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HomeMy WebLinkAbout02-08-79 COMMONWEAL TH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS .J! /-7 r-~~ a.J ltJEB 081979 Rce-S3 (4-731 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'llenue. (Section 703 of the Inheritance and Estate Tax Act of 1961,) IN THE MATTER OF THE ESTATE OF } AFFIDAVIT OF. EXECU1'OIl. rlX -M>MiI'lIB'fRA(FGR- BEULAH B. WILSON (STATE FULL NAME OF DECEDENT) Lat. of CUMBERLAND Stat. of PENNSYLVA.NIA County of CUMBERLAND HAZEr. r.. WTr.SON County "} ss, rix Execu~ :;iWnRRi.~ of the estate of the above-named decedent being duly swam, depose S and say S (DAY) . 19~ ~estate leaving a last will, copy of which i. hereto attaChed..} ( ~~-A--;-\:tfllot__te- Decedent died October (MONTH) Name and address of attorney or } other authorized repres.entative to whom all correspondence should be mailed. 20 ROGER R. TRWTN 44 South Hanover St.. Carlisle. PA 17011 That as such RXP-C!llt:-ri x deponent is familiar with the affairs of said estate and the property constituting (EX E CU TO R-MiM4++l-ii"~'"f6-R1- the assets thereof and their fair market value. That at the time of death there was no safe deposit box registered in decedenCs 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 Farmers Trust Co. M. J. Mall Beulah B. Wilson Carlisle, PA 1701'1 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 due at death, name of mortgagee, date, rate of interest, and book and page of record thereof. It also sets forth in the coluIlUls provided therefore the assessed valuation of each of said parcels, the estimated market value thereof as of date of death of decedent. That Schedule 8 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 decedenCs 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 pri(Jf 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 securities owned by the decedent at the time of death. with the market value there- of at such time. ,/",.-- ,. In the case of' securities of' close or f'amily corporations, the values reported are as f'ar as possible substantiated by f'inancial statements of' the corporations, showing the assets and liabilities thereof' as of' the date of' death. The schedule also sets f'orth 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, f'inancial statements showing the assets and liabilities of' said co-partnership or lmsiness. A copy of the co-partnership agreement, (if' oral, a statement setting f'orth the nature of' the agreement) together with a statement setting f'orth the character of' the business, its location, and such other facts pertaining to the business as may be pertinent to a f'air and just appraisal of' the decedent's interest therein must be submitted. It should also set forth in itemized f'orm, together with the f'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 f'orth a true answer to each inquiry contained therein and in the case of' transf'ers of'property, real or personal, within two years of' decedent's death, in contemplation of' decedent's death, or intended to take ef'f'ect in possession or enjoyment at or af'ter death, said schedule sets f'orth the nature and value of' such property, to whom transf'erred, the relationship of' the transf'erees to the decedent, the proportionate share received by each transf'eree and all other f'acts of' a pertinent nature regarding said transf'ers. In the case of' transf'ers intended to take ef'f'ect in possession or enjoyment at or after death, there is also attached to the schedule a copy of' the deed, trust agreement or other instrument creating the trust. Ther~ is also set f'orth 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 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 f'orth the names and addresses or all persons benef'icially interested in this estate at the time or decedent's death, the nature o~ 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 ror lire under decedent's Will. It also contains a statement showing which or the benef'iciaries named in the decedent's will, if' any, died prior to decedent, the dates o~ their death, their issue, and the relationship or such issue to the benef'iciary. That Scpedule E attached hereto and made a part hereof' sets f'orth all property, real and per- sonal, owned by the decedent jointly with