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Home My WebLink AboutOC1970-0553 - ESTATE OF HOLTZRCC-39 (5-68) COMMONWEALTH OF PENNSYLVANIA TRANSFER INHERITANCE TAX RESIDENT DECEDENT MAX SUMMARY DATE OF DEATH 10-10-69 FILE NO. 63-70-553 Estate of HOLTZ, (Last Name) (First Name) (Initial) REPORT OF INHERITANCE TAX APPRAISER I, the undersigned duly appointed Inheritance Tax Appraiser in and for the County of Washingtm 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 i tern in the last column to the right in Schedules "A", "B", "C", and "E". Dated: ___ _,0""'6-__,2=6~-....L7-"'-0 ___ _ 10-10-69 REPORT OF THE REGISTER OF WILLS I, the undersigned duly elected Register of Wills in and for \vashingtan 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?2reat r lesser a·m.ount represents the sum allowed as a deduction. Dated: 06-26-70 . t~erL ~~ REGISTER OF WILLS INVENTORY Real Property (Schedule A) Personal Property (Schedule B) Transfers (Schedule C) VALUE AS APPRAISED VALUE AS REAPPRAISED $ $-------------+---R. 1)00 )() 2.205 '39 Joint-Held Property (Schedule E) TOTAL GROSS ASSETS Less Debts and Deductions (SCHEDULE F) CLEAR VALUE OF ESTATE Valuation of life estates or 10 705 39 1 437 50 9 267 89 annuities................... $--------4--- EST ATE TAX ASSESSMENTS $ 10,705 39 1,437 50 9,267 89 FOR USE OF REGISTER ONLY COMPUTATION OF TAX Tax on$ cy Tax on$ q 267 8q Tax on$ 0 Tax on $ 10% Tax on$ 15% Exemptions * Total Estate TOTAL TAX Less tax previously paid $ BALANCE $ Less 5% of tax if paid within 3 months after death $ BALANCE OF INHERITANCE TAX DUE Add interest at rate of 6% from ------to ------ $----------~r4~~ $ ___ ___,5~5~6...::.0..!.-.7- $-------------4---- $ ___________ -4---- $-------------4---- $--------------L---- AMOUNT OF ESTATE TAX ASSESSED $-----------1-- Estate tax paid $----------'-- (*) As evidenced by Charitable Exemption Certificates issued by the Secretary of Revenue. BALANCE DUE $ ________ -J __ _ 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 .......... . MA TIER OF THE APPRAISEMENT OF THE ESTATE OF .. l'11\.X HOLTZ Deceased Late of . . CAL.IfORN I.A County of . . . :VfASHlNQ'I'.a.;f ............... . Commonwealth of Pennsylvania REPORT AND APPRAISAL RCC-81 (2-64) COMMONWEALTH OF PENNSYL VANtA DEPARTMENT OF REVENUE ~UREAU OF COUNTY COLLECTIONS INHERITANCE TAX DIVISION NOTICE OF FILING OF APPRAISEMENT TrillODOSIA HOLTZ Informant IN YOUR REPLY PLEAOE REP'IER TO In Re: Estate of ________ ~MAX~~HO~L~T~Z~------------------ _____ W~A""'L:::I::..F"""'OR~N"-!..:IA~----County -File No. 63-70-553 Dear Mrs. Holtz: You are hereby notified that the original appraisement in the estate of Max Holtz has been filed in the office of the Register of Wills qf Washin~ton County on June 26 , 19 70. Said appraisement reflects the following valuations: Rea 1 Estate ---'-----=8~, "-50::::.;0~·~0~0:..__ ___ _ Personal Property __ ~2~·~2~0~5~·~3~9 ________ _ Transfers----------------~----~--- Total ------------•1~0~1 7~0~5~,~3~9~· ------- As to such tax that is paid within three months from date of death, a five (5%) percent discount is allowable. As to any tax that remains unpaid after one year from date of death, interest at the rate of six (8%) percent per annum is charged. Any party in interest who is aggrieved by an appraisement may appeal therefrom as provided by law. Date ______ ~J~un~e~2~6~,~1~9~70~-----Signed {2/J(? ~ £.~ Title W.R. CHANEY, CHIEF Hi.AISER DATE OF DEATH: October 10, 1969 Note: This is not a bill. j Fonn RCC-2 DEPA~TMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS HARRISBURG. PENNA. 1712 7 COMMONWEALTH OF PENNSYLVANIA DATE ......... . June 26, 1970 RESIDENT INHERITANCE TAX . ' ·couNTY .......................... W.~~.hl.P.~.9.P.: ....... . APPRAISEMENT FILE NO .............. ?..2.:79..:?..?..?. ................. .. Whereas, ............................... ~ .... H9..+.:t?i ....................................................................................... late of .................................... 9..~~:i!..?.:r.~.~~ ................. . in the County of ............................ W.9.-9..b:t.ngt.QP. ................................................................ Commonwealth of Pennsylvania, having died on the ................................ J.O ... th ........................................... day of ................ .9.~t.9..P~.:r. ............................... 19 ...... ~.9, seized and possessed of an estate subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania; Therefore, I, .............................. W .•. R., ..... COO.n..ey: ............................................................. , 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. Appraisement Unit Description of Asset Values Made for Inheritance Tax Purposes $ REALTY: See copy of Schedule 11A11 attached to appraisement 8,500 00 PERSONALTY: ,, See copy of Schedule "B attached to appraisment 2,205 39 " Total 10,705 39 ............................... , Penna. - WASHINGTON County RESIDENT INHERITANCE TAX APPRAISEMENT Estate of J:.WC HOLTZ Deceased. Late of CALIFOmiA Date of Death, ...... O.cto.b.e.r ... l0., ... 