HomeMy WebLinkAbout94-00132
Estate 01 Mary Leone. Deckman
also klluwlI as Leone G. Deckman
PETITION FOR PROBATE and GRANT 01<' LETTERS
0</-94 -I.!>~
No.
To:
Register of Wills for lhe
Deceased. County of Cumber] and in the
Social Security No. 171-28-1496 Commonweahh of Pennsylvania
The petition of the undersigned respeetfulll' represenlS lhat:
Your pelitioner(s). who i.1/are 18 years of age or older anlhe execul or" named
in lhe last will of lhe above decedent, dalcd March 22 , 19.JlL
and codicilOO daled AUgIlR'" 14. IqRl)r I1nrl :1TP pntitlpd to T.P.ttPTR nf .
TeRtRmentary heCIUIRp. of thf? TPnllncintinn of the nthPT Cn-EXP~l1tnT_
Dorothy D. Belden.
(SIUle relevanl circlImslllnccs, e,g. rcnuncialion, dealh of executor, ctc.)
Decendent was domiciled al death in Cumberland
h H last family or principal residence at 210 Big Sprin~
Newville PA 17241 West Pennsboro Townshio
(list slrccl. number and muncipalilY)
County. Pennsylvania, with
Road. Swaim Health Center,
Decendenl, then 92 years of age, died Januarv 22 ,19 94
at GTPpn RingE' Vi l1ngp.. NptJVi 11 P ppnnRyl\7:1ni:1 .
Except as follows, decedenl did not marry, was nol divorced and did not have a child born or adopted
after execution of the will offered for probate; was notlhe victim of a killing and was never adjudicated
, incompetent: nnnp
Decendent at dealh owned properly with eSlimaled values as follows:
(If domiciled in Pa.) All personal property
(If not domiciled in Pa.) Personal properly in Pennsylvania
(If not domiciled in Pa.) Personal properly in County
Value of real estale in Penn,lylvania
siluated as follows: None
$
$
$
$
----------
1.1n,nnn nn
WHEREFORE, pelitioner(s) respectfully requesl(s) the probate of the last will and codicil(s)
presented herewith and lhegrant of letlers Testamentary
theron.
(testamentary: administralion c.t.a.; adminislration d.b.n.c.l~a.).
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I' Robert L. Belden
60 White Onk Drlvp
r!1rlic:ln PA 17nl~
~ fJO,pJ
Edward D. Belden
q41 ~rppnRpring Rnnd
_ Newville PA 17241
OATH 01<' PERSONAL REPRESENTATIVE
COMMONWEALTH m' PENNSYLVANIA } ss
COUNTY OJ- r...mhprhnd
The petitioner(s) above-named swear(s) or affirm(s) thaI the statements in the foregoing pelition are
true and correcllo the hesl of the knowledge and belief 0 pelitioner(s) and that as personal repre..n-
tative(s) of the above decedenl petitioner(s) will well a~) ulyadmi . 111e estale according to Jaw.
Sworn to or affirmed and subscribed {.'. (4 c.. t> '"
before me this 4TH~ day of ~.
~ ft' ;:) ---' I --9-4- ~
(..- .;t (~A' _Edward D. Beldpn .a.
I. EW I S Register , <:!
HAMILTON C. OAVIS
Auout''', LAw
NtWW'llU , 'MI"UIIUIII
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under this will or otherwise to a minor and wIth re"pect to which I am
authorized to appoint a guardian and have not otherwise specifically done so,
provided that this appointment of a guardian shall not supersede the right of
any fiduciary in its discretion to distribute a share where possible to the
minor or to another for the minor's benefit. Such guardian shall have the
power to use principal as well a" income from time to time for the minor's
support and education (including secondary, college education, both graduate
and undergraduate, professional and other education) without regard to his or
her parent's ability to provIde for ouch support and education, or to make
payment for these purposes, without further responsibility to the minor or to
the minor's parent or to any person taking care of the minor.
ITEM XIII: I direct that all taxes that may be assessed in consequence
of my death, of whatever nature and by whatever juri"diction imposed, shall
be paid from my residuary estate as part of the expenses of the
adminiatration of my estate.
