HomeMy WebLinkAbout11-21-79
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RCC.33 (4-73)
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COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
.2!-11-os-tt,
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\tenue. (Section 703 of the Inheritance and Estate Tax Act of 1961.)
L.ate of
Charles H. Collins, Sr.
(STATE FULL NAME OF DECEDENT)
Mechanicsburg,
Cumberland
} AFFIDAVIT OF
EXECUTOR
i\:9Ml~IS~
IN THE MATTER OF THE ESTATE OF
County
State of Pennsylvania
}"
County of Cllmberland
A:UH\~tFt~
Richard W. Collins,
Executor
of the estate of the above-named decedent being duly sworn, depose S
and soy S
(MONTH)
Nome and address of attorney or }
other authorized repres.entative to whom
011 correspondence should be moiled.
(DAY!
, 19 ~{testQte leaving a 105/ will, copy 01 which is hereto ottached. }
(YEAR) ~l!=
Decedent died
October 4,
Wil J ; ('I'" L. Sl}nday
39 West Main Street, Mechanic1';hnre, FA. 1701)1)
That as such Executor deponent is familiar with the affairs of said estate and the property constituting
(EX E CUTO R-ADMI NI ST R A TO R!
the assets thereof and their fair market value.
That at the time of death there was no safe deposit box registered in decedent's individual name, or jointly with, or
as agent or deputy of another, or in decedent's individual name, with right of access by another as agent or deputy, with the
exception of the following: -
NAME AND ADDRESS OF BANK OR O,HER INSTITUTION
IN WHICH DECEDENT RENTED A S....FE DEPOSIT BOX
THIS SAFE DEPOSIT BOX RENTED
IN NAME OR NAMES OF
RELATIONSHIP OF JOINT
HOLDERS ,0 DECEDENT
Th€5 First Bank &
That the contents of said safe deposit box or boxes are itemized under Schedules of this return,
with the exception of the following, for the reasons hereinafter set forth: Box rented as tenants by
entireties 12-31-71.
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 8 attached hereto and made part hereof sets forth fully and in detail all personal property
wheresover situated owned by the decedent at the time of death; all moneys left by the decedent at the time of
death, whether in decedent's immediate possession, standing to decedent's credit in banks of deposit, savings
banks, trust companies, or other institutions, whether individually, or in trust for any other person or persons
giving also separately the accrued 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 designated as tax free, of the United States,
or any state, or political subdivision thereof, or of any foreign country, which are owned at the time of death;
all wearing apparel, jewelry, silverware, pictures, books, works of art, household furniture, horses, carriages,
automobiles, boats, and any and all other personal chattels of whatsoever, kind or nature, left by decedent,
together with the fairly estimated market value thereof; all bonds and mortgages held by decedent and of all
claims due and owing decedent at the time of death, and all promissory notes or other instruments in writing
for the payment of money of which decedent died possessed, of whatsoever nature, with interest thereon, if
any, giving the face value and estimated fair market value thereof, and if such estimated fair market value be
less than the face value, it sets forth briefly the reasons for such depreciation as to each item; all moneys
payable to the estate from life insurance policies carried by decedent; all annuity and endowment contracts
the proceeds of which were payable upon the death of the decedent; all and the corporate stocks and dividends
due thereon and unpaid as of tl;, ,L,,,' of death, bonds and accrued interest thereon to the date of decedent's
death and other investm. , ,J by the decedent at the time of death, with the market value there-
. at such time.
In the case of securities of close or family corporations, the values reported are as far as
possiblp substantiated by financial statements of the corporations, showing the assets and liabilities
thereof as of' the date of' death. The schedule also sets f'orth 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 schednle, f'inancial statements showing the assets and liabilities of said co-partnership or business.
A copy <11' tht' co-partnership agreement, (if oral, a statement setting f'orth the nature of the agreement)
togt'Uwr .,ith a statement setting f'orth the character of the business, its location, and such other facts
per ti: il. nf" to the business as may be pertinent to a f'air and just appraisal of the decedent's interest
therein ',,"st be suhmittf'd. It should also set f'orth in itemized form, together with the fair market value
thereof, cwy other property owned or bequeathed by the decedent at the time of death.