1.96.9 ................. . Appraisemel!t Docket Vol., ........ :3.?....':':. ............................ . 8 ..-. :2 Page, ........ ..;$ .. "": .. "'-". ............ No .... 9.3.~.79::55.3.. ............ . Filed in Register's Office, ..... .J..@.~ .... ?..9.., .... 19 . .79 Amount of tax due, $ ................................................................. . DEPARTMENT OF REVENUE Received, Examined and Approved, Wrote abo.ut Appra.isement, Appeal f1'om Appraisement, Entered and charged, . 1( - ' ' I Form RC C910 DEDUCTIONS ALLOWED IN J OFFICE OF TME REGISTER OF WILLS 5o.3i;tt7o STATEMENT OF DEBTS · -AND DEDUCTIONS ;H~ SUM OF . . . . . . . . . . . . $ .. 4 ?.<l.z~ .'Vt2,..... . . . . . . . . ···· ... ~ = ~~ ~zo. . u.~ ~~1-#t/(). Regi.ter of Wills, Agent ESTATE OF MAX HOLTZ California Borough LATE OF Wasn1ng'ton.County, Pennsylvanja DATE OF FILING APPRAISEMENT_....::G.=.._-_.£_;_t-;::_-......;,7_cJ ___ DATii OF DEATH October 10, 1969 DATE NO. OF NAM&: OF PAYEE REMARKS AMOUNT VOUCH"" D'Al+.or;n li'11n1P ... a1 HnmiP Rus~ell::_Maii{qQ Reg1ster o 1ils Patrono Cei!';ler Russell Marino Rel:!'ister of Wiils COMMONWEALTH OF PENNSYLVANIA COUNTY OF WASHINGTON 1, KATHRYN HOLTZ & Edwards •.· ' li'nno-ral H'vno'YIC!OC! ~, ?.!=!7 Filing Inve¥tor6 ane Aff1d vit o De ts& spenses 3 A++ornev!'; li'P.e<= l?.!'i Filing Petition for Settlement of Small Estate fd;. -;;)fAL / /,(1, HERESY CERTII"Y. THAT. TO THE BEOT OF MY KNOWLI!:DGE AND BELIEF, THI! FOREGOING 18 A JUST AND TRU I! STATEMENT OF DEEITS, FUNERAL EXPENSES AND EXPENSD 01" ACMINISTRATION SUBMITTED TO THE EST-1\TE OF -.....!!JMA~X~.LIH~Q.t...L!.l.J.T...I.Zo~..-____ /_J _____ ~::~ED, AS DEDUCTIONS FOR <NHER<'>NC£ TAX PURPO .. S. ~';----"----(L. &.< SWORN AND SUBSCRIBED BEFORE Ml! THIS ol Jd DAY 01' ~ ~~~~A-(/~_/ ~R~·~ California, Washington ~o., Pa. My Commission Exp1res January 29, 197'1. !'iO 00 00 '{)'<:J ~0 - -. '' '1-J,o j ·~· \ .· ~ •_f) .... -:r. :.T (J _.l 0- "":,;:7:. _.l ........ -0 c;:~ ""':':1'· <. ~w C' :l:~·· .... ~-... ~ ~-:?:::. 0 " .... ·-c· """ t/~ _ _; •. -.....-1·--... )....- ' ;.. ~olf:. · . .\',.~ .... ---~ ; .. d .:. .. ...\ _,,. :--...... "· t. ., f;,.;J':.,;.l \,)} t.J) ~ <.J.'J"":J -=- ~ ... .;;;::J ~ 0 (,)") ..,...~ ·-.> tl:t: 'Ul'1 ·4 r.c!: > ~~~161 ;;;::=> ~ r--\~ .... I l Fonn RCC-2 .. ' . . DEPARTMENT OF REVENUE . BUREAU OF COUNTY COLLECTIONS HARRISBURG, PENNA. 77 1 2 7 APPRAISEMENT Whereas, ................................... Max .... Ho.lt.z ............................................................................. late of ............................. California ....................................... . in the County of ........................ JV:ashin.gt.on .................................................................. Commonwealth of Pennsylvania, having died on the ......................... !.9. ..... ~1: ............................................ day of ................... .O.c.t.ob.er. ............................ 19.6.9 .... , seized and possessed of an estate subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania; Therefore, I, ..................... 1.V .... R. ....... Chan.ey .................................................................. , 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. Appraisement \ Unit Description of Anet Made for Inheritance Values Tax Purposes $ Jt. Held: Jt Sav Acct # 8677 held in the Pittsbur_.e_h National Bank California Office California Pennsylvania. In the names of ~1AX HOLTZ or MISS KATHRYN HOLTZ Onened 9-30-69 8.1 2R ,c; ,c; T+ .<:::!ll'tT; 1"t <TCI fl l"'l"'i-Jl 7?A7 l..e>ld in~~-c ll'l -o <;;; N::~t-inn::~l H::~nk r.::~lif'nrni::~ ()f'f'irP C::~ 1 i f' n rn i ::1 .. 7 PPR'R .:::vl 'r:l n i ::1 in rhP n:l.mP.::: nf' 'T'HEODOSTA HOL'T'2 nr KA'l'HRYN HCH.'T'Z nr MAX HOT.'l'Z OPened 7-3--"R l.d.~ 11 Tt-S!:! .,d n rr a fl. ,.. ,.. + Jl7 ?.A 7 h t:> 1 rl ; n + h P. Pi 1-1-C! h.r.ft '-' '-' Natioiilal Bank. California Office California Pe>nn t:>'trl v:l n i ::1 T_n t-l..e> n!:!me>c.o n.f' 'T'J..IROnfi~T!J. _HOLT_'7 " or KATHRYN HOLTZ or MAX HOLTZ. OBened 7-3-5$ 145 11 .Tt: HPld SPriP~ \IE~' S::~.vi nP'~ Hnnd C! _Ly,) ...... t'tvo $25.00 bond~ in the name~ of MAX HOLTZ 1.1 P!O.D. to A] ex Holtz St Purcha_ae_d from '"' R-42 'tn Q-42 HalancP a.::: nf dat-P nf deat:h { Rn 1 1 .,,.. 'T' <> 'V' ' $ Q () ?. h $?c; flfl 'Rnnde! in f-hP n!:!mPc.o l'IT M::~Y. "J / .... Holtz or ~JRS Theodorsia Holtz Purcha~ed frnm .~ .. ~h Cin h .hQ d fl -,~ nrP ::1 C! nf' ~ _n_f' n P.:lf-} " $.c; ~Ql Q~ !. T:lYahlP 2 7R6 23 ... T_o_.t.al , 20.c; 00 fonn~;"!,':fhb~~ :::h:Sw"':' ·~~~· ~:; :rer~b~:::P~~':§s ?~:i ~,e . . ~~ ··~···········z··· .................................................................................................... .... ... .... ...... ~-<, '-(!'" .,~~'' , Penna. I WASH.lNO'rQN County RESIDENT INHERITANCE TAX APPRAISEMENT Estate of ............ NAX HQ:L.T.~.. ... . . ... Deceased. Late of ... CALIF.ORNl.A ................................................ . Date of Death October 10 1969 ' ······················································'···························" Appraisemel!t Docket Vol., Page, No. . ........ 9..J..~.zo.