HomeMy WebLinkAbout11-20-78
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Rcc-3-3 (4.73l
,
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
,r
i,,\.,1 5<)
t'l.-.l
,1061
'i.J ' ...
RESIDENT DECEDENT
COUNTY OF CUMBERLAND
IMPORT ANT,
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; Retwn is due within nine months after date of death, unless an extension is granted
by the Secretary of Re'ienue. (Section 703 of the Inheritance and Estate Tax Act of 1961.)
Late of
Cumberland
Pennsylvania
} AFFIDAVIT OF
EXECUrOR
~
IN THE MATTER OF THE ESTATE OF
Reverend Stephen J. Hribick
(STATE FULL NAME OF DECEDENTl
County
County of
Cumberland
J u,
State of
~
Reverend James R. O'Brien
Executor
Decedent died
of the ..tot. of the above-named decedent being duly sworn, depo.eS and say S
February 23. 19~J tutate leaving a lost will, copy of which is hereto attached. }
(MONTH) (DAY) (YEAR) ~
Name and address af attorney ar }
ather authorized repres-entative to whom
all correspondence should be moiled.
James D. Bogar, Attorney At Law
23 West Main Street, Shiremanstown, Pennsylvania 17011
That as such Exerutor deponent is familiar with the affairs of said estate and the property constituting
(EXECUTOR-~
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 THIS SAFE DEPOSIT BOX RENTED RELATIONSHIP OF JOINT
IN WHICH DECEDENT RENTED A S....FE DEPOSIT BOX IN NAME OR NAMES OF HOLDERS TO DECEDENT
First Bank 8 Trust Co. . Merh~nicsbun' Pa Reverend Stpnhen J. Hribick
Fi..."+ i~ R""k 'T ^ . ;01,1 Reverend Steohen J. Hribick None
Par and Marie Therese Burke M.I
That the contents of said safe deposit box or boxes are itemized under Schedules B & Eof 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 fully 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 indebtedness of the United States to the de-
cedent; 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, 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 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 policies carried by decedent; all annuity 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.
In the case of securities of' close or family corporations, the values reported are as far as
possible substantiated by fin(incial statements of the corporations, showing the assets and liabili ties
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 statemimts showing the assets and liabilities of said co-partnership or husiness.
A-copy of the co-partriership agreement, (if oral, a statement setting forth the -nature 01' 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 decedent1s interest
therein must be submitted. It should also set forth in itemized f'orm, together with the rair 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 f'orth a true answer to each inquiry
contained therein and in the case of' transfers of property, real or personal, within two years of decedene 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 transf'erred, the
relationship of the transferees to the decedent, the proportionate share received by each transferee and
all other f'acts of a perttnent nature regarding said transfers. In the case of' transfers intended to
take ef'f'ect in possession or enjoyment at or after death, there Is also attached to the scherlule a copy
of the deed, trust agreement or other instrument creating the trust. TheN~ 1s also set f'orth in said
schedule a list of all propert;r, real and personal, with its value, which pa:::ses 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 benef'icially 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 0-1'
decedent's death of all minors, annuitants and benef'iciaries f'or lire 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 benef'iciary.
That Schedule E attached hereto and made a part hereof sets f'orth all property, real and per-
sonal, owned by the decedent jointly with another or others, including intangible, standing jn the name
of the decedent and others, plus the date and place of record of instruments ef'fecting the ~estiture of'
real estate and the date of acquisition of personalty, plus the name, address and relationship, if any,
of co-owners to the decedent.
ThatSchedu/e 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 hlneral expenses paid;
family exemption, where applicable; costs of administration of this estate; counsel f'ees and f'udlclary's
~oDDl1issions paid or to be paid; cost expended for burial trusts, tombstones o'r gravemarkers, and reli-
gious services, in cons~quence of the death of the decedent; debts and claims owing anrt unpaid at time of
death; taxes accrued chargeable f'or 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 I)ledged f'or obliga-
tions, if any. It is agreed that the f'iduciary 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 colunms in Schedules "A", "B", "e", "E", and "F" as directed therein,
have been carried forward and properly registered in the Summary.
Subscribed and sworn to before me this
...g~..:::~...&~.~........_...
~~~~~~~ Reverend James F
C Clinton Drive O'Brien
.......................................... ...........~..............
