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Home My WebLink AboutOC1971-0287 - ESTATE OF HAVELKA"-1 ·-COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS HARRISBURG RCC-81 (6-71) 17127 IN YOUR REPLY PLEASE REFER TO Inheritance Tax Division NOTICE OF FILING OF APPRAISEMENT 38-151-7 ROENE E. SEVERYN (Executor o~ In Re: Estate of _EL_I_Z_.11J3_E_TH_HA __ VEL __ KA ___________ _ __ _;_W:..::...A...:.::S=H=IN::..:....::..GT.::...O_..:N:.;__ County-File No. 63-71-287 Dear Mrs. Severyn, You are hereby notified that the--=o=r~1:=.:. 9:::~.:1=· n=a=1'--------------- appraisement in the estate of ELIZABETH HAVELKA has been filed in the office of the Register of Wills of WASHINGTON County on October 3 , 19 72 , Said appraisement reflects the following va I uations: Rea I Estate ___ ____,1:..:3:=....,<-.:0::..:0::..:0::..: • .....,0::..:0,__ ___ _ Persona I P roperty __ ...._2=0-L, _,.2 ....... 7__..2._..'-"5"""2..____ ___ _ Transfers ______________ _ Jointly Owned------------- T ota I _____ ___:3=-.:3"'-'''--'2=-7:....:2=•"--'5=--=2=-------- 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 nine (9) months (fifteen months when death occurred from December 22, 1965 to June 16, 1971, inclusive; and twelve months when death occurred prior to December 22, 1965) 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. Date October 3, 1972 Title _AP_P_RAI __ S_E_R_I_I _______ _ DATE OF DEATH: February 7, 1971 Note: This is not a bi II. J . ~· . ·,, ·-~. : •:. . . . . . . . '' :., .; ... ·· .. Jmo ,.RCC-39 (!!-68) COMMONWEALTH OF PENNSYLVANIA TRANSFER INHERITANCE TAX RESIDENT DECEDENT SUMMARY Estate of HAVELKA · (Last Name) ELIZABETH. DATE Of DEATH .. 2-7-71 FILE NO. 63-71-287 (First Name) (lr).itial) REPORT OF INHERITANCE TAX APPRAISER 1, the undersigned duly appointed Inheritance Tax Appraiser in and for the County of WASHINGTON Pennsylvania, do respectfully report thil.t I have appraised the real and personal property as reported in the foregoing return at the values set forth opposite each item in the Jast column to the right in Schedules "A", "B", "C", and "E". Dated: ---=-0-=c-=t-=o=b-=e=.r___::::3..L, ---=:1..::;.9...:..7..=2_ ~~~~~b$ . IN~E;RIANCE TAX APPRA15& 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 cht,imed by depon,erit, e s to those items where a greater or lesser amou~t is set forth in the last column. to the right in Schedule "F" tch greater lesser amount represents the sum allowed as a deduction. Dated: OCT 4 197lRUSSEll MARINO 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 FOR USE OF REGISTER ONLY Tax on$ ________ -+--...-~~ Tax on$ _3_1. 169 Ql:i · Tax on$ o Tuoo$ lK Tax on$ 15% VALUE AS REAPPRAISED $------------~--- 33 -2 31,168 95 I $----~-----4--- $----~~~~~~. $---------4----$_~---------~---$ _______ -4-- ~~ptioos * Total Estate ______ ___.~- (*) As evidenced by Charitable Exemption Certificates issued TOTAL TAX Less tax previously paid $-=======+====- BALANCE $----~~~--- Less S% of tax if paid within 3 months after death $====:::;:;::::::!:::::;:;::= BALANCE OF INHERITANCE TAX DUE Add interest at rate of 6% from ________ to ____ _ AMOUNT OF ESTATE TAX ASSESSED $---........-..---+-- Estate tax paid · $~-----~-- BALANCE DUE $ ____,.,_...;..-+--! $ ,.,...--------__..J_--- Add interest at rate of 6% from ---------~.1 0------ TOTAL TAX BALANCE !:. =========~+=·== PAID $ ____ ..,....,.,. ___ .~.._ --- FOR USE OF REGISTER ONLY ADJUSTMENTS by the Secretary of Revenue. 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. l Will Administration t No ..... . IN THE Year .......... .. MATTER OF THE APPRAISEMENT OF THE ESTATE OF ELIZABETH HAVELKA Deceased Late of ..... C::E.C:J:~ .'rW'l?.'! ... County of WASHINGTON Commonwealth of Pennsylvania REPORT AND APPRAISAL ' 0.