Loading...
HomeMy WebLinkAbout94-00350 '. ~ ;',' :l'< '< I},' ,', I ~ _II'" ' ~. f. 'i"'!' ,'1\" , '~" , ,\:,~ 'I '!'~ '.: I~, I 'J4~p'j ":lir'~~."I}\" r;', ~\'.\\WI'~''"''J:'" 'j' . ~~' ~~::i~?ASi:'i"i<'\:"\" " ' , :1" "t;\J'lri"""I!"I(,:. \ "'I', " '~' l~.;.~~~-<<t~f\ll)II;~~h\~:"(: ,1../' Ii"" ~ ~ 'If,""li~IJI; ,\jU"i":' "11\'1 \," , ,,'. ~ 1 ~'filll~.' '!~' r,~'~ l,:!,ti'j"\,t:."/V:,, I j I \0 ,. ~,' "1 x l~"r" ',,. "" ,. , . ',r I" " \,1\ \, ~Ml" 't!1~"- tW I \1.ilt1;~. ~ 1','1". ,1/"'''<1 1/ :', I '';-(lj'fl<'ffil ,d11,,1;m '-?:tt k"'~~'il':'t','., ,'.,' .. :"\ ': III 1,1. '{It\.,' ,~';., ,'\ \I!'},:', "~ " : 1 .j' ,I,' I . I'~~\:'. T.' ;;<\ \\T' t ,., ,'I' '( I" n,I,.;'. " "I '.1 ' 1'~~:i"l':\lj ":t';" 1',;)''''; 'I fi\', ,~ 'j'{;~,'~,~"t;lf, iH ~)' '\', t,.\",.~l, "d -t' l CI,t, "il-j "11," l',..,\iI\1 ~ '" I', 1<: ~l-l I, "'/11' '.', I ,'" j " \'-- ~-.", " '1'.1, "~l\'\ '(1 ' .l, 'j It 'IFF' tl '" li.;t'1f ,: : ':"" 'I~ ',' '1' _I, d," , ), I \'. c 1\ ' ~: _ ~'\ ri:, )t:,', ',' ; - ' - I ,"r r\: i i i 'I; , , : ," 1': t~ 'iii\ \,:,..', :r:' I J' ',', I": i\,! ," , 'j ~ l\"~ I" l/l\' ,I ; '" ' J ;, I' i ,I' ,I ' ,~:',\I \ . ,'(, 'i','{'II'ld {i~ 1 h,' ~'l \ . "'-,f' "1\,l,"1,1 fill i "\~ '". ,n' jl I "'j,,' 'f. i' n.., 1,'.1" j~: ;:.\ ('I " ,,"; .. I ' 'II " ,\ Y ~.-~" 'I,' f j. .' f )~''', ' '. I ).' ,I, . !" '"( I') . i"ll' 'C~I, II' ,,"'~'. 1.;:" Il'f 11';\""""i":" ~;-,.'il' ;11'1' "I - ,..~ "1\ "' 1 " <i, \ \ 'I' \ 'iJ . l, 'f ,'_ - ; ~ I ',f " 'I , . 'I"" -, ~ " " . -' " ,,-, t" , '_r".l"II,. "_I' "',' ,-t,."/,_,,," ''', )", "\:,:' 'I' ,r-'I ,-i"'I'I{,vj~-"-,-,I'-'".:, -(,:\_I'_~I~',.\ .~; ;-:', j'I', ~,'I' -',Ii<::,:,,~' q"':,,, \;;;, J:,,:J /,'!Jj,:,~ '{<1\':_/-'.';', i\('~-;I/-.'::l-.~_I'.' !', / \ '(, 'I" { ',.I l' ,.\: II, ;\~;, Il"\~vt~li~_~'~:-".'~;~ .',,',~/," /:1-'/', '-',,I ''', -',I:, ; d,\.~I','I,l" 1\:-'" -I, , f", 'I; \ F: ,- .' I : \' ~jt\,' ,-:' '/'-1," ., ~ it . i 'pl, -,- - ".- \I - . -'... I", 11-'''' I , 'I' j'" - ,- i' :, \ ',~I , I'" r" ,';,:,- :~,','..', ; J \ ' '-. .''' , . _ 'I " - , " ~J' ,"-, '- ' \"'-' 1\ '- /, I'f" ." 1 ,t ,t, '!.; -, ~I I" "I l I ',i '1'1, " t~::,!;(~ ',,':~:::~~ ,:_{\.r\i{:_;,: :,:_:_::!;''-_';'' ',:,' ':,:'; :~'~-, j-: :';'.' '''1' 1.;1:; :\': :~:,: ,,'; ':, 'I "" , ,~~ (~;-. 'I _, _\ ,,:,), \ r> i, I.lf I ! ' I,: 1 1 .' \' '", '..,_1/" r ., ,\ . " ' \ i "I" 1,_ , _''';_ I, "'f~,N1.I'_,,--,1" I .,' " ./.' " i, ,;, ',".'.'. _' .. ,.. ~ I ' : , 'I) ( ',J"ti, ,,-:l,~'-:;'~f1J-.<~I-'J;i;-' 1- '_ _ .-.' f / -, \. '; :- 1 \1,1\ _': "', ~d," l/YI,I,~!:;!("I<'-r "I, ';! ,'-' ,p,',,-' ," ;':1, ;',', ' 'i \j~'Il\ .-, .',:_ ! ~.l (jI' l iJ,' .' \, i'", . " ,', ,,' ,n, '\"",-\l;'i"\l/,'~';~Vf-, ,'- "\, ,\,11. ',t' "'I ~l 'r i \.':' ) \ - ~~, i' 1 ,- I t, - " "'I ,I ,'. ,'/" \', jj ~: ,1; ,: ," I:,'" \: \, I', " ," .~,:'<...::.,~L;-};~_~ ?:::r:.,':,:,:;' 'r:;\j, '.'.\,.' ".-0'-:,:: - .'\I/,"!"l \'- 'Iii" '.. '.... {~" (t: . ,,\ ,,_l,<,_~ ", '~\F "i.. io ' 1 11' \.~'-'.'J..,},l;:""'\".;~,"t(j'"L. ""/:,' :".';,'-_,,' I" , ;,1(1::.'/ {(\\,\:,'\ :(III:', I",,:,: ;1-' ,.-, 1,_ t', 'I,.! '_I' 'I) 1',11'1 . I" ".'\': ",' ;rtf::'I"H 'f - '-'I .\;\ - II' " '1\'1' ,:," -"All i,l 11~\,.L'" "",',l't ,'" "i'\.' ,;,1' ".'