HomeMy WebLinkAbout03-02-79
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RCC-33 (4-73)
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COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
, _t.aLt,
~
RESIDENT DECEDENT
COUNTY OF CUMBERLAND
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'ltenue. (Section 703 of the Inheritance and Estate Tax Act of 1961.)
Late of
CUMBERLAND
PENNSYLVANIA
} AFFIDAVIT OF
EXECUTOR
XB~
IN THE MATTER OF THE ESTATE OF
FLORENCE M. RAFAEL
(STATE FULL NAME OF DECEDENT)
County
County of
CUMBERLAND
}"
State of
~Jt&-
JOSEPH P. AT.F.XA,
of the estate of the above-named decedent being duly sworn, depose S
Executor
ond sayS
Decedent died
OCTOBER
1,
(DAY)
, 19-11L{testate leaving a last will, copy of which is hereto attached. }
( YEA R) JEKHJlK
(MONTH)
Name and addres s of attorney or }
other authorized repres,entative to whom
all correspondence should be mailed.
Joseph P. Alexa, Executor
16 S. Market Street, Mechanicsburg, Fa., 17055
That as such Executor deponent is familiar with the affairs of said estate and the property constituting
(EX ECU TO R-ADMIN I ST R A TO RI
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 acce s s by another as agen t or deputy, with the
exception of the fullowing: -
NAME AND ADDRESS OF BANK OR OTHER INSTITUTION
IN WHICH DECEDENT RENTED A SAFE DEPOSIT BOX
Commonwealth Nationa
Main and Market Streets
Mechanicsburq, Penns 1vania 55
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 "E" of this return,
with the exception-of the following, for the reasons hereinafter set forth:
That Schedule A attached hereto and made part hereof sets forth fully and in 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 pos session, 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 de~'ignated 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 !1. ,,(,r death, bonds and accrued interest thereon to the date of decedent's
death and other investm ;,-1 hy 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
possibl" substFmtiated 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 the:> co-partnership agreement, (if oral, a statement setting forth the nature of the agreement)
toge!.),,,r with Il statement setting f"orth the character of the business, its location, and such other f"acts
,"'1' 'ill1V: to the business as may be pertinent to a f"air and just appraisal of the decedent's interest
tIiel'ein iIlllSt be submitted. It should also set forth in itemized form, together with the fair market value
ther.'o'" 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
conUdned ther'ein 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 eff"ect 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 proporUonate share received by each transferee and
all aU],,}' facts of a pertinent nature regarding sain transfers. In the case of transfers intender! to
take effect in possession or enjoyment at or after death, there is also attached to the schedule a cony
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,
wi th 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'~; 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 de,edent, 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, stanning in the name
of the decedent and others, plus the date and place of record of instrlooents 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 deceden t.
That Scf>edule F attached hereto and made a part hereof sets forth fully and in detail all dehts
and deductions claimed for and on behalf of this decedent's estate, inclufling funeral expenses paid;
family exemption, where applicable; costs of administration of this estate; counsel fees an,i flldiciary'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 plengerl 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", "CO, "E", and "F" as directed therein,
have been carried forward and properly registered in the Smrunary.
.........~.9..~....... ..
..~(J. I?p:io.d
LOU A. ZITTO, Notary Public
l:'i':.~',T..: ': !:c'; ',:;,', l'a.,
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."~""'J~1?...'~~~~;~~~~~:;!.~:~'.'.',~'.=".:':'.'...:.::~:'.
(Street Number)
dM.E!.~ll~!.l.~~.f:l~.~.1.';9.:.t"'~'~~''.dd'~ 7 0 5 5 d.d.........
(City or Town and State)
NOTE: Before signing affidavit make sure all blank spaces in the affidavit and schedules annexed are
filled in with details or the worn "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 stll.tements required under the parap;rll.ph above relating; to Schedule "B" are Il.ttached. ;\1so make
certain that column #1 in the "Summary" has been properly completed as above-directen.
dd day of dd~~~' .ddd" 19....:::rL
Subscribed and sworn to before me this
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LAST WILL AUD TFSTJ\MEN'r OF FIlJPE),WF M. I"V\,
-
"~--.-
I, FLORENCr: M. RAFAEL, of Mechanicsburg, Cnmberland
County, and the Commonwealth of Pennsylvania, being of sound
..fit! ;'ispot.ing mind, memory ilI.d ,:nd(!I'standing, do make, publish
, and declare this as and for my Last Wlll and, Testament, hereby
reVtlKinq and making void all former Wills and Codicils by me
~;. .....
~H: {Jny time h~n! tofort: made.
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FIRST:
I order and (I i rect that all my just debts
~t1(:l funerdl expenscf bf~ paid by my F.xecutor hereinafter named
'H~ soon as convenient 1 v May be done after my decease.
SE-:COND: . I hf>reby qive, devise and bequeath my note
for One ThousanC!. (Sl,('l')().OO) Oollars, dated June 8, 1977, Cex--
tificate Number B-2467, owe(1 Ly 'l'he Mission Board of the Oio-
cese of Ld!'risburg, to Saint Joseph's Ci'ltholic ChurcI1 of Me-
chanicsburq, f>ennsv 1 vania,
in me~ory of ~y beloved husband,
Fmil w. Rafael.
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TT!IPD:
I he r,,,by q 1 VC, r:evise ancl bequeath any auto-
jN"'lb i 1 ("~ nwne rl by me a t the t i rne 0 f my (le a th to my h rotheo r ,
LI 0 tf. FPPLf~Y, SE'1l01'r to be his ! rOtJerty absolutely.
POUI'(rH:
I he rpr'y (J 1 .,(', 'lAvi f:e ..md beq ueath the
I
followinq shares of::;tock, l(~'.:dt("d In IT'Y safe deposit box a~:
the Commonwealth 'JatJ.on~l Bank, ;'1c'chanicsburq, Pennsylvania,
to JOSEPH o. I'JTXA. uf r~( · 'nl{'" \ lIP', P0:1nsylvania, t.O be his
i'rope! "'/ d sG~ute.l.Y: CeDer-al Tj JI' an:~ lubber, twe.-,ty-nine (29)
shares; Penn Centra], one h\1ndn'(~ (LOO) shares; Forcr:\ost McKes-
~on, t....0nty (20) sh;)!'p's; Sir.->In,jnds ,)rprision, bJenty-two (22)
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shal<(,s; ('("c~u~t-,i11 Carib:je,:~, one l-l1n(lrer1 (10'; ,I
F ~ F';'l! :
J Sivf', devIse ano bcq'J~ath certa'_d items
9f' fT1'/ personal property to the /lcnefici<lri.es designatec ir; a
written l~~:t:. containec. i.n a stronq box located at my residence.
SlX~Il:
I her<"l>y authnri7.f' J"IY sister, GLADYS COMP,
my ~~Tothf'r, Lr.O Tl. T'PPLFY, SF;'-Hrm, r"v niece, :'-1ARTIIJ\ ANN EP-
fH!!,,!, anrl ny neiJhew, LEO r.:[>iL',q", ,TlflTlOR, to retain in kind
if.:)r thei T persf'na 1 possession, i'lny or all of my househo) d
furnishinqs not dispos~rl of ir the written list containe~ in
fIlv str0CQ boy as Sf't fort.l In thp pr.;'cc(:inq ~)<.1raqraph r'IPTH I
of this, PlY l.ast Lill and 'f'cstC\r1pnt.
,
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C'lC'ices by thc':,p b('np;.o
ficiaries unuer this para'jri; \. are to be li'iH1e on a rotational
basis in an ord~r to J'P ,~ptprr'1irL'(i b" l;1V ::".'cutor, h~reinafter
ni"J"Ie(~ .
r.ny furn lshi1"(ls 'vh i eh " r,> unili spc Sf'(l of under this
"rovision ,1rc to he:> sold ~w,;p,...t to +-'1f' +-prrs anc' ("("lnditions
of the fol.L("lwlnc' "i1ri1nr<lph, !"at.3oraph ~or'.r:.:'l'T'H, of this, my
'::"i1st ~',ri 11 2lnr. '''r>stcl!')f'nt.
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· ordf'r elf'cl (1) "(->rt that the premises situ-
ate i'lt,104 Sc'uth Filbert ~treet, :~('chanjcsburq, Pennsylvania,
t:OQ0tJwr wit:: '1 I hOlls! :lol(~ fllnllS~il'(F; riot proviollsly ':lspnse~
"'e s t ar.10 nt., ~;..,
,>(:oJ(: ,"j~; :~, r: ",ftpr :"'. "f'oc.th
my Last \'ill an'l
as is practicable.
nf unr1€"r Ulf'
t " r e q 0 1 r q n r 0 v j .; ~ G,' S 0 r t h .1 5 ,
;,ueh sa::"~ p'ay j)c rrthlj(, (' r nrl.va~.' :)ne1 ~',.ll';eet to such terms
llH'1 CO[1t'.i t i I Jr' <~ d:1 IT'" 1 ~ r, (., Itor r in, h i ~ ch. seret ion, r0n.MS fit.
rurCH"'r ord'-'r .'if'
,'In.,.' tll.l!' ~;,. ! i.ccp, r1AR'rHA A'~N l;PPLEY,
,lnd f"'.
