HomeMy WebLinkAbout94-00595
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Oath of Personal Representative
Commonweallh 01 Pennsylvania
Counly 01
The Pelllloner(s) above. named swear(s) or afflrm(s) that the statements In the loregolng Pellllon are true
and correct to Ihe best of the knowledge and belief of Pelllloner(s) and that, as personal representallve(s) 01
the Decedent, Pelllloner(s) \'/ill well and truly adynlster the estate acoordlnll,to law;-
Swam to or afllnned anti subscribed .~d ') ) I/.)~/r
before me this __!.H-.D..__day of
" I / ( ';
JULY .__19_~_ .1..'/1""1':1 .'"
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( ;t' ),/.llf
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For Ihe <1oglsler
, )( / '\ {; ( .;:
No 21-94-595
Estale 01 ..__..~li.'!'JLIl..R I. SPEll~E Deceased
Social Secllrlly No: 166-03-046 Dale 01 Death: 4-19-~4
AND NOW, __.i!.\L~i___. , 19-1i_. In conslderallon
01 the Pellllon on the reverse side heroon, sallsfaclory proal having been presenled before me,
fT IS DECREED that Lellers ~ Testamentary 0 01 Admlnlstrallon
db n e.L..: pef\dlnl._ll; dullJ1tlltiCtAl.: dUlIJl1. m1nott\1l1
are hereby granted to __..PATSY J. SHAFFER
In the above estate and Ihat the Instrurnenl(s) dated DECEMBER 7, 1973
described In the Pellllon be admllled to probale and flied of record as the last Will 01 Decedent.
FEES
Letters """.........."". $ 25.00
Short Certlllcate(s) 2,. $ 6.00
Renllnclallon ".."""" $ 5.00
'tYjafl:J C.. ~~~^ B" Rl~DV"'1-
R.glslSr'. Wills I
Aflldavlls ( ) ",,,..,,.,,. $__._
Extra Pages (1) ."""" $ 3.00
Codicil """"".....""", $
JCP Fea .""........".." $ 5.00
Inventory ............"".. $I__
other """"""..".."". $_____
TOTAL .""..""" $ 4 4 00
Atlorney:
1.0. No:
Add/e9ft:
Telephone:
Fo"",RW.\ PlOt 2 012
P'opaIod by Itot Penn,ylv.,,', OM ^,oodn1loo \991
~.~ -Uwj~, S-/S.rJ'I
\VAIININt;: II IS 11.1.11;(11 H) ALl 1:11 IIIW (:(11'1 1<11
ro ()lJI'I.ICATl' flV 1'11()IC.~d^l 011 I'IIOI(l(ill""IL
COII.MONWEM TlI or I'ENNSll.V^NI^
OEI'AH\MENT or f1E^lTlI VITAL ReCORDS
CERT. NO. 2121046
...' 4J?.:,.p../,t'.gd~!'Y.._
r"'~~IIHI"' I'T '!IIt~o'rllll(ftl"H1
NameofDecedent..___~~ty_._..,. ". .,E....... ._nn..._#".!4~________
SeK __....L.._.__soclal Security No..j~ tI~ D~L.n (,). yc)~._ .. Dato of Denth.....t:-(.,,~ fV
Dato of Blrth__._.,L.-_Z..:Lr'._. Blrthplaco. WA.:--4.IIA./cI. z-.~,r:' ..... ..--.-...-.---.-.-.---
Place of Death~/y ~#~f?PkC.C~!:~~.d-:4ri,~4~~Z;;r'-~-- t'J1D.MYJYMll!!.
Raco_~_€ft..~_..occuPtltlon _....n~.(;":,,(.,u'V AflTltlcl Forcos? (Yos or~)h_"'________
Marital statu~Ji'~.~~t.t~I~~;~~~(lr(Jss /'T4kJV,i/~~nn.~t.p/i(L--d.LZJJL/
~ ' II '''I!.'' 7'-'.11"'1 (,'II-':;'T'~'fII Sr~to
~~~~:~~ A'fu'f!f-J~~-ff:~;/' r.l1n::dr::4~tf/C;,nt..,.L"!~6-..a ----
Fllneral Establishment _.s.,.;!l11,T-?'u/:;.n..J.;l..i. ., ",' .~/<..ff. . .J)~~_~-::,':!.rJ -V LEd:.___
: Interval Belween
Part I: Immediate Causl'1 : Onset and Death
I
(a) -_C&..dhf2~~A~T &0<4.:1-1'. - .............,...,.-f-...-..-.--.-----
(b) __...L._L2.._~fJ.~~~. . ..nn-nn..n-h..._h_____f_._____.____
(cl__..__C..:'f2J)___.___.., .. . nh,' . h...... n......._.___.hh.._.J_..__.