~.s.s..1 Filed in Register's Office, ..... July. ... -14 .. 19 .. ?.0. Amount of tax due, $ ................................................... : ............... .. DEPARTMENT OF REVENUE • Received, Examined and Approved, Wrote abo.ut Appra.isement, Appeal f1'om Appraisement, Entered and charged, ~ .,____ --- •• •' ' _, N THE COURT OF COMMON PLEAS OF ~SHI.NGTON COUNTY, PENNSYLVANil ORPHANS' COURT DIVISION NO. JS.:? e-1!970 v IN RE: ESTATE OF MAX HOLTZ, Deceased. PETITION FOR SETTLEMENT OF SMALL ESTATE AND fAMILY EXEMPTION _0c: 11 / ; l)~ ~ ~ =o \ ~ C.n ~~., \"' .2:' --r ~ . .~ J \ --~:.i !;;; r.: ~ ;;; ~ ,. ..... -.. <..J # ._~" . o~: .. ~ "' ~ -. -·-· ~ -oJ:::2 ~ ?-cno ~ ~J. ~ "'{ \) ~ ... ---.} <::::> - ~ ~ r ---·c ' '''-> -......! ·-o ~ . ..., Lv -...J ~..., J t t r--, "-....J .. ~J· ~.~ PATRONO, CEISLER ond EDWARDS fl.: Attorneys at Law 80 East Chestnut Street * Washington, Pennsylvania 15301 / ..At-3-dso II \ l .. IN THE COURT OF COMMON PLEAS OF WASHINGTON COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION IN RE: ESTATE OF MAX HOLTZ, Deceased. NO, PETITION FOR SETTLEMENT OF SMALL ESTATE AND FAMILY EXEMPTION TO THE HONORABLE, P. V, MARINO, PRESIDENT JUDGE OF THE SAID COURT: The petition of THEODOSIA HOLTZ respectfully represents: l. That she is the mother of Max Holtz, deceased, and that she resides at 212 Pennsylvania Avenue, California Borough, Washington County, Pennsylvania. 2. That the said Max Holtz, died intestate on October 10, 1969; leaving to survive him as his only heir at law, your petitioner, Theodosia Holtz. 3. That the said Max Holtz was the owner of the property known as 212 Pennsylvania Avenue, California Borough, Washington County, Pennsylvania, and he resided there at the time of his death; and your petitioner was a member of the decedent's household and part of decedent's family at the time of death. 4. That no Letters of Administration have been issued in the Estate of Max Holtz, Deceased, and there is no contemplatio of applying for Letters of Administration. 5. That the above named decedent left an estate consisting of personal property, a statement of said personal property being as follows: a. One (l) 1968 Ford four-door Sedan automobile, Manufacturer's Number 8G54Fl2853l, Title Number Al9437088, at the value of Nineteen Hundred and No/100 ($1,900,00) Dollars. Affidavits as to the value of the said automobile by . . two (2) persons familiar with the value of the asset involved are hereto attached and made a part hereof as Exhibits "A" and "B". b. Check of Pittsburgh National Bank, No. 40446, in the sum of $3.67, drawn to the order of the Estate of Max Holtz, being a rebate on the loan of Max Holtz to Pittsburgh Nat i o na 1 Bank . c. A refund due from the United States Government, Internal Revenue Service, for over-payment of the 1969 Income Tax, in the sum of $301.72. d. United States Saving Bond, Series E, Serial No. Q61917460E, fssued in August, 1942, in the name of Max Holtz, the said bond now being worth approximately $45.61. e. United States Saving Bond, Series E, Serial No. Q73783953E, issued in September, 1942, in the name of Max Holtz, worth approximately $44,65. 6. That all of the expenses of the said decedent have been paid, including funeral expenses, and there are no outstandin Claims against the estate of Max Holtz, Deceased. WHEREFORE, your petitioner, under the authority of Section 282 of the Fiduciaries Act of 1949, prays your Honorable Court to award all of the above assets to your petitioner, as sole heir of the said Max Holtz, Deceased, and further prays your Honorable Court to set aside an award to her without notice or further appraisement or advertisement, that portion of the above assets which totals $1,000.00, on account of the family exemption, to which she is entitled under and by virtue of the provisions of Section 211 of the Fiduciaries Act of 1949, and your petitioner further prays your Honorable Court to direct the Department of Revenue, Commonwealth of Pennsylvania, upon application of your \ petitioner, to transfer the registration of the Certificate of Title, covering the 1968 Ford Sedan automobile from Max Holtz, now deceased, to your petitioner or to any person that she may so appoint; and your petitioner further prays your Honorable Court to direct the Pittsburgh National Bank to pay the proceeds of the said check in the sum of $3.67 to the said Theodosia Holtz; and your petitioner further prays your Honorable Court to authorize and direct the United States Treasury to pay the proceeds of the said bonds to Theodosia Holtz; and your petitioner further prays your Honorable Court to authorize and direct the United States Treasury, Internal Revenue Service, to pay the 1969 Income Tax refund in the sum of $301.72 to the said Theodosia Holtz. And she will ever pray, etc. Theodosia Holtz PATRONO, CEISLER & EDWARDS COMMONWEALTH OF PENNSYLVANIA: ss. COUNTY OF WASHINGTON THEODOSIA HOLTZ, petitioner, being duly sworn according to law, deposes and says that the facts set forth in the foregoing petition which are within the personal knowledge of the deponent are true; and~ as to facts based on information and belief, the deponent, after diligent inquiry, believes them to be true. sworn to and subscribed before me this day of ___ ~~....