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HomeMy WebLinkAboutOC1969-1276 - ESTATE OF GOGGIN....', Form RCC-33 RESIDENT DECEDENT COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS COUNTY OF j wAS~NGr.9.N .. 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 _J~J!~LJnheritance.an9-Estate'I'axA,ct of 1991.) IN THE MATTER OF THE-ESTATE OF } . AFFIDAVIT OF "H.~.~.~N W..!QQGq~N............~ (State full name of decedent) Donora,~RH~ Late of ,Wg,$h.i.ngt9p..County Joint Tenant :.:.~~::~;~:::::-:-_::::::::}'" ...........Do.r..othyK..GQggin :J.QJ:[~,tT~p,~~t......... of the estate of the above-named decedent being duly sworn,depose S and sayS Decedent'died .....$~Pt~~M~~~···········~R~y),19(t~i..'{~::::::t~eaVing a last will,copy of which is hereto attached.} Name and address of attorney or} other authorized representative to whom all correspondence should be mailed. Geo O Fraz.ie.r,Attorney at La.w . P..Q.Bo:x359,..Donor~~PeP.Jl$ylyctni,ctl5.Q:3J . That as such J..Q.i.nt.:r..~n~nt deponent is familiar with the affairs of said estate and the property con- (~llW') stituting the assets thereof and their fair market value. That at the time of death there was no safe deposit box registered in decedent's individual name,or jointly with,or as agent or deputy of another,or in decedent's individual name,with right of access by another as agent or deputy,with the exception of the following:- NAME AND ADDRESS OF BANK OR OTHER INSTITUTION IN WHICH DECEDENT RENTED A SAFE DEPOSIT BOX 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 full v 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,byJtheI9~cedent at the time of death,whether in decedent's immediate possession,standing to decedent's'credit i~-banks of deposit,savings banks,trust companies,or other insti tutions,whether individuall"y;o~-tn··trust for any other person or persons giving also separately the accrued interest thereon,if any,down to the last ~'--..:interest day prior to decedent's death in the case of savings banks,and to the d~te of decedent's death in all other cases;all bonds,postal savings,treasury certificates or notes and:ather'evidence of in- debtedness of the United States to the decedent;all obligations,whether by statyte ,or'.agre,ement they are designated as tax free,of the United States,or any state,or political subdfvision thereof,or of;............-any foreign country,which are owned at the time of death;all wearing apparel,jewelry;Isilverware,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 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 policles 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. r 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 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,transf~rs..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 cony 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 ~he ~ill,deed,or other instrument of another, with a copy of the instrument creating such power attached to the schedule.-, That Schedule D attached hereto and made part hereof sets forth the nameS and addresses of all persons beneficially interested in this estate at the time of decedent's death,the nature of their res- pective interests,their relationship,if any,to the decedent,together with the ages at the time of decedent's death of all minors,annuitants and beneficiaries for life under decedent's Will.It also contains a statement shoWing which of the beneficiaries named.in the decedent's will,if any,died prior to decedent,the dates of their death,their issue,and the relationship of such issue to the beneficiary. That Schedule E attached hereto and made a part hereof sets forth all property,real and per- sonal,owned by the decedent jointly with another or others,including intangible,standing in the name of the decedent and others,plus the date and place of record of instruments effecting the vestiture of real estate and the date of acquisition of personalty,plus the name,address and relationship,if any, of co-owners to the decedent. That Schedule F attached hereto and made a part hereof sets forth fully and in detail all debts and deductions claimed for and on behalf of this decedent's estate,including funeral expenses paid; family exemption,where applicable;costs of administration of this 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 collater'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 Summary• .'