· :, ~-~ .. I f. --------------- - Fonn RCC-2 COMMONWEALTH.OF PENNSYLV M~IA DATE .. O.ct.o.ber ...... 3 . ., ........ 19.7.2 ...... ....... DEPARTJ\lltl'~T OF REVENUE ":1. RESIDENT INHERITANCE TAX COUNTY .... WM.~ING..T.ON ..................................... BUltEAU OF COUNTY COLLECTIONS .... "" HARRISBURG, PENNA. 1712 7 APPRAISEMENT FILE NO. ?..~.: .. ?.~.: .. ?.?..?. ............................................... Whereas, ............................................ ~.l.~A.a..~T.H ..... HAW.l:!.Kh ................................. late of ............ CEC.l.l.! ..... TWP. ..... .................................................... in the County of ........................... ~~~-~-~?;9.~ ...................................................................... Commonwealth of Pennsylvania, having died on the ....................................... ~.~.Y.~~.t.h ........................... day of .................... ~.~P~1;l.~~Y ........................ 19 .... .7.~ seized and possessed of an estate subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania; Therefore, I, DOMINIC R. DeMARIA 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 inheritance taxes at the lawful collateral rate on any such future interest. assess transfer Unit Appraisement Description of Asset Values Made for Inheritance Tax Purposes $ REALTY: SEE COPY OF SCHEDULE A ATTACHED TO APPRAISEMENT 13,000 00 PERSONAL: SEE COPY OF SCHEDULE B ATTACHED TO APPRAI SEMEN T 20 272 52 i-nt-:::~1 33,272 52 ::· ". j, •• ::;. ·;, '· "' .• ' . , , .. .. :, .. t . . . . ., ' .. .. ,, .. ;·. .. ' . ' .. ; . r . . <" , .. -... •. ~ . I I ................... , Penna. WASHINGTON. County RESIDENT INHERITANCE TAX APPRAISEMENT Estate of ELIZABETH HAVELKA Deceased. Late of CECIL TWP. Date of Death, ..... 2 .... .1. .... 11 ................................................... . Appraisemel!t Docket Vol., ..... <le. .................................... . Page, ... 1.5.1.~7........................ No. . .. 9..~.:':':" . .7.l.~.~-~.7 ..... . Filed in Register's Office, .. ?..~:':. .......... ~ ............. 19 .. ?..?. Amount of tax dtte $ , ····································································· DEPARTMENT OF REVENUE Received, Examined and Approved, Wrote abo.ut Appraisement, Appeal f1'om Appraisement, Entered and charged, • . , / ' COMMO~W~Al:.TH OF PENNSYLVANIAa~f,~ftVfo DEI"'ARTMENT OF REVENUEOUNTY ~aAU OF HARRISBURG . t. LLECT;itPrqi:S RCC•43 (5-65) NOTE: TO BE SUBMITTED IN TRIPLICATE Pennsylvania Department o·f Revenue Bureau of County Collections 26 S. 4th Street Harrisburg, Pennsylvania Dear Sir: ,fEB 1/l 3 - .. 11 1 2-" rOJJ 'lJ "'"' *-' ~r:n , f ,. . I I I February 10,1971 Pursuant to Section 742, Pennsylvania Inheritance and Estate Tax Act of 1961, we herewith submit the following report: NAME OF REPORTING FINANCIAL INSTITUTION __ P_i_t_ts_b_u_r_g_h_N_a_t_io_n_a_l_B_an_k______ J/ n~ ADDRESS 4 w. Pike Street, Canonsburg, Pao 15317 ~~i·~oj ACCOUNT NO. OF JOINT, -,, TRUST OR INVESTMENT DEPOSIT ___ 8_2_-_2_6_9_80_9_4 _______ _ j NAMES ON ACCOUNT OR INVESTMENT Elizabeth M. Havelka or Roene Elizabeth Severtnn. DECEASED JOINT DEPOSITOR, Elizabeth M. Havelka TRUSTEE OR INVESTOR---------------- ADDRESS _________ s_o_x_1_9_s_,_L_a_w_r_e_n_c_e_,_P_a_. ______ l_s_o_s_s ______ _ DATEOFDEATH ____ F_e_h_ru_a_ry __ 7_,_1_9_7_1 __________ ___ SURVIVING DEPOSITOR, Roene Elizabeth severyn BENEFICIARY OR INVESTOR---------------- Box 195, Lawrence, Pa. 15055 ADDRESS _______________________ _ Mother & Daughter RELATIONSHIP TO DECEDENT ______________ _ DATE DEPOSIT OR INVESTMENT WAS ESTABLISHED October 5, 1970 BALANCE, INCLUDING INTEREST$lG 234 82 DUE, AT DATE OF DEATH$ ___ , __ • ____ ___,::---------r-"" r;~, p :_jJ_ <R/t, o/3/ Ro? G) t;Z= S% .0~ { s-J-71)=: d.J-vc v /'/1-'J);tl Assistant Secretary --------------Signature TITLE . -~~ ~~~ f~ RCCc .134 ( 1-69) COMMONj'fEAL Tf-4. OF PENNSYLVANIA DEPARTMENT OF REVENUE BUftEAU OF COUNTY COLLECTIONS ,~ INHERITANCE TAX DIVISION OFFICIAL NOTICE OF INHERITANCE TAX APP.:RA·l5Ef.