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HomeMy WebLinkAbout05-10-79 FOll?, No. RCC-62 (6.70) THIS FORM REQUIRED IN ALL ESTATES WITH GROSS ASSETS UNDER '10,000, l1NDER SECnON 101 OF ACT OF SVNE I., IN1, B~IV" JANtJ'ARY I, 10.2. (PILE IN DUPUCATE WITH COPY OF WILL ATTACHEDl ""/ <,,' ~/7.-' ~( 0. -71'-~' "'IW, 1J *' OFFICE OF' THE REGISTER OF WILLS County of . . . .<;IJI!IP~.r:WJ;l!l. . . . . . . . . . . . .... .Paul.E..S:iJJ101ons..... ...................... of Jl... P....?. .~'n(..l,7.f!,~!!!l.I1'!-I).;i!l.~l?':lrg.,.I.'~I).!1!'.Y.~y~nia (NUM) (Addr_) being duly.__.____~W9rIL__________________..ccording '0 law. deposes and says ,ha, he is ,he.i1;lf.Q:rroB.lJ.t.__gD.(l..@..):l..lj!.;j,!:::g:t,:,.~gW (Exec., Adm., Lcpcee, Etc.) of ,he esta'e of....___RJ.l.th__N.,___$.~Q!l.~_____.____________.. ,,'hose last residence was:!-.9_9.J~:.t;_'~'!!~~"!?'~?-(~s~!:.,)~!:!~;!.~:.::!.~ge (No.) treet ....u.P.I!g~..A..:!J,!m__.T.Q.1!ffi!>h;j,IL__.dec<ased. and ,ha, the whole of ,he estate of said decedent. who died .!'.~.I.?-!:~D'R.Y.l--.~~.,--J.9 78 (City, Borol,1,h or Township) ( ate consisted of: REAL PROPERTY REAL PROPERTY IN PENNSYLVANIA, WITH STATEMENT OF MORTGAGE ENCUMBRANCES UPON EACH PARCEL AT DEATH OF DECEDENT. WHERE PROPERTY HELD AS JOINT TENANT OR TENANCY BY ENTIRETIES, GIVE NAMES. ADDRESSES A1m RELATIONSHIP OF OTHER OWNERS. Real Estate Estimated Value NONE Personal Property 1 Savin s - Q. c.., "\" vJ'~ " .\~- '? Mec nicsb S. 1 7l8.6~ 74- 50----- 2. Refund: Blue Cross 3 r- r- 4-. Personalt 1 0 70 5. Savin s Account No. 502-819-6 The First Bank n rust C m n Mechanicsbur Penns Ivania re istered in the names of Paul E Simmons or Earl J. Lehman decedent herein , Balance on date of death 4- Accr ed inte es 22 67~ 1 NOTE: You may expedite the processing of this return by filing with it, and as a part of the return, letters from financial institutions or mortgage holders, certifying to amounts on deposit or owed by the decedent as of the date of death, Such letters must be signed by a responsible officer of the financial institution or mortgage holder and indicate clearly amounts of principal and interest in the decedent's account at the date of death and the type of account, account number and the exact name or names in which the account is registered, . . Jointly Held Property Estill'lfted Val ue NONE Transfers within TWO YEARS Prior to Death NONE That at the time of death there was no safe deposit box registered ih 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:- i RELATIONSHIP OF JOINT HOLDERS TO DECEDENT NAME AND ADDRESS OF BANK OR OTHER INSTITUTION IN WHICH DECEDENT RENTED A SAFE DEPOSIT BOX THIS SA~'E DEPOSIT BOX RENTED IN NAME OR NAMES OF BENEFICIARIES P.ELA TlONSHIP SURVIVED AGE OF LIFE , BENEFICIARIES AND ADDRESSES (if step-children or DECEDENT TENANTS OR INTEREST OF (State full names of all and their addresses who have illegitimate children STATE YES ANNUlT ANTS BENEFICIARY an interest, vested, contingent or otherwise, in estate.) are involved, set OR NO AT DEATH OF IN ESTATE forth this fact.) DECEDENT See Attached Schedule - . I , . , , I I . . I I , I I- I I ---+---~_.- i I I I I '1ESIDENT DECEDENT DEBTS AND DEDt:CTIONS CLAIMED TE: List first five items in the spaces so provided, observe notations thereon, and instructions. DEBT OR CLAIM NATURE OF SAME AMOUNT Funeral expenses paid $ ". ". "., Family exemption (will not be allowed unless decedent died residing with a spouse or children.) Administration Expenses · Counsel fees · ~ ~ Fiduciary commission · OTHER DEBTS AND CLAIMS (.) See Note below '''". '~ ~ ~ Total N ot~: The estate agrees to advise the Register of W ills if the amount actually paid in settlement of any fee, commission 01' debt is greater or l'i!sS than the estimated amount claimed and allowed. Subscribed and sworn to before me this. . . . . . . . . . . , . . . . . . . . . . , . f!5? 