HomeMy WebLinkAbout01-09-79
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
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RCC-33 (4-73)
RESIDENT DECEDENT
COUNTY OF Cumberland
IMPORTANT,
This return must be completed in detaiJ 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 Re1:enue. (Section 703 of the Inheritance Bnd Estate Tax Act of 1961.)
IN THE MATTER OF THE ESTATE OF
Late of
Cumberland
Pennsylvania
Cumberland
} AFFIDAVIT OF
EXECUTOR
~
County
Daniel Gerald Wise
(STATE FULL NAME OF DECEDENT)
State of
County of
} 55,
~;VMU'ac.x
National Central Bank
of the estate of the above-nomed decedent being duly sworn, depose
Executor
Decedent died October 29
(MONTH)
Name and address of attorney or }
other authorized repres.ntative to whom
all correspondence should be moiled.
and soy
(DAY)
19~{testate leaving a lost will, eopy of whieh is hereto attoehedo,}
{Y EAR) JiIUfaCaC
Kevin D. Dolan. ESQ. - Ball & Skelly
P. O. Box 1108, Harrisburg, PA 17108
That as such Executor deponent is familiar with the affairs of said estate and the property constituting
(EXECUTa R-ADMINISTRA 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 r 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
CCNE D. G. W~se
29 H11nr..PT T.~np
Camp Hill. PA 17011
That the contents of said safe deposit box or boxes are itemized under Schedules B
wi th 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
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 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 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 in4ebtedness 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 politica~1 subdivisi~n 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 or securities or close or f'wmily corporations, the values reported are as rar as
possible substantiated by rinancial statements or the corporations, showing the assets and liabilities
thereor as or the date or death. The schedule also sets rorth the interest or decedent at the time or
death in any co-partnerShip or business, and in support or the value of such interest there is annexed to
said schedule, :financial statements showing the assets and liabilities o:f said co-partnership or lmsiness.
A copy or the co-partnership agreement, (i:f 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 ~usiness 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 Corm, 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 ot'property, real or personal,. within two years of' decedent's
death, in contemplation ot' decedent's death, or intended to take effect in possession or enjoyment at or
after death, said schedule sets f'orth the nature and value ot' such property, to whom trans:ferred, the
relationship of' the transferees to the decedent, the proportionate share received by each transt'eree and
all other facts of a pertinent nature regarding said transf"ers. 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 CORY
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 instrwnent of' another,
with a copy of the instrument creating such power attached to the schedule.
That S~hedule 0 attached hereto and made part hereof sets forth the names and addresses or all
persons beneficially interested in this estate at the time or 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 beneCiciaries for lire under decedent's Will. It also
contains a statement showing which of the beneficiaries named in the decedent's will, ir any, died prior
to decedent, the dates or their death, their issue, and the relationship of" such issue to the beneficiary.
That Sc~edule E attached hereto and made a part hereor 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 or record of instruments effecting the vestiture of'
real estate and the date of acquisition ot' personalty, plus the name, address and relationship, if any,
of co-owners to the deceden t.
That S~~edule 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;
family exemption, where applicable; costs of administration of this estate; counsel fees and fUdiciary's
commissions paid or to be paid; cost expended f"or burial trusts, tombstones or gravemarkers, and reli-
gious services, in consequence of' the death of the decedent; debts and claims owing anil lmpaid at time of"
death; taxes accrued chargeable f"or 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, ir 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 or tax assessed can be reassessed in accordance therewith.
That the totals of the appropriate columns in Schedules "A", "B", "e", "E", and "F" as directed therein,
have been carried forward and properly registered in the Summary.
JLIDITH A. NOROSTROM. NOTAIlY PU8bl€
HARRISBURG. OAUPHIN COUNf\'
MY COMMISSION EXPIRES SEH 2' 1981
Member. Pennsvlvania A,ssociation 01 No~
NOTE: Before signingafridavit make sure all blank spaces in the affidavit and schedules annexed are
f"illed 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.
National Central Bank, Executor
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BX.".\~...:.~:.17.~-c.?.<:.lk."';;.L~:::::::_._.....___
. (E.,ecutor-Adm.niBtTator) V~ce Pres. &
222.Market St. Trust Officer
......,..................................~...........................-.................-......................................-..
(StTeet Number)
Harrisburg, PA 17108
..... ................."......._................................~............
(City or Town /1M Sto.te)
Subscribed and sworn to before me this .................................
....._.....~.....__........rz~ day of ~~~{j"''''' 19z..,9'.
'.
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LAST WILL AND TESTAMENT
I, Daniel Gerald Wise, make this as and for II1Y last will and
testament.
