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COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
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RCC-33 (4-73)
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 Re~enue. (Section 703 of the Inheritance and Estate Tax Act of 1961.)
(STATE FULL NAME OF DECEDENT)
} AFFIDAVIT OF
I:KECU'f8R
ADMINISTRATOR
IN THE MATTER OF THE EST A TE OF
DORIS JANE GOTTSHALL
Late of
Cumberland
Pennsylvania
County
County of
Dauphin
Richard L. Gottshall
}"
State of
C'~'9Yt8r
Administrator
of the estate of the above-named decedent being duly sworn, deposeS
and sayS
Decedent died
December
6
, 19-1L{t..t.tl h. iRI. I... i1t, ....~ .f ..~ ial
(y EAR) intestate
i_ harata att'''haJ,,}
(MONTH)
Nome and address of attorney or }
other authorized repres.ntative to whom
all correspondence should be moiled.
(DAY)
William R. Balaban" Esquire"
P. O. Box 1188" Harrisburg, PA 17108
That as such Administrator deponent is familiar with the affairs of said estate and the property constituting
(~~~~"T';1A ADMINISTRATOR)
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 wi th, 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: - NONE
NAME AND ADDRESS OF BANK OR OTHER INSTITUTION THIS SAFE DEPOSIT BOX RENTED RELATIONSHIP OF JOINT
IN WHICH DECEDENT RENTED A S,.FE DEPOSIT BOX IN NAME OR NAMES OF HOLDERS TO DECEDENT
That the contents of said safe deposit box or boxes are itemized under Schedules
with the exception-of the following, for the reasons hereinafter set forth:
of this return,
That Schedule A attached hereto and made part hereof sets forth fully and in detail all the real property
in the Commonwealth of Pennsylvania of which decedent died having an interest therein. It also sets forth the
mortgage encumbrances upon each parcel of real property at the date of death, giving the amount still due at
death, name of mortgagee, date, rate of interest, and book and page of record thereof. It also sets forth in the
columns provided therefore the assessed valuation of each of said parcels, the estimated market value thereof
as of date of death of decedent.
That Schedule B attached hereto and made part hereof sets forth fully and in detail all personal property
wheresover situated owned by the decedent at the time of death; all moneys left by the decedent at the time of
death, whether in decedent's immediate possession, standing to decedent's credit in banks of deposit, savings
banks, trust companies, or other institutions, whether individually, or in trust for any other person or persons
giving also separately the accrued 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, 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 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 liabili ties
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"ma-rket 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 a~swe!\ 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 enjoymeQt 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 receJ.ved'bYnea~h 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 COllY
of the deed, trust agreement or other instrument creating the trust. Ther~ is 111 so 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;{)r jointly wlth -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 attac~ed to the scnedule.
That ScheduleD 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 fun~ral 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.
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.
Subscribed and sworn to before me this .................................
............................Q?..~..l'!! "n..... day of ...~.~.~E.':l:~EY....................... 19.....?.~...
WI ----- ------_____________
(B.'l:ael:&6"r-Administrator )
225 North 21st Street
..............................................................-............................................................-..-..
(Street Number)
.....c;.a.:~p....~~.~!.~......~.~......}.?9}}..:...............................................
(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.
...................................4Li.(~~...:.....................
H.tr~lI. PA Dcwpbin County
RC C-34 (4-73)
COMMONWEALTH 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 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 .hould be
described by lot and block number, .treet and .treet number, together with
a general de.crlptlon of the property, with a reference to the record of the
conveyance by which the decedent took title; If a farm .tate number of a.
ere.; 01.0 .tatement of mortgage encumbrance. upon each parcel at d.ath
of decedent. Taxe., a.....m.nt., accrued Inter..t on mortgag.., etc.,ar.
to be II.ted on Schedule ifF" and mu.t not b. deduct.d from thl. .chedul..
Lots Nos. 56 and 57 on a Plan ot Camp Hill
Estates, being known as 225 North 21st Street,
Camp Hill, Pennsylvania, 17011, bounded and
described as tollows:
(1)
(2)
(3)
DEPARTMENT
VALUATION
CAUTION
(Do not writ.
In this spoc.)