Tbe Scf>edule C attached hereto and made part hereof' sets forth a true answer to each inquiry
contained therein and in the case of transf'ers of property, real or personal, within two years of decedent's
death, in contemplation of' decedent's death, or int.ended t.o take eff'ect. in possession or enjoyment. at. or
af't.er death, said schedule sets f'orth the nature and value of' sucb property, t.o whom transferred, the
relationship of the transf'erees to the decedent, the proportionate share received by each transferee and
all other t'acts of a pertinent nature regarding sain transf'ers. In the case of transfers intendeel to
take effect in possession or enjoyment at or after neath, there is also attached to the schedule a copy
of the deed, trust agreement or other instrument creating the trust. Ther.~ is also set forth in said
schedule a list of all property, real and personal, with its value, Which pa~ses at decedent's death by
virtue of the exercise by decedent, either individually, or ,jointly wi t.h another, or any power of appoint-
ment ve,;ted in decedent, either individually or jointly, by the will, deed, or other instrument of another,
with a eopy of the instrument. creating sucb power attacbed to the schedule.
Tllat Scf>edule D attached heret.o and made part hereof sets forth tbe 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, to!!;ether with the ages at the time of
decedent's death of all minors, annuitants and beneficiaries for Ii fe under decedent's Will. It also
contains a statement showing which of' the beneficiaries namen in the decedent's will, if any, died prior
to decc;dent, the dates of their death, their issue, ann the relationship of such issue to the beneficiary.
That Scf>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, standing in tbe name
of the decedent and others, plus the date and place of record of' instrlwent.s effecting the vestiture of'
real estate and the date of acquisition of personal ty, plus the name, address and relationship, if any,
of co-owners to the decedent.
That Scf>edule F attached hereto and made a part hereof sets forth fully and in detail all (lebts
and deductions claimed for and on behalf of this decedent's estate, inclucting funeral expenses paid;
family exemption, where applicable; costs of' administration of this estate; counsel f'ees anrl funiciary'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 unpain at time of
death; taxes accrued chargeable f'or period prior to decedent's death (except t.hose allowed under Sectinn
651 of the Inheritance and Estate Tax Act); together with a statement of' collateral plenged 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 tbe
estimated amount claiming and allowed, that the same will be reported t.o the Register of Wills, and that
the amount of' tax assessed can be reassessed in accordance therewith.
That the totals of the appropriate colunms in Schedules "A", "B", "en, "E", and "F" as directed therein,
have been carried forward and properly registe!'ed in the Sununary.
Subscribed and sworn to before me this ...............................
.::?~_T-h ~ 79
:~=.;.Ae;;~:~;~c............19m.......
/<......t.k....! (j(j ~,J..t.."(.. ..."',~.L.,I'. [J[Mi, NOTARY PUBLIC
r" I"~, :WiCSBlJfiG BOROUGH
(;U:,:L;CiiLAND COUNTY
:.,',::.;:)!U,; ~Xl'iRE$ DEC. 29, 1979
NOTE: Before signing affidavit make sure all blank spaces in the affidavit and schenules annexed are
f'i lIed in wi tll details or the worrl "None", ann in case the assets include rare ami unlisted securities,
securities of close or family corporations or an interest in any eo-partnership or business, that tbe
data and statements required under the paragraph above relating to Schectule "R" are attached. .Uso make
certain that column #1 in the "Summary" has been properly completect as above-directerl.
.....*~~~~:.t..vJ...:......~..............
( Executor.i7fi1:iieTi"mffifi7i7
.]19$.:i:~.~J.~.1::?;.....gg.~4... ..........................................
(Street Number)
Me c J::1~~.~.c:.~.:l:>:lJ.:!..f?; , P a . 17055
(City or Town and State)
.Re <:-34 14.7,3) ,
COMMON~EAL TH OF PENhSYLVANJA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE HA"
REAL PROPERTY
*
Real property in Pennsylvania, with statement of mortgage encumbrances upon each parcel at death of dece-
dent. Property held by the decedent os 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 os joint tenants with right of surviorship or tenancy by entireties should be reported on Schedule "E.")
