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'.' :1','" Hl051U nEV, e.ea IFEEP'OATlU!I tl:!RrtfICAlE f200) WAflNING: IT m ILl.EGAI. 1'0 ^I.I Eft THIS COpy on TO DLJPI.ICATE OY f1HOTOf.T^T Ofl f'1I0TOGfcAf'l1. COMMONWEALTII OF PENNSVLVANIA OEPARTMENT OF ilEAL Ttf VITAL RECORDS LOCAL REGISTRAR'S CERTIFICATION OF DEATH CEAT. NO. 2145297 Mal'ch 14 1994 .-BireriTT~riiic"llr,calioo- Name of Decedent ------..---....._,SLql]tJIi '_ . filII Elellnor l.eitzel . ~-l;i-i'(, --- _._._-_h_-_...._--~-.---rMi-___ Sex -fomall:1____Soolal Seourlty NO,...-..-....-~01:l::21.~092'!.__.___..___.Date of Death March 12 , 1994 Date of Birth _August 24 , IJ19___ Birthplaco__!!~.LUs.I!l!!:g.L J~tl_._______.._____________ Place of Death Hershel Medical COI!~____._lJmlE!!in FaWllyN.mo C'HI"I/ Derry '/'we. -ClltlJ'lfoIJon OJ' '1'/1'iiii1p PennsVlvQ Race_ Whlli--Occup~tion__.l'!.I!Lescl\'.!'L__._.._..____.__..Armed Forcos? (Yes or No)._ I'!o Decedent's Marital Status Marl' led.____ Mailing Addros~ ..-HLI\'.'..P.9J.lIL~J-,.L~/.IIJlB Ie ...Rt\ 1701.1 tj'lIllt"'1 SlrMI C1l/Wlonll ._.~__ Part I: Immediate Cause Informant Clark LQJ tzoL__________.....__... Funeral Dlroctor -_Rjc!!!!.~~L~.'__Roj I!horcL.__.__._ Name and Address 01 Funeral Establishment __Re I nl]lIrd Fgnora L .!.l1l111.Q d1i.!Jer~b.!!Xgd)A .l.Z9ti 1______.___._ ___ : Inlerval Between : Onsel and Death I , 1 .-.--t-__ , , , -, , , 1 (a) -..r.LQ.~ed !f!!.!.llLl'fi!\ll!Ll!.__..__.___..__.________._ .______ (b) ----------..+---------- (c) (d) Part II: Other Significant Conditions .-..--------.--..--.---.---~--.-----4._._.._ --------. Manner of Death: Natural 0 Accident IKI Suicide 0 -----.-------------...-------.- Homicide Pending Investigation Could not be Determined o o o Describe how Injury OCcurred: -- Pe~.~~~r.t Iln_v.~~_Y~Qi5:.~_______ .-....---.-.-..--.----------.--..--.-- Name and Title of Certifier ...Jot t)~_h.g!!!beI~1 Chl~LJ2~.l!.!.l_C()r2.I}!lL___.____,,__.._.___..______ (M.D.. 0.0.. Coroner, M.E,) Address -L?05 SL 28Jb...~G..I_II/j1'l' I ~I'!:!!:!UJ'.~_L?IJ.L__._______________. ________,,____ This Is to cortlfy that the Inlonnat/on hero given Is correctly copied trom an orlglnRI certificate of death duly filed with me as Local Roglstrar, Tho;;zrlOlfl I certlfioate will bo forwardod to the State Vital Rocords Office for permanont filing. /' 1......-/ /:< ' . ___;u:,.~.t C/. "7~~ _ _~~-~19 _._ (2r"I'''''~rrH'''\II~~ Il'lfl,;!tl() - Mllrch 14, 1'l'l4 RD2, Box 56, MIIIl!I'i;burg, I'A 17061, MifflIn Tw/>. ,,,,, Ti~r.;;:'7ii;;;""M""- ',;""", ^,.:,,,.;, '.. '.. '_.. ..... _ _. 