HomeMy WebLinkAboutOC1970-0791 - ESTATE OF MCCHESNEYR C C-BI (2-64)
COMMONWEALT'f.t OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY :OLLECTIONS
INHERITANCE TAX DIVISION
NOTICE OF FILING OF APPRAISEMENT
WILLIAM R.McCHES:~Y-INFORMANT
IN YOUR REPLY PLEA.E
REP'ItR TO
J
f ,625.49,L,:_'
In Re:Estate of__M_O_L_L_I_E-,.._M_c_C_HE_SNE_Y _
____W_A_S_H_IN_G_T_O_N County - F He No.63-70-791
Dear Mr.Mc~hesney,
Ycu are hereby notified that the original
appraisement in the estate of MmLLm McCHESNEY'
has been filed in the office of the Register of Wills qf '.JASHINGTON
County on October 7 ,19-11 Said appraisement reflects the
following vcluations:
".
Jt.Hd.~XU~"----'-Personal Property ~'~~~_
Transfer s _
Tota1 ----------...,....---,..#-,T',....6""2....5.........4.,;9~__
A3 to such tax that is paid within three months from date of
death,a fi"e (5%)percent discount is allowable.As to any tax that
remains unp:iid after one year from date of death,interest at the rate
of six (8%)percent per annum is chargee.
Any party in interest who is cggrieved by an appraisement may
appeal therefrom as provided by law.
Date __O_c_t_o_b_e_r_7-',"-1_9_7_1 _
DATE OF DEATH:June 11,1970
Note:Thi~is not a bill.
"3igned
ritle
0-,=/,~/;1 ,rt::J I'«J~){u)f ~,.=I/'yJ ""\,.
ALFRED TOSI,APPRAISER I
RC~39 (5-681
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SUMMA(;.Y
Estate of McCHESNEY MOLLIE
(Last Name)(First Name)(Initial)
DATE OF DEATH 6-11-70 FILE NO.63-70-791
REPORT OF INHERITANCE TAX APPRAISER
I,the undersigned duly appointed Inheritance Tax Appraiser in and for the County of WASHINGTON
Pennsylvania,do respectfully report that I have appraised the real ald personal property as reported in the foregoing return at
the values set forth opposite each item in the last column to the rigbt in Schedules "A","B","C",and "E".
D.tad,October 7.1971 ~d ~gM../),~
iNRiTANCE TAX APPRAISER'
REPORT OF THE REGISTER OF WILLS
I,the undersigned duly elected Register of Wills in and for 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:_
REGISTER OF WILLS
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
VALUE AS REPORTED
$--------4--
7 625 49
VALUE AS APPRAISED
$-------1--
NONE
7 625 49
VALUE AS REAPPRAISED
$-------+--
FOR USE OF REGISTER ONLY
Tax on $----------1--2%
Taxon $~
Tax on $5%
Tax on $10%
fix 00 $1~
Exemptions *
Total Estate --\-__
TOTAL TAX
COMPUTATION OF TAX
$------'------+---
$--~-----+--
$-------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 ::::::::::::::1====·
$=t=TOTAL TAX BALANCE $----~
PAID $-'--_------J.
BALANCE OF INHERITANCE TAX DUE $t=
Add interest at rate of 6%fro~_____to $------J
AMOUNT OF ESTATE TAX ASSESSED $--~-_L-
Estate tax paid $L-
BALANCE DUE $----ll_
Add interest at rate of 6%from
------lto-----
FOR USE OF REGISTER ONLY ADJUSTME'ITS
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 INo.Administration
IN THE
Year .
MATTER OF THE APPRAISEMENT
OF THE
ESTATE OF
.MO:r.:r.:r.~.).fcCHENEY
Deceased
Late of .WASHINGTON
County of .\vASHINGTON
Commonwealth of Pennsylvania
lOt .
~.
REPORT AND APPRAISAL
/
{,'t'
.-
Flinn RCC-2
DEIARTMENT OF REVENUE
B~EAU OF COUNTY COLLECTIONS
HARRISBURG.PENNA.17 127
"COMMONWEALTH OF PENNSYLVANIA
RESIDENT INHERITANCE TAX
APPRAISEMENT
October 7 1971DATEJ .