.4 Th SubscrIbed and sworn to before me thIS ./.... ................................................",day of .N.Qy.emb.e.r.19 6.9 . /~~Notary Public~;~=;:::~&::;···ih~··;·;,··;;;~ ..I1-----.~~~~t ....~.?7.r.h.9.m ..~.Qn Ay..e.nue ,. (Street Number) ....l?9.I.l:?!..~.f :p.~.~.~.Y..!Y..~.:q,~.~J.?.O'~.}. (City or Town and State) NOTE:Before signing affidavit make sure all blank spaces in the affidavit and schedules annexed are filled in with details or the word "None",and in case the assets include rare and unlisted securities, securities of close or family corporations or an interest in any co-partnership or business,that the data and statements required under the paragraph above relating to Schedule "B"are attached.Also make certain that column #1 in the "Summary"has been properly completed as above-directed. RCC-34 (1-64) COMMO~EALTH OF PENNSYLVANIA D{iPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTION'S TRANSFER INHERITANCE TAX RESIDENT DECEpENT SCHEDULE "A" ~AL PROPERTY .*R.,, Real property in Pennsylvania,with statement ~f mortgage encumbrances upon each parcel at death of dece- dent.Where property held as joint tenant or tenancy by entireties,report on Schedule /IE".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 Commo~wealth af Pennsylvania should be (1)(2)(3)I described by lot and block number,'str'eet and street number,together wi th D~PARTMENT a general description of the property,with a reference to the record of the ASSESSED VALUE VALUATION conveyance by whi ch the decedent took title;If a farm state number of a·FOR YEAR OF ESTIMATED CAUTIONcres;also statement of mortgage encumbrances upon each parcel at death DECEDENT'S MARKET VALUE (Do not writeofdecedent.Taxes,assessments,accr.ued Interest on mortgages,etc.,are DEATH In this space)to be listed on Schedule "Fit and must not be deducted fram this schedule. None . , , •, " ,-. · .; · Insert this total opposite /lreal property",Schedule "A"in the X X X X X /lAs Reported"column on the last page of this return.None RCC-35•,COMMONWEALTH OF PENNSY;LVANLt). TRANSFER INHERITANCE TAX RESIDENT DECEDENT SCHEDULE "n" PERSONAL PROPERTY INSTRUCTIONS:This Schedule must disclose all tangible and intangible personal property owned individually' by the decedent,at the time of his death.Property owned by the decedent jointly with another or others must be listed under Schedule "E".Inta~gible personal property,titled in the name of the decedent,but payable at death to another or others,including but not limited to p.a.D.U.S.Savings Bonds and tenta- tive trust accounts,must be listed,despite the fact that they are not of the administered estate. Tangible personal property should be listed first (e.g.jewelry,wearing apparel,household goods,and furnishings,books,paintings,automobiles,boats,etc.) Intangible personal property,such as bonds,treasury certificates,cash on hand and in bank,.. stocks,'mortgages,notes,together with accrued interest or dividends,salaries or wages,insurance pay- able to the estate or fiduciary in said capacity,partnership interests,interest in anyundistributed estate of or income from any property held in trust under the will or agreement of another,even though located outside of the State,at the time of death,should be listed in this schedule. Item