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"-E:
I)ETITION FOR I)ROHA TE and GRANT OF LETTERS
Es/tIll' of ..ll2t/1'Tt( ".t!, ""dAm, ___. No, ._A~l-::.(jjL-~.j $2___
IIlso kl/oll'l/ II,S "."'. To:
_....._"",___ u__, , Register of Wills for the
.____,_ .uu..... _" ,_",.. _____..,' [J"('('IIsl'tI, Coullty of _..CU1'm.~1ANQ___ In the
Soe/III S"l'lIriry No, " 1:'1 () ,-..~_f)_:,]:~~,'fLm.._" Commoll\l'elllth of l'ellllsy)vlIlIllI
The petltlollof tl1l' IInderslgncd respectflllly represellts thllt:
Your petltloller(s), \l'ho is/II11' IN YCllrs of IIge or oldcr IIl1thc c,wclltll'1Jl___...._____.,___lIl1mcd
III the IlIst \1'11101' the IIhovc decl'dellt, dllted ___....____,_____,__.._.______, 19:t..1...-
IIl1d eodlcll(s) dlltcd "Ill" 1',,>,L_,?!>':...l?'12___..__,__.__..______.__,______
___..____m__._._....._...,._ n.__...._.._.____..__..__.__.._....___.____________...____
('IIII~' JCll'\'allll'll\'lIl11'llllll'Cl, l',N. rt.'III1I11:I11lloll, ,ll'iIlh uf l"C~lIl(1l, cIC,)
Ilcl'elldent \\'IIS domldled lit dCllth III .,__,"'C!./,J/lJ!1ft'J._l,dlkJ.L.____ COllllty, I'cllnsylvlIlIllI, with
I~_~_~-_::: IlIs~rllll~IIY,or prIIIC,IPIlI:esld~I~~~llt,:::l!_A{~~d/1fj1:~0r~~f~~~u-.
(lilt 'th'el, IlIIlUhl'r lInd Illtlndflllllt~'1
Decelldent, thellu_,L'1 ' ,ycllrs of IIgc, died _,..,....__!l1!1.!,""_..<L___.____, 19.f"
IIt_jl~~. ....u.. _ _.,.... '" _.,..,,,.....__ __.__,_____..._______.___________,
Exccptlls follows, dccedcnt did lIotmlllry, \l'IIS 1I0t divorced IIl1d did 1I0t hllve II child born or IIdoptcd
lifter excclltlollof thc \1'111 olTcrcd for prohllt,'; WIIS lI(ltthc I'lctlm of II kllllllg IInd IVIIS IIcver IIdjudlellled
IlIcompctcm: '._,., ,'.u ,., m_... . ._m_.n ...."._.'_m________._....__'m_.___
Dccelldclllllt delllh oll'lIed properlY wllh esthullted vulucs liS follows:
(I I' domiciled III I'll,) All personul propcrlY
(If lIot domlellcd 1111'11,) I'crsolllll propcrlY inl'ellnsylvllnlll
(If not domlcllcd In 1',1.) I'er,sollul propcrty ill County
Yuluc of relll estull' in l'ellnsl'll'lIl1ll1
sltllllted us follows: ___,fC~&._..._m_..m._______
$ __utt! .
$---
L
$---
WllEREFOIW, petltlollcr(s) respcl'tfully requcst(s) thc probutc of thc IlIst 11'11I nnd codlcll(s)
plllScnted hcrcwlth IIn.! the grllnt of ICllersm,._IDI.d."""" r~_~
(l~"llllI\CllllH~'; IIdminhlrluir.n c.l.lI.i admlnlslrlllloll d,h.fl.c.l.n.)
theron.
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..._n________ _....____
..___.__..____n__ _.____._
.... ... _...~~._____._u_______._.
m n_.. ..._.__...._.____u._.___ .__._
OATIl 011 PERSONAL REPRESENTATIVE
g~~~gN~I~::AI~I:~G~~~~:~~~~~.~~...~~_N,,~~n. } ~~
Thl' pctitioncr(s) IIIHl"C'IHIIIICd swellr(s) or IIffillll!S) thlllthc sllltcmellts IlIthc foregolllg petition llIe
trlle IInd corrcct \0 tlic hest of the kllowledgc ,lIld hcllef of petitiollcr(s) IInd thullIs pcrsonlll represell'
tlltil'c(s) of IIIl' IIhlll'l' dccedcllt p"'lltlolll'r(s) wlllwclllllld tlllly Ildl'linlsll'r the cst ute IIccordlng to Inw.
