HomeMy WebLinkAbout02-20-79 (2)
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RCC-33"(4-73)
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
RESIDENT DECEDENT
COUNTY OF
--
IMPORT ANT:
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\tenue. (Section 703 of the Inheritance and Estate Tax Act of 1961.)
WILLIAM H. THEURER
(STATE FULL NAME OF DECEDENT)
} AFFIDAVIT OF
XxmxREK Executrix
ADMINISTRA TOR
IN THE MATTER OF THE ESTATE OF
Late of Carlis le Borough, CumberlaIl<d,unty
County of
Pennsylvania
Cumberland
},
Executlid.X
State of
MILDRED K. THEURER
X~lKjKiK\il~]'jXJX~--~f the estate of the above-named decedent being duly sworn, deposeS
and say S
(DAY)
, 19~{testate leaving a last will, copy of wh,iCh is hereto attached. }
(YEAR) ~ '
Decedent died Augus t
IMOt,TH)
Name and address of attorney or }
other authorized reprf~sentativ~ to whom
all correspondence shaule;" ~.L
18
WILLIAM F. MARTS ON , P.C.
Ten East High Street, Carlisle, PA
17013
That as such_~~ecutrix_deponent is familiar with the affairs of said estate and the property constituting
, EXECUTOR-ADMINISTRATOR)
the assets thereof and their fair market value.
That at the time of death there was no safe deposit box registered in decedent's individual name, or jointly 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 SAFE DEPOSIT BOX INN AM E 0 R N AM ES 0 F HOLDERS TO DECEDENT
That the contents of said safe deposit box or boxes are itemized under Schedules
with the exception of the following, for the reasons hereinafter set forth:
of this return,
That Schedule A attached hereto and made part hereof sets forth fully and in detail all the real property
in the Commonwealth of Pennsylvania of which decedent died having an interest therein. It also sets forth the
mortgage encumbrances upon each parcel of real property at the date of death, giving the amount still due at
death, name of mortgagee, date, rate of interest, and book and page of record thereof. It also sets forth in the
columns provided therefore the assessed valuation of each of said parcels, the estimated market value thereof
as of date of death of decedent.
That Schedule B attached hereto and made part hereof sets forth fully and in detail all personal property
wheresoyer 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 prim to decedent's
death in the case of savings banks, and to the date of decedent's death in all other cases; all bonds, postal
s av ings, treas ury certificate s or note s and other evidence of indebtednes s of the United State s 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;
U:: """';110 "ppd,d. j<:wdry, "iIlverware, 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 frol11 life insurance policies carried by decedent; all annuity and endowment contracts
the proceeds of which we" 'layable upon the death of the decedent; all and the corporate stocks and dividends
due thereon and unpaid as of ti ; date of death, bonds and accrued interest thereon to the date of decedent's
death and other investment see" ;; es 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 !Jusiness.
A copy of the co-partnership agreement, (if oral, a statement setting forth the nature of Uie a~reement)
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 two years of decedent's
death, in contemplation of decedent's death, or intended to take effect in possession or enjoyment at or
after death, said schedule sets forth the nature and value of such property, to whom tranSferred, the
relationship of the transferees to the decedent, the proportionate share received by each transferee and
all other facts of a pertinent nature regarding said transfers. In the case of transfers intended to
take effect in possession or enjoyment at or after death, there is also attached to the schedule a cogy
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 decedent'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 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.
That the totals of the appropriate columns in Schedules "A", "B", "en, "E", and "F" as directed therein,
have been carried forward and properly registered in the Summary.
Subscribed and sworn to before me this .................................
,10 +h
........................;;):...................
...... day of .~~............... 19..7.$.......
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(Street Number)
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(City or Town and State)
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SIC'
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.