ITEM XIV: I appoint my daughter, DOROTHY D. BELDEN, my grandson, ROBERT
L. BELDEN, and my grandson, EDWARD D. BELDEN, co-executors of this my last
will.
IN WITNESS WHEREOF, I hereunto set my hand and seal to this my Last Will
and Testament, written on four (4) "heets of paper, dated this J.~rJ. day of
W) ~.A
-.-'
1985.
~.~l
The preceding instrument, consisting of this and three (3) other
typewritten pages, each identified by the signature of the testatrix, was on
the day and date thereof aigned, published and declared by the testatrix
therein named, as and for her Last Will, in the presence of us, who at her
request, in her presence, and in the presence of each other have subscribed
our names aswi~sses hereto.
._~ C ~___ rl!siding at Jojp"WII'IIi} A.
. ~fi'..4JJ residing at ,.5/';fle.",S~&U'7t fJa..
3
21 - 94 - 132
RENUNCIATION
In Re Estate of Mary Leone Deckman a/k/a Leone G. Deckman
deceased.
To the Register of Wills of Cumberland
County, Pennsylvania.
The undersigned
Dorothy D. Belden. named Co-Executor
of
the above decedent, hcreby rcnounce(s) the right to administer the estate and respectfully ask(s) that Letters
Testamentary
be issued to Robert L. Belden and Edward D. Belden
WITNESS ~'f1'l~ r}fkv---.,.->7handthis 21~ dayof JItvo<A....l ,19-1:1-.
. "& ;';I'l'~ .~P.fJ_'
(SIBn re)
23 Cambridge Ct.. Carlisle PA 17013
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LAW OFFICES OF
JOEL R. ZULLINGER
HAMILTON C. DAVIS
310 CHAMBERSBUAG TRUST BLDG.
CHAMBERSBUAG PA 17201
P.O. BOX 375
SHIPPENSBUAG PA 17257
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P.O. BOX6 Vd'
NEWVILLE PA 17241 \In'
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REGISTER OF WILLS CUMBERLAND COUNTY
MARY CLEWIS
ONE COURTHOUSE SQUARE
CARLISLE PA 17013
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INHERITANCE TAX RETURN
RESIDENT DECEDENT
COMMD~~~";;\~I,W'~IP~1t7~U~ANIA I (TO BE FILED IN DUPLICATE
H.'r,,,fJ:~: ~:.'r,:",o"" WITH REGISTER OF WI.LLS) COUNTY CODE
. ---'---~_____.___..J__._.~ _ .__ ._ _... _
I Dl(flITN'l":"l/ NAI~f"itA1f,l"Ml:-l,."o MIt.r.~("jj;ifii.l: 0 C DtN . M ~ A
biD . I I Swaim Health Center
CCi<.man, Ml1ry Leone, a k a Leone G. Deckman ,
~ociil~icUII11'f NGMfE1-~'--lLA'i(""i)riJ~ DAft Of "laTH 2iO Uig Spring Road
I Newville. PA 17241
171-28-1.496 1:.g,-.94 10-6-01 c.", Cumberland
I] I. Originol Relurn 0 2. Supplemenlol Relurn 0 3.
D 4. linlited e,'nlo 0 40. FVlur. Inlerlll Compromi.. 0 5.
Ilor dOle. oJ deolh ollOr J 2. J 2.82/
ex 6, OC(C~ttlll Ditld T"\loI8 t"J 7. OecedenT Moinlolnfld 0 li\ling Trull
(Allach Cl)py of Will) (Allach cop)' of Trull)
ALL CORRESPC;NDENCE ANOCONFIDENTfALTAX INFORMATION SHouiii-BiliiiiiCiEO TO,
NAM~-' ]'OMPUltMAlllNc:.ADDRfSS
75 East King Street
Hamilton C. Davis. Es . P.O. Box 375
u: H N NUMBER
IShippensburg, PAO. ~.1,7257
717 L5.?2-5713 --L _"
1. Real Ellole (Sch.dule A) ( 11 None
2. Slacb and BondI (Sch.dule BI ( 2) __ 226.609.50
3. Clallly Held S'ock/Palln."hip In'''OII (Schedule CJ (31 None
4. MorlgogOl and No'.. Roc.iyabl. (Schedule OJ ( 4) 95.424. 08
5. Ca.h, Bonk Depo,;" & Mi"eUoneou. Pe"anal Praperly( 5) 12,003.95
(Schedule E)
6. Joinlly Owned Properly (Schedule FI
7. Tra",ferl (Schedule 0) (Schedule l)
8. TOlal Gron Auen (Iolollinel t.7)
9. Fun.ral Explnses, Administrative COlh, Mi".lIaneous ( 9)
E.penlll (Schedul. HI .
