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21-78568
RCC-33 14-73) .
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
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.)
IN THE MATTER OF THE EST A TE OF } AFFIDAVIT OF
G. MEADE CAREY EXECUTOR
(STATE FULL NAME OF DECEDENT)
Late of Cumberland County ~~XI}SC
State of Pennsylvania } ..,
County of Cumberland
Martha Cornman Executor
:tn~~~n of the estate of the obove-named decedent being duly sworn, depose S and say S :
Decedent died October 1 , 19~{;estate leaving a last will, copy of which is hereto attached. }
(MONTH) (DAY) ( YEA R) N>>JfIlt
Nom. 0" .dd.... of ......"' .. } James R. Humer. Atty. . 1 W. High St. . Carlisle. PA
other authorized representative to whom
all correspondence should be mailed.
That as such Executrix deponent is familiar with the affairs of said estate and the property constituting
( EXECUTOR-ADMINISTRATOR)
the assets thereof and their fair market value.
That at the time of death there was no safe deposit box registered in decedent's individual name, or jointly with, or
as agent or deputy of another, or in decedent's individual name, with right of access by another as agent or deputy, with the
exception of the following: -
NAME AND ADDRESS OF BANK OR OTHER INSTITUTION THIS SAFE DEPOSIT BOX RENTED RELATIONSHIP OF JOINT
IN WHICH DECEDENT RENTED A SAFE DEPOSIT BOX INN AM E 0 R N AM ES 0 F HOLDERS TO DECEDENT
None
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:
That Schedule A attached hereto and made part hereof sets forth fully and in detai 1 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
col umns provided therefore the as se s sed valuation of each of said parcels, the estimated market value thereof
as of date of death of decedent.
That Schedule B attached hereto and made part hereof sets forth fully and in detail all personal property
wheresover situated owned by the decedent at the time of death; all moneys left by the decedent at the time of
death, whether in decedent's immediate possession, standing to decedent's credit in banks of deposit, savings
banks, trus t companies, or other ins titutions, whether individually, or in trus t for any other person or persons
giving also separately the accrued interest thereon, if any, down to the last interest day prior to decedent's
death in the case of savings banks, and to the date of decedent's death in all other cases; all bonds, postal
savings, treasury certificates or notes and other evidence of indebtedness of the United States to the de-
cedent; all obligations, whether by statute or agreement they are designated as tax free, of the United States,
or any state, or political subdivision thereof, or of any foreign country, which are owned at the time of death;
all wearing apparel, jewelry, silverware, pictures, books, works of art, household furniture, horses, carriages,
automobiles, 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 the date of death, bonds and accrued interes t thereon to the date of decedent's
death and other investment securities owned by the decedent at the time of death, with the market value there-
of at such time.
J
FARMERS TRUST COMPANY
CARLISLE, PENNSYLVANIA
Date ,October .26" 1978
James R. Humer Esq.
1 West High Street
Carlisle, Paa 17011
Re: Estate of
G. 'MA.tIilA C.tI'rP.;Y
Date of Death . October 1. 1978
Dear Mr. Humer
In answer to your request concerning accounts owned, either separately or jointly, by
the above referenced decedent and the balance in each account .as of the date of
death, we have checked our records and are submitting the following information jn
duplicate. We suggest that you file one of these letters attached to the Pennsylvania Inven-
tory forms (RCC) to substantiate the balance you report.
Note that we have shown the correct registration for each account. Also, interest accrued to
the date of death, if any, is listed as a separate figure.
Very truly yours,
Balance in checking account # 4-5626Q8 $2.820.07
CD #16295 $10,000.00
Accrued Interest 13.30
Olive Bolinger
Supervisor
Bookkeeping Department
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,
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CUMBERlAND
~LLEY ~IN(75
AND L04N ASSOCI~TION
16 West High Street. Carlisle. Pennsylvania 17013 249-2525
October 26, 1978
Mr. James R. Humer
Attorney At Law
Farmers Trust Building
One West High St.
Carlisle, PA 17013
RE: Estate of G. Meade Carey
Date of Death--October 1, 1978
Savings Accounts #124604 & #151617
Dear Mr..Humer:
Please find listed below the only two savings accounts held by the deceased as of
October 1, 1978:
#124604
#151617
Balance --------------$11,709.34
Balance -------------~-$5,512.24
Accrued Interest -----
252.26
Accrued Interest ------
77.78
Total ---------$11,961.60
Total ----------$5,590.02
A mortgage collateral hold is on savings account #151617. The collateral pledge
agreement is on mortgage #962837 under the names of Dale M. & Carolyn J. Carey.
