HomeMy WebLinkAbout01-26-79
RESIDENT DECEDENT
COUNTY OF
,9.77
n r T 1 0 1978
CmYB~RLAND
"'fe-sa (4"'3)
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
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'lenue. (Section 703 of the Inheritance and Estate Tax Act of 1961.)
IN THE MATTER OF THE EST A TE OF
CUMBERLAND
} AFFIDAVIT OF
EXECUTOR
~
'T'HRT MA 13: ROODY
(STATE FULL NAME OF DECEDENT)
Late of
County
State of Pennsylvania
;."
County of Cumber land
William B. Boody
Executor
~
of the estate of the above-named decedent being duly sworn, depose
'and say
Decedent died
August
29,
(DAY)
, 19~J testate leaving a last will, copy of which is hereto attaChed..}
(YEAR) ~e
(MONTH)
Name and address of attorney or }
other authorized repres.entative to whom
011 corresflondence should be mailed.
James K. Arnold, Esq., 2109 Market Street, P. O. Box 737
Camp Hill, PA 17011
That as such Executor deponent is familiar with the affairs of said estate and the property constituting
(EXECUTO R-ADMIN 1ST RA 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 IN NAME OR NAMES OF HOLDERS TO DECEDENT
TIRllphin TIppol'lir R.<m 1c ~ ~ f",..
r.::Irlil'llp PilTs:. office
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 pos session, 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 interes t thereon, if any, down to the last interest day priM 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, Illft 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 otherinstruments in writing
for the payment of money of which decedent died possessed, of whatsoever nature, with interest thereon, if
any, giving the face value and estimated fair market value thereof, and if such estimated fair,market value be
less than the face value, it sets forth briefly the reasons for such depreciation as to each item; all moneys
payable to the estate from life insurance policies carried by decedent; all annuity and endowment contracts
the proceeds of which were payable upon the death of the decedent; all and the corporate stocks and dividends
due thereon and unpaid as of the date of death, bonds and accrued interes t thereon to the date Of decedent's
death and other investment securities owned by the decedent at the time of death, with the market value there-
of at such time.
.. ..
In the case of securities of close or family corporations, the values reported are as far as
possible 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 l>.usiness.
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 contemplation of decedent's death, or intended to take effect in possession or enjoyment at or
after death, said schedule sets forth the nature and value of such property, to whom transferred, the
relationship of the transferees to the decedent, the proportionate share received by each transferee and
all other facts of a pertinent nature regarding said transfers. In the 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 lmpaid 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", "e", "E", and "F" as directed therein,
have been carried forward and properly registered in the Summary.
SUbSCribet:rd sworn to before me this .................................
:.~......m..t...'.-:........ <.. 78
:::-.-.'iJii:J~10f~:~--~::
Thel~~(Causlin, Nota;f Public'
Mv Commission Expires Julv 1, 1980
Clmp Hill, PA Cumberland County
J~d~~m_--_._--
.......23...M.ain....S.tl:.eet..............................................................................
(Street Numbef')
Ne.w.to:wn...Sq.uax:.e......PA.......1.9.0.13..............................................
(City or Town 11M Sta.te)
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.
RC C-34 14-73)
COMMONWEALtH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "A"
REAL PROPERTY
*'
Real property in Pennsylvania, with statement of mortgage encumbrances upon each parcel at death of dece-
dent. Property held by the decedent as tenant in common with another or other, should be identified
as to quantum of interest and the estimated value should be that of the decedent's interest only. (Property
held as joint tenants with right of surviorship or tenancy by entireties should be reported on Schedule "E.")
The real property located In the Commonwealth of PennsylvanIa should be (1) (2) (3)
described by lot and block number, street and street number, together with DEPARTMENT
a general description of the property, with a reference to the record of the ASSESSED VALUE VALUA TION
conveyance by whIch the decedent took title; If a farm state number of a. FOR YEAR OF ESTIMA TED CAUTION
cres; also statement of mortgage encumbrances upon each parcel at death DECEDENT'S MARKET VALUE (Do not write
of decedent. Taxes, ass.ssments, accrued Interest on mortgages, etc.,are DEA TH In th Is . pace)
to be listed on Schedule "F" and must not b. deducted from thIs schedule.
