HomeMy WebLinkAboutOC1968-0254 - ESTATE OF WALTERSRcc-al (2-64)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
INHERITANCE TAX DIVISION
NOTICE OF FILING OF APPRAISEMENT
GRACE RADIOND
IN YOUR REPLY PLEAGE
REP'ER TO 37-93-4
In Re:Estate of ..:L:.:IL=L=IAN='--=L:.:;._W..:..:..:..;.A;:;:;LT.:;;;ERS==--_
_____....Iw:u:AS!t!>aJoH..nt.l'~Glo!.oT~O~N!..--County -File No.63-68-254
De ar Mrs.Raymond:
You are hereby notified that the original
appraisement in the estate of Lillian L.Walters
has been filed in the office of the Register of Wills of Washington
County on JWe 2 ,19..22..Said appraisement reflects the
following valuations:
Real Est ate .,..---=---=-=-::-~-
Personal Property 2~,~O~O~O~.~O_O~_
Transfers _
Total --,-__..::2:.1.~O;:!OO~.OO~·~_
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 one year from date of death,interest at the rate
of six (6%)percent per annum is charged.
Any party in interest who is aggrieved by an appraisement may
appeal therefrom as provided by law.
Date .!!!!:mm~o~2=:..1.~lcL96~9L..·_SiBnej&UeC/:;r &~
Title W,R,CHANEY,C ..APPRAISER
DATE or'DEATH:January 1,1968
ESTATE INSOLVENT
Note:This is not a bill.
RCC-39 (5-66)
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SUMMARY
Estate of Walters
(Last Name)
Lillian
(First Name)
L.
(Initial)
DATE OF DEATH 1-1-68 FILE NO.63-68-254
REPORT OF INHERITANCE TAX APPRAISER
I,the undersigned duly appointed Inheritance Tax Appraiser in and for the County of Washington
Pennsylvania,do respectfully report that I have appraised the real and personal property as reported in the foregoing return at
the values set forth opposite each item in the last column to the right in Schedules "A","B","C",and "E".
Dated:__--=:.0.::..6--'0'-'2'--~6~9-----
01-01-68 #£~.e~INHERiTANCE~APPRAISER·
REPORT OF THE REGISTER OF WILLS
I,the undersigned duly elected Register of Wills in and for Washington County,Pennsylvania,do respect-
fully report that I have allowed deductions in the amounts claimed by deponent,except as to those items where a greater or
lesser amount is set forth in the last column to the right in Schedule "F",which greater or lesser amount represents the sum
allowed ..a dedoetioo.?~~~~_~_~,
Dated:06-02-69 ~PVI/'Vf/~
REGISTER OF WILLS
$2,000 00
2.000 00
3,506 95
e Insolventat
$
2.000 00
2.000 00
3,506 95
Est
VALUE AS REPORTED VALUE AS APPRAISED VALUE AS REAPPRAISED
$-------+--
INVENTORY
Real Property (Schedule A)
Personal Property (Schedule B)
Transfers (Schedule C)
Joint-Held Property (Schedule E)
TOTAL GROSS ASSETS
Less Debts and Deductions
(SCHEDULE F)
CLEAR VALUE OF ESTATE
Valuation of life estates or
:::::~.~~.~~~~~~~;:..... :===========t=-t
FOR USE OF REGISTER ONLY
Tax on $--1-__2%
Tax on $@
Tax on $5%
Tuoo$lK
Tax on $15%
~e~tioos *
Total Estate ~--
TOTAL TAX
COMPUTATION OF TAX
$--------+---
$--------+---
$-------4--
$--------+--
$-------4--
$L..-_
(*)As evidenced by Charitable
Exemption Certificates issued
by the Secretary of Revenue.
Less tax previously paid
BALANCE
Less 5%of tax if paid within
3 months after death ::::::::::::::1===
BALANCE OF INHERITANCE TAX DUE $t=
Add interest at rate of 6%from
to ----C$---AMOUNT OF ESTATE TAX ASSESSED $.
Estate tax paid $I
BALANCE DUE $....JL--
Add interest at::te of 6%from $---------It=
TOTAL TAX BALANCE $------i.