RC C-34 (4-73)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
B.UREAU OF COUNTY COLLECTIONS
TRANSFER INHERITAtoICE TAX
RESIDENT DECEDENT
SCHEDULE "A"
REAL PROPERTY
*
Real property in Pennsylvania, with statement of mortgage encumbrances upon each parcel at death of dece-
dent. Property held by the decedent as tenant in common with another or other, should be identified
as to quantum of interest and the estimated value should be that of the decedent's interest only. (Property
held as joint tenants with right of surviorship or tenancy by entireties should be reported on Schedule HE.")
The real property located In the Commonwealth of Pennsylvania should be (1) (2) (3)
described by lot and block number, street and street number, together with DEPARTMENT
a general description of the property, with a reference to the record of the ASSESSED VALUE VALUATION
conveyance by which the decedent took title; If a farm state number of a- FOR YEAR OF ESTIMATED CAUTION
cres; also statement of mortgage encumbrances upon each parcel at death DECEDENT'S MARKET VALUE (Do not write
of decedent. Taxes, assessments, accrued interest on mortgages, etc.,are DEATH In this spoce)
to be listed on Schedule "F" and must not be deducted from this schedule.
NONE NONE NON-
Insert this total opposite "real prope.ty", Schedule "A" in the X X X X X
"As Reported" column on the last page of this return.
NONE
\\l Of)L.
Rec -35
RESIDENT DECEDENT
SCHEDULE "B"
PERSONAL PROPERTY
'*'
COMMONWEALTH 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.
Tangible personal property should be listed first (e.g. jewelry, wearing apparel, household
goods, and furnishings, books, paintings, automobiles, boats, etc.)
Intangible personal property, such as bonds, treasury certificates, cash on hand and in bank,
stocks, mortgages, notes, together with accrued interest or dividends, salaries or wages, insurance pay-
able to the estate or fiduciary in said capacity, partnership interests, interest in any undistributed
estate of or income from any property held in trust under the will or agreement of another, even though
located outside of the State, at the time of death, should be listed in this schedule.
Item
No.
ITEM
List and describe fully
UNIT ESTIMATED
VALUE MARKEr VALUE
DEPARTMENT VALUATION
(Do not write in
this space)
1.
1975 Chevrolet Sedan, Title No.
C2639678l, Vehicle Identification No.
lC 29H5B424884
Appraised value
$2,400.00:'
~) ~ 00. DO
2.
Six (6) United States Savings Bonds,
$25.00, Series "E", registered in name
of decedent.
Date of Issue Serial Number
June 1974 Q5 180 938 354E
August 1974 Q5 188 735 838E
October 1974 Q5 203 814 098E
November 1974 Q5 216 482 397E
January 1975 Q5 235 763 597E
March 1975 Q5 253 716 016E
22.97"
22.971
22.31:
22.31,
22.31'
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.;tel. Cf7
Cld. <) 7
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~~.31
3. 552 shares, common, United Utilities,
Incorporated, now United Telecommunicatiors,
Inc., registered in name of decedent. /
Date of death value 19.125 10,557.00 / \OJ 5:57. 00
(All other property, both real and
personal, was owned by decedent and
Mildred K. Theurer, his wife, as tenants
by the entireties.)
.......... .
Insert this total opposite "Personal Property", Schedule "B" in
the "As Reported" column on the last page of this return.
x X( ~~3~.Q~l-_:.~) \ ~I tR ~. \ cg'
RCC-36
'COMMOXWEALTH OF PENNSYLVANIA
TRANSPER INHERITANCE TAX
SCHEDULE "c"
TRANSFErtS
~.
WlI
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) no
(2) Did decedent, within two years of death, transfer property from himself to himself and another or
others (including a spouse) :I.n 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)---!LO______
(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) nn
(6) If the answer to (5) (b) abovE' is in the affirmative, 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 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)
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)
NONE
NONE
t\\ 0 t"\L
Insert this total opposite "Transfers", Schedule "C" in the
"As Reported" column on the last page of this return.
NONE
t\\~
'RCC-37 (12-63)
COMMONWEALTH OF PEN;\ISYYLANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "0"
BEl'\EFICIARIES
\
h
r RELA TIONSHIP !
