The URL can be used to link to this page

Home My WebLink About12-28-78 RCC~33 (4-73) " C ,QOR'* COMMONWEAL TH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS of j-11'-IJt,J 0 lr' .\ ~"_. ' I, ;, i. 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'otenue. (Section 703 of the Inheritance and Estate Tax Act of 1961.) IN THE MATTER OF THE ESTATE OF } mID""", Charles B. Hollinger (STATE FULL NAME OF DECEDENT) EXECUTOR Cumberland AmlIlil5XJU::roJ1. Late of County l' 1 . } 5"' State of .ennsy vanJ.a County of Cumberland Samuel P. Hollinger Executor ~OIiOC of the estate of the obovewnomed decedent being duly sworn, dep-ose and ~ay Decedent died Nov. 7. , 19~f=leaVln. 0 1051 will, copy of which Is he,elo ottoched, } (MONTH) (DAY) (YEAR) X Nome ond odd,e.. of ottomey 0' } J. Robert Stauf'f'er, Market Square Bldg .. other authorized repreuntotive to whom l1echanicsbure;, Penna. 17055 all correspondence should be mailed. That as such Executor deponent is familiar with the affairs of said estate and the property constituting (EXECUTOR-ADMINIST RA 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 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 The Commonwealth -Waflonal Bank. Cha"'les B. HollinO'er None ~ain a~d Market Sts. Mechanlcsburg, Penna. . That the contents of said safe deposit box or boxes are itemized under Schedules B of this return, with the exception-of the following, for the reasons hereinafter set forth: That ScheJule 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 ScheJule 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 perSOll 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, treasury certificates or notes and other evidence of indebtedness of the United States to the de. cedent; all obligations, wheJher 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, automobiies, 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 thl: d;ll\.' of death, bonds and accrued interest thereon to the date of decedent's death and other investment 'i,-\.';" ' " Ill'O 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 rar as Possible substantiated by 1'inancia1 statements 01' the corporations, showing the assets and liabilities thereoi' as 01' the date 01' death. The schedule also sets 1'orth the interest 01' decedent at the time 01' death in any co-partnership or business, and in support 01' the value 01' such interest there is annexed to said schedule, 1'inancia1 statements showing the assets and liabilities 01' said co-partnerShip or !>usiness. A copy of the co-partnership agreement, (11' oral, a statement setting forth the nature 01' the agreement) together with a statement setting i'orth the chracter 01' the bUSiness, its location, and such other i'acts pert;-.:ini1:g to the business as may be pertinent to a fair and Just appraisal of' the decedent's interest therein !llllst be submitted. It should also set forth in itemized f'orm, together with the f~ir market value thereof. any other propert:r 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 trH::rein and in the case of transf'ers of'property, real or personal, within two years of' decedent's death, in contemplation of' decedent' 5 death, or intended to t~ke efTect in possession or enjoyment at or af'ter death, said schedule sets forth the nature and value of such property, to whom tranSferred, the relationship of the transf'erees to the decerlent, the proportionate share received by each transferee and all oUWI' f'acts of' a pertinent nature regarding said transfers. In the case of transf'ers intenderl to take e:ff'ect in possession or enjoyment at or af'ter