Sworn to or IIffirmcd 11I,1(1, sllhscrihcd I "",',6.,,$,,' /1 }(,j;'<Jf~_m____m_ ~
'i~;2~ ~!lit~~ ;;:~ r9)X(fij1'~JJ~ u '. ----~:-:==:~~=- ~ 1
~AR~JC. LfWIS 1I{'.~il(('r r:{lu. .. ",." ___n___ ~
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NOTICE OF BENEFICIAL INTEREST IN ESTATE
BEFORE THE REGISTER OF WILLS, COUNTY OF ('1.11111: I:I.IIN () , Pr:NNSYLVANIA
In re Estate of !l11J/71/ 1-1 1//1/11
No. 357 of /791.(
'I'D I /iJ 1\, 1-1 /) (11 J/;~
deceased,
---'
f\" ) L "," .h ,'I /
(beneficiilry)
(address)
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Please take notice of the death of decedE.nt and the grant of
letters to the personal representative(s) named below. You may have
a beneficial interest in the estate as followsl
t(j..Uf\~ stir-Vet ul' fiN)' iYlClv'i)1 IliN4' f)",,, DtilLl tlt:E (/'110,
(if additional space is needed, use back of page)
Name of decedent
Inri / /I t / /. 1I,1f\7
I,lIst known address,
I :/.'1 ('/)ml1 il'II)(.,1 /)/'
of decedent
/l}{,JtlflNJ,I,r, ,f{.J,(I(, //1 /'"/(/,j-,'-
Date of death
Place of death
f:I t",.'I,. ';I , I ~'I)'I
^tfj/'-)~'.(i('.!' - L.t'(~J{(o..' IJ~./..f./tI "{(.UI',
County of grant of original letters
Decedent died / testat.A
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t. (/IYIIJJI:'~,/)If()
intestate.
A copy of the will ~ is
is not attached,
Name(sl, address(es) and telephone number(s) of all personal
representatives appointed
Name Address
Telephone
/3l7 7 Y II \7Cd.,,,"}()N. 1.2 S (l/),:JIA/,';('t,[ I}(>, /J?t""I,g~;, 1',1.
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INHERITANCE TAX RETURN
RESIDENT DECEDENT
COMMONWEAIT" OF PENNIYIVANIA (TO BE FILED IN DUPLICATE 21
OfPA~TMENT Of REVmUE
flARRllmib, ~~On\2806111 WITH REGISTER OF WILLS) COUNTY COilE
i ~u,"~_~ :a:': N~a t t^:: ":11." AND MIDO'\i INITIA'li'~ ----liirUMNR' WMPllfnITITlffi\
_J~,u, SOCi~~:~~~~~M~~R~~~==-:J:~~r~~- rA\E~~ ;'~';'o (,,,~~~~h~~::E~~~~~:\:~f;~V(! 17055
!XI 1. Original R.lurn [J 2, Supplomonlal R.'urn [ I J, Romolndnr R.lurn
(lor dolOl 01 deolh prlo,lo 1 ~.13,82)
[ -I 40. Futuro Inlor,.st Compromiso [ 15 Fodoral ellalo Tell(
(lor dalel 01 d.<I,h oiler 12,12,021 Relurn Requhed
IXI 6, D.cedenl Died T e.lal. II 7, O.codonl Maln',,'nad <I living T ru,I 0.. 0, Tolal Number of Safe Oepo.1I BoxOl
IAuoch copy 01 Willi IAuach copy 01 Tru.'1
..... ... --- ALL CORRESPONDENCE AND CONPIDENTIAl -YA,f"iNPORMAfIO-N.SHOULD BE DIRECTED TOI
NAME .------..--..... co~ii{n("~fAHiN.b-Abiiii{S-5-...--~-- ..---------.----
1. R.al E.Iolo (Schedule AI ( II
2, Slock. and BondI (Schodule BI I 2)
3, Clo.ely Held SlocklParlne"hip Inlernll ISchedule C) I 31 .'
