HomeMy WebLinkAbout03-14-79 (2)
Form RCC-lO
::({~ 7J'~ (,/;;...
DEDUCTIONS ALLOWED IN
OP'FICE Oil' THE
REGI8TER Oil' WILLS
STATEMENT OF DEBTS
AND DEDUCTIONS
THE SUM OF ............ $
5 <v- <:J~ C,{
..,._._..,.'L..~".....,...~
. 2-J?2~.
ESTATE OF
Carrie M. Hurlev
l.ATIi OF
Middlesex Townshio
OF
(~nnl"lP.,.l RnrJ
COUNTY
AND AGENT Oil' THI COMMONWIALTH
';l'
n. MOn /J. r'f' I Y OAn OF DEATH October 17, 1978
DATE OF FlUNG APPRAISIMIINT
..-
DATI![ NO. 01" NAMI[ OF PAYEE REMARKS AMOUNT
VOUCMn
10/ 0/78 Belvedere Medical Corp. 3alance due 10 00
10/ ~/78 Brothers Funeral Halle Puneral ses 2547 00
11/ /78 Register of Wills Letters TestlUOOntary 28 00
11/ /78 The Evening Sentinel ~ertising Letters Testamentary 16 65
111 1/78 CuniJerland law Journal Mvertisinlz Letters Testamentarv 18 00
111 7/78 Ebv Granite lAfl 100
eel:
JlUOOS R. Huroor, Esq. t\ttorney fee 1,38l. 8
Farmers Trust Co. ssion 1,381 98
Closing and Filing Costs 250 00
5,828. 61
COMMONWEALTH OF ..ENN8VLVANIA
COUNTY OF
CuniJerland
}..,
'or VP &. TO Fanrers Trust
I.
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AV OP
(L. ..)
I,
NY kNOWL.IDClI AND .ELla,.. THI P'O....ClOING I. A "UaT AND TRU a: .rATIIN
ADMINlaTRATION .U.MITI'lg TO THI leTATI 0" ie M.
INHIRITANCI TAX PUIUlro8...
DORCAS A. Al_RiG~T, NOTARY PUBLIC
CI..RLlSlE BORO, curiaE':' Aim COUNTY
MY COMMISSiON EPF:cS AUG. 16, 1982
Memb2r, Penlis~'lvanja Association of Notaries
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
.d-/~-7t
_~~-11'-O&I:L-
_O-/f~-J'
RCC-33 (4~73)
RESIDENT DECEDENT
COUNTY OF CUMBERLAND
IMPORTANT,
This return must be completed in detail and riled 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't:enue. (Section 703 of the Inheritance and Estate Tax Act of 1961.)
IN THE MATTER OF THE ESTATE OF
} AFFIDAVIT OF
EXECUTOR
ADMINISTRATOR
County
CARRIE M. HURLEY
(STATE FULL NAME OF DECEDENT)
Late of CUMBERLAND
State of PENNSYLVANIA } ..,
County of CUMBERlAND
Administrator
Farmers Trust Canoanv
of the estate of the aboveenomed decedent being duly sworn, depose
Executor
and ..ay
Decedent died
October 17
19 78
(MONTH)
Name and addr... of attorney or }
other authorized r.prea.entative te whom
all corres.pondence should be mailed.
