HomeMy WebLinkAbout06-15-79 (4)
RCC-33 (~73)
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
'11-5j7;
--1.../- /1'- t:j __"13
~
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 Rellenue. (Section 703 of the Inheritance and Estate Tax Act of 1961.)
Late of
r.nMRF."RT.7\Nn
Pennsylvania
Coo"" }
~x~
IN THE MATTER OF THE ESTATE OF
AFFIDAVIT OF
JOHN C_ DIRS'l'
(STATE FULL NAME OF DECEDENT)
ADMINISTRATMR IX, D.B.N. ,C.T.A.
County of
}.
State of
cumberland
, ELAINE M _ YF.INGS'T'
AdministratN rlX, of the estate of the obove-named decedent being duly sworn, depose S
D.B.N., C.T.A
Decedent died Sept.eni:ler 16,
(MONTH)
Name and address of attorney or }
other authorized representative ta whom
all corresflondence should be mailed,
KMooxOC
and say S
(DAY)
, 19~{~estate leaving a lost will, copy of which is hereto attached.}
(YEAR) I~
Myers, Myers, Flower & Johnson
P. O. Box 125, Lemoyne, Pennsylvania 17043
That as such Administratrixdeponent is familiar with the affairs of said estate and the property constituting
(EX ECU TO R-ADMIN I ST 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
IN WHICH DECEDENT RENTED A SAFE DEPOSIT BOX
Dauphln Deposlt Bank & Trust Co.
3045 Market St.
Camp Hill, Pa. 17011
THIS SAFE DEPOSIT BOX RENTED
IN NAME OR NAMES OF
Decedent
RELATIONSHIP OF JOINT
HOLDERS TO DECEDENT
That the contents of said safe deposit box or boxes are itemized under SchedulesA&B of this return,
wi th 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 detai I 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, nalr.e 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 se s sion, s tanding to de cedent'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 priIDr to decedent's
death i~ 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 th,e time of death;
all wearing apparel, jewelry, silverware, pictures, books, works of art, household Jur~iture" .horse's, carriages,
automobiles, boa ts, and any and all other personal chattels of whats oever, kiNl Qrn~.iW'e, :"lert bS' '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 seem' ~;:;s 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 t'1ere is annexed to
said schedule, financial statements showing the assets and liabilities of said co-partnership or llUsiness.
A copy of the co-partnership agreement, (if oral, a statement setting forth the nature of the agreement)
together with a statement setting f'orth the character of' the business, its location, and such other facts
pertaining to the l:lUsiness as may be pertinent to a f'air and just appraisal of the decedent's interest
therein must be submi tted. It should also sct forth in itemized f'orm, together with the f'air 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 enjo~~ent at or after death, there is also attached to the schedule a cony
of the deed, trust agreement or other instrument creating the trust. Thern is also set forth in said
schedule a list of all property, real and personal, with its value, which pa~ses at decedent's death by
virtue of' the exercise by decedent, either individually, orjointly 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 benef'iciaries f'or 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 vesti ture of
real estate and the date of acquisition of personalty, plus the name, address and relationship, if any,
of co-owners to the decedent.
That Schedule F attached hereto and made a part hereof sets forth fully and in detail all debts
and deductioll" claimed for and on behal f of this deceden t' s estate, including funeral expenses paid;
family exemption, where applicable; costs of administration of this estate; counsel fees and f'udiciary's
commissions paid or to be paid; cost expended for burial trusts, tombstones or gravemarkers, and reli-
gious services, in consequence of the death of the decedent; debts and claims owing and nnpaid 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", "en, "E", and "F" as directed therein,
have been carried forward and properly registered in the Summary.
Subscribed and sworn to before me this
...................................I.Q...:kA..1. day of. ..*'- ~
\' d.
...................... ..~j~~ ;;~~y pu~-r-:- ~
ComIJI,iIlIiQ1l i.&'pitea Dc. 21, 198~
My p cumberland Cgun.y
LelXlO'1M, Q.
