HomeMy WebLinkAboutOC1971-1236 - ESTATE OF HOFFMANN'.
TENTATIVE STATEMENT
PENNSYLVANIA TRANSFER INHERITANCE TAX
j
Date 1...~8::.~.I..r...7....f:.
TO ~t.).._LV-?-'~~...........__.2!J.7J...__......_,_.._...-.._L __.
~~~~~~~fJJ#).~~iH~~r-.,2.:?..1..1.7..':_..._.
~;~eraised ~~~~~:.~l ..:.::?:.~..~:..?..i\.~~..~..=z.t.::...J.?..~~
Real Estate
Personal Property
Joint Accounts
....................................................................................................................................................................................................................
Less Exemptions
Less Debts and
Administration Expenses ..
TAXABLE AMOUNT
'X.TAX on @ ~~70 .
TAX on @ ~70 ~~=~.l.Z /..;J..
Amount Previously Paid
/TAX BALANCE
//"<-16 ,)/.lJa..bInterestfromX.~to h:':':.
........f.70 on ~.J..t:../..":!....
............................................................
.........Q/..':!....?:./.':!...
22 '?o..............................:.
BALANCE DUE COMMONWEALTH 1t.il..?I.2:3 .
DISCOUNT (5%)IF PAID WITHIN THREE MONTHS
FROM DATE OF DEATH.
PAYABLE TO:
REGISTER OF WILLS
WASHINGTON COUNTY
COURT HOUSE
WASHINGTON,PENNSYLVANIA
····_····~···~~A:g-,1'i:?-·············
Commonwealth of Pennsylvania.
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/2..tJ-c.r ../'f"P'
JOSEPH L.HOFFMANN
Attorney at Law
242 WEST MAIN STREET -MONONGAHELA,PA.15063
Phone 258-8444
TO Harvey stuart,.Agent._........
Court House
__..Washington,_P..a._15301 ~._
OATE._._-,~_.--_.-._-.._.....-
.Octo.•.9,1976
________RELEstateof Susie ihepitka
63-71-1236
_There.is enclosed in.the amount of.._
$316.93 being balance of inheritance
tax on above estate.
RCC and Debts and deductions'will be filed
the week of October 19 1976
SIGNED SIGNEO
FORM AVAILABLE FROM GRAYARC CO••INC.
882 THIRD AVE.,B'KLYN..N.Y.11232
THIS COPY FOR PERSON ADDRESSED
..-_._------------,------..,--....,...,.-..,....~----------,----,
JOSEPH L HOFFMANN
Attorney at Law
242 WEST MAIN STREET·MONONGAHELA.PA.15063
Phone 258-8444 /
I
TO Harvey Stuartt Agent j
Court Hoqse .
~l1aShingtoll\~pa.:r1
L
DATE ,.Octo.~"'9t "It}76 '
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I y
D~TE '1 ill',j ,
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I':~~/._........'-,.,1
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,\ijEl".~¢ate;..of..~usi6.',snepitk{l-,<~
63-71~1236 "l .
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~_' .•~_i "fJ,.•......-1:..'"
There is enclosed in the amount of
$316.93 :peing.'6alance of inheritance:I .ta~"on above estate.
RCC and Debts and deductions mll be filed
~"
the \'1eek of October 19 1976
...~.}/':.:-
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>.///'.'"
SIGNED
Q/.!_//~./C~'./SIGNED
FORM AVAILABLE FROM GRAYARC CO.,INC.
882 THIRD AVE.,S'KLYN"N.Y.11232
PERSON ADDRESSED RETURN THIS COpy TO SENDER
",
RCC-33 (4-73)
COMMONWEALTH OF .PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
J
RESIDENT-DECEDENT 63-71-1236 COUNTY OF WASHINGTON
IMPORTANT:This return must be completed in detail and filed in duplicate,with all attached,with the Register of Wills of the
County where decedent resided;Return is due within nine months after date of death,L\nless an extension is granted
by the Secretary of Reuenue.<Section 703 of the Inheritance and Estate Tax Act of 1961.)