(Street NumbllT)
Shi!!!l9.kj,p.~l'e!ID.syJYiID,i".m1787.Z.. .
(City CYr Town and State)
........ly"yfc:c ... day of/t{~??"i<~.. . 191/.
f.,yt.'Id/)ld'ict. ARNOLD, Noto,.,. Public
(; , Shjremanstown~Cumberland Co., Ita.
My Commission Exp.res Sept. 6, 1982
NOTE: Before signing af'fidavit make sure all blank spaces in the af'f'idavit and schedules annexed are
f'illed in with details or the word "None", and in case the assets include rare and unlisted securities,
securi ties of close or f'amily corporations or an interest in any, co-partnership or business, that the
data and statements requirerl unner the paragraph u?ove relating to Schedule "B" are attached. Also make
certain that column #1 1~ the "Summary" h~s been. properiy completed as I:l.bove-directed.
RC C-34 (4_73)
COMMt}NWEALTH'OF PENNSYLVANIA
DEPARTMENT 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. Property held by the decedent as tenant in common with onother 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 (1) (2) (3)
described by lot and block number, street and .treet number, together with DEPARTMENT
a general description of the property, with a reference to the record of the ASSESSED VALUE VALUA TION
conveyance by which the decedent took title; If a farm state number of a~ FOR YEAR OF ESTlMA TED CAUTION
cres; also statement of mortgage encumbrances upan each parcel at death DECEDENT'S MARKET VALUE (Do not writ.
of decedent. Taxe., as.e.sment., accrued Int.r..t on mortgage., etc.,ar. DEATH In thl. space)
to be listed on Schedule IIF" and must not b. deducted from this schedule.
Nme No nL
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.
~Ol').(,.
RCC -35
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
'*
SCHEDULE "B"
PERSONAL PROPERTY
RESIDENT DECEDENT
INSTRUCTIONS: This Sched.ule 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 REn. 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 estat~
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, mortg~ges, 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 any undistributed
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
No.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
IS.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
1971 Cadillac Sedan, Serial No. 681691Q136624
1970 Olrys1er New Yorker Sedan, Serial
No. CH41TOF1l5945
Jewelry items, including ruff links and wrist
watches
Fumiture items (Desks, chairs, table, gold
rocker, etc.)
Steuben glassware
Remaining persooa1 items
First Bank & Trust Co. , Mechanicsburg, Penna.
Checking Account No. 130-538-2, Titled in the
name of Reverend Stephen J. Hribick.
Account Established: April 19, 1963
Balance at Date of Death
First Bank & Trust Co. , Mechanicsburg, Penna.
Savings Account No. 505-904-3, Titled in the
name of Reverend Stephen J. Hribick.
Account Established: May 23, 1973
Principal Balance: $6,399.06
Accrued Interest: 23.93
Balance at Date of Death: $6,422. 99
First Bank & Trust Co. , Mechanicsburg, Penna.
Time Certificate No. 2487, Titled in the name
of Reverend Stephen J. Hribick.
Principal Amount:
Accrued Interest:
Balance at Date of Death:
Interest Check Received
Cash on Hand
ITEM
List and describe fUlly
Interest in the Estate of Emma V. Hribick
(Undistributed)
Boods
(All boods were o.vned solely by
Reverend Stephen J. Hribick.)
E Bond, $50.00, L2046853339E
" ", $50.00, L2018355205E
" ", $50.00, L1055320686E
" ", $50.00, L1019107467E
" ", $50.00, L778336965E
" ", $25.00, Q2609126513E
" ", $25.00, Q244357285lE
" ", $25.00, Q2295211353E
" ", $25.00, Q2379701309E
" ", $25.00, Q2153844387E
" ", $25.00, Q2023343462E
" ", $25.00, Q1940169970E
" ", $25.00, Q1908261368E
" ", $25.00, Q1908261369E
UNIT ESTIMATED
VALUE MARKEr VALUE
$
550.00
Series
"
"
"
"
"
"
"
"
"
"
"
"
"
400.00
130.00
495.00
400.00
200.00
974.75
6,422.99
$1,000.00
7.85
$I ,007.85
$21. 14
1,007. 85
21. 14
648.00
7,758.53
12/20/76
12/22/75
12/17/73
12/19/72
12/17/70
12/20/71
12/22/69
04/10/68
12/20/68
12/21/65
12/01/64
12/02/63
11/24/61
11/24/61
39.54
41. 20
45.94
48.58
55.34
26.21
29.15
30.79
30.51
34.47
35.02
36.51
40.79
40.79
Insert this total opposite "Personal Property", Schedule "B" in
the "As Reported" column on the last page of this return.