ASSESSED VALUE
FOR YEAR OF
DECEDENT'S
DEATH
ESTIMA TED
MARKET VALUE
BEGINNING at a point on the eastern side of
North 21st Street, which point is S. 2 degrees 14'
E., sixty and tift?-hundredths (60.50) feet from
Clarendon Street, at the northwest corner ot Lot
No. 57; thence N. 87 degrees 46' E., one hundred an
ninety-nine hundredths (100.99) feet to a point on the
division Une between Lots Nos. 57 and 58; thence S.
2 dggrees 14' E., sixty (80) feet to a point on the
division line between Lots Nos. 56 and 55; thence S.
87 degrees 46' W., one-hundred and ninety-nine
hundredths (100.99) feet to a point on the eastern
side of North 21st Street; thence N. 2 degrees 14' W.,
sixty (60) feet, to a point, the place of BEGINNING.
BEING the same premises which Russell F.
Gottshall, Sr. and Beatrice V. Gottshall, his wife,
by their deed dated July 27, 1954 and recorded on
July 30, 1954 in the Recorder of Deed's Office of
Cumberland County, Carlisle, Pennsylvania, in
Deed Book X, Volume 15, Page 79, granted and
conveyed to Doris Jane Gottshall, single.
One (1) story aluminum dwelling.
(See attached Real Estate Appraisal from
D'Angelo Real Estate)
/'/
$45, 000. o'C
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.
$45,000.00 4Sjooo,o~
"
RCC -35
'*
~OMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "B"
PERSONAL PROPERTY
Item
No.
1
2
3
4
5
6
7
8.
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 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
List and describe fully
UNIT ESTIMATED
VALUE MARKEr VALUE
DEPARTMENT VALUATION
(Do not write in
this space)
TANGIBLE:
Wearing Apparel
Jewelry
Household Goods
Hous ehold Furnishings
200. 0
50.0
75.00
425.00
!NT ANGIBL E.:
Paychecks :
No. 71596; County of Dauphin; No. 24 (net)
$260.48
No. 72987; County of Dauphin; No. 25 (net)
$185.83
(Both deposited into checking account. Item 5)
Checking Account at Cumberland ( ounty
National Bank, No. 331-160-2; Balance of
Date of Death $1, 158. 72
Total
See Attached letter and statement of account
from Cumberland County National Bank. N. ~I\,..
paychecks were deposited into this account after
death. However, there were two (2 checks. No
1079 - $20.00 and No. 1080 - $10.00, both
attached, which were paid atter decedents death.
for close out balance of $1,575.02)
1.575.0
Check No. 74388; County of Dauphin; No. 26;
sick and vacation pay (net)/
Social Security lump sum benefit (tax e~~t)
$255.00
Dauphin County employees retiremen~~
death benefit $45. 149.80 (tax exempt. Act
of August 31. 1971, P. L. 408. No. 96. S27.
16 P. S. 11677)
3.002.56
x x
'5\32..:159
Insert this total opposite "Personal Property", Schedule "Bft in
the "As Reported" column on the last page of this return.
$5,327.58
(
(
CCNB
MAIN OFFICE 331 BRIDGE STREET NEW CUMBERLAND, PENNSYLVANIA 17070 (717) n4-7000
CCNB BANK. N.A.
January 2, 1979
Shaffer, Calkins & Balaban
223 North Front St.
P.O. Box 1188
Harrisburg, PA. 17108
ATTN: William R. Balaban
Dear Atty. Balaban:
Reference to your letter of December 27, 1978, concerning
the checking account of Doris Jane Gottshall, account number
331-160-2.
The balance as of December 6, 1978 (date of death) was
$1,158.71.
The balance as of December 22, 1978 (closed date) was
$1,575.02.
If you have any questions, please contact us.'
Very truly yours,
D.E. Machemer, Manager
Bookkeeping Department
DEM : s d
€... -::. . '",,~ : . .. r' --,
., r f' ~"" l~>>
".-....... .................
(:;C"" I I'~-""."" N A
STATEMENT OF ACCOUNT
1
DORIS JANE GOTTSHALL
225 N 21ST ST
CA/-1P HILL. PA
17011
000072Q 12Q -c. NUMBER
PAGE. 0 1
- SOCIAL
SEC. NO.
