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Home My WebLink AboutOC1969-1146 - ESTATE OF MEHOVICS-Form RC C-10 DEDUCTIONS ALLOWED IN j OFFICE OF THE REGISTER OF WILLS COUNTY '" STATEMENT .qF DEBTS AND DEDUCTIONS TH~ SUM OF "" ........ S .. ?{..](f.·.~~ AND AGENT OF THE COMMONWEALTH "'"(2:;_e_~ 1968 nPt"' nee Register of Wills, Ageot ESTATE oF Al'>l.NA MEHOVICS LATE oF _T..,.h....,e-..B ... o..._..r~o .... u'Eig,...h......,.o....,f.........,C...,a=n=o=n=s=b...::u=r:..c:g.__ __ _ ? 7 November 28, 1968 DATE OF FILING APPRAISEMENT -~0:::::-:....-....J./:....6::::._-~~0---DATS OF ·DEATH ----------:....------ DATE NO. OF NAMi OF PAYEE REMARKS AMOUNT VOUCH~Jt 18 John Yonev Funeral exnensP~ 1 ?f..7 Father Jugar Funeral services 55 St Patrick's Church Cemetery grave ooening 40 St Patrick's Church Cemeter_y_ lot 200. Malone 1 s Flower Shop Funeral flowers 31 John Gaydos Landscaping grave so Kurtz Monument Stone 120 nailv Not:es _D_eat:h Not:ice t; St:eve 1 s Superette Account 72 ~8 Mrs M ne.Iohn Registered _Nurse 160 E. Stanko Day nursing 180 Canonsbur~ General Hospital Last Illness 145 I A. Richards --~ 220" I Geor!!e J _Modrak. Esa. Account 25_ J Inghram. M D Last Illness 98 Dr. Concilius Lc:st Illness 111 Dr. s. Safran Last Illness 199 John Yonev Amhulaike 12 r.olonial Pharmacv Me =e_Accoun t: 1'10 Peter Mehovics Reuse old Exe~tion, li~E~ 1.000 son in same _ho_1,1$_e.h9ld a§_mo_t er rusa I ·, Greenlee Richman. Derrico &·Attorney's _f~es 75 ,. TOTAL DEBTS & DEDUCT O:t\S ~ 4~216 COMMONWEALTH OF PENNSYLVANIA COUNTY OF Washington '· HET.ENe-reHOVICS, Informant, HEREBY cERTIFY. THAT. To THE &EST oF MY KNOWLI!:OGE AND BELIEF, THI!:°FOREGOING IS A JUST AND TRUE STATEMENT OF OEBTS, FUNERAL EXPENSES AND EXPENStS OF ADMINISTRATION SUBMITTED TO THE ESTATE OF ANNA MEHOVICS, 0EC£ASED. AS DEDUCTIONs; FOR INHERITANCE TAX PURPOSES. ~~~ - . /rt4 -----u.---1;,/ f t <L. s.l SWORN AND SUBSCRIBF.O I!EFORE ME THIS;, DAY 01' ne • U ,orntaD A •. ~t#i-~~: 1J~ ML ~3lary ~lilAc: •·.JYa~1rigton Washington c_quU:_ty, Pennsylvania '-...... "''' ' :."~ My Commissi..on .... Expires: ~--1----"'1_..3=-__;,------- 00 00 00 ·00 80 00 00 loo O_Q_ loo 00 IQO 00 00 00 00 60 00 04 00 00 44 I I I I I .... ~ . . ,.,._ R C C-81 (2-64) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS INHERITANCE TAX DIVISION NOTICE OF FILING OF APP3.AISEMENT HELEN G. MEHOVICS Informant ( ~~'OQ\z'CYAYd~4IWs'Wa'tW). ,. IN YOUR REPLY PLEA8E REFER TO In Re: Estate of ANNA NEHOVIC.3 --------~~~~~~~------------- ____________ W_AS_H_ll_'X3-_' _'ID __ N ________ County _ File No. 63-69-11.46 Dear J1rs. J:c1ehovics: You .are hereby notified that the original appraisement in.the estate of Anna Nehovics has been filed ip the office of the Register ~f Wills qf Washington County on }ia,rch 10 , 19..1Q. Said appraisement reflects· the following valuations: Jt. Held Real Estate ________ ~~~~,~~------~':..----=ll:::..o,L::!4:.J...:76::.::·•:...::::8~9-- Tr ansfer ~ --------------'-· ·----"7~----- Total --·-·----------~l~l~·~4~7~6~.8~9L------ .< As to·s~ch tax that is paid within three months from date of death, a five (5%} percent discount is allowable. As to any ~ax that remains unpaid after one year from date of death, interest at therate of six ( 8%) percer"t per an.num is charged. Any party in interest who is aggrieved by an appraisement may appeal therefrom as provided by law. Date _____ ~M~ar~c~h~l~O~·~l~9~7~0 ______ __ DATE OF DEATH: ~~:® , . ·r""' November 28, 1968 l~ ···:.: Note: This is not a bill. j -<: .... RCC-39 (5--68) COMMONWEALTH OF PENNSYLVANIA TRANSFER INHERITANCE TAX RESIDENT DECEDENT SUMMARY Estate of HEHOVICS, ANNA DATE OF DEATH 11-28-68 FILE NO. 63-69-1146 (Last Name) (First Name) (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 retunn at the values set forth opposite each i tern in the last column to the right in Schedules "A", "B", "C", and "E". Dated: ---""-03,L;;.-""'l~0-~7..