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HomeMy WebLinkAbout94-00284 , , I:' " I", , ""I' 'Ji"I" , , t " I II "':,;' , ! I ~ ~ I :'.' I;' ~~:,tl<; ~\'J~:'!' (~//i,,~:': I 1"1,' !:", 'I' ",ll<'\i I' ',;' ~\ : ' . '.,;'}!.l, I, '"",. ,.1 J: \, "":1" 'I ::".',')/ , :\<:i'.,., :..,1,','" 'Sl" . t, ';: I '\:':,:}'!,<:':,\(:;' ,}' "r I ~ \I~'; l I, I ";1 '1:" '\,. ,'., I ,Ii " ,'II" , I' . "", "',,, ",I .i>. 1,':'_, "0, \, " -:., -,I '1,' , -,t,' " "J. ", , " ,II,'" 'l':" ~ " , . ;, ~ II J" 'I " : j " '/-!\'i I"', 'I'" l' " t "~.,,,,: \ 'i', ,..r" "~I' " :1 "I' . ,~" (; " ,')(. '(. ,I,' " ,":1,,-: ,.":/" " I' '." ,': 'I ,I,;,. i' " L", , 1 t ~ , ,,',jl ,,':!,' j ~; \ ," ',l,' I' " ", :'L, q . " J: , , ,I' ,. "" ,j", /'1' :',jl' -H,.l.J.~"~~'....I~ " . I"" ,. \: ,I' , ',,' , " ,,' " '"I " , 'd, " t\." II', ,',i I, , '/", :<'.1 " It. ,,\.,1\ ,) ,,' ',(," '. "i , ",',,' I:' 'I'. .1', ,/', ," ',' , If ," ~ (',' ,\"" ,'",,/'1:1 '\ 1\ ',I '", ""\ ," I. ,. '1': , , ',',I "".\:,! '1:' ",t' ';1 ',I, !",;' .., ,,',I "~'I " ,,' . ~ ~', " , ~; ;':'" ~ ~::.' " . ~. I ' '.', ":" \ ,"I' ""'.' ';",: I ~:' ~"/' i 'r \ ' ,';\'; " " 'i , \'\ i, " I' '/", . i.i' "I '1' " 1,,1 '\',:. , II:" I,'. "",' " /"'J:, , , I, I '~, "~'I' ',I' '.' "1' "1,,,'> I.' , , I,~ ,\ ", ",II "" .1;, " "', " " " ',l,. ,. :/ " " ,';.'! "" '1'/ " , .. ,. " ;:', , ',i," I,d , :,\,,' ; .' " .. ',I.' ,j .' '.,' I " , " . ,Il~ " 'II";' '" '" "" " '1" \'1' l;.' , ' " '1'<0 ''. '\:;'<' ".1\' " ," " " . '"I' " " of .., " ,II \' , II'l ,'/" \, '..' 'I ", I' .' \, " I,: '\"\,:,:;' , , '\ ('"J.'" )\ ,', , , ;, 11" , I' " ,".. ,", '.' , ',I "). "! '\', .. '." d, .... /"11' ,';' ,,, " , ,'I ,J~I , , , ,I, i' , ! .,,1, '" (,' , '" . " ," " '''I. " " '"' " ''':. :',' I:,. , ' ," "', i,';: " " ,.(', " '\., "I' "/ \<. ;1' , II,', !' : I ~ , ,t' " ,\'., ".', , ,I' J ", ,I .1,\' ,It ""'1 "'I"." " , , r" , " " I' ....1 '.1.' \,.. ," ""'<:' ',I '\ ,....... , ,I ", '>~'~r'~::1' 1,;.. "'" " ",' " I',' ,f I';" " ;",! 'j, ,'!. I' I '" " i. " ,:' 1;1" ':/,'11: 'i".,. ;'" ~ '.. ~);: .;'~',' '" ';~, ;,:,', ' " ,', ", " :, 'j I, ", '} \:' . i, ',(, " "~I, , , '0. !' , , " ',r!. , ,',1" ",,' !\l , , !,'''i ",, " " " ~ I 'i'. I::; '" .' . "I ~ ' , i I'" 'JI' ," j "'\'" " r,. " ',1'0: 'rl ".), ',0 "I': f, .... .,,'.......1, ',' ., ,,' '~ ' ... I'"" , " "", " '" r "~. I ,'.. 'I " >.' :" " , "\ ' " , "It I . , , "', I.JII, , 'I' ,I' '" I, ,I ," ..' ,:", " .! " 1 ',\,' ~ II ' ,," ".1 '."'" '" ..