HomeMy WebLinkAbout02-08-79
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RCC:33 (4-73)
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
.
-. '.
t.~ 10. tJ
RESIDENT DECEDENT
COUNTY OF
CnmnpY'l ;:mrl
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~enue. (Section 703 of the Inheritance and Estate Tax Act of 1961.)
IN THE MATTER OF THE EST A TE OF
Late of
Cumberland
} AFFIDAVIT OF
EXECCTOR
ADMINISTRATOR
County
Marie J. Smith
(STATE FULL NAME OF DECEDENT)
State of Pennsylvania
County of Cumberland
John M. Eakin
} 55:
~
of the estate of the above-named decedent being duly sworn, depose
Executor
and say
Decedent died
November
10
4!r
, 19_~{testate leaving a last will, copy of which is hereto attached. }
(YEAR) ~
(MONTH)
Nome and address of attorney Or }
other authorized representative to whom
all correspondence should be mailed.
(DAY)
That as such Executor deponent is familiar with the affairs of said estate and the property constituting
(EX ECUTO R-ADMINIST RA 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 access by another as agent or deputy, with the
exception of the ftdlowing: _
John M. Eakin
Market Square Building,Mechanicsburg, Penna., 17055
NAME AND ADDRESS OF BANK OR OTHER INSTITUTION
IN WHICH DECEDENT RENTED A SAFE DEPOSIT BOX
The Commonwealth Nakion 1
Mechanicsburg, Penna.
THIS SAFE DEPOSIT BOX RENTED
IN NAME OR NAMIC.S OF
RELATIONSHIP OF JOINT
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 s et forth:
B 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
where saver 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
gi ving al so separately the accrued interes t thereon, if any, down to the las t in teres t day prior to decedent's
death in the case of savings banks, and to the date of decedent's death in all other cases; all bonds, postal
savings, treasury certificates or notes and other evidence of indebtedness of the United States to the de-
cedent; all obligations, whether by statute or agreement they are 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 pa ya b1 C upon the dea th of the decedent; all and the corpora te stocks and div id ends
due thereon and unpaid as of I' ,,( death, bonds and accrued interest thereon to the date of decedent's
death and other investml ;,.J by the decedent at the time of death, with the market value there-
of at such time.
III the case of securities of close or family corporations, the values reported are as far as
possible substilIltiated by financial statements of the corporations, showing the assets and liabilitles
thereof as of the date of death. The schedule also sets forth the interest of decedent at the time of
death in any co-pFlrtnership or business, Flnd in support of the value of such interest there is annexed to
said sched1l1e, financial statements showing the assets ann liabilities of said co-partnership or r,usiness.
,\ cop" of' Ull' co-partnership agreement, (if oral, a statement settin;:!; forth the nature of the ag;reement)
to.,,-'" r "i'l1 a statement setting forth the cJoaracter of the business, its location, and such other {'a(,ts
1"'1'1 ",: "r, to the business as may be pertinent to a fair and just appraisal of the decedent's interest
p1erP!1l :!,,,,j loe sul,mittpd. It should also set forth in itemized form, together with the fair market value
tlH'r"';:'. a,,:' other property owned or bequeathed by the decedent at the time of death.
The Sc!>edule C attached hereto and made part hereof sets forth a true answer to each inquiry
contai!)"d t.JwT'cin amI in the case of transfers of property, real or personal, within two years of decedent's
death, ;L r,ontemplation of decedent's death, or intended to t'l.ke effect in possession or enjoyment at or
artei' ,leath, said schedule sets forth the nature and value of such property, to whom transferred, the
relat.Jonsilip of' the transferees to the decedent, the proportionate share received by each transf'eree and
all olh!'r fa,cts of' a pertinent nature regardin;:!; sairl transfers. In the case of transfers intende''! to
take e{'fpet in possession or enjoyment at or after death, there is also attached to the schedule a eony
of tll" deed, trust agreement or other instrument creating the trust. TJoero' is also set forth in said
sched"l" a 1 ist of all property, real and personal, with its value. which paf-ses at decedent's death hy
virtu" ")1' the exercise by decedent, either individually, or,jointly with another, or any power of appoint-
ment Vf"ted in decedent, either individually or jointly, 1,y the will, deed, or other instrument of another,
with Ii ('opy of the instrument creating such power attached to the schedule.
That Sc!>edule D attached hereto and made part hereof sets forth the nameS and adrlresses of HII
persons beneficially interested in this estate at the time of' decedent's death, the nature of their res-
pectiv(' int"rests, their relationship, if any, to the decedent, top;etl1er with the ages at the time of
decedelli's rleath of all minors, annuitants and beneficiaries for life under decedent's Will. It also
contains a statement showing which of the heneficiaries named in the decedent's will, if any, died prior
to (l"'Hient, the dates of their death, their issue, anrl the relationship of such issue to the beneficiary.
That Sc!>edule 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, standin;:!; in the name
of the decedent and others, plus the date and place of record of' instruments effecting the "estiture of
real estat.~ and the date of acquisition of personalty, 1l1us the name, ivldress and relationshij', if :m\',
of co-owners to the decedent.
