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Inventory of the real and personal estate of
I':/.\RT. I': r::RDRR
__ deceased
1. Dauphin Deposit Bank & Trust Company
Checking Account No. 38-95-913-5
Savings Account No. 16-6-1523-9
2. Blue Cross Reimbursement
3. Blue Ridge Haven West - Refund -
4. Pennsylvania Railroad Voluntary Relief payment -
5. Railroad Retirement Board -
6. Medicare Reimbursement
--~----_._----
..---.---- -
TOTAL
100 00
8,580 53
1,800 00
658 98
503 68
792 00
39 68
22,474 87
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
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_______I>~_RL2_'__.9~lJ.lH~_r .iJR...__ _ __ ____.________ -------
being duly _5W_0=--___ according to law, depo,e, aud ,ay' that he __.i5-ExecutOL--____
______ of the E,tate of EARL E. GRUBB
late of ____!':_<'l~1::I'E!nns_boro_'I'Q;m_shil2_ ______, Cumberland County, Pa" deceased and that the
'th" 't d b him th 'd Executor
WI In IS an Inven ory mil e V .+___________~ -- .--------., e sal
of the entire estate of ,aid decedent, consisting 01 all the personal prop.rty and real estate, except real estate outside
the Commonwee/th 01 Pennsylvania, and that the ligures opposite each item 01 the Inventory repre,ent it's fair value
as of the date of decedent's death,
Sworn to
and subscribed before me,
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NOTARY PUlJl.LC~ ("::, -
Id Coo>InlasioD. !:<pire. Dee, 21, 1%'
J c wberbod Cou:c,. i
Lemo.,uB, PQ. U
19
?l
Earl
1038
Lancaster, PA 17601
Addreu
Day
January
Month
1981
Date of Death
13
Velar
INSTRUCTIONS
I. An inventory must be filed within three month, after appointment of personal representative,
2. A supplement inventory must be filed within thirty day' of discovery of additional assets,
3. Additional sheets may be attached as to personalty or realty
4. :':See Ar~le IV,'.F,iduciaries Act of 1949,
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF EXAMINATION
OFFICIAL NOTICE OF
INHERITANCE TAX
ASSESSMENT
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COUNTY FILE ['lO:
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ESTATE
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DATE OF DEATH J" "\ I ~ I 4 ,vI
FILE NO,
COUNTY
Appraised Value of Estate:
Real Estate
s
+ wI, C-,~A X '7
Personal Property
+
Jointly Held propertylTransfers
s ;~I ("X1J. X '7
,
Total Gross Estate
'7 '7 30 Q]
s / ~~ (, LJ?, iLl
Total Approved Oeductions
Clear Velue 01 Estate
Less: Approved Charitable Exemptions
s Jj 1 !/3, .!i1
Clear Value of Estate subject to Tax
s 2" :n. c,3
Amount Taxable @ 6% Rate
s / ,3 Cf'-./:l" 'jf~
tax due
tax due
Amount Taxable @ '5% Rate
s
Y36>,W
TOTAL PENNSYLVANIA INHERITANCE TAX DUE
... * ... * . '" A five percent discount totaling $
will be granted if the Inheritance Tax is paid by
Less Credits:
DATE OF PAYMENT AMOUNT PAID DISCOUNT INTEREST TAX CREDIT
L/-P-'6'/ S ~ O(),OO + L~ S = s (,3/,51
~-Ik'.XI d-,d5, oJ' + = ,;Z (~r.; 05
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+ =
Interest accrues at the rate of six (6) percent per annum
on the unpaid balance of Inheritance Tax from
to date of payment. Interest due if paid by
is
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BALANCE OF PENNSYLVANIA INHERITANCE TAX DUE
Assessed by: i /,:>1..(./ 0"", 'l I' ".1 "'~"./
. . Agent for tHe Com.n)Onwaal\h . I .J'"
Se.lnlo,matoon on R."rs. S,d. .. . ,! .!()f~'" .,f[,_j/
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COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
AFFIDAVIT OF
FIDUCIARY
(Instructions on Roverso Side)
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Estate 01
EARL E. (;RUBB
Dole 01 Death
January 13, 1981
Lost Address BJ ""-Ridge H"""n W""t
770 Poplar Church Rd.
-.CamP Hi 1.1 , PII 17011
(CITY) (STAlE} (ZIPl
Social Security NO'_7_~0_9292
Bureau File No.