.!!, ',I, ,i. ' j;;,;.:;j;:()~i;~,;~:;~. ':i\:;:;::~',::i " ,'.':' :':"';':;;,,. ,:'", ','" :' ", '~\"'~'Ii"l~~....",:,'/ri ":'.'1 II,," \_~', ,fl, i!,,,! !ii\;}:i;.',/::,"';:;;i' :,\:.' ". I ,\ ".':~.." t';': " Y:''';'~}~~l'i;'''\\';:; ,) : ;-;~] 1,,\' ", li~ , t /, Ill'" ," ,I' ',-"1_-;:,',\':':" ".' ," \'",j. l' 't" \r,q'i, . ! ~,'" . '_, ';' '1,," . 't 't[",:"f.:-;I:" ',"1', 1:\': ,\ 'j\' If ,.,i',', ," '"I '1, I, I I ':! I':' ~ I , 'i:'-' i' / . II", , '\_~I,~, '", 'i I..., " " I it,- '1\', : '1,1'1/ " 1,.1,' ,/t-," ,,' ,'f _;"k~I:\ if, ,l", ,.',.', Ji} ;,',l ~, ( :~, '\ I ~ \ i '.', ",1."""_,,1 \!,j:l/ : 'j, / fi_'\I' ,~),:, ~t.,.J 1 !I./, .lIJ,,;/:- 1/,..', "/::;>,:>',';':;'. ;", ,,'-' ;:1',1' ,,)),l, II \1 \" ,'" ,,- - ) .':',.-\\ -'"'1/ ,'i" 'j \,' ".. "\1 " " :';' ". '-'(,:";"~( , I," ,',i ". '<,":\\'1, "'q" ' '''I:t,:, " 'I.I , " ,'I' ,I" , ' I': . \, ,j " " ,,:.\1; ". .... \ I.' ,.' ',"\; Jt,l I_I.',' " .' " ~', : I;,' ~ H-' "j, ;' "l " . " .' "~ ,q, '" ','" I ,',; ~ I':" I),' !('I., , '.. \', ";.1 , I", " oI' " , " '" I'. " II. " '" ' , i"' , 'II II, ' ,. , ",i,l' ',I' I ";,', ". 'II" '" ,. " ( ", "I' ", ,. " " I, '. ./.:1' I.p, " " ,/I , II ,,~;. ~,\ j '-" " , /,1> " " 11 '.-' 1 ;!' ~::.' ~ ' ',,,,.f ',\1\ ," .I; 'j' , 'J" ;1: II' , '~ ' ,. "'I , , " ' ~' 'tl' i'" .' " ~ ' ' 'ii' , '" " I'" 'j'l ", 'i' ',I i' ,. .. , ", ,i , .1' '. I' " . .',;' ,... \,rt ' ~ \ .;.~, ';"j'- I' ,", ". ,,' " 'I,',," " I., . ,I """'" " "J'11 'i \,'1., 'I,' \. ,!1 '~.,"", -,- , , ' , ' ,. /,''-.. ' '., " :3 . ...,... 'C\I ... o Ill,:' " " '.' . ~O', Z',: " ,. ,'i'" /: , ". '," I, ",I, ", "i " , i ~ ,I I-_,:i', , ", .,' ,,, 'll.. , I,il/: .I'j ,j" I: !I,. Il,\l, ,. '1,-'" I ,'. ~: " !'\"';, " "~"~I' ,'; ,,' ,I,' ,,' ':I'!" I{,/ \ ': , .'J' . ,1'1 ,/ .' . " ,.. d', .: , , ," " ;.'11 I:' " ,. , :ij ,,\:1', .,1 " ,e I' \ I,' '1"\ ,. , " , ,III' I' I' '., ' ',1-, " '" " " " " ,. ", I,',f\ d' :"i,i'-' " ....'., " ,lJ, : ~ ',.' :\ ,. j,;j ,. d .. " " ,'I' , ,.r ,i. ~ " " , , \'1)' , 1 '" ,\ " " , ,,', ,1,'1 '", " ., II" ,,:'., .,. I,' , ., , ' " "':1 " " '"f, ,,', '" " '.I' 'I'_i , , .,. ,',I '1," '. .' , " . :, , P ,I' , ." " , ' " ,',JI" 'I,"' '" II'",; ',", " .P'., ." (." '. ~ -, 'rl' ", , '. ,: ",' , " ~ ,,'-I', I ;' ,', ,,' " '/, " " ~- - I)ET~TION }~OR 1~lwnATE and GRANT OF I:ETTER~_ /'\/11I1' '!!. . L ohl< f<., It/I'" .\... No, . _(y.L~.q!1~3~() ol,\'() kl/oll'l/ 0.1. To: Krgislrr of Wills for Ihr " '.' , ,/1<".:;:'0'\'1'11, ('oullty or __.n~V.MBER!'_~.tlL in \hr Soc/o/ Sl'cwil,l' No, S'? (' . (, .:1, ..; 01 y. J. l'ollullonwrulth of I'rnnsyll'lInill Thr prlltlonof thr ulldrrsignrd rrsprrlflllly rrprrsrnls Ihill: YOIl1' prlillonrr(s), who is/llrr 1M yrilrs of i1gr or ollkr i1nlhr rxrruL",v'- '__0 Inlhr lilsl 11'11101' thl' lIbo\,~ (Il'rl'drnl) ("i,rd. n' n_.__n__.___.__..__._. , d. I' 'I( I I ~v:: J' /4 '( r '( KIllr-T\>{ leI .)-< Ktt'< . . (1'.."....-'-., ....--..----------.--.--- mimed :;1~ (\lUlt' rl'll'\,imll'iI\'1I1l1,tUIKt". l',~, rCIl\1l11:illlloll, dl'illh of c\ct'lIWr, ell") Ilrrrl1(lrnl II'ns dOlllkilrd ill drillh in. ..c:.~!,:~. J.,., {.:--!Z~ ,6r--lounty, PClll\SYIVnl~.' Wllly'-' ILL-L._.. lilsl rlllllity or prindpllllysidrnrr al/_c/ ;' I ( -- L1.J~"'" 1);'1->< (~/ t(L c.. ..._._......._../,ou,)'c.1.:.. lILk<!.lI!. .JtJpm_n__._._______ . (Ihl ,IH'l'l, 11Il1llhcr lInd lllundpalllY) Dec~zdclll, Ihrn .7l yrilrs of i1gr, dird _.iJ..f~",l-.