HomeMy WebLinkAbout12-14-78
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R C C-~'ti (4-73) . **
COMMONWEAL TH OF PENNSYLVANIA
DEP AR TMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
I' , .J,
. 'I- i
j.,! ),~ 'c.J ". ' -' ,;
RESIDENT DECEDENT COUNTY OF C-umberland
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 Re1tenue. (Section 703 of the Inheritance and Estate Tax Act of 1961.)
IN THE MATTER OF THE ESTATE OF } AFFIDAVIT OF
Sara D. Davidson EXECUTOR
(STATE FULL NAME OF DEC EDEN T)
Cumberland County ADMINISTRA TOR
La te of
State of Fennsv'ivPl'li .:01 } '"
u
County of CUJ:lberl8.nd
.Tane B:. 1l~widson,. dtil..u,Ght~r Executor
Administrator of the estate of the above-named decedent being duly sworn, deposes and says :
Decedent died Oct,oner 11 , 19-2B-~aVing a last will, capy af which is hereto attached. }
(MONTH) (DAY) (YEAR)
Ho.. o.d .dd,... .1 ....,.., " }
other authorized repres,entative to whom
all carrespandence should be mailed.
That as such rl::ll10'nt.P't' deponent is familiar with the affairs of said estate and the property constituting
(EX ECUTO R- ADMIN I ST R A 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
i'lonA
That the contents of said safe deposit box or boxes are itemized under Schedules of this return,
with the exception'of the following, for the reasons hereinafter set forth:
That Scheau/e 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 as se s sed valuation of each of said parcels, the estimated market value thereof
as of date of death of decedent.
That Scheaule 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 pos ses sion, s tanding to decedent's credit in banks of deposi t, 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 primr 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
s av ings, treasury certificates or note s 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:!ies owned by the decedent at the time of death, with the ,market value there-
of at such time.
:( 1-.f) 3- bbb
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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 there is annexed to
said schedule, fjnancial statements showing the assets and liabilities of said co-partnership or business.
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 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 f'orth the nature and value of such property, to whom transferred, the
relationship of the transf'erees to the decedent, the proportionate share received by ea~h transferee and
all other facts of a pertinent nature regarding said transfers. In the case of transfers intended to
take eff'ect in possession or enjoyment at or after death, there is also attached to the schedule a cOAY
of the deed, trust agreement or other instrument creating the trust. There is also set f'orth 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 with another, or any power of appoint-
ment vested in decedent, ei ther individually or jointly, by the will, deed, or other ins trument of another,
with a copy of the instrl~ent 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 and others, plus the date and place of record of instruments eff'ecting 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 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 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 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 Schedules "A", "B", "en, "E", and "F" as directed therein,
have been carried f'orward and properly registered in the Summary.
Subscribed and sworn to before me this ............................
:~ ~ M). f'
........L.f.:...~y............._ day ~ ..>..(t~"j;-Y.,:~........19..Z...~...
.......~~;c"'&,(-i!...L_......X .. .......b?.~/i+~~~=........h.......h
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....2... .Haldeman....cour.t.......................................h.............................
(Street Number)
...N~w....C.:umD..e.r.l.g,n.~1,.....P.a.......17o.70......... ...........................
(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.
''I
RC C.34 t 4.73)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
,TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE IIA"
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 Penn.ylvanla .hould be (1) (2) {3l
de.crlbed by lot and block number. .treet and .treet number. together wi th DEPARTMENT
a general ducrlptlon of the property. with a ref.rence to the r.cord of the ASSESSED VALUE VALUATION
conv.yanc. by which the dec.d.nt took tltl.; If a farm .tat. numb.r of a. FOR YEAR OF ESTIMATED CAUTION
cr..; al.o .tat.m.nt of mortgage encumbrance. upon each parc.1 at d.ath
of d.c.d.nt. Taxe., a.....m.nt.. accru.d Inter..t on mortgage.. etc.. are DECEDENT'S MARKET VALUE (Do not write
to be lI.t.d on Schedul. "F" and mu.t not be d.duct.d from thl. .ch.dule. DEATH In thl. .pace)
-O- N 0 f\L
HarJE
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.
