HomeMy WebLinkAboutOC1969-1086 - ESTATE OF SHANNONI ,, '\
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OF. ADA M. SHANNON
I, ADA·M. SHANNON, a widow, of Fallowfield Township,
Washington County, Pennsylvania, being of sound and disposing ~ind,
memory and understanding, do make, publish and declare this to be
my Last Will and Testament, hereby revoking and making void any and
all Wills by me at anytime heretofore made.
FIRST: I direct that my Executrix, hereinafter named,
pay all of my just debts and funeral expenses as soon as may be
practicable after my decease.
SECO~~= I give, devise and bequeath all of my estate
of whatsoever kind and nature and wheresoever situate at the time
of my death, to my beloved daughter, Tv'JYLA S. WORTHINGTON, her heirs
and assigns,absolutely and forever.
·THIRD: I hereby nominate, constitute and appoint my
beloved daughter, T~YLA S. WORTHIKGTON, as Executrix of this,my
Last Will and Testament.
seal the
IN WITNESS \VHEREOF, I have hereunto set my hand and
/~ day of August, 1966. ·
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The foregoing instrument, consisting of two pages,
including this page, each page being typewritten only on one side,
was at the date thereof by the said ADAM. SHANNON, signed, sealed,
and declared to be her Last Will and Testament in the presence of
us, who at her request, ·in her presence·, and in the presence of each
o•ther, have subscribed our names as attesting witnesses thereto.
Residing at Charleroi, Penna.
Penna. ·
.. ·:··
-Second and Last Page-
1\ffillauit ®f fxrrutnr ®r 1\~ministratnr
§tatr nf Jrnnayluania~ t BB:
C!tnunty nf lllllaaqingtnn \
Personally before me, the undersigned authority, a. ................................... ;t .............................................. in and for said
County and State, appeared .... 7 ...... '£~.Y.:J:.~ ..... ~~; ..... W.2.t'.~hJ.~S.~9..P. .............. ~:""""'""""""""'~""""'"who, being duly
sworn according to law, deposes and says that S he is the executJ.t~ ~~e estate of
.: ............... A.O.a ... .M. ..... :Bharmon ........................................................... deceased, that the foregoing schedules constitute a
complete inventory and appraisement of the real and personal estate of.. ......... AQ..~ ... M. ...... .Sha.nnon ................ ,
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 dateJ.&~.~~s death: based upon a just appraisement of each
item made by the above named ExecuteriX ~-
-):·~·
day o~.~~~~-.:~~.:~~~~~~~~;;~&.:is ... /.2:. .. :... ~¥~~ .......... , ....... :.~ .... ·; .. ~
...... . .. .... ... ·::. . . . . . . . :~........... · Executt'ltX . ·. .
..,., ... ,~ ~ DDITIONAL INSTRUCTIONS
......... 1. An inventory mus;~ withi~~ 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 '!_nd 2 RCRI-34, Under $10,0QO; 1 Original and.2_C.oP.ies ~d ~_BCRI:.~,
Over $10,000, including_CoP¥-oLWill;.J Original and 3 Copies and 2 RCRI-33:-0ver $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
3Jttnrtttnrg attb .Apprai.armrttt of the goods and chattels, rights and credits which
were of ................. A.cta .... M ...... S.banDQ.n ................................ Jate of T.o.Y.f.u.e.hi;P. .... O.f .... F.allo:w.f.i~.l.d ................... .
Washington County, Pa., taken and made in conformity with the abO"Ve affidavit.
One story frame house
One and one half story frame house
15.9572 Acres farm land "-.}
All situated on Freemont Road, Box#39,
Township of Fallowfield, County of Washington,
Tax Acct. No. 19.35
DOLLARS CENTS
6895 00
Savipgs Acct., First National Bank, Charleroi, Pa. 3016 57
Savings· Certificate, First Federal Savings and Loan,
Charleroi, P'a. 0,000 00
Three shares-common stock, Chemetron Corp. 9} 00
(listed on New York Stock Exchange)
....
