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HomeMy WebLinkAbout12-04-79 R't C-33 (4-73) ,1 i "I ~{I .., " COMMONWEAL TH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS ::; / - 78" (~~~ j~ 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.) IN THE MATTER OF THE ESTATE OF ANN M. KOLTALO Late of CUMBERLAND PENNSYLVANIA } AFFIDAVIT OF EXECUTBR I X ADMINISTRA TOR County (STATE FULL NAME OF OECEDENT) County of CUMBERLAND } '" State of ~ BETSY A. KUNTZELMAN Exec~rix of the estote of the obove.nomed decedent being duly sworn, depose ond say Decedent died November (MONTH) 22 , 19----1JL{testate leaving a last will, copy of which is hereto attached. } (YEAR) iK~ (DAY) Name ond address of ottorney or } other authorized repres,entotive to whom all correspondence should be moiled. Executrix That as such deponent is familiar with the affairs ( EX E CU TO R-A OMI N I ST R A TO R) Myers, Myers, Flower & Johnson P. O. Box 125, Lemoyne, Pennsylvania 17043 of said estate and the property constituting 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 IN WHICH DECEDENT RENTED A SAFE DEPOSIT BOX THIS SAFE DEPOSIT BOX RENTED IN NAME OR NAMES OF Deceden t and Bets A. Kuntzelman RELATIONSHIP OF JOINT HOLDERS TO DECEDENT Dauphin Deposit Bank & Trust Co. Summerda1e Plaza F.nola, Pa. Daughter 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 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 du{: 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 gi ving also separately the accrued interes t thereon, if any, down to the last interes t 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 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 secur:l;cs 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 copy 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 l'air 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 t'3.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 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 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 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. I t 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, andthe 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 tntangible, standing in the name of the decedent and others, plus the date and place of record of instruments effecting the vesti ture 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 Schedule F attached hereto and made a part hereof sets forth fully and in detail all debts and deduction~ 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 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 alloWE!d 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", "C", "E", and "F" as d:lrected therein, have been carried forward and properly registered in the Summary. Subscribed and sworn to before me this ................................. ............................~..~ ~...~ ') . .... day of ....~:t~."I."...... 19....1...J ~i~:~~k<C~ 15.4.0.....S.e.l.tz.e.r.....CQ.ur..t.......................................................... (Street Number) ~<=.. 9.1;:1. 9:p.. ~g.~p..:9.;::,g.,.... ..?.9:..~. ".. ...!..?.9..? .?..... ... ........... ...... ...... (City or Town and State) ~ ~.. ................................................".."--.:-~..."........... ..........~.. NOTARY PUBL \.~ My Commission Expires Dec. 21, 19>3, r p, r...-,~.,..l.erl::.nd Count; ...