HomeMy WebLinkAbout03-22-79
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COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
"Q7~1aLt.._
;'.
RCC-33 (4-73)
RESIDENT DECEDENT
COUNTY OF
Cl.J.mbcr 18. tIc!
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'otenue. (Section 703 of the Inheritance and Estate Tax Act of 1961.)
Late of
ClFlber1and
Pennsylvania
} AFFIDAVIT OF
EXECUTOR
K!}l11tJNW~
IN THE MATTER OF THE EST A TE OF
Myrtle ~. Cleland
(STATE FULL NAME OF DECEDENTI
County
County of
Cumberland
}.
State of
~ro:m>~
.t;Trt Ie I'~ohr
01 the estate 01 the above-named decedent being duly sworn, depose
Executor
and say
(MONTH)
Name and address 01 attorney or }
other authorized repres.entotive to whom
all correspondence should be moiled.
(DAY)
, 19~{testate leaving a last will, copy of which is hereto ottached. }
( YEA R) JlDjgIj,*iK
Decedent died
Setp. 27,
J. Robert Stauffer-Narket SqUDre Bldg.,
Mechanicsburg, Penna. 17055
That as such I-<::xecutr5.x deponent is familiar with the affairs of said estate and the property constituting
( EX ECU TO R-ADMIN I 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 OTHER INSTITUTION
IN WHICH DECEDENT RENTED A SAFE DEPOSIT BOX
Tho Firs t Bank and Trus t G o-rrn;8.D' oJ..
1.Tecban",csb,)-!,0'. Pa. .t.-l1ain and ;'1arket
Sts.. l'Iechan5_csbur9' Pa.
THIS SAFE DEPOSIT BOX RENTED
IN NAME OR NAMES OF
~wrtle ~. Cleland and
l'ol~Trtle E. Kohr
RELATIONSHIP OF JOINT
HOLDERS TO DECEDENT
nl8ce
That the contents of said safe deposit box or boxes are itemized under SchedulesAco:B of this return,
with the exception'of the following, for the reasons hereinafter set forth:
That Schedule A attached hereto and made part hereof sets forth fully and in detail all the real property
in the Commonwealth of Pennsylvania of which decedent died having an interest therein. It also sets forth the
mortgage encumbrances upon each parcel of real property at the date of death, giving the amount still due at
death, name of mortgagee, date, rate of interest, and book and page of record thereof. It also sets forth in the
columns provided therefore the assessed valuation of each of said parcels, the estimated market value thereof
as of date of death of decedent.
That Schedule B attached hereto and made part hereof sets forth fully and in detail all personal property
wheresover situated owned by the decedent at the time of death; all moneys left by the decedent at the time of
death, whether in decedent's immediate 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 al so separately the accrued interes t thereon, if any, down to the last 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 hriefly 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 I Lc ,1.i), of dea th, bonds and accrued interes t thereon to the date of decedent's
death and other investrn'. I '0 , IcJ by the decedent at the time of death, with the market value there-
of at such time.
In the case of securities of close or family corporations, the values reported are as far as
possible substantiated by financial statements of the corporations, showing the assets and liabilities
thereof as of the date of death. The schedule also sets forth the interest of decedent at the ti.me of
death in any co-partnership or business, and in support of the value of such interest there is annexed to
said schedule, financial statements showing the assets and liabilities of said co-partnership or business.
A copy of the co-partnership agreement, (if oral, a statement setting forth the nature of the agreement)
together with a statement setting forth the character of the business, its location, and such other facts
pertdnlng to the business as may be pertinent to a fair and just appraisal of the decedent's interest
therein mllst be submitted. It should also set forth in itemized form, together with the fair market value
there,.,r, Ilny other property owned or bequeathed by the decedent at the time of death.