Late of
IN THE MATTER OF THE ESTATE OF }AFFIDAVIT OF INFORMANT
s:....::U:....:s:..:.:A=N=----=s..::H:.::;:E~P.:..:K~O,~a?/-=k.:L/..,.:a=--:::-S==U::=.:S:_:::I_::::::E~SH::;:.E=P~I-T::..::KA-e:...:....·_U~
(STATE FULL NAME OF DECEDENT)•
Monongahela,Washington County DKaWlrofDmRX
and say Softheestateoftheabove-named decedent being duly sworn,depose S
State of __....:P~e~n~n~s~y~l~v!...a=n~i~a~-..:\
County of w:...:a...:..s=-h:..-i_n~g:.....t:..-o_n J 55:
__~M~a~r:."ly~S~h~e::!:p~k~o~,~___=I.=:.n:.=f~o:::r.=:.m=a:::n:.:t::____~~xx~Q{
~~x
Joseph L.Hoffmann,Attorney at Law
242 West Main St.,Monongahela,Pa.15063
Decedent died _~J:..:a:::n=..:·~u~a=..:r:..y,--~3~0:...!'L-'19--.IL{~aIKfKUvmlX~lO»JU'~M«rXIDfI*lltXMfK~ex}
(MONTH)(DAY)'(YEAR)Intestate
Nome and address of .attorney or }
other authorized repres.entative to whom
all correspondence should be mailed.
That as such Informant.deponent is.familiar with the affairs of said estate and the property constituting
(EX ECU TO R-ADMINIST RA TOR)
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 l!-nother~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 INNAME 0 R N AMES 0 F HOLDERS TO DECEDENT
None
That the contents of said safe deposit box or boxes are itemized under Schedules of _~I~!S return,
with the exception'of the following,for the reasons hereinafter set forth:
That Schedule A attached hereto and made part hereof sets forth fully and in detail all the real property
in the Commonwealth of Pennsylvania of which decedent died having an interesttherein.it also-:gets forth the f '..~~mortgage encumbrances upon each parcel of real property at the date of death,giving the amou~t still due ai,
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 markef\yalu~.thereof\\',-.~as of date of death of decedent.-,\_.t
...;..
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 prit1Jf to decedent's
death in the case of savings banks,and to the date of decedent's death in al~other cases;all bonds,postal
savings,treasury certificates or no~es and other evidence of indebtedness of the United States to'the de-
cedent;all obligations,whether by statute oragreement 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,jewelry,silverware,pictures,books,works of art,household furniture,horses,carriages,
automobiles,boats,and any and all other personal chattels of whatsoever.kind or nature,left by decedent,
together with -the fairly.;estimated market value thereof;all bonds and mortgages 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 ~uch 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 policies carried by decedent;all anilUity and endowment contracts
the proceeds of which were payable upon the death of the decedent;all and the corporate stocks and dividends
due thereon and unpaid as of the date of death,bonds and accrued interest thereon to the date of decedent's
death and other investment securities owned by the decedent at the time of death,with the market value there-
of at such time.
,I.
·····~~~;;~t
.+..?..~..~~i.f.t1in b.Y..~.P.:g ~.
(Street Number)
..~g.~~?~~?.~..~.~..L ~.~.~~.?..9..§}.
(City or Town and State)
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 husiness.
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.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 another,or any power of appoint-
ment vested in decedent,either individuaVy 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 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 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 uoUO .
................;j.3.~day of Oc.tQb.er.,19..1.6 .
......................~~~.d:~~.~ary ~EW~~~;~~~·OTARY PUBLIC
MONONGAHELA,WASHINGTON COUNH
MY COMMISSION EXPLRES MAY 9,1980
Membllf PenOJwlvaniaAssociationofNotarle!iNOTE:Before signing afYiaavlt make sure all Dlank spaces in the affidavit and schedules annexed are
filled in with details-"o,.-the word -"None",3.nd 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 a.bove-directed•..
,,
RC C-34 (4·73)
COMM,oNWEALTH OF PENNSYLVANIA
DEPARTMENTUF REVENUE
BUREAU OF COUNTY COLLECTIONS
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "A"
REAL PROPERTY
~~1 .~
Real property in Pennsylvania,with statement of mortgage encumbrances upon each parcel at death of dece-
dent.Property held by the decedent as tenant jn common with another or other,should be identified
as to quantum of interest and the estimated value should be that of the decedent's interest only.(Property
held as joint tenants with right of surviorship or tenancy by entireties should be reported on Schedule "E.")
The real property located In the Commonwealth of Pennsylvania should be
described by lot and block number,street and street number,together withageneraldescriptionoftheproperty,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 "Fit and must not b.deducted from this schedule.
None
(1)
ASSESSED VALUE
FOR YEAR OF
DECEDENT'S
DEATH
0.00
(2)
ESTIMATED
MARKET VALUE
0.00
(3)
DEPARTMENT
VALUATION
CAUTION
(Do not write
In this space)
I~sert this total opposite "real property",Schedule "A"in the X X X X X
I As Reported"column on the last page of this return.
0.00
RCC-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 with accrued interest or dividends,salaries or wages,insurance pay-
able to the estate or fiduciary in said capacity,partnership interests,interest in anyundistributed
estate of or income from any property held in trust under the will or agreement of another,even though
located outside of the State,at the time of death,should be listed in this schedule.