COUNTY ..W.A.~.~.I~Q.T..9.~..
FILE NO §..~.:..?2..:.?..~.!.
Whereas,MO'LLIE.Mc.CHES..NE.Y late of J'lASHING.T.ON ..
...-WASHINGTON .:.. . .In the County of :Commonwealth of Pennsylvama,haVIng dIed on
the l1.th ·..· ·day of J.:u.n.~19 7.0,seized and possessed of an estate
subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania;
Therefore,I,A.1.f..R~P..:r..9..~I ,an appraiser duly appointed according to law,
having been designated to make a fair and conscionabl:l 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 AppraisementDescriptionofAssetValuesMadeforInheritanceTaxPurpoles
$
JT.HELD:
SAVINGS ACCOUNT #15732 with FIRST NIl FEDERAL SAVINGS AND LOAN
ASSOCIATION OF WASHINGTON 7.625 49
PAID 8-14-70 Rec#A085574
,
)
.,
,
,
-
Having been duly sworn according to law,I do hereby certify'that the above appraisement is made in con-
formity with law on this.~day of ~..:.~,1~...7L .
..............................~\...l..~~~..
Appraiser
W (Number and Street)
...............................................~,Penna.·········..··....···....·ip;J···oiii~~i··..···.
WASHINGTON County
RESIDENT INHERITANCE TAX APPRAISEMENT
Estate of
.}m:r,.J..I.E.M99~§}~~~X
Deceased.
Late of
..~iA.sJU}IG.l.'QN .
~:;a;:e,~:~:h;o;~;/);~;l~:.;f.y .
J ••••••••••••••••••••••••••••••••••••••••.
Page,Y...t./..=~No §J~.7.Q~.7.~.l...
Filed in Register's Office,.....9.~.~..~.....?......19 ...7J
Amount of tax due,:tJ .
DEPARTMENT OF REVENUE
Received,
Examined and Approved,.
Wrote abo.ut Appraisement,
Appeal f1'om Appraisement,.
Entered and charged,.
I'
..
".J
./COMMONWEALTP,.oF PENNSYLVANIA
DEPARTMENT OF REVENUE
HARRISBURG
RCC-43 (5-65)
NOTE:TO 3E SUBMITTED IN TRIPLICATE
Penns}'lvania Department of Revenue
Bureau'gf County Collections
26 S.4th Street'
Harrisburg,Pennsylvania
Dear Si":
s-15132
Fursuant to Section 742,Pennsylvania Inheritance and Estate Tax Act of 1961,
we here....ith submit the following report:
Pirst !deral,Savinge and Loan Aaaoc.of WashingtonNAMEOFREPORTING
FINANCIAL INSTITUTION _
77 South M81n Street WasM.ngtoh.Pa,15301ADDRE~·S _
ACCOUNT NO.OF JOINT,
TRUST OR INVESTMENT DEPOSIT _
NAMES ON ACCOUNTMol11e McChesney or WUUam Robert ~2cCheaneyORINVESTMENT _
Mollie ..:icCnesneyDECEAS=D JOINT DEPOSITOR,TRUSTEE OR INVESTOR _
n..D.ft4 lilash1ngton.Fa.15301ADDRESS _
'IllUam Robert McChesney ,
.June n.1970DATEOF'DEATH --'-_
SURVIVIHG DEPOSITOR,
BENEFICIARY OR INVESTOR _
TITLE
Son
1 IB..63
R.D.#4 WaslUngton.Pa.15301
ADDRESS.~---------------
RELATIO-,-lSH'IP TO DECEDENT _
DATE DEPOSIT OR INVESTMENT
WAS ESTABLISHED .......,-.---,,;--_...,
BALANCE,INCLUDING INTEREST $15,2,50_,93 '~,Y2,J~~
DUE,AT DATE OF DEATH $~~-~(-:Jtf~L'?R~
/j~,atureJ&~s-,i9
"is;S.3
o?~.rtf
~;~6 V fi 2 9 L
:;
;..'...
,COMMONWEALTH Of PENNSYLVANIA RE '
DEFARTMENT-DF REVENUE ('0 .Bull'VEO
',..HARRISBURG ,~.fJflr r cotr~C:".