10. Deb". Mortgag, Liabilitie" lien$ ISchedule II
11. TOlal DeduClion. ('alallinOl 9 & 101
1~. N" Vallll of E,'ol. (line 9 minus line 11)
13; Charilable and Goyernmenlol Brqull" (Schedule JI
I... Ntl Value Subjecl to Tax (line 12 minus lin. lJI
15. A.mounl 0' line ,. taxable at 6% rol.
(Include yolu.. from. Schedule K or Schedule M.)
16. Amount of line 14 loaobl. 01 15% rolt
(Include yolu.. from Sch.dul. K or Schedule M.J
17. Principal'iOIl due (Add taa from lin. 15 and Irom lin. 16.)
18. C"diU Prior Puym.nh DilCounl
1.3 ._400..QL. + ._7Q.5,.?L___.
NJlMSER
'EV.U'.,", EX. 112.101
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fill NUMBER
1994-00132
PA 2194-0132
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(lor dalol 01 deolh prior 10 12.13.821
hderal ellale TaK
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..l B. T 0101 Number of Sofo Depo,il 80."
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33,383.58
( 81
334.037.53
(10)
926.58
(11)
(12)
(131
(141
34.310.16
299.727.37
450.00
299.277.37
17.956.64
(151_ 299.277.37
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(16)
x .15",
None
(17)
17.956.64
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(181
1191
._!~,lQ~.25
19. II line 18 I. nroolf!l thon linl' 17, "n'tor the dillt're!ue on lint.' 19 Ttli, i, 1hl'! OVERPAYMENT,
aiJI.~:rT3"" '. .1.''''1'..10.. 1'('11111."...,. .l'II":T:"~.''''I'I.'l'' u:llIo'"..r f.1.
20, IflinCt 17 j. greolfH .han lin. 18, ,nlrr tI.. djff,rence on line 20. This jl .h. TAX DUE. (20J __!~ 851-:...~9
A: Enter the inlllf'" on thr balanc, due on line 20A'(20AJ __~
B, Enl" ,he 10101 01 line 20 ond 20A on line 20B, Thi. i"he BALANCE DUE. (20B) ____ _ 3..~?!!}L.__
Mo~, Ch"'~.~~VDb'!_".o: R.gi~.~!!-~!_~~~A_g_."t __ .."_ n" ____." .. _. _ _ __._____.____
.. ..6ESI"-Ri-jO'ANS\>iEIi-ALLQUESTIONScm-REViiSESIOE.H"0 TO RECHECK MATH...
ij--P;~--;;;--i d,,;f ;"'h-;;r"a"~ ~lia"'ifl.,fihi~-;;:;~:-i~~llldinB~m;;;.pa~yin9 \(h;;i~i;~ and ,lol.m.ll", and ta the b." 01 my knowl.dg. oftd b.li.~
t i. r " art:t d 0 tl. I do,. th~l all ,.allllnl.. hot b'tn r.porled 01 IfloI' ",Olhl "0111', O.dOfotiol\ of prtpar.rather thon Ihe pftno r. '.n oli". i,
o ... 'por., 1101 any hOwl.dQ' _
-- '" '10" ~~t,ii.~reen-~~'il'Ih'fRoad. Newville, PA 17241 A'L'::? ? .n......
60 White Oak IJr.. Carlisle. I'A 17013 7-"'-~
.. 6~r~~."f"'ilIl'hl.ll.;r--lJ56Ils~ rnr-
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HAMllTDN C. DAYIS
AnOllln.'u l,w
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Eastern Star past matron'a pin to the Old Belair Chapter of the Order of the
Eastern Star.
ITEM VII: I bequeath to each of the following named persons one hundred
(~OO) shares of Dauphin Deposit Bank snd Trust Company to BETH B. BELDEN,
PATRICIA A. BELDEN, EDWARD D. BELDEN snd ROBERT L. BELDEN.
