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"'" 1,\ ".. ", " '.' ." .. '" .. :,1'. "1 'I" ,/'- "" , .:fl, ,lI' \ :'1';') , . " 'il '.. ; ~ '/'.'" \ ,'I,' " 'I, fl, '" ". ,I' '''''I, ""1'", . \',,, ~': " , ""l, 1':"11 ". !. 1,1' ' " , " , " ,. ,( /' , " ,::;:::.-- t-c:... Pf:TITION FOR GRANT OF LETTERS Of' AIlMINISTRATION lJ:!lale of _~~~_ M.Cl~."'u . t\~\I"'~~~')( al.!o kl/lIIl'l/ II,! . ..._.. . ...... ")/ I('I! X I No, .. ._.L:i. 'h~ m .~...:::".~'._.,(!......._ '10: R~glst~r of Wills for th~ COllnlY of .tI.1l~~~'>t-.~. in the Commonw~lIlth of I'ennsylvllnlll _,,_,,'_"'m' ............ '.S ~O". /J/'<'I'IIII'II. Social SI'('I/rlly No, . Z'] .-:-"0. ~.O YlliZ- Th~ petition of the IInderslgn~d re\p~I't filIII' r~prc.ICnts thllt: Yonr p~tltloner(s), who is/llr~ IH ycurs of lIg~ or old~r, lIppLy.. d"_ for lellers of lIdmlnistratlon ._..-.................._ ....... ..... ..............,_._.______.u__._ on the estate of (d,h.ll.j !)(.'lllll'llll' Ill('j llllrllllll' lIh\cnlla: durilUll' mill(HllaH') the nbove decedenl. Decendent WllS domiciled lit denth In .j:_\.!~ ~",:~.~~.Ctv~ t"'(1{HtnIV, I'cenJl'lvanla. with h e" 11Ist fllmily ur prlndplll residence lit _.l,-~ ..Qu~.\:t~~~rll~l.~~ \ ") C2..13.. (11\1 \UCCI, ll11rnhl" and municipality) Decenden!, thcn...Ia.,.,-.. Y~lIrs o( ~ dl~d .....A~:r\l_~._------, 19...!L~, nt.._J...\."\""._t1I1._~,,!:\""\ .~H...S_.JllcumCar.LNeK11e.illL . , De~cndent lit d~lIth oll'oIcd propcrty with ~slimlll~d vlllIICS liS folllows: (If doml~iled In I'n,) All pcmllllll P[(\P~rty (If not domklled In I'a,) I'cr\onlll propcrty Inl'~nnsylvnllill (If nOI domiciled In I'u,) I'ersonul pr(lp~rly in ('(HIlIlY Value of r~ul eslllle In l'ennsYlvunlu;\\ ~. ~~~Ied as fO~~~S~ (~.;.~~\t~~::::~;.,~ !:\I.~J~__. $ $ $ $ - D- -0- '1S I CJ:r) I'ctllloncr__ nftcr II proper scarch hll~.... as\'Cflaincd thai dcccdcnll~ft no wlllllnd was survived by the following spollse (If nny) lInd hcirs: , ,^^.' \ Nnmc. Relationship Residclll:c. -T.!l\~..A.I,;.\--l~~J.'!'J.~..--... ~(,>\I'- .. ~~ba.~~ MS$~(>\J""'I.. I-Tho\M,.Q,~ . .. ~___ _'~_h'_'" ~, Lll\Jf.:!o M\~r.o"rl . .' h\"'~~_~~!?.'&i.,.;--___ ___M~'n:l:!:c._.__ '\J.~"""c"''''~ ,^W ~\\.4.(~\c.l:> _~ I"- s.~~~.__ _...J.j>,,,,_~ Co."'~\'I. 'a"',,^$,,\l \I" ~\... l...'Il\'J>.~i'...&~..--L__..._ ..__....~.._____ lll<\I~'" c.~ '1~ i..... THEREFORE, pClilloner(s) respectfully rcqucsl(s) the grant of ICllers of udmlnlstrnllon in thc appropriate form 10 thc undersigncd. - j 'fb,d.tu"'t il ~.(yLcmv)---- '0_ '~~ co: g ,U 1(, tl"Vl/J -"&_fL___~~ Tl,2 , ~= _J.!J\J 1M..! C j l' Y &JL..J.cz.a ~ v;~ 'C~ 50 ! Vi .){-'/,/,,'n ,-1 l/C' lJ O/~'''1' -&z'7M' 6<<-< 'f~~ "..,,?,,;It IAJ-r.&...7 d.' '0/ ~~~_.../.A / }Ie,,; II( .' ,J( I.~j - III '. " " , l llrCUllJH. W,I, E IIr'll Eva \AU[; 5., I DAl[ or [II!ITH lmo dol'(, vII .r",tlll!lhd,I'f ~ Fe b, t , t 9 30 IJEC((lUH ItISI'AUIC 7 64 J. z 0 :a E ..... If) 8- 0 a. , If) is z 0 g ~ "5- u u: g r= a: t---- UJ u e CIl ~ 1 II ~ -"1--- " ~-- '" 1;111111,',1\ f!C[){IIO I) YotSPOC1fv ) iifJSfllT^l on OTtlUlltltiTITUTlotl' ~W1\IlIIIIHlI(tlO! \l"~o ,lflIllI /loll rlllmtloq o UJ" Trigg Memorial Hospital !f; HOSPITAL .. OTtlUl . lil 1~ln",1Iint\\ [l Ul.'OIJIP,ll,onl (1 OOA I \1 tlulslflY 110mo II IltlbllfO!1Cll (l OIlIM (Spocdyl U ~ltA.TE oli COu.""."or; .'.".'.-ITH\CItIIUl 01' WHAl 1 ~lAll."",[l~IEVf.:II.MAI1.'lI!~ll \~llJfWIVIWl HI'OllHt (111'1110. y. I''/'O hlllll nIlnilil '-\WAS otC!:-.OEtiT ~ 1 CO~I!lJ.nY WIDI~VIPd) OIVOIlCUJ. Spoclly US AIIMW FO , Germany "u;:;A " '(11 owed " .13 [1 VESl(! SOCIAi Sl'ClIIIITY ;'U"''''" '. UIIU^, llCClII'^Tlm, IK"'" "I."" "01," '''''''''J ""..I "i """'9 101" ''',,'' ,","," \KIN[)Or nUSINfSS on INO . " 2'75- 50-0462 I ",1 Homemaker IIh Home ' IIE510E/lCf: . Ufa"IO' . Ie'. "'."'. . . ICilY T(I",II Of lO<:<lllon - IINB'DE CITV 1I : IlJew Mexioo 16..Q.uay 1"Tucumcari "l<JIAYES~:_ :::'EEl ~~~M~::~bc;=~kin \:~;GOnE 88401 t'1 FAhiEFr."N";,ije( fi;&-'''-- - ~liddlO lflS\ 1 MortU:fl OlnTH NAM[ f1111 Mlddlll Lllsl ~ 11 Ru6.olf _ iJp.al1a 110, An'^la !o1aj:'l" na "NFoW.i'NT-:1i.,inl". 0<";0'[-.... .\M."A.'l6'N008A_ODE'1E",S sR"'a"n"Fko1~'rll T1ICUlncc"ar,nowi" I New MeviOsl"QIO _8"-8-4-0-'1'.