-~', (( "J,! ,\ ,'~ ,'J '/. S ~ CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent I Arthur P. Deihl February 17, 1994 Date of Death I Will No. 21-94-28L. Admin. No. To the Registerl I certify that notice of beneficial interest required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the (ollowing beneLiclaries' o( the above-capt.ioned estate on April I'd ,199/1 I Name Jacob B, Deihl Address 1505 Longs Gap Road Carlisle, PA 17013 Notice has now been given to all persons entitled thereto under Ruie 5.6(a) except Datel April 13. 1994 " /,' d f .</' ~----, " , #- -' \./ ~~ ,.' -, '--- -'~;)'''-'''''''' .--sJgnature Name Stephen L. Bloom Address 10 E. High Street Carlisle, PA 17013 Telephone(71"1 243-33/~1 ,f) '.;' (, . 1..' ",' ,: , , " , 1'1; " ( ~-: Ii. , " , .J (,)U CapacitYl Personal Repres~ntative v Counsel for personal representative . ' .- P.'/ REY-1547 EX AFP 110"93* C_AlTH Of PENNtVlVAHIA IlPAATItEHT Of Rf:YENIJt: IlMEAU Of INDIVIDUAL lAkES o(P1. 210601 H4mh5lURG, Pi 17121-0601 NOTICE OF INHERITANCE TAM APPRAISEHENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSHENT OF TAM ACN 1~1 DATE 10-03-94 DATE OF DEATH 02-17-94 S~b~T~O. CUMBERLAND HOTE. TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBHIT THE UPPER PORTION OF THIS FORH WITH YOUR TAM PAYHENT TO THE REOISTER OF WILLS. HAKE CHECK PAYABLE TO "REDISTER OF WILLS, ADENT" REMIT PAYMENT TOI STEPHEN L BLOOM ESQ MARTSON ET AL 10 E HIGH ST CARLISLE PA 17013 REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 ~ __Aoount RO"ltt'_~___-j ~.!'.!n~~.!l~~.!.,:!~!_.~IrNl~..m._~.___!l_~!~~_t!.~.!l.l!.~~.!..~~!_~~~_!.~~--~~~!l..~~P_l!.~~~.___~_________mmm___. REY-1D47 EX AFP O.9~) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ISTAT! OF DEIHL ARTHUR P FILE NO.21 94-0284 ACN 101 DATE 10-03-94 TAK RETURN WAS, I X) ACCEPTEO AS FILED ( ) CHANQEll RESERVATION CONCERNING FUTURE INTEREST . SEE REYERSE APPRAISED YALUE OF RETURN BASED ONI ORIGINAL R~TURN l. Roo1 eatoto ISohodulo A) ll) 2, Stocko _ Sond. (Schodulo S) 12) S. Clo.oly Hold stook/Portnor.hlp Inhrut (Schodula C) (3) 4. Herta_./Het.. ROCl.lvoblo (Schodulo D) (4) i. Co.h/Bonk Dopo.lto/Hi.c. Por.onol Proporty (Sohodulo EI Ii) 6. Jointly Ownad Proporty ISohodulo F) 16) 7. Trondoro (Sohodulo 0) 17) I. Tctol A...h ,00 , .illL ,00 ,00 1,145.93 ,00 ,00 III 1,145,93 APPROYilD DEDUCTIONS AND EXEMPTIONS I 9. Funorol Expon.../Ad"lnhtrotivo Co.hl HhooU""oou. E.pon... ISohodulo H) (9) 10. Dobh/HortaollO L1N>l1iti../Llono (Sohodulo I) liD) 11. Total Doduotion. 12, Not Value of To. Roturn 13. Choritoblo/Oovorn"onhl Soqu...h (Sohodulo J) 14, Not Voluo of Eototo Subjoot to To. 6,266,75 40,00 llll ll21 1131 ll41 6,306.75 5,160,82- ,00 ,00 NOTE I If an a....IM.nt WI' i..uld previou.ly, linee rlfllct figure. thlt includl thl total of ALL ASSESSMENT OF TAXI - 16. Aoount of Lln. 14 to.oblo at 6X rota (161 16. Aoount of Llno 14 to.oblo .t lSX rota 1161 17, Prinoipol To. Duo 14, 15 andlor 16 and 17 will return. a..e"ld to dati. . 