~m;)yne,~. ~- ~ NOTE: Be fore signing affidavi t 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 requirerl under the paragraph above relating to Schedule "B" are attached. Also make certain that column #1 in the "Surrunary" has been properly completed as above-directed. RC C.34 (4-73) CO.MMONWU.L TH OF PENI'lSYLVANIA 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 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 af 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. Real Estate - No. 125 Altoona Avenue, Enola, East pennsboro Township, Cumberland County, Pennsylvania in the name of the decedent by deed dated July 20, 1976 recorded in the Cumberland County Recorder's Office in Deed Book "R", Volume 26, Page 901. ~_ Iic.~~.J.-'--.../ Undivided one-half interest in lot of land in Hampden Township, Cumberland County, Pennsylvania - Deed Book "E", Volume 19, Page 339; Deed Book "B", Volune 26, Page 313. Residue after highway condemnation (1 ) ASSESSED VALUE FOR YEAR OF DECEDENT'S DEATH ftlt!, ,,( ,j-C, 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. (2) (3\ DEPARTMENT VALUATION CAUTION (Do not write In this space) ESTlMA TED MARKET VALUE 24.000.00~/ !::c (. I,' (, 4 5'O'~OO' -...-.::.::----- ~ "/ J.- ( ('. (C / /,'1,'/ .1' R E V-4~ I (6-76 I RESIDENT DECEDENT SCHEDULE "B" PERSONAL PROPERTY COMMONWEAL TH OF PENNSYLVANIA TRANSFER INHERITANCE TAX INSTRUCTIONS: This Schedule must disclose all tangible and intangible personal property owne:d 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 uE". 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 tentative 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 payable to the estate or fiduciary in said capacity, partnership interests, interest in any undistributed estate of or income from any property held in trust under the will or agreement of anot.her, 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 ESTlMA TED MARKET VALUE DEPARTMENT V ALUA nON (Do not write in this space) 1. Household Goods 800.00 2. 1978 Chevette (sale price) 2,000.00 3. Dauphin Deposit Bank & Trust Company Checking Account No. 52-32-3021 393.69 4. Decedent's claim against Allstate Insurance Company for basic loss benefits under the PA. No Fault Motor Vehicle Insurance Act arising out of accident of June 14, 1977 467.00 5. Internal Revenue - refund - decedent's 1978 Income Tax 281.15 6. Camp Hill Convalescent Home - decedent's final pay checks 7. Unliquidated personal injury claim vs. Knisely 106.30 10.00 8. Dauphin Deposit Bank & Trust Co. Interest refund - automobile loan 164.41 9. Allstate Insurance Co. - Deductible Re fun d 80.00 10. Sunderland Chevrolet - Service Contract Re fund 95.19 Ins ert thi s total opposite "Personal Property", Schedule "B" in the "As Reported" column on the last page of this return. xx 4 ,397. 74 ~'!7..1.? I / YJ~/ RCC-lS t'l)\1Ml)\Wl,'AL~'I! l1l-' J>l::\\S'dXi\\I A r'{A\~F;.'i, I\F~"lUT?\:CF TAX SCIIEDULE "c" T 1{\ X ~ rl~nS ~' ~~ ~ ~r'. 4.'" ". \Y . I:,.~,,_JJ /j . ,~:;-r;ii' It" /i - \:,;<~,;r~~ n...)~..c!'\")",, './f;<.