- .'. !!.Lil1cla,_QOX1Z!~I},_(';"'___u_. - -' '" ".' . METHOD OF OISPOSlTlml \CEMET(fIYICRF.MATOHY Nama : 20. U ,,"" Xl CIO"""O" [J II,movell"m S"" U 0011""" Cl E"lOmhm'OI 1101"" IS",,,,,, ". Memor ial _ p!'l,rk_ . --' l6CATIO~C-'- -"~ciiyiro;n'-'- ----- . ~. - -'SIAill- 'lfLINEIlAL SEIWIC( \ICHlS1.t I)( flf:IlS0N ACTINll AS--~ CH :---nalure LICENSE NUMBE 2" Amar 1110 I Texas __._ _ 1,1''''''.: Charles F, D !l - FACiLifi-;-NAMfu-.---.------.-----m. -- -P-'.6,CIUTY. ADonEsn Slwo!illl D ~jo 2Ie Dunn Funeral Home .11.l.1.5_Jo '." 3rd, Tuoumcari ,-_U~w .1'1~xi_c.Q ...-.---' CERTIFfER'S-fUONATURE ; OnthebaSIS oi ii.amlr'UlIIOn aOliTo;- ~ ()ff\Ce 01 MlKllCllllnVllliQlllor I OATE SIGNED (mo day, yr) \HOUA OF OEATH ~ invUh\latlOn.lllnlyoPlnlond",lhoc.currodallhOllmo,dalo Tliba~'MllrtaryAulhollly ,// e:" U 5 25 P . and plleo and due 10 !llO caulo(S) 11alod J Certlliod PhY~ICliln 22,: ':I - /.".... (' _ ~_ _ 2?d - I -- - -~-' 220 ~L~~"-;:;,, ~;.:~\~~ ~\-.'t::, \:~,~;;C,EO[~:O~~;4 ,/I . :~,O;~N~~D~~~: ;;:8P.~:~~~~~m~~.~~g~~~~~u~~~ t~~x i CO . p..... C~:EllD~ D;U~~'~E ~~_~ ::~,~,~:Al- ~~:~~ADCE~: : OAT~lJ..I!.D AT BVRHS {mo. day. 'II) STATE REGISTRAR'S SIGNATURE J d l~L / WAS AN UT(}PSY PERfORMED I [I YES tJ NO [J YES NO 248 24b 24c ~~~ciifo~~~~~~~~~~o;uYVES'SPECIFVTY';E 6VFii6cEOuiiC'-' -' DATE Of PI10CEDUII. ----\~~~~\PJff~l~l~~~~~ANT11~~~~1-~i~ [] VES [] NO J 0 YES IXNO ~~S6RiiiF. II0W INjUAY OCCUAII~t~icDj,ol;lETEF6F\ACCiDrlir:sUlcioCiiOi.i'CIDE, UliDi~F\M'NEDI -~.- 'l::."R ~~~NJU:=t:: O"~'U}~.: (100 , ~HiJAY AT wOHK-----IpCACEOFTNJUifv-:-specily hOme:-iaim~;ilii"OlC-- --~L'6(;Afl(:JN StreolJAFO No. CllyfTowll DYES 0 NO 1 _____ 111__._ _ __.~____ -~-- .--- 211____~____~__ PAnT' Enler lhodlsOlUO~. ,nluCIOS or complications which causod thO dualh 00 nol ontor tho modt'l 01 dylnQ, such lIS cardiac or fUPl/alof)'llllfJS1. s 10ck,orhOftf1talluco li~l or.!yono causoporlldch hl10 l' \2 r- -- i8 ! 'S---.-, )l L--- Il: .... o r '1--- 'j 1 IMMEDIATE CAUSE Wlnal dlseaso or conclillon ---a.... ~ rlllull1nQlndOalhl --,...-- ( Arter 10 sclero t ic Carcllo\TaSCl1:J.~Ll)lp(Hl,p~-!-..__..... oUE TO (on AS A CONSEQUUIC[ OFI i SequonllallyhslCOndlllOM, II any. loading lounrnodllllo cause Enlol UNOUIlYlflO CAlHiE lOi,oaso or Inlury which inllll\!od o~onl~ luulhnQ In dealh\ lAST . o-ui: TO (OF1 AS kc(msl:a-u[t-~C[ on o-uf TO (OFt 'A-S A CONSEC1UENc(on ,- .-\ d 11Ani' -1l-01t;.-, tii~nillc.ril c:onclll'lo'nll-c-{)nll;b(;llfi~ 10 rlollui llui'no,-r'o-'-ul1;orJ Ill'thfi IHldorlYlnq r'lljsB-gl~on-lcl-flii-r; i 446349 SHADED AREAS FOR MEDICAL EXAMINER. LEGAL OFFICER USE ONf UI&)~-L~.; :i':":j~' ~." ('I,llIlnEl)('OI'Y onTI AI. KH'I)\l\) .' Th'.'" '"" "" "''' ",,,."""00.,.11 '" p'" 0' .h, ,,,,,m..' Stllle Rr~' UI' otnclllly Ttalltered IlId mrd with Viti' H~ro,dllnd lIullh. L l (. ( ",II.lIeo, "".11' 1I"lIh 111".1..., lI'p"..",.1 ,111"'"', O^ TE ISSUED -.-!.i I I lL_ WAnNIN II 11'1 llIoynl 10 n I(IF Of tOUAlo' (1111 fl co, cAlo ADVERTENC'A h 110 III tlllOl1II 0 I fjlflCnr sl., c:orlWclIclo " , " I'> ,'I I . "I' I'" , I " " " , , , ' ,1;; I.' ,', . , i'l '\ ' \ "I i, il ;'_ \_,I"\\j '\11 :i. .\1 : \'! 1::',:'1 ,! ii. 'oti, I' '\'(I! 't (' 'I, ~ I : i" d i, ", . It I ~ I' I' I \ i F o! 'i! I I , It 'j ! I ',IIL II!' 'j, '" "1 \ 'I ,,' " , \ I \1 'i " t ii," 'i "Ill: I,!,'\, ,._1' II I '" 1.,1 Y" \11, ji ;L,~!:;! ',I,',' .,,1 ",\1, II 'II '("'I,Il" j. I. ,p:, 'II ),li"" "1'",, ';~ ",i: ,i~I' 'I, II 1",i\I!'\\ ~!i,_; - \\1 ,il' :;", j,,!j~~1 ;"! ' ~f\i !: [I 'OJ "'I' "1,\']1<,-\'\ Ill' ,II, ,,,' il I,',.' 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I' ,\1 ". , , , j i'\';, ..,,', , " " I. II t" ',' I, 'I' k-, "d ," " ,. ,I"p , ';, 'I " I' .. .,:.. ,. 1,':'1.\ , I " ,. , " . ,,'1. " , , f'j 'I.i' .: 1 , " . '" " '.. . , I i' ,,- I II ,t,' '. 11' ~ I , I" II I ~ ; " ,~.... ,I . , 'i:' . I I I I I ".\" o ,~ " ,I,i' 'i I i " .. .\ " ~.. ,', , ,. ."~ " I " " " " 'I .. l. " "-.....----r-.;.~.~.JJl ~__ ( . , ..~.. ........- ."'....t.. . " , ',' " ~ L . --'.... .:. ~ . CERTIFICATION OF NOTICE.UNDER RULE 5.6(al Name of Decedentl E"o... M.