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Home My WebLink AboutOC1969-0249 - ESTATE OF POTASHMANRCC-8\(2-64) COMMONWEALTH OF PENNSYL VAN IA DEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS INHERITANCE TAX DIVISION NOTICE OF FILING OF APPRAISEMENT Rose Ann Potashman (Executor ~r) IN YOUR REPLY PLEA8E REFIER TO ~ 37-190-1 J In Re;Estate of__....;;}:.:.;1e~yl...:e:.:r:........:P...:o:.:t:..::a::.::s:.:..:hnE::.:;.=n:.........-------_ ______.....:\.:.::\Ta:::.:s::.:.h~i:::.ng:o..::t:..::o:.:..:n:-----County -FileNo.63-69-21+9 Dear Mrs.Potahman, You are hereby notified that the_~o~r~i~g~i~na~l~_ appraisement in the estate of ~}~1e~y~e~r~PuQ~twta~s~b~m~a~n~------_------------ has been filed in the office of the Register of Wills Qf Wash:L"1~ton County on December 4 ,19-19.Said appraisement reflects the following valuations: Re al Est ate __~.::::X:....._ Personal Property __~1~.~5~5~5~.~OO~----- Transfer s -:;-~;::-;::-...,..::__------- Total -=1;L,.::...5:::;.:55::...:.~0:..:0:-.---- 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 (8%)percent per annum is charged. Any party in interest who is aggrieved by an appraisement may appeal therefrom as provided by law. Date 12_-_1+=--....:..7_0 _Signed Title !tL~(l.~~/lP=A.~~ 11.R.CHANEY ,CHIEF APPRAISER ESTATE INSOVENT DATE OF D~~TH:January 20,1969 Note:This is not a bill. RCC-39 (5-68) COMMONWEALTH OF PENNSYLVANIA TRANSFER INHERITANCE TAX RESIDENT DECEDENT SUMMARY Estate of Potashman (Last Name) Heyer (First Name) DATE OF DEATH 1-20-69 (lnitial) FILE NO.63-69-249 REPORT OF INHERITANCE TAX APPRAISER I,the undersigned duly appointed Inheritance Tax Appraiser in and for the County of__VJ_a_s_h_ing_~_t_o_n _ 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:_.....:1=.2::....-..:.,:4:-.-7.!-0 _ REPORT OF THE REGISTER OF WILLS I,the undersigned duly elected Register of Wills in and for \i,Jashington 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 gre er 0 lesser amount represents the sum allowed as a deduction. Dated:12-4-70 VALUE AS REAPPRAISED $-------+--1,555 00 1,555 00 3i.2'36 57 E IJIBOLVENI'AT $ 161i0 63 1640 6~? t;2it t;7 :B~T VALUE AS REPORTED VALUE AS APPRAISED $ INVENTORY Real Property (Schedule A) Personal Property (Schedule B) Transfers (Schedule C) Joint -Held Property (Schedule E) TOTAL GROSS ASSETS Less Debts and Deduc'tions (SCHEDULE F) CLEAR VALUE OF ESTATE Valuation of life estates or FOR USE OF REGISTER ONLY Tax on $----------1--2% Taxon $~ Tax on $5% Tax on $10% Tax on $15% &~pti~s * Total Estate -+-__ TOTAL TAX COMPUTATION OF TAX $--------1-- $--------1-- $-------+-- $-------+-- $--------+--- $--------'--- (*)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 ::::::::::::::t=== BALANCE OF INHERITANCE TAX DUE $t= Add interest at rate of 6%fro~ to --~--IC$----AMOUNT OF ESTATE TAX ASSESSED $ Estate tax paid $I BALANCE DUE $....JL- Add interest at rate of 6%from to $-~t=TOTAL TAX BALANCE $------1-PAID $......1 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 Administration (No. IN THE Year . MATTER OF THE APPRAISEMENT OF THE ESTATE OF .MEYER..POTASHMAN .. Deceased Late of .........CAI'\,JNSBURQ. County of ...WASHINGTON... Commonwealth of Pennsylvania REPORT AND APPRAISAL I • Fonn RCC-2 .D§:PARTMENT OFIREVENUE~.. BUREAU OF COUNTY COLLECTIONS HARRISBURG,PENNA.17127 COMMONWEALTH OF PENNSYLVANIA RESIDENT INHERITANCE TAX APPRAISEMENT DATE p.e.c.emb.e.r .4.,19.7.O'., COUNTY ..Jlas..hingt.Q.n :..~.=. FILE NO..??-::..§..2:?4..?.. Whereas,~~~y.