(DAY)
(YEAR)
testate leaving a last will, copy af which Is hereto attached.,}
James R. :IIi.uoor. Esquire
<he West Hie:h St.. Carlisle. Pa. 17013
That as such Executor deponent is familiar with the affairs of said estate and the property constituting
(EXECUTO R-ADMIN1STRA TOR)
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 S...FE DEPOSIT BOX IN NAME OR NAMES OF HOLDERS TO DECEDENT
N(")NR
That the contents of said safe deposit box or boxes are itemized under Schedules
with the exception. of the following, for the reasons hereinafter set forth:
of this return,
That Schedule A attached hereto and made part hereof sets forth fully and in detail all the real property
in the Commonwealth of Pennsylvania of which decedent died having an interest therein. It also sets forth the
mortgage encumbrances upon each parcel of real property at the date of death, giving the amount still due at
death, name of mortgagee, date, rate of interest, and book and page of record thereof. It also sets forth in the
colunms 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 pe~s,ons
giving also separately the accrued interest thereon, if any, down to the last interest day prim to d~cede~t's
death in the case of savings)ba~s, and to the date of decedent's death in all other cases; all bo~s;postal
savings, treasW'y certificates or notes and other evidence of indebtedness of the United States !iJ- the de~
cedent; all obligations, whether by statute ot agreement they are designated as tax free, of the U!iitedStates,
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 interest 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.
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 time 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 Qusiness.
A copy of the co-partnership agreement, (if oral, a statement setting forth the nature of toe agreement)
together with a statement setting forth the character of the business, its location, and such other facts
pertaining to the business as may be pertinent to a fair and just appraisal of the decedent's interest
therein must be submitted. It should also set forth in itemized rorm, together with the fair market value
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
contained therein and in the case or transrers of property, real or personal, within two years of decedent's
death, in contemplation or decedent's death, or intended to take effect in possession or enjoyment at or
after death, said schedule sets forth 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 the schedule a co~y
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 passes at decedent's death by
virtue of the exercise 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 Schedule D attached hereto and made part hereo~ sets forth the names and addresses o~ all
persons beneficially interested 1n this estate at the time of decedent's death, the nature o~ their res-
pective interests, their relationship, if any, to the decedent, together with the ages at the time o~
decedent's death of all minors, annuitants and beneficiaries for lire under decedent's Will. It also
contains a statement showing which or the beneficiaries named in the decedent's will, if any, died prior
to decedent, the dates o:f their death, their issue, and the relationship of such issue to the benef'iciary.
That Schedule 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 instruments ef~ecting the vestiture of
real estate and the date or acquisition or personalty, plus the name, address and relationship, i:f any,
of' co-owners to the decedent.
That Schedule F attached hereto and made a part hereof' sets f'orth fUlly and in detail all debts
and deductions claimed for and on behalf of this decedent's estate, including f'uneral expenses paid;
family exemption, where applicable; costs of administration of this estate; counsel fees and fUdiciary'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 unpaid at time or
death; taxes accrued chargeable :for period prior to decedent's death (except those allowed under Section
651 of the Inheritance and Estate Tax Act); together with a statement of collateral pledged for obliga-
tions, if any. It 1s 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 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 therewith.
Subscribed and sworn to before me this /f....ll/..............
Fanrers
d "F" as directed therein,
That the totals of the appropriate columns in Schedules "A", "B", "en,
have been carried forward and properly registered in the Summary.
lfu.r ley
:::C);;;~ day o~<e('~ .. ...19..Z,?
1/ &/~;EP,;.IT' WTI,RY PU511C':'!;'~~~~~~ ~r""'''''''''''''''''''''-''''''--'
CARI.,SI., GORJ. UI:i3'~U\NO COUNTY Carlisle, 17013
fill CO;'I,t:iJ:;SiGN i:.\?::';LS. AUG. 16, 1982 ..... ..................n..............mm.m..._......~...................m............. ...................................
Memo", Pennsylvania ^;,ocIa(icn of Notaries (City or Town aM StAte)
NOTE: Before signing affidavit make sure all blank spaces in the affidavit and schedules annexed are
filled in with details or the word "None", and in case the assets include rare and unlisted securities,
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. Also make
certain that column #1 in the "Summary" has been properly completed as above-directed.
"Ct-,. 14-73)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
TRANSFER INHERITANCE TAX
RESIDENT DEC!DENT
""._~ ...;.;.......'u__..,...,
SCHEDULE "A"
REAL PROPERTY
*'
Real property in Pennsylvania, with statement of mortgage encumbrances upon each parcel at death of dece-
dent. Property held by the decedent as tenant jn 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.")