~n~ \\e.,^-&" ix Date of Deathl I-\~' Will No. Admin. No. 19QY -003(;,\ To the Registerl I certify that notice of beneficial interest required by Rule 5.6 (a) of the Orphans' COUt't :Rules was served on' or mailed to the rolll,i~lng beneficiaries of the above-captioned estate on (0 ~ 'i ~ I Name ~ddress .$,U.. ~~ Notice has now been given to all persons entitled thereto under Rule 5.6(a) except v\.ij\~ Ii, '. . _~AJO',' Signature ' , Name ~ ~'\- L OQ:",.e.-.:.. Address n W, '::::.o~ ~'"' ~\l::'\~ PA nO\~ Telephonel7J'il 2;~1- 6 g 73::> Da te l--=t~ '" '-\ f') , <>. 11' 1[; ~ i uo CapacitYI Personal Representative ~el for personal representative ..... .,. LfGLlC n tlMlOLr.n Cllle oJ, Wlr.N[H' w neon Ur.'lNINC" DAVID II H09l:NUtRO", HANDLER AND WIENER AnORtH:YS'ANO COUNSeLORS AT LAW 319 MARK<T SfRr.'" p,O, Bo' 1177 H.RRISBURG, P.. 17108 (717)234'0031 r., NO, (7171233,3029 oj May..Y, 1995. , 5,o\ttlUr.I, ~iANOLt" (lsaa'1b) 'ALSO AOMIT.rcO CONNCCTI",~Ul "ALBO AOMITTr.O rL.ORIOA " Office of the Register of Wills Cumberland Coun~y Courthouse One Courthouse Square Carlisle, Pa. 17013 Dear Sirs: , Re: Eva M. Hendrix Estate 0("1- q f- .3&/ ' Date of Death: 418/94 Please find enclosed a check in the amount of $5,100.00 to the order of the Register of Wills, Agent, to be applied to the inheritance tax in the above estate as follows, viz: (1) To the real estate to be reflected on the Inheritance Tax Return that will be filed shortly; (2) The balance against any other assets. Very truly yours, LBH/b/w/enc1 cc: William P. Adams , . ," " , ."'" t~'( '1_. R (J J~ :'30:; r", ',';1 'Ill" f;: .. ".1 1"'\ ,\ I I :-' (. :;S :i..o " I.. ,. . I 0\11 IUU: ~ WC: CC' _:3 UC) I , " " " I , ,I , ,. " '" I', " II' " ," ,I ,J4' , 'I '~ 'I l'" , " I, , , ,. ',. " '~"!'('!.i~n'~!; , ",' 1 !...~' ('J " , ,.t; 11..1. . , ~'l fl) ! I.... , I ' 11':;, j~ , ~\" 1 ,- "'ll''';'!I. I r\\~"((1.iv,.. ~. ::~l . I' ~\\ "I :'" . , ,\''', ( ,~'.' 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( I I f' ~", , ,/ 'I :1 , ~. " ,I: ,I ,: . ,., , i " .{~ l " ., , I " .". ..........--- ~~",,,,,,Jf~ _'nl... ~~ ,PO' ,..,.,......."...-.,....'..-..... 1'" ':' ,. ,. " ., ,. .'i ,,-. , '" ..~...... , '.' 1'\' P" \ . -,',' -"'- -' -"., ,','. ' ,l'\W',; \qi~f!i"~~i'J-lfhtr"'\....~~~'Ur.,'...'f... ' .,j I "....,t,.. , ' . ~~>>ltl.J~I~tli'f~",M(iS.,!lIl\h,\.;,"'... ,;:., .,,,,,,,,,,,,~ .,~',. ,'-I. W. ,'.\, ""jl~l1JR~ " "ll'l ' , ,. " " .. ~ " " ,', . .' \,1;' " ,. 1-" , ,'j , ." .,;...,.... .:' ~(- q If- 3Col .:-............-) ~"''''I rS~(..'!!f'-,.:-V .',#(.~,"- '24':)6 (11 y. /\l i' (.JII i. KJ; , , II. . II '~(' (II ,n " ~('Inl,^... " , " I ,0 I i " HANDLER AND WIENER "., ,P POST OFFICE BOX 1177 " HARRISBURG, PA 17108 TO: Office of the Register of Wills CUIT,ber1and County Courthouse One Courthouse Square " , Carlisle PA 17013 , ,.;: FIRST CLASS MAIL " Vd ' 111.( " ". ""_'\ f'o' ",; , , !limo "!!lID ,," 10: II\iSZ AV~I " \lil!i\i,I'i jO /. i ' , i :8" ~. ~\.t,;. JJ) lJ ,'\'it:{~,;l\i~' w,:.r'/-1tlll~l'" I .1." 'f ,t;I~'Ujr~Jh H\' , " , " ~ " ! I;, - -, ~ . -, . " '. , ..!l. 1:'\"- , "If.. '" . ,....-'..... ;-.,- ;"1'-'-;0' ..:.-.....:'"- '~', "'~i ,... ;I' .' ,,\ ", ", i., ('~ ,1J, ,i!.j..!-,i,i.j~)H' ,""P,lhb9l:l " .,_,,,,, ~-''l__,,'c~' ",-", ' ., . ... ~". ............. . ...11 ., \ I ! "IF....--. .J I"~ J"}'\" ,. I"" " ,..p,,'" '~l '! " . , ~ . . . . . j. " ...,.., . ,I .. f . ' " HANDLER AND WIENER L.ESL.IE n, HANDL.ER CHIC oJ, WIENER' W. SCOTT utNNINO DAVID tt ROSttlOERO" , ATTORNeys AND COUNIlEL OR6 AT LAW 319 MAk ,ET STR<ET p,O, Box 1177 HARRISBURO, PA. 11108 (717) 234,6031 fAX No, (7171233,3029 , '1I\.SO ADMITTED CONN~CTICUT "At..OO ADMITTED rl..ORIOA SAMUEL HANOLE:R (1(122-70) May 24, 1995 Office of the Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, Pa. 17013 Rei Eva M. Hendrix Estate Date of Death: 4/8/94 Dear Sirs: Please find enclosed, in duplicate, the Inventory and the Inheritance Tax Return, with supporting Schedules, being filed in the above estate. Very truly yours, LBH/b/w/encls cel William P. Adams, Administrator By: P~S. Also enclosed is the $25.00 check for the filing fee. ~~ 't5i ::0 :Om ;:1" (I., g n '.