~.r.·~9.~?-.~~~~late of g~.?~~9.~~. in the County of W9,§.h.;\.J1g~.9.P.Commonwealth of Pennsylvania,having died on the 2.Qt.b.day of J..@JJ..SlJ.'Y 19 9..9..,seized and possessed of an estate subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania; WR CHANEYTherefore,I,..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 AppraisementDescriptionofAssetValuesMadeforInheritance Tax Purpoles $ PERSONAL: See copy of schedule "B"attached to appraisement 1.555 00 I Total 1.555 00 ESTATE INSOLVENT , ;". '.... .. .. '. I forrn~;vi';:~h7.':::~~'W<ll"ll~:'~~~e~~;y~~.~~e~;i.=~~ Appraiser .................................................................................................................................................................. ~,(Number and Street) .....................~......................................................,Penna. (Post Oftlee) ....................vlAS.HINGTON .County .' RESIDENT INHERITANCE TAX APPRAISEMENT Estate of ...........}~@.P.Qr.A§JI/:ly1AN Deceased. Late of ..cA.NONS.BURG . Date of Death,l~.~O'~69 . Appraisemei!t Docket Vol.,.3..7.. Page,~.?9.~~:No ??~~.9.~.?4.2 . Filed in Register's Office,.P..~.C:..•.....4 19..7.Q. Amount of tax due,$.. DEPARTMENT OF REVENUE Received, Examined and Approved,.. Wrote abo,ut .A ppra.isement, Appeal f"om Appraisement,.. Entered and charged,. ~ , .......a F--.:tA.·•. D." .LAST WILL A-~D TESTANENT OF MEYER POTASHMAN I,Meyer Potashman,of the Borough of Canonsburg,Washing- ton County,Pennsylvania,being of sound and disposing mind and memory do hereby make,publish and declare this to be my Last Will and Testament,hereby revoking all Wills and Codicils thereto,by . me at any time heretofore'made. FIRST~I direct that all my just debts and funeral ex- penses be paid by my Executrix hereinafter named as soon as con- venient after my deceaseo SECOND:I give,devise and bequeath to my son,Harvey J. Potashman,the sum of Five Thousand ($5,000.00)Dollars. THIRD:All the rest,residue and remainder of my estate ot whatsoever nature,real and personal,and wheresoever situate, I hereby give,devise and bequeath to my wife,Rose Ann Potashman. FOURTH:I hereby empower my Executrix to sell any and all property of whatsoever nature~real and personal,of which I may die seised,at such time or times for such price or prices and upon such terms and conditions as she shall deem advisable and without liability upon any p~rchaser or purchasers for the appli- cation of the proceeds of a~y such sale by my Executrix. FIFTH:My Executrix is hereby authorized and empowered to make distribution in cash,in kind,or partly in cash and partly in kindo SIXTH:I hereby nominate,constitute and appoint my wife, Rose Ann Potashman to b e the Executrix of this my Last Will and Testament without being required to furnish any bond for acting in such capacity. IN WITNESS \oJHEREOF,I,Meyer Potashman have hereunto sub- scribed my hame and affixed my seal"to this my Last Will and ~ I•, ft" ; ...""1'1... IIII I! -'----'---~_.~--~- d"t-'t-k-/7 '1957· Cj;1Y:(t17Za;dtt£cUt (SEAL) MeY,tf Po tashman day of Name Signed,sealed,published and declared by Meyer Potashman other•. '-j- as and for his Last Will ,and Testament in the presence of us,who have hereunto subscribed our names at his request and as witnesses "thereto in the presence of the said Meyer Potashman and of each :Tes tamentthis .;" l\ffibuuit (@f 1txrrutnr (@r l\bmilttatratnr ~tutt nf 't~Uliluutliu1 11'1 t f>!A e en lili:\U-nuu 9 n Personally before me,the undersigned authority,a .J:fQt~~y...