0.-.<-;<./1." . ,t. . ~:'l.1:J:J-:Z.'.~. . . . . . . . (RX<<K~*~Km~* .. .. ... .... .. 7.~... . . day of . .. ..'-??:?~. ... ... ., 19.?.1. (~ ~ /r',.:..? ................~....6....~.................. CATHARi:',E E. 13CUSUM, NOTARY PUBLIC MECHMHCSBURG BOROUGH CUrIBEDlAUftJ'nIINTY lilY rJlMMISSION EXPIRFS FER 27. 1982 Having been duly sworn according to law, I do hereby certify that the above appraisement is made in conformity with law on this .... .., ... ... .. . ... ...... ......... day of. ...... . .. ... .,. ...... '. .. .... .. . ..... ... .., ..,19. .... . .. . R... D... . 2 . ..Box. 176. . .. .. . .. . .. . .. . . . . . . . . (Street Number) .... ~~.c:lY;l;I!.~<??l?~~g.,. . ?~.... ~?9?~........... (City or Town and State) ApprRiser In the event that any future interest in this estate is transfened in possession 01' enjoyment to collateral heirs of the decedent after the expiration of any estate for life 01' for years, the Commonwealth hereby expressly reserves the right to appraise and assess transferinheri- tance taxes at the lawful collateral rate on any such future intel'est. REPORT OF THE REGISTER OF WILLS I, the undersigned duly elected Register of Wills in and for. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. County, Pennsylvania, do respectfully report that I have allowed debts and deductions in the amounts claimed by deponent, except as to those items where a greater or lesser amount is set forth in the last column to the right in said schedule above, which greater or lesser amount represents the sum allowed as a deduction. Dated: ............................................. Register of Wills '~ f.. REV"455 (8-78) ''', / / /-/ -- (. ~ / -- - / DEDUCTIDNS ALLDWED IN DF CUMBERLAND COUNTY AND AGENT OF THE COMMOHWEAL TH r ..-1Ci'-L , OFF ICE OF THE REGISTER OF WILLS STATEMENT OF DEBTS AND DEDUCTIONS THE SUM OF DATE OF FILING APPR~ISEMENT ~L /~-''' ')9 DATE OF DEATH February 12. 1978 DATE NO. OF NAME OF PAYEE REMARKS AMOUNT VOUCHER Myers Funeral Home Funeral eXDenses $1 928 00 Messiah Home Account 101 75 HarriSburg Hospital Account 195 15 Pastor Bur<rard Contribution 25 00 Rev. John Bundy Contribution 10 00 Rev. Earl Lehman Contribution 10 00 Reimbursement for funeral Paul E. Simmons exnenses telenhone calls and moving furniture 100 00 I Bell of Pennsvlvania Account 5 62 Re~ister of Wills J:'ilin~ fees fi Inn Snelbaker, McCaleb & Elicker Attorneys fee 250 00 I . TOTAL $2 631 52 ESTATE OF RUTH N SIMMONS LATE OF Upper Allen Township COMMONWEAL TH OP PENNSYL VANIA } SS: COUNTY OF CUMBERLAND I PAUL Eo SIMMONS HEREBY CERTIFY, THAT TO THE BEST OF MY K'NOWLEDGE AND BELIEF. THE FOREGOING IS A JUST AND TRUE STATEMENT OF DEBTS, FUNERAL EXPENSES AND EXPENSES OF ADMINISTRATION SUBMITTED TO THE ESTATE OF Ruth N. Simmons DECEASEO, AS DEDUCTIONS FOR INHERITANCE TAX PURPOSES. y.( SWORN AND SUBSCRIBED BEFORE ME THIS 9 191L. {.3J~ 1/~ (L.S.) DAY OF c~7~ #?_JM__/ CATHARINE E. BOUSUM. NOTARY PUBLIC MECHMICSBURG BOROUGH CUMBERLANO COUNTY \4Y NlMMISSION EXPIRES FEB. 27, 1982 ESIDENT'DECEDENT DEBTS AND DEDUCTIONS CLAIMED TE: List first five items in the spaces so pro'V~ded, observe notations thereon, and instructions. 1 _~.__ / / _...F. ___...... .