-:'I-j? ;.' L( HI_..___I.';' .re,l,:c ~'.(I. m __un (...._._____._. Excrpl as follows, dl'eedl'1l1 did IlOllllllrry, was nOI dil'orrrd IInrl did nol hlll'C n rhlld born or ndoptcd IIftrr cxrrulioll of Ilw willolkrr<1 for probillc; WilS nOI the I'klil11 of iI killing i1nd was nCl'cr adJudlcutcd incol11prlenl: _.:Y".v.. ... ..._. m__.m_m_______.__.__..____ Drccndrnl at drillh owned proprrty \\'ilh rSlimalrd valul's i1S follows: (If domidlrd in I'll,) All pmollal proprl'lY (If IWI dOl11idlrd in 1'i1,) I'crsonilll,ropcrty in I'rllnsyll'i1lliil (If nOI dOlllkilcd inl'a,) I'crsonill property ill CoulIlY Ynlur or rrill ,'sIIUr ill l'ellnsyll'i1nin silulIIcd i1S follows: .__....._.__.__._____ ,19 (k" I '_,r() 0-;) I $ $ $ $ ,/ ,,'\..;;./'--' WIIEREFORE, prlitiollcr(s) rl'spL'ctflllly reWlcSI(:;),..lhc p;r blltc of thc IlIst will and eodld\(s) prcsclllrd hrrrwilh alld thc gl'l\lIl of ICltcrs____~e!~.. .___ _ (IC'illllllCl\IlUY; lit milll~trlllillll c,l.a.; IHlllIlnl'ilrilllOIl d.b.n.c,l.n,) thcroll. -;; " " c " "0- '~i '" . ~.~ ~,~ 7~ "- ;; 0 ;; c .~, '" _;fdm{l~j(~ffi-- ~~==~0..\[iTji;Q7 ' . ~i((C_.. __/:::It.di.~A<: I e':u2u::-9,._1:.2-..L?LeJj . ~~___n__.__n_._._____.___._______ . .. __n_________"________.___ --------...-...... .._-~..__. -~_.__.__.._- .._----~-_.~----- OATH OF PERSONAL REIJRESENTATIVE COMMONWEALTH OJ! PENNSYLV ANIA ~ >is COlJNTY 01' _~c..VM6ER.lJl_N.L__~_____ _ .. The pl'liliollrr(s) abol'r-IHlIlwd swear(s) or affirm(s) Ihallhe slalrmcllts illlhr forcgolllg pClitiollllrc Irllc IIl1d col'lwllOlhc h,'sl of Ilw kllowll'dgl' alld belicf of pdilioller(s) and Ihllt liS personlll rcprrscn. lalil'c(s) of the ahol'e deeeden\ petilio",'r(s) will w,~~~,ln,d;try;' :ldl,~ni,s/I?,SS1!.yt II~ IIC~Tlillg 101llIV, SI,\'~lI'Il 10 '~r affirmed IInd .\lIbsr.l'ibrd I' L-./c!I..."-((O:_-L..j-i..fLt.)-_ ~ brlorc IIII' Ih!> 1/ 14TH . ,Ial of ._-u-_...--u-u_.\._---.L-.__ ~ /i:j-. ,(/ ~- . A~RI~, yq)~ (I 'vtr.~)",'-I"u-,--" :__c::"':.~_______. ~ !/~al/.I.I.. ,AIWc..) /' { ,i'lI..k(L"--ll~'f--H' --...---__ ;, MARy' C, LEWIS Ik~r.\(l'I __'~..(/nnmnnnn~m- ~ Ul051UnEV 8.88 IfEE fo.~ HilS : ctRTlflCATE $:I' (0) WAIlNING: II Hi ILl Hi^, I (I AI.II.II IIW, CtJi'Y tll! TO llUPl.ICA n' flY PliO I ()!il AT Oil 1'lI:nOGIlAPII. CDMMDNWEM HI Of PENNSVLVANIA DEPARTMENT Of flEAL TH VITAL RECORDS LOCAL REGISTRAR'S CERTIFICATION OF DEATH CERT, NO. 2167122 1/-)- ~tj --'.~1i'iiOOmIUOO1Tt1Is Cerll!,ullon -- ....~._L1ML_L11.y~. Sex It! _.s lal s~:'urity No.i1._L.dJ~l;'2"7.:~_____/Date of Deat~~l ~ I ~ftL_ Date of Birth ~ J.-./ I l!.l_ Blrthplace__ - -I;4~!-;"i-' !.U-_~L__.__.___ PI." ./ D.,," -f..t4!.,fj,,11--/l !J. .J-'<1LJ ~(,4.6.",2, - "'"" ",,,.... Race j<JL~,__occu 1I0~e ed~:~L;-I"--:A{t.~d~rmed FOrCe;? (Ye; l No) __.LttLA --. Marital Status~~ __Mailing Addless.. il/-(,.H~.JdffYJ.~~r-~1y~.'Ut..t( sC;"-- _ Informant /.c::J..~.~L4- .i~1L L,i-d__ Funeral Director ..--a~..7T. !.~>=l:..- l1L-kt4-'L ._ Name and Address of I / ;L ..j cl + 12'-1 j/JI ~7'- Funeral Establishment. .LV-,- ~"'- J.!.1.1. '-__.I-: (~) . I. a..ft.u-.L'-_Ef_' _ .~ e } ,/: Interval B ween Part I: Immediate cysA . __ L' l j Onset and Death (a) .~?;;t!.~k,-_~.\~~_f1t{'_JHd-::~____: (b). ___h__________. _ : I , , .._-~_.