\ENT AND ASSESSMENT OF ASSETS NOT SUBJECT TO ADMINISTRATION TO: ROE:NE ELIZABETH SEVERYN BOX 195 LAWRENCE, PENNSYLVANIA 15055 Date: February 24, 1971 County \vashington County File No. ________ _ Bureau File No. ________ _ We have received notice that)ia~~~~~~~~~mXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX on February 7 .19.11., you came into ownership of certain property through ~~.X.XW ~~1~X~~~~~~iK transfer from, ELIZABETH M. HAVELKA, deceased. Under the Inheritance and Estate Tax Laws of the Commonwealth of Pennsylvania such transfers are taxable and the liability for the payment of the inheritance tax due is imposed upon you, as transferee. The property on which tax is hereby assessed consists of: Jt • Bank Account # 82-2698094, held in the PITTSBURGH NATIONAL BANK, CANONSBURG, OFFICE, CANONSBURG, PENNSYLVANIA. In the names of ELIZABETH H. HAVELKA or ROENE ELIZABETH SEVERYN. Opened, October 5, 1970. Balance as of date of death, $16,234.82. appraised by the Commonwealth; as of the date of death, at $ 16 '234 • 82 100 % of this amount is taxable at the rate of 6 % DATE OF ASSESSMENT TAXABLE AMOUNT LESS: ALLOWED DEBTS NET TAXABLE AMOUNT AMOUNT OF TAX DUE D If you pay the above amount within three (3) months of the date of death of the decedent, or on or before May . 7 19 71 you may deduct a discount ~f 5% of the amount of tax due, or D This tax became delinquent, fifteen (lS) 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 a_lso due as of*_--~- l9 __ 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 TOTAL AMOUNT DUE $ ORIGINAL ASSESSMENT AMENDED ASSESSMENT $ 16,234.82 __ ..:__ ____ _ $---------------- 974.09 48.70 ----------- ------------ 974.09 $ ================= ASSESSED BY: ______________ _ (Agent for the Commonwealth) INSTRUCTIONS TO TAXPAYERS Make checks or money orders payable to: To insure proper credit to your account this Official Notice must accompany your payment. Mai I or bring it to: If you have already paid this tax to an executor, administrator, attorney or other personal representative of the decedent for forwarding to the Commonwealth, list belov,: the dot~ paid, name and address of the per$on to .. whom you made payment, their official title and the amount. · .... · . -' ),' ·\..· Date Paid Name and Address of Payee . Official Titt~· .. Amount. P~id 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, i.t is recommended that you itemize the payments below, execute the affidavit, and return this notice. The Register of Wills will examine the debts claimed an.d 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 administration 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 if required) COMMONWEALTH OF PENNSYLVANIA) SS: COUNTY OF: _______ _ 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 pay out 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 ____ _ Signature of Taxpayer REPORT OF REGISTER OF WILLS 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$ --------• Date of Approval: ______________ _ Register of Wills '\ 'Form RCC-33 RESIDENT DECEDENT COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS COUNTY OF ~ 5-7/-·:13'7 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 the Inheritance and Estate Tax Act of 1961.) County of -·-----Pennsy.lvania ................................. } .. ..... Was.bin.gt..o.n.............................................. ss: State of ..... ............................................................. . ......... Ro..e.n.e. ..... E ........... S. .. e.ve.typ .. , ................... , ............... .. . .................................. Eueutor