HomeMy WebLinkAbout94-00335
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CF.RlIfIGATi: 11001
WllliNIN\,; II IS Ill.ll:!d ,,' ^' II II I II IIi I.III'Y 1111
TO lllJi'I.IC^'11. /lY I'II(JII.J!,II,I (," I'IIO'iO(;f'M'11.
De~R'"''t~~~b^'!-liW ~.'t'VIm\IY~'IJ~Ds
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
CERT, NO, 2051426
!f I ( /Jfif-l.
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~ltlltlA~jkfl'II'c.llon
Name of Decedont _______/e1ULL._......_ I..L_._....J1/~.J!...Lll.&1<:J:JL_. .__
II~- ~1,,1H t- 1111
Sex ..J2J_~_soclal Security No..I._23:.:j!..3..:..__.J.~._jL'Z_~.... Dale of Death ~J.3:;-L.ig..!L....-
Date of B1rt9-''V'L\!.. ~ tJ) CiJ 1/ Blrthplace_...__ ..._4:ti:::I/::l..aJ_1wl2L.._~u..L__
Place of Death ell "/1;",blruII.d. ~.h'1t';Jl~1JLwJ~J{ld~, ,,~ ' Pennsylvania
Race AJI:-:&.J~ Occupation }:l-ifJ..1J:-~Li.L:lktJl/ltkfMJ__ Armed Forces? (Yes or No) __...:.:..1:1A2__
AAA.d Decedlfilt's l.:e ' f I" /) ~ '~ rA
Marital Status ' _ ,/ Mailing AddressL____-t>_../'j'S-,_~J...d....w_~~-~'--- _lfL....___
'Iv'It.!' Mr,'ol ~ C'l,/,o' TCwn !H&lll
/
Informant EQ:.tl,..ycA...a t!.._.22:;..u...I}J ~o'__ Funeral Director ___~_:wy:u1__W_L._ tUA"Wjfi(}...)( __
Name and Address 01~, :;7-- /J II '}- () 1 J (l-T~-':_?
Funeral Establishment /1<,~_ISi:.dT.1.~.lJ..L-~Y.i..1Ll.JJL!:MJ..._~ M_____
: I nterval Between
Part I: Immediate Cause : Onset and Death
(a) ~jU;<J /.) A' d---.____._.____._________._._._______!___.____.__
,
.--------
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.--..---.--.--....---------.---------'-------
I
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Part II: Oth~~)Slgnlflcant COndltlOn~ /1\ . . i:---~-,~'a];.n---7r----;"--. . -<i~'j, I
~.~ '-=i<d...~:n..u.1.I~?"-FL-
Manner of Death: Descrlee how Injury occurred:
o
o
o
(b)
(c)
~
Accident 0
o
Natural
Homicide
Pending Investigation
Could not be Determined
Suicide
Name and Title of Certifier L~~{l._.tt.UI.-.~/.:lf..--.-....--f.f...nl-----
-, I, ,. A J fi.' ~ A (~:J D.O" Coroner, M.E.)
Address __1:5 U _v.t.L.M,.:l:l"kj,Ll3...~I'!llf)_d,---.c..AA.M~h-~-I__~.I.-------------___
This Is to cerllfy that the Information hOle glvon Is correctly copied from an original certificate of
death duly filed with me as Local Registrar, The orl(linol certlflcale will be forwarded to the State
Vital Records Office for permanent filing,
(2-..'[, A,1J...G.J Y. _ 9 f--
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(1",'lll"j\i""L,rVolil~"d\ lj--'- ,1,1Il1';ltlo
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1I~.'J~:.9." INHERITANCE TAX RETURN
..5!iQ_1' RESIDENT DECEDENT
COMMONWI.lIIIOf mmsuy.tu. (TO BE FilED IN DUPLlCA TF. 21
DI"!tMIN' Of RlVUI I
Il'RRlSfJ:H~r,\1I0601.. WITH REGISTER OF WlllS'____ coUt~',~COD~..
i, n iffo'i tlAM=; IIA\i,I;i~Di;D ;.tomliijifi~i1=~=="'=-==-==f,!tfo!tn'S7.6Mpmn1i~mS
~ MEIJIORN, Paul E. 345 Pine Grove Road
t:l
__._~___ !:~:~~:~~:;'~~~~__._~-J~j;;:~_i;~Il_... J~~;~~;1~9~__ ~::::~;.~~~n~7~~__.
Lx I. Original Relurn II 2, S"pl'l.molllol Relurll IJ 3, Remainder Re1u,n
Ifor dole, 01 doolll prior 10 12.13.82)
[] 4. lImllorl Ellnlo 1'1 40, Fuluro 11110 roil Compromho [Is. Foderol Ellole To.