~;;i? i\}~~~ I nEXT nEC FIW\ '1' (1) Did ~e~e(lent, within two yeitrs of'deatl1, make any transfer of any material part of_l1is estate, without reCelV.lng a valuable [lEd adequate consideration therefor? (Answer yes or no) ~~_ (:2) Did (lecedent., within two years of death, transfer propercy from himself to himself anr! another or (,thers (jllclwiing a spouse) in joint ownership? (Answer yes or no) No (a) If the answer to (1) or (:2) above is ill the affirmative state: (a) Age of decedent at time of transfer (b) State of decedent's heal th at time of making the transfer. (Note 1). (c) Cause of decedent's death. (~ote 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 after his death? (Answer yes or no) No (a) Was tnere any possibility that the property transferred might return t.o transferer or his estate or be subject to his power of disposition? (Answer yes or no) No (b) What was t.he transferee's age at time of decedent's death? (5) Did decedent in l1is I ifetime make any transfer without receiving a valuable and adequate consideration therefor lffi(ler which transferor expressly or impliedly reserves for his life or any period which does not in fnct. end before his death: (a) The possession or er!joyment of or the right to income from Uw property transferred? (Answer y(~S 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) Dirl (lecedent in his 1 if'etime make a transfer, the consideration for which was t.ransferee's promise to pay income t.o or f'or the benefit of care of transferor? (Answer yes or no) No (8) Did decedent, at any t.ime, transfer property, the beneficial enjoyment of' which was subject to change, because of :~ reserved power to al tel', 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 or the benef'iciary reserved in the decedent. alone or the decedent anrl others? (Answer yes or no) No NOTE 1: TJc,e answers t.o these questions should be supported by arfidavi t hy the atten<Ung physician as well as a copy or the death certificate. NOTE 2: If answer to any of' the above quest.ions is yes, set forth below a description of the property transrerred, it's f'air market value at date or death, dates of transfers and to whom transrerred, with relationship or transf'erees to rlecedent, if any. Submit copy of any trust <ieed or instrument, ir trans- fers are claimed to be non-taxable, also slilimit rletailed statement of facts on which said claim is based. NOTE 3: List apjllicahle property below in manner in which provided in Schedules A, 13, or E. ITEM 1!ESCRIPTION MARlillT VALUE (Es tima ted) DEPT. VALTJATION (Dept. Only) NONE Insert this tot.ril opposite "Transfers", Schedule "CO in the "As Reported" column on the] ast pag;e of this return. !\k-n_" " <19ft: * RE V-453 (8-78) COMMONWEALTH OF PENNSYLVANIA TRANSFER INHERITANCE TAX RESIDENT DECEDENT SCHEDULE "D" BENEFICIARIES BENEFICIARIES AND ADDRESSES RELA TIONSHIP I (Sta te full names and addresses of all who (If step-chiWren or SURVIVED DATE INTEREST OF have an intnest. vested, contingent or other- illegi tima te children DECEDENT OF BENEFICIARY wise, in estate) are involved, set ST ATE YES BIRTH IN ESTATE forth this fact.) OR NO "A Tl'l1n+-701m;:,n nal1 n-h +-er Yps Ann1f-. Entire Residue 1540 Seltzer Court Mechanicsburg, Pa. 17055 - - - - Deponent further says that all the above-named beneficiaries are living at this time except below: NAME DATE OF DEATH RESIDENCE .... .8rJ)~ "'~ ..... .!:l. =I:t: CIl. = '= E E .- <D ::l E- - "00..0 E U "1 0 ~ .... U ~ o "0 ........ <D ::l CIl .... U ::l .... <DE 8. :< <D e ~ SUMMAR Y (Sch. "A") $ (Sch. "8") $ (Sch, "C' ') $ $ $ $ (1) (As Reported) 24,150.00 4,397.74 -0- ?~,r;.17 74 (2) (As Determined) $ - $ $ $ $ $ Real Property Personal Property Transf ers Gross Taxable Estate ::: ..