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HomeMy WebLinkAbout03-25-79 Form RC C .10 DEDUCTIONS ALLOWED IN OFFICE OF THE REGISTER OF WILLS '--:\) / 7 &: -5 :,/ STATEMENT OF DEBTS AND DEDUCTIONS THE SUM OF "..,.. ESTATE OF DANTET, T, F:T TrKF:'R L~TE OF B01,WUCH OF 'MF.r.HANTr.SRTTRr:. OF CUMBERLAND COUNTY ~ND AGENT 0'" THE COMMONWEALTH /-<. it'. DATE OF FILING APPRAISEMENT r::1ti7 .1 ;);; I q v1 QDATE OF DEATH q/4!7P, \\ . - ( O....TE NO. OF NAM&: OF PAYEE REMARKS AMOUNT VOUCH-'t Sept.13 Register of Wills, Cumberland Co. Letters Testamentarv & two Cfirtf. 25 )0 s or 29 Cumberland Lat.T .Tournal . , . <>0 T - lA In net. 10 Cocklin Funeral Home FnnerR.l ~ 1 q<;? () 10 Seid1e Memorial Hosnital ProfpssionR,l ~ . H. <; 'i 10 David S. Zimmerman M.D. l-"nf",cclnn<>1 ~ 210 )0 20 Register of Wills, Cumbo Co. One short Certifi~~~p 1 1() ~OV. 7 West Shore Tim"'c , . ~o T Testamentarv 1h ') --- RESERVES: Jan M. Wiley Attorney's Fee 1,181 )0 r.ommo "'T.r"'~ 1 h al Bank F:ve~u~()r'<:: li'pp 1,181 0 - Closing Costs 100 0 4,830 8 COMMONWEALTH OF PENNSYLVANIA COUNTY OF DAUPHIN The ~?mmonwea1th National Bank by P. Conway, Vice President and Tax Manager HEREBY CERTIFY. THAT. 'to THE BEaT OF MY KNOWLEDGE AND BELIEF. THE FOREGOING IS A JUST AND TRU E STATEMENT OF DEBTS. FUNERAL EXPENSES AND EXPENSe! 0,.. ADMINISTRATION SUBMfrrED TO THE ESTATE OF DANIEL L. ELICKER DEC~.EO. AS OEDUCTION!i FOR 'N::~~::N::O':::':~R< ~H:: d 1 ;;~=-~ .2 (~~ 'L ., ~A.J o~ .H-L{ }s.: Robert We, N.)T:.~," ""r MV Commission Ex~ir~' " {iJ'.u n, 1980 IlarriIbUl'll. PA Diluphjn Yiuoty R.CC-33 (4.'73) COMMONWEAL TH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS .3/3(/11 ,*-Z1-7f-t>5:l1 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 Reuenue. (Section 703 of the Inheritance and Estate Tax Act of 1961,) IN THE MATTER OF THE EST A TE OF CO"O', } EXECUTOR AFFIDAVIT OF DANIEL L. ELlr.KER (STATE FULL NAME OF DECEDENT) Late of Boro. 0 f Mechanicsburg. Cumb. ~m~m State of Pennsylvania County of cumberland }. The Commonwealth National Bank by Robert P. Conway, Vice President & Tax Manager Administrator of the estate of the above-named decedent being duly sworn, depose and say Decedent died September 4 , 1911L-{testate leaving a last will, copy of which is hereto attached. } [MONTH) (DAY) (YEAR) ~~ Nome and address of ottorney or } The Commonwealth National Bank other authorized repres_entotive to whom 011 correspondence should be mei led. 10 S. Market Square, Harrisburg . Pennsylvania Executor That as such Executor deponent is familiar with the affairs of said estate and the property constituting ( EX E C U TO R-"K~WXX"KX~!J12 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 S....FE DEPOSIT BOX IN NAME OR NAMES OF HOLDERS TO DECEDENT NOTIp. That the contents of said safe deposit box or boxes are itemized under SchedulesNj A wi th 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 las t in teres t day prior to decedent's death in the case of savings banks, and to the date of decedent's death in all other cases; all bonds, postal savings, treasury certificates or notes and other evidence of indebtedness of the United States to the de- cedent; all obligations, whether by statute or agreement they are designated as tax free, of the United States, or any state, or political subdivision thereof, or of any foreign country, which are owned at ~he time of death; all wearing apparel, jewelry, silverware, pictures, books, works of art, household furniture, horses, carriages, automobiles, boats, and any and all other personal chattels of whatsoever. kind or nature, left by decedent, together with the fairly estimated market value