IIor dolo, 01 donlh ollor 12-12.821 Rolurn Required
l.:j( 6. Oec.donl Ol.d Tonole 1.':1 7. (l"edoll' Molnlllln.d a lI,lng Trull Q..8, Tolol Numb" of Safe Oepo," Bo.e,
(Allocll co~1 Willi IAllo<1I coPY AI Tru'll
--... ',,~L CQRmpONP'NcfA-NO CONfIPINfIALTAi!'I~'O"M TION-iiroU~Del DIMlcno TOI .,'" "l, '.' ".,"
;T~- .. -- ...-._.~-~.__... c5l.iHTfll.immliAlibmJ-' -
stephen P. Linereugh 119 East Market streot
mmrofllTIUi.im------------------'-----. York, PA 17401
l 717 I 8~3-!!.~~~__~~=c."~.=.,...,~=.,_,.,_,=~~_=~~=.
1. R.ol Ellole (Sch.duI3 AI ( 11 --.......- ..---......-- .....-.--..---
2, Sloc~. and Bond'ISclledul. BI ( 21....__ ...---....... .-.---....-..-
3. Clolely field Slocl/PorlnOllhlp Inler0l1 (Scllodulo CI I 3) ....___...._______._ ....__n. --
4, MOlI809" olld Nole. Rocel,oblo (Schodule 01 ( 41 ...._,...______....__.____..
S. Co,h, BanI Oepollll & MhcellonooUl Pe"onol Propollyl S) _____I1JiB6 "~}--'-
(Schedule E)
6, Jolnlly Owned Proporly ISchedule FI ( 6) ...---...-...-------
7. Tran.I". ISch.dule GI15ch.dul. l) ( 71.___._____.__..,
8, Talol Groll Ami. (Iolollln.. 1.71 ( 8)
9. Funeral E.p.n..., Admlnlllroll,e Coli., MI"ellon.oUl I 9) _......2!.~2~.~~___
E.pelll8. ISchedul. Il)
10. D.hll, Mor1000e llobllllle., lIolll ISchedule II (\01 4, SJG. 13
11. Tolal Doduclionl (lolollinOl 9 & 101 (11) 12,452.53
12. Nol Yolue of Ellol.lllne B mlnulllne 111 (12) _-59../,4,1 n
13, Chorlloble and Go,ornmenlol B.quo'I'ISch.dule JI 1131 ------"
14, Ne1 ~!ue .~ubl!~":!~~jline 12 n"-n':"..I!~~_~~J._____ 114) .59,/,4.1 n
IS. Amounl of line 14 la.obl. 016% role (IS)__...._..___X ,06.. .-----.-.-.
llnclude ,o\uel from Sclledule K or Schedul. M.I
14, Amounl 01 line 14 lo.oble a' IS% role
Ilnclude volu.. from Sch.dule K or Schedule M,I
17, Principal 10. duo IAdd lo.trom line IS and from IIn. 16,)
18. C"dill Prior Poymonh Ohcounl
.._........_.._ .m.... t. ____..._.
19, II line 18 h grealor ,hon IIn. 17, enlor ,ho dlllo"nce on IIno 19, 'hh 1,lh. OVERPAYMENT,
m
20, II line 17 h greol., Ihon IIn. 18, enler ,ho dillOlOnco 0/\ line 20, 'hll" Ih. TAX DUE,
A, Enler ,h, Inl"e.1 on Ih. bolonce duo on 1100 2QA,
B. Enler Ih. 10101 of line 20 and 20A on line 20B, TIlII h Ih. BALANCE DUE,
Make Checl Payable '01 Regl.,., 01 WillI, Agen'
~:tJ:J\'" '~:.~=~='-:.I.i~~ifo ~Ni~I.~:~!__~u.~~!!~~~:C?~ ~E.~i.~_S~~I!l.E}~D 1~)eCHIC~...MATH"" ":', __.:.~
Under pennllllll 01 perlury. I cfecloroll1ol1 have l!lknmlnod Ihll return, Indudlng nccompnnylng IcllOdulol clnd Ilolemooll, nnd 10 Ih, hOlI 01 my ~nowlodgll nnd bello I,
It h Irue, (OHtlcl nnd complele. I dido,. 11101 011 1801 IIII(1lfl hOl bean reporled 01 true m(Jf~ol volue. Oodurnllon 01 pleporet other 'hon 11111 peflonal r.pr811!1Olnllve II
bOled on nlllnlo,mollon of wl,lth p,e/louu hen ony knowlodgtl.
liOTIAfiiil'onmOHliBPofi!ill! foli fillNO iifliii\j-- ---.. .,;oiEii --.-... -- , "..-..---..-----. .-'.... -------..- 6A1f----...----.-----..-
( t Ii I 2020 Park street
( 'I,~TIA~M(~_#,"tlihn\~ 1\tl~ ~ijwJ~fi'- J~n~lo'lii~dyn . M ~ .s.m~.t!:_ --LbVeJ:r!'A 1-nl~ --.... ..--.-.
.-StePl;d,~d:r'.Jl.d:uU9h . 119 Il. t>hrket s.trec_t, York, .PA 1.7~~1. ._ _m'
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flll NUMBIR
94
YEAR
0335
NUMB~~
.
71,6B6.63
(161_..__.....5.C)~2.l4..1.(L--x .15.. -~-6-.__.