death, there is also attached to the schedule a copy of the deed, trust agreement or other instrument creating thetrlist. Therl~ is also 'set forth in said scherlule a list of all property, real and personal, with its value, which pa~ses at decedent's death by virtue of' the exe'rcise 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 s'uch power attached to the schedule. That Schedule D attached hereto and made part hereof' sets f'orth the names and addresses of' all persons benef'icially interested in this estate at the time of' decedent's rleath, the nature of' their res- pective interests, their relationship, if' any, to the decedent, together with the ages at the time of' deceden t' 5 death of' all minors, annul tants and benef'iciaries for Ii -re underdeceden t' s Will. I t also contains a statement showing which of' the benef'iciaries named in the decedent's Will, if' any, died prior to deef;-dent, the dates of' their death, their issue, and the relationship of such issue to the benef'iciary. That SChedule 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, i~cluding intangible, standing in the name of the decedent and others, plus the date and place of' record of instrmnents effecting the '\-estiture of' real estate and the date of' acquisition of' personalty, plus the name, addre~s and rel~tionship, if' any, of co-owners to the decedent. That Schedule F attached hereto and made a part hereof sets forth fully and in detail all debts and deductions claimed f'or 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 ~ldiciaryls 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 allowed 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 f'iduciary 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 Scherlules "Aft, "B", "e", "E", and"F" as directed therein, have been carried forward and properly reglste~ed in the Summary. Subscribed and sworn to before me thiB...2..t..t..lz. ...,.....,........ ..... day ofLJ~c~~E~19...7~. ~:f~t;~fL.~.. .... .... JJr.'l&. ...~~..J"~,:~~;;:NOTARY PUBLIC .... B,])'i~t;:;;;/3&~b~......................._. ',161 'C' "0 ::?~"~;J'~~';~;wwOHrl M, ;uH,~B~:EICR'slA6UNkDGCBDOURNoTYuaH . ..... ~11?9hl:\I]:i,Q~p1,l,rg~)'e.I.1J:la,! .:lJCJ2?. ...... 'elj,,,.., Q,'!" "'...",' " ,n (C't T nd State) ~mn(ttJl'~J B:,fi82r~i~UH:dW .~ i4J. COMMISSiON EXPIRES DEC. 29.1811 1. Y or OWn a NOTE: B~ ,l$lf~.ihg.ar-r1aa:v.fiSiHike sure all blank sp_aces 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 or 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 completerl as above-directed. '::""~:"'.."';""-~."'~."'~<< .'.....-.......".. ..-.- .~." KOO.... "....'1) COMMONWEAL TH OF PENNSYLVANIA *' DEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS SCHEDULE "A" TRANSFER INHERITANCE TAX RESIDENT DEC~DENT REAL PROPERTY Real property in Pennsylvania, with statement of mortgage encumbrances upan each parcel at death of dece. dent. Property held by the decedent as tenant in common with another or other, should be identified as ta 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 ft1. Commortwealth of Penn.ylvanla should be (1) (2) /31 described by lot and block number, .treet and str.et number, together with DEPARTMENT a general de.crlptlon of the property, with a r.ference to the record of the ASSESSED VALUE VALUA TlaN conveyance by which the decedent took title; If a farm .tate numb.r of aw FOR VEAR OF ESTIMA TED CAUTION ere.; also .tatement of mortgage encumbrance. upon each parcel at d.ath DECEDENT'S MARKET VALUE (Do not write of deced.nt. Taxe., a.....m.nh, accru.d Int.r..t on mortgag.., .tc.,ar. DEATH In this space) to b. lI.t.d