-j s:: .c: 0 (J) (J) ~ ~ s:: ('V') .... Z "0 .s:: "'" ~ <D 0 0 ~ CIl 0 Q) ~ '" E-f f-J r-- >< <D ~ U r-I rn <D 0 ..J t.(l - Q ~ -<l: cO <<t 0 V) ~ ..-j Q::: ~ ..Q '" ;( & s:: c... 0 (J) "d .- Q: cO c... = s:: m '" Q.. 0 :> Q) <<t Q)~ 0 s:: ;> Q.. r-I r-I ..s:: ~ ..s::~ ~ (!) r-I '>, -<l: ~ >t 0 ~ ~<<t A.. ~ CIl (J) :c = c Z s::: ~ '-~ (!) = Z .. U"l s:: ...... om H .j.J <D ~ ~ 0.. -<l: (J)N s:: ~ 0 (J) l--i r-I (!) 0 ~ cO ::l '- t- (!) A.. IE: 0 Q: 0 Q::: ~ C) ..c: 0 >t~ ...... . .... :E:o .. - ~ Q.. ttl :E: III (!) ... ~ '" w - <D s:: rJj ~ '- ~ Q: Z 0 (J) .>t ...... <<t '- = s::: ~ C ~ 0 0 ...... ~ 0 0 - E <D = E (!) S ::="0 ';;j ::l E :>1.(!) ==~ 0 0 :E:A..H ..J u U , R C C-38 RESIDENT DECEDENT SCHEDULE "E" JOINTLY OWNED PROPERTY COMMONWEALTH OF PENNSYLVANIA TRANSFER INHERITANCE TAX INSTRUCTIONS: This schedule must disclose all prop.~rty, real and personal, ~1pd I~L_~~~'i.'.:.'~'~i.~2._. ointly with another ur others, ineluding intangibles, sUcnding in the name of' the dpe('d''fl! ,"li~ " he,.". List. real estate first, as entireties, or joint. t.enant.s, giving brief clescript.ion, as in(}jer,!yc! 'mrl"r S.:hedule "A", plus the dat.e and pla.ee of' record of instrwnent effecting vestl t,lll'e, but do not include pnt. 1""ties or out of' state real estate value in estate vlduation column. Personal property should be listed as !n Schedule "B", plus date of acquisi tion, and the name, address a.nd relntionship (i f' any) <:0 f' co-ownerC' 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 DEPARTMENT VALUATION CAUTION-Do not Write In This Space. Value of En ti re Property Value of Decedent's lnterest 1. Dauphin Deposit Bank & Trust Company - Savings Account No. 32-6-0371-1 in the name of the decedent or Betsy A. Kunzelman - opened 9/10/76. Date of death balance, plus interest - $1,072.64 50% 536.32 Insert this total opposite "Jointly Owned Property", Schedule "E" in the" As Reported" column on the last page of t.his return. ..J:5' c I ..3.2..... 8jft( RC C-39 (So771 21-Curnberland County, Number and Name File Number ;)1-2&_oh53 Date of Death November 22, 1'978 File Date January 31. 1980 Estate Name KOLTALO ANN SUMMARY (LAST NAME) (FIRST NAME) M. (INITIAL) COMMONWEALTH OF PENNSYLVANIA TRANSFER INHERITANCE TAX RESIDENT DECEDENT REPORT OF INHERITANCE TAX APPRAISER I, the undersigned duly appointed Inheritance Tax Appraiser in and for the County of Cumhel"] And 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". Do ted: January 31. 1980 )!H~"L/ ,0 'cRft.jl/l H j ) 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) Jolnt.Held Property (Schedu Ie E) Transfers (ScheduleC) TOTAL. GROSS ASSETS Less Debts and Deductions VALUE AS REPORTED $ VALUE AS APPRAISED CODE VALUE AS REAPPRAISED $ CODE 00+ 0+ 29 06 40. (SCH EDUL E F) CLEAR VALUE OF ESTATE Valuation of life estates or ~ PRINCIPLE FACTOR VALUE ~ annuftles....................._ $ t= E ESTATE TAX ASSESSMENTS _ $ FOR USE OF REGISTER ONLY Tax on $ Tax on $ Tax on $ Tax on $ Tax on $ Exemptions Total Estate ~ COMPUTATION OF TAX 2% 6% 5% 10% 15% $ $ $ $ $ * TOTAL TAX $ (*) As evidenced by Charitable Exemption Certificates issued by the Secretary of Revenue. Less tax previously paid BALANCE Less 5% of tax if paid within 3 months after death $ $ $ t= $ I I 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 $ c $ $ TOTAL TAX BALANCE $ PAID $ 48-Adjustment 49+Adjustment 56-Annuity 6O-Life Estate 92+Remainder Appraisal 93-Remainder Deduction 93C-Charity 94-Remainder Residue 96-Successive Li fe Estate Supplemental Codes: (FOR USE IN HARRISBURG ONL Y) 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. ' 0. s:: E-< ".