x X
DEPARTMENT VALUATION
(Do not write in
this space)
550.00
"tOO. 00
\'ao.OO
"'~6'. DO
ltDD. 00
doDO. 00
en",. 15
/"",~.<t9
1,001.115
.11. t If
1."+ 11.00
1, 15~.!S?>
3Q.5'i
'i~_o
"t6.Q>f
'tf.51l
55.51'
-.t...~1
~'1.IS
30.1'\
~o.$1
a...'i1
~.O~
310.$1
"to. 11
1f!).1"!
1.\1 05.5'.1.\4
)
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 "Eft. 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 estat~
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, mortg4ges, 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 anyundistrlbuted
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 ESTI MATED DEPARTMENT VALUATION
No. List and describe fully VALUE MARKET VALUE (Do not write 1n
this space)
26. Series E Bmd, $25.00, Q1957694428E 11/23/62 39.01 nOI
27. " " " $25.00, Q1957694429E 11/23/62 39.01 ,".01
,
28. " " " $25.00, Q2080618814E 11/30/64 35.85 ~.15
,
29. " " " $25.00, Q2023174046E 11/29/63 37.37 31. a,
,
30. " " " $25.00, Q1667675866E 12/15/58 44.54 4*.5'1
,
31. " " " $25.00, Q1807725473E 12/15/59 42.72 't~.'~
, 'to.S'I
32. " " " $25.00, Q1857813038E 12/14/60 40.54
,
33. " " " $50.00, L1089795454E 12/01/74 43.42 o.j3.'1~
,
34.
35.
36.
37.
38.
39.
40.
41.
42.
43.
44.
45.
46.
47.
48.
49.
50.
51.
52.
Stock (All stock held solely in the name
of Reverend Stephen J. Hribick.)
American Te1ephme & Telegraph Co. 07/23/59 59 3/8
No. 1-021369 - 1 share
American Te1ephme & Telegraph Co. 01/27/60 59 3/8
No. 7-005482 - 7 shares
American Te1ephme & Telegraph Co. 04/20/61 59 3/8
No. J-725431 - 6 shares
American Te1ephme & Telegraph Co. 03/12/65 59 3/8
No. C-700588 - 58 shares
American Te1ephme & Telegraph Co. 04/24/59 59 3/8
No. D-627095 - 20 shares
American Telephone & Telegraph Co. 04/29/59 59 3/8
No. D-262608 - 8 shares
American Te1ephme & Telegraph Co. 08/31/59 59 3/8
No. 2-011869 - 2 shares
American Te1ephme & Telegraph Co. 04/24/59 59 3/8
No. P-744371 - 4 shares
American Te1ephme & Telegraph Co. 04/01/59 59 3/8
No. X-A28997 - 10 shares
American Te1ephme & Telegraph Co. 03/06/68 59 3/8
No. 0316-9210 - 10 shares
American Te1ephme & Telegraph Co. 03/30/6459 3/8
No. 64R984241 - 6 shares
American Te1ephme & Telegraph Co. 06/01/6459 3/8
No. 64XA659941 - 12 shares
American Te1ephme & Telegraph Co. 07/08/64593/8
No. 64T575269 - 2 shares
American Te1ephme & Telegraph Co. 11/23/71 59 3/8
No. 2912-4293 - 14 shares
Benguet Cmso1idated Incorporated 01/05/68 3
No. N045568 - 3 shares
Intercmtinenta1 Diversified Corp. 03/08/74 13 7/8
No. AV0018316 - 1 share
Weis Markets, Inc. 12/22/7127
No. P05206 - 20 shares
Weis Markets, Inc. 10/06/67 27
No. N07758 - 20 shares
Family Security Life Insurance Co. 10/15/62 0
No. 381 - 100 shares
Insert this total opposite "Personal Property", Schedule "B" in X X
the "As Reported" column on the last page of this return.