ITEM UNIT ESTIMATED DEPARTMENT VALUATION No.List and"describe fully VALUE MARKET VALUE (Do not write in this space) None Insert this total opposite "Personal Property",Schedule "B"in X X None the "As Reported"column on the last page of this return. RCC-)6 COM!lfON1\K\LTH OF PENNSYLVANIA· TRANSFER INHERITANCE TAX ~SSIDENT DECEDENT SCHEDULE "c" TRA.NSFERS (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)~o (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)~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 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)Was there any possibility that the property transferred might return to transferer or his estate or be subject to his power of disposition?(Answer yes or no)_ (b)What was the transferee's age at time of decedent's death?.------(5)Did decedent in his lifetime make any transfer without receiving a valuable and adequate consideration therefor under which transferor expressly or impliedly reserves for his life or any period which does not in fact end before his death: (a)The possession or enjoyment of or the right to income from the property transferred? (Answer yes or no)~o (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 0 thers -----,--_ (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)~o (8)Did decedent,at any time,transfer property,the beneficial enjoyment of which was sUbject to change, because of a reserved power to alter,amend,or revoke,or which cOllld revert to decedent under terms of transfer or by operation of law?(Answer yes or no)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 None DESCRIPTION MARKET VALUE (Es timated)DEPT.VALUATION (Dept.Only) Insert this total opposite "Transfers",Schedule "C"in the "As Reported"column on the last page of this return.None •C.c\MMI)NWFI\1.TH OF PENNSYLVANIA' n;\X~':;l'Flt IKHE1UTANCE TAX ItF~InENl'DECEDENT SCHEDULE "E" JOINTLY OWNED PROPERTY DiSTRlTTIO~S: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-o-wners to. the decedent. Mellon National Bank &Trust Go.-Donora Office -Checking Account held in name of Helen Goggin or Dorothy Goggin,mother and daughter -Total -$1,7Z4.38- 1/2 of $1,7Z4.38 Taxable = Description of Property,Date of Acquisition,N~me!Unit Address and Relationship of Co-Owners,and Place I Value of Record of Instrument,where Real Estate.! I The following stocks were held in the name of decedent,Helen W.Goggin,and Dorothy K. Goggin,mother and daughter,as joint tenants with the right of survivorship and not as tenan S in common: 54 Shares'Common Stock -Atlantic Richfield Co.@ 100.50 =.$5,4Z7.00 1/2 of $5,427.00 Taxable = percentage Share ( Estate Valuation Z,713.50 DEPART~lENT VALUATION CAUTION-Do not Write In This Space. Value of Value of Entire Decedent's Property Interest 486 Shares Common Stock -U.S.Steel Corp. @ 36 7/8 =$17,921.25 lIz of $17,921.Z5 Taxable =I I $2,200 -U.S.Steel Corp.-4 5/8%SubordinJted I Debenture Due 1996 •$1,45Z.00 I II l/Z of $1,452.00 Taxable =Ii I TOTAL 95 Shares Common Stock -Eastern Stainless Steel Corp.@ 18 3/4 =$1,78-1.25 1/2 of $1,781.25 Taxable = 84 Shares Common Stock -The Greyhound Corp.@ 17 7/8 =$1,501.50 1/2 of $1,501.50 Taxable = 10 Shares -Voting Trust Certificate - Society Corp.@ 7Z =$72,0.00 liz of $720.00 Taxable = NOTE:All of the above property was held as joint tenants by mother and daughter for more than two years prior to death of mother,and under Section 241 of the Inherita Tax Act of 1961,one-half of the value of the above property is subject to tax. I 6k iI I I ; I iI ,ce II I 890.6Z 150.75 I 360.00 1 I Ii 8,960.64 I I I I I II7Z6.O~ ~15,263.6~ I i I I I I Ii I I i I I I Insert this total opposite "Jointly Owned Property",Schedule"E"I in the "As Reported"column on the last page of this return.$15,261.6~~~J RCC-3Y':.,.