,
,
(d) , I
___~_..~____~..___._...._____._.__.__._.._..._....__.__.___~o__.__.____I.._______
Part II: Other Significant Conditions #1..---
____....... ... ._~.Xd.,.. __..... ...__........__n._.........n_n
Manner of Death:
Nutllral i2l'
Acoldont 0
Sulcldo 0
Doscrlbo how Injllry occurred:
Homicide
Pending Investigation
Could not be Dotormlnod
o
o
o
'_ ..'.n....____. _.___...._...__.._____.0
Namo and Tltlo of Certifier --.. ...))A.,'J.ftmd.ll2~f~~L.... ..................._..._..___________
Addross__LcU..~d~~..__~~,.;~/di.,.... ....,......... ......_...,,(~.~.~:.~~~..~cor~:~~~~~E.)
This Is to cortlfy that tho information horo [jlvon Is Gorroclly cop lad from on original cortlflcate of
death duly flied with mo as LOCHI RO[jlstrar.
Vital Records Office for pormanent filing.
~ /~ /f8(r
. 411."I~".nl\l'~h;;-I-;i::~T,""j.ii;;li --
.., ... .... ".. .,' .~, ..~ .
I\HOISTER OF WILLS OF
COUNTY
OATH OF NON-SUBSCRIBING WITNESS
I --' //
(ench) II subscrlher hereto, (ellch) helllg duly qualified IIccordlngto law, depose(s) and saY(I)that. she
fllllllllllr with till' Sigilli lure or Esther I. soease
codicil
subscl'lhlnll Wlllll'SSl's 101 the 11'111 prcsclltcd hcrewlth IInd thlll_ she
codicil.
will Is III Ihl' hllllllwrltlllg of Esther I .~CUl3 the best of her
,Iestal~of(one of the
believes the signature on the
kllowledge and beller.
Swum 10 ur lIr1illlll.d :llId sob.
\\\:l\\
c-~~__
~
scribed hefure III" this.. ___dIlY or
1'1__
Fill' fl/(' /It'gl,IICI'
(Nome)
(Md'ell)
.l\IK1IS'I'EI\ 01' WILLS or
COUNTY
OATH OI? WITNESS TO WILL EXECUTED
BY MARK
., (olleh)
cod iell
a subscribing witlless 10 the will prescllled herewllh, (each) bcill8 dilly qualified IIccordl1l8 10 IIIW,
depose(s) and say(s) Ihllt: leslnt__was IInable to sign h_lIl1l11e therelo; Icslal._'s nal11e WIIS
subscribed therelolllleslal 's prcscllce; teslnt made h mark therUOII; leslllt nnd
deponent(s) WIIS (were) present when teslnt 's nlll11e was subscribed IIIllI whclI Icsllll.___
codicil
wns present when the underslglled signed Ihe will liS wltness(es),
made h_mnrk; II:HI tcstat
Sworn to or nHlrmcd nlld sub.
scribed before I11C this.____.dny of
(Nlllle)
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Name(s)', address (es) and telepho~e number(s) of' all couneel
Name
Address
Telephone
None
Additional information may be
Date
~,8.q(.1
obtained from t~) underSi9ne~}}1 ~
Signature.:&:~ ,1~1~
Name Patsy J 0 Shaffer
Address-ll WaYne Road
Camp Hill, Fa. 17011
Telephone (717) 761 - 5963
" ,
CapacitYI x
PersDnal Representative
Counsel for personal
representative
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COMMONWEAlTlt 0' PfUN$YlVANIA
O~PAR'Mf.NT Of REVENUE
OfPT ?HObO I
HARRI~BURO, PA 11 28,0001
DE iDf~iT'5 ,jAMf IIA5T~ 'I~S,,-ANO~M-Irwlf 'tlllIAiJ-------------------. - -. --- .-- -- --- - - ------. __n
~ iOCiA;ii~~ilf.ai~ii\:.-.L.\Jlj},fdi jiiAJ.'- -. "!O-,(Tf-O(S'IlUii' n.
~ ,-if.. &.ci3.flJ".('~:_u.u...'/~j').J'ilII . .'2.C11.'!'i./'I
c 1" "'\IC~lllllvl"W'tlO l'OUHS '11\4111.""'. 'IU' A'ID MI{l[Jlf HIII1411 ~OC!AI ~!CU~I'Y tHJM8E11
_...______.___. _..___.n_______.__._~_...._... ...._... _..___ .... ... . ,.. ...._. _. ___. m.._._ .._ .. .....
