HomeMy WebLinkAbout05-01-79 (2)
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COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
sf I /71
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R C C-33 (4-73)'
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RESIDENT DECEDENT
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COUNTY OF Cumber] and
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 Reuenue. <Section 703 of the Inheritance and Estate Tax Act of 1961.)
Late of
Cumberland
} AFFIDAVIT OF
EXECUTOR
ADMINISTRA TOR
County
IN THE MATTER OF THE ESTATE OF
ROBERT H. CARR,
(STATE FULL NAME OF DECEDENTI
State of
F~r.lr.U.~71 HAr.li:;l
) ..,
County of
Admini s tra tor
Joseph R. Carr
of the estate of the above.named decedent being duly sworn, depose
Executor
and say
(MONTH)
Name and address of attorney or }
ather authorized representative to wham
a II correspondence should be me i led.
(DAY)
, 19~{testate leaving a last will, copy af which Is hereto attached..}
( YEA R) }{1}P)[M~XX
Decedent died
November 23,
Jan M. Wiley. Esquire ~ Wilpy ~ Rpnn
O{1~sb~~k~i~Rrr7aI9' P.O. Box 288
That as such Executor deponent is familiar with the affairs of said estate and the property constituting
(EX ECU TO R-ADMINI 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 following: -
NAME AND ADDRESS OF BANK OR OTHER INSTITUTION THIS SAFE DEPOSIT BOX RENTED RELATIONSHIP OF JOINT
IN WHICH DECEDENT RENTED A SAFE DEPOSIT BOX IN NAME OR NAMES OF HOLDERS TO DECEDENT
C..C..N.R. RANK, N...A p,...ho....t- l-l r"''''....
Roiling C;rring~, PA 17nn7
That the contents of said safe deposit box or boxes are itemized under Schedules
wi th the exception of the following, for the reasons hereinafter set forth:
of this return,
That Schedule A attached hereto and made part her,eof 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 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 pri<Of to decedent's
death in the case of savings banks, and to the date of decedent's death in all other cases;. all bonds, postal
savings, treasury certificates or notes and other evidence of indebtedness of the United States to the de-
cedent; all obligations, whether by statute or agreement they are designated as tax free, of the United States,
or any state, or political subdivision thereof, or of any foreign country, which are owned at the time of death;
all wearing apparel, jewelry, silverware, pictures, books, works of art, household furniture, horses, carriages,
automobiles, boats, and any and all other personal chattels of whatsoever, kind or nature, left by decedent,
together with the fairly estimated market value thereof; all bonds and mortgages held by decedent and of all
claims due and owing decedent at the time of death, and all promissory notes or other instruments in writing
for the payment of money of which decedent died possessed, of whatsoever nature, with interest thereon, if
any, giving the face value and estimated fair market value thereof, and if such estimated fair market value be
less than the face value, it sets forth briefly the reasons for such depreciation as to each item; all moneys
payable to the estate from life insurance policies carried by decedent; all annuity and endowment contracts
the proceeds of which were payable upon the death of the decedent; all and the corporate stocks and dividends
due thereon and unpaid as of the date of death, bonds and accrued interest thereon to the date of decedent's
death and other investment secur: l,'S owned by the decedent at the time of death, with the market value there-
of at such time.
In the case of securities of close or family corporations, the values reported are as far as
possible substantiated by financial statements of the corporations, showing the assets and liabilities
thereof as of the date of death. The schedule also sets forth the interest of decedent at the time of
death in any co-partnership or business, and in support of the value of such interest there is annexed to
said schedule, financial statements showing the assets and liabilities of said co-partnership or Qusiness.
A copy of the co-partnership agreement, (if oral, a statement setting forth the nature of the agreement)
together with Ii statement settin)!; forth the character of the business, its location, and such other facts
pertaining to the business as may be pertinent to a fair and just appraisal of the decedent's interest
therein must be submitted. It should also set forth in itemized form, together with the fair market value
thereof, any other property owned or bequeathed by the decedent at the time of death.
The Schedule C attached hereto and made part hereof sets forth a true answer to each inquiry
contained therein and in the case of transfers of property, real or personal, within two years of decedent's
death, in contemplation of decedent's death, or intended to take effect in possession or enjoyment at or
after death, said schedule sets forth the nature and value of such property, to whom transferred, the
relationship of the transferees to the decedent, the proportionate share received by each transferee and
all other facts of a pertinent nature regarding said transfers. In the case of transfers intended to
take effect in possession or enjoyment at or after death, there is also attached to the schedule a copy
of the deed, trust agreement or other instrument creating the trust. TherR is also set forth in said
schedule a list of all property, real and personal, with its value, which paE:ses at decedent's death by
virtue of the exercise by decedent, either individually, or jointly with another, or any power of appoint-
ment vested in decedent, either individually or jointly, by the Will, deed, or other instrument of another,
with a copy of the instrument creating such power attached to the schedule.
