HomeMy WebLinkAboutOC1969-0436 - ESTATE OF HLUBEN•·:-
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RCC·39 (5-68) .,,
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
' '
SUMMARY
Estate of H1uben
(Last Name)
John
(First Name)
DATE OF DEATH 3-23-69 FILE NO. 63-69-436
(Initial)
REPORT OF INHERITANCE TAX APPRAISER
I, the undersigned duly appointed Inheritance Tax Appraiser in and for the County of Washington
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".
Dated: _ _,1=2=---=1=1-_7"-'0=-------
REPORT OF THE REGISTER OF WILLS
I, the undersigned duly elected Register of Wills in and for l'lashington County, Pennsylvania, do respect-
fully report that I have allowed deductions in the amounts claimed by d~ponent, 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 u a deduct;on, ~~ -~~ _
Dated: 12-11-70 ~~ 1~ROFWILLS
INVENTORY VALUE AS REPORTED VALUE AS APPRAISED
Real Property (Schedule A)
Personal Property (Schedule B)
Transfers (Schedule C)
Joint-Held Property (Schedule E)
TOTAL GROSS ASSETS
Less Debts and Deductions
(SCHEDULE F)
CLEAR VALUE OF ESTATE
Valuation of life estates or
$ l 0. 1)00 OD $
1 ')C::. nn
10.625 00
annuities . . . . . . . . . . . . . . . . . . . $-------4--
ESTATE TAX ASSESSMENTS $ ______ J____
10./)00 10
121) 00
10,625 00
4.662 BO
l),q62 flO
FOR USE OF REGISTER ONLY COMPUTATION OF TAX
Tax on $ -------::-~d~=--2%
Tax on$ 5. 962 70 @
Tax on $ ----------+---5%
Tax on $ ----------+--10%
Tax on$ 15%
$--------~~~~-$~--~3~517J.--+.L:7',6~
$-------------4----$ ____________ -4----
$ ____________ -4----
VALUE AS REAPPRAISED
$ ____________ -+---
·, ,.
~~pti~s *
Total Estate _______ --4----
TOTAL TAX $------------~----
(*) As evidenced by Charitable
Exemption Certificates issued
by the Secretary of Revenue.
Less tax previously paid $=======ll===
BALANCE $----------+---
Less 5% of tax if paid within
3 months after death $=====~===
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
---------~'0-----$-----------4---
TOTAL TAX BALANCE $ -----------l----
p AID $ -----------~----
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.
Will
Administration t No.
IN THE
Year ........... .
MATTER OF THE APPRAISEMENT
OF THE
ESTATE OF
.....
Deceased
Late of
County of
Commonwealth of Pennsylvania
REPORT AND APPRAISAL
..
I
..
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I
Fonn RCC-2 . ~ .. COMMONWEALTH -OF PENNSYLVANIA DATE ............ D~~G.~mJt~.f~ .... .l..l..~ ...... J.:.2.7.9. .......
DEPARTMENT OF REVENUE RESIDENT INHERITl\NCE TAX ........... W.?.:~h.~:t:Jg~9~ .. ,~ ............................. bF COUNTY COUNTY BUREAU COLLECTIONS ..
HARRISBURG, PENNA. 1712 7 APPRAISEMENT FILE NO. 63-69-436 .............................................................................................
Whereas, .................................. John ... Hlub.e.n ............................................................................... late of .............. N.!! .... ~.Y..J;9.:q~.~ .... ~~.~ ............................ ...........
in the County of .................................................... Y:l:9:.~.hJpgY..9.:rl: .................................................. Commonwealth of Pennsylvania, having died on
the ................................... ?..3..4 .................................................. day of .......... ~~!..~.J:l ................................................... 69 19 ............ , seized and possessed of an estate
subject to Inheritance Tax under the laws of the Commonwealth of Pennsylvania;
Therefore, I, ................................... W .• R. •. CHA..NE.X ............................................................... , 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 Appraisement Description of Asset Values Made for Inheritance Tax Purpoees
$
REALTY:
See COPY of schedule "A" attached to aupraisement 10,500 00 .
PERSONAL:
See COPY of schedule "B" attached to appraisement 125 00
TOTAL 10.625 00
.
