
17 WEST HICiH STREIET, CARLISLE. I"A. 17013
YOUR ENDORSEMENT ON THE ABOVE CHECK WILL ACKNOWLEDGE RECEIPT IN FULL FOR THE ITEMS LISTED BELOW. SHOULD THERE BE ANY QUESTIONS REGARDING THIS CH
RETURN IT TO US WITHOUT ALTERATION.
DATE
DESCRIPTION
AMOUNT
9/14/78
wo.# Cert. 05-3813
Close-out
A. Eppley
O. Goritz
$27,557.16
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Savings & Loan Association
of Harnsburg
Se~te~hpr lQ, 1978
Mr. David C. Gority
Farmers Trus t Company
Carlisle, p~ 17013
Re: EstRte of A. RRymond Eppley
DOD - 9-1-78
Dear Mr. Gority:
Accorrlin'3' to your instructions, we have clospd the
Money Market Certificate #727-900131 listed in the name of the
above decedent. Enclooed herewith you will fil1d our check
No. 1-15036 in the amount of $20,243.48 representinr. princinal
and interest to the date of withdrawal.
For your records, the value of th~s account a~ of
September 1, lQ78 WilD 520,000.00 plus 1)166.74 interf'st to date
of death. Our records show that thiR i.,:: the only ,'tccount held
by Mr. Eppley in this association.
If we can be of any further help, please advise.
Very truly yours,
/1' --,- {,.-
f/.A:~^ Ii ;.;'--<.....1 (r>
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Enclosure
(~rs.) Catherine E. Natson
Savings Counselor
234 NORTH SECOND STREET, POBOX 1111 . HARRISBURG, PA 17108 . (717) 232-6661
JPij~~m
f
)
.---
16 West High Street. Carlisle. Pennsylvania 17013 249-2525 KLEY' ~
A\D l.O4\l ASS:)CJ\TO\I
Carlisle, Pa.
10/12/78
A. Raymond Eppley Eatate
% Farmers Trust Co.
Cert. 16689521 Face Value $1,000.00
Earnings to date of Death
7/1/78 to 9/1/78 $ 11.10
Cert. I 6688182 Face Value $2500.00
Earnings to date of Death $32.05
Cert. , 6688108 Face Value $20,000.00
Earnings to date of Death $256.40
Passbook 1136093 Face Value $50,192.04
Earnings to date of Death $ 448.56
6-- /L~
Ch'rQ - e~~ k
A1el:h~ner, \.--
V. Pres.
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CCNEI
CCNB EIA............ NoA.
STATEMENT OF ACCOUNT
RAYMOND EPPLEY
BOX 85
PLA PJFIELD PA
17081
(\ 0 0 0 1 32, 6 2l- C. NUMBER
PAGI: . 0
1 8 4. 1 2. 2 1I 1 . SOCIAL
SEC. NO.
SfASONS GREETINGS FROM CCNB . YOUR FULL SERVICE BANK
.
SAVINGS ACClJUIH ~IEXT INTEREST t,AST STATEto1ENT THIS STAff"Ft T
NO 01& 02889a q DATE 03/27/7Q BALANCE lbQ.41 BALANCE ~~J.12
....--......-.................................................------------......
TOTAL DEPOSITS TOTAl.. wITHDRAWALS SF"RVICE YTO ST^H"~ ,r PfRIOr:
NO AMOUNT NO AMnU~T C~ARGFS INTEREST r~r' 12/27/77
4 8.'1 1 50,eo o.on 8.71Ft Tn '2/27/7"
..........-...............................................----....--------....-.
DEPOSITS DEPOSITS OFPOSITS WITH!'lRAWAI..S 1;.6LA Ct
50 00 21/I.l.q 02/2(
O,OOTE · ;>lll.nl 02/21
~:I~I~ ~!~.l~ 8l~~1
2. 191 tJ .' . 1 0 q 12 t
2.21 N 2?~.12 12/21
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PLEASE EXAMINE AT ONCE. IF NO ERROR IS REP0RTED WITHIN 10 DAYS THIS STATEMENT WILL BE CONSIDEBED CORRECT
It-'ATANT TAX INFORMATlr ) ACCOUNT COQ"'PEAR ON BACK OF STATEMENT
RCC- 36
COMMOXWEALTH OF PENNSYLVANIA.