Item ITEM UNIT ESTIMATED DEPARTMENT VALUATION
No.List and describe fUlly VALUE MARKEr VALUE (Do not write in
this space)
none 0.00
\
I
Insert this total opposite "Personal Property",Schedule "B"in X X 0.00the"As Reported"column on the last page of this return.
'RCC-3&
CO'1lf\!ON1I'EALTH OF PENNSYLVANIA.
TRAf}/SFER INHERITANCE TAX
~~SIDENT DECEDENT
SCHEDULE "c"
TRANSFERS
(1)Did decedent,within two years or 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)~n~OL-_
(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 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)yes
(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)~n~07-__
(b)What was the transferee's age at time of decedent's death?all sui juris
(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)~y~e~s~_
(b)The right to designate the persons who shall possess or enjoy the property transferred or
income therefrom?(Answer yes or no)yes
(6)If the answer to (5)(b)above is in the affirmative,state whether the right was reserved in decedent
alone or others to transferor
(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 _
(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)n_O _
(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.
1 ALL those five lots or parcels of land
situate in the Second Ward of Monongahela
City,Washington County,Pennsylvania,
known and designated as Lots Nos.124,
125,126,127,and 128 in the Corrin Plan
of Lots,which said Plan is of record in
the Office of the Recorder of Deeds of
Washington County,Pennsylvania,in Plan
Book No.5,pages 190 and 191,and which
said Lots Nos.124,125,126,127,and
128 in said Plan are together bounded and
described as follows:BEGINNING at a poi t
on the Eastern side of Fifth Avenue in
said Plan,at the Southwest corner of Lot
No.123 in said Plan;thence extending
Southwardly,along the Eastern side of
said Fifth Avenue,a distance of 300 feet
to line of Lot No.129 in said Plan,thenl:e
extending Eastwardly,along the Northern
side of said Lot No.129 in said Plan,a
distance of 190 feet,more or less,to li~e
of lands formerly of Elijah Teeple,decea~ed,
now known as Park View Plan of Lots;then~e
South 68°East,along line of said Park
View Plan of Lots,a distance of 200 feet
more or less,to a point,common to lands
hereby conveyed,lands of Park View Plan
of Lots and lands of Isaac S.Crall
Estate;thence North 11°02'East,along
line of lands of Isaac S.Crall Estate
continued
ITEM DESCRIPTION MARKET VALUE
(Estimated)DEPT.VALUATION
(Dept.Only)
I.
Insert this total opposite "Transfers",Schedule "C"in the
"As Reported"column on the last page of this return.
SCHEDULE "c"TRANSFERS
Continuation
and H.C.Frick Coal and Coke Company,
262.36 feet to line of Lot No.123 'in
said Plan;thence extending Westwardly,
along the Southern line of said Lot No.
123 a distance of 244.8 feet to the point
in the Eastern side of Fifth Avenue in
said Plan,at the place of beginning.
Assessed value $5275.00
Title Reference -See Declaration of
Trust recorded in Deed Book Vol.1283,
page 549;and deed dated May 5,1972
2 Property located at No.632 Hancock
Street,Monongahela,Pennsylvania,
described as follows:ALL that certain
piece or parcel of land situated in the
Third Ward of Monongahela City,Washington
County,Pennsylvania,being part of the
Northern portion of Lot No.9 in the Plan
of Lots laid out by Mark Hilton and Joseph
Brooks,which said Plan of Lots is of
record in the Recorder's Office of Wash-
ington County,Pennsylvania,in Plan Book
Vol.516,page 406;said piece or parcel
of land hereby conveyed being bounded
and described as follows:BEGINNING at a
point on the Southern side of Hancock
Street,which point is South 61°35'East,
and 33;50 feet distance from the Southeast
corner of Grant Street and Hancock Street;
thence,South 61°35'East,along the
Southern side of said Hancock Street,20.50
feet to corner of Lot No.10 in the above
mentioned Plan of Lots;thence,South 22°
53'West,along the Western line of said
Lot No.10,75.60 feet to line of land of
the Heirs of Wallace J.Hilton,deceased;
thence,North 61°20'West,along the Northern
line of said land of the Heirs of Wallace J.
Hilton,deceased,26.10 feet to a point;and
thence,North 27°08'East,along line of land
of the Heirs of Antonio Spalla,deceased,
75.14 feet to the point on the Southern side
of Hancock Street at the place of beginning.
(Property in very poor condition and termite
infested)
Title reference -See Declaration of Trust
recorded in Deed Book Vol.1283,page 5491
and deed dated May 5,1972..
Assessed value $1195.00,-~
Total
RCC-38
COMMONWEA[;TH OF PENNSYLVANIA
TRANSt<'ER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE"E"
JOINTLY OWNED PROPERTY
INSTRUCTIONS: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 mlder 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-owners to
the decedent.