on Schedule "F" and mu.t not b. d.ducted from thl. schedul.. None None f\J D I\(., I I I Insert this total opposite "real property", Schedule "A" in the X X X X X None I\lOIlL "As Reported" column on the last page of this return. RCC -35 *' COMMONWEALTH OF PENNSYLVANIA TRANSFER INHERITANCE TAX . SCHEDULE liB" RESIDENT DECEDENT PERSONAL PROPERTY INSTRUCTIONS: This Schedule must disclose all tangible and Intangible personal property owned individually by the decedent, at the time or his deat~ 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 :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 any undistributed 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 ITE!I UNIT ESTIMATED DEPARTMENT VALUATION No. List and describe fUlly VALUE IIARKEr VALUE (Do not write in this space) ( 1) $25.00 Denomination, Series E, U. S. Savings Bonds, registered in the names of' Charles B. Hollinger or Bessie E. Hollinger, (Bessie E. Hollinger pre- deceased Charles B. Hollinger, therefore /' said bonds are reported at 10qh value), as follows, to wit: / Q674l5l75E - dated Sept. 1942 25.00 '14.01 74.01 Q83568486E - dated Oct. 19~2 74.01 '....01 Q99762!.L95:<: - dated Nov. 1942 74.01 1....01 C,110116411-72::: - cJated Dec. JQL2 72.82 14.n "U223721!?7E - dated Jan. 1943 72.82 1~.'l:l.. Q1394213e5~ - dated Feb. 1943 72.82 14.'U. Q14996ll03E - dated March 1943 72.82 1a.n Q173717l69E - dated April 1943 72.82 1a.'l.l Q1988l9742E - dated May 1943 72.82 Ui:t Q205~57021E - dated June 1943 71.62 11. c,.l Q226 24353E - dated July 1943 71.62 11.1,.1 Q245l83399E - dated Aug. 1943 71.62 11 w.. Q255769586E - dated Sept. 1943 71.62 1U,;1. Q273l95572E - dated Oct. 1943 71. 62 1/."~ Q309987899E - dated Nov. 1943 71.62 1/.e"a. Q3l93l6023E - dated Dec. 1943 70.11-4 10."~ Q3~2432226E - dated Jan. 1944 70.44 10-"~ Q3 340lj934E - dated Feb. 1944 70.411- 1o.~~ Q376494687E - dated l1arch 1944 70.1+4 1/)'I1f Q39l267599E - dated April 1944 70.44 "70. '1~ Q408097209E - dated May 1944 70.44 '1().t.j1f Q433623389E - dated June 1944 69.25 lJl.~ ~ Q4~35243l0E - dated July 1944 69.25 lo'\,~l> Q4 7467421E - dated Aug. 1944 69.25 ,,1.Ol.S' Q506603170E - dated Sept. 1944 69.25 IJ'I.~' Q502084289E - dated Oct. 1944 69.25 "".~s Q526330438E - dated Nov. 1944 69.25 c.'1.~ Q5245l0246E - dated Nov. 19411- 69.25 W'f. ~t Q550855005E - dated Dec. 1944~ 68.14 lit l't Q490054943E - dated Dec. 1944 68.14 1oi'.1'f Q573264l76E - dated Jan. 1945 68.14 '-'C. It Q,59l390441~E - dated Feb. 1945 68.14 '-i'.I'f Q,60l20574 E - dated March 1945 68.14 loUr Q656l03825 E - dated April 1945 68.14 ("i.l'f- Q670388658E - dated May 1945 68.14 "V~ Q678l78728E - dated Jlille 1945 67.05 lo 1. 05 Q.697967834E - dated July 1945 67.05 !Ii oS Q703211-l431E - dated Aug. 1945 67.05 t"tOS Q7l0476272E - dated Sept. 1945 67.05 lc1.0'i' Q724l78090E - dated Oct. 1945 67.05 "1.0~ Q726960402E - dated Nov. 1945 67.05 (01. 0$ Q740519468E - dated Dec. 1945 66.55 /okS:; RCC -35 '* COMMONWEALTH OF PENNSYLVANIA TRANSFER INHERITANCE TAX SCHEDULE liB" RESIDENT DECEDENT 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 rmder Schedule "E". Intangible personal property, titled in the name of' the decedent, but payable at death to another or others, including but not limited to P.Q.D. U. S. Savings Bonds and tenta- tive trust acco\Ults, 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 certlrlcates, 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 rlduciary In said capacity, partnership interests, interest in any undistributed estate or or income from any property held in trust under the will or agreement of another, even though located outside of the State, at the time of death, should be listed in this schedule. Item ITEM UNIT ESTIMATED DEPARTMENT VALUATION No. List and describe fUlly VALUE lIARKET VALUE (Do no t wri te in this space) ( 1) Continued:- 66.