Nor"lL.
pee -35
RESIlE:~n DECEDENT
SCHEDULE "B"
PERSONAL PROPERTY
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COMMONWEALTH 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 with 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 filrnishings, 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 fiduciary in said capacity, partnership interests, interest in anyundistributed
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.
Item
No.
ITEM
List and describe fil11y
UNIT
VALUE
ESTIMATED
MARKEr VALUE
DEPARTMENT VALUATION
(Do not write in
this space)
1
r~ld Coins (appraised by Commercial Coin Company)
V
$1,160000 V"
2
Cash
4.23 v'
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)
'i.~~
(n,164.23
Insert this total opposite "Personal Property", Schedule "B" in
the "As Reported" column on the last page of this return.
x X
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t!o.vru.'U!ial C!oln C!0Inpan.!J
. fP. O. !Box 607 ttr!/
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RCC-36
COMMONWEALTH OF PENNSYLVANIA
TRANSr~R INHERITANCE TAX
SCHEDULE "c"
TRANSFErtS
RESIDENT DECEDENT
(1) Did decedent, within two years ofdeuth, make any transfer of any material part of his estate, without
receiving a valuable and adequate consideration therefor? (Answer yes or no) gg
(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 transfer of property without receiving a valuable or adequate
consideration therefor which was to take effect in possession or enjoyment at or after his death?
(Answer yes or no) nil
(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) nn
(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 promise to
pay income to or for the benefit of care of transferor? (Answer yes or 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 c01l1d 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)
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 Schedules A, B, or E.
ITEM
DESCRIPTION
MARKET VALUE
(Es Uma ted)
DEPT. VALUATION
(Dept. Only)
i,-;~\,_,",
-0-
t\\ont
Insert this total opposite "Transfers", Schedule "C" in the
"As Reported" column on the last page of this return.
NOnl
RCC-J7 (12':..63)
CO~tI\!O~\\'EALTIl OF rE;''::'\SYYL:\~IA
TRANSFER INHERITA]\,'CE TAX
RESIDENT DECEDENT
SCHEDULE "D"
~r~.~. t
r'::+i:;i "
/J"l,', ,,4. ,\
IjJ:!:~~~.:~;'F;,,,D,
BENEFrCIAHIES
--r- RELA TIONSH!P I
BENEFICIARIES AND ADDRESSES, mL _ I (If step-children or I
\State fuII na.mes and addresses of all who I ilIl'gitimate chlrlren I
have an interest, vested, cont ingent or other-, are involved, set
wise, in estate!.. -+-- fort.h t.hls f~act.) I
Marion M. Pleasants i Son-in-law I
I
-----.--l
SUr..VIVED
DEC";'I>F"T
ST A;rI~ YES I!
OR NO
I
I
DATE
OF
BIRTH
INTEREST OF'
m:NEF'ICJ AllY
IN EST HE
Yes
'"
Box 1105
,Jane Eliza1)eth Davidso
? PR] c1AlURJ) (;nll,...t.
Dau~hter
Yes
leral
]~- Residue
New Cumof"r1and, PaA 17070
on Sara Davi o!';on Pl easant!';
Daw'hter
Yes
leo-al
I
-L ~ Residue _
fioX llOc:' i L
Front Royal, Va. 22630 I I
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Deponent ftlrther says that all the above-named beneficiaries are living at this time except below:
NAME
DATE OF DEATH
RESIDENCE
....
c
~ ...~ ~-
~:' ~
.~ 1; E
.~ ~ .3
-0.0
'0 _ <.J
<:: c
, 0;
s.... C'.J "C
,0) '",
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u ::l 0
~ E e
>:: ~
Heal Property
Personal Property
Transfers
JointlyO\med Property..
SU~fMARY
(Sch, "A")
, ( Sch, "B")
(Sch. "e")
(8' w-n)
.....' .cn..r::.. .
Gross Taxable Estate
~ '0
Z a.>
.... t.il '"
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(1)
(As Reported)
-O~
( 2)
(As Ddl'rmiIH'd)
$
$
$
$ .,.24,08S.63
$
$,
$
$
$
$
$
$
1,161+.23
,-.-0...