~...:0,__ ___ _ 11-28-68 REPORT OF THE REGISTER OF WILLS I, the undersigned duly elected Register of Wills in and for \11/ashington 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 Jr lesser amount is set forth in the last column to the right in Schedule "F", which greater or lesser amount represents the sum Dated: ____ -:;03.:.--....;1:::...0-:...._:.7...;..0 __ _ ~5Jh~ '~WILLS allowed as a deduction. INVENTORY Real Property (Schedule A) Personal Property (Schedule B) Trartsfers (Schedule C) Joint-Held Property (Schedule E) VALUE AS REPORTED VALUE AS APPRAISED VALUE AS REAPPRAISE:;) $ $ $------------~--- TOTAL GROSS ASSETS Less Debts and Deductions (SCHEDULE F) 11,476 89 4 216 44 CLEAR VALUE OF ESTATE 7 260 45 7,260 45 Valuation of life estates or annuities . . . . . . . . . . . . . . . . . . . $ ---------+--- ESTATE TAX ASSESSMENTS $ __________ .......__ FOR USE OF REGISTER ONLY COMPUTATION OF TAX Tax on $ ------------+----2% Tax on $ ? 260 1.,_ S @ Tax on $ -----------+--5% Taxon$ ______________ ~---10% Tax on $ ------------+----15% Exemptions=======:::::j:== * Total Estate------------'--- TOTAL TAX $ ______ ~~- $ ____ ....::ak:.::..3~ 56:.L.'3_ $------------4----$ _________ ~- $ ___________ -4---- $-----------~---- Less tax previously paid BALANCE Less 5% of tax if paid within $======4== 3 months after death BALANCE OF INHERITANCE TAX DUE Add interest at rate of 6% from --------to ------- $ _______ ~--- $====~= AMOUNT OF ESTATE TAX ASSESSED $----------+-- Estate tax paid $----------'-- (*) As evidenced by Charitable Exemption Certificates issued by the Secretary of Revenucz:, BALANCE DUE $--------~--- Add interest at rate of 6% from -------~10------$-------4-- TOTAL TAX BALANCE $ -----~- PAID $----------~--- FOR USE OF REGISTER ONLY ADJUSTMENTS NOTE: Where subsequent adjustments are made to the above computation of tax by the Register of Wills, for proper reason, same should be noted below, with short explanation. ,, Will Administration ~ No ...... . IN THE ... Year ........... . MATTER OF THE APPRAISEMENT OF THE ESTATE OF ANNA MEHOVICS Deceased Late of . CAIDNSBURG County of ... vi ASH I NGTON Commonwealth of Pe~nsylvania REPORT AND APPRAISAL .; .· t (] I Funn RCC-2 DEPARTMENT OF REVENUE --~ BUREAU OF COUNTY COLLECTION~ DATE ............... ~~.2!.J: .... J.:.Q.1. ...... J.::2.7.Q ............................. . COUNTY ................... !.r.?.:.~.h.tpgt.2.!!. ................................. . • ,? HARRISBURG. PENNA. 17 12 7 COMMONWEALTH OF PENNSYLVANIA RESIDENT INHERITANCE TAX APPRAISEMENT FILE NO. . ............... ~~.::::.f?..2::::;h~J.±f?. ............. _ ...................... . Whereas, ................................ J.\.~ .... ~~.~)}.9..\.?.:.<?..~ ........................................................................ late of ............................... 9.9.P.:.<?.t:l.~.l?~"FK .......................................... . in the County of ............................. W.~§ht.OO.t.9.D.. ........................................................................ Commonwealth of Pennsylvania, having died on the ......................................... ?$. ... t.h ...................................... day of .................... NQY~m.P~.:r. .............................. 19 ........ 6..$ seized and possessed of an estate subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania; Therefore, I, ....................... W..!.R., ..... G.ha~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 Appraisement Description of Asset Values Mad a for Inheritance Tax Purpoaes $ JT. HElD: See copy of Scheda.t:.le "En attached to appraisement 11,47~ 89 ' Total 11.476 89 .. Having been duly swo.rn according to law, I do here~y that the above appraisement is made in con- formity with Jaw on this ............. ,L:<i. .. d-.... day of ................... d....,.L .. z::;~················ ·:··········· .. 19 ..... .? .. 