~' (" Sf; .. , ~ " t)J .I ~-' ''r,> " . t._ ;... ~. 1.2?! ~ ~j i~ c> ;:I ~. - . 'Ii " ", I r ! I i I " " I .' / 'i , 'l'~ 'I " d,1 L "j .. ,,. " . ) I I 'l',',l,.i I\!' '. , , 'I :' " , ,I' ~ " " ... ~ ~" ' ~ ' ... , , " II d ,C>: ; , \'. " ] ""i" '" 1', . I 1/1 Ii, '":!. ~ ,I,' " , .J .J "'t .... ,~ ." ~, ".. .,'., . 'II.... "I I, 'I' , d" " ,. S :1:, 'El ~, ~ i~&g .~~. ~ '8 ~ ]i ~' ~~I~'B 'I " " , ,. 'V,I '1".) " 1,"1'1' .. ", '\1 , n: \\1\\1 ,,' '",IJ(J "',i(J~l:J , , I " " ~ . ',' \, \ ,. , " ~ , " , , ," ... I, = ., '::1 - -- '1i .' ~ . "- . ::: " - .. .. - .. - .. -= - :; - .- . . . '- - ~ - - ~ ., .. cJ1 - . . ., '- - '- .. .. ..:: " , 1,), , " I I" I" " (~. ' "N " , , 1;! I' 'r r~' , I' . Ij ,. ";, r.;. ," . " ... , :1' '. ~ " ~ I I. " " 1,'~, ) "~ d .' I I '1 " ( ',., ~". I r , /. .' .,1 I d' ,. I ~" .o' il " 1',.1' ,. '4't " J: " '.' r ,. . " '.J , , Il' ( " ) ~ ,- r ,\ ,\ . I ., I ";,,' '" i' ',' ,. ;'1.'''' , " I ,. .' , ..' 1'- '.' I, ..I , , , .r I '!\ " t I I' " I' , .... .... .. '" " M ...." .....- , ................--.. I, ~...."""'.M....... _ ~T.... t. I " ,. \"1'" I' I. " ,. , " " " " "~I, '\ I' " ~ ' . , I,' ,. t'.' ,.., .1 ,II , . " " .. , . ,. ., __ , ' . . ,'" ' . "., __. '.' __ .-'. . .' ., -' ," ""~ .'.., '. " " ' , ,- II ' , '1 " , .' , '.'It"!' '" "'V' "i""."" 'I. ''''f,,,,,,,'\''irl"'I~'1~n(''''Ir;~'~W\!~III..II~l11\o1'I~t~,,kll>l'lII!\'I\1~tlrf.W,\'I!'"~~VI\,An'1""""',\"""w,,''','' ~,.,...,.w,"".h\';/l , HANDLER & WIENER 75 3 5 ;11 l ii " " 'I' Ii. ", ~ \: i \. ;/ , 1.1 , \ .o,I~i""L~.""..r;""""". ,'~.. .... '. " '," ,. " " " I.' , , , " , ,'I, ., " ", " I' '. ... I' I' I, ., " ,. " 'oi " :, ..,1 ,,' , " 'I If i' , ' " 'Ill, , .\,', I' " ,1. " 'I' 1,' ,. ,. iI' " '\ it ~ ! I" , ". I' ii, ,.,; 1 ,I' ',','\" ,"1 , , / , I i)' " " , 1,1, , ' .:".... ,. ' ,. ,. CHECK DATE CHECK NO, 4AGE 32250 HENDRIX OB/21/95 59.6B 59.6B Cheok total .00 HENDRIX ESTATE 00 ("' ,., ~- \: l-,t' ;\(\ 'II I:' " , ;:r. l:~: ' 'tiJ " .1'\ .<1 " ,. \,r,'l ,t,,;', ILl ~j;j ',. ~l;' ,I' I'.' ',I " " I, " , ". "/,,,,\.,'''1' , ~MI",,"""""'l,W~"'~\\lWIlW(,l"'"''''''''''''''''''':';;'''''''''''~'.'''''.+:--.."'''17''''''''.....'''..''..'' ", ,.:. ' ,..., .' ,_ ,. '.j" ',!, I ., . . :.', ..,.. ,i--.l'.'. , , , ,,' j ,/ J. I. \,~, I' I' .,', ,. .,. 1/' , ,i' ", ,.1" ,Ii' I' I' , I' , " " ,:" , ','-11, " dJ , , " , ,. , ,. " ". ,. I; I, " , ~ \ ' . " ,. "" " r 1;, " H, ;1 ,. ': " , " I. " " .. " " ,. '\1 .. " !." ,,'f . ' , ", .. ,. 4 ~,' ".. .... ~...... .,-...... "."" "_~'1' .!..... i',"il" ., ...... . , "....._...'." -r"~_"~'.", 1 .., j." " ..if' .. .~.... ,- ,-' " ',', " 007535 . CHEcli llMtfi.llT " 59.6B :n ~: I" I ~ \ I " Ii, ,', " " "",', , ':,t, :,,',i~ : ',"'~r.:. ,,~" -. " . ,.i.l, r " f I'~ .~, 'I'~ 1 I , \',', ,,'il'4 , " .,~ ...\ " " " ~ - j. i" I' '\ "'i: ..~' , '1' , _r~" .t; f. I I ,) , , ') I . 1 , \, ." I ,. I I, ..J ',I , , I !I, i '( ii , 'I , I ! I ,I 'I ,I I I i ,I 00 c:: r;, \,', , , -rj 'Jl:; . -'"\ hi LoJ .-) ,,' ;',\ ld PAV..Nfl DttlOh the top portion 0' thll HoUce Ind .ubIlit with your pav.ent .ad, payable to the nHI end 'delrl" prlntld on tho r"v"r," .Ido. 1/ RlIlDfHl DECED!:Hl .okl chl<:k or ...,., ardor ,"'0011 tal REGISTER OF WILLS, AGENT. 1/ HOH'RUIDEHl DECEDEHT .okl chock or lIOn" ardor ."0011 101 COHmlNWEALTH OF PENNSYLVANIA. All Plvwent. reoelvtd Ihlll be IPPllld flr.t to any lnter..t which lay bl dol with any r".lnd.r cpplJId to thl tax. ~'UHO (eM)1 a r.'und of . tlW cr.dlt, which w.. not r.qul.tld on the TaM R.t~rn, ,ey b. r.qu..ted by co~l.tlng en "AppllClltlon 'or Rlfund 0' Plnn,Ylvanle Inherltanc. and E.tate taM" (REY~UU)' ApPllcetlont are avalhbll It t~ o"lcI 0' thl R.gl.tlr 0' Will., bny 0' the 25 RIVlnut DI.trl~t 0"lei' or 'roe the Depart..ntt, 24~hour In'Wlrlnt IIrlllo. nuMMir. 