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' Form RCC-33 COMMONWEALTH OF PENNSYLVANIA
:DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
I
RESIDENT DECEDENT COUNTY OF ...... _. .... Washingt.o.n ....................... ······.··:·······
IMPORTANT: 'Ihis return must be completed in detail and filed in duplicate, ·with will attached, with the·
F.egister 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_J.nt~rit~nce __ ~n!i.:E.~t!lt~ .T.~x A.ct of lQ!il.)
AFFIDAVIT OF IN THE MATTER OF THE·ESTATE OF }
___ AQ;> _!~!_,_ i?.h~,)t;~~~-~~;-;i;;~-;;;~;;------------~
Late of .................................... Wa shTngt on...... . .. ................................. county , · / /
State of ........... P..e..OO..S.y.l.Va..nia ................. -.............................. }
' . ss:
County of ... W.c;!3..b.1.ngt..9.J.l ......................................................... -.
, , , , , .................................. 'r.WY.l~ ...... S ... ! ..... W..9.r.:t. . .b..i.ngt.o.n. ......................................................... ·······-··········· ~@'eX{ of the estate of the above-named decedent being duly sworn, depose S /' . '
Decedent ·died ...... 1.\JJ..e;lJ..~.:!:.. ..f.9......... ............ . .
(Month)
..... , 1969.·-··'·•{. ~t!~~_Jeaving a last will, copy of which is heret~ attached. }
(!lay) (Y(:IIr) ~ . . .
N~,;e and address of attorney or} ............. TWyla .S ..•.... Wo.r.thing.ton ......................... . other authorized representative to
whom all correspondence should be. . ... RD#l,. BO:X .. #39., .. G.harler.o.i, ... Pt:j. .•..........
mailed.
That as such ....... ~.~.cut.r.ix ............ deponent is familiar with the affairs of said estate ·and the property con-
< l•:xt~m•tor-AdminiRtrator)
stitu.ting 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
IN WHICH DECEDENT RENTED A SAFE DEPOSIT BOX
First National Bank
5th St Charleroi Pa. or
THIS SAFE DEPOSiT BOX RENTED
IN NAME OR NAMES OF
RELATIONsHIP OF JO.INT
HOLDERS TO_D~CEDEUT
That the contents of sald safe deposit box or boxes are itemized under Schedules ·B
return, with the exception of the following, for the reasons hereinafter set forth:
of this
. That Sc.hedu/~_j_at_tached h,ereto and made part hereof sets forth fullv and in'·detan all tho:!
real property in the Commonwealth of Pennsylvania of which decedent died having an interest therein. I~
also sets forth the mortgage encumbrances upon each parcel of real property at the date of death, givin~
the amount still due at death, name of mortgagee, date,_ rate of interest, and book and page of record
t~f. It also sets forth in the columns provided therefore the a~sessed valuation of each of said
parcels, the estimated market value thereof as of date of death of decedent. ·
That Schedule B att~hed 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, s~vings banks, trust companies, or other institutions, whether individually, or in trust for
any other person or persons giving also separately the·-accr.ued interest thereon, if any, down to the las-:;
interest day ·prior to decedent's death in tJ:!e 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 evide~ce 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 subdivision ther-:!o~ 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 nat\lre, left by decedent, together with the fairly estimated
market value the.reof; 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 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 a·ccrued interest thereon to the date of dece-
dent's death and other investment securities owned by the decedent ~t the time of death, with -:he market
value thereof at such time.
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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 set-s 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 answer 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 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•~ is 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 vested in decedent, either individually or jointly, by t~e will, deed, or other instrument of another,.
with a copy of the instrument creating such power attached to the schedule.
That Schedule 0 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 is.sue, and the relationship of such issue to the beneficiary.