That Sc!>edule F attached hereto and made a part hereof sets forth fully and in detail all debts
and deductions claimed for ann on behalf of this decerlent's estate, incluriing funeral expenses pliid;
family exemption, where applicaLle; costs of lirlministration of this estate; counsel fe'~s and f'udiciar:.,' "
commissions paid or to be paid; cost expended for burial trusts, tombstones or gravemarkers, and reli-
gious services, in cons'equence 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 Sectinn
651 of the Inheritance and Estate Tax Act); together with a statement or coIl literal pledged for oblig"-
tion5, if any. It is agreed that the fiduciary will present proof of said claimer! old i[~ations \11'0n 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 ttegister of IHl is, Hnd th"t
the amount of tax assessed can be reassesser! in accordance therewith.
That the totals of the appropriate columns in Schedules "A", "E", "en, "E", and "F" as directed therein,
have been carried forward and properly registered in the Summary.
Subscribed and sworn to before me this
............................. day of [- ~
1::J;#jrlz7 ffi~
..~,t/;.....
19...Z{ .
~t~~.m..mm_..
Ma et Sqp9xe..,..B.,1Jilding .."" ........ ............
(Street Number)
Me c.hi?nJG.?1:l1Jrg"....P..$Jl.nB,.o., .. l.7Q55......
(City or Town and State)
NOTE; Before signing affidavit make sure all blank spaces in the af'fi.davit and schedules annexerl. are
filled in with details or the word "None", anrl in ease the assets include rare ane! unlisted securities,
securi ties of close or family corporations or 'ln intprest in an~' co,-partnership or business, that the
data and statements requirerl under the 1'Ilragrapll above rt~latin;,; to Sc]wdulp "13" are attacherl. \lso make
certain that column #1 in the "Sunnnary" has heen properly completed liS al)()ve-di reeted.
-
'Re e-34 14-73)
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
TRANSFER INHERITANCE TAX
RESIDENT DECEDENt
SCHEDULE "A"
REAL PROPERTY
-.
Real p"'pe,ty in Penn sy Ivan i 0, wi th s tatemen t of m",tgo ge encumb'on ces Upon each p o,cel at death of dece-
dent. Pmpe'ty held by the decedent os tenant in common with onothe,", othe" should be identified
os to qu ontum of inte,est on d th e estimated v o'ue should be that of the decedent's in te'es t on Iy. (Pmp e'ty
held os ioint tenants with 'ight of sU'Vio'Ship 0' tenancy by enti'eties should be ,epMed on Schedule "E. ")
The real property located In the Commonwealth 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 "F" and must not b. deducted from this schedule.
(1)
(2)
(3)
DEPARTMENT
VALUATION
CAUTION
(Do not write
In th Is space)
ASSESSED VALUE
FOR YEAR OF
DECEDENT'S
DEATH
ESTIMA TED
MARKET VALUE
House and Lot of Ground in Lower
Allen Township, Cumberland County, Penn-
SYlvania, (244 Creek Drive, Camp Hill);
being a two story brick dwelling house
converted into four apartments. Part
of the same premises described in Deed
Book "C", Volume 15, at Page 57
?/3l.
$ 50,000.OCV
C'~'
-,
I.
. .
l
Ht this total opposite "real property", Schedule "A" in the X X X X X
; Reported" column on the lost page of this return.
$ 50,000.00
~ 0 0,.);) 0:'
- I
~,,'--"-1 ........_
~.,. ',~ -,''',--
rO\L\IONWK\LTH OF PJ':NNSYLVANI\
TIL\N"~lm INHElUT\NCE TAX
I:FSlnK~T DECEDE;'H
S CHEIH:LF " 1-3"
PEHSONAL P){OPEHTY
J\STIU!CTIONS: This Schedule must disclose all tangible and intangible personal property owned indiVidually
hy the decedent, at the time of' his death. Property owned hy the decedent Jointly with another or others
mFst be listed under Schedule "E". Intangible person.ll property, t1 Uee! in the name of' the decedent, but
payable at death to another or others, including but not limited to P.O.l). V. S. Savings Bonds anci tenta-
tive trust aCCOtU"!ts, must be listed, despite the fact that th,,'Y '"rc not of the administe;'ed estate.
Tangible personal property shoulrI be listed i'irst (e.g. Jewelry, wearing apparel, household
goods, and furnishings, hooks, paintings, automObiles, boats, etc.)
Intangihle personal property, such as hands, treasury certit'tcates, cash on hand and in bank,
stocks, mortgages, notes, together with accrued interest or rHvidends, salaries or wages, insurance pay-
able to the estate or f'iduciary in said capacity, partnership interests, interest in anyundistributed
es tate of or income from any property held in trus t under the will or agreement of another, even though
located outside or the State, at the time of death, should be listed in this schedule.
-
~o.-n---""'t"""-_I't:lov-.r-
I t~?m
ITEM
List and describe fully
"'0,
-
-,
TJNIT
VALUE
ESTIMAT@
MAPJ~r VALUE
DEPARTMENT VALUATION
(Do not write in
this space)
1.
-
2.
Savings Acct. #507-070-1 with the First' if
Bank & Trust Company of Mechanicsburg ,Pa .I~ /
Cert. cf Deposit No. 198, with The First
Bank & Trust Company of Mechanicsburg,Pa.