4, Morlgago. and Nole. Rocolvable ISchedule 01 ( 4)
5, Calh, Bank Oopo.il. & MI."lIaneou. Penonal Propo'Iyl 51
{Schedulo EI
6, Jolnlly Ownod Properly (Schedule FI
t T rOnTle" (Schodulo GllSchedulo LI
8, Tolal Groll Alleill'olalline. 1,7)
9, Funeral hp.",o" Admlnhlralivo COIL., Mhcollonooul ( 91
Expen.e. ISch.dul. H)
10, Oebil, Mortgog. Llabllill.., Lie" ISchodulo I)
II. T 0101 Oodutllo,,, (Iolalllno. 9 & 10)
12, Nol Valuo of Ellole (line 8 mlnUTllno II)
13, Chari'able ond Govornm.nlal Boquo.iI (Schodulo JI
_mm m~___I~,-~~~~alu-,,~Sublo"-.'."~T ax (lI"e 12 ..!"~nu~._"n,,~ 1 ~L
15, Amounl 01 lin. 14 laxablo 01 6% ral.
Ilnclude valu.. Irom Schedulo K or 5chedulo M,)
16, Amounl of line 14 laxabl. 01 15% ralo
Ilncludo valuOl Irom Sch.dul. K or Schodulo M,I
17, Principal lax duolAdd lodrom IIno 15 and from Ilno 16,1
18. Crodits Spousal Povorly Crodil Prior Paymonts
+
19, If lino 18 I. groaler Ihan line 17, enler Ihn dilloronc. on II no 19 TIlII i"ho OVERPAYMENT.
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20, If line 17 I. groater Ihan line 18, enlor Ih. dlfforencn on IIno 20, Till. h Ih. TAX DUE, 1201
A, Enlor Ih. Inlere" on Ihe balance duo on IIn. 20A, 120AI
B, Enler Iho 10101 of IIn. 20 and 20A on IIno 20B, Thil iT Ih. BALANCE DUE, POBI
.~a~.~h!c~ ,P."~~~I.t~'~'l!~~.r~IYJilll,Agent u u_
____h__.___ ___.__.._.4 ... BE SURI TO ANSW!R AlLQuifsiio.NS ON REVERSE SIDE AND TO RECHECK MATti...-.-.------
Under ponollhu of perjury, I declaro Ihol I have examined thit rolllrn, Includlnfl occo~~;~~;~;{J~;~Taulo;~~~~~OiurnO"", Clnd 10 Iho bOl' of my knowledge and bellof,
ill, lruo, corrflcl Clnd complete. I dedcue Ihal all reol oslale hen boon r'lportod ollruo nHlrknt ....UIL" Duclurnlion or flropmor olhor ,two tho porsonal roprcl1onlallv8 I.
basod on olllnlormol1on of which preparer hell any knowlodge.
SiON.A1URf-6rPERSOr-rREsr'oN"SfBtnCijHii"fNt;-RTiURfr---- ...-.. 'A()fJREKs - - - OAl(-....--------------.-.-.
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SltJlj^'{;~~Of~:k~d~'t~.61It~E)~:it{ANrlp~~sEiN~i~iS11. ~J'11-:1\hi:R-t~51 "I i.- ,.' It I? . / /,1 / il,) \ '.'
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D(I 4, L1mllod Ellale
Betty H. Johnson
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lOR OATIS 01 OIATH AnlR 12/31/91 CHICK HIli
I' A SPOUSAL ,-
POVIRTY CAIOIT IS CLAIMIO U
fill NUMBii ~ __~~~~__u_._~_,,__~~__'_~__
1994
YEAR
357
,N~/'\m
123 Cambridge Drive
MechnnieBburg, PA
17055
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582.00
5971..51
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( 61
I 71
9293.39
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6556.51
1101
9293.39
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-2736.88
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Dlswunl
Informl
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(101
11'11
Chock hOle if you afe toquoslinu 0 rofund 01 your ovorp(lymonl.
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"",1109 fit 112011'
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'r::YIIiJt
COMMONWIAllH 0' PINNSYLVANIA
INHUITANCI TAX mURN
R!lIDINT DICIDINI
. .
SCHEDULE F
JOINTLY-OWNED PROPERTY
---
Mattie H. Ham
PILI NUMBER
357
ESTATE Of
Jolnl lononl(111
A.
NAME
Betty ,H. Johneon
ADDRI~______._ RELATIONSJ:lIP TO DECIDINL.,
123 Cambridge Drive Daughter
Mechanicsburg, PA 17055
B.
c.
