HomeMy WebLinkAbout02-08-79
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Form RCC-33
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
COUNTY OF
RESIDENT DECEDENT
CUMBERLA~D
IMPORTANT: This return must bE! completed in detail and filed in duplicate, with will attaChed, with the
Register of Wills of the County where decedent resided; Return is due within one year after
date of death, unlt~ss an extension is granted hy the Secretary of Revenue. (Section 703 of
the Inheritance and Estate Tax Act of 1961.)
. .. . .. ". .... ........ ............... ..... ..............".
IN THE MATTER OF THE ESTATE OF
................... ........M.JCHA.EL.E...,J1JL1ER.
(State full name of decedent)
} AFFIDAVIT OF
JR. .... JllaK<<.mk
I Cumb er ~ij ADMINISTRATOR
Late of ......E...c:l:13.t::Pel1rlsb():r-()1.'~p,
State of ...Pennsylvania
Coanty of Cumberland
Charlotte I.
..........}ss:
.......,_.
Miller
Administra tor
of the estate of the above-named decedent being duly sworn, depose S
and say S
Decedent dJed ....... ........ Nov~mb e r
(Month)
Name and address of attorney or}
other authorized representative to
whom all correspondence should be
mailed.
6
(!lay)
197.8....J testate leaving a last will, copy of which is hereto attached. }
(Y~ar) L intestate
Fowler, Addams Shughart.........
28 South Pitt Street, Carlisle,
Pa.
17013
. .....,...................................
That as such Admin.isootr.a..tr.ix deponent IS familiar with the affairs of said estate and the property con-
e J<:XI'(,,'l tor- Admin istrator)
stituting 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:_
OTHER INSTITUTION
SAFE DEPOSIT BOX
THIS SAFE DEPOSIT BOX RENTED
IN NAME OR NAMES OF
RELATIONSHIP OF JOINT
HOLDERS TO DECEDENT
Juniata Avenue and Enola
Enola. Pennsylvania
That the contents of said safe deposi t box or boxes are itemized under Schedules NA of this
return, with the exception of the fOllOWing, for the reasons hereinafter set forth:
Contents limited to papers of no intrinsic value
That Schedule A attached hereto and made part hereof sets forth fully and in detail all the
real property in the Connnonweal th 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 si tua ted owned by the decedent at the time of death; all moneys left by the decedent
at the time of death, whether in deeedent's innnediate possession, standing to decedent's credit in banks
of deposit, savings banks, trust cOI~anies, or other institutions, whether indiviiually, 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 in-
debtedness of the United States to the decedent; 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, pic-
tures, Looks, works of art, household furni ture, 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 mortgae:es 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; and all the corporate stocks and dividends
due thereon and unpaid as of the date of death, bonds and accrued interest thereon to the date of' dece-
dent's death and other investment securities owned by the decedent at the time of death, with the market
value thereof at such time.
Executor
In the case of securities of close or family corporations, the values reported are as far as
l' 0" i b1 e ",b' tan t I a ted by f I nand al ,ta t emen" a l' Ih e cocpoca tl 00', ,haW 1 ng thc a"e t, and 1 i "bHI tl "
theccor aR of the date or ,Ieath. Tbe "hedule aHO ,." focth the Intec"t af deeedent at the time or
death In any co_pactnec,hlp oc bu,ine'" and In suppoct or the value or such lntecest thece " anuexed ta
said schedule, financial statements showing the assets and liabilities of said co_partnership or business.
,\ copy 0 f t he on-I''' too" hip a,ceemen t, (H 0,,1, a ,ta temcn t ,e t tlng I'M th the nR tn' e or the a<,eemen t)
to,,"lh" with a statement ,.Wng racth the c,""et" or the b,,,'neaR, Its location, and aud' othe' rac"
pe,talning ta the 'uslne,' a' may be pe,tlnent to a rai' and ju,t app,alsal or tbe deccdent', intece,t
the ,e In m." t be ,ubm It ted. It' hou 1 d al ao ,e t roc I h in Item I "d rocm, to ge t b" with the fal, m.. Ire t ,,1 ue
thereof, any other property owned or bequeathed by the decedent at the time of death.
