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HomeMy WebLinkAbout94-00708 t-E;-- PETITION .'OR PROBATE and GRANT 0.' LETTERS ;21--!l!L -'lOl' IIEM'IIER ,J. ADAMS No, To: &Iale of a/so known lIS ______.._._..._.___ Register of W~tlJBrE'lltAND _ 'r.c' . -" Decea.red. County of ' In the Soda/ Se('urlty N6.I:: - u rr - ~!~-'--.___ Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petltloner(s), who Islnrc IH years of age or older an the eKecut or In the lust will of the above decedcnt, dated _.__ June 29 aud codlcll(s) dated _._____.__________ ~~med , 19_ I ------------.. (UIIIC relcvunl c1rCllnuIIUlCC1, e,g. rcnundllllon, dealh or c~cclllurl etc,) Philadelphia Decendent was domiciled at death In -- R-- County h .e r_. :, Ji/St {llgW~~y~h~~alcf~sl~a'iaI~t IIi 11, 1'/\, (1 ~~~._._____--E (11'1 ,lrecl, Ilumber alld OIl11u.:lpalll)'1 . Decendert then _ 26 ycars of age, died ,July 16 ,19.94 at 73 7 lIa~rook/\Venue, Philac!el.phia, pfi , EKcept as follows, decedent did not marry, was not divorced and did not have a child born or adopted afler eKecutlon of the will offered for probate; was not the victim of n killing and was never adjudlcatcd Incompetent: __ Decendent at death owned properlY with estimated values as follows: (If domiciled In Pa,) All personal property $ 1;'0 I 000.00 (If not domiciled In Pa,) Persunal properlY In Pennsylvania $ (If not domiciled In Pa,) Pcrsonal properlY In County $. Value of real estate In Pennsylvania $ situated as follows: __. WHEREFORE, petltloner(s) respectfully request(s) the probate ~f t~ last 'rM ~l1d codlell(s) presented herewith and the 8TUnt of letters . .es a nen ry (tesI8menlary; 8dmlnl"'8110n C.1.8'; a<lmlnl"'81100 d,~,n,c,I.8,) theron. I~ iJ r glC'AI~y " ck W. W n era !US- PpnnAyr -Road cam~ lIill, PA 17011 f( 117-731.3~,,/ W) 7,;> - 7(../. :N:lL. OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH 01<' PENNSnVANIA }' 88 COUNTY 01<' CUMBERLAND _ /4 - dcYi - :; The petltloner(s) above-named swear(s) or afflrm(s) that the statements In the foregoing petition are true and correct to the heSl of the knowledge and belief of petltlnner(s) and that as personal represen. tatlve(s) of the nbovc decedent petltloner(s) will well and tru9' administer the estate accordln8 to law. Sworn to or afflrme9 fnd SllbscrlbCd4 J" (/.'~tJ I-v.t..t;/ III before me this 2 day of ,,:.- <S' UGUST i,f~~ ~' - I; 4Q-flL~ULL14 .- . LEWIS HeR/slcr '- ! , " "1 ", I " ., ,21 ~'94 . '708 " I. " ,. I ,,' .\, " I.;' , ' ,. 1\1" ,\ 1 'I I '/I, '" i ; \ I I 'I ' , ' ' , J " ' ; , ; ~ ,q ) \ 1\ '; I \ : \l ,I \0' jl';-' ,-iii' i 1\ i'j' I') II" j; ,,",/",_.; \1" 1.: ' :\'1/ "I ,"!!: . , ,_ _ i' I, . 'I 1,- .,1 I', I;! ,IlL", . I, \. i \ ,; 'I ' i ' I ~ '1;, I , ; I \ 1" ; " ' , . ' I J I ' I ' I ,. 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'i ;',' ;! ;i " : i} \ ~,>; ,! " " '1, t!: " . , " " \,,' I ,. " ,'; I'P ;, ,d,' , -,'1 111'I;ii I, ' i \ 1"', ~ , " " ,. i\' :'1 , " " 1'1 ,I j,: 1 ~ " "I, ;.';) ::p li.