=.t::~f------ 1970, My Commission Expires: Theodosia Holtz, Petition~ PHHLIS l. SHROYER, No~ary p,,JIIC" California, Wa~hington Co., Pa. My Commission Expires Jl\llUArl 291 1971 COMMONWEALTH OF PENNSYLVANIA: COUNTY OF WASHINGTON AFFIDAVIT AS TO THE VALUE OF ONE (1) 1968 FORD SEDAN MANUFACTURER'S NUMBER 8G54Fl28531 TITLE NUMBER Al9437088 I, CATHERINE VENTURI, of Wood Street, California Borough Washington County, Pennsylvania, being duly sworn according to law, depose and say that I am the Manager of the Pittsburgh National Bank, California Office, California, Pennsylvania, and as such, I am familiar with appraising automobiles; that I am familiar with the value of the one(l) 1968 Ford Sedan, Manufacture's Number 8G54Fl2853l, Title Number Al9437088, the title to which is in the name of Max Holtz, now deceased; and that the present market value of said Ford automobile registered as aforesaid is Nineteen Hundred and No/100 ~1,900.00) Dollars. e.-U~ rg;;JL v~~-Cat~Venturi, Manager, Pittsburgh National Bank, California Office, California, Pennsylvania Sworn to and subscribed before me this :J..s-d day of 1970. ~ P1,i#L:SHROYER, """'Y P"hll< Caii;ornia, Washington C:'. ?a. My Commission Expires: My Commission Expires January 29, 1971 E X H 1.. B I T "A" • . COMMONWEALTH OF PENNSYLVANIA: ss. COUNTY OF WASHINGTON AFFIDAVIT AS TO THE VALUE OF ONE(l) 1968 FORD SEDAN MANUFACTURER'S NUMBER 8G54Fl28531 TITLE NUMBER Al9437088 I, JOHN MAHANEY, of 428 Wood Street, California Borough, washington County, Pennsylvania, being duly sworn according to law, depose and say that I am a mechanic in California, Washington County, Pennsylvania, and have been engaged in the business of repairing Ford vehicles for over 30 years, and as such, am familiar with appraising automobiles; that I am familair with the value of the one (1) 1968 Ford Sedan, Manufacturer's Number 8G54Fl28531, Title Number Al9437088, the title to which is in the name of Max Holtz, now deceased; and that the present market value of said Ford automobile registered as aforesaid is Nineteen Hundred and No/100 ($1,900.00) Dollars. J/hn Ma haney ,/ Sworn to and subscribed before me this c:J!id day o f __ flz+-""-~~=->~-- 1970. ~~~ My Commission Expires: PHYlL.IS L: SHROYER, Notary Publle Cahfornta, Washington Co., Pa, My Commissio11 Expires Januar1 ,m; 1971 E X H I ~ .l 1:, "B" I • IN THE .COURT OF COMMON PLEAS OF WASHINGTON COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION IN RE: ESTATE OF MAX HOLTZ, NO. Deceased. 0 R DE R ----- AND NOW, this ~tkday of Petition having been presented, it is to be filed, and after consideration of the same IT IS HEREBY ORDERED AND DECREED that the following assets are awarded to Theodosia Holtz, as sole heir of Max Holtz, Deceased, under the authority of Section 202 of the Fiduciaries Act of 1949, and $1,000.00 in value of the sai assets being awarded to the said Theodosia Holtz as and on accoun of her family exemption, under the authority of Section 211 of the Fiduciaries Act of 1949: a.. One ( 1) 196 8 Ford four-door Sedan automobile Manufacturer's Number 8G54Fl2853l, Title Number Al9437088, at the value of Nineteen Hundred and No/100 ($1,900.00) Dollars. b. Check of Pittsburgh National Bank, No. 40446, in the sum of $3.67, drawn to the order of the Estate of Max Holtz, being a rebate on the loan of· Max· Holtz to Pittsburgh National Bank. c. A refund due from the United States Government, Internal Revenue Service, for over-payment of the 1969 Income Tax, in thesum of $301.72. d. United States Saving Bond, Series E, Serial No. Q61917460E, issued in August, 1942, in the name of Max Holtz, the said bond now being worth approximately $45.61. e. United States Saving Bond, Series E, Serial No. Q73783953E., issued in September, 1942, in the name of Max Holtz, worth approximately $44.65. AND IT IS FURTHER ORDERED AND DECREED that the Pennsyl- vania Bureau of I~otor Vehicles is hereby authorized and directed • • . ' .. to transfer the Certificate of Title to the said 1968 Ford four- door Sedan automobile to Theodosia Holtz or to any person to whom she may desire to transfer the samei the Pittsburgh National Bank is hereby authorized and directed to pay the said sum of $3.67 to the .said Theodosia Holtzi the United States Treasury Department, Internal Revenue Service, is hereby authorized and directed to make the 1969 Income Tax refund in the amount of $301.72 to the said Theodosia Holtzi and the said United States Treasury Depart- ment is hereby authorized and directed to pay over the proceeds of the United States Saving Bond, Series E, Serial Nos. Q61917460E and Q73783953E, issued in August, 1942 and September, 1942, respectively, to the said Theodosia Holtz. Form RCC-33 ..... -• CO~M:ONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS RESIDENT DECEDENT COUNTY OF WASHINGTON. IMPORTANT: This return must be completed in detail and filed in duplicate, with will attached, with the Register of Wills of the County where decedent resided; Return is due within one year after date of death, unless