~ ., ESTATE OF RUTH N. SIMMONS, DECEASED 21-78-617 BENEFICIARIES Page 1 BENEFICIARIES AND ADDRESSES RELATIONSHIP 1. World Missions Charity c/o Brethren in Christ Church Marble and High Streets Mechanicsburg, Pa. 2. Brethren in Christ Church Charity Marble and High Streets Mechanicsburg, Pa. 3. Donna May Nicklis 1 York Circle Mechanicsburg, Pa. Friend 4. Samuel L. Simmons 201 Hempt Road Mechanicsburg, Pa. Brother 5. Blanche I. Lebo 498 Glenn Street Mechanicsburg, Pa. Sister 6. Helen P. Potteiger 10 Sherwood Road Carlisle, Pa. Sister 7. Dessa M. Diller 2318 Arcona Road Mechanicsburg, Pa. Sister 8 . Paul E. Simmons R. D. 2, Box 176 Mechanicsburg, Pa. Brother 9 . Rhoda L. Lehman R. D. 2 Hopewell, Pa. Sister 10. Mary J. Bundy 33 N. Grant Street Manheim, Pa. Sister 11. Martha J. Ginder 21 Grandview Road Hummelstown, Pa. Sister SURVIVED DECEDENT INTEREST OF BENEFICIARY IN ESTATE Cash Bequest: $1,000.00 Cash Bequest: $1,000.00 Yes Cash Bequest: $ 200.00 Yes One-eighth (1/8) of the residue Yes One-eighth (1/8) of the residue Yes One-eighth (1/8) of the residue Yes One-eighth (1/8) of the residue Yes One-eighth (1/8) of the residue Yes One-eighth (1/8) of the residue Yes One-eighth (1/8) of the residue Yes One-eighth (1/8) of the residue ESTATE OF RUTH N. SIMMONS, DECEASED 21-78-617 BENEFICIARIES Page 1 BENEFICIARIES AND ADDRESSES RELATIONSHIP 1. World Missions Charity c/o Brethren in Christ Church Marble and High Streets Mechanicsburg, Pa. 2. Brethren in Christ Church Charity Marble and High Streets Mechanicsburg, Pa. 3. Donna May Nicklis 1 York Circle Mechanicsburg, Pa. Friend 4. Samuel L. Simmons 201 Hempt Road Mechanicsburg, Pa. Brother 5. Blanche I. Lebo 498 Glenn Street Mechanicsburg, Pa. Sister 6. Helen P. Potteiger 10 Sherwood Road Carlisle, Pa. Sister 7. Dessa M. Diller 2318 Arcona Road Mechanicsburg, Pa. Sister 8. Paul E. Simmons R. D. 2, Box 176 Mechanicsburg, Pa. Brother 9. Rhoda L. Lehman R. D. 2 Hopewell, Pa. Sister 10. Mary J. Bundy 33 N. Grant Street Manheim, Pa. Sister 11. Martha J. Ginder 21 Grandview Road Hummelstown, Pa. Sister SURVIVED DECEDENT INTEREST OF BENEFICIARY IN ESTATI Cash Bequest: $1,000.00 Cash Bequest: $1,000.00 Yes Cash Bequest: $ 200.00 Yes One-eighth (1/8) of the residue Yes One-eighth (1/8) of the residue Yes One-eighth (1/8) of the residue Yes One-eighth (1/8) of the residue Yes One-eighth (1/8) of the residue Yes One-eighth (1/8) of the residue Yes One-eighth (1/8) of the residue Yes One-eighth (1/8) of the residue RCC-3'3l APPLICATION FOR CHARITABLE EXEMPTION FROM PENNSYLVANIA TRANSFER INHERITANCE TAX (Act 01 May 28,1956, P.L. 1757, and Act 01 June 15,1961, P. L. 373, as amended) COMMONWEAL TH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS Application is hereby filed for the opproval of an exemption from Pennsylvania Transfer Inheritance Tax on the transfer of the property described below: 1. Bureau File # 21-78-617 2. Date 01 Death February 12. 1978 3. Date 01 Approvol 4. Name 01 Decedent Ruth N. S inunons 5. The Commonwealth's appraised value of the property for which an exemption is claimed is $ 1.000.00 (Note: Where the property is other than a specified amount of cash, the exemption cannot be approved until the value of the property has been established by appraisal by the Commonwealth, except in those cases where the amount of the gift or bequest represents a stated fractional or percentage portion of the entire estate or the entire residue. In those cases enter such fractional or percentage amount above). 