The Sc/1edule C attached hereto and made part hereof sets forth a true answer to each inquiry
contained therein and in the case of transfers of property, real or personal, within two years of decedent's
death, in contemplation of decedent's death, or int.ended to take effect in possession or enjoyment at or
after death, said schedule sets fort.h the nature and value of such property, to whom transferred, the
relationship of the transferees to the decedent, the proportionate share received by each transferee and
all other facts of a pertinent nature regarding said transfers. In the case of transfers intended to
take effect in possession or enjoyment at or after death, there is also attached to t~e schedule a COllY
of the deed, trust agreement or other instrument creating the trust. There is also set forth in said
schedule a list of all property, real and personal, with its value, which passes at decedent's death by
virtue of the ex.ercise by decedent, either individually, or jointly with another, or any power of appoint-
ment vested in decedent, either individually or jointly, by the will, deed, or other instrument of another,
with a copy of the instrument creating such power attached to the schedule.
That Sc/1edule D attached hereto and made part hereof sets forth the names and addresses of all
persons beneficially interested in this estate at the time of decedent's death, the nature of their res-
pective interests, their relationship, if any, to the decedent, together with the ages at the time of
decedent.'s death of all minors, annuitants and beneficiaries for life under decedent's Will. It also
contains a statement showing which of the beneficiaries named in the decedent's will, if any, died prior
to decedent, the dates of their death, their issue, and the relationship of such issue to the beneficiary.
That Sc/1edule 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 the name
of the decedent and others, plus the date and place of record of instrlooents effecting the vestiture of
real estate and the date of acquisition of personalty, plus the name, address and relationship, if any,
:
of co-owners to the decedent.
That Sc/1edule F attached hereto and made a part hereof sets forth fully and in detail all debts
and deductions claimed for and on behalf of this decedent's estate, including funeral expenses paid;
family exemption, where applicable; costs of administration of this estate; counsel fees ann f'udiciary'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 aml 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 of collat.eral pledged for obliga-
tions, if any. It is agreed that the fiduciary will present proof of said claimed obligations l~on re-
quest, t.hat if the amount actually paid in settlement of any fee, commission or debt is less than the
estimated amount claiming and allowed, that the same will be reported to the Register of Wills, and that
the amount of' tax assessed can be reassessed in accordance t.herewi tho
That the totals of the appropriate columns in Schedules "A", "B", "en, "E", and "F" as directed therein,
have been carried forward and properly registered in the Summary.
Subscribed and sworn to before me this ...............................
. cf .~
m~~t.mm. fiitifday of ,fer. .~m.. 19...7.9
...............~.~ ;<? . .
}C~)/1.A-1./ u~/ r'::'s. GL~lY;: i' r-. , r:"71;";' ;>,.::UG
,~ '-'" -;r t, , .
S9l~i\:~~~~jL~;;.;~-;;;;:...
. ....... .'.~iB.~le..e.:!;,.e:w.:ft.:J..':...F..~.fl.~.~.!:....J.7J1.?_.............
(Street Number)
...I1.a.prJ.e.~~~?cr.2..L..X~.P9..~.~...
(City 01' Town and State)
p. J ..' IfJlt}
NOTE: Before signing affidavit make sure all blan.k spaces in tDe affidavit. and schedules annexed are
filled in wi th details or the word "None", and in case the assets include rare anel unlisted securit.ies,
securities of close or family corporations or an interest in any co-partnership or business, that the
data and statements required under the paragraph above relating to Schedule "B" are attached. 'Usa make
certain that column #1 in the "Summary" has been properly completed as above-directed.
RC e-34 (4-7 3j
COMMONWEALTH OF PENNSYLVANIA
DEPARtMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
. TRANSFER INHERIT ANeE TAX
RESIDENT DECEDENT
SCHEDULE uA"
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 as joint tenants with right of surviorship or tenancy by entireties should be reported 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 wi th
a general description of the property, with 0 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, Taxe., a.silssment., accrued Interest on mortgages, etc.,are
to be listed on Schedule" F" and must not b. deducted from this sched",le.