thereof; all bonds and mortgages held by decedent and of all claims due and owing decedent at the time of death, and all promissory notes or other instruments in writing for the payment of money of which decedent died possessed, of whatsoever nature, with interest thereon, if any, giving the face value and estimated fair market value thereof, and if such estimated fair market value be less than the face value, it sets forth briefly the reasons for such depreciation as to each item; all moneys payable to the estate from life insurance policies carried by decedent; all annuity and endowment contracts the proceeds of which were payable upon the death of the decedent; all and the corporate stocks and dividends due thereon and unpaid as of the dale of death, bonds and accrued interest thereon to the date of decedent's death and other investment Sl'l'Urii. " U "'led 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 possihle 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 thp co-partnership agreement, (if oral, a statement setting forth the nature of the agreement) tog!'tlWI' wi th a statement setting forth the character of the business, its location, and such other facts pert"inin~ 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 wi th the fair market value thereof, Rny other property owned or bequeathed by the decedent at the time of death. The Scl>edule C attached hereto and made part hereof sets forth a true answer to each inquiry contained th.'rein 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 t'l.ke effect in possession or enjoyment at or after death, said schedule sets forth the nature and value of such property, to whom transf"'~rred, thp relationship of the transferees to the decedent, the proportionate share received by each transferee anti all other facts of a pertinent nature regarding said transfers. In the case of transfers intcnde~ In take effect in possession or enjoyment at or after death, there is also attacherl to the schedule a cony of the deed, trust agreement or other instrument creating the trust. There is also set forth in said schedule a list of all property, real and personal, with its value, which pa~ses at deced.?n"s deatil i,~. virtue of the exercise by decedent, either individually, or .jointly with another, or any power or appoint- ment vested in decedent, either individually or jointly, by the will, deed, or other instrument of anoth,')', with a copy of the instrument creating such power attached to the schedule. That Scl>edule D attached hereto and made part hereof sets forth the nA.mes A.nd adrJressC1s nf' 1:1! 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 tll\' time .,,' decedent's death of all minors, annuitants and beneficiaries for life IlIHler decedent's W1:11. It .,1,;" 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, anri the relationship at' such issue to H,'> "",.prieiary. That Scl>edule E attached hereto and made a part hereof sets forth all property, J'eal anr! per- sonal, owned by the decedent jointly wi th another or others, including intangible, standing in the nam.? of the decedent and others, plus the date and place of record of instrtIDlents ef'fecting the, esti ture of' real estate and the date of acquisition of personalty, plus the name, Ilddress ;1:;'; 1'.,lati""'c!,:,., of co-owners to the decedent. That Sct>edule F attached hereto and made a part hereof sets r"l'Th "n!'.' ."