~~J?~.~~..._....._..in and for said County and State,appeared R2.~~..Ap.p...r~.t~~~·~~g···············t._.•............who,being duly.execu rlXswornaccordingtolaw,de~oses and says that Ehe is the m~![}~~~of the es- tate of ~~1.~E..~~~~.~~.':l:~:deceased,that the foregomg schedules constItute a complete inventory and appraisement of the real and personal estate of ._..:NJ:.~Y.~~.)~Qt'?:~h~~p.., deceased,except real estate outside the Commonwealth of Pennsylvania;that the figures opposite each item of real and personal 'estate in the foregoing schedules are determined and stated by the undersigned to be the fair value of said items as of the date of the decedent's death,based upon a just appraisement of each item made by the above named ExlllIXItox Ac~x.Executrix. d Y :ffw.o.~rnand.::~:~before.~e this ..J.q.t.h..........}/JP~_4~P,;lar7I'??Z~. a~~Jdd~"".K~mr~~ExecutrIX ......C'ARql·J:'lalt~""'';';;;1 'P·ulirrc····..··..·..··..·..·..····..·..··..·····Pi~toilurg\l,i;;I~7JiIn;COI."1ty,Pa,ADDITIONAL INSTRUCTIONSMyCom~5'~.n-Expires 1.An fn'lfl'!moi:~WMst be filed within three months after appointment of personal representative. 2.A supplemental inventory must be filed within thirty days of discovery of additional assets. 3.1 Original and 2 Copies and 2 RCRI-34,Under $10,000;1 Original and 2 Oopies and 2 RCRI-33, Over $10,000,including Copy of Will;1 Original and 3 Copies and 2 RCRI-33,Over $50,000,in- cluding Copy of Will and copy of Federal Estate Tax Return. REFERENCE FOR ADDITIONAL COpy Act of 1947 P.L.513 Sec.5.2,72 P.S.4844.2 31uUtutnrg uu~.ApprUilitmtut .of the goods and chattels,rights and credits which Meyer Potashman Canon sburgwereof'"..,late of ,. Washington County,Pa.,taken and made in conformity with the above affidavit. ./ 1.10 shares United States Steel Corporation 2.10 shares Chrysler Corporation 3.1 share Washington Grocers Association, 4.1965 Ford Econo Line Super Van Truck DOLLARS CENTS $447 50 543 13 Inc.50 00 500 00 163 ITotal$1,640 , liS-Sf fo3 -to 9-c9tJ9 Inventory and Appraisement IN THE ESTATE OF MEYER POTASHMAN •••••••••••0••••••••••••••••••0 ••••••••••••••••••••••••••••:•••••••••••':••••••• Filed ............................................•19 . ----•.<}..•t -J J 1 ::F ~:JJ>m:'U (f)G:>C: :I.:-(() ~~~:;~ •I'i r- _.,,A-.-~ .~0 'J- ----;1 '0;:c:::::::;.~~-'--r-Z-oro::>U) = l-::') -.:::::; -w ._.:'\: ''-1 :'""-1 tJ...) IU! t:=; "" JEROME MEYERS~ Attorney at Law 806 Frick Building PittsbUI'g~~nnsylvtiBia 15219 DWC 8/-(P~lJ/1o ~~~~~~-----:----------------_._._--------_._._--- >j ,-...., Form RCC-33 RESIDENT DECEDENT COMMONWEALTH OF PENNSYlVAN IA DEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS COUNTY OF WASHINGTON IMPORTANT:This return must be completed in detail and filed in duplicate,with will attached,with the· Register of Wills of the County where decedent resided;Return is due within one year after date of death,unless an extension is granted by the Secretary of Revenue.(Section 703 of the Inheritance and Estate Tax Act of 1961.) IN THE MATTER OF THE ESTATE OF liiAFFIDAVITOF".................,~.¥.:g:.BPQ.TA$I.iMAN.. . (State full name of decedent) ~~Late of :w9.:§.h~:rgtQp...,.,.,,.,.,,.,""County XECUTRIX state of ..pennsylv;;mia : } County 0;-,.~..ss: ROSE ANN POTASHMAN,Executrix. ,,•.••.••,""••••••••..,,.•",1,..,.••.•,•••",,."..~r of the estate of the above-named decedent being duly sworn,depose and say Decedent died ,........