(1)
(2)
(3)
DEPARTMENT
VALUATION
CAUTION
(Do not writ.
In this space)
ASSESSED VALUE
FOR YEAR OF
DECEDENT'S
DEATH
ESTIMA TED
MARKET VALUE
~\T,IJ fl~'~~'-::();3;:~ ~l~~_..~~l (2) acl.jc)~_r1~1 TJ0tS of (J.j~olJnd
Sit.1J2.tA 0":'] t~.!_C ~'~()rt1"l [)i(~."e of -:;ast ;::;:I.""1#lS0n
~~,',treet, .~_~~~ tl"~~e second 11a~~6 of' tlle 'I'3oroll(~~C. OI'"'}
~"'ec~~.2"j."'~_c:~:i:.':\;_r'~, CQ1J.nt~T of (~1,.J.r~tl)crl[l1""}6, n.r~() St2.t
of onn2:-J,_1!a~~a, bounded and described 8S
fnJJOFS:-
~<\. 1 - B-:~(J TT(; at 8. 'no';rt 0':1 the' '~cpt;'l ,,1. '8 of
pst 3~-'-~I;SO:.~~ tr'88t 8.t corner) o~r IJotfoY'~1.er~1 T oi'l 13. r-.
"ecl:loy, rm.J D8rcol "0.2 heretn,ci'tsl' 6escpi ed; thence
1) y ;- fO . rJ T, 8 t, ;' 0 ~~' t 'r> (', 1 9 S . 0 r e e t~ to a pub 1 call c y ;
thence b: s~;d alley, ~estward, 20.0 feet to a point
pt 1.7>:"8 of Lot Corr:erl~- of -0'. S.:f)11SET', DOH of
f~)ob0!~t ~'i~. ~3t8."\:'J~Ja1Jr:h nnd~ ~!if'e; tller~ce D.lorl::;
sn~2 Tot, 3out~wa~d, 195.0 fa t to a point i.l line of
--'""t- ';' '.:"""'0'" :'.!-1","P+' o I"'o"f' " p.j c'. c'nce 81 (,1'1(7 sa'1 d
;c..,_) ._J k... .'';',L-~-' ..J ~'..) '_J,o. '.J --' ,.I,.~ 1 ,,-~.)........__ ._" ~ L". .....-"-. :";" ..._
~jt!~eet, t"l/18_1~d, 2tj.O :eet t.o the IJoin.t a,neJ. }"")lace
of -J~'~:'~- I?~~. ~VT:~G t~erecn erected the
'astern one-half of a two story double frame
01-',-' .., , r., "t'
c11,,.:e]_1-Lr:...... t:~;use, ~'l.:.J)srfQ .-J..7 ~JasG ;:-.)L:n:pso~~) eeL"
:: e c }, a '1'. c E b 11 I' ~= , , 8 Y, E', ~T 1 va:-i i 8. .
'_"0. ~) - :'?~~=C_Ti..,._M~_,,..~ ,s_t a~~ '~.rorl ~~;!rl on the
buLlcH l'ne oc~ "sst 3L:.rson ~)treet, CO"r1er of Lot 1'01':. ply or
/\rl~:-~e ~:.~~. f'~~stl-~..~...~e, ~01--i OI' .~or-::_1fjrl:r of S1'::'6
,:~;,.~:~-: 0 r J. e:;; trl c.;~! C e'".~ e s t1,.'.' arc1 8. J_ Ol1,':.::~ tl'} e b l)i 16 i nL~ 1
l:'1e of s~id Stroot, 27.4 feet to a point at!
~orY~.er) of ~~ot ~',C.). ]~, h8re-~r:8.t)o\Te ()escr.ilJt~d; t~:lCDCe
, , - 1 . , T t 10'7" In t' r) I
O~""C(},1'Ja:i.'"lC f:...:,.O~'.::~: s~.] C --JO, / f .'-.J ee J ~,O r;.t ~
. -l-' f-' ... +. , . 1 l' ]. CO ,r c'-'-
pO'.DI, '.D .vne OD,;18 :':;Ul___C1T," . ,,',~ uL..