00 K.06 . .OOK.U' ll71 ,00 .00 ,00 TAX CREDITSl PAYHENT DATE RECEIPT NUHBER DISCOUNT (+) INTEREST (-) AHOUNT PAID TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST TOTAL DUE .00 .00 .00 .00 l · IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS LESS THAN fl, NO PAYHENT IS REQUIREO, IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRI, YOU HAY SE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS,) "~I ..-.. .. ...... " RESERVATlONI Elt.t" of dec.dlnh dvlnw on or before DteHb.r 12, 1982 ~. If In)' future Int.rllt In thl utlte II trenlf.rr,d In PG.....lon or .nJoy..", to ellu . (ooll1t.,.O bln,flclarl" of thl dlcwdlnt .ft.r the IlCplr.tlon of InY ntl't far Uf. or for v.lre, thl to..onwllth hlreby lI(pr...l)' rll,r\lll thl rlaht to Ippr,h'lnd ...... transfer Inhtrltanco Tallll tt tM lw'ul ell.. a (ool1,t,r,U rat. on eny luoh future Intlrn.. PUIlPlISEllF HOTlCEl To fulf111 the r.qulrlMntl of Slatlon 21U 0' the InhtrltlllClI and Estill TalC Act, Act 22 of 1991. 72 P.S. Socllon 2140. PAYHENTI DellOh the tOP portion of thlt Notlct and tUO,it Nlth your ply..nt to thl Rlgltt,r of Nlll1 printed on thl r''II.r.. ,Ide. ..IW<. chl<:k or ..... ordlr p..ob1. to, REOISTER OF MILLS, AOENT AU ply..",. r,cllv,d .hlU flret bt ~lltd to any Intlr..' ~Ich laY bt dUI with any r"llndtr appll,d to thl taM, REFUND (tA)1 A r.'\.rId of I talC crldlt, which.... not reque,tld on thl Tile Rlturn, 'IV bl rlqualtld by cOIIP11t1nll an "Appllcltlon for R.f~ of PtM'Ylvanl1 InhtrHanoe Ind fltltl Tlx" (REV.UU), AppllclItlonl IIrl IVlllabll It thl OffiCI of thl Reghtlr cf W1UI, Iny of thl 25 RIV'~ Dlltrlct Offlc.., or by cllllng thl 'PIOIII 24-hlXlr en.wtrlnt ..rvlcl nt.WMr. for fcr.. orderlngl In P,nn.ylv.,," 1-800-562-Z050, outsldl PlMlylvtnll and within 10011 Hlrrlsb4Jrg UII (717) 7'7-1094, TUD. (717) 71Z.ZZU (Helrlng 1."llred Only), OIJECTlOMII Any plrtv In Int.rut not IIthfltd with thl Ippr.I....nt, allo..anol or dlslllowancl of dlduatlon., or a.......nt of'tax (lnaludlng dhcoont cr InterllU II ohown on this HotlCI IU.t object within .lxty (60) d.y, af recllpt of thi. Hotlc. bYI --..rltten prot"t to the PA DlfllrtHnt of RIVInYI, Board of App..lI, DEPT, Z11021, Harrisburg, PA 17121-10Z1, --.laotlon to hlVI thl ..tter dthralned It tudlt of thl account of thl plrtonll reprlltnhtlvl, OR -......1 to thl Orphanl' Court, OR AOltlN IITRATlVE CORRECTlOHlI Factual .rrort dlscoverld on this .......Nflt .hould b. addre...d In writing tal PA DePlrt.."t of R'Vlnu., Bureau of Indlvidu.l T.x.., ATTNI POlt A.....Mnt Aevllw Unit, DEPT. 210601, Harrl.burg, PA 17\21-0601 Phone (717) 