(12-63) COMMONWEALTH OF PENNSYYLANIA TRANSFER INHERITANCE TAX . RESIDENT DECEDENT SCHEDULE "D" BENEFICIARIES ( h BENEFICIARIES AND ADDRESSES RELATIONSHIP SURVIVED(If step-children or DATE INTEREST OFStatefullnamesandaddressesofallwhoillegitimatechildrenDECEDENTOFBENEFICIARY ave an interest,vested,contingent or other-are involved,set STATE YES IN ESTATE wise,in estate)forth this.fact.)OR NO BIRTH.. Dorothv K.GO!H!in ,n;:ll1O'ht~r Yes Over 21 vr~All -~pp Nntp "RP1n 827 Thompson Avenu'e ( .Donora,Penna.15033 NOTE'Decedent Ie t no estate othe than loin Iv held DrODertv listed under Schedule E - ~ w Deponent further sa.ys that all the above-named beneficiaries are living at this time except below: None NAME DATE OF DEATH RESIDENCE (Executor-Administrator must complete "As Reported"column #1.) .... 'C-j ...,""0 ~:0 ...('l)('l):.....~;:;1 ~:::1 ~0 -:rl-.....::l '"t:l:....('l)~... "<:;...-0-til "0 ""0 ('l).......g ~ ~,.. '< ::r: :(1):....:p. :'tl:Ii '0"0:(1):1"'/:rl- ~ ..., ~~~ o...otiltil trJtil....~....('l) P.Il THE ESTATE OF OF THE HELENW~..GQOGIN~ Deceased ~IATTER OF THE APPRAISEMENT ~t Go~~(,9-<~,7~ JOINT TENANT Late of ...PQNQ~AI..PENNA... Commonwealth of Pennsylvania .- County ofWASfUNOTON rJ:J C~ ~:> :..-....-.....-.....-..~ :(1)W en en >-<: :()::r"(")("):;:r .?"'?"':=(')~>:M :: :-""-"-"*"*"*"*"*"* ~:....U1 :\J1 ;;..~~tiltvN2':2':Z ~........:0':0'.:y.,:y.,0 g g ('l)_..:.t:l 'g~ :0':0'(1)(1)(1).......:00 :00 ('l).,c.. ~ 0-·..-...J :x::.=r c..e ,...", -." 5:en ~--f'~c..o ~.~...REt~!t f*ND ~R~L =(/')(/"I ..-r Z"';m -I'"'P"'!rnrn r:..-"I'~;Vr-°0~~.~ Q _c,..*'~p =:;1) 11 ,-."""-".... '"l:'I F=:.1<: f>'(,nO "*"*"*"*000"* GEO.O.FRAZIER Attorney at Law Donora,Pac 15033 ;;.. :r. o8-l;...~2.:::lr;c.. RC C-81 (2-64) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS INHERITANCE TAX DIVISION NOTICE OF FILING OF APPRAISEMENT DOROTHY K.GOGGIN IN YOUR REPLY PLEAtS RE".R TO J I In Re:Estate of H_E_L_E_N-.-,;,\v_._G_O_G_G_I_N_J _ ____~''!:..:.;A:.;:S:..:.H:.::I:.:..N:..::G:..:::T~O~N"__County - FHe No.63-69-1276 Dear Hs.Goggin: You are hereby notified that the original appraisement in the estate of Helen ,~.Goggin has been filed in the office of the Register of Wills Qf Fa ~hin~tQn County on December 18,19.6.9.Said appraisement reflects t e following valuations: Jt.Held Real Estate _......;.._ Personal Property __~1~5~,~2~6~3~,~6~8~___ Transfers --=-..",....-",,-,::--.......,.._ Total .....:1:::..;5:::...1.;,2=-6~3~.6~8~_ 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. Dat e _---"-!D.s;ei..lo..c..s;eaIDwh.l.lpc..r.L:-.,bJ..I;;8"',r--=1b-:9~6e.¥9---Signed Title Date of death:Sept.30,1969 Note:This is not a bill. 'CC-39 (5-68i COMMONWEALTH OF PENNSYLVANIA TRANSFER INHERITANCE TAX RESIDENT DECEDENT SUMMARY i:state of GOGGIN (Last Name) HELEN (First Name) w. (Initial) DATE OF DEATH 9-30-69 FILE NO.63-69-1276 REPORT OF INHERITANCE TAX APPRAISER I,the undersigned duly appointed Inheritance Tax Appraiser in and for the County of__'_vA_S_H_I_N_G_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:12-18-69 ;))0 ~~,O 9-30-69 INH~CETAX AtiAiSER 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:__]~2=-..&.]....8....-...6....9;L-_ VALUE AS REAPPRAISED $~- 15 263 68 15.263 68 1.667 44 13.596 24 15 263 68 15.263 68 1.667 44 13.596 24 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 Deductions (SCHEDULE F) CLEAR VALUE OF ESTATE Valuation of life estates or -=1= ================================ FOR USE OF REGISTER ONLY Tax on $-+__ Tax on $__-.lll.-.