6. Check the manner in which the transfer was effected and submit a copy of the document auth,orizing the transfer, unless such material has been previously filed. WILL 0; DEED 0; TRUST INDENTURE 0; SURVIVORSHIP 0; OTHER ~; (If other, explain) Hp-p- ::I+T::I~heil ~opy of Wl"'it"Ten nO~l1men+ of npC"'pnpn+' ~ n;~po~;T;nn n-f Personal property and personal effects 7. Correct Business Name and Address of Charitable Organization receiving property: NAME Mechanicsburg Brethern in Christ Church ADDRESS Marble and High Streets, Mechanicsburg, Pa. 17055 D See listing on reverse side for odditionol charitable organizations covered. 8. I certify that the information contained herein is, to the best of my knowledge and belief, true and correct. Signature of Applicant (:?tudpauff~ Address 01 Applicant R. D. 2, Box 176, MechanjcRbuT'g, Pa. 170SS Ollicial Title Informant and an heir-at-law Date s/9h9 , f This form must be completed in triplicate and all three copies delivered to the Register of Wills for the County in which the decedent resided. or in which letters were issued for a non..resident decedent's estate. If the decedent was a non_resident of Pennsylvania and letters were not issued by a Pennsylvania Register of Wills, deliver all three copies to the Director, Bureau of County Collections, Penna. Department of Revenue, 26 S. 4th Street, Harrisburg, Po. Do not write below this line. For Ollicial Use Only APPROVED: For the Secreta~':1 Revenue REFERRED to Bureau Headquorters Approved 0 ,ltQ ~ - For Secretary of Revenue Denied' 0 (Signature of 'Yi~~~:r: :f ~,~~:I_!;~1( (Initials 01 Register 01 Wills) (Authorized Signature) . REGiSTER OF ".V:U3 .etJ.lJErL.JI;HJ l-l):..1 liT (Cou nty) (County) (Title) (Date 01 Approval) (Date 01 Relerral) (Date of Action) * See reverse side for reasons -- 5^,-to 1? MUST BE FILEO IN TRIPLICATE RCC.3 {4-073l APPLICATION FOR CHARITABLE EXEMPTION FROM PENNSYLVANIA TRANSFER INHERITANCE TAX (Act of Moy 28, 1956, P.L. 1757, ond Act of June 15, 1961, P,L. 373, as amended) *' CotAMONWEAL TH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS Application is hereby filed far the approval of an exemption from Pennsylvania Transfer Inheritance Tax on the transfer of the property described below: 1. Bureau File # 21-78-617 2. Date of Death February 12, 1978 3. Date of Approva I 4. Name of Decedent Ruth N. Sinunons 5, The Commonwealth's appraised value of the property for which an exemption is claimed is $ 1,000.00 (Note: Where the property is other than a specified amount of cash, the exemption cannot be approved until the value of the property has been established by appraisal by the Commonwealth, except in those cases where the amount of the gift or bequest represents a stated fractional or percentage portion of the entire estate or the entire residue. In those cases enter such fractional or percentage amount above). 6. Check the manner in which the transfer was effected and submit a copy of the document auth,orizing the transfer, unless such material has been previously filed, WILL 0; DEED 0; TRUST INDENTURE 0; SURVIVORSHIP 0; OTHER &'; (If other, explain) See attached copy of written document of decedent r s disposition of personal property and personal effects 7. Correct Business Name and Address of Charitable Organization receiving property: NAME World Missions c/o Brethren in Christ Church ADDRESS Marble and High Streets, Mechanicsburg, PA 17055 o See listing on reverse side for additional charitable organizations covered. S. I certify that the information contained herein is, to the best of my knowledge and belief, true and correct. Signature of Applicant e~E:~L~ Address of Applicant R. D. 2, Box 176. Mechanicsburg. PA 