$10,000.00 dated Mar. 24, 1975,@ 7i% into
Prin. $10,000.00
Int. 34. 23
3.
Cert. of Deposit No. 4049,with The First
Bank & Trust Company cf Mechanicsbur~,Pa.
$10,000.00 dated July 14, 1978, @ 7i% int
Prine $10,000.00
Int. 54.37
Checking Acct. No. 79 83 971 1, with
Dauphin Deposit Bank and Trust Company
4.
5 .
SaVings Acct. No. 066 06032 with Dauphin
Deposit Bank and Trust Company
Prine $10,493.47
Int. 59.74
6.
Cert. of Deposit No. 3059, with Carlisle
Bldg. & Loan Assoc.,for $15,000.00,dated
July 18, 1977, @ 7!% Int. Int. accumu-
lated and added to principal.
Prine $16,107.62
Int.7/1 - 10/10 491.06 I
Cert. of Deposit No. 6693258 with Cum- I
berland Valley Savings & Loan Assoc., I
$15,000.00, dated July 15, 1977,@7!% Int.
Prine $15,000.00
Int. 272.91
7.
8.
Cert. of Deposit No. 14-3126 with Com-
monwealth National Bank, $15,000.00 dated
I Nov. 3, 1978, Int. @ 7i% /
Prin. $15,000.00 ',j
Int. 10/3 - 10/10 21.88
f.
Food
June
No.
-r
Fair Development Inc.,6% bonds of
15, 1984, as follows:
Denominat~on Registered
$5,000.00 Harry j. Smith & Mari
Smith,Harry Predeceased
$1,000.00 Harry J. Smith & Mari
Smith,Harry Pred?ceased
$1,000.00 Bearer Bonds
$ 500.00 Bearer Bonds
lIlt. 7/1-10/10 Ull BeanoI' Bond0
,er t this to tal opposi te "Personal Prop,?]' ty", Schedul e "Rn in
~ "As Heported" colum on the last page of this return.
5
arie
,
---14 Z
arie
..\ , '.
> $~6,113.08/
\\.,
10,034.23'
I
I
~V
I'" 10, 054 . 3 7.;
'''''s, 553 .1V
I
I
I
I
10,553.2r
I
I
I
I
, I
\16,598.61
I I
" I /
~15' 272 .91/ /'
,j . I
~15,021.88~
x X
5,000. oJ ~.
1,000.001/
48,000.00~
2 , 000 .od// /
I 1,08<:.OOr~.
I ,; '"II
IjLOSI3"1
/'
r'O.\J1If01\WE\.LTH or; PE\TNSYLVANIA
TIL\.:'-iSl'im INHEl1fT\.NCE TAX
HFSmEI\T DECEDENT
--
-
SCHEDULE "l-l"
PEnSCJN AL PHOPEHTY
I\STRIJCTIONS: This Schedule must disclose all tangible and intangible personal property owned individually
)'y the decedent, at the time or his death. Property owned hy the decedent Jointly with another or others
must be 1 isted under Schedule "E". Intangible persomd pr'opel'ty, ti tIed in the name of' th,~ decedent, but
payable at death to another or others, including but not limited to P.O.D. IJ. S. Savings Bonds ancl tenta-
tive trust aCCOUI!ts, must be listed, despite the f'act that th2y iere not of' the arl.Jllinistel'cd estate.
Tangible persona] propei'ty sihJuLd be listen f'irst (e.g. jewelry, weal'ing apparel, household
goods, and f'urnishings, hooks, paintings, automobiles. boats, etc.)
Intftngible personal property, such as bonds, treasury certif'icates, cash on hand and in bank,
stocks, mortgages, notes, together with accrued interest or dividends, salaries or wages, insurance pay-
ab.~e to the estate or f'iduciary in said capacity, partnership interests, interest in anyundistributed
estate of' or income f'r'om 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.
~"-':7'-:~.......--=o....,.".. T
~'l...-...
r t'~m
]\p,
-....--
ITEM
List and clescr'ibe fully
DEPARTMENT VALUATION
(Do not write in
this space)
UNIT
VALUE
ESTIMATED
MAPJ&'f VALUE
10.
10 $1,000.00 Consolidated Bottling Co.