~ f;ll1. Orlolnol Relurn [I 2, Supplomonlol Relurn
......
lrlf" [I 4, Llmiled E.lole [ 140, Fuluro Inlere" Comp,omllO
'"''''9 I/o' dolOl of doolh ollor 12, 12.B21
ug:..
:;; [J 6, Oocedonl Olnd Tellole I I 7, Oocodent Moinlolnod 0 Living T,ull
IAUoch copy 0/ Willi (Au"ch copy oIT,UlII
..-----.---.--- ALl. CORRII'ONDINCI AND CONPIDENTiAL TAX INPORMATION SHOULD II! DIRICllD ,YO,
cJl&j mMf'?). (<, COMPtE f MA,HltlQ A,OO~7H
~i! .......:\oJ\o,{~r..~.'--..;J{ljy)CL /() 1[',/,:;",,1'0/)
81t '''''''O"''"M''' C" / ' / / I, I 7 " I I
....-......_~:1~~~~;~:~;I~c:;1:~"~I(L(~.~ ,.. , III ,.,~o~c;,,(~(~.~.~~L.7:.C. .~~,'.~~~".~.1~
2. Slockl ond Bondll~chedulo BI 121 I' c.... .,.. :.~
3, Clolely Held SlockIPo,'nDflhlp InlOloll iSchodulo q 131 1:.. . ~ (,: :',
4, Mo'lgogOl ond Nolel Rocolvablo ISch.dulo 01 14 I ' ,. . ,., . ..... \ ~ ~.:.'"
~. C",h, Bonk Oepo.I" & Mllcell"nooUl Pe'lOnol P,oporly I ~ I _~~.~'.cJ(LP.l). (\ ,,:" .' '
ISch.dule EI f' ') -0 ".:.',
6, Jolnlly Owner! Proporly ISchodulo FI 161 . .. ........_.. ......,...._................ 0 -' vi 9-
~(':. ;.:.
7, T'''nllorI(Schedul. GI (Schodule LJ (71 ........-.-....., .................... :P ~ ~.- cJ
B, Tolol G'OIl Allo" 110101 line. 1.71 I B) ._...~,'~.~~.!.!...!.~_
9. Funeral Expente', Admlnlstralivo COlh, Mllcollanuoul 19J ..._____.._________~_~.____~.~..
E'penlOl ISchodule HI
10, Deb", Mo"goge llobllllle., 1I0nl IS,hodulo II
II. TOlol Oeducllonl 110101 Line. 9 & 101
12. Nel Volue 01 Ellole (Line B mlnUl lIno III
13, Chorlloblo ond Govornmenlol BoquOl" (Schodul. JI
14, No! Volue.Sublecllo To, 11Ino 12 mlnU\.Llno.J~.__.._____.
15, SpoulUlT,onlloll 110, dole. 01 deolh oltor 6.30,941
See In II ructions lor Applicable Percentoge on Revert!
Side, Ilndude voluel !rom Schodule K 0' Schodule M.I
16. AmQunt of line 14 taKable al 6% roto
Ilnclud. voluOl fro,,, Schedule K or Schodulo M,I
17. Amounl of line 14 taKable 01 15% rale
(Include volue, from Schedulo K 0' Schedulo M,I
Ie, Principal 10' duelAdd 10K from LlnOl 15, 16 ond 17,1
19. Crodi" Spoulal Poverty Crudit Prior Paymonll
.1
h) /j
REV.llOO EX. ['.9'1
~. ,..
d...._ .
fj:n V
pI;
Ie;. J"2-I'/1
INHERITANCE TAX RETURN
, RESIDENT DECEDENT
(TO BE FILIlD IN DUPLICATE
WITH REGISTER OF WILLS)
NUMBER
. -
f..:..::::'
~.
h~: :~
,".
'OR PATIS O' PlATH AnlR 12/31/01 CHICK HIRI
" A 9POUSAL ..
P.OVIRTY CUPI! ISCLAI.I~.I.I!..I)............__
riLl NUMIIR
,..; / {/ 'I - (, !; ,/ I
COUNTY COOE YEAH
. -- fl[CllJ'E~i,'~ cOMPIEr[ AO-ORES-$ . '':';';';''' ..m
/(1 1(1.,.'/.". /".<
nr ,"(lV H, // /"/ 1'1" II
. CO"",( ^"o,~:i~li~~h'f;iit(~ciN~'- -.-.----.--
113.