:- "'''' . ~', .., ~",>.;""'~;..",. "n~r.~~~~.,.-w';.,F'):- <"~ # ~-~ ''::;' :-~~.~~... -~ .. t! ~~1~", """"':.uk
tfNEf-S'AVE'RS-'CCUB"-HAWA'fi"Hoi.IOAY 'TRIP APR-ii.--s-'';' 13, 1 Q79
CHECldNG:'~CCOUNT LAST S T A TEMENT ,j~' THI S ":,$ TATEMENT':' ':;
w033! .1bO=:2.: BAlANCEl, IS! .71 BALANCE C:.::.:,: c '-'0.00
.--------~----...------_._-----------_._----------.---.-------------------------
TOT,\1. CR.t:DITU.S... ............. . TOTAl.eli.fC.. K. 5 :. ,;:?:;..MAINT~. NANCE;::::>~.' '.8.. r.A."T!:M. lENT PE~10D
NO ... AHa n'r ''-. , NO. . AMOUNT:'''' CHAnGES, ::'''.'~ '';F.. ,?.'Ot-..:.1ZI. Ob/7S
2 - " ~1I6.313 "1,005.02 0.00' .N'''''-::'TO:Ol1CS/7Q
-------_.~---~-------------------~-------------_.----------------~--~--~---_.._.
CHEC~S CHECKS CHECKS CHECKS:~ OEP051TS>-
10.00 20.00
-----------------..---------------.-----.----------------------------.-.--------..
j,575.02
", 260.~8
185.83
12/08
12/1~
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c:=.~~. '2 8(;'7<r:.
PLEASE EXAMINE AT ONCE. IF NO ERROR IS REPORTED WITHIN 10 DAYS THIS STATEMENT WILL BE CONSIDERED CORRECT.
IMPORTANT TAX INFORMATION AND ACCOUNT CODES APPEAR ON BACK OF STATEMENT,
,,-~
' I
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RCC-3b-
COMMO'\\'iEi\LTll OF PENNSYLVANI i\
TRANSFFH. INHE1UTANCE TAX
SCHEDULE "c"
T RAN S PlmS
BESIDENT 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)_~
(2) Did decedent, within two years of death, transfer property 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 ~ NLA
(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) 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 trroJsferee'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 er>.joY!'lent of or the right to income from thl' property transferred?
(Answer yes or no) NO
(b) The right to designate the persons who shall possess cr enjoy the property transferred or
income therefrom? (Answer yes or no) No
(6) If the answer to (5) (b) ab70ye is in the affirmative, state whether the right was reserved in decedent
alone or others N A
(7) Did decedent in his lifetime make a transfer, the consideration for which was transferee's prolnise 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 reserverl power to alter, amend, or revoke, or which c0111d 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) N/A
NOTE 1: The answers to these questions should be supported by affidavit by the attending ph~'sician as
well as a copy of the death cer-tificate.
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 I"hom 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. VALUAT:WN
(Dept. Only)
NONE
N CJ--ll.-
Insert this total opposite "Transfers", Schedule "C" in the
"As Reported" column on the last page of this return.
"RCC-37 (12-63)
COMMONWEALTH OF PENNSYYLANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "D"
BENEFICIARIES
(
h
BENEFICIARIES AND ADDRESSES RELATIONSHIP 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
'PBrother .~ lIi2/2/35 -; :.
Richard L. -Gottshall ;)Yes one-half
225 North 21st Street
Camp Hill, PA 17011
mussell F. Gottshall
225 North 21st Street
Camp Hill, PA 17011 Brother Ye~ 8/9/28 one-half
Deponent further says that all the above-named beneficiaries are living at this time except below:
NAME DATE OF DEATH RESIDENCE
Robert Gottshall October 10, 1968 Dickinson Ave, Camp Hill, PA
.... -;
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Real Property ......
Personal Property
Transfers .......
Gross Taxable Estate ..
SUMMARY
.. ......( Sch, "A")
...(Sch. "B")
.......( Sch. "C")
( 1 )
(As Reported)
.......45.?()OO.OO
5,327.58
......:.;O~
$
$
$..
$
$
$....~O, 327 _ 58
(2)
(As Determined)
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R C C-38
RESIDENT DECEDENT
SCHEDULE" E"
JOINTLY 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
Address and Relationship of Co-Owners, and Place
of Record of Instrument, where Real Estate.
unit
Value
percentage
Share
Estate
Valuation
DEPARTMENT VALUATION
CAUTION-Do not Write
In This Space.
Value of Value of
Entire Decedent's
Property Interest
NONE
Insert this total opposite "Jointly Owned Property", Schedule "E"
in the "As Reported" column on the last page of this return.