ITEM VIII: If. st the' time of my desth. I sm still the holder of
interest in an unpaid mortgage receivable originating from the sale of my
shares of stock in Arthur D. Deckman, Inc., I devise and bequeath unto my
grandson, ROBERT L. BELDEN, 12.25% of all sums received in payment on said
mortgage by my executors until the same shall be paid in full.
ITEM IX: I devise and bequeath the residue of my estate of every nature
and wherever situate to my daughter, DOROTHY D. BELDEN, providing she shall
survive me by thirty (30) days.
ITEM X: Should my daughter, DOROTHY D. BELDEN, predecesse me or die on
or before the thirtieth day following my death, I devise and bequeath all of
the residue of my estate of every nature and wherever situate to my issue,
per atirpes, living on the thi~ty-first day following my death.
ITEM XI: Should either of my two grandsons, ROBERT L. BELDEN or EDWARD
D. BELDEN,' predecease 'me,.. then' and in that event, the shares of said
predeceased grandson in my estate as herein provided for shall be distributed.
as follows:
A. One-half (1/2) thereof to his surviving wife.
B. The residue thereof to his issue, per stirpes, surviving me and if
there be no such surviving issue, to my then living issue, per stirpes.
ITEM XII: I sppoint DAUPHIN DEPOSIT BANK AND TRUST COMPANY. of
Carlisle, Pennsylvania, guardian of any property which passes outright either
2
under this will or otherwise to a minor nnd with respect to which I am
\
authorized to appoint a guardian and have not otherwIse specifically done so,
provided that this appointment of a guardian shall not supersede the right of
any fiduciary in its discretion to distribute a share where possible to the
minor or to another for the minor's benefit. Such guardian shall have the
power to use principal as well as income from time to time for the minor's
support and education (including secondary, college education, both graduate
and undergraduate, professional and other education) without regard to his or
her parent's ability to provide for such support and education, or to make
payment for these purposes, without further responsibility to the minor or to
the minor'a parent or to any person taking care of the minor.
ITEM XIII: I direct that all taxes that may be asseased in conaequence
of my death, of whatever nature and by whatever juriadiction impoaed, shall
be paid from my residuary estate as part of the expenses of the
adminiatration of my estate.
ITEM XIV: I appoint my daughter, DOROTHY D. BELDEN, my grandson, ROBERT,
L. BELDEN, and my grandson, EDWARD D. BELDEN, co-executors of this my last
, will.
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IN WITNESS WHEREOF, I hereunto set my hand and seal to this my Last Will
and Testament, written on four (4) sheets of paper, dated this J..'}...d day of
.
M tMrA.
, 1985.
L)
HAMILTON C. DAVIS
.noun At L..
IC'W'ILl.l '. IIII,"UIIIIII
PIIUlA.
The preceding instrument, consisting of this and three (3) other
typewritten pages, each identified by the signature of the testatrix, was on.
the day and date thereof signed, published and declared by the testatri.x
therein named, as and for her Last Will, in the presence of us, who at her
request, in her presence, and in the presence of each other have "ubscribed
our names as wit sses hereto.
residing at
tfp#rl It. f* .
,
01,: flt.tts'u.r7: Ik.
residing at
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COMMONWEALTH OF PENNSVLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
,ESTATE OF
Mary Leone Deckman, a/k/a Leone G. Deckman
(All prop.tv Jolnlly<owntd with Right of SiurYlvonhlp ml.llt b, dlltClotld on Schedule "F")
SCHEDULE "B"
STOCKS AND BONDS
FILE NUMBER
1994-00132 PA 2194-0132
ITEM
NUMBER
1.
DESCRIPTION
State of Mississippi Bond #17213 issued 2/1/67, face amount,
plus accrued interest
State of Mississippi Bond #17214 issued 2/1/67, face amount,
plus accrued interest
Prudential Securities, Account #044-234076-15:
a. Slack Rock, 2,450 shares @ $9.00 ea.
b. Hyperion, 5,050 shares @ $8.125 ea.
c. Franklin U.S. Government, 5,699 shares @ $7.11 ea.
d. Prudential High Yield, 5,194 shares @ $8.76 ea.
e. Putnum High Yield, 3,224 shares @ $13.43 ea.
f. Money Market Account
(see attached confirmation)
Van Kampen Merritt U. S. Government Fund, 11496800, 1,061. 440
shares @ $15.68 ea. (see attached confirmation)
2.