County File No.
2J-1l1-IiO
1. Decedent died:
( ) Intestate (without 0 will)
()\) Testate (Ieoving 0 lost will--copy attached)
2. Is the Iiling 01 0 Federal Estate Tax Return required for this estate? Yes__ No X
3. (x) Executor/Executrix ) Administrator/Administratrix
Nome EARL E. (;RURB. om.
Address
l01R Hnn!=:ir.kp.1'" Rn,:)n
Lancaster, PA
(CITV) {STATEl
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4, All correspondence should be moiled to ( x) Attorney
) Fiduciary.
5. II on attorney is representing the estate, indicate:
Nome
Thomas I. Myers
Myers, Myers, Flower
P. O. Box 125
& Johnson
Address
Lemoyne
(CITYI
PA
(:'TATEI
17043
(ZIPl
List all safe deposit boxes registered in the decedent's individual namel or jointly with, or os on agent or deouty
01 another, or in decedent's individual name with right of access by another os agent or deputy. Include the namo
and address 01 the bonk or other institution where the sole deposit box is located, the nome (s) in which the box
is registered and the relationship 01 the joint holders te the decedent.
NAME AND AODRESS OF BANK OR OTHER INSTITUTION
IN WHICH DECEDENT MAINTAINED A SAFE DEPOSIT BOX
NAME OR NAMES IN WHiCH
SAFE DEPOSIT BOX IS REGISTERED
RELATIONSHIP OF JOINT
HOLOERS TO DECEDENT
Dauphin De osit Bank & Trust Co.
Decedent
Viola M. Vogelsong,
De t
301 Market St., Lemo ne PA
17043
Under penalties of perjury, I declare that I hove examined this return, including accompanying schedules and
statements, and to the best of my knowledge and beliel it is true, correct and complete.
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SIGNATURE OF.FIDUCIA Y
8/f4/f"!
DATE
~~'{"4:'1 t.....t.11l-601
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
TRANSFER INHERITAN~E TAX
RESIOENT OECEOENT
SCHEDULE "B"
PERSONAL PROPERTY
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(Instructions on Rovo(sr. SidfJ)
Estate of
EARL E. GRUBB
ITEM
HO.
D ESCRI PTIOH
UNIT
VALUE
ESTIMA TED
MARKET
VALUE
DEPARTMENT
VALUATION
{OFFICIAL USE ONL YI
1 Dauphin Deposit Bank & Trust Company
Checking Account No. 38-95-913-5 100.00
Savings Account No. 16-6-1523--9 18,580.53
2. Blue Ridge Haven West - re fund 658.98
3. Blue Cross & Medicare
Reimbursements 1,839.68
4. Pennsylvania Railroad Voluntary
Relief payment - 503,68
TOTAL
21,682.87
If additional space is necessory/ use 8!2" x 11" sheets.
QUESTIONS CONCERNING PROPERTY TRANSFERS
1. Did decedent, within two years of death, make any transfer of any material part of his estate without receiving
yaluable and adequate consideratien? (Answer "Yes" or "No",)
2. Did decedent, within two years of death, transfer property from himsel fI hersel f to himsel f/hersel f and another party
or parties (including a spouse) in joint ownership? (Answer "Yes" or "No",) _
3. If the answer to one or two above is "Yes" and the transfers are claimed to be nontaxable, provide the following
information:
a, Age of decedent at time of transfer,
b, Copy of death certificate.
c, Aftidayil by the attending physician indicatin,l! the state of decedent's health at time of transfer,
d, All other information supporting nontaxabi I i ty of transfer,
4,Did decedent, in hiS/her lifetime, make any transfer of property without receiYing a valuable or adequate consideration
therefor which was to take effect in possession or enjoyment at or after his/her death? (Answer "Yes" or "No",)
a. Was there any possibility that the property transferred might return to transferor or hiS/her estate orbe subject
to his/her 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/her lifetime make any transfer without receiYing a valuable and adequate consideration therefor
under which transferor expressly or impliedly reseryes for his/her life or any period which does in fact end before his/her
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 shall possess or enjoy the property transferred or income therefrom?