PAID $---'
FOR USE OF REGISTER ONLY ADJUSTMENTS
NOTE:Where subsequent adjustments are made to the above computation of tax by the Register of Wills,for proper reason,
same should be noted below,with short explanation.
-------------------------------------
Will l N
Administration ~o.
IN THE
Year .
MATTER OF THE APPRAISEMENT
OF THE
ESTATE OF
LILLIAN L.W'ALTERS
Deceased
Late of ...........STOCKDALE .....
County of ..WASHINGTON ...
Commonwealth of Pennsylvania
REPORT AND APPRAISAL
:;,<"
DEPAR"MENTOF REVENUE
BUREAU OF COUNTY COLLECTIONS
HARRISBURG,PENNA.17 127
COMMONWEALTH OF PENNSYLVANIA
.~RESIDENT INHERITANCE TAX
APPRAISEMENT
DATE ~~.~~?,L J:.9.§9 .
COUNTY ~~~.~.~.?:l.l:.
"fiLE NO..§.?:§.?::::.~.?4..
Whereas..J4J:..~.~~.~w.~~.~~.~late of $:t.Q.~J.5.9l~~~.~.
in the County of .w.~.~.~~~9..~Commonwealth of Pennsylvania.having died on
the J S?t day of ~~.mi~~;r.y 19 A.?seized and possessed of an estate
subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania;
Therefore.I w.~~..~9.h~P.:~y.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.
Unit Apprai.ementDescriptionofAssetValue.Made for Inheritance
Tax Purpose.
$
PERSONALTY:
Amount collected as a result of Action in Trespass
filed to No.1..37 March Term.1966 in the Court of
Common Pleas of Favette County,Pa.,entitled Grace
Raymond,Administratrix Estate of Lillian Walters,
dec'd et al a.gainst James R.Leonard,Executor Estate
of Jennie L.Basile et al.Amount received as per
settlement dated March 30.1969.2,000 00
Total 2,000 00
Estate Insolvent
fonn~;V;';;~hb:::::h~w"'ll:?~~l~~:~a~o~e~..~~~~~eaboVe~~~raise=~=~~
·"ifPr~i[~~·
~-..
(or d Street)
..........................................Penna.
(Pa.!;Olllee)
WASmINGTO~County..........••...•. .
RESIDENT INHERITANCE TAX APPRAISEMENT
Estate of
LILLINA L.WALTERS.................-.
Deceased.
Late of
STOCKDALE
••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••4••
Datc of Dcath,&1.~~~.Y ~,L..+..9.9..~.
Appraisemel!t Docket Vol.,)7 .
Page,93~4 No...6.3""6.8 254 ·
Filed in Register's Otfice,J.une 2,19..69.
A11WUnl of tax due,$..
DEPARTMENT OF REVENUE
Received,
Examined and Approved,..
Wrote abo.ut Appra.isement,
Appeal f1'om Appraisement,.
Entered and charged,..
,•
..
FOIln ;\0.RCC-62 (12-66)THIS FORM REQUIRED IN ALL ESTATES WITH GROSS ASSETS UNDER $10.000.UNDER SECTION 701 OF ACT OF JUNE 18.1981../
E~~CTIVE.,iANUARY 1.1982.(FILE IN DUPUCATE WITH COPY OF WILL ATTACHED)
OFFICE OF THE REGISTER OF WILLS
WASHINGTONCountyof .
.............~~~~.MW.Q@ of .~.~~.?~~,J ..~~~??~~.t.~.·..~?~.~T .
(Name)(Addreoa)
being duly f3!&Q};ltL .according to law,deposes and says that he is the ~_S!!l:_:!:~~_~_~£~~_~~~__~_~~_~~_~_
(Exec.,Adm.,Legatee,Etc.).
of the estate of ~~.lJj=a_n__.k~W~Jt_~_~~~_t.g_.whose last residence was ------------------------
(No.)(Street)
___S_t..g_C_kg_?-J._e :6_Q~_QUglL-----.deceased,and that the whole of the estate of said decedent,who died ~~~_~~£Y___}!..__.1968
(CitY,Borough or Township)(Date)
consisted of:
REAL PROPERTY
REAL PROPERTY IN PENNSYLVANIA.WITH STATEMENT OF MORTGAGE ENCUMBRANGES UPON EACH PARCEL AT DEATH OF DECEDENT.