The real property located In the Commanwealth 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 martgage encumbrances upon each parcel at death
of decedent. Toxes, assessments, accrued Interest on mortgages, etc.,are
to be listed on Schedule "F" and must not b. deduc:ted from this schedule.
(1)
(2)
(3)
DI;PARTMEHT
VALUATION
CAUTION
(Do not write
In this space)
ASSESSED VALUE
FOR YEAR OF
DECEDENT'S
DEATH
ESTIMA TED
MARKET VALUE
ALL that certain house and lot of
ground situate on the South side of East
Locust Street in the Borough of Mechanics-
burg, County of Cumberland and State of
Pennsylvania, bounded and described as
follows, to wit:
BEGINNING at corner of lot of Mary
Berkheimer Finkenbinder; thence East along
said Locust Street 20 feet 4 inches to lot
of John Hartman; thence South along said
lot 193 feet to St. John's Alley; thence
along said alley West 20 feet 4 inches to
above mentioned lot of Mary Berkheimer
Finkenbinder; thence along said lot North
193 feet to the place of Beginning.
BEING same: Sadie Berkheimer Blosser
and David C. Blosser, her husband, by Deed
dated November 10, 1922 and recorded with
the Recorder's Office in and for Cumberlan<
County in Deed Book "K", Vol. 9, Page 128,
granted and conveyed unto Isaac J. Collins
and Mary E. M. Collins, his wife. The sai<
Isaac J. Collins died December 25, 19~
whereupon title vested solely in the said
Mary E. M. Collins, his wife, by virtue of
the law of survivorship.
The said Mary E. M. Collins died
December 10, 1956 leaving a last Will and
Testament dated February 17, 1930 wherein
and whereby she gave, devised and bequeathEd
all of her estate unto her son, Charles H.
Collins, the decedent herein.
Valued at appraisal, copy attached
otf f (),
$ 21,000.00 V
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.
~~~~
$ 21,000. OOV II,,(-~ MH),&()
Rec -:35
RESIDENT DECEDENT
SCHEDULE "B"
PERSONAL PROPERTY
'*
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
INSTRUCTIONS: This Schedule must disclose all tangible and intangible personal property owned individually
by the decedent, at the time of his death. Property owned by the decedent jointly with another or others
must be listed under Schedule "E". Intangible personal property, titled in the name of the decedent, but
payable at death to another or others, including but not limited to P.O.D. U. S. Savings Bonds and tenta-
tive trust accounts, must be listed, despite the fact that they are not of the administered estate.
Tangible personal property should be listed first (e.g. jewelry, wearing apparel, household
goods, and furnishings, books, paintings, automobiles, boats, etc.)
Intangible personal property, such as bonds, treasury certificates, cash on hand and in bank,
stocks, mortgages, notes, together with accrued interest or dividends, salaries or wages, insurance pay-
able to the estate or fiduciary in said capacity, partnership interests, interest in any undistributed
estate of or income from any property held in trust under the will or agreement of another, even though
located outside of the State, at the time of death, should be listed in this schedule.
Item ITEM UNIT ESTIMATED DEPARTMENT VALUATION
No. List and describe fully VALUE MARKET VALUE (Do not write in
this space)
None except as shown on Schedule E None
Insert this total opposite "Personal Property", Schedule "B" in X X -)'(
None (f --7-
the "As Reported" column on the last page of this return.
. RCC'~-36
rOMMO'\WEALTll OF PENNSYLVANIA
THANSFER INHE1UTANCE TAX
SCHEDULE "c"
TRANSFEllS
rms IDENT DECEDENT
(1) Did decedent, within two years of death, make any transfer of any material part of his estate, without
receiving a valuable and adequate consideration therefor? (Answer yes or no) NO
(2) Did decedent, within two years of death, transfer properLY from himself to himself and another or
others (including a spouse) in joint ownership? (Answer yes or no) NO
(3) If the answer to (1) or (:2) above is in the affirmative state:
(a) Age of decedent at time of transfer
(b) State of decedent's heal th at time of making the transfer. (Note 1).