''" '· 0 ...
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form~;·:~hb:: ::~h~sw<>rD ~· ~.~ .~~~~ ci~ ~~~r.~":~~~ti:;:;g~:
A pratser
.......................................................................................................... ........................................................
,.:: ( Ku!"ber and Street)
Penna. ........... 4).~ .......................................... ,
(Poat Office)
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Washington County
RESIDENT INHERITANCE _TAX APPRAISEMENT
Estate of
JQH HLUBEN. .....
Deceased.
Late of
....... . ............. N •.... STRABANE ... TlVO.P. •.................................
Date of Death, ...... : ... 3~.~3.~.9.9 ........... .' .................... .' ........ .
Appraisemel!t Docket Vol., ......... .3..7 ................................... ..
Page, ........... ?..94~~3... ...... , ..... No ......... ~?.::-::.~9.~4.?~ ...... .
Filed in Register's Office, .' ... P.E?..~.~ ... .J...:I,. ....... J9.79 .. .
Amount of tax due, $ ................................................................... .
DEPARTMENT OF REVENUE
Received,
Examined and Approved,
Wrote abo.ut Appra.isement,
Appeal f1'om Appraisement,
:! Entered "and charged, •
Form RCC-33
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RESIDENT DECEDENT
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENIT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
COUNTY OF WASHINGTON
IMPORTANT: This return must be completed in detai.l and filed in duplicate, ·with will attached, with the·
Register of Wills of the County where decedent resided; Return is due within one year after
date ~f death, unless an extension is granted. by the Secretary of Revenue. (Section 703 of
the Inheritance and Estate Tax Act of 1961.)
IN THE MATTER OF THE ESTATE OF } AFFIDAVIT OF
::-~.-::~~~=::~~~~~~::~::::~ ==-
::.:· ~ ;::::~~:::~:-::::~:=-:=}"'
....................................... ~X ..... ~9..Y.~~------~P.9. ..... ~:f:.. ----~9..~§~ ........................................................... .. I Eeeutor
of the estate of the above-named decedent being duly sworn, depose and say
Decedent dJed ....................................... ~Ci.~.9..h .. .
(Month)
Name and address of attorney or}
other authorized representative to
whom all correspondence should be
mailed.
~E:!()l:'9E:! .. .:f. ... M:9¢l:t'Cl.~, .. _ bt..t.9.:r::.D..~Y .... ~.t ..... ~-~W.: ..... . . ........................... .
22 N •. Q~:q:t::r::~l ~Y~IJ1l~. GCJ:J:l9.P~PlJ.J::'9,.J?..~ .. J.,;i~JZ ................................ ..
That as such ~.~~9..Y.:~.fJ.9..~.~ ............ deponent is J'amiliar with the affairs of said estate and the property con-
e Executor-Administrator)
stituting the assets thereof and their fair market value.
That at the time of death there was no safe deposit box registered in decedent's mdividual name, or jointly
with, or as agent or deputy of another, or in decedemt'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
IN WHICH DECEDENT RENTED A SAFE DEPOSIT BOX
NONE
THIS SAFE DEPOSiT BOX RENTED
IN NAME OR NAMES OF RELATIONSHIP OF JOINT HOLDERS TO DECEDENT
That the contents of said safe deposit box or bo-xes are itemized under Schedules ___ of 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 full v 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 8 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 in-. \ . debtedness of _!;he.Un!,ted S.t!ites t_o. t~e decedent; all ·obl~g~tions, 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 de!l ~h; all_~wea~~~g. appa~el, jewelry, silverware, pic-
tures, books, ~.~orks.-\.of .a.:r;.t, household furniture, horses, carr~ages, automobi
1
les, bo!lts, and any and all
other personal chattels of whatsoever kind or nature, left bydecedent, ·together with the fairly estimated,
J ~ ,. • t i ; . ."-~ -g • • .... l . market value thereof; all bonds and mortgages held by deeedent and of all claims due and owing decedent .. .