an extension is granted by the Secretary of Revenue. (Section 703 of ___ q~einl).eritll.nce __ an!l Estate Tax Act of 1961.) of the estate of the above-named deced.ent being duly sworn, depose and say Decedent dJed ... .O.C..t .. O.b.e..:r. .. ................. .l.O ............. , 19 .. ...13..9. .... J testate leaving a last will, copy of which is hereto attached. } (Month) (llay) (Year) l intestate Name and address of attorney or} other authorized representative to whom all correspondence should be mailed. I>AT:Fl.QNO .. , ... C.E.lS.L.ER_. __ !S,_ ___ EPWARP.S, .. S. .. O ....... E~ $1;. C:l:l~$ti11Jt $..t:r~~j;, .. Wa.sh.ingt.on, Pe.nn.s.ylvania That as such ...................................................... deponent is familiar with the affairs of said estate and the property con- < Exer.u tor·Administrator) stituting the assets thereof and their fair market value. That at the time of death there was no safe deposit box registered in decedent's individual name, or jointly with, or as agent or deputy of another, or in decedent's individual name, with right of access by another as agent or deputy, with the exception of the following:-' NAME AND ADDRESS OF BANK OR OTHER INSTITUTION THIS SAFE DEPOSIT BOX RENTED RELATIONSHIP OF JOINT IN WHICH DECEDENT RENTED A SAFE DEPOSIT BOX IN NAME OR NAMES OF HOLDERS TO DECEDENT NONE That the contents of said safe deposit box or boxes are itemized under Schedules ______ of this return, with the exception of the following, for the reasons hereinafter set forth: That Schedule A attached hereto and made part hereof sets forth 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 by the decedent at the time of death, whether in decedent's immediate possession, standing to decedent's credit in banks of deposit, savings banks, trust companies, or other institutions, whether individually, or in trust for any other person or persons giving also separately the accrued interest thereon, if any, down to the last interest day prior to decedent's death in the case of savings banks, and to the date of decedent's death in all other cases; all bonds, postal savings, treasury certificates or notes and other evidence of in- debtedness of the United States to the decedent; all obligations, whether by statute or agreement they are designated as tax free, of the United States, or any state, or political subdivision thereo~ or of any foreign country, which are owned at the time of death; all wearing apparel, jewelry, silverware, pic- tures, books, works of art, household furniture, horses, carriages, automobiles, boats, and any and all other personal chattels of whatsoever kind or nature, left by decedent, together with the fairly estimated market value thereof; all bonds and 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 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. J In the case of securities of close or family corporations, the values reported are as far as possible subStantdate.d 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 wi,th 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 fo~th a· true -'a~swer to each inquiry contained therein and in the case of transfers ofproperty, real or personal, within two ye_ars of decedent's death, in contemplation of decedent's death, or intended to take effect in posse'ssion cir :e~jo~ent at 'or after death, said schedule sets forth the nature and value of such property, ~o whp,m tran~>ferred, the relationship of the transferees to the decedent, the proportionate share received by.~ach t·~ansferee and all other· facts' o·f 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 ~rust. Thero~ 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'de~dent; e.ither inqividually or jointly, by the will, deed, or other instrument of another, with a copy of the instrument creating. such power attached to the. ~chedule. 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 show!ng 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 Sch~dule 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 trus.ts,. tomqstone~ or gravemarkers, and reli- gious services, in consequence of the death of the decedent; debts an~ ,claims owing and tmpaid 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 statement of collateral pledged for obliga- tions, if any. It is agreed that the fiduciary will present proo~f'of said claimed obligations upon re- quest, that if the amount actually paid in settlement of any fee, commfssion 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 YLLIS L. SHROYER, Notary Publi California, Washington Co., Pa. My Commission Expires January 29, 1971 . (Street Number) (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) COMMONWEALTH OF PENNSYLVANIA DE-fARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS TRANSFER INHERITANCE TAX RESIDENT DECEpENT SCHEDULE 11A" -iEAL 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 de.cedent as tenant in common with another or others, should .be identified as to quantum of interest and the estimated value should be that of the decedent's interest only. The real property located In the Commo('lwealth of Pennsylvania should