(c) Cause of decedent's death. (Note 1).
(4) Did decedent, in his lifetime, make any transfer of property without receiving a valuable or adequate
consideration therefor which was to take effect in possession or enj,Qyment at or after his death?
(Answer yes or no) Onj,y as an incident of ownership 01: property pwned 'its t~nants
(a) Was there any possibility that the property transferred might return tJ>Yra~~tJ;eJTi~.
estate or be subject to his power of disposition? (Answer yes or no) Yes, as above
(b) What was the transferee's age at time of decedent's death?
(5) Did decedent in his lifetime make any transfer wi thout receiving a valuable and adequate consideration
therefor under which transferor expressly or impliedly reserves for his life or any period which does
not in fact end before his death:
(a) The possession or enjoyment of or the right to income from the property transferred?
(Answer yes or no) Yes. as tenants by entireties
(b) The right to designate the persons who shall possess or enjoy the property transferred or
income therefrom? (Answer yes or no) Yes, as tenants by entireties
(6) If the answer to (5) (b) above is in the affirmative, state whether the right was reserved in decedent
alone or others
(7) Did decedent in his lifetime make a transfer, the consideration for which was transferee's promise to
pay income to or for the benefit of care of transferor? (Answer yes or no) No
(8) Did decedent, at any time, transfer property, the beneficial enjoyment of which was subject to change,
because of Ii reserved power to alter, amend, or revoke, or which cOllld revert to decedent under terms
of transfer or by operation of law? (Answer yes or no) Yes, as tenants by entireties
(9) If the answer to (8) above is in the affirmative, was the power to alter, amend, or revoke the inter-
est of the beneficiary reserved in the decedent alone or the decedent and others?
(Answer yes or no)
NOTE 1: The answers to these questions should be supported by affidavit by the attending physician as
well as a copy of' the death cer-tificate.
NOTE 2: If' answer to any of the above questions is yes, set forth below a description of the property
transferred, it's f'air market value at date of death, dates of transfers and to whom trllnsferred, with
relationship of transferees to decedent, if any. Submit copy of any trust deed or instrument, if trans-
fers are claimed to be non-taxable, also submit detailed statement of facts on which said claim is based.
NOTE 3: List applicable property below in manner in which provided in Schedules A, B, or E.
ITEM
DESCRIPTION
MARKET V ALOE
(Estimated)
DEPT. VALUATION
(Dept. Only)
None except as shown in Schedule E
None
Insert this total opposite "Transf'ers", Schedule "C" in the
"As Reported" column on the last page of' this return.
None
y1 OVl (
.R~V-453'(8-78)'
COMMONWEALTH OF PENNSYL V ANlA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "D"
BENEFICIARIES
BENEFICIARIES AND ADDRESSES RELA TlONSHIP
(State full names and addresses of all who (If step-childten or SURVIVED DATE INTEREST OF
have an interest, vested, contingent or other- illegitimate children DECEDENT OF BENEFICIARY
wise, in estate) are involved, set ST ATE YES BIRTH IN ESTATE
forth this fact.) OR NO
Evelvn M r.ol1in<:! ~nl"\""'o VA", Q_1E;_f'lQ T; f=o ....."'i-...i-'" ;....
~
llQ li'<l",i- T c.... 118 East Locust St
Mechanicsburg, Pa. 17055
Charles H. Collins Jr. Son Ye~ ?-21-?lJ. ()np-n;:\lf . .,.., rl "',..
920 N. W. 74th Way interest
Hollvwood, Fla. 33024
Richarcl w. r.ol1in<:! ~nn Vp<:! 1=.._??_,)7 n.........._l-....lf= .........,.,.,...;......-:1"'....
71g ~in('l."li,.. Rn."lrl interest
M",,,r,,,,.,..,; 1 p", 17f'll\l\
~
Deponent further says that all the above-named beneficiaries are living at this time except below:
NAME DATE OF DEATH RESIDENCE
None
-
....