The Schedule C attached hereto and made part hereof sets forth a true answer to each inquiry
contaloed the"ln and in the c~e ortnn,re" orp,opec", "aJ OC p"annal, wlthln Iwo yea" or decedent',
death, in contemplatlon or decedent" death, oc lntended to take erfeet In po,se"lon oc enjoyment at oc
art" death, oaid ..hedule se" rocth the natuce and "oiue or ,uch 1"01'''''' to whom "ansrened, tbe
celationshlp or the tcan,r"e" to the decedcnt, the penpoctlonate shace "ceived by each tcan,re,ee and
all othH roc" or a pectinent natoce 'egacding ,.101 tc"n,re". in the CO" or "anafHS intended t.o
take errect in po,ses'ion oc enjoyment at oc artec deatb, thece i' aI'o attached t.o the "hedule a ,0RY
or the deed, teust .gccement 0' othH inst,ument ceeating the tcu,t. ThH" i' ateo act fMth ,n aaid
schedule a list or ali pcopecty, ceal and pec,onal, witb it' value, which pa,'" at decedent.'a death by
vI c tue or the exeCO I ee by decedent, eithec i nd i vl duall y, M j 01 n t 1 Y with ,no the" 0 c an Y pOWH 0 l' appo 1 n t-
ment V" t,d in decedent, ei thec 1 ndi vidoal1 Y oc join t1 y, by the will, deed, M 0 th'C In' t",~en t or ano t.hH,
with a copy of the instrument creating such power attached to the schedule.
That S,hedo" 0 attached hHetO acd made pact heceor ,et, focth the 0"'" and addte"" of all
l' e"on' hene n ei all y in tee" ted in thia es tate at the time 0 l' doceden t' a death, the n" tote 0 l' t.he te ces-
pectlve lntece,ts, thelc cel.tionshiP, II' any, to the de,edent., t.ogethec with tbe agc' at the t'me or
01 e ceden t' a dea t.h 0 l' all m' no", annu lt. an t, and benerl c t.a d ea I'M 11 re undee d ceeden t.' s Will. it al so
contains a ,tatement showing which or the benerl,i,cle, named In the de,edent', will, 11' any, di~1 p,ioc
to decedent, the date' or tbeic death, theic laSue, andtbe ceiation'bip or ,och isauc to tl.e henefl,lacy.
That S",do'e E attacbed hecet.o and made a pact heceof ,et' ro,th all p,opecty, ceal and peC-
sonal, owned by the decedent. jointlY with anothe' oc othe,a, including intangihle, ,tandIng in the name
or the decedent and othec', plu' the date and place or cecocd or In,tcumenta errecting the ve'tlt.oce or
,eal estate and the date or ac~,isitlon or pe,sonalty, plu' tbe name, addce" and ,elation'hip, ir M'y,
of co-owners to the decedent.
That S,h,do" F attached heceto ond made a pact heceor set' mcth !'Wly and in detail all debta
and dedoc tions claimed roc and an behall' 0 l' thi' dceeden t' s e, tate, i n" mil ng 1\mecaJ e'pe"''' paid;
ram1Iyexemption, whece appllcahle; co,t, ar ,dmini,tcat.lon or thta e,tate; ,00n,e1 ree' ,nd 1\,dlel'CY',
,oami,sion' paid 0' to be paid; co,t expended 1'0' bocial tcusta, tomhstones oc gcavemackecs, and cell-
giouS "cvices, In consequence or t.he death or the decedent; debt' and claim' nw'ng an,1 unpaid at. time of
death; tave' accc,~d Cb,cgeable roc pe,iod pcloc to decedent', ,Ieatb (e,eept thosc allowed ,mdec SOctlnn
651 or the inhedtance ,nd E,tate Ta> Act); t.ogethee wlt.b n ,tate,~nt nr collatHal pJ~Jg~1 roc ob11ga-
tl on', i l' any... it is agteed th,t the nduei acy will pce,en t pcoo l' 0 l' sal d e1 aimed a bllga tI ons upon ce-
qne,t, th,t ir the amount aetuaily paid in ,ettJement or any ree, eomml,sian 0' debt I' Ie" th,n the
esttmated amaunt claiming and ,liowed, that tbe ,ame will be c~'octed ta the Reg"tec ar "11', and that.
the amount of tax assessed can be reassessed in accordance therewith.
That tbe totaiS or the appcopciate column' In Scheduiea ".", "B", "CO, "E", and "F" as di,eeted thecein,
have been carried forward and properly registered in the Summary.
Subscribed and sworn to before me thi......................... ~~o..&--ttJ>. ;:) ~~
..2~. ...... day of *..$.....w":"~ ..... 191'1;-"b.6~~~!.!;S:A!~i~i;;;f/i..............