be described by lot and block number, street and street number, together 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· eras; also statement of mortgage encumbrances upon each parcel at death of decedent. Taxes, assessments, acciued Interest on. mortgages, etc.,are to be listed on Schedule "F" and must not be deducted from this schedule. ALL that certain parcel of ground situate in the Borough of California, (formerly East Pike Run Township), Washington County, Penna., being Lot No. 56 and a part of Lot No. 57 in the Homeland Plan, which plan is of record in the Recorder's Office of Washington County Pennsylvania, in Plan Book 1 page 110, situate on the southerly side of Seventh Avenue in said Borough of California (formerly East Pike Run Township), and bounded and described as follows: Lot No. 56 fronts fifty (50) feet on ' Eighth Avenue and extends back therefrom in a northerly direction, of uniform width, along Union Street a distance of one hundred twenty-five (125) feet to Seventh Avenue. Upon said Lot No. 56 is erected a two-story frame dwelling house of six rooms. That I , ps or t ion of Lot No . 57 in sa i d plan adjoining aid Lot No. 56 fronting fifty (50) feet on Seventh Avenue and extending back therefrom of uniform width, along said Lot No. 56 a distance of twenty-five (25) feet to the remainder of said Lot No. 57, EXCEPTING AND RESERVING such coal and such mining rights heretofore sold or reserved, BEING the same premises conveyed to Max Holtz by Priscilla Holtz Tymora and Theodore Tymora, her husband, by deed dated the 28th day of September, 1955, and recorded in the Recorder's Office of Washington County, Pennsylvania, in Deed Book 943, at page 601. 7o~-47t> ( 1) ASSESSED VALUE FOR YEAR OF DECEDENT'S DEATH .. ·" 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) I D~PARTMENT VALUATION CAUTION (Do not write In this space) $8,500.~~ COMMONWEALTH OF PENNSYLVANIA TRANSFER INHERITANCE TAX RESIDENT DECEDENT SCHEDULE "B" PERSONAL PROPERTY INSTRUCTIONS: This Schedule must disclose all tangible and intangible personal property owned individually by the decedent, at the time of his death. Property owned by the decedent jointly with another or others must be listed under Schedule "E". Intangible personal property, titled in the name of the decedent, but payable at death to another or others, including but not limited to P.O.D. U. S. Savings Bonds and tenta- tive trust accounts, must be listed, despite the fact that they are not of the administered estate. Tangible personal property should be listed first (e. g. jewelry, wearing apparel, household goods, and fUrnishings, books, paintings, automobiles, boats, etc.) Intangible personal property, such as bonds, treasury certificates, cash on hand and in bank, . . stocks, ·mortgages, notes, together with accrued interest or dividends, salaries or wages, insurance pay- able to the estate or fiduciary in said capacity, partnership interests, interest in 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 NO• ITEM List and describe fUlly 1968 Ford Sedan automobile, Al9437088, Manufacturers No. Title No. 8G54Fl28531 Check, Pittsburgh National Bank, No. 40446, dated November 14, 1969, being a refund on car payment. ~..(, ~""'~ .dv-t. {-... .,..._ <+ L_ 'r.t.-J~._,~J .t..""-Tev't\.~1 fC>..J(Mv~ S'e"'ll'&, ~ \ cH, c\ ;:t:::h~ +a.'ll re.-t;o-....-, Insert this total opposite "Personal Property", Schedule "B" in the "As Reported" column on the last page of this return. UNIT VALUE ESTIMATED MARKEl' VALUE $1,900.00 ........ 3.67 DEPARTMENT VALUATION (Do not write in this space) RCC-30 COU'IfON'\'EALTH OF PENNSYLVANIA TRANSFER 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) _..N.._0=---- (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) ___;;N'-'-0.;;;_ __ (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) 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) -~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 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) ____ N_O ___ _ 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 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) ::'i.CC-:18 C~M\IIl'\''JF\LTH uF PENNSYLVANIA fH \:\::':'FH I:\llElUT,\Nf'E TA\: llF~InF~T DECEDENT SCHEDULE "E" JOINTLY OWNED PROPERTY I\STRrCTIO!\"S: This schedule must disclose all property, real and personal, owned by the riecedent 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 unrier Schedule "A", plus the date and place of record of instrument effecting vesti ture, 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. Descriptio~ of Property, Date of Acquisit-ion, N~me! Unit -~rcent.;:g-;··-~-E;tate - Address and Relationship of Co-Owners, and Place ; Value Share Valuation of Recorcl of Instrument, where Real Estate. 