",'.:iO"
JJJL it S
3 JJ P,H '10
NOTE:TO BE SUBMITTED IN TRIPLICATE
Pennsylvania Department of Revenue
BYrGlQIJ of CQunty CQIII1l'.:TICln'
26 S.4th Street ,
Harrisburg,Pennsylvania
Dear Sir:
,Pursucr.t to S~ctio~742,Pennsylvania Inheritance and Estate Tax Act'of 1961,
we herewith submit~the foflowing report:,
NAME OF REPORTING First :@deral Savings and Loan AsSOC,;"of Washington
FINANCIAL INSTITUTION _
ADDRESS 77 South Main Street Washingtohn,Pa;1 15301
ACCOUNT NO.OF JOINT,>
TRUST OR lNVESTMENT DEPOSIT__S",_-_1_5_7_32 _
NAMES ON ACCOUNTORINVESTMENTMollie McChesney or William Robert McChesney
I "
•
DECEASED JOiNT DEPOSOITOR,Mollie McChesney ,./'TRUSTEE OR INVEST R "'--__V__'_
ADDRESS R~·b·:;t;t4 Washington2J Pa;"15301
DAT~OF DEATH June 11,1970
SURVIViNG DEPOSiTOR,
BENEFICIARY OR INVESTOR William Robert McChesney
ADDRESS __R_:1_D'_;I#_4_W_as_li_'i_n..::;.g_to_n...lla~P-,a~:;..o"_1_5...;3o_1 _
RELATIO~~SHiP TO DECEDENT Son------------------DATE DEPOSIT OR l!\iVESTMENT
WAS ESTA3USHED 1 18-63
BALANCE,INCLUDING INTEREST $15,250:"98
DUE,AT DATE Of DEATH $__~~-:::=::::::--:::::~----------
TITLE
/'
~
l.
-----------------------.
!
OFFICIAL ~OTICE OF'HHERITAHCE TAX
APPRAISEMEHT AHD ASSESSMEHT OF·
ASSETS HOT SUBJECT TOADMIHISTRATIOH
.'....
Date:__-=J:..=u==1:.Ly.....:l~1!..lliJ..--.,.el~9.L10:z.._
County __W.::.:a~l:::.!h~i~l\~gD.!tl!.l!!ou.n!L.·_
TO:_l_'I--:-L....;..L_IA_M__ROB_E_RT_·_M_cC_HE_-_SNEY_·__
183 OAK HItL DRtvE
,".)
COMMONWEALTH OF PENNSYLVANIA
~J DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
INHERITANCE TAX DIVISION
__lY._A_S_HI.....··NG..;.,·.....TO.....N~,.....::P;....;.;E......NN;;;;;;.SY;....;::;~LV~A=N.::::IA:.::.-.-.,;15301 County File No._
Bureau File No.to J ."7D-79/
'We have rec~ived'notice that,_mXXXXXxuxXxxmXXXXXXDX..vXXUX
on June U 19-.m,you came into ownership of certain property through .''..
.~transfer from,MOLtIE McCHESm.deceased.
Under the Inheritance and Estate Tax Laws of-the Commonwealth of Pen,nsylvania such transfers are taxable
and the'liability for the payment of the inheritance tax due.is imposed.upon you,as transferee.
The prope'rtyon'which tax is hereby assessed consists d:Jt.Held Dank AccOUnt #1..::15732"
held in the FIRST FEDERAL SAVlNOS 6'LOAN ASSOC.OF WASHINGION.WASBINGTAN,
OFFICE,WASHINGTON,PENNSYLVANIA •.In the names of MOLLIE McCHESNEY or ,
WILLIAM ..ROBERT McCHESNEY.Opened.1...18...63..Balance as Of date of deatb.