That Schedule E attached her·eto .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 fu~al expenses paid;
. -' f~y exe!!!P-tion, where applicable; costs of j!:.diDJ..n~s_t.r~t.iQ!'l,.O_f __ t~tate; counsel fees al}d ~diciary s
commissions paid or to be paid;' cost expended for burial trusts, .tombs,t.Q))es or g~ers, and reli-
gious services, in cons·equence of the death of the decedent; debts a~d claims owing and unpaid at time of "" .. death; taxes accrued. charge.able for period prior to decedent's death (except those allowed under Section
. 651 of the Inheritance and Estate Tax Act); . together with a stateme~t of .coilater.al 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~umrna~~
. 74
Sul;>scribed and sworn to before me this ..... ./ .. ~ ............. ..
·~ t--f ................ ~ .......... '7J ................ day of .............................. , ............................. 19 .............. .
(j~ ih~ ............................................................ : ...... : ..................... ~ ............................................. ..
~~~~----
............. B.o.x. .... #.3.9 ..... (..fiD#.l.). ...................................... ;,""""'"--"
(Street Number) .
.............. O..h~.;r.l. .. ~.;r.9. .. i.~ ..... P..{;I. .. ~ ............................................................. .
(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.
1
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RCC-34 (1-64)
COMMONWEALTH OF PENNSYLVANIA
DEP'ARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
'TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
2
~;
. ' t SCHEDULE "A"
REAL PROPERTY
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 "E". Property helc 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.
The real property located In the Commonwealth of Pennsylvania should be
described by lot and block number, street ·and street number, together with
a general description of the property, w:ith a. refe;;;;c-;t;'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 p'clr'Cenrt-death
ofdecedent. Taxes, assessments, accrued Interest on mortgages, etc.,are
to be listed on Schedule" F" and must not be deducted from this schedule.
One story frame house
One and one half story frame house
15.9 572 Acres of, farm land
All are situated on Freemont Road,
Box #39, Township of Fallowfield, County_
of Washington.
/' Deed recorded in deed box
Page ___ _
Tax Acct. No. 1935
TOTAL
( 1)
ASSESSED VALUE
FOR YEAR OF
DECEDENT'S
DEATH
1,970
1,970
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.
(2)
ESTIMATED
MARKET VALUE
6,895
(3)
DEPARTI.IENT
VALUATION
CAUTI•JN
(Do not wr lte
In this space)
RCC-35
GOMMONWEALTH OF PENNSYLVANIA
TR.{\NSFER 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 de.ath. 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 an•i in bank. . . .
stocks, ·mortgages, notes, together with accrued interest or dividends, sal!J.ries or wages, insurance pay-
able to the estate or fiduciary in said capacity, partnership interests, interest in anyund~stributed
estate of or income from any property held in trust under the will or agreement of another, e·1en though
located outside of the ~tate, at the time of death, should be listed in this schedule.
Item
NO•
1.
ITEM
List and describe fully
Three shares common stock, Chernetroh
Corp. (listed on New York stock
exchange) ·
2. Savings Acct., First National Bank,
Charleroi, Pa.
3. Savings Certificate, First Federal
Savings and Loan, Charleroi, Pa .
.:If itf·lj__
.TOTAL
Insert this total opposite "Personal Property", Schedule "B" in
the "As Reported" column on the last page of this return.
UNIT
VALUE
31.00
ESTIMATED
MARKET VALUE
93,00
DEPHTMENT VA!.UATION
(D·J not write in
this space)
RCC-36
COm!ON'I'EALTH OF PENNSYLVANIA
TlL\.NSFER INHERITANCE TAX
~~SIDENT DECEDENT
' •
SCHEDULE "C"
TIUNSFEil.S
(1) Diet ctecedent, within two years of death, make any. transfer of any material part· of 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 ·XXX
(b) State of decedent's health 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) NO ·
(a) \Vas 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) XXX
(b) What was the transferee's age at time of decedent's death? XXX
(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) ___ N~O ____ __
(6) If the answer to (5) (b) above is in the affirmative, state whether ·the right was reserved in decedent
alone or others ____ ~XJG(~~\----------------------------------------------------------~~----------(7) Did decedent in his lifetime make a transfer, the consideration for which was transferee's pll'omise to
pay income to or for the benefit of care of transferor? (Answer yes or no) _ _..N...,O..,__ __ __
(8) Did ctecedent, .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 could revert to decedent under terms
of transfer or by operation of law? (Answer yes or no) __ ~NuT~0~-----
(9) If the answer to (8) above is in the affirmative, was the power to alter, amend, or revoke t:,e inter-
est of the beneficiary_ reser\"ed in the decedent alone or the· decedent anct others?
