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HomeMy WebLinkAbout09-25-78 Form 'RC C -10 OFFICE OF THE REGISTER OF WILLS OF (~i'--l-lb';,l'l~""d COUNTY AND AGENT Oil' THE CO"'MONWEALTH ':2/. l,f -. I STATEMENT OF DEBTS AND DEDUCTIONS DEDUCTIONS ALLOWED IN THE SUM OF , , , .. ,9l/lt3L , . .:?G,ICQ? 12. H.Ll1'l1'lY li:nGAJ CT. El1l1 rL n JL." " fj .-.- ESTATE OF LATE OF .. . T ,/17 11l.d~ ;?!;' JC)YJ% DATS: OF DEATH JANUARY 26. 1978 DATE OF FILING APPRAISEMENT ..( U DATI!: NO. 0... NAME 0'1=' PAYEE REMARKS AMOUNT VOUCHIiIt 2/24/ 78 1 VICKY BARRICK WITNESS FEE 10 00 /I 2 GURNEY B. RUBY, JR. ~ETTERS 6: SHORT UERT. 6: 79 75 ADVERTISING /I 3 BONNIE L. STARR WITNESS FEE 10 00 /I 4 JOHN STARR ApPRAISAL 20 00 /I 5 CAROLYN E. BAI SH J10NEY COUNTING 25 00 /I 6 CUl1BERLAND LAW JOURNAL ADVERTISING 18 00 /I 7 BELL TELEPHONE FINAL BILL 1 20 /I 8 OSTEOPATHIC HOSPITAL HOSPITAL BILL 33 00 If 9 CHARLES STEWART REPAIRS 27 00 /I 10 KEYSTONE OIL CO. OIL - 102 SALT RD. 66 26 /I 11 l1EDICINE EQUIPl1ENT CENT ~OXYGEN 32 58 /I 12 P. P. & L. ELECTRIC BILL 20 27 /I 13 ANESTHESIA ASSN. ANESTHESIA 29 96 /I 14 BLAIR Hus TEAD HOl1EOWNER'S POLICY 66 00 /I 15 KEYSTONE OIL PROD. OIL - 102 SALT RD. 87 06 /I 16 STEINl1ETZ ApPRAISAL OF COINS 10 00 /I 17 BLAIR HUSTEAD LIABILITY POLICY 40 00 H 18 CLAUDE WOLFE AUCTIONEER & COSTS 34'1 28 /I 19 JACK RICHARDSON FUNERAL FUNERAL 2,599 36 /I 20 KENNETH GINTER Twp. & CTY. TAXES 76 35 /I 21 E. PENNSBORO Twp. SEWER BILL 39 00 /I ~~ P. p, & L ELECTRIC BILL 16 15 /I 23 RICE J1E110RIAL CUTTING DATE ON STONE 20 00 717/ 7A 24 P. P. & L. ELECTRIC BILL 3 ,99 " 25 E. PENNSBORO TOWNSHIP SEWER BILL 39 00 /I 26 KEYSTONE OIL PROD. OIL BILL LJ:.b IIU COMMONWEAL.TH OF PENNSYLVANIA }..: JR. COUNTY OF CUl1BERLAND I, r:TTJ'/ WRY R. RUBY. HEREBY CERTIfY. THAT. TO THE BEaT OF MY kNOWLEDGE AND eEL.IEF. THI!: FOREGOING 18 A JUST AND TRU It arA;tEMENT OP' DEBTS, FUNERAL EXPENSES AND EXPENS" OP' ADMINISTRATION SUBMITTED TO THE E8T"'TE OF HARRY E. ULEl1l1 ~ ....I:CU..D. "'S DEDUCTIONS P'OR 'NHI:RITANCE TAX PURP08ES. . ~.. /z:-.J__ ~ f/r__ Lc='..~.&.l CRrBaD 81:"0 E Mil THIS ~ nAY OF ~~\. '8 78 J1y CONff. EXPIRES: JUNE 2, 1981 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 priIDl' 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 indebtedness of the United States to the de- cedent; all obligations, whether by statute or agreement they are designate.d 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: Form RC;: -10 .- /- DEDUCTIONS ALLOWED IN ,. :' ~.r ~/ OFFICE OF TNE REGISTER OF WILLS STATEMENT OF DEBTS AND DEDUCTIONS OF COUNTY AND AGENT OF THE COMMONW&ALTH ESTATE OF HARRY EDGAR GLEl1l1 LATE OF ..ENOLA. PA .../'// JANUARY 26. 1978 DATE OF FILING APPRAISEMENT OATS OF DEATH DATE NO. OF NA"''' OF PAYEE REMARKS VOUCHEJIt AMOUNT 7/7/ 78 27 OS~{,EOPA'PHIC HOSPITAL HOSPITAL BILL I 375 ~ 8/11 /78 28 KEYSTONE OIL PROD. OIL BILL I ,4(S li /I so ~ HARRISBURG GET'fETERY PERPETUAL GAFtE ? ,05 H C._I~- .w. " .30 DE TvlEI LER REAL ESTATE GOl1TfISSION OF HOUSE 1 4. 7(; ()() ._. J' ,. /I 7,1 RECORDER OF DEEDS TRANSFER TAX 210 00 1/ f7 r, KENNETH GINTKR 1978 SCHOOL TAXES ')'')8 1 9,1 L),0 L~ '-_." t.. " r;"f"? GURNEY B. RUBY, JR. EXECUTOR FEE 1 , 5.s 7' T~5 2 DO " .34 GURNEY B. RUBY, JR. ATTORNEY FEE 11,557 L_~~ /I ,35 BOUNIE L. STARR NOTARY FEE =1 15 00 I- /I r? /'> REGISTER OF ~I ILL S FILE DEETS ,..e DEDUCTIONS ....., n_...., ~:) 0 '...:C o iJ( -- ---- ----- F CI~ RESERVE FOR FILING [ I - 200 I on -..