HomeMy WebLinkAbout05-30-80
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REV-449 (8-78)
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF FIELD OPERATIONS
AMENDED SCHEDULE "A"
..
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; 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.)
Cumberland
} AFFIDAVIT OF
EXECUTOR
ADMINISTRATOR
IN THE MATTER OF THE ESTATE OF
Ruth A. Walsh
(STATE FULL NAME OF DECEDENT)
Late of
County
~XK1l<
Cumberland
David W. Brubaker
} n,
State of
Pennsylvania
County of
Executor
of the ",state of tho above-named decedent being duly sworn, depose S
and say S
(MONTH)
Name and address of attorney or }
other authorized represen,totive to whom
all correSflondence should be mailed.
(DAY)
, 1978
(YEAR)
testate leaving a last will, copy of which is hereto attached. }
)(I);K
Decedent died
December 18
Jyn F. LaFaver. Esquire
3 7 Third Street
New Cumberland. PA 17070
That as such Executor deponent is familiar with the affairs of said estate and the property constituting
( EXECUTOR-ADMINISTRATOR)
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
wi th 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 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 interes t 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 nll-ture, teft 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 corpcrations, 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, f'inancilll statements showing the assets and liabilities of said co-partnership or ~usiness.
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
pertaining 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 deat~
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 received 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. There 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 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 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 ppoof 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 an~ 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", "e", "E", and "F" as directed therein,
have been carried forward and properly registered in the Summary.
Subscribed and sworn to before me this .................................
................~.........r:!:..t!~.. ..... day of .. ..... ~...................... 19...~~Q......
--~~2;~~. __
My Commission b"ires Jill, 23. 1983
.... Cumllerland. PA CumbedIad COlIIIIt
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(Street Number)
I.9.W~.ng.g..:I.....p.8......J.a~.4~...........,...........................................................
(City or Town and St4te)
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.
H~ C;U (+-13'
(O~THOPtt~V~"A
DEPARTMENT OFR!VENl1E -
BUREAU OF COUN'tY COLLECTIONS
TRANSFER INHERITANCE TAX
RESIDENT DECIEDENT
~ .
AMENDfO -
SCHEDULE "An
REAL PROPERty
--
Real property in Pennsylvanio, with statement of mortgage encut'rtDt.ances upon each parcel at death of dece-
dent. Property held by the decedent as tenant .in common with 'another or other, should be identified
as to qUOntum of interest and the estimated value should be that ()fthe decedent's interest only. (Property
held as joint tenants with right of surviorship or tenancy by entire'fies should be reported on Schedule ClE.")
The real property located In the Common_alth of Pennsylvania should be
described by lot and block number, street and street number. together with
a general descriptiOn of the property, with a reference to the record of the
conveyance by whli!hthe decedent took title; If a farm state number of a-
cres; also statement-bf mortgage encumbrances upon each parcel at death
of decedent. Tax.s. assessments, accrued Interest on mortgages, etc..are
to be listed on Sch.eilvle "F" and must not be deducted from this schedule.
(1)
AsnSSED VALUE
"OR YEAR OF
DECEDENT'S
'DEA TH
ALL THAT CERTAIN piece or parcel of land situate
in the Borough of New Cumberland, Cumberland County,
Pennsylvania. Having thereon erected a single
dwelling house known as No. 1726 Warren Street,
New Cumberland, Pennsylvania. For a complete
description, see deed recorded in the Cumberland
County Recorder1s Office in Deed Book IIA", Volume 23,
Page 700 (current tax assessment is $5,050.00).
SOLD FOR --
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.
(2)
(3)
DEPARTMENT
VALUATION
CAUTION
(Do not writ.
In this spoce)
ESTIMA TED
MARKET VALUE
36,000.00
36,000.00
.::, .,: ../(
REV-449 (8-78)
c2/- 7&-4:6:.)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF FIELD OPERATIONS
Ar.1BNDEO SCHEDULE "A"
..
