HomeMy WebLinkAbout03-05-79
RCC-3j (4-73)
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
r,
, :t.c&.,,_
"DB
J '
RESIDENT DECEDENT
COUNTY OF
CUMBERLAND
IMPORT ANT:
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.)
MINNIE T.
BARR
} AFFIDAVIT OF
""'8(-E€t:lreR-
AImlNTSTR'A Tm<'
SURVIVING CO-TENANT
IN THE MATTER OF THE ESTATE OF
(STATE FULL NAME OF DECEDENT)
Late of
Cumberland
Pennsylvania
County
County of
Cumberland
Janet B. Windsor,
J..,
State of
A~~~~
Surviving Co-tenant
J>>;xooxx
of the estate of the above-named decedent being duly sworn, depose S
and say S
Decedent died
Ma y 8,
1978
(MONTH)
Name and address of attorney or }
other authorized representative to whom
all correspondence should be mailed.
(DAY)
, 19 _{~l!llv1"'dll-t<nI'"W'ttt,~erJ>T lri"1l'tnrif"1rJorereftl'tJ~.r. }
(YEAR) Intestate
James K. Arnold, Esq., Arnold, Slike & Bayley
2109 Market St., P.O. Box 737, Camp Hill, Pa.
That as such co-tenant deponent is familiar with the affairs of said estate and the property constituting
(EX ECUTO R-ADMIN I ST RA TO R)
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 fullowing: -
NAME AND ADDRESS OF BANK OR OTHER INSTITUTION THIS SAFE DEPOSIT BOX RENTED RELATIONSHIP OF JOINT
IN WHICH DECEDENT RENTED A SAFE DEPOSIT BOX INN AM E 0 R N AM ES 0 F 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 fully and in detai I 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
gi ving al so separately the accrued interes t thereon, if any, down to the la s t in teres 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 dale of death, bonds and accrued interest thereon to the date of decedent's
death and other investment ~U:Ui" .; (i',. lied by the decedent at the time of death, with the market value there-
of at such time.
~/-?Y-.b?8'
I O-~ (J if-. if
~" :/;'
In the case of securities of close or family corporati.ons, the values reported are as f'ar as
possible substantiated by financial statements of the corporations, showing the assets and liabilities
thpreof 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 schedllle, 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)
togeth0r with It statement setting forth the character of' the ~lsiness, its location, and such other facts
,lprtdiping to the husiness as may be pertinent to a fair and just appraisal of the decedent's interest
therein n,llst be submitted. It should also set forth in itemized form, together with the fair market value
therc'0f, a;]~' 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 tflerein 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'l.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 intenden to
take effect 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 forth in said
schedule a list of all property, real and personal, with its value, which passes at decedent's deatll hy
virtue of the exercise by decedent, either individuall y, or jointly wi th 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 nllmes and addresses of all
persons beneficially interested in this estate at the time of decedent's neath, the nature of their res-
peeU.ve interests, their relationship, if any, to the decedent, together with the ages at the time of
decedpTlt's death of all minors, annuitants and beneficiaries for life under decedent's Will. It also
contains a statement showing which of the beneficiaries named in the decedent's will, if any, died prior
to der.:edent, the dates of their death, their issue, ann the 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 intangible, standing in the name
of the decedent ami others, plus the date and place of record of instrwnents 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 deceden t.
That Schedule F attached hereto and made a part hereof sets forth fully and in detail all debts
and deductions claimed for ann on behal l' of this decedent's estate, including funeral expenses paid;
family exemption, where applicable; costs of administration of this estate; counsel fees and f'urliciary's
commissio~s 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 pledgerl 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 Wil] s, and tha t
the amount of tax assessed can be reassessed in accordance therewith.
That the totals of the appropriate columns in Scherlules "A", "B", "e", "E", and "F" as directed therein,
have been carried forward and properly registe~ed in the Sllimnary.
Subscribed and sworn to before me this
/11 th
~?::j
/
..../
. day of HH,~P~c::~rr;tl::>~.:r..
" e / /'
//7 &[.~~~
H'H.'HmH 19..7..'~'''H
.'4~:~~1A~~t.b1:~~!.!'1--_..
~tl18 ....A.l?J?.~.~....Px:..i y.~ ....... .. ..... .......,.......,.......
(Street Number)
.... ..M~c::h.~P.:.~.G.RP.!1.;t:::g..'H.....:p.h. ..J. 7.. Q.??..
(City or Town and State)
(\
Thelma S. McCauslin, Notary pubm
My Commission Expires July I, '980
Camp Hill, PA Cumberland County
NOTE: Before signing; affidavit make sure all blank spaces ill the affidavit and schedules annexed are
filled in with details or the word "None", and in case the assets include rare ami unlisterl securities,
securi ties of close or family corporations or an interest in any co-partnership or business, that the
data Ilnd statements required under the paragraph above relating to Schedule "B" are attacherl. Also make
certain that column #1 in the "Summary" has been properly completed as above-directed.