JOlntly-ownod proporlYI
ITEM LmER DATI DOLLAR V ALUI OF
fOR TOTAL VALUE DECO'S
NUMBEI JOINT MADE DESCRIPTION Of PROPERTY Of ASSET % INT, DECEDENT'S INTEREST
TENANT JOINT
--
1, A 4-30-91 PNC Savings Account 8319.87 50 4159.94
1/5030092236-040
2. A 4-30-91 PNC Checking Account 3629.14 50 1814.57
1/5070069348-040
.
"
"
"
" , , ,
, "
"
"
, , ,
.
. , ' ,
" ,
" ,
, ,
,
" "
. ,
.
,
,
. ,
, .
" ,
, " ,
,
,
" ,
.
----- -----~----_. -" - ~---
, TOTAL lAlla enler an Iln. 6, R.,apllulallanl S 5974.51
.__._--.--.~_..._-...-._~-~_.-.__...__._--_.__.__._--._._-~.--- +-'_.~---
(II mare Ipaco I, n..ded In,er' addilianal.heal, a' ,orne Ill.)
"V.UII Ih 1'.111 ,.
.
~~
COMMONWIAITH 0' PINN!YlVANIA
'NHIRI!ANCI TAR mURN
RIll DINT OICIDIN!
J SCHEDULE It
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES
mATE Of
Mattie H. lIum
Pllal. Print or Typ.
jE NUMBER
357
ITEM
NUMBER
A.
B.
4.
C.
1,
2,
3.
4,
5,
6,
7,
8.
DESCRIPTION
funllal bp.nl.11
1.
Brown-Wynne Funeral Homos - Statement attached.
P. O. Box 12195
Raleigh, Nt: 12195
Johnson-Paschal Florist - Casket Spray
Montlawn Memorial Park - Opening grave and marker
Admlnlltratlv. Calhl
1. Perianal Representative Commlulonl
Social Security Number of POllonal Represenlatlvtl
Year Commlulonl paid
2, Attorney Fees
3,
Family Exemption
Clalmont
Mdreu of Claimant at decedent'l death
Slreet Addreu
City
Relatlonlhlp
Slale __ Zip Code________
Probale Fell
Mllc.llan,oul Exp.nl'" For Executrix
Roundtrip to Raleigh, NC, 772 mileR @ .26 per mile
Holiday Inn, Raleigh, NC
Meals - 5 days @ $15 per day
Telephone bill for 766-8666
TOTAL (Allo enter on line 9, Rucapitulallonl
(If malllpac. II nlld.d, Inl.rt additional ,hllh of lam. Ilz..)
"
AMOUNT
7923.26
265.00
525.00
57.00
200.72
221. 76
75.00
25.65
$
9293.39
"
, .
Brown-
YQn~
illld ('11'HIlIIlll)'
A TfiHIIIIO/l of O(lptHlllllhlllly ~_ilJlc:{) uno
MRS. .BETTY H. JOHNSON
123 CAMBRIDGE DRIVE
MECHANICSBURG, PA 17055
32400514
SERVICE FOR: MRS. MATTIE HOUSER HAM
(II rr,l:IIMIOllt 11I1lt/WITlIIlU,UIIMlCr
,
FUNERAL DIRECTOR AND STAFF SERVICES
FUNERAL CEREMONY: CHURCH SVC./VISITATION
OTHER PREPARATION
VIEWING
FUNERAL VEHICLE
FAMILY VEHICLE
ADDITIONAL TRANSPORTATION
FLOWER VEHICLE
CASKET
OUTSIDE ENCLOSURE
MEMORIAL BOOKLET
TENT
PUBLIC TRANSPORTATION
OUTSIDE FUNERAL DIRECTOR'S EXPENSE
NC SALES TAX
TOTAL
ADDITIONS I
HAIRDRESSING
OBITI N&O
TOTAL
PAYMENT:
04/14/94
BALANCE DUE
PAYHENTS:
05/05/94 PAYHENT
"
'II
P/\ID IN FU LL'
, , , , , . , , , , "., , , , ~'/.!? ./.1,lJ, , , , , , , .,
1';'i((I'iJI\!V/Y~II\Ir:. rllr--JElmL I-IOME
, ,,'r~ "1~ ,<-dl>-, . ('--:1\
i I I . " ~ I ,c.t'r I . . , , . , I . ~~ ~)
r,o, Box 12195
Rnloloil, NC 2'1005
'ololll1ono: 831. 4nOO
Fnx No, fl1'I-46?8
SJATEMENT
$ 1,065,00
625.00
115.00
. 185.00
165.00
95.00
110.00
60.00
3,145.00
1,085.00
35.00
85.00
239.06
506.00
316.20
$ 7,831.26
35.00
57.00
$ 7,923.26
- 2.000.00
$ 5,923.26
_,~_:.~.!i?}! _~E_
$ 0.00
\
~
R!V'1947 EX AFP 110.93*
COHHOHWEAlTH Of PENNSYLVANIA
DEPARTHENI Of REY1'HUE
BUREAU OF INDIVIDUAl TAXES
DEPT, 110601
HARRISBURD, PA 1711a'0601
ESTATE OF HAM '-", ~ FILE NO.