1 ---··-------_j _____ l_ ______ _ Pittsburgh Office, California, Pennsylvania, in the names of Theodosia Holtz or Kathryn Holtz or Max Holtz. The total amount in the account at the time of death was $~, 1/3 of which is taxable. This ount was opened more than two years prior to death. Theodosia Holtz is the motJO.e·r:-of Max Holtz, and ! of the 1/3 taxable amount, being $145.11, is taxable at 6%. Kathryn Holtz is the sister of Max Holtz, and ! of the 1/3 taxable amount, that is, $145.11, is taxable at 15%. (J4Jei.JctP 1-j-a"¥ Joint Savings Account No. 8677, Pittsburgh National Bank, California Office, California, Pennsylvania, in the names of Max Holtz or Miss Kathryn Holtz, in the sum of $8,128,5~. This account was previously in the I name of Max Holtz alone, and was not J put in joint names until September 30, 1969, and therefore the entire balanc in the account is taxable at 15%, Kathryn Holtz being the sister of Max Holtz. 6PEI(f!J) 9-7;~-{,f SEE ATTACHED SHEET FOR LIST OF U. SAVINGS BONDS, SERIES E. $8,128.5 Insert this total opposite "Jointly Owned Property", Schedule "E" in the "As Reported" colwnn on the last page of this return. DEPART}!ENT VALUATION CAUTION-Do not Write In This Space. Value of Entire Property i ! I .j I I Value of Decedent's Interest L--~---.......JI~I ?"t>~y /~ o-5'7 i J U. S. J.!;aving (these bonds Bonds, Serids E,-in the denomination of $25,00, as follows: ·ere in the names of Max Holtz, payable on death to Alex Holtz, Sr. ISSUE DATE August, 1942 September, 1 2 SERIAL NO. Q61917460E Q73783953E SUB-TOTAL VALUE $45,61 44,65 $90.26 U. S. Saving (these bonds Bonds, Series E, in the denomination of $25.00, as follows: ·ere all issued in the names of Max Holtz or Mrs. Theodorsia Holtz) ISSUE DATE March, 1956 April, 1956 April, 1956 May, 1956 May, 1956 Fe b r ua r y , 19 August, 1957 August, 1957 September, 1 7 September, 1 7 November, 19 December, 19 July, 1959 August, 1959 December, 19 December, 19 January, 1960 April, 1960 April, 1960 May, 1960 May, :J_960 June, 1960 June, 1960 July, 1960 August, 1960 August, 1960 September, 19 0 September, 19 0 October, 1960 November, November, December, December, January, 1961 January, 1961 February, 19.6 February, 196 March, 1961 March, 1961 April, 1961 April, 1961 May, 1961 May, 1961 June, 1961 June, 1961 July, 1961 July, 1961 SERIAL NO, Ql262585247E Ql267577738E Q 12 7 2 8 7 2 7 9 6E Ql274189535E Ql273606814E Ql317602069E Ql512027028E Ql511419057E Ql519830212E Ql519445815E Ql611475309E Ql612576716E Ql705690525E Ql709907120E Ql812365202E Ql806103360E Ql817873802E Ql826370524E Ql829142820E Ql829857466E Ql832465951E .Ql833075229E Ql836120844E Ql838510007E Ql848052589E Ql848099517E Ql852531697E Ql852660967E Q 1 8 52 9 4 515 3E Ql857030104E Ql861207824E Ql857115944E Q 186 57 39848E Ql865709772E Ql870850128E Ql870906783E Q 18 7 4 8 8 8 9 7 3E Ql881361492E Ql881414002E Ql881825014E Ql890548996E Ql885864451E Ql892448072E Ql892406344E Ql892962266E . Ql895891851E Q 189 8896477E Ql898974578E VALUE $29.88 30.38 30.38 30.38 30.38 30.42 29.93 29.93 29.93 29,93 29.31 29,44 27.85 27.85 27.34 27.34 27.34 27.35 27.35 27.35 27.35 26.83 26.83 26.83 26,83 26,83 26.84 26.84 26.84 26.84 26.84 26.84 26,34 26.34 26.34 26,34 26.34 26.34 26.35 26.35 26.35 26.35 26.35 26.35 25,87 25,87 25,87 25,87 ~. ISSUE DATE August, 1961 Al,lgust, 1961 September, 1 1 September, 1 October, 196 October, 196 November, 19 November, 19 December, 19 December, 19 January, 196 January, 196 February, 19 February, 19 March, 1962 March, 1962 April, 1962 April, 1962 May, 1962 May, 1962 June, 1962 June, 1962 July, 1962 August, 1962 August, 1962 September, 1 2 September, 1 2 October, 196 October, 196 November, 19 November, 19 December, 19 January, 196 January, 196 February, 19 February, 19 March, 1963 March, 1963 April, 1963 April, 1963 May, 1963 May, 1963 June, 1963 June, 1963 July, 1963 IJuly, 1963 August, 1963 August, 1963 September, 19 3 September, 19 3 October, 196 October, 196 November, 196 November, December, December, January, 1964 February, , February, 196 SERIAL NO. Q 1 9 0 3 9 0 7 52 3E Ql904433173E Ql904529193E Ql909156446E Ql910229495E Q 1913772 589E Ql914363885E Ql914554172E Ql918048006E Ql918799142E Ql923393069E Q 1 9 2 3 3 4 6 4 a· 6E Ql928289088E Ql928332412E Ql933028429E Ql932641395E Ql9 3_69 654 67E Ql937028658E Ql940920462E Ql940869835E Ql941555068E Q 1 9 4 5 8 2 0 3 6 8E Ql951733289E Ql956220495E Q 1 9 5 6 2 7 2 0 51E Ql956615958E Ql956400295E Ql968130091E Ql960826850E Q 19 6 819 8 5 5 7E Ql970918212E Ql973531622E Ql980720300E Ql977561575E Ql988066924E Ql983906042E Q 1 9 9 0 5 7 4 0 3 3E Ql990386648E Ql990633509E Q2000068348E Q2001280427E Q2001356592E Q2002168315E Q2004306848E Q2006413960E Q2004366335E Q2012239933E Q2009539867E Q2019957697E Q2019903745E Q2020036769E Q202'402 89 62E Q2024790881E Q2028625094E Q2029085390E Q2029129800E Q2038358134E Q2040935026E Q2044611790E Q2042153820E VALUE $25.87 25.87 25.97 25.97. 