{i V Q735963920E - dated Jan. 1946 25.00 ~/'..5 6 Q7325400l8E - dated Feb. 1946 66.55 ~.55 Q768068265E - dated ),larch 1946 66.55 /'lAS~ Q748595791E - dated April 1946 66.55 l.45S Q750633402E - dated Bay 1946 66.55 ~.SS Q754539994E - dated June 1946 65.46 t,S. It/' Q759l74236E - dated July 1946 65.46 I,S, If'- Q762009343E - dated Aug. 1946 65.46 (,~, .,./, Q765406370E - dated Sept. 19}-I-6 65.46 t,~."i/' Q802578625E - dated Oct. 1946 65.46 (,$. "1(" Q770904766E - dated Kov. 1946 65.46 t,<;''t(, Q773256029E - dated Dec. 1946 64.43 ("'f. ~:a Q777082180E - dated Jan. 1947 64.43 I,,/:'i~ Q778382l38E - dated Feb. 1947 64.43 (,,'1.1{3 Q78l986468E - dated I-larch 19)1-7 64.43 "....&4 " Q,79884S4l5E - dated A!cril 19)~7 64.43 (,'/:lt~ Q7989l97l3E - dated May 1947 64.43 ~'f:..?1 Q799032l33E - dated June 1947 63.40 c..~*O Q830276434E - dated July 1947 63.40 <D,3.'tC> Q830525S57E - dated Aug. 1947 63.40 Ic3,\-O Q8307535l8E - dated Sept. 1947 63.40 1.3. ... C> Q83l062839E - dated Oct. 1947 63.40 ~~f) Q831l12593E - dated Nov. 1947 63.40 ~...o Q832067507E - dated Dec. 1947 62.38 ~~8 Q832l52537E - dated Jan. 194~ 62.)8 ~.'li Q83l608l21E - dated Feb. 1948 62.38 1.:1. at Q831882673E - dated March 1948 62.38 /,.,1.~1 Q832353023E - dated April 1948 62.38 ~3i Q832469~37E - dated ~ay 1948 62.38 Uol8i Q85l557 l3E - dated June 1948 61.40 "'. 'to Q852ll873~E - dated July 1948 61.40 (,L 110 Q85240~08 E - dated Aug. 1948 61.40 101.'10 Q85243 231E - dated Sept. 19~8 61.40 (,1.'/0 Q8669~2259E - dated Oct. 194 61.40 ilIAD Q8669 1058E - dated rove 1948 61.]-1-0 (,/. *6 Q867283605E - dated Dec. 1948 59.67 sq.r.1 Q6675682l6E - dated Jan. 1949 59.67 ~.(,1 Q8798l7525E - dated Feb. 1949 59.67 31.'" Q880072530E - dated March 1949 59.67 ~.(,1 Q880384099E - dated April 1949 59.67 S'i.101 Q88052l086E - dated April 1949 59.67 3't.1#1 Q880720039E - dated May 1949 59.67 Silo1 Q8969l2455E - dated June 1949 60.99 110. 't'l Q89736~125E - dated July 1949 60.99 (,0,,,, Q89762 l57E - dated Aug. 1949 60.99 c..o." Q909002543E - dated Sept. 1949 60.99 /'0. 'tIt Q909l262~3E - dated Oct. 1949 60.99 cw.'t'\ Q9093377 2E - dated Nov. 1949 60.99 I"C, It'; Q909632665E - dated Dec. 1949 59.83 5HZ! RCC -35 '* COMMONWEALTH OF PENNSYLVANIA TRANSFER INHERITANCE TAX SCHEDULE "BI! RESIIlEKT DECEDENT PERSONAL PROPERTY 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 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 any undis tributed estate of or income rrom any property held in trust under the will or agreement or another, eVen though located outside of the State, at the time or death, Should be listed in this schedule. Item ITElI UNIT ESTIMATED DEPARTMENT VALUATION No. List and describe rully VALUE lIARKE.T VALUE COo not write In this space) ( 1) Continued:- Q923870970E - dated Jan. 1950 25.0 59.83 Sq.U Q924164724':<~ - dated F'eb. 1950 59.83 Sq.n Q924365437E - dated March 1950 59.83 sct.t8 Q924563232E - dated April 1950 59.83 .sq.U Q92~752292E - dated M~y 1950 59.83 6'1.0 Q93 1160983 - dated June 1950 58.74 SW.