0. ~~./?:.............. . .. . ..... ···················~····~~········· z:z; ¥';;;;;;;-;;;;..,;;;;; . ...... . . ............................................................................... , Penna. (Post Ofliee) ( I I I I I --·· ----------------------------------- -.................................. ~f!\..S..Hl.NG.'IP.N .. Cou11ty .. ,, RESIDENT INHERITANCE TAX APPRAISEMENT Estate of ANNA MEHOVICS ............................................................................................................. Deceased. Late of CANONSBURG Date of . Death, ............. N.9.Y.~.P.I?..+#.$., .... J.99.$. .......... . Appraisemel!t Docket Vol., ~--········· ....................... . Page, .£..~.-~./. ................... No ....... 63.~.6.9~ll.4.6...... . Filed in Register's Office, ... Ma.r..ch .... l.0 ......... .19 . .7.0. .. . ·. Amount of tax dtce, $ ................................................................... .. DEPARTMENT OF REVENUE Received, I Examined' and Approved, Wrote abo.ut Appra.isement, Appeal f1'om Appraisement, Entered and charged, .. " . _,.....,._ ; t: n ,, .. Form RCc-33 C0MMO\JWEAL TH OF PENNSYLVANIA .DEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS J RESIDENT DECEDENT COUNTY OF ............ WA.SHINGT.ON ............................... : ..... .. IMPORTANT: This return must be complete-i 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_Int).erit~nce __ !ln!i _E_!!t!lte .T8JC A,ct of 1~91.) IN THE MATTER OF THE·ESTATE OF 1:: AFFIDAVIT OF ~~~::!:::::~:~~:~~:::~~=:-::: -=.:. ~ ~ State of ........................ P.enn.s.ylv..a.ni.a .................................. } 1V ~~,)·'' Cou~ty of ............ W:9..§.bi:ng_t;_QP............................................... ss: ................................................. HE..u.;.N. ..... G. .. !t ....... ~.HO.Y.l.G.~ .. , ....... l~.~.9.~1P~!l.~., .................................................... ....................................................................... Bai¥ of the estate of the above-n3.med decedent being duly swern, depose S and say S Decedent. died ................. N.9..Y.~Q-~.J.: ....... ?..~. '-···· ................................... , 19 .§~ ........ ,{·:x«H~KlfiKX:XBXMK~~BXXX~»XXH~X} (Month) . (llay) (Yf:11r) intestate . . other authorized representative to Nan:e and address of attorney or} p :8 t.:ri.~~ .. -~-...... P..e.:rti.C.O ., .ES.q .... ,. ..... GREE.N.LEE ,.RICHMAN.,.DERRI.CO ...... & ... P.OSA, whom all correspondence should be 325 Washington Trust .Building,. Washington, ... P.ennsy.lvani.a. mailed. · That as such lnfo.nnant ... : ............... depc·nent is familiar with the affairs of said estate and the property con- ( l•:x.,r.u tor-A rim in istrator) stituting the assets thereof and their fair market value. ··That at the time of death there was no S:\,fe 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:- That the contents of said safe deposit box or boxes are itemized under Schedules E return, with the exception of the following, for the reasons hereinafter set forth: of this That Schedule A attached 1'\ereto and made part hereof sets forth full v and in'·detail all th:! 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, givin~ 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 8 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 individ'!ally, or in trust for any other person or persons giving also separately the accrued interest thereon, lf. any, down to the las-: ~~ .... , interest day prior to decedent's death in the case of savings banks, and to the~:d~te-,of. decedent's deatb ~ . . in all oti}~r ca~es; all bonds~ postal sa"ings, treasury certificates or notesfand·.o_.ther evidence of in- debtedness of the United States to the. dP.cedent; all obligatior.s, whether by fst"a._'tTI-te o·r: agreement the!' are designated as tax free, of the Unitec States, or any state, or political subd1~sion thereof, or of d ;.t\'/, 1 any ftireign country, whicli are owned at the time of eath; all wearing apparel, ·~e,.el_r~,. si verware, pic- tures, books, works of art, household furniture, horses, carriages, automobiles}tb~ats, 