That Schedule D attached hereto and made part hereof sets forth the names and addresses of all
persons beneficially interested in this estate at the time of decedent's death, the nature of their res-
pective interpsts, their relhtionship, if any, to the decedent, together with the ages at the time of
decedent's death of all minors, annuitants and beneficiaries for life under decedent's Will. It also
contains a statement showing which of' the beneficiaries named in the decedent's will, if any, died prior
to decedent, thfl dates of their death, their issue, and 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 and others, plus the date and place of record of instruments effecting the vestiture of
real estate and the date of acquisition of personalty, plus the name, address and relationship, if any,
of co-owners to the decedent.
That Schedule F attached hereto and made a part hereof sets forth fully and in detail all debts
and deductions claimed for and on behalf of this decedent's estate, including f\meral expenses paid;
family exemption, where applicable; costs of administration of this estate; counsel fees and fudiciary's
commissions paid or to be paid; cost expended for burial trusts, tombstones or gravemarkers, and reli-
gious services, in consequence of the death of the decedent; debts and claims owing ami unpaid at time of
death; taxes accrued chargeable for period prior to d~cedent' 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 fiduciary will present proof of said claimed obligations upon re-
quest, that if the amount actually paid in settlement of any fee, commission or debt is less than the
estimated amount claiming and allowed, that the same will be reported to the Register of Wills, and that
the amount of tax assessed can be reassessed in accordance therewith.
That
have
the totals of the appropriate columns in Schedules "A", "B",
been carried forward and properly registered in the Summary.
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"en,
"E" ,
and "F" as directed therein,
Subscribed and sworn to before me this
.... ..........." ...,. day of ..1L Lcfmm:7," ......... 1, Q.:...?.~....
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JOSE H R. CARR
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(ExeC'Utor-~~X
Church St. ~A~tt~f1~APi:i
......................................................h.........................................................................
(Street Nu.mber)
. .., ,... .....A ~.le.n.~. ...P..A....1.Z'O.QZ........ .... .............. .... ... ... ..... ........... ....... ........
(City M Town and State)
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NOTE: Before signing affidavit make sure all blank spaces in the affidavit and schedules annexed are
filled in with details or the word "None", and in case the assets include rare and unlisted securities,
securities of close or family corporations or an interest in any co-partnership or business, that the
data and statements requirerl under the paragraph above relating to Schedule "B" are attached. Also make
certain that column #1 in the "Summary" has been properly completed as above-directed.
RC C-34 (4-73) .
COMMONWEALTH OF PENNSYLVANIA
DEP~RTMEN"T OF REVENUE
BUREAU OF COUNTY COLLECTIONS
TRANSFER INHERITAtoICE 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 Commol'lwealth of Pennsylvania should be (1) (2) (3\
described by lot and block number, street and street number, together with DEPARTMENT
a general description of the property, with a reference to the record of the ASSESSED VALUE VALUATION
conveyance by whl ch the decedent took title; If 0 farm state number of 0- FOR YEAR OF ESTIMA TED CAUTION
cres; also statement of mortgage encumbrances upon each parcel at death DECEDENT'S MARKET VALUE (00 not writ.
of decedent. Taxes, assessments, accrued Interest on mortgages, etc.,are DEATH In this space)
to be listed on Schedule "F" and must not be deducted from this schedule.
.
NONE
Insert this total opposite "real prope, ,.,", Schedule "A" in the X X X X X
"As Reported" column on the lost page of this return.
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Rcc-36
.COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
SCHEDULE "c"
TRA.NSFERS
RESIDENT DECEDENT
ROBERT H.CAAR
(1) Did decedent, within two years of death, make any transfer of any material part of his estate, without
receiving a valuable and adequate consideration therefor? (Answer yes or no) no
(2) Did decedent, within two years of death, transfer property from himself to himself and another or
others (including a spouse) in joint ownership? (Answer yes or no) no
(3) If the answer to (1) or (2) above is in the affirmative state:
(a) Age of decedent at time of transfer
(b) State of decedent's heal th at time of making the transfer. (Note 1).
(c) Cause of decedent's death. (Note 1).
(4) Did decedent, in his lifetime, make any transfel' of property without receiving a valuable or adequate
consideration therefor which was to take effect in possession or enj~yment at or after his death?
(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?
(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
(7) Did decedent in his lifetime make a transfer, the consideration for which was transferee's prolnise 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 could revert to decedent under terms
of transfer or by operation of law? (Answer yes or no) no
(9) If the answer to (8) above is in the affirmative, was the power to alter, amend, or revoke the inter-
est of the beneficiary reserved in the decedent alone or the decedent and others?
(Answer yes or no) no
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 of 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 S~hedules A, B, or E.