WHERE PROPERTY HELD AS JOINT TENANT OR TENANCY BY ENTIRETIES,GIVE NAMES.ADDRESSES AND RELATIONSHIP OF OTHER OWNERS.
Real Estate
NONE
v _
{{,M I!J -.J1__AA7 .,~,
J C/,~-r:;1VLAA t?tf/.b,~~~.~
Estimated
Value
.
(/.,.
Personal Property
Amount collected as a result of Action in Trespass filed to
No.4~7 March Term.1966 in the Co~~t of Common Pleas of
FaYette County,Pa.entitled Grace Raymond.Administratrix
Estate of Lillian Walters,dec'de et al against James R.
Estate ofLeonard~Executor/of Jennie L.Basile et al
Amount received as per settlement dated March 30.1969 $2.000~~
v
NOTE:You may expedite the processing of this return by filing with it,and as a part of the return,
letters from financial institutions or mortgage holders,certifying to amounts on deposit or owed by the
decedent as of the date of death.Such letters must be signed by a responsible officer of the financial
institution or mortgage holder and indicate clearly amounts of principal and interest in the decedent's
account at the date'of death and the type of account,account number and the exact name or names in
which the account is registered..
-..,..----."-_.-.-..------,--.---------_._-_.--------:----------
Jointly Held Property Estimated \
Valire---r,;.
~,.
,,-.-
..'.~N -0 N E --
.
~~
-
Transfers within TWO YEARS Prior to Death
N 0 N E
That at the time of death there was no safe deposit box registered ih 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
n 0 n e
-
BENEFICIARIES
BENEFICIARIES AND ADDRESSES
RELATIONSHIP SURVIVED AGE OF LIFE
(If step-children or DECEDENT TENANTS OR,INTEREST OF
(State full names of all and their addresses who have illegitimate children STATE YES ANNUITANTS BENEFICIARYaninterest,vested,contingentor otherwise,in estate.)are involved,set OR NO AT DEATH OF IN ESTATEforththis(act.)--DECEDENT .
Lewis G.Walters I.-',-
Stockdale,Pa.Husband Yes All.,
,
Thelma L.Ermlich "~,.-
.-2506 N.20th Road Daughter V~p.NoneArlington,Va.
George H.Walters
5285 Hamilton Ave.
Lake Wood Park
Fort Pierce,Florida Son Yes None
R'EmDENT DECEDENT DEBTS AND DEDUCTIONS CLAIMED'
NOTE'List first five items in the spaces so provided,observe notations thereon,and instructions.
DEBT OR CLAIM NATURE OF SAME ...AMOUNT THIS COLUMN
iKEGISTER ONLY
Emil Eckert Funeral expenses paid $1~~7 bo $.
Family exemption (will not be allowed unless
decedent died residing with a spouse or children.)
Russell Marino Administration Expenses •l~==iO
August L.Sismondo Counsel fees •61 )0
Fiduciary commission •
I
OTHER DEBTS AND CLAIMS
(•)See Note below
Dr.Joseph Buch 100 OCDr.James Zaiden 100 OCUniontownHospital1914:
Att~.Henry R.Beeson 1700 g~Bet y J.Sweeney ,2
ESTATE INSOLVENT
Total 3,506 95
.....•...•...•0.·............•..•...··•··...·0 ...•
(City or Town and State)
..~<?~..5~~~.
(Street Number)
Ro~coe,Pa.15477
May...........day of
~'9-...V;"'-:~.r........,........~v
Note:The est~te agrees to advise the Register of Wills if the amount actually paid in settlement of any fee,commissio or debt is greater
or Ie.ss than the estimated amount claimed and allowed.~
. ..lOth ~Subscnbed and sworn to before me this.. . . . . . . . . . . . . . . . . . . . .., .