Description of Property,Date of Acquisition,Name
Address and Relationship of Co-Owners,and Place
of Record of Instrument,where Real Estate.
None
Unit
Value
percentage
Share
Estate
Valuation
0.00
DEPARTMENT VALUATION
CAUTION-Do not Write
In This Space.
Value of Value of
Entire Decedent's
Property Interest
Insert this total opposite "Jointly Owned Property",Schedule "E"0 •.00
in the "As Repo~ted"column on the last page of this return.
RCC.-3'?(12-63)...
COMl'IlONWEALTH OF PENNSYYLANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "D"
BENEFICIARIES
(
h
BENEFICIARIES AND ADDRESSES RELATIONSHIP SURVIVED(If step·children or DATE INTEREST OFStatefullnamesandaddressesofal}who'illegitimate children DECEDENT OF BENEFICIARYaveaninterest,vested,contingent or other-are involved,set STATE YES .IN ESTATE
wise,in estate)forth this fact.)OR NO BIRTH
Andrew Shenko.Jr.1570 Sot)
Street,Seaside,Cal.93955 son [yes sui juris 1/5 of trust
Mary Shepko,1233 Fifth Ave.
Monongahela,Pa.15063 daughter yes sui juris 1/5 of trust
Susan Shepko,1233 Fifth
Ave.Monongahela,Pa.15063 daughter Iyes sui juris 1/5 of trust
Peter Shepko,632 Hancock St
Monongahela,Pa.15063 son yes sui iuris 1/5 of trust
Ann S.Gamble,1233 Fifth
Ave.Monongahela,Pa.15063 daughter yes sui juris 1/5 of trust
Mary Shepko,1233 Fifth Ave.
Monongahela,Pa.15063 daughter yes sui juris Specific beneficiary
or trust
,
Deponent further says that all the above-named beneficiaries are living at this time except below:None
NAME DATE OF DEATH RESIDENCE
~IATTER OF THE APPRAISEMENT
SUSAN SHEPKO,a/k/a SUSIE
OF THE
ESTATE OF
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(Executor·Administrator
must complete "As
Reported"column #1.)
~~~en
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Year .
P.I<THE
(No,Will
Administration
63-71-1236
SHEP1'l:'KA,
Deceased
Late of .'.Monongahela
REPORT AND APPRAISAL
Commonwealth of Pennsylvania
WashingtonCountyof
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Form RC C·lO DEDUCTIONS ALLOWED IN J
OFF~CE OF THE STATEMENT'OF DEBTS THE SUM OF ............$..fjSI~..£s-
•REGISTER OF WILLS
DATE ';;i~~j;-?=::/washington AND DEDUCTIONS
OF COUNTY
AND AGENT OF THE COMMONWIilALTH 63-71-1236 Regllter ~IIIS.Agent W,
ESTATE OF Susan Shepko,a/k/a LATE OF Monongahela,washington Co.,Pa.
Susie Shepitka
DATE OF FILING APPRAISEMENT OATS 01"DEATH January 30,1970
DATI!:NO.OF NAME OF PAYEE REMARKS AMOUNTVOUCH"'1t
Bebout &Yohe Co.Funeral expenses 1270 66
Father Ivan Dornic Honorarium 50 00
Cralls Flower Shop Funeral flowers 35 00
Tri Community Ambulance AmbulanQe service 60 00
Memorial Hospital Hosoitalization 252 00
J.P.Huqhes,M.D.Professional services 170 00
~n::l'"Ii.'fl."',,.......nr1ttJ C'!n Account v decedent 30 00-
Dawn sl1nnlv Co 'lI.V ,.'"1?1;nn
West Penn Power Co.Final bill 14 50
Bell "'A1A"),one Co.Final bill 17 I;n
Monongahela City Water Co.Final bill 6 00
Equitable Gas Co.Final bill 34 50
Monongahela City Authority Final bill 5 00
Joseph Horne Co.Account v decedent 40 00
Kurtz Monument Co.Marker 115 00
Reaister of Wills Filina debts &d •""",,,,a 3 00
Betty E.Wenzel Notary fees 3 00
Recorder of deeds Recording certification of
'.",.=1£1 19 00
Monongahela City 1970 tax 223 21
Washington County 1970 tax 116 46 -
Ringgold School District 1970 tax 329 72
Joseph L.Hoffmann Attorney fees 75 00
Mary Shepko (daughter)Familv allowance 1500 00
4514 55
COMMONWEALTH OF PENNSYLVANIA }so:COUNTY OF Washington
I,Mary Shepko,informant daughter,HEREBY CERTIFY.THAT.TO THE BE8T OF
MY KNOWLEDGE AND BELIEF.THE FOREGOING IS A JUST AND TRU I!:srATEMENT OF DEBTt FUNERAL EXPENSES AND EXPENSES OF
AQMINISTRATION SUBMITTED TO THE ESTATE OF Susan Shepko,a/k/a Sus e OECllAlIlED.AS DEDUCTION$FOR
'HH"'''HC'TAX PUR"""n.shepil:ka,<::.~~~r
(L.S.)