None li-CtN E
;. ~ ". ".
nsert this total opposite "real property", Schedule "AJJ in the X X X X X
'As Reported" column on the last page of this return.
INONF~
'---
.ReC-3& .
.
RESIDENT DECEDENT
SCHEDULE "B"
PERSONAL PROPERTY
'*
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
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 rurni~hings, books, paintings, automobiles, boats, e~c.)
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 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.
ITEM
List and describe rully
UNIT
VALUE
ESTIMATED
MARKEl' VALUE
DEPARTMENT VALUATION
(Do not write 1n
this space)
1
Certifica,te No. 3095 - Bloomsburg Fair
(formerly Columbia Co. Agricultural, Harticu1-
tura1 & Mechanical Asso.) 50.-pa~; reduction
obtained from Fair Secretary; stock not traded
publicly
700.00
7aJ .O?J
2
First Federal
of deposit:
~
Savings & Loan Asso. certificates
/
02-16-607287 of 3/18/75
accrued ~st
01-16-708885 of 7/7/75
accrued i7est
02-16-121255 of 10/26/77
accrued interest
1,206.21
14.96
~ )..a6" '-I
~ / 'I."
J~/~f'.~
/6'1, r7
L/./ !2. 0 ~ t) ?
'S'J... ~ I
d (X). f)l)
13,268.28
164.57
4,209.09
52.21
3
1973 Ford Sedan
1,000.00
Insert this total opposite "Personal Property", Schedule "B" in
the "As Reported" column on the last page of this return.
20,615.32
) 0 , / J-; J c.....
J
x X
L
"
1!fCC- 36
COMMONWEALTH OF PENNSYLVANIA
TRANS}~R INHERITANCE TAX
SCHEDULE "c"
TR.\.NSFERS
RESIDENT DECEDENT
(1) Did decedent, within two years of death, make any transfer of any material part of his estate, without
receiving a valuable and adequate consideration therefor? (Answer yes or no) nn
(2) Did decedent, within two years of death, transfer property from himself to himself and another or
others (including a spouse) in joint ownership? (Answer yes or no) no
(3) If the answer to (1) or (2) above is in the affirmative state:
(a) Age of decedent at time of transfer
(b) State of decedent's heal th at time of making the transfer. (Note 1).
(c) Cause of decedent's death. (Note 1).
(4) Did decedent, in his lifetime, make any transfer of property without receiving a valuable or adequate
consideration therefor which was to take effect in possession or enjoyment at or after his death?
(Answer yes or no)~_
(a) Was there any possibility that the property transferred might return to transferer or his
estate or be subject to his power of disposition? (Answer yes or no)
(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 under which transferor expressly or impliedly reserves for his life or any period which does
not in fact end before his death:
(a) The possession or enjoyment of or the right to income from the property transferred?
(Answer yes or no) no
(b) The right to designate the persons who shall possess or enjoy the property transferred or
income therefrom? (Answer yes or no) no
(6) If the answer to (5) (b) above is in the affirmative, state whether the right was 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 for 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 beneficiary 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 forth below a description of the property
transferred, it's fair market value at date of death, dates of transfers and to whom tranSferred, with
relationship of transferees to decedent, if any. Submit copy of any trust deed or instrument, if trans-
fers are claimed to be non-taxable, also submit detailed statement of facts on which said claim is based.
NOTE 3: List applicable property below in manner in which provided in Schedules A, B, or E.
ITEM
DESCRIPTION
MARKET VALUE
(Es tima ted)
DEPT. VALUATION
(Dept. Only)
None
9\'1' '
~.;.,,~,,; f'---." -
': ~ : <I, _
'-
,-...1
Insert this total opposite "TranSfers", Schedule "e" in the
"As Reported" column on the last page of this return.
