HomeMy WebLinkAbout10-18-79
OFFICE OF' THE
REClISTER OF' WILLS
~ j-7t-6dlO
STATEMENT OF DEBTS
AND DEDUCTIONS
DEDUCTtONS ALLOWED IN
Form ReC.lD
AND AGENT 0" THE COMMONWII:ALTH
'a;t It: 919
(}ft,((, ')0
THE SUM OF ............ $ ,...l.."...., ...."....._......~
PPROVED J1W ,~I..,10'1f
OF
CUMBERLAND
COUNTY
DATE OF FILING APP"AlS.M.NT~.di t 1~1t. DATI: 0'" DEATH OCTOBER 20. 1978
DATE NO. Oil' NAME OF PAYEE REMARD AMOUNT
YOUCMUI
11/14 1978 Register of Wills. Cumb. County Letters of Administration 13 00
11/14 1Q78 Re"ister of Wills Cumbo Count v 5 Short Certificates 5 00
1 10 10,0 'l"ho . -, _" T ?n 1'i
1/5 1979 Cumberland Law Journal Advertisement of Letters 18 00
1/3 979 District Justice Mary Cross File Suit v. Progressive 25 00
~erV1ce l;ompany
1 1< 10,0 {' li'.n,,;rp Ailm;n; .'r".'~~ -" ~ -. .. 2.nnn Inn
1 ? 1 10,Q c, , ~ , . 49 56
12/ 1978 Exxon Decedant's Debt 38 54
12/ 1 Q,R {',,1<' on - ..'. n_L. 1" 7/.
12/ 1978 Robert E. Fackler Funeral Home Decedant's Funeral Exoenses 1 892 00
12/ 1978 Pealer's Flowers Decedant1s Funeral Ex~ense. 11'; 7'i
101 10,Q u___'_ --.'- 'M <0
12/ 1978 Sears Roebuck and Co. Decedant's Debts 300 77
12/ 1978 FHN Association Anesthesiologist for Decedant 110 00
12/ 1978 Miller Auto Supplies Decedant's Debt 159 60
12/ IQ,R R1"p n'...__ " _1 Opo,.... .. , ~ 0.. nn
12/ 1978 Brenners Decedant's Debt ,Q? ,;,
12/ 1978 J.C. Penney's Decedant's Debt 735 44
12/ 1978 Bank Americard Decedant1s Debt 1,502 56
12/ 1978 Borough of Worm1eysburg Decedant's Personal Taxes 236 50
12/ 1978 Arco Decedant's Debt 45 85
101 10,0 o. . . Decedant's Debt 76 00
12/ Q7R {' T. , n.Lo 600 00
TOTAL --- 9,616 70
ESTATE OF
HERBERT G. WERTZ
COMMONWEALTH 01' P'ENNeVLVANIA }
COUNTY OF CUMBERLAND ...
I, C!UT1)1ll'V M l..mV'1'7 At1m~n~ ~f"r$lf"r~x
NY KNOWLEDClIl AND .ELI.", THI "OlllaOING 18 A ..un AND TIlU I
ADMINI8TIIATION aU.MITT.D TO TH. ISTAT. 0"
IN....IUTANe. TAX PUAPOan.
Iot.,...v cIRTIP'Y. THAT. TO THI .AT 0'
erATDlIlHT 0.. DI:.Te, "UNIlIIAL. up.Ne.a AHD UP.H8. 0"
eWORN AND au ac
.1:"011:11 ,.. THI.
,
(L. a.)
SARAH . APPlEBY, Notary PuIlIic
My ComlRission Expires 0.. 13~ 19U
C.... Hill, PA Cumberlond '-
RCC-U (4-73)
JI/-7 Y-6~o
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
"'" 10/1 P/71
RESIDENT DECEDENT
COUNTY OF CUMBERLAND
IMPORT ANT,
This return must be completed in detail and filed in duplicate, with aU attached, with the Re.ister of Wills of the
COWlty where decedent" resided; Return is due within nine months after date of death, unle.. an extension is lI'anted
by the Secretary of Re'lenue. <Section 703 of the Inheritance and Estate Tax Act of 1961.)
lat. of
CUMBERLAND
} AFFIDAVIT OF
EXECUTOR
County ADMINISTRATOR
IN THE MATTER OF THE ESTATE OF
HERBERT G. WERTZ
(STATE "FUL.L. NAME 0... DECEDENTl
Administrator
CUMBERLAND
SHIRLEY M. WERTZ
") n:
Stat. of
l'ENN!;YT.VANTA
County of
!~
of the .stat. of the abav.-nam.d deced.nt being duly swam, d.po.. S
and soy S
(MONTH)
Nom. and addr... 0' atto,n.y or }
oth.r authorl..d r.pt...ntatjvlI to whom
011 corr.sftOnd.nce should b. moll.d.