." i" <I".;;. ..11 'I"),'.' and deductions claimed f'or and on behalf of this decedent's estate, i.nclwl:n~~ ;'ulc,';d .'x;,,'ns,cs 111t.1d: family exemption, where applicablej costs of administration of this est'll'" ,."OJ.. conunissions paid or to be paid; cost expended for burial trnsts, tmpi,c .'1' " gious services, in consequence of the death of' the decedent; debts and cla.ims owing and nn]", jel at J.ime oj' death; taxes accrued chargeable for period prior to decedent's rleath (except those allowe,l mi"",' S,'cUnll 65101' the Inheritance and Estate Tax Act); t.ol~pther witl1 a stat.em<,"! ,,1' ,.,,'1' 1",',"! 'I","".' ,..... "UiC'.- tions, if a.ny. It is agreed that the fiduciary will present proof or S"id ;';,;i,,,';1 '..,,; ",oJll ; ... quest, that if the amount actually paid in settlement of any fee, commission OJ' riebt is [pSS than t!w esti)Tlated amount claiming and allowed, that the same will be reporteri to the Register of WLl Is, and tl"" the amount of tax assessed clln be reassessed in accorrlance therewi tho t. ,', ~ ~' .! ,. ~ ' ~; i (" ; .'_: yo. ',' 1 ~.p -\ ; That the totals of the appropriate columns in Schedules "A", "B", "CO, "E", and "F" as directed therein, have 'been carried' forward and properly registe!"ed in the Summary. Subscribed and sworn to before me this .jIJ . ...............;..............a.1... day of ...~.......... 19.....71- ..1:;:. .ijog; tp.~I.C ......... ",,)~f: h MV. Commission fx;Jires GClohe, 13, 1980 Ha/TIsbullj. PA Oa'~b. ( ." Ul OlInt~ NOTE: Bet'ore signing; af'fidavit make sure all blank spaces in the affirlavit and schedules ::.nn,'xed ;\1'., fIlled in with details or the word ")o1one", ann in case the assets include rare ane} unlisted se('llritir.", securities of close or family corporations or an interest in any co-partnership or business, Ulat ti", data and statements required under the parap;raph above relating to Scherlule "B" are Ilt.r.ached. \1 So 1;::11;" cerUtin that column #1 in the "SlIrrnnary" has been properly completed as ahove-directed. --~~g~i:}~:~i~i' .....1D...South...Mar.ket...Squa:r.eh..h............ (StTcct N1'''''';;;:;< .....I:I~I:rifl.QY.rg.....P.e.nnsylvania.. -(City -ai' 'rown and State) and ,,~,--34 (4-73) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS TRANSFER INHERITANCE TAX REsmENT 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 shauld be (1 ) (2) (3\ described by lot and block number, street and street number, together wi th DEPARTMENT o general description of the property, with a reference to the record of the ASSESSED VAL.UE VAL.UA TION conveyance by which the decedent took title; If 0 farm state number of a. FOR YEAR OF ESTIMATED CAUTION cres; also statement of mortgage encumbrances upon each parcel ot death DECEDENT'S MARKET VAL.UE (Do not write of decedent. Taxes, assessments, accrued Interest on mortgages, etc.,are DEATH In this space) to be listed on Schedule "F" and must not he deducted from this schedule. NONE t\lIY'Y-l.. 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. NONE RESIDENT DECEDENT SCHEDULE n Bn PERSONAL PROPERTY ~- I(I{f)lt pct~-~<=: 1 CO~a{ONWEALTH 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. Tangibl e 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 undis tributed 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 fully UNIT VALUE ESTIMATED MARKET VALUE DEPART.MENT VALUATION (Do not write in this space) Tangible Personal Property 1. 1976 Oldsmobile Automobile, Omega, Four Door Sedan. Sold at Intangible Personal Property 2. Savings Account #22-0005133-8 with The Commonwealth National Bank. 16,325.92 3. Accrued Interest on Item #2 to date of death'. 8.94 4. Savings Account #14-0010562-1 with The Commonwealth National Bank. 3,094.46 5. Accrued Interest on Item #4 to date of death. 21. 