SWORN AND SUBSCRIBED BEFORE ME THIS 13th DAY OP'Inf~t daU9frt8
C>ctmber ,&q ~·-:C~~~iP
BETTY E.WENZEL,NOTARY PUBLIC
MONONGAHELA,WASHINGTON COUNTY
MY COMMISSION EXPIRES MAY 9,1980
Member,PennsylvaniaASsociationofNotaries
1"•
-,
RCC-Bl (6-73)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
HARRISBURG
17127
NOTICE OF FILING or APPRAISEMENT
Mary Shepko
(Executor or Administrator)
IN YOUR REPLY PLEASE
REFER TO
Inheritance Tax Division
37,500.00.~_
In Re:Estate of __S_u_s_an_S_h_e_p_k_°_
__W_a_sh_J._·n-=g:......t_on County _File No.__6_3-_7_1_-1_2_3_6 _
Dear Ms.Shepko:
You are hereby notHied that the~--.-__o:..;.r=...:J.::.I·g.-.:i:..:n:..:a~1=----_
appraisement in the estate of__S_u;..::s=-an=----_S_h_e.=-p_k_o._
has been filed in the office of the Register of Wills of_.!!.W!i:!c.a2sh~J.=:!·n:!:l:g:..;t~o~n=:..-_
County on Oct.22,,19 76,Said appraisement reflects the following
valuations:
Real Estate _
Personal Property _
Transfers ~3.L7L:,'_"5~OO:..::..:.:.:.0:.:.0 _
Jointly Owned _
Total
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 this notice may object thereto within
sixty days after receipt of said notice as provided by Section 1001 of the Inheritance and
Estate Tax Act of 1961,72 P.S.2485-1001,P.L.373.
Date Oct.22,1976 Signed'~)Q ~J!L1~
D.O.D.Jan.30,1970
Note:This is not a bi II.
Titl e A-"'p-"'p_r_a_i_se_r_I_I _
RCC-39 (S-58)
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SUMMARY
Estate of Shepko
(Last Name)
Susan
(First Name)
DATE OF DEATH 1-30-19~FILE NO.63-71-1236
(Initial)
REPORT OF INHERITANCE TAX APPRAISER
WashingtonI,the undersigned duly appointed Inheritance Tax Appraiser in and for lhe County of _
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","8","C",and "E".
Oct.22,1976Dated:-------------~R£t){,l~~ANCETAX APPRAISER
REPORT OF THE REGISTER OF WILLS
WashingtonI,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 gre er or lesser amount represents the sum
allowed as a deduction.
Dated:,If)--;;?I;;---?b
VALUE AS REAPPRAISED
$~
37,500 00
37.500 00
4.'514 r.:;r.:;
32,985 45
$
-
VALUE AS REPORTED VALUE AS APPRAISED
$
INVENTORY
Real property (Schedule A)
Personal Property (Schedule B)
Transfers (Schedule C)
Joint-Held Property (Schedule E)
TOTAL GROSS ASSETS
Less Debts and Deductions
(SCHEDULE F)
CLEAR VALUE OF ESTATE
Valuation of life estates or _t
FOR USE OF REGISTER ONLY
Tax on $I 2%
Tax on $,,-1'~CjR4-ij~-®
Tax on $---------+--5%
Tax on $10%
Tax on $15%
Exemptions *
Total Estate -+.__
TOTAL TAX
COMPUTATION OF TAX
$------,---=:----==4--...,.....,=_
$-++..L..L.++.£!I..!oo::!q~
$-----"----+--
$--------+--
$-------4---
(*)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
$Ir'tJt7 "t:r /$--_.,L?~?'~1IS-.
$======:::==
BALANCE OF INHERITANCE TAX DUE $t=
Add interest at rate of 6%from
_____to $--------'
AMOUNT OF ESTATE TAX ASSESSED $__~_---jL-
Estate tax paid $---JL-
BALANCE DUE $------__~
Add interest at rate of 6%from
------Ito-----$-----"""""t=TOTAL TAX BALANCE $------1.
PAID $-J
FOR USE OF REGISTER ONLY ADJUSTMENTS
NOTE:Where subsequent adjustments ar"made to the above cumputation of tax by the Register of Wills,for proper reason,
same should be noted below,with short explanation.