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 f'amily corporations or an interest in any co-partnership or business, that the
data and statf'ments required under the paragraph above relating to Schedule "B" are attached. Also make
certain that coltunn #1 in the "Surrunary" has been properly completed as above-directed.
7"
.......... 19..............
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~.~9.!l~~.~e.'J.!.g.L..~IY1.~y:t.~~c:l....~.?q.??..............
(City or Town and State)
RC C-34 (4-73)
COMMONWEALTH OF PENNSYLVANIA
DE.pARTMENT OF REVENUE
BUREAU OF', COUNTY COLLECTIONS
TRA",SFER INHERITAIIICE TAX
RESIDENT DECEDENT
SCHEDULE "A"
REAL PROPERTY
*
Real property in Pennsylvania, with statement of mortgage encumbrances upon each parcel at death of dece-
dent. Property held by the decedent as tenant in common with another or other, should be identified
as to quantum of interest and the estimated value should be that of the decedent's interest only. (Property
held as joint tenants with right of surviorship or tenancy by entireties should be reported on Schedule "E.")
The real property located In the Commonwealth of Pennsylvania should be
described by lot and block number, street and street number, together with
a general description of the property, with a reference to the record of the
conveyance by which the decedent took title; If a farm state number of a.
cres; also statement of mortgage encumbrances upon each parcel at death
of decedent. Taxes, assessments, accrued Interest on mortgages, etc.,are
to be listed on Schedule "F" and must not be deducted from this schedule.
(1 )
(2)
(3\
DEPARTMENT
VALUATION
CAUTION
(Do not write
In this spoce)
ASSESSED VALUE
FOR YEAR OF
DECEDENT'S
DEATH
ESTIMA TE 0
MARKET VALUE
Real Estate - No. 3424 Bedford Drive, in
the Borough of Camp Hill, Cumberland
County, Pennsylvania, in the name of the
decedent and Louise Z. Dirst (died July
19, 1977) by deed from Joseph J. Cignetto
and Jean I. Cignetto, his wife, dated
August 14, 1958, recorded in Deed Book P,
vol. 18, Page 217.
Sale price -
/'
'- =; (JU-
44,000.00
L..\ L.\ () () (~! . I:(!}
Insert this total opposite "real prope. ;y", Schedule" A" in the X X X X X
"As Reported" column on the last page of this return.
44,000.00
RCC -~5
RESIDca DECEDENT
SCHEDULE "B"
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
T'ftfu'l(SFER INHERITANCE TAX
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 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 ~act that they are not o~ the administered estate.
Tangible personal property should be listed ~irst (e.g. jewelry, wearing apparel, household
goods, and f'urnishings, 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 es tate or fiduc iary in said capaci ty, partnership interests, interes t in any undistributed
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 of death, should be listed in this schedule.
I tern
No.
ITEM
List and describe fully
UNIT
VALUE
ESTIMATED
MARKEr VALUE
DEPARTMENT VALUATION
(Do not write in
this space)
1. 1973 Chevrolet Caprice - Sale Price
2. 1 - $20.00 American Express Travelers
Cheque
3. Household Goods - appraised value
4. Jewelry (see Appraisal attached)
Platinum man's wedding band
Lady's wedding band - 14 kt. white gold
Lady's zircon ring, 18 kt. white gold
Lady's diamond ring, 18 kt. white gold
Lady's five-diamond wedding band - 14 kt.
whi te gold
5. Bank Accounts:
Dauphin Deposit Bank & Trust Co.