6~% Subordinated Sinking Fund Debentures
of December 1, 1977
11. U. S. Series E. Bonds as
Date Denomination
June 1951 ~ 200.00
Mar. 1951 200.00
May 1952 200.00
Feb. 1942 25.00
Apr. 1942 25.00
May 1942 25.00
July 1942 25.00
July 1942 25.00
Aug. 1942 25.00
Nov. 1942 25.00
Jan. 1943 25.00
Feb. 1943 25.00
Mar. 1943 25.00
Apr. 1943 25.0C
May 1943 25.00
June 1943 25.00
July 1943 25.00
July 1943 25.00
July 1943 25.00
Aug. 1943 25.00
Sept.1943 25.00
Oct. 1943 2~.00
Nov. 1943 25.00
Dec. 1943 25.00
Jan. 1944 25.00
Jan. 1944 25.00
Feb. 1944 25.00
Mar. 1944 25.00
May 1944 25.00
June 1944 25.00
July 1944 25.00
July 1944 25.00
Aug. 1944 25.00
Sept.1944 25.00
Oct. 1944 25.00
Nov. 1944 25.00
i Feb. 1945 25.00
IMar. 1945 25.00
I Apr. 19Li:5 25.00
,May 1945 25.00
I July 1945 25.00
I July 1945 25.00
I Aug. 1945 25.00
~ept.1945 25.00
follows:
Value
$ 453.92'
46-1". 84-
LA. \.- (.\ - . L (1j".6_~DS:'
74.71- /
7 4.71 .--
75.28-
74.01
74.01
74. or
74.01
72.82
72.82
72.82
72.82
72.82
71.62'
71. 62
71.62
71.62
71.62-
71.62
71.62'
71.72
70.44
70.44
70.44
70.44
70.44
70.44
69.25
69.25
69.25
69.25
69.25
69.25
69 . 25- ./
68.14
68.14'
68.14
68.14
67.05
67.05
67.05
67.05
I,
I
No Value I
I
i
v
;ert tltis total opposite "Personal Property", Schedule "B" in X X
, "As Heported" column on the last page of' this return.
-
~,~~ '"' -.~,:::;
('()\L\IONWE\LTH GI,' PE'\TNSYLV.\NI\
TIC\NC:FEH INHEHTT\NCE TM;,"
SCHEDULr'; liB"
PEnSON AL PllOPEHTY
l:FSITlE!\'T DECEDE1\'T
J\STHUCTIONS: This Schedule must cHsclose all tangible and intangible personal property owned individually
l,y the decedent, at the time of' his death. Property owned ~)y the decedent Jointly wlth another or others
must be listed under' Schedule "E". Intangible person.,l property, ti tIed in the name of' the decedent, but
payable at death to another or others, including but not limited to P.O.D. G. S. Savings Bonds and tent~
t ive trust accounts, must be listed, despite the f'act tlHiL th'"y ere not of the administel'ed estate.
Tangibl e personal property shoul,! be ] isteri i'irst (e. g. jewelry, weal'ing apparel, household
goods, and f'urnishings, hooks, paintings, automobiles, hoats, etc.)
Intangible personal property, such as bonds, treasury certif'icates, cash on hand and in bank,
stocks, mortgages, notes, together with aCCrued interest or diVidends, salaries or wages, inSurance pay-
able to the estate 411' fiduciary in said capacity, partnershi;l1interests, interest in anyundistributed
estate nf' or income f'rom any property held in trust under the will or agreement of' another, even though
located outside of the State, at the time ot' death, should be listed in this schedule.
.....~~.-T-~-
Item
'---r---~r-----
UNIT I ESTIMATED
VALUE MAHlCE'T VALUE
11. U. S. Series E. Bonds cont'd
IT11\1
l,is t and descl"ibe fully
DEPARTMENT VALUATION
(Do not write in
this space)
tiC>,
Date Denomination Value
Mar:l945 $ 25.00 $ 68.14
Aug. 1945 25.00 67.05
Jan. 1946 25.00 66.55
May 1946 25.00 66.55
Sept.1946 25.00 65.46
Feb. 1947 25.00 64.43
July 1947 25.00 63.40
Dec. 1947 25.00 62.38
Apr. 1948 25.00 62.38
Aug. 1948 25.00 61.40
Jan. 1949 25.00 59.67
May 1949 25.00 59.67
Sept.1949 25.00 60.99
Feb. 1950 25.00 59.83
July 1950 25.00 58.74
Nov. 1950 25.00 58.7~
Mar. 1951 25.00 57.73 I
July 1951 25.00 56.74 I
Jan. 1952 25.00 55.76. I
May 1952 25.00 55.5~ I
Se pt .1952 25.00 55.67. '/~ I
Feb. 1953 25.00 54.73' I I
June.1953 25.00 53.79" . I I
~~~: mE ~~:gg ~n6 -1 t .')!)y 1.LiJ.:
A ug. 1954 25 . 00 52 . 02' 1 5 749. 18 J'
261 Shares, Rockwell International Corp. L. 00 I ,,' ~~6~;. 00 I'/"
300 Shares, Diversified Mortgage Investorb3.25 , 975.001
200 Share s, C. 1. Mor:gage Croup r 1. 625/ 325. 00 ~
700 Shares, R. Hoe & Co., Inc. ~3.937i 2,755.90,/1
1118 Shares, Washington Steel Corp. 3.3751 26,133.25'
450 Shares, U. S. Stee 1 2.687' 10,209.15"/
1304 Shares, Transcontinental Gas Pipe ~ .ji '---
Line Corp., now Transco. 8.75. 24,450.00-
,~
9. 900 Shares, Suburban Propane Corp. C'" ;~, 7.06215,355.80- __
J. 1500 Shares,Commonwealth Realty Trust 19.25 '13,875.00-
1. 200 Shares, Inland Steel Co. f' 4.00 '6,800.00'
(. 330 Shares,Penna. Power & Light,Common 0.125t,.6,641.25
I. i 126 Shares, Penn Dixie Industries 3.00 378.00 I
eo I 10 Shares, Penn Dixie Lea sing Corp. (name I
. I changed to Castle Capital Corp.5/20/70! .375
'. I 270 Shares ,National Distillers & Chemicall I
_-L_ Corp. ~9.1251 '
I
x x I
I
I
I
j
I
'I
I
I
L2.