(DAY)
, 19.?~J t.stat. IlICIvll'lg 0 last will, copy of which I. h.r.to attaChed,,)
~Inte.tat.
Decedent died
OCTOBER 20
GREGORY C. HARTMAN, Esquire
1517 Cedar Cliff Drive, Camp Hill, PA 17011
That as such Atl......;n.; C1f".....Of"......;V deponent is familiar with the affairs of said estate and the property constituting
(EXECUTO R-ADMINISTRATORl
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 flOX RENTEO REL.ATIONSHIP OF JOINT
IN WHICH DECEDENT RENTED A S.4FE DEPOSIT BOX IN NAMEORNAMESOF HOL.DERS TO DECEDENT
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 ScheJu/e 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 ScheJu/e 8 attached hereto aod 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
hanks, trust companies, or other institutions, whether individually, 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 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 f~r~ig~ coun~rY',)'I~ic~ a~e.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 sec:u'rities' of 'close or family corporations, the values reported are as far as
P.os~~~J,~,,.....s'\.l~,$~.~.ntl~:tetiJ),y fln4nc1,~.1 ,statement,s of~ the corporations, showing the assets and liabilities
thereo~,as of, the date of death. The schedule also sets forth the interest or decedent at the time of
deathin'any,co*partnership or business, and in'su~port or the value of such interest there is annexed to
said ~~_~e~Ule,financi~l st~t~m~nt~ showirtg the assets and liabilities, of said co-partnership or Q,usiness.
- A copy-or thtll cO~'Partner!l-hlp---agreement, (U' oral, 'a statement setting forth the nature or tne agreement)
together with a statement setting rorth the character of the business, its location, and such other racts
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 or 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 or decedent's
death, in contemplation of 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 transrerred, the
relationship of the transferees to, the deceaent, the proportionate share received by each transferee and
all other facts of a pertinent nature regarding said t'ransfers. In the case of t~ansfers intended to
take efrect in possessi,on or enjoyment at or after death, there is also attached to the schedule a CORY
of the deed, trust agreement or other instrument creating the trust. TheNf'is also set forth in said
Schedule a list of all property, real and personal, with its value, which pa~ses at decedent's death by
virtue of the exercise by decedent, e~ther i,ndividually, 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 0 attached hereto and made part hereof sets rorth the names and addresses or all
persons beneficially interested in this estate at the time of decedent's death, the nature or their res-
pective interests, their relationship, if any, to the decedent, together with the ages' at the time of
decedent's death o~all minors, Annuitants and beneficiaries for life under decedent's Will. It also
contains a statement showing 'Which of the benerlciarles 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 Schedule E attached hereto an~ made a part hereor sets forth ~ll 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 or record or instruments errecting the vestiture of
real estate and the date or acquisition' of personalty, plus the name, address arid relationship, if any,
of co-owners to the decedent.
That Schedule 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;
ramily'exemption, where applicable; ~osts of administration of this estate; criunsel fees and fUdiciary's
commissions paid or to be paid; cost expended'for burial trusts, tombstones or 'gravemarkers, and reli-
gious services, in consequence or the death of th~. deced~t;, debts and,claims,owing"and lmpaid at time or
death;' taxes accrued chargeable for period prior to decedent's death (except those allowed under Section
651 of t"he Inheritance an'd Es'ta'te ;Tax' Act),; togethe~ 'wi'th ast'a~ement o~ collateral pledged ror obliga-
tions, if any. ,It is agreed 'that the, fiduciary will pr,esent pr'oof of saId claimed obligations upon re-
quest, that ir the amount a~tu8.l.1y ,p'aid in settlement 01' any ree, 'corninission or debt is less than the
estimatect'amount clalniingand allowed, that the same will be reported t6 the Reg.tster of Wills, and that
the amount of tax assessed can be reassessed in accordance therewith.
That the 'totals of the appropriate columns in Schedules' "A", ItB", tlCtl', ItEtI~and tlF" as directed therein,
have'been carriedrorward and properly registered in the Summary.