Checking Account No. 28-59-269-7
Savings Account No. 14-6-0546-5
.900.0(1./
''''
2 0 . 0 0--
3,603.0
,8.1
'''3.2r
" 4.0
250.00-"'--
210.00/
Industrial Valley Bank & Trust Company
Subordinated Debenture - No. X062412
Face Value -
\
2,513.3
" 2,422.06-
State Capital Savings & Loan_/~
Certificate No. 002-02-1362 f'//
Certificate No. 002-20-05295~
Certificate No. 002-20-04497 /,,/
Certificate No. 002-20-07330/
* Savings Account NO. 002-00-01371
*Louise Dirst died July 19, 1977)
5,068.17/
5,068.17/
\ 5,068.17 __
\10,136.3
'i:4,64L94
6. First Federal Savings & Loan
Savings Account No. 2-10041
Harris Savings Association
Optional Passbook Account No. 1-36360
Industrial Valley Bank & Trust Company
Savings Account No. 50-062412
~550.00
7. Residual assets - Pension Account of
Louise Z. Dirst - Federation of Telephone
Workers of Pennsylvania, payable to the
Estate of John C. Dirst -
8. Bell of Pennsylvania - final payment
from surviving spouse's Annuitant -
16 days -
3,613.07
'~ 38.40
Insert this total opposite "Personal Property", Schedule "B" in
the "As Reported" column on the last page of this return.
x X
86,806.93
o . (] "'1. (..~
cL)'CUlV. 1.-,
RCC- 3'S
CIHI1MO{\'i'EALTH (l[<' PE\'\TSYLPN I A
1'1-LA\~F~m I\'m;:lUTA\CF T:'X
S CEE])CLE 'I C"
Trn\TSFEltS
1fJ- j~~. .it
~ >:~'::;' -',~
';lfu;r: '[\
I), "IA,~c-',I!(""J
~i:~.'{~':~
l\ESIDE\T !WCFllF\T
(1) Dirt decedent, within two years ofdeatl1, Ollike any transfer of any rnatl~rial ]Jart of his estate, without
receiving a valuable ar.rt adequate consideration therefor? (Answ.~r yes or no)-.NQ_
(2) Dirt rtecedent, wi thin two years of (leath, transfer propen,y from himself to himsel I' and another or
odlers Unelw1jng a spouse) in joint ownership? (Answer yes or no) NO
(3) I:' the answer to (1) or (2) above is in the affirmative state:
(a) Age of decertent at time of transfer
(b) State of decertent' 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 rteath?
(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) 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 actequate consideration
therefor uncleI' which transferor expressly or impliedly reserves for hi.s life or any period which does
not in fact end before hi.s death:
(Ii) The possession or enjoyment of or the right to income from the property transferred?
(Answer yes or no) No
(b) The right to ctesignate 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 i.s in the affirmative, state whether the ri.ght was reserved in decedent
alone or others None
(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) Di.d decedent, at any time, transfer property, the benefi.cial enjoyment of' which was subject to change,
because of a reserved power to alter, amend, or revoke, or which c01l1d revert to decedent under terms
of transfer or by operation of law? (Answer yes or no) No
(9) If the answer to (8) above i.s in the affirmative, was the power to al tel', amend, or revoke the inter-
est of the benefic.iary reserved in the decedent alone or the decedent aml others?
(Answer yes or no) No
NOTE 1: The answers to these questions should be supportect 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 i.s yes, set f'orth below a description of the property
transferred, it's fair market value at date of death, dates of transfers and to whom t.ransferred, with
relationship of transferees to decedent, if any. Submi.t copy of any trust deed or instrument, i.f trans-
fers are clai.med to be non-taxable, also submit detai.lert statement of facts on which said claim is based.
NOTE 3: List applicable property below i.n manner in whi.ch provide'} in Schedules A, B. or E.
ITEM
DESCRIPTION
MARKET V AI,UE
(Estimated)
DEPT. VAI,UATION
(Dept. Only)
NONE
N (y-,-,L
Insert this total opposite "Transfers", Schedule "C" in the
"As Reported" column on the last page of this return.