Th. r.al prop.rty located In the Commo"wealth of Penhlylvanla .hould b. (1) (2) (3\
d..crlb.d by lot and block number, .tr..t and .tr..t numb.r, tog.th.r with DEPARTMENT
a general de.crlptlon of the prop.rty, with a r.f.r.nc. to the record of the ASSESSED VALUE VALUA TION
conyeyanc. by which the dec.dent took tltl.; If a farm .tat. numb.r of a. FOR YEAR OF ES TlMA TE D CAUTION
cr..; 01.0 .tat.m.nt of mortgage encumbranc.. upon each parc.l at d.ath DECEDENT'S MARKET VALUE (Do not writ.
of deced.nt. Tax.., a.....m.nta, accNed Int.r..t on mortgag.., .tc.,are DEATH In thl. .pace)
to b. lI.ted on Schedule "FH and mu.t not be deducted from thl. sch.dule.
!UlE
I
N ~
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.
RCC -3,5
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
RESIDENl DECEDENT
SCHEDULE "B"
PERSONAL PROPERTY
'*
INSTRUCTIONS: This Schedule must disclose all tangible andintapgible personal property owned individually
by the decedent, at the time of his deat~ 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 certiricates, 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 riduciary in said capacity, partnership interests, interest in any undistributed
estate or or income rrom any property held in trust under the will or agreement or another, even though
located outside or the State, at the time or death, should be listed in this schedule.
Item
No.
ITEM
List and describe fUlly
UNIT
VALUE
ESTIMATED
lIARKE.T VALUE
DEPARTMENT VALUATION
(Do not write in
this space)
5.
6.
7.
8.
Checking Acct. 5 4916 9, Flum3rs Trust Co.
statanent Savings 1 30501 8, :Fa.rIrers Trust Co.
Interest to date of Death on Itan # 2
Certificate of Deposit 15949, Flum3rs Trust Co.
dated 5/16/78 @ 5.50%
Interest to date of death on Itan #4
Refund, Presbyterian Haoos, Ine.
Refund, Blue Shield
Refund, Medicare
,/
1,778.5;;::: ......-
5,134.4~ ..-
85.8V
20,OOO.~__
186.38....-
445.9E3/
2.:~>
5.0lT
1.
2.
3.
4.
Insert this total opposite "Personal Property", Schedule "B" in
the "As Reported" colunm on the last page or this return.
x X
,.-
27,639.51
"2-1",,\ <':'3"(.5 t
Ii
FAR~1ERS TRUST COMPANY
\\/\\
STATEMENT
CARLISLE. PENNSYLVANIA 1701:1
.EU\'W~'1J':;~.
PERIOD ENDING
10/25178
u
57.916-9 01
r
1 CA~Rlc M HURLEY
MAC L ~U~LEY PATTY
116 N MIDDLESEX DR
CAQLISLE PA 17013
-,
JSE REVERSE SIDE FOR
'NCllING YOUR ACCOUNT
L
.J
Of CORRECTED ADDRESS: If this address is incorrect. please give correction to any teller.