59.38
.s~. 3 1I
LtIS.(,f.,
3:s1.. ~..
3,4*&.1-. D'f
" ,'i1. (,,0
'115.0'/
415.66
356.28
3,444.04
1,187.60
475.04
118.76
\ I~.''''
:l.?>,.5~
5'\3. 'So
S '1'3. 10
3SI.. ~'i
11..51-
\lll.11o
t S I. '& ~
237.52
593.80
593.80
356.28
712.56
118.76
831. 32
9.00
.:t.oo
\ a. '8'i
13.88
540. 00
540.00
540.00
.s >+0. DO
No Value
NON..
RCC -35
RESIDENT DECEDENT
SCHEDULE "B"
PERSONAL PROPERTY
'*
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
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 "En. 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 estat~
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
No.
ITEM
List and describe fully
UNIT
VALUE
ESTIlIATED
MARKEr VALUE
DEPARTMENT VALUATION
(Do not write in
this space)
53.
55.
Proceeds fran medical insurance policy with
Pennsylvania Blue Shield, Contract No. 204308486
Proceeds fran medical insurance policy with the
Prudential Insurance Company of America, Policy
No. H0l745882
Exe rut or , s camnission for services rendered prior
to death in the Estate of Errnna Hribick
One - $50.00 American Express Travelers Check
American Telephone & Telegraph Co.
Dividend Reinvestment Plan for all above-listed
shares - ACOlll1Ulated shares at date of
death - 50.242
RefWld from safe deposit box
3,193.00
3 Iii!!, DO
,
54.
56.
57.
1,513.53
50.00
.:l,'iJltq,co
1,51~..s~
50.00
2,844.00
59 3/8
2,983.37
2.30
.:I, qi~. 31
,;". !!o
58.
Insert this total opposite "Personal Property", Schedule "B" in
the "As Reported" column on the last page of this return.
x X
41,055.44
RCC-42 (+-77) -. ,
BANK NO.
COMMONWEALTH OF PENNSYLVANIA 130-$)(\-2 :/
OEPARTME NT OF REVENUE
-
DATE FILED
NOTICE OF DECEDENT ACCOUNT STATUS 9 N./78
Submit in truplicate within 10 days alter knowledge of STATUS OF ACCOUNT NO: (JOINT. TRUST, OR INVESTMENT
the death. TN!
IE' ,.
I.... "A
RETURN COMPL ETED NAMES ON ACCOUNT SOCIAL SECURITY NUMBER1;SJ
FORMS TO LOCAL COUNTY Stephen J. Hrlblok 204-30-84116
INHERITANCE TAX OFFICE
SURVIVING DEPOSITOR (Beneficiary) INFORMATION DECEDENT INFORMATION
NAME RELATIONSHIP NAME Oi12'P','eEATH
TO DECEDENT. Stephen J. Rriblck
ADDRESS ADDRESS
420 E. 1l1.l1I1"1'on st.
CITY c~~er1and
Mechanlcebur~ ZIP CODE 1105'5
BANK/INSTITUTION ADDRESS BALANCE OF ACCOUNT AT 000 $
INTEREST ACCRUED AND COLLECTIBLE AT 000 $ 'Zj.
The P'1rlJt Bank 1< Trust Co. TO TAL $" 7~./J
Main 11< Market Ste. BANK AUTHoRIZA TION
loIechanlosburg, 1>A 17055 I HEREBY CERTIFY THAT THE INFORMATION CONTAINED HEREIN IS A
CORRECT REPRESENTATION OF INFOR~ATlON IN OUR FILES IN ACCORD
WITH SEC..IION 742 PI&; E TAX ACT OF 1961.
S~J:i'B%~IN~r~AT~ DATE
?- /~4,~ '1-14-7'$'
SEP 19 197B
'(P"PPD S!SDQdw3) .,'(OlE'l),
..DlloP p"'pun~ ""'~, P""'x" IOU s"op ~,oap 10 "W!, ,,~,
40 Hsodap 8'11 U8'lM IUnO:>>:)D 'pns 0'" p,i06... u! paJ!nb... aq
110'15 UO!lD3!j!'&oU ON ....uno:):>>D..... 0.(. ,..oAIAlns .10 "oAIAln!
