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RC.'C-33 (4~7!)
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COMMONWEAL TH OF PENNSYLVANIA
DEP AR TMENT OF REVENUI!
BUREAU OF COUNTY COLLECTIONS
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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'otenue. <Section 703 of the Inheritance and Estate Tax Act of 1961.)
IN THE MATTER OF THE ESTATE OF
} AFFIDAVIT OF
EXECUTOR
ADMINISTRA TOR
County
Dessie E. Skelly
(STATE FULL NAME OF DECEDENT)
Lote of Cumberland
Stote of
PENNSYLVANIA
County of
CflMRF<;RLAT\TD
}"
Admini s tra tor
G. Irvin Van Scyoc
of the estate of the above-named decedent being duly sworn, depose
Executor
and soy
October 1,
(MONTH)
Nome and address of attorney or }
other authorized representative to whom
011 correspondence should be moiled.
(DAY)
, 19~{~estote leaving a last will, copy of which is hereto attached. }
(y EAR) Intestate
Decedent died
John H. Brou.ios. Esquire
Broujos and Andrews
Four North H:mover Stroot
Carlisle, Pa. 17013
That as such executor deponent is familiar with the affairs of said estate and the property constituting
(EXE CU TO 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
IN WHICH DECEDENT RENTED A SAFE DEPOSIT BOX
1\TrI1\TR
THIS SAFE DEPOSIT BOX RENTED
IN NAME OR NAMES OF
RELATIONSHIP OF JOINT
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 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, 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 ses sion, s tanding 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 pen,ons
glvrng also separately the accrued interest thereon, if any, down to the last interest day prior to decedent'~.
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 interest 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 husiness.
A copy of the co-partnership agreement, (if oral, a statement setting forth the nature of' the agreement)
together with a statement setting forth the character of the business, its location, and such other facts
pertaini ng to the business as may be pertinent to a fair and just appraisal of the ctecedent's interest
therein must be submittl~d. 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 transf'erred, 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 copy
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 pa~ses at deceflent's death by
virtue of the exercise by decedent, either individually, or jointly wi th 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 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 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 unpaid 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.
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..216h..West...King...St.r..eet..............h..........................................
(Street Numbe-r)
...Shippens.bur.g;.~....PA..h..172S7.h......
(City or Town and State)
Subscribed and sworn to before me this .................................
NOTE: Before signing affidavi t make sure all blank spaces in the affidavit and schertules 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 requirefI 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.
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I, DESSIE E. SKELLY, 28 West Pomfret Street, Carlisle, Cumberland
County, Pennsylvania, declare this to be my last will and revoke anv
will previously made by me.
ITEM ONE. I direct that all my just debts and funeral expenses in-
cluding the marking of the year of death on the gravemarker, shall
be paid from my residuary estate, as soon 88 practicable after my
decease, as a part of the expense of the administration of my estate.
ITEM TWO. T bequeath the sum of One Hundred Dollars ($100.00) to
the Visiting Nurses Association, Carlisle, Pennsylvania.
ITEM THREE. I specifically bequeath the items of personal property
specifically and clearly marked within the residence at 28 East Pomfret
Street to those persons so designated in the markings. In the event
of any controversy in this regard, my executor shall make the final
and absolute decision.
lTEM FOUR. r give, dev~ge and bequeath the remainder of my estate
to be divided equally among the following institutions, to he used
for the general purposes of such institutions:
A. The First Lutheran Church, Carlisle, Pennsylvania.
B. Carlisle Hospital, Carlisle, Pennsylvania.
ITEM FIVE. All estate, inheritance, succession, and ocher taxes,
imposed or payable by reason of my death and interest and penalties
thereon, with respect to all property comprising my gross estate for
tax purposes. whether or not such property passes under this will.
shall be paid out of the principal of my residuary estntE", withol:~
apportionment or r 19ht or ndmbursement.
ITEM SIX. I authorize my executor and his or her successors to
exercise the following powers, in addition to those given by law, to
be exercised in his sole discretion:
(a) To invest in any real or personal p.roperty without restriction to
legal investments.
(h) To repair, alter, improve, or lease for any period of time nn}'
real or personal property and to give options ior leases.
(c) To se 11 at pub 1 ie or private sale, for cash or cred it, with or
without security, to exchange, or to partition real or personal
property and to give options for sales or ~xchanges.
(d) To compromise claims.
(e.1 To make d tatr ibution in kind.
(0 To exercise all power, authority, and discretion given by this
will after the termination of any trust created therein until
the same is fully distributed.
r'l1:'1I1 SEVEN. I appoint G. IRVIN VAN SCYOC, 112 west King Street,
Shippensbllrg, Pennsylvania, to be my funeral director and my executor.
Should HR. C. IRVIN VAN SCYOC for any reason fail to, qualify or cease
to act as executor, I appoint Carlisle Deposit Bank executor of this
:11) last will, with the Si1l'nt' duties, powers, and discretions as if
originally appointed.
I'clf~l' ont> of two p,lges
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ITEM EIGHT. I direct that my personal representative shall not be
required to give bond for the faithful performance of his duties in
any jurisdiction.
