HomeMy WebLinkAbout12-04-78
. RCC-33 ;'4-73)
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COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
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RESIDENT DECEDENT
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COUNTY OF
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CUMBERLAND
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 Reuenue. (Section 703 of the Inheritance and Estate Tax Act of 1961.)
Late of
CUMBERLAND
PENNSYLVANIA
} AFFIDAVIT OF
EXECUTMllRIX
~~
IN THE MATTER OF THE EST A TE OF
JAMES B. HEIDER
(STATE FULL NAME OF DECEDENT)
County
State of
} u,
County af
CUMBERLAND
Roberta A. Heider
Executw.xri)
~
of the estate of the abave.named decedent being duly sworn, deposeS
and say S
September
(MONTH)
Name and oddr.. s 01 attorney or }
other authorized representative to whom
all correspondence should be moiled.
16
, 19~J testate leaving a lo.t will, capy of which i. hereto attached. }
(YEAR) ~j(t~
Decedent died
(DAY)
SNELBAKER, McCALEB & ELICKER
44 West Main Street, Mechanicsburg, PA
17055
That as such Executrix deponent is familiar with the affairs of said estate and the property constituting
(EX E CUTO R-ADMI N I ST RA TO R)
the assets thereof and their fair market value.
That at the time of death thert~ 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 follow iog: -
NAME AND ADDRESS OF BANK OR OTHER INSTITUTION THIS SAFE DEPOSIT BOX RENTED REL A TIONSHIP 0 F JOIN T
IN WHICH DECEDENT RENTED A S...FE DEPOSIT BOX IN NAME OR NAMES OF HOLDERS TO DECEDENT
That the contents of said safe deposit box or boxes are itemized under Schedules
wi th the exception.of the following, for the reasons hereinafter set forth:
of this return,
That Scheclu/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
columns provided therefore the assessed valuation of each of said parcels, the estimated market value thereof
as of date of death of decedent.
That Scheclu/e B attached hereto and made part hereof sets forth fully and III 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, trus t companies, or other ins titutions, 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 priM 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 1.0 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 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 l:>,usiness.
A ~6py 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
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 form, 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 of transfers of property, real or personal, within two years of' 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 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 pa~ses 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 instrmnent of another,
with a copy of the instrument creating such power attached to the schedule.
That Schedule 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 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 effecting the ~estiture 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 Scpedule 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 hlneral expenses paid;
family exemption, where applicable; costs of administration of this estate; counsel fees and ~ldiciary'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 of
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 is 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.
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 .............,...............'...
w.....w,................./'~pC ""P day of:.:z;;i~~.::n'=/L;,1....:..... 19.?JL...
iLln,J~Dmm____
(E:recutor-~
u?..?..?.?......~:t:.Y-,~.!.'.t....p.r..t.yg........,..,.....w...,....................................
(Street Number)
Me c.I:.i:l.~.~.~,~.~.~E~.?.....~~........:~.!..q?..?......
(City or Town and 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.
,......c:::;;:;.,t.L,l--c:~ '-<---(~...)'r;;2c;;;.<;;;<<:~L,~V,...........,..,....,
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RC ~-34 (4-7 3}
COMMONWEAL.:rH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
TRANSFER INHERITANCE TAX
RESIDENT DECEDE~I
SCHEDULE CIA"
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
os 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 (I) (2) (3)
described by lot and block number, street and street number, together wi th DEPARTMENT
o general description of the property, with a reference to the record of the ASSESSED VALUE VALUATION
conveyance by which the decedent took title; if a farm state number of a- FOR YEAR OF ESTIMA TED CAUTION
cres; also statement of mortgage encumbrances upon each parcel at death DECEDENT'S MARKET VALUE (Do not writ.
of decedent. Taxes, assessments, accruecllnterest on mortgages, etc.,are DEA TH In this space)
to be listed on Schedule "f" and must not be deducted from this schedule.
NONE NONE N.:cnu
Insert this total opposite "real prope.i/', Schedule "A" in the X X X X X
"As Reported" column on the last page of this return.
N Df\Q...
RCC -35
RESInE.iI DECEDENT
SCHEDULE "B"
PERSONAL PROPERTY
~
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~
COMMONWE.~TH 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 "E". Intangible personal property, titled in the name of the decedent, but
payable at death to another or others, including but not limited to P.O.D. U. S. Savings Bonds and tenta-
tive trust accounts, must be listed, despite the fact that they are not of the administered estate.