.T0l'l~1 E: f''.. lo~r; tbJ.?DCe :ast~"\T[lrlrJ, alon:~ tr1t::'
buUcFnr' lCJi8 of 8216 .:"\.11c7}, 52.I+. reet, ('lore
or less, to an ~ron ~cn at cornsr of afore-
sr~-icJ. TJot fO}:-.>l.GJ~]_-..-: ot'- j.\rlrlj_~:j e~;_st15_r:e, _.:-:C"lrJ
C.,:, - fo~.-,l(~rl '.- of ~)~Je rley; the'lce ~;c',tblr)ard
q~0Y1;~ r~H1_(Jt.-.'-ef- ]c.~7 c; f"o.et ~n_Ol"'e ()r less,
U" ,L '-" ... ,_~ _ _ _ ..J U , ~..!. "'"' --'_ '-- ,
to on :ron ~l~ at t~le poirt f:~d place of
~ ."1 ('i -- ~' r' -;- "7,- ,.~
..'.J --'.
A~~esse~ for lacsl reaJ. est2te taxes at..... ~ 4060.00
;_~old 8 t :.'ubl ic 81jC ticn to Anne S. lAme is
"or" 27,200. ~0
./~/
".;
.h'
~.:.7,200.l0 ~'I.\OO,OO
{_; (c
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.
27 ,20Q.JC ~1,~OO.OO
,r,Cc"-3F
COMMONWE.\LTH OF PENNSYLVANIA
TllANSF'EH INHERITANCE TAX
..1lI;i..
. - ~~ .
.'~'
/j ';.:" t\
6?i' . 'tt
HESIDENT DECEDENT
SCHEDULE liB"
PERSONAL PHOPERTY
I tern
No.
I NSTIUJCTIONS: This Schedule must disclose all tangible and intangible personal property owned individually
lJY the decedent, at the time of' his death. Property owned by the decedent jointly wi th another or others
must be listed under Schedule "E". Intangible 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 f'act that they are not of' the administered estate.
Tangible personal property should be listed f'irst (e.g. jewelry, wearing apparel, household
goods, and f'urnishings, books, paintings, automobiles, boats, 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 or fiduciary in said capacity, partnership interests, interest in anyundistributed
estate of 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 of' death, should be listed in this schedule.
ITEM
List and describe f'ully
UNIT
VALUE
ESTIMATED
MARKET VALUE
DEPARTMENT VALUATION
(Do not write in
this space)
1
C}-~sc'7~r!.: \(?C.')11y:,t ~:o. l20-11~-)i. T'-Lth The
~l''''.. ~.7: --"~"',;;Y"l ,- -~rld 10rust C()"n.:_'t)2,-Y:l-~'- of ~,Tec'!flclni.cs
. . ~ ~ u' _,":. J ,. _ " _ .h .... 1,.1
r)l~_:_r:--.:, ?8.. ('-:,a18.nce [~S of 9/?7/7Pl.......
~~:8'I-LrJ 'YOS ,':~CC01J.1lt 0. 500-516-0 1-rt th r:rl~e
::'~~"rs t-: :3fi:11{ n.nc (rr'.l_~ t CO"':lr\an7/ of ~'..ec~-~8_nI.cs
, T-~ (CC 1,-"... rc- p C/')7/7f()
o l.lr , .:.' ~.l.. . :__18. _L ct. . ; C G r':":;. ....-) 01. /' L I' .~~ I . . . . . . . .