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 mortga~~s held by decedent and of all claims due and owing decedeni 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 wha~soever 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 dividend~ due thereon and unpaid as of the date of death, bonds and a·ccrued i_nterest 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. In the case of securities of close or family corporations, the values reported are as far as possible subst_antiated' 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 ousine~s 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 a~swer to each ·inquiry contained therein and in the case of transfers ofproperty, real or personal, within tw.o years of decedent's death, in contemplation of decedent's death, or intended to take effect in possessio~ 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 transfe~ee and all other facts of a pertinent nature r_:egarding .sai(i ~ransfers. In, the .case of transfers intended to take effect in possession or enjo~ment at or after death, there is also attached ~o the schedule a co~y. Qf the. deed, trust agreement or o~her _instrument creating the trust. Ther~~ is also set forth in said schedule a list of all property, real· and· personal, with its value, which pa~'ses -at decedent's death by. virtue of the exercise by decedent, either individually, or jointly with another, or any power of appoint- ment vested in d~cedent, ei ~her individual_lf or jointly, by the will, deed, or other instrrunent of another, ' .. .... f'; " • ~ith_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 de~th, the ~ature 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 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 instrrunents effecting the vestiture of real estate and the date of acquisition of per!\onalty, plus. the name, address and relation.ship, if any, of co-o·wners :to. the dec.ed_ent. 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 tmpaid at time of death; taxes accru~d ch~rge.able 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. Subscribed and sworn to before me this ............................... .. ................ " .. /....S.:.. ... ~1. ............. da~~f· ...... ~~.p.~~~ ... b.e.r...19 ..... 6.9 .. ... o.d ..... C. ... r.,..-J...J.f. ..... ~J~ .............................. . . ' DONNA JO ANN FURDA, Not•rv Publta Washington, Washington Co., Pa. My Commiuion &pires April 9, 1973. NOTE: Before signing affidavit make sure all blank ········~;~;;:A=~····················-........... . Helen G. Mehovics, rJniormant ...2-Jo .... vint,St:r~tr.e:,m;;r .......................................... --.. ... G.~~.9..~.~J;.rg:;~;·g_, ...... f..~'Q9..S.Y.lY.ani.a ........................ .. (City or Town and State) 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) COMMONWE'AL TH OF PENNSYLVANIA DEPARTtt'.ENT OF REVENUE BUREAU OF COUNTY COLLECTIONS TRANSFER INHERITANCE TAX RESIDENT DECEDENT SCHEDULE 11A11 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 held 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 wl 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, accrued Interest on mortgages, etc.,are to be listed on Schedule "F" and must not be d_educted from this schedule. NONE . --. (1) ASSESSED VALUE FOR YEAR OF DECEDENT'S DEATH • • • • ~ ·~ '·' ' • • • 'I • • : . ~: ' , ... ,~t; .. ,:;.. ... . ...... 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 (3) DEPARTMENT VALUATION CAUTION (Do not write In this space) 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.Q.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 o~ 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. 