'or 'or.. ord.rlngl In f1lnn.y1llInJa 1-800-362-2050, ouhid. Plnn.ylllanla end within 10011 IltrrhbYrg u.. (717) 7a7~80U, TOOl (717) 71Z-ZZSZ (He.rJng tlpelred only). REPLY TDI OllClHJIfl' IIrrEREIT I OUlltlont rltgerdln, Irror. cantelnld 0,' thlt noUc. .hould be tddrt"ld tal PA OtPart...,t 0' R.Vlnut, BUrt'" 0' IncU",ldull TIMII, ATTNI Po.t A......."t RIIII.w Unit, Olpt. Z80601, Harrisburg, PA 11128-0601, phone (111) 111-6501, I' any tew due I, plid within thr.e (ll cal.ndsr lonth. a'tlr thl dlcedent.. de,th, a ,ivI perc.nt (S~) dl.count ~, thl tlM Plld I. alloWld. Int.r..t I. eh.r,ld b.glnnlng with 'Ir.t d.y of dlllnquency, or nine (9) IOnth. and ~ (1) ~.y 'roe the dlt. 0' dteth, to ,~ detl 0' pay,en'. TIMe. which bee... delinquent be for. JDnUlry 1, 1982 b.ar Int.r..t It the r.tl 0' .he (6". percent plr .~ cllcuJlted at I dltUy rat. 0' .000164. .U taxII whIch bee.... dllln~t on and tlfter J~ry 1, 1982 wlii beer Jnt.r..t .t a ratl whJch will vary fro, Clllnd.r y..r to callndar YI'r with thlt rate ennounced by the PA Dlp,rt,,"t of R,v'nul. Thl applicabll lntlre.t r.te. for 198Z through 1995 .r'l Vllt Inter..t Rete CallY Intere.t F.ctor Vllr Inter..t Rat. Dally Intere.t Factor 1911. lOX .000548 1'81 'X ,000147 1.85 IU ,000431 1.08-1991 llX .oonol 1914 ll~ ,000301 1991 'X .000147 1915 UX .000556 19.5-1.94 7X .000191 1916 lOX .000114 1995 'X .009247 -"Interllt It c,lcul_tld a. 'OUOWII INTEREST . BALANCE OF TAX UNPAID X NU"BER OF DAYS DELINQUENT X DAILY INTEREST FACTOR ~~Any NoUc. III",d a'ter thl tlW blCOlIII dtllnquent wUl r.flect an internt celculetlon to '1ft"" (15) daya beyond thl date of thl ......-.nt. I' p'y,,"t I. lade a't.r thl Inter..t cOIpUtltlon date .hown on the Notlcl, addltlonel Int.r,.t IU.t be calcullted. /~(p, fJitl :1''l~ P1, Ho V JI-,^I-IIS Rr.Vo1547 EX AFP 112094* COHHONWFALTH OF PENNSYLVANIA DEPARTHEH' Of REVEHUE IUREAU Of INDIVIDUAL TAXES DEPT, 280601 HARRISIURO, PA 1712a-06DI (STATE OF HE FILE NO. DATE OF DEATH 04- 08-94 COUNTY CUMBERLAND NOTE. TO INSURE PROPER CREOIT TO yOUR ACCOUNT, SUBHIT THE UPPER PORTION OF THIS FORH WITH yOUR TAX PAyHENT TO THE REOISTER OF WILLS. HAKE CHECK PAyABLE TO "REOISTER OF WILLS, AOENT" REMIT PAVMENT TOl /~ -A()'~ -/4 c.. ACN 101 NOTICE OF INHERITANCE TAX APPRAISEHENt, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX LESLIE B HANDLER 319 MARKET ST PO BOX 1177 HBG PA 17108 DATE 08-14-95 REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 L ~ Anounl Ronl Hid CUT ALONG THIS LINE .. RETAIN LOWER PORTION FOR YOUR RECORDS .... ii{v: is;.-, "EX" "A j:p" C IF94i"NciT"i is if "OF" I NH~ii ifANC E"i'""iC" 'iiPPRA is EM ENr;- At rowANcE" oli"" - --""".. -" - - -- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF HENDRIX EVA M FILE NO. 21 94-0361 ACN 101 DATE 08-14-95 TAX RETURN WAS I (X) ACCEPTED .IS FILED RESERVATION CONCERNING FUTURE INTEREST " SEE REVERSE APPRAISED VALUE OF RETURN BASED ONI ORIGINAL RETURN 1. ROil Eslal. (Sohldull A) (1) 2, SIocks and Bonds (Sohodull B) (2) 3. Clo,"ly Hald SIock/Parlnorshlp Intora.t ISohodula CI (3) 4, Hortglgas/Nol.. Rloalvobll (Sohldull DI lIt) S. CIsh/Bank Dlposlls/Hllo. Plroonal Proplrly (Sohldula E) 151 6, Jointly Dwnad Proparly (Sohldull F) (6) 7. Transfars ISo""dull 0) 171 B, Tolal A..lto APPROVED DEDUCTIONS AND EXEMPTIONS I 9. Funorll EXPlnsll/Adn, Coslo/Hho, Expons.. (Sohadull HI (9) 10, Dabls/Horlgagl Lllblllllos/Lllns ILohldula I) liD) 11. Tolal Daduollons 12, N.I Valul of Tax RlIurn 13. Charllabla/Oovlrnnlnlll BaquIsls ISchldull JI 14, Nal Valul of E.tato Subjlol 10 Tax I I CHANOED 97.000.00 9,970,47 .00 ,00 2.000.00 .00 .00 (B) 108.970.47 23,858.34 1.498.70 llll lI21 1131 lI4) '~.3~7 Of, 83,613.43 ,DO 83.613.43 NOTEI If an allelsment was illued previouslY, 1inel 14, lS and/or 16. 17 end 18 will reflect figurel that include the total of !bh returnl allelled to dete. ASSESSMENT OF TAXI IS, A"ounl of L1nl 14 al SpoulIl rail liS) 16. Anounl of Llnl 14 laxlbll al Llnlll/Cll.s A rlla (16) 17, Anounl of Llna 14 laxlbla al Collllarsl/Clas. B rlla (17) lB. Prlnolpal Tax Dua TAX CREDITS I PAyMENT DATE 05-02-95 RECEIPT NUHBER AA047715 DISCOUNT 1'1 INTEREST 1"1 141,26- I INTEREST IS CHARGED FROM 05-03-95 TO 08-22-95 AT THE RATES APPLICABLE AS OUTLINED ON THE REVERSE SIDE OF THIS FORM ,00 X' DO, 83,613,43 X ,06, .00 X .15, lIBI ,00 5,016.81 ,00 5,016.8..L AHOUNT PAID 5.100,00 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST TOTAL DUE 4,958.74 58.07 I. 61 59.68 . IF PAID AFTER DATE INDICATED. SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST, IF TOTAL DUE IS LESS THAN .1, HO PAYHENT IS REQUIRED, IF TOTAL DUE IS REFLECTEO AS A "CREDIT" (CRI. YOU HAY BE DUE A REFUNO. SEE REVERSE SIDE DF THIS FORH FDR INSTRUCTIONS,) ... 