alp to SSaJppD pUD awou 8"1 PUD uO''''RI'4SU! ID!3UDU!j
8'1'" \filM qlDap fO ....op 8'l1 ID Hsodap UO,lO paIS.AU! ...unOWD
altl '4ueWIS8AU! olD Hsodap Isn.14 olD IUloI 8'1'" fO DO'4D.":) ..
fO ....op aLf'" 'uo!.lad pasD8:)ap 81f1o to aWDU 8'14 6u!^!6 J08"8"1
"nue^"~ 10 ,uewjJDdea ,,~, AjI'oU OJ ~'D"p "", 10 ,,6p"I"ou~
'''IjD dDp (01) u", uI~'I" uOI,nl!"uI ID!'UDU!l "", 10 -4np
8'14 eq I1o'ls 4' 'alp IIDli' tU.WIS__AU! .10 Hsodap a~ 0'" s8'....od
8'14 fO auo PUD 1.......0,10 Jaq40uD JOj 4sn,q P! suosJad .10 UOI..8(1
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R CC..42 (....7 " . BANK ~5-q(\4-3
, "
COMMONWEALTH Of PENNSYLVANIA J ,
DEPARTMENT Of REVENUE
DATE F'AED
NOTICE OF DECEDENT ACCOUNT STATUS 9 2tr8
Submit in truplicate within 10 days alter knowledge ot STATUS OF ACCOUN;:~: (JOINT. TRUST, OR INVESTMENT
the death.
BST A"....H BU
r!/^" "'"
RETURN COMPL ETED NAMES ON ACCOUNT SOCIAL SECURITY NUMBER(S)
FORMS TO LOCAL COUNTY ste"pen <:. Hrlb'ick 204- ;\I)-?4B6
INH ERITANCE TAX OFFICE
SURVIVING DEPOSITOR (Beneficiary) INFORMATION DECEDENT INFORMATION
NAME RELATIONSHIP NAME D~Y~d?7JfATH
TO DECEDENT. Ste-r.>hf.'n J. H!'1bielr
ADDRESS ADDRESS
1120 E. 81l1l1'''orI St.
CITY 'eWnMltrhnd
Mechanic.burl ZIP CDDB U'.l~~
/
BANK/INSTITUTION ADDRESS BALANCE OF ACCOUNT AT 000 $
INTEREST ACCRUED AND COLLECTIBLE AT 000 $ c-, _37''1.
The first B"nk Y TrUl)t Co. TO TAL $ c'
"A'in ,~ Market st.". BANK AUTHORIZATION
Mech.,nicsburg, PA 17055 I HEREBY CERTIFY THAT THE INFORMATION CONTAINED HEREIN IS A
CORRECT REPRESENTATION OF INFORMATION IN OUR FILES IN ACCORD
WITH SECTION 742 PI&: E TAX ACT OF '961.
S~. E~F7LnA~ DATE
'" _ v <----c~ /1!~ ~ 9.(4''1~
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RCC - '\6
Cl)~'MO\w}:^ LTII OF l'l!NNSYLVANI ^
TRA~~FFH Ii\'HFHIl'AXCF, TAX
SCHEDULE "e"
TR\NSI<"nS
ItESlnE:\1' nEC\.:nENT
(1) Did decedent, within two years of'death, make any transf'er 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 properLY from himself to himself and another or
others (including Ii spouse) in joint ownership? (Answer yes or no) No
(3) If the answer to (1) or (2) above is in the af'f'irmative state:
(a) Age of' decedent at time of' transfer
(b) State of decedent t 5 heal th at time of making the transfer. (Note 1).
(e) Cause of decedent's death. (Note 1).
(4) Did decedent, in his 11f'etime, 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) No
(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 bef'ore his death:
(a) The possession or enjoyment of or the right to income from the property transferred?
(Answer yes or no) No
(b) The right to designate the persons who shall possess or enjoy the property transferred or
income theref'rom? (Answer yes or no) No
(fi) 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 transf'er, the consideration for which was transferee's promise to
pay income to or for the benefit of care of transf'eror? (Answer yes or no) No
(8) Did decedent, at any time, transf'er property, the beneficial enjoyment of' which was subject to change,
because of a reserved power to alter, amend, or revoke, or which cmtld revert to decedent under terms
of transfer or by operation of' law? (Answer yes or no) Nn
(9) If the answer to (8) above is in the affirmative, was the power to al ter, 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 supporterl by affidavit by the attend.ing physician as
well as a copy of the death certi ficate.