RCC-37. ',(12-.6J)
CO:\l:\\IJ~'n:..\LTI! OF' f'E:'~;\:SYYL\,:\lIA
TRANSFEI, t~HERITAr\'CE TAX
RESIDEN,T DECEDENT
SCHEDULE "D"
~.'~. t
>,;,~~T:..'" ~~
,I..,..... ......" ~
",',:,:,:yJ
I(-.,;i;'h,j'ii(~!'\
~'_.~~,?i~'~?'~)':;_,.,,:.:.3),
BE:\EFICIARIES
, B~NEFJCJARIES AND ADDRESSES ~ (lr~t~~1~~;~~PorT~~'i~YIv~~11
\:state tU.ll na. m. es and addre. sse::; of all who I ilIf'gitimate c. hldrcn I J.)El;~~I)EN,.
have an interest. vested, contingent or other-I arc lnvolved, s~t I STA.1'. ,YES
wise, in 2St3t(')__--1- forth thIs fact.I -,--OR N? i
! i I
Elaine M. Yeingst IStep-Daughter I Yes Adul t
d . I I
13 Edgewoo Drlve I I
Mechanicsburg, Pa. 17055 J~ ~-
F.sta:te. of John L. Dirst Son___~ Yes - i Adult
7309 Dickenson Street I died
Sprinqfield, Virginia 221501 3/5/79
1-
DATE
OF
BIRTH
INTEEEST OF
BENEFICIAllY
TN EST.\TE
One-half residue
One-half residue
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Deponent further says that all the above-named beneficiaries are living at this time except below:
NAME
DATE OF DEATH
RESIDENCE
; *
~ :~' S
...... ::u ,-
.::: ....... :;
E":;-
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~ _ u
~ t: .
, O.
~c.;"C
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u :l 0
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~ 0;
~. 0::
Heal Property
Personal Property
Transfers
SU~1\lARY
(Sch. "A")
. (Sch. "B")
(Sch. "e")
( 1 )
(As Reported)
$ 44,000.00
$ 86, 8~. 6 . 9 3
$ -0-
$
$
$ .1}Or 806.93
(:2 )
(As DI'tI'nnilled)
~
Gross Taxable Estate
$
$
$
S
$
$
s::
0
r- oo
Z '0 r-l s:: M
'"
... W <fl r-l ..c: q<
rn <"J ...-1 ....l 0 0
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0 rIJ r-l
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- P4 ..( <.<l
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w ~ w CI) s:: ..( ~ cO
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w m ~ ...... ..U") s::
------ ~ U ::1 0 1- OON s::
0 0 ::1 ,.. == lo-lr-l Q)
c: p::; Z lo-l U .... 0 Q) Il.I
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R C C-38'
RESIDENT DECEDENT
SCHEDULE" En
JOINTLY OWNED PROPERTY
COMMO~WEAL TH OF PENNSYLVANIA
T-RA'NSFER INHERITANCE TAX
INSTRUCTIONS: This scheoule must disclose all property, real and personal, owned by the rtecedent 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 oescription, as indicated Imaer Schedule
"A", phAs the aate ana place of record of instrument effecting vesti ture, but ao not include entireties
or out of state real estate value in estate valuation column. Personal property shoula 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 ana Relationship of Co-Owners, and Place
of Record of Instrument, where Real Estate.
unit
Value
percentage
Share
Estate
Valuation
DEPART1fENT 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.
NONE
N(~~
REV-5I8 (3-79)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF FIELD OPcRATiOf'IiS
P. O. BOX 2970
HARRISBURG
17105
IN YOUR REPLY PLEASE
REFER TO
I nvestigation Division
NOTICE OF FILING OF APPRAISEMENT
Elaine M. Yeingst
13 Ed.gewood Drive
Mechanicsburg, PA 17055
(Executor or Administrator)
In Re: Estate of John C. Dirst
Cumberland
County - File No. 21-78-0533
Dear Ms. Yeingst:
You are hereby notified that the original
appraisement in the estate of John C. Dirst
has been filed in the office of the Register of Wills of Cumberland
County on Jul,. '30 . 19-29.... Said appraisement reflects the following valuations:
Real Estate
Personal Property
Transfers
Jointly Owned
Total
44,000.00
86,806.93
None
None
1130,806.93
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.