25.,249.86
R C C-38
RESIDENT DECEDENT
SCHEDULE" E"
JOINTLY OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
INSTRUCTIONS: This scherlule must disclose all property, real and personal, ~ned 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 Imder Schedule
"A", plus the date and place of record of instrument effecting vesti ture, but do not include entireties
or out of state real estate value in estate valuation column. Personal property should be listed as in
Schedule "B", plus date of acquisi tion, and the name, address ami 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.
DEPART1ffiNT VALUATION
CAUTION-Do not Write
In This Space.
Value of Value of
Entire Decedent's
Property Interest
~CIIlLc;~ecking Acc9lilllt #195-936-0, Balance
C,s6h2.2W \ '-I ':L \.., [A, '\\~~,\'l 'r
CO-()'{{11er: Jane 2. Davidson, DauGl1ter
2 Haldeman Court
New Cwnber1~~d, Fa. 17070
state Capital ~ines & Loan A~unt
#002-o007J.49yi3a1ance :1;6783.64
A.ccrured Intsrest)1l3.00 v'
Co-Owner: Jane Eo Davidson, daughter
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3,391.821~
56.50.
.3) '3l\. /. ~ ~
5/', s V
::220,999 u.s. Treasury Notes 8t~0 dlllE 6-30-80
$19,843.75 I
Accrued Interest ~~472.08
Co-Owner: Sara D. ~easants, dauehter
Box 1305
Front Royal, Va. 22630
$20,000 U.S. Treasury Notes 8t% due 6-30-80
!p19,843.75
Accrued Interest .472.08
Co-();mer: Ja.'1e E. Davidson, daughter
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;61.9'74,(/ (..; 't/~6.J..DO
f
... ,.r' __,
Cj 24,085 .~?~
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Insert this total opposite "Jointly Owned Property", Schedule "E"
in the" As Reported" colunm on the last page of this return.
~~~l.1. ~
November 7, 1978
To wnom It May Concern:
As of ~ber 11, 1978, t,he balance in account number
002-0007149 (Sara D. Davidson or Jane E. Davidson, her dau-
ghter) was $6,783.64,~th accrued earnings of $113.00. ~/
Sincerely,
r" I',
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"'___ r:t. -\.__~"':"-~-,-",.". f-,
! l
',,;1<'u~_<.L
Darlene K. Ricci
Branch Manager
Camp Hill Branch
State Capital Savings & Loan
'"
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*'
REV-SIB (B-7B)
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
NOTICEJOF FILIIIlG OF -APPRAISEMENT
ane K". - Davidson
2 Haldeman Court
New Cumberland, PA 17070
(Executor or Administrator)
In Re: Estate of
Sara D. Davidson
Cumberland
County - Fi Ie No.
21-78-0666
Dear Miss Davidson:
You are hereby notified that the original
appraisement in the estate of Sara D. Davidson
has been fi led in the office of the Register of Wi lis of Cumberland
County on February 28 , 19~, Said appraisement reflects the following
va I uations:
Real Estate
Personal Property
Transfers
Jointly Owned
Total
None
1,164.23
None
23,367.29
$24,531.52
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 February 28, 1979 Signed c:;:; ''----:> \.. '\~'---'-- U"'v--A--"'-^--.-
Title
Administrative Officer
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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
APPRAISEMENT
DATE
February 28, 1979
Cumber1e,nd
21-78-0666
COUNTY
FILE NO.
Whereas, Sara D. Davidson late of Ne,.} Cumber1c:nd
in the County of Cumberland Commonwealth of Pennsylvania, having died on
the 11 th day of October 19 ~, seized and possessed of an estate
subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania;
Therefore, I, Leo Fulgini ti , 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 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 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 Appraisement
VALUES Made for Inheritance
Tax Purposes
$ None
Real l:'ronertv
Personal froperty 1 , l6il 23
Transf ers Fone
Joint-Held Property 23,367 29
TOTAL ASSETS 24,531 52
Have been duly sworn according to law, I do hereby cl;lrtify that the above appraisement is made in conformity
with the law on this 28th day of \.". '---, _ . -February 19 79 .
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Appraiser
(Number and Street)
Harrisburg
(Post Office)
. Penna.
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