711-6505. !:t.. P80I J of thl booklet "In.tructlon. fer 1f1h.rltlnC:l TlIC Rlturn for. Ruldl"t Deoldtnt" (REV-1501) for an IKplanttlon of ftdalnlatratlvllv corrie tab I. Irror.. If any tBx due Is plld within thrll (5) cllendlr aonth. aftlr thl dle.dlnt'. daath, I flvl parcllnt (S:O dltoO\M1t of thl tllx plld II IUowld. OIlCWlT, INlEREIT I Intlr..t 11 charg.d blglnnlng ..lth flr.t dlY of cMl1rlqU1OOV, or nlnl (9) IOnth. and onl (1) day froa ttMI dltl of death, to th41 dltl of Ply..nt. Tlx" wh.\ch btc... dlllnqu.nt bltar. January 1, 1912 blar Intar..t It the rltI of .1M U:O peroant par ~ cllculatad at I dalh rata of ,000164, All tlICII which bICH. dtllnquent on Met IIftlr Januarv I, 19IZ will bltr Il\t.rut 'It a rltl which wUl vary frol callndlr Ylar to Clllne1l1r y.ar with that ratl IMO\Mtd by the ~A Dep.rt..nt of Rav.nut. Th. app!lolbl1 lntlrllt rUt' for 1982 through 1994 ar.1 '!!!! Int.r..t Rltl DIUy Interllt F.ctor :!.!!! Intar..t Aat. DailY Il\t.r..t Factor 1912 20l ,000141 19M lol ,000274 1981 16l ,00001 19&7 9l ,000Z"7 1914 m .000301 1911-1991 1l~ ,000301 1981 m ,000116 1992 9~ ,000247 5993-1994 7l ,000192 .-Intlrllt II cllculattd II follo"ll INTEREST . BALANCE OF TAK UNPAIn K NU"BER OF DAYS OELINQUENT X DAILY INTEREST FACTOR --Any NotlcI Inl;td aft.r thl tlM blCOIIII dlllnquent will raUlot In Intarllt calculation to flft..... (15) dlY. blYond the dati of thl .......ent. If PIVunt I. llda If tar thl Intlr..t COIPUtltlOI'l data shown on thl Notln, addltlontl lntlrllt MI.t ~ c.lculat.d. " '~-.. ,~ , , \ I I t , :. .... ~fV,IIOO (x. 1",011 ," .' c{ . )..c' (J - I\' ~. 20, If lino 17 h g,oa'or Ihon Ilno 18, onlor Iho dlfforonce on Ilno 20, Thh i"ho TAX DUE, 1201,..."".._.__ 0 A, Ento, Iho inloroll on ,ho bolance duo on lino 20A. (20AI _ _ ___ ___,_n 0.__ B, Enlor Iho 10101 01 Ii no 20 and 20A on Ii". 20B, Thl. i. ,h" BALANCE DUE, 110BI ,.." n. _n_ 0 ___ n.t.\~~t~~t(.k'p~y~~ltla,Rtgllltraf Willi, Aqtnl _......._n____'_.___..__,____________ ------ -- .'. BE'SuiiToAN5Wiii-AUQUESTIONS ON REVERSE SIDE AND TO RECfficKMATH..---------n.---n-. r,! ~~~ i5~" ..01 .. ~ ~ ffi .. Q o Z u 0 .. " ~. i'.-,IY I,1.h.Ji, " . ,(':Y.. INHERITANCE TAX RETURN RESIDENT DECEDENT lTO BE FILED IN DUPLICATE WITH REGISTER OF WILLSl 'OR OATIS O' DIATH A"II Ut3!'" CHICK Hili " II SPOUSAL POVIRTV CIIDIT II CLAIMID 0 PiLI NUMIII COMMONWEAlTH OF PENN$VLVANIA DEPARTMENT Of REVENUE OEn 280601 ~ARRI$a~RO, PA 1~~?8,~601 N ,.. AM LA , IR ,ANO MI l INllAl , I' 21. r.oUNIY CODE ----- _.._n. -"'-'1OEcEDENT"~ COMPl~rr=- I 'Vi(1'i LOIl<Jfl Gnp Hand ICnrl inlo, PA 17(1]3 , 284 I,IUMBER ...-.-~--- .--.. 94 YEAR ffi ~ Q IJIUIIL, Arthur P. SOCIAL $ECURllY NUMBER: "G~O;~~~~'~~.