RC C-34 (4-7 3)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COL.L.ECTIONS
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 (1) (2) (3)
described by lot and block number, street and street number, together wi th DEPARTMENT
a general description of the property, with a reference to the record of the ASSESSED VALUE VALUA TlON
conveyance by which the decedent took title; If a farm state number of a. FOR YEAR OF ESTIMATED CAUTION
cres; also statement of mortgage encumbrances upon each parcel at d.ath DECEDEMT'S MARKET VALUE (Do not writ.
of decedent. Taxes, assessments, accrued Interest on mortgages, etc.,ar. DEATH In this space)
to be listed on Schedule "Fit and must not b. deducted from this schedul..
NCf)~
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 Ofll,
RCC :-35
RESl DSl, L DECEDENT
SCHEDULE I' B"
PERSONAL PROPERTY
~~J
,~4,
CO~WONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE 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 wi th another or others
must be listed under 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.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 f\lrnishings, 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 pay-
able to the estate or t'iduciary in said capacity, partnership interests, interest in any undis tributed
estate of 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.
1 tern ITEM UNIT ESTIMATED DEPARTMENT VALUATION
No. Lis t and describe fully VALUE MARKEl' VALUE (Do not write in
this space)
N OOG
NONE
I
I
,
Insert this total opposite "Personal Property", Schedule "6" in X X N Df\L
the "As Reported" column on the last page of this return.
PC' C' -.1, ~
Cl)'vIMU\0il:>U/fIl ell-' I'FX~:-;YL\-j\:-iI A
T1{A'iSFF1, I'iIWllI1',),\CF TAX
SCHEDULE "e"
T 1{ \. '\'~ F)<;] L'-'
II
~.~;~~t
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/j" ~-~W" .(\
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IlES IIW\T nITFl1F'iT
(1) Dill ~e~edent, within two years of death, make allY trnJlsf'er' of any material part 0:&611.S estate, without
reeplvlng 11 valuable aEd adequHte consid8ratiCl!l Uw:'efor') (A.nsw'lr yes 01' no)
(2) Dill riecedent, wi thin two years of deatll, trnnsfer' property from himsel f to himsel f and another or
(,thers (including It spouse) in joint ownership? (Answer yes or no) ~<?___
(3) If the answer to (1) or (2) above is in the aff'irmaLive stilte:
(a) Age of dececlent at t im,~ of transfer _____
(b) State of llecedent's heal th at time e)f making the transfer. (Note 1).
(c) Calise of decedent's death. (Note 1).
(4) Did decedpnt, in hL~ lifetime, make any transfer of property without receiving a valllable or adequate
consideration therefW( which was t.o t.ake effect. in possession or enjoyment at or after his dpath?
(Answer yes or no) 0
(a) Was t.here any jJossibil i ty that the property t.ransferred might return t.o transferer or his
estnte or be subject. to his power of disposition? (Answer yes or no)
(b) What was t.he transferee's age at time of deced.ent's death?
ej) Did clecedcnt in his 1 ifetime make any transfer without receiving a valuable and adeqlrate consideratton
therefor uncler which transferor expT'e:~s]y or impliedly reserves for his life or any period which does
not in fact end before his aeath:
(a) The possession or er!joyment of or the right to income from the property transferred?
(Answer yes or no) No
(b) The right, to nesignate the persons who shall possess cr enjoy the property transferred or
income there from? (Answer yes or no) ~__
(0) If the answer to (5) (b) above is in the affirmative, state whether the right was reserved in decedent
alone or others
(7) Did decedent in his lifetime make 11 transfer, the consideration for which was transferee's promise to
pay income to or for the benefit of care of tl'ansferor? (Answer yes or no) No
(~) Did decedent, at any t.ime, t.ransfer property, the beneficial enjoyment of which was subject to change,
because of a reserved. power to alter, amend, or revoke, or which cOllld revert to decedent under terms
of transfer or by operation of law? (Answer yes or no) No
(9) If the answer to (8) above i3 in tile affirmative, was the power to alter, amend, or revoke the inter-
est of' the bepeficiary reserved in the decedent alone 01' the decedent ane! others?
(Answer yes or no)
:-;OTE1: The ICnswers to these questions should be supported by affidavi t hy t.he at.t.encHng physician as
well as a copy of t.he death certificate.
:iOTE 2: If answer to any of the above questions is yes, set forth below a descript.ion of the property
t.ransferrect, it.' s fair mnrket vallie at dat.e of death, dates of' transfers and to I"hom trrtnsferre'l, with
relationship of transferees t.o e!ecedent, if any. Submit copy of any trust deeel or inst.rument, if trans-
fers are claimed t.o be non-t.axable, also slilimit det.ailee! statement of facts on which said claim is based.