52 6. Checking Account #222-322620-6 with The Commonwealth National Bank. 1,513.19 7. Death Benefit Proceeds from Fraternal Order of Eagles. ,,//' 250.00 8. Death Benefit Proceeds from Loyal Order of Moose. ./ 9. Refund from Nationwide Insurance 100.00' 147 .6(}~ 10. Claim Payment from Medicare 160.00' Q,~, ") ".> L L I . l,:._ -.-- l~ ll-?,t--,--~K Insert this total opposite "Personal Property", Schedule "B" in the "As Reportell" column on the last page of this return. x X 23,621.63 L. t- . Commonwealth J~ National Bank ~ October 16, 1978 Mr. Robert K. Reitzel Trus t Manager Carlisle Deposit Office Commonwealth National Bank Re: Estate of Daniel L. Elicker Dear Mr. Reitzel: In reply to your letter dated September 12, 1978 on the above estate, the following information listed below is as of D.O.D. September 4, 1978: Checking Account - #222-322620-6 $1,513.19 Opened - 1/31/74 Jointly held with Marie Elicker Savings Account - #22-0005133-8 $16,325.92 Opened - 5/28/75 Accrued Interest - $8.94 In his name only. Savings Account - #14-0010562-1 $3,094.46 Opened - 7-22-71 Accrued Interest - $21.52 Jointly held with Marie Elicker If YOII n..<lvP. any questions, please feel free to contact us. Very truly yours, ~~/J ~~/eI.! Daryl S. Myers ;;C Vice President DSH/cg The Commonwealth National Bank, 10 South Market Square, Harrisburg, Pa. 17108 (717) 564-9500 RCC- 36 COM'MO\;WEALTH OF PENNSYLVANIA Tl-lA'\SFEH. rXHEllITA;>;CE TAX SCHEDULE "e" TRANSFEIlS H.ESIDEXT 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) No (:.ll Did decedent, wi thin two years of death, transfer property from himsel l' to himsel l' 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 af'firmative state: (a) Age of decedent at time of transfer N/ A (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) No (b) What was the transferee's age at time of' decedent's death? N/A (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 transf'erred or income theref'rom? (Answer yes or no) No (G) If the answer to (5) (b) above is in the affirmative, state whether the right was reserved in decedent alone or others N/ A (7) Did decedent in his lifetime make a transfer, the consideration for which was transferee's promise to pay income to or f'or 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 al tel', 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 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, i.f 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 Insert this total opposite "Transfers", Schedule "C" in the "As Reported" column on the last page of this return. NONE N Cy-~- RCC-37 . (12-63) l'lnOIONWEALTII OF PENNSYYLANIA TRANSFER INm:HITANCE TAX RESIDENT DECt:DENT SCHEDULE "0" BEI\'EFICIARIES T T [ RELATIONSHIP , B~NEFIC.ARIES AND ADDRESSES (If step-children or \:state tull name5 a.nd addresses of all who I illegitimate children have an interest, vested, contingent or other- are involved, set wise, in estate) forth this fact.) SURVIVED DECEDENT STATE YES OR NO DATE OF lH RTH INTEREST OF BENEFICIARY IN ESTATE Charles R. Elicker 1000 Apple Drive Mechanicsburg, Pa. 17055 Son yes legal one-half re.sidue Maurice P. Elicker Son yes ,legal I one-half residue 28 Holly Street Mt. Holly Springs, Pa. Deponent further says that all the above-named benef'iciaries are living at this time except below: NAME DA TE OF DEATH RESIDENCE I I ~\. \ .... o . -"'..... ~<* ~:: C .a Q) e .a ~ E .. - 0 'C Po CJ 1 g: ....CJ'1:l o Q) ............ ::l '" .... CJ ::l 0 ~e~ ~ ~ Real Property Personal Property Transfers ........ . ...............(. Gross Taxable Estate SUMMARY .. .. .(Sch. "A") . ... . ..... ..(Sch. "B") .......(SCh. "C") ( 1) (As Reported) $ $ $ $ $ $. . (2 ) (As Determined) $ $. $ $ $ $ -^-' c: .9 ..... ce .t; VJ ~~ :::: E >~ ~~ .... ce Il) ;:.