appraised by the Commonwealth,as of the date of death,at $1S.2S0.,.98
SO %of this amount is taxable at the rate of 6 %
ORIGINAL ASSESSMENT AMENDED ASSESSMENT
DATE OF ASSESSMEHT
TAXABLE AMOUHT
LESS:ALLOWED DEBTS
HET TAXABLE AMOUHT
$__7::...J.L.=.6.=25::::..::.:...::4...::.9~_$--------
AMOUHT-OF TAX DUE 457.53
D If you pay the above amount.within three (3)months
of the datesof deatlLQ.f the decedent,or on or
before ept.1.1.19 70 you may deduct a
discount of 5%of the amount of tax due,or
D This tax became delinquent,fifteen (15)months
after the date of death and,in addition to the
tax,statutory interest at the rate of 6%of the
tax per annum is also due as of * _
19__in the amount of ---------~--,
*If the tax is not paid by the above date additional
interest is due at the rate of 6%per annum until
paid
(Agent for the Commonwealth)
APPRAISED BY:
TOTAL AMOUNT DUE $~3 $.Zx_,~-ASSES!ED BY,==============
(Inheritanc'e Tax Apprai r)
UCTIONS TO TAXPAYERS
Make checks or money orders payable to:
1?~II M{~0._+?~.t'~J'/c.;-0:'
J'~/:/-;?cJ
?c:e-r ,bJO·f'~-.r/y
To insure proper credit to your account
thiS Official Notice must accompany
your payment.Mai I or bring it to:
1(~JIAU~
AGENT FOR THE {O:~?~!J1J1WfAl TH
COUnT nCWSE
WAIKUilfltt PEfiNA.1530J
\r
,,"you have alrea:dy paid this tax to ad executor,administrator,attorney or other personal representative of-the'·I'
'decedent for forwarding to the Commonwealth,list below the date paid,name and address of the person to w~om
you made payment,their official title and the amount.v--.--'"
Date Paid Name and Address of Payee Official Title Amount Paid iii
Under certain circumstances,if,after the date of death of the decedent,you personally paid funeral expenses
or other just debts of the decedent,with funds derived from the property herein taxed,such amounts expended
,by'you may qualify as deductions against the gross value of the property in the computation of tax due.If any
"such expenditures meet all of the three following tests,it is recommended that you itemize the payments below,
execute the affidavit,and return this notice.The Register of Wills will examine the debts claimed and allow
those which he determines to be proper.The tax will then be recomputed and you will receive an amended
assessment of tax.
THE THREE TESTS WHICH MUST BE MET ARE THAT:
1 •You were personally legally responsible for these debts,and
2·You actually paid these debts out of the account or property described above and can furnish proof
of such payment,if required,and
3·These same debts are not also claimed,for tax purposes,by an executor,administrator or other'
personal representative of the decedent handling the administ,ration of the general estate of the
decedent or any other transferee.
SCHEDULE OF DEBTS
Date Paid Name of Payee..Description of Obligation Amount Paid
...
\,,-TOTAL $
(attach separate sheet d requ Ired)
COMMONWEALTH OF PENNSYLVANIA)
COUNTY 01=:_
SS:
I,hereby certify that the foregoing is a just and true statement of
funeral expenses and other debts of the decedent,,for which I
was legally responsible and which I did payout of the property herein taxed.I further certify,that to the
best of my knowledge and belief,these same debts will not be claimed by any other person,for inheritance
tax purposes.
SWORN AND SUBSCRIBED BEFORE ME THIS DAY OF____________19 __
REPORT OF REGISTER OF WILLS
Signature of Taxpayer
I,the undersigned,duly elected Register of Wills in and for the above county,do respectfully report that I
have allowed deductions listed above in the total amount of $g
Date of Approval:_
Register of Wills
Fonn ~CC-2_
DEPARTMENT OF REVENUE
BURtAU OF COUNTY COLLECTIONS
HARRISBURG,PENNA.17 127
COMMONWEALTH OF PENNSYLVANIA
RESIDENT INHERITANCE TAX
APPRAISEMENT
DATE A~.g~.~.~.1.4..t J ..~.!..Q .
COUNTY W.!:I:.~.h1~.g.~.9..~.
63-70-791FILENO ..