L3.
.4.
-5 .
6.
7.
8.
3.75
,ert this total opPosite "Personal Property", Schedule "B" in
~ "As tteported" column on the last page ot' this return.
5,163.75/
I
I
I
J
--
('CIMWINI'IR\LTH CFPV'mSYLV\NL\
Tll\NC;~:~r, INHEt\TT/\.NCE TAX
s C Hl~J) U.LE TI 1-3 rl
PEHSONAL PIlOPEHTY
H Fe; I nE,~T DECEm~N T
"'TIluen 0'", TI. j, Sohod.., e mu>t OJ, d.. eo "" tangil.lo ",d ""''''' j bl" p" ,"oua t p "npe" " nv ned j nd i v Jduatl y
jJY tIle decedent, c,t the time of' his death. Property owned hy the decedent Jointly with another or others
mHst be listed uncler ScheduJe "E". Intangible person:,l property, tItled in the name of the rlecedent, but
pa)~ble at death to another or others, including but not limited to P.O.D. G. S. Savings Bonds and tent~
t ive trust accou~ts, must be listed, despite the fact that th,~y i~re not of the administel,'ed estate.
Tangibl e personal property Shoulr! be listed i'irst (e. g. ,jewelry, wearing apparel, household
goods, and furnishings, hooks, paintings, automobiles, boats, etc.)
Intllngihle personal property, such as honds, treasury certificates, cash on hand and in bank,
stocks, mortgages, notes, together with accrued interest or dividends, salarif~s or wages, insurance pay-
able to the estate or ficluciary in said capacity, partnership interests, interest in anyundistributed
estc'te of' or income from any property held in trust under the will or agreement of' another, even though
located outside or the State, at the time of death, should be listed in this schedule.
1 t1..~m
r~"0;>
ITEM
List and describe fully
-~r-
UNIT ESTIMAT,,-:D
VALUE MAH.1ili~r VALUE
DEPARTMENT VALUATION
(Do not write in
this space)
26.
200
Shares,Larvin Mortgage Investors(Name
changed to LMI Investors on 1/3/75
then to Growth Realty Investors,6/78)
27.
28.
29.
30.
31.
32,
33.
34.
35.
36.
37.
38.
39.
4Q.
41.
+2.
+3.
238 Shares, Dresser Industries,Inc.
352 Shares, Copperweld Corp.
1200 Shares, Chatham, Corp.
150 Shares, Giant Portland Cement Co.
Miscellaneous Household Furnishings,
Appraised Value
ert this total opposite "Personal Property", Schedule "B" in
"As Heported" column on the last page of this return.
I
I
I
L
I
I
I
I
I I
I ~~~~.I
X X [$360,515.481 3'---0 S\3 -IL-
I I '. C )
I j
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I1fT_le:
(' (lV \ill \~}'.\ L~ Ii (Ii' ! I :~'\" "'1' L L1 \ ] i\
FtA\'-T:,'i, I \I".'n n'. \'Cl.' T\X
SCfI:mlu" "e"
T I { \.\ ''; )1'! ["
111 Il Id d"i',"","" 'HI,;', i'co 1"''"'' cor <I,'" t h, '"'' ke ""I I, "'" f,',' "f "ny ''',,"e,' L<l 1'"" n l' h j" "'" te, '''h''n I
rpt'pivIng :i vctllwblc and ade'111ntc t"lnsidprnt.iun UIi'i'C['or'> ('\nsw"r yes or' no)___J'l-~___
(") Il i" d,' ",d",,,, ""hin t ", :!Cn", ,,1' d,'," "" I"",,, f". I" "/'" n., f"nm /, ,.."" J' tco h' 'O''' II' ond ",'" the" ",.
(,thers (inelllding a SPO!lS") in joint ownership') ('\nswer }"S or no) --___NQ_
(;1) It' the answer to (1) or (;2) allOve isi:l the at'f'irmilr,ive stitLe:
(a) A:2;(' of' decedent at time of tr'an~;f'er _______
(b) State of decedent's hecdUJ at. Urne rd' l1Iakin.2: t!1P (,ransfer'. (Note 1).
(c) Cause of (j,ecederlt' s ,je.tf h. ('iote 1).
(,) Ill" de",'<lenf, In hh I1fH '",e, "'''ke 'u'1' I",,,,, re " n /. I' "cop" "" 'Hi..",/. "",,", v, "" " "'" n"hl" "" "dequate
consideration t.herefor ~hich was to take erf~CL in possession 01' enjovment at or nfter his dpath?
(.\nswer yes or no) --.l::L9__ , .
(I,) h", II..,,, 'u''y ,,,,,,, hi ]j t l' th,,, t he I' ""I' e n'y l" ,"CO" f~ ned .." gh t "H" no t co l r il n" fe "e r 0" It,,,
estat" or be Subjpet to his pow<~r of disposition? (.\nsw(',r YleS or PG) No
(h) \~l1itt was the transferee's age at tim<e of decedent's death? ____
r3l Illd d""edent I" 101" I tre If,. make "coy t """",,,,, ., 1I,,,u l "COd ,j COR a ""I nah/ e "..I 'de,/"" f" e",,, ider., liun
",ceo fu" ,,,d,.,. ,It Ie" ""an..r"e" e "'P "nan I y 'or ''''p]j edIy """ene, fu" h '" I ;J'" or "coy pc '" "d whleh doe,
no ti n LJ.l; I. end lJ,' 1'0 re his de a th:
(a) The po.SsPssion or ef'joYOlent of' or the right to ineome from UH' property tl'ilnsf'erred?