of the estate of the above-named decedent being duly sworn, deposeS and say S Decedent died ................. J.f.e..Q:I::'lJ(~~~) .. .Z, .l.9..ZJ.;;;·~) .. , 19(v~~~·j ... ,{;:;~aving a last will, copy of which is hereto attached. } Name and address of attorney or} other authorized representative to · GREENlEE RICHMAN DERRICO & POSA ......................................... , ........................................... ,, .. , ........................................................................................................... . whom all correspondence should be .. mailed. 325 W~~ll~~gt:C>~ ':r~~~t:]fl~c;lg-., Y!~~~.~~g~<:)?~ Pa ~ ... !.?..~.9 .. !. .. That as such ......... :$..~.~.~-Y.t.t.i~ ......... deponent is familiar with the affairs of said estate and the property con- (J<:x.,cutor-AdministratorJ 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 ,•; ~HIS 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 thereof,~or of any foreign country, which are owned at the time of death; all wearing apparel, jewel~y, silverware, pic- tures, books, works of art, household furniture, horses, carriages, automobiles, boats, and ~y and all other personal chattels of whatsoever kind or nature, left bydecedent, together with the fairly;estimated . ' market value thereof; all bonds and mortga~es held by decedent and of all c~aim~ due and ow~ng decedent. at the time of death, and all promissory notes or' other instruments in writing for the payment~of money· of which deceden't died possessed, of whatsoever nature, with interest thereon, if ~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 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. I 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 b~siness, 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 tr.ansfers. In the case of transfers intended to .take effect in posse~sion or enjoyment at or after death, there is. also attached to the schedule a COJ:IY ·of the deed, trust agreement o"r' other instrument creating the trus·t. 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 or jointly, by the will, deed, or other instrument of another, with a copy of the instrument creating such power attached to the schedule. That Schedule 0 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, andthe relationship of such issue to the beneficiary. That Schedule E attached hereto _and made a part hereof sets forth all property, real and per- sonal, owned by the decedent jointly with another or others, including intangible, standing in the name of the decedent and others, plus the date and place of record of instruments effecting the vestiture of real estate and the date of acquisition of personalty, plus the name, address and relationship, if any, of co-owners to the decedent. That Schedule F attached hereto and made a part hereof sets forth fully and in detail all debts and deductions claimed for and on behalf of this decedent's estate, including funeral expenses paid; family exemption, where applicable; costs of administration of this estate; counsel fees and fudiciary' s commissions paid or to be paid; cost expended for burial trusts, tombstones or gravemarkers, and reli- gious services, in consequence of the death of the decedent; debts and claims owing and unpaid at time of death; taxes accrued chargeable for period prior to decedent's death (except those allowed under Section 651 of the Inheritance and Estate Tax Act); together with a statement of 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 ... ./9,:..d....~ .. -~~~------- .... §§.~ .... A.~P.;~~ .... P.;:.~.Y.~ .............................................. ~ .. ·-"""" (Street Number) .... 9~~.~.~.~-~.~!.S .. '-.... J?..~~.~~ .. ! .... J~.