[J 5,
RemaInder Return
(/0' dol.. "I d.olh prlo, 10 12.13.821
Fedoral estate Tall; Relurn Required
_ B. Tolol Numbe, 0' Safe Oepolll Bo,e,
z
'"
5
E
~
a:
1101........,._........_..._.._..___..
;;> /0 <.'</
{III ..-...:>4-.......-:.1.::----
1121 .=_:J (. L.9i/ .__
113) .____.
114) - 3k {! 9(/ _
o 0
(151 .....m_.........._................_...~, .._.~ _..---'
(.)
1161 ",.,..........
,..._. ~ ,06 ~
o
1171....,..,_'.."n.n_....'_......_....~ .15 =
/')
.__._~---_._--_..
z
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E
~
.
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u
S
IIBI .,.,........._......_..._.._____.
Ollcounl
Inlerell
+
+. ..._n____...
1191__.__..._.__
1201 ...______._____
20, If line 191. g,eole, Ihon line lB, onle' Ihn dlllerence on Line 20, Thl. I"he OVERPAYMINT,
fall
C1tc(~ hell! If -you (lie feCluc\hng (l lofunc:.J of yDur oVl"fHlynwnt
21. If Line 1B II oreole, Ihon line 19, onlor Iho dllleronco on lIno 21. Thll Illho TAX DUE. 1211 ..........n......._.__.___m......__.
A. Enler Ih" Inlerell on the balance due on line 21A. 121Al ____.nn __._...____~__..__._~~~_
B. Enl" Ihe 10101 0/ line 21 ond 21A on Line 21B, Thll II Iho BALANCE DUE. 121BI ........................_.._._...._.
...._~oh_~..~..~ Po.~bl. to0!!.@I~.!..~!'!..~.JI.I!!~.!'.'!_.___....._.._. .. .
..._m_ .-): ~ II SURE TO.ANSWER ALL QUESTIONS ON REVERSe SIDE AND TO RECHECK t,\ATH -c -c . - , .
Under penaltlel of perlury, I declare thai I have eKamlOlld Ihll roturn, Including occompanylng tchedulftl and Italementl, and 10 the bell of my Mnowledoe and bellefj
II II true, corrflcl Clnd complete. I declare Ihat all real filiate hOl been roported 01 truo market valuo. oedarallon of proparer other than Ihe personal reprellntaHve Is
bOled on alllnformallon of which preporer hell nny knowledge.
~TO~iMuifDt;ETIONif~POtjSii(ff(J~fiii~(n-if"~i'--~"- "-Ao-fi~gr-' _______.____:_u___. "'1'."-' .---.-... ..-. --------.;-.-"7 - -----.------~
i,-5i;~,' R;~t~61~~r,iAN~iZ.. ,j: .lD'.~~/pLi(./L/L!l_)Li?.. [\:./~!~.;L__..___
" t J
i/
om----------
) .., J -.
_...::...=,l....-.!.l..,___
OAlf
...a." SCHEDULE H
~ FUNERAL EXPENSES,
CQMMONWEAlIti 01 PENNSYlVANIA ADMINISTRATIVE COSTS AND
_ IN~:::b~~1Eo'tciE~:~!iN um M.~SCELLA~~I:)U_SdE~PENSES. _ Plla.1 Prlnl or T_~e.!
::~:_~ "- . .-,~-~.L.~.l-~~-r_CiL~:!:... __.nu__u..___.=r:(,~;I:/- (! S' ' ,~u.
ITEM
NUMBER DESCRIPTION
.--- -------------..-.-.----------
A.
'llV.UII 1_. 1'"1
AMOUNT
1.
Funllal hplnsll'
(Ro., {I IrJ C. l.. '~/VI I' .Il F(( (1';'((' J 11(1,,/ 'f'
f- J b 1\) C>f.\. L. s 'h~ f J... ....s.,.,\'~ I=- /"",. e.o''!....:?
).L
:~ If Ie,.
Iff-'.
() (i
B. Admlnl.lratlvl CO.hl
4.
C.
1.
2,
3,
4,
5,
6.
7.
8,
1.
Personol Representative Commissions
Social Security Number of Personal Representative,
Yeor Cammlulons paid _________
C)
2,
Allarney Fees
c.;
3,
Family Exemption
Clalr,)ont ,_.__.
Address of Claimant 01 decedent.s death
Street Addreu _
City _______
Stole ___ Zip Code
Rolatlonshlp . '
tf:t#~
Proboto Fees
I::" C' J .\ (' ,.I (I, , ,I" <
C 'I r r C\ ..1 \,. ,.. t._ (' f I, -t' I C. 'I t p.\
Mlsclllanlau. Expln.lu
'\\ll'.~ , \ (1\- tV \",0 ~'.