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; Return is due within nine months after date of death, unless an extension is granted
by the'Secretary of Rellenue. (Section 703 of the Inheritance and Estate Tax Act of 1961.)
Lote of
Cumberland
} AFFIDAVIT OF
EXECUTOR
ADMINISTRATOR
County
IN THE MATTER OF THE ESTATE OF
Ruth A. Walsh
(STATE FULL NAME OF DECEDENT)
Stote of
Pennsylvania
County of
Cumberland
David W. Brubaker
} ."
Executor
XAIld(M~
.of the estote of th.. above-named decedent being duly sworn. deposeS
and sayS
(MONTH)
Home and address of attorney or }
other authorized representative to whom
all carres.pondence should be mailed.
(DAY)
, 197(j
(YEAR)
testate leaving a last will, copy of which is hereta attached. }
. ..~t<
Decedent died
December 18
Jon F. LaFaver, Esquire
317 Third Street
New Cumberland. PA 17070
That as such Executor deponent is familiar with the affairs of said estate and the property constituting
(EXECUTOR-ADMINISTRA 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 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
wi th 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 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 interes t 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 promis sory 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.
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,,,.: C-34 '(4.73)
~OMMOM1ft!ALTH-O'~"V"'.A
DEPARTMENT OF itlVENUE
BUREAU OF COUNTY COLLECTIONS
TRANSFER INHERITANCE TAX
RESIDEN,r DECEP.ENT
AME:NO~fY'-
SCHEDULE "An
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 cine"'er or other, should be identified
as to quantum of interest and the estimated value should be thalbi the decedent's interest only. (Property
held as joint tenants with right of surviorship or tenancy by entir-eties should be reported on Schedule "E.")
The real property located In the Common_alth of Pennsylvania should be
described by lotcm-dblack nUl11ber, street and street number, together with
a general descr4p'tldi'l of the property, with a reference to the record of the
conveyance by which the decedent took title; If a farm state number of a-
cres; also statement of mortgage encumbrances upon each parcel at death
of decedent. Taxes, assessments, accrued Interest on mortgages, etc.,are
to be listed on Schedule "F" and must not be deducted from this schedule.
(1)
(2)
(3)
DEPARTMENT
VALUATION
CAUTION
(Do nllt write
In this space)
ASUSSED VALUE
j:OR YEAR OF
OECEDENT'S
'DE A TH
ESTIMA TED
MARKET VALUE
ALL THAT CERTAIN piece or parcel of land situate
in the Borough of New Cumberland, Cumberland County,
Pennsylvania. Having thereon erected a single
dwelling house known as No. 1726 Harren Street,
New Cumberland, Pennsylvania. For a complete
description, see deed recorded in the Cumberland
County Recorder's Office in Deed Book "All, Volume 23,
Page 700 (current tax assessment is $5,050.00).
SOLD FOR --
36,000.00
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.