= ---- - C 1 1- ,-- =r' L ~T- =, r + 1 I_ i ~-_...~]--- J C - __T_____I - ---~I--" J" T ---- T-~ q /11[" <;1 L-' , ..i_ I) L.J ~ - COMMONWEALTH OF PENNSYLVANIA } COUNTY OF GUl'1BERLAND a8: I, (iTT~?JP.Y F3. RUBY. JR. DECEASED, AS DEDUCTION$ "OR ~ E ME THIS / J:~OAY 01'" -~-~~'--7;- le~ ~:j r~-~ ~ ~ ,;/ J/ '\ ""'..-:_ "- ~ ' (L. S.l ry COffff. EXPIRES: JUNE 2, 198.1 COMMONWEAL TH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS Rr:C--~:' J-7"31 f( .~, f t CD':N"r '('. ,. '(. '1 '.'J. I; 9'18 ti U I' , \, " r. v (,..J 'J ,- f COUNTY OF GU1fBERLAND IMP 0 Vi Thl~ return mw; I be completed in detail and filed in duplicate, with all attached, with the Register of Wills of the { ,;LIlr, '",here decedent resided; Return is due within nine months after dale of death, unless an extension is granted In the ""cret'r)' of Re\tenue. (Section 703 of the Inheritance and Estate Tax Act of 1961.) _._._---,~ ----..-.- - -. '-'-"."--~""~ Co,"" } EXECUTOR ;', dll~ VL'\TTER OF THE ESTATE OF AFFIDAVIT OF HARRY E .,__ QJ:;,J;l1lf . "t: F !_L_ ".~ ,~~ft:: <;:. F CECEDEN'! Late ai CIUNB ERLAJ.iTn - ,....-- ~- ADMINISTRA TOR 1',4 ~:~~~:~:;:~A~~} ." GUJUfEy-Jl.--I1.:a-JJ Y J JR. of 'he e,-ote of the above-named decedent being duly sworn, depose S Executor County :\.....".,,,..~.-... and say S I')eer-de JA. NUAR'L________J__, 19-2rL." {testate leaving a last will, copy of which is hereto attached.} , ": (DAY: (YEAFI: fIInrs'fbTfl o+her ~u1r 1 ,-- !'O' r ) GURNEY B. RUBY. JR. Box 292, LEffOYNE, PA. 1704,-0 NCl'T conI:; , i1 ,1 EXECT.lTQB...,_deponent is familiar with the affairs of said estate and the property constituting 1'''1 i ~~ 1ST R A TO R) a... ~ " lill" (~lir market value. >", : J 'I, "i!!'., ;J!I'; ut dl',lth there was no safe deposit box registered in decedent'si~c1h'-ld~1 name, or jointly with, or i" agen, ,j.:]lJ!):li alUllhel. lie in decedent's individual name, with right of access by another_'-as agent or deputy, with the j,'\"CplllI'i ~'nIJ{. )l1~.~. ,:: ~3 ;:'J' ~ "-:.~. . "- OR OTHER INSTITUTION THIS SAFE DEPOSIT BOX RENTED '~A,i~SHIP OF JOINT E;::' A SAFE DEPOSI T BOX IN NAME OR NAMES OF HOL-a RS TO DECEDENT -, ~-~,-- --.-.---- -_....~. ,.- - - ....=~~7TQ!ii=-=:~c=_= The! :he '.:ol1!cnts of said safe deposit box or boxes are itemized under Schedules --- of this return, ,n Ii. I", ,,,,,,:p! un IH (he following, for the reasons hereinafter set forth: II,at Schedui, A uached hereto and made part hereof sets forth fully and in detail all the real property In ilL C'mr;wnwealth 01 Pennsylvania of which decedent died having an interest therein. It also sets forth the rnortgJ':!C Icncumbral1n1S r:pon each parcel of real property at the date of death, giving the amount still due at dea h. name uf mortgag2, date, rate of interest, and book and page of record thereof. It also sets forth in the CUiUi'll1'S pn.vidnl therc,flHc the assessed valuation of each of said parcels, the estimated market value thereof as dat~ Jl~a~ h ~J:';\~\ ':<lent. lh! i 5chedlJle B [ached hereto and made part hereof sets forth fully and in detail all personal property "11," " )!idled o\\ned hy the decedent at the time of death; all moneys left by the decedent at the time of ;; " ;n ;1ecedcnt's immediate possession, standing to decedent's credit in banks of deposit, savings h:!!1 ':..r:-,panies, PI' other institutions, whether individually, or