After payment of all just debts, including expenses of II1Y funeral,
I give and bequeath II1Y entire estate, absolutely, unto II1Y nephew, Arthur
Joseph Wise, residing at the present time at 11 Dawn Way, Watchung, New
Jersey.
I also appoint the National Bank and Trust Company of Central
Pennsylvania, Harrisburg, Pennsylvania, executor of II1Y estate.
A~;(/~~j/ ~
(SEAL)
Signed, sealed, published and declared by Daniel Gerald Wise, as
and for his last Will
and Testament, in our presence and in the presence
request, this ,rcln'/7' c/ day of May, A. D. 1968.
of each other, at his
Mr. Leo J. Hart
2846 Banks Street
Penbrook, Pa. 17103
(-f~./- <=l
'~.~X-:~EAL)
Mrs. Dora K. Prayer
1338 S. 19th Street
Harrisburg, Pa. 17104
RC C-'34 (4-73)
COMMONWEALTH OF PENNSYLVANIA
OEPARTMENT 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 ather, should be identifi ed
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 tenoncy by entireties should be reported on Schedule "E.")
The real property located In the Commonwealth of Pennsylvania .hould be (1) (2) I])
described by lot and block number, street and .treet number. togeth.r with DEPARTMENT
a general description of the property. with a reference to the record of the ASSESSED VALUE VALUA TlDN
conveyance by which the decedent took title; If a farm .tate number of a. FOR YEAR OF ESTIMA TED CAUTIDN
ere.; also statem.nt of mortgage encumbrance. upon each parcel at death DECEDENT'S MARKET VALUE (Do not wrl"
of d.cedent. Taxes, a.....m.nts. accrued Int.re.t on mortgage.. etc., are DEA TH In this space)
to be lI.ted on Schedule "Fit and mu.t not b. d.ducted from thl. schedule.
None
Insert this total opposite "real property", Schedule "A" in the X X X X X
"As Reported" column on the lost page of this return.
0.00
N lJ'----L-
RCC -35
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "B"
PERSONAL PROPERTY
*'
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 wEa. 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 accormts, must be lIsted, despite the :fact that they are not of' the administered estate.
Tangible personal property should be listed f'irst (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 :fiduciary in said capacity, partnership interests, interest in anyundistributed
estate or or income :from 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.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
Contents of apartment, see attached
appraisal
1975 Chevrolet Coupe automobile
$10,000 Province of Ontario, Canada Bond,
8.20% due 6/15/82
Accrued interest on item 3, 6/15/78 _
10/29/78
$15,000 Harris Savings Assn., savings
certificate, 7~% due 3/27/79
Accrued interest on item 4, 7/1/78 _
10/29/78
Harris Savings Assn., Optional Savings
Account #1-51753
Accrued interest on item 5, 7/1/78 _
10/29/78
316 shs. Allied Chemical, Inc., common
2,000 shs. Duquesne Light Co., common 16.46875
200 shs. General Telephone & Electronic
Corp., common 28.59375
200 shs. B. F. Goodrich Co., common 18.53125
480 shs. Manufacturers Hanover Corp. 4.375
1,000 shs. Penna. Power & Light Co.,
common
400 shs. Union Pacific Corp., common
Balance of checking account #965-290-0
at CCNB Bank, N.A.
Dividend on 480 shs.. Manufacturers
Hanover Corp. at .52 per share,
payable 10/25/78
Colonial Penn Insurance Co., refund on
cancellation of automobile policy
Smith Insurance Agency, refund on
cancellation of homeowner's policy
ITEM
List and describe fUlly
1.
2.
3.
4.
5.
Insert this total opposite "Personal Property., Schedule "B- in
the "As Reported" column on the last page o:f this return.
UNIT ESTIMATED
VALlIE IIAIIKEr VALlIE
DEPARTMENT VALUATION
(Do not write in
this space)
.-/
"
~ 490.0
1,600.00
~,6l2.5
1303.2
~5,000.0
~76. 48
~66.4
~.38
10,052.7
32,937.5
......-"
2 .062 '20,062.50
53.59375 21,437.5
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9-,547.2
"-....
~
249.60
135.90
~8.00'
x X
148, 111. 14 \ L\. <e. \ t l \, '-l
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., Phbnli ;!;M.&838
(!Lol. ~arry m. lIiuttr
Auctioneer & Appraiser of Real Estate and Personal Property
Harrisburg's Only Full Time Auctioneer
1919 Brookwood Street
Harrisburg, Pa, 17104
November 16, 1978
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To whom it may concernl
I, the undersigned, appraised the fOllowing items in the estate
of Daniel G. wise, 10 Richland Lane, Camp Hill, PA to the best
of my ability and have no interest in same whatsoever.
