HomeMy WebLinkAbout06-25-79
RCC-84
(8-77)
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COMMONWEALTH OF PENNSYLVANIA
OEPARTMENT OF REVENUE
INHERITANCE TAX OIVISION
OFFICIAL NOTICE OF
INHERITANCE TAX
ASSESSMENT
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For County Information purposes only
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COUNTY FILE NO:
-------------------------------- -- - - -_.- - -- -- ---- - ----- --_.- - -. - -- - - - - - --
Appraised Value of Estate:
Real Estate
Personal Property
Jointly Held Property/Transfers
$
.~/ /- ,/ /
Total Gross Estate
$
f"; / I
Total Approved Deductions
Clear Value of Estate
$
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Less: Approved Charitable Exemptions
Clear Value of Estate Subject to Tax
$
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Amount Taxable @ 6% Rate
$
tax due
$
Amount Taxable @ 15% Rate
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tax due
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TOTAL PENNSYLVANIA INHERITANCE TAX DUE
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Less Credits:
DATE OF PAYMENT
AMOUNT PAID
DISCOUNT
INTEREST
TAX CREDIT
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$ ! ~// ':-1
+ $
$ I 2~,
$ I-IZ,;3
+
+
BALANCE OF PENNSYLVANIA INHERITANCE TAX DUE
$
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rnterest will accrue at the
Inheritance tax from
rate of six (~) p~r,s=.ent per annum on the unpaid balance of
'/1-- L,3"/(
.,' to the date of payment.
Assessed by:
Agent for the Commonwealth
SEE REVERSE SIDE FOR INSTRUCTIONS
REGISTER OF WILL'S COPY
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Rcc-n (4.73)
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
RESIDENT DECEDENT
COUNTY OF CUMBERLAND
,;'-
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. unless an extension is granted
by the Secretary of Re'lenue. (Section 703 of the Inheritance and Estate Tax Act of 1961.)
Late of
Cumberland
Pennsylvania
Cumberland
} AFFIDAVIT OF
EXECUTOR
~
IN THE MATTER OF THE ESTATE OF
Reverend Stephen J. Hribick
(STATE FULL NAME OF DECEDENT)
County
County of
J's.
State of
~
Reverend James R. O'Brien
Executor
of the estate of the obove.named decedent being duly sworn, deposeS
and say 5
Decedent died
February
23
19~{ta5tole leaving 0 lost will, copy of which I. hereto attached. }
(YEAR) ~
(MONTH)
Mome and oddre.. of attorney or }
other authorized representative to whom
011 comllpondence .hould be moiled.
(DAY)
James D. Bogar, Attorney At Law
23 West Main Street, Shiremanstown, PA 17011
Executor
That as such deponent is familiar with the affairs of said estate and the property constituting
(EXECUTOR-AOMINIST 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 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
That the contents of said safe deposit box or boxes are itemized under Schedules
with the exception-of the [ollowing, for the reasons hereinafter set forth:
of this return,
That Scheclule A attached hereto and made part hereof sets forth fully and in delail all the real properly
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 dale of death of decedent.
That Schedule Battached 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 prim 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 or 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; aU 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 th~ uatc of death, bonds and accrued interest thereon to the date of decedent's
death and other investment sccuriti~s owned by the decedent at the time of death, with the.tnarket value there-
of at such time.
In the case of securities of close or family corporations, the values reported are as far as
possible, subs tfl.n tifl.ten by financial statements of' the corporations, showing the assets ann liabilities
tht"reof AS o'f the date of death. The schedule also sets f'orth the interest of rlecedent at the time of
dpath in any co-partnership or business, and in support of the value of such interest there is annexed to
said ache-dille, financial statements showing the assets and liabilities of said co-partnership or 'husiness.
A Cbpy of th(> co-partnership agreement, (if oral, a statement setting f'orth 'the nature of tile agreement)
together with a statement setting forth the cl1aracter of the bllsine~s, its location, and such other facts
pertflininp: to the hllsiness as may be pertinent to a fair and just appraisal of the decedent's interest
theretn must he submittp.d. 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 Scf>edule C attached hereto and made part hereof sets forth a true answer to each inquiry
contfl.ined 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 t6.ke eff'ect in possession or enjoyment at or
af'ter rlenth, said schedule sets forth the nature and value of such property, to whom transf'erred, the
relationship of the transf'erees to the decerlent, the proportlonate share received by each transferee and
all other facts of a pertinent nature regarding said transfers. In the case of transfers intenderl to
take ef'fect in possession or enjoyment at or after death, there is also attached to the scherlule a COllY
of the deed, trust agreement or other instrument creating the trust. Tl1erl'! 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 .1ointly with another, or any power of appointf.-
ment vested in decedent, either individually or jointly, by the will, deed, or other instrwnent of another,
with 8. 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 benef'icially interested in this estate at the time of decedent's neath, the nature of their res-
pective interests, their relationship, if any, to the decedent, together with the ages at the time of
decedent' 5 death of all minors, annuitants and beneficiaries for lire unner decedent's Will. It also
contains a statement showing which of the beneficiaries named in the decerlent's will, if any, died prior
to decedent, the dates of their death, their issue, and the relationship or such issue to the beneficiary.