ITEM
DESCRIPTION
MARKET VALUE
(Es tima ted)
DEPT. VALUATION
(Dept. Only)
NONE
NONE
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Insert this total opposite "TranSfers", Schedule "C" in the
"As Reported" column on the last page of this return.
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LAST WILL AND TESTAMENT
I, ROBERT H. CARR of YoungsvillQ Borough, County of Warren and
State of Pennsylvania, being of sound mind and memory, do hereby make,
publish and declarQ this to be my Last Will and Testament, in manner and
form following, hereby revoking any will or wills heretofore made by me.
FIRST~ I direct that all my just debts and funeral expenses be
fully paid and satisfied, as soon as conveniently maybe, after my deceasQ.
SECOND: All of the rest,' residue and remainder of my estate,
real and personal, of whatsoever kind and wheresoever situate, I give,
devise and bequeath to my. wife, ANNA CARR, absolutely.
THIRD: In the event that my said wife, Anna Carr, predeceases
me, I give, devise and bequeath all of the rest, residue and remainder of
my estate to my children, HELEN WILSON of R. D., Clarendon, Pennsylvania,
MARY MOORE of Coudersport, Pennsylvania, and JOSEPH R. CARR of Allen, Penn-
sylvania; pr:the survivors or survivor.of them, in equal shares; provided,
however, that if any of my said children shall predecease me leaving issue,
him or her surviving the issue shall take the share his or her parent
would have taken if living at my death.
FOURTH: I do hereby make, constitute and appoint my daughtQr
~> HELEN WILSON arrl my son JOSEPH R. CARR to be my Executors of this my Last
31 2..-' I' .; Wi 11 and Tes tament.
IN WITNESS WHEREOF, I, ROBERT H. CARR, the Testator above named,
have hereunto subscribed my name am affixed my seal, the
.~ -l:-I:-
day of
April in the year of our Lord one thousand nine hundred and sixty-five (1965).
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RCC-37 (12-'63)
COl\tl\t()NWEA"LTH OF PENNSYYLANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
.SCHEDULE un"
BENEFICIARIES
(
h
BENEFICIARIES AND ADDRESSES RELATIONSHIP SURVIVED DATE
(If step;.ehildren or 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
JoseDh R. Carr rhilrlrpn /':1. ,..d' raC';,.J"'lru
-
Allen, PA yes pstate.
Mary Moore children yes /3 of residuary
Coudersport, Pennsylvania ,pstate.
Marie Silvis grand-daughter yes /9 of residuary
San Antonio, TX state
Mrs. Frazier - Barnett /9 of residuary
S:1r.l. ^r.l.t9r.l.i9, 'T'V --' --' ,
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Mark Wilson 2randson VPC: /9 of residuary
1~ e w 1. U 1. t\., 1~. 1. . scate
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Deponent fUrther says that all the above-named benericiaries are living at this time except below:
NAME
DATE OF DEATH
RESIDENCE
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Signed, sealed, published and declared by the above named
ROBERT H. CARR as and for his Last Will and Testament in the presence of
us, who have hereunto subscribed our n~mes at his request as witnesses
,
thereunto, in the presence of ~aid testator, and of sach other.
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SUMMARY
Real Property ..................................................... .. (Sch. "A")
Personal Property .................................................................. (Sch. "B")
Transfers . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . .. .. . . . . . . . . . . . . . . . . . . . . . (Sch. "e")
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Gross Taxable Estate ..
(1)
(As Reported)
None
$
$ ..........~&,)04~.6.4.....
$...........N o.ne.......
$...............
$................. ...................
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(2)
(As Determined)
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~'C C-38
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 decedent 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 rIo not include entireties
or out of state real estate value in estate valuation column. Personal property shoulrI be listed as in
Schedule "B", plus date of acquisition, and the name, address anrI relationship (if any) of co-owners to
the decedent.
Description of Property, Date of Acquisition, Name
Address and Relationship of Co-Owners, and Place
of Record of Instrument, where Real Estate.
unit
Value
percentage
Share
Estate
Valuation
DEPARTAffiNT VALUATION
CAUTION-Do not Write
In This Space.
Value of Value of
Entire Decedent's
Property Interest
NONE
NONE
Insert this total opposite "Jointly Owned Property", Schedule "E"
in the" As Reported" colUlill1 on the last page of this return.
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REV.5IB (3-79)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF FIELD OPERATIONS
P. O. BOX 2970
HARRISBURG
17105
IN YOUR REPLY PLEASE
REFER TO
I nvestigation Division
NOTICE OF FI LING OF APPRAISEMENT
Joseph R. Carr
Church Street
Allen, PA 17007
(Executor or Administrator)
In Re: Estate of
Robert H. Carr
Cumberland
County - File No.