~]~1~:~~7::~..- 208-38-6490 _ .:.('JV~I_V . c,;\lll1bcrl.-tuCL___._____ n____.__". [) 3, Remainder Rolurn 110, dole. of dea,h p,ior 10 12.13.821 [] 5, f ,deral E.lolt Tax Relurn Required .ll B, Tolol Number of Sole Depo.1I B'JXe, [] 2, SupplomUnlol Rolurn z o 3 ::l t: ~ .. [KI 1, Original Relurn [] 4, l,miled ellole iJ 40, Fulure Inlore,l CompromllO Ilor dale. 01 deolh oiler 12,12,B21 [J 6, Oecedenl Died Te.lole [J 7, Decedenl Molnlalned 0 living Trull IAlloch copy of Willi (Allach copy 01 TrUll' ALL CORRISPONDiNCI AND CONPlDINTIAL lA"iiNFoRMATION SHOULD BI DIRECTED TOI NAME lCOMPLElE MAILING ADDRESS StC[,hOIl L. "100m, ESljuirc jMARTSON/ IJEAHIJOHFF, WILLIAMS .--- '1'011 I~pst Iligll ,'trcct 'ELEPHONENUM6f~----'-- --- .--------- ~ "' >) J.. 71 7 .l-2 ~,~.. ~_1il~"=,=,=~ooc~~~,,=="'~===,~nr 1 i_ S 1 c'.., PA l7013 1. Real ElIolelSchedule AI 1 11 _ ________ .. ._._~_.__,.. o 2, Slock. and Bond. (Schedule BI 1 21__.. _......_,.....______ 3, Clo.ely Held Stock/Pa,lne"hlp Inlere,l ISchedule CI (3I,___.....,_,..Q___._ 4, Morlgoge. and Nole. Recelvoblo ISchedule 01 ( 41 _____.__..__0....___ 5, Co.h, Bonk OopolilS & MhcolloneoUl Pe"onol Proporly( 51 ' _....__..._....1.L14 ~~.9 3 _. (Schedule EI 6, Joinlly Owned Prope,ly ISchedule FI 7, Tronlle" ISchedule GIISchedule II B, Tolal G'Oll AllolS (10101 line. 1.71 9, Fune,ol E'po",e., Admlniltralive Co,I., Mhcellonoou. I 91 ...______.l?,J,~6 6 ~,~_ Expe",e. ISchedule HI 110, DeblS, Morlgago Llobllilie., Lie", ISchedule II 11. Tolol OedUClI"", 110101 line, 9 & 101 12, Nel Vaiue 01 Ellalelline 8 minu. line 111 13, Charlioble and Governmental Bequell' (Schodulo JI 14, Nol Value Subject 10 Tax ~Ine 12 mlllu.llne 131 15. Amount of line Id taxablo at 6% rale (Include value. from Schedule K or Schlldulo M,I 16, Amount of lino 1.1loKoblo 01 15% rolo (Include value, from Schedule K or Schod"le M,I 17, P,incipalla, "uelAdd 10' Irom lin. 15 and from line 16,1 18. Crodits Spousal Povorly Cradil Prior PovmonlS + & O'P'l'O 161 I 71 __' ....._ ..__....L___, o (8)____..L145.93.... 1101__ 40.00 1151 1I1l_.___6/30~0...5._ 1121 ---------Q,-.-__. 1131 ,____~-.--m-O-----.. , 1141 0 _...._..........,.0_______ X ,06 = _______ (1 1161 o ..._____x ,15 = o ------------______0-+ z o ;: <l ... ::l .. :E o u )( ~ (171 o ._. ____.__.~______.__.n'_.' Discount InforfHI o o -- .------...-------.-. + 1181 1191 19, IIllno 18l'greale, ,hon lino 17. onter Iho diffe,enco on line IQ Ihl." ,h. OVERPAYMENT, mil] Cheele hpro if you m'o rO(luo!l.ting 0 rofund 01 your ovorpnymo"t. iJ-;'d-;;,'ro'nnllifll of pOrjury, I dflc/oro InOI 11~';-~'IIKnmln"d Ihil ~~;i~~-~~;\717;dm{-1~I-t.