1101 .- ~. ('1\ <n: I' "-:t~ .'_'n~ ,.. '.' , , \0 ~ '-~l :';;;! '- , l ~ I U: cr.: In VI oj ...1 l:: ,'!!::l 00 RfIERYATlOHI Eltltll of dec.d.nt. dvlng on or tMforfl Dial., 12, 1912 .... If Inv future lnt.'lIt In the IItat. it ',.."f.rred In pOI....lon or unJoyltnt to CII" . (coll.t.r.l) blneflclarl.. of the dlc.d.nt a't,r thl .~plr.tlon of any ..t.t. for 11'. or for YI.r., thl COelOnwellth hereby IMpr..,ly r...rv.. thl right to .ppr.I.. and ...... transfer Inh.rltance TIM" It thl 1""1.11 ell.. . (coUltlr.1) r.t. on any luch futuru Int.rllt. PURPOSE Of' HOTICEI To ful,111 thl r.qulrl-.nt. of Slot Ion 2140 of thl Jnntrltanc. and Eltat. TIM Act, Act 22 of 1991. 12 P.S. SteUon 21\0. PAMMT, Detach the tOP portion of thlt HoUc. and tub.it with Y(Xlr ply..nt to U\I Regllt,r 0' NUll printed on thl r,y,r.. .Ieft. "H"I chick or 10"" ardor ...obl. to, REOIJTER OF NILLS, AOENT All ply.."t. rlc.lv.d .tllll flr.t be aP9ll.d to aM lnttrut which laY b. du. with .,y r..alndtr IPpll.d to the taM. RlFUND (CAli A raflMMt of a tlx cr.dlt, which WII not r.qullt.d on the TIlM R.turn, IIY be raqua.t.d by cOIlpI.tlnl an "Application for A.fund of P.nnlylvania Inherltanc. and E.tatl TIM" (REY-lSlS), Appllcltlon. Ir. IVIllabl. It thl Offlc. of thl AIII.t.r of Will., any of thl Z5 Rlv,nu. Dlltrlot O'flo.., ar by oalllng thl .pealal Z4-hour an.werlng ..rvlcl nuabtr. fcr for.. orderlngl In Penn'Ylvanta 1-800-S6Z-Z0S0, out.ide P.nn,Ylvanl1 BOd within loc.1 H.rrllburg Ir.. (717) 181-'094, TOOl (711) 71Z-ZZSZ (Helrlnl I"llr.d Only). OIJECTIONS, Any ~Irty In Int.r..t not .atl.fl.d with the IPpralltetnt, allowlne. or dl..llowlnC. of d.ductlon.. or ......-.nt of talC (Including dhcount ar lnt.rllU .. .hewn on thit HoUo. au.t object within .h:t!' (60) dlY' of reollpt of thit HoUcl bYI -.wrlttln prottlt to thl PA D.part..nt of R.v.nutI, BOlrd 0' Appnlt, D.pt. Z&I021, Hlrrhburg, PA 11128-1021, OR "'I.ctlon to ha". th. .aUer d.terlJntd at audit of the account of th. PIr.onal rl"r'''ntltlv., OR ueppIII to the Orphll,.' Court. ADIlIH IIlAATlVE CORIIl:CTlOHSI FlOtuII .rror. dl.covlr.d on thi, a,.I'.lent .hould be Iddr....d In writing tOI PA O.,.rt..nt of AIVtnUI, fturltu 0' t~dl"ldual TIW.., ATTHI po.t A..I',I.nt R.vltw unit, D'Pt. 2.0601, Hlrri.hurg, PA 171ZI-0601 Phon. (717) 717-6505, Se. paOl S 0'1 the booU.t "In.truotlon. for InhlrJtane. TIll R.turn for a Rllld4nt Decedent" (REV-ISO!) for an IMPI~tlon of edalnittrlt1v.h corrlCtlbl. .rror.. INTEREST , If any tlX due I. plid within thr.. (51 calandar IOMth. .ft.r the dleldlnt', dllth, . flvl plreent (I~) dl.aount of the tlM Plld I. allowld, Interu, it chlrgad blglnnlng with flrtt d.v of d.lInquency, or nlnl (9) tonth. and OM (1) day fra thl dltl 0' delth, to the dlt. of PIYMnt, Tuu which bee... delinquent b.fora JanulrV 1, 1911 bur Int.rut It the rlt. 0' lhe (6~) perelnt per IMUI allcutltad It I dalh "t. af ,000164. All tlX.. which bee.. dlllnquant on end eft,r Januery I, 1912 will bur lnterllt et I rate whlah wllllJ,ry frol elhndar YI., to ellandlr Yllr with th8t rlt. announcld by the PA Oepartt."t of R.vanul. Thl appliCable Intar..t ratll 'or 1911 through 1991 Irll OISCOUHT. '!!!! Interll' Rot. DailY Int.r.tt Factor !!!! Intar..t Aat. Olllv Intlr.,t Factor 1912 20~ .00054. 1917 9~ .000207 1915 16~ ,000436 1911'1991 III .00uOI 19" 1I~ ,00uOI 1992 9~ .000207 1985 U~ ,00u56 1995.\99~ 7~ .000192 19" 10~ ,000274 1995 9~ .000207 --Interllt It calcul,'ed at followtl INTEREST . SALANCE OF TAX UNPAIO X NU"8ER OF DAYS OELINQUENT X DAILY INTEREST FACTOR uAny HoUel Iuued Ift.r the tllC blCOH' clllInqotnt wUI reUlct an lntlrut calcullUon to flft"" CIS) diy, MYond tM data of thl ........"t, If PIYHnt It Itdt Iftar thl Int.rllt CHP\ltltlon ut. .hewn on the HoUel, addltlon.l lnttrllt MI,t be clleul.tld. ~ ~ o .' "R(P,R>c<L.,q~It?