(M~~t~~muary~ie;i'19(~~~i'{~~;;~eaVing a last will,copy of which is hereto attached.} o t herNaa:t:::i :::r:::r::e:\tao;;::;:}JerQID,e.M •..,Meyers ,.......... whom all correspondence should be 806 Fri~J:(13tlJldiI1g,:pittsl:>tlI'gh,:pCl•.,.J5~J~. mailed. That as such ~~~.~~~E~deponent is familiar with the affairs of said estate and the property con- (Ext~cutor·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 accessby another as agent or deputy,with the exception of the following:- NAME AND ADDRESS OF BANK OR OTHER INSTITUTION IN WHICH DECEDENT RENTED A SAFE DEPOSIT BOX None , THIS SAFE DEPosiT BOX RENTED IN NAME OR NAMES OF RELATIONSHIP OF JOINT HOLDERS TO DECEDENT 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 fullv 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 irit~rest 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 certificates or notes and other evidence of in- debtedness of the Bnt ted 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 subdivision thereo~or of any foreign country;which are owned at the time of death;all wearing apparel,jewelry,silverware,pic- tures,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 mortgal!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 polici'es 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 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 ,lQ.:t.b . 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 bequeathed by the decedent at the time of death. The Schedule C attached hereto and made part hereof sets forth a true answe'r to each inquiry contained therein and in the case of transfers ofproperty,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 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 rega~ding 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 copy of the deed,trust agreement or other instrument creating the trust.Ther,~is also set forth in said schedule a list of all property,real and personal,with its va..lue,which pa~ses at decedent's death by virtue of the exercise by decedent,either individually,orjointly with 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 at.tached 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,andthe 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 relationsrip,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 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", "C","E",and "F"as directed therein, have been carried forward and properly registered in the Summary. 1..lP..~4.~rt:~~~..(~~~xecutrix ...2.0.5 G.r.ace..Av.enue ···········..·······..··..· . (Street Numhe-r) .....qa.:P:C?P:~.~.~!:g";R.~.~..J..§..~.!.7... (City (Yr 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-34 (1-64) COM~I)NWEALT~OF PEt:lNSYLVANIA DEPARTMEIH OF REVENUE BUREAU OF COUNTY COLLECTIONS TRANSFER INHERITANCE TAX RESIDENT DECEpENT SCHEDULE "A" REAL PROPERTY r Real property in Pennsylvania,with statement of mortgage encumbrances upon each parcel at death of dece- dent.Where property held as joint tenant or tenancy by entireties,report on Schedule liE".Property held by the .de,cedent 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. The real property located In the Commo[lwealth of Pennsylvania should be described by lot and block number,street and street number,together wi th a general description of the property,with a reference to the record of the conveyance by which the decedent took title;If a farm state number of a· cres;also statement of mortgage encumbrances upon each parcel at death of