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f ~ "~' T )
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i' )' " :JC pai(1 F: '/,' 'l'hol1sanc
(r:r;,nn1.0r;) ':0) 1ar;' "re.!f tl1t! on ",. " ')( this sale, with the
}'alancf> (F 1 \.".... pro:-::c.",,>{;: t.o hl~
is t r.l} llted ir~ acc.:orocmce '.:i th
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the prOViSlf)n~, of tho follo\".ne< y),-l'.tl'lranh, T>i'1t"..\
of this, f"'" Last ~':iU C:H1'~ mest('mc~llt.
r"TG!ITI' :
('1. VE', (~f'''! se (Hi ;-"1 !Jf' q \.Ie il t ~i L, (',
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due and ren:ainrler of yny I:stc;tn, n',ll, p(~rsonal dr.n p'i:.'0(\, what-
;;oeVt3r anc: wheresoe>vr~r situi'ltt', III eqlla1 I:>hiU"(H1, unto rry 5i5-
ter, r;!.r,~~"(' ('(V~fI, nIle' 1")',' l rot:ln,!,", ~f'(' II. !"'T",J'Y, ~r~:II')R.
!.i\;:"'T'L'r> I nOll'in.1te, con<,t-illlte and appoint .TO[;CPII
h. l\LfXI" r,XE'C1Jtor of' thil:>, ;''f" J.'1~.t ~}i 11 and ~estament, hut
if ror (\ny n~ason he s)'lall fall t.O flUrlli fy as such rxecutor, or
H>as(~ <,0 to act, thpn I r()rrlindt~., c0I1sti ttite an~ appoint my
-r . ""pm1 r II A'.T>] r'r'l')T! .
dleCt~, .It' ,.,.. I.. .
to sc'rve' in hi g place and stead.
Finall.y, if h,"'t~l of UH.'S(> ilf,)"',_' Sl! U] iflC:lviriuals faiJ t:o (\lalify
4"H' r:eas(' so tc act, t\\PD [ " tl',\:.l', ('"Qnstitute and anpoint
th(' '~()!1r1()":\ 'T:r",;,:r:{ ~1A'l'l(v:/ L ';'..:
to) Sf.' r've: 1 j: t ~n ir pI ace ar(~
ste.:\,l.
:1C'ri'r)" auth',"'lze ,ln" ()f tlH' .,i"i0 Executors t.o serv(~
w:.t hnut i()Tl (1 .
I! 1"rr",~:t~S~
IFF'Jr,
i'r,'"rn":f':' ". ~".F,:'I,FJ., hn':,. hv n~-
lmt0' +
fl'\! 1',1:' I 61'" S"ill t.O
T.<'tst ~'Hll ann ':.'esti'uncnt,
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in~~tJH'cnt, ('or.sistin(~ of f:1lis ctn(1 two
'<'i"~, ,>.,,', 1('entif:i0.(1 hy t.;lf..~ si~;nutllre
-',,' c""" ~'r,,(.,f, ~,d(1nt~(l, seoled, puh-
: 'r\L'1'L, t_h(~ "C' 5 tdt riy. tl1f~reil'1
..Jl cl,1 '.nflpnt, i!"\ t:.et)r~~ience
'it ,)1\ ~ I 'j }1('; 1~"'SenCf>, co''; in the pre-
,'r narlCS :IR wi tnesses
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ACY. .JOW LF DGMr~N'T'
COMMmll'lLJ\I:rn OF PF."JNSYLVN!JA
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COUNTY OF CUMEI. RLAND
I. FLOReNCe H. RhFAEL, T~statrix, whose
name is .."igned to the attaC'h~d 0r foregoina instru-
rrent, havinC' t-"',"'-r: (hlly 'lU1111fied acc0n'inq to law,
do he reby ack L!)wl e(I(~c t hit t I ~:;iqned imd executed
the instrument as rr~':, : 'lst \','.1.11; that I signer. it
willinalv; anrl that] SLonect it as my free and
voluntary act f"or tl]p l>urposes t.herein expressed.
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i'lr-.r-ence M. RafaeX
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o forp IJ1C th i "
I'j (!~ 'Jovcmr:nf, 1':177.
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AFFIDAVI'1'
=~===--=
COMMONWEALTH OF prNNSYLVANIA
(' C'
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COUNTY Of' rtTMBF. nLM: D
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and
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, whose
names are si qnen to the attacheci or foregoinq instrument,
beinq duly (! lalifif"d accorrlin(~ to lr\w, do depose and say
that we \'lerE: present and saw the '!'p.statrix sian and exe-
cute thE> instrument a<~ h0r ~.a':t t'lill and Testament; that
FI~CREnCE M. RAf'AEL siqned \<!illindly and that she executed
it as her free anfl voluntar'f act for the purposes therein!
!
express(>o; that ea"h ,.,f \15, 1.11 the hearinq and sight of
the Testatrix, signf!~ the l'Iill a,3 'dtnesses, and that to
th,:' hf"~t of our Knc:",'l\''';(;(', t'.!I.' I'estatrix was at tl.at time
eiqrl~.eeI. \;O:i) ,,1' ;:,orc year:; 'J! el';.f€"', or tiuI.lTldm.ln(. :'~nd
nnn, r r~l-J constraint or ttr~,lil'.' lnf \;lence.
s......)~r, t(J or aff.. rnfc':',
.0 and subscribed befo~e
and
me ~)?
, witnesses, this
day ,.f ~.o"emt:er, ,". f'l.;977.
Witne!';::. :
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SUPPLEMEN'r TO LAS'l' lHLl. NH) 1'}<}STAHENT
---Oi;;-""FLORErl(j~--~f.-RAF;-1\FC----'
I hereby give, devise and beCJueath the follow ing
items of personal property to the hereinafter designated
beneficiaries:
a. ~~y Swisr:; Wall Clock to my sister, GLADYS COMP,
or, if she fails to survivp me, to my niece, MARl'IIA ANN EP-
>
?l~I3V .
h. My gold, four-candle Candelabra and my antique
::aIi\j.ly dishes to my niece, UARTHA ANN EPPLEY.
c. My Eppley Family Crest, my Uncle Hose China
'itcher, and my large Dining noom Radio and Record Collec-
~:ion to ny nephew, LEO II. EPPLRY, JUNIOR.
.~
c.
J'.ly Italian Nativity Set and Back Drop to STELLA
ALEXA, of Mechanicsburg, Pennsylvania, or, if she fails to
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survive Me, t.o her daurrhter, ]~ATHRYN ALEXA, of Mechanicsbutg,
Pennsyl van ic .
e. '1y tlJrnUOiS0 ilnd silver Indian Jewelry to THEO
r-'OLN'J, of C'i1np :'ill, Pennsylvania, or, if she fails to survive
me, to her qran(~Hdauqhter, AMY BOLAN, of New Cumberland, Penn-
;
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sylvaniR.
f. My Saint Francie Statue, my brown Abstract Paint-
ing, ano my ceral'1ic fish wind Chimes to JOSEPH P. ALEXA, of
Mechanicsburg, Pennsyl vania.
q. r~y Nativity Picture, my Cedar Chest, and my cera-
mic "'urtle Table to KATHnY!'j ALf'XA, of Hechanicsburg, Pennsyl-
va.nia.
" '..
h. Hy two Pilintinqs, wi th hanel carv(~s f r- ,fl' ;.i('
pictin<] Fall an0 "'!int~r. scenes, fOTP'lerly owneel hy !",V
in-law, Mary Rafael, to NILT..I1\H ano Sl'..NDY HAFAEL, of L("
Ve<J~~ i J'Jevada.
i. My Twin BedrooM ~et to my brother, LEO H. EPPLEY,
mmIOR, or, if he fails to survive me, to my sister, GLADYS
t'ji~Mp .
j. My antique Cane Seat Chairs to my niece, MARTHA
AliM EPPLm:, or, if she fails to survive me, to my nephew, LEO
H~ EPPLEY, JUNIOR.
;;) ~tu<-f J1i P~I 0 (SEAL)
-----""'- LPlorence M. RijJaeY'---.
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co;VtriONWEALTH OF PENNSYLVANIl\
Sf..
COUNTY OF ClJ~UW' PLA~m
'"
I, FLORENCE M. MFAl"L, Testa.trix, whose name
is siqn:><! Ul the ,lttachcc1 or foreqoing instrument, having
been duly qualifie(l acconUna to law, do hereby acknow-
ledge that I signed and executed the instrument as a Sup-
plement: to my Last t^iill ann Testament; that I signed it
as my free and voluntary act for the purposes therein
expresrec1.
1.[ ~I
____::~g:1l.,(j )11 . -'~., W /
Florence M. Ra 1 --
\
Sworn )r a~firme~ to
he fon~ r'x~ th 1.~;
dav of I'Jover:bpr, 1977.
j;-,
't.;
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"'__ C-34 (4-731
COMMONWEAL TIf ()F PI!NN5'YLVANfA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "An
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 liE.")