~~ ,/,,1/- Cf') ;( '~IW}~ "- .."''',, COMMONWEALH1OF PfNNS't'lVANtA DfPARIMENT OF REVENUE DEPT. 280601 ._HARRIS8~RG, PA 17128.0601 N' NA A, I ,AND MIDDlE INITlAl".'-- I-tO I If Ill' JtYJ-. INHERITANCE TAX RETURN RESIDENT DECEDENT (TO BE FILED IN DUPLICATE WITH REGISTER OF WILLS) Rl:V.1500 eo{. (ll.QlI , COUNTY CODE m'mmi C/O KAren Sue lIendrix -'fDAUOTB'R1H--- 226 Wa1mlt Bottan Road 2/1/30 Carlisle, Pa. 17013 !O~~L.cumberJ.and [) 3, Remainder Relurn Ifar dole' of dea,h prior 'a 12.13,821 [15, Federal E,'a'. Tax Re'urn Required __ 8, T 0101 Number of Safe Oepall' Baxo, llemlrix,Eva M. soBXfSECURITVNUMBER 275-50- l:x.62 DATE Of DEA H 4/8/94 ,11\1.'/',1 I '01 DATlS 0' DIATH AmI 12/31191 CHICK HIU ~o~:::'-rumDn IS CLAIMID 0 PILI NUMBiR' 2194 - 0361 YEAR NUMBER I!! Ki 1. Original Relurn D 2, Supplemen'al Ro'urn ~~~ LI 4, lImllod Ellale [140, FuMe Inlere,1 Campraml,e ofil9 Ifar dale' of dealh after 12.12.92) ll:\1O [J 6, Oecedenl Died To'lalo [I 7, Oocedonl Malnlalned 0 U,lng TrUll ___<1:._... ___ IAllach copy of Willi (Atlach copy 0' TMII _ ALL CORRESPONDENCI AND CONfiDENTIAL TAX INfORMATION SHOULD BE DIRICTED TOI NAME - .. MPlETTMAIUNO ADDRm- Leslie B. Handler 319 Market Str~-) "i P.O. Box 1177 1_.,. '" r1.[fpHoNE-HuMBER----------------- Horrisburg, Pa. 17108-Hn :~r ~ffi "'0 o z vo ... 1. Real Ellalo ISchedule AI I 11---..--91,000.00___ 2, Slack, and Band, ISchedulo BI ( 21__2.,.9.Z0.47..__ 3, Clo.oly Hold Slack/Par'nDrlhlp In'ere,1 ISchedule C) I 3) ---.....oone _......u __..w_ , 4, Mortgages and Notes Receivable 15chodule DJ I 4J ______u~none.._.__~______.. ~);" 5, Calh, Bank Oepo,lI, & Mlscellaneou, Pe..anal Praper'y( 51 .___.._6...90Q.,.OO...__u._ (Schedulo E) 6, Jolnlly Owne,1 Property (Schedule F) I 6) _.. none 7, Tranl'o" ISchedulo GI(Schodulo LI ( 71 __.._._.oooe___...____ 9, Tolal Grall Aile" Ila'olllno, 1,71 9. Funeral Expense" Admlnhlrallve Cast" Mlscollanoau, ( 9) _._21..8.5.8...34 E,ponlo, ISchodule H) 10. Oohll. Marlgage LI.blllll.., Uen, (Schedule II 11. T 0101 Oeducllons I'alalllno, 9 & 10) 12, Nel Value a' E,'ale (Ii no B mlnUlllne 11) 13, Charllable and Govornmonlal Beque'I' (Schodulo J) 14, No! Value Sub~cI 10 Tax IlIne 12 mlnUlllne 131 15, Amaun' of lino 14 laxable 01 6% ra'o C1?).. 83 , 613..43 (Indude ,aluo. from Schedulo K or Schedule M,J 16, Amoun! of line 14 laxable 01 15% role Ilndude value, from Schodul" K or Schedule M,I 17, Principal lax duolAdd lax from line 15 and from line 16,) 19, Cred'" Spau,al Povorly Credl' Prior Pay men', Ohcaunl In'erell ..-..----..----- + ------- +---.-.-.- - ..--- 19, II IIno 19 I, grea'er Ihallllne 17, enler Ihe dlllorence on line 19, This l'lhe OVERPAYMENT. m[] 20, II IIno 171, grealer than line 19, enler Ihe dlllerence on line 20, Thl, h Ihe TAX DUE. A, ElI'or Iho Inlere,I on ,he balance duo on line 20A, 8, ElI'er tho 'alai of line 20 and 20A on line 20B, Thl'I'lhe BALANCE DUE, Mak. Ch.ck Pavobl. tOI R.gl.t., .f Will., Agont .L?17 ) 238-2000 .n -'"j ~: -.~ ,.1 '" ., VI ~"Ir, z o 3 E ~ '" ( 9) ___108L970.4Z_.. 1101 -----1,498T7'O.---- (111__.l.~35!.~04 '" (12) -_-.B1,fUl.y:L (13) _._-11one___. (141 83 ..61J-'..LQ:=..;. x ,06 = _-2,Ol~LIiL._ 1161----n/a-.---_x ,15 = --'--"--0/8---'" 117).___._?,QlQ,8L z o g ~ ~ Check Itere if you arc requestinn (I refund of your ovorp(lyrnulll. (191-.._........0.,.oQ.. (191 -........____uo/a.. . 5 016.81 120) ..._...._L_...... ...... (20A) .._..u__.._......_ 120BI___u'.i..J2lR. BJ ...... BE SURE TO ANSWER A-LL QU'ESTIONS ON REVERSE SIDE AND TO RECHECK MATH". Undor ponClltlas ~porlury, I declare Inal I hove examined this rolurn, Including accompanying Icho'dulos andtlatemenll, and 10 Ihe bell of my knowledge and bolio', It II IrUD, corrocl ond complele, I doclaro Ihal all real e.'ale has been reported ollrue market value, Declaration of preparer olher Ihao tho peflonal repuulInlallv(I Is baled on alllnformollon 01 which preparer hOI any knowledgo, /!r1~~r.:~~.'...1~. IfA'l:l~../~.~ .. ..;;';; Bycd Rd., "0100 Clly GA ;0,;;:=. ~''it1iL1;5 ~1iNJJ.;C(jrpf;PAREJ. OT"'R1HAN.~rPRESHIlMlV..' / / ADDREII , DATE Lesn(v;f41fElh~1~f' {'____n~.' . /(ll' .o.~EX.1 177, lIarrisbllrgLP~....