in trust for any other person or persons .eLI Vj i! a!so ,',~ rl1ra tely the accrued interes t thereon, if any, down to the last in teres t day prior to decedent's Jca ~!1 '11' ca.;e or savings banks, and to the date of decedent's death in all other cases; all bonds, postal s ~l\ n '~t:;ury ccrtifi cates or note s and other evidence of inde btednes s of the United Sta te s to the de- J,;ii~~llion', hethel' by statute or agreement they are designated as tax free, of the United States, Ld , or political.;ubdivision thereof, or of any foreign country, which are owned at the time of death; va"", '-":', ~liVLlWul'e, piClUfes, books, works of art, household furniture, horses, carriages, :'1'.) ;,> boat~, and' any and all other personal chattels of whatsoever, kind or nature, left by decedent, t~)i'l'Jh ( \,;i1, l!h~ fairly estimated market value thereof; all bonds and mortgages held by decedent and of all clan:; du, :;d '1"ing dr'l'dent at the time of death, and all promissory notes or other instruments in writing fC! h, '1d Viler'_ Df 1111''l(;) of which decedent died possessed, of whatsoever nature, with interest thereon, if an\. ,he ac',' \i\!:)l'md estimated fair market value thereof, and if such estimated fair market value be 1c.- i: \'~ fa ,due d s,,1,; forth briefly the reasons for such depreciation as to each item; all moneys 1'1.1'" , Ire insurance policies carried by decedent; all annuity and endowment contracts [hi; " " ;; " 1-,k UP(Jr1 the death of the decedent; all and the corporate stocks and dividends , .r ~h:;' bonds and accrued interes t thereon to the date of decedent's ",nell by the decedent at the time of death, with the market value there- nr a 1 ,..; \..' 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 !lUsiness. A copy of the co-partnership agreement, (if oral, a statement setting forth the nature of Ule agreement) together with a statement setting forth the character of the business, its location, and such other facts ~ertaining 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 of property, 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 ~eceived 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 pa~ses at decedent's death by virtue of the exercise by decedent, either individually, or jointly wi th 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 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 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", "en, "E", and "F" as directed therein, have been carried forward and properly registered in the Summary. Subscribed and sworn to ~e me this ....LJ~ ,...........................~.... / day of ~.it.t. '- .L.'/.~ 19...7..8. \ ~~ - ~ - .......... ..... ... I _ :YYflJ!. ...... 4:-'-1 {;'l ... .. . . ....... . VJ7~r Umm C~?~"'. Jk>U'-:>1 / <tg I -.-~/ .j ~ . ,"'7/,,('"/7 .r. /-;"2 .\/ c.~___ -~ --- /- ~ .'./ ...... ~ ......~..'lif~i;;:Aji?~t;;Tmm ---- .....J.LOX......W.9..c:;,................................................................................................. (Street Number) LENOYNE FA. 17045 ........................................J............................................................. (City or Town and State) NOTE: Before signing affidavit make sure all blank spaces in the affidavit and schedules annexed are filled in with details or the word "None", and in case the assets include rare and unlisted securities, securities of