TRAr\8FFR I:-iHEIUTANCF, TAX
SCHEDULE "c"
TR\NSFEllS
rillS !DENT DECEDENT
(1) Dirl rlecedent, within two years ofrleuth, make any transfer of any material part of his estate, without
receiving a valuable and adequate consirleration therefor? (Answer yes or no) Y~s
(2) Did rlecedent, within two years of death, transfer properLY from himself to himself and another oc
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
(b) State of decedent's heal th at time of making the transfer. (Note 1).
(c) Cause of decerlent'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) No
(a) Was there any possibility that the property transferred might return t.o transferer or his
estate or be subject to his power of disposition? (Answer yes or no)
(b) What was the transferee's age at time of decedent's death?
(5) Did decedent in his lifetime make any transfer without receiving a valuable and adequate consideration
therefor unrler 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 reserved in decedent
alone or others
(7) Did decerlent in his lifetime make a transfer, the consideration for which was transferee's promise to
pay income to or for the benefit of care of transferor? (Answer yes or no) No
(8) Did rlecedent, at any time, transfer property, the beneficial enjoyment of which was subject to change,
because of a reserverl power to alter, amend, or revoke, or which cOllld revert t.o decedent unrler terms
of transfer or by operation of law? (Answer yes or no) No
(9) If the answer to (8) above i3 in the affirmative, was the power to alter, amend, or revoke the inter-
est of the beneficiary reserverl in the decerlent alone or the decedent and others?
(Answer yes or no)
NOTE 1: The answers to these questions should be supporterl 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 rlate of death, dates of transfers anrl to !"hom transferred, with
relationship of transferees to rlecerlent, if any. Submit copy of any trust deerl or instrument, if trans-
fers are claimed to be non-taxable, also submit detailerl 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)
1.
1976 Cadillac Seville
Marian E. Battista
NADA Valuation
Galbraith Buick
appraisal
Dix Cadillac
appraisal
given to daughter,
in August 1978
8,575
8,400
6,750
23,725 .. 3
7,908.33
2.
Coin Collection as appraised, given to
daughter, Marian E. Battista in August
1978
173.73
Insert this total opposite "Transfers", Schedule "C" in the
"As Reported" column on the last page of this return.
8,082.06
<it D~~. O~
-
-
.
GALBRAITH BUICK-CADILLAC-GMC., INC.
R. D. 7, BOX 18 - HOLLY PIKE
CARUSLE, PENNSYLVANIA 17013
TELEPHONE 243-3086
~
B U I CK
c . ~
J--r''/'''L- r -
l. --'>:,~~-~i""~/?:) /
-'
1 November 1978
To Whom It May Concern:
Re: A. RAymond Eppley
1976 Cedill~c SeVille SedAn
Serial #6s69R6Qh87892
It is my opinion that the above-captioned vehicle ha~ a
fair market vAlue of ~8LOO.oo.
Sincerely,
-_....---
" I "
'. \/ " - , \
\\ " / ~'\"\ l \<\ r
, , \
\John K. :lu"kle
'Sales HRn.q~r
lID
TRUCKS
'~~
~
.,
P.ONTIAC
DIX CADILLAC PONTIAC CO.
''''00 N. "'THI!:~TON ST~I!:I!:T
STATE COLLEGE. PENNSYLVANIA 16801
TEL~PHONI! 8'<4. 238-e71j
Market Value
1976 Cadillac Sere No. 6~69R6~87892 E~timatpd t6,7~O.oo
$1: MaD
~7)~ ·
Gen. Mgr.
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'1CC-37 (12-(,3)
,'O\t:\IO'\\\L\LTI! ~)F PE'\'\SYYL:\NIA
TRANSFEI\ 1'\1 J I:RITA:\CE TAX
RESIDFl\T DEO:DE:\T
'\
SCHEDULE "1)"
~-~~~... t
II.c,W!...
J.,,'-'''i~
I; .t, 'iTt,/\: .~
,J<.~y,;~_j
......),<<"~.r"~l1:!f'~..'.,~~
BE'<EFICIARIES
--.-------------r--;:;-, -
. RENEFICIAflIES AND ADDRESSES . (lf~~~~1~1~~~Por SURVIVED DATE INTEREST OF
&tate full 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
Evelvn R. Eonlev Wife Yes Over 18 IElecti ve ,.,1..
