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OFFICE OF THE
REGISTER OF WILLS
...., I - /7,..'O0--""'~.' _~c ~.?
&-<. /" ..', -,
SUPPLEMENTAL
STATEMENT OF DEBTS
AND DEDUCTIONS
DEDUCTIONS ALLOWED IN
Form RC C .10
2-~t.. 60
THE SUM OF ............ $.....................................
, .
DATE NO. OF NAME OF PAYEE REMARKS AMOUNT
VOUCHn
Tota 1 as n. . :lv ... -'- J on'., 'tl:'
.bmDC 0 -~ Attorneyls Fee 113 00
I-Iow~r
The Commonwealth National Bank Executorls Fee 113 00
226 00
.n , ':In '1.l:..
-
,
DATE APPROVED ........ ..7..~..~.~?f...
~~ ~~"P~~
Roglltor of Wills, ~ l' S.
LATE OF THE BOROUGH OF CARLISLE
DATi: OF DEATH AUGUST 6, 1978
OF
CUMBERLAND
COUNTY
AND AGENT OF THE COMMONWEALTH
HARRY F. RUBERT
t, -L//-??
DATE OF FILING APPRAISEMENT _
ESTATE OF
COMMONWEAL.TH OF PENNSYLVANIA
WE,
}SS.
COUNTY OF CLJMBERL"ND .
TH~ COMMONWEALTH NATIONAL BANK BY JOHN
E. GARRY , ESTATE TAX M"~ERTIP'Y. THAT. TO THE BUT OF'
MY kNOWLEDGE AND BELIEF. THE trOREGOING IS A JUST AND TRU It SrATEMENT OF DUTS, "UNERAL EXPENSES AND EXPENSES 0,.
ADMINISTRATION SUBMITTED TO THE ESTATE OF HARRY F. RUBERT OECU.SIED. AS DEDUCTIONS FOR
9dn I! .A0/lrp
AY Of' (/ /
INHERITANCE TAX PURPOSES.
(L. Ii.)
My (011I ssion Expires October 13, 1980
Harrisburg, PA Dauphin County
R C C-33 (~-7 31
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SUPPLEMENTAL RETURN
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
~
RESIDENT DECEDENT
COUNTY OF
CUMBERLAND
IMPORTANT:
This return must be completed in detail and filed in duplicate, with all attached, with the Register of Wills of the
County where decedent resided; Return is due within nine months after date of death, unless an extension is granted
by the Secretary of Re'.ienue. (Section 703 of the Inheritance and Estate Tax Act of 1961.)
(STATE FULL NAME OF DECEDENT)
} AFFIDAVIT OF
EXECUTOR
~X<<OC($:tltX}t~li
IN THE MATTER OF THE ESTATE OF
HARRY F. RUBERT
Lote of
CARLISLE, CUMBERLAND
PENNSYLVANIA
County
Stote of
}.
CUMBERLAND
THE COMMONWEAlTH NATIONAl
Administrator of the estate of the above-named decedent being duly sworn, depose
County of
RANK RY JOHN E. GARRY. ESTATE TAX MANAGER
Executor
and say
Decedent died
AUGUST
6
, 19---1.LJ testate leaving a lost will, copy of which is hereto attached.}
(y EAR) \.xrx~~
(MONTH)
Name and address of attorney or }
other authorized repres.entative to whom
all correspondence should be mailed.
(DAY)
COMMONWEALTH NATIONAL BANK
10 S. MARKET SQUARE, HARRISBURG, PENNSYLVANIA
That as such EXECUTOR deponent is familiar with the affairs of said estate and the property constituting
( EXECUTOR~X>~~XIX*){RK'X
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 SAFE 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 following, for the reasons hereinafter set forth:
of this return,
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 pos session, s tanding 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 al so separately the accrued interes t thereon, if any, down to the las t in teres t day priClr to d0cedent'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 sccUlriti,~s o',\ned 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 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 business.
A copy of the co-partnership agreement, (if oral, a statement setting forth the nature of the agreement)
together with a statement setting forth the character of the business, its location, and such other facts
pertain! ng to the business as may be pertinent to a fair and just appraisal of the decedent's interest
therein mllst be submi tted. It should also set forth in itemized form, together wi th the fair market value
thereof, any other property owned or bequeathed by the decedent at the time of death.