:iOTE 3: List applicable property below in manner in which provided in Schedules A, B, or E.
ITEM
DESCRIPTION
MARKET VALUE
(Estimated)
m~)'l'. VALUAT':ON
(Dept. Only)
NOelL
I
I
Insert this totrll opposite "Transfers", Schedule "e" in the
"As Reported" column on the last page of this return.
Nb()L
RCC-~7 (11-63)
<..'0~IMO~~'EALTH OF PEX7\.';.YYL.\?\lIA
TRANSFER INHERITA]\'CE TAX
RESIDENT DECEDENT
SCHEDULE "I)"
l'
~~a
\~,;;t~:t!. ~.,
1.~'I;ll,t-"'/1 ,\
IJ;~f,,:'~~:.~t:(:~:J.
B E ~\ EFl C fAHI ES
~ BEN!=FICIARIES AND ADDRESSES -~~r~t~~~~~~~po~i Sl.~;~~p~~--'-II .-- DATF I
.:state ~ud names and addres~es of all who I iJlpgitlmnte chldrcn I-,?E(:~;.~)ENf O}'
lave an lntere~t, vested, contmgent. or other-'I arc lnvolved, set I STA d_ TYE:s BIRTJT
wise. in esta!p) . I forth thIs fact.l I OR NO I _____~ I
Janet B. Windsor i Daughter i Yes; ~
1118 Apple Drive ~ l ] !
Mechanicsburg, Pa. I .. . f -I~
~- I I ~
=t. II -I --r-
I ~...~ I ~
-L- I ~ I
i ! I I
I '. --l-
+== I
INTEHEST OF
nrNEFICTARY
!>S EST\TE
100%
I
I -
I I
I
=t ,
t-
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--
t== I
1 I
I I
I
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Deponent further says that all the above-named hene:ficiari.es are living at this time except below:
- -- .
NAME DATE OF DEATH RESIDENCE
I
....
c
, ..-
:~ ~ @
E~~
"0 0. u
1 g,
sc.;~
:;~t:
r:.; :=; 0
~ E e
~ 0::
SUM~1ARY
( Sch. "A")
(Sch. "B")
_ _. (Sch. "C")
Heal Property
Personal Property
Transfers
Gross Taxahle Estate
( 1 )
(As Reported)
$
$
$
$
$
$
( Z)
(As Ikkrmirll'd\
$
$
$
$
$
$
!:- "0
Z QJ
... W <Il
C':l ~ ~
~ - QJ
..... ,.,., <:.> <
W QJ
Q rr.,
(fJ -
...... <
-< ~ CI:
0::: ~ '2 =-
p... 0 ~ =-
p... .2:
w -< w <
:t ~ W ;,.
..... W t-< f-< S Q
C ~ ...... ~ ~ c:; Z
- 0 f-<
Z t- Vl p... ~
~ W ...... ~
--------- 0 0 CI:
,...
5 ~ .... 0
'"' :..
-.c W ;...;
t';; t- ...... " c=:
... t- o "
.... 5
.~ ~ C 1::. ~
.5 ,;'. ~ :=
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......
R C C-38
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERIT ANCE TAX
RESIDENT DECEDENT
SCHEDULE" En
JOINTLY OWNED PROPERTY
INSTRUCTIONS: This schedule must disclose all property, real and personal, owned hy 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 descriptl.on, as indicated tmder 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 acquisition, and the name, address and relationship (if any) of co-owners to
the decedent.
Description of Property, Date of Acquisition, Name Unit percentage Estate
Address and Relationship of Co-Owners, and Place Value Share Valuation
of Record of Instrument, where Real Estate.
The following accounts were in
the joint names of Minnie T. Barr
and Janet B. Windsor:
F & M Savings Association, ~.
savings account 51-621557 ~
100%
F & M Savings Association
savings account 33-048436, opeped
in June of 1971 - $9,221.58 ~
50%
Dauphin Deposit Bank and Trust
Company checking account
13-83-59]-9 onened in June of
1971 - $1,094.27
50%
Insert this total opposite "Jointly Owned Property", Schedule "E"
in the" As Reported" COIWl111 on the last page of this return.
DEPARTtlENT VALUATION
CAUTION-Do not Write
In This Space.
Value of Value of
Entire Decedent's
Property Interest
/'"
20,134.79
II "..--. ....,.
~,610.79 %~z..JIJ
5/1:7.13
---------
2~,292.71
~.5 dq~." l
J.~13i.f.1
ltJ (p I D. 1
.5'ii. l~
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COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
HARRISBURG
17127
r'1AY 12 1978
RCC-43 (4-71)
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-: I~I W
\-- . Q {iJtfi\- ('
(l:tJ;ff'l/YI..; Y ~ Ii yYlJi
NOTE: TO BE SUBMITTED IN TRIPLICATE
REPORTING FINANCIAL INSTITUTION
ADDRESS
).J) t-1
:U-1 $'-(,71
Pennsylvania Department of Revenue
Bureau of County Collections
Gable Building, 3rd, Floor
411 S. Second Street
Harrisburg, Pennsylvania 17127
Daaph1n Depoal t Bank I Tl'uet Ca.