decedent.Taxes,assessments,acqued Interest on mortgages,etc.,are to be listed on Schedule "F"and must not be deducted from this schedule. (1)(2)(3\/ DEPARTMENT ASSESSED VALUE VALUATION FOR YEAR OF ESTIMATED CAUTION DECEDENT'S MARKET VALUE (Do not write DEATH In this space) NONE Insert this total opposite Clreal property",Schedule CIA"in the X X X X X "As Reported"column on the last page of this return. NONE ·.'RCC:-35 '-COMMONWEALTH OF PENNSYLVANIA TRANSFER INHERITANCE TAX RESIDENT DECEDENT SCHEDULE "B" 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 anyundis 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 listed in this schedule. Item ITEM UNIT ESTIMATED DEPARTMENT VALUATION No.List and describe fully VALUE MARKET VALUE (Do not write in this space) l.10 shares United States Steel Corporation /444;-$447.50 '1'-/1.56 /S5~5":r'7'.[o 2.10 shares Chrysler Corporation 543.13 #'Q}.,.7 /50·Do3.1 share Washington Grocers'Association,Inc.50.00 4.1965 Ford Econo Line Super Van Truck 500.00 6~trDD'Db \./~\ Insert this total opposite "Personal Property",Schedule "B"in X X $1,640.63 la f&.I>-3 the "As Reported"column on the last page of this return.los-em r-I .... ·.. RCC-36 ,. cOm!O\'\~?\LTIl OF PE~NSYLY..\NL\. T1UNSFEH INHEIUTANCE TAX I1ES InE:\T DECEDENT SCHEDULE "c" TIU~SFEnS (1)Dirl rlecedent,within two years of rleath,make any transfer of any material part of his estate,without receiving a valuable and adequate consideration therefor?(Answer yes or no)~O (2)Did rlecedent,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)-=~-'-O~__ (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 decerlent'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)~_O _ (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 e!1joyment of or the right to income from the property transferred? (Answer yes or no)_1_\10 _ (b)The right to designate the persons who shall possess or enjoy the property transferred or income therefrom?(Answer yes or no)~~~O~_ (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)__~~Q~__ (8)Dirl decedent,at any time,transfer property,the beneficial enjoyment of which was subject to change, because of a reserverl power to alter,amend,or revoke,or which could 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 ~ffirmative,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)_ NOl'E 1:The answers to these questions should be supportefl.by affidavit by the atten<Ung 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 fleed or instrument,if tr,tns- 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 ~one MARKET VALUE (Estimated)DF..PT.VALUATION (Dept.Only) Insert this totHl opposite "Transfers",Schedule "C"in the "As Reportetl"CQlu1TD1 on t.he last page of this return. --~-----------------------------'---~-----"'----_._---_..._--_...~one ;~... ReC-.38 '- .CC~{QNWE~L'rH OF PENNSYLVANIA TRANS}~R INHERITANCE TAX RESIDENT DECEDENT SCHEDULE "E" JOINTLY OWNED PROPERTY INSTRFCTIONS:This schedule must disclose all property,real and personal,owned 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 tmder 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-owners to the decedent. Description of Property,Date of Acquisition,Namel Address and Relationship of Co-Owners,and Place of Record of Instrument,where Rea!Estate.!. NONE Unit Value percentage Share Estate Valuation DEPARTMENT VALUATION CAUTION-Do not Write In This Space. Value of Value of Entire Decedent's Property Interest _________________________---I ...L..--'....L..