Whereas..MQ.l..l..i.~M~.q.b.~$JJ~.y late of W.~.$..hJ.l.1:gt.QI.1:.
in the County of :W~.$..h..i..n.gt.Q.n.Commonwealth of Pennsylvania.having died on
the .ll t.h day of J..\UHL 19.7.0 seized and possessed of an estate
subject to Inheritance Tax under the laws of the Commonvealth of Pennsylvania;
Therefore.I,W R.Cha.ney.,an appraiser duly appointed according to law,
having been designated to make a fair and conscionable :l.ppraisement 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 n possession or enjoyment to collateral heirs of the decedent after
the expiration of any estate for Ufe 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 AppraisementDescriptionofAssetValuesMadeforInherllanceTaxPurpoles
I
$
JT.HELD:
Jt.held B:a.nk Account held in the FIRST FEDERAL
SAVINGS &'LOAN ASSOC.OF WASHINGTO~.WASHINGTON
OFFICE,WASHINGTON,PENNSYLVANOA.In the names
of MOLLIE McCHESNEY or \VILLIAM ROBERT McCHESNEY.
n ..'_'R_~~malance as of date of death
6;
$15 250.98 (!taxable)7.625 a
...,,
...
l ,
..',}.'""-1 --'-.--.,.i,-",,.....•,.J .......
~,
~
.......
'4';;
Total 7.625 49
I Having been duly sworn according to law,I do hereby c~rtify that the above appraisement is made in con-
formity with law on this ...............................................................day of ................................................................................................................................................19 ...............
I ...................................................................................................................................................................
I Appraiser
..............................................................................................................................................................
(Number and Street)
.......................................................................................................................................,Penna.(Post Ofllee)
,-
.Washington\l
County ,-
t...
RESIDENT INHERITANCE TAX APPRAISEMENT
~
Estate of ~
MOLLIE McCHESNEY ,'.
Deceased.
Late of
WASHINGTON
Am.ount of tax due,:{i .
Filed in Register's Office,...A~.g~~.~....J419 ..7.9.
DEPARTMENT OF REVENUE
."
Date of Death,J.u.n..~..ll..,..l.~.7..Q .
Appraiselllel!t Docket Vol.,.
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63-70-791......................................No.Page,
Received,
Examined and Approved,.
.Wrote abo.ut Appraisement,
Appeal it-om Appraisement,.
Entered and charged,.
-'.
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Fprm RCC-33
RESIDENT DECEDENT
.~
COMMONWEALTH OF PENNSVLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
COUNTY OF
J .
Inf.
............x~r
Late of Y!.f3..:l:l.~~.I.:1.s..~~~County
:,1p-~1 'S&ete of J>..ennsylvani.a :}ss~~
County of ~l:l:f.l~.~.J::l,g:t.;~J::l...............................................................~
Wi1~l~i~m.<~McChesney........................................................n'....~,.............•.............••..•......••..........••...........••.........•..•••
~or the estate of the above-named decedent beiag duly sworn,deposeS and say S
IMPORTANT:This return must be completed in detail and filed in dupl1cate,with will attached,with the'
Register of Wills of the County where decejent resided;Return is due within one year after
date of death,unless an extension is grarted by the Secretary of Revenue.(Section 703 of
the Inheritance and Estate Tax Act of 1961.'
_MQJ.!LIE MCC~~~··;;;;·;;;~··~i··d~;;d~~t·)"·····~tXJoo~a
AFFIDAVIT OF
IN THE MATTER OF mE ESTATE OF
Decedent died ,.....J..w,J,~.
(Month)
Name and address of attorney or}
other authorized representative to
whom all correspondence should be
mailed.
.1.ffap-k..C.Ca.rrQll............................
......3.3 We.s.t..Beau.Street..,.WashingtQn,Pennsylvania 1.5.3.01 ..
That as such l.nf.o.r.ma.n:t deponent is familiar with the affairs of said estate and the property con-
(~:~tor)
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 TEISSAFE 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 bcxes are itemized under Schedules o~this
return,with the exception of the following,for the reascns hereina~ter set forth:
That Sc.hedule 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 o~real property at the date'o~death,giving
the amount still due at death,name of mortgagee,date,rate o~interest,and book and page o~record
thereo~.It also sets forth in the columns provided there~ore the assessed valuation o~each o~said
parcels,the estimated market value thereof as of date of death of decedent.