~CL-
~
Flee':3? '(1'2-63)
COMMONWEALTH OF PENNSYYLANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "0"
BENEFI CIARIES
BENEFICIARIES AND ADDRESSES RELA TIONSHIP SURVIVED
(If step-children or DATE INTEREST OF
(State 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
M::Iri nn F. o.
72 Cherry Lane
Country Manor
R. D. #8, Carlisle, PA sister yes $1573.43
- ...,.
tJilli::lm R Rnnrlv
23 Main Street
Newtown Square, PA son yes Residue
.---- -
..'-
I ----
h
Deponent fUrther says that all the above-named beneficiaries are living at this time except below:
NAME
DATE OF DEATH
RESIDENCE
....
o .
..."'....
~<'11:
ti: =
'= QI e
.-..... ::s
eQl-
_'aO
.... e u
~ 0:
....U"O
-S.....Q)
::StIlt:
u ::s 0
~e~
~ ~
SUMMARY
Real Property .............. ............................................................ (Sch. "A")
Personal Property ............................. ..................................... (Sch. "B")
Transfers ............................... ............. ........... ........................... (Sch. "C")
......~.................. ..................
Gross Taxable Estate
(2)
(As Determined)
(1 )
(As Reported)
$...
$..................
$....
$....
$....
$...................
$.
$...
$..
$
$.
$.
E- '''0
Z .QI
.... W ''''
t1l ,'" ...:l
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>< :u ~
W 'QI fI.l
en c:l -
- ~
-< t1l ClI:
r:x:: r.. 'S Q"
~ 0 ~ Q"
~ ~
III -< III ~
~ :1: W ~,
r< t- V) Q
W c
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Z t- en ~
r.. w ..... ~
----- 0 0 ell:
...c
c r:x:: .::: 0
0 <':l l:l..
:c W <l.i \.I.l
t1l t:: ..... ::: ell:
b 0 c
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'S 0 E
's "., <l.i C ...
- ::: c
- ....
.- "'0 t1l 0 0
:::-< ..J U U
. .....
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
HARRISBURG
17127
RCC-43 (4-71)
NOTE: TO BE SOOM! TTED IN TRIPLI CATE
SEP 01 1979
REPORTING FINANCIAL INSTITUTION
ADDRESS
Dauphln D.po.l' hnk I T..u.t Co.
21' "~., I're.'
"~l.b~g, '~n.vlv.n1.
ZIP CODE 171D5
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 l' 10 011 1
NAMES ON ACCOUNT OR
INVESTMENT Thel.. E. Blady O~ "~.. Marton E. Harp.t.~
DATE OF DEATH Augu.' 29.1".
DECEASED JOINT DEPOSITOR, TRUSTEE
OR INVESTOR Mr.. Thel.. E. Baod,
ADDRESS 72 Ch.n, L.... R. D. .
&';_.1.181., J...,.,.y1v..i.
COUNTY
ZIP CODE 1710'
SURVIVING DEPOSITOR,
BENEFICIARY OR INVESTOR
RELATIONSHIP TO DECEDENT
Mr.. "..10n E. H..,.'.r
Unkna..,
Sl.'ar
ADDRESS
DATE DEPOSIT OR INVESTMENT
WAS ESTABLISHED
&-7-71
BALANCE, INCLUDING INTEREST
DUE, AT DATE OF DEATH $
"Jilt." /'
~~~~~U
Si a~re TITLE
Ja Ann C. Stav.1'
A..l.,." """.1'
Oapoalt Acoaunt S.rvic..
.~
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
HARRISBURG
17127
RCC-43 (4-71)
NOTE: TO BE SOOM! TTED IN TRIPLI CATE
REPORTING FINANCIAL INSTITUTION
ADDRESS
I..,hi" hpod' Ienk I TNet Ca.
." "*"'.' Iu..,
"_ri.HUl"lt .....ylv...t.