.... .. ....... ... .... ;&~.~~ cf .. ~~ !a]('!Jrti:;!fif..c;;;,:!/ed........--...
~~,. .0., p, ,..;;:Ci~;:;'i";; ""dIL'Yl>fY.IEKPflLi:PILLZIJCl..3m
My'" " ",g. 23, l' (City or Town .nd State)
NOTE' Be roce ,I go in. ,frl olav it. make 'u ce all b I sck '1' ae", in th e am 01 ow it. and so hedu lee annev ~I ace
riiled tn with details oc the wocd "None", and tn ea,e the as,et' in,lude cace and unll,ted ,ccnc'tie',
,ecu,iti.' or cioae 0' r~IIy cocpo,at'on' oc an lntece,t 'n any eo_pa,toec'htp 0' bua'ne'" that tbe
da ta ,n,1 st. temen ta ce qn teed undee the pa eag caph aboye eel' tl ng to Se hedn 1 e "B" ace a tinehed. AI ,n "ake
certain that column #1 in the "Summary" has been properly completed as above-directed.
RCC<t4 (1-64) .
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "A"
REAL PROPERTY
-
Real property in Pennsylvanio, with statement of mortgage encumbrances upon each parcel at death of dece-
dent. Where property held as joint tenant or tenancy by entireties, report on Schedule "E". Property held by
the decedent as tenant in common with another or others, should be identified as to quantum of interest and
the estimated value should be that of the decedent's interest only.
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 ., 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 encumbrarlces upon each parcel at death
of decedent. Taxes, assessments, accrued interest on mortgages, etc.,are
to be I isted on Schedule "F" and must not be deducted from this schedule.
(1)
(2)
(3)
DEPARTMENT
VALUATION
CAUTION
(Do not write
In this space)
ASSESSED VALUE
FOR YEAR OF
DECEDENT'S
DEA TH
ESTlMA TED
MARKET VALUE
1. Legal title to tract of land, Township
of East Pennsboro, Cumberland County,
Pennsylvania, 75 feet by 150 feet, being
improved with brick and aluminum cape code
style residence with one story addition and
attached one car carport, subject to a
mortgage and bond in favor of Cumberland
County National Bank and Trust Company.
Valued in accordance with attached appraisal
of Joseph McGraw, Inc.
Purchased from Frederick L. Clements et ux
Deed Reference:
----
19 "F" 246
\::.- .
$4,650.00
$39,000.00
--
Insert this total opposite "real property", Schedule "A" in the
"As Reported" co/umr on th'~ lost noge of this return.
/'
xxxxx
$39,000.00
I) 0 000
~) -\ '\
.... -',
, tJ"-"
Rce -3.5 .
RESIDENT DECEDENT
SCHEDULE "B"
PERSONAL PROPERTY
CO~~fONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
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 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 f'iduciary in said capacity, partnership interests, interest in any undistributed
es tate 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.
I tern
No.
ITEM
List and describe fully
UNIT
VALUE
ESTIMATED
MARKEr VALUE
DEPARTMENT VALUATION
(Do not write in
this space)
1.
2.
Clothing and other personal effects.
One-sixth personal property interest in
cabin and contents situate in Susquehanna
River (no interest in real estate owned),
value based upon actual sale price.
1973 Ford Bronco, value based upon
insurance proceeds paid for complete loss.
1970 Ford truck, value based in accordancE
with actual sale price.
1965 Chevrolet Sedan, valued in accordancE
with attached appraisal.
Carlisle Camper, valued in accordance witl
attached ~ppraisal.
1971 Rupp mini-bike, valued in accordance
with attached appraisal.
10.00
450.00
3.
4.
4,048.13.
900.00
5.
500.00
6.
150.00
7.
40.00
Insert this total opposite "Personal Property", Schedule "B" in
the "As Reported" column on the last page of this return.
x X
V---"
$6,098.l~ \';\,-)(l\:; l--:2)
-
. RCC- 36
COMMO\\'VEALTI! OF PENNSYLVJ\N I A
THAXSFER INHERITANCE TAX
SCHEDULE "c"
THA.NSFEnS
liES IDEXT 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
(::!) Did r1ecedent, within two years of death, transfer property 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 af'firmative state:
(a) Age of' decedent at time of' transf'er
(b) State of' decedent I s heal th at time of making the transf'er. (Note 1).