National Central Bank - Executor
LIVINGRO<:I4
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rugs
T.V.
mirror
nest of tables
desk
sora
pro end tables
gold lamp
pr. white lamps
2 floor lamps
drop leaf table
oval table
pr. chai rs
footstool
table with 4 chairs
magazine rack
pictures
KITO-lEN
contents of cupboards
BEDRO<:I4
bedroom suite
lamps
CLOSET
sweeper
TOfAL
c-.2. (~1 0
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Col. Harry M. Wimer
Auctioneer and Appraiser
$ 5.00
100.00
1.00
10.00
75.00
10.00
15.00
3.00
10.00
3.00
. 2'",00
10.00
5.00
10.00
75.00
5.00
10.00
10.00
100.00
3.00
5.00
$490.00
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Area Code 717/236.4041
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T:ac k~=~j /;9:.\.1;, Ii ,;' \ ' ,,,:.;) Savings Association
205 PINE STF'fEET . HARnlSFJUAG, PENNSYLVANIA 17105
OFFICES
DOWNTOWN' COLONIAL WRK . CAMP HILL' LEBANON' UNION DEPOSIT
CAPITAL CITY' NEW CUMBERLAND
Novemb~r 16, 1978
National Cerotral Ban}.
Attn. Haymond T. Cam~ron
P. O. Box 1071
Unrrirbllr;s, PA 17108
SUBJECT: DANIEL G. ~rIS~ ESTATE
The HarriJ Savings A~;Gociation has savings accounts under
th~ ll"'1C of D. G. '.1i,,~ of lOB Rich1and Lane, Apt. T6.
Camp Hill, F^ and hi" social security number is
208-21'-0589.
Th~ account numbers "nd date of c]c'ath figures are as
[0110;.ls:
Opt. 1-51753
3366.'+:; U"Jance
6 ~~ ~~rnings due
J372:S3 ~L death October 29, 1978
Certi[ic~IO 1-09-115590
315,000.00 Balance
376.4~ egrnings due
~15,376,48 at de~th October 29,1978
Very truly YOlll";,
tl., m. #~
Mrs. A. M. Hei6~Y
Savifigs Couns01or
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MAIN OFFICE 331 BRIOGESTREET NEWCUMBERLANO, PENNSYLVANIA 17070 17171774-7000
CCNe BANK. NA.
Date
November 20. 1978
TO: National Central Bank
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222 Market Street
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Harrisburg. PA 17108
RE: Estate of Daniel G. Wise
Name of Decedent
The following is a complete record of the above decedent's accounts
as of
October 29, 1978
Date of Death
'Account No.
Type of Account
Balance en
Principal
Date of Death
Accrued Int.
Na~es on Account
(All Owners)
Date of Creatic
of Joint
Ownershin
965:"290-0
Checking
$9.547.29
None
Daniel G. Wise
00379-09 Safe Deposit,Bo
(East Pennsbol-o)
Daniel G. Wise
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COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
SCHEDULE "C"
TRANSFERS
~.
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RESIDENT DECEDENT
(1) Did decedent, within two years o:fdeath, make any transf'er of' any material part of' his estate, without
receiving a valuable and adequate consideration theref'or? (Answer yes or no) no
(2) Did decedent, within two years of' death, transf'er property from himself to himself and another or
others (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 time of' transfer
(b) State of decedent's health 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 transf'er of' property without receiving a valuable or adequate
consideration therefor which was to take effect in possession or enjoyment at or after his death?
(Answer yes or no) no
(a) Was there any possibility that the property transferred might return to transferer or his
estate or be subject to his power of' disposition? (Answer yes or no) no
(b) What was the transferee's age at time of decedent's death?
(5) Did decedent in his lifetime make any transfer without receiving a valuable and adequate consideration
therefor 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 transf'erred?
(Answer yes or no) no
(b) The right to designate the persons who shall possess or enjoy the property transf'erred or
income theref'rom? (Answer yes or no) no
(6) If' the answer to (5) (b) above is in the af'firmative, state whether the right was reserved in decedent
alone or others
(7) Did decedent in his lif'etime make a transf'er, the consideration for which was transferee's promise to
pay income to or f'or the benefit of care of' transf'eror? (Answer yes or no) no
(8) Did decedent, at any time, transf'er property, the bene~cial enjoyment of' which was subject to change,
because of' a reserved power to al ter, amend, or revoke, or which could 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 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 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 deed or instrument, if' trans-
fers are claimed to be non-taxable, also submit detailed statement of f'acts on which said claim is based.
NOTE 3: List applicable property below in manner in which provided in Schedules A, B, or E.