The Scl>edule 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 trmls1~rred, the
relationship of the transferees to the decedent, the proportionate share received by each transferee an,l
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 cony
of the deed, trust agreement or other instrument creating the trust. Ther,~ 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 to~
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 anothel',
with a copy of the instrument creating such power attached to the schedule.
That Scl>edule D attached hereto and made part hereof sets forth the nllmes anri addressc~s of i:l!
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 ,,/'
decedent's death of all minors, annuitants and beneficiaries for life uncler decedent's \\'U1. It it)so
contains Ii statement showing which of the beneficiaries named in the (lecedent's w11 l, if any. died prior
to decedent, the dates of their death, their issue, and the relationship of such issue to H,,> !;".,...j'iciary.
That S.::l>edule E attached hereto and marle a part hereof sets forth all property, real and per-
sonal, owned by the decedent jointly wi th another or others, including intangible, standing in the name-
of the decedent and others, plus the date and place of record of instnunents et'fecting the \estiture of
real estate and the date of acquisition of personalty, plus the name, a(ldress '''1<1 r.>I,d,,"""!':'" :r
of co-owners to the decedent.
That Scl>edule F attached hereto and made a part hereof sets t'onhfltP-- '0',,: j.. -1".,,; i ..11 ++!~
and deductions claimed for and on behalf of this decedent's estate, inelwlin~~ 1"i;t:'.;!','tl ,'x;"'nses pIL'd:
family exemption, where applicable; costs of anministration of this eSt'itY: ,'O'J"I" t....;< ",")icl!I~'
conunisstons paid or to be paid; cost expended for burial trusts, t01ill;~t(ynt_.~:, '-;~ :",,-\, i..
gious services, in consequence of the death of the decedent; debts and claims owing linn Imp"i,t iLL t.ime 01'
death; taxes accrued chargeable for period prior to decedent's death (except those idlov;e.l Ill."":' S,"ct.jU!l
651 of the Inheritance and Estate Tax ,\ct)j tngpther with Ii statenl(>"i "r ,''''!!'"o.t.,',: 'I'" ",' !'"" ,..t;:i,c'-
tions, if any. It is agreed that the fiduciary will present proof' or saLl "L..LI"':; ,,;,;: '". .','<ill '.'-
quest, that if the amount actually paid in settlement of any fee, commission or debt. is less than t!w
estimate(l amount cl aiming and allowed, that the same will be reported to the Register of' WLlls, and tI",;
the amount of tax assessed can be reassessed in accordance therewith.
That the totals of the appropriate columns in Schedules "A", "B", "en, "E", an(l "F" as directe..l thereir"
have been carried forward and properly registe!'ed in the Summary.
Subscribed and sworn to before me this .................................
..................................?'iJ.
.... day of .
. ~ .......19..7.1.
?FIJ;~
THE GOMMONWEALTH NATIONAL BANK
.BY ; ..\r:/J..:.t7..~ZV:~,,:..~:! ............... ....n. ~S.TA T.E....TAX._MANAG ~
I (Executor- ~inistrator)
v ~
10 SOUTH MARK ,L..SQ.UARE. . w. .. ....
(Street N1"i7,b",
~A Rg.I.?~v.gG.,.....P..~NN.$.Y..kV,l\Nr..,l\.
(City or Town and State)
..td'~d
~ . ,,': .,
~\,t r"'~..\: J'...'y ..~,'
~.~, Commiss"m Expires Odol>er 13, 1980
t ";' " ri~ D:!!..:..+:~~ ''--;;::.~v
NOTE: Before signing affidavit make sure all blank spaces in the affidavit and schedules ,u>1H'xed ClY-P
filled in with details or the word "None", ann in case the assets include rare anc! unlisted <;el'nrit'ir"".
securi ties of close or family corporations or an interest in any co-partnership or business, nwt 1:11>:
data and statements requirerl under the paragraph above relating to Scherlule Un" are attrH~hed. \-1 so n.'ll,~'~
certain that column #1 in the' "Summary" has been properly completed as ahove-rlirected.
.....
.
RESIDENT DECEDENT
SCHEDULE "B"
PERSONAL PROPERTY
'*
r.:;c:~ -?-..~
COMMONWEALTH OF PENNSYLVANIA
TfulliSFER 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 estate.
Tangibl e 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 f'iduciary 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.