(c) Cause of' decedent's death. (Note 1).
(4) Did decedent, in his lif'etime, make any transf'er of' property without receiving a valuable or adequate
consideration theref'or which was to take ef'f'ect in possession or enjoyment at or af'ter his death?
(Answer yes or no) No
(a) Was there any pOssibility that the property transf'erred might return to transf'erer or his
estate or be subject to his power of' disposition? (Answer yes or no)
(b) What was the transf'eree's age at time of' decedent's death?
(5) Did decedent in his lif'etime make any transf'er wi thout receiving a valuable and adequate consideration
theref'or under which transferor expressly or impliedly reserves f'or his lif'e or any period which does
not in f'act end before his death:
(a) The possession or enjoyment of' or the right to income f'rom thE' property transf'erred?
(Answer yes or no) No
(b) The right to designate the persons who shall possess or enjoy the property transferred or
income theref'rom? (Answer yes or no) No
(G) If' the answer to (5) (b) above is in the af'f'irmative, state whether the right was reserved in decedent
alone or others
(7) Did decedent in his lif'etime make a transf'er, the consideration f'or which was transf'eree'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 benef'icial enjoyment of' which was subject to change,
because of Ii reserverl power to al tel', amend, or revoke, or which COllld revert to decedent under terms
of transf'er or by operation of' law? (Answer yes or no) No
(9) If the answer to (8) above is in the af'f'irmative, was the power to alter, amend, or revoke the inter-
est of' the benef'iciary 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 af'f'idavit by the attending physician as
well as a copy of' the death certif'icate.
NOTE 2: If' answer to any of' the above questions is yes, set f'orth below a description of' the property
transf'erred, it's f'air market value at date of' death, dates of' transf'ers and to whom transf'erred, with
relationship of' transf'erees to decedent, if' any. Submit copy of' any trust deed or instrument, if trans-
f'ers are claimed to be non-taxable, also submit detailed statement of' f'acts on which said claim is based.
NOTE 3: List applicable property below in manner in which provided in Schedules A, B, or E.
ITEM
DESCRIPTION
MARKET VALUE
(Es tima ted)
DEPT. VALUATION
(Dept. Only)
NONE
Insert this total opposite "Transf'ers", Schedule "C" in the
"As Reported" column on the last page of' this return.
NONE
N'.. ,
0"-'---
::lCC-3S
nr~I])EKT DECEDEr\T
SCHEDUI.lE "E"
JOINTLY OWNED PROPEHTY
COM\IU\;WE\LTH OF PEN\'~YLVi\NL\
TlL\!'i~I:~n I\"HE1UT\Nn: TAX
I\STHl'CTIO'iS: This schedule must disclose all property, real aTH! 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 under Schedule
"A", plus the date and place of record of instrument effecting vestiture, 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 date of acquisition, and the name, address and relationship (if any) of CO-owners to
the deceden t.
Description of Property, Date of Acquisition, Name I unitl~perce~t~~e-I Es-tate
Address and Relationship of CO-Owners, and Place : Value Sharp Valuation
of Record of Instrument, where Real Estate. !
-- - - ..-" ---x
' y
('\, x,
DEPART~ffiNT VALUATION
CAUTION-Do not Write
In This Space.
Value of Value of
Entire Decedent's
Property Interest
.;xv
NONE
Insert this total opposite "Jointly Owned Property", Schedule "E" NONE
in the n As Reported" colwTD1 on the last page of this return.
IN(;~
RCC-37 (12-63)
COMMONWEALTH OF PEN;\JSYYLANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
-
SCHEDULE "D"
/j
BENEFICIARIES
::.
BENEFICIARIES AND ADDRESSES RELATIONSHIP I SURVIVED DATE INTEREST OF
State full names and addresses of all who . (If step-chIldren or I DECEDENT BENEFICIARY
IllegitImate chIldren STATE YES OF
aYe an interest, vested, contingent or other- are InVolved, set OR NO BIRTH IN ESTATE
wise, in estate) forth this fact.)
Wife Yes 7/19/39 11S t $20, uOO + 1i2
Charlotte I. Miller tremalnder
Diana L. (Miller) Timlin Daughter Yes 5/22/57 1/6 of remainder
E. Miller Son Yes i 1/6 of remainder
Torrence I 7/8/59
Judith L. Hiller Daughter Yes I 3/10/63 1/6 of remainder
i
,
I
-
-
- ,
\
h
?ponent further says that all the above-named benef'iciaries are living at this time except below:
NAME
:::
DATE OF DEATH
RESIDENCE
-----
-~
-.:
...... ..... ....... ......