36,000.00
Form RC C .10
OF
Cumberland
COUNTY
,;2/- '78'-~f?S
STATEMENT OF DEBTS
AND DEDUCTIONS
DEDUCTIONS ALLOWED IN
OFFICE OF THE
REGI9TER OF" WILLS
DATE OF FILING APPRAISEMENT J IJ ~ I) ID t-tv OAT&: OF DEATH December 18. 1978
( / T
'"
OAT!: NO. OF' NAM&: OF PAYEE REMARKS AMOUNT
YOUCHE"
Register of Wills Letters & Certificates 40 00
UGI Gas service 461 27
Gil bert W. Parthemore Funeral Hon e Funeral Expenses 2,285115
FHN Associates Professional Services 58 60
Bell of PA Telephone Service 25 73
William H. & Dorothy N. Brubaker Reimbursement for Expenses 119 50
RCWCO Water Service 23 55
The Patriot-News Legal Advertising 20 25
PP&L Electric Service 74 33
Cumberland Law Journal Legal Advertising 18 00
Surgery Inc. Profess iona 1 Services 45 38
Holy Spirit Hospital Professional Services 19 40
The Patriot-News Advertising sale of real estate 22 40
Borough of New Cumberland Sewer & trash 32 00
Family Physician Associates Professional Services 30 00
David W. Brubaker Executor's expenses 15 00
Claude C. Wolfe . J;<elrill upement lor CO~tS aava~feq wr ate 200 15
oalntlng, c eanlng maln enance 0 rea es
Edith Seipe, Tax Collector Real estate taxes 518 14
William H. Brubaker Lawn maintenance 42 00
Register of Wills Filing Fees 6 00
U.S.F.&G. Insurance Company Fire insurance premium 117 00
C. M. Det~*i6:~d~eaTtor Realtor's commlSSlon 2,Oi:::U uu -
1 % Transfer Tax 360 00
X~n F. LaFav5r~ Tsqulre ke~al Fe~ ~'~1& U
Ivid W. Bru a er x cutor s Fee
Register of Wills Filing Account 75 00
ESTATE OF
THE SUM OF ............ $1(,.?~uZ. {3
..........~...I~&Q
AND AGENT OF THE COMMONW&:ALTH
COMMONWEALTH OF PENNSYLV....NI.... I
COUNTY OF /!;./--"" /1..f./r~/2 '" r/ J..:
I, David W. Brubaker
/ I, 7 (p 7. 13
SIIUftfte M. ........, "otary PIWic
M, CoauIIission Ix,ir.. JIll. 23, 1983
... c.nIlerIand, M CumIIetItM COUIlIy
/ / - /"f-71
'. 'p.+. -- .
REV-449 (8-78)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU ^"!7 'l:'T~l.D f)PF.'RATIO~S
'*
:;2/- 7f'-h8S-
RESIDENT DECEDENT
-"'-.,1 -..J
COUNTY OF
Cumberland
IMPORTANT:
This return must be completed in detail and filed in duplicate, with all attached, with the Register of Wills of the
County where decedent resided; Return is due within nine months after date of death, unless an extension is granted
by the Secretary of Re~enue. (Section 703 of the Inheritance and Estate Tax Act of 1961.)
Lete of
Cumberland
} AFFIDAVIT OF
EXECUTOR
County m<<Mt$tW-Xll
IN THE MATTER OF THE ESTATE OF
Ruth A. Walsh
(STATE FULL NAME OF DECEDENT)
State of
Pennsylvania
County of
Cumberland
David W. Brubaker
}"
DW~~&
Executor
of the estote of the obove.named decedent being duly sworn, deposes
and say S
Decedent died Dpc~mhpr
(MONTH)
Nom. and addre.. of attorney or }
ath.r authorized r.pr....n.totiv. to whom
all carr..flondenc. should be mail.d.
lR
(DAY)
, 1~ t..tat. leaving a last will, copy of which i. h.r.to attoched. }
~i)(l)(~t)(
Jon F. LaFaver. E~quirp
317 Third Street
Npw r.lJmhprli'lnr1, PA 17070
That as such FXPclltnr deponent is familiar with the affairs of said estate and the property constituting
(EXECUTOR-ADMINISTRA 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 SAFE DEPOSIT BOX IN NAME OR NAMES OF HOL<lERS TO DECEDENT
That the contents of said safe deposit box or boxes are itemized under Schedules
wi th 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 a~ 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 interes t 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 owne.d at the time of deat&;
all wearing apparel, jewelry, silverware, pictures, books, works of art, househ'old furniture, horses, 'c~rriages,
automobiles, boats, and any and all other personal chattels of whatsoever kind or nature, teft by.4ecedent,
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 promis sory 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.
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..
RC C-34 (4-'3)
COMMONWEAL TH OF PENl'iSYLVAN'A
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "Au
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 another 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 liE.")