- ::!" , " , " :1\'1" ."i'\ 1 'I' L'1 " . "'; 1;1 ,. ,I ." , Ii" ". ,I> " " " ,I " 't, , , , " , , " ',(,I':, :, 'II,'! I, 'Ii' .' ., 'Ie "i . , ,. " ,I, , " " . i (j , "" ." ." ," , " )' LAST WILL AND TISTAMBNT or HIATHIR J. ADAMS I, HIATHIR J. ADAMS of Camp Hill, Cumberland County, Pennsylvania, declare this to be my Last Will and Testament, hereby revoking any will previously made by me. I - I direct the payment of all my just debts and funeral expenses out of my estate as soon as may be practical after my death. II - I bequeath certain items of my tangible personal property, not including cash and securities, in accordance with a written list made by me during my lifetime. In the absence of such a list or designation on said list, I bequeath my tangible personal property to my mother, Merrily J. Cole. III - I devise and bequeath all the rest, residue and remainder of my estate of whatever nature and wherever situate, SAlOIS, GUIDO including the balance in my annuity fund (unless otherwise " MASLAND 2109 Market SUeel designated subsequent to the date of this will) as follows: C8mp Hili, PA A. 60% of said residue shall be paid to my brother, David K. Adams, or if he is deceased, to his issue per stirpes. 1/1/ Page 1 . . Additio~al information maybe obtained from the undersiqned., Datel August 23, 1994 John E. slrke POBOX 737 CAMP HILL, PA 17001-0737 Phone I 717/737-3405 ' , Connsel for personal representative " , "., '1, , , .' .' , . . " "1 " " . .,,, . I"" ,I' . . .. j,', . I :/i,: ,. I' " " ," " "I ". I I " .. " " I .' . I, I .. SAIDIS, GUIDO, '. .' " " SHUFF '" .. I, '" I, " MASLAND " .. ~109 Mllkel SlIcel I ClI11p Hili. PA I' I. iI .' ". " I. H; I' ,,' i, ", . " , ,I Additional information may beobtain~d from, the undersigned. , I' i I' I I' \, \; ,: i 1 Datel August 23, 1994 John E. slike POBOX 737 CAMP HILL, PA 17001-0731 phone I 717/737-3405 Counsel for personal representative I, ,I " " I' I, I I, il 'f' ,,' " " ,'I "." ,I' " , ," " I, " , I" I, 1\, ," " I' .,. SAlOIS, GUIDO, SHUFF '" MASLAND ~109 Markel SlIeel Camp HIli, PA 'I " "(.' , , , , I, " " ,. " 'I 'I . , ' , HO~ICE OF BENEFIQIAL IN~ERES~ IN ES~A~E BEFORE THE REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA: IN REI Estate of Heather J. Adams, deceased, No. 1994 - 00708 TOI Mr. Michael Flannery 7317 Hasbrook Avenue Philadelphia, PA 19111 Please take notice of the death of the decedent and the grant of letters to the personal representative named below. You have a benefioial interest in the estate as follows: 40% of the residue of the estata. Name of decedent: Heather J. Adams Last known address: 515 Penn Ayr Road, Camp Hill, PA July 16, 1994 Philadelphia, PA Date of death: Place of death: SAlOIS, Gumo, SHUFF '" MASLAND ~109 Markel Slreel Camp Hili, Pit County of grant of original letters: CUmberland Decedent died to state and a copy of the will is attached. Name, address and telephone number of the personal representative appointed: Jack W. Winters 5l.5 Penn Ayr Road Camp Hill, PA 17011 717/761-2222 " Name, address and telephone number of all oounsell ' John E. Slike, Esquire, Saidis, Guido, Shuff & Masland POBOX 737 CAMP HILL, PA 17001-0737 Telephone number: 717-737-3405 I" "~I , " " "i ,,' ,'~\ ' " "I I I' . " i" " , , , :.J' .., "". ..'I j.d' "j. " , I' I, ,. , 'H, 1,,/ /, I , I I I I I. 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" IT 4riT'T.~ "~.', -~....~..".-,,,..,,,,,....... .... " :-~"', " , , ! "I ( 1 I I I I 1 " I i :.'1 " ' "i 'I I , "1 I ..1 ,I ,r. I' .