ITEM
DESCRIPl'ION
MARKET VALUE
(Es tima tee!)
DEPT. VALUATION
(Dept. Only)
None
Insert this total opposite wTransfers", Schedule "CW in the
WAs ReportedW column on the last page of this return.
0.00
N (f'-'--
RCC-37 (12-63)
COMMONWEALTH OF PENNSYYLANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "D"
BENEFICIARIES
(
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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) forth this facl.) OR NO BIRTH
Arthur J. Wise nenhew ves of ap'e Entire estate
11 n"T.Jn T.T~u
Watchunl!. New Jersev 07060
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Deponent further says that ail the above-named benericiarles are living at this time except below:
NAME
DATE OF DEATH
RESIDENCE
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SUMMARY
Real Property .....................................(Seh. "A")
Personal Property ....................... ...........(Sch. "B")
Transfers ..................................................... ...................(SCh. "C")
....... ................ ........ ........-.......................................
Gross Taxable Estate.
(1)
(As Reported)
$...0.00
$JA13.J:11.14
$.. ........... .....0.00
$..
$..
$ ....)~13,111.)4
(2)
(As Determined)
$.
$..
$
$ ..
$
$.
00
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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 under Schedule
"A", plus the date and place or record or instrument erf'ecting 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 or Property, Date of' Acquisitiqn, Name
Address and Relationship of' Co-Owners, and Place
of' Record of' Instrwnent, where Real Estate.
v<. ex::
X
unit
Value
percentage
Share
Estate
Valuation
;.
~~
:xx
::x
X<x
&
:x X
0<
DEPARTlIENT VALUATION
CAUTION-Do not Write
In This Space.
Value of' Value of'
Entire Decedent's
Property Interest
None
Insert this total opposite "Jointly Owned Property", Schedule "E"
in the" As Reported" colUllJl on the last page or this return.
0.00
N~
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*'
R E V-518 (8-78)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF FIELD OPERATIONS
P.o. BOX 'J!I70
HARRISBURG
17105
IN YOUR REPLY Pl.EASE
REFER TO
Inheritance Tax Division
NOTICE OF FILING OF APPRAISEMENT
Raymond L. Cameron
National Central Bank
222 Market St. Hbg. 17108
(Executor or Adm ini strator)
In Re: Estate of
Daniel G. Wise
Cumberland
County - Fi Ie No.
21-78-0621
Dear
You are hereby notified that the Original
appraisement in the estate of Daniel G. Wise
has been fi led in the office of the Re~ister of Wi lis of Cumberland
County on 9 April , 19~, Said appraisement reflects the following
valuations:
Real Estate
Persona I Property
Transfers
Jointly Owned
Total
None
148,111/14
None
None
148,111.14
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. L. 373.
9 April 79,S)
Signed
r,
r
Date
r- .."-'./""V'" <
r"'"'. "--_"..,
Title Administratiye Officer
( -,..--
. ~,-
\~/~
Note: This is not a bi II.
. .
.. .
RCC-39 (l5-68)
COMMONWEAL TH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
I ' If'
SUMMARY
Estate of Wise
(Last Name)
Dani e 1
(First Name)
DATE OF DEATH 10/29/78 FILE NO.
G.
(Ini ti al)
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".
Dated:
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 have allowed 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 Schedule "F", which greater or lesser amount represents the sum
allowed as a deduction.
Dated:
REGISTER OF WILLS
INVENTORY
Real Property (Schedule A)
Personal Property (Schedule B)
Transfers (Schedule C)
Joint - Held Property (Schedule E)
TOTAL GROSS ASSETS
Less Debts and Deductions
(SCHEDULE F)
CLEAR VALUE OF ESTATE
Valuation of life estates or
annuities. . . . . . . . . . . . . . . . . . . $
ESTATE TAX ASSESSMENTS $
t=
t=
t=
FOR USE OF REGISTER ONLY
Tax on $
Tax on $
Tax on $
Tax on $
Tax on $
Exemptions
Total Estate
TOTAL TAX
Less tax previously paid
BALANCE
Less 5% of tax if paid within
3 months after death
BALANCE OF INHERITANCE TAX DUE
Add interest at rate of 6% from
to
AMOUNT OF ESTATE TAX ASSESSED $
Estate tax paid $
BALANCE DUE
Add interest at rate of 6% from
to
COMPUTATION OF TAX
2%
6%
5%
10%
15%
*
$
$
$
$
$
(*) As evidenced by Charitable
Exemption Certificates issued
by the Secretary of Revenue.
$
$
$
t=
$
$
c
$
1=
L-
1=
$
$
TOTAL TAX BALANCE $
PAID $
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,
same should be noted below, with short explanation.
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