another or others, including intangible, standing in the name o~ the decedent and others, plus the date and place or record of' instruments erf'ecting the vestiture of' real estate and the date of' acquisition or personalty, plus the name, address and relationship, if' any, or co-owners to the decedent. That Scpedule F attached hereto and made a part hereof' sets f'orth fUlly and in detail all debts and deductions claimed f'or and on behalf' or this decedent's estate, including fUneral expenses paid; ~amily exemption, where applicable; costs of' administration of' this estate; counsel rees 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 and 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 ror obliga- tions, if' any. It is agreed that the f'iduciary will present proof' of' said claimed obligations upon re- quest, that if' the amount actually paid in settlement or 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 therewit~ That the totals of' the appropriate columns in Schedules "A", nan, "en, "E", and nF" as directed therein, have been carried f'orward and properly registered in the Summary. Subscribed and sworn to before me this . ...... day ofj:::?t~~,~. m.0.~y.,,- .19.79..,.,. ,~~~~~ 2,03m.Walnu.t....'s,t"'..",....""..",............"mm",,,,..,,,......."..,,..,,,,._. ( Street Number) t;1J,TJJ:;;J!:!...P.A....1IQ13..... (City or Town and St;a,te) ........................ RCGH{ C. CARU3LE neF.C', MY C.QMMISSiQ;i ;:::;'i;;~j "i,i-, NOTE: Berore signing af'ridavit make sure all blank spaces in the af'ridavit and schedules annexed are rilled in with details or the word "None", and in case the assets include rare and unllsterl securities, securities of' close or ramily 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. ACC"U (+73) COMM"'AL TN OF ...11It'I!L...., DEPARTMENT OF RllvENUE BUREAU OF COUNTy COLLECTIONS TRANSFER INHERITANCE TAX RESIDEN.T DECI!Ot!NT SCHEDULE "A" REAL PROPERTY *' Real property in Pennsylvania, with statement of mortgage encombronces upon each parcel at death of dece. dent. Property held by the decedent Os tenant in common with 'another or other, should be identified os to quantum of interest and the estimated value should be th(\.t 'oi the decedent's interest only. (Property held os joint tenants with right of surviorship or tenancy by entireties should be reported on Schedule "E.") . The real properttlocated In the Commonwealth of Pennsylvania ahould be (1) (2) (3\ described by lot 'and block number, .treet and atreet numb.r, together with DEPARTMENT a genefol de.crlptlo" of the property, with a reference to the record of the ASSESSED VALUE VALUA TlDN conveyance by wh'lc:h the decedent took title; If 0 farm .tate number of 0_ FOR YEAR OF ESTIMA TED CAUTION cres; also statement of mortgage encumbrance. upon each parcet at death .DECEDENT'S MARKET VALUE (Do not writ. of deceden.. To'xe., asse.sments, accrued Int.r..t on mortgage., etc.,or. OEATH In this .pace) to be lI.ted on Sch.~ole "F" and must not b. d.ducted from thl. .ched"le. NONE NONE N o----<L 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. Rec -35 RESIDENT DECEDENT SCHEDULE "B" PERSONAL PROPERTY '* CO~ONWEALTH OF PENNSYLVANIA TRANSFER INHERITANCE TAX INSTRUCTIONS: This Schedule must disclose all tangible and intangible personal property owned individually by the decedent, at the time or his death. Property owned by the decedent jointly with another or others must be listed under Schedule "E". Intangible personal property, titled In the name or 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 f'act that they are not of' the ac:bnlnlstered estat~ Tangible personal property should be listed f'lrst (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, mortg~es, notes, together with accrued interest or dividends, salaries or wages, insurance pay- able to the estate or riduciary in said capacity, partnership interests, interest Inanyundistributed 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 ttme or death, should be listed in this schedule. Item No. ITEII List and describe fully UNIT VALUE ESTIIlATED IIAIIKE1' V AWE DEPARTIIENT VALUATION (Do not write in this space) 1. Furniture and Household items 1l0.Op 8,869.111"~ 259.32 /" 2. Cumberland Valley Savings and Loan Association - Account # 123404 Christmas Club Account 3. Farmers Trust Company Checking Account #4-5191-6 ./' 42,412.50" ------ 9.60' --- 2.40' ,~ 189.36 4. ]VIedicare refund 5. 