close or family corporations or an interest in any co-partnership or business, that the data and statements required under the paragraph above relating to Schedule "B" are attached. Also make certain that column #1 in the "Summary" has been properly completed as above-directed. ,....... . S"E'ENf'Y...KIGn1 (1918) GURNEY 8. RfJJ1T~JR,., EXECU'/OR OFTHR !S'l'A" OF HA.RRT E. CLElfl'f, IlJt1t11INA.rrft CALr.,1I1t GRAN1'Ofl AN!) PARTY 0,,1;' THE FIRST PART -ANIl- .!l41Wt.,JJ R,. BOfJKS, ,'!JI'g:(JL:m r1.1.1(, or li..1t1l1S1:JIItAO. !JAil PIll N OOUN').'.,., P1l1flll!lr L,. A1It A, ItnJIr'J(An.-. CAL&1ID fJRAlf'fEI AND PAR'll J"S -- . 1J.WE/iTY-ONE i'WOlJSJJIlJ AlflJ NO/l,()()..--..._-........................ -,-........-....---..----~-..-...... -.....-- ((';~2111.00(1. 00 )-...............-.........---- f11l1 y rIAI': bOll. y HIS ALL T1LU' CERTAIN PIECE 01&)>.ABC.ltL OFL,l.f11l tJIftUA'1!E Ill""." 1'.11.... BO.RO TOWNSIlIP, Crnf131!:lu..AN1) ()QllN'1'Y, PENllSY"'''AN:tA, M{}tiJI PAIU'ICV&ARL!" 130(JND1t:D .AlID lJIlBCBIS1t:D IN ,,4CC01tDANCE laTH $UIlVEr OF1;bESff J'. 1.'ALKEl1, P. l.~." 1)A'J!ED AM:rL 1.4-, 19'NJ, AS FOL&OWS, '1'Q Jlrfl' BEGl1/NIlIO .AT A POINr ON TIlE EASTERN SIDE OF SALt ROAa, WJ(ICN porN'.: IS ALBO !'Ult LINE DIVIDING L.l.ND NOW on FOI1:lflCll~r Olf EDfifA1f.D J. R1lD~llS AND HArmr E. CLJCnNJ 'l'1JIlNCENOR'1'H ea DJEOUICS ao "Z"","1I8 UST 222.40 FEJCT 'J'Q A POINr A'.t LANDS OF BRI..lf R.1ltlA.a.Si'lI-SNCII SeW'!'H S2 DEGR,1CES 54 lUNU'J'rs .E.A.IU' 75F''6E'J' 'J'O A 33 11'118'1' WZD. AIGliT-OF-I{A,Y; THENCE SOUTH 82 DEGIUCE8 50 1'!IllUTE$ 'lIlBIi' 222.40 FEE'!' ro A POINT ON PHIl EAS'1'IlNi LINE OF S..r..T ROAtJ; '1i~t;J: llQaf'1l 32 DEGREES 54 MINUTES !\'ES!t '10 FilE'" 'l'0 f'liB POIN", AND Plt.A.CB" 0' BEGINNING.. H.A. rIlIG '1'HEREON ERECTED A ONE :n.'05r BUl'lGALOW Ntl7f1J.1MII.>> J.02 $.A./,'1' .'loA!}.. ENOL.A.. PENNSYLVANIA, 17025. SEE Pl.AN BatiK aI., PAQIt 4!J. BEING PAFl.'!' OF THE SAl1E PFlJf/'!ISES W'FlrOIl S'tANL1lf' H. KUII" AlII) .7AclIEL V. J(tr!rN, FlU$ l~lInr~ a71 J)1IJIED DA'ItrD FE131tUAIU' as, 194-8, UD 1tllCOllDD IN IJ'RE CUlIS_ltMtIJ COU"Jfr RlIcflu..'s Ontoll ZN DBED BOOK T.. VOLUJfE.' 15, PMde 82, On.A.N'l'ED AND CONtttrYED urno HAIUU' E. Cr.Et1'tf MfDE'1'ElEL S. tiLiC7m, "IS ~{tF1!J. THE BA:tD .E'tl1rL 5'. ()LElfll DIED lh/(W5T ':J~.. 1.9'10 MID 'l'If'LE SEC.A.l1:$ YES:fED tN HAMY J:. CLEl1l'f. H.A.RItY E'. ''h,{;'/'f11 DIlS!; ~lANV.A.tty 5, 1978~ ANDay ,{lILt. ltlleIS..,...>> [11 THE CJU"DERLANJJ COUNTY RJlJGIlJ"fJ!rP. OP'/ILLS OFFICE, DJ:'1'.D NOY811DJ:1l . 9, 1977, APPOINTED OURin,'l' B. FluJ<3r, In.~.A.s ExECf/'1'OA ()J;' rllE LAtH' [JILL MID TESTA'!1F:mr OF' HAMY E'. (Jr-E"f'm:, THe: GrtAN'PCFR. HlIAIIIlI. RCC -35 *' COMMONWEALTH OF PENNSYLVANIA TRANSFER INHERITANCE TAX RESIDENT DECEDENT SCHEDULE "B" PERSONAL PROPERTY Item No. 10. 11. 12. 13. 14. INSTRUCTIONS: This Schedule must disclose all tangible and intangible personal property owned individually by the decedent, at the time or 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 or 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 ract that they are not or the administered estate. Tangible personal property should be listed rirst (e.g. jewelry, wearing apparel, household goods, and rlirnishings, books, paintings, automobiles, boats, etc.) Intangible personal property, such as bonds, treasury certiricates, 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 riduciary in said capacity, partnership interests, interest in anyundistributed estate or or income rrom any property held in trust under the will or agreement or another, even though located outside or the State, at the time or death, should be listed in this schedule. ITEM List and describe rlilly UNIT VALUE ESTIMATED MARKET VALUE DEPARTMENT VALUATION (Do not write in this space) 1. CASH ON HAND - $638.54 + $4,853.00 8-002625-5 " 6. SAVINGS ACCOUNT - CCNB 3. 