(Executor-Administ
Having been duly sworn according to law,I do her y certify that the above appraisement is made in conformity with law on this.&
..............~~dayof ~..~.~-""-'·~2 ~"':':o~..•~•.~~~.~.*
App~rEr
In the event that any future interest in this estate is transferred in possession or enjoyment to collatera heirs of the decedent after the
expiration of any estate for life 01'for years,the Commonwealth hereby expressly reserves the right to appraise and assess transfer'inheri-
tance taxes at the lawful collateral rate on any such future interest.
REPORT OF THE REGISTER OF WILLS·
I,the undersigned duly elected Register of Wills in and fo~.ounty,Pennsylvania,do respectfully
report that I have allowed debts and deductions in the amounts claimed by deponent,exc as to those items where a greater or lesser amount
.s set forth i the st column to the right in said schedule above,which greater or les amou.m presents the sum allowed as a deduction.
Dated:...~~~.....:=r:::..<:9c;z...............l..........~~...
Register of Wills
Fo,m No.RCC-62 (12-66)
.')
"..,,,Will'Administration }No,, , , , , , , , "Year , , , , ,
IN THE
MATTER OF THE APPRAISEMENT
OF THE '.(
ESTATE OF
LILLIAN L.WALTERS
Deceased
Late of Stockdale Borough................................
County of ,.~~,~J;1f..ngton.....................
...::...I
t'S::o1~m ~REP0!P'~~SP AP~A$AL
~U1 r"r·~~~l "t _{.
C:")fTl F'I""V.
-I ;:'-'1 i-..-:lQ......."...........0 .-..-0'"~"'n ~~--...o ~....---or"S:;u~.r-r.~
"'Or-Q~<fl,
Commonwealth of Pennsylvania
a;"""11
u::>
AUGUST L SISMONDO
ATTORNEY AT LAW
337 FALLOWFrELD AVE.
CHARLEROr.PA.
;
"~
...
RCC-39 (5-68)
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SUMMARY
Estate of FURMAN,
(Last Name)
JOHN
(First Name)
SR.
(Initial)
DATE OF DEATH 1-23-68 FILE NO.63-68-255
REPORT OF INHERITANCE TAX APPRAISER
I,the undersigned duly appointed Inheritance Tax Appraiser in and for the County of Washington
Pennsylvania,do respectfully report that I have appraised the real and personal property as reported in the foregoing return at
the values set forth opposite each item in the last column to the right in Schedules "A","B", "C",and "E".
VALUE AS REAPPRAISED
$--------+---
REPORT OF THE REGISTER OF WILLS
$IS '791 98
15.791 98
VALUE AS REPORTEDINVENTORY
Real Property (Schedule A)
Personal Property (Schedule B)
Transfers (Schedule C)
Joint-Held Property (Schedule E)
TOTAL GROSS ASSETS
Less Debts and Deductions
(SCHEDULE F)
CLEAR VALUE OF ESTATE
\~I,the undersigned duly elected Register of Wills in and for County,Pennsylvania,do respect-
fully report that I have allowed deductions in the amounts claimed by deponent,exce t as to those items where a greater or
lesser amount is set forth in the last column to the right in Schedule "F",ch greater r lesser amount represents the sum
allowed as a deduction.
Dated'~l~')'\....
Dated:__F=-=eb=,=-ru=a==-rJ-y--=5~,-=1=9.!...71~
Valuation of life estates or
(*)As evidenced by Charitable
Exemption Certificates issued
by the Secretary of Revenue.
COMPUTATION OF TAX
$-----r-":"-::-+....,.....,=_
$--......;.{...~3:.c12"'+~~·7-
$--------+---
$------~-
$------~--
$=::l:>-:..3_L.L....:~=--.,7_
:::::8:=L(._=_3:=t==~="
TOTAL TAX
Less tax previously paid
BALANCE
Less 5%of tax if paid within
3 months after death
FOR USE OF REGISTER ONLY
Tax on $------.,..-,....--1-.....,..,.-.YJ~
Tax on $11'\1;1./.)..71'~
Tax on $5%
Tax on $10%
Tax on $15%
~e~ti~s *
Total Estate----4-__
BALANCE OF INHERITANCE TAX DUE $t=
Add interest at rate of 6%from_____to $------
AMOUNT OF ESTATE TAX ASSESSED $------11-
Estate tax paid $---IL-
BALANCE DUE $---JI_
Add interest at rate of 6%from
------tto-----$~
TOTAL TAX BALANCE $----=----i
PAID $:2..10 .":7 OUet (JQ leL
FOR USE OF REGISTER ONLY ADJUSTMENTS
NOTE:Where subsequent adjustments are made to the above computation of tax by the Register of Wills,for proper reason,
same should be noted below,with short explanation.