Box 85 Under Act 23
Plainfield. Pa. 17081
M::ll"'i::lYl E "I=:+'::l D,q1J H' -' Yep, Over 18 112 Rpl=:irl1JP
335 Hillsdale Avenue
Lewistown, Pa. 17044
H .N Rnn 1 PV ~(m VPI=: OVPY' 18 1/2 Rpl=:inllP
R. D. 2, Box 543
Carlisle, Pa. 17013
,
\
h
Deponent fUrther says that all the above-named benericiaries are living at this time except below:
I
NAME DATE OF DEATH RESIDENCE
-
:
....
o '
...."'....
~<:~
~:: c::
'2 Q) e
'8 Q; .z
'Op.O
<: e.t.I
.:.~::o
o Q)
.... ........
;::l '" ....
t.I ;::l 0
~eg.
f5 ~
SUMMARY
Real Property..................................... . (Sch. "A")
Personal Property......................................... ...(Sch. "B")
Transfers........................................ . ...(Sch. "e")
Gross Taxable Estate ...
( 1 )
(As Reported)
.....$2,500.00
133,244.74
.E3.,08>?~. 60
$
$
$..
$....
$...
$.???~.E327.)4 .
(2)
(As Determined)
$
$.
$.
$
$
$
r--
z '0
.... .Q)
~ ~ :'" -:
Q) ..,.. :'" ~
~ . ell $
r< t.I <
~ Q)
CJ'J Q CJ'J
- -
< >> <
~ Q) b. o:u CIl:
~ ~ r-l H 'd' 'c =-
~ 0 Pi a s::: o:u =-
w < ~ ~ ~ .0 ro ~ <
~ ~,
~ ... E-< tIl r-l Vl Q
< E H c
0 ~ ::r: "" ,.. Z
0 E-< 'd Q) v
Z E-< CJ'J s:: Q) ..0 ~ ~
-------- ~ ~ 0 ~ 9 ..... I-
0 S 0
c >> -R t) ..c CIl:
0 ~ ro Ul .:::: 0
',p ~ 0::' ill ~ =-
Q) \.i.l
0:: E-< :3: ..... ::;
l:l CIl:
Vl E-< .: 0 C
'c < ~: ..... .c' 0
- 0 E
'6 "'" 5
- Q) ,..
- c:
,- "'d .... 0
::::< <e 0
...:l U U
".~"""'-_._,~-,~..,-_..-,-_....~<.~.~...._"--~.~'-----'~~>,.
'.
I
........'.~... -"-"" .
./ \~ .t~
V ~Jf
IN R.B, ESTATE or A.
RAYMOND EPPLEY, LATE
or WEST PENNS80RO TOWNSHIP,
CUMBERLAND COUNTY,
PENNSYLVANIA, DECEASED
,
,
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
.
.
ORPHANS' COURT DIVISION
: NO.
NOTICE or ELECTION
--
TO THE rARHERS TRUST COMPANY, EXECUTOR 0.. mE LAST WILL AND
TESTAMENT or THE SAID DECEDENT,
TO THE REGISTER OF WILLS AND CLlIUC or THE ORPHANS' COURT OF
CUMBERLAND COUN?V, PENNSYLVANIA'
YOU WILL PLEASE TAKE NOTICE that I, Ruth E. Epplf> , widow of
the aaid A. RaYMOnd Eppley, Decea.ed, do hereby elect to take
aqainat the N.1ll of the aaid,Decedent, dated June 29,1978, and
aqainat all conveyance. inter vivos made by the Decedent which
may be treated by me a. t..tamentary di.PO.itions 80 far as r am
concerned under Act No. 23 of 1978, and in lieu thereof to take
and receive the Ahare of the Decedent'a Eatate to which I aM
entitled by my election. a. p'rovided in 20 Pa. C.S.A. 2202 et .eg.
and request you record and file this notic. in accordance with
the Act of As..Mbly in .uch ca.. mad. and provided.
.
I l' .' -;:-
/'\' ~c~U\.." 4:;'
Ruth E. Eppley
t.~ 7.)~"i1, d
/ (-
ralll.. .."....
.... .. .lOWNeotot
'(lilt..., ". A' LAw
~. ........, el r..a,.
..0....1. ,.........
.... Mf... ..,...~
~LI"l.. ,~~
,
I
-
RCC-38 .