21' ~e' 8'l'ee'
H"1'18bu1'g. penneylvanl.
ZIP CODE 17105
Pursuant to Section 742, Pennsylvania Inheritance and Estate Tax Act
of 1961, we herewith submit the following report:
ACCOUNT NO. OF JOINT, TRUST OR
INVESTMENT DEPOSIT
13 83 531 ,
NAMES ON ACCOUNT OR
INVESTMENT
Mzo.. Hinnie T. SUI' 01' Jan.t B. Windeal'
Mev 8.1'78
DATE OF DEATH
DECEASED JOINT DEPOSITOR, TRUSTEE
OR INVESTOR
MI'.. Minni.
ADDRESS 1118 Appl. Dl'lve
Mechanlcllbura. Penn.vlvani.
COUNTY
ZIP CODE
T. Berl'
/i ,
C Li Ii!, t.',-
1'1055
, ,
"U(/:(.(
SURVIVING DEPOSITOR:1
BENEFICIARY OR INVESTOR
J...., 8. Windeal'
Unknolll1
ADDRESS
RELATIONSHIP TO DECEDENT
D.ughter
DATE DEPOSIT OR INVESTMENT
WAS ESTABLISHED
&-28-71
BALANCE, INCLUDING INTEREST
DUE, AT DATE OF DEATH $
'1,0'''.27
\\-~G'I C1 ~Jh l~(,
~re TITLE
Ja Ann C. Staver
A..l.tent Man...1'
D.pad t Account S.rvic..
..
R E V.5IB (B.7B)
DEPARTMENT OF REVENUE
BUREAU OF FIELD OPERATIONS
P.O. BOX 2970
HARRISBURG
17105
IN YOUR REPLY PLEASE
REFER TO
Inheritance Tax Division
NOTICE OF FILING OF APPRAISEMENT
Janet B. Windsor
1118 Apple Drive.
MpC'h.<mi C'~hn't"gJ PA
(Executor or Administrator)
In Re: Estate of
Minnie T. R;::Jrr
Cumberland
County - Fi Ie No.
21-78-0678
Dear
Yau are hereby notified that the Original
appraisement in the estate of Minnie T. R::lrr
has been filed in the office of the Register of Wi lis of r.nmh"''t''1 ~"r1
County on 5 March , 19...1.9.-, Said appraisement reflects the following
valuations:
Real Estate
Personal Property
Transfers
Jointly Owned
Total
NnJle
bIn"'"
No"",
?11,?Q? 71
$25,292.71
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), month,S
(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 Inherit~~~~ and
Estate Tax Act of 1961,72 P. S. 2485-1001, P. L....)l:\3. \"-~ ," ",.,---,--\---"
Date
11 M;::J't"('h 1979
Si gned
c_/
\...._)
Titl e Administr::l'tiv", Offi ('er
L-.,..-,
----.
Note: This is not a bill.
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-----.....,; ...-1,
oa V,
REV-457 (8-78)
DEPARTMENT OF REVENUE
BUREAU OF FIELD OPERATIONS
P.O. BOX 2970
HARRISBURG, PENNA. 17105
COMMONWEALTH OF PENNSYLVANIA
RESIDENT INHERITANCE TAX
APPRAISEMENT
D....;.:.
5 March 1979
COUNTY _ ~lmhpr1~n~
FILE WJ. 21-78-0678
Whereas, Minnie T. Barr late of Mechanicsburg
in the County of Cumberland Commonwealth of Pennsylvania, having died on
the Rt"h day of May 19 ~ , seized and possessed of an estate
subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania;
Therefore, I, T.po 1"111 ~initi , 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 ~}I'owing 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 the right to appraise and assess transfer inheritance taxes at the lawful collateral
rate on any such future interest.
DESCRIPTION OF ASSET
UNIT
VALUES
l Appraisement
Made for Inheritance
Tax Purposes
1"n.,..~l
}:::: r
~ Non:=Ju~_
F ~~:~:~f~~~
L I~
~ -+
~ E-
I
Real Estate
Personal Property
'T'r;:tn!; fp.r!;
Jointly "Owned
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Have been duly sworn according to law, I do hereby certify that the above appraisement is made in confor.mity
with the law on this 5th day of ,SJ Mar-ch, ... 19 EL-.
(""---- 7--(~,~'_:'~' '" - - - , - ~f~-.~..
Appraiser
Harrisburg
(Number and Street)
(Post Office)
. Penna.
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