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ts. :1:1:
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o "0
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;< e
s "
Real Property
Personal Property
Transfers
SUMMAR Y
(Sch. "A") $
(Sch. "8") $
(Sch, "e") $
$
$
$
(1)
(As Reported)
(2)
(As Determined)
$
$
$
$
$
$
Gross Taxable Estate
E- "0
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R" C; 3 8
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERIT ANCE TAX
RESIDENT DECEDENT
SCHEDULE" E"
JOINTLY OWNED PROPERTY
INSTRUCTIONS: This schectule must disclose all property, real and personal, ownerl by the rlecedent 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 tmder Schedule
"A", plus the date and place of record. of instrument effecting vestiture, but do not include entireties
or out of state real estate value in estate valuation column. Personal property shoulct be listed as in
Sche(1ule "B", plus date of acquisition, and the name, address amI relationship (if any) of co-owners to
the ,Ieceden t.
Description of Property, Date of Acquisition, Name
Address and Relationship of Co-Owners, and Place
of Record of Instrument, where Real Estate.
j<.
All other property in which
decedent had any interest was owned
by decedent and his surviving SpOUSE
as tenants by entireties for an
excess of two years.
Unit
Value
percentage
Share
Estate
Valuation
None
Insert this total opposite "Jointly Owned Property", Schedule "E" None
in the "As He lorted" column on the last page of this return.
"^
DEPARTtlENT VALUATION
CAUTION-Do not Write
In This Space.
Value of Value of
Entire IDecedent's
Property Interest
~~D\J-)
PF \1_11" I' 10..:11\
(>ul:y,N~mbera~dName (21) CUlllherland
21-7~ 0566
10/4/78
Collins
SUMMARY
"umber
: f Death
(LAST NAME)
(FIRST NAME)
H.
(lNITI AI-)
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
"1 t':
Name
Charles
REPORT OF INHERITANCE TAX APPRAISER
'~;'Ie undersigned duly appointed Inheritance Tax Appraiser in and for the County of Cumberland
r or:ia, do respectfully report that I have appraised the real and personal property as reported in the foregoing return at
~ ,.-;t forth opposite each item in the last column to the right in Schedules "AIt, "B", "C", and "EIt.
,.
21 November 1979
~(f'j /
REPORT OF THE REGISTER OF WILLS
., the undersigned duly elected Register of Wills in and for County, Pennsylvania, do respect-
:,.;Qrt that I have allowed deductions in the amounts claimed by deponent, except as to those items where a greater or
,,' umount is set forth in the last column to the right in Schedule "Fit, which greater or lesser amount represents the sum
~,~ ,] S a deduction.
REGISTER OF WILLS
~;?G
CODE ADJUSTMENTS
,~NENTORY V ALUE AS APPRAISED (HARRISBURG USE ONL VI REMAINDER APPRAISEMENT CODE
iSchedule Al $ .., , ('If'll'\ nn 00+ 92+
erty (Schedule BI rJC'ln~ 10+
operty (Schedule El nnTlQ 20+
edule C) Nnne 30+
ROSS ASSETS S?l ()()() nn
d Deductions 4()' 93-
UlE F)
UE OF ESTATE
R"
Pel 0 ,-fOp
Joi,' ,; I"'r
Tr~ (S,;h
.,._ G
Le', '"
Cl vAL
Ve,
"f life estates or
~
PRINCIPLE
FACTOR
VALUE
CODE
I
ES'
-AX ASSESSMENTS _ $
t=
t=
COl..,
'." ". .... ....... ......- $
,'L.OP REGISTER ONLY
CODE
COMPUTATION OF TAX
EQ.