21-78-0671
Dear Mr. Carr:
You are hereby notified that the original
appraisement in the estate of Robert H. Carr
has been filed in the office of the Register of Wills of Cumberland
County on June 29 ,19~. Said appraisement reflects the followiJ'lg valuations:
Real Estate
Personal Property
Transfers
Jointly Owned
Total
None
57,383.64*
None
None
$57,383.64
As to such tax that is paid within three months from date of death, a five (5%) percent
discount is allowable. As to any tax that remains unpaid after nine (9) months (fifteen months
when death occurred from December 22, 1965 to June 16, 1971, inclusive; and twelve months
when death occurred prior to December 22, 1965) from date of death, interest at the rate Of six
(6%) percent per annum is charged.
Any party in interest who is aggrieved by this notice may object thereto within sixty
days after receipt of said notice as provided by Section 1001 of the Inheritance and Estate Tax
Act of 1961, 72 P. S. 2485-1001, P. L. 373.
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Date
.TllnF~ 29, 1979
Signed
Title Administrative Officer
*The Railroad Retirement Board death benefit in the amount of $821.00
is not taxable for Inheritance Tax purposes.
NOTE: This is not a bill.
REV-457 (8-78)
DEPARTMENT OF REVENUE
BUREAU OF FIELD OPERATIONS
P.O. BOX 2970
HARRISBURG, PENNA. 17105
I, COMMONWEALTH OF PENNSYLVANIA
RESIDENT INHERITANCE TAX
APPRAISEMENT
DATE
COUNTY
FILE NO.
June 29, 1970
--
Cumberland
21-78-0671
Whereas, Robert H. Carr late of '=1"\111-1-. M-f rlrI1 9tQR Tg~:l;uill;dp
in the County of Cumberland Commonwealth of Pennsylvania, havin~: c.",,' or
the 23rd day of November 19 2@...., seized and possessed ~,tcl e
subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania;
Therefore, I, Leo Fulginiti , an appraiser duly appointed according to la; 1,
having been designated to make a fair and conscionable appraisement of the said estate, and to assess and fix the cash
value of all annuities and life estates growing out of said estate, hereby file the following appraisement:
In the event that any future interest in this estate is transferred in posseSSion or enjoyment to collateral heirs of the decedent after H1" '''':0: Ion
of any estate for life or for years, the Commonwealth hereby expressly reserves the right to aporalse and assess transfer inheritance taxes at t!lc 'awful (nHatral
rate on any such future interest.
DI::SCRIPTION OF ASSET UNIT P.pprClis( I
VALUES tor I nh
Purp
---.,
$ i
Real P"'^F^"""f-y' None I
:J
Personal Property 57, 383 ~
Transfers None!
Joint Held Property None:
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TOTAL ASSETS 57,383,
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Have been duly sworn according to law, I do hereby certify that the above appraisement is made in COnfC,T1lty
with the law on this 29th day of" ' , '. June 19 ~L.
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COMMONWEALTH OF PENNSYLVANIA
COUNTY OF 6UMBERLAND 11 t ,r 1:
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55:
JOSEPH R. CARR
being duly sworn according to law, deposes and says that he is
the Executor of the Estate of RORFRT H r.ARR
late of churc~'_!~=-r:'_~ic-~~;~~:~~s,-:::.", /,_.-l~~ ' Cumberland County, Pa., deceased and that the
within is an inventory made by Joseph R. Carr ;/__ _ -J the said Executor
of the entire estate of said decedent, consisting of all the personal property and real estate, except real estate outside
the Commonwealth of Pennsylvania, and that the figures opposite each item of the Inventory represent it's fair value
as of the date of decedent's death.
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and subscribed before me,
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Church Street
Allen, Boiling Springs,
Pa, 17007
Address
Date of Death
23
Day
November
Month
197R
Year
INSTRUCTIONS
I. An inventory must be filed within three months after appointment of personal representative.
2. A supplement inventory must be filed within thirty days of discovery of additional assets.
3. Additional sheets may be attached as to personalty or realty
4. See Article IV, Fiduciaries Act of 1949.
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Inventory of the real and personal estate of
ROBERT H. CARR,
deceased.
1. C.C.N.B. Bank, N.A. checking account #713-4867-6
5,174. 3
2. C.C.N.B. Bank, N.A., Savings Account #077-117105-5
(interest to date of death)
21,890. 9
167. 4
3. C.C.N.B. Bank, N.A. Certificate of Deposit #6337
(interest to date of death)
27 ,000. 0
222. 3
TOTAL GROSS ESTATE
10.r5
568.10
I 82l-pO
I I
112,350.po
II L
$58,204.64
4. Refund from Blue Cross - Blue Shield
5. Pennsylvania Railroad Voluntary Relief fund
6. Railroad Retirement Board (death benefit)
7. Joseph R. Carr - debt owed decedent