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HomeMy WebLinkAboutOC1970-0599 - ESTATE OF SIERACKIRCC-81 (2-64) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS INHERITANCE TAX DIVISION NOTICE OF FILING OF APPRAISEMENT LOUISE PAUL IN YOUR REPLY PLEA8E REFER TO J In Re:Est ate of F_'L_O_R_\E_N..,;.TC_E_:_S_IE_R!.....:--A.::.C.:.:K=I_~__---.,.._ _____lV...;.A:.::S:.:.H:.:I:.:.N.:..:JG::..;T~O:::..:N~County - FHe No. Dear Mrs.Paul: 63-70-599 You are hereby notified that t~i original appraisement in the estate of'orence S1eracki has been fili,d in the office of the Register of Wills qf \vasbi ngton County on ugust 5,,19.19.Said appraisement reflects'the following valuations: Real Est ate ---,--~-.,,;,2...5....,-Io:Q,l.\:Q040.J-.-I.O~610---Personal Property _ Transfer s -="'~."..",_=_~----- Total ..,.....;2::.;5::::...1.:.O~O~O~.:..:.O~O~_·__ 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 (6%)percent per annum is charged. Any party in interest who is aggrieved by an appraisement may appeal therefrom as provided by law. August 5,1970Date _Signed Title DATE OF DEATH: Note:This is not a bill. April 11,1970 RCC-39 (5-68) COMMONWEALTH OF PENNSYLVANIA TRANSFER INHERITANCE TAX RESIDENT DECEDENT SUMMARY Estate of SIERACKI,FLORENCE (Last Name)(First Name)(Initial) 4-11-70 63-70-599DATEOFDEATHFILENO._ REPORT OF INHERITANCE TAX APPRAISER 08-05-70Dated:------------- I,the undersigned duly appointed Inheritance Tax Appraiser in and for the County of WASHINGTON Pennsylvania,do respectfully report that I have appraised the real and personal property as reported in the foregoing return at the values set forth opposite each item in the last column to the right in Schedules "A","B","C",and "E". Jti REPORT OF THE REGISTER OF WILLS VALUE AS REAPPRAISED $-------+-- 22 47 60 2 521 50 22 478 50 25 000.00 VALUE AS REPORTED $25 000 00 CLEAR VALUE OF ESTATE Dated:08-05-70 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) I,the undersigned duly elected Register of Wills in and for \vASHINGTON 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". h g ater or lesser amount represents the sum allowed as a deduction. Valuation of life estates or FOR USE OF REGISTER ONLY Tax on $-----...,..T-~~~_A_Tax on $L,_;L,....:...,4_'_b-+-"__V Tax on $----------4-- Tax on $--------~f_-Tax on $-+__ Exemptions========~=Total Estate ---L.__ TOTAL TAX 2% 6% 5% 10% 15% * COMPUTATION OF TAX $1.,j4b 7T$------'-'----4--- $--------4-- $--------4-- $--------+--- $-----_---1._- (*)As evidenced by Charitable Exemption Certificates issued by the Secretary of Revenue. Less tax previously paid BALANCE Less 5%of tax if paid within 3 months after death :::::::::t===== BALANCE OF INHERITANCE TAX DUE $t= Add interest at rate of 6%from_____to $---J AMOUNT OF ESTATE TAX ASSESSED $--__~L- Estate tax paid $--Jl- BALANCE DUE $---J~ Add interest at rate of 6%from t= ------lto-----$-----~, TOTAL TAX BALANCE $------~PAID $....1 FOR USE OF REGISTER ONLY ADJUSTMENTS. NOTE:Where subsequent adjustments are made to the above computation of tax by the Register of Wills,for proper reason, same shoul~.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 Fonn RCC-2 .~COMMONWEALTH OF PENNSYLVANIA DATE ..............AJJ.g~..~.t......?...L ....1.~..79........ DE~\RTMENT OF REVENUE ~,.WASHINGTON BUREAU OF COUNTY COLLECTIONS RESIDENT INHERITANCE TAX COUNTY .......................,............................................................................ HARRISBURG.PENNA.17127 APPRAISEMENT FILE NO...........?~.=.?2.=.?.?..~........................, Whereas,FLORENCE SIERACKI BENTLEYVILLE....................................................................................................................................................late of ............................................................................................................... in the County of ......................y~.~.~~.~~.!.9..