, r/~'7 /'70
I D t 8 c' Fe, ~,t [1 c C r l:. e (iG 0 '; c: / : ,- - - - - - - - - - - - - -
rl1,.,:el"'t\.:e (l?) 'SC~l[tr9S 0.0 CO"'lr"~o-r-' stoc1: of
r~~,e Flir2t~ ~jP~K 8nc j1rust C qD~ of
SC~~R~tcsbur'-, F8., sole at 1.].05.00 per
\ a lD 0.00
J
~/
1 '7''''"1 ~1" ....../"
..., {I, ,'.--v
1)111. ~ I
~
L
r, ",/
,;,()77.0~ /
('2.56/
~ ~11, Do
I
ca!.5L.
",
-'
>
1,260.00/
)!
1
., r:[ire . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . .. .
m'i'ent,r-OD<:; (?1) :3h8r'3S of CO,IJT':on stock or
the C~)nC)erJ.8"'o Valley Co-operative
;ssociation. 10.00
ceres s :cece .:;,ts fron: nu.blic s ale of houc;e-
h~ll(; .fl) ~~:: -i. s r. -~ rL~" s ~~ v:cJ pe rs on ~ll be 10 i nCs ,
nplci "'-()\T 2c lo7:~ 8:1d. COn(~1J.ctf;c3 [)"'\/
. ~ . --,' -./ \f. - _" . - , I _ ..-
Col. !J. =. F.=ocker, .\uctioneer, aT.'
''-p_rr~f'1)')_.~ , r(c;n""'S~)"I\lftn-.L2.....
2 ? c') ~7 if'
..,-';.~.
~ :3 ~ Af. 1 0
I
210.()O'
~ \ O. DO
5
~
i\\J.+t./!.11~t.a.f\ ~ ..JVl-O---
\\.1 (). Ii 5 d & q Ii ('Y,\ - /'YL-t~
"
Lc,' tl o-l!U' La
v-Uutl (( Clft.L~
'SL\~ i4
~~.I~
Insert this total opposite "Personal Property", Schedule "B" in
the "As Reported" column on the last page of' this return.
x X
ltl,408.121
\ 5 ~ 00 · ~ ID
\
"
BCC-lL,
CU"1MO\WEi\LTIl OF l'E\NSYLri\\I!\
TH.A"~FI,'i, I\liFl, ITA:'\CF TAX
SCHEDULE "c"
TH. \\SFlm,c.;
~:~~t
,Yi;:~:;,1.<~, '
/j',~""~!c-..t\
~\~;">~QltJ~~t~
i,ESllW'\T 1lFCF1W\T
(ll Did decedent, within two years of death, /llltke fH1Y transfer of any mater'fal part of his estate, without
receiving a valuable and adequate considerlltio!l therefor? (Answer yes or' no) -119___
(:n Did r1ecedent, within two years of dellth, trnnsfer properLY from himself to himself ilnd another or
(,thers (inclllliing a spouse) in joint ownership? (Answer yes or no) -.l::LCL___
(:1) I f the answer to (1) or (2) above is in the affiI'Hlative state:
(a) Age of decedent at time of trllnsfer FnnA
(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 hL~ lifetime, make any transfer of property without receiving a valuable or adequate
consideration theref?! which was to take effect in possession or enjoyment at or after his death?
(Answer yes or no) 1.0
(a) Was there any possibility that the property transferred might return to transferer or his
estate or be subject to his power of disVosition? (Answer yes or no) 1:0
(b) What was the transferee's age at time of decedent's death? l'Jor:e
(5) Did decedent in his 1 ifetime make any transfer w1thout receiv1ng a valuable and aderl1wte cons1deration
therefor unr1er which transferor exvressly or imp11edly reserves for his lit'e or any per10d which does
not in fact end before h1s death:
(a) The possession or enjoyment of or the right to income from tht' property transferred?