The real property located In the Commonwealth of Pennsylvania should be
described by lot and block number, street and street number, together with
a general description of the property, with 0 reference to the record of the
conveyance by which the decedent took title; If 0 form state number of a-
cres; also statement of mortgage encumbrances upon each parcel at death
of decedent. Taxes, assessments, accrued Interest on mortgages, etc.,are
to be listed on Schedule "F" and must not be deducted from this schedule.
(1)
(2)
(3)
DEPARTMENT
VALUATION
CAUTION
(Do not write
In this space)
ASSESSED VALUE
FOR YEAR OF
DECEDENT'S
DEATH
ESTIMA TED
MARKET VALUE
ALL THAT CERTAIN piece or parcel of land situate
in the Borough of New Cumberland, Cumberland County
Pennsylvania. Having thereon erected a single
dwelling house known as No. 1726 Warren Street,
New Cumberland, Pennsylvania. For a complete
description, see deed recorded in the Cumberland
County Recorder's Office in Deed Book "A",
Volume 23~ ~ge 700 (current tax assessment is
$5,050.001{:'
~-: oS-o,
35,000.00
Insert this total opposite "real property", Schedule "A" in the X X X X X
II As Reported" column on the last page of this return.
35,000.00
f .3 S- o-H), tKl
-; ~
R>E V-4151 (8'-78)
RESIDENT DECEDENT
SCHEDULE "8"
PERSONAL PROPERTY
-*
COMMONWEAL TH 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 liE". 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 tentative trust accounts, must be listed, despite
the fact that they are not of the adminis tered estate.
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 payable to the estate or
fiduciary 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 HEM UNIT ESTIMA TED DEPARTMENT
No. List and describe fully VALUE MARKET V ALUA nON
VALUE (Do not write in
this space)
1. Household furnishings sold for $1,494.96 1,494.96
2. CCNB Bank, N. A., checking account No. 930-744-8 753.71
3. CCNB Bank, N. A. , savings account No. 001-007597-6 8, 1 34 . 1 9) v ~3'11..!>""'/
Ins ert thi s total opposite "Personal Property", Schedule "B" in XX 1 0 , 382 . 86 f/ 1f1 lPJ...I./'
the "As Reported" column on the las t page of this return. ~
RCC-36
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
SCHEDULE "c"
TRA.NSFERS
'*
RESIDENT DECEDENT
(1) Did decedent, within two years of death, make any transfer of any material part of his estate, without
receiving a valuable and adequate consideration therefor? (Answer yes or no)
(2) Did decedent, within two years of death, transfer property from himself to himself and another or
others (including a spouse) in joint ownership? (Answer yes or no)
(3) If the answer to (1) or (2) above is in the affirmative state:
(a) Age of decedent at time of transfer
(b) State of decedent's health at time of making the transfer. (Note 1).
(c) Cause of decedent's death. (Note 1).
(4) Did decedent, in his lifetime, 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)__
(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 before his death:
(a) The possession or enjoyment of or the right to income from the property transferred?
(Answer yes or no)
(b) The right to designate the persons who shall possess or enjoy the property transferred or
income therefrom? (Answer yes or 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)
(8) Did decedent, at any time, transfer property, the beneficial enjoyment of which was subject to change,
because of a reserved power to alter, amend, or revoke, or which could revert to decedent under terms
of transfer or by operation of law? (Answer yes or no)
(9) If the answer to (8) above is in the affirmative, 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)
NOTE 1: The answers to these questions should be supported by affidavit by the attending physician as
well as a copy of 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 and to whom transferred, with
relationship of transferees to decedent, if 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 applicable property below in manner in which provided in Schedules A, B, or E.
ITEM
DESCRIPTION
MARKET VALUE
(Es tima ted)
DEPT. VALUATION
(Dept. Only)
NONE
Mnr..u
Insert this total opposite "Transfers", Schedule "C" in the
"As Reported" column on the last page of this return.