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o
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5
...
:IE
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S
(17)
IlIloro,1
118)
(191
'.1 Che[k horo I VDU aro rO(lUostll1D n rofund o' OUf DVOlflU munt.
8,B85.12
120) ______.__.______.....'
(20A1________...____.
120B) .-----8 ,E8~-2--........-
8/ /I- / 94
0"1"-"--' ....-..... ----
81/(,/94
--~--_.~----.-......-....
.~V.1S0' I~. '}-")
~Ih
COMMONWEAlTH 0' PENNSYWANIA
INHIIITANCITAX lIlUIN
IIIIDINT DICIDINT
ESTATE OF
J SCHEDULE E
CASH, BANK DEPOSITS AND
MISCELLANEOUS
PERSONAL PROPERTY
Please Print or T e
FILE NUMBER
21-94-0335
MELHORN, Paul E.
LAII p~-ptfiVTo'I~tlv'own.d with tho Righi oi Su,uluo"hlp mull b. dl.c1o..d on Sch.dul. 'I
ITEM DESCRIPTION VALUE AT
NUMBER DATE OP DEATH
--- ------ ----
1. a1ecking Account: PNCBank Acct. #5140402098 65,084.64
2. C.D.: York Bank #8-001-0070305862 1,003.97
3. C.D.: York Bank #8-001-0070307057 1,042.42
4. C.D.: York Bank #8-001-0070308634 1,036.28
5. ,C.D.: York Bank #8-001-0070308638 1,O~7 .47
- C.D.: York Bank #8-001-0070309601 1,034.87
o.
7. C.D.: York Bank #8-001-0070316533 1,017.90
8. Refund: Carlisle Imaging Associates 4.05
9. Cash' 329.18
10. REFUND 95.85
, '
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,: '
___._J.
----"-..-,.
TOTAL (Allo enter on line 5, Recapltulallon $
71 &!!~l_
IAllach additional 81f," )( II" Iheeh If more Ipace II needed,j
, ~ THE YORK BANK.
A First Maryland BiUlk
1111' YOII< 1I:111k N 'liu~1 Co 111 1':111\' · Po. Box H(ll) · YolI<, 1'1'1 II1s\'1 1':1 111:1 I HO'j.OH69 · (717) 8'13.H6'i 1
Ff'bl'IIf\I',Y 'I, 1 (1(11,
Kn 111, BI'OWII /. Holmr I.n
^"lm'I1p.'yn nl. Lnw
11'1 I\nnl. 1.111l'i<o1. C;l.,
YOI~, I'n 17401-1~7n
RE: puu] 1";, 1-\e11101'1I
D.O. 0,: 1-/'-'11,
Plense be advised that at the time of the death, the above-named
deoedent had on deposit with this bank the following:
1. 'l'ype of Aooount Cerl.U'lcal.e or Deoou1l.
Aocount Number L- B-001-0070JO')B62
Ownership ( names of) I Paul Ii, 11e 1 1101'11
HU/or 11amlo n .1'lel 1101'11
opening Date: 12-IJ-Bl
Balanoe on Date of Death: $ I .000, 00
Acorued Interest $ J,q7
2. Type of Aocount Cel'l.l1'1cal.p. 0(' llepollll.
Aooount Number * B_OOI_OIYlO10'/or,'f
ownership (names of) : 1'''111 F:. Mp.l hnr'n
IIUI or M",'~ I I' ^. MI'lhnrn
opening Date: ??-R?
Balance on Date of Death: $ l,l10o.on
Accrued Interest $ I,?....!J2
3 , Type of Account Corl.il'lcal.e or Deposit
Account Number # 8-001-0070J086JII
ownership (names of) : paul E, Hell1ol'l1
IIUI or t'lill'p,le n, 1101110 I'll
Opening Date: J-22.B2
Balance on Date of Death: g 1 ,000,00
Aoorued Interest $ J6,~1l
4. 'l'ype of Account C01'l.U'lcnI.0 or Deoos1l.
Account Number # 8-00l-00'/OJOI36J8
ownership (names of) : Paul E. t'lQll1orl1
~or Hande n, 1,le11101'11
opening Date: ]-22-132
Balance on Date of Death: $ 1.001, J(,
Accrued Interest $ Je" JJ
Accrued interest is included as of date of death.
VGJY truly your!,
(J (l'l.b-O Jvf'I,_ ~) 9N,,}.C-U> (lV\
Barbara S. Beaverson
Dnposit services supervisor
'!V,IS1JU. (""1
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......
(OMMONWULltl o. 'ftmHLYAUlA
IHHUllANCI 'AX mUIH
1"1011'4' DICIDIN'
J
SCHEDUlE J
, BENEFICIARIES
MELHORN, Paule E.
fiLE NUMBER
21-94-0335
ESTATE Of
ITEM
NUMBER
NAME AND ADDRESS Of BENEfiCIARY
RELATION5HIP AMOUNT OR
SHARE Of ESTATE
----.'---- ------
niece 1/5 of residue
nephew 1/5 of residue
niece 1/5 of residue
niece 1/5 of residue
nephew 1/5 of residue
A. Taxable Beque,'"
1.