'-1'1 .' (I
~.OU
, II
(I I ,PI) /. (!A, \'" ,1.,
i. L'" (}(\' -"
J.:J.. () ,)
</~;i.., "I CJ
..~ 9 ?</
I') c)).,
I ()-y, .) ()
c'(l r 7. ~~(I<I
~'_<I.. C](/
~\>,.A'\f'Lj'~ .S"I/IO('" r;:('(V '<.~ '~'<'\'(I' r 1.(1ly ;" (< ~ftrf:\1 ,V.lln'
( '. . J I\. I,) I ({ e,l l. {./ .s (~/I c:./( ( r
'j) , '\ ~I v r T-:" y q 1/': ,\ (',. 0.1 ~c:... ('0',>'1" r~, J' Il.,.j : (i.1 (I,l r;.,J
U01~ /' (, /) ~ r=!.c<)("'J- 'I
1.':::' -.. ..., "ll\~' -:'0 l'(1 r ,:~s 'J;.'(.3 ,,1<' .lJ.1 S'S' I'-~I'I J3,c."..'-
---------~---_._-------_._...
TOTAL (Also enler on line 9, Recapitulation) S 3Y((' (J () (!
(II mOil .pacI Is n..dld. In.1I1 additional .h.... 01 .aml Sill.)
REV-1543 EX AFP 11-911.
COHHONWE'Al Ttl OF PEHltoloVLVAHIA
DEPARTHENT Of REVENUE
BUREAU Of INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128'0601
INFORMATION NOTICE
AND
TAXPAVER RESPONSE
FILE
ACN
DATE
-9 ~-
NO. 21 - (N- S
94127888
06-29-94
ESTATE OF SPEASE
5,5, NO. 166-03-0406
DATE OF DEATH 04-19-94
COUNTY CUMBERLAND
TVPE Of ACCOUNT
L ~' SAVINGS
CHECKING
TRUST
CERTIFICATE
REHIT PAYHENT AND fOHHS TO.
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
ESTHER
SHAFFER
19 WAVNE RD
CAMP HILL
PATSY J
PA 17011
HSHBERS 1ST FEDERAL CU hili prol,lldtd thl nlp"h",.,t with thl lnforlUltlon Il'hd below which hu bl.n u..d In caJcuhtlng thl
potlntlll taM dUI, Thllr rlcordl Innlcat. that at thl dl.th of thl abovI dlcedlnt, ~ou w.r. II joint own.r/btn.~lol.rY af thl, account.
If you f..l thh Infor..tlon II Incorrllot, ph... obtain written carrlctlon frolt thl IIn.molnl Io.tltutlon, IIttach II oopy to thh for.
:;:"l:~ "',".lrr. :t tn t:..... AI.:;\{,. ^J"".l1~ '!'hl~ ~.~.'.':-,' \:- t,~,'h\' Ii- ","'I,' ~;. ~'lth V. '. 'n'lh-."~ T.... ! ~ or ~l t"~ t"~"'''''I.'.',~ ~1. n., ..'\,;:R,I,.:.
QU'lticn, ~'Y b. anlw.rld by cIlllng (1171 181.8121,
COMPLETE PART 1 BELOW M M M SEE REVERSE SIDE FOR FILING AND PAVMENT INSTRUCTIONS
Aooount No, 6979-11 D.h ]2-01-87
E. hbll,h.d
Aooount a.1ono. 451. 63
P.ro.nt To..bl. X 50 , 0 0 0
A.ount Subj.ot to To. 225,82
To. R.h X , 15
Pohntlol To. AU. 33,87 3.1. IS'
~~ TAXPAVER RESPONSE
COI FAZLURI TO RBSPOND WXLL RESULT IN AN OPPZCIAL TAX A&SBSSNBNT BASID ON THIS NOTZel I
A.
To Inlurl prop.r orldtt to your account, two
(1) copl.. of thh not lei ~u,t acco.pany your
pl'ly..nt to the Reghter of Willi, Makl chick
paYl'lbtl tOI "R.gI,t.r of WI11~, Aglnt".
NOTE I If tax paY'lntl are IIdl wltnln thrll
(1) ~onth' of ths d.oedlnt', dati of dlathl
YOU uy dlduot a 5% dhcount of thl taM dUI,
Any Inh.rltance hM dUI wHI blco~' delinquent
nlnt (9) llonthl aftlr thl date of dClath,
[CHECK ]
ONE
BLOCK
ONLY
fk] Thl I'Ibtll,f. Inf!lrlutlon lInd tIlll dUI II corrlct.