__.._-----_._--~_._---- , , I , Name of Decedent (c) (d)_ Part II: Other Significant Conditions Manner of De~!.h: Natural 5" Describe how Injury oCGurred: o o Suicide 0 Could not be Determined 0 (l t) - Name and Title ~f Certlfl,r ---;,_.!~__~Y_.:.E.I.1-'";'7.<<"f-1..I_l.=.!:::f._._--------____.____. _ AddressJJ_L_Lrl,,-v__ {{/L<--<ol,-.._jJ(~_lf&::!7~:a: .._~._~~~,~~_~oroner, M~ Accident 0 Homicide Pending Investigation This Is to certify that the Information hore glvon is correctly copied from nn orlglnnl certificate of death duly flied with me as Local Registrar. The original cortlflcnte wili be forwarded to the State Vital Records Office for permanent filing. I .:;.,......"t . :'J'~?~ 1. 7.. 'ly' .... i; .,1 jii~I~\lr,i; ,;iv;i;j-ii~::;,~,' .... ,., ....--., "'IJij,r-;(itTr;---.-- ...nli":1i;;-fir:.~ft';;;-i';I;~~;'-!l;::l;-;l(I;-- .-.. ,.f -I., i ",'1 '~.J.:..... I' d '.... _ .'.l.!;.':". . , ' 'Jld tr/lt11llr1,. 11.,I'(j,ll " .. '''(:,'i;- fl,-,~;;-;;:j;,'y,~~.';;l,~i: ..---.- .., '. i ~: 'I_{)." ,t.) RfV.\IOO fX, I"'~'I I\vi~lv~ INHERITANCE TAX RETURN :'!)r'i;, RESIDENT DECEDENT COMMONWfAllH Of PfNNSYlVAN'A (TO BE FILED IN DUPLICATE OEPARTMfNT Of REVENUE HmllfJ:b~~or!\1H0601 WITH REGISTER OF WILLS) COUNTY CODf --...- 'N-;SnNAMf-(lAil,"iiR$l,-AND -;lOo,-r INI -jA --j'" O~C[DENT'~-rnMPrfjE ADoRE"ssu_u !Z 'IY!'!'" J I I !921 cl111thll1l1 Ilrlvl' w \' 'j "', ,Olll L ~ 'OC::~~~R;:~N;::E'-----r:~-:;;~:m--T~i:-~F~8~';~~---- C,~C;:~II:~II::I~: ':1\d i'^ 170 \1 ---~- -'[1 ~Orlglnol Rolurn [I 2. 5upplumunlol ROlu,n [] 3, Romolndor Rolurn ~~B [I 4. limllod E.lolo [] 40. Fuluro Inlo,o.1 Compromlso [] 5. ~:~:r~lo~:llo~:~~:r1or 10 12,1 ~,82) .00 (lor dolo. of doolh ohor 12.12,821 ROlu,n Roqui..d u~~ Ill] 6, Docodonl Dlod Tollolo [I 7, Docodonl Moinlolnod a living Tru'l _ 8. Tolal Numbo, of Solo Dopo.1I80xo. ~ IA~c"-~~eY~~~I~ !Alla.c~_~~J:L:',I~rul!l________n ._____ _ ----- ALLCORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO. I... -NAMf 3'OM-Plne MA"iITOAi'DRf-n- ~ ~ .Ta1l1e" II. Ste"art, .Jr., Es,!ulrl' ..__ I',[), Ilox 867 o z f(ffpHONfNUMBER IIl1rrl"lIlIr" "^ 17108 u 0 " .. 1 U 7 232-8696 ___ .__ _ _ -c-~~ 1. Roal E.lalo (Schoclulo AI I 11___0_,0.0. .__,___tr:: CI' 2, Slack. and 80nd. (Schodulo 01 I 21 .0,0..0 ___ ._______~. . 3, Clo.oly Hold Slock/Portno"hip In'oro.1 (Schodulo CJ I 31 -.--..Q,..QQ...------------5 4. Mortgogo. and NOlO! Rocolvoblo (Schodul. D) I 41__~":"00 ------f" 5. Coli., Oonk Dopo.il' & Miscelionoou. Pellanol P'oporlyl 511~!~~~~___......; h ISchadulo E) ~ ~ 6. Joinlly Ownod P'oport). ISchodulo F) ( 61 _ 0, DO __ __'1> 7. T,o",lo" (Schodulo GI (Scheuul. LI I 71 __~.:..?~_____ 8, TOlol Grall AllOII Ilolollin.. ,.7) Q. Funorol Expon.o., Adminl.lra,l" COlli, MI"olionooUl ( QI _~_495, 72 Expo",e. (Schodulo HI \0, Dobl., Mortgogo Liobillll.., Lion. ISchodulo II 11. T 0101 Doduction. 110101 line. Q & 10) 12. Nol Yoluo 01 ElIolo IlIno a mlnu. lino 111 1 J, Choriloblo end Govornmontol OoquOlI' (Schodule JI 14. Nol Yoluo SubjoCllo Tax Iline 12 minu.lln"...!.3) 15. Amounl of lino 14 lo,oble 01 6% rola Ilneludo voluo. from Schodula K or Schodulu M,I 16. Amoun' of lino 14 loxable 01 15'10 rolo Ilndudo voluo. lrom Schadulo K 0' Schodulo M.) 17, Principal lox duolAdd lox from lino 15 and lrom IIn. 16.) 18. Credih Spoutcl Povorty Crodit Prior Paymonh Dhcounl ----..