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE" E"
JOINTLY OWNED PROPERTY
INSTRUCTIONS: This scherlule 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 rlescripUon, as indicated tmder 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 rlate 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 Recorrl of Instrument, where Real Estate.
o ,/
Unit
Value
percentage
Share
Estate
Valuation
DEPARTMENT VALUATION
CAUTION-Do not Write
In This Space.
Value of Value of
En ti re Deceden t' s
Property Interest
'0
v
Yo
1. House and lot located in West
Pennsboro TownShip. Owned by
A. Raymond Eppley and Evelyn R.
Eppley as Tenants by the Entireti~s.
Appraisal by George L.
Realtor, Attached
$19,500
.00
Insert this total opposite ",fointly Owned Property", Schedule "E"
in the" As Reported" column on the last page of this return.
1\1 () f\1 e-
R E V-48 4 (8-78)
County, Number Gnd Name~
File Number 21-78-0482
Date of Death 09/01/78
- Cumberland
SUMMARY
E state Name
EPPLEY,
(LAST NAME)
A.
(FIRST NAME)
Ravmond
(INITIAL)
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
!, the undersigned duly appointed Inheritance Tax Apprdiser 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", "8", "C", and "E".
REPORT OF INHERITANCE TAX APPRAISER
Dat"d:
September 19, 1979
\:,~i;? IlLiz({,'
./
INHERITANCE TAX APPRAISER
\4t~-) ,;'
.- .' 1.< /
" :;he undersigned duly elected Register of Wills in and for County, Pennsylvania, do respect-
fu:l)< report that I have allowed deductions in the amounts claimed by deponent, except as to those items where a greater or
lessu amount is set forth in the last column to the right in Schedule "F", which greater or lesser amount represents the sum
allov,"?d as a deduction.
REPORT OF THE REGISTER OF WILLS
Dater!:
REGISTER OF WILLS
Rea! "
Person
b I ADJUSTMENTS
INVENTORY VALUE AS APPRAISED ODE (HARRISBURG USE ONL YI REMAINDER APPRAISEMENT CODE
,w)erty (Schedule Al -L- 82,500 00 00+ 92+
:Jl hoperty (Schedule B) 133,244 74 -
10+
; bd ?rqperty (Schedule EI none 20+
-
~,s (Schedule C) 8,082 06 30+
-
T..\L GROSS ASSETS 223,826 80
-
etts and Deductions 40- 93-
CHEDULE F) -
H \f1\LUE OF ESTATE
~;'~-':n t'.
Trnnsf
TO
LessD
(S
CLEA
Valuation of life estates or ~
annulf:e.s....................._ $
PRINCIPLE
t=
I
FACTOR
t=
VALUE
!~
:STATE TAX ASSESSMENTS _ $
::.QB.UE.g,_~~TER ONLY
lax 0;"': i:
r ox on ~
-ax en ~;
:-
CODE
-
COMPUTATION OF TAX
2%
6%
$
$
$
$
$
r
ox -::-':1 .."
ox on ~;
xemptions
'otol Estate
'15~~
*
TOTAL TAX
$
(*) As evidenced by Charitable
Exemption Certificates issued
by the Secretory of Revenue.
Less tax previously paid
BALANCE
ess 5~.~ .,f tox if paid within
month:, offer death
~~--~---+=
$=- r-
\C,:" 0: OF INHERITANCE TAX DUE
~':! i: at rote of 6% from
$
\\OUi~ ~ OF ESTATE TAX ASSESSED
$
$
+-=
$
-
.-.--___,__ -~o_
;tOf "'c": paid
!c! i'-l~':: -',.sf c~ i::1tc of 6% from
'to
BALANCE DUE
$
$$$ ~
TOTAL TAX BALANCE _
PAID
1
-~
pr!'''''"ntal Codes: (FOR USE IN HARRISBURG ONL Y)
48 -lldi l'stment
49+Adju..tment
56...f,nnui+y
6O-Life Estate
92+Remainder Appraisal
93-Remainder'Deduction
93C-Chari.ty
94-Remainder Residue
96-Success i ve
Life Estate
NOTE: Where subsequent adjustments are made to the obov'e computation of tax by the Register of Wills for proper reason
same should be noted below, with short filxplanction. I,
ADJUSTMENTS
FOR USE OF REGISTER ONLY