~ 1. You lIay chooll to rllllt paY"lnt to thl Rlgl'ter of Wllh, with two coplu of thh I\otlc~ to obtaJn
H dhcount or al,fold Int.rut, or YOU Uy chick bOM "A" l'Ind rlturn thh not lei to thl Roglatllr of
Willi "nd an official lIt.uulnt w111 bl Itllled by thl PA DIPlrt~lnt of RlvlnuQ, .
n. 0 Thl l'lboVI Utlt hll tllln or will bl reported and tal( paid lllth the P"nnlvll,fonla Inh.rltancl TIIM r.turn
to bl fll.d by thl dlcldont'. rIPrl.tntatll,ft,
C. 0 Tht above In'or~atlon 10 Incorrlot and/or dtbts and dtduotlonl wert paid by YOU,
You IUlt cOlptet. PART ~ and/or PART ~ bilow,
If you Indlo.t. . dlff.r.nt t.. r.t., pl.... .t.t. yuur
r.l.tlon.hlp to d.o.d.nt,
pt:FiCIAL .USE ONL~ 0 AAF:
PA DEPARTMENT OF'REVENUE .
PART
~
TAX fill I UflH . UOH~U'I A r ~UN O~
LINE I. D.t. E.hblhh.d I
2, Account Babno. 2
3. P.rolnt T...bl. 3 X
4, A.ount Subj.ot to T.. 4
S, D.bt. .nd D.duotlon. S
6, A.ount To..b1o 6
7, T.. R.t. 7 X
8. T.. DUI 8
lAX U~ JU1Nf/lKUSI A~UOU~IS
f'AIl
1
2
3
4
5
6
7
8
DEBTS ANQ DEDUCTIONS CLAIMED
-
-
-
-
.
PART
~
DATE
PAID
PAVEE
DESCRIPTION
AMOUNT PAID
.
TOTAL I Enhr on L1n. S of T.. COMput.tlon I
I
t
-
Und.r pln.ltl.. of p.rjury, I d.ol.r. thot tho f.ot. I
oo.pl.t. to tho b..t of MY knowl.dg. .nd blll.f.
haya rlport.d Ibov.
HOME
WORK (
TELEPHONE
Ira truI, oorr.at and
REV-1!43 EX AFP (10911_
' CU""~WWEAL lH Of PEWWSYl VAWI! ,
OEPAR1HEWl Of REVENUE
lunEAU Of IWOIVIOUAl IA~ES
DfPl, Zl0601
HARRISIURO, PA 17111-0601
J'/'. /)<"), I - I (
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
v..s~'l..j -
NO. 21. q
94127870
06-29-94
ESTATE OF SPEASE
5,5, NO, 166-03-0406
DATE OF DEATH 04-19-94
COUNTY CUMBERlAND
TYPE OF ACCOUNT
L ~ SAVINGS
CHECKING
TRUST
CERTIFICATE
REHtT PAVHENT AND FORHS TO'
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
ESTHER
SHAFFER
19 WAYNE RD
CAMP HILL
PATSY J
PA 17011
HEHBERS 1ST FEDERAL CU hu provld.d th, Depertll8nt with thl Infor'IUon Iht.d bllow which hat bun ulld tn calculating thl
pot,nUII till clu.. Thlt, r.cora. Indicate that at thl duth of thl ubov. dIC:ld.nt, you WIf. a Joint own,r/b.nDflohlry of thl. Iccount.
If you ,..1 thi. lnfortatlon I, lncorr.ot, plea.. obtain wrltt.n corr.ctlon frol thl 'Inan~111 Inltltutlon, attaoh a topV to thl, for.
:.i~:! rllturr. It t.. tt,:l I'ltU\'J/\ .,d-l',:,:: lh1a r~~.'.:'. ~. ~',,'~h'.~ h M~,ar1'..v;r. tdtt': tt':" r....u~t"~~: 'T:,' !.r,:'~ "I H'._ ('"....~..~I:..1.k ~~ n~..,:1"t"!;'
QUI.tIQn. I.Y bl an'Wfftd by cftlllng (717) 78748527,
COHPLETE P^RT 1 BELOW M M M SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Aooount No, 6979-00 D.~. 12-01-87
E.hblhh.d
To Incur I proper crldlt to your a"count, two
(2) caple. of thl. notlcl IU.t aceolpany your
paY.lnt to thl Reghhr of 1011111. HlIk. ch.ck
payobll tOI "Righter of Will., AlIlnt".