Date
July 30, 1979
Signed J:~l n dv (?. l.;llt).' (
Title Appraiser
NOTE: This is not a bill.
(,
RC C-S9 (~77)
.~unty, Number and Name ::>1- C"111;IlhPr1 nn. n
;. File Number 21-7B-022~
Date of Death ~rtember 16, 1975
File Date
Estate Name DIRST JOHN
-~
SUMMARY
(LAST NAME)
(FIRST NAME)
C.
(INITIAL)
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
REPORT OF INHERITANCE TAX APPRAISER
I, the undersigned duly appointed Inheritance Tax Appraiser in and for the County of Cumb.ithnd
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:
July 30, 1979
,.,--1,.'
,-~ I
'- /
--
INHERITA
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
CODE VALUE AS REAPPRAISED
004+
10+
+
CODE
00+
0+
INVENTORY
Rea I Property (Schedu Ie A)
Personal Praperty (Schedule B)
Joint-Held Property (Schedule E)
Tran$fers (ScheduleC)
TOTAL GROSS ASSETS
Less Debts and Deductions
VALUE AS REPORTED
$
VALUE AS APPRAISED
$ 44 000 00
40.
(SCHEDULE F)
CLEAR VALUE OF ESTATE
Valuation of life estates or
..:L-
PRINCIPL.E
FACTOR
VAL.UE
CODE
I
annuities.................... __ $
t
t=
ESTATE TAX ASSESSMENTS _ $
FOR USE OF REGISTER ONL.Y
Tax on $
Tax on $
Tax on $
Tax on $
Tax on $
Exemptions
Total Estate
~
COMPUTATION OF TAX
2%
6%
5%
10%
15%
$
$
$
$
$
*
TOTAL TAX
$
(*) As evidenced by Charitable
Exemption Certificates issued
by the Secretary of Revenue.
Less tax previously paid
BALANCE
Less 5% of tax if paid within
3 months after death
$
$
$
t=
BALANCE OF INHERITANCE TAX DU E
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
$
$
$
$
c
$
$
TOTAL TAX BALANCE $
PAID $
Supplemental Codell: (FOR USE IN HARRISBURG ONL Y)
48-Adjustment
49+Adjustment
56-Annuity
6O-Life Elitate
92+Remainder Appraisal
93-Remainder Deduction
93C-Charity
94-Remainder Residue
96-Successive
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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REV-457 (8-78)
DEPARTMENT OF REVENUE
BUREAU OF FIELD OPERATIONS
P.O. BOX 2970
HARRISBURG, PENNA. 17105
COMMONWEALTH OF PENNSYLVANIA
RESIDENT INHERITANCE TAX
APPRAISEM ENT
DATE July 30, 1971.-_
COUNTY Cumberland
FILE NO. 21-78-0533
Whereas, John C. Dirst late of Borough of Camp Hill _.,~__
in the County of Cumberland Commonwealth of Pennsylvania, having H
the 16th day of Sentember 19 ~ , seized and possessed of a r, ", .(~ G
subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania;
Therefore, I, Sandra L. Stone , an appraiser duly appointed according t:) L:n I,
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 oos-session or enjoyment to collateral heirs of the decedent after the eXJ:-':'
of any estate for life or for years, the Commonwealth hereby expressly reserves the right to appr~ise o1nd assess transfer inheritance taxes at the lawful iii,lt'I';1;
rate on any such future interest.
DESCRIPTION OF ASSET UNIT /\.;:;):.115{
VALUES Mad.' 1()'- I rjh
T::l>< Pljrp
--.,
Real Property $
M,OOO!
Personal Property 86.806 i
,
Joint-Held Property N one_,
Transfers None
I
,
---
TOTAL ASSETS $130,806 i
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Have been duly sworn aC<;;'Q~ing to law, I do hereby certify t
with the law on this _;>vl: day of '.
/\');Jfcjj
//
Harrisburg
(Number and Street)
(Post Office)
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