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HomeMy WebLinkAboutRegister of Will • _ Ir Form RC I-33-50M-1.52 -44B50-10 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE OFFICE OF THE REGISTER OF WILLS COUNTY OF FRANKLIN RESIDENT DECEDENT IN THE MATTER OF THE ESTATE OF AFFIDAVIT OF Otha D. Martin EXECUTOR (State full name of decedent) Late of Montgomery Townships County ADMINISTRATOR State of Pennsylvania County of .... Franklin $5' John D. Martina Administrator of the estate of the above-named decedent being duly sworn, depose S and say • . Decedent died February 11th , 19 S3 intestate leaving a last will, copy of which is hereto attached.} (Month) (Day) (Year) Name and address of attorney or Pala K Crider other representative to whom all correspondence should be mailed Chaiiibersburg.Penn* That as such Administrator deponent is familiar with the affairs of said estate and the property con- (Executor•Admin Istrator) stituting 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 of Bank in which decedent rented a safe deposit box. This safe deposit box rented in name or names of: None 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 seized and possessed, or in which decedent had any right, title or interest at the time of death. It also sets forth the mortgage encumbrances upon each parcel of real prop- erty 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. In the case of building and loan mortgages it sets forth the face value of the mortgage and states separately the number of shares of building and loan stock pledged to secure the same, the name of the association and the withdrawal value of said shares. As to property encumbered by a building and loan mortgage, the face amount of the mortgage has been deducted from the estimated market value of the property in ascer- taining the value of decedent's equity therein, and the building and loan shares have been listed in Schedule "B" at their withdrawal value. 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 wheresoever situated owned by the decedent or in which said decedent had any right, title or interest at the time of death; all moneys left by the decedent at the time of death, whether in decedent's immediate possession, stand- ing to decedent's credit, or in which decedent had any right, title or interest in banks of deposit, savings banks, trust companies, or other institutions, whether individually, or in trust for, or jointly with any other person, giving also separately the accrued interest thereon, if any, down to the last interest day prior to decedent's death in the case of savings banks, and down to the date of decedent's death in all other cases; all bonds, postal savings, treasury certificates or notes and other evidences of indebtedness of the United States to the decedent; all obliga- tions, 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 or in which the decedent held an interest 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; and all 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 in- vestment securities owned by the decedent at the time of death, with the market value thereof at such time. In the case of securities of close or family corporations, the values reported are as far as possible sub- stantiated 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 business. A copy of the co-partnership agreement, if written, or a statement setting forth the nature of the agreement if oral; 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. It also sets forth in itemized form, together with the fair market value thereof, any other property owned or left by the decedent at the time of death. That 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 one year of decedent's death, in con- templation 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 re- garding said transfers. In the case of transfers intended to take effect in possession or enjoyment at or after decedent's death there is also attached to the schedule a copy of the deed, trust agreement or other instrument creating the trust. There is also set forth in said schedule a list of all property, real and personal, with its value, which passed at decedent's death by virtue of the exercise by decedent, either individually, or jointly with an- other, of any power of appointment 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 bene- ficially interested in this estate at the time of decedent's death, the nature of their respective interests, their re- lationship, if any, to the decedent, together with the ages at the time of decedent's death of all minors, annui- tants and beneficiaries for life under decedent's Will. It also contains a statement showing which of the bene- ficiaries named in the decedent's will, if any, died prior to decedent, the dates of their deaths, their issue, anu the relationship of such issue to the beneficiary. That all the statements made herein are to the best of deponent's knowledge, information and belief and that the respective schedules set forth all the property of the decedent insofar as the deponent has knowledge at this time. That the totals of the appropriate columns in Schedules "A," "B" and "C," as directed therein, have been carried forward and properly registered in column #1 in the "Summary" on the reverse side of Schedule "D." Subscribed and sworn to before CC me this /day of )274) - rffitgittrili--Administratcrr) R. R. *2 NOTARY PUBLIC (Street Number) My Commission Expires Mar.22,1955 Nex'esrburga Pennsylyania4 s * *'. - A (City or Town and State) Note: Before signing affidavit make sure all blank spaces in the affidavit and schedules annexed thereto 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" on the reverse side of Schedule "D" has been properly com- pleted as above-directed. a.