(Answer "Yes" or "No".)
6. If the answer to fiye b. aboye is "Yes," state whether the right was reserved in decedent alone or others.
7. Did decedent in hiS/her lifetime make a transfer, the consideration for whjch was transferee's promise to pay income
to or for the benefit or care of transferor? (Answer "Yes" or "No",)
8, Did decedent, at any time, transfer property, the b61eficial enjoyment of which was subject to change, because of
a reserved power to alter, amend, or reyoke, or which could revert to decedent under terms of transfer or by operation of
law? (Answer "Yes" or "No".)
9, If the answer to eight aboye is "Yes," was the power to alter, amend or reyoke the interest of the beneficiary reserved
in the decedent alone or the decedent and others? (Answer "Yes" or "No".)
HEV.453 (1,80)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT OECEDENT
SCHEDULE "0"
BENEFICIARIES
*
(lnstruct/ons Oil Reverse Side)
Estate of
EARL E. GRUBB
BENEFICIARIES AND ADDRESSES RELATIONSHIP SURVIVED DATE OF INTEREST OF BENEFICIARY
DECEDENT BIRTH
Earl E. Grubl:!..-J:l:. C::"n -Y"" ''',,1.. lD Residue
1038 Hunsicker Road
Lancaster, PA 17601
Viola M. Voqel sorr.q, Daughter Yes Adult 11.3 Residue
34 Buttonwood Lane
Carlisle, PA 17013
'"" M _Grubb C::"n Ve" ll.il111t_ 1 10 0, 'iil""
1905 Good Hope Road
Enola, PA 17025
--
.--
- .. ------ --
-
The abov~ beneficiaries are living at this time except for the following:
NAME
DATE OF DEATH
R'ev-4'4 EX+ (3-S0)
COMMONWEAL TH OF PENNSYLVANIA
OEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT DECEOENT
SCHEDULE "E"
JOINTL Y OWNED PROPERTY
{Instructions on Reverse Side}
Estete of
EARL E, GRUBB
ITEM
NO,
DESCRIPTION
TOTAL
MARKET
VALUE
NONE
P
E VALUE OF
~ DECEDENT'S
N INTEREST
T
TOTAL THIS PAGE NONE
'*
DEPARTMENT
VALUATION
IOfflcial Use Onlv}
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REV-.4a.4 EXt (5-801
INHERITANCE TAX SUMMARY SHEET
(BUREAU USE ONLY)
Estate Name
Earl E. Grubb
o Original
o Supplemental
o Remainder
Fi I e Number
21-R1-00hO
Date af Death
,j,muary 1:1, ,QR1
Sacial Security Number
716-10-0?Q?
REPORT OF INHERITANCE TAX APPRAISER
I, the undersigned duly appointed Inheritance Tax Appraiser in and for the County of Cumbe1'1 an.d
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 t e ri,?ht in S~ules "A", "B", "C", and "E"
Dated: ~p.p'pmhp" ?5. '9R1 ' .' &;.. J
INH TANeE TAX APP ISER
ADJUSTMENTS REMAINDER APPRAISEMENT CODE
INVENTORY VALUE AS APPRAISED CODE (HARRISBURG USE ONLY)
Roal Property (Schedule A) $ None aa+ 92+
Personal Property (Schltdul. B) ,a+
Jolnt.Held Property (Schodulo E)
Transfers (Schedule C)
TOTAL GROSS ASSETS
Less D.bts and Deductions 40- 93-
(SCH EDULE F)
CLEAR VALUE OF ESTATE
o Life Estote RATE FACTOR PRINCIPLE VALUE CODE
o Annuity
FOR USE OF REGISTER ONLY
Tax an $
~
COMPUTATION OF TAX
S
$
$
$
$
6%
Tax on $
15%
Tax on $
Tax on' $
Tax on $
Exemptions
Tuta! Estato
TOTAL TAX
INTEREST FROM
BALANCE
TO
$
$
$
Less Credits
DATE OF PAYMENT
!'MOUHT PAID
S
TAX CREDIT
$
INTEREST FROM
BALANCE au E
COMMONWEAL TH OF P[NNSYLVNII^
DEPARTMENT OF r,EVLNUI
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
INHERITANCE TAX
APPRAISEMENT
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REY"457 EX+ (7"110)
GfORIG-INAi.-...----..-O SUPPLEMENT AL
Estate of _--.llacLE_...JJ~ubb _._____
File No. _.___2.1...B.bQOOO
Coun ty
!;_\imb_~_.rlaI)L___.___ _
Date of Death
January 13., 1981
In the event that anr. fuluro Inlot..t~-,i~. ulula I. transferred In pOII"lIlon Of enloymont to collatoral heirs of tho decodent ofte, the
expiration of any oltate or IIfo or lot Yllor., tho COll1rlJOnwoolth hcrehy OlCpreuly rOlarvall the right to appraise and oSS055 transfor
Inheritance 10xOl 01 tho lawful collotorol ralll on nny luch futuro Intorost.
