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HomeMy WebLinkAbout09-07-79 Inventory of the real and personal estate of Mary Jane Gutshall deceased. CASH AND CASH ITEMS: Dauphin Deposit Bank & Trust Company - Checking Account # 39 23 594 7 Dauphin Deposit Bank & Trust Company - Regular Passbook Savings Account # 1215532 Accrued interest - Harris Savings Associ~tion - Optional Payment Savings Account # 37653 Accrued interest - Received from American Water Works Service Company, Inc. - Accrued and earned vacation pay Received from Aetna Life Insurance Company - Claim payment Received from Mohlers Insurance Agency - Refund on Homeowners Policy Received from Bankers Life & Casualty - Refund on Medical Insurance Received from Internal Revenue Service - Refund on 1978 Individual Federal Income Tax Received adjustment of Real Estate Taxes and Utilities to date of sale 8/13/79 REAL ESTATE: 502 Williams Grove Road, Mechanicsburg, Penna. - Proceeds of sale MISCELLANEOUS: Household effects - Proceeds of sale $ 3,477 39 80 88 12 46 51 1 15 566 80 128 57 17 00 25 36 125 00 394 24 42,000 00 1.236 05 $48.099 07 COMMONWEALTH OF PENNSYLVANIA .l COUNTY OF CUMIIILAND ~ 55: Charles H. Faustt Trust Officer of Dauphin Deposit Bank & Trust Company according to law, deposes and says that the y Rr~ th~ F.x~C'l1t"or~ of the Estate of Marv Jane Gutshall late of Mech~1!ic~u!,~____________ I Cumberland County, Pa., deceased and that the within is an inventory made by Dauphin Deposit Bank & Trus.t.....C.o.mpRny 0' the said F.:x~('l1tor of the entire estate of said decedent, consisting of all the personal property and real estate, except real estate outside the Commonwealth of Pennsylvania, and that the figures opposite each item of the Inventory represent it's fair value as of the date of decedent's death. DAUPHIN DEPOSIT BANK AND TRUST COMPANY t Executor the Estate of Mary J ~~sha>> B: ~ Executor. ArdMIIIdJtRltM Trust Officer being duly sworn ~G and subscribed before me, ~ s 191~ ~,\<,~~ NOT ARY PUBliC o 0 E ires December \. \980 M'.I CommISsIon xP hO C~..ty Daup m ...... Karri$burQ. PA 213 Market Street Harrisburg. Pennsylvania Address 17101 Date of Death 16 Day December Month 1978 Vear INSTRUCTIONS I. An inventory must be filed within three months after appointment of personal representative. 2. A supplement inventory must be filed within thirty days of discovery of additional assets. 3. Additional sheets may be attached as to personalty or realty 4. See Article IV, Fiduciaries Act of 1949. >- " Q) .... w ... ~ c::: .... III W <( Q) 0. .... U 0 0 V) ...-I Q) II W W C 01 I c::: ...-I I-l III t- o. LL cO ;:l 0. Z .... -I .s:: ,0 III LL -I <( 0 en en 0. ~ W 0 <( w .j.J (,) .,;. '" > Z c::: 8 .,.-j ~ ... "" Z 0 c " C :;, 0 V) Z 4.1 '5 0 c::: <( ~ 0 Z w 4.1 J - 4IIto 0. l-J ;:E: " ..Y c ..I III ... "'i: I-l 0 Q) cOi ...0 ;:E:i Q) E " ...lIl ... ..! 0 I III :;, 0 -I U u:: all "arm RC C -10 '1/_ -77': {- Ff (< / DEDUCTIONS ALLOWED IN OFFICE OF THE REGISTER OF WILLS STATEMENT OF DEBTS AND DEDUCTIONS .",- OF Cumberland COUNTY AND AGENT OF THE COMMONWEALTH { ,& (' L . \. -"'" ESTATE OF Mary Jane Gutshall LATE OF MpC'hani l'!'lhllrg DATE OF FILING APPRAISEMENT ~ct: ~DAU OF DEATH December 16, 1978 I I DATI!: NO. OF NAME OF PAYEE REMARKS AMOUNT VOUCHSlt 1978 ~ 27 Daunh;n nenosit Bank & Trust Reimbursement for Letters Company - '~_n ~~ Inn 1979 -:r <In 1 American Water Works Service Reimbursement Medical Insurance Company. Inc. - -~ 1?