The reol property located In the Commonweolth of Pennsylyanla should be
described by lot and block number, street ond street number, together with
a general descrlJitlon of the property, wl.n a reference to the record of the
conveyance by which the decedent took title; If a form state number of a-
cres; also statement of mortgage encumbrances upon each parcel ot death
of decedent. TalCes, assessments, accrued Interest on mortgages, etc.,are
to be listed on Schedule "F" and must not b. deducted from this schedule.
(1)
(2)
(3)
DEPARTMENT
VALUATION
CAUTION
(Do not write
In this space)
ASSESSED VALUE
FOR YEAR OF
DECEDENT'S
DEATH
ESTIMATED
MARKET VALUE
Lot with residential dwellinq at 304 South
Filbert Street, Mechanicsburg, C~ber-
land County, Pennsylvania, said tract
being more fully described in the Deed
of Helbilt IJomes, Inc., to Emil W. Rafael
and Florence M. Rafael, his wife, dated
March 3, 1954, and recorded in the Office
of the Recorder of Deeds for Curober1and
County, Pennsylvania, at Deea Book /lp",
volume 15, Page 365, and in the Deec of
Dora Richwine and The First Bank and
Trust Company of Mechanicsburg, Pennsyl-
vania, Executors of the Estate of James
L. Young, to ~mil W. Rafael and Florence
M. Rafael, his wife, dated April 6, 1956,
and recorded in the Office of the Recor-
der of Deeds for Cumberland County,
Pennsylvania, in Deed Book "I", Volume
17, Page 63. The said Emil W. Rafael
died April 14, 1972, whereby title to
both tracts vested in Florence M. Rafael
as the surviving tenant by the entire-
ties. The estate has entered into a
contract to sell the property to nartin
L. Myers and Margaret ~. Myers, his wife,
for $45,000.00 on or before January 15,
1979 :
6,230.00
45,000.00
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.
45,000.00
RCC-42 (4077)
COMMONWEALTH Of PENNSYLVANIA
'DEPARTMENT OF REVENUE
Fr:p O~- .
..Lu D1979
BANK NO.
DATE FILED
NOTICE OF DECEDENT ACCOUNT STATUS
Submit in trup icate within
the death.
STATUS OF ACCOUNT NO: (JOINT. TRUST. OR INVESTMENT
f--j
'-'"il ", 17 ,'r'.
':"-'/-1
RETURN COMPL ETED
FORMS TO LOCAL COUNTY
INH ERITANCE TAX OFFICE
NAMES ON ACCO T
SOCIAL SECURITY NUMBER(s)
.~_ ... ) l' ,
~ ~ _. _.J
NAME
SURVIVING DEPOSITOR (Beneficiary) INFORMATION
RELATIONSHIP
TO DECEDENT.
DECEDENT INFORMA ON
NAME
DATE OF DEATH
lJ ~:'l~
.
~" 1
...LOl"r" j I:' ~ .
\ ct. 1, /;fl
ADDRESS
ADDRESS
7r<.
, ee'';. d, (: '
COUNTY
'r e
I.C. ~.O'
':nrrl' '
"", ''''1 - +- i C.""
; e henicsaur [).
BALANCE OF ACCOUNT AT DOD
INTEREST ACCRUED AND COLLECTIBLE AT DOD
TOTAL
"'! r-"r r-
BANK/INSTITUTION ADDRESS
"~"l v;,
$ ",'
$
$
'1' ..'
BANK AUTHORIZA TION
I HEREBY CERTIFY THAT THE INFORMATION CONTAINED HEREIN IS A
CORRECT REPRESENTATION OF IN FORMATION IN OUR FILES IN ACCORD
WITH sE TION 742 P I 8< AX ACT 0 F 196 I.
:UO paJ!nbaJ S! ~odaJ oN
"(pappD S !SDlIdw:1) II "(0<1:'$)
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JD Hsodap a'lJ ua'lM JUnO;);)D 'l;)ns OJ pJD6aJ U! paJ!nbaJ aq
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alp JO SSlUppD PUD awau a'lJ PUD UO!JRJ!JSU! ID!;)UDU!I
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anuaAa~ 10 Juaw~Ddaa a'lJ .<JHoU 01 'lJDap alp JO a6palMoU'I
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a'lJ 10 auo PUD SJalpo JO Ja'lJOUD JOJ JsnJJ UI suosJad JO uosJaCl
D JO aWDU a'lJ U! JO aJlM PUD puoqsn'l UDlp Ja'fJo SUOSJad aJOW
JO OMJ 10 saWDU alp UI DIUDAI.(suuad UI paJD:>>01 uOHnHJsuI
ID!;)UDllIJ D UI paJsaAuI JO paHsodap S I .(auow ua'lM..
".(IIDnPIAIPUI Juapa;)8p a'fJ .(q Pla'l sJuno;);)y (E
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RCC-89
COAillONWEALTH OF PENNSYLVANIA
Department of Revenue
ENTRY INTO SAFE DEPOSIT BOX
TO REMOVE A WILL OR CEMETERY DEED
Oe~ha.. 20, 1978
(Date of Entry)
1.
Name of decedent:
Florence M. Rafael
304 S. Filbert St., Mechan1csburg, Pa., 17055
2.
Address of decedent:
3.
Date of death:
10-01-18
4. Name and address of person who requested the opening of the box:
Joseph P. Alexa, 16 S. Market St., Mechanicsburg, Pa., 17055
5. Name and address of the financial institution where the safe deposit box is
located: The Commonwealth National Bank. Main & Market Sts.. P. O. Box 320,
~~chan1csburQ, Pa., 17055
6. Number of box: 452
7. Title under which box is registered:
fm11 Rafael (deceased) or Florence M. Rafa.l
8. Was there a will in the box? (Yes or No)
no
8. If yes, state date of will, name and address of personal representative, if
named in the will, and name and address of attorney, if any:
And now this JOtk day of Q(tohap, 18 78 , I hereby
certify under penalty of perjury that the above record is correct and complete
to the best 0< my knowledge and belieL / ~ /~/,/<C). (~
l ~lIA'~ ~~
Signature
Anna L. Rankin. Personal Loan Officer
Print Name and Title
.,
*'
RCC-87 (10-68)
COMMONWEALTH OF PENNSYLVANIA
Department of Revenue
SAFE DEPOSrr OOX lNVENTORY
October 20, 1978
(Date of Entry)
Florence Rafael
1. Name of decedent.
2. Address of decedent.
304 S. Filbert St., Mechanicsburg, Pa., 17055
3. Date of death.
10-01-78
4. Name and address of person who requested the opening of the box.
Joseph P. Alexa, 16 S. Market St., Mechanicsburg, Pa., 17055
5. Names, addresses, and relationship, if any, to decedent of persons present at
opening of the box. Executor--Joseph P. Alexa, 16 S. Market St.,
M~chanicsburq. Pa., 17055
6. Name and address of the financial institution where the safe deposit box is
located. The Commonwealth National Bank, Main & Market Sts., P. O. Box 320,
M~rh~ni~~hlJr9. Pa.
7. Date of contract to rent box.
February 6, 1954
8. Number of box. 452
9. Title under which box is registered.
Emil R~fa~l (deceased) or Florence Rafael
10. Names and addresses of persons having access to box.
F1Qr~nr~ M R~f~pl. 304 S. Filbert St.. Mechanicsburg, Pa., 17055
Ja&Qpl::l D Al~l(r11 nppllty_ Hi S. Market St.. Mechanicsburg, Pa., 17055
li. Name and title of employee charged with the duty of making the inventory.
~RRe l Rrln~in, P~r,nn~l I n~n Officer
12. Was there a will in the box? (Yes or No) No
13. If yes, state date of will, name and address of personal representative, if
named in the will, and name and address of attorney, if any.
.. ..
Pa.ge 2
.,:
SAFE DEPOS IT OOX INVENTORY
Instructions: 1 CASH: Report total only. 2 STOCK: List in detail every common or
preferred certificate, warrant or other rights found ';"~ box. Stocks are to
be designated by name of company, certificate number, date of \.-artificate,
name in which stock is registered, number of sh~es and class of stock.
(3) OBLIGATIONS of U.S. GOVERNMENT: Number of pieces, dates of issue, face
value, names in which registered. (4) BONDS: Designate uy name, amount,
serial number, or otherwise. (5) SAVlNGS BANK or PASS BOOKS: State name
of depositor, number of book, last date appearing in book, name of bank a!ld
branch, and balance. (6) JEWE'J.RY, coms, STAMPS, MANUSCRIPTS, ETC.: List
and describe as fully as possible. (7) List Deeds, Mortgages, Current
In ranc Policies or other evidences of indebtedness. 8 All other contents.
1. None /<'
2. Non&' /
3. on~25.00 Series E, Oct. 1943, Mrs. Florence M. Rafael POD Emil W. Rafael,
seri~ #Q2l9630554E
Mr~lorence M. Rafael POD Mrs. Gladys M. Comp
~200.00 Series E, dated Feb. 1977 Serial #R205048l93E, #R205048194E, #R205048195E,
#R205-048196E.~ ',ooc C<:l ~ e I cla:i:uV F-d.>, \'l'"17
2--$1,000.00 Ser' s E, dated February 1977, Serial #M202562848E,#M202562849E, registered
Mrs. Florence . Rafael POD Mr. Leo H. Eppley, Sr.