The pledge amount is $4,200.00. The balance of the mortgage is not reduced enough
to release the collateral hold.
If additional information is needed, please contact me at this office.
Very truly yours,
'flv;~'('li!l ; II ~i':sr
Richard L. Kuntz
Bookkeeping Dept.
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RCC- Y)
Cr)M,\Hl\,WEALTll OF PE\'N~YLP.'H A
T\.l.A'i~FFH. I.'\lW!UT"\\'CF TAX
~CHEDVLE "e"
T Ft\\' S 1<'EI LS
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itESIIW\'T nI,;('FlW'iT
(1) Did-' j
"ece, ent, wi thin t~o years or death, make ,my transfer of any m.'lterial part of his pstate, wi thout
reeeiving a valuable ap-d adeqwlte consjdpr<ltion thprefor? (Answer yes or no) No
(2) Did decedent, within two years of death, transfer }JI"OperLY from himself to himself and another 0..
others (including Ii spouse) in joint ownership? (Answer yes or no) No
un If' the answer to (1) or (2) above is in the affirmative state:
(a) Age of decedent at time of transfer N / A
(b) State of' decedent's health at time of making the transfer. (Note 1).
(c) Cause of decedent's declth. (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 enjoymept at or after his df'ath?
(Answer yes or no) No
(a) "as there any possibility that the property transferred might return t.o transferer or his
estat.e or be subject to his power of disposition? (Answer yes or no) No
(b) What was the transferee's age at time of decedent's death? N/ A
(5) Did decedent in hls lifetime make any transfer wl thout receivlng a valuable and adequate consideration
t.herefor uI1der which t.ransferor expressly or impliedly reserves for his life or any period which does
not in faet end before his death:
(a) The possession or elOjoyment of or the right to income from the property transferred?
(Answer yes or no) No
(IJ) The rlght to designate the persons who shall possess er enjoy the property transferred or
income therefrom? (Answer yes or no) No
(0) If' the answer to (5) (b) above is in the afflrmative, state whether the right was reserved in decedent
alone 01' others N/A
(7) Did decedent ln his lifetime make a transfer, the consideration for which was transferee's promise to
pay income to or for the benefit of care of tl'alOsferor? (Answer yes or no) No
(8) Did decedent, at any tlme, transfer property, the beneficial enjoyment of which was subject to change,
because of II reserved power to alter, amend, or revoke, or whlcl1 cOllld revert to decedent under terms
of transfer or by operation of law? (Answer yes or no) No
(9) If the answer to (8) above is in the afflrmatlve, was the power to al tel', amend, or revoke the inter-
est of the bepeficlary reserved in the decedent alone or the decedent and others?
(Answer yes or no) No
NOTE 1: The anSwers to these questions should be supporteo by affldavit by the attenlUng physiclan as
well as a copy of' the death cenificate.
NOTE 2: If answer to any of the above questions is yes, set forth below II clescrlption of the property
transferred, it's fair market vallie at date of death, dates of transfers and to y'hom transferred, with
relationship of transferees to decedent, if any. Submit copy of any trust oeed or lnstrument, if trans-
fers are claimed to be non-taxable, also submit detalled statement of facts on which said claim is based.
NOTE:J: List applicable property below in manner in which provirled ln Schedules A, B, or E.
ITEM
lJESCRIPT ION
MAlUmT VALUE
(Es Uma ted)
DEPT. VALUAT~ON
(Dept. Only)
None
None
Insert this total opposite "Transfers", Schedule "C" in the
"As Reported" colunm on the last page of this return.