C\nswPt' Yps or no) No
(h) Th<' right to designate the persons who shall possess cr enjoy the property transferred or
Income UIPrefrorn? (Answer yes or no) No
(0) 1ft he "",,,,, 'co (0) (b) "h""" j, ,,, the 'ffte",,, fhe, "'a te wbe lh"" II,,, "I gl. ( wan ""''''''''d In deeedent
H10ne ')1' others ________________~___~ ___~_~_________~
(7) Dj d ,Jeeedent Ie l.t" I He lime make a / "a ""''''', (j.., eun,He"" ti "n fo" wbi"h wno ( e'''''f""e,,', P"""'he tn
pay income to or for the benefi t of' eare of' tl'ar:sferor'? C\nswpr yps or no) -M___
(8) !I'd d",."/",,t, "" "n.,' 'ime, .."'"",.,," P "ope ny', the hecoe rt d a1 "co.i oymen t "J' ..I" tih Wi" 'u".I eel '0 eiko"ge.
/)pcause of " reserved power to a1 tel', ampnd, or revoke, or which cOllld revprt to decedent under terms
of transfer or by operation of law? (Answer yes Ot' no)_~__
'") J f the '" """" ,,, (H) n 1,,<,.. L, 'n tin, "ffl ","" tt en, w,,, / I, e !' own.. t" a1 "'" emend, "" "c,,, kn tI," in t"",
est of the hepeficiarv reserved in tllP decPdent a10n<~ or the decedent and others?
(Answer yes or no) "No
'iOTE1: The ilnswers to these questions should be sUPport.ed by aff'irlavIt. hy t.he atten,[jng physician IlS
well as iI copy of' the death ceni fica I.e.
'iOTE 2: If' answer to any of' the above 'pwstions is yes, s,'t. forth helow " rlescription of the property
t.ransferred, it's fair market vallie at date of' death, dates of' t.ransfers and to whom trrlnsferred, with
relationship of' transf'erees to deeedent, if' any. SuLrnit eopy of any trust 'leed or instrument, if' trans-
1'ers are claiT1lpd to be !Ion-taxable, also Submit. rletaiJpd statement 01' 1'''cts on whieh said claim is based.
\OTE ;3: List apjllicahlp property below In manner in whieh provide'l in Schedules c\, JJ. or E.
it:-:S I ll!'\T ))1''(')1)):\1'
ITE,ll
~--._~----_._--~.~--~--~_.,-- -------------------..--
---._._-------------_._~_.__.
!Jj';SCItIJ'T 10'1
NONE
Insert this tot:d OPposite "TranSfers", Schedule "e" in the
"'\s Report,pd" COlllITUl on the J ast p'l;;e of this retllrn.
~f~ i
-"" ~.,'{ ~
/) ;";';-;; ..(\
,'lTft"/ .
I >~C~~
'''-\.;,:,'';",.<;;1/<::.;t---
\!Am::ET VALUE
(Es Uma ted)
-'=
DEPT. VALl'ATcO\
(Dept. Only)
t\. '\
\'-J \)~
~
. RCC-37 (12-63)
l'O\D10~\\E.\LTII OF PE;\;~SYYL\l'\L\
TRANSFER Il'\HEHITA'\'CE TAX
RESIDENT DEL'EDENT
SCHEDULE "I)"
m:~" I, FIe L \ in r:s
--'-1 RELA TIC)NSl-{"iP----r-- " ~
BENEFICIARIES AND ADDRESSES (If step ch,:dren or ! ST!H":'IVED I DA'IE I
\State full names and addr.esses of all who IllegItimate clllldref11 J?~_OpEN~ I OF
have an interest, vested, contingent or other- are Involved, set SltJ~N~LS : 'JIRTH
wise in estate) forth thiS fac' ) ) ," I
, ----- - ----------r-------,
Eugene R. Smith _______ yes __~-------1-~nnn.nn
I I
R. D. 4 Box 178 I ~
I L
---t----+
I .
I yes
i
__I
--------1
~hew - -I yes
i
-t----r-
----e-----r-
nephew -1-~~::.L--1
------1--------+-----------
-t -1
--d=
INTEREST OF
BENEFICIARY
IN ESTATE
Dillsburg, Pa., 17019
he.N_
~3}nnn.nn
St.
-r---------
Dillsburg, Pa., 17019
Sherril Smith
R. D. 1,York Springs,Pa.
1737;?