6. Pennsylvania Blue Shield refund Columbia Accident and Helath Insurance Co. - illness benefit 51,852.29 - ~ ~ ) -ra s '2- _ '2-"{ Insert this total opposite "Personal Property", Schedule "B" in X X the "As Reported" column on the last page of this return. . CUMBERlAND ~LLEY WI~ AND LOAN ASSOCNKJN 16 West High Street. Carlisle. Pennsylvania 17013 249-2525 Irwin, Irwin & Irwin Att: Roger B. Irwin 44 South Hanover Street Carlisle, Pa. 17013 NOV 1 : November 10, 1978 RE: Estate of Beulah B. Wilson Account 11123404 Dear Mr. Irwin: In regards to your inquiry of recent date concerning the above mentioned account number, please be advised that as of October 20, 1978 the balance of the account was $8,727.39 plus accrued earnings of $141.72 making a total of $8,869.11. The account is written in only the name of Beulah B. Wilson. In order to close the account we will need a short certificate. .Very truly yours, \ c' J /1/ ,t j II -_. ( ~ Richard Kuntz Bookkeeping Department RK:ymr . NOV 1 ~ h~]. F~RSTRUSTCOMPANY CAOT TlIlt.J:. PENNSYLVANIA Date 1I0vember 13. 1978 Roger B. II"Ifin 44 South Hanover Street Carlisle, Pa. 17013 Date of Death Beulah B. Wilson October 20, 1978 Re: Estate of Dear R<leAr B. Irwin, EsQ. In answer to your request concerning accounts owned, either separately or jointly, by the above referenced decedent and the balance in each account .as of the date of death, we have checked our records and are submitting the following information in duplicate. We suggest that you me one of these letters attached to the Pennsylvania Inven- tory forms (RCC) to substantiate the balance you report. Note that we have shown the correct registration for each account. Also, interest accrued to the date of death, if any, is listed as a separate figure. Very truly yours, ~~<-L #. ~d~ Be'ftlrl1 {'. Nickel Bookeeping Dept. Balance in .checking account#L.-1)191-6,:t42...412.50 The account is in the name '0/ Ileulah 9. ..i18on only". RCC- 36 COMMONWEALTH OF PENNSYLVANIA TRANSFER INHERITANCE TAX SCHEDULE "c" TRANSFERS . RESIDE"T DECEDENT (1) Did decedent, within two years o:fdeath, make any trans:fer of' any material part oJ: his estate, without receiving a valuable and adequate consideration there:for? (Answer yes or no) NO (2) Did decedent, within two years or death, transrer property rrom himselr to himselr and another or others (including a spouse) in joint ownership? (Answer yes or no) l\Tr. (3) If' the answer to (1) or (2) above 15 in the af:firmative state: (a) Age of decedent at time of transf'er N/ A (b) State of' decedent t s heal th at time of' making the transfer. (Note 1). (e) Cause of decedent's death. (Note 1). (4) Did decedent, In his lifetime, make any transfer or property without receiving a valuable or adequate consideration therefor which Was to take e:f:fect in possession or enjoyment at or arter his death? (Answer yes or no) No (a) Was there any possibility that the property transrerred might return to transrerer or his estate or be subject to his power or disposition? (Answer yes or no) Nn (b) What was the transferee's age at time of decedent's death? N / A (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 before 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 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 N / A (7) Did decedent in his lifetime make a transfer, the consideration fUr which was transferee's promise to pay income to or for the benefit of care of transferor? (Answer yes or no) No (8) Did decedent, at any time, transfer property, the beneficial enjoyment of which was subject to change, because of a reserved power to alter, amend, or revoke, or which cmlld revert to decedent under terms of transfer or by operation or law? (Answer yes or no) l\Tn (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) N / A 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 or 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 facts on which said claim is based. NOTE 3: List applicable property below in manner in which provided in Schedules A, B, or E. ITEM DESCRIPTION IlARKET VALliE (Es tima ted) DEPT. VALUATION (Dept. Only) NONE NONE ~~ Insert this total opposite "Transfers", Schedule "e" 1n the -As Reported" column on the last page of this retu~ RCC-37 (12-63) COMMONWEALTH OF PENNSYYLANIA TRANSFER INHERITANCE TAX RESIDENT"DECEDENT SCHEDULE "0" .