4--$200.00 Series E Bonds dated February, 1977, serial #R204750695E, #R2-475-606E,
#R204750697E, #R204750698E
2--$1,000.00 dated February, 1977, serial #M202562847E, #M202562846E, registered
Mrs. Florence M. Rafael or ~g~~y \.-.ec ~-. S-I.,.
1-$200.00 Dated February 1978, serial #R20704ll27E, reglstered Mrs. Florence M. Rafael
or Jess j l.d -ev/J 1 ey \-.a..a..L"-0-.- ~ ~
1-$200.00date February, 1978, 'serial #R207041128E, registered Mrs. Florence M. Rafael
or Laupa. Su ppley
1-$200.0 ated March, 1978, serial #R207323610E,registered Mrs. Florence M. Rafael or
Andrew -(eo Eppley
1-$200.00 dated March, 1978, serial #R207323606E, registered Mrs. Florence M. Rafael
or Kathryn M. Alexa
1-$500.00 dated February, 1977, serial #D203871421E, Mrs. Florence M. Rafael or
Andrew~euschler
1-$500.00 dated February 1977, serial #D203871422E, Mrs. Florence M. Rafael or
Kathryn M. Alexa
1-$500.00 dated February, 1978, serial #0205852242E, registered Mrs. Florence M. Rafael
or Andrew Neuschler
1-$500.00 dated February, 1978, serial #0205852241E, registered Mrs. Florence M. Rafael
or Samuel Barley
1-$500.00 dated February, 1978, serial #D205852240E, registered Mrs. Florence M. Rafael
or William Barley, Jr.
1-$500.00 dated February, 1978, serial #0205852239E, registered Mrs. Florence M. Rafael
or Joseph P. Alexa
1-$1 ,000.OOctated February, 1978, serial #M206935767E.
4. None
5. Harris Savings Association, Hbg., Pa. Certificate No. 111817 dated
June 3, 1974, amount $10,000.00 to Florence M. Rafael, interest rate 7~%, due 6-3-78.
Certificate #113058 dated Oct. 5, 1974, amount $1,000.00 to Florence M. Rafael,
interest rate 7~% due Oct. 5, 1978.
6. None
7. None
8. 1975 Pontiac coupe, title No. A26999730, serial #2G37M5Gl18051 to Florence M. Rafael.
And now this 20th day of October, 19~, I hereby
certify under penalty of perjury that the above record is correct and complete
to the best of my lmowledge and belief. / .'.. /\
(.. "\y /) / <)
~,-..<r<-- A. ,AC2.rd:M'~~
Signature
AFlFla ~rMf'~~e PSiJ(;),pfJI~QaFl Offi cer
NOTE: Use separate sheets if necessary.
..
'*
RCC-87 (10-68)
COMMONWEALTH OF PENNSYLVANIA
Department of Revenue
SAFE DEPOS IT OOX INVENTORY
{t!~~5f ~r.J'18
1. Name of decedent.
810rence Rafael
2. Address of decedent.
':t()4 ~ -=." h"...+ ~+ . ~han" I'C h~I'1I. Pa . 17ne\"
3. Date of death. 10.-01-16
4. Name and address of person who requested the opening of the box.
JO'IP~ P. A1lxa. " S. Market St.~ M8(~iR1crburg. Pi.. 17055
5. Names, addresses, and relationship, if any, to decedent of persons present at
opening of the box. EMesvtet J8seph P. AleMa. ,& i. Mapke' it..
MeGh4n1t!b~rg, Pa.. 17955
6. Name and address of the finBIlcial institution where the safe deposit box is
located.
Ti.c CUlI.llOn_A1 Lt, Na t1 0..a1 8~1I."" Ma 1.. A Ma ~ k.e t S t~., ,. 6. 8uJIo 326,
Me\ol.ai, I (.;>>bt.l g, 'a.
7. Date of contract to rent box.
reb'~alY 6, 19S4
8. Number of box.
452
9. Title under which box is registered.
Ek,.l1 bfbe1 (dcc.e:alcd) ()~ Fl~~c"c.e Rafael
10. Names BIld addresses of persons having access to box.
F1on:u\oc M. ItafClcl, 304 5. fnbt:, L 5L., Mt:,"hClnh;~bu'lI' Ita., 17055
Joseph ,. A1"J!oCl, Deputy, 18 S. Market St., ~chanl,":sburg, 'a., 11055
li. Name and title of employee charged with the duty of making the inventory.
Anna l. Ranlttn, Personal Loan Officer
12.. Was there a will in the box? (Yes or No)
13.
NO
If yes, state date of will, name and address of personal representative, if
named in the will, and name and address of attorney, if any.
"
,.._~c~:.""'.,
\
, 'W tf"O."
/
Page 2
SAFE DEPOS IT OOX INVENTORY
Instructions: 1 CASH: Report total only. 2 STOCK: List in detail every common or
preferred certificate, warrant or other rights found -;..~ box. Stocks are to
be designated by name of company, certificate number, date of ;.,artificate,
name in which stock is registered, number of sheree and class of stock.
(3) OBLIGATIONS of U.S. GOVERNMENT: Number of pieces, dates of issue, face
value, names in which registered. (4) BONDS: Designate uy name, amount,
serial number, or otherwise. (5) SAvmGS BANK or PASS BOOKS: State name
of depositor, number of book, last date appearing in book, name of bank a.'1.d
branch, and balance. (6) JEWELRY, COINS, STAMPS, MANUSCRIPTS, Ere.: List
and describe as fully as possible. (7) List Deeds, Mortgages, Current
Insurance Policies or other evidences of indebtedness. 8 All other contents.
1. None
2. None
3. one-$25.oo Series E. Oct. 1943, Mrs. Florence M. Rafael POD Emfl W. Rafael,
serial #Q219630554E
Mrs. Florence M. Rafael POD Mrs. Gladys M. Comp
4-200.00 Series E. dated Feb. 1977 Serial flR205048l93E, 'R205048l94E, 'R205048l95E,
flR205-048l96E.
2--$1.000.00 Series E. dated February 1977. Serial IM202562848E,#M202562849E. registered
Mrs. Florence M. Rafael POD Mr. Leo H. Eppley, Sr.
4--$200.00 Series E Bond~ dated February. 1977, serial IR204750695E, flR2-475-606E,
#R204750697E, #R204750698E
2--$1.000.00 dated February. 1977, serial 'M202562847E, IM202562846E, regfstered
Mrs. Florence M. Rafael or Laura Sue Eppley
1-$200.00 Dated February 1978, serfal IR20704l127E, registered Mrs. Florence M. Rafael
or Jessica Eppley
1-$200.00 dated February, 1978, serial IR207041128E, registered Mrs. Florence M. Rafael
or Laura Sue Eppley
1-$200.00 Dated March. 1978, serial IR207323610E,reg1stered Mrs. Florence M. Rafael or
Andrew Leo Eppley
1-$200.00 dated March, 1978. serfal IR207323606E, registered Mrs. Florence M. Rafael
or Kathryn M. Alexa
1-$500.00 dated February, 1977, serial #0203871421E. Mrs. Florence M. Rafael or
Andrew Neuschler
1-$500.00 dated Februar,y 1977, serial '0203871422[, Mrs. Florence M. Rafael or
Kathryn M. Alexa
1-$500.00 dated February, 1978, serial #0205852242E, registered Mrs. Florence M. Rafael
or Andrew Neuschler
1-$500.00 dated February, 1978. serial 10205852241E. registered Mrs. Florence M. Rafael
or Samuel Barley
1-$500.00 dated February, 1978, serial l0205852240E, registered Mrs. Florence M. Rafael
or Wtlliam Barley. Jr.
1-$500.00 dated February, 1978, serial 10205852239E, registered Mrs. Florence M. Rafael
or Joseph P. Alexa
1-$1.000.00 dated February, 1978. serial 'M206935167E.
4. None
5. Harris Savings Association, Hbg., Pa. Certtficate No. 111817 dated
June 3, 1974, amount $10,000.00 to Florence M. Rafael, interest rate 7Js.%, due 6-3-78.
Certificate #113058 dated Oct. 5, 1974, amount $1,000.00 to Florence M. Rafael,
interest rate ~ due OCt. 5, 1978.
6. None
7. None
8. 1975 Pontiac coupe, title No. A26999730, serial #2G37M5G11805l to Florence M. Rafael.
And now this 20th day of October, 19--...1...8., I hereby
certifY under penalty of perjury-that the above record is correct and complete
to the best of my knowledge and belief.
/ ~) /
\ ./ ~1 <. ..~ ~A' x(z.,/ ~.~
Signature
Anha ~~&e ~Of!\.\J.oah Officer
NOTE: Use separate sheets if necessary.
...
Commonwealth J~
National Bank ~
P. O. Box 320, Mechanicsburg
December 12, 1978
Richard Anderson, Register of Wills
Court House
Carlisle, Pa., 17013
Re: Estate of Florence M. Rafael, Deceased.
Gentlemen:
We are sending a revised second page of form #RCC-87
for the above which we sent your office on October 25, 1978. We had
typed the names of owners of the bonds incorrectly but the amounts
were correct. If you have any questions, please contact us.
Very truly yours) ~
~~~~~~
Personal Loan Officer
ALRjnch
Encl.