. . . . ef' . h' J J "f~
Subscn'bedand sworn to b ore me t 18 ......U.R............,......
............................. . .......day of(J~..19.....?~....
[' . , .
.......~~d 'f~m,~~..
M~, f,;,...~:,:f~;, 'ty_o..','. I)~c. 13. 1982
(a:t!~;::::", Ll ". ::!,,,d (ctmty
't"~7J.~{!J~f!;!L~..
6~.1.~".~1(~!/!f..;!;;;.be;i .....~...................._.
.........CamlLHil.l.,....PA.......nOll............. ..........................
. (City Of' Town and Sto.te)
NOTE::,~efo~esigning,~rrl~avit ~ake sur~ .all blan~ spaces in the affidavit and schedules annexed are
filled' in w~th, det~ils or the,.wor~ ItNone", and in case ,the assets include rare and unlisted securities,
, . ,',. . ,,' "
secur~ti~s of c~ose or ~a~i~y corporations or ~n interest in any co-partnershi~ or business, that the
data'and statements r~qUlrerl'~~~rthe paragraph a~ove, relati~g to Schedule ItBtI are attached. Also make
certain that colwnn '#1 in the ~'ItSUmtarylt has bee;" ,prope'rly completed as above-directed.
RCC_34 (4_73)
COMMONWEAL TM OF PEllNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
TRANSFER INHERITANCE TAX
'RESIDENT DECEDENT
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 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 surviarship or tenancy by entireties should be reported on Schedule "E.")
The real property located In the Commonwealth of Penn.ylvanla .hould be (1) (2) /31
de.c:rlbed by lot and block number, .treet and .tr.et number, together with DEPARTMENT
a general d..crlptlon of the prop.rty, with 0 ...f.r.nce to the record of the ASSESSED VALUE VALUA TION
c:onveyanc:. by whlc:h the decedent took title; If a farm .tate number of 0- FOR YEAR OF ESTIMATED CAUTION
c:r..; al.o .tatement of mortgage encumbrance. upon each parcel at death
of dec:.dent. Taxe., a.....ments, accrued Int.r..t on mortgage., etc.,ar. DECEDENT'S MARKET VALUE (Do not writ.
to be lI.t.d on Sch.dulellFu and mu.t not be deduc:ted from thl. schedule. DEA TN In this spac.)
NONE NONE NONE
TOTAL - 0.00
Insert this total apposite "real property", Schedule "A" in the X X X X X
.. As Reported" column on the lost page of this return.
/U;-Yt':J
RCC -35
RESIDENT DECEDENT
SCHEDULE "Bn
PERSONAL PROPERTY
'*
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
INSTRUCTIONS: 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 wEw. 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 estat~
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, mortg4ges, 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 any undistributed
estate or or income Crom 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.
ITEII
List and describe fUlly
UNIT ESTIIlATED DEPARTIIENT VALUATION
VALUE MARKFr VALUE (00 not write 1n
this spses)
- $1,200.00....-
- $ 600.00 ...-
- $ 100.00 -
1.
1973 Dodge Sportsman's Royal Van
1971 Mercury Capri automobile
1948 Ford Pick-up Truck
AT&T Stock 11556-2131 31 shares (Q\.~ ~
IT&T Stock 11DF-662415 22 shares J. B. 'OB
$1,898.75-
2.
3.
4.
5.
$ 635.25-
TOTAL -
$ 4 ,434.00
Insert this total opposite -Personal Property., Schelhlle -B- in
the WAs Reported- column on the last page of this return.
x X
)/, 13'1 O{J
J
RCC-36
COMMO~WEA.LTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
SCHEDULE "c"
TRA.NSFERS
*~
RESIDENT 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
(2) Did decedent, within two years or death, transrer property rrom himselr to himselr and another or
others (including a spouse) in joint ownership? (Answer yes or no) NQ
(3) If' the answer to (1) or (2) above 15 in the affirmative state:
(n) Age of decedent at time of transfer
(b) State or decedent' 5 heal th at time of' making the transf'er. (Note 1).
(e) Cause of decedent' 5 death. (Note 1).
(4) Did decedent, in his lifetime, make any transfer of property without receiving a valuable or adequate
consideration therefor which was to take effect in possession or enjoyment at or arter his death?
(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,transreree's age at time or decedent's death?