~....................................................................Commonwealth of Pennsylvania,having died on 11th April 70 .the ............................................................................................day of ..............................................................................19............,seIzed and possessed of an estate subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania; Therefore,I,W.R.CHANEY 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 I $ RRA T,'T'Y • A~ner Schedule llAn attached 25,000 00 ITOTAL25,000 00 I , I I v : ./ \ Penna. ~,(KU~d :tr:t) .......................................:::r...... . (Post Ofll Having been duly sworn accor<li.ng to law,I do hereby certify t the above ppraisement is made in con- formity with law on this 0..~day of l.L'::~::".."r:~~~/.!--.<:.~.,,«...-..;...e.c~..1~. APprai~ WASHINGTON County RESIDENT INHERITANCE TAX APPRAISEMENT Estate of FLOHENCE SIERACKI Deceased. Late of BENTLEYVILLE Date of Death,A.p.~.i.:1.:..~~..?..J.~.?..9. Appraisemeilt Docket Vol...38,. Page,No 6.3...~.7.O':::'..5.9.9 .. ...........9/~.5:.... Filed in Register's Office,.8.",.5...",19 70 Amount of tax due,$; . DEPARTMENT OF REVENUE Received, Examined and Approved,;.. Wrote abo.ut Appra-isement,.. Appeal f1'om Appraisement,.. Entered and charged,. , J, r-----~-------------.,--------------------------------.-.-- .~ Form liCC·IO DEDUCTIONS ALLOWED IN j•. OFFICE OF THE REGISTER OF WILLS WashingtonOF-=-COUNTY . ~AGENT OF THE COhilMONWIiiALTHV')/J 7?-.-~'£3-76-$77' STATEMENT OF DEBTS AND DEDUCTIONS THE SUM OF ..•.....•.•.$~-:J.;!.!..~.? ~-:D i~=2i!~ "lIegter of Wills,Agent Florence Sieracki BentleyvilleESTATEOFLATEOF--==--_ April 11,1970DATEOFFILINGAPPRAISEMENTDATIiOJl'DEATH _--==--..;..-_ DATE NO.OF NAME OF PAYEE REMARKS VOUCH"" AMOUNT Thompson Funeral Horne Funeral Services ~1,699 00 Fr.Felix pyzowski Burial Services 651-00 cemetery Association Opening &closing Grave 60,-00 Bianchi Monument Company Memorial 4271-50 Foodland Market Merchandise 50,-00 Bentleyville Telephone Co.utility 10 .00 Polish club of Washington Obligation 210 .00 Total..................................................~2,521 50 , - COMMONWEALTH OF PENNSYLVANIA }S.:COUNTY OF Washington I,Louise Paul HEREBY CERTIFY.THAT.TO THE BEaT OF MY KNOWLEDGE AND BELIEF,THE FOREGOING IS A JUST AND TRU E 8,rATEhIlE~,OF DEBTS,FUNERAL EXPENSES AND EXPENsa 0 .. ADMINISTRATION SUBMITTED TO THE ESTATE OF Florence S~erac ~DECEASED,AS DEDUCTIONli FOR INHERITANCE TAX PURPOSES..~.~<-..f (L.S.l,,' SWORN AND SUBBCRIBI£D ISE"'O~E ME TXls 20th n"yOP .~ @ .14ay "0.70)~~I~ TH CCR..."J\MUTO ~ Notary Pu"I;~.C,-,'"r-.o.,':>\in~+0n Co/ My Come (j'r ,_I._ •I.1973 jt' " J COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS WASHINGTONCOUNTYOF .. 't'l .'{~C'/£,/) Form RCC-33 V RESIDENT DECEDENT 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 theIni').~ritance.an!iE.!1tatel,'ax A,ct of 1961.) Administrator ........F~;~;;?~~;;;;;157E '.~:~~~.E.~~}::::u:::OF (State full name of decedent) Late of :s.~.pt.J..E:!yyil.1e,.lh1i:i.§.:h.i.ng"~.9..I}..........County ADMINISTRATOR state of lI?~.~~.~y.~y~~~~:..}ss: County of WCl,§P:i::ng.tQn .. ......,LP:u...;i..§.eJ?a:u..l.......................................................... of the estate of the above-named decedent being duly sworn,depose and say ..Eueutor Decedent'dJed .....................ApJ;.il..l...l... (Month) Name and address of attorney or} other authorized representative to whom all correspondence should be mailed. ..........,19...7.Q.........,r testate leaving a last will,copy of which is hereto attached.} (lIay)(Yf1lr)Lintestate J..D.....Costa,.Esq.. ~O 7~CiAIl$treE:!i:,.J.3E:!nj:J~.yy:i.~~~,PCi·.. That as such ~.9..~.~:h.~JE deponent is familiar with the affairs of said estate and the property con- (Ex<!cutor-Adminiatrator) 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 1'110ne --- That the contents of said safe deposit box or boxes are itemized under Schedules of this return,with the exception of the following,for the reasons hereinafter set forth: That Schedule A attached hereto and made part hereof sets forth fullv and in'detail all the real property in the Commonwealth of Pennsylvania of which decedent died having an interest therein.It also sets forth the mortgage encumbrances upon each parcel of real property at the date of death,giving the amount still due at death,name of mortgagee,date,rate of interest,and book and page of record thereof.It also sets forth in the columns provided therefore the assessed valuation of each of said parcels,the estimated market value thereof as of date of death of decedent. That Schedule B attached hereto and made part hereof sets forth fully and in detail all personal property wheresover situated owned by the decedent at the time of death;all moneys left by the decedent at the time of death,whether in decedent's immediate possession,stilnding to decedent's creMltJ/.iTl banks·'f\\'''~'.'"of deposit,savings banks,trust companies,or other institutions,whether individually,~\o,r-\in t~usf;,for,..