0:';";"';':1;''-10,,,,,;,;--' ,,_.. last Bill aub ~t$tctmttU I, CLEAT I S E. LE ITZEL, of the Borough of Car li sle, ,Cumberland County, Pennsylvania, declare this instrument to be my last wlll and testament, hereby revoking all w1l1s and codiclls heretofore made by me. 1. I direct my executor to pay all of my debts, funeral aod administrative expenses as soon as may be done conveniently after my decease. 2. I authorize and empower my executor to sell any realty owned by me at my death, and not specifically devised herein, at either public or private sale, and to give good and sufficient deeds therefor, in fee simple, as I could do if living. 3. I devi se and bequeath all of my estate of every nature and wherever situate to my husband, Clark E. Leitzel, providing he shall survive me by sixty days. 4. Should the gift in Paragarph No. 3 not take effect, I devise and bequeath all of my est.ate of every nature and wherever situate to my son, Troy E. Leitzel. 5. I nominate and appoint Clark E. Leitzel to be the executor of this my last will and testament, he is to serve as such without bond. Should he die before my death, renounce 01' refuse to serve for any reason, or die leaving any of my estate unadmi n is tered , I nomi nate and appoi nt Troy E. Lei tEe 1, as substitute executor, also to serve as such without bond, with the the same powers as are given herein to ,my executor. 6. I hereby suggest that my personal representative reta1l'\ the services of Irwin, Irwin & McKnight, as attorneys in the settlement of my estate. IN WITNESS WHEREOF. I have hereunto set my hand and seal this I~r day of November. 1986. ~ ll; e. l.J; L CLtAT S E.XEITZEL (SEAL) S1'gned ,sealed. published and declared by Cleat1s E. Leitzel, the testatrix above named, as and for her last will and testament, in thE presence of us. who, at her request, in her presence and in the presence of each other have subscribed our names as witnesses hereto. -+-~~u_J.,~~ 2 ~ COMMONWEALTH Of PENNSYLVANIA COUNTY OF CUM_IRLAND } Ul Cl.J\RK E._~,~~~EL ___. ______________ being duly sworn .____._ a~cordlng to IIW, dlpOIU and I^YI th,)t h. i R !-Iv> executor ____.._________ of the Ellat. 01 Cleatis E. TAibA] III. of -1lQr.ough_oLCarliale ' " .- --______, Cumb.rllnd County, PI., d.cultd Ind thlt the within II In Inv.nlory made by ,_ClarK..E....Ia;i.t.zQ1._ '_ ._.___, the laid mC8C1l!-.nr 01 the entire elllte oluld decedent. conlllllng of III Ihe perlonll prop'drty Ind ruluhh, except rulutele ouhld. the Commonwealth of Pennlylvanla, and Ihel Ihe IIgurtl oppoll" uch Item 01 the Inventory repru.nt 11'1 fair yalu. II of the dele of decedent'l d..lh , ~ 19q4 _~ / fi' I>: /-~ __C {-;1{"--L--D-~ ' ClClI'kE. Ell,.'.' . Leitzel 9.