Aooount B.hno. 476 , 65
P.ro.nt r...bh K 50.000
A.ount Subj..t to r.. 238.33
T.. Rite K . 15
Potentlol T.. Du. 35.75 Iv "'~
~n ' TAXPAYER RESPONSE
COI PAILURI TO RlsPOND WILL RESULT IN AN OFFICIAL TAX ASSESSHENT IASID ON THIS NOTICI
.,
HOTEl If ta~ paYllnt. erl .ede within thrl.
(Sl lonthl of thl dlcldlnt', dati of dQeth,
you lay dlduct a ~% dllcount of thl taM dUI.
Any Inheritancl taM due will blco.e dlllnquent
nine (9) lonthl aftlr tht dati of dtath.
[CHECK ]
ONE
BlOCK
ONLY
[] Thl abaye Infarletlon and taM dut II carrlot.
1. You lay chao. I to r..lt pay..nt to th. R.gl.tlr of Will', with two oapll' of this natlol to obtain
a dlsoaunt or avoid Inter..t, or you IUly chick baM "A" IInd return thlJ notlcl to thl RIlfhtlr of
1011111 and en offlolal 1I....lIont will bl IUllld by the PA Olplrtllnt of RIYlnUI,
B. 0 Thl abov. uu.t hel bltn or will bl rlportld IInd t.1M paid with thl rlnn.vlvanla Inhlritancl TaM r.turn
to bl fllld by the dlcldent'. rlPrlllntllttvl.
C. ~IThl aboVI Infarlatlcn i~ncorrlct and/or dlbt. and dlductlont Wlrl put~ by you.
l.fl You IU.t oOlplltt PART ~ and/or PART [!] below.
If you indio.t. . diff.r.nt t.. r.t., pl.... .t.t. your
rll.tion.hip to dloldlnt,
QFFICIAL USE ONLY 0 AAF
PA DEPARTHE~T OF REVENUE
PART
I!l
rAX RI!TUNN . UUI11'UTAflt.lN 01'
LINE 1, D.t. E.t.bli.h.d 1
2. Aooount B.l.no. 2
3, P.ro.nt T.~.bl. 3 M
4. A.ount Subjlot to T.. 4
5. Dlbt. .nd Dlduotion. 5
6. A.ount T...bl1 6
7, T.. Rltl 7 X
a, T.~ Du. 8
lAX UN JCI:LN', /1 KUli' 1\!;!;ulJli f~
':.L- (, I o\l, '7
J/ ')1.- I.'.~
:;'-0. ,'0 (,
t, 01 8:. 3;$
J : J J .~!).. j-'
I " LI S"
, I:"J /
/ '7, (" ",&<1<" s% l(,lIK
PAil
1
2
3
4
5
6
1
8
DEBTS AND DEDUCTIONS CLAIMED
--
-
-
-
-
-
PART
[!]
DATE PAID
PAYEE
OESCRI PTION
AMOUNT PAID
) 0
f.-( .(i ,--,
~ ....1(1 /iI \, (' I 1-
L .
,(
TOTAL IEnt.r on Lin. 5 of T.. Co.putltion) .
Undlr pln.ltll. of plrjury, I dlol.rl th.t tho f.ot. I
~tl to thl bl.t of .y kn;wl.dg~ .nd b.ll.f,
TAXPAf~~NArJ~ ---j~/(/r ,
hive rlPort.d abovI ar. tru., oorroot
HOME _( II} ) 7G' / .Y'?t.,l'
WORK ( .~) ) ~ C' { ~ (I'll (I
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IREV01!47 EX AFP (12094)*
COMHCNWEAlTH Of PEHN~YlVAHIA
OI:PARlllfNT OF RlVENtJ(
ButllAU OF INDIVIDUAL TAKES
DEP!. lIOAGI
HAAAlllUAO, PA 17Il'~0601
!BTATE OF SP~U~ --m - -= FILE NO.
DATE OF DEATH 04-19-94 COUNTY CUMBERLAND
NOTE I TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBHIT THE UPPER PORTION OF THIS FORH WITH YOUR TAK
PAYHENT TO THE REGISTER OF WILLS, HAKE CHECK PAYABLE TO "REGISTER OF WILLS, AGENT"
REMIT PAYMENT TOI
,(-j t (. .;,'
/' I
I'
JO'.L-
...--
NOTICE OF INHERITANCE TAK
APPRAISEHENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSHENT OF TAK
ACN
101
DATE 03-20-95
PATSY J SHAFFER
19 WAYNE RD
CAMP HILL PA 17011
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 11013
I
A~ount Ro~lttod
--;--
CUT ALONG THIS LINE ... RETAIN LOWER PORTION FOR YOUR RECORDS ..