Will IN
Administration)o.
IN THE
year .
MATTER OF THE APPRAISEMENT
OF THE
ESTATE OF
JOHN FURMAN,SR.
Deceased
Late of ,.,ASHINGTON...........................
.,
County of WASHINGTON
Commonwealth of Pennsylvania
REPORT AND APPRAISAL
J
-I
Fonn RCC-2--'~
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
HARRISBURG.PENNA.17 127
COMMONWEALTH OF PENNSYLVANIA'
RESIDENT INHERITANCE TAX
APPRAISEMENT
~DATE .f..~.p..r.~~.:r.y ?.~J~7J
COUNTY ~~.~.~.~.~.~~.~.~.
FILE NO §.~.::..§.e..::..~.??.
Whereas,J.<'..h~¥.~.~~~.n,§!...!late of ~~.~.l.t.~.~.~:t:.~.~.
in the County of Wa..s..b..ingt.p..n.Commonwealth of Pennsylvania,having died on
the ~.3.t..h day of J..~.~~~.!.y 19 §.~.,seized and possessed of an estate
subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania;
Therefore,I,Al:fr..~g lQ.~.~,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.
Unll Appralsemenl IDescrlpllonofAsselMadeforInherllanceValuesTaxPurpoles
$
REALTY:
See COpy of Schedule llAll attached to appraisement 15,791 98 I
Total 15.791 98
i
Having been duly sworn according t law,I do h~reb rtif that the above appraisement is made in con-
.,.~
...."7/~J :(~~..;.;;d..St~;~t ;.
··C··~··..·····~·......·....····..··......······........·····..,(Post Office)
Penna.
WASHINGTON.........................................................County
RESIDENT INHERITANCE TAX APPRAISEMENT
Estate of
JOHN FURMAN.SR.
Deceased.
Late of
lvASHINGTON
Datc of Dcath,.J..~t:l:1.l.~.~y ~~..,J.~.68 .
Appraiseme/!t Docket Vol.,~.7....
Page,.2...J.:::..;:,,-:No....Q.3..:::':.Q.8.:77.,z5...5..
Filed in Register's Office,Fe.b 5..,19 7.l
Amount of tax due,$.
DEPARTMENT OF REVENUE
Received,
Examined and Approved,.
Wrote ab(),ut Appra.isement,
Appeal j"om Appraisement,..
Entered and charged,..
!
Form RCC·J:<)
OFFICE OF THE
REGISTER OF WILLS
OF COUNTY
AND AGENT OF THE COMMONWEALTH
STATEMENT OF DE~~SL.
AND DEDUCTIONst/'Y"
~
DEDUCTIONS ALLOWED IN
5l.LJ Q 'L0
THE SUM OF $1 .
