HomeMy WebLinkAbout04-09-78
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RCC-33 (4-73)
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
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Estate No.
(21-78-530)
RESIDENT DECEDENT
COUNTY OF 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 Re~enue. (Section 703 of the Inheritance and Estate Tax Act of 1961.)
(STATE FULL NAME OF DECEDENT)
} AFFIDA VlT OF
rMld/ldJ
ADMINISTRATOR
JOHN P. FULLER
IN THE MATTER OF THE ESTATE OF
JOHN F. FULLER
Late of
Cumberland
Pennsylvania
County
'-
County of
Cumberland
==} ...
Ijl.kli
State of
JOHN P. FULLER
Administrator
of the estate of the above-named decedent being duly sworn, depose
and say
Decedent died August
(MONTH)
Nome and address of attorney or }
other authorized repres_entative to whom
all correspondence should be moiled.
23
(DAY)
, 19~f!:lt~~(elllr//~/t/V/;~//Ojl /E/v/./cj,jlf/e/,ltllt/a}!r/J. }
DONALD B. OWEN. Esq uire
105 Mt. View Drive
Enolu, rA 17025
(717-732-3552)
That as such JOHN P. FULLER deponent is familiar with the affairs of said estate and the property constituting
(I-I'i#fi}/ADMINIST RA 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 fld lowing: - NONE
NAME AND ADDRESS OF BANK OR OTHER INSTITUTION THIS SAFE DEPOSIT BOX RENTED RELATIONSHIP OF JOINT
IN WHICH DECEDENT RENTED A SAFE DEPOSIT BOX IN NAME OR NAMES OF HOLDERS TO DECEDENT
That the contents of said safe deposit box or boxes are itemized under Schedules N/ A 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 detai I 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 Jeft by the decedent at the time of
death, whether in decedent's immediate pos session, 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 0.. persons
giving also separately the accrued interes t thereon, if any, down to the las t in teres t day prior 10 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 de~'ignated 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 in~urance 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" (f" ,i",,, ,,1' death, bonds and accrued interest thereon to the date of decedent's
death and other invC'stn: , J by lhe 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
thl"reof' liS of the date of death. The schedule also sets forth the interest of necedent 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 sc!lPdllle, financial statements showing the assets and liabilities of said co-partnership or l:lusiness.
A copy of the co-partnership agreement, (if oral, a statement setting forth the nature of the agreement)
togellwr '~i th a statement setting forth the character of the business, its location, and such other facts
,H?rt'iin ')', to the business as may be pertinent to a fair and just appraisal of the decedent's interest
therein llJllSt be submitted. It should also set forth in itemized form, together with the fair market value
thpru,f', an:u 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
denth, in contemplation of decedent's death, or intended to t'l.ke 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 0~cts 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 COllY
of the deed, trust agreement or other instrument creating the trust. There is also set forth in said
schedule Ii list of all property, real and personal, with its value, which paf:ses at decedent's death by
virtue of' the exercise by decedent, either individually, or jointly wi th another, or any power of appoint-
ment ve~;ted 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 hereof sets forth the names and addresses of all
persons beneficially interested in this estate at the time of necedent'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 unner decedent's Will. It also
contains a statement showing which of the beneficiaries namen in the necedent's will, if any, died prior
to de~cdent, 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 instnunents effecting the vestiture of
real estate ann the date of acquisition of personalty, plus the name, adnress and 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, inclucling funeral expenses paid;
family exemption, where applicable; costs of aclministration 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 of
death; taxes accrued chargeable for period prior to decedent's c1eath (except those allowed under Section
651 of the Inheritance and Estate Tax Act); together with a statement of collateral pledgea 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 nebt is less than the
estimated ilmount claiming ana allowen, that the same will be reported to the Register of' Wills, and that
the amount of tax assesserl can be reassessed in accordance therewi tho
That the totals of the appropriate columns in Schedules "A", "B", "en,
have been carried forward and properly registered in the
"E", ann "F" as di rec ted therein,
Subscribed and sworn to before me this
..._m.....sf;:.y of a&>'.............
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79
qq...... 19...............
sn~n~ I a~
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.. .~:O...#...l.l... ..p.@.e.E?t....J?J.:::t.Y..E?....................... ..................................
Hollida/~t&~ ,N~rbEJ:~648
...................... ...................
(City or Town and State)
NOTE: Be fore signing affidavit make sure all blank spaces in the affidavit and schedules annexed are
f'i lIed in with details or the word "None", and 1.n case the assets inclucle rare aml unlisted securities,
securities of close or family corporations or an interest in any co-partnership or business, that the
data and statements requiren under the paragraph above relating to Schedule "B" are attached. Also make
cerUdn that column #1 in the "Sununary" has been properly completecl as above-directed.
fit'" (..34 (4.' 3)
COMMOMWeA"L TH OFP:lKIltSVLVANtA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
TRA~SFER 'INHERITANCE TAX
RESIDENT DECEDEHT
SCHEDULE CIA"
REAL PROPERTY
*
Real property in Pennsylvania, with statement of mortgage encombronces 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 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 a 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. Taxes, assessments, accrued Interest on mortgages, etc.,are
to be listed on Schedule "F" and must not b. deducted from this schedule.