ZIP CODE 17"
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 l' JG a., 1
NAMES ON ACCOUNT OR
INVESTMENT Thill. I. IDody 0.. M... Marlon t. tterp....
DATE OF DEATH A"",., 21.'"1
DECEASED JOINT DEPOSITOR, TRUSTEE
OR INVESTOR Mr.. Thel.. E. ....,
ADDRESS 71 Chen, L.., R. D. .
a...U81a, """ay1vanl.
COUNTY
ZIP CODE 1711)
SURVIVING DEPOSITOR,
BENEFICIARY OR INVESTOR
RELATIONSHIP TO DECEDENT
.... "_Ion E. H........
Unk....
Sl.'.r
ADDRESS
DATE DEPOSITOR INVESTMENT
WAS ESTABLISHED
...7.7,
BALANCE, INCLUDING INTEREST
DUE, AT DATE OF DEATH $
133M."
....-....\
Si~t~~.~b ,
A.d.'.., Man.....
OIIpad' Ac......' luvlen
\......-.
TI TLE
.
REV-SI8 (8-78)
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
William B. Boody
23 Main Street
1i[eTJt-nT..7Tl Sq11"''''e. PA
(Executor or Administrator)
In Re: Estate of
'J'h",lm." F., Snony
Cumherland
County - File No. 21.,..7R-04Q7
Dear
You are hereby noti fied that the Oriiinal
appraisement in the estate of 'l'll91ma E. Bggd~t
has been fi led in the office of the Register of Wi /Is of Cumecrlaa6
County on '6 J"'nn"'ry , 19-19., Said appraisement reflects the fo/lowing
valuations:
Real Estate
Personal Property
Transfers
Jointly Owned
Total
bloue
20.615.32
None
3.432.39
$24.047.71
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.
Da.o 26 January 12 S;gnod ~ \C'~
Title Anl1l:\Distratiue OfficQr
Note: This is not 0 bill.
.'
~ C C-38
RESIDENT DECEDENT
SCHEDULE" E"
JOINTL Y OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
INSTRUCTIONS: This schedule must disclose all property, real and personal, owned by the decedent jointly
wi th 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 effecting vestiture, but do not include entireties
or out of state real estate value in estate valuation column. Personal property should be listed as in
Schedule "B", plus date of acquisition, and the name, address and relationship (if any) of co-owners to
the decedent.
Description of Property, Date of Acquisition, Name Unit percentage Estate
Address and Relationship of Co-Owners, and Place Value Share Valuation
of Record of Instrument, where Real Estate.
DEPARTMENT VALUATION
CAUTION-Do not Write
In This Space.
Value of Vaiue of
Entire Decedent's
Property Interest
1. Dauphin Deposit Bank & Trust Co.
checking account 16-50-091-1, held by
decedent and sister, Marion E. Harpster
as joint tenants with right of survivor-
ship; in existence more than 2 years prior
to death
50%
~.
1,682.39" ;'O(,Y,7~
1'750'00...V;J ! Od, d tJ (t 7 )""tJ '!~
--
l,g;,.J7
2. 1971 Sheffield Mobile Homes, mnfgrs
No. 260SAZBA43585
50%
Total
3,432.39
,/4~J., 39
Insert this total opposite "Jointly Owned Property", Schedule "E"
in the "As Reported" column on the last page of this return.
RCC-~9 (8'n~'-
County, Number and Name
Fi Ie Number
Date of Death August 29,1478
Cumberland
SUMMARY
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
Estate Name Boody. Thelma
(LAST NAME) (FIRST NAME)
E.
(INITIAL)
REPORT OF INHERITANCE TAX APPRAISER
I, the undersigned duly appointed Inheritance Tax Appraiser in and for the County of
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", "S", "COO, and "E".