1964 DODGE SEDAN - SOLD 150.00 4. NEN'S DIANOND RING 150.00 SOLD 5. HOUSEHOLD FURNISHINGS AT 102 SALT RD. ENOLA, PA. - SALE 6. COINS - PER ApPRAISAL 7. CASH 22.90 8. NEDICAL PAYNENTS 36.80 9. SHOTGUN - CASH 90.00 l1EDICAL PAYNENT 9.60 REFUND FRON CAR INSURANCE ~o.oo HOSPITAL REFUND 26.~0 R. R. DEATH BENEFIT REBATE ON TAXES AND SEWER PRORATION ON SALE OF AROPERTY 500.80 2~ 1 . ~8 Insert this total opposite "Personal Property", Schedule "B" in X X the "As Reported" colunm on the last page or this return. TOTAL .10,391. 85 1 ., 110,391.85 '. . RCC - 36 rOmIO\'\'F\LTll OF PENNSYLVANIA T!L\\SFFi{ I:\'IlEIUL\:-irE TAX SCHEDULE "c" TRANSFEnS RESIDE\T DECEDE:\'T (1) Did decedent, within two years or death, make any transrer or any material part or his estate, without receiving a valuable and adequate consideration thereror? (Answer yes or no) .,..,0 (2) Did decedent, within two years or death, transrer property rrom himselr to himselr and another or others (including a spouse) in joint ownership? (Answer yes or no) NO (3) lr the answer to (1) or (2) above is in the arrirmative state: (a) Age or decedent at time or transrer (b) State or decedent's heal th at time or making the transrer. (Note 1). (c) Cause or decedent's death. (Note 1). (4) Did decedent, in his liretime, make any transrer or property without receiving a valuable or adequate consideration thereror which was to take errect in possession or enjoyment at or arter his death? (Answer yes or no) .,..,0 (a) Was there any possibility that the property transrerred might return to transrerer or his estate or be subject to his power or disposition? (Answer yes or no) NO (b) What was the transreree's age at time or decedent's death? (5) Did decedent in his liretime make any transrer without receiving a valuable and adequate consideration thereror under which transreror expressly or impliedly reserves ror his lire or any period which does not in rlict end berore his death: (Ii) The possession or enjoyment or or the right to income rrom the property transrerred? (Answer yes or no) NO (11) The right to designate the persons who shall possess or enjoy the property transrerred 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 subject to change, because of a reserverl power to al ter, amend, or revoke, or which conld revert to flecedent under terms or transfer or by operation of" law? (Answer yes or no) NO (9) If the answer to (8) above is in the ~ffirmative, 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) ]V 0 NOTE 1: The anSwers to these questions should be supported by arfidavi t by the litteJl<iing physician as well as a copy or 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 ann to whom transferred, with relationship or transrerees to decedent, ir 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 appl icable property below in manner in which provided in Schedules A, B, or E. ITEM DESCRIPTION