(1 )
(2)
(3)
DEPARTMENT
VALUATION
CAUTION
(Do not write
In this space)
ASSESSED VALUE
FOR YEAR OF
DECEDENT'S
DEATH
ESTIMA TED
MARKET VALUE
All that certain tract of land located in
Cumberland County, Silver Springs Township,
PA, as will more fully appear in Deed Book
'!G", Vol.-15, Page 307. Property was unen-
cumbered as of date of death. Fair market
value as of date of death, $3,500 as per
iiiii~~~ appraisal by H. Don Smith, of Jack
Gaughen Realtor, a copy of which is attached
hereto and made a part hereof.
$3,500.0~
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.
$ 3,500.00
~ 500.00
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2 PINETAEE 081"':
'..ECHANICSSU'1G. PA 170S5
7\ ],[;9].469\
AP~ORA
CERTIFICATE
For:
Donal d B. OWl
105 r~ountain
Eno 1 a, Pa. 1, \J"'~
I hereh}' certify that I haye
Sample Bridge Road
Silver Spring Township
Enola, Pa. 17025
personatly examined the property described as
Ground value only $3,500
approx. 1 acre
The 2 shacks on property .~.
have no economic value
.. .....
Estate of JohnF. Fuller
.',
and :t is my 01'ininn tJllt
August
the value of said property as of the 23rd
A. D. 1978 is three thousahd,
five hundred ($3,500) dollars
day of
The prnpnty was apprai,;ed as a whole owned in fee simple and unencumbered
I,y ;~ny inc1el)terJrH':,s.
r fmth>r certify that I ha\'c no prc:jcnt or contemplated future interest in the
pn ,wr'v :1ppr :is(.d or th(~ restllt of this appraisal.
_......_~>..,,':L..._.._._:~:..~..L_...L:..~.: ~/' SEAL
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'./<f
LIMITING
::;ONDITIONS
Tile opinioll (If ,';llue cxprcss::d above is the result of "nd is subject to the data and con-
ditions d...,cri'.('(! j" (kt~il in the accompanying report of one pages.
N (> rC"l'(llh;hiti\y i~ ;I "sl1mcd for matters of a Ie-gal nature concerning the appra.ised prop-
ertv. nDr of que;ti"u, of s~!rn:y.
. t--:'o fr"ct;OIt;l! p:lrt of this appraisal is to be used in conjunction with another appraiial.
Such u'e n.".!er'. it ill,,:t1id.
~cc -?f=:
RRSIDENT DECEDENT
SCHEDULE "B"
PERSON AL PROPEJ1TY
rOMMONWK'\LTH OF PENNSYLVANIA
TrlltNSJ.<~R INHElUT}\NCE TAX
I ~STRUCTIONS: 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
mltst be listed under Schedule "E". Intangible persomtl 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.
Tangibl e personal property should be listed first (e. g. jewelry, weaJ'ing 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.
I tern
No.
ITEM
List and describe fully
UNIT
VALUE
ESTIMATED
MARKEr VALUE
DEPARTMENT VALUATION
(Do not write in
this space)
1
Checking Account # 120-737-2, First Bank & Trust
Company of Mechanicsburg
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1:nsert this total opposite "Personal Property", Schedule "B" in
the "As Reported" column on the last page of this return.
x
x
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~72'
(, ~(j x
lA.-./-.:....--c. >- -ry
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RCC-jS
C~)MMn\!n:ALIII llF l'E:i\'SYLfA.NI A
T!{A\~FFj, I\H!:lHTA\TF TAX
SCHEDULE "c"
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1 ,1::: S I1W\T nl.:n:]))-'\'1'
(1) Di,l ~e:ed_ent, Idthin two years ofde'lth, nlllkp any tl'tlllsfer of allY material parL/.f his ,'statp, without
receIving il valuable ilp.d adeqW-l te considerilt ion tllPref'or? (Answpr ves or no).N A
(2) Did decedent, within two years of death, transfer property f'rom I;imself to himself and another Of'
,-,tllers (including a spouse) in joint ownersllip? (Answer yes or no)--1I/-A-_
(a) If the answer to (1) or (2) above is in the at'firmfJiive state:
(a) Age of decedent llt time of transfer NLA
(b) State of decedent' s h.~al th at time of maki no- the transfer. (Note 1).
(c) Cause of decedent's de'lth. (Note 1). ""
(4) Did decedent, in hL; lifetimE', makE' any transfer of property without receiving Ii valuable or adequate
consideration therefor which was to take effect in possession or enjoyment at or after hi.s dE'ath?