CHECKING ACCOUNT -4916-" PREVIOUS BALANCE .. (601',,4('
NlJMBER
, .,., CHECKS, DEBITS 8. CHARGES - ___u___
DEPOSITS.s. CREDITS DATE BALANC E
2QO(1 1 i ; 09/").7 C586142
4fj46 1 1 306140 10/10 c84613fl
1D6~79 1 1 1 10/L3 P7"l:';7
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177 85 7 M 1 1 I 101).4 10G
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..,1,...(& ""ON ..' ' TOT.&. AMOUNT IlIO. 0" ""," NO. 0'- ""," TOT"'\. AholOUMT .~_~~~ l
... ITlMS NEW IALANeE
~AlVfova .TA~~.~; 0" OIlO.T. CHt.CKS _rr' ou', I:HCI"Qal)lll:U 0,. CfllOITS tHAftG'
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RCC - ,S
CLlMMO\W1:ALTII OF PEXNSYLVANIA
TftA\SFFII IXHEI\ITANCF TAX
SCEEDlfLE "e"
TJ-L\:\TSf<EHS
I1ESIDEXT DFCFDEXT
(1) Did. decedent, within two years of'death, nldke any trans:fer of' any material part of his estate, without
receiving Ii valuable and adequate cons!rlpr,lt ion therefor? (Answer yes or no) no
(2) Did decedent, wi thin two years or "eath, iransrer properr.y rrom himself' to himseH and 'nother or
others (including a spouse) in joint ownership? (Answer yes or no) nn
(3) If the answer to (1) or (2) above is in the af'firmative state:
(a) Age of decedent at time of transfer
(b) State of' decedent's health at time of' making the transfer. (Note 1).
(c) Cause 0 f' decedent I 5 death. (Note 1).
(4) Did decedent, in his lif'etime, make any transfer of' property without receiving a valuable or adequate
consideration thereror which was to take errect in possession or enjoyment at or after his dp.ath?
(Answer yes or no) no
(a) Was there any possibility that the property transferred might return to transrerer or his
estate or be subject to his power of disposition? (Answer yes or no)
(b) What was the transfer-eels age at time of decedent's death?
(5) Did decedent in his lifetime make any transf'er without receiving a valuable and adequate consideration
therefor under which transf'eror expressly or impliedly reserves f'or his life or any period which does
not in f'act end berore his death:
(a) The possession or enjoyment of' or the right to income f'rom the property transferred?
(Answer yes or no) no
(h) The right to designate the persons who shall possess cr enjoy the property transrerred or
income therefrom? (Answer yes or no) no
(6) rr the answer to (5) (b) above is 1n the affirmative, state whether the right was reserved in decedent
alone f)r 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 trans:feror? (Answer yes or no) nn
(8) Did decedent, at any time, trans:fer property, the beneficial enjoyment of which was subject to change,
because of a reserveri power to alter, amend, or revoke, or which cmtld revert t.o rlecedent under terms
of transfer or by operation of' law? (Answer yes or no) no
(9) If the answer to (8) above i3 in the arrirmative, was the power to alter, amend, or revoke the inter-
est or the benericiary reserved in the decedent alone or the decedent and others?
(Answer yes or no)
NOTE 1: The answers to these questions should be SUPpof'ted by af'f'idavit by the attemling ph;rsician as
well as a copy or the death certif'icate.
NOTE 2: Ir answer to any of the above questions is yes, set forth below a description of the property
transrerred, it's fail' market value at date of death, dates or transrers and to 'l"hom trftnsferred, 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 or facts on which said claim is based.
NOTE 3: List applicable property below in manner in which provided 1n Schedules A, B, or E.
I TEll
DESCRIPTION
MARKET VALUE
(Es tima ted)
DEPT. VALUATION
(Dept. Only)
N:Iill
I
N~
Insert this total opposite "Transfers", Schedule "e" in
"As Reported" colunm on the last page of this return.
the
RCC-37 . (12-63)
COMMONWEALTH OF PENNSYYLANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "D"
.
BENEFICIARIES
BENEFICIARIES AND ADDRESSES RELATIONSHIP SURVIVED
(If step-children or DATE INTEREST OF
State full names and addresses of all who illegitimate children DECEDENT OF BENEFICIARY
ave an interest, vested. contingent or other are involved, set STATE YES IN ESTATE
wise, in estate) forth this fact.) OR NO BIRTH
Berneita M. BaughmuJ. Daughter Yes Over 21 25%
R.D. 3 Box 83
Newville, Penna. 17241 . .