¥\."any other person or persons giving also separately the accrued interest thereon,if any',~dqim··to'·the last •-;:j~"......-~interest day prior to decedent's death in the case of savings banks,and to the date~of'Aecedent'sdeath~~-'i ....., in all other cases;all bonds,postal savings,treasury certificates or notes and other eV1dence:of in-c ....l";......debtedness of the Uni ted States to the decedent;all obligations,whether by statut~;Qr~reement they' are designated as tax free,of the United States,or any state,or political sUbdiJiSi,6p>the;eo~;or of- any foreign country,which are owned at the time of death;all wearing apparel,jeWel'r.yr..S-i3;yerwate,pic- #,.........of>tures,books,works of art,household furniture,horses,carriages,automobiles,boats~and~any and allilotherpersonalchattelsofwhatsoeverkindornature,left bydecedent,together with the fa:trly,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 ~o 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 ~t 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 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 transfers.In the case of transfers intended to take effect in possession or enjoyment at or after death,there is also attached to the schedule a co~y of the deed,trust agreement or other instrument creating the trust.Ther.~is also set forth in said schedule a list of all property,real and personal,with its value,which passes at decedent's death by virtue of the exercise by decedent,either individually,or jointly with another,or any power of appoint- ment vested in decedent,either individually <!r join~ly,by the .will",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 Impaid at time of death;taxes accru~d 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 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 wiil 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. ~. .;.;;, ....................::.::~~~.. '/)(E:r:ecutor-Admmistrator) ..7..+..~:M~.~.~§.~.~~.~.~~~. (Street Number) .:I3.~.r.>:~.!.~.y.y.~..!..!..~..r.R~P.-.P.:e.~.. (City or Town and State) Subscribed and sworn to before me this ..-...............,?.Q.t.h <..~day of Mgy 19 ..7..0 ......................£~~..~. ','...r TI1~RESA MUTO -;Notary PUI11ic,'Canton Twp••Washington Co. ...MY'Commi3sion Expires September 3.1973 '.NOTE:''''Bef~re 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. \c RCC-34 (1:641 COMMONWEALTH OF PENNSYLVANIA DEPARTM'ENT OF REVENUE BUREAU OF COUNTY COLLECTIONS TRANSFER INHERITANCE TAX RESIDENT DECEDENT " SCHEDULE IIA" .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 hdd 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 of Pennsylvania should be described by lot and block number,street and street number,together wi th a general description of the property,with a reference to the record of the conveyance by which the decedent took title;If a farm state number of a· cres;also statement of mortgage encumbrances upon each parcel at death of decedent.Taxes,assessments,accrued Interest on mortgages,etc.,are to be listed on Schedule "F"and must not be deducted from this schedule. (1 )(2)(3)/ DEPARTMENT ASSESSED VALUE VALUATION FOR YEAR OF ESTIMATED CAUTIONDECEDENT'S MARKET VALUE (Do not write DEATH In this space) ALL that certain lot or parcel of ground situate,lying and being in the Borough of Bentleyville,Washington county, Pennsylvania,being known and designated as part of Lot No.41 in the Original Plan of Bentleyville,and being further bounded and described as follows,to-wit: BEGINNING at the Southeast corner of Main Street and Washington Street;thence by said Washington Street,South 69°06' East,a distance of 69.80 feet to the Western side of a Private Alley;thence by said Private Alley,South 21°00'West,a distance of 24.22 feet to a point;thence by land now or formerly of John Haddad, North 68°50'West,a distance of 69.80 feet