ESTATE OF ---::J:...;o:...;h.:.:n~F:...u.:...r=-m=a.:.:n~,-..::S....::r:....;.'---__LATE OF the Borough of Canonsburg,
DATE OF FILING APPRAISEMENT DATIi OF DEATH --'J~aldJn~u_a.r+y--Ao2...34,l----'1...9£..l61L:81oL------
DATE NO.OF NAM&:OF PAYEE REMARKS AMOUNTVOUCH"Jt
2/68 !Malone's Flower Shop Funeral Flowers 47 70
2/68 Citizens'.Water Company Last Bill 7 13
2/~8 ~est Penn Power Co.Last Bill 7 89
2/68 lBell Telephone Co.Last Bill 5 17
2/~8 Daily Notes Funeral Notice 5 00
2/68 Dr.Wm.Silvers Last Illness 10 00
2/~8 Father Ermakov-St.John's Ch.Funeral Services 97 00
2/~8 St.John's Church Opening &Closing Grave 75 00
2/~8 Csbg.-Houston Joint Authorit~Sewerage 5 31
2/68 Death
l 00IF.J.Bucklev Agency Liabilitv Insurance Due on 23
2/~8 ~anonsburg General Hospital*Last Illness gOH 100-
2/~8 ~ony Co laizzo Real Estate Appraisal 25 00
2/68 Dr.Jos.Carazola Last Illness 50 00
2/~8 p-ohn Yoney Funeral Services 1209 00
6/5lIng ITf'lhn n T~,-'-Recorder Stamp Taxes -Sal~2-8pertv 98 00
9/26V69 P.C.Derrico-Attorney-Reim Jursement of Following:
R.Marino-Reg.of Wills Grant of Letters 18 00
G.Rodgers Securing Witness Signatures 10 00
Washington Co.Reports Advertising Estate 12 50
Observer Publishing Co.Advertising Estate 12 50
9/26/69 .Hous!poid .. .household 1000 00MikeFurman-Son-:xemnt1.on Decedent l1.ved 1.n same
9/26169 Psbg.-Houston Authority . .1..DeathMun1.cipa Lien Pr1.or to
12/3/70 ~ohn Furman &George Furman Executors'Commission 800 00
12/31 70 ~.1 . h .pos~Attorneyl s Fee 800 00lTreeneeR1.c man Derr1.co
12/3/Posa *~~~~~08al Advancement for70Greenlee,Richman,Derrico &1.1.n osts 23 00
Total $5249 20
COMMONWEALTH OF PENNSYLVANIA }
COUNTY OF Wa shington so:
I.John Furman,Jr.,amid George Furman.
MYRA J.HARSHWashingtonCounty,Penna.h't Waohington Co.l10t8rYrliJ:;'.,Was 109 on.J~y Commbsion Expires March 12,1973
HEREBY CERTIFY.THAT.TO THE 8EOT OF
MY KNOWLEDGE AND BELIEF.THE FOREGOING IS A JUST AND TRUE STATEMENT OF DEBTB.FUNERAL EXPENSES AND EXPENSES OF
;::::~:::~:~~:::.::~.~~~~E.~~:~~OF 3r:o
hn o~yu~an~~.§~=~:~oua'O~:F:'~t:/~ecerJ!be~....10 ~____~ota'~~c~~~--
i '
.''lid "00 IJJL.'NIHSl1J.\
Sj 11 /1\:!C ~!'1.1,SJ~j :.t
01:1'.1',,',",1SjnH
:
6E 2/ii{j ul no 01..
t {J':f -'I',if........•~,J
:
.'-
.,,....
:
Form RCC-33
RESIDENT DECEDENT
·-
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
COUNTY OF
IMPORTANT:.This return must be completed in detail and filed in duplicate,with will attached,with the'
Register of Wills of the County where decedent resided;Return is due within one year after
date of death,unless an extension is granted by the Secretary of Revenue.(Section 703 of
the Inheritance and Estate Tax Act of 1961.)
Administrator
--_Jg~:-~:;;;ii;:;~:~~-------c..o....~·t..y···}==-
Late of W.~shing~.on._.
::.:::J':::~::~:_::=:-=:-:J'"
John Furman Jr..................................................,............
of the estate of the above-named decedent being duly sworn,depose
R-----
and say
Executor
Decedent died .......J.anuarv 23..,.,19.6.8 ..J testate leaving a last will,copy of which is hereto attached.}
(Month)(lilly)(Y""r)Lintestate
Name and address of attorney or}
other authorized representative to .
whom all correspondence should be
mailed.
G1:'~~Ill~.E!.,..Rj,GhqlgIl,P~+.X.:L.c.Q ~.P..Q aa ..
325Wa511 in~t:c:>1JT:r':1~t:Bl~g..:Y!.:I~~~1Jgt:'?l:1~~~!l1J..:I.~..