MARKET VALUE (Es Uma ted) DEPT. VALUATION (Dept. Only) NONE NONE Insert this tot'll opposite "Transrers", Schedule "C" in the "As Reporterl" colunm on the last page of this return. RCC-37 (12-63) COMMONWEALTH OF PENNSYYLANIA TRANSFER INHERITANCE TAX RESIDENT DECEDENT SCHEDULE "D" BENEFICIARIES BENEFICIARIES AND ADDRESSES RELATIONSHIP SURVIVED (If step-children or DATE INTEREST OF State full names and addresses of all who illegitimate children DECEDENT OF BENEFICIARY ave an interest, vested, contingent or other are involved, set STATE YES IN ESTATE wise, in estate) forth this fact.) OR NO BIRTH HARRY B. GLEnn SON YES 11/14/14 1/3 OF ESTATE R D, /1=1 DAUPHIN PA. DOROTHEA G. STEWART DAUGHTER YES 2/9/17 1/3 OF ESTATE 405 N F'FI.ONT ST'FI.P.ET I liE S T FAIRVIEW, PA. I i ANNA NAE SHAUB DAUGHTER YES 2/19/22 1/3 OF ESTATE 1183 KINGSLEY ROAD GAl-!P HILL, PA. 17011 i ! ( h Deponent f'Urther says that all the above-named beneficiaries are living at this time except below: I NAME DATE OF DEATH RESIDENCE RCC-38 RESIDENT DECEDENT SCHEDULE "E" JOINTL Y OWNED PROPERTY CpMMONWEALTH OF PENNSYLVANIA TRANSFER INHERITANCE TAX INSTRUCTIONS: This scherlule must disclose all property, real and personal, owned by the decedent jointly with another or ot.hers, including int.angibles, standing in t.he name of the decedent. and ot.hers. List real estate first., as entireties, or joint tenants, giving brief description, as indicated ,mder 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 value in estate valuation column. Personal property should be listed as in Schedule "B", plus date of acquisi tion, 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. ~ ^ ~~ ~ X~V ~~ ?< ~~v;;><:): ">< >< ">0 ;;>< '\ 9;;>< x, '\ ~~ X, Unit Value percentage Share Estate Valuation 5 '^..? >< ~~:>< x, 'V 1\1' X> ;;><;;>< DEPARTMENT VALUATION CAUTION-Do not Write In This Space. Value of Value of Entire Decedent's property Interest NONE NONE Insert this total opposite "Jointly Owned Property", Schedule "E" in the "As Reported" column on the last page of this return. RC COSO (..77) - . Co .. b rwlf 21 Cumberland . unty, ...um er aZ ~~.o_ l' 7 file Number (0 u Date of Death JANUA'RY b" 7 !FIR file Date September 25y. 1978 Estate Name U LEl1l1 HA R R _ P. (LAST NAME) (FIRST NAME) lINITIAL) SUMMARY COMMONWEAL TH OF PENNSYLVANIA TRANSFER INHERITANCE TAX RESIDENT DECEDENT REPORT Of INHERITANCE TAX APPRAISER I, the undersigned duly appointed Inheritance Tax Appraiser in and for the 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", "B", "C", ond "E". Cumberland Dated: September 25. 1978 -, (, lJL c, , INHERITANCE TAX APPRAISER u;. REPORT Of THE REGISTER Of WILLS I, the undersigned duly elected Register of Wills in and far County, Pennsylvania, do respect- fully report that I have allowed deductions in the amounts claimed by deponent, except os to those items where a greater or lesser amount is set forth in the last column to the right in Schedule "f", which greater or lesser amount represents the sum allowed as a deduction. Dated: REGISTER OF WILLS INVENTORY VALUE AS REPORTED V ALUE AS APP RAISED CODE VALUE AS REAPPRAISED CODE Rea I Property (Schedu Ie A) $ :-?7 non nn $ 21.000 00 004+ 00+ Personal Property (Schedule B) .L U, .jy 1 . tJtJ 10.391 85 10+ 10+ Jolnt.Held Property (Schedule E) -u- -0- ~u+ TransIers (ScheduleC) ---:51~ g:9 111 -0- 30+ TOTAL GROSS ASSETS tJ5" $31.391 85 Less Debts and Deductions 9.418 21 40. (SCHEDULE F) 21.975 . 