Dated:
INHERITANCE TAX APPRAISER
REPORT OF THE REGISTER OF WILLS
I, the undersigned duly elected Register of Wills in and for County, Pennsylvania, do respect-
fully report that I have allowed deductions in the amounts claimed by deponent, except as to those items where a greater or
lesser amount is set forth in the last column to the right in Schedule "F", which greater or lesser amount represents the sum
allowed as a deduction.
Dated:
REGISTER OF WILLS
ADJUSTMENTS
INVENTORY VALUE AS APPRAISED ~ODE (HARRISBURG USE ONLY) REMAINDER APPRAISEMENT CODE
Real Property (Schedule A) $ 00+ 92+
Personal Property (Schedule B) ?O f\1C; ~? 10+
Joint-Held Property (Schedule E) ':l. I. ':l.b 1q 20+
Transfers (Schedule C) 30+
TOTAL GROSS ASSETS ?b 01t.7 71
Less Debts and Deductions 7.0RR f\2 40- 93-
(SCHEDULE F)
CLEAR VALUE OF ESTATE 16,959 09
Valuation of life estates or
.:&.-.
PRINCIPLE
annuities.................... __ $
FACTOR
VALUE
CODE
1-
t=
t=
:STATE TAX ASSESSMENTS _ $
"OR USE OF REGISTER ONLY
rax on $
r ax on $
rax on $
rax on $
rox on $
:xemptions
rotal Estate
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COMPUTATION OF TAX
$
$
$
$
$
2%
6%
15%
*
TOTAL TAX
$
(*) As evidenced by Charitable
Exemption Certificates issued
by the Secretary of Revenue.
t=
Less tax previously paid
BALANCE
_ess 5% of tax if paid within
I months after death
$
$
$
lALANCE OF INHERITANCE TAX DUE
Idd interest at rate of 6% from
to
IMOUNT OF ESTATE TAX ASSESSED
:state tax paid
Idd interest at rate of 6% from
to
$
$
TOTAL TAX BALANCE $
PAID $
I
I
$
BALANCE DUE
C:
$
$
$
.upplementdl Codes: (FOR USE IN HARRISSURG ONL Y)
48-Adj u stment
49+Adjustment
56-Annuity
6O-Life Estate
92+Remainder Appraisal
93-Remainder Deduction
93C-Charity
94-Remainder Residue
96-Success i ve
Life Estate
FOR USE OF REGISTER ONLY
ADJUSTMENTS
NOTE: Where subsequent adjustments are made to the above computation of tax by the Register of Wills for proper reason
same should be noted below, with short explanation. "
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COMMONWEALTH OF PENNSYLVANIA
RESIDENT INHERITANCE TAX
APPRAISEMENT
DATE ?F. T:::mll~ry 7q
~DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
HARRISBURG, PENNA, 17127
COUNTYCt1mh..rl~nrr
FILE NO. 21-78-0497
Whereas, Thelma E. Boody late of Middlesex Townshi-p
in the County of ClImhp-rl and Commonwealth of Pennsylvania, having died on
the 29th day of August 19...l!, seized and possessed of an estate
subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania;
Therefore, I, J..aQ i'vlgiRiti , an appraiser duly appointed according to law,
having been designated to make a fair and conscionable appraisement of the said estate, and to assess and fix
the cash value of all annuities and life estates growing out of said estate, hereby file the following appraisement:
In the event that any future interest in this estate is transferred in possession or enjoyment to collateral heirs of the decedent after
the expiration of any estate for Ufe 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.
Unit Appraisement
Description of As..t Values Made for Inheritance
Tax Purpoles
Real Estate $ Nnnp-
p -, Pr~per~Y 20,615 32
Transfers ~ne
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'I'n~"ll Co?/. M'7 11
Having been duly sworn according to law, I do hereby certify that the above appraisement is made in con-
formity with law on this ?I\~h day of T"lnl1"lry ~ 19-1L.
_ .p.-e, ~~~
Appralaer
R"lrri I'Zh11'rg
(!l\Imber and Strfft)
(Poft 0IIee)
, Penna.
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