at the time of death, and all promissory notes or other instruments in writing for th~ payment of money
of which decedent "died pos·sess~d, of whatsoever nature, with interest thereon, if any, giving the race
! 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 i tern; all moneys payable
to t'he estate from life insurance polici-es carried by decedent; all annuity and endowment contracts the
proceeds of which were payable upon the death of the decedent; and all the corporate. stocks and dividends
due thereori and unpaid as of the date of death, bonds and accrued interest thereon to the date of dece-
dent's death and other investment securities owned by the decedent at the time of death, with the market
value thereof at such time.
j
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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 char~cter of the business, it~'focation, a~d s·u~h 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 shou1d also set forth in itemized form, together wi·th the fa'ir m~rket 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 fprth a true answer to each inquiry
contained therein and in the case of transfers ofproperty, 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 pature regarding s.aid transfers •.. In the case of transfers intended to
~ ~ .. ~ ... J '0 ·. take effec·t in possession or enjoyment at or after death, there is also attached to the schedule a co-py
of the deed, ·trust ·agreement· or other instrumen't creating the trust. Ther1~ 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 D 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, andthe 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 applicabl~.; costs of administration of this estate; counsel fees and f'udiciary' s
commissio~s 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 tmpaid 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 proof of said clafmed obligations upon re-
quest, that if the amount actually paid in settlement of any fee, commission or debt is less than the
estimated amount clai~ing 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 Schedules "A", "B", "C", "E", and "F" as directed therein,
have been carried forward and properly registered in the Summary.
ttl
Subscribed and sworn to before me this ..... <:6.£ ...... :::.
-----·--·~ day of .7lt'~!:.~ .. 19 • .?.9 .. .
.... _ ....................................... lf2t ... 9: ........ ~ ....................... .. ~E~E J. MODRAK. Notary Public
Canonsburg, Wast! ington Co .• Pa.
~Y Commission Expires May 14, 1972
(Executor-lbl~)
.. %. .... :?..7. ..... N.! ...... G~.n.t.~.9,l .. itY.~.P.:Y.~ ................................ -..
(Street Number)
.......... G~2.~.~:l.?.~.~-9.« ..... J?..~.! ...... !.?..~ .. !.7.. ................................ .
(City or Town and State)
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.
__ j
FORll£ NALI: No. 112-S WILL
II JOHN HLUBEN
of N. Strabane Township
and State of . Pennsylvania
For Sale by P. 0. Naly Company, Prlhtera & Publlslters Uo O.rant Street, l:'lttsburgh, Pa.
, County of· Washington
being of sound mind and memory~ do hereby make,
publi3h and declare this to be my Last Will and Testament, in manner and fo1"11i following, hereby
revoking any will or wills heretofore made by me.
First. I direct that an my just debts and funeral ·expenses be fully paid and sati3fied, as soon
as conveniently may be, after my decease,
' Second. I give, bequeath and devise, all of my estate, real, per-
··• sonal and mixed, to the following: To my beloved daughter, Mary Novak-,
a one.,fourth (1/4) interest; to my beloved daughter, Martha Mathia, a
one-fourth (1/4) interest; to my beloved daughter, .Anna Koneski, a one-
fourth (1/4) interest; and, the remaining one-fourth (1/4) interest' to
my two .be-loved ~randchildren, Richard Hluben and Paul Hluben, share and
share. alike. --------------------------------~----------------------~
/
& • .,
. ;
-~~r~v-~~i~.,.~~~rr-~:·--. ·~~-.....,_.....-._...-,_.,.,.~.-. ~.-.... _.,.,.·~·~-~--~-,... .. -... --~·~-..,.,...,.,~~-"""":'"~-~---.,-.--·-":'"-~~,_....,....... _ _:.....,..~..,.~_ .. ,........~., .. ~"'""-·-.. ..,.,._~"'"..,.,"".~~ ..... ,.--.~ -~---------~
·:~~~
(do-: hereby make, constitute and appoint", my two beloved daughters, Mary_ Novak¢
and Anna Koneski,
_to be my e~~cu~~s of this my Last Will and Testam~nt ; tilHX sbal ~-9al§o b~ the t~starii·e:ntaty gu8:rdians of the estates, of any mino4f:$a{if.~Hg '-la~i,r respec-
tive minoriti-es.