IN WITNESS WHEREOF. I have hereunto set my hand this
'l)( / '1 ]"," fri . in thF year of our Lord one thousand
and aixty e~.,,} i't '", '
/ I , \ l~_
day of
nine hundred
SIGNED
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The preceding instrument, consisting of this and one other typewritten
page. each identified by the signature of the testatrix, was On the
day and date thereof signed. published, and declared by DESSIE E. Sr"ELLY.
the testatrix therein named as and for her last will in the presence of
\IS, who at her requeAt. in her presence and in the p~~ence of each
other have subscribed our names as wi tn se hereto. f _~
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SIGNED
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Address '"
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SIGNED '"f.... t ~ ,~ _ .~ ^__
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Addres:; \'~<'\..'-~"'" \I. 11
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Address
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Page two of two pages
I
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COD I elL
I, DESSIE E. SKELLY, 28 East Pomfret Street, Carl isle, Cumuerland,
County, Pennsylvania, having made my Last Will dated March 13,
1969, do hereby make, publish, and declare this to be a Codicil
to my said Last Will.
ITEM ONE. In Item Seven of my Will, I hereby revoke the designa-
tJon uf Carlisle Deposit Bunk as alternate Executor after G. Irvin
Van Spyoc and hereby designate and appoint John H. Broujos, 4 North
Hi'lIlOVe r Street, Carl is Ie, I'ennsy1 vani", as r~x(:!cutor wi th the same
dutieB, powers, and discretions as if originally appointed, in
the event that Mr. G. Irvin Van Scyoc for any reason fails to
qualify or ceases to act as Executor.
ITEM TWO. I hereby ratify and confirm my said Last Will and
Testament except insofar as any part thereof is rovoked or modi-
fied 'by thia Codicil.
TN WITNESS WHE1-<.EOF, I hereunto set my hand this l3th day of
March, in the year of our Lord one U10usand nine hundred .'trHl
sixty-nine.
SIGNED
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The precedin"" i ne trllment, ('ons ist inq of th i s one Lypewr i t ten page,
was on the day and dale thereof signed, publ1sLcd, and declared
by DESSIE E. SKELLY as a Codic i 1 to h(~r Las t Wi 11 and TestdmE"~1t
dated March 13, 1969, in lhe presence of us, who at her request,
in her presence, and in the presence of each other have subscribed
bur names as witnesses hereto.
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Addre!;s <:7 ~ \ ') 6 ~'-~-..,
SIGNED t~~L~ .. '-J~ A___~
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Address ~~.... ~........~_ \~ QI\L')'\.~,- \.~_.~"-,,,-,
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SIGNED
SIGNED
Address
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RC ~-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 locat8d In the Commonwealth of P8nnsylvanla should be
descrlb8d by lot and block number, street and street numb8r, together with
a general descrl ptlon of the property, with a reference to the record af the
conveyance by which the decedent took title; If a farm state number of a-
cres; also stotoment of mortgage encumbrances upon each parcel at death
of dec8dent. Taxes, assessments, accrued Interest on mortgages, etc.,are
to be listed on Schedul8 "F" and must not be deducted from this schedule.
(1 )
(2)
(3)
DEPARTMENT
VALUATION
CAUTION
(Do not write
In this space)
ASSESSED VALUE
FOR YEAR OF
DECEDENT'S
DEATH
ESTIMA TED
MARKET VALUE
NONE
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.
RESIDENT DECEDENT
SCHEDULE "B"
PERSONAL PROPERTY
.RCC -35.
COMMONWEALTH OF PENNSYLVANIA
Ta4NSFER 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 li~ted under Schedule "En. 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 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.
1.
-0-
DEPARTMENT VALUATION
(Do not write in
this space)
Item
No.
ITEM
List and describe fully
UNIT
VALUE
ESTIMATED
MARKET VALUE
Clothing and personal effects
-0-
2. Blue Cross-Blue Shield Check No. 45213599
45305928
62174341
3.
Series E Savings Bonds.
interest
$100.00
C624682E, 7-19-41, Anna B. Skelly
P.O.D. to Dessie E. Skelly
$100.00
C624683E, 7-19-41, Anna B. Skelly
P.O.D. to Dessie E. Skelly
299 .80 ~
$ 50.00
L675763E, 7-19-41, Anna S. Skelly
P.O.D. to Dessie E. Skelly
(*Note: Anna B. Skelly deceased
4-25-60)
149.90
TOTAL received
$759.10
4.
Metropolitan Life Insurance Co.
Polivy #134-400-428
Beneficiary: Anna B. Skelly who deceased
4-25-60
452.73
5.
Penn Mutual Life Insurance Co.
Policy #1 066 751
,/
1,033.96/
6.
Commonwealth National Bank
Balance from Trust 11,031 Units Fund A
Accrued interest on above to 10/1/78
Principal cash balance 10/1/78
Income cash balance
11,416.55
7.
Reimbursement for amounts expended by Dessie E.
Skelly, Administratrix c.t.a. for Estate of
Anna B. Skelly in administering estate
1,212.20
8.