-j 0 ..c: ...J Ul Z '0 Ul <t: s:: M .... ~ cu ~ ..c: (\:l ., ~ <::I' (l) ::!: '" - 0 0 cu ~ ;;... ~ () 0 I-:l r-- ~ cu E-t c:a::: r-l - Q c.. <t: <.<l c:a::: 0 III c.. r(j c.. ~ "0 '2 ~ ~ ".-j 0.. ~ 0 s:: 0 Q) s:: 0 III ~ ~ ~ ..0 r(j > Z ~ r(j ::c ::c ~ Ul r-l - ~ 0 ~ >> . f-< ~ f-< Eo-< s:: ~ CI.l r-l r-l 0 z :I: ll. ~ 0 s:: Q) c Eo-< Iil :>t Z - Eo-< 0 Eo-< ~ Q) ~ c c:a::: Ul III (l) 0 ~ ~ c.. 'Lf'l @ 0 ~ ::I c.. UlN r'? H +J () '- ~ ~ r-l Q) 0 c:a::: 0 Ul c:a::: Q) III .8 ~ ~ r(j ..c: :>tx .... .... E-< r.:l - :a: 0 , (\:l Eo-< . (\:l I1l Q) .... :a: CI) .... <t: '- ~ , .~ CI.l 0 'S ::!: '- c Ul Z 0 >> 0 ~oo ..... ~ .... 6 =6 (l) c Q) S ..... "0 .... ::3 6 :>t . Q) ~<t: (\:l 0 0 ...J U U :a:IllH REV-5IB (3-79) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF FIELD OPERATIONS P. o. BOX 2970 HARRISBURG 17105 IN YOUR REPLY PLEASE REFER TO Investigation Division NOTICE OF FI LING OF APPRAISEMENT Betsy A. Kuntzelman 1540 Seltzer Court Mechanicsburg, PA 17055 (Executor or Administrator) In Re: Estate of Ann M. Kol talo Cumberland County - File No. 21-78-0653 Dear Mrs. Kuntzelman: You are hereby notified that the oritinal appraisement in the estate of Ann M. Koltalo has been filed in the office of the Register of Wills of Cumberland County on JAnua17 31 ,19-80 Said appraisement reflects the following valuations: Real Estate Personal Property Transfers Jointly Owned Total 24,500.00 4,397.74 None 129,~~:~ 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. Date January ::51, 1980 Signed ~Ar.l~ / ~~4A)('-) Title Chief Appraiser NOTE: This is not a bill. R~V-457 (8-78) DEPARTMENT OF REVENUE BUREAU OF FIELD OPERATIONS . P.O. BOX 2970 HARRISBURG, PENNA. 17105 COMMONWEALTH OF PENNSYLVANIA RESIDENT INHEFlJTANCE TAX APPRAISEMENT DATE _ January 31, 1980 COUNTY CnmhAT'lAnn FILE NO. 21-78-0653 Whereas, Ann M. Koltalo late of East Pennsboro Township in the County of CumberlAnd Commonwealth of Pennsylvania, having died on the 22nd day of November 19 78 ,seized and possessed of an estate subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania; Therefore, I, Gloria J. Richard , 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 (he right to appraise and assess transfer inheritance taxes at the lawful collateral rate on any such future interest. DESCRIPTION OF ASSET UNIT Appraisement VALUES Made for Inheritance Tax Purposes I $ 24.l)()() Real Pronertv 00 ... " ... 4.3Q? !74 Joint-Held Prooertv E)~ 1~2 Transfers None mnmA T ~~n 1."%.1. cv:; I Have been duly sworn according to law, I do hereby certify that the above appraisement is made in conformity with the law on this ~lAt day of Januarv 19 tsO. .RPA--'r/d /' J'f,t,-..JIU)f7J' Appraiser Harrisburg (Number and Street) (Post Office) , Penna. "'0 :::., I- (I) CI) ..... Z ru e:: w (I) ::l ~ t) 8 (I) ~ w Q CI) ,"') <( a: ~ ~! ~ ~ <( , x '0 <( ~ I- (I) ~! '0: w ..... t'-.. u ru ~~ 2: ..... .: <( ~ x: , J..: I- ~i "" .: a: ..0: w ~ g~ :I: 0: 2: I- 2: w C CI) w a: J:2t: i! ~~ 0: !of: 0: a~ <+-. ..0' o 10: (I) m: iO .= ....:j At ~ . : 1":01: * '-0: c2i 0\ ...... '0: ri: /'l"( .: M; w ::> z w > .....' .....' w ] a: e:: "'0' (I) ~ u. ~ ~ 0 CI) 0 CI) 'ra ~' I- a. 