BENEFICIARIES AND ADDRESSES (If step-children or r SURYIVED DATE INTEREST OF
State full names and addresses of all who illegitimate children I DECEDENT OF BENEFICIARY
ave an interest, vested, contingent or other- are involved, set STATE YES BI RTH IN ESTATE
wise, in estate) forth this fact.) ! OR NO
Mildred K. Theurer Wife Yes /Entire Residue
R. D. 5, Box 68A
-..-
Carlisle, PA 17013
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)eponent further says that all the above-named beneficiaries are living at this time except below:
NAME
DATE OF DEATH
RESIDENCE
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Real Property
Personal Property
Transfers
SUMMARY
...(Sch, "A")
...(Sch. "B")
...... (Sch. "e")
( 1 )
(As Reported)
(2)
(As Determined)
Gross Taxable Estate
$
$
$..
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$
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R C C-38
RESIDENT DECEDENT
SCHEDULE" E"
JOINTLY OWNED PROPERTY
. COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
INSTRUCTIONS: This schedule must disclose all property, real and personal, owned by the decedent jointly
wi th another or others, including intangibles, standing in the name of the decedent and others. List
real estate first, as entireties., or jolnt tenants, glving 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 vdluation column. Personal property should be listed as in
Schedule "B", plus date of acquisi tlon, Ilnd the name, address and relationshlp (if any) of co-owners to
the decedent.
Description of Property, Date of Acquisition, Name
Address and Relationship of Co-Owners, and Place
_e Real E':te.
Unit
Value
percentage
Share
Estate
Valuation
DEPARTllENT VALUATION
CAUTION-Do not Write
In This Space.
Value of Value of
Entire Decedent's
property Interest
NONE
NONE
NonL
Insert this total opposite "Jointly Owned Property", Schedule "E"
in the" As Reported" colu1Jm on the last page of this return. NONE
f\t 0 \)L
*'
REV-518 (8-78)
COMMONWEALTH OF PENNSYLVANIA
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
Mildred K. Theurer
RD 5, Box 68A
Carlisle, rA 17013
(Executor or Administrator)
In Re: Estate of__
William H. Theurer
Cumberland
County - Fi Ie No. 21-78-512
Dear
You are hereby notified that the Original
appraisement in the estate of William H. Theurer
has been fi led in the office of the Register of Wi lis of Cumberland
County on 20 February , 19-12, Said appraisement reflects the following
valuations:
Real Estate
Personal Property
Transfers
Jointly Owned
Total___
None
13.092.18
NonQ
NonQ
$13,092.18
As to such tax that is paid within three months from date of death, a five (5%)
percent discount is ctllowable. 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 o.f 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. 2485-1,001, P. L. 373.
Date
20 February 1979
Signed
Title __
Administrative Officer
J
- .--..----.-..----.....
Note: This is not 0 bi II.
REV-457 (8-78)
DEPARTMENT OF REVENUE
BVREAU OF FIELD OPERATIONS
P.O. BOX 2970
HARRISBURG, PENNA. 17105
COMMONWEALTH OF PENNSYLVANIA
RESIDENT INHERITANCE TAX
APPRAISEMENT
DA1~ 20 February 1979
COUNTY Cumberland
FILE NO. 2l=.l.8.-0s12 ~
Whereas, William H. Theurer late of . Carlisle
in the County of Cumberland Commonwealth of Pennsylvania, having died on
the 18t:h day of Ammst 19 ~ I seized and possessed of an estate
subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania;
Therefore, I, T.pn 1"111 gin; f"; , 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 1\1,..,..,0
.... " - 13.092 18
- None
Jointlv Owned None
on - ~ C1 ~ nn'1 10
I
Have been duly sworn according to law, I do hereby ce~fy that the above appraisement is made in conformity
with the law on this 20th day of '- ... Febr~ " -. 19 1.!l.-.
- ..{ ---'
Appraiser
(Number and Street)
Harrisburg
(Post Office)
, Penna.
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