<.orn Ind lublcrlbed before me, 447 W. Penn Street B. IrMn, t<<MlY P\d:l ,C\irbelIai"cl ColICY t.t(Ccn'n1teiOn E1pI8s Oct, 3. 1996 _Carlis~ PA 17013 AddlOlI Del. of Duth 12 DIY 03 Month 94 VII' INSTRUCTIONS I. An Inventory mull be flied withIn thru monthl liter appolnlment of perlonll r.prellntatlv.. 2. A lupplnm.nt Inventory mUll be flied within thirty daYI of dllcovery of additional tlllh. 3. Additional Ihuh may be attaohed II to perlonllly or rulty 4. S.. Artlcl. IV, Flduclarlll Act of 1949. If I , I.' " ~j ] i uo ~ I!! I .. ~ lli '< .. ~ ~ ~ u .. rg ~ 0 LlJ Q 01 I i!; .. q< !Z ... oJ u. i ... . ~ U. ..J ~ 0 '" ~ III w 0 ~ C<: I t N ~ o Q il ~ I - ~ ~ (l 0 - Z ... -a c ... .. "'i: 0 ~ .0 -a .... ~ e ... ~ 0 .. ~ 0 .... U .. lD I;J. / 4.. ,,;( / () n' c-:J INHERITANCE TAX RETURN RESIDENT DECEDENT COMMONWIAlTH 01 PlNNmVAN" (TO BE FILED IN DUPLICATE 21 DEPARTMENT 01 REVENUE W LLS) H"R1\~J:l, ~~O~\l'ObCIl WITH REGISTER OF I _ _ C()U~TV CODE -~I;;':~!~:';;~'sA~~'OOLI !N'''Ail' - jOICIOINI.\ COMP1[lf AOOR!S\ 500Al!!CUR~j"NuMm-~ruro101'f;r-1Alr6flTm,- 447 W. P~ STREE:l' 20B-24-0924 I 03-12-94 8-24-29 CARLISLE, PA 17013 .._._. ._____ C.,,,, O1>ffiT.'TU.l\ND D11. Original Relurn rJ 2. Suppl.monlal Relurn 03. Remainder kelurn (far dalll 01 dealh prior 10 12.13,92) o 5, Flderol E1lall Tax Relurn Requlrod _ 9. Tolol Numbor 01 SaIl DlpO.IIBoxll Jlf,....15oo f.I+ 111.911 ,. . ~,~ ~ ~'!;'.~,~{r" '. :t'..". 1. Real E,'a'e (Schldull AI ( 11_ 2, Sloch and Bond. (Schldule B) j 21 3. Clolely Held SlocklParlne"hlp InlorllljSchedul1 q I 3)_ A. Morlgag" and Nole. Receivable (Schedule D) ( A) 5, Ca.h, Bank Depo.lI. & Mllcollaneou. Pe"onol P,operly( 51 (Schedule EI 6, Jolnlly Owned Properly ISchedule F) I 6) 7. Tran.le" ISchedule GI (Sche~ule L) I 7) 8, Tolol Groll AliI" (Iolollln.. 1.7) 9. Funeral Expe"'II, Admlnlllrallve Call., MI,,"lIaneou. I 91 Expen... (Schedule HI 10. Debl.. Mortgagl lIablllllll, lien. (Schldull I) 110) 11. T 0101 OeduCllon. (Iolalllno. 9 & 10) 12, Nel Value 01 E.late Illne 9 mlnu.line 111 13. Charilable and Governmenlal BequolI' (Schedull J) lA. Nel Value SubllClIO Tax lline 12 mlnUlline 13) 15. Arnounl 0' line lA laxoble 01 6% roll (1lldude valulI from Schedule K or Schedulo M,) 16, Amount of Ilnl lA laxoble 01 15% role (Include va lUll Irom Schedule K or Sch.dule M,) 17, Principal lax dUI (Add lax from line 15 and from line 16.1 19. Crodlll SpoUlal Poverty Crodll Prior Paymenll OllCounl -.---____, + ____ L.