PRDPERTY NOT INCLUDED IN RETURN BUT APPRAISED BY THE COMMONWEALTH
ASSET SUMMARY
DEPARTMENT'S
APPRAISED VALUE
Totol Reol Property _ SC:H. "A". . . , " $ -1~one
Totol Personol Property _ SCH. "B", . , . $ -2.1.,.68:> .87
Total Jointly Owned Property - SCH. "E" $ None
Total Transfe.. _ SCH. "C". . ,., , . " $ JOnA
Unreported $
Unreported $
Unreported $
Unreported $
$ None
$ ~,.68:>. 87
$ None
o LIFE ESTATE
DANNUITY
TOTAL GROSS ASSETS
DREMAINDER
$ _lkme
$
21,682.87
TOTAL VALUE
$
I do hereby cartify thotthe above appraisement is mode in conformity with Pennsylvania law and has been filed this
day with tho Ragistar of Will$. ~ '. dt
~4V ~~~ ~ppt"'mhiP 25 1981
APP'lPSER DATE '
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Unsatisfied liabililies incurreel by the e1cceelent prior to his/her death ore deductible against his/her taxable
estote. In addition to debts incurred by Ihe e1ecedent or estate, other items Clre claimable including the cast of
administration, attorney fees, liduciary fees, funerul and burial expenses including the cost of 0 burial lot, tombstone
or grove marker and other related burial expenses.
GENERAL INHERIT ANCE T AX INFORMATION
All debts being claimed against on estote are subject to the approval of the Register of Wills with whom the
Inheritance Tax Return is liled. Evidence to support the decedent's or the estate's liability for the debts being
claimed should be attached to this schedule.
A family exemption may be claimed by a spouse 01 a decedent who died domiciled in Pennsylvania. If there is
no spouse, or il the spouse has forfeited his/her rights, then any child of the decedent who is 0 member of the same
household can claim the exemption. In the event there is no such spouse or child, the eXlllOption con be claimed by
o parent or parents who are members of the same household as the decedent. The family exemption is allowable only
against assets which pass by a will or by the Pennsylvania Intestate Lows.
NOTE: Compensation paid to on estate representative; namely, on executor or administrator, for services
performed in administerir,g on estate is reportable for Pennsylvania Income Tax purposes. This taxable income
item should be reported on form PA.40.lndividuallncome Tax Return.
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INSTRUCTIONS FOR COMPLETING SCHEDULE "F"
1. If the family exemption is being claimed, indicate the claimant's nome, address and his/her relationship to
the decedent. Enter "family exemption" in the remarks column and the amount claimed in the amount column.
2. Assign consecutive numbers to each item listed.
3. Enter the date on which each debt was incurred and/or paid.
4. Enter the names of each payee.
5. Provide a brie( explanation in the remarks column for each debt claimed.
6. Enter the amount of each debt being claimed.
7. The form must be signed by the person who has assumed the responsibility for paying the debts.
IF ADDITIONAL SPACE IS NECESSARY USE 8W' x 11" SHEETS.