',
lin ~ithtSS [[lbeteof, I, JOHN HLUBEN the Testator
above namedi1ve hereunto subscribed "'Y name and affia;ed my seal, the / :.'3 .~
day of //Urn the year of our Lord <me thousand nine hundred and sixty-four
c 19 64) . : -~ a_ -<?_l£~~~-----2-!::i.h.d:~:::::: __ ~------~-~n .n.LUuen ~
Signed, sealed, published and declared by the above named · JOHN HLUBEN
i'as and for his La.st Will and Testament
in the presence of us, who have hereunto sHbscribedour names at his request as witnesses
ther~unto, in the presence of said testator
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RCC-,34 (l-64) •
·COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
.BUREAU OF COUNTY COLLECTIONS
TRANSFER' INHERITANCE TAX
RESIDENT DECEQENT
SCHEDULE 11A"
REAL PROPERTY
Real property in Pennsylvania, with statement of mortgage encumbrances upon each parcel at death of dece-
dent. Where property held as joint tenant or tena1.1cy by entireties, report on Schedule "E". Property held by
the decedent as tenant in common with another or others, should be identified as to quantum of interest and
the estimated value should be that of the decedent's interest only.
The real property located In the Commonwealth of Pennsylvania should be
described by lot and block number, street and street number, toget.her wl th
a general description 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 •Jt death
of decedent. Taxes, assessments, accrued lnter<!lst on mortgages, etc.,are
to be listed an Schedule" F" and must not be deducted from this schedule.
ALL those certain three (3) lots of
ground together with the improvements
erected thereon, situate in North Strabane
Township, Washington County, Pennsylvania,
being known and designated as Lots Nos. 361,
362 and 363 in a plan of lots laid out by
the Alexander Land Company, and recor:ded in
4 the Recorder's Office in said Washington
County in Plan Book 3, page 18, and being
together bounded and described in deed from
Mary Novak and Anna Koneski, Executrices of
the Estate of John Hluben, to Richax:·d A.
Hilderbrand and Rosalie E. Hilderbrand, his
wife, by deed dated October 24, 197~ ~/
record in D. B. Vol. I?;J!l, page ,2!J_k:.._,
Washington County Records.
Having erected thereon a one story frame
house and garage. Sale Price $10,500.00
(1)
ASSESSED VALUE
FOR YEAR OF
DECEDENT'S
DEATH
Insert this total opposite 11real property", Schedule "A" iln the X X X X X
"As Reported" column on the last page of this return.
(2) (3)
DEPARTMENT
VALUATION
ESTIMATED CAUTION MARKET VALUE (Do not write
In this space)
10,500.00 /4oOo.OO
RCC-35 ·
COMMONWEALTH OF PENNSYLVANIA
'tRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "B"
PERSONAL PROPERTY
INSTRUCTIONS: This Schedule must disclose all tangibleandintangible 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 adlministered 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 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.
1
2
ITEM
List and describe fully
1957' Pontiac Sedan, junked
One lot of old furniture mostly given
away (few old family pictures and
remembrances distributed among children)
Insert this total opposite "Personal Property", Schedule "B" in
the "As Reported" column on the last page of this return.
UNIT
VALUE
ESTIMATED
MARKET VALUE
$ 25.00
DEPARTMENT VALUATION
(Do not write in
£) ,. this 1 space)
1oo.oo ~oo.od
X X $ 125.00
(
/~~-Oc)
ROC-36
cm-~r0N'I'K\LTH OF PENNSYLVANIA
TlUNSFER INHERITANCE TAX
~~SIDENT DECEDENT
SCHEDULE "C"
TRA . .t<SFEilS
(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
NONE
Insert this total opposite "Transfers", Schedule "C" in the
"As Reported" column on the last page of this return.
MARKET VALUE
(Estimated) DEPT. VALUATION
(Dept. Only)
. ,
RCC-38 .