That as such .~~.!?.9.~..~Q;E deponent is familiar with the affairs of said estate and the property con-
(Execlitor-Administrator)
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 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
None
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 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 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 to the date of decedent's death
in all other cases;all bonds,postal savings,treasury eertificates or notes and o~her evidence of in-
debtedness of the United States to the decedent;all obligations,whether by statute or agreement they
are designated as tax free,of the United States,or any state,or political subdi;ision thereof,or of
any foreign country,which are owned at the time of death;all wearing apparel,jewelry;silverware,'pic-
tures,books,work~of art,household furniture,horses,carriages,automobiles,~oats,and any &nd all
other personal chattels of whatsoever kind or nature,left by decedent,together wi th the fairly estimated
market value thereof;all bonds and mortga~es 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 Qf death,bonds and accrued interest thereon to the date of dece-
dent's death and other investment securities owned by the decedent at the time of death,with the market
value thereof at such time.
~"-------------------
Subscribed and sworn to before me this J.~.g ..
.....
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 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 bequE'athed 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 ofproperty,real or personal,within two year~of decedent's
death,in contemplation of decedent's death,or intended to t~ke 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 co~y
of the deed,trust agreement or other instrument creating the trust.Ther,~1"s also set forth in said
schedule a list of all property,real and personal,with its value,which passes at decedent's death by
virtue of the exercise by decedent,either individually,orjointly with another,or any power of appoint-
ment vest;edindecedent,either individu,ally 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 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 funeral expenses paid;
family exemption,where applicable;costs of administration of this esta~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 lrnpaid 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", "C","E",and "F"as directed therein,
have been carried forward and properly registered in the Summary.
4/uJ~a~9J.......=..;.d.Y~:;19..10 ~;;;i;;;;:~_._"N~~~r~m.~MyIlAJ:~~~~~~lI,R~7~!~!;;:f;;j·······_·_"
My Commission Expires:-\~:r.i~'Wlll;!ri~~ll\'Wallhington Co G.9.D.O'P..SP.yxg,,.P.en.n.a .
~y COmmi~slon Expires March 12,1973 (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.
RCC-S<l (1-64)
-COMMONWEALTH OF PENNSYLVANIA'~t>EPARTMENTOF REVENUE
BUREAU OF COUNTY COLLECTIONS
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "A"
REAL PROPERTY
1
Real property in Pennsylvania,with statement of mortgage encumbrances upon each parcel at death of dece-
dent.Where property heid as joint tenant or tenancy by entireties,report on Schedule "E".Property hf'ld by
the decedent as tenant in common with another or others,should be identified as to quantum of interest and
the estimated value should be that of the decedent's interest only.
o1,hJ
4900.00 (
A 2-story frame house &lot situate in First
Ward,Borough of Canonsburg,known as
809 Laurel Street,Canonsburg,Penna.$
The real property located In the Commo"wealth of Pennsylvania should be
described by lot and block number,street and street number,together with
a general description of the property,with a reference to the record af the
conveyance by which the decedent took title;If a farm state number of a·
cres;also statement of mortgage encum~rancesupon each parcel at death
of decedent.Taxes,assessments,accrued Interest on martgages,etc.,are
to be listed on Schedule "F"and must not be deducted from this schedule.
(1)
ASSESSED VALUE
FOR YEAR OF
DECEDENT'S
DEATH
(2)
ESTIMATED
MARKET VALUE
(3)
DEPARTMENT
VALUATION
CAUTION
(Do not write
In this space)
2 Houses:
(Being the same conveyed to Mary Furman an~
John Furman,Sr.,Deed Book 516,Page 514.
The said Mary Furman died September 29,
1965,survived by John Furman,Sr.)
\./("-t~./It/I 11 tJ '
1d-.1f1-33 .f ~.'...~,/(((~~tq ~-.5~J !4qD )
(1)2-Story Frame House and Lot known as
335 Forrest St.and
(2)2-Story Frame House and Lot known as
341 Forrest St.
(See Deed Book 698 ,Page 323)
Redevelopment Authority Settlement 10,891.98
Total 15,791.98
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.
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "n"
PERSONAL PROPERTY
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 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 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 ITEM UNIT ESTIMATED DEPARTMENT VALUATION
No.List and describe fully VALUE MARKEl'VALUE (Do not write in
this space)
None
-
-
Insert this total opposite "Personal Property",Schedule "B"in X X
the "As Reported"column on the last page of this return.