Vicki Kay Lynn Peterman
6316 Old Carlisle Rd., Dover, PA 17315
2.
Greg Nathan Lynn
790 carlisle Rd., York, PA 17404
3.
Bonnie Lou Lynn Senft MorItz
345 Pine Grove Rd., Gardners, PA 17324
4.,
sharyn L. Smith Altland
3610 Williow Rd., D:lver, PA 17315
5.
steve Alan Lynn
205 Kendale Rd., Red Lion, PA 17356
ITEM
NUMBER
NAME AND ADDRESS Of BENEfiCIARY
AMOUNT OR
SHARE Of ESTATE
B, Charitable and Governmental Beque'tll,
1.
NONE
"
,TOTAL CHARITABLE AND OOYERNMENTAL BEQUESTS IAha enler on line 13, Recopllulallonl S
(If moro .paco I. n..dod, Intt,t additIonal .hoo'. of .am. .1101
See Instructions on Cover Page
CllRLISIJE InIWGII
Lalo 01 "-D..iiiil3efI6.iid COUiity Decoasod,
AFFIDAYIT OF PERSONAL REPRESENTATIVES
(OllllllollwtnlllJ of ~tllllll',,'lbnllin,
llll,
(oUIII", of Dork,
INVENTORY
l No.
OJ
,21..-~4:70335. .__...____..__..__..._, 19__
ESTATE OF
P^UL E. MmJlmN
_'_-0 ... ...._ __ ..~_.._..-.. .,-
Porsonally oppoarod boforo mo, a ' ,.,. ,N.O@LY.!?1.1b,U9._.....___..._._, In and lor sold County,
Ray N. l,ynn and Evelyn M. Smith
.. .- ...-....---..--....---.-----.--.----
who bolng duly ..__swqm.___.... according to law, say .Jl , .. thallhe within Invontory ollhe personal prDporly
and roal oslale whloh woro 01 ..__.__.___. .._ ,l'aulE._._f1elhorll__.. ._.....__.___..._.__________._, late 01
_9'!~!J~I~..lli?rClu.9h'_~):~am County.. Doooaso~, Is truo and 00"00110 Iho besl 01 .._!:h~k..-_
knDwledgo, Inlormotlon and bo/lof.
. NOTARIAl SEAl. . ._, .....-.
STEPHEN p, LINEBAUGH, Nowy Public
CIIy 01 YOlk. YOlk COII"'Y
M COlnllli5sirn EXOlf09 M3 5. 1996
I) ~
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.L~(rti,~.r::.~1.t.t..~:.-.-._---
( :'.-'-e.).i?Y'-.::hJ.--!JcY.1~i~--.,~---
Welyn M. Smith' I
.~~~Il__. -l' ..- " , and subsorlbod 10 boloro me
IhIS..__J(~:.. day 01 4-v-sWlt. A,O, 19 94 _.,_
. "
~~
ollhe porsonal properly and roo I oslalo sltualo mlho Commonwealth, whlet, wOle 01 ----!?~l,ll_lh.~lbQJ;&.nrerland
, ... _.._ , 1010 01 , _ carlisle IJoI.'ougl:L...___, _____. 111 Iho Counly ollOOll(
lakon and mado In cDnlormlty with Iho above deposition under Soctlon 3301 and following 01 the P,E.F Coda,
INVENTORY
2. C.D.: York Bank#8-001-0070305862
._------_.._~-------_._-_.-- -.
DOLLARS
65,084 64
1r003 97
1,042 42
1,036 28
1,037 47
---.-
1,034 87
1,017 90
4 05
PERSONAL PROPERTY
1. Olecking ^ccount: J:'Nrnank ^cct. 1/5140402098
.-...--. ..~_.._.. -----~..__.._----------------------
3. C.D.: York Bank #0-001-0070307057
4. C.D.: York Bank #8-001-0070308634
._- -_._-_.__._-----_.__..._-~
5. C.D.: York Bank #8-001-0070308638
__.....__. __ __u____ ____..______~
6. C.D.: York Bank #8-001-0070309601
7. C. D.: York Bank 1/8-001-0070316533
-----. ..' -_._---_._-_._--~.----_._---
8. RefUlld:_ c::',r ~~.~!~_~'l!..nin<;!.!'~.s__oc:!a ~~~_.
9. cash
329
_.___..____________._._______._____ _'_~__h ___.._._..__.. _ --
95
18
'-'-'-"'-.'--
85
1 0, Itefund__.- __._.__..