$
$
$
$
$...
$45,098.13
( 1 )
(As Reported)
39,000.00
.6,098.13
-0-
( 2)
(As Determined)
....
o '
....."'....
r:<'"
..... - ~
'~ -Q) S
'S Q) ~
'00.0
< S .'-'
, O.
....'-''0
o Q)
.......... .....
::l '" ....
'-' ::l 0
~ S g.
~ p::
Real Property
Personal Property
Transfers
SUMMARY
(Sch, "A")
.. (Sch,"B")
. (&h. "e")
$
$
$
$
$
'"
'.
Gross Taxable Estate ............ .... . .......... .
00
r--; Poi
cri .,-1
r--i ,..c:
t- '0 (/)
Z Q) ~
... til r '" 6
o::l ~~ .l
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til 0 rIl
C""l r.fl -
..... . 0 ..(
\..0 -<
cO ~ H o::l ~
~ ~ r4 0 '1j '2 =-
r---; p.. 0 j ,.0 g o::l =-
p.. .=:
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r-I :I: :I: til H ~ r-I :.-.
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~ til ~ ..... i-
~ +J ;j 0
0 ...4 (/) u ...c ~
a ~ ~ cd ~ 0
0 ~ ~ =-
',C w ::r:: ill .....
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.b t- u 0 ..-
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V> -< H ..... 0
'2 ..... ?: 0 .c. E
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.
.
TELEPHONE 737.0415
INC.
APPRAISALS . PROPERTY CONSULTANTS
P. O. Box 7. LEMOYNE, PENNA. 17043
3RD AND MARKET STREET. LEMOYNE. PENNA.
December 18, 1978
Mr. Dale F. Shughart, Jr.
Attorney at Law
28 South Pitt Street
Carlisle, Penna. 17013
Re: Michael E. Miller Estate
107 Mountain Street
Summerdale, Penna.
Dear Mr. Shughart:
of the
1978.
In compliance with your request we have made
above property to estimate its Market Value
Our findings are outlined as follows:
a series of studies
as of November 6,
Site
South side of -"_U.:..ru:ain Street in the East
Pennsboro Township community of Summerdale.
Utilities include electricity, telephone,
water and sewer. It is not in Flood Haz-
ard Area. Approximate dimensions are 75
feet frontage by 150 feet in depth.
Improvements
Brick and aluminum Cape Cod style residence
with one story addition used as a taxidermy
office and an attached I-car carport.
Main Level
Living room with fireplace; dining room;
modern kitchen; two bedrooms; 3-piece bath; .
taxidermy office; and storage room.
Upper Level
Master bedroom (unheated).
Basement
Partitioned into furnace room and paneled
work room. Concrete block foundation walls
and concrete floor. Heat is oil forced warm
air; electric service is 100 amp.
Condition
Average
'lCAN INSTITUTE OF REAL ESTATE APPRAISERS
SOCIETY OF REAL ESTATE APPRAISERS
mEmBER
NATIONAL ASSOCIATION OF REAL ESTATE BOARDS
AMERICAN RIGHT OF WAY ASSOCIATION
. .
Atty. Dale F. Shughart, Jr.
28 S. Pitt St.
Carlisle, PA.
Re: M. E. Miller Est.
107 Mountain St.
Surnmerdale, PA.
12/18/78
- 2 -
A market study of area sales with adjustments for differences
has indicated the value of the Miller Property as of November 6, 1978
to be in the range of:
THIRTY-NINE THOUSAND DOLLARS - - - - - - - - - - ($39,000.)
I / -:
Respect~.'JJ/ljj( ~m :.'t.,t..ed,
,I! ' /1/kJo
.l' / ../! /,!)ji/
Josep7 MdGra~~ ~.AI-SREA
George C. Clauser
Staff Appraiser
GCC/ j f
)SEPH McGRAW
. Appraisals. Property Consultants .
THIRD and MARKET STREETS, LEMOYNE, PA.