~J-,-~r::.,+QI~Ih_---f-"''J;..!:.11:-- I Tax on $---------+--Tax on $-+__ Tax on $-4-__ Exemptions========1:==Total Estate I--_ TOTAL TAX 2% 6% 5% 10% 15% '" COMPUTATION OF TAX $-------+-- $----o.Q!',I,..;;;l-C:+-I-"'./--" $-------+-- $-------~­ $-------+-- $-----_---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 BALANCE OF INHERITANCE TAX DUE $t= Add interest at rate of 6%fro~_____to $--l AMOUNT OF ESTATE TAX ASSESSED $--~----lL- Estate ta1\.paid $....ll- BALANCE DUE $----ll_ Add interest at rate of 6%from -------'lto-----$------It= TOTAL TAX BALANCE $------i. PAID $--l FOR USE OF REGISTER ONLY ADJUSTMENTS NOTE:Where subsequent adjustments are made to the above computation of tax by the Register of Wills,for proper reason, same should be noted below,with short explanation. Will Administration !No. IN THE Year MATTER OF THE APPRAISEMENT OF THE ESTATE OF Deceased Late of . County of Commonwealth of Pennsylvania REPORT AND APPRAISAL r - Fonn RCC-2 ~COMMONWEALTH OF PENNSYLVANIA DATE P'..~.~..~,.......!..§.~.......~.~..?..~..............................,...... ....DEPARTMENT OF REVENUE RESIDENT INHERITANCE TAX WASHINGTONJ"COUNTYBUREAUOFCOUNTYCOLLECTIONS..............................................................................,.................... HARRISBURG.PENNA.17127 APPRAISEMENT FILE NO•.............?}..:..§..~.:.!..~.?§................................. Whereas,HELEN \".GOGGIN late DONORA......................................................................................................................................................of ............................................................................................................... in the County of ...................J.i.A,$..H!N.Q.IQ-N..........................................................................Commonwealth of Pennsylvania,having died on the ................................~.9.~.h...............................................day of ..............;........~.~.p..!.~.~?.~.~...................69 seized and possessed of estate19............,an subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania; Therefore,I,................................W:.~.....JL.......G.HAN.E.x....................................................,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 Made for Inheritance Tax Purpoles $ JT.HELD PERS... As ner annraisement filed 1 .r;2fl~flR ! Having been duly sworn according to law,I do hereby certif~that the ~~ve appraisement is made in con-formity with law on thls/£...L:;:-Lmm day Of_~~,,;:'j;r:t.:~:...~ ......·..........·........................7 ..·....·..·......................·....·..·........·..·.......................................................(KU~~and Street) ·..............····..·..··..·....····=······..···..·....·......···..··..;t~...........~....................,Penna.(Post e) WASHINGTON County RESIDENT INHERITANCE TAX APPRAISEMENT Estate of HELEN W.GOGGIN Deceased. Late of DONORA Date of Death,Se.p.t..•......3.O'.,.l.9.6.9 . Appraisemel!t Docket Vol.,J.~. Page,~I.~?.N o...§.;?.:-::.§..9..:-::.i..~.7.9.. Filed in Register's Office,D.e..c..•......l.8 .19 6.9 Am,ount of tax due,$. DEPARTMENT OF REVENUE Received, Examined and Approved,'" Wrote abo.ut Appra.isement, Appeal j,.om Appraisement,. Entered and charged,. " Form RC C·lO DEDU~Tl.ONS ALLOWED IN j ~GENT OF THE COMMONWIiALTH ~#-t..J-t9-~ THE SUM OF $.I{tLE~STATEMENT OF DEBTS AND DEDUCTIONS u • COUNTY OFFICE OF THE REGISTER OF WILLS OF WASHINGTON ESTATE OF _---'H~e::.:1~e::.:n::..-W.:..:_:.~G=0..cgu::g:a..:i=n=__L.ATE OF -:;:D;;..o.;;.n:;::...:o:...:r:...:a::..:J:.....:P:......:;e:...:n;;..n.,;.s.,;.y~lv..:....::a.:.;n:;:i.,;.a _ DATE OF FILING APPRAISEMENT DATE OF DEATH _~S_e~P....t_e_m--..:.b_e_r_3_0..:.,_1.:.9_6_9:........_ DATE NO.OF VOUCH"11 NAME OF PAYEE REMARKS AMOUNT Oct.16 Nov.10, Nov.10, Home Lawson-Rabe Funeral Home Kurtz Monument Co. Geo.O.Frazier Nursin Home Funeral Expenses Grave Marker Attorney's Fees 23 65 1,378 79 ll5 00 150 00 TOTAL 1 667 44 COMMONWEALTH OF PENNSYLVANIA } COUNTY OF Washington S8: I,Dorothy K.Goggin,Joint Tenant ..••/rJ.J -_-6~--=-.:::z.-I-~/--:-I-~sz:.:'-I--l-~'--(L.5.) SWORN AND SUBSCRIBED 'SEFORE ME THIS -.L:C~DAY01" ..N.mLember·18 69/~~.L--Notary Public My commis~xplres:~/~/97..9