~
-4J1t
RCC-37 (12":63)
COMMONWEALTH OF PENNSYYLANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "D"
BENEFICIARIES
\
h
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
David W. Brubaker Qrandson Yes Adult Jne-sixth fl/6) rpsidue
50 Hillcrest Drive,
R. D. 1, Box 70 -
Towanda, PA 18848
Jul ian C. Brubaker orand son Yes AdlJlt bnf)-sivth (1 n:;) rp(ddlU~
570 Walnut Street
Columbia. PA 17512
Will iam H. Brubaker Qrandson Yes Adult Jne-sixth fl/6) residue
-
R. D. 2, Box 330
--
Hal ifax, PA 17032 I
! <--
Aanes Marie Brubaker dauQhter Yes Adult One-half (1/2) resid~~___
Trinity House, Apartment #809 i(Held in trust by
--~-
400 Mill Street David W. Brubaker, Trust
Columbia, PA 17512 -----
,
._--
-
eel
Deponent further says that all the above-named beneficiaries are living at this time except below:
NAME
DATE OF DEATH
RESIDENCE
""
o .
...."'....
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~: =
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..... ~ ='
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~ S u
~ 0:
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o ~
............
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u ;::l 0
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f:! ~
SUMMARY
Real Property ...................................................... .........(Sch. "A")
Personal Property ............................. ..................................... (Sch. "B")
Transfers ................ .................................... .............................. (Sch. "C")
Gross Taxable Estate
( 1)
(As Reported)
$..3.5:.000.00
$.. ... 1.0 s.3.8Z...S6.. .
$..............
$.....
$...................
$..4~.,}8.?~8.6.
(2)
(As Determined)
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R C C-3B
RESIDENT DECEDENT
SCHEDULE" E"
JOINTL Y OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
INSTRUCTIONS: This schedule must disclose all property, real 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 tmder Schedule
"A", plus the date and 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 "B", plus date of acquisition, and the name, address and relationship (if any) of co-owners to
the decedent.
Description of Property, Date of Acquisi tion, Name uni t percentage Estate
Address and Relationship of Co-Owners, and Place Value Share Valuation
of Record of Instrument, where Real Estate.
DEPARTMENT VALUATION
CAUTION-Do not Write
In This' ace.
Value of
Entire
Property
. alue of
Decedent's
Interest
1. At the time of her death, decedent owned
approximately 63 shares of Keystone
Custodian Funds, Inc. B-1, approximately
103 shares of Keystone Custodian Fund B-2,
and approximately 127 shares of Keystone
Custodian Fund K-l, all as Trustee for
Agnes Marie Brubaker under a Declaration
of Trust dated August 17, 1962. It is
the Executor's determination that these
funds held in trust are not subject to
Pennsylvania Inheritance Tax.
Insert this total opposite "Jointly Owned Property", Schedule "E"
in the "As Reported" column on the last page of this return.
N.nu.J
~IL
RE V-484 (8-78)
County, Number and Name
(21) Cumberland
SUMMARY
File Number
Date of Death
Estate Name
21 78 0685
12-18-78
Walsh Ruth
(LAST NAME)
(FIRST NAME)
(INITIAL)
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
A.
REPORT OF INHERITANCE TAX APPRAISER
I, the undersigned duly appointed Inheritance Tax Appraiser in and for the County of ~llmhp-l"'] and
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", and" E".
Da ted:
11 December 1979
$J,.AA JI1 ) If il.Jr (J )( J )
INHERITANCE TAX APPRAISER
REPORT OF THE REGISTER OF WILLS
I, the undersigned duly elected Register of Wills in and for County, Pennsylvania, do respect-
fully report that I have allowed 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 Schedule "F", which greater or lesser amount represents the sum
allowed as a deduction.