___,__ 5//11 /95 \ , IH, UV.ISotlllt(2.171 * SCHEDULE E CASH, BANK DEPOSITS AND MISCELLANEOUS PERSONAL PROPERTY PI.a.. Print or T . FILE NUMBER COM!f~~WI~~UHI~~ e'r~.~l~AN'A ~~IDrN~ DICIDINT ESTATE OF EVil M.Hendrix (All proplrtv 101.llv.'''''.ld with thl Riehl 01 'u..l..llhlp mUll bo dllllo..d o. 'chldull PI ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 2,000.00 1. Value of Household Goods (estimated) '<' . ,. .. ,. ." " "', " , , ", , , , " , ." " II " , ".'. , .. ,. , S 2,000 .00 IAlla<h a~dlllo.al sy,' " 11" .h..I,I! mOil 'paco It ...dld,J . , uv.un,Utll'''1 ~~ COMMONWEALTH 0' rlNNIVLVANIA INHUllANCI TAX IIlURN IUtOINT OICIOINT SCHEDULE H l FUNERAL EXPENSES, ADMINISTRATIVE COSTS AND MISCELLANEOUS EXPENSES PI. a.. Print or Tvp. J fill NUMBIR (STATI OF Eva M. Hendrix ITIM NUMBER DESCRIPTION AMOUNT A. Fun.ral bp.n..., 1. 2. 3. Holman Funeral Service Eva Hendrix Cremation Death Certificates 1,645.17 897.00 100.00 B. Admlnlllratlv. co.t., 1. P.rlonal R.pr'l.ntotlv. Commllllonl Social Security Number 01 Perlonol Reprelentatlve: Veor Camml..lanl paid 2. Attorney Feel - Ilandler and WIener 4,050.00 2a. O'Brien, Baric & Scherer - paid 950.00 3. Family Exemption Claimant Relatlanlhlp Addre.. 01 Claimant at decedent'l death Street Addre.. City State Zip Code 4, Probate Feel C. MI.e.llan.au. bpen..., 1, Realtor's Commission on Sale of House 5,820.00 la. Real Estate Transfer Stamps on Sale of House 970.00 2, Carlisle Water/sewer Acct. #39 33.76 2a. Money paid in escrow to atty. for buyers for Radon test, chimney and lighting features to make hO\lse whole 1,200.00 3. House repairs in order to sell house 5,500.00 3a. Register of Wills - $3.00/Cumberland Law Jrnl.-$40.oo/ and 4. the Sentinel - $82.28 - paid - O'Brien, BarIc & Scherer 125.28 Look-N-Good Svcs. - House RepaIrs 2,000.00 5. William P. Adams, Executor - Reim. for travel exps. to funeral 307.27 6. William P. Adams - reim. - overnIght lodging 140.00 7. William P. Adams - reim. - car rental - because of death 119.86 TOTAL (Alia enter on line 9, Recapltulatlonl (II mar. .pace I. nlld.d, Inlert additional .hllt. al.am. .b..) $ 23,858.34 , " . ..tv.lSllt.. 11.1'1 ,;~ (.O~MONWUWI 0' "NNIHYAtlI4 INHIIUANU fAJlllIUlH 1I110U'" O~~!!H' ._u ___._.._ _._ _.. SCHEDULE J BENEFICIARIES ESTATE Of Eva M. Hendrix ITEM NUMBER 1. 2. 3. 4. 5. ITEM NUMBER 1. NAME AND ADDRESS Of BENEfiCIARY A, Taxabl. Boqu'UlI William P. ~dams6 6516 Byrd Road, Union City, Georgia 3 291 Karen Sue Hendrix, 226 Walnut Bottom Road, Carlisle, Pa. 17013 Michael Hendrix, Rte.4, Box 438, Lebanon, Missouri 65536 Linda Gonzalez, 608 E. Rankin St., Ticiurncari, New Mexico 88401 Thomas Adams, 2800 Olive St.-Apt. 13, St. Louis, Missori 63103 NAME AND ADDRESS Of BENEfiCIARY e. Charltabl. and Gavernm.nlal e.quIIII: L fiLE NUMBER RELATIONSHIP AMOUNT OR SHARE Of ESTATE son 1/5 of residue daughter 1/5 of residue son 1/5 of residue daughter 1/5 of residue son 1/5 of residue TOTAL CHARITAe'LE AND GOVERNMENTAL BEQUESTS (Ah. .nl" an IIn. 13, Recapltulatlanl S (II more .paco I. need.d, InlOrt additional .h.e" 01 .ame .110) . AMOUNT OR SHARE Of ESTATE / - , \ STATUS REPORT UNDER RULE 6.12 Name of Decedent I P,m Mari9 Il'illldrix Date of Deathl 4/8/94 Will No. 21-1994-0361 Admin. No. Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, 1 report the following with respect to completion of the administration of the above-captioned estatel State whether ~ini!trat~f,th~e is complete I Yes No (''''''''''' . 7 ' ~v./ "& ' 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete 1._ 1. J. I f the answer to No. 1 is Yea, state the following I a. Did the personal ~epresentative file a final account with the Court? Yes No b. The separate 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_____ No d, Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Cerk of the orphans' Court and may be attached to this report. ~k5!1~- r'~ i at-ure Datel ~1J-11 .... 0-' 0 (Il ~y~, ',: .r l'" 1:'.~ <- ;_ ~~ L~ r.' ", Cl. t!' (.. I') '0 I l,,' ;',il ~ n (~; " I...... l') l..iJ " lrl n, .:) 0: ~ ..:: ~.:: 0: 00 Name (Please type or print) Address ( ) Tel. No. CapacitYl Personal Representative __ ~ounBel for personal representative (MAH I rmf/ AMJ )