~ "7 ''''-1m Jan. 10 Rea & Derick, Inc. - Pharmacy 10 75 Jan. 10 Mechanicsburg Oil Company - Balance due as per statement 40 43 Jan. 12 Dauphin Deposit Bank & Trust Reimbursement for deposit to Company - cover overdraft in checkinC!' It- ~ 7" Jan. 12 Penna. Power & Light Comnany - Electric service to 1/2/79 22 68 Jan. 16 Dauphin Deposit Bank & Trust Reimbursement for two Short Company - r."',.t-;&.:__.... ? Inn Jan. 19 Holy Spirit Hospital - Balance due on hospital bill 5 95 Jan. 19 Chuck E. Bricker - Appraisal of household effects 20 00 Jan. 23 Cumberland Law Journal - Cost of AdvertisinC!' & Proof of Publication lR 100 Jan. 23 Mechanicsbure: Boroue:h - Sewer & refuse service 17 1"i0 Jan. 25 Bell of Penna. Telenhone bill rI",t-_rI 1/lQ/7Q ~~ 1(:,,, Feb. 2 Mechanicsbure: Oil Comnanv - Oil delivery on 1/15/79 "i4. "i7 Feb. 9 Penna. Powpr Ii, LiD'hr r~-, - F,l",C'r,.;C' !'lp,.u;ro", t-n 1/':tn/7Q " h., Feb. 14 Mohlers Insurance Ae:ency, Inc. - Homeowners Insurance to 3/1/79 92 00 Feb. 16 William J. Davlor - Annraisal of 502 Williams Grove Road MechaniC'!'lhurC!' !-'@nna l?"i 00 Feb. 16 Holy Snirit Hospital Radiology Professional services' chest Associates - x-ray 12/15/78 13. 00 I'orm RC C.lO ESTATE OF Mary Jane Gutshall I.AT&: OF Mechanicsbure OFFICE OF TME REGISTER OF WILLS STATEMENT OF DEBTS AND DEDUCTIONS Ownherland COUNTY AND AGENT OF THE COMMONWEAI.TH DATE OF FII.JNG APPRAISEMENT DATE 0.. DEATH n"'...pmh"'T 1 (" 1 q7R I I DATE NO. OF NAME OF PAYEE REMARU AMOUNT VOUCH"" 1979 Feb. 23 Holv Snirit Hospital - Balance due on hospital bill 1 70 F",h 26 Cumberland Publishers. Inc. - Cost of Advertising & Proof of Plln1;"'::lt-inn 1(, 65 28 Jackson Gastroenterology - Professional services / Feb. 145 80 Mar. 6 Mechanicsburg Oil Company - Oil delivery on 2/12/79 53 73 Mar. 9 Robert W. Stahl, M.D. - Professional services 38 50 Mar. 9 Rav W. Anderson - 1979 County Real Estate Taxes 112 29 Mar. 9 Mechanicsburg Water Corp. - Water service to 2/22/79 25 43 M::l,... q Penna. Power & Light Company - Electric service to 3/1/79 6.18 Mar. 9 Mechanicsburg Oil Company - Oil delivery on 3/6/79 32 .93 Mar. 13 Brickers Auction House - Commission on sale of household effects 370 .05 Mar. 16 Gingrich Memorials - Gravestone & foundation 470 .00 Mar. 16 Sites Village Deli - Food and refreshments for after funeral 174 .90 Mar. 16 Mvers Funeral Home - Funeral expenses less lump sum death benefits 1 981 .00 M::lr 20 Mechanicsbure Water Comnany - Water service to 3/14/79 19 27 Apr. 3 Mechanicsburg Borough - Sewer & refuse service to 4/2/79 17 .50 Apr. 10 Penna. Power & Light Company - Electric service to 3/30/79 3 24 Mav 2 Mechanicsburg Oil Company - Oil delivery on 4/23/79 25 57 Mav 9 Penna. Power & Light Company - Electric service to 5/1/79 2 58 Mav 10 Ernest Beckward - Trash removal and cleanine of residence ~n nn June 13 Penna. Power & Li~ht Companv - Electric service to 5/31/79 2 53 T..1,. 1 '1 n___ _ TI_____ r T ~ _'--.&... ,., -~--- - - _1 . .. . - - . -- OFF ICE OF THE REGISTER OF WILLS STATEMENT OF DEBTS AND DEDUCTIONS THE SUM OF REV-4II11 (8-78) OF Cumberland COUNTY AND AGENT OF THE COMMONWEALTH ESTA TE OF Mary Jane Gutshall LATE OF Mechanicsburg DATE OF FILING APPRAISEMENT DATE OF DEATH December 16. 1978 DATE NO. OF NAME OF PAYEE REMARKS AMOUNT VOUCHER 1979 July 13 Mechanicsburg Borough - Sewer & refuse service $ 49 40 Aug. 9 Penna. Power & Light Company - Electric service to 8/1/79 2 48 Au~. 17 Rothman & Schubert Real Estate Miscellaneous surveying costs, tax adiustments and notary fees 495 06 Aug. 17 Recorder of Deeds - Realty Transfer Tax 420 00 Aug. 17 Rothman & Schubert Real Estate Commission on sale of 502 Williams Grove Road, Mechanicsburg. Penna. 