Tax
To>
Tox
Tax
To,
2%
6%
15%
$
$
$
$
$
EXtSl, .' ;....d$
To .""0
*
TOTAL TAX
$
(*) As evidenced by Charitable
Exemption Certificates issued
by the Secretary of Revenue. '
Le
3 r"
Less tox previously paid
BALANCE
of tox if paid within
",her death
$
$
$
l=
BAL ,,':E OF iNHERITANCE TAX DUE
Ad, ,,,3\ at rate of 6% from
"__ to
Of ESTATE TAX ASSESSED
$,
$
A~'
Es
'" pa;Q
$
$
I=:
Ad
BALANCE DUE
.c,~', at rote of 6% from
to
TOT AL T AX BALANCE
PAID
;
$
Sl .,,'01 Codes: (FOR USE IN HARRISBURG ONL Y)
cstrr:ent
:'j'js'i'ment
.."wity
6O-Life Estate
92+Remainder Appraisal
93-Remainder Deduction
93C-Charity
94-Remainder Residue
96-Succ:essive
Li fe Estate
,:.e OF REGISTER ONLY
ADJUSTMENTS
HUTE: Where subsequent adjustments are made to the above computation of tax by the Register of Wills for proper reason
same should be noted below, with short explanation. "
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REV-518 (3-79)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF FIELD OPERATIONS
P. o. BOX 2970
HARRISBURG
17105
IN YOUR REPLY PLEASE
REFER TO
Investigation Division
NOTICE OF FILING OF APPRAISEMENT
Richard W. Collins
719 Sinclair Road
Mechanicsburg~ PA 17055
(Executor or Administrator)
In Re: Estate of
Charles H. Collins, Sr.
Cumberland
County - File No.
21-78-0566
Dear
You are hereby notified that the Original
appraisement in the estate of Charles H. Collins, Sr.
has been filed in the office of the Register of Wills of Cumberland
County on 21 N nvpynnpl" . 19--1.9 Said appraisement reflects the following valuations:
Real Estate
Personal Property
Transfers
Jointly Owned
Total
$21,,000.00
None
Non e
Non e
$21,000.00
As to such tax that is paid within three months from date of death, a five (5%) percent
discount is allowable. As to any tax that remains unpaid after nine (9) months (fifteen months
when death occurred from December 22, 1965 to June 16, 1971, inclusive; and twelve months
when death occurred prior to December 22,1965) from date of death, interest at the rate of six
(6%) percent per annum is charged.
Any party in interest who is aggrieved by this notice may object thereto within sixty
days after receipt of said notice as provided by Section 1001 of the Inheritance and Estate Tax
Act of 1961, 72 P. S. 2485-1001, P. L. 373.
Date
21 November 1979
Signed ~ It ciA L1) (>-:it 1.. -~ 1 ( j
Title Chief Appraiser
NOTE: This is not a bill.
REV-457 ifl-78)
DEPARTMENT OF REVENUE
BUREAU OF FIELD OPERATIONS
P.O. BOX 2970
HARRISBURG, PENNA. 17105
COMMONJ'JEALTH OF PENNSYLVANIA
RESIDENT INHERITANCE TAX
APPRAISEMENT
DATE
COUNTY
21 November 1979
FILE NO.
Cumberland
21-..::1.~=_Q5.~,L"~,~,,._
Whereas, Charles H. Collins ~ Sr. late of Mechanicsburg
in the County of Cumberland Commonwealth of Pent1syh'3nia, havinq diet{ 011
the 4th day of October 19 ~, seized and possessed of an e3ti4te
subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania;
Therefore, I, Gloria Richard ,an appr1isr;r duly i1.ppointed acc':J:dinc; to };,w,
having been designated to make a fair and conscionable appraisement of the said estate, a:,d to dSS2~S an.d ~iz the
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 11eirs of the decedent aH~r tile expiration
of any estate for life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer inheritance taxes et the lawfui call1teral
rate on any such future interest.
DESCRIPTION OF ASSET I UNI r t /PI:-r;:nSf::1l1ent
Vi>,LUES. l'vl.::.\dC fr.;.r ; nheritance
T ax Purposes
,
,., . T'" ~.ll.J' 0 0 f~
Personal Property I None I .
'- 1 .'1
Transfers None ! \
-
JointlY Owned None
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Have been duly sworn according to law, I do hereby certify that the above appraisement is made in confo~ity
with the law on this 21st day of Noverm~r \It-. 19 -.
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