Tangible personal property should be listed first (e.g. jewelry, wearing apparel, household
goods, and furnishings, books, paintings, automobiles, boats, etc.)
Intangible personal property, such as bonds, treasury certificates, cash on hand and in bank,
stocks, mortgages, notes, together with accrued interest or dividends, salaries or wages, insurance pay-
able to the estate or fiduciary in said capacity, partnership interests, interest in anyundistributed
estate of or income from any property held in trust under the will or agreement of another, even though
located outside of the State, at the time of death, should be listed in this schedule.
Item
NO.
ITEM
List and describe fully
UNIT
VALUE
ESTIMATED
MARKET VALUE
DEPARTMENT VALUATION
(Do not write in
this space)
1.
V
Evergreen Savings Account No. 16-0010702-1,~
Commonwealth National Bank, balance on date
of death
Accrued interest
$1,871. 95 .....v
22 .13 --~-
/'
3,050.00 V
\)11L~5
~.l~
~,D50.00
2.
Ford Maverick, 1976 model, sale price
4.
Pontiac Coupe, 1977 model, appraised value
/
4,100.00 V'"
/'
3,125.00"""'"
4) 100 . DC>
~I l~:l'. 00
3.
Dodge Station Wagon, 1977 model, appraised
value
Insert this total opposite "Personal Property", Schedule "B" in
the "As Reported" column on the last page of this return.
x X $12,169.08
\ a I \l~'l. Ocg
Rec - 3S
nl\fMO\WE'\J.TlI tW l'E~\SYJ.\-j\:H A
TJ{A\~Fl~:l\ I\nt;:!ZrTA\CF TAX
SCHEDlJLE "c"
Tl{ X\) c.: FEltS
~~.
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~"',7~-;1 ,~~~
i> . .,1''-j:I..I,'' ~Il..
Tjl _ ' ,'., t~' " 'tt
i \ ........-. ,,"F ",
\:0:~:-,~~:~2
l1ES IDE\T nUTDE\T
(1) Did rlecedent, withill two years ofdeatl1, make any transfer of any material par't of his estatp, without
receiving; a valuable anrl adequate consideration therefor? (Answer yes or no) No
U~) Dtd decedent, within two years of death, transfer propercy from nimself to himself and another or
Gthers (including; a spouse) in joint ownership? (Answer yes or no) No
(:3) If the answer to (1) or (2) above is in the affirmative state:
(a) Age of decedent at t tme of transfer
(b) State of decedent's health at time of making the transfer. (Note 1).
(c) Cause of' decedent's death. (~ote 1).
(4) Did decedent, in his lifettme, make any transfer of property wtthollt receivtng: a valuable or ade'luate
consideration therefo,t: which was to take effect .In possession or enjoyment at or after hts death?
(Answer yes or n~ NO
(a) Was there any possibtlity that the property cransferred might return to transferer or 11is
estate or be subject to his power of (lisposttion? (Answer yes or no)
(b) What WIlS the transferee's age at time of decedent's death?
(5) Did decedent in his 1 ifetime make any transfer without receiving a valuable and adequate consideration
therefor under which transferor expressly or impliedly reserves for his life aI' any period which does
not in fact end hef'ore his death:
(11) The possession or enjoyment of or the right to income from th(' property transferred?
(Answer yes or no) No
(b) The right to designate the persons who shall possess or enjoy the property transf'erred 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 lit'etime 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) No
(8) Did decedent, at any time, transfer property, the beneftcial enjoyment of whtch was subject to change,
because of a reserveo power to al tel', amend, or revoke, or whtch conI d revert to decedent under 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 benef'iciary reservefl in the decedent alone or the decedent anfl others?
(t\nswer yes or no)
NOTE 1: The answers to these questions should be supporteo by affidavit by the attewUng physician as
we] 1 as a copy of the death cert.ificate.
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 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 deefl or instrument, if trans-
fers are claimed to be non-taxable, also subrntt detailefl statement of facts on whtch said claim is based.
NOTE 3: List appl icable property below in manner in whi.ch provider! in Schedul es A, il, or E.
ITEM
DESCRIPTION
~L\RImT VALUE
(Es tima ted)
DEPT. VALUATION
(Dept. Only)
NONE
NONE
(\J6'NJ
Insert this total opposite "Transfers", Schedule "e" in the
· As Rcpor ted" co 1 unm on the 1 as t raSe of this return.
N tfYv-,.I
RCC-37 "(1?-63) .