Will
Administration !No.
IN THE
Year .
•
MATTER OF THE APPRAISEMENT
OF THE
ESTATE OF
Sll:;;~J3!t~p1{().
Deceased
Late of .....Monongahela.........................
County of Washington
Commonwealth of Pennsylvania
REPORT AND APPRAISAL
---------~.~
J~.
,i
--
R C C-2 (2-64)Oct.22,1976-'-.COMMONWEALTH OF PENNSYLVANIA DATE...:.
DEPARTMENT OF REVENUE-<J RESIDENT INHERIT~CE TAX WashingtonBUREAUOFCOUNTYCOLLECTIONSCOUl'i"TY,
HARRISBURG,PENNA,17127 APP.RAISEMENT FILE NO.63-71-1236
Susan Shepko,-,
Whereas,late of Monongahela
in the County of Washington Commonwealth of Pennsylvania,having died on
the 30th day of Jan.19 70 ,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 foHowing 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 AppraisementDescriptionofAssetValuesMadeforInheritance
Tax PurpoleS-
Transfer $37,500 00
Spp cnn'\T nt'.<=lnn,..
I
!
'I
1
i
~
1 ,~
j
~
Having been duly sworn a~~,I do hereby certify that ~o~ppraisementis made incon-,
formity with law on this day of :1 \A ~1926
....'\.nVu.AllA:.....LV f~/f/VC~1 ./1
~Y~//h,J/_~.7.jfP~·A.
d~/..,(T6~.nd Str'~t)~.
'.uP ~--~A --.,Penna.V (Pa-t OftIee)
Washington CoUllty
19..1£
RESIDENT INHERITANCE TAX APPRAISEMENT
Estate of
Susan Shepko
Deceased.
Late of
Monongahela
Date of Death,Jan.30,1970
Appraisement Docket Vol._.•(js;.;2~~"6-rrJ,,~,;-'!'+--'''-''-'~-''''~''''
Page,No.63-71-1236
Filed in Register's Office,Oct.22,
Amount of tar dfle,$_
DEPARTMENT OF REVENUE
Received,
Examined and Approved,_
Wrote abaut Appraisement,
Appeal j,.om Appraisement,_
Entered and charged,_
.,
I.
,
TENTATIVE STATEMENT
PENNSYLVANIA TRANSFER INHERITANCE TAX
Date /.~?LIJ3l::..,I..r..2..~.
TO ??f.~~=__.......................................................
.............../..r2....J..Y..~&.r ~~~g.;!..~.!!.f~,..
:::~~..-.J~?7h7~~~~::;3.,J ..?.z.e.·········
GAppraisedFile~..~..:F'"3..::::-2.1.:::./t:2..,J ..
Real Estate
j
Personal Property
'/fiA.,.JSh-ts
J€liBt Acccnmts
Less Exemptions
...~.Z....£.r!...r!..:..<:.J!.....:........
J'Z ...s-OO·oa.....................................................................................................................................................................................!.
Less Debts and ~_
Administration Expenses (,~!i.£-.f .
TAXABLE AMOUNT ....?d,7tf~-,y'J-............................................................
..
COURT HOUSE
WASHINGTON,PENNSYLVANIA
TAX on @ ro ..
TAX on .f..~'1..I!.~..i.L.@ ~%L.f...?.t..:..I...':!....
Amount Previously Paid t q.9...?..:...7./...
TAX BALANCE ?..?..4..:.:?..d....
Interest from £:~..~~2.~:to £~..
.......?'1'0 on f...Z.rl...;??..'3::..
BALANCE DUE COMMONWEALTH ./yaZ 9.'..f.~9 ..
DISCOUNT (5'M IF PAID WITHIN THREE MONTHS '\
FROM DATE OF DEATH.\__
PAYABLE TO:I/jiJ··~#.-r--~
REGISTER OF WILLS /fe.e.;//9"'73 t ~J ·..Re ·~..~·;··~f~fII~~:;:f~X ..g~·~t·..f~;.d(·L?·
WASHINGTON COUNTY CO nwealth of Pennsylvania.
FA ~/r2.1~.3o
~a/~'?'crz..r;I P 7 c"
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT.280601
HARRISBURG,PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
REV-1607 EX AFP (03-96>
j
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
08-05-96
SHEPITKA
01-30-70
63 71-1236
WASHINGTON
101
Amount Remitted
SUSIE
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
WASHINGTON CO COURT HOUSE
WASHINGTON,PA 15301
NOTE:To insure proper credit to your account,submit the upper portion of this form with your tax payment.