~[[(j
L.B. 5)mD~~,~~(j;. Ford Division
Market Street at Twelfth, P. O. Box 138
Lemoyne, Pennsylvania 17043
Phone: 717 - 761-6700
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ST ANDARD
RETAIL RV
BUYERS
CONTRACT
MAf(nN CAiv:?:-:R SALES
717/766-5569 - 1503 Carlisle Pike
MECHANICSBURG, PENNSYLVANIA 17055
PHONE: I
S0LD TO DATE
ADDRESS SALESMAN I
SnJECT TO THE TERMS ANO CONOITlONS STATEO ON BOTH SlOES O-;-:;:;;IS AGREEMENT SELLER AGREES TO SELL ANO THE PURCHASER AGREES TO PURCHASE THE FOLLOWING OESCRIBEO PROP_ER~--]
-MAKE -- rODEL _~ IL APPf:x [STOCK ~UMBE~~__------,
",,., NOM'" ~ - ~, NeW -Fmo, ~o.o"o ~Fn NON"" i
J~_~ USED I _ ~lIVERY DATE I -- _I
CUSTOMER MAY CHOOSE PERSON FROM WHICH INSURANCE IS OBTAINED. III P~ICE OF UNIT :!$ -+'
~- N; COVE~:~UERt~~Y~~~E:~g~:~~~ow O~~~~ET~S Ii $ I ~~~~~FA~:T~U~PP:~~: _~__- -1 -1
o FIRE AND THEFT - CAC I I I I
=:J FiRE AND THEFT ~ COMPREHENSIVE I. SUB-TOTAL
o PERSONAL EFFECTS
O-HOMEOWNER'S :i
-CLOther insuranceJDes:.~ 11
SALES TAX IF NOT
INCLUDED BelOW IN '4.1
NON-TAXABLE ITEMS
--r-OT Al Pli'tMlUM fOf '"iuronCe {oy.rog_' on the
(o.....mod;ly if obtained hom Of through ,.11..
..
FEES IF NOT INCLUDED BELOW IN (41
~se purchose the co~-;r-~ges~ed;d above.
SIGNED X
o Pvrchaser has purchased required insurance tn rough:
"GENT!> "DO"'ES~"
I
I
1. CASH PRICE
TRADE_IN
ALLOW ANCE
lESS BAL. DUE
ON ABOVE
NET ALLOW ANCE
CASHDOWN
PAYMENT
CASH AS AGREED
SEE "REMARKS"
2 LESS TOTAL CREDITS
3. UNPAID BALANCE OF CASH SALE PRICE
$
$
I
I
\--
1$
......Mf OIC ,....Su"l......CE CO>.1"''''NY
$
--~-
THIS IS NOT A TRUTH.IN-LENDING-ACT DISCLOSURE FORM
INSURANCE AGAINST LIABILITY FOR BODILY INJURY OR PROPERTY
~AMAGE TO OTHERS IS NOT INCLUDED IN THIS TRANSACTION
OPTIONAL EQUIPMENT, LABOR AND ACCESSORIES
,:... / b. t
.I-. .)...., 1... c:
~;~~:-;
-/.;L C 00 ? 7 7 50 q
F
14.: L't/,; eo-~
c':'~
4. OTHER CHARGES
a. Official Fees' Specifyl $
VSI $
b. Iniuronce on Commodity. $
c. Credit life Insurance. .$
7 d. Credit Accident & Health. $
e. TOlles [Not incl, above) . $
t. License Feu $ }$
:::!:.... Regist. Feu $ (Totall
(er'if. of $
Title Fe.s
REMARKS:
TOTAL OTHER CHARGES (0 + b + c + d + . + II. $
s. UNPAID BAL. - AMOUNT FINANCED 13 + 41 . . $
6. FINANCE CHARGE. . . . . . . $
7.ANNUAL PERCENTAGE RATE I "I
B. TOTAL OF PAYMENTS (S + 61 . . $
9. TOTAL DEFERRED PAYMENT PRICE (1-t-4+6) ..,.... $
Payable in monthly in.tallments of S
of each successive month commencing
I
I
each)
, all payable the liMe dale I'
,19-.