CQ;\ll\W~\rEALTI! OF rE;\;:'\SYYL\~IA
TRANSFER INHERITA!,;CE TAX
RESIDENT DECEDENT
SCHEDULE "D"
BE:'\EFICIARlES
BENEFICIARIES AND ADDRESSES RELA TIONSHIP r ~ ,
(If step-chIldren or SIJ~VIVED DATE INTEREST OF
State full names and addresses of all who illegitimate children i DECE~EN~ OF BENEFICIARY
lYe an interest, vested, contingent or other- are involved, set STAT1'" YE", BI RTH IN ESTATE
wise, in estate) forth this fact.) ! OR NO
Roberta A. Heider Wife Yes Entire residue
5225 Stuart Drive i
Mechanicsburg, PA 17055
-
,
l I
leponent further says that all the above-named beneficiaries are living at this time except below:
I
NAME DATE OF DEATH RESIDENCE
....
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Heal Property
Personal Property
Transfers
SUMMARY
(Sch. "A")
( Sch. "B")
(Sch. he")
(1 )
(As Heported)
(2 )
( As Ikknllinl'd)
$
$.
$
$
$
$
$
$
$
$
$
$
Gross Taxable Estate
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R C C-38
RESIDENT DECEDENT
SCHEDULE" E"
JOINTL Y 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 tmder Schedule
"A", plus the date Ilnd 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, Ilnd Place
of Record of InstrtUnent, where Real Estate.
Unit
Value
percentage
Share
Estate
Valuation
DEPARTMENT VALUATION
CAUTION-Do not Write
In This Space.
Val~e of Value of
Entire Decedent's
Property Interest
().
NONE
NONE
NCftl)
Insert this' total opposite "Jointly Owned Property", Schedule "E"
in the "As Reported" colurrm on the last page of this return.
1LmtJ
. .
*'
REV-SI8 (8-781
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
NOTlRCE OF FILINGHOf ,APPRAISEMENT
oberta A. e1.oer
5225 Stuart Drive
Mechanicsburg. LA 17055
(Executor or Administrator)
In Re: Estate of
James B. Heider
Cumberlcmd
County - File No. 21-78-0529
Dear Mrs. Heider:
You are hereby notified that the original
appraisement in the est'ate of James B. Heiaer
has been filed in the office of the Register of Wi lis of Cumberland
County on Februo.ry 28 , 1922-, Said appraisement reflects the following
valuations:
Real Estate
Personal Property
Transfers
Jointly Owned
Totol
None
12.1b9.08
None
None
$12.169.08
As to such tax that is paid within three months from date of death, a five (5%)
percent discount is allowable. As to any tax that remains unpaid after nine (9) months
(fifteen months when death occurred from December 22,1965 to June 16,1971, inclusive;
and twelve months when death occurred prior to December 22, 1965) from date of death,
interest at the rate of six (6%) percent per annum is charged.
Any party in interest who is aggrieved by this notice may object thereto within
sixty days after receipt of said notice as provided by Section 1001 of the Inheritance and
Estate Tax Act of 1961, 72 P. S. 2485-1001, P. ~R3. " .
r-., Ii _ f '
Dote
February 28. 1979
Signed
Title Administrative Officer
."-
----~.~.~-,....
Note: This is not a bi II.
REV-457 (8-78)'"
DEPARTMENT OF REVENUE
BUREAU OF FIELD OPERATIONS
P.O. BOX 2970
HARRISBURG, PENNA. 17105
COMMONWEALTH OF PENNSYLV~,NiA
RESIDENT INHERITANCE TAX
APPRAISEMENT
DAT,-
February 28, 1979
Cumberland
21-78-0529
COUNTY
FILE NO,
Whereas, James B. Heider late of Borough of Hechanics~__
in the County of Cumberland Commonwealth of Pennsylvania, having died on
the 16th day of September 19 ~, seized and possessed of an estate
subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania;
Therefore, I, Leo Fulginiti ,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
VALUES
Appraisement
Made for I nheritanc
Tax Purposes
TCTAL ASSETS
~ ~$ r1o~
f II12,l69I~a
1 II NO-::t~
I If t,one l_
I. :+ 12. i69r3~
.. =t~---J
Rec:l Property
iersonal ~roperty
Joint-Held Property
Transfers
J _~
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Have been duly sworn.~ggrding to law, I do hereby certify that the above appraisement is made in conformity
with the law on this L day of .. . i"cDrUc.ry 1979"_ .
.~, '.
'- '.-.,'-
Appraiser
(Number and Street)
Ha rri s bu rg
(Post Office)
. Penna.
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