ESTATE OF SHEPITKA SUSIE FILE NO.63 71-1236 ACN 101 DATE 08-05-96
THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE.SHOWN BELOW
IS A SUMMARY OF THE PRINCIPAL TAX DUE,APPLICATION OF ALL PAYMENTS,THE CURRENT BALANCE,AND,IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT:
PRINCIPAL TAX DUE:
PAYMENTS (TAX CREDITS):
10-22-76
1,979.13
PAYMENT RECEIPT DISCOUNT (+)AMOUNT PAIDDATENUMBERINTEREST(-)
12-16-71 XF011928 74.65-796.83
10-12-76 XG047209 363.22-316.93
11-16-76 XG047365 53.50-1,296.30 /08-03-96 WRITEOFF 16.71-30.86
TOTAL TAX CREDIT 1,979.13THEDEPARTMENTHASWRITTENOFFTHE
BALANCE DUE AS UNCOLLECTABLE BALANCE OF TAX DUE .00
INTEREST AND PEN..00
TOTAL DUE .00
RCC-4 (8-68)
No·B
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE11928OFFICIALRECEIPT0PENNSYLVANIAINHERITANCE AND ESTATE TAX
.~~--~----.--~~_._~.-~--~-~--dollars
2%Tax on
6%Tax on
I RECEIVED SEVEN HUNDRED NINETY..SIX and 83/100
From:ATTY"JOSEPH L.HOFFMANN
Address 242 WEST )fAINS STREET
MONONGAHELA,PENNSYLWANIA 15063
representing Pennsylvania Inheritance or
Estate Tax due from the following estate:
$----,.,O=n,......."A..."c..."c-::'o=un=t--
$UI!lIIXX
I
Ir
63-71..1230D f D h 1.30..70FileNo.ate 0 eat --------i
December 16.1971
Date of Payment _--,===-......,==-=-==::':""<_-...--:.-_--1SUSIESHEPITKAa
Name of Decedent -----------------1
WashingtonCounty --1
Remarks:
MJR
i
15%Tax on $,_
%Tax on $_
Estate Tax,Act of
May 7,1927
TOTAL TAX CREDIT
Less five percentum of tax if
paid within three months after
date of death
Plus interest at the rate of
-'-%from -s/~36 -?I
to c..::.JJ:::.,.a.Lv=-::..::--_
lroo ~[p [L~@illlrrnSEALTOTALAMOUNTPAID$=7=9=6=.S=3===I!:J1
NOTE:This Triplicate Receipt to be retained lor audit purposes.("-;'I i I '711f ..-
Received b~M,v:::..-.JJJ-I J\!..)j,J"II.J)
NOTE:In accepting the transler inheritan:e tax on luture estates,prior to the death 01 the'l;fe --..J.--(Signature~.'
tenant or tenant lor years,as evidenced by t~is receipt,it is understood that the Commonwealth 'shall /..),_.A'IJ i j I
not be precluded or prevented Irom herealter assessing additional inheritance tax at the death of the~I "*"':\'-,Y...<-...../.-it.,-'._':l.¢.J
life tenant or tenant for years whenever it appears that such additional tax may be legally due and ---\(T'f1 )
collectible for any reason whatsoever.t;e
$__7.L...!7'-I..~80!!.-··--iI1,
,-i
$===;=::::=:31==:6=,::::::::9:::=3===Irill
$On Account 239.13-.::..:...--..:....;:......:.-~......:.---$-----------IU!
$---------$---------!"i
I'
$---------$---------:~
III%Tax on $$\'1
Estate Tax,Act of I :
May 7,1927 $i~.1$_2......:._39_._13~_~
i
i
$-------1111
II
6%Tax on
2%Taxon
100..--..----.....•...•......---·....--...---d IIoars
representing Pennsylvania Inheritance or
Estate Tax due from the following estate:
TOTAL AMOUNT PAID
TOTAL TAX CREDIT
15%Tax on
Less five percentum of tax if
paid within three months after
date of death
Plus interest at the rate of
--6.-%from 4-30-71
to Date
""
,~."...