~ . .!.? ......................... .. (City or Town and State) NOTE: Before signing affidavit make sure all blank spaces in the aff'idavi t and schedules annexed are filled in with details or the word "None", and in case the assets include rare and unlisted securities, securities of close or family corporations or an interest in any co-partnership or business, that the data and statements required under the paragraph above relating to Schedule "B" are attached. Also make certain that column #1 in the "Summary" has been properly completed as above-directed. RCC-34 (1•64) • COMMO.NWEAL TH OF PENNSYLVANIA DiPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS TRANSFER INHERITANCE TAX RESIDENT DECEDENT 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 others, should be identified as to quantum of interest and the estimated value should be that of the decedent's interest only. The real property located In the Commonwealth of Pennsylvania should be described by lot and block number, street and street number, together wl th a general description of the property, with a reference to the record of the conveyance by which the decedent took title; if a farm state number of a- cres; also statement of mortgage encumbrances upon each parcel at death of decedent. Taxes, assessments, accrued Interest on mortgages, etc.,are to be listed on Schedule "F" and must not be deducted from this schedule. ALL that certain lot or parcel of land situate in the Township of Cecil, County of Washington, State of Pennsylvania, more particularly bounded and described in Deed dated July 23, 1970, D.B. 1321, Page 740, and previous Deed dated January 28, 1946, Deed Book ~00, page 441. The said Stanley Havelka died November 4, 1969, thereby vesting title to the above premises in his wife, Elizabeth Havelka, as surviving tenant of an estate by the entireties. (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 13,000.00 (3) DEPARTMENT VALUATION CAUTION (Do not write In this spoce) (jO 1~ ooo .,.. JJie/l R_CC'-35 ~ COMMONWEALTH OF PENNSYLVANIA TRANSFER INHERITANCE TAX RESIDENT DECEDENT SCHEDULE "B" PERSONAL PROPERTY INSTRUCTIONS: This Schedule must disclose all tangible and intangible personal property owned individually by the decedent, at the time of his death. Property owned by the decedent jointly with another or others must be listed under Schedule "E". Intangible personal property, titled in the name of the decedent, but payable at death to another or others, including but not limited to P.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 witi1 accrued interest or dividends, salaries or wages, insurance pay- able to the estate or fiduciary in sa:td 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 tlme of' death, should be listed in this schedule. Item NO• ITEM UNIT List and describe f\1lly VALUE ESTIMATED MARKET VALUE DEPARTMENT VALUATION (Do not write in this space) 1. 2. 3. 4. 5. 6. t. Social Security Benefit Check Sale of Furniture Insurance Refund -Fire Insurance on Decedent's Dwelling Western Penna. National Bank-Savings Acct. Mellon National Bank -Account Pittsburgh National Bank-Acct.#82-2698094 NOTE: Item No. 6 above was held in the names of Elizabeth M. Havelka or Roene E. Severyn, and opened October 5, 1970. Said Roene E. Severyn certifies that this ac- count was only an accommodation account with her name on it and all the money in the said account belonged to Elizabeth M. Havelka and shown here as the property of Elizabeth M. Havelka Insert this total opposite "Personal Property", Schedule "B" in X X the "As Reported" column on the last page of this return. 113.10 400.00 68.00 1,874.15 1,582.45 16,234.82 , I g, I D ;.;.oo.