2 940 00 Notary Fees 1 00 RESERVE TO PAY THE FOLLOWING: George M. Houck - Attorney's Fees 2,404 95 Daunhin Deposit Bank & Trust Company - Executor's Fees 2,404 95 Reserve to File Account - 65 00 $12.976 40 - COMMONWEAL TH OP PENNSYLVANIA} SS: COUNTY OF Dauphin I, Ch,qr1 PI'; H _ Falll';t, Trust Officer of Dauphin Deposit BankH~RlB\JS&rFfl'~~lf~AT TO THE BEST OF MY KNOWLEDGE AND BELIEF, THE FOREGOING IS A JUST AND TRUE STATEMENT OF DEBTS, FUNERAL EXPENSES AND EXPENSES OF ADMINISTRATION SUBMITTED TO THE ESTATE OF M,qM;~ DECEASED, AS DEDUCTIONS FOR INHERITANCE TAX PURPOSES. ~,~~ 5 0...:, (L.S.) SWORN AND SUBSCR1!'SED BEFORE ME THIS DAY OF ~ 19 '\~ ~ ~. ~::rt NOTARY PUBLIC Mv (omm;,sion Expir~ Oecember I. 1980 Harri$burg. PA llauphin Cll\IIIly .~ COMMONWEAL TH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS ,2/- 7/-- (:1r . .. "-1-71 RCC-S3 (4-7~1 .. 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'ilenue. (Section 703 of the Inheritance and Estate Tax Act of 1961.) IN THE MATTER OF THE ESTATE OF Mary Jane Gutshall (STATE FULL NAME OF DECEDENTI } AFFIDAVIT OF EXECUTOR ~ County Late of Cumberland State of Pennsylvania County of Dauphin }., Charles H. Faust. Trust Officer of Dauphin Deposit Bank & Trust Company ~ - of the estate of the above-named decedent being duly sworn, depose and say Executor Decedent died December 16 , 19-1.L{~estate leaving a last will, copy of which is hereto attached. } (y EAR) 'ntestate (MONTH) Name and address of attorney or } other autharized representative to whom n" corr-e$pondence should be ma i led. (DAY) Charles H. Faust. Trust Officer of Dauphin Deposit Bank & Trust Company 213 Market Street. Harrisburg. Penna. 17101 That as such Executor deponent is familiar with the affairs of said estate and the property constituting ( EXECUTOR-X~la~X~ 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 .. ---... - .-. That the contents of said safe deposit box or boxes are itemized under Schedules 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 interest thereon, if any, down to the last interest 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 the time of death; all wearing apparel, jewelry, silverware, pictures, books, works of art, household furniture, horses, carriages, automobiles, boals, and any and all other personal chattels of whatsoever, kind or nature, left by decedent, together with lhe 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 Jes~ than the face value, it sets forth briefly the reasons for such depreciation as to each item; all moneys pay"ble to the estate from life insurance policies carried by decedent; all annuity and endowment contracts the pwceeds 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 de,,' h ,l11d "I ber j llVC stment securities owned by the decedent at the time of death, with the market value there- of <11 such lime. ~ 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 inter~st there is mlnexed 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 pertaining to the business as may be pertinent to a fair and just appraisal of the decedent's interest therein must be submitted. It should also set forth in itemized form, together with the fair market value thereof, any other property owned or bequeathed by the decedent at the time of death. The Schedule C attached hereto and made part hereof sets forth a true answer to each inquiry contained therein and in the case of transfers of property, real or personal, within t.wo years of decedent's death, in contemplation of decedent's death, or intended to take effect in possession or enjoyment at or after death, said schedule sets forth the nature and value of such property, to whom transferred, the relationship of the transferees to the decedent, the proportionate share received by each transferee and all other facts of a pertinent nature regarding said transfers. In the case of transfers intended to take effect in