I tern ITEM UNIT ESTIMATED DEPARTMENT VALUATION
NO. Lis t and describe fully VALUE MARKET VALUE (Do not write in
this space)
Total as Previously Reported ~?2.82
Refund from Presbyterian Homes, Inc. 2,257.22'" /'
I
Insert this to tal opposi te "Personal Proper ty", Schedule "B" in X X $0~51'O~04 ~ .'":) ?. c; l . 1-1-
the "As Reported" column on the last page of this return. L,
REV-5IB (3-79)
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
John E. Garry, Estate Tax Manager
Commonwealth National Bank
Ten South Market Square
Harrisburg, FA 17108
I Executor or Administrator)
In Re: Estate of
Harry F. Rubert
Cumberland
County - File No. 2h-78-0483
Dear Mr. Garry:
You are hereby notified that the supplemental
appraisement in the estate of Harry F. Rubert
has been filed in the office of the Register of Wills of Cumberland
County on June 29 ,19-.1ll Said appraisement reflects the following valuations:
Real Estate
Personal Property
Transfers
Jointly Owned
Total
None
2,257.22
None
None
$2,257.22
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 29. 1979
Signed
Title Administrative Officer
NOTE: This is not a bill.
REV-457 (hI'S)
DEPARTMENT OF REVENUE
BUREAU OF FIELD OPERATIONS
P.O. BOX 2970
HARRISBURG, PENNA. 17105
SUPPLEMENTAL
COMMONWEALTH OF PENNSYLVANIA
RESIDENT INHERITANCE TAX
APPRAISEM ENT
DATE
COUNTY
FILE NO.
June 29, l~_
Cumberland
21-78-0483
Whereas, Harry F. Rubert late of Borough of Carlisle
in the County of Cumberland Commonwealth of Pennsylvania, having . "
the 6th day of August 19 ~, seized and possessed 0'. ",,'d e
subject to Inheritance Tax under the Iaws of the Commonwealth of Pennsylvania;
Therefore, I, Leo Fulginiti , an appraiser duly appointed according t:: ]ii' "
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 enjoy;nent to collateral heirs of the decedent after the ex ;::;,1
of any estate for life or for years, the Commonwealth herebY expressly reserves the fight to appraise and assess transfer inheritance taxes at the lawful culiat,'ral
rate on any such future interest.
DESCRIPTION OF ASSET UNIT I /.,:-;p~ais(
VALUES 1 () ~ In 11
Purp
Real $ _.=~---,
Property NO::l
Personal Property
2,257 i
Joint-Held Property None
Transfers None
TOTAL ASSETS 2 , 257
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r---=--==-=----- - - -=-=-==-=-=-=-- - =-=-= ===-==-==--=-=--=-==--=--= - - - - --
CC 4(11/78) COMMONWEALTH OF PENNSYLVANIA
J003148 DEPARTMENT OF REVENUE
OFFICIAL RECEIPT. PENNSYLVANIA INHERITANCE AND ESTATE TAX
~~~-~-~---~~TWO HURDRED SEVERTY~OHB & 87/100~-~----~~~~-~-~--~~~
IECEIVED dollars
representi ng Pennsylvania Inheritance or
Estate Tax due from the following estate:
rom:
tonal Bank
~ddress
Ca.r11a1e,Pa.
17013
2%Taxon $
,. " of Poyment May.4 ,1979
% Tax on $
Estate Tax, Act of
May 7, 1927
$
$
$
$ ~
$
$ 2n.81
6% Tax on $
No. 21-78-483
Dote of Death 8-6-1978
15% Tax on $
,-.lame of Decedent HARRY F. RUPER'l'
,:ounty CUIlberland.
TOTAL TAX CREDIT
Less five percentum of tax if
paid within three months after
dote of death
Plus interest at the rote of
_ % from
to
$
! emorks:
$
NOTE: This Triplicate R~pt to be retained for audit purposes.
$
\
~'r · 87
uOO ~ [P [L~ @Li\ u~
SEA L
TOTAL AMOUNT PAID
Received by
NOTE: In accepting the transfer inheritance tax on future estates, prior to the death of the life
tenant or tenant for yeors, as evidenced by this receipt, it is understood that the Commonwealth shall
not be precluded or prevented from hereafter assessing additional inheritance tax at the death of the
life tenant or tenant for years whenever it appears that such additional tax may be legally due and
collectible for any reason whatsoever.
------------------------------~--------_.p