The Commonwealth National Bank, 10 South Market Square, Harrisburg, Pa. 17108
(717) 564-9500
Page 2
SAFE DEPOS IT OOX INVENTORY
Instructions: 1 CASH: Report total only. 2 STOCK: List in detail every cor:nnon or
preferred certificate, warrant or other rights found ~~ box. Stocks are to
be designated by name of company, certificate number, date of (.artificate,
name in which stock is registered, number of shcres and class of stock.
(3) OBLIGATIONS of U.S. GOVERNMENT: Number of pieces, dates of issue, face
value, names in which registered. (4) BONDS: Designate uy name, amount,
serial number, or otherwise. (5) sAvmas BANK or PASS BOOKS: State name
of depositor, number of book, last date appearing in book, name of bank and
branch, and balance. (6) JEWELRY, COINS, STAMPS, MANUSCRIPTS, ETC.: List
and describe as fully as possible. (7) List Deeds, Mortgages, Current
Insurance Policies or other evidences of indebtedness. 8 All other contents.
1. None
2. None
3. 1-~25.00 Series E , Oct. 1943 Mrs. Florence M. Rafael POD to Emil W. Rafael
serial #Q219630554E
Mrs. Floremce M. Rafael POD Mrs. Gladys M. Comp, 4--$200.00 Dated Feb. 1977,
serial #R205 048 193E, R205 048 194E, R205 048 195E, R205 048 196E
2--$1,000.00 dated Feb. 1977, serial #M202 562 848E, #M202 562 849E
Mrs. Florence M. Rafael POD Mr. Leo H. Eppley, Sr. 4--$200.00 dated Feb. 1977
serial #R204 750 695E, R204 750 696E, R204 750 697E, R204 750 698E
2--$1,000.00 dated Feb. 1977, serial #M202 562 847E, M202 562 846E.
Mrs. Florence M. Rafael or Laura Sue Eppley, 1--200.00 dated Feb. 1978,
serial #R 207 041 127E.
Mrs. Florence M. Rafael or Jessica Eppley, 1--$200.00 dated Feb. 1978
serial #R207 041 128E.
Mrs. Florence M. Rafael or Laura Sue Eppley, 1--200.00 dated March, 1978
serial #R207 323 610E.
Mrs. Florence M. Rafael or Andrew Leo Eppley, 1--$200.00 dated March, 1978
serial #R 207 323 606E.
Mrs. Florence M. Rafael or Kathryn M. Alexa, 1--$500.00 dated Feb. 1977
serial #0203 871 421E.
Mrs. Florence M. Rafael or Andrea Neuschler, 1--$500.00 dated Feb. 1977
serial #0203 871 422E.
Mrs. Florence M. Rafael or Kathryn M. Al~xa, 1--t5CO.QO dated Feb. l'H8
serial #0205 852 242E.
Mrs. Florence M. Rafael or Andrea Neuschler, 1--$500.00 dated Feb. 1978
serial #0205 852 241E.
Mrs. Florence M. Rafael or Samuel Barley, 1--$500.00 dated Feb. 1978
serial #0205 852 240E.
Mrs. Florence M. Rafael or William Barley, Jr., 1--$500.00 dated Feb. 1978
Serial #0205 852 239E.
Mrs. Florence M. Rafael or Joseph P. Alexa, 1==$1000.00, dated Feb. 1978
Serial #M206 935 767E.
4. None
5. Harris Savings Association, Hbg., Pa. certificate #111817 dated June 3, 1974
amount $10,000.00 to Florence M. Rafael, interest rate 7~% due June 03,1978.
Certificate No. 113058 dated Oct. 05, 1974, amount $1,000.00 to Florence M. Rafael
interest rate 7~% due Oct. 05, 1978.
6. None
7. None
8. 1975 Pontiac coupe, title No. A26999730, serial #2G37M56118051 to Florence M. Rafael.
And now this 20tt:iay of October 19 78 I hereby
certif,y under penalty of perjury that the above record is ~orr~d complete
to the best of ~ knowledge and belief. __ ~_ /
/ /.:/yy /) /.
L cl//u"~ignalre ~'~L~'>h'-Y~
Anna L. Rankin, Personal Loan Officer
Print Name and Title
NOTE: Use separate sheets if necessary.
Page 2
.
SAFE DEPOS IT OOX INVENTORY
Instructions: I CASH: Report total only. 2 STOCK: List in detail every common 0::-
preferred certificate, warrant or other rights found 'h~ box. Stocks are to
be designated by name of company, certificate number, date of certificate,
name in which stock is registered, number of sh~res and class of stock.
(3) OBLIGATIONS of U.S. GOVERNMENT: Number of pieces, dates of issue, face
value, names in which registered. (4) BONDS: Designate 01 name, amount,
serial number, or otherwise. (5) SAV:mGS BANK or PASS BOOKS: State name
of depositor, number of book, last date appearing in book, name of bank and
branch, and balance. (6) JEWE1.RY, COINS, STAMPS, MANUSCRIPTS, Ere.: List
and describe as fully as possible. (7) List Deeds, Mortgages, Current
Insurance Policies or other evidences of indebtedness. 8 All other contents.
1. None
2. None
3. 1-$25.00 Series E , Oct. 1943 Mrs. Florence M. Rafael POD to Emil W. Rafael
serial 1Q219630554E
Mrs. F10rellCe M. Rafael POD Mrs. Gladys M. Comp, 4--$200.00 Dated Feb. 1977,
serial 1R205 048 193E, R205 048 194E. R205 048 195E. R205 048 196E
2--$1.000.00 dated Feb. 1977. serial 1M202 562 848E, 1M202 562 849E
Mrs. Florence M. Rafael POD Mr. Leo H. Eppley, Sr. 4--$200.00 dated Feb. 1977
serial 1R204 750 695E. R204 750 696E. R204 750 697E, R204 750 698E
2--$1.000.00 dated Feb. 1977, serial 1M202 562 847E, M202 562 846E.
Mrs. Florence M. Rafael or Laura Sue Eppley. 1--tpO.00 dated Feb. 1978.
serial IR 207 041 127E.
Mrs. Florence M. Rafael or Jessica Eppley, 1--$200.00 dated Feb. 1978
serial 1R207 041 128E.
Mrs. Florence M. Rafael or Laura Sue Eppley. 1--.1.00.00 dated March, 1978
serial 1R207 323 610E.
Mrs. Florence M. Rafael or Andrew Leo Eppley. 1--$200.00 dated March. 1978
serial IR 207 323 606E.
Mrs. Florence M. Rafael or Kathryn M. Alexa, 1--$500.00 dated Feb. 1977
serial 10203 871 421E.
. Mrs. Florence M. Rafael or Andrea Neuschler. 1--$500.00 dated Feb. 1977
serial 10203 871 422E.
Mrs. Florence M. Rafael or Kathryn M. Alexa. 1--$500.00 dated Feb. 1978
serial 10205 852 242E.
Mrs. Florence M. Rafael or Andrea Neuschler, 1--$500.00 dated Feb. 1978
serial 10205 852 241E.
Mrs. Florence M. Rafael or Samuel Barley. 1--$500.00 dated Feb. 1978
serial 10205 852 240E.
Mrs. Florence M. Rafael or William Barley. Jr.. 1--$500.00 dated Feb. 1978
Serial 10205 852 239E.
Mrs. Florence M. Rafael or Joseph P. Alexa, 1..$1100.00, dated Feb. 1978
Serial IM206 935 767E.
4. None
5. Harris Savings Association. Hbg.. Pa. certificate 1111817 dated June 3, 1974
amount $10,000.00 to Florence M. Rafael. inter~5t rato ~ due June 03, 1978.
Certificate No. 113058 dated Oct. 05. 1974. amount $1,000.00 to Florence M. Rafael
interest rate 7J(I, due Oct. 05, 1978.
6. None
7. None
8. 1975 Pontiac coupe. title No. A26999730. serial 12G37M56118051 to Florence M. Rafael.
And now this 2Qtay of nr+nh.... , 19-Za, I hereby
certify under penalty 0 perjury that the above record is correct and complete
to the best of my knowledge and belief.
Signature
Anna L. Rankin. Personal Loan Officer
Print Name and Title
NOTE: Use separate sheets if necessary.
Diocese of Harrisburg
Post Office Box 3651
Harrisburg, Pennsylvania 17105
Phone 717/652-3925
Office of Financial Administration
December 28, 1978
Joseph P. Alexa
16 S. Harket Street
Mechanicsburg, PA 17055
Dear Mr. Alexa:
As you have requested, our office is sending this letter to you
in regard to the savings account held here for Mrs. Florence Rafael(#01-37770).
At the time of her death (October 1, 1978), the balance of her
account was $1,059.31. Since that time, interest was added to her account
(October 15, 1978) and it now stands at $1,072.02.
As you had stated, you hold Mrs. Rafael's note certificate #B-2467,
dated June 8, 1977 for $1,000.00. If you wish to collect the amount of her
account, all you need do is send our office a letter stating so, a copy of
your Power of Attorney and the note certificate. (Depending on when you
close her account, more interest might be accrued.)
If there are any more questions concerning this matter, please
contact our office.
Sincerely, ~ "
~/;:/ v?