possession or enjoyment at or after death, there is also attached to the schedule a copy of the deed, trust agreement or other instrument creating the trust. Therp. is also set forth in said schedule a list of all property, real and personal, with its value, which passes at decedent's death by virtue of the exercise by decedent, either individually, or jointly with another, or any power of appoint- ment vested in decedent, either individually or jointly, by the will, deed, or other instrument of another, with a copy of the instrument creating such power attached to the schedule. That Schedule D attached hereto and made part hereof sets forth the names and addresses of all persons beneficially interested in this estate at the time of decedent's death, the nature of their res- pective interests, their relationship, if any, to the decedent, together with the ages at the time of decedent's death of all minors, annuitants and beneficiaries for life under decedent's Will. It also contains a statement showing which of the beneficiaries named in the decedent's will, if any, died prior to decedent, the dates of their death, their issue, and the relationship of such issue to the beneficiary. That Schedule E attached hereto and made a part hereof sets forth all property, real and per.. sonal, owned by the decedent jointly with another or others, including intangible, standing in the name of the decedent and others, plus the date and place of record of instruments effecting the vestiture of real estate and the date of acquisition of personalty, plus the name, address and relationship, if any, of co-owners to the decedent. That Schedule F attached hereto and made a part hereof sets forth fUlly and in detail all debts and deductions claimed for and on behalf of this decedent's estate, including fUneral expenses paid; family exemption, where applicable; costs of administration of this estate; counsel fees and fUdiciary's commissions paid or to be paid; cost expended for burial trusts, tombstones or gravemarkers, and reli- gious services, in consequence of the death of the decedent; debts and claims owing and 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. ...................~................... day of .....$.~..kD...... 19.Tlf..... ..................~~~..,....~~.................... Nor ARY PUBLIC 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. DAUPHIN DEPOSIT BANK & TRUST COMPANY, Executor of e Estate of Mary Jan utshall By..:...................... . ..........................'2.....~~ (E:recutor-JbbriUliw.~) Trust Officer ~.:L.J....Mar.k.et.....s.Ue.e.t.......................................................................... (StTeet Numbrr) My Commission Expires De(2m~er I, 1980 ~f!..r.rJ.~.b.ur.i.~....F.~nnS31y..ania.......ll.1O'l....................... HarriJburg, PA Dauphin CQl/llty (City Of' Tow" aM 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. Subscribed and sworn to before me this ................................. RC C-34 (4-73) COMMOtiWEAL1H OF PENNSYLVANIA 'DEPARTMENT OF REVENUE BURE'AU OF COUNTY COLLECTIONS TRANSFER INHERITANCE TAX RESIDENT DECEDENT SCHEDULE "A" REAL PROPERTY *' Real property in Pennsylvania, with statement of mortgage encumbrances upon each parcel at death of dece- dent. Property held by the decedent as tenantjn 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 Common_alth 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 II 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 1 1/2 Story detached single family dwelling with an attached carport situated at 502 Williams Grove Road, Mechanicsburg, Penna. Sale price - tj 1'f(), $42,000.00 t/ J/f-~"C(),(J{) $42,000.00 tlA)A4It +.L tUJ iIid ~ 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. # Lf~ IJ()(), (J{) RESIDENT DECEDENT SCHEDULE "B" PERSONAL PROPERTY .. REV-4!l1 (8-781 G:OMMON\vEAL TH 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 liE". 