to a point on the Eastern side of Main Street in the center of a Party Wall;thenCE by the Eastern side of Main Street,North 21°00'East,a distance of 23.90 feet to tle corner of Main Street and Washington Street, the place of beginning. SUBJECT to and together with the rights vested in the grantors herein by a Party Wall Agreement made September 30, 1944,and of record in Deed Book Vol.683, page 614,Washington County Records, reference thereto will more fully and at large appear. BEING the same premises conveyed to Louis Sieracki and Florence Sieracki,his wife,by deed of Andrew Harchar et ux., dated March 2,1948,and recorded in Deed --Book 740,page Ill.The said Louis Sieracki died December 16,1962,thereby vesting title to the above described premises in his wife,Florence Sieracki, as the surviving tenant of an estate by the entireties.The said Florence Sieracki died Intestate,April 11,1970,leaving to survive her as her only heir at la'l.'I1,one daughter,Louise Paul. UPON which is erected a two story brick building having a value of••••••••••• Total . $25'OOO.OO,~ $25,000.00 Insert this total opposite IIreal property",Schedule "A"in the liAs Reported"column on the last page of this return. xxxxx '-RCC-35 CON&ONWEALTH OF PENNSYLVANIA 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.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 None. UNIT VALUE ESTIMATED MARKET VALUE DEPARTMENT VALUATiON (Do not write in this space) ?-------.... Insert this total opposite "Personal Property",Schedule "B"in X X the "As Reported"column on the last page of this return. RCC-30 COM~roN1I'EALTH OF PENNSYLVANIA ~~iNSFER INHERITANCE TAX ~S~IDENT 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)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 wi thoutreceiving a valuable and adequate consideration therefor under which transferor expressly or impliedly reserves for his life or any period which does no t in fact end before his death:no ° (a)The possession or enjoyment of or the right to income from the property transferred? (Answer yes or no)__ (b)The right to designate the persons who shall possess or enjoy the property transferred or income therefrom?(Answer yes or no)_ (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)__n_o__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 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)__ 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 (Estimated)DEPT.VALUATION (Dept.Only) Insert this total opposite "Transfers",Schedule "C"in the "As Reported"column on the last page of this return. :1C(-;')8 CCMMdNWFALTH OF PENNSYLVANIA fHl\:\::;rFH TNH1.;HITANCE TAX ItF~IJ)ENT DECEDENT -, SCHEDULE "E" JOINTLY OWNED PROPERTY J:liSTRrCTIOSS: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-<rwners to the decedent. Description of Property,Date of Acquisition,N~me I Unit perc~t~g~----E;tate Address and Relationship of Co-Owners,and Place ,Value Share Valuation of Record of Instrument,where Real Estate.! None. DEPARTMENT VALUATION CAUTION-Do not Write In This Space. Value of Value of Entire Decedent's Property Interest i I II I Insert this total opposite "Jointly Owned Property",Schedule"E" in the "As Reported"column on the last page of this return. RCC-37 (12-63) COl\1l\tONWEALTH OF PENNSYYLANIA TRANSFER INHERITANCE TAX RESIDENT DECEDENT SCHEDULE "D" BENEFICIARIES . 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 Louise Paul Daughter Yes All. 718 Main Street . Bentleyville,Penna. ( h Deponent further says that all the above-named beneficiaries are living at this time except below: NAME DATE OF DEATH RESIDENCE :\IATTER OF THE APPRAISEMENT OF THE ESTATE OF (Executor-Administrator must complete "As Reported"column #1.),. ''')'''''' ...,"'d ~ ...('l)('l)ll:>...ll:>:;,til _ til 0(b':;,"'d "1 ~8 til '0"'d ('l)........g ~ ('l).......'< trltil....ll:>....('l) ..., ll:>Xll:>0""~ o...otiltil Year . DO THE (No.Will Administration FLORENCE SIERACKI...... Deceased Late of BENTLEYVILLE,-. Count\'of WASHINGTON.-,........... Commonwealth of Pennsylvania REPORT AND APPRAISAL U'lc:~ ~>~U'l~~O-< (')(')(') ?"?"?"n t:J ;;::::::: -&9-&9 :l'): :01 : :'":0::0: :0:. 0::0: -00-&9-&9-&9 :l')____ :01 ;>.",til :0:o~­:('l)......0'0__..• 0 0:4-o~ -&9 -&9 -OO-&9-<iP.>-&9 ;> '"UI't_2"tv...--..:3:;. ~c..