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HomeMy WebLinkAboutMatter of Appraisement RCRI.33a-50M-5-51 -1O c OMMONWE..LTH OF PENNSYLVANIA TRANSFER INHERITANCE TAX RESIDENT DECEDENT SCHEDULE "A" REAL PROPERTY REAL PROPERTY IN PENNSYLVANIA, WITH STATEMENT OF MORTGAGE ENCUMBRANCES UPON EACH PARCEL AT DEATH OF DECEDENT. WHERE PROPERTY HELD AS JOINT TENANT OR TENANCY BY ENTIRETIES, GIVE NAMES, ADDRESSES AND RELA- TIONSHIP OF OTHER OWNERS. The real property located in the Commonwealth of Pennsylvania should (1) (2) (3) be described by lot and block number, street and street number, together DEPARTMENT with a general description of the property, with a reference to the record ASSESSED VALUE VALUATION of the conveyance by which the decedent took title; if a farm state number FOR YEAR OF ESTIMATED of acres; also statement of mortgage encumbrances upon each parcel at DECEDENT'S MARFET VALUE CAUTION death of decedent. Taxes, assessments, accrued interest on mortgages, etc., DEATH (Do not write are to be listed on form RCRI-10 and must not be deducted from this in this space) schedule. TACT #1: Farm 65-Acres, situate in Montgomery Township, Franklin County, Pennsylvania, adjoining Stouffer and Smith, conveyed to the decedent by Clyde Wingert by Deed recorded Vol. _172_, Page �. 4,320.00 13,000.00 13,000.00 Improvements: Brick and frame house, frame barn and other buildings. TRACT #2: Farm situate in Montgomery Township, Franklin County, Pennsylvania, containing 86••Acres, adjoining Stouffer and Fri}r, conveyed to the decedent by Newton Wingerd, by Deed recorded Vol. 214 , Page 334 , 5,000.00 13,000.00 13,000.00 (Executor-Administrator must total column No. 2 and carry total to column No. 1 in x x x x "Summary" on reverse side of Schedule D.) 26,000.00 26,000.00. • • RCRI-33b-50M-1-52 --l0 COMMONWVEALTH OF PENNSYLVANIA TRANSFER INHERITANCE TAX RESIDENT DECEDENT SCHEDULE "B" PERSONAL PROPERTY Cash in hand, Cash on deposit, Bonds and Mortgages, any interest In a Copartnership or Unincor- (z) porated Business, Judgments. Royalties, Rights, Shares in Trust Funds, Leaseholds, Pensions, Promis- (1) sory Notes, Claims, Insurance payable to Estate of Decedent: Annuity and Endowment Contracts: ESTIMATED DEPARTMENT Corporate Bonds and Stocks, with Accrued Interest and Dividends Declared and Unpaid to Date of Unit VALUATION MARKET VALUE Death, Accounts Receivable, Jewelry, Wearing Apparel, Silverware, Household Goods, Automobiles Values CAUTION and All Other Personal Property of Every Nature Wherever Situate. (Property held jointly by AT decedent and another must be listed showing names and addresses of other Joint Owners and their DATE OF DEATH (Do not write in relationship to decedent.) this space) Balance shown on Final Account of Guardian of Otha P. 8,797.83 8,797.83 Martin, a weakminded person. now deceased in cash - _ :3 20-shares of stock First National Bank of Mercersburg9 Par Value $10.00 600.00 600.00 (Executor-Administrator must total "Estimated Market Value" column No. 1 and carry total t.. © q column No. 1 in "Summary" on reverse side of schedule D.) $ ,t ,39/f 83 9,397.83 Note: This schedule must list all intangible personal property such as, cash in bank, bonds and mortgages, promissory notes, claims, insur- ance, corporate bonds and stocks, accounts receivable, interest in partnership, etc., even though physically located outside the Common- wealth at the time of death. As to tangible personal property (e.g., jewelry, wearing apparel, silverware, household goods, books, paintings, automobiles, boats, etc.) state where it was actually located on the day of the decedent's death. Tangible personal property which is definite- ly established to