~__. - 19. If lino la II groaler Ihon line 17, enl.. Ihe dlllorenee on line 19, Thll II Ihe OVERPAYMENT, aU 20, If line 17 II groolor Ihon line la, Inler Ihe dill..enee on line 20. Thll h Ihe TAX DUE. A. Enl.r Ihe Inlorlll on Ihe balanee due an line 20A. B. Enler Ihe 10101 of line 20 and 20A on line 20B. Thl. h Ihe BALANCE DUE. Make Chock Poyobll 101 Reglsler of Will.. Aglnt .. .. BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND TO RECHECK MATH.. Under p.nalll.. of perjury, I declare thai I have eJlamin.d Ihh relurn, Including accompanying Ichedul.. and 1I01.monh, and to thl bill of my ~nowl.d91 and blll.f, II Is tru., correct and comple!e. I d.c1ar. th..11 all ,.01 "Iole hOI bun r.port.d ollrue mark" value. Oecloralion 0' preporer olhlr than th. plrlanal rtp,,,.nlollv. II baled on alllnformolic," of which pr'parer has any knowledge. IIO~,AlUIl1lr~i!~5tni!Tll5RTll'!1O mURN AOOIII\ OAT!- //'dd.-/ (v"'CL-/ ( 44] W. Penn St.. Carlisle PA 17013 06-07-94 1\rl.\'A\~![ Sf ,wm,OY" n~:9;lr~mNmII'!'----'li6'ff! ~ 6AT! /}~?5/-1) cf,.~ t{{/, _____ 60 W. Pornfret St., Carlisle,. PA 17013 06-07-94 ! '~ l!! ~fg Ot; <( ii 82 'OR DATIl O' DIATH Ami 12/31/91 CHICK Hili I' A .,OUIAL 0 C '/ ~9VIITY CUD!!JI CLAIMID._ -} PILI NUMBII 94 .. YE!lR. 433 I!UMBER o A. limited Ellalo rJ Au, Fuluro Inl,,"1 Campromhe l'or dalll 01 dealh a~" 12.12.82) o 6. Oecedenl Died Tlllale 0 7, Docodenl Malnlalnld a living Trull (Allach co~ Will) (Allach copy 0' Tru.') ALL CORMESPONDENCE AND CONfiDENTIAL TAX INfORMATION SItOULD BE DIRECTED TO. N M - M t f MAilING AOORU~ ~~~I' NL~ & McKNIGm' 60 WEST Pa>lF'REl' STREEn' CARLISLE, PA 17013 17 L 249-2~.L c; .,., 43.878.69 z o i ( 8) 43.878.69 10,292.24 (11) (12) (13) _ (UI 10.292.24 33.586.45 (151 33,586.45 )( ,C6.. 33,586.45 2,015.19 z o ~ I u s (161 )( ,15.. (17) Inter..t 100.76 Check here If you (nO r~qutslino a rofund of your ovorpaymont. (181 (19) (20) _.~14.43 120A) (20B) _-l...9JA.AL IIV.lSlllh p.II) . .-... , ISTATE OF ITEM NUMBER ~:J~:~ ....MiI'..,.. COMMONWEAlTH 0' '~NNmV'NI' INHIRITANCI TAX R1TURN RESIDENT DECIDENT SCHEDULE H FUNERAL EXPENSES, ADMINISTRATIVE COSTS AND MISCELLANEOUS EXPENSES PI.a.. 'rlnt .r Type CLEl'\TIS E. LEITZEL 21-94-433 DESCRIPTION AMOUNT 1. A. Funeral bplnu.l Peinhard F\merald Ibrre . . . . . . . st. Peters eerretery Association .. (cerretery lot perpetual care) Elizabeth /obnUllent Cb. ...... 4,613.24 450.00 905.00 . . . . . .. ... . .. ...... . . . . . . . . . . . 1. B. Admlnl.tratlvl Ca.t'l 2. 3. 4. C. 1. 2. 3. 4.. 5. 6. 7. 8. Penonol Rlpresentallve Commllllon. Social Security Number of Penonal Represlntallvel Year Cammllllon. paid Attorney Fe.. IRWIN, IRWIN & McKNIGffi' . . . . . . . . . . . . . . 2,200.00 Family Exempllon Claimant Clark E. Leitzel Rllallonshlp Husband 2,000.00 Addrell of Claimant 01 decedent's dlalh Stroet Addrell 44 7 West Penn Street Clly C'Arlisle Slate ....PA- Zip Codl ] 7013 Probale Feel letters Testarrentary . . . . . . . . . . . . . . . . 