CCMMuNWFALTH"OF PENNSYLVANIA
THAN~FEH TNHERI TANCE TAX
HFSIDENT DECEDENT
SCHEDULE "E"
JOINTLY OWNED PROPERTY
nSTRt"CTIO~S: 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 est~te first, as entireties, or joint tenants., giving brief description, as indicated tmder Schedule
"A", pJ,us 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 a~quisition, and the name, address and relatiemship (if any) of co-owners to
t.he riecedent.
percentage
Share
Estate
Valuation
Insert this total opposite "Jointly .Owned Property", Schedule "E"
in the "As Reported" column on the Jast page of this return.
DEPARTMENT VALUATION
CAUTION-Do not Write
In This Space.
Value of
Entire
Property
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Value of
Decedent's
Interest
.
Form RC C·lO • l l • DEDUCTIO~S 'AL~OWEO IN J
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QFFICI! OF THE
REGISTER OF WILLS STATEMENT OF DEBTS
AND DEDUCTIONS
THE SUM OF • . . . . . . . . . . . $ t}:LlJ.Jc:
omo;;;:a~=
Register of Wills, Agent
OF WASHINGTON
AND AGENT OF THE COMMONWEALTH
63.6
COUNTY
DATE OF FILING APPRAISEMENT ---------DAT5 OF DEATH _ _.Mt.:.!.k!oa.r.looC""-h"---"2,._,3J-4-f --o!.l...t.9.!o6!..o9~----
DATE NO. OF
VOUCH~ii;Jt NAME OF PAYEE REMARKS
gas bill
CC>·lumbia Gas Of Penna. advanced by Mary Novak
electric bill ~est Penn Power co. advanced by Mary Novak
sewer bill
Citizens Water co. advanced bv Marv Novak
water bill
Citizens Water Co. advanced by_Ma~y Novak
lot, grave openinq .and St. Patrick Church & Cemeterty .tune~,al ~Sjerv~ces 1\0v.oy
............. x '"~"' v """" advanced by
Yoney Funeral Home funeral serviee1 Marv Nova
telephone bill , Bell Telephone co. advanced by Mary Novak
'
1969 Rd ,Light & School Tax s Joseph A. Kern I advance~ by Mary Novak
~969 County Tax
Malcolm L. Morgan advanced by Mary Novak
Est. share of 1970 taxes pai~ by First Fed. s. & L. Ass• •
legal advt. Washiriqton County Reports [advanced bv Georqe J. Modrak
legal advt.
The Daily Notes advanced b_y.George J. Modrak
putt~ng grass & keep~ng out-
Joseoh Novak · ~ide of house _p_resEmtable fo""
sale. \4-.L-o9 to 10-24-70)
IMarv Novak k.eenina' inside of house c 1Pa1
and-presentable for sale
(4-1~69 ·to 10-24-7~
Georqe J. Modrak preparinq Aqreement
AMOUNT
167 04
'
43, 70
:· ...
9 35
5 46:
100 00 .. . '
1.404 00
13 80
~ ' 95 26
26 14
'" 109 03
14 loo
·, I 12 50
200 00
~-----~--+---+G~e~o~r~g~e~J~·~Mo~d==r~a~k~-----~~-"~---~D~e~e~d~--~--~--+--~~~r--~ Real estate closing and Georqe J. Modrak settle~ent £ee
i Mary Novak " i Extr. Commission
~----~--+---~An~n~a=-~K~o_n~e~s~k~~~·--~---r-----~·-• __ •c _____ " ________ ~+---~+-~-
George J. Mo~rak
Recorder-·of Deeds
Mary Novak
Cheryl Compeggie
Russell Marino
RusseLL Mar ~no Joseph Koneski
COMMONWEALTH OF PENNSYLVANIA }
COUNTY OF WASHINGTON SS:
1, MARY NOVAK and ANNA KONESKI
Atty. Comm.
~ documentary trans. stamps
.ram~.Ly exempt~on
l dP-cP-ased kent bv hP-cl
l/J)Vtti'Vr.!E.. o IN witness fee IYIM-V Alo'I/3-K..
probate of w~ll and letters advanced by Mary Novak Inn.Tax Ret. carpenter work
TOTAL
105 00 . ' ' ' 1 ()()() ()()
5 00
ll :so
3 00 100 00.