(~r~~;o~~~;.;ch~~;-;;jI~i-;~r~d~~;,'ii~~d 10 tho bo~1 01 my knowll1dqo'tlnd bul~ II is Irun, corroct and complnlo. I docloro Innl nil roal 0"010 hen IHwn foporlnd III truo morkot vo/uo. ()lldntolion III prnpurlJr olnor Inon tho porsonal rnpro'onlotivll II boltJd on nil infarmallon of which prnpmor hrn IIny l.,nowlndl111 ~MIiNAill"Of"ri\i'''~P~ii~i~l(~-l)VIl/~(jWilliR~j - ,\(l(HHS~ 1 r}()~) I,onqn Gi1p Hond ./r,~/, 1,~ L{0...t. _ CilrlJdc', I'A 170lJ r~AIlJiif l)rp~!I,...lt(.,,) utR It':;lM~ II 'PIH~Wl,A'I'{1 ,\lln~1 S~ j , I --?'" " .<j () I':il~;t: 111'11 SU,'ot -~ . ~,1('" . . . . ___ .' -' (.__. .>-, Cilrll;;]((/I'^ flAT[ ", IN., Ie/ 'I Oti1'(---...-----..-)-..--- . L,/;J5/'iLI \ .tj~ I SCHEDULE E i CASH. BANK DEPOSITS AND MISCELLANEOUS L ~ERSONAL PROP!RTY Pleolt Print_or Ty'p~_...._._..__ '- FilE NUMBER ilv "Of I" 111'1 COMMONWIAltH O' 'INN\YlVAN" . INNlIlIANCI I.' IIIUIN IlIIDINI OICIDINI ESTATE OF DEIHL, Arthur P. 21-94-2B4 ~- IAIl P'OP'''Y jOlnll"ow".d 'fWlth Ih. RIOhl 01 $ul~i'iO'lhip "IU1! b. dlUlolld on S(h.d"l, '1 N~T~~ER DESCRIPTION VALUE AT DATE Of DEATH 1 Farmers Trust Company, savings account #1-393635 .93 511. ob 2. U.S. Treasury, 1993 income tal< refund 3. Ruger .22 ca1. single s1l< revolver 175.00 4. 1980 Chevrolet Ma1ibu Sedan, VIN T19KAD474224, poor condition 100.00 5. 1982 Ford Courier Truck, VIN poor condition Yamaha Motorcycle, 750 cc., 215408, poor condition Cash in wallet GC2UA1214C0611740, 1982, VIN J'lA4X7009CA'" 150.00. 2 0 0.00 9.00 6. 7. ' " I ," I I I , , I I .. , I, I I I i I' " i \: , "., , , " ' " I' 1 ! -1-. TOTAL (Allo. enler on line 5, Recopllulolionj Ls .1,145.93 _I v ~ \ II f ~. I', U, &STATE OP \>A'y "':'!j11J;.!' COMMONWEAltH 01 PENNSYlVAtjlA INHfRHANCE lA,( R~lURN RESloEN! DfaoEN! __ _.. _. _ 4"_ SCHEDULE H FUNERAL eXPENSES, ADMINISTRATIVE COSTS AND i MISCEllANEOUS EXPENSES L;:.;;__ Pita.. Prlnl or Typ. I PILE NUMBER L 21-94-284 PEIIIl" Arthur 1'. , N~~~R 1--'-'--"---'---'--'-~E5CRIPTION ---._-~----- AMOUNT A. Pun.,ol bp.nloll 1. 4,521.20 286.55 Hoffman-Roth Funeral Home, Carlisle, I'A 2. Grave opening Cumberland Valley Memorial Gardens I ' Marker 895.00 3. B, Admlnlltratlv. COlh, 2, 3, 4, C,' 1. 2. 3, 4, 5, 6, 7, 8, ~_. 1.' Personal Repre.entatlve Commllllons Social Security Numb.r 01 Personnl Reprelentative, Year Commllllons paid _.____ None Attorney Fees: MAR'rSON, DEARDORI~P, WI LLIAMS & OTTO 500.00 Family Exemption Claimant ,___.___~____ Relationship Address of Claimant al docedent's death Street Addrell _.____ None City _.___.'_________. Stale . Zip Code Probate Fees 54.00 Mllc.lloneoul bpenlll' :Register of Wil151Fil1ng fee 10.00 TOTAL (Also enter on line 'I, Recopltulationl S (If more space II needed, Inlerl addltlanallhooh of lamo size. 1 6,266.75