17055 Official Title Informant and an heir-at-law Date sl1hr This form must be completed in triplicate and all three copies delivered to the Register of Wills for the County in which the decedent resided, or in which letters were issued for a non_resident decedent's estate. If the decedent was a non.resident of Pennsylvania and letters were not issued by a Pennsylvania Register of Wills, deliver all three copies to the Director, Bureau of County Collections, Penna. Department of Revenue, 26 S. 4th Street, Harrisburg, Po. o t 't b I th' I' F Off" I U 0 I - o no WfI e e ow IS Ine. or ICla se n y APPROVED: For the Secretary of ~venue REFERRED to Bureau Headquarters Approved 0 ~L1MJ-"-- For Secretary of Revenue Denied' 0 (Signature of ~ft~m~fir i'~~lt~~~ (Initials of Register of Wills) (Authorized Signature) , REGISTER OF W!ll, t.iIMBFRI tIr~n r,'i TY (County) (County) (Title) (Date of Approval) (Dote of Referral) (Date of Action) * See reverse side for reasons ~ ---ID--17 MUST BE FILED IN TRIPLICATE ,,<CC-39 (8-77) County, Number and Name 21 - CUMBERIAND SUMMARY File Number Dote of Death 21-78-617 February 12, 1978 Estate Nome S TMMONS (LAST NAME) RUTH (FIRST NAME) N. (INITIAL) COMMONWEALTH OF PENNSYLVANIA TRANSFER INHERITANCE TAX RESIDENT DECEDENT REPORT OF INHERITANCE TAX APPRAISER I, the undersigned duly appointed Inheritance Tax Appraiser in and for the County of Pennsylvania, do respectfully report that I have appraised the real and personal property as reported in the foregoing return at the values set forth opposite each item in the last column to the right in Schedules "A", "B", "C", and "E". Da ted: INHERITANCE TAX APPRAISER REPORT OF THE REGISTER OF WILLS I, the undersigned duly elected Register of Wills in and for County, Pennsylvania, do respect- fully report that I hovE.' allowed deductions in the amounts claimed by deponent, except as to those items where a greater or I esser amount is set forth in the la st col umn to the right in Schedule "F", wh i ch greater or les ser a mount represents th e sum allowed as a deduction. Doted: REGISTER OF WILLS INVE !cODE ADJUSTMENTS ,NTORY V ALUE AS APPRAISED (HARRISBURG USE ONLY) REMAINDER APPRAISEMENT CODE edule A) $ 0 00+ 92+ {Schedule B) F. Ll~ Ll qfl 10+ y (Schedule E) n 20+ e C) 0 30+ :S ASS n's F. LHHI- qfl ductions 40- 93- F) IF ESTATE ! Real Property (Sch Personal Property Joint-Held Propert Transfers (Schedul TOTAL GROS Less Debts and De (SCHEDULE CLEAR VALUE C Valuation of life estates or % PRINCIPLE FACTOR VALUE CODE t= f C- annuities.. ........ ..... ......_ $ 1= ESTATE TAX ASSESSMENTS _ $ FOR USE OF F!EGISTERONLY Tax on $ Tax on $ Tax on $ T ax on $ Tax on $ Exemptions T ota I Estate CODE COMPUTATION OF TAX $ $ $ $ $ ~2% Go/c .. '~~ I TOTAL TAX $ (*) As evidenced by Charitable Exemption Certificates issued by the Secretary of Revenue. Less tax previously paid BALANCE Less 5% of tax if paid within 3 months after death $ $ t= $ BALANCE OF INHERITANCE TAX DUE Add interest at ,-ate of 6% from to_ AMOUNT OF ESTATE TAX ASSESSED Estate tax paid $ $ c $ $ BALANCE DUE Add interest at rate of 6% from to $ $ TOTAL TAX BALANCE $ PAID $ Supplemental Codes: (FOR USE IN HARRISBURG ONL Y) 48-Adjustment 49+t.djustment 56-Annuity 6O-Life Estate 92+Remainder Appraisal 93-Remainder Deduction 93C-Charity 94-Remainder Residue 96-Succ ess i ve Life Estate FOR USE OF REGISTER ONLY ADJUSTMENTS NOTE: Where subsequent adjustments are made to the above computation of tax by the Register of Wills, for proper reason, some should be noted below, with short explanation.