(5) Did decedent in his liretime make any transfer without receiving a valuable and adequate consideration
thereror under which transferor expressly or impliedly reserves for his life or any period which does
not in fact end bef'ore his death:
(a) The possession or enjoyment of or the right to income from the property transferred?
(Answer yes or no) NO
(b) The right to designate the persons who shall possess or enjoy the property transferred or
income therefrom? (Answer yes or no) NO
(6) If the answer to (5) (b) above is in the affirmative, state whether the right was reserved in decedent
alone or 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' transferor? (Answer yes or no) MO
(8) Did decedent, at any time, transfer property, the beneficial enjoyment of which was subject to change,
because of a reserved power to alter, amend, or revoke, or which could revert to decedent rmder terms
of transfer or by operation of law? (Answer yes or no) NO
(9) If the answer to (8) above is in the affirmative, was the power to alter, amend, or revoke the inter-
est of the beneficiary reserved in the decedent alone or the decedent and others?
(Answer yes or no) NO
NOTE 1: The answers to these questions should be supported by affidavit by the attending physician as
well as a copy of the death certificate.
NOTE 2: If answer to any of the above questions is yes, set forth below a description of the property
transferred, it's f'air market value at date of death, dates of transfers and to whom transferred, 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 of facts 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
IlAHKET VALUE
(Estimated)
DEPT. V ALU AT ION
(Dept. Only)
NONE
NONE
TOTAL -
$0.00
Insert this total opposite "Transrers., Schedule .C. in the
"As Reported" column on the last page or this return.
}lO:VL V
m~",~'/~"'-,,-"- .
;';:;;i'RCC-31 (12-63)
('O~i~IONWEALTll OF PEN:-lSYYLANIA
TRANSFER, INHt:RITANCE TAX
RESIDENT DECEDENT
0;..' ..e,-
SCHEDULE "0"
..,
'>ill. 1\
. ------..---
BENEFICIARIES
"~ ;;~ ::
(
h
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
aye an interest, vested. contingent or other are involved, set STATE YES IN ESTATE
wise in estate) lorth this fact.) OR NO BIRTH
SHIRLEY M. WERTZ Wife Yes T "'"''' ,
611 Rupley Road ,
Camp Hill, ,PA 17011 . ,
HERBERT G. WERTZ ,JR. <:rw, v~~ T~l
'l<;()1
r,;,mn Hi" PZI 1 7()11
GEX:RGEITE M. u::N3 Daunhter v~~ T~l
945 C Bosler Avenue
Laroyne, PA 17043
DENISE M. BAKER u_ T -,
, -,
Vi Mi
.. Dauahter Y"'~ T "'"''' ,
611 Rupley Road ~
Camp Hill, PA 17011
.
.
.
Deponpnt further says that all the above-named beneficiaries are living at this time except below:
..
I .
NAME DATE OF DEATH RESIDENCE
~ ~ NC1NR
.
RCC.38
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 lUlder 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 "a", plus date of acquisition, and the name, address and relationship (if any) of co-owners to
the decedent.
~(W~
Description of Property, Date of Acquisition, Name
Address and Relationship of Co-Owners, and Place
of Record of Instrument, where Real Estate.
~<Y. <Y.~ ~
6< 'S< M 06'S<
Unit
Value
percentage
Share
Estate
Valuation
(X
(X 0<
DEPARTMENT VALUATION
CAUTION-Do not Write
I n This Suace.
Value of Value of
Entire Decedent's
property Interest
x.;v NV
1. 611 Rupley Road, Borough of Wormleysbur ,
Cumberland County, pennsylvania
As conveyed to decedant and his wife,
SHIRLEY M. WERTZ, as tenants by the
entireties, by Deed dated April 1,
1965 and recorded in the Cumberland
County Recorder's Office in Deed Book N
Volume 21, Page 927.
2. 0.999 Acres, Borough of Wormleysburg,
Cumberland County, pennsylvania
As conveyed to decedant and his wife,
SHIRLEY M. WERTZ, as tenants by the
entireties, by Deed dated February 11,
1976 and recorded in the Cumberland
County Recorder's Office in Deed Book N
Volume 26, Page 310.
3. Checking Account at Dauphin Deposit
Bank and Trust Company, #89-805313,
held jointly with his wife SHIRLEY M.
WERTZ
TOTAL -
0.00
Insert this total opposite "Jointly Owned Property", Schedule "E"
in the "As Reported" column on the last page of this return.
'ltnU/