1'C1rN.,
71,68G
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,( (lllott UOI1~ns '1'.~llllldllll lOll 1;11\ 1'~1"l'ill"'\ ,'11 11"11\
Sf OJIllls DlallM POI-l~SlII oq ~UIII SloOllS IUUDI1IPPV '9
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1111UOh\l101111110:J DIll In ol'lslne Oll1l1l1S olU1S3 IUoU
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^11 P"1111.1\~1' nq IOU (10',111 Inll 1"'!I1IlIlIl! il'l 1'11111 '(lI"~MUOllllill1:) mIl "I ~J~II,\\,\1I11 Oll'OIlS 01111\3 IUDU 't
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'~po:) ..1':'1'11 ~III JO ~(I{:(;'f(ll:!: IIIOII""S JO 111I~IlI,lllllh~1 m(l!,1,1111 OJ 1"'IJ111P SI uueJ SitU 'I
SNOIlJfUllSNI
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See Instrucllons on Cover Page
INVENTORY
ESTATE ~~ E. MELliOON ) No n ~1:-~j.-;03~L...._..__.__._.."
~~~~;'-'~~i~~~y---"-u Docoas~d. ~ \ . ,
AFFIDAVIT OF PERSONAL REPRESENTATIVES
(ol1lmolllurl1lt~ oC ~rllllll'1.'ltJl1l1il1. I
..... !lIl,
((OUllt" oC !>ork, \
19..__
Personally appeared belore me, a ,.. ...__ , ..,.., ..[Il9.t:~1I:YJ:)l!b.U.9..._.._.____, In and lor said County,
Ray N. Lynn and EVelyn M. Smith
_ ,"_ _ ___ ._+_ __...___________n__.__.______.___.__.._..__________._.__._~
who being duly ,_!>'I'IO.J:n. ___... according 10 law, say ..::1 , .._,.. . "Ihatthe within Inventory 01 the psrsonal properly
and real estate which were 01 .m__._. . .!"al,ll..J:...Melh.om. ..., ..... ._... __._._____ ._.__.___.___._, lala of
.~r:li~J:eJ~roll.9I1L~rlc'lmCqun.1;:y.,. Deceased, is true and correct 10 the best ol_____their ,_
knowledge, Inlormatlon and be/lel.
. 8w?E1.--(4l'--.. " and subscribed 10 bel;: me
this ----t..::::,. day 01 ~~t. A,D" 19 ,.. --
'~__m__.__"...
~TEPfIEN.pNO" u~~~tIJ8~A~ol~r~;;:~;I~'-' .. -. . . . ,...
CllyolYork,YorkCounlV INVENTORY
My CommIssion ExOtros ~1Jv 5. 19')6
'/.7 'J c.Jl I
'Ra~(ttL~ . ~-r:"JJ-"lLf&!r<._.._.-------
~elSr;W~ith'11../.h'I~.il-~-..-...-
01 the personal property and real estate situate In the Commonwea/lh, which were 01. .-. .J@.l!L~L/<!E;!lhQ.J:&nt:erland
__,.._ ..__.___ __..n. , lalO of, ,CarHsleBorougl:l In the County 01 ~
taken and made In conlormlty with Ihe above deposition under Section 3301 and fo/lowlng 01 the P.E.F Code.
PERSONAL PROPERTY
1. Checking Account: PNCBank Acct. #5140402098
2. C.D.: York Bank#8-001-0070305862
3. C.D.: York Bank #8-001-0070307057
. --..-..--~_._.._-------------_._--------
4. C.D.: York Bank #8-001-0070308634
5. C.D.: York Bank #8-001-0070308638
6. C.D.: York Bank #8-001-0070309601
7. C.D.: York Bank #8-001-0070316533
_.8. .Ref~~:._~rl.isle Irreginin\L~ssociat~s
9.
10.
Cash
R,:l.Tl1nd
rorAL
TOTAL
REAL ESTATE SITUATED IN THE COMMONWEALTH
----.--
NavE
-..._- .-----.---.........-....--.
._---~~.._-,.....~--_._------_..-.---- ~---_._--_..__._.__.-.-._---_.~.
___..'_._ _w ...._.__. .__ __ _ _.. ".__ _._. ..___..___.___._. ..._.__._._.______~.--.------ .__.~~.___.________.
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spall lis alallM PJl,lnSUI aq ~UlU SlaallS \I1I1DlllPPV 'S
't
SN0I1:>nll1SNI
Register of Wills of Cumberland County, Pennsylvania
PETITION FOR GRANT OF LETTERS
Ellall ol
1110 known U
Paul E. Melhorn
No,
..___.-' Dtcellld SoclaJ Seevrtty No, 1 83 - 03- 5 4 7 6
Ptn.no~ll, ""."'lIllI Yllf. .1 ~ Of .1dtf.1jl!l~1"')lor.--
(COMPLETE 'II' OR ~' BELOW:)
~ A. Probale and Grlnt ot llnlrl Testlmlntary and ....r INI P.li1ion.~" Ih.,. th...taJ1-=.glamed ;, tit 1111 Wil of
tit o-dIn~ dlltd ---<..A"" Ll~ I ~? , \(IL,8 M~ ..'IlIII) illI~ \.Iv'" \.l f W I U I" _L. l~~ .1.. I
V\, ( I~Lflc (, ,~~L, ( {, .il...::.-U. ( "Ira" , .-J I ;. ,,) '/! b I rn
be rMwnI-UtcuTii.V.c.. ...7~~ of...~,..