87.00 MI.elllan.au. bpln...1 Notary Fees: ADger B. Irwin ............... 12.00 Pegister of Willsl Filirq Fee . . . . . . . . . . . . . . .25.00 TOTAL (Also Inler an line 9, Rlcapltulallan) $ 10,292.24 (If mOil .pael I. n"dld, Inurt additional .h".. .f .am. llal.1 t.. '\ 'J( ., r"-J .. I ~ , . '-' . 1.'1( ~ REV-1547 EX AFP (oa-94_ COMMONWEALTH OF PENNSVLVANIA DEPARTHENI uf REVENUE NOTICE OF INHERITANCE TAX BUREAU OF INDIVIDUAL TA,rs APPR4ISEHENT, ALLOWANCE OR DISALLOWANCE ~~:~iG:~~:~lpA 11111-0601 OF DEDUCTIONS AND ASSESSHENr OF TAX DAT! 11-07-94 rnAfl"'OF LEl --" FILE NO. 21 94"0433 DATE OF DEATH 03-12-94 COUNTY CUMBERLAND NOTE, TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBHIT TNE UPPER PORTION OF THIS FORH WITH YOUR TAH PAVHUNT TO THE REGISTER OF WILLS, HAKE CHECK PAVABLE TO "REGISTER O~ WILLS, AGENT" REMIT PAYMENT TOI 8/0 ACN 101 - IRWIN ETAL 60 W POMFRET ST CARLISLE PA 17013 REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 l AMount RIMlttld ~ CUT ALONG THIS LINE ... RETAIN LOWER PORTION FOR YOUR RECORDS ~ il 'EV: iSti; - Eif" AFP" - i oii:94 T - iloT"i lir "OF - YN'H!il"i f AiicE - T"A'x-XP'piliif iiEifEilT -; -A i:. rowANcE" iiri - - ---" - - --- -" - - -- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF LEITZEL CLEATIS E FILE NO. 21 94-0433 ACN 101 DAT! 11-07-94 TAH RETURN WAS I (X I ACCEPTED AS FILED I I CHANGED RESERVATION CONCERNING FUTURE INTEREST . SEE REVERSE APPRAISED VALUE OF RETURN BASED ONI ORIGINAL 1. Rnl Eltetl (Schldull Al 11). 2. Stcckl Ind Bcndl (Schldule B) 121 3, Clollly HIld Stcck/Plrtnlr.hlp Intlrolt ISchldul1 C) (3) 4, Nortglgl./Notll RICllvlbll ISchldulo DI 141 5, Cuh/Bonk OopoII to/Hhc, Plr.onll Proporty ISchedule E I 151 6, JointlY Ownld Proplrty ISchldull F) 161 7. Trlnlflrl ISchldule GI 171 8, Totd A..oto ,00 ,00 ,00 . DO. 43.878.69 ,00 ,00 181 43,878.69 APPROVED DEDUCTIONS AND EXEMPTIONS I 9. Funlrll E.ponlOl/AdM. COlh/Hhc. E.pon... ISchodule HI 191 10. Dlbh/Hortgogl Lhbllltlol/Llln. ISchldule II 1101 11, Totll Doduutlon. 12, Nit VIlul of TI. Rlturn 13, Chlrltlbll/GovlrnMlntll BlqUI.t. ISchldull J) 14, Nit Volul of Eltete Subjlct to h. 10,292,24 .00 III I (12) 1131 (14) In.''9~ '4 33,586,45 ,00 33,586.45 If an assls.mlnt wa. i..U.d pr.viou.ly, lin.. 14, 15 and/or 16, 17 and ~a will r.flaot figur.. that includB the total of aib r.turn. a......d to dat.. ASSESSMENT OF TAXI 15, AMount of L1nl 14 It SpcuIII "ltO 115' 16. AMount of Llnl 14 tl.lbll It Llnlll/CII" A rltl (161 17. AMount of L1nl 14 h..bll It Collltorll/Cle.. B roto 1171 18. PrincipII TI. OUI TAX CREDITS I PAYHENT OATE 06-08-94 NOTEI ,00 H'OO, 33,586.45 X .06. . 