~~wer yes or no) l\JO .
/NOTE~ The answers to these questions should be supporterl by affidavit by the attending phy~ician as
well ~ 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 rlecedent, 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 js based.
NOTE 3: List applicable property below in manner in which provided in Schedules A, B, or E.
ITEM DESCRIPTION
None
r
Insert this total opposite "Transfers", Schedule "C" in the
8 As Reported" column on the last page of this return.
MARI\ET VALUE
(Estimated) DEPT. VALUATION
(Dept. Only)
RCC-38
CC'1MONWEALTH OF PENNSYLVANIA.
TRANSFER INHERITANCE TAX.
RESIDENT DECEDENT
' •
SCHEDULE "E"
JOINTLY OWNED PROPERTY
INSTRUCTIONS: 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-owners to
the decedent.
Description of Property, Date of Acquisition, Name t Unit
Address and Relationship of Co-Owners, and Place I Value
of Record of Instrument, where Real Estate. 1
None
Percentage I Estate
Share Valuation
Insert this total opposite "Jointly Owned Property", Schedule ·"E"
in the "As Reported" column on the last page of this return •
. ". -
DEPARTMENT VALUATION
CAUTION-Do not Write
In This Space.
Value of
Entire
Property
Value of
Decedent's
Interest
(
h
, ¥ ·~."t ., .....
RCC-37 (12-63)
C'Ol\11\10!~\rEALTH OF PENNSYYLANIA
TltANSFER INHERITANCE TAX
RESIDENT DECEDENT
BENEFICIARIES AND ADDRESSES
State full names and addresses of all who
ave an interest, vested, contingent or other
wise, in estate)
I
'l'wyla S. \ilorthinp.;ton
....
.·
SCHEDULE "D"
. BENEFICIARIES
RELATIONSHIP SURVIVED (If step-children or illegitimate children DECEDENT
are involved, set STATE YES
forth this fact.) OR NO
daup;hter ves
..
DATE 11 INTEREST OF
OF BENEFICIARY
IN ESTATE BIRTH
1-28-10 to take all
I
Deponent further says that all the above-named beneficiaries are living at this time except below:
NAME DATE OF DEATH RESIDENCE
/'
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'11"'' ·. ~ ' "~::·-:: j ================================::;:::=== j )~· r-'•r
Will
Administration t No .. · ......... :.
IS THE
Year .... .19.. .69.
~lA TIER OF THE APPRAISEMENT
OF THE
ESTATE OF
.... A.da ... M ..... Sh.an.n.o.n ..
Deceased
Late of .t.he ... T.ownship ... o.f ... Fallo.w.fi.eld ..
County of ....... Washington ............................ .
Commonwealth of Pennsylvania
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.,.
,.
j
(Executor-Administrator
·must complete "As
Reported" colum'n #1.)
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Form RCC-10 DEDUCTIONS ALLOWED rN
OFFICE OF TME
REGISTER OF WILLS
THFI: SUM OF ............ $ .cJ!....~~s; ..... W.
OF _....!;tfull~B!.Z.Ih~1-AD~gt~OO!JD~-COUNTY
STATEMENT OF DEBTS
AND DEDUCTIONS DATE / p(1 -.:?.:; . c,~
APPROVED • • . . . . . . .. ................................................. . ~w'~~ AND AGENT OF THE COMMONWEALTH
ESTATE oF Ada M. Shannon LATE oFFnllowf.1 el d TnwnsbS p, Wash! ngton countY'
DATE OF FILING APPRAISEMENT _..,.t::.:·~::::......--!::.;2:;._c:l_,_;t~'_F:___ __ DAT!il OF DEATH _,ftl::u:Uill.S\l~u:ftut!.-29=-z...lltl........!l~9.!!..· ~6:..!9:___ ____ _
' DATE NO. OP' NAME OF PAYEE REMARKS AMOUNT VOUCH"" .