--..------. -..... + .--.-'--'.'-...-. +.--.-----.. - ------------ c.. 'OR OATIS 0' DIATH AfIIR 12/311~1 CHICK HIRI II A SPOUSAL POV~R...T..Y_ CRl_~I!_!!..~LAIMID 0 IILI NUMBIR 1 99I,-O())50 YEAR...._m . ___ ~~./,\~ER if :0 -7Ji11lJ ron ''1.0 ~1 ti. I', "I ., \.J o C"? r:-3 "', t z o 3 ::> t:: .. 5 w .. ;8 c:) ,. lei ."" :;;,';:-j' 2 ~l (ij'o ~, ( 8) 34,611. 08 POI 2,965,53 6,461.25 28,149.83 0,0.0 28,149.83 P5) __~~.L~~2.Jl} (Ill (12) (131 1141 X ,06 = __-1.i>J!~, 99 (161 ----- X ,15 = z o ~ !:i .. ~ o u ~ ... (171 ____L,688..,2_~__.__ loletGsl IQ. II II no 18 i. grool" Ihon IIno 17, onlurlho ull/o,onco on line lQ. Thll II Iho OVERPAYMENT, mI[] 1181 n_______._____ (lQj --.---- Chod, horo if you aUI roquos.lino (I refund of YOllr dvorpbvmon'. 20. IIlIno 17 i. groolor Ihon lino 10, onlor Iho dll/oronce on Ii no 20, Thi. i.lho TAX DUE, 1201 _____.______ A. Enlor the inlo,oll on Iho balance duo on IIno 20A, (20A) ._____~..J!,B8, 99 8. Enlo' Ihu 10101 ollino 20 and 20A on IInu 200. Thl. ;. Iho BALANCE DUE, 12001_ ...___. .___.________ ~~k. Chock_Poyobl. to, R'ul.t"..! WI!I._'--Ao."-'--_____________._____. ---.---- . ... B{S.URI TO ANSWER ALL QUESfiONS-o;f RE'isRSfsIDEANOTCf jfic-HiicKMATH .... Undor-p 01 II 01 perlury, I declare Inol ave eKomlned 11111 r.'urn, In'eluding occompa-nylng leho'dul,. and .'alem,nl', and 10 Inl ball 01 my knowl.dgl and belli'; II Is tru , co, oel and c;~~~le, I deelo olna (111 reClI ,,1010 nOI boon 'tlflutlod III Uuo markol valuo. Oeclarallo.\ 01 proparlH nlnor lI1un Ihe portonol rOptOlonlOlivl it ~-,"'.~- al~~~VlII~~r ~oror_ -~h'(,~~~~"'I?,d2~ijRlii----.--------- -------, o-Aii------ ~1~~~\~[i_~FiiR',P!lj'~Mjf c \ -- 'p;lffIAII'f-----~tiJ;I"~un)!<:-dE\Jl..'-,..'.!i!!..'lrl.L..l'LJ]n1 1._._..,__......__ jj:.!.b._ii ~ t ...:......_':__:-T..:.:_:.__-'-{....L..,~_______!~nx_..~0z..!_!!'!':~_~ "bllrg 1''\ 17 J.~_.,____ ..!2_~G.~ .J1I1I1"" Ii, St"I"lIrL, ,Ir,,' E",!lIll"l' SCHEDULE E' 1 CASH, BANK DEPOSITS AND MISCELLANEOUS PERSONAL PROPERTY __ ___ PI~a!-o Prl!'.! or Typo FilE NUMBER 1991, -0()350 UV,Uot ._. 11~11 J t~ COMMONWIAIIH 01 PlNNSYlVAN'A INHUIIAHCI lAX IIlUIH ___ UIIDIH_'-DIC!DIHl ESTATE OF flYlmH, ,John II. --- (Ail p'.porly 1.lnll~'.w",d wlI~ I~, RI8hi-;;s.;;j,,"hlp;;;;'~1 h_, dl!!'..~_.n S!f!-~ul' PI ITEM NUMBER DESCRIPTION 1. I'ormern TruHt Company, Chock1ng ^ccount 1/: 1l1l-8-78901 2, Jlarml'rn Trllst Company, Hovinga ^ceount II: 1'11-0010360846 3, Douphin llepoaJt Trllal ^ccollnt 4, VW Rtatton \Vagon 5, CadJ.11ac Fleetwood VIN \r.6ClIs331L1,3194sl pl'r J.. 11. Rmith l1pprainll1 6, Rdmhurn(,mnnt for Hod I cllre Premium from lIrotherhood' n Rellef IInd ComponsatJon !'und 7, .1Irothorhood' n Ileo] icf IInd ComponAllt Ion Fund llel'1 remont RofundA 8, SlImmonn 9, lIrothorliood'n Relll'f l1nd Compcnnlltion Fllnd Illlea 10, lIllle Rhl eld 1/94 II, Trnvolorn lnnllrnnco 12, Brothl~rhood'n Ilollef nnd CompenAlltion Fund Medicare Iloimhuraomont , $123,30 13, 14, $ 39,00 PatrIot Mohil 011 $ _~9.0Q 15, 111110 CrOAA Hn.lor HedJ.cn.l 16, PhysJcillns Mutual VALUE AT DATE OP DEATH $12,741.35 $ 3,261,26 $ 1,990,92 $ 400,00 $12,325,00 $ 41.10 $ 2 , 150 , 00 $ 10,09 $ 15,20 $ 84,07 $ 292,54 $ 191. 