E...pl u Ionawl, Dee.OIlnl dd not m.ny, WII nol d,l'Orced, .nd cld nol h.... . cNld born 0' lldopled II1Ir "",,,bon ollhl doc:unInll
oHmd lor proball: WII nol tho \Icbm 01. killing IIld WII IlIVII edlud..lBd "compolOllt:
o
e, G'lnl of lolllrG 01 A.dmlnillrlUon
tdb.M..l...;'~lie~llllrt/l1. ...tt1~;4\1l'&1"W rnMrtaWI
P.litiolll~.l .lIor I prol* ...rch hull,.,. llcertlillld thll DecoOllnlloh /lO Willllld WIII~wd by IhI loIlowv1g IpoIIN (If .ny) and
heirs:
NItre
Relaaonlhlp
Relldenoe
(COMP\.ETE IN AU CASES,) AUdllddiiNIll1Hta ~ ,*'"III'f.
Dt<:edtnt WII domlcilod II de.~lIn Cumbflr land
otptiocipli"IIdenoe.1 1 Longsford Way, Carlisle, PA
{.tl "'''':M~ 1M mf.l\loptMy)
Deotdonl,lhIn 94 Y.lTlof.go,ded._-yanuarLL..I,_jA t1.C.UJJlberland Crossings,
ILoeanon) J
.____bc?!) C\l
.
(
.
Co..,ly, Poonl)'lvInia, with hl"""lul family
r.,", 1 isle
Borough
o.c.denlll death awned propel1y with ..blll.1ed l/IIutllllollowa:
(II domiciled n PAl AI poIIOnIi pnlpeny
(If nol doIn.cil..d n PA) ".,..nol propeny In ~OIlnlylvln~
(II nOI domlc<1ed ~ PAl Per,,,,,,' P"'I'OI1Y In Counly
Vii", 01 real ilIA. "POIlnlylvtnil
~~18d u Ionowa:
Nlh .
"""..10111, P.tiao",,~11 relpeettuny roquoll(J\ the prob.. 01 tt,o la.\ Will o"d e...a:_l(l) "'''OIlllld with "'II P,lition .nd "'0 gl'llll of
1I118" ~ lh'IIlPlOpnatA form ill thn undonigned:
Slgnaturo T dot nloo name and ros'donce 1
~', .,f'f~.l1J.L;\.--.-ol.- IJ,,(C[ .Evely'~M.~~lnLth"6-b~~r~~k.!i~~1 ~oad,
//'/ ~f'!./-:r'~"-X~~=~=~~;" '!~y'N~\~rin,___~~20 ParI;' St., Dover, PA
Fonn IRy(, PlOt' 012 . ... 1 731 5
Pltpllodlly'" P'MIY~tr\OI 8at "u.o..... 11101
Oath of Personal Representative
Commonwtlllh 01 Pennsylyenla
Counly 01 Cumberland
The Pelhloner(s) above.named swear(s) or affirm(s) thai the statements In the foregoing Petition are lrue
and correct 10 the best 01 the knowledge and benel 01 PeUtloner(s) and that, as personal representatlve(s) of
the Decedent, Petltloner(s) v.ill well and truly admniste' the eslale according to law,
SWam 10 or affirmed and subscr1bed L ' ( II I I. ' ,Ii Ii' '(-,-------,I II;';;'
t:velyn It;'. Smit~
belore me this day 01 . ''''\~,
lQ_ / (, 1"/ ),: ',I'd, ,('I, , '/ (
-Ray ft.1. Lynn' /
"hI"",,,,
For the Register
(11 '.r j ( 1
), , to 0: ,.,fl'
lil
No,
Esta1e of Paul E. Melhorn Deceased
Social Security No: 183-03-5476 Date 01 Death: January 4. 1991
AND NOW, _ ,19 9 4 0 In consideration
ollhe Pellllon on the reverse side hereon, satisfactory prool having been presented before me,
ff IS DECREED that Let1ers rn Testamenlary 0 Of AdmlnlstreUon
-~;~ N,ClVfatlW tbWtI&;ch...".."*'*'*
are hereby granted to
Evelyn M. Srn.il.h andRay-H. Lynn
In the abeye estate and that the Inslrument(s) dated
descr1bed In the Petition be admitted to probate and filed 01 record as the last WlII 01 Decedent
FEES
Let1ers ."""""""""" $..lL2Jl D _
Short Certlficate(s) ''''
Renunclatlon ",,"",,"
AIf1davlts ( ) """"",,,
Exlta Pages ( ) .",,,,,,
Codicil......................
JCP Fee ...................
Inventory ....,.,...........
Other .......................
TOTAL .............
$_ 'l.OO
$_.