I
I
1--
'-~-------aALANCE CARRIED TO OPTIONAL EQUIPMENT
Title 10 the within described lJnit posses
os of the date of signing of the retail
installment or security ogreement by
the purchasers. even though physical
delivery may not b. mad. until a
later date.
and one final installment of $
ijESCRIPTION OF TRADE-IN
x
j
IT IS MUTUALLY UNDERSTOOD THAT THIS AGREEMENT IS SUBJECT TO NECESi
I SARY CORRECTIONS, AND ADJUSTMENTS CONCERNING CHANGES IN NET
Ii PAYOFF ON TRADE.IN TO BE MADE AT THE TIME OF SETTlEMENT
I
II SOCIAL SECURITY
II
~i SOCIAL SECURITY
$
BEDROOMS
SI':R'Al NO
COLOR
.,ADE-iN u:'::ST TO BE PAID BY ~ DEALER =:: CUSTOMER
-_._- .__._.__._~-------- - --_.---.-
, J,c;'_"$I\Jil2d cert,fy I".JI n-.e m,:Jt;er prinled on the back hereof is agreed 10 as a part of this agreement, the same as if it were printed above Ihe Slgna-
._. 1':,' C .:...'OIgnec" c-r S:Cjtui,.;, i a,,~ or nos been legally emancipated; that the purchase of the above described trailer, mobilehome or vehicle; Ihe OfJ'
. ':) <!2;.',"'iC. . (Jri(i a:c'O,scr,es th,:rson, Ihe Insur'~nce os described has been volunlary; that the property being traded in is free f'om all encumbrances
~.sc:,ve'. .HC2,:l1 c, I,uled here,n The undersigned agrees each paragraph and proviSion of this contract is severable; if one portion Ihereof is invalid the re
-,'J.lnlng pOrtl0f' .:.nail. nevertheless, remain in full force and effect.
__....J
MARTIN CAMPER SALES
_.___~.____.__________. ________ ______DEALER
""'01 Valid unless Sl~ned and Accepted by on OftlCU of the Company
I, OR WE, HEREBY ACKNOWLEDGE RECEIPT OF A COPY OF THIS ORDER
SIGNED X PURCHASER
8,
SIGNED X
PURCHASER
..\P~"O'..-fi'u Sublecl 10 Q(cep!once ot f,non(InQ by borlk or finance company
:- :J r;:\^ 777 !'C< c< M,o, ahcone P'inle"
''- 'I .....:;;s.c0..;10'"' II; COPYright 1977
Prmted In uSA
DEALERS COPY
~
ST ANDARD
RETAil RV
BUYERS
CONTRACT
MA~~TlN CAf~?ER SALES
717/766-5569 - 1503 Carlisle Pike
MECHANICSBURG, PENNSYLVANIA 17055
PHONE:
,O,D TO
DATE
AGE: N T 5 ,...A,.n
....GE: N r S "'OORE '~s
N.......E OF 'NSURA,,<CE CO....PANY
INSURANCE AGAINST LIABILITY FOR BODilY INJURY OR PROPERTY
DAMAGE TO OTHERS IS NOT INCLUDED IN THIS TRANSACTION
e. Toxes INol incl. abo....el
$
$
$
.$
$
$
OPTIONAL EQUIPMENT, lABOR AND ACCESSORIES
b, Insurance on Commodity.
v,r-:;
c. Credillife Insurance
/-"7, )7 , I
~:~
/
d. Credit Accident& Health
,
,1.;"7
'I f license Feu $
I
1
I
Ii TOTAL OTHER CHARGES 10 + b + c + d + . + II .
II 5. UNPAID BAt. - AMOUNT FINANCED 13 + 41
, 6. FINANCE CHARGE. . . . . .
7.ANNUAL PERCENTAGE RATE I
8. TOTAL OF PAYMENTS (S + 61
}$
ITotol1
Regist. Feu $
~~;ti~ ~~ts $
$
.$
.$
"I
$
9. TOTAL DEFERRED PAYMENT PRICE (1+ 4+ 6) , ...... $
I
[
1---
~ -_.~.._----
~SC!~!T10N ~j:D~~~ C_A~~~_~_D TO OPTIO~~~ EQUIPMENT
......f '-lODE!.. BEDROOMS
Titl. 10 the within described unit pone~
os of the dote of signing of the retail
installment or security agre.ment by
the purchasers even though physical
delivery may not b. mod. until 0
later dot..
Payable In_____monthly in.tollments of $
ond one lonol in.tollment of $
I
I
each!
x
_, 011 poyoble the li,e dotel
,19--
I
!I . ----~.J
liT IS MUTUAllY UNDERSTOOD THAT THIS AGREEMENT IS SUBJECT TO NECES.I
i!SARY CORRECTIONS, AND ADJUSTMENTS CONCERNING CHANGES IN NET!