-. w ~ ci ~ Z ~ Z tiI ...,. ~ tiI (/) ..... < ~ ~ ~ < tiI ::r: f-< ~ o ~ tiI f-< f-< ~ .-'. ~ o w :t tiI l-< f-< tl. ~ o f-< (/) tiI '1:l 4> .<il .<:1 Q.l .CJ Q.l p::: t:l ~. ~ U H ....:I. ~. . : ....:I. ....:I. ~. H ~. t=l 0: ~. j:Q: Cf.l: U ~. U: ~. ~: o G :::>. o p:: o j:Q '- o Il) .... ce .J t=l ~. f:2. ~. ~. U ('Il .2 ('Il ..:: ;.., en ;: V ~ '- o ~. :: (5 u '- o ...c .... - Il) ;.. ,.. c o E E o U ..J ~ CI.l :; ee =- =- ~ Q Z ~ f- ee o Q., ~ cz:: R C C-38 RtSIDENT DECEDENT SCHEDULE" E" JOINTLY OWNED PROPERTY COMMONWEALTH OF PENNSYLVANIA TRANSFER INHERIT ANCE 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 Imder 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 acquisi tion, 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 pe rcen tage Share Estate Valuation DEPARTtffiNT VALUATION CAUTION-Do not Wri te 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" colunm on the last page of this return. NONE N ()-..J... RCC-39 (8-77) .County; Number and Name File Number Date of Death 9/4/78 Estate Name ELICKER., (LAST NAME) SUMMARY DANIEL (FI RST NAME) To (lNITI AL) 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 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 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 ADJUSTMENTS INVENTORY V ALUE AS APPRAISED (HARRISBURG USE ONL YI REMAINDER APPRAISEMENT CODE Real Property (Schedule Al $ None 00+ 92+ Personal Property (Schedule BI 23 621 63 10+ Joint-Held Property (Schedule EI None 20+ Transfers (Schedule CI None 30+ TOTAL GROSS ASSETS 23 621 63 less Debts and Deductions 4 830 S8 40- 93- (SCHEDULE FI CLEAR VALUE OF ESTATE 1 A 70n 7r::. Valuation of life estates or ~ PRINCIPLE FACTOR VALUE CODE I annuities.. 0................. -_ $ t= t= ESTATE TAX ASSESSMENTS _ $ FOR USE OF REGISTER ONLY Tax on $ Tax on $ Tax on $ Tax on $ Tax on $ Exemptions Total Estate CODE COMPUTATION OF TAX 2% 6% 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 DUE Add interest at rate of 6% from to AMOUNT OF ESTATE TAX ASSESSED Estate tax paid $ $ c $ $ BALANCE DUE Add interest at rate of 6% from to $ $ TOTAL TAX BALANCE $ PAID $ Supplemental Codes: (FOR USE IN HARRISBURG ONL Y) 48-Adj ustment 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. " .. -- .'. ..-. .. .'n__ ..J .<f: \ ~ .<f: t-' ~ Z 0- W ~ ... ~ ~ ~ ..... ~ ~ c: 0 ;;.-< ~ z ~ ... .<f: A - \ re .,.., ~ ~ rJJ ~ 0 c: ~ ~ c: 0 ~ W ~ ~ 0- 0- W ~ t-' % ..... w ~ ;::. ~ .<f: 0 ~ 0 z. t-' 0 ~ .e ... z ~ w ~ ~ 0 ~ ~ H ~ ~ ~ '0 c: w % 0 t-' A '-' .,.., ..... 0 .. e .. ~ c: ~ ~ := 0 ... .. 0 W .. ~ ~ rJJ W ..... ..J c: -'S ~-e ~.<f: .'r.""-. ....' . --....... ..~J.+-'" ' ---~ ( - IDttstlIill ann Qlentam.ent of DANIEL L. ELICKER BE IT REMEMBERED, that I, Daniel L. Elicker, of 605 Sunset Drive. Dillsburg Borough, York County. Pennsylvnnia. being of sound mind; memory and understanding, do make, publish and declare this as and for my Last Will and Testament, hereby revoking and making null and void any and all Wills and 'Testaments and writings in the nature thereof by me at any time heretofore made. ITEM 1: I direct that all my just debts and ftneral expenses be paid as soon after my demise as may be convenient. 