3.
4.
TOTAL IAlso enler on line 2. Ree.pitulll;onl
III mor. apeu I, needed InNrt MidI,loN' IhHtI of ..me ,1,.1
VALUE AT DATE
OF DEATH
5,000.00
750.00
5,000.00
750.00
22,050.00
41,031.25
40,519.89
45,499.44
43,298.32
6,067.22
16,643.38
$ 226,609.50
Pleale Print ar Tvye
[mE NUMBER
l!!94-00132 PA 2194-0132
AMOUNT
IrV.1SlIlhI1.811
'!~i~
COMMONWEALTH Of PENNSYlVANI....
INHtRlTANCE Tt.X RETURN
R(SIDENT DECEDENT
._-...._-.. .
SCHEDULE H
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES
ESTATE OF
Deckman, Mar Leone, a/k/a Leone G. Deckman
ITEM
NUMBER
A.
DESCRIPTION
Funeral Expen.e..
Egger Funeral Home
Wayne Noss Flowers
Westminster Cemetery. engraving
5,153.00
71. 02
B7.50
1.
B.
Admlnl,tratlve COltll Robert L. Belden (55.//202-36-7074) 5,000.00
Edward D. Belden (55.//175-40-9644) 5,000.00
Personal Representative Commissions
Social Security Number of Personol Repro.entotive:
Year Commission. poid _.1994
1.
2.
A"orney Fee. - Hamilton C. Davis
3. Family Exemption
Claimant
N/A
Relotion.hip
Address of Claimant at decedenl" death
Street Addre..
City
Stole
Zip Code
4.
C.
1.
2.
3.
4.
5.
6.
7.
8.
Probate Fee. - Zullinger/Davis, reimbursement
Short certificates. (12)
MI,.ellaneoul Expenlell
Mountz Jewelers. appraisal fee
349.50
36.00
21. 20
40.00
Cumberland Law Journal, legal ad
The Sentinel, legal ad
92.36
Robert L. Belden, reimbursement for insurance
premium
Reserve for contingencies
33.00
500.00
TOTAL (AI.a enter on line 9, Recapitulation)
Ilf "'ore .p.see I. """eel. Insert additional .heeh 01 .ame Ilze.)
5,311. 52
10,000.00
17,000.00
385.50
686.56
S 33.383.58
Inventory ot the real and personal estate ot
E
Marv Leone Deckman. also known as Leone G. Deckman , deceased
Personal Property:
1.
state of Mississippi Bond #17213 issued 2/1/67,
face amount, plus accrued interest
2.
state of Mississippi Bond #17214 issued 2/1/67,
face amount, plus accrued interest
Prudential Securities, Account #044-234076-15:
a. Black ROGk, 2,450 shares @ $9.00 ea.
b. Hyperion, 5,050 shares @ $8.125 ea.
c. Franklin U.S. Government, 5,699 shares
@,$7.1l ea.
d. Prudential High Yield, 5,194 shares
@ $8.76 ea.
e. putnum High Yield, 3,224 shares @ $13.43 ea.
f. Money Market Account
4. Van Kampen Merritt U.S. Government Fund, Account
#496800, 1,061.440 shares @ $15.68 ea.
3.
5. Note receivable from Robert L. Belden to Mary
Leone Deckman, with a principal balance as of
date of death, plus accrued interest as of date
of death
6. Note receivable from Beth B. Belden, principal
balance of date of death, plus accrued interest
as of date of death, plus accrued interest as
of date of death
7. Jewelry:
a. One white gold engagement style ring
b. One white gold lady's fashion ring
c. One platinum eternity ring (lost)
8. Farmers Trust Company, checking account #10-56379,
plus accrued interest
9. Eastern Star pin, estimated
Amount
5,000.00
750.00
5,000.00
750.00
22,050.00
41,031.25
40,519.89
45,499.44
43,298.32
6,067.22
16,643.38
4,109.00
5.87
91,079.00
230.21
2,800.00
490.00
380.00
7,627.59
6.36
450.00
00 :o:D
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REV-1547 EX AFP (08-94*
tOHHONWEAl TH OF PENNSYLVANIA ,
DEPARTHEHT OF REVENUE
BUREAU OF INDIVIDUAL TAICES
DEPT. Z8D6Dl
HARRISBURO, PA 17128-0601
/'1- I'ltJ- I
C/
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOHANCE OR OISALLOWANCE
OF OEOUCTIONS ANO ASSESSMENT OF TAX
ACN 101
DATE 12-26-94
A FILE NO. .