$
L
$.___
L_ 5.00
$
$
$
>;:''--'.'h- ~~. -'1'(11I.
t.:..) ,-,)'.!1 "
.stephen'---p,. Linebaugh
16280
Morney:
lD, No:
Add"..:
__J..Ul._IC"qt ~1r"'1- Strlillilt:
York / PlI ~'t4o 1: ,. ,~)
(717) 843-8968
Telephone:
I.'
t:l
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Fonn .AW.' PIVI2 012
Pr_od by.... PIMIYIvanlI e. A...duon '18'
:)''/ 0 'I' I
( REV-1547 EX AFP (08094* ' ;I i
COHHOHWEAll1l OF "H""VAHIA NOTICE OF INHERITANCE TAX ACN 101
~ r.~:':' ,~,::~~ "". "':.:,,"~ ::"":,, .. """0"'"
~miS:~:~~lpA 111/0-0601 or DEDUCTlONSAND ASSESSHENT OF TAX DATE 12-26-94
EsfAn of-='Amlil'itN'~~'==P'AU .... E . "~'~===~~=~FILE NO-: '--==rr 9'4-0335
DATE OF DEATH 01-04-94 COUNTY CUMBERLAND
NOTE I TO INSURE pnJPER CREDIT TO YOUR ACCOUNT, SUBHIT THE UPPER PORTION OF THIS FORK WITH YOUR TAX
PAYHENT TO THE REDISTER OF WILLS, HAKE CHECK PAYABLE TO "REGISTER OF WILLS, AGENT"
REMIT PAYMENT TO:
.,
(../
STEPHEN P LINEBAUGH
119 E MARKET ST
YORK PA 17401-9746
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
I::: AM"nt ROnlttO:d__::3
CUT ALONG THIS LINE .. RETAIN LOWER PORTION FOR YOUR RECORDS ....
R 'EV'- i 5;;1 - EX "A j:ii" i 0 ij: Ii" Y "NoT" i c r"ci F - i"NH Eiii;: ANtE" T"i. x" A"p piiA"i S EHEN 'f," -A r. rciwAN"c E" eiFi"" -" - - - - - -""" - - -"
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF MELHORN PAUL E FILE NO. 21 94-0335 ACN 101 DATE 12-26-94
TAX RETURN WAS I I X) ACCEPTED AS FILED
RESERVATION CONCERNING FUTURE INTEREST - SEE REYERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL
1, Roo1 E.toto ISohodule Al
2, Stook. ond Bond. ISohedulo B)
3, C1o.01y Hold stook/Portnor.hlp Intoro.t (Sohodu10 C)
4. Horigogo./Notoo Rocolvob10 ISoh.dulo 0)
5. Co.h/B.nk D.poolt./HI.o, Plr.onll Proplrty ISchodul1 E)
6, Jointly OHnod Proporty I Schldull F)
1. Tranaflrl ISch,dull G)
&, Totol Alllto
I ) CHANGED
Ill_
12)
13)
14)
IS)
(6)
(7)
,00
,00
,00
.00
71.686,63
.00
,00
IB)
71,686,63
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funaral E~p.nl'I/Ad~. Costa/Hisc. Expans.. (Sch.dull HJ
10. Dlbt./Hortgogl Llobllltlo./Llon. ISohldulo I)
11, Totol Dlduoilon.
12, Not Volul of TI. Rlturn
13, Chorltlble/Govlrnnlntol Blquo.tl ISohldulo J)
14, Not Vllul of E.toto SUbjoot to To.
19)
liD)
7,622.39
4,830,1~
Ill)
(12)
(13)
(14)
1?45? 53
59,234,10
,00
59,234,10
If an assa9sment was issued previously, lines 14, 15 andlor 16, 17 and 18 will
reflect figures that include the total of ALL returns assessed to date.
ASSESSMENT OF TAXI
IS, Anount of Llno 14 .t Spou.ol roto 115)
16, Anount of Llno 14 t...blo .t Lln..1/C1... A r.to 116)
17, Anount of Lln. 14 t...blo .t Coll.t.r.I/CI... B r.tl 1171
1B, Prlnolp.1 T.. Duo
NOTE:
~x,OO,
.00 x,06,
59,234,10 X ,15,-
1181
,00
,00
8,885,12
8,885,12
TAX CREDITS I
rAYHENT
DATE
09"15-94
RECEIPT
NUKBER
MM912959
DISCOUNT (+)
INTEREST 1-)
AHOUNT PAID
8,885,1.2
,00
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST
TOTAL DUE
8,885,12
,00
,00
,00
· IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST,
IF TOTAL DUE IS LESS THAN II, NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICR), YOU HAY BE DUE
A ReFUND, SEE REVERSE SIDE DF THIS fDRH FOR INSTRUCTIONS,)
RESERVATION I E.tlt.. of dtctdtnt. dying arl Dr b.far. Dlc..btr 12, 1912 ~.. If anv future Inter..t In the utet. .. tran.f.rr.d
In po.....lon ar .nJaYI.nt to CI... B (collat.r,l) blnlflolftrt,. of the dlcld.nt aft.r the IKplratlon of Iny ,.tlt, for
Ufl or for Yllr., thl CO.lanwlal1h her,bV 'KPI'..t1V r..,rv.. the right to IPpral" and II.... tran.fer Inherltanc, YaK"
at thl Itwful Clall B lcalhterll) rat. on .ny .uch future Inter..t.