25.97 25.97 25.97 25.97 25.41 25.41 25.41 25.41 25.41 25.41 25.41 25.41 25.41 25.41 25.41 25.41 25.13 25.13 25.13 25.13 25.13 24.55 24.55 24.55 24.55 24.55 24.55 24.61 24.61 24.61 24.61 24.61 24.04 24.04 24.04 24.04 24.04 24.04 24.09 24.09 24.09 24,09 24.09 24.09 23.54 23.54 23.54 23.54 23.54 23.54 23.59 23.59 23.59 23.59 23.59 23.59 ~. :.. ISSUE DATE SERIAL NO. VALUE March, 1964 Q2044979969E $23.05 March, 1964 Q2044984070E 23.05 April, 1964 Q2050158249E 23.05 April, 1964 Q2049852193E 23.05 May, 1964 Q2055230244E 23.05 May, 1964 Q2058350026E 23.05 June, 1964 Q2062881560E 23.10 June, 1964 Q2062929669E 23.10 July, 1964 Q2063247956E 23.10 August, 1964 Q2070946326E 23.10 August, 1964 Q2070892615E 23.10 September, 1 64 Q2077958996E 22.58 September, 1 64 Q2075995489E 22.58 October, 196 Q2078580119E 22.58 October, 196 Q2083377185E 22.58 November, 19 4 Q2083746230E 22.58 November, 19 4 Q 20 8 379457 2E 22.58 December, 19 4 Q2088712195E 22.62 December, 19 4 Q2089231959E 22.62 January, 196 Q2093375842E 22.62 January, 196 Q2093634163E 22.62 February, 19 5 Q2093949763E 22.62 February, 19 5 Q2105351413E 22.62 March, 1965 Q2105421217E 22.11 March, 1965 Q2108052440E 22.11 April, 1965 Q2110382627E 22.11 April, 1965 Q2115665125E 22.11 May, 1965 Q2118500970E 22.11 May, 1965 Q2118387486E 22.11 June, 1965 Q2125244728E 22.15 June, 1965 Q 2118 5 59 3 9 7E 22.15 July, 1965 Q2133630392E 22.15 July, 1965 Q2135211218E 22.15 August, 1965 Q2140129288E 22.15 August, 1965 Q2135270804E 22.15 September, 1 65 Q2140469292E 21.65 September, 1 65 Q2144074728E 21.65 October, 196 Q 214 4116 3 8 3E 21.65 October, 196 Q2150540308E 21.65 November, 19 5 Q2150507195E 21.65 November, 19 5 Q2150571201E . 21.65 December, 19 5 . Q2152206851E 21.90 December, 19 5 Q2156134252E 21.90 . January, 196 Q2161854837E 21.90 January, 196 Q2161773756E 21.90 February, 19 6 _Q2161928489E 21.90 February, 19 6 Q 2 16 8 0 2 41 0 3E 21.90 March, 1966 Q2172720803E 21.42 March, 1966 Q2176010780E 21.42 March, 1966 Q2176178429E 21.42 April, 1966 Q2176240677E 21.42 April, 1966 Q2177728697E 21.42 May, 1966 Q2184847534E 21.42 June, 1966 Q2185105126E 21.43 June, 1966 Q2186098915E 21.43 July, 1966 Q2185326055E 21.43 August, 1966 Q2185520768E 21.43 August, 1966 Q2202347519E 21.43, August, 1966 Q2191028580E 21.43 September, 1 66 Q2202636979E 20,96 ·' ISSUE DATE SERIAL NO. VALUE September, 66 Q2202822087E $20.96 October, 196 Q2206443343E 20.96 November, 19 6 Q2206816445E 20.96 November, 6 Q 2 2 0 6 614 5 3 6E 20.96 December, 6 Q2211890252E 20.97 December, 6 Q2211982157E 20.97 January, 19 Q2216629668E 20.97 January, 19 Q2226678652E 20.97 February, 1 7 Q2226777477E 20.97 February, 1 7 Q2239443412E 20.97 March, 1967 Q2239673154E 20.52 March, 1967 Q2245766976E 20.52 March, 1967 Q2245842946E 20.52 April, 1967 Q2255656466E 20.52 May, 1967 Q2256060625E 20.52 May, 1967 Q2261660792E 20.52 June, 1967 Q2269664804E 20.53 June, 1967 Q2281022160E 20.53 July, 1967 Q2281308543E 20.53 July, 1967 Q2281142684E 20.53 August, 196 Q2291142617E 20.53 August, 196 Q2291013237E 20.53 September, Q2291289594E 20.10 September, Q2298133100E 20.10 October, 19 Q2298444085E 20.10 November, 1 Q 2 3 0 1 8181 3 3E 20.10 November, 1 Q2307551008E 20.10 December, 1 Q 2 31 3 54 6 3 0 OE 20.11 December, 1 Q2313604425E 20.11 January, 19 Q2313809452E 20.11 January, 19 Q2316979173E 20.11 January, 19 Q2317107365E 20.11 February, 1 Q2323606241E 20.11 February, 1 Q 2 3 2 3 8 0 7 0 6 8E 20.11 March, 1968 Q2335319112E 19.70 April, 1968 Q2335362282E 19.70 April, 1968 Q2342201612E 19.70 May, 1968 Q2342341687E 19.70 May, 1968 Q2342469904E 19.70 June, 1968 Q2348102673E 19.71 June, 1968 Q2342638854E 19.71 July, 1968 Q2348281401E 19.71 July, 1968 Q2362436060E 19.71 August, 196 Q2362609342E 19.71 August, 196 Q2369492984E 19.71 September, Q237608,3320E 19.32 October, 19 Q 2 3 7 6 2 16 3 7 4E 19.32 October, 19 Q2376279058E 19.32 November, 1 Q2382742886E 19.32 November, 1 Q2382803452E 19.32 December, 1 Q2382943035E 19.33 December, 1 68 Q2389398757E 19.33 January, 19 9 Q2389540841E 19.33 January, 19 9 Q2389615270E 19.33 January, 19 9 Q2389733204E 19.33 February, 1 69 Q2395895471E 19.33 February, 1 69 Q2402759747E 19.33 March, 1969 Q2402913088E' 18.96 April, 1969 Q2409943106E 18.96 April, 1969 Q2416938104E 18.96 May, 1969 Q2422685727E 18.96 May, 1969 Q2422740545E 18.96 June, 1969 Q2 42 287 87 57E 19.05 SUB-TOTAL hJ~$5,391.93 o<, iP JS,j 7 ........ ' .... RCC-,37. (12-63) COMMONWEALTH OF PENNSYYLANIA TRANSFER INHERITANCE TAX RESIDENT DECEDENT BENEFICIARIES AND ADDRESSES State full names and addresses of all who ( h ave an interest, vested, contingent or other wise, in estate) . T heodosia Holtz I 212 Pennsylvania Avenue ·- c alifornia Pennsylvania 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 BIRTH Mother VP..::: "' 1 1 Deponent further says that all the above-named beneficiaries are living at this time except below: NAME DATE OF DEATH RESIDENCE Will Administration ( No. Year ........... . :P.Il" THE :\lATTER OF THE APPRAISEMENT OF THE ESTATE OF Late of. County of Commonwealth of Pennsylvania --~- ~-,,---: ( .... . -, # .-, Deceased ---, • j . REPORT) AND :APPRAISAL :: -:· ~-i ! f~ ,..,;.,,. 1- .~.:: C· .-I .("") ., ·; t...-:> : ~ ---:D ;: . ·' ~>irlu ·. j .-J ........ ,. -~ ~ : I L (Executor-Administrator must complete "As Reported" column #1.) 0 ..., '"d ::r;l .... .... co co 0 II' .... ~ "' ::s "' "' "' 0 ..., ...... ::s '"d (1) ~ .... II' .... 0 "' >< '"d '"d II' (1) 0"' .... .... ~ 0 ~ '"d t%1 co .... "' ,.... ..... '< II' ,.... (1) C/) c ~ ~ > : .. ,. ::r;l ................. ->-<: w IJ) C/) n n ?"' ?"' ?"' n ~ > :: :: :: ........................ "* "* -oo "* "* "* -> "' ~ ~-tf\":S ....... . o-0 :4. :c (1) ~ c.. :o : .. "* ~ -oo "* .00 "* -> "' 0 ~-r. tv 3- ::l r. c.. \ '"· --, . .