---,,-I-+" Insert this total opposite "Jointly Owned Property",Schedule"E" in the "As Reported"column on the last page of this return.None RCC-37 (12-6J) ~..•I COMMONWEALTH OF PENNSYYLANIA TRANSFER INHERITANCE TAX RESIDENT DECEDENT SCHEDULE "D" BENEFICIARIES . " BENEFICIARIES'AND ADDRESSES ,RELATIONSHIP SURVIVED I (If step-children or DATE INTEREST OFstatefullnamesandaddressesof,alL who illegitimate children DECEDENT OF BENEFICIARYaveaninterest,vested,contingent or other-are involved,set STATE YES IN ESTATE wise,in estate)forth this fact.)OR NO BIRTH --Rose Ann Potashman Wife Yes All 205 Grace Avenue , .. Canonsburg,P ennsy1vania 15137 -- i I ,- ( _. ~ .,- (' ( Deponent further says that all the above-named beneficiaries are living at this time except below: NAME DATE OF DEATH RESIDENCE (Executor-Administrator must complete "As Reported"column #1.)Will (Administration ~No.6.3.:-:.69:-:24!Year ..19.6.9 . Dr THE ~IATIER OF THE APPRAISEMENT OF THE ESTATE OF MEYER POTASHMAN Deceased Late of ...Canonsburg oa'"'">-3~~Cb t%1'"s-et >-3 ""d ~....Cb Cb$lJ ....IlO::l '".-'"0(;)'::l ""d....e:..a '"'t:l""d Cb.....,.g ~ ~'< '.. County of W~~l1ington Commonwealth of Pennsylvania REPORT AND APPRAISAL Jerome M.Meyers Attorney at Law 806 Frick Building Pittsburgh.Pa.15219 •'V c1 •.O~)hI Cl1 C)>1 \HSVt,\ S111 f'.\J C)L!~.L ~)I~)J :1 o1~i ,,~_~'~'!l !J :)':n':'1 CJ)c: ~~>:~---0<:(W CJ)CJ) ()()?'"?'"?'"n t:J >:::------- ~~-(I)~~~ :1-':1-'......> :0):Z :0)Z '":H::-:0 :H::-0 ~:0 :lj ;o::S Cb-,.:,.CD ":l- :0)·CD..0-.:0)'"'l :W :W 8':::..- r I ;"illl O}L I ,:U['._1,n -);J(. .4'1Lt~-\U <:01","'~, -~ I-,..! ~-00 -(I) "-.~~(~~.~. -oo-oo~ ,-.: Ib-: .\~.~\~. D >:r. t:I<1:_8"1'-0'"'l_35' C'::::.. <. Form RC C ,If,• OFFICE OF TIo1E REGISTER OF WILLS OF __W~a::.:s::.:h:;l:::on""gt::l.t,::.:o::.:n~_COUNTY AND AGENT OF THE COMMONWEALTH STATEMENT OF DEBTS AND DEDUCTIONS DEDUCTIONS ALLOWED IN " THE SUM OF ,...........sti.{d~~<~J DATE APPROVED ...../.¢..,~1....~26~~_.,., Register of Wills,Agent ESTATE OF MEYER POTASHMAN LAn;OF Canonsburg,Pa, DATE OF FILING APPRAISEMENT DATfil OF DEATH __...;;J;.,,;a_n;,;;,.u;:;;,a=rJ.Y.-;;;;2...;;0,-&!~1;.;:9;,,;:6~9.:..-_ DATE NO.OF NAME OF PAYEE REMARKS AMOUNT VOUCHIi" Rose Ann Potashman Family Exemption .1..000 00 Blank Brothers..Inc.Funeral expense ,1..116 00 I William Speakman Ambulance 15 bo I Plot for grave Funeral expense I 625 PO Rabbi Lichtner Funeral expense \25 bo Rabbi Matzner Funeral expense \50 bo Gaydos Monument Company Funeral expense ,735 pO Register of Wills Probate of Will..Short Certifica es, and certified copies of deeds (23 bo Jerome Meyers Reimbursement for cost of ~ advertising and filing inventory •48 pO 50%of 1968 Federal Income tax 1°ability (2687.72)1,343 ~6 Bell Telephon.e Co.of Pal 41 ~2 Columbia Gas Co.26 JID West Penn Power 12 JO West Penn Heating 30 ~3 Citizen Water Co.6 8 John McGuiness,M.D.15 )0 Canonsburg Wage Tax 1968 (1/2 of171.59)85 >0 Washington Hospital 5 07 Dr.Berman 32 60 - Total 5,236 57 COMMONWEALTH OF PENNSYLVANIA } COUNTY o;~llegheny s.: '.Rose Ann Potashman HEREBY CERTIFY.THAT.TO THE BEaT OF 1liiY KNOWLEDGE AND ,BE;LIEF,THE FOREGOING 18 A JUST AND TRU E srATEMENT OF DEBTS,FUNERAL EXPENSES AND EXPENSES OF ADMINISTRATION SU~MITTIED TO THE ESTATE OF Meyer Potashman .DECEASED,AS DEDUCTIONS;FOR INHERITANCE TAX PURPOSES.a~t1~.t:-~?~.(L.S.) SWORN ~SCRIBEDIIEFO?THIS 16th DAY 01" emher 18 -LQ...~-'.-/'~.?ZC'~ CAROL J.,ErYPublicPittsburgh,e .eny County,P::l,~ My Com IS810n Expires February 21,1()7~