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 tentative trust accounts, must be listed, despite the fact that they are not of the adminis tered 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 payable 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 Ii s ted in thi s schedule. Item No. I1EM List and describe fully UNIT VALUE ESTIMA TED MARKET VALUE DEPARTMENT VALUATION (Do not write in this space) CASH AND CASH ITEMS: Dauphin Deposit Bank & Trust Company - Checking Account # 39-23-594-7 Dauphin Deposit Bank & Trust Company - Regular Passbook Savings Account # 1215532 Accrued interest - Harris Savings Association - Optional Payment Savings Account # 37653 Accrued interest - Received from American Water Works Service Company, Inc. - Accrued and earned vacation pay Received from Aetna Life Insurance Company - Claim payment Received from Mohlers Insurance Company - Refund on Homeowners Policy Received from Bankers Life & Casualty - Refund on Medical Insurance Received from Internal Revenue Service - Refund on 1978 Individual Federal Income Tax Received adjustment of Real Estate Taxes and Utilities to date of sale 8/13/79 $ 3,477 . 39 80.88 .12 46.51 1.15 566.80 128.57 17.00 25.36 125.00 394.24 MISCELLANEOUS: Household effects - Sale price 1,236.05 Insert thi s total opposite "Personal Property", Schedule "B" in the "As Reported" column on the last page of this return. xx $ 6,099.07 ~tJ99.tJ7 ;uo Rcc-36 COMMONWEALTH OF PENNSYLVANIA TRANSFER INHERITANCE TAX SCHEDULE "c" TRANSFERS 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) (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) (3) If the answer to (1) or (2) above is in the affirmative state: (a) Age of decedent at time of transfer (b) State of decedent's heal th at time of making the transfer. (Note 1). (c) Cause of decedent's death. (Note 1). (4) Did decedent, in his lifetime, make any transfer of property without receiving a valuable or adequate consideration therefor which was to take effect in possession or enjoyment at or after his death? (Answer yes or no) (a) Was there any possibility that the property transferred might return to transferer or his estate or be subject to his power of disposition? (Answer yes or no) (b) What was the transferee's age at time of decedent's death? (5) Did decedent in his lifetime make any transfer without receiving a valuable and adequate consideration therefor under which transferor expressly or impliedly reserves for his life or any period which does not in fact end before his death: (a) The possession or enjoyment of or the right to income from the property transferred? (Answer yes or no) (b) The right to designate the persons who shall possess or enjoy the property transferred or income therefrom? (Answer yes or no) (6) If the answer to (5) (b) above is in the af'firmative, state whether the right was reserved in decedent alone or others (7) Did decedent in his lifetime make a transfer, the consideration for which was transferee's promise to pay income to or f'or the benef'it of care of transf'eror? (Answer yes or 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) (9) If the answer to (8) above is in the affirmative, was the power to alter, amend, or revoke the inter- est of the beneficiary reserved in the decedent alone or the decedent and others? (Answer yes or no) NOTE 1: The answers to these questions should be supported by affidavit by the attending physician as well as a copy of the death