N~
RCC-39 (5-68)
COMMONWEAL TH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
Estate of Gottshall, Darts J.
(Last Name) (First Name)
SUMMARY
DATE OF DEATH 12-6-78
FILE NO.
(Initial)
REPORT OF INHERITANCE TAX APPRAISER
I, the undersigned duly appointed Inheritance Tax Appraiser 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", "B", "C", and "E".
Dated:
INHERITANCE TAX APPRAISER
REPORT OF THE REGISTER OF WILLS
I, the undersigned duly elected Register of Wills in and for CumherlAnd 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:
INVENTORY
Real Property (Schedule A)
Personal Property (Schedule B)
Transfers (Schedule C)
Joint - Held Property (Schedule E)
TOTAL GROSS ASSETS
Less Debts and Deductions
(SCHEDULE F)
CLEAR VALUE OF ESTATE
REGISTER OF WILLS
VALUE
$
annuities. . . . . . . . . . . . . . . . . . . $
Valuation of life estates or
ESTATE TAX ASSESSMENTS $
t=
t=
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FOR USE OF REGISTER ONLY
Tax on $
Tax on $
Tax on $
Tax on $
Tax on $
Exemptions
Total Estate
TOTAL TAX
Less tax previously paid
BALANCE
Less 5% of tax if paid within
3 months after death
BALANCE OF INHERITANCE TAX DUE
Add interest at rate of 6% from
to
AMOUNT OF ESTATE TAX ASSESSED $
Estate tax paid $
BALANCE DUE
Add interest at rate of 6% from
to
COMPUTATION OF TAX
2%
6%
5%
10%
15%
*
$
$
$
$
$
$
(*) As evidenced by Charitable
Exemption Certificates issued
by the Secretary of Revenue.
$
$
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$
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C
,-
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$
TOTAL TAX BALANCE $
PAID $
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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REV-510 (0-78)
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF FIELD OPERATIONS
P.O. BOX ')970
HARRISBURG
17105
IN YOUR REPLY PL.EASE
REFER TO
Inheritance Tax Division
NOTICE OF FILiNG OF APPRAISEMENT
Richard L. Gottshall
225 North 21st Street
Camp Hill, Penna. ]7011
(Executor or Adm ini stratar)
In Re: Estate of
Doris J. Gottshall
Cumberland
County - Fi Ie No.
21....78-0684
Dear
You are hereby notified that the Original
appraisement in the estate of Doris J. Gottshall
has been filed in the office of the Rej{jster of Wills of Cumberland
County on 9 April , 19_, Said appraisement reflects the following
valuations:
Real Estate
Personal Property
Transfers
Jointly Owned
Total
45,000.00
5,327.58
None
None
50,327.58
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. ~7\~. ,,'
9 April 79
Date
Si gned
Title
Administrative Officer
~-,
Note: This is not a bi II.
REV-457 (8-78)
DEPARTMENT OF REVENUE
BUREAU OF FIELD OPERATIONS
P.O. BOX 2970
HARRISBURG, PENNA. 17105
COMMONWEALTH OF PENNSYLVANIA I
RESIDENT INHERITANCE TAX
APPRAISEMENT
DATE
COUNTY
FILE NO.
9 April 79
Cumherland
21-78-0684
Whereas, Doris J. Gottshall late of Camp Hill
in the County of Cumberland C m Viealth f Pl' h d' d
6th lJecemoer 0 mon_/~ 0 ennsyvama, aving Ie on
the day of 19 _ , seized and possessed of an estate
subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania;
Therefore, I, T .po Ful iini ti , 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 life or for years, the Commonweaith hereby expressly reserves the right to appraise and assess transfer inheritance taxes at the lawful collateral
rate on any such future interest.
DESCRIPTION OF ASSET UNIT AppraIsement
VALUES Made for Inheritance
Tax Purposes
Real Estate $ 45,000 00
11 5.327 58
Transfers Nnna
Jointly Held Prooerty None
Total Assets 50,327. 58
.
Have been duly sworn accotding to law, I do hereby certi~ that the ~bove appraisement is made in conformity
with the law on this 9th day of \"v ..... Ap~ ". 19 .1.!L..
c. .--\ t..!. --t:'
"-., '-. '-J-_' .--c-~ j _
(,J Appraiser
l~umber afld Street)
Harrisourg,
(Post Office)
, Penna.
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