NOTE 2: If' answer to any of' the above questions is yes, set forth below a description of' the property
transf'erred, it's fair market value at date of' death, dates of' transf'ers and to whom trflnsferred, with
relationship of transf'erees to decedent, if' any. Submit copy of any trust deed or instrument, if' trans-
f'ers are claimed to be non-taxable, also submit detailed statement of' f'acts 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
MARKET VALlIE
(Es tima ted)
DEPT. VALUATION
(Dept. Only)
N at App li cab Ie
NoN.....
Insert this total opposite "Transf'ers", Schedule "e" in the
"As Reported" column on the last page of this return.
~61ru.-
RCC- 37 (12.-63)
l'OMMON\\-EALTH OF PENNSYYLANIA
TRANSFER Il'iHEHITANCE TAX
RESIDENT DECEDENT
SCHEDULE "D"
BENEFICIAHIES
\
h
BENEFICIARIES AND ADDRESSES RELATIONSHIP I SURVIVED
(If step-children or , DATE INTEREST OF
State full names and addresses of all who , DECEDENT
illegitimate children OF Br;NEFICIARY
ave an interest, vested, contingent or other. are involved, set STATE YES IN ESTATE
wise, in estate) forth this fact.) OR NO llIRTH
Joseph Hribick Brother Yes Adult Personal Property per
Main Street, Branchdale, Penna. Will
Dr. Marie T. Burke None Yes Adu It Personal Property per
--
601 Newton Street Road , Will
Newton Square, Penna.
~e I
St. Joseph's Catholic Church - i - Specific Bequest per
Me chani csburg , Penna. I I Will
I I
I I
-------'t"- ..-.-."--
Mary Pope
Niece
Yes
,,"1' :=j Specific B."", p"
--~_.- I ----- .,.~----_._~
Pottsville, Penna. I Will
.----
I
....- .~ I ______d_ .
Kevin Hribick Nephew ----l Yes I Adu It I Specific Bequest per
ELJ1t; 'c ~ I Will
Branchdale, Penna.
"'-"'---
I
Dr. Marie T. Burke None Yes Adult I Residue
---._.-
601 Newton Street Road ,
i
---------.
Newton Square, Penna. I
i --
Villa Vianney Priest Heme None - - Specific Bequest per
------ '----.--
915 Lincoln Avenue I Will
, _m.__._.__
Lebanon , Penna. , !
.._-~~--
.---.----
....
..
Deponent further saj's that all the above-named benef'iciaries are living at this time except below:
- .
NAME DATE OF DEATH RESIDENCE
-----
-"
~
o .
-~-
~<~
Vi: c:
'2 Q) S
.-..... :l
E~-
"00.0
E"
~ 0:
~(,J"O
...........3
o ~ ~
" 0 0
~ E fr
~ i>:
SUMMARY
(Sch. "A")
(Sch. "B")
.. (Sch."C")
Real Property
Personal Property
Transfers
Gross Taxable Estate
(1 )
(As Reported)
$ none
$ 41,055,44
$. none
$.
$..
$41,055.44
(2)
(As Determined)
$
$
$
$
$
$
00
r-:
O'i
.-; ...
Z 'tj",
~ ~ -,-1 ~
oj ..o~ ...l
" -
>< "" 'M" -<I:
~ H~ ell
"" '" :r::Q -
'<t - -<I:
...... -< ~ Ill:
, ~ ..... "'"J e." '2 '"
00 ~
0 ~ ::;' ~ '"
r-- ~ 2:
, '" -< '" <J) ~ @ -<I:
...... ~ :I: ~ ~ ~ ".
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0 0 E- ..., @ H 0:;
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0
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0 c
:S ~ i:. 0
0 E
"'. 1: E E
::; " " 0
...l U U
-
RCC-:J8
RP:~ IJlE:-iT DECEDENT
SCHEDULE "E"
JOINTLY OWNED PROPERTY
CQMMONWE\LTll llF PENN~YLVANIA
TnAN~n:1\ r,HE1UTANCP: TAX
I~STRlTTIO]\S: This schectule must disclose all property, rea] and personal, owned by the decedent jointly
with 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 under Schedule
"A", plus the date and place of record of instrwnent eff'ecting vestiture, but rla not include entireties
or out of state real estate value in estate valuation column.. Personal property should be listed as in
Schedule liB", plus date of acquisition, and the name, address and relationship (ir any) of co-owners to
the decedent.