Dr. Curvin C. Smith
10 Appaloosa Drive
----$3 ) nnn nn
T,itit~, P,q.,
1 7 5 II 3
Clyde J. Smith
R. D. 1,Dillsburg, Pa., 1
n~J2.hew
000 00
1
Mrs. GoJdie R8rnes
2817 Boas Street
yes
---l___iln ,000.00
I
Penbrook,Harrisburg,Pa. I
=r r---------I
I . i
Mrs. Helen Breiteg<'lm -:;r-ni et:e ---t-y8s.---+-
Box 47 LKim be rt on, P a .1~:1L2-+--------------t--------.-+_-------
1-----------+.-------1
Mrs. _ Nancy Fleming .I niece ___L-X.e_s. 1_ I
R.D. 1,Dillsburg, pa.,170=i mece LMn____J I
! i '
- - -----~---------+-----~
___Mrs. Erdean Taylor . I ye..s____+ I
Box 95,East Berlin, Pa. 'EI -+-' -------I- I
17316 I I .
=---_ L- =~---+ ~
$3,000.00
$3,nnn.nn
$3}nnn,nn
Lieroncnt further says that all the above-named benefieiaries are living at this time except below:
-- .~._- I ~_.~-----.~-
NAME DATE OF DEATH RESIDENCE
I
--1--.
'-' ,', '~.
Heal Property
Personal Property
Transfers
SUM\lAHY
(Sch. "A")
(Sch. "B")
(Sch, "e")
( 1 )
(As Heported)
(2)
(A,<; D/'tl'lnlined i
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Cross Taxable Estate
$
$
$
$
$
$
$
$
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$
$
$
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.... ~ '"
oj <"J ...l
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p., > <
w .-r: "-l
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""
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c .... 0 f-< S ~
;r: f-< (fJ >:-.
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-"-' c
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r;J::; ..., 0
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..., ....
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...... .-r:
, ..
, 11(:C-)7 (-:'''-0')
,,'O~1\!():\\\T\LTi1 (W "):~':\"'\"\-l ,\ '\;1\
THA:\SFEK i:\HEHlT),]\CE: TAX
RESIDENT DEe'EDEN'!'
SCHEDULE "I)"
~'h\
~'f'li~ ,~,
~,.,.- '.' .~~"
I.~ ;:,"_,--,""'1 .::('l
f, ~. ,- - e" \ ,.
J] _,;,'.1,.1.;: ;:;:':',' ~/~..11
BE',; !:J'! t .'A){ [E';
BENEFICIARIES AND ADDRESSES I (lr~t~'~;~l~~;~P()( 9,.m V 1': r:D D\l'F nnEHfS'1 OJ
\ S ta t e iu ;.1 ~3res J !H~ address ec,: of ill] wll 0 I illl'gitimate criJd,::n DEC:DE "f;' 0 ;" J,];>1.r.Fl: 'po nv
have an t~t2:ie?1, vpsted, c()nf.inf~ent or ot:".('r,..j arC'lnvo~ved, set STATE: V:::,:S r'.~' V-:<'T\TF:
____ wi F l?!._~ 1; ,,:::!.J t. eL________u_j___l:'E!~_t h is f ac~L__4__~:(?__i_ _~)!~_l'~~___+---,-----n-- _,_______________
. .' I
_-.E.d__W_a 1 t e r s ___________..J_ N nn p----l- Y e S___~------------L$4-,11QQ..-QQ-Jie..que-Q.t----
! I : i
R.D. #1,Mechanic_9burg ,Pa. +-____-+-__-+______-+-_ .", _
~-,-------l---------L------L----.----------
(', ~ ry W alleLE-___________~--l9'-q}l~--l- Y e_e.._j_____________LiJ.-LQ9_Q_~QQ__]~g1.2:~~_!____
__R . D Jtl_~ft!l:_e c_hg.ni c s b~W-.X?_~_L,-------J-----_+----------+-----------------.--__
----------------L----------t----.----~------.----+.---.-- --------------.------
F.vprpt,t 'Potter _ ----1 None ____~ Yes 1______+.$2,000.00 Bequest
4400 Carlisle Pike Iii
--------------t---,----------~--+---------~---r-----.-----~-- ----------------------
I ii'
_~ arnI2-Jiill~_P e IlI1_l,L!.__________~---------+_----' ----1--------------
i i i I
------I----------I------i------- '
_~hn...Mkha.el.E..akin +__N.Qn~______+_-- Y ei:L__~---------~~OOO .00 ___f2.e Q"ue st___
R. D. Me-QJ)..9.DiQ12bU,~.-E9L-l---- I _____~_-__--_-L--------- ------------------
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__ ____________1- ---------+----------~-----------
-L r. n <;) r i t, Y -i-----l ~-$l~..llo....B.e.que.s.t ---
-L I _____+ +-------------------
I I, ,
-: -i-~-----t-----------------------
,Tnnn M R~kin) 1'Y'lJst.B...e-_--t-__Cn;:Jrit,~hl P: 1'rl1st, 1_ i ..RBsicJl1P____________
Ma r k ~_t._ligua re Build inL--i-------------------t---------.L--------+-------------._____ ___
Mechanicsburg, Penna. +----------+-----+-------t---------------------------
i -----.------ I -! -t---
____~=--==---=--=-l----=-~=r=-==--=[-====-------------
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==~===-=~-------:-----====~~-=L===-~=--t_- -=-~~~_J=~____.___
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--l =+::--:::.:r=-==.l---- --===----
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.C_-'--'--T -"-~-I-----.-:---..----~--.--I-----.,.------.-
______________,_______--1..__________.___1..____._______1______,------~_____".__,_.____,_________,__
Ii: :
=----=-==-----=-:=-----= C==--+=.~:~t=~----==-=
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_______________._._____~______.______._..___.....__._.._..."_____......,_..__..____".L_____,_.__~.._______"._......___
Colllmban F61tnpY's
St. Colurnban, Nebraska
n"ponent further says that all the above-named henef'ipja.rjf's are ltving at this time except below:
----.-~~-T----.--------- ------------.-.--.----;-
=1= DATE or nEATH -+
-l ---I
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NAME
RESIDENCE
'-
u;' e
Hl'~t1 Property
Personal Property
Transfers
SI;\l~HHY
( Seh. "A")
( Sch. "E" )
(Sch. "e")
.~ ~~
~..... v
~ ~
<.. .- .