Al100da G. Dunlao DaUlZhter Yes Over 21 25%
8 Rrultl
Carlisle Penna. 17013
HI1..1"" I Son Ye", 91 2;;q',
R.D.4
Newville, Penna. 17241
Mac L. Hurlev Son Yes Over 21 25%
116 North Middlesex Drive
Carlisle, Penna. 17013
(
h
Deponent fUrther says that all the above-named beneficiaries are living at this time except below:
NAME DATE OF DEATH RESIDENCE
Ralph E. Weigle May 6, 1967 CurriJerland Cotmty, Penna.
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SUMMARY
Real Property """'''''''''''''''''''' ............ ..... .............(Sch. "A")
Personal Property............................ .............. ........(Sch. "8")
Transfers ...................... .(Sch. "C")
Gross Taxable Estate
(1)
(As Reported)
$.........00
$..~7.,!>.5.~,~
$ ................,09.
$ ..........
$.............. ..........
$.....~7.9S1,6.1..
(2)
(As Determined)
$. .
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$
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RCC-3!l
RESIDENT DECEDENT
SCHEDULE" E"
JOINTLY OWNED PROPERTY
*
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
INSTRUCTIONS: This schedule must disclose all property, 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 unner 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 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 Recorrl. of Instrument, where Real Estate.
. .
unit
Value
percentage
Share
Estate
Valuation
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%
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:x
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~~
X
DEPARTMENT VALUATION
CAUTION-Do not Write
In This Space.
Value of' Value of'
Entire Decedent's
Property Interest
l'Kl'lE
Insert this total opposite "Jointly Owned Property", Schedule "E"
in the" As Reported" colwnn on the last page of this return.
NfI-L.
*
R E v-s 18 (8"78)
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF FIELD OPERATIONS
P.O. BOX 2970
HARRI5BU RG
17105
IN YOUR REFLY PLEASE
REFER TO
Inheritance Tax DivisioJ'l
NOTICE OF FILING OF APPRAISEMENT
Farmers Tmlst Company
One West High Street
Carlisle. FA l70B
(Executor or Administrator)
In Re: Estate of
Carrie M. Hurley
Cumherl.."n County - Fi Ie No.
::>1-7R-nhl::>
Deor
You ore hereby notified that the OriiP "..1
appraisement in the estate of Carrie M. Hurley
has been filed in the office of the Register of Wills of Cumberlend
County on April 4 , 19--'Z9, Said appraisement reflects the following
valuations:
Real Estate
Personal Property
T raosfers
Jointly Owned
Total
None
27.639.51
None
None
$27.639.51
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 mte 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 oy Section 1001 of the Inheritance and
Estate Tax Act of 1961, 72 P. S. 2485.1001, P. L. 3ZJ? ,-.,.~", ,.'
, '\ , . 1"- '-_-'
-,) .
Date
April 4, 1979
Si gned
'-J
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~~.
Title
Administrative Officer
Note: This is not a bi II.
REV.457 (8"-18)
DEPARTMENT OF REVENUE
BUREAU OF FIELD OPERATIONS
P.O. BOX 2970
HARRISBURG, PENNA. 17105
COMMONWEALTH OF PENNSYLVANIA
RESIDENT INHERITANCE TAX
APPRAISEMENT
DATE
J\nril 4. lq?q
Cumberland
21-78-0612
COUNTY
FILE NO.
Whereas, Carrie M. Hurley late of Carlisle
in the County of Cumberland Commonwealth of Pennsylvania, having died on
the 17th day of October 19 78 ,seized and possessed of an estate
subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania;
Therefore, I, Leo Ful..initi ,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
Real Pronertv $ None
Personal Pronertv 27.639 51
T ~- IInnA
- _UA'" - linn..
~"''''_!';7;Q ",
.
Have been duly sworn according to law, I do hereby certify that the above appraisement is made in conformity
with the law on this L.tb day of ,\I r- . !p~n 19 ~.
- "
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\..-!
Appraiser
Harrisburp:
(Number and Street)
(Post Office)
. Penna.