HomeMy WebLinkAbout02-05-79
Form No, RCC.62 (6-70) THIS FORM REQUIRED IN ALL ESTATES WITH GROSS ASSETS UNDER $10.000. UNDER SECTION 701 OF Acr OF JUNE Ill. IMl.
EFFECTIVE .lANUARY 1. 1962, (FILE IN DUPUCATE WITH COpy OF WILL ATTACHED)
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OFFICE OF" THE REGISTER OF WILLS
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County of .. .~~~r~~.4.,.........,.
, .. . .. .. .. . .. Cyril E., .r: QlJ~t.." .. .. .. .. . .. . .. . ... of . ,4;6.. ~I).t~;r. P.tiv.~ ,. CPIJlP. H:i.ll, ,l?enn.a.., .. . .. .. .
(Name) (Addreu)
being duly -------------~WQnLm___m__maccording to law, deposes and says that he is the -----------~~-Wt9I__m____..________m____mm
(Exec., Adm., L__. Etc.)
of the estate of -mm-____~J.b._tI_~nE.~_~_t____m_'___m______ whose last residence was n__+'~nW~~t__~..t~n__~t.r~~t___m______m___n
(No.) (St....t)
----m---~b.J-~!!1.9!!_~:t_~_m____m__mdect:ased, and that the whole of the estate of said decedent, who died m~g!!~~n~_2__J~Z.~
(City, Borough or Township) (Date)
consisted of:
REAL PROPERTY
REAL PROPERTY IN PENNSYLVANIA, WITH STATEMENT OF MORTGAGE ENCUMBRANCES UPON EACH PARCEL AT DEATH OF DECEDENT,
WHERE PROPERTY HELD AS JOINT TENANT OR TENANCY BY ENTIRETIES. GIVE NAMES. ADDRESSES Aim RELATIONSHIP OF OTHER OWNERS,
Real Estate Estimated
Value
Nme
Personal Property
(See /'
1. Vari illS and misce 1 lane illS coins attached appraisal) 477. 83
2. Madism Fund. In c. 5 shares at $15.00 per share - Dividend Check 7~2'5
received under terms of policy /'
3. Mmarch Life Insurance - Payment 1,060. 18
4. Mmarch Life Insurance - Refund of premium 23<'53
5. P avrnent received fran Medicare 25((."76
6. Canmmwealth National Bank Check No. 169364 - Christmas Club Refund 10e('6'o
7. Capi tal Blue Cross and B 1ue Shie ld - Refund of premium 1~-80
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8. Holy Spirit Hospital - Refund check 8.23
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NOTE: You may expedite the processing of this return by filing with it, and as a part of the return,
letters from financial institutions or mortgage holders, certifying to amounts on deposit or owed by the
decedent as of the date of death. Such letters must be signed by a responsible officer of the financial
institution or mortgage holder and indicate clearly amounts of principal and interest in the decedent's
account at the date of death and the type of account, account number and the exact name or names in
which the account is registered. '
Estimated
Value
Jointly Held Property
No jointly CMIled real estate
CamnOlwealth National Bank - Certificate of fuposit #16-1356, Titled Lruise
Faust and Ruth H. Faust, Joint tenants with right of survivorship
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Date of fuath Balance (Principal and Interest) $10,066.89 - 'V
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5,033.45
CamnOlwealth National Bank - Certificate of Deposit # 16-1304, Titled Lcuise
Faust and Ruth H. Faust, Joint tenants with right of survivorship
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Date of Death Balance (Principal and Interest) $1,001. 88
CamnOlwealth NatiOlal Bank - Certificate of Deposit # 16-1275, Titled Lruise
Faust and Ruth H. Faust, Joint tenants with right of survivorship L \ ~ .-1\
Date of Death Balance (Principal and Interest) $1 ,all. 34 \9 -
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000'.-94':
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Transfers within TWO YEARS Prior to Death
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Not Applicable
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That at the time of death there was no safe deposit box registered ih 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:-
THIS SA~'E DEPOSIT BOX RE~-;ED-- . I RELATIONSHIP OF JOINT
IN NAME OR NAMES OF ~LDERS TO DECEDENT
Ruth H. Faust or Cyril E. Fau~f Mother and SOl
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NAME AND ADDRESS OF BANK OR OTHER INSTITUTION
IN WHICH DECEDENT RENTED A SAFE DEPOSIT BOX
CamnOlwealth National Bank Shirernanstown
Pennsylvania
BENEFICIARIES
P.ELA TIONSHIP SURVIVED AGE OF LIFrr--
BENEFICIARIES AND ADDRESSES (If step-children or DECEDENT TENANTS OR INTEREST OF
(State full names of all and their addresses who have illegitimate children STATE YES ANNUITANTS BENEFICIARY
an interest, vested, contingent or otherwise, in estate.) are involved, set OR NO AT DEATH OF IN ESTATE
forth this fact.) DECEDENT
Cyril E. Faust Son Yes Adult 1/3
46 Center Drive
C amp Hi ll. Penn a.
Lruise Faust Daughter Yes Adult 1/3
112 West Main Street
ShirernanstGJIl , Penna.
Albert C. Faust Son Yes Adult I 1/3
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1390 Wynwood Drive I
RivertOl, New Jersey
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RESIDENT DECEDENT
DEBTS AND DEDt:'CTIONS CLAIMED
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NOTE: List first five items in the spaces so provided obseTve notations thereon and instructions
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DEBT OR CLAIM NATURE OF SAME AMOUNT THIS COLUMN
I KEGISTER ONLY
Funeral expenses paid $ 0:
...
: Family exemption (will not be allowed unless
decedent died residing with a spouse or children.)
Administration Expenses · I
Counsel fees · I
Fiduciary commission *
OTHER DEBTS AND CLAIMS I
I (*) See Note below
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Total
Note: The estate agl'ees to advise the Register of Wills if the amount actually paid in settlement of any fee, commission 01' debt is greater
or less than the estimated amount claimed and allowed.
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Subscnbed and sworn to before me this, . . of, T' . , , . . . . , . . . . .
""..,..','.... do, of/~tJ-;j" 1979,
......" do~. ,tJ'~AN1.;,R~~;; 'p,',","""""""
d ShiremJr.::!own, Cu",berland Cc., Pa.
l'l\y~ Expir~< <:opt A 1982
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. . .. . ~. ........ .............................
(Execu or~)
46 Cente r Drive
(Street Number)
.... ,., ,., . .<;:~I? ~t~.~" ?~~~~................
(City or Town and State)
Having been duly sworn according to law, I do hereby certify that the above appraisement is made in conformity with law on this
.... ,..... ... , ,. '" , ., .,. ,., ...... day of..., ..' ,.' ... ". , ,'" , " ,....,...,.....,.,..,19.....
ApprAiser
In the event that any futul'e interest in this estate is transfel'l'ed in possession or enjoyment to collateral heirs of the decedent aftel' the
expiration of any estate for life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transferinheri-
tance taxes at the lawful collateral rate on any such future interest,
REPORT OF THE REGISTER OF WILLS
I, the undersigned duly elected Register of Wills in and for. , , . . , . . . . , , ' . , . . . . , , . , . , . . . . . . , . . .. County, Pennsylvania, do respectfully
report that I have allowed debts and deductions in the amounts claimed by deponent, except as to those items where a greater or lesser amount
is set forth in the last column to the right in said schedule above, which greater or lesser amount represents the sum allowed as a deduction.
Dated: .,............,..............................
Register of Wills
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