None
N~--"--
RCC-37 (12-63)
CO'IMO~WEALTll OF PE;>\:,\SYYL\NIA
TRANSFEI\ INHERITA!\'CE TAX
RESIDENT DECEDENT
SCHEDULE "D"
BENEFICIARIES
\
h
BENEFICIARIES AND ADDRESSES RELATIONSHIP I I
(If step-children or SUR\;'IVED DATE INTEREST OF
State full names and addresses of all who illegitimate children I D~Cf~pENT I OF BENEFICIARY
ave an interest, vested, contingent or other- are involved, set S'lATE YES BIRTH IN ESTATE
wise, in estate) forth this fact.) OR NO
Martha Cornman
R.D.2 Box 401
Gardners. PA 17324 Daullhters Yes Lellal 1/3
Dale M. Carey
509 W. Louther St.
Carlisle. PA 17013 Son Yes Legal 1/3
Randall L. Carey
12 Mason Lane
Rome. GA 30161 Son Yes Lella1 1/3
Deponent further says that all the above-named beneficiaries are living at this time except below:
NAME
DATE OF DEATH
RESIDENCE
a I Care
wife
A ri1 26 1978
R.D.2 Gardners PA 17324
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SUMMARY
. .(Sch. "A")
. (Seh. "B")
(Seh. "C")
Real Property
Personal Property
Transfers
Gross Taxable Estate
( 1 )
(As Reported)
$
$
$
$..
$
$..
(2\
(As Determiner])
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$
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R C C-38
RESIDENT DECEDENT
SCHEDULE "E"
JOINTLY OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
INSTRUCTIONS: This schedule must disclose all l-lroperty, 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 tmder Schedule
"A", plus the date and place of record of instrument effecting vesti ture, but do not include entireties
or out of state real estate value in estate valuation column. Personal property should be listed as in
Schedule "B", plus date of acquisition, and the name, address and relationship (if any) of co-owners to
the decedent.
Description of Property, Date of Acquisition, Name
Address and Relationship of Co-Owners, and Place
of Record of Instrument, where Real Estate.
Unit
Value
percentage
Share
Estate
Valuation
DEPARTMENT VALUATION
CAUTION-Do not Write
In This Space.
Value of Value of
Entire Decedent's
Property Interest
None
None
Insert this total opposite "Jointly Owned Property", Schedule "E"None
in the II As Reported" column on the last page of this return.
N ~..-,--
R E V-518 (8-78)
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF F!ELD OPERATIONS
P.O. BOX 'J.970
HARRISBURG
17105
IN YOUR REPLY Pl.EASE
REFER TO
Inheritance Tax Division
NOTICE OF FiliNG OF APPRAISEMENT
Martha Cornman
R. D. 2, Box 401
Gardners. FA 17324
(Executor or Adm ini strator)
In Re: Estate of G. Meade Carey
Cumberland
County - Fi Ie No.
21-78-0568
Dear Mrs. Cornman:
You are hereby notified that the Original
appraisement in the estate of G. Meade Carey
has been filed in the office of the Register of Wills of Cumberland
County on April 9 , 19..12...., Said appraisement reflects the following
valuations:
Real Estate
Personal Property
Transfers
Jointly Owned
Total
25.000.00
31.404.02
None
None
$.56,404.02
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 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 notice as provided by Section 1001 of the Inheritance and
Estate Tax Act of 1961, 72 P. S. 2485-1001, P. L. 373.
Date
April 9, 1979
Signed
T" I Administrative Officer
It e__
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--....-,..
Note: This is not a bill.
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
DAle.
April 9, 1979
Cumberland
21-78-0568
COUNTY
FILE NO.
Whereas, G. Meade Carey late of s. Dickinson Township
in the County of Cumberland Commonwealth of Pennsylvania, having died on
the 1 Rt day of October 19 -Z.a, seized and possessed of an estate
subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania;
Therefore, I, Leo ]''''u1lli. ni ti , 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:
I n the event that any future interest in this estate is transferred in possession or enjoyment to collateral heirs of the decedent after the expiration
of any estate for life or for years, the Commonwealth herebY expreSSly reserves the right to appraise and assess transfer inheritance taxes at the lawful collateral
rate on any such future interest.
DESCRIPTION OF ASSET UNIT Appraisement
VALUES Made for Inheritance
Tax Purposes
Real Prnnertv $ 25.000 00
Personal Property 31,404 02
Transfers None
Joint-Held Property None
TOTAL ASSETS $1:)6.404 0::>
]
Have been duly sworn according to law, I do herel;.ly~ertify th~t,the above apprai~ement is made in conformity
with the law on this 9th day of ,.) ( " .,~ ": . Apr~~. . 19 22-.
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(~-~~)
Appraiser
(Number and Street)
Harrisburg
. Penna.
(Post Office)
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