That Schedule B attached hereto and made part he::-eof sets forth fully and in detail all personal
property wheresover situated owned by the decedent at the ~ime o~death;all moneys left by the decedent
at the time of death,whether in decedent's immediate poss~ssion,standing to decedent's credit in banks
o~deposit,savings banks,trust companies,or other institutions,whether indiVidually,or in trust ~or
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 saVi~gs banks,and to the date o~decedent's death
in all other cases;all bonds,postal savings,treasury certificates or notes and other evidence o~in-
debtedness of the United States to the decedent;all obli~ations,whether by sta~ute or agreement they
are designated as tax ~ree,o~the United States,or any state,or political subdivision thereo~,or of".a~y foreign country,which are owned at the time of death;!ill wearing apparel,.Jewelry,silverware,pic-
tures,bOQks,works 'of art,household furniture,horses,carriages,automobiles,boats,and any and all
other personal chattels of whatsoever kind or nature,left l'oydecedent,together with the f'airly estimated
market value thereof;all bonds and mortgages held by decedent and of all claims,due and owing decedent
at the time of death,and all promissory notes or other in5truments in writing ,for the.payment o~money
of which decedent died possessed,of whatsoever nature,with interest thereon,i~~y,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 dep~eciation 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 deceder.t;and all the corporate stocks and dividends
due thereon and unpaid as of the date of death,bonds and Lccrued interest thereon to the date o~dece-
dent's death and other investment securities owned by the d~cedent at the time of death,with the market
value thereof at such time.
~'
,.,,
"
1
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 a(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 showin(l;.t.he as~.ets 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 busines~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 her.ey~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 contempl~tion of dec~'dent's death,or intended to take effect in possession or enjoym~rtt ~t ~'r'
after cleat~,-~~id·.s<:.J:l~~u,l.e::s.ets:forth:~t!e::naJ.l1J:~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 transfe~s.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 _lieed,.tru§,t :ag.r~ement.o,r·other.lnstr4men.t.creating tile trust.Therl~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 ano.ther,_or ~y power of appoint-
ment vested in decedent,either indiVidually or jointly,by the will,deed,:01'-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 lmpaid 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 collateral pledged for obliga-
tions,if any.It is agreed that the fiduciary will present proof of said claimed obligations upon re-
quest,that if the amount actually paid in settlement of any fee,commission or debt is less than the
estimated amount claiming and allowed,that the same will be reported to the Register of WillS,and that
the amount of tax assessed can be reassessed in accordance therewith.
That the totals of the appropriate columns in Schedules "A","B", "C","E",and "F"as directed therein,
have been carried forward and properly registered in the Summary.
Subscribed and sworn to before me this 7 ..
"C ~~iI_Z.~(l~.~.=..'16:::-_2;==~____1_9 __~-:
Wa$blQ(Jton.Wasldnp<m County.hnnsylvanln
tto_1'1 Public~r f!..-ryy7.~3J :J..d,I?7 (
NOTE:jfefore signing ;~davit~ake 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 bF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
TRANSFER INHERITANCE TAX
RESIDENT DECEpENT
),
SCHEDULE "A"
REAL PROPERTY
Real property in Pennsylvania,with statement of mortgage encumbrances upon each parcel at death of dece-
dent.Where property held as joint tenant or tenancy by entireties,report on Schedule "E".Property held by
the decedent as tenant in common with another or otherst should be identified as to quantum of interest and
the estimated value should be that of the decedent's interest only.
The real property located In the Commonwealth of Pennsylvania should be
described by lot and black number,street and street number.together wi th
a general description af 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.
None
(1)
ASSESSED VALUE
FOR YEAR OF
DECEDENT'S
DEATH
(2)
ESTIMATED
MARKET VALUE
(3\
DEPARTMENT
VALUATION
CAUTION
(Do not write
In this space)
Insert this total opposite "real property"t Schedule "A"in the X X X X X
"As Reported"column on the last page of this return.
RCC-35'.
G0MMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
"
SCHEDULE "B"
PERSONAL PR(·PERTY
INSTRUCTIONS:This Schedule must disclose all tangible an~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 Iroperty,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 thEt 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,bO!l.ts,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 unde~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 MARKEl'VALUE (Do not write in
this space)
None
..~
"
,
Insert this total opposite "Personal Property",Schedule "B"in X X
the "As Reported"column on the last page of this return.