Edward G. Faraday ~
Director
EGF/mem
DIOCESAN CENTER - 4800 UNION DEPOSIT ROAD
Commonwealth J~
National Bank ~
December 21, 1978
Joseph P. Alexa
16 South Market Street
P.O. Box 1216
Harrisburg, Pa. 17055
Re: Estate of Florence M. Rafael
Dear Mr. Alexa:
In reply to your letter dated December.J(1978 on the above estate, we
have a checking account #142-732072-4, the~alance as of D.O.D., October 1,
1978, is $2,524.57. This account was opened on or before 4/5/74, in the
above name only.
If you have any questions, please feel free to contact us.
1:;;:;;'~~4
Daryl S. Myers ~
Vice President
DS~1/ cg
The Commonwealth National Bank, 10 South Market Square. Harrisburg, Pa. 17108 (717) 564-9500
The I-I~R HIS Savings Association
205 PINE STREET. HARRISBURG, PENNSYLVANIA 17105
OFFICES
Area Code 717' 2 36..4041
DOWNTOINN . COLONIAL PARK. CAMP HILL' LEBANON' UNION DEPOSIT
CAPITAL CITY' NEW CUMBERLAND
December 13, 1978
Joseph P. Alexa
Attorne,. At Law
16 South Market Street
MechanicsburC, Pa_ 17055
SUBJECT: Estate of Florence M_ Ratae1
As per your request, the following are the balances as of October 1, 1978, on
the accounts in the Estate of Florence M_ Rafael.
Account #1-09-110630(Cert_ #113058>
11,726.60 Balance as of 10-1-78
33.04 Earnin.gs to 10-1-78
11,759.64 DOD Balance as of 10-1-78
Account #l-Q9-111817(Cert. #111817)
113,574.27 Balance as of 10-1-78
259.77 Earnings to 10-1-78
113,834.04 DOD Balance as of 10-1-78
$1,037.82 Balance as of 10-1-78
13.82 Earnings to 10-1-78
$1,051.64 DOD Balance as of 10-1-78
Optional Account #1-35743
Please feel free to contact me if there are any questions or problems concerning
these accounts.
~~~cere1,., n
Wi: rJ );/ ~~ /1
Philip JI'~180n, Jr)" .
SaTings Counselor
PJD/pjd
~
~ fJJIIt ~t1K. ~~
I
Savings & Loan Association
of Harrisburg
December 11, 1978
JOSEPH P. ALEXA
Attorney At,Law
16 South Market St.
P.O. Box 1216
Mechanicsburg, PA 17055
Re: Estate of Florence M. Rafael
Dear Mr. Alexa:
In regard to our telephone conversation today and my letter
of December 8, 1978, below is the information you requested con-
cerning the decedent's account with our association.
Emil W. Rafael or Florence M. Rafael
Account No. 2-357
Balance on date of death.
Accrued interest to DOD
Total value on DOD. . .
.$5,840.01
77.70
. .$5,917.71
I am sorry for any confusion my first letter may have caused
you. Unfortunately, we were using the wrong account number. If
you have any further questions, please call me at 232-6661.
Sincerely, ~~
.)/1
<::_e,. __ ..'
-. . /
....-...:-~.,~i. }'U.. j ~/,-_....., h
/,//' Jam~s R. H{ftman '. 1/1
. Savings Couh~elo~1 I
/ ,.../",
.''-....-
234 NORTH SECOND STREET. PO. BOX 1111 . HARRISBURG, PA 17108 . (717) 232-6661
I tern
No.
1.
2.
3.
4.
5.
('6.
\7.
8.
10.
11.
12.
13.
14.
15.
16.
17.
1e.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
pee -~~
..~...>>. ~
1t~1i'
"('7 ""'"
r,O~WONWEALTH OF PENNSYLVANIA
TltANSFEH INHERITANCE TAX
HFSInENT DECEDENT
SCHEDULE liB"
PERSONAL PROPERTY
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 wi th another or others
must be listed under Schedule "E". Intangible persomcl 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 shoulrt 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
List and describe fully
UNIT ESTIMATED
VALUE MARKET VALUE
DEPARTMENT VALUATION
(Do not write in
this space)
9.
Swiss wall clock
4-Stick candleabra
Falni1y dishes
Eppley Family Crest
Ceramic Pitcher r n
Magnavox- 1'-/ <f(J 0... /'1 ~Lf
Dining Roo~ Radio and Record Player
Records
Nativity Set
Saint Francis statue
Brown abstract oil painting ~/frame
Ceramic wind chimes
Nativity picture w/frarne
Cedar chest
Ceramic Turtle table
2 Oil Paintings, Fall & Winter scenes,
frame c
2 Cane sent chairs, woooen
Twin beds (bedroo~ set) ~/mnttress
2 ~fuite cane seat chairs, living room
Circular Living Room Tru)le (slate tops)
Bed with mattress
Hooden bedroom chest vl/b1anket
Bedroom bureau and chest of drawers
Night table
I Portable radio
Metal jewelry box
~vall mirror
~ecretaria1 Desk, wooden, w/chair
Metal lawn furniture (2 chaise lounges,
table, 4 chairs, coffee table)
Glass table, living room
Green ceramic living room lamp
Print with fra~e, dining room
2 small oil paintings, dininq room
Approximately 30 used books, novels, etc.
Personal clothing
Pocketbooks
Turquoise and silver Indian jewelry,
necklace, earrings, bracelet
Miscellaneous jewelry
Pearl Ring
! Imitation Topaz ring
2 Fabric living room chairs
Sofa, living room, several pillows
2 living room end tables
2 metal lamps, living room
Glass and metal living room coffee table
Dining Room table and 4 chairs
Ottoman reclining chair
125.00
25.00
350.00
10.00
50.00
75.00
10.00
10.00
10.00
40.00
5.00
25.00
25.00
35.00
10.00
50.00
100.00
100.00
100.00
20.00
10.00
100.00
10.00
5.00
2.00
10.00
100.00
200.00
40.00
50.00
30.00
20.00
30.00
400.00
100.00
38.
39.
40.
41.
42.
43.
44.
45.
46.
47.
200.00
150.00
150.00
150.00
160.00
120.00
40.00
100.00
100.00
40.00
40.00
Insert this total opposite "Personal Property", Schedule "B" in X X
the "As Reported" column on the last page of this return.
t "
49.
49.
50.
5!.
52.
53.
54.
55.
56.
57.
5e.
59.
60.
6l.
62.
63.
64.
65.
66.
67.
68.
69.
70.
71.
72.
73.
74.
75.
76.
77.
7B.
79.
80.
8l.
82.
93.
84.
85.
86.
87.
88.
89.
90.
91.
92.
93.
94.
95.
96.
97.
98.
(PAGE Tl"10)
SCHEDULE "B"
PERAONAL PROPERTY
--_._-----"'._~~.~.--'-~---------"_.~------,..
Glass and metal display table, living
room
Storage bureau, dining room
2 Lamps and mirror, dining room
Silverware set
Square bedroom night table
Bedroom bureau, white
Kitchen dishes, pots and pans
Electric knife
Pressure cooker
Dutch oven
Glass birds
Clay pot
Candlestick
Christmas decorations and wrappings
Coffee pot
Copper pot and cups
Miscellaneous dishes and glasses
Chafing dish
Leaded stained glass angel
Food processor blender
30 Wall decorations, pictures, etc.
Small wall barometer
Brown leather suitcase
Black and Decker electric trimmer
Silverware set
ifuite metal lamp
~~ite and gold Venetian Waste basket
2 ~lliite dress hangers
Cookbook s
Four tan ceramic cannisters
Padded chest - bedroom
Sylvania T. V., 24-inch screen
2 Pillows, cushion
2 Electric vacuum cleaners
Travel bag with umbrella
Towels
Leather suitcase
Small ceramic pitcher, white vase
Sewing Kit
Small valise
Manumatic slide projector,35 mm.
with screen
Pratlflex Camera, 35 rom. with leather
carrying case
6 Aprons
Linen towe ls
4 Flannel blankets
Nooden jewelry box
2 Men's scarves
Small wooden table box and plastic
jewelry box
5 glass vases wit~ seashells
2 ~fuite cane lawn chairs, metal legs
1975 Pontiac LeMans Coupe, Title
No. A26999730, Serial Number
2G37M561l8051
100.00
100.00
150.00
50.00
25.00
25.00
30.00
5.00
5.00
10.00
10.00
3.00
5.00
5.00
2.00
20.00
10.00
3.00
5.00
10.00
50.00
5.00
10.00
10.00
10.00
10.00
5.00
2.00
2.00
25.00
5.00
50.00
1.00
75.00
5.00
10.00
15.00
1.00
5.00
20.00
35.00
35.00
2.00
30.00
5.00
2.00
2.00
10.00
15.00
6.00
I
I
_..1.___._. __.__...__.__.._..
2150.00
I
I
.. ..-.1_... ..... ... _....
.
pee -~f=:
COMMONWEALTH GF PENNSYLVANIA
TltANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "B"
PEHSONAL PROPEHTY
I KSTRUCTIONS: This Schedule must disclose all tangible and intangible personal property owned individually
by the decedent, at the time of his death. Property owned!:Jy 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 am} tenta-
tive trust accounts, must be listed, despite the fact that they are not of the administered estate.