certificate. NOTE 2: If answer to any of the above questions is yes, set forth below a description of the property transferred, it's fair market value at date of death, dates of transfers and to whom transferred, with relationship of transferees to decedent, if any. Submit copy of any trust deed or instrument, if trans- fers are claimed to be non-taxable, also submit detailed statement of facts on which said claim is based. NOTE 3: List applicable property below in manner in which provided in Schedules A, B, or E. ITEM DESCRIPTION MARKET VALUE (Es tima ted) DEPT. VALUATION (Dept. Only) Mortgage on 16 South Washington Street, Mechanicsburg - Forgiven prior to death (mother to daughter) Balance of Mortgage - $12,584.72 $12,584.72 Insert this total opposite "Transfers", Schedule "C" in the "As Reported" column on the last page of' this return. /~.r%~ 7~ ~ RCC-37 (12-63) . , CO!\tMO~WEALTH OF PENi\SYYLANIA TRANSFtR 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 ave an interest, vested, contingent or other are involved, set STATE YES IN ESTATE wise, in estate) forth this fact.) OR NO BIRTH Marv Kathleen McGlou2:hlin a/k/a McLau2:hlin Daughter Yes $1,000.00 Pecuniary 18 East Maplewood Avenue Beouest + 1/5 Residue Mechanicsbur2:. Penna. 17055 Alton D. Gutshall Son Yes 1/5 Residue Ft. Belvoir. Vir2:inia Grace E. House DaulZhter Yes 1/5 Residue 16 South Washington Street Mechanicsburg, Penna. 17055 Mariorie A. Berkheimer Daughter Yes 1/5 Residue R. D. fI2 White Rock Acres 72 Kuhn & Valley View Drives BoilinlZ SorinlZs. Penna. 17007 Peter D. Gutshall Son Yes 1/5 Residue 2332 Chesterfield Lane Mechanicsburg, Penna. 17055 Dauphin Deposit Bank & Trust Trustee Net oroceeds from Company, Trustee for the sale of real estate benefit of Theresa G. Shank, grand-daughter I~... j:t.,<""9 Crippled Children and Adult 1\T nn '" h"~ nf' R@mainder Trust Society of Penna. FullinlZ Mill Road Middletown, Penna. 17057 Deponent further says that all the above-named beneficiaries are living at this time except below: NAME DATE OF DEATH RESIDENCE RCC-37 (12-63) COMl\lO~WEALTH OF PEN":\'SYYLANIA 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 D. T. Watson Home for Crinnled None 20% of Remainder Trust Children Leetsdalet Penna. Cerebral Palsey Center None 10% of Remainder Trust 15 South 30th Street Camp Hillt Penna. 17011 - St. Jude's Research Center None ~ of Remainder Trust , (Dannv Thomas Foundation) Donaldsonville. Louisiana , . Deponent further says that all the above-named beneficiaries are living at this time except below: NAME DATE OF DEATH RESIDENCE .... ""':' 'sCI;I"f""'t e<'" 1;;: = '2 ~ e 0- ~ :s .5-ao ~ e u ~ 0: su-g "St;t: u ;:l 0 ~eg. f5 P:: SUMMARY Real Property .................. ..................................... (Sch, "A") Personal Property................................................................. (Sch. "B") Transfers ................ .......... ..................... ..... ............... ............ (Sch. "C") Gross Taxable Estate .. ( 1 ) (As Reported) $42.,OOO.~OO.. $ ......6.,.99.~~OL $.. ..J..2."',5.8.4.72..... $ .............. $.................. ................. $..... ~.o. ",.Q.8.:J..79.. (2 ) (As Determined) $ $ $. $ $. $. -------- ~ Q) >< ~ o ~ z c o :c ell b V'l '2 == 'E .~ "0 ::::~ b Z w :E w (J) .... <: ~ ~ ~ <: w ::r: r-< ~ o ~ ~ ~ <: - "" ~ o ~ :z: w !-< t-< II. <: o r-< (J) w ,....j 'ci ..c; (/) -IJ ::! ~ Gl ~ tJ >- 1-1 Cll ::E1 "0 :~ : ell :co ~ :u :~ Q 00: 1-1: ::!: ,0: (/). tJ 'M: 1=1: Cll .c tJ. G,l: ::E1 -- o <1.1 .... ell ...:l ~ ~ ctt r-I k G): i ~ u ~ '2 ~ ~ ;;. V'l C C <1.1 ~ -- o .c' s o u -- o .J: .::: ~ ::: c o E ,... c o U ..:l < CI:l - < c:.: =- =- < Q Z < P- c:.: o =- ~ c:.: RCC-36 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 vesti ture, 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. ~ ~ RCC-39 (8-77) County, Number and Name (?1) CUmbE.