HomeMy WebLinkAbout03-03-79
RCC-33 (4-73)
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
~~ .~,':
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~enue. (Section 703 of the Inheritance and Estate Tax Act of 1961.)
Cumberland
} AFFIDAVIT OF
EXECUTOR
ADMINISTRATOR
IN THE MATTER OF THE ESTATE OF
HAZEL C. TAYLOR
(STATE FULL NAME OF DECEDENT)
Late of
County
State of
Pennsylvania
} ..,
County of
Cumberland
Kathryn T. Newcomb, daughter & Sllrvi v; ng .To; n t- Ownpr
KUx.x.K:,,.,f the above-named decedent being duly sworn, depose S and sap
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Decedent died
September 18.
(MONTH) (DAY)
, 19~{~estate leaving a last will, copy of which is hereto attached..}
(YEAR) Intestate
Name and address of attorney or }
other authorized representative to whom
all correspondence should be mailed.
Robert L. Myers, III, Myers, Myers, Flower & Johnson
1rn &. Market Streets, P.O_ Box 125. T.emoyne. Pa
] 7043
That as such dauqhter deponent is familiar with the affairs of said estate and the property constituting
( ~InOX~U~*D()XOOX~
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
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
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 pri€lT 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, silvf:rware, 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;lics owned by the decedent at the time of death, with the market value there-
of at such time.
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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 t!1ere is annexed to
said schedule, financial statements showing the assets and liabilities of said co-partnership or llUsiness.
A copy of the co-partnership agreement, (if oral, a statement setting forth the nature of the agreement)
together with a statement setting forth the character of the business, its location, and such other facts
pertaining to the business as Illay be pertinent to a fair and just appraisal of the df'cedent's interest
therein must be submittpd. It should also set forth in itemized form, together with the fall' 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, sai,i schedule sets forth the nature and value of such property, to whom transferred, the
relationship of the transferees to the decedent, the proportlonate share recelved 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 enjo~~ent at or after death, there is also attached to the schedule a co~y
of the deed, trust agrf!ement 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 pa~ses at decedent's death by
virtue of the exercise by decedent, either individually, 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 names and addresses of all
persons beneficially interested in this estate at the time of decedent's death, the nature of 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 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, the 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 Ilnd 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 deceden t.
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 funeral expenses paid;
family exemption, where appli cable; cos ts of adminis tra tion 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 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 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 cl aiming 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 total s of the appropriate columns in Schedules "A", "B", "e", "E", and "F" as directed therein,
have been carried forward and properly registered in the Summary.
Subscribed and sworn to before me this .................................
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My Co1I1mi.~ion Expir'.!s De=. 21, 1981 ...~~.:mQy.ne...f......p..e..nns.Y.l.vania....l.7.Q.4.3..............
Ldnoyus. Pa. Cumb.dand COUl':'Y (City or Town and State)
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 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.
. day of . ...w..i.,.~..".,,"";..:.~,~.... ....... 19...1..X..
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RCC-34 (4-73)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
. TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE uA"
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 liE.")
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 TION
conveyance by whl ch the decedent took title; If a farm state number of a. FOR YEAR OF ESTIMA TED CAUTION
cres; also statement af mortgage encumbrances upon each parcel at death DECEDENT'S MARKET VALUE (Do not write
of decedent. Taxes, assessments, accrued Int.rest on mortgages, etc.,ore DEATH In this space)
to be listed on Schedule" F" and must not be deducted from this schedule.
None yl/~
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.
rtor:.u
RESIDLNf DECEDENT
SCHEDULE "B"
PERSONAL PROPERTY
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I3CC -35 .
CO~lliONWEALTH OF PENNSYLVANIA
T~~SFER 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 with another or others
mllst 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 furnishings, 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 rlivldends, salaries or wages, insurance pay-
able to the estate or firluciary 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 listerl in this schedule.
Item
NO.
IT)!::M
List and describe fully
UNIT
VALUE
ESTIMATED
MARKEr VALUE
DEPARTMENT VALUATION
(Do no t wri te in
this space)
Bequest from Estate of Martha M.
Morris, Deceased
$750. 00 y...~r
750. &0
Insert this total opposite "Personal Property", Schedule "B" in
the "As Reported" colUllll1 on the last page of this return.
x X
73().f)tJ
RCC- ')S .