PURPOSE Of
NOTICE I To fulfJ11 thl requl,..."" of Slotlon 2140 of th, Inhlritancl and E.tatl TIK .lot, Aot 21 of 1991. 72 P.S.
SI(lUon 2140.
PAYKEN1,
Dltach tht top portion of thl. Hotlcl Ind 'UbAlt with your plVllnt ta thl Rlgl.tlr of will. prlntld on thl rlYlr.t .Idl.
uHakt ch.ck or loney ordtr payablt tOI REOISTER OF MILLSJ AOENT
All pIY.lnt. rectlY,d .hlll IIrtt bl applied to Iny Interllt which .av bl due with any "Ialnder appll'd to tht taK.
REFUHD (CR)1 A refund of a ta)( crtdlt, which WII not requI,tld on thl TaK R.turn, lay b. r.qu..ttd by cOlplttlng an "Application
for R,fund of P.nn'Ylvanla Inh.r1tanc. and E.tat. YaK" (REV-13U), Application. art avallablr. at thu Dfflc.
of the RIlIhter of Will., any of th. 23 RtVlnl1l Dlltrlct OffiCII, or by calling the 'Plclal 24-hour
an.wtrlng ..rvlct nUlblr. for fori' ordlrlngl In Plnn.vlvanla 1-800.362-2050, outlldt P.nnlylvanla and
within local t1arrhburg aru (717) 187-8094, TDD_ (717) 772-U52 Olurlng Ilpalrld Only).
OaJECT10HSI Any party In Interl.t not IItllllld with the apprals...nt, allowance or dltallowancl of dlduotlonl, or a.......nt
of tu (InclUding dllcount or Int.r..O III .hown on thlt Notlc. lu,t obJlct within IIKty (60) daYI of r.o.lpt of
this Hotlcl bYI
uNritten prot.lt to thl PA O'PDrtllnt of Alvlnu., !loard of "PPIllIt, OEPf, 211021, Harrltburg, PA 1712a-l021, OR
..lllotlon to havI thl latttr d4t.r.ln.d at audit of thl acc~unt of the p.rlonal rtpr"lntatlv., OR
."apptal to th. Orphan.' Court.
AOtUN
1S1RATlvt:
CORRECTIONS,
Factual errort dhcover.d on this ........nt .hould bl addrUlld In writing tal PA D.partllnt of A.v.nut,
BurleY of Individual TaK", ATTNI PO:lt h......nt R.vlaw Unit, OEPT. 280601, lIarrhburg, PA 17128.0601
Phont (717) 161-6S0S. SII page 3 of thl bookl.t "Inltruotlon. for Inh.,lhnu Ya)( Rtturn for a Allldlnt
O'c~d.nt" (REY.ISOI) for an IKpl.natlon of adtlnt.tratlv.ly corrlctabl' trror..
DISCOUNT I
If any taK du. It paid within thrn (3) calendar lonthl aft.r the dGud.nt'lI dlath, a flv. plrClnt (SiO dlteount of
thl taK Plld It aUowld.
INTEAESTI
Interllt It charg.d blglnnlng with flrtt day of d.llnqulncy, or nlnl (9) lonthl Ind unl (1) day frol the date of
d.ath, to the dati of ply..nt. Tou which b.ca.. d.l.Inqulnt b.for. JAnUlry I, 1982 bllr Int.,..t at tht rate of
IllC (6i:1 perotnt per annul calculetld at a dilly rete of .000164. All taKII which b.ca'l d'llnqu.nt on and alter
Jenuary 1, 1982 will b.ar Jnt.r'lt at a ratl which will vary frol callndar 'lIar to oal.ndar year with that ratl
announe.d by th. PA Clpart..nt of AlVlnul. Thl applloabl. lntlr..t rat.. for 1982 through 1995 Irll
'!!!! Internt Ratl Dilly Int.,..t faotor !!!.r Tnterut Aatl DillY Inter..t factor
1982 20~ ,00m8 1987 9X .000241
1981 16X .000418 1988-1991 IIi: ,ooom
198~ IIX .000301 1992 9X .000241
1995 IlX .000356 1993.1994 IX .000192
1986 lOX .000274 1995 ?i: ,DOOm
....Int.,..t II cllculatld a. followlI
INTEREST . BALANCE OF TAK UNPAID X NUHBER OF DAYS DELINQUENT K DAILY INTEREST FACTOR
"-Any NoUe. IlIuld .Iter the tlK b.eol" delinquent Nlll reUlot an Interllt c.lcuiatlon ta flft"n (IS) dl."
blYond the d,t, of th, ........nt. If ply'.nt I. IIde lifter the Int.,..t caputltlon dltl .hown on the
Notle., Iddltlontl Int.,..t IlUlt b. c.lcuht.d.
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