DATE OF DEATH 04-09-94 COUNTY CUMBERLAND
NOTE I TO INSURE PROPER CREDIT TO "OUR ACCOUNT, SUB"IT THE UPPER PORTION OF THIS FOR" WITH YOUR TAM
PAV"ENT TO THE REOISTER OF WILLS, "AKE CHECK PAVABLH TO "REOISTER OF WILLS, ACE NT"
REMIT PAVMENT TOI
Q05
6
NOTICE OF INHERITANCE TAK
APPRAISE"ENT, ALLDWANCE OR DISALLOWANCE
OF DEDUCTIONS, AND ASSESS"ENT OF TAK
ACN
101
DATIl 10-03-94
BETTY H JOHNSON
123 CAHBRIDGE DR
MECHANICSBURG PA 17055
REGISTER OF WIllS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
L.
A.ount Ro.Uted
J
CUT ALaND THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ...
R ifY': is,j"- i'jf"" F ii. iiii: 93"). iliiTi ci"OFo INti iifi l' Aifc E. 'fAx 0 ifP' PRAYs iifliilr;" "L.loiiAifcE 0 iiri 0 0 0.." nO."""" 0.0
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF HAM MATTIE H FILE NO.21 94-0357 ACN 101 DATE 10-03-94
TAK RETURN WAS I (X) ACCEPTED AS FILED
RESERVATION CONCERNINO FUTURE INTEREST . SEE REVERSE
APPRAISED VALUE OF RETURN BASED aNI ORIGINAL RETURN
1, Rool E.toto ISohodulo AI
2. Stook. and Bond. ISohodulo BI
S, Clo.oly Hold Stook/Portnor.hlp Intoro.t ISohodulo CI
4, "ortgogo./Not.. Roool.oblo ISohodulo Dl
5, Co.h/Bonk Dopo.lt.I"I.o. por.onol Proporty ISohodulo EI
6, Jointly Oonod Proporty ISohodulo FI
7. Tron.hr. (Sohodulo 01
8, Totel A..oh
I I CHANOED
III
121
ISI
1',1
151
161_
171
,00
,00
.00
,00
58? , 00
5,974,51
,00
(81
6,556,51
APPROVED DEDUCTIONS AND EXEMPTIONS I
9, Funorol E.p.n.o./Ad.lnlotrotl.o Co.t.1
"loooUonoou. E.pon... ISohodulo HI 191 9 ,293.39
10, DObh/"ortgogo L1obllltlu/Llon. ISohodulo II 1101 ,00
U, Total Doduotlono IUI
12, Not Voluo of To. Roturn 1121
15. Chorltoblo/Oo.orn.ontel BoquOlh ISohodulo Jl 1131 .
14, Not Volu. of E.teto Subjoot to To. 114 I
NOTEI If an a..e..ment wa. i..ued previouely, line. 14, lS and/or 1& and 17 will
reflect figure. that include the total of ~ returnl allelled to date.
ASSESSMENT OF TAXI
15, A.ount of Llno 14 t...bl. .t 6% r.to
16. A..unt of Llno 14 t...blo .t 15% roto
17. Prlnclp.l To. DIlo
TAX CREDITS I
PAYHENT
DATE
9,293.39
2,736,88-
,00
,00
US)
(16)-
--:.!!.!!. K. 0 6 =
.00 K.15 =
1171
.00
,00
,00
RECEIPT
NU"BER
DISCOUNT (tl
INTEREST (.1
AHOUNT PAID
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST
TOTAL DUE
,00
.00
,00
,00
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST,
IF TOTAL DUE IS LESS THAN n, NO PAY"ENT IS REQUIRED,
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRI, YOU "AV BE DUE
A REFUND, SEE REVERSE SIDE OF THIS FOR" FOR INSTRUCTIONS, I
R!URVATJOHI flbt.. of dRlden" dvln, on or before Dtclllbtr 12, 1912 -.. If My future Int.,..t In the ..t.t. h trM.f.rred
In poII...lon or enJoy.."t to ClI.. I (coUlt.rl1) beneflohr'" of the decldent Ift.r thl .xplr.Uon of In)' ..\.1t. for
lIf. or for Yllr., the Co~.lth hertb)' txpr.uh r...rv.. thl right to Ippr.ltl and ...... trlO.f.r Inhtrltenc. 'IMI'
.t thl l.wful Cl,.. I (0011.tlr.l) rltl on In~ .uoh future Int.r..t.