Harold Schrock Funeral Home Funeral 1~384 4l
;
Valley Independent 10 ~0
Washinrl.on Re~orts 14 00
Trip to Charleroi 15 00 Guv Rollers t.n n'l'"i'lhAt.A l.T-4 1 1 .
Recorder of Wills p,..nhAt.l'! W-l 1 1 & short. ce:rt i fi'r~At. ~s 21 50
Twyla s. Worthington Executrix Commission 1,000 23
..
TOTAL 2,445 64
COMMONWEALTH OF PENNSYLVANIA }s•: COUNTY OF \taShif.lStOn
I, Twyia s. Worthington
H£REEIY CERTIFY. THAT. TO THE BEaT OF'
114Y KNOWLEDGE _AND BELIEF, THE FOREGOING IS A J 1a~N'M TRUsli'.IATEMENT OF DEBTS, FUNERAL EXPENSES AND EXPENSES Ofll'
AOMINlSTRATION SUBMITTED TO THE ESTATE OF • nnon .OECIEAIIED, AS DEDUCTIONS I"OR . .
INHERITANCE TAX PURPOSES. ~~);~ ~ (L. &.l
SWORN AN~UI!SSCRIBI~EFORE Me: THI!ll I .J.--~
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RCC-81 (2-64)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
INHERITANCE TAX DIVISION
NOTICE OF FILING QF APPRAISEMENT
IN YOUR REPLY PLEA8E
REJI'I:R TO
In Re: Estate of-_____ A=DA~M~·~·-=5::.!f~lA::.:tl.I:::!'N.:.::O:::t'd:..· -------
_____ _!!:WA:::S:::::H::I::::m:::..:· '1'01:..:::·=-----county -File No. 6)-69-1086
Dear lire. WorthingtonJ
You are hereby notified that the or!ginal
appraisement in the estate of Ada Me Shannon
has been filed in the office of the Registe_r of Wills qf Washington
County on Deoemb6r 22 , 1969. Said appraisement reflects·the
following valuations:
Real Estate ---'-----...=6~•8....,9m5!:.-• ...... oo ... -....---
Pe rs anal Property ____ U..:;·..::t_1_09...;._•.:;..!f..;,.1 __ _
Transfers ___________ ~~~-==----
Total --------...;.;2;...:;0.z.t.;;.004.;;.;;:..•=-:5;..:7~---
As to such ~ax 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.
DATi!: OF D!ATH:
Note: This is not a bill.
J
"'i(C•39 (5-68)
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
estate of SHANNON, ADA M.
(Last Name) (First Name)
SUMMARY
DATE OF DEATH __ 8-_2_9_-_69_FILE 1'-0._6_3_-6_9_-_10_8_6
(Initial)
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: ----=12::.-..:,2~2:.._-..:;.6~9 ____ _
08-29-69
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 as a deduction. ::) ~•
Dated: 12-22-69 ~ ~~
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
annuities . . . . . . . . . . . . . . . . . . . $
1 8 93
ESTATE TAX ASSESSMENTS $ __________ .J....__
REGISTER OF WILLS
VALUE AS APPRAISED VALUE AS REAPPRAISED
$ $ ________ ~---~.1:5'1~ uu
lj, 10~ ';'{
20,004 57
2,M.5 64
17,558 93
FOR USE OF REGISTER ONLY COMPUTATION OF TAX
~ 2%
17,55.93@
Tax on$
Tax on$
$
$ l,t:}?J )J "Paid In Full", Noi-. 12, 1969
Tax on $ ---------1-L---5% i:~ ~~ :---------11~-~~~
Exemptions : ..