~ ~" BENEFICIARIES ( h 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 fact.) OR NO BIRTH Hazel L. Wilson Sister vp" ~Qoi- ~Q~<n"Q "nn 203 Walnut St. remainder Carlisle, PA 17013 . . .. .. I Deponent fUrther says that all the above-named beneficiaries are living at this time except below: NAME DATE OF DEATH RESIDENCE ... o . ~<~ '" .. ... t:: s::I 'c ~ e .... -::5 e"- "dQ.B <( e_ s:..8;, o " ;;~t: ~ " 0 "e'" ~ ~ Real Property. ...... ........ ..... ... ... Personal Property.......................... Transfers ....................... ............. ..;rq:tnt lY:en ".10'....P ~.9. P.~ r:1;y SUMMARY ........(Sch. "A") ...(Sch. "B") .....(SCh. "C") ..(S<;I1,..~). (1) (As Reported) $......0.00 $.. ....... .5l..,.~. 5;<.29.. $... .......0.00 $.... ...?,..2.91,2J $........... ....... $ .....6.Q..143.56 (2) (As Determined) .....y........................................ $. $. $ $ $.... $. Gross Taxable Estate .... co: to-' O'i E- ~ .., Z ." 1a f.:I ,.. " ::E II ...l ;.. f.:I ! .<::: -< Z '" CD <I> Ol) - H '" .... ;::l' -< ~ \0 < 0' " Ill: I IX: ~ H' 'S ... p.. H CD p.. 0 c' 0: '0, " ... 2: t-- ~ < !i! f.:I 0' ~, c. ;., -< "" I f.:I ... E- "" cd .. Q H H' <I" H' c '" c:i ~ :t .. < .-1' H' H' c Z Z 0 E- ClI H Z E- <I> ;3. tJ): (J)' p.. < ;3 ~ f.:I 'M' .0 - t: ~ ~ 0 H: I'i: 0 H ~, H ;::l .c c IX: cd 0 .::: 0 ~ 0 " ... :c f.:I .<:: 0 ClI '" Z '" !: cd - ~ Ill: H b H 0 c ~ .. ~ ;::l - .co 0 'S (J): 0 E 's "" ~: ClI c E H - ~ ::: .~ "'C '" 0 0 a:< ....l U U RCC-3e 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 rlecedent 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 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 "B", plus date of acquisi tion, and the name, address and relationship (if any) of co-owners to the decedent. ~5? ;A~ J( OC Description of Property, Date of Acquisition, Name Address and Relationship of Co-Owners, and Place of Record of Instrument, where Real Estate. :x~ <<><5~ <xc)< X << ~ :x;. <x;x ;X . . Unit Value percentage Estate Share Valuation fY';A )0< <x <x ;X~;x << << DEPARTlIENT VALUATION CAUTION-Do not Write In This Space. Value of Value of Entire Decedent's Property Interest House and Lot at 230 Walnut Street, Carlisle, Cumberland County, Fa. acquired March 14, 1944 by Beulah a. Wilson and Hazel L. Wilso (sister), as joint tenants with the right of survivorship Recorded Cumberland County Deed Book T; Vol. 12; page 1P0. (assessment $4,060.0~ 4) 50 8,120.0 ~ ~. t) D.S.E. Bonds Beulah B. Hilson or Hazel L. Hilson::J J~ (sister) ~b~:>~~ so June 1942 Q21210730E -T<{,/ f': .0 V June 194"4 Q411932196E \G>q. '5 ( May 1945 Q559957032E "7' 25 fob. S ~ i_ Dee. 1945 L99705833E 50 \ '33. f) '-'-' ;J v , \~291.2 D go.f(/J-"~ €i,L\1o ....SI Insert this total opposite "Jointly Owned Property", Schedule "E" lIa3/. d.5-- in the "As Reported" column on the last page of this return. Rcc.ag (5-68) <COMMON'wEA~ TH OF PENNSY~VANIA TRANSFER INHERITANCE TAX RESIDENT DECEDENT SUMMARY Estate of WILSON (Last Name) BEULAH (First Name) B (Initial) DATE OF DEATH 10/20/78 FILE N021-78-628 REPORT OF INHERITANCE TAX APPRAISER I, the undersigned duly appointed Inheritance Tax Appraiser in and for the Cnunty of Cumberland 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 Cumberland County, Pennsylvania, do respect- fully report that I have allowed deductinns 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 uP", 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) VALUE AS REPORTED VALUE AS APPRAISED $ $ 182 2 VALUE AS REAPPRAISED $ 60 143 6 , :::J'r , CLEAR VALUE OF ESTATE Valuation of life estates or annuities. . . . . . . . . . . . . . . . . . . $ t= t= t= ESTATE TAX ASSESSMENTS $ FOR USE OF REGISTER ONLY Tax on $ Tax on $ Tax on $ Tax on $ Tax on $ Exemptions Total Estate $ $ $ $ $ 2% 6% 5% 10% 15% * COMPUTATION OF TAX 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 $ $ 1= $ 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 $ ,= l=$ L t= $ $ TOTAL TAX BALANCE $ PAID $ FOR USE OF REGISTER ONLY ADJUSTMENTS NOTE: Where subsequent adjustments are made to the above cumputation of tax by the Register of Wills, for proper reason, same should be noted below, with short explanation.