PIJRPOIl! Ilt'
HOTJCf;1 To fulfill thl r...lrttent. of Section 1140 of the lnh4lrltancl tnd Ettatl TIM Act, Aot ZZ of 1991. 72 P.I.
S..Uon 21~0,
PAMHTI DetlCh thl top porUon of thlt HotlcI ann .ubIIlt with your P'V""t to thl Rlgltt.r 0' WUIt printed on thl rtv.r.. tide.
--Itok. cMck or _. orellr p.....1. to, PEOISTER OF MILLS, AOENT
AU P'VMOh rtctivld .hall IIftt be IPPlIld to eny Int.r..t Ntllch IIY be duI with In)' r...indtr -..lItd to the tlM.
REFUND CCR)l A rtflMld of . t.M orlodlt, liIhlch WII not rMIUI.tld on tM T'M R,turn, IIV bl r.que.ted by cap1tUng an "ApPUoIUon
for Rlfund 0' Pemlvlvanla Inhtrltenc, end E'tetl Tax" (REy-nUL AppllcIUon. Ifl IVIUtbl, at thl OffICI
0' thl Allltt" of Will', any of thl U R,vtnlM Dhtrlot OfficII, Dr by Clll1nt thl ,peelll 24"hour
..,....rlng ..rvlcl nutblrt for 'or.. ordlrinQl In PIM.ylvlI1h 1-100-162-2050, outlldt PIM.ylvlnll end
within 10C1.1 HIIrr"burg Ifll (717) 787-1094, TOD. (717) 772-1,252 (",.,Int I~.lrld Only).
OIJECTJOHIl Anv perty In Inttr..t not "tltfled with thl appr.I....nt, .UOWancl or dh.llowll101 of deduotlon., or ........"t
0' t.x Unoludlng dhoount cr Intarllt) II thown on thlt Hotlc. MI.t obj.at within Ilxty (60) dlY' of rlc.lpt of
thlt HoticI bYI
"written protut to thl PA DIfIlrt.."t of RlvtnUtlt Board 0' Awe.h, DEPT. Ul0l1, H"rhbUrg, PA 17121-1021, OR
--.leotlon to hlv. thl ..Uer at"llned It tudlt 0' thti ICOOU'\t 0' thl ptrtantl rtprllentlltlv., OR
........1 to the Orphenl' Court.
AIIIII"
IITRATlvt
C_CTlOHS,
FeotUll .rror. dl.covlr.d on thll .......ent .hould b. eddrl..ad In writing tOI PA o.p.rt-.nt of A.venue,
lurtllU of IncUvldulll TaxII, ATTHl Po.t a......."t R,vl... Unit, DEPT. 210601, Herrltburg, PA 17121-0601
Phone (717) 717-6505. S.. Pili S 0' the booklet "In.truatlon. for Inherltanc. tlM Rlturn for I A..ldent
Decedent" CAlV-IS01) lor an 'XPl80.tlon of adllnlttrltlvlly corraot~l. .rrcr..
INT!RI!IT,
If lilY t.x duI It Plld within thrH (S) c.lIndar IIOnth. .fter thl deoltdtnt'. da.th, " flv. percent <5:() dl,oCM\t of
the t.M Plld II .Uowtd.