00 ~ . IS, (18) ,00 2,015,19 ,00 2,015,19 RECEIPT I NUHBER "'''151 I OISCOUNT (') INTEREST I.) 100.76 AHOUNT PAID 1,914,43 TOTAL TAX CREDIT ---- BALAN~E OF TAX DUE INTEREST TOTAL DUE 2,015.19 ,00 ,00 ,00 . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIDNAL INTEREST, I IF TOTAL DUE IS LESS THAN .1, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECT EO AS A "CREDIT" ICRI, YOU HAY tiE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. I RElERVATlDH' PURPOSE Ol' fIOlIC!. PAYHfHT I REFUND ICRlI OIJECTlONS. AONlN ISTRAlIVE CORRECTlONS. OISCOUHT' INTEREST' ., ,.' I', I :'.' ,. I.,., " I,',() Est.tu of dlc,don" dving on or bl'or. O,cllbtr 12, 1982 .... if tnv future lntlr..t In thl .,ht. II trll1lf1rr.d In po.....lan or enJoVI.nt to Ch.. . (cCtlht.rIU bln.flohr.,. of thl dlGld.nt tfter thl IICPlratlon of tnv IItst. for llf. or for y..r., the CORlOn~..lth h.r.by .lepr...ly r..lrVRI the rleht to .ppr,l.. end lant.. trln,f.r Inh,rltlncl TIM" et thl 1,w'ul el... a (ooll."r'll r.t. on inv .uch future Int.rl.t. To fulfill the requlr...nt. of Slotlon 21~O of the Inh.rlttno. and ~.t.t. TOM Aot, Aot 22 of 1991. 72 P,S. Station 2140. D.tlen the top portion of thll Hotlcl .r.d tub,1t with your plyl.nt to the Reghtlr of Willi prlnt'd on the r'Vflr.. Ilde. --Kllko ,ho,k " oon.. "dor povob10 to! REOISTER OF MILLS I AOENT All p,yalntt r.c.tYla .hlll flr.t bt ,ppl1.d to any lnt.r..t which "'1 b, dUf with tny r..alndt' applied to thl tlM. A r.fund of ft till or.dlt, which WII not "qullt,d on thl TalC R.turn, ..y b, r,qullt'd b!f coephUng tn "App1JcIUon for R,fund 0' P,nnlvlv.nlfl Inherltlnc, and flt_t. TIIC" (REY-1S13), Applloatlon. Irl av.l1llbl, It the (Iffte. of thl Right.., of WHII, 'MY of thl 23 Alv.nul Ohtrlct OffiCII, or by calling thl sPld,1 24-hour ,nlw.rlng ..rvlel nueb,r. for for.. order1nsll tn Plonlvlvant, 1-800-362-2050, outtldl Plnnlvlvanl, .nd wlthln,loclt Harrhburg .r.. (717) 787-8094, TOOl (117) 772-2252 Ollnlng lipalr,d Only), Any p.rt.,. In Jntlrllt not "thUld wJth thl IIp,.rai....nt, .11owllncl or dll.11ow.nol of deduotlon., or .......tnt of tllC (Inoludlng dl.count or int.r..t) a. .hown on thl. Notlc. .u.t objlct within .iKtv (60) dlY' of r,ollpt of thlt NoUc. b~' "writt.n protllt to thl PA D.p.rt..nt of R.v.nu., Board of Appuh, DEPT. 281021, tltrrhbvrg, PA 17128-1021, OR .