D TE OF DEATH 01-22-94 COUNTY CUMBERLAND
NOTE. TO INSURE PROPER CREOIT TO YOUR ACCOUNT. SUBMIT THE UPPER PORTION OF THIS FORM WITH YOUR TAX
PAYMENT TO TIlE REGISTER GF WILLS. MAKE CHECK PAYABLE TO "REGISTER OF WILLS, AGENT"
REMIT PAYMENT TO:
HAMILTON C DAVIS ESQ
75 EKING ST
PO BOX 375
SHIPPENSBURG PA 17257-9746
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
AIlOLlt1t R..l thd
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
iiifli:i!;4j-Ex-iiFP-ioii:94riiiifii:iniF-YNHEiiii'AiicE-TAx-A'ppii7iisEif€iiT-;-iii:.rciwA'N-CE-b-Ii--------m-m--
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF DECKMAN MARY L FILE NO. 21 94-0132 ACN 101 DATE 12-26-94
TAX HETURN WAS. (X) ACCEPTED AS FILED
( I CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL
1. Rool Eltoto ISchodulo Al 111
2. Stock. end Bond. (Schedula Bl (2)
3. Closely Held stock/Partnarship Inter..t (Schedule Cl (3)
4. Hartg.ga./Not.. Receivable (Schedule OJ (4)
S. Cach/B.nk Deposita/Hilc. Parlonal Property (Schedul. EJ (5)
6. Jointly Owned Property (Schedule fJ (6)
7. Tranaf8rl (Schedul. G) (7)
8. Tot.l A...t.
.00
226,609.50
.00
95.424.08
12.003.95
.00
.00
IB)
334.037.53
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expen.eI/Ad.. COltl/"llc. Expense. (Schedule H) (9)
10. DObt./Mortglgo Llobl11tlol/Llon. ISchodulo I) 110)
11. Total Doductlonl
12. Net Value of Tax Return
15. Charltable/Govarneantal Bequa.t. (Schadule J)
14. Nat Value of Eltata Subjact to rax
33,383.58
926.58
Illl
1121
1131
1141
~~.~ln 11i.
299.727.37
450.00
299.277.37
, NOTE:
If an assessment was issued previously, lines 14, 15 and/or 16, 17 and 18 will
reflect figures that include the total of 6~ returns assessed to date.
ASSESSMENT OF TAX:
15. Aaount of Llno 14 ot SPOUlal roto I1S1
16. Aoount of Llno 14 to.oblo at Llnell/C11.. A roto (161
"17. AlOunt of line 14 taxable at Collataral/Cla.. I rate (17)
11. Prlnclpol Ta. Duo
TAX CREDITS:
PAYMENT
DATE
04-20-94
09-08-94
.00 X . DO.
299.277.37 X .06.
.00 X .15.
I1BI
.00
17.956.64
.00
17.956.64
RECEIPT
, NUHBER
XA885984
MM912924
DISCOUNT ('1
INTEREST (-I
705.26
.00
Al10UNT PAID
13.400.00
3.851.39
TOTAL TAX CREDIT
IALANCE OF TAX DUE
INTEREST
TOTAL DUE
17.956.65
.0ICR
.00
.0ICR
o IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL IHTER~ST.
.5'-(.,/-3 ~
I IF TOTAL DUE IS leSS THAN n. NO PAYMENT IS REllUIRED.
IF TOTAL WE IS REFLECTED AS A "CR~DIT" ICRI, YDU MY IE DUE
A REFUND. SEE REVERSE SlDE OF THIS rDIlIl FOR INSTIlUCTIOIIS. I