Description of' Prop.~.rty, Date of A~quisition, Nam~T unit-
Address and Relationship of Co-Owners, and Place i Value
of Record of Instrument, wh_er~T~e~! E;!:!1~~__ ~.--,~ -.-- 3<5
:><5< 0-0-:;xx:><5<vvv<.XXX><X><X><X><&:M
~)<)< )<)< )<)< 00 00 XX X>< :><5<<< ;:;: X>< %:&;.:><5<:X
percentage
Share
Estate
Val ua t ion
ex 0-
Y> Y>
)<8;
~I
DEPARTMENT VALUATION
CAUTION-Do not Write
In This Space.
Value of' Value of'
Entire Decedent's
property Interest
No jointly owned real estate.
First Pennsylvania Bank I
Savings Accrunt No. 19-04307-4, Titled
Stephen J. Hribick or Marie T. Burke, M. D. ,
Joint tenants with right of survivorship.
Account Established: September 9,1966
Principal Balance: $712.65
Accrued Interest: 4. 15
Balance at Date of Death: $716.80
50%
358.40
35~."i 0
American Telephme & Telegraph Co.
No. 6-047453 - 6 shares Acquired: 1/30/62
Stephen J. Hribick and Marie T. Burke,
Joint tenants with right of survivorship.
Date of Death Value: $356.28
50%
178.14
11<i. I L./
American Telephme & Telegraph Co.
No. 0316-9213 - 12 shares Acquired: 3/6/68
Stephen J. Hribick and Marie T. Burke,
Joint tenants with right of survivorship. as I.. ~ ~
Date of Death Value: $712.56 50% 356.28
Municipal Investment Trust Food
No. 10424730-9 - 10 shares Acquired: 10/31/7
Stephen J. Hribick and Marie T. Burke, I
Joint tenants with right of survivorship. I I.\j016.0 ()
Date of Death Value: $8,150.00 50% 4,075.00
Carrier Corp. I
No. 09965-144465 - 200 shares i
Stephen J. Hribick and Marie T. Burke, I
Joint tenants with right of survivorship. 1)51.0. DC
Date of Death Value: $3,126.00 50% 1,563.00
HerCllles, Inc.
No. 24378-427056 - 200 shares i
Stephen J. Hribick and Marie T. Burke, I
Joint tenants with right of survivorship.
Date of Death Value: $2,576.00 50% 1,288.00 \ ~'ll!( t>l
j
Pennsylvania Power & Light Co.
No. LCO-1399l - 50 shares Acquired: 8/1/74
Stephen J. Hribick and Marie T. Burke,
Joint tenants with right of survivorship. 559. 50
Date of Death Value: $1,119.00 50% 559.50
Pennsylvania Power & Light Co.
No. LC 30176 - 100 shares Acquired: 11/19/7
Stephen J. Hribick and Marie T. Burke,
Joint tenants with right of survivorship.
Date of Death Value: $2,238.00
50%
1,119.00
1,119.00
Insert this total opposite "Jointly Owned Property", Schedule "E"
in the II As Reported" coluITDl on the last page of this return.
I~ 4'+.5.S1 I
RCC:38
RESIDENT DECEDENT
SCHEDULE "E"
JOlNTL Y OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
INSTRL1CTIONS: This schedule must disclose all property, real and personal, owned by the ctecedent jointly
with lillother or others, including intangibles, standing in the name of' the decedent and others. List
rea.l pstate first. as entireties, or joint tenants, giving brief description, as indicated under Schedule
"A", plus the date lina 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 "H", plus date of acquisition, Iind the name, address and relationship (if' any) of co-owners to
the deceden t.
Description of' Property, Date of' Acquisition, Name unit percentage
Address and Relationship of' Co-Owners, and PI ace Value Share
of' Record of lTH,trument, where Real Estate.
Estate
Val ua t ion
/V'
( X><
~
X><X><:>;9::X><(X><:;S::;S:~X><X><%X><X><W
:x :XyYxYxX><(%XX;X:x:xx><<S<SX><X><
X><( X><
DEPARTMENT VALUATION
CAUTION-Do not Write
In This Space.