64 CLE AR VALUE OF EST ATE I Valuation of life estates or ~ PRINCIPL.E FACTOR VALUE CODE 1- annultles....................._ $ t= t= ESTATE TAX ASSESSMENTS _ $ FOR USE OF REGISTER ONL.Y Tax on $ Tax on $ Tax on $ Tax an $ Tax on $ Exemptions Total Estate ~ COMPUTATION OF TAX $ $ $ $ $ 2% 6% 5% 10% 15% (*) As evidenced by Charitable Exemption Certificates issued by the Secretary of Revenue. * TOTAL TAX $ t= Less tax previously po id BALANCE Less 5% 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 $ $ 1== $ $ BALANCE DUE $ $ TOTAL TAX BALANCE $ PAID $ Add interest at rate of 6% from to Supplemental Codes: (fOR USE IN HARRISBURG ONL Y) 48-Adjustment 49+Adjustment 56-Annuity 6O-Life Estate 92+Remainder Appraisal 93-Remainder Deduction 93C-Charity 94-Remainder Residue 96-Success i v'! Life Estote fOR USE Of REGISTER ONLY ADJUSTMENTS NOTE: Where subsequent adjustments are made to the above computation of tax by the Register of Wills, for proper reason same should be noted below, with short explanation. ' RCC.81 (6.73) COMMONWEAL TH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU Of COUNTY COLLECTIONS HARRISBURG 17127 IN YOUR REPLY PLEASE REFER TO Inheritance Tax Division NOTICE Of fiLING or APPRAISEMENT Gurney B. RUby, Jr. (Executor or Administrator) In Re: Estate of ---1::ial'.~v E. CleMM CUMberland County - Fi Ie No. 21-78-0037 Dear Mr. Ruby: You are hereby notified that the oriainal appraisement in the estate of H2Irrv E. CleM. has been filed in the office of the Register of Wills of CUMberland County on aepteMbel' 25 , 19.:za., Said appraisement reflects the following valuations: Real Estate Persona I Property T ronsfers Jointly Owned Total $?1,nnn nn 1n,,91_A"i -0- -0- $31,391.85 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 obiect 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 SepteMber 25. 1978 Signed K. l f. '-...'- S r.hiRf" Arr1"l'Ii.R1" (L- . Title { -------:------- '.~-, Note: This is not a bill. RC C-2 (2~64) . DEPARTMENT Of REVENUE BUREAU OF COUNTY COLLECTIONS HARRISBURG, PENNA, 17127 COMMONWEALTH OF PENNSYLVANIA RESIDENT INHERITANCE TAX APPRAISEMENT DATE ~c>r+'c>.hR-r?"i, 197fl COUNTY CUMberland FILE NO. 21-78-0037 Whereas, in the County of r.1I.hR-r1 Plnrl Commonwealth of Pennsylvania, having died on the 5th day of January 1978 , seized and possessed of an estate subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania; Therefore, I, T'I'l'I K_ [:;1 Rill , 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: H2Irrv E. CleMII late of E2Ist Pennsboro Township In the event that any future interest In this estate is transferred in possession or enjoyment to collateral heirs of the decedent after the expiration of any estate for life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance taxes at the lawful collateral rate on any such future Interest. Unit Appraisement Description of Auet Values Made for Inheritance Tax Purposes REAL ESTATE $21,000.00 $ 21,000 00 PF'RSnNAI PROPj;"OTV !ll:1n,391.B<; 10,391 85 TRANSFERS NONE -0- ,1nII\IT _HF'I n I-' y NnNF' -0. TOTAL ESTATE $31,391.85 $31,39' 85 .- - Having been duly sworn according to law, I do hereby certify that the above appraisement is made in c:..on- formity with law on this 25th day of Septellber' . , , . ' , 19~. :. /,. ,I 1:, / Appraiser <"",mbe< and St".t) H"ppi.bUl'l;! (PM 0ftI..1 , Penna.