30 $ 1,089,09 '$ 19,16 IAllach addlllonol8Ya" Ie 11/1 Ihllllll more 'pa". II n..d.d.1 TOTAL lAlla onlor~~I~~ 5, Rocap!!ulatl~'!L S 31,.611.08 IIV-U~U.IIU'1 ,. ~~ COMMONWIAUH 0' IINNlYlVANIA INHIRITANCI TAl mURN RIIIDINI DICIDINI ESTATI OF MYERS, John R. Joint tlnontl.)1 SCHEDULE F JOINTLY.OWNED PROPERTY . J_~ L:JllMBER 1994.,00350 .._, - ._._ _"0 _ ..____._.__.0_._..__..______ __ - ._. ... ._._._ ._.. _. .. _. __ ....._.0 '0-'."-' .... ._.. _.-...___ - ._.__....._ - ._.~.._.----- -..--.... - ._~o_ NAME ~DRB5S RELATIONSHIP TO DECEDENT A, NONE B, C, Jolntly.ownld prop"rlVI L_ ITEM LEnER DATE NUMBER FOR MADE DESCRIPTION OF PROPERTY TOTAL VALUE DECO'S DOLLAR VALUE OF JOINT JOINT OF ASSET % INT, DECEDENT'S INTEREST TENANT 1. . , . . , , . , - TOT AL IAho enlet on IIn. 6, R.copltulotlon) S , ! (/I mo,. IpOCO II n.eded In..,' addiliona',heell 0' lame lize) , . ,\ IIV,lllO IX, 11,111 ' * .-..:~~~~rb~~J~~~\I~\flr~\t~I^..,....._ ... _ ... mAti oP....-------... -----.-. ...... SCHEDULE G TRANSFERS ........ ---.............---,.... -. .._....fL~AS.UR.!t:!.!,9.~m!..._.......... ........--..----.. --pinNUMBiiC..............------...---..--. MYgRS, ,lohn Il, 1994-00350 --.---.-.-- ----.....-. ...---.-..----..... .._..,-~ .--.--..-----..---...-.-..---...--..-..-- .-.----.--.-. -.. .-- -~ -"'-----...-.-_. "__n___ THIS SCHIPULE MUST BI COMPLITIP ANP flLEP If THI ANSWIR TO ANY Of THI QUESTIONS ON THI RIVIRIE SIPI Of THI COVER SHUT IS YIS, -'I;~~- .-..-...-._..._._...~~7CRIP;~;.~ ..~,-~~;;~;V..,-'-._._-..._.-'_.-.. ~~~~~~~....;;TA~.~~-L~~-. '-i>E~D~"- '-'-8Pbi~~gtiiWC.. .NU~~~ ~ncl,d,~~"!.~.~h....~~~~!_'.!.!!'!!0.~~~~~p~_~~!i.':.."!!_d?'!.O(.I!."-"-'1!~:. . ,... .....,.. _. n..: <:l!~~~~!_._ ..~IMr.... ...._ _L~ m.m.__. ~ONE ,'. ,. , ' 1",: " " ,'1 ',. ., , , ,.:' i', Ii' ,> ", , ".' " I , 'I " , " ,-,", , ' ." .. , .. .. , " '.' , " , " , .. , , , , -, ". --~---- .......,-. !_~.!~_Lj~I~~!!_~~. 7, R.~~!'l<'.~&. -L~-___....:.._. ., ,(/I molt 'Ao" '.n"d.d, In",' addil/on.o' ,h,," oll.m.'I...) " jREVOl!147 EX AFP (12"94'. COHHOHWEAlTH Of PENNSYLVANIA rEPARIHfNl Of REVENUE NOTICE OF INHERITANCE TAK lURE AU Of INDIVIDUAL TAKf.S APPRAISEHENT. ALLOWANCE OR OISAllOWANCE DEPI, 110601 OF OEDUCTIDNS AND 'SSESSHENT OF TAK OAT" 03 06 95 HARRISSURD, PA 11121-0601 "~ -- !STATt o~-=HVrrrn~=~'JOlnl"~ '---T~=='==:==='=== FILE NO. 'n- 94-m=D'-- DATE OF DEATH 04-04-94 COUNTY CUMBERLAND NOTE, TO INSURE PROPER CREDIT TO YOUR ACCOUNT. SUBHIT THE UPPER PORTION OF THIS FDRH WITH YOUR TAK PAYHENT TO THE REOISTER OF WILLS, HAKE CHECK PAYABLE TO "REGISTER OF WILLS. AGENT" REMIT PAVMENT TOI J i/j OfJ ~- - .~) JAMF.S H STEWART JR ESQ PO BOX 867 HBG PA 17108 ACN u 101 -- - RF.GISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 I . .. A.ount RI.I t~!.d j CUT ALONG THIS LINE ... RETAIN LOWER PORTION FOR YOUR RECORDS .. iiIV': iiieii" E if -AF ii 0 r iF 94 yo NoYi ani F 0 "iNHEii iT ANc E or-Ax - Xli liii AO is EHENT"; -A L i:ciwANOc E - erR 0 0 0 _".o.ooooo...o DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF MYERS JOHN R FILE NO. 21 94-0350 ACN 101 DATE 03-06-95 TAK RETURN WAS, (X I ACCEPTED AS FILED RESERVATION CONCERNING FUTURE INTEREST - S!E REVERSE APPRAISED VALUE OF RETURN BASED ONI ORIGINAL 1, Rill E.tltl (SOhldull A) 2, Stook. Ind Bond. (Soh.dull BI S, Clo,"ly ~Ild Stook/Plrtnlr.hlp Intlrl.t (Soh.dull C) 4, HOrtglgll,,:,t.. Rlollvlblt (Sohldull D) 5, CI.h/Blnk Dlpo.lt./HI.o, P'r.onll Proplrty (Sohldull EI 6, Jointly O.nld Proplrty (Sohldull FI 7, Trln.llr. (Sohldull 0) D, Totll A..lt. APPROVED DEDUCiIONS AND EXEMPTIONSl 9, Funlrll E,pln.../Ad.. Co.h/Hho, E.pon.1I (Sohldult H) (91 10, Dlbh/Hortglgl Lhbllltlll/L1on. (Sohldult II 1I01 ).1, Totol Dlduotlon. 