have been physically situated outside this Commonwealth other than for a temporary purpose, is not subject to tax in this Commonwealth. In the absence of a specific declaration as to actual situs, said property will be presumed to have been physically present within this Commonwealth at the time of death. RC'R.I-33c-100M-3-49 COMflIONWEALTH OF PENNSYLVANIA TRANSFER INHERITANCE TAX RESIDENT DECEDENT SCHEDULE "C" TRANSFERS ANSWER EACH QUESTION SEPARATELY (1) Did decedent, within one year of death, make any transfer of any material part of estate without receiving an adequate, valuable consideration therefor? (Answer "Yes" or "No") (2) Did decedent, at any time, make any transfer of property in contemplation of death, without having received an adequate valuable consideration therefor? (Answer "Yes" or "No") .. DID (3) Did decedent, at any time, make any transfers of a material part of his estate without having received an adequate, valuable consideration therefor? (Answer "Yes" or "No") NC... Is It conceded that such transfers were made in contemplation of or to take effect at death? (Answer "Yes" or "No") Nq. (4) Did decedent, at any time, transfer any property in trust by deed or agreement? (Answer "Yes" or "No") TO (5) Did decedent, deputy, or joint renter, within one year of death, withdraw property or evidence of property from any safe deposit box, registered either in decedent's individual name, Jointly with another, or to which decedent had access by an agent or as agent for another, and make distribution ofsuch property without having received an adequate, valuable con- sideration therefor? (Answer "Yes" or "No") If the answer is "yes" to this question, state below the name of the bank in which the box was located, in whose name registered and set forth the nature and value of the property removed, date of removal, and to whom distributed. (6) If the answer to any of the questions from 1 to 5 is "yes," then detail below the nature and value of the property trans- ferred, date of transfer, to whom transferred, and all other facts surrounding said transfer, and in case the transfer was in trust, attach a copy of the deed, agreement or other instrument creating the trust if not of record, otherwise by reference to such recording. Department DESCRIPTION Estate Valuation Valuation as of CAUTION Date of Death (Do not write in this space) NONE • (Facecutor-Administrator, if any of the transfers listed above are conceded to be taxable, must total "Estate Valuation" column No. 1 and canes total to column No. 1 in "Summary" on reverse side of Schedule D.) Note: If additional space is required attach riders of the same size. • COMMONWEALTH OF PENNSYLVANIA TRANSFER INHERITANCE TAX RESIDENT DECEDENT SCHEDULE "D" BENEFICIARIES BENEFICIARIES AND ADDRESSES RELATIONSHIP SURVIVED AGE OF LIFE INTEREST OF (State full names of all and their addresses who (If step-children or DECEDENT TENANTS OR BENEFICIARY illegitimate children ANNUITANTS have an interest, vested, contingent or other- STATE YES IN ESTATE are involved, set AT DEATH OF wise, in estate.) forth this fact.) OR NO DECEDENT John D. Marti* E. R. #24lercersburgo Penna. Son Yes — — — Entire • Deponent further says that all the above-named beneficiaries are living at this time with the exception of:— NAME DATE OF DEATH RESIDENCE }load IMPORTANT-SEE REVERSE SIDE SUMMARY (1) (2) o — (As Reported) (As Determined) a Real Property (Sch. "A") $ 26,000.00 $ 26,000.00 Personal Property (Sch. "B") $.. 9,397.83 $ 9,.397...83 1 g Transfers (Sch. "C") $ .U0 $„ .00 w li y $ $ � 4 $ $ Gross Taxable Estate $... 35,397.&0 $ 35,397.83 5 H ..9 a w <1 1 0 w Z W w w o a a r___A_Th w w a o O a xpt O a W 0 W w o a E 1� V y