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IN THE
COURT OF COMMON PLEAS OF CUMBERLAND COUNTY
PENNSYLVANIA ORPHANS' COURT DIVISION
NO. 21-81-60
IN THE ESTATE OF EARL E. GRUBB
LATE OF EAST PENNSBORO TOWNSHIP
ACCOUNT OF EARL E. GRUBB, JR., EXECUTOR
STATEMENT OF PROPOSED DISTRIBUTION
Balance for Distribution as
.per First and Final Account -
Proceeds of Life Insurance paid to
Viola M. .voge1song -
$ 14,974.32
1,900.91
Total
$ 16,875.23
DISTRIBUTION
TO: CHARLES M, GRUBB One-Third
Cash - $5,625.08
TO: EARL E. GRUBB, JR. One-third
Cash 5,625.08
TO: VIOLA M. VOGELSONG One-third
Cash - $3,724.16
Life Insurance - 1,900.2.!, 5,625.07 $16,875.23
STATEMENT OF REASONS
Decedent in his will left his entire estate to his three
children, named above, but directed that the share of any child
who received proceeds of life insurance be reduced by the amount
of such proceeds, The distribution shown takes account of
insurance proceeds received by viola vogelsong.
'-
L\glR 99 PAGE 669
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PRINCIPAL RECEIPTS
Inventory Fi led
8/81
Per Copy of Inventory Attached
TOTAL PRINCIPAL RECEIPTS
PRINCIPAL CONVERSIONS INTO CASH
NONE
TOTAL
PRINCIPAL DISBURSEMENTS
1/27/81
2/11/81
2/27/81
2/25/81
4/9/81
Register of Wills - Letters & Short
Certificates
Musselman Funeral Home - Funeral expenses
Cwnberland Law Journal - Advertise Letters
Patriot-Evening News - Advertise Letters
Register of Wills - Inheritance Tax
Payment $631.58
Less Discount - 31.58
PA Dept. of Revenue - decedent's 1980
Income Tax
Orthopedic Surgeons, Ltd. - balance
decedent's account
Register of Wills - Short Certificate
East pennsboro Ambulance Service -
decedent's account
Rice Memorial Works - Marker
4/9/81
4/27/81
4/10/81
4/27/81
4/27/81
6/10 &
7/23
Holy Spirit Hospital - decedent's account
Outstanding checks at death:
Dr. Dietrich - $108.00
Blue Ridge - $1,514.80
Professional Pharmacy - $124.16 -
Register of Wills - File Inventory,
Debts & Deductions & RCC forms
Notary Fees - all documents
8/14/81
L1B[R. 99 PAGE 665
-2-
$ 22,474,87
$ 22,474,87
NONE
23.00
3,086.25
18,00
24.24
600.00
48.83
60.00
1.00
10.00
90.00
42,80
1,746.96
9.00
3.00
100 00
8,580 53
1,800 00
658 98
503 68
792 00
39 68
Inventory of the real and personal estale of
P.A ilL F..._GllrIRR
deceased
1. Dauphin Deposit Bank & Trust Company
Checking Account No. 38-95-913-5
Savings Account No. 16-6-1523-9
2, Blue Cross Reimbursement
3, Blue Ridge Haven West - Refund _
4, Pennsylvania Railroad Voluntary Relief payment _
5, Railroad Retirement Board _
6. Medicare Reimbursement
TOTAL
22,474 87
L1~Lr. 99 PAGE 666
INCOME DISBURSEMENTS
PA Dept. of Revenue - Estate Income Tax
$ 25.00
TOTAL INCOME DISBURSEMENTS
$ 25.00
COMMONWEALTH OF PENNSYLVANIA:
COUNTY OF CUMBERLAND
ss.
EARL E. GRUBB, JR., being duly Sworn according to
law, deposes and says that the Account as stated is true and
correct and that the Grant of Letters and the first complete
advertisement thereof occurred more than four (4) months before
the filing of the Account.
Sworn to and Subscribed
/'"
EARL E.
......"" l'd
..,::'l?$:t;.orfm~ thi s 7' day
....'>.:.~~,.~..,~.:"':..: -,> ....
/,,/,:~:fAu'9ili;;~, '-A. D. 1981.
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.. ":. 'M,~IIiiClll Erplroo Doc. 21, 111!11
. '.,iII.,.., Pa. CumberlQad Cow>tj
lIBlR 99 PAGE 668
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