>t'latlQ SUMMARY File Number Date of Death 21 7 Q l'l 9 I, December 16, 1978 COMMONWEALTH OF PENNSYLVANIA TRANSFER INHERITANCE TAX RESIDENT DECEDENT Estate Name ~lIt"Rh",ll (LAST NAME) M::!ry T::!n... (FI RST NAME) (IN I TI AL) REPORT OF INHERITANCE TAX APPRAISER I, the undersigned duly appointed Inheritance Tax Appraiser in and for the County of ('11~'h......, ......rt 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: 10 October 1979 Ja..rLclL LtJI d:tn1..L1 /' INHERITANCE TAX APPRAISER 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. REPORT OF THE REGISTER OF WILLS Dated: REGISTER OF WILLS $ I ADJUSTMENTS ODE (HARRISBURG USE ONLYI 00+ 10+ 20+ 30+ REMAINDER APPRAISEMENT CODE INVENTORY Real Property (Schedule AI Personal Property (Schedule BI Joint-Held Property (Schedule EI Transfers (Schedule CI TOTAL GROSS ASSETS Less Debts and Deductions (SCHEDULE FI CLEAR VALUE OF ESTATE 92+ 40- 93- Valuation of life estotes or ~ ]nnuities.~..................._ $ PRINCIPL.E r= FACTOR t= VAL.UE 1~ :STATE TAX ASSESSMENTS _ $ 'OR USE OF REGISTER ONL.Y 'ox on $ 'ax on $ 'ax on $ .ax on $ ox on $ xemptions otal Estate ~ COMPUTATION OF TAX 2% 6% 15% $ $ $ $ $ * TOTAL TAX $ (*) As evidenced by Chorltable Exemption Certificates issued by the Secretary of Revenue. Less tox previously paid BALANCE ess 5% of tax if paid within months after death t= $ $ $ "LANCE OF INHERITANCE TAX DUE jd interest at rate of 6% from to oiOUNT OF ESTATE TAX ASSESSED $ ;tate tax paid $ $ I t BALANCE DUE C: $ Id interest at rate of 6% from to $ $ TOTAL TAX BALANCE $ PAID $ pplemental Cddes: (FOR USE IN HARRISBURG ONL Y) 48-Adjustment 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. , REV-SIB (3-79) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF FIELD OPERATIONS P. O. BOX 2970 HARRISBURG 17105 IN YOUR REPLY PLEASE REFER TO Investigation Division NOTICE OF FILING OF APPRAISEMENT Mr. CharlesH. Faust Trust Officer Dauphin Deposit Bank & Trust Co. P.O. Box 2961, Hbg., PA 17101 (Executor or Administrator) In Re: Estate of MaryJ. Gutshall Cumberland County - File No. 21-78-0694 Dear You are hereby notified that the Origi tl a1 appraisement in the estate of Ma:ryJ. Gutshall has been filed in the office of the Register of Wills of Cumhe'r'land County on 1 n OCTohp.T' ,19_1_9.: Said appraisement reflects the following valuations: Real Estate Personal Property Transfers Jointly Owned Total 42,000.00 6,099.07 12,584.72 None $60,683.79 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 ]0 October 1979 Signed Title ~ndAtv dt~ Appr;liGor NOTE: This is not a bill. REV-457 ~8-78) 'O!PAR'TMENT OF REVENUE BUREAU OF FIELD OPERATIONS P.O. BOX 2970 HARRISBURG, PENNA. 17105 COMMONWEALTH OF PENNSYLVANIA RESIDENT INHERITANCE TAX APPRAISEMENT [jAil.:. 10 October 1979 Cumberland 21-78-0694 COUNTY FilE NO. Whereas, MarvJ. Gutshall late of Mechanicsburg in the County of Cumberland Commonwealth of Pennsylvania, having died on the 16th day of De cember 19 ..::!., seized and possessed of an estate subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania; Therefore, I, ~;:tnt'l'l";:t ~Tnn". , 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 R".;:t1 F.!O:T::lte $ PO 42.000 - ;:t 1 - .'l"TV 6,099 D7 Transfers 12 584 72 .ToinTlv Owned None "'-...... , r;F;O F;R3 79 . , / Have been duly sworn according to law, I do hereby certify that the above appraisement is made in conformity with the law on this lOt h day of 0 c ~ xt!:t..n 19 ...:z.g,.. . /)dA~ uj Appraiser (Number and Street) lore g . (Post Office) , Penna.