Total Estate
$----------~-$ ____________ -4----
$ __________ ~_
TOTAL TAX $--------~-
Less tax previously paid $======l===
BALANCE $--------+---
Less 5% of tax if paid within
3 months after death $=========
Add interest at rate of 6% from ________ to ________ _
AMOUNT OF ESTATE TAX ASSESSED $---------+--
Estate tax paid $ ______ _J._ __
(*) As evidenced by Charitable
Exemption Certificates issued
by the Secretary of Revenue.
BALANCE DUE $-------~----
Add interest at rate of 6% from
------~0--------$-----------+---
TOTAL TAX BALANCE $ -----+--
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 reasnn,
same should be noted below, with short explanation.
....... ---------------------------------------~ ------· -----
t No ...... .
,_ .. ·
Will Year Administration
IN THE
MATTER OF THE· APPRAISEMENT
OF THE
ESTATE OF
............. M;>.A. .. 1-1.~ ... S. I:IAliJl\J()l\l_ .................
Deceased
Late of F.A.LLOWF.:J:.E.:LJ:) .. :1'\IJP. ~-......... .
C:nnnty of ................... l:'fA0~JNG'T'()~ ......... .
Commonwealth of Pennsylvania
REPORT AND APPRAISAL
..
.. .
L
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Fonn RCC-2
PEr~\>RTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
HARRISBURG, PENNA. 17 1 2 7
COMMONWEALTH OF PENNSYLVANIA
RESIDENT INHERITANCE TAX
· " APPRAISEMENT
DATE ............. .P.~.9..~.~-~!. ...... ?.3.?. ...... ~.?..?..?. .................. .
-COUNTY Washingtai ..... . ............................................. _ .................................................. .
FILE NO. . ....................... QJ..~.Q.9.::1.Q?.~ ..... -....................... .
Whereas, ....................................... A.9.~ .... ~.! ..... ?.h~n~9..~ ............................................................ : late of ..................................... .f.~+--~.9.~.f.J.~+...9 ................................ .
in the County of ........................................ W.~.~.h.~gt.9..P.. ............................................................. Commonwealth of Pennsylvania, having died on
the .................................. ?..9 ... ~-h ............................................. day of ........................... :!?:~.~--~·-···························· 19.~.9. .... , seized and possessed of an estate
subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania;
Therefore, I, ......................................... .W.~3..~ ...... ~~-~.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 1n 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 Aaset
REALTY:
One story frame house. One and one half story
frame house 15.9572 Acres of farm land.
BERSONALTY:
See copy of Schedule "811 attached to appraisement
. '
Total
Unit
Values
$
Appral:ement
Made for Inheritance Tax P•rpoaes
6,e95 oo
13,109 57
20,004 57
Having been duly sworn according to law, I do hereby certE that the ove appraisement is made in con-
formity with law on this ............ .:2.2d:d ............. day of ······::/D::::::·::: ..••••.• ·~~.-.~~~~~> ~~;~.
... .. . ... · .. 1 AL. ............................................................................................. , Penna.
• ( (Post OfBee I
L-------------------------------------------------------------------~~----
. WAS.HJ.:NG'r.ON ........................ . County
RESIDENT INHERITANCE TAX APPRAISEMENT
Estate of
ADA M. SHANNON
Deceased.
Late of
F ALLOWFIE LD TWP.
Date of Death, ........ J.\.~~':>.1?. .... ?.?..~ ..... ~.9.§.9. ...................... .
Appraise1ne1!t Docket Vol., ................. :nt .......................... .
Page, ........... ?..:.? ........................... No ...... §:?. .. :::§.9~.J::9..f3.f? ....... .
Filed in Register's Office, .P~.<::.E3.J!tl:>~.I.: .... ?.?.J99..9 ... .
Amount of tax dtte, $ .................................................................... .
DEPARTMENT OF REVENUE
Received, .................................................................................................. .
Examined and Approved, .................................... : ...................... :
Wrote abo.ut-Appra-isement, .................................................. .
' ..................................................................................................................... : .......... .
. .
Appeal f1'om Appraisement, .................................................... ..
Entered and charged, .................................................................... . f
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