Refund, Presbyterian Home
n.oo
Insert this total opposite "Personal Property", Schedule "B" in
the "As Reported" column on the last page of this return.
x X
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14,986.98/
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RCC -'36
COMMO~WEALTH OF PENNSYLVANIA.
TRANSFER INHERITANCE TAX
SCHEDULE "c"
TRA.NSFEIlS
'*
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) tIo
(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)---11o______
(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 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 NA
(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) 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)
NA
N~
Insert this total opposite "Transfers", Schedule "e" in the
"As Reported" column on the last page of this return.
RCC-37. 02-63)
CO~II\IO:'II"'EALTII OF PEX:,\SYYL\NIA
TRANSFER INHEHITAl\'CE TAX
RESIDENT DECEDENT
SCHEDULE "D"
BE:\EFICI.\l\lES
\
h
RELA TIONSiiIP[ I
BENEFICIARIES AND ADDRESSES (If step-children or SURVIVED DATE INTEREST OF
State full names and addresses of all who 011 T hOld I DECEDENT I OF BENEFICIARY
1 egllmate c 1 ren STATE YES
aye an interest, vested, contingent or other- are Jnvolved. set OR NO BIRTH IN ESTATE
wise, in estate) forth this fact.) ,
l. The Visitin~ Nurses' Assn. $100.00 cash bequest
r/n r:::lY'lic:lp Hnc:nito~l
Carlisle. Pa. 17013
2. The First Lutheran Church 1/2 remainder
East High Street
Carlisle. Pa. 17013
3. Carlisl~ Hospital 1/2 remainder
Carlisle, Pa. 17013
Deponent further says that all the above-named bene~iciaries are living at this time except below:
NAME
DATE OF DEATH
RESIDENCE
3
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SUMMARY
( Sch. "A")
. (Sch. "B")
(Sch. "e")
H.eal Property
Personal Property
Transfers
Gross Taxable Estate
$
$
$
$
$
$
( 1 )
(As Reported)
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(2)
(As D/'tr'rmilwd)
$
$
$
$
$
$
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R.C C-38
RESIDENT DECEDENT
SCHEDULE" E"
JOINTLY OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
INSTRUCTIONS: This scheclule must disclose all property, real and personal, owned by the decedent jointly
with 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 tmder Schedule
"A", plus the date and place of record of instrument effecting vestiture, but do not include entireties
or out of state real estate value in estate valuation column. Personal property should be listed as in,
Schedule "B", plus 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 VALUA'l'ION
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 "Eft
in the "As Reported" column on the last page of this return.
-0-
N~
REV-SIB (8-78)
COMMONWEALTH OF PENNSYLV ANIA
DEPARTMENT OF REVENUE
BUREAU OF F!ELD OPERATIONS
P.O. BOX 7.970
HARRISBURG
17105
IN YOUR REPLY PL.EASE
REFER TO
Inheritance Tax Division
NOTICE OF FILiNG OF APPRAISEMENT
G. Irvin Van Scyoc
216 H. King St.
31lipjJt::us1 ut.~, P A
(Executor or Administrator}
In Re: Estate of
Dessie E. Skelly
---.Cumberland
County - Fi Ie No.
21-78-0558
Dear
You are hereby notified that the Orig:i nal
appraisement in the estate of Dp$~;p Foe ~'k:",lJy
has been filed in the office of the Register of Wills of r.l1mnpY11 ripil
County on 11 April ,19-.29.., Said appraisement reflects the following
valuations:
Real Estate
Personal Property
Transfers
Jointly Owned
Total
None
14,898.24-
None
None
$1'1,89B.2Jt
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.
Date
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.
Signed L--e--o \=. ~ -----~
()
Title Administrati ve Officer
11 April 1979
(.'~._----
. -------- ~
Note: This is not a bi II.
REV-45/(S-7B)
DEPARTMENT OF REVENUE
BUREAU OF FIELD OPERATIONS
P.O. BOX 2970
HARRISBURG, PENNA. 17105
COMMONWEALTH OF PENNSYLVANIA
RESIDENT INHERITANCE TAX
APPRAISEMENT
DA I c.
" ApY>i.' 1070
Cumberland
21-78-0558
COUNTY
FILE NO.
Whereas, );)essi{;l to 5Ik{;llly late of VI. FSRIH1BGFB
in the County of C 11m heY" 1 ;:m il Commonwealth of Pennsylvania, having died on
the 2nd day of October 19 -1..8, seized and possessed of an estate
subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania;
Therefore, I, Le 0 rulE: i nit i , 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
-
$
Po:>l r ..... u
P~~~~_~1 p~~~~~+.. 1'+ 898 24
- .t=. fiT,..,,., 0
,T,..,;,.,+1" (h",.,t:>t1 >T
Total kll.t QOQ ,)l.t
I
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 J 1 t], day of \""Y>~1.A \ ~ ,-JL.,., '_ ~\ 19 ...:J...S..
<- " Appraiser
-)
(Numbel and Street)
HarriSburg
(Post Office)
, Penna.
c1
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