I .;,
~-
RCC-.}o'
,;f:mmON'I'EALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
~~SIDENT DECEDENT
SCHEDULE "c"
TR..A.NSFERS
(1)Did decedent,within two years of death,make any tr:l.nsfer of any material part of his estate,without
receiving a valuable and adequate consideration therefor?(Answer yes or 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?(A.,swer yes or 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 heal th at time of ma.dng 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)_
(a)Was there any possibility that the prop~rty transferred might return to transferer or his
estate or be subject to his power of di5position?(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 with0ut receiving a valuable and adequate consideration
therefor under which transferor expressly or impliecly 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)__
(b)The right to designate the persons who siall 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 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 transferQr?(Answer yes or 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)_
(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 ye~,set forth below a description of the property
transferred,it's fair market value at date of death,cates 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 whi~h 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.
Ret-S8
;/
CCMMLlNWEi\LTH OF'l'ENNSYLV,\NIA
TnAN~F'1.::n TNHEIU Ti\NrE TAX
r~~IDENT DECEDENT
SCHEDULE "E"
JOINTLY OWNED PROPERTY
DEPARTMENT VALUATION
CAUTION-Do not Write
In This Space.
Value of Value of
Entire Decedent's
Estate
Valuation
percentage
Share
DSTRtTTIO~S:This Schedule must disclose all property,real and personal,owned by the decedent jointly
wi th another 01"oth~,rs,including intangibles,standing in the name of the decedent and others.List
real estate first,as ~tltiTeties,or joint tenants,giving brief description,as indicated lmder Schedule
"A",plus the date and place of record of lnstrument effecting vestiture,but do not include entireties
or out of state real estate value in estate valuation column.Personal property should be listed as in
Schedule "B",plus date of acquisition,and the name,address and relationship (if any)of co-owners to
the necedent.=--=:::.==:-=-=============r====r====::;=,.===::;::========
Description of Property,Date of Acquisition,Name I uni t
Address and Relationship of Co-Owners,and Place !Value
of Record of Instrument,where Real Estate.i
'....
1."
Property Interest
Savings account #15732 with
First Federal Savings and Loan Associaticn
of Washington ~15,250.98 $7,625.49
II
I III iI
I I II
I I I
I IIII!III
I I
I III
!I IIIII
I I
Insert this total opposite "Jointly Owned Property",Schedule "E"7,~~s:<17inthe"As Reported"column on the last page of this return.
.."
RAC-'37 (12-63),
COMMONWEALTH OF PENNSYYLANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDU~E "D"
BENEFICIARIES
RELATIONSHIP ,
BENEFICIARIES AND ADDRESSES (If step-children or ;SURVIVED DATE .INTEREST OFstatefullnamesandaddressesofallwhoillegitimatechildrenDECEDENTOF.;,.BENEFICIARY
ave an interest,vested,contingent or other are involved,set STATE YES IN ESTATE
wise,in estate)forUI this fact.)OR NO BIRTH
,,--,,---'
William Robert McChesnev ~on Yes one-half
Veterans Administration'Hosnit 1
Leech Farm Road .,-."
Pittsbure:h Pennsvlvania
,..._.Son Yes one-half
ls;t~n ..1r U;lln...;uo
Washine:ton Pennsylvania
,,
,
(
-
(-..
(
h
Deponent further says that all the above-named beneficiaries are living at this time except below:
NAME DATE OF DEATH RESIDENCE
"
'-
OF THE
ESTATE OF
~IATIER OF THE APPRAISEMENT
..'4c;>::I,;li,~.M.GC.h~~n.~y · .
Deceased
(Executor-Administrator
must complete "As
Reported"column #1.)
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('I).....'g ~/~~...
'"~...UlIl:>il:-I ...('I)
0(')./0I§}_/~t't'
IN THE
!No Year .Will
Administration
~l.,
't
Late of ..AIllW~;\..:J,.'J;'9~~P,;i,P..·."~.
REPORT AND APPRAISAL
Commonwealth of Pennsylvania ,
FRANK C.CARROLL,ESQUIRE
33 West Beau Street
Washington,Pennsylvania
County of W~~h:i.Ilg~9:n....
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