$ 4,662.30
HEREBY CERTIFY, THAT. TO THE BEaT OF
MY I<NOWLEOGE AND BELIEF, THE FOREGOING IS A JUST AND TRUE STATEMENT OF DEBTS, FUNERAL EXPENSES AND EXPENSI!:S OF
ADMINISTRATION SUBMITTED TO THE ESTATE OF __ __,;;Ji;...;:O:..-.:H;;;;;N;;..;.._;H=L""U..:;::B:-=E::;N~-------DECEASED. AS DEDUCTION$ f'OR
INHERITANCE TAX PURPOSES.
GEORGE J. MODRAK, Notary PubliC
Canonsburg, Washington Co., Pa.
My Commission Expires May 14, 1972
h
RCC-37, (12-63)
COIUMONWEALTH, Of PENNSYYLANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
-·
BENEFICIARIES AND ADDRESSES ' State full names and addresses of all who
ave an interest, vested, contingent or other
wise, in estate) --·---
Mary Novak
360 Wylie Avenue
-Strabane~: Pa. ' . \
!
Martha -~/k/a Marqaret Mathie'
34 Latimer Avenue
strabane, Pa.
Anna Koneski
115 Walmi~ Street
Houston. Pa. 15342
Richard Hluben
Walnut Street
Ambr id_g_e, Pa.
Paul Hluben
'\7th Avenue
Ambridqe. Pa. !
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SCHEDULE "D"
BENEFICIARIES
RELATIONSHIP ;
(If step-children or SURVIVED DATE INTEREST OF illegitimate children DECEDENT OF BENEFICIARY
are involved,. set STATE YES IN ESTATE
forth this fact.) OR NO BIRTH
daughter yes ----1/4 share
II II ----1/4 share
'\'; ,,
~~ n ----1/4 share
grandson '" ----1/8 share ,.
II II ----1/8 share
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Deponent further says that all the above-named beneficiaries are living at this time except below:
NAME DATE OF DEATH RESIDENCE
!
-~ \_
Will
Administration ~ N(~ ~~~ar ~~
I!ll THE
MA TIER OF THE APPRAISEMENT
OF THE
ESTATE OF
JOHN HLUBEN
Deceased
Late of. N.<>rtJ:l .. ~t:..r.cil:>C¥.1:f3. •:rc:>~S.f.l:i.P.
County of WC:l~1lj,ng1:<>Il.
Commonwealth of Pennsylvania
~ -.. . .,..~~~.~RT ~D APPRAISAL
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GEORGE J. MODRAK
ATTORNEY AT LAW
l/.2 i\<ORTJ-1 CENTRAL AVENUE
CANONSBURG, PA.
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must comp:et~ "As
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R C C-81 (2-64)
COMMONWEAL TB OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
INHERITANCE TAX DIVISION
NOTICE OF FILING OF APPRAISEMENT
Mary Noyak & Anna. Koneskj
(Executor~)
IN YOUR REPLY PLEA8E
REFER TO
37-204-8
In Re: Est ate of ___ -=J-=o~hn~ . ..:.:H:=l:.::::u::::.b=en=-----------
_______ v;,;,:·fa=.:s:..:h~im='-~...::t:..:::o::..:n:._,_ ___ County -File No. 63-69-436
You are hereby notified that the __ ~o~r~i~g~in~a~l~----------------
a pp ra is eme n t in the estate of ___ ,.,!JL:.o.L&h..un..lo....o!Hu~o1uu.~.~b.Lle'"n,~,_ __________ ..,.--___________ _
has been filed in the office of the Register of Wills qf t·fashington
County on December 11 , 19~. Said appraisement reflects the
following valuations:
Real Est ate -~---=l~O,.~_,.t...50~0~· ·~00~----
Personal Property ____ ~l~2~5-u0~0 ____ __ Transfers _________________________ _
Total ___________ 1:0~·~6~2~5~·~00~------
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 one year from :date of death, interest at the rate
of six (8%) percent per annum is charged.
Any party in interest who is aggrieved by an appraisement may
appeal therefrom as provided by law.
Date ____ D~e~c~em==b~e~r~l=l~·~l~9w7~0~---
Title H.R.CHANEY, CHIEF APPRAISER
DATE OF DEATH: l·1arch 23, 1969
Note: This is not a bill.
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