(Answer yes or no) No
(b) The right to designate the versons who slmll possess cr enjoy the property transferred or
income therefrom? (Answer yes or no) Fn
(6) If the answer to (5) (b) above is in the affirmative, state whether the right was reserved in decedent
alone or others ~J o:r::e
(7) Did decedent in his I ifetime make a transfer, the consideration for whi.ch was t..r;ansferee's promise to
pay income to or for the benefit of care of tl'ansferor? (Answer yes or no) 1\0
(8) U1d decedent, at any time, transfer property. the beneficial enjoyment of which was subject to change,
IJecause of It reserved power to aI tel', amend, or revoke, or which cOll1d revert to r1ecedent under terms
of transfer or by operation of law? (,\nswer yes or no) No
(9) If the answer to (1;) above i" in the affirmative, was the power to ai tel', amend, or revoke the inter-
est of the beneficiary reserved in the decedent alone or the decedent and others?
(Answer yes 0 r no) 1: 0
NOTE 1: The answers to these questions should be supported by affidavit hy the attewu.ng 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 fair market valliS at date of death, dates of transfers and to whom transferred, with
relationship of transferees to decedent, if any. Submit cavy of any trust deerl or instrument, if trans-
fers are claimed to be non-taxable, also ~ilimit detailed statement of facts on which sa1d claim is based.
NOTE 3: List ~Iplicable property below in manner in which provided in Schedules A, U, or E.
ITEM
DESCRIPTION
MARKET VALUE
(Es tima ted)
DEPT. VALUAT.'.:ON
(Dept. Only)
1'; 0 ne
~~ one
ND~
i
I
Insert Ulis tot,,] opposite "Transfers", Schedule "C" in the
"As ReT'orted" column on the last page of this return.
FODe
~<SY\.L>
...
RCC-37 (12-63)
CO:\Il\lO~\rEALTII OF PE;\;:'-:SYYL\NIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "D"
BE~ EFI CIARIES
\
h
BENEFICIARIES AND ADDRESSES RELATIONSHIP I SURVIVED
(If step-children or DATE INTEREST OF
State full names and addresses of all who illegitimate children I DECEDENT OF BENEFICIARY
aye an interest, vested, contingent or other are involved, set ' STATE YES IN EST ATE
wise, in estate) forth this fact.) OR NO BI RTH
~:yrtle " 'h r' One-ninth
.Cdr .'J 1 e c e
59113 Lar1..1e st . ( L :i.n:'l es tovm)
:1' arr'i s bur S, ?a. 17112
~:)8tr'Lci8. G:orrt'::;ercer Niece One-ninth.
lS'LI 0 IJ i s b :).I)"Cl ?oad
"
"'~ Co ,... >, <:1 ,., ~ (' Q },1' Y' r" Cenna
;:di th (Torte s ";IJ . One-ninth
l.lece
112 co 2r:.d (~ +-
.;) . uu .
i;"'1....'Cort. lJe "r:.a. 1707)1
81o~'(1 ~'"\.11 tZ8.y;y:J.e ?1ephe'd One-ninth
~'),o:r. '71 0 , '7' i '"'
/ "
L i.n"'].!'" s t01rm. ') :J. h ~ I :::-..- /
- ~ . . l:.-'a.
Davi,G. "1)1 t zarp1e NeDhew Cne-ninth
C:;L_OO ~;'ocl -'-ers Ave .
,T arri saure, Penna. 17112
Pa~.'l :~ul t zapD1e I~ e Dhe1,v ()V)c_n-j n+-,1'1
1(1C5 SeeDery 1\ .
.:...Irlve
~I 8. Y'r i s 'au. 1";:' PODYla 1.710g
--~ubert :Iul t zapple NenhovJ :,;Ine-ninth
Jo.:,: 716 1711 ?
L i "0 "1 est OvTr2 (R.D.L)) T'<:1 /
, ... c......
Irerl8 1,,1 t za~)r,18 A u:~is t'i,no 1T; eee One-ninth
lCee; Pei::'fers \)sne
~-I arl)ls l)l.~ r ~. PCnrlEl.. 1710g
:~ e 1en :~:uJ. t zapp1e =101tie Fiece O.r1e-niDto..