-.I.otlon to havI the ..t'-r dlter.lnld It audit of the Icccunt of thl Ptrl'Jnlll rtprll.ntaUvI, OR "'PPlll to the Orphan I . Court. Flctull .rror. dltcov.rld on thll a.......nt should be addre"ld In writing to, PA D.part..nt of RIV'nu., BurllU of Indlvldull TUI., ATTNI Po.t A.......nt RIVllw Unit, DEPT. Z80(.01, Harrhburll, PA 11121.0601 Phon. (117) 187-6SC5. S.. P'O' 5 of thl bookl.t "Instruotlons for Inherltanc. TIK R.turn for I Resid.nt D.oedlnt" (REY-ISOI) for an IKpllnation of ad.Jnl.tratlv.ly corrletabll Irror.. If any tlk dUI i. paid within thr'l (S) cal.nd,r .onthl aftlr thl dlcldlnt1. dllth, a flvl Plro.nt (SX) dlloount of thl taM paid I, allewld. Int.r..t J, ohlrgld blglnnlng with firlt day ef d.l1nqulnoy, or nln. (9) .onth, and onl (1) day frol the date of d.eth, to the dati of pay"nt. Te'llll which beoa.. dlllnqul.lt b.fore J3nUary 1, 1982 blar In\fratt It the rete of ,he 16X) Plrc.nt ptr ann~ oalculatld at a dalh rat. of .OOOI6ft, All tl'llll which ble... d.lInqu.nt on and IIftlr January I, 1982 will b.nr Int.r..t at I ratl which will varv fro. callndar ylar to cal.ndar Vlar with that r.t. anncuncld bv the PA D'Pllrt..nt ef Rlv.nu.. Thl applicabl. Intlre.t ratl' fer 1982 through 1994 are, '!.!!! Int.r..t R.t. ~.llv Intlr..t Factor ~ Intlrllt Rat. OoU, Int'rllt Flotor 1912 20X ,000541 1916 lOX ,000274 1911 16X ,000438 1987 9X ,000247 1986 llX ,000101 1988-1991 llX ,000101 1911 UX ,OOOSS6 1992 9X .000247 1995'1994 IX .000192 -.Jntarut ia cllculltad al followII INTEREST . SA LANCE OF TAX UNPAID X NU"SER OF DAYS DELINqUENT X DAILY INTEREST FACTOR -.Any Nntiol h.uld aft.r thl t.M b.eo.1I dellnquant wUI rlfllet an Interllt Cllculatlon to flfilen CIS) dav. blvond the date of the ,"a..."nt. If PlYlant II lIad, ,ftar tha intarllt oOlputaUen date .hown on the NOtiOI, addltion'l lnt.rllt IUlt ba caloulatad. p(p I ()[I.:L ~.'},-j, r,j I /I.rd ft.5 1- STATlIS REPORT UNDER RULE 6.12 Name of Decedent I CLF.ATIS E. \,EITZE\, Date of Death I 03-\2-94 Will No. Admin. No. 21-94-433 Pursuant 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 estatel I. State whether administration of the estate is completel Yes X No 2. If the answer Is No, state when the personal repl'esentar.J.ve rSr1sonably believes that the administration will b~) completel _.____ 3. If the answer to No.1 Is Yes, state the followingl a. Did the personal representative file a final account with the Court? Yes No X b. The serarilte 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. C'opiefl of receipts, releases, joJ.nders and approvals of formal or informal accounts may be filed with the Cerk of the Orphans' Court and may be attached to this report. Datel 11lJ!/t'- co t'<{ ,.. 1f,I () ((1 l() D, " . " r:!" " ) IQ ., .' " ' , r:>:: " Pi! () .U {ti ,}.) c\:C1: IS:: UiE. G8 ]!.- '3 cL Signature I l ROGER B. IRWIN Name (Please type or print) 60 West Pomfret St., Carlisle, PA 17013 Address ( 717) 249-2353 Tel. No. Capacity I Personal Representative X Counsel for personal representative (MAH I rmf/AM3)