CU\l:\HJ\WEALTIf OF l'L::\\~YL\-J\NT;\
Tl-lA\SFFE T\HFlUT!-\\CF TAX
SCHi~:)1JLL'; "e"
T 1\ \\<..:FEJtS
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ii.ES Il1E\T fWCFnF\T
(1) Did decedent, within two years ofoeath, make any tl'l.lilsf'er" of any material part of his estate, without
receiving a valuable and ade1luate consideration theref'or? (Answer yes or no) No
(:2) Did npcedent, wi thjn two yell.rs of dRath, transfer properLY from himsel f to himsel f and another 01'
(,thers (includj n!!; Ii spouse) in joint ownership? (Answer yes or no) --.Ye..s___
(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 decerlent's ih"!alth at time of making the transfer'. (Note 1).
(c) Cause of dece(lent's death. (Note 1).
(4) Did decedent, in his lifetimf', make any t.ransfer of property without rec(~iving a valuable or adequate
consideraUon therefor which was to take effect in possession or enjoyment at or Ilfter his death?
(Answer yes or no) No
(a) Was there any i10ssibili ty that the property transferred might return to transferer or his
estate or be subject to ids power of disposition? (Answer yes or no) Nn
(b) What was the transferee's age at time of' decedent's rteath?
(.5) Din decedent in his lifetime make any transfer without receiving a valuable awl ade'luate consideration
therefor un(ler which transferor expressly or impliedly reserves for bis life or any period which does
not in fact end IJef'oT'e his death:
(a) The possession or e'Moyment of or the right to income from the property transferred?
(Answer yes or no) 0
(b) The right to tiesignate the persons who shall possess cr enjoy the property transferred or
income theref'rom? (Answer yes or no) Nn
(fi) If the answer to (5) (b) above is in the affirmative, state whether the right was reserved in decedent
alone or others
(7) Dirt decertent in his lifetime make a transfer, the consideration for which was transferee's promise to
pay income to or for the lJe>1efit of' care of tr'ansf'eror? (Answer yes or no) l\[n
(8) Did decedent, at any time, transfer property, the beneficial enjoyment of which was subject to change,
because of' it reserverl power to alter, amend, or revoke, or which cOl1ld revert to c\ecedent under terms
of transfer or by operation of law? (Answer yes or no) No
(9) If the answer to (8) alJOve 1.3 in the affirmative, was the power to a1 tel', amend, or revoke the inter-
est of the beneficiary reserved in the decedent alone or the decedent and others?
(Answer yes or po) No
~OTE1: The answers to these questions SllOUl d he supporteel by affidav i I, by the atteTHUng physi cian as
well as a copy of the neath certificate.
~OTE 2: If answer to any of the above questions is yes, set f'orth below a description of the property
transferre'l, it's fair market value at date of death, dates of transfers and to I"hom transferrerl, with
relationship of transferees to elecedent, if any. Submit copy of any trust deed or instrument, if trans-
fers are claimed to be non-taxable, also stililoit detailen statement of f~cts on which said claim is based.
~OTE 3: List apj11 icable property below in manner in which pr'oviden in Schedules A, B, or E.
ITEM
UESCRIPTlON
MARKET VALUE
(Es tima ted)
DEPT. VALUATTON
(Dept. Only)
Dauphin Deposit Bank and Trust
Company, Checking Account No.
owned by Hazel C. Taylor or Kathryn
T. Newcomb opened September 7, 1977.
. /I
$490.16
.if q (). / It,
Insert this tntal opposite "Transfers", Schedule "e" in the
"As Reported" colllnID on the last page of this return.
$490.16
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RCC-37 (12-63)
. .
CG:\ll\ll):'\\\'E.-\LTll OF l'EXXSYYL\l'\IA
TRANSFER 1:\'IlERITAl'\CE TAX
RI<:SIDENT DEl'EDENT
SCHEDULE "1)"
BE!\EFICIARlES
BENEFICIARIES AND ADDRESSES
State full names and addresses of all who
lave an interest, vested, contingent or other
wise, in estate)
Kathryn T. Newcomb
808 Riverview Road
Lemoyne, Pa. 17043
RELATIONSH~--r--.