Urn ~[p [L~@illV~;:'z:SEA L
mjr/,b
Remarks:
\~;;;:;::'~:~:=,-'::~~~~!"",.,;«~...<!o <~!".~m"=-'_,¥,!B":COk>"*:~==-="'J
I i~l!COMMONWEALTH OF PENNSYLVANIA I
i~!DEPARTMENT',OF REVENUE
1=:NO.F 47209 OFFICIAL RECEIPT 0 PENNSYLVANIA INHERITANCE AND ESTATE TAX
U==========================~~=
!='RECEIVED lIITHREE HUNDRED SliUEEN and 93
I~Mary Shepko
I=!From:t J
!:l!~:Add,."---a::I.a..~~t!!........!Ua~in~-!S~t~r~G~e~t~----l
~~:I~ilSi~1!File No.63-71-1236 Date of Death 1-30.70
e!1 Date of Payment ~O~C!...l!t~o~b!...l!e~r'----"!1~2~....:!!1~9~7~6~_-lI~i
I Name of Decedent _~S..!!!u!!!!B~i~e~S~h~e~l~t=k~a:.....-~,
I County ~t1l1ak.OJl1Jtl4t.olL ~
NOTE:This Triplicate Receipt ta be r.\ltained for a.'jilr;'2'3'2_6 .••
j \.'........'....,l!_.."Received by
•NOTE:In accepting the transfer inhO!itance tax .ar>future estates,prior to the deoth of the life
tenant or tenont for yeors,as evidenced by this te~eipt"itl'is under'stood that the Commonwealth shall'-"'J
not be precluded or prevented from herepfter assessing additional,mheritonce tax at the deoth of the
life tenant or tenant for years whenever it oppe~rs that s~cb.od'ditionol tax may be legolly due ond-e:::=:~!L-~~q::L.~p.~~~-,.A.&¢::~~-IUI
collectible for any reason whatsoever,•',~,,
Ibo......~,__•~,...,5).__
6%Tax on15063
r·...'i'.
PeMS 1vania
THOUSAIJD mo HUNDRED NINETY.Sa abd 30/100 __-..Jollars
.representing Pennsylvania Inheritance or
Estate Tax due from the following estate:
------------------Ittl
2%Tax on $$---------Inl
$32.985.45 $1.919.13 I!
________11:115%Tax on $$
:~II%Tax on $$11
Estate Tax,Act of I !
May 7,1927 $H:
,~~~_I~'~:I"TOTAL TAX CREDIT $_1.979.13
Less five percentum of tax ifPreV.Pd.;J..:/l006·"!1 I,
paid within three months afterBalQllCe 912.22 I
dote of death $III
Plus interest at the rate of !~%from 4-30-711I
to Date $,__3~24ZJ1!'~.O~8~-!l1i
I,I I
hela
Remarks:
I County ------.!~~~!.OJ~~--------___j
I~-IJIf==:'=-Q~=Q.:m:u:;;:"H.d etdUl'~nil!"*#.'llU...Ei::..Q!~*•~Jirnl2:;:;'=<1Rli :;:;;.'..R•mi.g Ii')e::;.g>t~~~;:=C~'l:iJI~i RCC-4(6-74)COMMONWEALTH OF PENNSYLVANIAi~l!DEPARTMENT OF REVENUE
i=i NO.F 47365 OFFICIAL RECEIPT 0 PENNSYlVANIA INHERITANCE AND ESTATE TAX
1111===============================IDI
!=,RECEIVED ONE
iJf
i=i
I
l:;ll From:Mary Shopko
IIll
lffl'.Address 1233Flfth Avenue
I~I~fi~!1-30-70~!File No,63.71.1236 Dote of Death--""'--'-""-7't----"-":'----1
I~i Dote of Payment Nov mber 16 1916I~!
Nome of Decedent -=:!!!!.!£!~~~~~---------1
TOTAL AMOUNT PAID.SEA L
...t.../
NOTE:This Triplicate Receipt to be retained lor~,,:,dit S'8~232-6 ci:
I ),_I •','.,Received by --I-W:3.L.l.4.-Ck~'I=~~:.!..£~~~~::::.---I NOTE,In accepting the transfer inheritance tax an luture estates,'prior to the death 01 the life
I tenant ,or tenant for years,as evidenced by this receipt,.it is ungersrood that the Commonwealth sha~~jl nat be precluded or prevented Iram hereafter assessing "';dditi~nal inheritance tax at the death of the_.,.......:.=~~w::J,.~.:::;::._:_==:;...p:::=:..-==~~~=:::;..:..~l life tenant or tenant lor years whenever it appears that such additional tax may be legally due and
collectible for any reason whatsoever.
'0
_------~---"".......__-..J'-.......,.........."""""-_
I
i
1 .
Il..
o
**3 4.0 0 .J.J J
J.5 J v.J :)
3 7.5 0 v.O 0 *
1.2 7 0.6'6
5 V.O 0
3 ,.J 0
6 G.0 0
252.00
1 7 li.0 0
3 v.J 0
125.00 i
.I,1 4.5 0 I
3 7.5 0
6.0 0
3 4.5 0 i
5.0 0 iI
4 G.O a 1
1 1 j.0 0 -\
j.OO
.:i.0 0
1 9.0 0
223.21
11b.46
3 2 9.7 2
7 ;).a 0
1.5 0 V.O 0
4.5 1 4.5 5 *
o
*3 7.5 0 v.J 0
3 7.5 C v.;)J (;)
4.514.55-