Tangible personal property shoul(! 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 anyundistributed
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
Tl. S. Series E Bonds, registerec "F1orenc
M. Rafael, POD Mrs. Gladys M. Comp"
!3ond ..!.LUIl1iJ_~r
Date
R2050., 81 f) 3r
R2050481941:
R20504B19SE
R205048196E
H202562848E
H202S62849r;
2-77
2-77
2-77
2-77
2-77
2-77
u. s. Series 1: Bonds, registered "Florenc.
M. Rafael, POD r.,eo II. Eppley, Sr. It
Bond Numl.>er
-.-- _._-_._-
Date
R2047506951'
R204750696J~
n204 7506971~
R20475069m:
M202562847::
f-f2 0 25628461;
2-77
2-77
2-77
2-77
2-77
2-77
u. S. Series E Bonds, registered "FlorenCE
M. Rafael, POD Emil W. Rafael, Number
Q219630554E, dated 10-25-43:
~tocks :
Simmonds Precision Products, Inc., 22
Share B Common
Coastal Caribbean Oils & Minerals Ltd.,
100 Shares Common
Penn Central Co., 100 Shares Common
I General Tire and Rubber Co., 29 Shares
Common
Foremost ""c}~esson, Inc., 20 Shares Common
Note given by the Mission Board of the
Diocese of lTarrisburg to Florence M.
Rafael, Certificate No. B-2467, dated
, June 8, 1977, in the amount of
I $1,072.02 (including accrued interest)
$1,000.00 certificate of Deposit Nwrher
113059 with the Harris Savings 1\8S0-
ciation of Earrisburg, Pennsylvania,
elate of death balance
UNIT
VALUE
200
200
200
200
100 I)
1900
200
200
20e
200
1000
1000
25
ESTIMATED
MARKEl' VALUE
DEPARTMENT VALUATION
(Do not writ,e in
this space)
162.16
162.16
162.16
162.16
R10.aO
810.80
162. 16
162.16
162.16
162.16
810.80
RIO.80
71.62
440.00
5R7.50
200.00
~35. S6
443.75
1,072.02
1,759.64
(nsert this total opposite "Personal Property", Schedule "B" in
the "As Reported" column on the last page of this return.
x X
..
. -
(PAGE TWO)
SCHEDULE "BIi
PERSONAL PROPERTY
Item
Estimated
t.1arke t
Val ue
I $10,000.00 Certificate of Deposit 11um-
I ber 111817, with the Harris Savings I
I Assocition of Harrisburg, Pennsyl- I
I vania, aate of death balance: 113,834.04
I Savings Account Number 1-35743 with I
' the Harris Savings Association of I
Harrisburg, Pennsylvania, date of I
death balance: I 1,051.64
I
I
I
I 5,917.71
I
i
I
I
I
I Savings Account Number 2-357 with
I First Federal Savings ana Loan
ill Association of Harrisburg, Penn-
I sylvania, date of death balance:
I Checking Account Number 142-732-
072-4, with Commonwealth National
Bank of Harrisburg, Pennsyl-
vania, date of death balance:
2,524.57
10-30-78 Foremost McKesson, Stock
Dividend:
6.20
12-8-78
I Stock
10-2-78
I
10-2-78
General Tire and Rubber,
Dividend:
10.88
Mo. Social Security Pay~ent
313.10
Stock Dividend
34.32
10-30-78 Refund, West Shore County
Club Dues
140.00
10-30-78 Credit Card reimbursement
58.00
11-6-78
I pital
112-8-78
\
I
1
I
I
I
Refund, Seidle Memorial Hos-
401.25
Refund, Bell Telephone Company
I
I
I
I
I
I
Total j
5.37
I
I
40,930.65 i
I
7
RCC-1S
Cl)\lM(l\WEA 1.1'1[ (IV l'L:\\'~YL\-A:-iI /\
T4.A\~J:'Fi\ I\E1':!\ITA'\CF 'L\X
SCHEj)UU~ "e"
T!{ \ \J ~ FE IlS
~
~~~~
~ :~S;y 11.
r J _;., ,,;1;tJ;/; ",~, ;~ ..
I..,~;.t"-c.".
'\ <. ;'ir'~:;~1(i?
ilES I JW\'T j)IT lillF\T
(1) Did decedent., wUJlin t.wo jears ofdeat.h, make any trltHsfer of any mat.erLiL part of his estat.e, ,,jthout
receiving a valuable and adequate considpration thprefor? (Answpr yes 01' no)_NO__
(2) Di(1 deced.'nt., wit.hin t.wo yeflrs of death, trfln;;fe,' property from hil14"\.elf to himself and another oc
(,t.hers (inclwli ng a spouse) in Joint ownership? (Answer JPS or no) ~__
(3) If t.he answer t.o (1) or (2) above is in the affirmative stat.e:
(a) Age of decedent at time of transfer ---"=-_
(b) State of' decedent's health at time "f making the transfer. (Not.e 1).
(c) Cause of decedent.' s de'itll. (Not.e 1).
(4) Did decedent, in hi:, lifetime, make any t.ransfer of property wit.hout receiving a valuable or adequat.e
considera 1, ion t. heref'o I' which was to t.ake efrect. in possession or enJ oymen 1, at. 0 I' aft.er hi s dpat.h?
(Answer yes or no) j.[O
(a) \\as t.here any possibility that. the property transferred might return to transferer or his
est.ate 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 neath?
(5) Did necedent in hls lifetime make any transfer without receiving a valuable and adequat.e consideration
therefor under which transferor expressly or impliedly reserves for his life or any perioe! which does
not In fact. end l)efore his deat.h:
(a) The possession or e~joyment of or the right t.o income from the property transferred?
(Answer yes or no) No
(11) The right. to designate the persons who shall possess or enjoy the property transferred or
income therefrom? (Answer yes or no) No
(0) If the answer to (5) (b) above is in the affirmative, state whether the right was reserv(~d in decedent
alone or ot.hers -
(7) Did decedent in his lifet.ime make a transfer, the consideration for which was transferee's promise to
pay income to or 1'01' the benefit of care of tra~sferor? (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 al tel', amend, or revoke, or which con] d revert t.o decedent. under terms
of transfer or by operation of law? (Answer yes or no) 1'TO
(9) If the answer to (8) above L; in the affirmative, was the power to 11.1 tel', amend, or revoke the inter-
est of t.he beneficiary reserved in the decedent alone or the decedent. and others?
(Answer yes 0 r no) ?jo
NOTE 1. The answers to these questions should be supported by affidavit hy the attending physician as
well as a copy of the death certificate.
NOTE 2: If answer to any of the above (Iuestions is yes, set forth below a descript.ion of the property
transferred, it's fair market vallle at. date of death, nates of transfers and to phom transferree!, with
relationsh~) or transferees t.o e!ecedent, if any. Submit copy of any trust. deed or instrument, if trans-
fers are claimed to be non-t.axable, also submit detailed statement of facts on which Side! claim is based.
:'<iOTE 3: List apl'licable property below in ffianner in which provinect in Schee!ules A, B, or E.
ITEM
L>ESCRIPTION
MARKET VALUE
(Es t ima ted)
DEPT. VALUAT~ON
(Dept. Only)
NONE
NOUE
I
I
I
I
Insert this totril opposlte "Transfers", Schedule "e" in t.he
"As Reported" column on the last page of this return.
NONE
..
RCC-J7 (12-6])
CO:\Il\lO~\\-EALTI! OF rE:'~;,\SYYL\NIA
TRANSFER INHERITAl'\CE TAX
RESIDENT DECEDENT
SCHEDULE "D"
f~
I"'~;::~).
~ .:t..3"I. ~
TJ ,:-,/It:J>~~ "''''
l/')~'!;'-'" Ij
~'_: Jf."~,-,;' <. ot'" " I
BEN EFIC!AHIES
Cedar
Ca '
l-
I
I 11
1
t
rincirial
$1,O.72.~2
lof ",ill
-I
11975
INTEREST OF
BENEFJC:JARY
Jl\' EST.\TE
BENEFICIARIES AND ADDRESSES
~State full names and addresses of all who
have an interest, vested, contingent or other~
- in estate) I
WIRe, _ ,
\
I
I
. S."e. Joseph's Roman Catholic I
Church, 420 r,ast Si~pson I
St.. Mechanicsburg. P
17055
RELATIONSHIP I
(If step.children or I
i)lpgitimate cr iJdren I
are Involved, set
forth this fact.) I
I
I
I
!