'ra a. z Q., a. Q., (I)' w q:; Q., ~ ::l :iiE "'0 q:; ~ "'0 l- e:: ..... ~ a: ru ::l ru 0 ~ ..... <t: "'0 .0 <+-. 0.. "U (I) ru ~ 0 w e:: ~ .~ (I) ~ ..... c ..... e:: '(j) 0 ::l t) ~ ~ 0 (I) ~ e:: "'0' & lil i3 "'0 ~ 13 ~ ..... ~ 0: M; 00: ~ I: <3 N: N: :::::. I: ..... ..-I: (I) ,....,: ..!x: g Q ~ (I)' t) ~ o ,CI) ~ ..... CI) '6, (I) ec; ,S "'0 (I) -. k; ..c: ..... ru (I) Q <+-. o (I) ..... c3 ..... a; ~ CI) 'ra a. g; ~ &: ,....,: 0: N: COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND t J 55: BETSY A. KUNTZELMAN being duly Executrix East sworn according to law, deposes and says that She of the Estate of Ann M. pennsboro Township is Ko1ta1o late of , Cumberland County, Pa., deceased and that the within is an inventory made by __ her __ __, the said Executrix of the entire estate of said decedent, consisting of all the personal prop~rty and real estate, except real estate outside the Commonwealth of Pennsylvania, and that the figures opposite each item of the Inventory represent it's fair value as of the date of decedent's death. Sworn to and subscribed before me, ;J.d~R [/~~>/C~~ Betsy . Kuntze man,' Executrif 1540 Seltzer Court ~.........,- ~O 19 ~} or ~~~~. ~ NOTAEY PUEL :.1.., 80lIllnillsioIl E..'!pire3 Dec. 21, 1981 l..:lA:lyne, Pel. Cj:nberbnd COil:' i Mechanicsburg, Pa. 17055 Address Date of Death 22nd Day November Month 1978 Year INSTRUCTIONS I. An inventory must be filed within three months after appointment of personal representative. 2. A supplement inventory must be filed within thirty days of discovery of additional assets. 3. Additional sheets may be attached as to personalty or realty 4. See Article IV, Fiduciaries Act of 1949. M ~ 0 0.. l' or-! s:: r-l .c: 0 Ul Ul s:: s:: l'll ~ .c: ~ 0 0 8 I-J ')) >- -0 0 Gl "" \..) I- W lo-l ... 0::: I- III ~ ~ W <( 0 0 CIl lo-l CL. I- ~ U Q) ) 0 0 In CIl ~ Gl ~ I w 0::: w C 0\ ~ J: 8 III 0 t-- CL. CL. ~ Z I- ...J LL H III r-l II <( 0 0' 0 LL ...J ~I CL. " W 0 <( w >. \i > 0::: j~ II z of- . 'i Z 0 c . c II ::E: ~ ~ 0 I: In Z 0 ~ 0::: U ~ z II w <( Z - 0 CL. ~ ." III c III I' : - -.: . 'I 0 CIl 0 ...0 CIl E "'tl ~ Ii of- ...! 0 . III ~ 0 ...J U ~ CICl ~ Inventory of the real and personal estate of ANN M. KOLTALO 1. Real Estate - No. 125 Altoona Avenue, Enola, East pennsboro Township, Cumberland County, Pennsylvania, in the name of the decedent by deed dated July 20, 1976 recorded in the Cumberland County Recorder's Office in Deed Book R, Volume 26, Page 901. 2. Undivided one-half interest in lot of land in Hampden Township, Cumberland County, Pennsylvania - Deed Book E, Volume 19, Page 339; Deed Book B, Volume 26, Page 313. Residue after highway condemnation 3. Household Goods 4. 1978 Chevette (sale price) 5. Dauphin Deposit Bank & Trust Company Checking Account No. 52-32-3021 6. Decedent's claim against Allstate Insurance Company for basic loss benefits under the PA. No Fault Motor Vehicle Insurance Act arising out of accident of June 14, 1977 7. Internal Revenue - refund decedent's 1978 Income Tax 8. Camp Hill Convalescent Home - decedent's final pay checks 9. Unliquidated personal injury claim vs. Knisely 10. Dauphin Deposit Bank & Trust Company Interest refund - automobile loan 11. Allstate Insurance Co. - Deductible Refund 12. Sunderland Chevrolet - Service Contract Refund deceased. TOTAL 24,000 00 II I ,I II I II I I II I 150 00 800 00 2,000 00 II II Ii I' II I 393 69 467 00 281 15 106 30 10 00 164 41 80100 I 95119 28,547 74 I "