12, Nit VlluI of To. Rlturn IS, Chlrltlbll/Govlrn.lntll Blqul.t. (Sohldull J) 14, Nit VIlul of E.tltl Subjlot to TI. 1I) (2)_ (S) 141 (51 (61 ( 71 ( I CHANOED or' ~ ;": ,00 OJ. . ,0 ,d ,00 I 0' ,00 34,611 ,08 ." 'n~:-: ) ...., 00 l;" (DI 3.49!i,72 2,965,53 (Ill (12) lIS) (14) \.c~ U'\ pI} "n\11 ., I' (;1 'd' 34.611. 08 6.461 ?5 28.149,83 ,00 28.149,83 If an all.l.ment wal ilsued previoully, linel 14, 1!1 and/or 16. 17 and 18 will reflect figurel that include the total of ALL returnl a.lelled to date. ASSESSMENT OF TAXI 15, A.ount 01 llnl 14 It Spou.11 rltl (15) 16, AMount 01 lln. 14 tl.lbll It llnlll/CII" A rltl (16) 17, A.ount 01 LIne 14 tl.lbll It Collltlrll/CII" Brat. (17) ID, Prlnolpal TI. DUI NOTEI TAX CREDITS I PAYHENT DATE 12-21-94 RECEIPT NUHBER AA022623 OISCOUNT (t) INTEREST (-) ,00 ,00 K ,00, 28.149,83 K' 06, . 00 K ,15, lID) AHDUNT PAID 1,680-:99 --. rOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST TOTAL DUE ,00 1,688,99 ,00 1.688,99 1,688,99 ,00 ,00 .--- ,00 . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST, " I}' I ( -- .)~)" -...J " IF TOTl.l DUE IS lESS THAN tl, NO PAYHENT IS REQUIRED, IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRI, YOU HAY BE DUE A REFUND, SEE REVERSE SlOE OF THIS FDRH FOR INSTRUCTIONS,) R1!IERYATlOll' PURPOSE OF NOTICE' . ~AYItENT' R1!FUNO (CRI, OIJECTlOHI, AOllIN IITRATlY1! COflRECTlONI' OIlCOUNT, INTERI!IT' " E,t,t.. of dtatdtnt. dvlng on or blfor. Dtollber 12, 19.2.. If any futurM Int.r..t In the I.t_t, II,trln.flrred In po.....lon or enJoy,.nt to CI,.. a (0011,t.r.1) b.neflcl,rl.. of thl dlc.d.nt .,t.r thl Ixplratlon of any 'Itat. for I1f. or for v..t., thl Co..onwl.lth hlr'bY ..pr..,IV t...rv.. thl right to appr,II' and 'I'l" tran,f,r Inhlrltanol TIK.. It the 1.w~ul Clift I (0011at.ral) rat. on tRY luch future int.r..t. To fulfill the r.qulr..,nt. of S.otlon 21QO of thl Inh.rltanc. .nd Eltat. TI. Aot, Aot 22 of 1'91. 72 P.S, lIoUon 2140. D,tICh the top portion of thl. Notl~. and tub.lt with your p,v..nt to thl RIgI.t't of Willi prlnt.d on thl r.v.r.. tide. --Nlh chICk cr Icney crdor peyeblll ,,, REGISTER OF HILLS, AGENT AU plvl.nt. r.ollvld .hlU f!r.t bl appU,d to Inv Intlr..t which .'v bl due with Inv r...lndlr IppU'd to th. tlX, A r.flN\d of . t.x cr.dlt, whloh w.. not r,qu..t.d on the Tlx A.turn, .ev b. requ'lt'd bv oOlPlltlng .n "Appllcltlon for A.fund of Plnn,Ylvanl. Inhlrltano. and E.tat. T_x" (REV'IS1!), Appllc.tlon. ar. .v.llebll at thl Offlol of the Righter of Wl1h, anv 0' the ,S R.yenu. Dhtrlot OffiCII, or by calling the ,plclel 24'hour an,wlrlng ..rvlet nUNblrl for for.. ord.rlngl In Plnn.ylv.nl. 1-HOO-S62-2050, out.ldl Plnn.vlvlnl. .nd within 10011 H.rrl.burg er.a (717) 187-8094, TOOl (711) 112-2252 (H.arlng IIp_lrld Onlv). Any pai'ty In Int.rllt not ..thiflld with the appreha..nt, allowanc. or dhaUowancl of deduction., or .......ent of t.x (Including dl.count or Int.r..t) II .hown PO thl. Hotlol IUlt obJlct within .Ixty (60) d.v. of r,cllpt of thh