(Answer yes or no) N/ A
(a) Was there any jlossibility that the property transferred migh.t return to Jransferer or his
estate or be subject to IllS power of disposition? (Answer yes or no) N_A
(b) What was the transf'eree's age at time of decedent's neath? N/A
(5) Did decedent in his lifetime make any transfer without receiving a valuable and adequate consideration
therefor w1der which transferor expressly or impl iedly reserves for his life or any period which does
not in f'act end hefore his death:
(a) The possession or en-.ioyment of or the right to income f'rom the property transferred?
(Answer yes or no) N/ A
., ;
(b) The right to designate the persons Wh..o shal) possess er enjoy the property transferred or
income therefrom? (Answer yes or no) NLA
(fJ) If the answer to (5) (b) above is in N'l af'f'irmative, state whether the right was reserved in decedent
alone or others _
(7) Did decedent in his lif'etime make a transfer, the consideration for which was transferee's promise to
pay income to or f'or the benef'it of care of' transferor? (Answer yes or no) N/A
(8) Did decenent, at any time, transfer property, the benef'icial enjoyment of which was subject to change,
because of a reserved power t.o al tel', amend, or revoke, or wpich call] d revert to decedent tmder terms
of' transfer or by operation of law? (Answer yes or no) NLA
(9) If' the answer to (8) above i.3 in the aff'irmative, was the power to al tel', amend, or revoke the inter-
e.,t of' the beref'iciary reserved in the decedent alone or the decedent and others?
(Answer yes or no) N/A
~OTE1: The ilnswers to these questions should be supported by affidavi t by the attending physi cian as
well as a copy or the death cer-tificate.
:-;OTE 2: If answer to any of' the above questions is yes, set forth below a description of' the property
transferred, it's fair market vallie at date of death, dates of transf'ers and to ~hom transferred, with
relationship of' transferees to decedent, if any. Submit copy of any trust cleed or instrument, i.f trans-
f'ers are claimed to be non-taxable, also submit detailed statement of' facts on which said claim is based.
~OTE 3: List ~)plicable property below in manner in which provided in Schedules A, D, or E.
ITEM
UESCRIPTION
MARKET V ALeE
(Es tima ted)
DEPT. V AL{lATlON
(Dept. Only)
NONE
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Insert tills totell opposite "Transfers", Schedule "e" in the
"As Reported" colunm on the last page of this return.
flCC- 37 (.~ 2 -63)
CO'I;\!l)~\\'E,.\LTl! OF rE:';:,\~Y\'L\NL\
TRANSFER INHERITA!\"CE TA.X
RESIDEJ'lfT DtXEDENT
SCHEDULE "I)"
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BE~;EFJCf;\HIES
, BEN,EFJCIARIES AND ADDRESSES -~Ir~~~:~~~~~l~por 1!?~!;~Y~;;9r DAT~-:~I'-----':!~Tr:REST OF
\:::;tate fud ns,mes and addresses of all who I illl'gitimate rhldren I ~El;~},lEN.r I OF BENF:F1CIAHY
have an interest, v,e. ste. d. . cont., ingent or ()t~er-II' are Involved" set I:' L\ ! l~"TYES I BI F 'rR . I IN E:'iT.\TE
wif'e, in es:ate'j i forth Uw; fact.) I OR ,,0 ,{ I
JOHN P. FULLER---l---sON-' I Yes i 3/03/47--1~;H~~-;;----
RD #1, Sunset Drive i ==+: I I Intestate Act -~
Hollidaysburg, FA 1664~ =--=__--+-~~-+---
~r~ ==+ -I 1
(Mother, Mary E. Fuller,_~d May 1, 1967; "ntestate)
(There was one other child orn to the marr e, Theod re
never having married and n ver having children.
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Fuller ~ died in
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1971,
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Deponent further says that all the above-named beneficlarJes are IJving at this time except..below:
~------ .
NAME DATE OF DEATH RESIDENCE
I ~~-~-_.-
,~
Heal Property
Personal Property
Transfers
SU~IMARY
(Seh. "A")
( Seh. "B")
(Seh. "e")
( 1 )
(As Reported)
3J500.00
1,179.72
( 2)
( :\s J)\'tl'nnil\('<!)
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Gross Taxable Estate
$
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4,979.72
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R C C-38
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE" E"
JOlNTL Y OWNED PROPERTY
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 'Ulder 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 "8", 111us date of acquisi tion, 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
Estate
Valuation
)<
NONE
-0-
Insert this total opposite "Jointly Owned Property", Schedule "E"
in the" As Reported" column on the last page of this return.
DEPART~{ENT VALUATION
CAUTION-Do not Write
In This Space.
Value of Value of
Entire Decedent's
property Interest
-0-
N if"V'A-