~ Q936487261E - dated July 1950 58.74 :sa. ''1' Q936652739E - dated Aug. 1950 58.74 st. ,'t Q954882002E - dated Aug. 1950 58.74 .sa.'" Q954934508E - dated Sept. 1950 58.74 .st. ,It Q955~15035E - dated Oct. 1950 58.74 5,.7't Q955 l7249E - dated Nov. 1950 58.74 st.,t Q95587943~E - dated Dec. 1950 57.73 51.1i1 Q95624852 E - dated Jan. 1951 57.73 S'lo ,~ Q966858669E - dated Feb. 1951 57.73 sn'\ Q9670ll327E - dated March 1951 57.73 5'7.'" Q967374224E - dated April 1951 57.73 ~" ,3 Q9677579l0E - dated May 1951 57.73 :n'~ Q972970~97E - dated June 1951 56.74 S-. ,'" Q972979 56E - dated June 1951 56.74 ~,'t Q9733429llE - dated July 1951 56.74 s.,,.. Q9737l9834E - dated Aug. 1951 56.74 S-1't Q9738l7093E - dated Sept. 1951 56.74 ~';'I'" Q9742l5648E - dated Oct. 1951 56.74 sy"'t Q97~299l23E - dated Nov. 1951 56.7~ ;S1.. , 't Q98 974950E - dated Dec. 1951 55.7 55.'c.. Q98620l472E - dated Jan. 1952 55.76 ~i<- Q986469~12E - dated Jan. 1952 55.76 $."l/, Q997l39 10E - dated Feb. 1952 55.76 ss. i<- Q997420064E - dated March 1952 55.76 ss. '1# Q1007236054E - dated April 1952 55.76 "' .,CI ( 2) Seventy-two shares of' co~~on stock of' I) 1.\-1l... 0 D The Pennsylvania Power and Light Company. 20.50 (3) Checking Account No. 142-482086-6 with Th ~ Commonwealth National Bank. Balance as :'\ of' Nov. 7, 1978: V.~}.5l 2,663.7 (4) Evergreen Savings Account No. 14-0011613- ~. with The Commonwealth National Bank. Bal- So I-\S 51\. 31 as of' Nov. 7, 1978: /45,5~1.3 I Accrued interest: 2 1.32 a"".a~ (5) Two shares of 4.5~~ Preferred Stock of 47.00 94.0 q~. ClO Pennsylvania POW8r & Llfht Company. Insert this total opposite "Personal Property", Schedule "B" in X X 57,815.63 51 "B 16. L\-S the "As Reported" column on the last page or this return. SCHEDULE "B" - PAGE "a" I J RCC.16 COMMO:\WEALTH OF PEXNSYLVANI A TRA:\SFFH !:'iHF1\ITANCF: TAX SCHEDULE lIe" TH.\\fSFEltS HESIDEXT m:n:I1FXT (1) Did decedent, within two years ot'detlth, make any transf'er of' any material part of his estate, without receiving a valuable and adequate consideration therefor? (Answer yes or no) No (2) Did tiecerl.ent, wi thin two years of death, transf'er properLy from hlmsel f' to himself and another Of' Gtllers (including a spouse) in joint ownership? (Answer ;yes or no) No (3) I t' the answer to (1) or (2) above is in the at'f'irmalive state: (a) Age of' decedent at time of transt'er None (b) State of' decedent's health at time of making the transfer. (Note 1). (e) Cause of' decedentls death. (Note 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 dpath? (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? None (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 f'act end before his death: (a) The possession or enjoyment of or the right to income from the property transferred? (Answer yes or no) Nn (b) The right to designate the persons who shall possess cr enjoy the property transf'erred or income therefrom? (Answer yes or no) Nn (6) If the answer to (5) (b) above is in the affirmative, state whether the right was reserved in decedent alone f)r others N/A . (7) Did decedent in his lifetime make It trans-rer, the consideration for which was transferee's promise to pay income to or for the benet'i t 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 reserverJ power to alter, amend, or revoke, or which COltld revert t.o decedent tmder terms of transfer or by operation of' law? (Answer yes or no) No (9) If the answer to (8) above i3 in the aff'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) to the~eOquestions should be SUllPorterl by a:ff'idavit by the attenfling llhysician as NOTE 1: The answers well as a copy of the death cel"tificate. NOTE 2: If answer to any of the above questions is yes, set f'orth below a description of' the property transferred, it's fair market value at date of death, dates of' transf'ers and to \I'hom trA..nsferred, with relationship of transf'erees 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. ITE~l UESCRIPTION MARKET VALUE DEPT. VALUATION (Es tima ted) (Dept. Only) None None t\1. 