:1 PAYOFF ON TRADE.IN TO BE MADE AT THE TIME OF SETTlEMENT
l! SOCIAL SECURITY
, SOCIAL SECURITY
of each slIccessive month commencing
$
,
. -- _.~~~--_._---~
I T ,f
,
~~-
! .....C'l.. O....,...G TO .....HO"'!
I~
~RADE-IN DEBT TO BE PAID BY =: DEALER I--:--i CUSTOMER __.____
~he unders'gned certify that the maUer printed on the bock hereof is agreed to os 0 port of this agreement, the some os if it were printed above the Slgno- I
lures; tnat undersigned IS of statutory age or hos been legally emancipated; that the purchase of the above described trailer, mobtlehome or vehicle; the op-
',onal equipment and accessories thereon, the insurance os described has been voluntary; thaI the property being traded in is free from 011 encumbrances
whatsoever, except os noted herein, The undersigned agrees each paragraph and provision nf this contract is severable; if one portion thereof IS onvol,d the re'
mainong porI Ion shall, nevertheless, remain in full force and effect.
Sf: RI"l "10
COLOR
.=
DEALER
I, OR WE, HEREBY ACKNOWLEDGE RECEIPT OF A COpy OF THIS ORDER
SIGNED X
PURCHASER
MARTIN CAMPER SALES
NOI Valid Unleu Sllj;~ned and Accepted by on Officer 01 the Company
By
Appi'"oved. Sublect 10 occeptance 01 finanCing by b(]nk or finonce compony.
SIGNED X
PURCHASER
Printed In l.J S A
FO RM 777 .:t"'ni(lns Mob;~ehome Pfln'er~.
\\)~outoh. III . CopyrIght 1 '177
O[AL[IlS COpy
REV-5IR (s-n)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF F!ELD OPERATIONS
P.O. BOX 7.970
HARRISBURG
17105
IN YOUR REPLY PL.EASE
REFER TO
Inheritance Tax Division
NOTICE OF FiliNG OF APPRAISEMENT
Charlotte I. Miller
107 Mountain St.
Summerdale~nna. 17093
(Executor or Administrator)
In Re: Estate of _________-.l!ichael~.k1j.,ller
Cumberland
County - Fi Ie No.
21-78-0639
Dear
You are hereby notified that the . Original
appraisement in the estate of Mlchael E. Miller
has been fi led in the office of the Register of Wi lis of_(;umberland
County on 17 April, , 191.9__, Said appraisement reflects the following
va I uatj ons:
Real Estate
Persona! Property___
Transfers
Jointly Owned
Total Md__
19 ,000 00
fi,09R.l1
~
~O..D~
45~098. 13 _
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.
Dote 17 April 79 Si gned 'L-t '<; \;_-"-=~- _~~
Administrative~icer
Titlc_
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 I...
RESIDENT INHERITANCE TAX
A,PPR,l\ISEMEf\JT 11
.Ii
DATE _.
COUNTY
17 April 79 ___~
Cumberland
ii-78-0639
FlU: (;0,
, ,,,:~,". ~''''''''''''''''''~.'' "-<>>1' ___ .r .
Whereas, Michael E. Miller late of _ East Pennsboro
in the County of Cumberland _ Commonwealth of Penn,yl"a"ia, C''I
th e 6 th day of - _ Novemb e r _ 1 9 ~, seized an d poes.""," of '0 ""M'
subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania;
Therefore, I, Leo Ful~initi _ ,an appr;user duly appointed '"
haVing been designated to make a fair and conscionable appraisement of the said estate, and to asse,,, ",.j ,," n"
value of all annuities and life estates growing out of said estate, hereby file the following appraisement
-..... - -"'_.~""..,-,,-,",~_....-
to ", "", '''' ", '" ,"" "","" " '"'' ""', " '"'''''''' " '"'~"'" 0, "j o,m", " M""" ",'" '" to, '""", ." c, co, "'" ," ,"
ot '"' """ to, ",' 00 '00 "m. ''', Com m ",w""" ",re" ..",,,,, m~"" e" ,''',' '0 0" ,",," "" ","" ,,, 'H" """,,"',. ,,, ,,, " ' ", ",W t, '0'"",
rate on any such future interest.
DESCRIPTION OF ASSET
Total Assets
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Have been duly SWorn according to law, 1 do hereby certify that the above appraisement is made in co::!~rmilY
th the law on this I hh day of L:' c-'!><P_ 19 __
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