1 ITEM 2: All the rest, residue and remainder cf my estate, of whatsoever it nature and wheresoever situated, whether it be real,personal or mixed, including eal property over which I have a power of appointment,1 give, devise and bequeath unto (- --.:... cl my two (2) sons, Charles R. Elicker and Maurice P. Elicker, in equal shares, per stirpes. ITEM 3: I direct my Executor to pay Lll inheritance, estate, succession and legacy taxes, of whatsoever nature and k1d, to which my Estate or the transfer of any property passing hereunder or other~se passing by reason of my death, may be subject and to charge such taxes alinst my residuary estate, it being my intention that none of the aforesaid taxeS' either federal or state on any property required to be included in my gross er'-te under the provisions of any state or fedeJ Ii / I law now in force and effect or hereafr enacted, shall be prorated among the persc interested in my Estate to whom Sl,.t property is or may be transferred or to WhOT any benefit accrues. / / ITEM 4: I direct m~.ereinafter named Executor to employ Jan M. W" WITNESS: -.\ .; \ o'v-.... ~ '_ w~ [~/Yl,$ .~M- / DANIEL L. ELICKE () . .-1 ~-ll} lOJ:;jL REV-457 (8-7.8) DEPARTMENT OF REVENUE BUREAU OF FIELD OPERATIONS P.O. BOX 2970 HARRISBURG, PENNA. 17105 COMMONWEALTH OF PENNSYLVANIA RESIDENT INHERITANCE TAX APPRAISEMENT DAlE ?S April 1979 Cumberland ?1_7R-ns37 COUNTY FILE NO. Whereas, Daniel L. Elicker late of T\OY'Ollf[l of tlechanicsburr; in the County of Cumberland Commonwealth of Pennsylvania, having died on the 4 t h day of S e p t em be1'" 19 -1..1, seized and possessed of an estate subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania; Therefore, I, Leo Fulgini 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 Commonwealth 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 u PpY'~OTlMl Prooertv ?1 F;?1 IF; 3 Tri'lTl!';ff>r~ M~ JoiTlt-lv Owned M~~ Tot-i'll :')':1 ';?1 ,~ I Have been duly sworn according to law, I do hereby certify that the above appraisement is made in conformity with the law on this :2 5 t:h day of .1l.}HH 1 19 ~. . \: (_./ Appraiser (Number and Street) 1I1g. (Post Office) . , Penna. >- .... c ~ o D 0~ !'('.. ~ \J' ~ ...., l'k ~~ c-~ f ~ -- $ "'"' .~ t 'i u.l 'ffi en 4- ex:: Q.. ~ ~ to- u.l U Z 4. to- ~ u.l :3: ~ 'i u.l o C;; u.l ex:: ..... o <l) .... ~ 1Il tx:\ "'0 <l) ~ <l) u <l) a j..<: <li: " , ....... 0: .M: M: ~: ,.:\: M: Q): .r-\ : ~: (\j: c::4~ CfJ: .-: v' : M: j..<: rf\ 1S \ . ~ ~: <:i : OJ: . .;->:-..;. p<: OJ: cf): .::r: bl) j..<: ?: .0: Ill: 0: .r-\: ~: ro: ,-., ,....., 0: Q): .: ..... o ~ <'3 ...:\ $~ 4-< : 0: ~~ os. ?: 0: 5-1: 0: ~: ~ ~ .; '-Y: o Z ...... o >- ~ .... <'3 <l) a .... <l) .!:<: 8 ;~ C\ '..J. C 60\ 8 -~ <l) : 1Il : .~ . ..... Q) 0.. 0'> ~ & ..... o <l) .... <'3 C\ C': ~ '" ...... ,--; .~ }.t P.. ~ ..0. ~ Q) ~ ..... o 1Il -..... ~ 1Il 'e, & ,S "d ~ tI:. ~ Q) ~ "d X <'3 .... ..... o .... c ~ o ~ w ::> ;z w ~ cc \.L- a """ ;z w ~ """ cc c::( 0- W o ...> c <l) 8 <l> <Il '@ a- 0.. <I:. "'0 <l) :> '$ u <l) lX. ..0- <l> :> o ..... 0... 0.. <I:. "d C <'3 "'0 <l> c '8 m X t.il .... ~ o ..0 <'3 <l> .... o ..... 3: ~.------------ ..... c <l) 8 <l> 1Il '(i3 a- 0... <I:. 8 o .;;; ...... <'3 <l> 0... ~ "d <l) O'l ..... <'3 ...c: u "d C <'3 "'0 <l) ..... <l) .... c tx:\ REV-518 (8-78) COMMONWEALTH OF PENNSYLV ANIA 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 Robert P. Conway, vice President The Commonwealth National Bank ]n~. M~~~p~ ~q_, RhEa, PA (Executor or Administrator) In Re: Estate of Daniel L. Elicker Cumberland County - File No. 21-78-0537 Dear You are hereby notified that the Original appraisement in the estate of Daniel L. Elicker has been filed in the office of the Register of Wills of Cumberland County on 25 .ll..pril _,19-1-9, Said appraisement reflects the following vo I uoti ons: Rea I Estate N () n p Personal Property-S.2::l ) h? 1 _ f) 3 Transfers Fone Jointly Owned None T ota I S 2 3 t f) 2 1 . 6 3 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 20 April 1979 Signed C)-- Title. AnminisT~dTive Officer l,-------- Note: This is not a bill.