~o (J,OO If 7tl!5' J _) 8 ;J., 'I~ 1 (;, :J. 3 </~ i 't- RCC:?6 ,fOmfON11'EALTfl OF PENNSYLVANIA TIUNSFER INHERITANCE TAX ~~SIDENT DECEDENT SCHEDULE "C" TRA.NSFEilS (1) Did decedent, within two years ofdeath, make any transfer of any material part of his estate, without receiving a valuable and adequate consideration therefor? (Answer yes or no) JSlO (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 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 sub,ject 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 o.f transfers and to whom transferred, with relationship of transferees to decedent, if any. Submit copy of any trust deed or instrument, if trans- fers are claimed to be non-taxable, also submit detailed statement of facts on which said claim is based. NOTE 3: List applicable property below in manner in which provided in Schedules A, B, or E. ITEM DESCRIPTION None Insert this total opposite "Transfers", Schedule "C" in the "As Reported" column on the last page of this return. MARKET VALUE (Estimated) DEPT. VALUATION (Dept. Only) l~OM\IL)~\\'F:,\ LTH lW l'EN~ SYLVAN I.\ Tl\.U\~;;-·E:l\ r~m:H.l TANC.E TAX RFSTDE~T DECEDENT SCHEDULE "E" JOINTLY OWNED PROPERTY I~STi\rCTIO~S: This schedule must disclose all property, real and personal, ownerl by the rlecerl.ent jointly with another or others, including intangibles, standing in the name of the decedent and others. List real estate first, us entireties, or joint tenants, .giving brief description, as indicated tmder 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 vulue in estate valuation column. Personal property should be listed as in Schedule "B", 11lus date of acquisition, and the name, address and relationship (if any) of co-owners to the decedent. Description of Property~ Date of Acquisition, Name I Address and Relationship of Co-Owners, and Place of Recorct of Instrument, where Real Estate. 1 Unit Value percentage Share Estate Valuation DEPARTMENT VAI1JATION CAUTION-Do not Write In This Space. -~~~ >->s See Schedule •iB" hereof for earlier bank account 4fo82-2698094-Pittsbu:i:-gh National Bank --$16,234 .82Bal. at date of death •. \ i·. ' ... ,I j,\• •• r '-.:·~.~ •• o< .·. .. ... I ' ' .. '· Insert this to tal opposite "Jointly Owned Pr,opcrty" 1 Schodulo .I•E• in the "As Reported" column on tho last pago or this return. Vdue of Value of Entire Decedent's Property Interest t '· • . ' ,('{cc ... 37 (12-63) CCMMON\\'EALTH OF PENNSYYLANIA TRANSFER INHERITANCE TAX RESIDENT DECEDENT BENEFICIARIES AND ADDRESSES . State full names and addresse~ of a~l who ( h ave an interest, vested, contingent or other wise, in estate) o Stanley A. Havelka a/k/a Stanley A. Havens -P.O. 366 Verdi, Nevada, 89439o Charles R. Havelka 4674 Marina Drive Pittsburgh, Penna. 15207 A1 £-rp_d 1<' J.l~uPl'k::1 25 75 Onnin_ &treat .. Sparks, Nevada 89431 Roene E Severvn 651 Alnine Drive Canonsbur~-Penna. Gerold J. Havelka '>/"\&.. C:tlmmjns Ave Houston, Penna. 15342 ' 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 son Yes ---1/5 son Yes ---.. 1/5 son Yes ---1/5 daughter Yes ----1/5 son Yes ----1/5 Deponent further says that all the above-named beneficiaries are living at this time except below: NAME DATE OF DEATH RESIDENCE Will ~ t No .. 6.~.~71.~.2ilar ..... l.9..71. ..... . 1!\l THE ~lATTER OF THE APPRAISEMENT OF THE ESTATE OF .. El:i,:z:~l:>~t:ll. ... » ..... a.av.ell:tc:l Deceased Late of Cecil T.ow.ns.hip ............... . Count-v of Washington ~ ........................... . Commonwealth of Pennsylvania REPORT AND APPRAISAL .. vd ··oo NOl~NIHSVM Slli1\A .:W U31SI~3U ONIBVrl llJSSnH .9l h Ud SZ .d3S. lL, tf ..... ., ll J -~U ,.:J . -~ - ---GREENLEE RICHMAN,DERRICO & POSA 325h~ash!ngtQn Trusf5Bldg. Was 1ngton, Penna. 301 (Executor-Administr·ator must compl~te "As Reported" column #1.) 0 '"1 0 Cl) Cl) :;;1 >c !)) C"' c:n tr:1 "' .... !)) .... (1) ~ '"t:l ~ ~ ~ "' Cl) 0 (;" ~ .... e. "' '"t:l .... 0 "0 ~ .... '< !:t:l ~ ~ .g ~ ~ Vl c:: ~ ~ > !:t:l -w Vl Vl ~ ::r' . n . ;:r ?