Value of Value of'
Entire Decedent's
property Interest
Pennsylvania Power & Light Co.
Dividend Reinvestment Plan for above
stock certificates -
Stephen J. Hribick and Marie T. Burke,
Joint tenants with right of survivorship.
Date of Death Value: 60.453 shares or
$1,352.93
22 3/~
50%
676.47
IPll..'"\l
American Telephone & Telegraph Co.
Dividend Reinvestment Plan for above
stock certificates -
Stephen J. Hribick and Marie T. Burke,
Joint tenants with right of survivorship.
Date of Death Value: 9.154 shares or
$543.56
59 3/~
50%
271. 78
~"\.1'i
10,445.57
Insert this total opposite "Jointly Owned Property", Schedule "E"
in the" As Reported" column on the last page of' this return.
-
*'
REV...~18 (8-78)
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF FIELD OPERATIONS
P.O. BOX 2970
HARRISBURG
1710S
IN YOUR REPI. Y PLEASE
REFER TO
Inheritance Tax Division
NOTICE OF FILING OF APPRAISEMENT
Reverend James R. O'Brien
Clinton Drive
Shamokin, PA 17872
(Executor or Administrator)
In Re: Estate af
Reverend Stephen J. Hribick
Cumberland
County - Fi Ie No. 21-78-0143
DearRev. O'Brien
You are hereby notified that the original ..
appraisement in the estate of Reverend Stephen J. Hr~b~ck
hos been filed in the office of the R79ister of Wills of Cumberland
County on January 19 , 19_, Said appraisement reflects the following
valuations:
Real Estate
Personal Property
Transfers
Jointly Owned
Total
*one
1,055.44
None
10,445.57
$51,501.01
As to such tax that is paid within three months from date af death, a five (5%)
percent discount is allowable. As to any tax that remains unpaid after nine (9) months
(fifteen months when death occurred from December 22,1965 to June 16, 1971, inclusive;
and twelve months when death occurred prior to December 22, 1965) from dote of death,
interest at the rate of six (6%) percent per annum is charged.
Any party in interest who is aggrieved by this notice may object thereto within
sixty days after receipt of said notice as provided by Section 1001 of the Inheritance and
Estate Tax Act of 1961, 72 P. S. 2485-1001, P. L. 37,3.
'\. \'
January 19, 1979
t~--~...
.
/".
Dote
Signed
Title
Administrative Officer
-----------
-......
Note: This is not 0 bill.
RCC-2 {2-64)
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
HARRISBURG, PENNA, 17127
COMMONWEALTH OF PENNSYLVANIA
RESIDENT INHERITANCE TAX
APPRAISEMENT
DATE
January 19, 1979
Cumberland
COUNTY
FILE NO.
21-78-0143
Whereas, Reverend Stephen J. Hribick late of Borough of Mechanicsburg
in the County of Cumberland Commonwealth of Pennsylvania, having died on
the 23rd day of February 19 78 , seized and possessed of an estate
subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania;
Therefore, I, Leo Fulginiti . an appraiser duly appointed according to law,
having been designated to make a fair and conscionable appraisement of the said estate, and to assess and fix
the cash value of all annuities and life estates growing out of said estate, hereby file the following appraisement:
In the event that any future interest in this estate is transferred in possession or enjoyment to collateral heirs of the decedent after
the expiration of any estate for life or for years, the Commonwealth hereby expreSSly reserves the right to appraise and assess transfer
inheritance taxes at the lawful collateral rate on any such future interest.
Unit Apprai$ement
DelcrlpUon of Anet Valuel Made for Inheritance
Tax Purpo,es
Real Property $ None
- --.- -
Personal Property 41,055 44
Transfers None
Joint-Held Property 10,44'5 '57
'- -
TOTAL ASSETS 51,501 01
,- --
Having been duly sworn according to law, I do here by certi~(.:that the /lbove
formity with law on this 19th day of (,j ":c.. .....
appraisement i~ made in con-
,. .J<\Ilu!lI'Y1-: 19"~.
AppraiBt'r
(NUmber and .,Street) .
tiarrJ.sburg
(PM 0ft'I~)
, Penna.
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