That S~f>edule 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 ~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.
That Sc/1edule F attached hereto and made a part hereof' sets forth fully and in detail a11 debts
and deductions claimed for and on behalf of' this decedent's estate, including funeral expenses paid;
f'amilyexemption, where applicable; costs of administration of' this estate; counsel fees and fudlciary's
commissions paid or to be paid; cost expended f'or burial trusts, tombstones or gravemarkers, and reli-
gious services, in oons4:J'quence: of the death of the decedent; debts and claims owing ami llnpairl at time of
deathl tax.. aoorued oharSIAbll tor perlod. prior to d.ecedent' 8 rieB.th (except thO" Allowed under Section
651 of the Inheritance and Estate Tax Act); together with l:L statem4:J'nt of collatera.l pledget\ 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 c'laiming 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 Schenules "A", nan, .e., "E", and"F" as directed therein,
have been carried forward and properly registered in the Summary.
Subscribed and Sworn to .before me this .................................
I ?~.... day of ..... /?.-...'.... :..IJ. ................. 19.'Z.2......
........".........~'._l..:.... . .~~
cr... ....c;,.. /) .. ........ . /t.?!? ..................................
..............."...........~.(.
JOAN E. ARNOLD, Notary Public
Shiremanstown, Cumberland Co., Pa.
My Commission Expires Sept. 6,1982
...&~~~~_s
. Clinton Drive O'Brien
................................................."............................................".......................-..-..
(Street Number)
$l1aJIl()1.<:i.IJ:,y~D.:Il~y~y'1.n.:i.i1.l7..?7?.......
(City 01" Town and State)
NOTE: Before signing affidavit make sure all blank spaces in the aff'idavit and schedules annexed are
f'illed in. with details or the word "None", and in case the asse,ts include rare and unlisted. securities,
securities of close or f'amily corporations. or ~n interest in any co-partne~ship or business, that the
data and.statements required. un~er t~e p~ragraph above rela~ing to Schedule nB" are at~ache~. Also make
certain that column,#~ in the'ftSummary. has been properly complet~d as above~directed.
-
RESIDENT DECEDENT
SCHEDULE "B"
PERSONAL PROPERTY
*~
RCC'~
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 "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 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 certi~icates, 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 ~iduciary 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 ITEM UNIT ESTIIlATED DEPARTMENT VALUATION
No. List and describe fully VALUE IlARKEr VALUE (Do not write in
this space)
Supplemental Return
l. Additional distributive share from the Estate //-"'
of Emma V. Hribick $319.67/
-
"3 t'1.. to"
Insert this total opposite "Personal Property", Schedule "B" in
the "As Reported" column on the last page of this return.
x X
.- .
REV-5IB {3-79l
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF FIELD OPERATIONS
P. O. BOX 2970
HARRISBURG
17105
IN YOUR REPLY PLEASE
REFER TO
Investigation Division
NOTICE OF FILING OF APPRAISEMENT
Rev. James O'Brien
Clinton Drive
Shamokin, PA 17872
(Executor or Administratod
In Re: Estate of
Reverend Stephen J. Hribick
Ctnnberland
County - File No. 21-78-0143
Dear Rev. O'Brien:
You are hereby notified that the Supplemental
appraisement in the estate of Reverend Stephen J. Hribick
has been filed in the office of the Register of Wills of Cumberland
County on JWle 25 , 19 79. Said appraisement reflects the following valuations:
Real Estate
Personal Property
Transfers
Jointly Owned
Total
None
319.67
None
None
$319.67
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
June 25, 1979
Signed
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o
Title Administrative Officer
NOTE: This is not a bill.
SUPPLEMENTAL
REV-4571:l:t=78) ..
DEPARTMENT OF REVENUE
BUREAU OF fiELD OPERATIONS
P.O. BOX 2970
HARRISBURG, PENNA. 17105
COMMONWEALTH OF PENNSYLVANIA
RESIDENT INHERITANCE TAX
APPRAISEMENT
DAii:.
June 25, 1979
Cumberland
-11-78-0143
COUNTY
FilE NO,
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 ~, 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 2,t the lawful collateral
rate on any such future interest
DESCRIPTION OF ASSET UNIT Appraisement
VALUE~, Made for Inheritance
Tax Purposes
Real Propertv $
None
Personal Property 319 67
Transfers None
Joint-Held Pronertv None
TOTAL ASSETS 319 67
I
Have been duly sworn according to law, I do hereby ce{!:o
with the law on this 2 'ith day of -
that th't-~ove A'Pp~aiSemjnt is made in cf~fo7Wity
'.-
Appraiser
(Number and ?treet)
Harn.sburg
(Post Office)
. Penna.
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