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HomeMy WebLinkAbout11-30-78 2/- 7J?- t 2t. i RCC-3a'i4-73) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS *' RESIDENT DECEDENT '110\1 ? fl CblYNTflOf: 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'\tenue. <Section 703 of the Inheritance and Estate Tax Act of 1961,) Late of Cumberland Pennsylvania } AFFIDAVIT .OF EXECUTOR1X D_... ......."J[ IN THE MATTER OF THE ESTATE OF G. B. McClellan Wilson (STATE FULL NAME OF DECEDENT) County County of CllmbArl "nn Nina } ss, State of x.lmlmillliilri Moore Wilson Executor ix of the estate of the above-named decedent being duly swom, depose S and say S Decedent died September 10 19 (MONTH) (DAY) (YEAR) Nome and addr... of attorney or} rT ohn M A "F,,q ki n other authorized repres.entative tc whom all correspondence shculd be mailed. Market Square BUilding, testate leaving a last will, copy of which is hereto attached..} Mechanicsburg, PennA., 170SS That as such Executrix deponent is familiar with the affairs of said estate and the property constituting (EXECUTOR-ADMINISTRA TORl the assets thereof and their fair market value. That at the time of death there was no safe deposit box registered in decedent's individual name, or jointly with, or as agent or deputy of another, or in decedent's individual name, with right of access by another as agent or deputy, with the exception of the following: - NAME AND ADDRESS OF BANK OR OTHER INSTITUTION THIS SAFE DEPOSIT BOX RENTED RELATIONSHIP OF JOINT IN WHICH DECEDENT RENTED A S.~FE DEPOSIT BOX IN NAME OR NAMES OF HOLDERS TO DECEDENT None 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 fnlly 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 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, treasW'y 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 securities owned by the decedent at the time of death, with the.market value there- of at such time. .._.~.,._.^.....,."".,-..--.....- ~._.. , .ec..Ntt--1'I1 COIIIMOHWEAL'I'H OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS TRANSFER INHERITANCE TAX RESIDENT DECI!DENT 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 identHied 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 Cornmo"~alth of Pefthlylvanla should b. (1) (2) (31 d.scrlb.d by lot and block numb.r, .tr..t and str.et number, tog.ther with DEPARTMENT a gen.ral description of the property, with a reference to the record of the ASSESSED VALUE VALUA TION conveyance by which the decedent took tltlei If a farm state number of a. FOR YEAR OF ESTIMA TED CAUTION ere.; also statement of mortgage encumbrance. upon each parcel at d.ath DECEDENT'S MARKET VALUE (Do not writ. 0' decedent. To..., a.....m.nt., accrued 1nt.,..t on mortgag.., .tc.,ar. DEATH In thl. .pac.) to b. ll,t.d on Schedule "Ftt and mu.t not b. d.ducted 'rom thl. .ch.dule. NDhU NONE 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. N tnuJ RCC -35 RESIDENT DECEDENT SCHEDULE "B" PERSONAL PROPERTY '* COMMONWEALTH OF PENNSYLVANIA TRANSFER INHERITA,'1CE 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 l1ated under Schedule _En. 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 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 riduciary in said capacity, partnership interests, interest in anyundistributed estate or or income rrom 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. ITEM List and describe fully UNIT VALUE ESTIIlATED IoIARKE.T VALUE DEPARTMENT VALUATION (Do not write in this space) 1 1976 Cadilac Sedanj Sold November 17, 1978 and the sale price is reported $ 7 ,000.00>1IDDOo 00 2 122 Shares Continental Bank, Norris- town, Penna., par value $5.00 '303/4 3, 751.50/~1151. 5D Insert this total opposite "Personal Property", Schech1le "B" in the "As Reported" column on the last page or this return. x X $ 10,751. 50 lo,151.5l> RCC- 3b COMMONI'/EALTlI LW l'ENNSYL\'AN I A TltANSFb]\ INHEIUl'A:-iCE TAX SCHEDUlE "e" TILINSFEJ\S d""".~. ~Ji'&,. t\ Tj ~.- v"~ . ..;~~.,' --;:;~~4= ItESIDENT m:n:nFNT (1) Dirl decedent, within two years of'death, make any tl'unsf'er of' any material part of his estate, wtthout receiving a valuable arad adequate considprrttion therefor? (Answer yes 01' no) No (2) Did decedent, within two years or dpath, transrer property rrom himseH to himseH and another or others (including a spouse) in joint ownership? (Answer yes or no) No {::n If the answer to (1) or (2) above is in the affirmative state: (n) Age of decedent at time of transfer (n) State o"f decedent's health at time of' making the transfer. (Note 1). (c) Cause of' decedent's death. (Note 1). (4) Did decedent, in his li"fetime, make any transf'er of' property without receiving a valuable or adequate consideration therefor which was to