0 f) (., I Insert thi.s total opposite "Transfers", Schedule "e" in the None t-..l 0 f)Q.. "As Reported" column on the last page of' this return. Ree - 37 (12-63) CO~IMO~\\'EALTIl OF I'EI\I\SYYLANIA TRANSFER INHERITANCE TAX RESIDENT DECEDENT *~ SCHEDULE "D" ~. .. BENEFICIARIES BENEFICIARIES AND ApDRESSES RELATIONSHIP SURVIVED (If step-children or DATE INTEREST OF \State full names and addresses of all who illegitimate children DECEDENT OF BENEFICIARY haye an interest, vested, con~ingent or other are involved, set STATE YES IN ESTATE wise, in esta~) forth this fact.) OR NO BIRTH Helen 11. Zimmerman Daughter Yes One-ei~hth or estate ~<l West Simnson St. Mechanicsbur~. Pa. 17055 Ru th N. Nicholson Daughter Yes One-eirrht of' estate 412 Norwood Avenue "M.. r.""t:l A pp.n~c 16101 Habel E. Kaon Daughter Yes One-eighth of' estate l' West Factorv St. Hechanicsburfl. Pa. 17055 Romaine H. Willhide Daughter Yes One-ei~hth of' estate 730 West North St. ('~~, ~ 01 e Pa 17011 Gladvs P. Lewis Daughter Yes One-eighth of' estate 1107 Baldwin St. Mechanicsburg, Pa. 17055 Samuel P. Hollinger Son Yes One-ei~hth or estate R. D. 2 - Box 84 Mechanicsburg, Pa. 17055 Bertha G. Bottenf'ield Daughter Yes One-eighth of' estate .,ol,'>c~ R^sl= Drive Sterlinfl Hei~hts, Mi.48078 Harold R. B:ollinrrer Son Yes One-ei~ht of' estate 1<=;10 Gough St. San Francisco, Ca. 94109 Deponent further says that all the above-named beneficiaries are living at this time except below: NAME DATE OF DEATH RESIDENCE J SUMMARY (1 ) (2) ~ ~ (As Reported) (As DI'l..rmilwd) .E _~ ...... E<'It: Real Property ........... ..(Sch, "A") $ ..0.00 $ "til:: i:::: ';:: III E Personal Property (Sch. "B") $ 57,81~.Q3 $ .::: C:;::3 ...... E-- 'C 0. 8 Transfers ..........(SCh...C..) $... 0.00 $ ~ g: ....... ~".", Jointly Owned . Prope.rt.y(S.ch.l.E"L $.. ....... .0.00 $ o " "St:;t:: " " 0 $.. $ ~E~ f"l J>: Gross Taxable Estate $.. ....S7,815.63 $ . . J ~ ." Z " ~ I.:i ~ '" " ..l " ::0 ~1J >- I.:i <t t'l~ '" <Fl - ... Z <t <: H " ell ~ ~ H 'd 'c lO. ""' 0 H ~ " lO. '" ""' '" 0 d ..:: <t :I: <: :I: I.:i ::r:: <D M ;.. ... ... E- ~ Q I.:i .-l H " 0 " ... '" .-. . '" <D " Z ... 0 E- o; Z E- D'! .,-j P ""' .( <Fl .-l S ~ I.:i ~ ~ (/) H '"' 0 E- O l'i1 d <5 ~ ell " ~ H 0 - 0 .9 I.:i p;; ;; lO. - ~ ... " E- ~ " ell J:: E- ~ 0 " ~ <: 0 ~ .c' 0 'c 0 E ~..s --, .E:i :: E " 0 0 :::~ ...l U u I RCC-36 COMMONWEALTH OF PENNSYLVANIA * TRANSFER INHERITANCE TAX SCHEDULE" E" RESIDENT DECEDENT JOINTLY OWNED PROPERTY INSTRUCTIONS: This schedule must disclose all property, re al and personal, owned by the decedent jointly wi th another or others, including intangibles, s tanding in the name of' the decedent and others. List real estate ~irst, liS entireties, or joint tenants, giving brief' description, as indicated under Schedule "A", plus the date and place of record of instrument ef'fecting 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", Vlus date of' acquisi tion, and the name, address and relationship (if any) of co-owners to the decedent. Description of' Property, Date of' Acquisi tion, Name Unit percentage Estate DEPARTMENT VALUATION Address and Relationship of' Co-Owners, and Place Value Share Valuation CAUTION-Do not Write of' Record of Instrument, where Real Estate. In This Space. <X 0< >& Value of Value of ( X::X: << ::x 0< % % :::><>< ~ &s ~ :::><>< ~ Entire Decedent's :>00:>< << >0< 0< :::><>< :::><>< (Y' ::x << Property Interest None None \\l 0 nL Insert this total opposite "Jointly Owned Property", Schedule "E" td r\ C\I in the "As Reported" column on the last page of this return. None