~ fi ~
"5~t
?j ~ g
~ E c;
~ ,::.:;
Gross Taxable Estate
( 1 )
(As Hl'port('d)
$ 50, 000 . 00
$ 360,515.48
$
$
$
$410,515.48
(2 )
(,\s f),.t,'rfllilwd.1
$
<.
'.'
$
.$
.$
.s
l- p;,
Z "0 .rl
Q.i
.... W '" ~
(oj :"J ,
e", Q.i [J) -
>-< ~ '-' ~ <(
W Q.i rJJ
(f] Q -
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< .+: E-< .~ cc:
~ r.... +.J "d (: ~
0.. 0 .rl >=: >=: ':':l ~
0.. 8 Ctj 2: <
tLI < tLI Q)
:I: ::r: W en rl rl ~,
"" W f-< f- rl H ~ Q
~ ..... '" < <r: Q) ~ z.
~ ..... 0 f- :..>
/, f- "':) ,D c... ~
(f] H ~
W "- 1-
r.... (j) Q)
0 .rl :s u IX
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.....
REV-5IB (S-78)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF FlELD OPERATiONS
P.O. BOX 2970
HARRISBURG
17105
IN YOUR PEPLY Pl.EASE
REFER TO
Inheritance Tax Division
HOTle!: OF FILING OF APPRAISEMENT
John M. Eakin
Market Square Building
___.____~_c.hanic.@Jl...~~A___11.Q5j
(Executor Of Administrator)
In Re: Estate of ____J.j:E:ri~__J~ Smith
_~umb_,=:r:la~~_______ County - Fi Ie No.___2l-78-636
Dear
Y h b t"f" d th h Original
ou are ere y no I Ie. at t c____________________
appraisement in the estate of __________Marie J. Smith
has been filed in the office of the Register of Wills of_..Gumb.er.1a.nd-
County on 2R ...MRrf'n , 19..1.9-, Said appraisement reflects the followi ng
valuations:
Real Estate___ SO~OOO.OO
Personal Property.......3.6.0., ')11 7?
T ronsfers.__________nNone
Jointly Owned _____None.._____
Total ________ .__~4_1.~13-'-Z2-----
As to such tax that is paid within three months from dote of death, 0 five (5%)
percent discount is allowable. As to any tax that remains unpaid after nine (9) months
(fifteen months when deoth occurred from December 22,1965 to June 16,1971, inclusive;
and twelve months when death occurred prior to December 22, 1965) from dote of death,
interest at the rote 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 notic~ as provided oy Section 1001 of the Inheritance and
Estate Tax Act of 1961, 72 P, S. 2485-1001, P. L. 373.
Dote
28 March_.l9.I9___________ Signed
Tit I e.__Acimi.ILi_s t r a tiYe...i).fiice r
Note: This is not 0 bill.
. 'RE'V.<f57 (8-78)
DePARTMENT OF REVENUE
BUREAU OF FIELD OPERATIONS
P.O. BOX 2970
HARRISBURG, PENNA. 17105
COMMONWEALTH OF PENNSYLVA,r\liA
RESIDENT INHERITANCE TAX
APPRAISEM ENT
28 March 1979
0,4,-1 r:
COUNTY Cumberland
FILE NO. 21.:18-612...0.'_..__"___
Whereas, M",.,.i p T ~m; t-n late of Lower AllelLTwo
in the County of Cumberland Commonwealth of Pennsylvania, havix;'J died OD
the lOt" day of NmTPmhpr 19 I8- 1 seized and possessed of an estate
subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania;
Therefore, I, l.liQ 1<',,1 g;n;H I an appraiser duly appointed according to law,
having been designated to make a fair and conscionable appraisement of the said estate, and to assess and fix the cash
value of all annuities and life estates growing out of said estate, hereby file the following appraisement:
In trle 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 !\ppraisoment
VALUES Made for Inheritance
Tax Purp,)ses
$
n .1 T:'_____ ~n nnn nn
Personal Property 360,000 00
- Nonp
'prs
,Toint-lv Owned Nonp
Total ~4l0.5l3 72
-
! !
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----+-
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Have been duly sworn according to law, I do hereby certify that the above appraisement is made in conf9tmity
with the law on this 28th day of March . .' 19 ~
Appraiser
Harrisburg
(Number and Street)
. Penna.
(Post Oftice)
>, 0\.
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