(If step.chlldre~' or ! Sl:~~:V,Ep DATE
iIle<'itlmate children DI'.CL.)f~NT OF
a~e involved sct STATE YES
forth this f~cL) OR NO BIRTH
Daughter
9-18-78
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INTEREST OF
BENEFICIARY
IN ESTATE
Entire
Yes
NAME
Deponent further says that all the above-named beneficiaries are living at this time except below:
DATE OF DEATH
RESIDENCE
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SUMMARY
(Sch. "A")
......(Sch."B")
......(SCh. "e")
( 1 )
(As Reported)
$.... ~O~
$ . .750~.O 0
$ ..490.16..
S
$
$1240.16
Real Property ..............
Personal Property
Transfers
Gross Taxable Estate
(2 )
(As Determined)
$
$
$
$
$
$
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R C C-38
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COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE" E"
JOINTLY OWNED PROPERTY
INSTRUCTIONS: This schectule must disclose all property, real and. personal, ownert by the (lecedent 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 Imder 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 VLlJuation 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 Acquisi tion, Name uni t percentage Estate
Address and Relationship of Co-Owners, and Place Value Share Valuation
of Record of Instrument, where Real Estate.
792.513 shares of the Dreyfus Fund,
Inc., Account No. 308240-9, owned
jointly by Hazel C. Taylor and
Kathryn T. Newcomb which account was
opened on July 2, 1968. Value of
$13.61 per share - $10,786.00. v'-
(See attached)
DEPART~ffiNT VALUATION
CAUTION-Do not Write
In This Space.
Value of Value of
Entire Decedent's
Property Interest
~-
$5,393.0
Savings Account, Dauphin Deposit
Bank and Trust Company, No. 12-1-05767
owned jointly by Hazel C. Taylor or
Kathryn T. Newcomb which account was
opened on September 7, 1977 with
proceeds from an account of Mutual
Savings and Loan Association of
Padadena, California, No. B-l-02672
registered in the name of Hazel C. ·
Taylor, Trustee for Kathryn T. Newcomb~
Insert this total opposite ",Jointly Owned Property", Schedule "E"
in the" As Heported" colunm on the last page of this return.
S7,084.9
Swt.
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17JI$'V
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*'
R E V-SI8 (8-78)
COMMONWEALTH OF PENNSYLVANIA
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
Kathryn T. Newcomb
808 River View Road
Lemovne. PA 17043
(Executor or Administrator)
In Re: Estate of Hazel C. Taylor
Cumberland
County - Fi Ie No.
21-78-0673
Dear
Yau are hereby notified that the Original
appraisement in the estate of Hazel C. Taylor
has been filed in the office of the Register of Wills of Cumberland
County on 1Ath of 59pt., 19~, Said appraisement reflects the following
valuations:
Real Estate
Personal Property
Transfers
Jointly Owned
Total
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-.
Date
8 Mar(''h lc}7c}
Si gned
Title Administrative Offj('pr
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Note: This is not a bill.
REV-457 (8-78)
DEPARTMENT OF REVENUE
BUREAU OF FIELD OPERATIONS
P.O. BOX 2970
HARRISBURG, PENNA. 17105
COMMONWEALTH OF PENNSYLVANIA
RESIDENT INHERITANCE TAX
APPRAISEM ENT
DA,E ~ March 1979
COUNTY Cumberland
FilE NO. 21-78-0673
Whereas, Hazel C. Tavlor late of Lemoyne
in the County of Cumberland Commonwealth of Pennsylvania, having died on
the 18th day of September 19 ~ , seized and possessed of an estate
subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania;
Therefore, I, Leo Fulginiti , 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 l1fowing 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 Commonwe,alth 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 APpraisement
VALUES Made for Inheritance
Tax Purposes
Real Estate $ None
Personal Pronertv .-zJ 00
T,..",na-Fo,..a 49C 16
Tn;nt'ly Ot..mPrl 1') 1.'7~ 93
-'--' -- -
Tnt'..1 $13,7H 09 -
- !
I
I
Have been duly sworn according to law, I do hereby qeptify that the. above appraiserpent is made in conformity
with the law on this RTh day of .. - MarC'h .' , 19 -1iL..
.
Appraiser
(Number a nd Street)
Harrisburg
. Penna.
(Post Office)
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