Dated:
REGISTER OF WILLS
ADJUSTMENTS
INVENTORY VALUE AS APPRAISED ~ODE (HARRISBURG USE ONLY) REMAINDER APPRAISEMENT CODE
Real Property (Schedule A) $ 3" noo 00 00+ 92+
Personal Property (Schedule B) ,n h')R , R 10+
Joint-Held Property (Schedule E) N',.,TlA 20+
Transfers (Schedule C) lIT,.,TI... 30+
TOTAL GROSS ASSETS ~111:\ h?R , R
Less Debts and Deductions 40- 93-
(SCHEDULE F)
CLEAR VALUE OF ESTATE
Valuation of life estates or
~
PRINCIPLE
FACTOR
VALUE
CODE
I
ESTATE TAX ASSESSMENTS _ $
t=
t=
annuitles....................._ $
FOR USE OF REGISTER ONLY
Tax on $
Tax on $
Tax on $
Tax on $
Tax on $
Exemptions
Total Estate
~
COMPUTATION OF TAX
$
$
$
$
$
2%
6%
15%
*
TOTAL TAX
$
(*) As evidenced by Charitable
Exemption Certificates issued
by the Secretary of Revenue.
l=
Less tax previously pa 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
BALANCE DUE
Add interest at rate of 6% from
to
~
$
c
$
$
$
$
TOTAL TAX BALANCE $
PAID $
Supplemental Cddes: (FOR USE IN HARRISBURG ONL Y)
48-Adi ustment
49 +Ad j'u stment
56-Annuity
6O-Life Estate
92+Remainder Appraisal
93-Remainder Deduction
93C-Charity
94-Remainder Residue
96-Success i ve
Life Estate
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. "
REV-518 (3-79)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF FIELD OPERATIONS
P. O. BOX 2970
HARRISBURG
17105
IN YOUR REPLY PLEASE
REFER TO
I nvestigation Division
NOTICE OF FILING OF APPRAISEMENT
David W. Brubaker
50 Hillcrest Drive, Box 70
Towanda PA 18848
(Executor or Administrator)
In Re: Estate of
Ruth A. Walsh
Cumberland
County-FileNo. 21-78-0685
Dear
You are hereby notified that the OT'igina1
appraisement in the estate of RuthA. Walsh
has been filed in the office of the Register of Wills of Cumberland
County on "np.~p.mhp.T' ,19-2.9- Said appraisement reflects the following valuations:
Real Estate
Personal Property
Transfers
Jointly Owned
Total
$35tooo.nn
10,628.,.18
None
None
$45,628.18
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
11 December 1979
Signed ~M.J d } 'II./-I'.J, iiJ1 ~)
Title
Chic f .^.pppais8P
NOTE: This is not a bill.
REV-457 (8.78)
DEPARTMENT OF REVENUE
BUREAU OF FIELD OPERATIONS
P.O. BOX 2970
HARRISBURG, PENNA. 17105
COMMONWEALTH OF PENNSYLVANIA
RESIDENT INHERITANCE TAX
APPRAISEMENT
DATE 11 De c e m b e r 1 9 7 9
-
COUNTY ...cumberJ,s,n.9__.,
FILENO. 21...78-0685
Whereas, Ruth A. Walsh _ late of New Cumber-Ian d _~~.__
in the County of Cumberland Commonwealth of Pennsylvania, having d;l~d 0,
the 18th day of,-__~~,&mber 19..z.a.., seized and possessed of an €Slaie
subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania;
Therefore, I, Glori a Ri chard , an appraiser duly appointed according to 1:11!,
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 exp'",'",,,
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 coi!.,! ral
rate on any such future interest.
DESCRIPTION OF ASSET UNIT Apprais(~l1lent
VALUES Made for Inll~ritance
Tax Purp;,)ses
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~"".::o' r_+..+.... $ ~" n n n 1..o..cL-
t
P"""""'nn",1 - 10.628118
I
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Have been duly sworn accQrding to law, I do hereby certifY. that the above appraisement is made in con:(pgmity
with the law on this 11th day of lJecember 19 ~. ,
fl/~//2 J/f/~~'~klj
Appraiser
Hb~.
(Number and Street)
(Post Office)
Penn L
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