112 :-j c -~~1J7IJ. e r ::all
'Tl".o:c'm1c co /\. T)ts .
~_7.0 "nfl ~ c~ rl' 1.....,,:-.. ;::-:8 1710J, -
Deponent further says that all the above-named benericiaries are living at this time except below:
NAME
DATE OF DEATH
RESIDENCE
5
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Personal Property
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SUM!vIARY
(Sch. "A")
. (Sch. "B")
(Sch. "C")
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. 14J408.12
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(As D/'tl'rmilll.d)
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R C C-3 B
COMMONWEALTH OF PENNSYLVANIA
TRi\NSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE" E"
JOINTLY OWNED PROPERTY
INSTRUCTIONS: This schedule must disclose all llroperty, 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", phiS 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
..)<
x
}T one
Insert this total opposite "Jointly Owned Property", Schedule "E"
in the" As Reported" colunm on the last page of this return.
Estate
Valuation
1.. .~
c,one
Fane
DEPART~{ENT VALUATION
CAUTION-Do not Write
In This Space.
Value of Value of
Entire Decedent's
Property Interest
N 5'1"W
(\lLIT\.LJ
R E V-!; tB (8-7B)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF FIELD OPERATIONS
P.O. BOX 2970
HARRISBURG
17105
IN YOUR REPLY PLEASE
REFER TO
Inheritance Tax Division
NOTICE OF FILING OF APPRAISEMENT
Myrtle Kohr
5943 Larue Street
Harrisburg, PA 17112
(Executor or Administrator)
In Re: Estate of Myrtle E. Cleland
Cumberland
County - File No.
21-78-0572
Dear Ms. Kohr:
You are hereby notified that the Original
,
appraisement in the estate of Myrtle E. Cleland
has been filed in the office of the Register of Wills of Cumberland
County on March 22 , 19....29.., Said appraisement reflects the following
valuations:
Real Estate
Personal Property
Transfers
Jointly Owned
Total
27 ,~OO.OO
15,300.26
None
None
$42.500.26
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 T ax Act of 1961, 72 P. S. 2485-1001, P. L. 373.
,,""" "-''',
Date
March 22. 1979
Signed
G,-
''''- \'..
Title
o
Administrative Officer
/
'-
Note: This is not a bi II.
REV-457 (8-78)
DEPARTMENT OF REVENUE
BUREA'IJ OF FIELD OPERATIONS
P.O. BOX 2970
HARRISBURG, PENNA. 17105
COMMONWEALTH OF PENNSYLVANIA
RESIDENT INHERITANCE TAX
APPRAISEMENT
DAlE
March 22, 1979
Cumberland
21-78-0572
COUNTY
FILE rJo.
Whereas, Myrtle E. Cleland late of Mechanicsbur~
in the County of r:nm'hA....l Rnn Commonwealth of Pennsylvania, having died on
the 27th day of September 19 ~, seized and possessed of an estate
subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania;
Therefore, I, T.An Fl1] gi 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:
In the event that any future interest in this estate is transferred in possession or enjoyment to collateral heirs of the decedent after the expiration
of any estate for life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer inheritance taxes at the lawful collateral
rate on any such future interest.
DESCRIPTION OF ASSET UNIT Appraisement
VALUES Made for Inheritance
Tax Purposes
~ARl - . $ 2?2oo
00
Per,,;onal Pronertv 15,300 26
... ^ None
.T^.;n+_HAlil - tv None
'lV'l'fl4 T. ^ COCOl:'mco it4? c:;oo ?h
Have been duly sworn according to law, I do hereby certify that the above aIlpraisement is made in conformity
with the law on this ;>;>nd day of March 1 ~ a.
"-.Q r"->" - -1--'
c::::) c.-u \., ''.,,,.>-\,' P\pl)raiser
(Number and Street)
Harrisburg
, Penna.
(Post Office)
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