----r--
s~r~XI~7~ i DA.TE
DEL',DEi' r i OF
STATE ,XES I 1~
OR N~In~_
I
I
i~~-24G7 to Mis-
of Diocese
Leo H. Eppley. 2108
Run Drive Ant. 106
Hill, Pa., 17011
Personal nroperty (Pal
IS of \.111), One-half
Residua. · estate
I (Par. r of \1i11)
I
I\eller
b urq , P a. ,
t"echanics-
Stella Alexa, 402 East
Keller Street, ~'~chanics-
buro, Pa., 17055
i
r-
of t~i11
11'ropert~
to ,-all
Common Stock (Par. 4
n 1
(Supplement
y
J-17-4R
t1ativit
plerfl.ent
Yes
Theo Bolan, 12 heaver Pel.,
Camp Hill, Pa., 17011
Yes
Tur uoise Jewel
(:::')un ler;ent. to Will)
Kathryn Alexa, 319 l~ast
Main Street, Y~chanicsbur~,
Pa., 17055
1--
~
Yes 3-21-50 Personal Property
_I (Suppler~nt to Wi11L
---I I
Deponent further says that all the above-named beneficiaries are living at this time except below:
NAME
DATE OF DEATH
RESIDENCE
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Heal Property
Personal Property
Transfers
SUMMARY
(Sch. "A")
(Sch. "B")
(Sch. "e")
( 1 )
(As Reported)
i:) ,
,... )
(:\5 I )dl'lnlilll'd )
1-.
~
Gross Taxable Estate
$
$
$
$.
$
$
$
$
$
$
$
$
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CO:\t:\IO:'I<\rEALTl! OF PE~.;:\'SYYL\:\I:\
TRANSFER Il\;HEHlTA]\;CE TAX
RESIDENT DECEDENT
(CONTINUED)
SCHFDULE "D"
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BE~EFIC1AHlES
T -IRELATI();~SIliPI-:-~~I-- ~ r---- I
~ BENEFICIARIES AND ADDRESSES I (If step-chIldren or I ,_,~.:~IV,EI? I DI\Tli; I'
\:::;tate full names and addresses of all Who! illf'gitlmate C'hJoren I DEe: J.lE~r: I OF
have an intere"t. vested, con t ingent or othpr- are lnvolve.j, s;:t ST,\ f", T\ -",S " T
- -. t't ) I forth this f-'et) OR NO BIRlh
W1Be, In 2S a e I (..l . I
------ -~----- I ----r------l-----
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Yes ---l 2 Paintings (Supple-
La~ ' ___I ment to vIill)
INTEREST OF
fJENEFICIARY
I~ EST\ TE
I..
Martha
414
l Nephew
I
L-
I
I
L N ie ce
Personal Proper~
Par. 6 of vlil
$5.000.00 (Par. 7
of Will)
~::r:P~:~~~,J:~~~~:::1
R
Fa.. 17022
--~ =1
Yes I 5-15 40
Virginia, 22110
Sister
I
Yes LB-7-
I
(Par. 6 of Will)
j $5,000.00 (Par. 7
I of ~Vill)
L-
One-half of
du
8 of Nil!)
bllrg, Pa_
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~I- j ~.~
Deponent further says that all the above-named beneficiaries are H.ving at this time except below:
NAME DATE OF DEATH
RESIDENCE
N E
NONR
3
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SUMMARY
(Sch. "A")
. (Sch. "B")
. (Sch. "C")
Heal Property
Personal Property
Transfers
Gross Taxable Estate
(1)
(As Heported)
$
$
$
$
$
$8.5.,930.6.5
45,000.00
40,930.65
..-0-
( 2)
(As l)l'lr'rlllilll'd)
$
$
$
$
$
$
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R C C-38
RESIDENT DECEDENT
SCHEDULE" E"
JOINTLY OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
INSTRUCTIONS: This scherlule must disclose all property, real and personal, ownerl by the decedent jointly
wi tl1 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 rlate and place of record of instrument effecting vesti ture, but rlo not include entireties
or out of state real estate value in estate valuation column. Personal property should be listed as in
Schedule "B", plus rlate of acquisition, and the name, address and relationship (if any) of co-owners to
the decerlent.
Description of Property, Date of Acquisi tion, Name uni t percentage Estate
Address anrl Relationship of Co-Owners, and Place Value Share Valuation
of Record of Instrument, where Real Estate.
DEPARThlliNT VALUATION
CAUTION-Do not Write
In This Space.
Value of Value of
~ntire Decedent's
Property Interest
u. S. Serie s
"Florence M.
Eppley"
P Bones registered
Rafael or Laura Sue
Bond Number
DAte
R20704ll27F
R2073236l0E
2-78
3-78
200
200
15 4 . 2 ~
153.6 (
Laura Sue Eppley resides at 10821
Moore Drive, Manasas, Va., 22110
u. S. Series
"Florence M.
pley"
E Bond registered
Rafael or Jessica Ep-
Bond Numbe r
Date
R20704ll28E
2-78
200
154 . 24
Jessica Eppley resides at 10821
Moore Drive, Hanasas, Va., 22110
u. S. Series
"Florence H.
Eppley"
E Bond registered
Rafael or ~~drew Leo
Bond Number
Date
R207323606E
3-7B
200
15 3 .6 (
Andrew Leo Eppley resides at 10821
Moore Drive, Manasas, Va., 22110
u. S. Series E. Bonds registered
"Florence M. Rafael or Kathryn M.
Alexa" .
Bond Numbe r
Date
D20387l421E
D205B52242E
2-78
2-78
500
500
385.61
385.6
Kathryn M. Alexa resides at 319 East
Hain Street, Mechanicsburg, Pa.,
17055
Insert this total opposite "Jointly Owned Property", Schedule "E"
in the "As Reported" colurrm on the last page of this return.
..., . --..
R C C-38
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
(PAGE TWO)
RESIDENT DECEDENT
SCHEDULE" E"
JOINTLY OWNED PROPERTY
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 lmder 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 unit percentage Estate
Address and Relationship of Co-Owners, and Place Value Share Valuation
of Record of Instrument, where Real Estate.
u. S. Series E Bonds registered
"Florence ~1. Rafael or l\n(~rea N'eu-
sch1er"
Bond Number
Date
D203871422E
D205852241E
500
500
405.40
385.60
2-77
2-78
Andrea ~eusch1er resides at 6160
Spring ni11 Terrace, 201, Greenbelt,
Maryland, 20770.
u. S. Series
"Florence H.
ley"
E Bond registered
Rafael or Samrnue1 Bar-
Bond Number
Date
D205852240E
2-78
500
385.60
Samuel Barley resides at 1040 Valley
Oaks Drive, A.1amo, California, 94507.
u. S. Series E Bond registered
"Florence M. Rafael or William Barley
Jr. "
Rond Numbe r M
Date
D20S8S2239E
3RS.6C
2-78
500
William Barley, Jr., resides at 1040
Valley Oaks nrive, Alamo, California,
94507
u. S. Series E Bond registered
"Florence M. Rafael or Joseph P.
Alexa"
Bond NUl'lber Date
-
.
M20693S767E 2-78 1, DOC 771.20
Insert this total opposite "Jointly Owned Property", Schedule "E"
in the" As Reported" column on the last page of this return.
DEPARTMENT VALUATION
CAUTION-Do not Write
In This Space.
Value of Value of
Entire Decedent's
property Interest
3,720.28
R E V-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
Joseph P. Alexa
16 S. Market St.
M8chanicsburg, p~ 17055
(Executor or Adm ini strator)
In Re: Estate of
Florence M. Rafael
Cumberland
County - Fi Ie No.
21-78-0560
Dear
You are hereby notified that the Original
appraisement in the estate of FlorQllcQ M. Rafael
has been fi led in the office of the Register of Wi lis of c'l1mhPT1.<1nrl
County on 28 February , 19~, Said appraisement reflects the following
valuations:
Real Estate
Personal Property
Transfers
Jointly Owned
Total
4l:j,nnn nn
40.960.65
None
3,720.28
89,680.93
As to such tax that is paid within three months from date of death, a five (5%)
percent discount is allowable. As to any tax that remains unpaid after nine (9) months
(fifteen months when death occurred from December 22,1965 to June 16,1971, inclusive;
and twelve months when death occurred prior to December 22, 1965) from date of death,
interest at the rate of six (6%) percent per annum is charged.
Any party in interest who is aggrieved by this notice may object thereto within
sixty days after receipt of said notice as provided by Section 1001 of the Inheritanre and
Estate Tax Act of 1961, 72 P. S. 2485-1001, P. L. 373
. L
Date 28 February 1979 Signed - ~
r:=- () ~ -
~ ~cJ~
Title Administrative Officer
~~.
Note: This is not a bi II.
REV-457 (8-78)
DEPARTMENT OF REVENUE
BUREAU OF FIELD OPERATIONS
P.O. BOX 2970
HARRISBURG, PENNA. 17105
COMMONWEALTH OF PENNSYLVANIA
RESIDENT INHERITANCE TAX
APPRAISEMENT
DA'L -L8 February 1979
COUNTY Cumberland
FILE NO. 21-78-056-.2
Whereas, Florence M. Rafael late of _~ Mechanicsburg
in the County of Cumberland Commonwealth of Pennsylvania, having died on
the 1 Qt- day of n,...t-nhpr 19 --2f3, seized and possessed of an estate
subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania;
Therefore, I, Leo Fulginiti , 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
$ I. <: nnn 00
..... .~
Personal Property 40 960 65
- ~ None
Joint-l u Ot.n'''>d 3,720 28
'T'n+- ...1 t:::RQ hRn a~
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 2ath day of ~rt;l~\.I--O..... ~ 19 72-- .
U Appraiser
(Number and Street)
Harrisburg
, Penna.
(Post Office)
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