'~,C:'36'
"yo COMMONWEALTH OF PENNSYLVANIA'
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "c"
TRA,NSFERS
(1)Did decedent,within two years of death,make any transfer of any material part <tC 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 denth.(Note 1).
(4)Did decedent,in his lifetime,make any transfer of property without receiving a valuable or adequate
consideration theref0li:..which was to take effect in possession or enj oyment at or after his death?
(Answer yes or no)l'iO
(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)_
(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)~
(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)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 cOllld revert to decedent under terms
of transfer or by operation of law?(Answer yes or no)__~~~O~_
(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
None
DESCRIPTION MARKET VALUE
(Estimated)DEPT.VALUATION
(Dept.Only)
Insert this total opposite "Transfers",Schedule "C"in the
"As Reported"column on the last page of this return.
,t
Hc~i8 •
¥CCMMl'\XWE.\1.TH elF l'ENNSYLV,\NL\
TrL\~Sl·"F:H INHElUTANCE TAX
RRSIDENT DECEDENT
SCHEDULE "E"
JOINTLY OWNED PROPERTY
I:'\STRl'CTIOKS:This schedule must disclose all property,real and personal,owned by the decedent jointly
with 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 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 acquisition,and the name,address and relationship (if any)of co-~wners to
the decedent..._.-
Description of Property,Date of Acquisition,Name I unit percentage Estate DEPARTMENT VALUATION
Address and Relationship of Co-Owners,and PIace I Value Share Valuation CAUTION-Do not Write
of Record of Instrument,where Real Estate.!In This Space.
Value of Value of
Entire Decedent's
Property Interest
None
I
I i
I
I!
I I
I I
I ,I I
I I
I I
I IIII
III
I
Insert this total opposite "Jointly Owned Property",Schedule ·"E"I
in the "As Reported"column on the last page of this return.J-
,..-li,..',•
-yfCC-37 (12-63).•
COMMONWEALTH OF PENNSYYLANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "D"
BENEFICIARIES
.
BENEFICIARIES AND ADDRESSES RELATIONSHIP SURVIVED(If step-children or DATE INTEREST OFStatefullnamesandaddressesofallwhoillegitimatechildrenDECEDENTOFBENEFICIARYaveaninterest,vested,contingent'or other-are involved,set STATE YES IN ESTATE
wise,in estate)forth this fact.)OR NO BIRTH
John Furman,Jr.son ves Over 21 1/7
326 Summit Avenue .
Canonsburg,Penna.
Marv Furman (n~~~....<"",:I)wife no Over 21 ---
Anna Helicke,now Silvers daughter yes Over 21 1/7
19 Shannon Avea
Washington,Penna.
li'''!:l''''''oc (';ccn,.,n •Vi'll!=:Ove,.21 1/7
Rid~e Avenue
Canonsburg,Penna.
Mike Furman son ves Qver 21 1 /7
809 Laurel Street
Canonsburga Penna.
Irene Belleno daughter ves Over 21 1/7
Muse Penn:::!
Stella Bevec daughter ves Over 21 1/7
Downev.California
GeorQ:e Furman .."''''_-..son ves Qver 21 1/7
.l..VV Ll._.I:".I..~C
ItiOOf
gaHBRBkHx~~xPenna.(Houston)
(
h
Deponent further says that all the above-named beneficiaries are liVing at this time except below:
NAME DATE OF DEATH RESIDENCE
Mary Furman (Wife)Se tember 29 '6 809 Laurel St.Canonsbur Pa.
~IATIER OF THE APPRAISEMENT
OF THE
ESTATE OF
(Executor-Administrator
must complete "As
Reported"column #1.)
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....,
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GJ...otiltil
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tilS"...('l)
Year .
Dl THE
!No.
Will
~~1l.QX
John Furman Sr.......................~,
Deceased
Late of ...B.prough ...ofCano.nobu~~.......
REPORT AND APPRAISAL
Commonwealth of Pennsylvania
County of Washington enc:~~>~wenen~
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