take eft'ect in possession or enjoyment at or after his dp.ath? (Answer yes or no) No (8.) Was there any possibility that the property transferred might return to trans:ferer or his estate or be subject to his -power of' rlisposition? (Answer yes or no) No (b) What was the transt'eree'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 no t in fact end he fore his death: (a) The possession or enjoyment of or the right to income from the property transferred? (Answer yes or no) No (b) 'The right to designate the persons who shall possess or enjoy the property transferred or income theref'rom? (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 ()r others (7) Did decedent in his lif'etime make a transf'er, the consideration for which was transf'eree's promise to pay income to or for the benef'lt of care of' transferor? (Answer yes or no) No (8) Did decedent, at any time, transt'er property, the beneficial enjoyment of' which was subject to change, because of' a reserved power to alter, amend, or revoke, or which cm\ld revert to decedent under terms of transfer or by operation of' law? (Answer yes or no) Nn (9) If the answer to (8) above 13 in the af'f'irmative, was the power to alter, amend, or revoke the inter- est of the bepeficiary reserved in the decedent alone or the decedent and others? (Answer yes or no) No NOTE 1: The answers to these questions should be supportect by aff'idavi t by the attenlUng 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 rair market value at clate of death, dates of' transfers and to \"hom transferred, with relationshiv of transt'erees to decedent, if any. Submit copy of any trust deecl 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 provirled in Schedules A, B, or E. ITEM DESCRIPTION lIlARKET VALUE (Es tima ted) DEPT, VALUATWN (Dept. Only) N6Y\..U None i I , I I N.01\JJ Insert this total opposite "Transf'ers", Schedule "c" in the "As Reported" column on the last page of this return. RCC-37 (12-63) CO~IMO:>l\\"EALTIl OF I'E~~SYYL\NIA TRANSFER INHERITANCE TAX RESIDENT DECEDENT SCHEDULE "0" BENEFICIARIES h BENEFICIARIES AND ADDRESSES RELATIONSHIP I SURVIVED (If step-children or DATE INTEREST OF State full names and addresses of all who illegitimate children I DECEDENT OF BENEFICIARY ave an interest, vested. contingent or other are involved. set STATE YES IN ESTATE wise in estate) forth this fact.) OR NO BIRTH Nina Moore Wilson Widow Yes Enr..; re E"r."tp. Deponent fUrther says that all the above-named beneficiaries are living at this time except below: NAME DATE OF DEATH RESIDENCE None E; :: ~ .~ 'It: .<'. - - " .2: 'Q) E "s ~.2 "00.8 ~~~ o ~ 'E~t: ~ ~ 0 ~ E fr f':! 0: Real Property Personal Property Transfers SUMMARY (Sch."A") ..(Sch. "B") ... ..(Sch."C") (1 ) (As Reported) $ $10.,751.50. $ $.. $d $ .10,751 .50... (2) (As D,'lformincd) $ $ $ $ $ $ Gross Taxable Estate \- '0 P, Z .. ~ ~ .,;, ~ .rl oj " ...l .. - 0 ~ .<:: .... .... (J) u (J) ..( ~ .. ~ '" '" rl Q - ,... .rl ..( < ~ 0 " Ill: ~ ~ 8, 11 '" ... '" 0 .,;, ." ... '" '" !;j OJ >:: OJ ..:: ..( :t < t.:i rl QT rl ;.. ... ~ ... .... rl rl H ~ Q S 0 i:i .,- '" < Q) rl Q) a:; ;z: - 0 f-' rl <>: .0 -e f-< ... Z '" 0 9 ~ ~ '-' H - ... ~ 0 0 ~ Q) 0 -" = " ~ p, '" 0 0 P, ." ... :c t.:i P'I P .. ~ oj .... - :< = .l: f-< 0 " "2 :::: - .c. 0 C'J 0 ;: s] ..-. .1:i ;: ~ i5 " " 0 :;~ ...l U U " RCC-~8 RESIDENT DECEDENT SCHEDULE liE" JOINTLY OWNED PROPERTY CCMMe)\WE.\LTH elF l'ENNSYLV.\NL\ TH.\\S;:':l\ I "HEll! TANrf<: TAX IXSTRrCTIOKS: This scherlule nrnst disclose all property, real and personal, ownerl by the rlecedent jointly wi th another or others, including intangibles, standing in the name of' the decedent antl others. List real estate first, as entireties, or joint tenants, giving brier description, as indicated tmder Schedule "A", plus the date and place of record of instrument ef'f'ecting vestivlre, but do not include entireties or out of' state real estate value in estate valuation column. Personal property should be listed as in Schedule ~Bw, Vlus date of' acquisition, and the name, address and relationship (if any) of co-owners to the decedent. of' Property, Date of' Acquisition, Name I . - -- Description unit pe rcen tage Estate DEPARTMENT VALUATION Address and Relationship of Co-Owners, and Place j Value Share Valuation CAUTION-Do not Write of' Record of Instrument, where Real Estate. , In This Space. (X << :x X :xx ':xx:x . >00 << @ Value of' Value of' )( X X X y<< X :&: %<: X ~X ~ l!.ntire Decedent's L >Q< X ;0<: :XXX xx: X << Property Interest I N O/\~ I I I I I I I I I I I I I I , I I I I I ! , I I I I , i I I I I , I I I Insert this total o-pposite "Jointly Owned Property", Schedule"E" in tbe "As Reported" column on the last Vage of this return. l\\OI"'lt...-