R i Ii: iil47 0 iiC -Ai: ii 0 r i'F 94"j" NOi" i or "oF - "iNHiii if ANc iOYAl(" A P ji R;i is iifENr;"A L l"owAiic i -iiri 0 0"".. - -." 0 0 o. 0""
DISALLOWANCE OF DEDUCTIONR AND ASSESSMENT OF TAX
ESTATE OF SPEASE ESTHER I FILE NO. 21 94-0595 ACN 101 DATE 03-20-95
TAK RETURN WAS, I X) ACCEPTED AS FnED
I CHANGED
RESERVATION CONCERNING FUTURE INTEREST . S~E REVERSE
APPRAISED VALUE OF RETURN BASED ONI ORIGINAL
1. Rool E.teto 1 Sohodulo A) 11 I
2, Stook. ond Bond. ISohodulo BI 12)
S. Clo.oly Hold Stock/P.rtnor.hlp Int.r..t ISohodul. C) IS)
4. Hortaoao./Noto. Rooolvoblo ISohodulo 01 141
6. Cuh/B.nk Oopool h/Hhc. Po..onol Proporty ISch.dlllo E I (6)
6. Jointly Ownod Proporly ISoh.dulo F) (6)
7. Tron.for. ISchodulo GJ 171
B, Totol A..ot.
or .
L, \.'i
:., .00 l.'fl
,00
,00 ;;j
.00 -'
..J
3.500,00
.00 ....
, \:1
~-,..OO ..
" '1 ' ,I
. (8)ln
:lJ
71<]'
'II,'
. ,
('!
~;500.00
APPROVED DEDUCTIONS AND EXEMPTIONS I
9. Funorol E.p.n.../Ad~. Co.t.IHI.c, F..p.n.o. ISchodule HI 191
10, Dobh/Hodaoa' Lloblll t1o.ILlon. 1 Schodulo I) (10)
11. Totol Doduotlon.
12, Not Voluo of T.. Roturn
IS. Chorltoblo/Dovorn~ontol B.quo.t. ISoh.dulo JI
14. Not Voluo of E.toto Sub!.ot to To.
3,B60.94
.00
Ill)
112J
I1S1
(14)
3.Atln.94
360.94-
,00
360,94-
will
If In I.....nllnt WI" illu.d preViouslY, line. 14, 15 and/or 16, 17 Ind 18
r.flect figure. thlt include the total of 61b return. as.s..ed to dlte.
ASSESSMENT OF TAXI
16. A~ount of Llno 14 ot Spou..1 rot.
16. A~ount of Llno 14 to..blo ot Llnool/Clo.. A r.to
17. A~ount of Lln. 14 to.oblo .t Collot.r.l/Cl... B roto
lB. Prlnoip.1 TI. Duo
NOTE I
(15)
1161_
1171
,00
.00
,00
K .00,_
K ,06.
K .15.
I1BI
.00
.00
,00
.00
TAX CREDITS I
PAYHENT
DATE
RECEIPT
NUHBE R
DISCOUNT 1"
INTEREST I-I
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 IHTEREST.
IF TOTAL DUE IS LESS THAN .1, NO PAYHENT IS REQUIRED,
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRI, YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.)
.
STATU$_REPORT UNDER RULE 6.12
Name of Decedent I t.. ~L}I E: R T 8 f {',Q .s '€.
Date of Deathl ~I- 10,- 10 Cf '-I
Will No._ J...I Of ' I 0 oS 't,\-- Admin. No.
Pursuant to Rille 6.12 of the Supreme Court Orphans'
Cour.t Rules, I report the following with respect to completion of
the administration of the above-captioned estate I
1.
State ~ether administration of the estate ie complete I
Yes V No
2. If the an&wer is No, stat~ when th& personal
representative reasonably believes that the adminiatration will be
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,' Ye& t/ 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 inform~l accounts may be filed with the
Cerk of the Orphans' Court and may be j7ttached to this report.
Datel ~;J-q1 e-;;~, (J j/ / ~
sign-a~~? ~/-<-v.
N
~ :;;{ fl'~"( ~r ~kCj f-fer
.r Name ~type or print)
Iq WCl1jf I'J~ ~4. (I. . 11.1/ ~o" /7u/1
Address 1/ ~
(71'1) ) ~ / - $.-7' ~-3
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Capacity:
........-.Personal Representat.! ve
_____Counsel for personal
representative
(MAH I rmf! AM3)