0 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. RCC-36 n CO\P.lmN'I'TULTH OF PENNSYLVANIA TlUNSFER INHERITANCE TAX ~~SIDENT DECEDENT SCHEDULE "C" TRANSFERS (1) Did decedent, 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 ----- (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)_N~O~-- (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) ____ _ (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 val_u_a_b_l_e_a-nd-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 th(· property transferred? (Answer yes or no) -~N~O~--- (b) The right to designate the persons who shall possess or enjoy the property transferred or income therefrom? (Answer yes or no) 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 could revert to decedent under terms of trans rer or by operation of law? (Answer yes or no) NO (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 DESCRIPTION NONE Insert this total opposite "Transfers", Schedule "C" in the "As Reported" column on the last page of this return. MARKET VALUE (Estimated) DEPT. VALUATION (Dept. Only) RCC-38 ' .. . .. ... CC~ONWEALTH OF PENNSYLVANIA TRANSFER INHERITANCE TAX. RESIDENT DECEDENT SCHEDULE "E" JOINTLY OWNED PROPERTY :1 ,. , . .,;- IlSSTRl'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 tena9ts, 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! Unit Percentage Estate Address and Relationship of Co-Owners, and Place Value Share Valuation of Record of Instrument, where Real Estate. 1 1/2 value of frame house situate at· 230 Vine Street, Canonsburg, Penna., Deed Book 585, page 609, Dec. 29, 1~ . 1932. In name of Peter Mehovics }& .. ~ ;~,"~ (son) and Anna Mehovics. To ta 1 q ~~~Ci _3 Y ...-z value $5,00~-1/2 v~A.ue ' 1/2 J1Dl"' .~ ~ ~~~ ~ 1/3 of Joint Bank account No. 3880-' Mellon National Bank, Canonsburg Office -Balance .$3070 • 70, in the .A":.~ JJ _.JI) ? mames of Anna Mehovics, Helen ~aN' .. ~· Mehovics and Peter ~eqpvics. -~~g 1 1/3 ~\Jo-')--C.f U. s·. Savings Bond in name of Helen G·. Mehovics and Anna Mehovics (see list attached) total value $2555.78 ' 1/2 u.s. Savings Bond in name of Anna~f( Mehovics or Pete Mehovics (see . ~~. list attached) total value-· -~ TOTAL JOINTLY HELD PROPERTY • • • • • • $ , c.on 18 ~{ ~'lt-Yf \ 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 I ( h .. . '~· ._ RCC..:37-(12-63) C'Ol\11\tONWEALTH OF PENNSYYLAN1A TRANSFER 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) . .\: .. Helen G'. Mehovics .. 230 Vine Street. Canonsburg. Penna.~··· ......... .... .1.. ..... • "L . Pete Mehovics 230 Vine St: Canonsburg. Pennsvlvania. .. ' ' . ' ~ ' : .. '. . .. . ' . . . , . -.. \ ;.I . r~1 ; ~ ': .. -~ . ~ ~:; .. !' lo r : ··":' !-: ' '. SCHEDULE "D" BENEFICIARIES ' RELATIONSHIP SURVIVED (If step-children or DATE INTEREST OF illegitimate children DECEDENT OF BENEFICIARY are involved, set STATE YES IN ESTATE · forth this fact.) OR NO ~IRTH r . Daughter Yes -----See Schedule E. Jointly Held Prop. - Son Yes -----~PP St".hPrln1P F. Jointly Held Prop . .. . .. . . - - - . I • .-. ' . . Deponent further says that all the above-named beneficiaries are living at this time except below: NAME DATE OF DEATH RESIDENCE ~---------------------------------------------------------------------------------------~ Will Administration ~ N~ ... //~~---· Year .... &. .. / IS THE ~lA TIER OF THE APPRAISEMENT OF THE ESTATE OF ANNA MEHOVICS .. D~ed c;n - -T !, ' ' • ' ~I r<le c.;C ...,.,.,.... \ ..... ~~ : Late of ... tbe-~,~~gb ... @ ... Ci}bons.b.U.l:'g ...... ' ~";-'"-~ --t = ~-~~ Fl., ~--;-:;:t~ t'=l'f'i_· .-\ .. C:i: M ~..,.. ~ t="":i T.~ "ri :i,= ~ Countv of ... ~S'.u:~;ngton ... . ~-...... . . ...,.:.~'?.'"· ~ ' ..,._ ~-.;.l ;;!z,. ::X 0 Y.~ Commonwealth ofi ~ii$\-Ivania.o -i r: ;;;: "'"Q.i;=@ ~c,p, c;.R' •. .c:"~~ .. _,. REPORT AND APPRAISAL Patrick C·. Derrico GREENlEE RICHMAN ·DERRICO & POSA . ' '. 325 Washington Trust Building Washington, Pennsylvania 15301 i j. :j _I-. .., . .. I' I ' . 'l ''l . ,• .,, (Executor-Administrator :, must complete "As ' Reported" column #1.) CJ :c... ...., '"d 3 :o ~ ~ ~ :...,. ~ ~ ...., ::s (;' ~ Po> :rt ;;l ,_ ·><· J-1 ~-'< ~ ,_ 0 ~ :::z: "0 1:%1' :m ~ "' :1-l ,.. 6t :o. '< ..... . 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