HotIc. bVI -.wrltt'n prot..t to thl PA Dlp.rt..nt of R.V.nul, Board of ApPlal., Dlpt, 281021, Harrl.burg, PA 17128-1021, OR --lllotlon to havI thl ..tt.r dtt.r.lntd et audit of th. .ocount of the Plrlonel rlpro..nt,tlvl, OR --apPIII to thl Orphan.' Court, Flatull .rrar. dl.covlrld on thlt ........nt .hould bl ."dr....d Jn writing tal PA DIPlrt-.nt of RIVlnut, lurllu of Indlvldull TIMI', ATTHI Po.t A.......nt RIVllw Unit, Dlpt. 280601, Harrl.burg, PA 17128-0601 Phone (717) 181-6505. S.. PI,I S of thl bonk let "Inttruotlon. for Inhlrltancl T'M R,turn for I RI.ldtnt DICldlnt" (REV-ISOI) for an Ixplanatlon of 1~lnl.trltlv.lv carrlct.bll Irror., If any tax due 1, Pftld wIthin thr.1 (S) c.l.ndar lonthl aft.r the dlcldlnt'. death, . flv. p.rolnt (S~) dJ.oount of thl tlX Plld 1. Illowed, Internt II chtrgld big Inning with IIrtt dav of d.l1nqu.ncv, or nln. (9) .onth. end on. (1) dlY frol thl dlt. of .Ith, to the d.b of plv..nt, T'M" ..hlch b.oa.. delinquent b.for. J.nu.rv 1, 19n bltr lntu..t at the rat. of .Ix (6~) p.rc.nt p.r annul olloulat.d et e daJly rete of ,onOI64. All t.x.. whIch b.oa.. d.llnquent on and .ft.r Jenuary 1, 1982 will b..r Int.r..t at a rat. whIch will v.rv fro. cal.nd.r y..r to oll.nder v..r with th.t r.t. announc.d bv the PA O.part..nt of R.v.nu.. Th. appllcabl. Jnt.r..t rat.. for 1982 through 1995 Ir'l !!!r !!l!!!.'.!!J!!!! D.IIY Int.r..t Factor !!!r tnterllt R,t. DIllY Int.r..t !!2!2! 1911 101 ,OO05~1 1981 91 .000247 1915 161 ,OOO~31 1981-1991 III ,OOO5DI 1981 III .000501 1991 91 ,ODOI11 1915 m ,000556 1995-1991 11 ,DOOl9l 1986 101 ,OOOI7~ 1995 91 ,OOOIIT --Interllt 1. c.loulatld a. fol1aw'l INTEREST . BALANCE OF TAX UNPAID X NUNSER OF DAY' DELINQUENT X DAILY INTEREST FACTOR .-Any Hotle. i..UId .ft.r thl tlM b,eOl" d'linqu.nt will r.fl,ot en lnt.r..t calculation to flftlln CIS) diY' blvond thl d.t. of tM ........nt. If p.v.tnt II ..d. .fter the Interllt co~utltlon dete shown on the Notlel, .ddltlonll Int.r..t .u.t b. cllcul,t,d, . . . STATUS REPORT UND~;R RULE 6,1.2 Name of oecedentl John R, Myers De~eased oate of Death I April 4, 1994 Will No. - Admin, No, 1994-00350 pureuant to Rule 6,12 of the Supreme Court orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate I 1. State whether administration of the estate is complete I Yes NoYes -~-- 2, I f the answer Is No, st.ate when the personal representative reasonably believes that the administration will be completel ----- 3, If the answer to No, 1 Is Yes, state the followingl a, Did the personal representative file a final account wl.th the Court? Yes___ No No , b. The separate Orphans' Court No, (if anyj for the personal representatl.ve's account iSI c, Did t.he personal representatl.ve sta~e an account l.nformally to the partl.es in I.nterest7 Yes Ye~ No d, Copies of receipts, releases, jol.nders and approvals of formal or informal accounts may be filed with the Cark of the Orphans I COUJ:t and may br tta!he~ ,t9/1i,~/report, oat" 5123196 '($ Si nature ames ~~, Attorney for Estate .~ c C,., <:'I~ ~ / Name (Please type or print) Box 867 , Harrisburg, PA 1 ill8 Address \" ..... -10': u '6 .,1) ::2 1 .... c.1. ( ) Te 1, No, I' I <:i' \, ~) (I> &0: ~ :;; >= CapacitYl Personal Representative x Counsel for personal. representatJ.ve \ t" .:: E 08 (MAH HmU AM3) \0 P'