- c-) t:J ~ = = .:: --- ~-(/)-(h-(1)-(,1')-(1) 'W :w ... :N ...... 'N .. :\.11 'N -:N)..;a~ :O:W!:t:l !W :-. ("D ..-.. 0 :N :•<::>0 .... 0'" :•oo-O'N"O~ . ~. ~. ~ 0 :\Jl 0.:::::: o-,.:o -(,1')-(/)"*-(1) -G'-' -(I) ~- ... ~. ~: ~: ~:·~· . . }J ~: ;r.J .;.;._ > 0 ~"' " .. , t:l 5l) -~ It . -....,..-. :~·: ~ t-v -~' 3--~ 0 5' ~~~. 0 r. 1'-J· c.. . - . .. ... . /I "' . i orne' or THii: lllEGIIIHR 01' WILL& . OF----'------COUNTY AND AGENT 0' THE COMMONWiiALTH STATEMENT OF D:::BTS AND DI::DUE:TIONS ,If, Aeglaltr ef Willa, Agrd ESTATE OF Elizabeth M. Havelka LATE 0 , ___ c;;;..e;;;..c~~;;;;.·l;;;._.T;;.o~w;.;.n;;;.s;;..h;;;.~;;..· p.__ ______ _ OA.Tt;: Ol" FILING APPRAIS[M£NT ---------OATil Ol" DV.TH _ _;;.F..;;.e...;.b,;;;.r.;:;;U;.;..a,;;;.r..r..y_;.;..7~,_;;;1.;;.9..;.7.;;1 ___ _ DATE 2/.7l to j 6/71 '-I 11 to I 6/71 t}~i to ! 3/71 4/71 0 7171 9171 ~llBJ 171 B/18J 71 B/291 71 ~/16/ 71 9/72 '9/72 tl.0/21 /71 . NAM[ 011' PAY££ REMARKS West Penn Power Co. t -ueceaent s Final Electric Bill-Residnc Columbia Gas Co. of Pa. Final Gas Bill-Decedent's." Citizens Water Co. Final Water Bill-" .. The Bell Telephone Co. of Pa Final Telephone Bill " DeAngelo Mortuary Funeral Expenses Real Estate Taxes Decedent's Residence ~eimbursement to Greenlee, Ri~hman, Derrico & Posa For: Re2ister of Wills Letters & S.C.s Guv Rodgers · Witness Fees Washington Co. Reports Advertising Estate I Daily Notes Estate Notice Russell Marino Filing Inventory & D & D ' Russell Marino Balance on Letters ~ 1 • hm • Posa ~reen e~,R~c an,Derr~co & Attorney's Commission AMOUNT 43 62 101 sol 10 29 3;J-64 I 1,596 10 1€ 62 ll.l .00 3(] 00 lli .00 12.50 3.00 18.00 200.00 I -·-~------· .0~------------f------+--' I --- .0 0 T 1 3:· J .; J ~c~ : 1 3; J c J .t j 5 1 1 310 4 G 0 .G 0 6 8 .00 L87L~J5 L582.ll5 1 6:2 ') L1 .3 2 33;~?72¥525 2)103.57- 31268.9S,: 3LlS:3.95, .0 0 T 4 3 .62 1 0 7 :8 0 10.29 3 7.64 LS 9 5-.10 16 .62 14~0 I 3 o .o·o ~~-----------+----+--11 lAO I I lAO-~------------~---~--1 4 .o a 1 12.50 ~-----------~--~-- 3 .0 0 r--1 --------4-----1-~ 1 8 .o o I 2 0 0 .0 c ~-----------4------1~~ 2) 1 :1 3 .s 7 s~ _ L -r -1 -~ --~-t.)-J .5 .J ( :..-~----------+----J-- . ' .. ,. -. Total 2,103 57 COMMONWEALTH OF• PENN~YLVA.NIA } COUNTY OF Wash~ngton ••• 1, Roene E • Severyn, Executrix U(AESY ClRTIP'Y. THAT. TO THC 'II£8T Of' .. .,. KNOWLEDGE: AND DELlE,, T14C P'OaE:GOING Ill A JUST ~ND bRUIt IITATI:NLHT 01" t:EBT8, FUNERAL. UPIN&Ea AND UP[NID Ofl AOMJNaGTRATION suow•n'o To THE nTAn 0 ,. El~za eth M(Q. H~ a ~ - ---liCUIU), Aa DIDUCTIONI P'Oil IIICIURITANCS: TAX PURP~II~8. ~ • Q /' . / : ~ c . u .. 5) 8WOitN AND ~~~t_c!,:oEO'iiU'70M NE THia 22nd oA,y M J!:XeCu • , Jl Septe~.r l /: f' ,.. 72 • Z/~ /'-'~ / -~.LAU - - Nota7J P~l:)":tJ:'c~wa~nJ.ngt:on-was _ "'v. , Pa. My COIIJ11liS s iori. EXpires 0 -I~ -ff? 3 • - .· ' . ' . ..--· RCC-4 (8-68) No:B COMMONWEALTH OF PENNSYLVANIA .. DEPARTMENT OF REVENUE 1l7S5·0FFICIAL RECEIPT•PENNSYLVANIA INHERITANCE AND_· .. RECEIVED TliB HU:t-f"DRED ROENE SEVERYN EIGHTY and OOilOO-.. --,.. ..... _ ......... _ .. ____ .,. ... ..,._,.. ____ ... .,.._ ... _ .. .,_ .. dollars representing Pennsylvania Inheritance or From:~~~~~~~~~~R~I~C~HA~·~M~~D~E~R~.R~I~C~O~&~P~O~S~-A~ __ E_st_at_e_T_ax __ du_e_f_r_om __ t_he __ fo_ll_ow_i_ng~e_st_at_e_: ----------II Address 325 WASHING'rON TRUST BUILDING WASHINGTON, PENNSYLVANIA 15301 File No6.3 ... 71 .. 287 Name of Decedent __ E_L_I_Z_A_D_E_T_H_HA_V_Et_K_A __ ----i County _____ W_A_S_H_I_NG_T_O_N ______ -; Remarks: 2%Tax on $ _________ $---------·~ ON ACCOUNT 280.00 6% Tax on $ _________ $---------1111 15% Tax on $ ______________ $ _________ _ %Tax on $ _________ $---------IIIli Estate Tax, Act of May 7, 1927 TOTAL TAX CREDIT Less five percentum of tax if paid within three months after date of death Plus interest at the rate of ___ %from----...,------ to __________ _ $ ______________ __ 280.00 $ ______________ __ $ ________ _ $ _____________ _ lJ 00 ~ [p [L~@ ill urn SEAL TOTAL AMOljJ>H-P~ID ~ ( \ 280,00 NOTE: This Triplicate Receipt to be retain~d.lor aud,e'!J'tSl-7 \ _ ) .J /} --.