Inter..t It c!\trged b..Jnnlng with flr.t d.V of dtllnquenoy, or nine (9) IOnth. end one (1) dlv 'rOft thl d.t. of
d..th, to thl data 0' P'VNnt. '.X.. which baoIH dlllnquent blfore J....ery 1, nl2 bier Inter..t at thl fit. of
11M (6:() percent ptr ennui c.lcul.tld at a dlll~ rite of .000164. All t.xu whloh beo... dtllnqutnt on end 1ft"
Jenuary 1, 19'2 will bI.r Int.r..t at . ratl which .,111 v.ry 'roe c"l.nd.r yl.r to c.lendtr y..r with th.t ret.
announced bv thl PA Deptrt"nt of R.venut, Thl applloabl. In'trllt ret.. for 19az throuot119M trll
DIICOUHII
'!!!t Int.rut Rtt. DillY Intlr..t FlOtar !!!r Intlrllt Rate Dilly Inter..t FtCltor
1'82 lOX ,000540 1'116 lOX .00027'
1'85 lU ,000451 1'81 'X .000241
1'84 m ,000501 19U-I991 llX ,ooom
1'85 III ,000356 1992 'X ,000141
1995-1'19< 1X , DOOm
....Int.r..t I. c.lout.ted .. 'ollow'l
INTER!lT . BALANCE OF TAX UNPAIO X NUNBER OF OAYS DELINQUENT X DAILY INTEREST FACTOR
--Anv Hotlca 111* afttr thl tlM blCOIII d.lInquent .,UI rtfllClt In Inttrllt c.louhtlon to flft"" IU) din
....vond thl dlt. of the ......IInt. If plynn' II Iltdl after thl Inttrllt COllPUtltlon dlt. .hown on thl
Hotlce, Iddltlon.l Int.r..t MI.t bI c.lcul.ttd,
I~
CERTIFICATION OF NOTICE UNDER RULE 5,6(a)
Name of Decedentl
/)71)771.' /( ((ilt"
Date of Deathl
II i'I,'"
9 ' /'1 ') <."
,
Will No.
<1- 'N' .J ,::;7
Admin. No.
To the Registerl
I certify that notice of beneficial interest required by
Rule 5.6(a) of the Or~~ans' Court Rules was served on or mailed to
the following beneficiaries of the above-captioned estate on
"I- /" 6'; ') '/ I
,Name
M;?, 1-11111), J,(',
Address
,2,<i)~.~tl'l J\.'> ;n"."1')AI~}i/ .2",,-SY-/
Notice has now been given to all persons entitled thereto under
Rule 5.6(a) except
Datel
~-~;;'~)y
;),"'<''''1';./ 0 /lj:..v'I-
Signature.7 ,~
Name 8l77Y 1../ ~J;f{;.I{,o;J
Address ,,2" Cfl"'(\~":>c.~ DL',
rn~,'HflNI(!,S/ji/':>',. /)/1 /7t!:J,""
(,(I .~(
: "
, ::, ,
r "
- ( ,
~ 1
(~
ql I ,
, ':j, .;~
1,: 00
Telephone ( 717) ? (. (:, .3 7 ~ c;
Capacity I
v' Personal Representative
Counsel for personal
representative
STATUS REPORT UNDER RULE 6.12
Name of Decedentl
/17 II l' 7/ ! fI Ii ,; 1)'1
Date of Deathl /l"Ij'" 'I, ,")<) <,I
Wi 11 No,
l/~'7 3:; /
Admin. No.
Pursuant to Rule 6.12 of the Supreme Court Orphans'
. Court Rules, I r.eport the fo11ow.lng with respect to completion of
the administr.ation of the above-captioned estatel
1. State whether administration of the estate is completel
Yes_~, No______
2. If tho c1nflwor Is No, state when the personal
representative reaJonably bolieves that the administrat.lon will be
completel_,. ______,_______.__
J. If the answer to No. 1 is Yes, state the fOllowing I
a. Did the personal representative file a final
account w.lth the Court? YEtS___ No_ v~ .
b. The sopara to Orphans' Court No. (if any) for
the personal representative's account iSI
c. Did the personal representative state an
account informally to the parties in interest? Yes v No__
d. Copies of receipts, releases, joinders and
approvals uf formal or informal accounts may be filed with the
Cerk of the Orphans' Court and may be attached to this report.
Datel /o-v. _'Ill
_~d({ j./, () ,.ll, '.;)(>.-'
Signatur ,:/
8fT! y 1/, ;:X"ftA.'':'(',.';
Name (Please type or print)
. /.23 ti.'olt~r,'I/.)d t)I' /nr""~/I
Address
( //7) 7~(, 3 'J(~-,
Te 1. No,
Capac!ty I
,/' Personal Representative
Counsel for personal
representative
(MAH I rmfl AM3)t.1
V'
-'
t