·~~ . · Received by~\-.'(t._~ / CV-.<./~ NOTE: In accepting the transfer inheritance tax on future estates, prior to the death of the1hfe lEmont or tenant for years, as evidenced by this receipt, H is understood that the Commonwealth shall nat be precluded or prevented from hereafter assessing additional inheritance tax at the death of th<>·- life tenant or tenant for years whenever it appea.s that.such'additional tax may be legally due and _ ___:;.,o=",---'-----,--~___;;;.---------IUI collectible for any reason whatsoever. 11 f I .~:...----.. lAST HILL AND TESTAHENT - I, ELIZABETH HAVELKA, Hidm-1, of Cecil Tmvnship, Hashington County, Pennsylvnia~ being of sound mind, memory and understanding, do hereby make, publish and declare this to be my Last Hill and Testament, hereby revoking and making void all former Hills or Codicils by me at any time heretofore made. FIRST: I direct and order that all my just debts and funeral expenses and the e:~penses of administering my estate shall by my Executrix hereinafter named, be paid out of my estate as soon after my decease as shall be her be found convenient. SECOND: I leave all the rest, residue and remainder of my estate to my children, STANLEY A. 1-IAVEL.T{A,(also knmm as STANlEY A. RI\VENS), CHARLES R. HAVELKA, GEP-.ALD J. HAVEU<A,. ALFHED E. l1A VEil<A, and ROENE E. SEVERYN. '· FIRI\LLY, I appoint my daughter, ROENE E. SEVERYN, Ei-;ecutrix of this my Lnst Hill. and Testament. IN UITNESS Ul-IEREOF, I have set my hand and seal this --~-~ 3..;;.__da y of ' 1969. ~/ l l ~-; )1 ~(Q}...;L..:u:.::..· .-..;;.J,ltcf?~O~~;...;;.t;!..L'/_...r./~...r.H:.:::;.:..J<..t--~:::Vf~/...~..b;;....:;...~--< SEAL, ~.izabeth Havelka Signed, sealed, published and declared by ELIZABETH HAVEU\A the ~bove named Testatrix, as and for her UJ.st \·!ill and ' . h Testament, in the p1.·esence of· us, \vho, at her request, and ~n cr presence, and in the presence of each other, have hereunto sub- scribed our names as attesting \•litnesses thi's d-,3 day of __ _ ~~~ '1969. • . . : ~:. -: ... ... lAST HILL AND TESTAHENT I, ELIZABETH HAVElliA, Hidmv, of Cecil To~vnship, Washington County, Pennsylvnia; ~eing of sound mind, memory and understanding, do hereby make, publish and_ declare this to be my Last Hill and Testament, lier'el:fy" reVo'king and· making void-all former ·Hills or Codicils by ·me at any time heretofore made, FIRST: I direct and order that all my just debts and funeral e:gpenses and the e~~penses of administering my estate shall by my Executrix hereinafter named, be paid out of my estate as soon after my decease as .shall be her be found convenient. SECOND: I leave all the rest,_ residue and remainder of my estate to my children, STANLEY A. HAVELKA,(also known as · STANLEY A. HAVENS)., CHARLES R. ~VEJJq\, ~Q~RALD J. HAVEU<A, ALFRED E. H.t\VELKA, and ROENE E. SEVERYN. FINALLY, :t appoint my· daughter, P.OENE E. SEVER):N, E~-=ecutrix of this my Last Hill and Testament. IN HITNESS ~·THEREOF, :e 11ave -set· my hand and seal this ;::( 3 day of .v?/~+t..; / ' 1969. . //} ;) iJ 1)/ . /y! ~z_,~(~·t.~te:-/(j;~/;_1 _. _.~,l_,tLc:~t-;....>:V~fi....,'P_· ·~-"-~--_ ___,(SEAL 1)iz~F~th Havelka. ' . Signed, sealed, published and declared by ELIZABETH HAVEU<A the above named·· Tes-tatri~~, as and for her Last 1~7ill and ' • 1 Testament, in the' p:res.ence of us, vJh~,-at her request, and J.n nc:r presence, and in the presence'of each other, have hereunto sub- scribed our names as att_esti,.ng_ \v~tnesses this ~3 day of __ _ ~~~ '1969. - Ii !I ' l ' i ! ! i r l ' ' .,