\ 'I "I "1"" w.. " \ ... C 2 o t; ~ - u. 'l5 \D ~r) elf. rn~ .- ,1( . (J I ''I'" ~ ", . ~ ...,. t~ ...: C) '(~i ~ . ,1., \\1 11 ill' ftl L to. 'p1/. ,\ O'i\i 1 C t,') ~Ql '.. ;:' rr: ~ 1~~ . _,"'f . ,...,...........,.,... 0, .~ .. " I \ i , " I' . " \ I ! . 'Ii I I I. <fit " I / , . .... " I ~ \ ti' I ~ I ., ,. \} , ,- . ~ ~ Ill~ ", Ill~~ ' ,.i- I u~.... I ~ ~ '... , .... ~ III I .... 'a " : !pi~ o 0 ..J , J . u ~ lJl >..:l . . .... .... >. ,> ~~~i~ :;1 g ~ 1Il ., ~ 0 5 .... U III " G ~ l>o l>o t; o",P-< U " 1 , ' ' ~ l:l . lii ~M ~ Ill~~ .... ~ lJl a: ~ ~ ~ lU .,-4 ii: '01)1.-1 III ~ / ! ~uu ,. j .. ~ CI)~~p.t~~~~i'~~lJ~WI1~A~I^ IIMRISRSA~,il2\IIIH'" ) q. ,? .:l, CJ ' .') INHERITANCE TAX RETURN RESIDENT DECEDENT (TO BE FILED IN DUPLICATE WITH REGISTER OF WILLS nlV. '5r,('~, 'PHIl) I cL ~1l6 c fit C K K S IH CEO[m'~ NAME (lA9T, FIR9T, AND MIDDLE INITIAL) AIWIS, IIEATHER J. FOR DATESOF DEATH An~R 12/10' CtlECK HERE IF ASPOUSAl POVERTY CREDIT IS CLAIMED FILE NUMBER 21-91,-0708 COUNTY CODE VEAR NUMBER DECEOENT'S COMPLETE A00F1ES9 515 Penn Ayr Road Camp 11111, PA 17011 NAME .John E. Slike, Esquire 'lOClfll SECURITY NUMIU/l 2E,.64.0787 X 1, Original ROIlHn CooO" Cumberland lELEPtiONE NUMOEA R E C A P I T U L A T I o H (1) (2) (3) (4) (6) o 4, L1m1lod E,IBlo 041, 07, PHluro Inloro'l Compromlso (for daloo 01 doalh ohor 12-12-82) Docedonl Malnl.lned a Living Trusl (Anach a copy 01 Trusl) 3, Romalnder Roturn (lor dalos of d,alh prior to 12-13-82) o 5, Federal Estalo Tax Relurn Required o 8. Tolal Humber 01 Sale Deposit Boxes C P AlL COARESPOHDENCE AND CONFIDENTIAL TAX INFORMATION ~ III! DIRECTED TO: o 0 R N R D E E S ~ ----'- []] 6, Decedont Dlod 'Toslalo (Anach copy 01 Will) CClMPlETE MAILlNO ADDRESS Saidis, Guido, Shuff & Mas1and 2109 Market Str;e{it' ~'i\ :TJi1i' Com Hill, PA nOll .'.' ~ None I . 3- r.' I . () 153,633.69 l:tl ~l. None r,\ .' () None :...\ ..:.'j ,) 31,567.37 " (0) (7) (8) (10) (15) ,. A X C o M p U T A T I o H (10) 717 737-3405 1, Roal E,late (Schodulo A) 2, Slack, and Bonds (Schodulo B) 3, Closoly Held StocklPartnerehip Inlorosl (Schodulo C) 4, Mortgag<ls and Nolos Rocoivable (Schodulo 0) 6, C.sh, Bank Dep~"ts & Mlscsllanoous PerBonal Proporty (Schedule E) 6. Jolnlly Ownod PIOPBrty (SChBdulo F) 7, Translors (SchBauls a) (Schodulo L) 6, TotAl aroas Ass.ts (Iolal IInos 1-7) 6, Funoral Expan,os, Admlnlslrativo COSIS, Mlscellanoous E'ponsos (Schedulo H) 10, Oobls, Mortgago Llablllllos, Lions (Schodulo I) 11, Total Deducllon, (101.1 lines 9 & 10) 12, Hel Value 01 est'to (line 6 mlnusllno 11) 13, Charitable and Govern menial Boquosls (Schedulo J) 14, HBI Value Subjocllo Tox (II no 12 minus line 13) 15, Amounl 01 IIns141axablo a16% mle (Include valuos horn Schodulo K or Schodule M,) 16, Amounl olllno 141axable a115% rale (Include valuos horn Sohodulo K or Schodule M,) 17, Principal tsx duo (Add tax Irom IIno 15 and Irom IIno 16,) 18,Crodll"Sp Pov,rty Prior Payments Dlscounl +~OOO,OO. 1,052,6~ 16, IIl1no 161s grealBr lhon IIno 17, onlor Ihe dlllaronco on 'I no 19, This Is Iho OVERPAVMENT, ~ 0 IChtck her." you .,1 rlqU.I~ng a rtlund of vaur OYllPlymont.l 20, IIl1no 17 is grealer Ihan IIno 10, ontar Iho dlllOlonco onllno 20, Tills Is Iho TAX DUE. A, Enlor tho IntarBsl on Iho balanco duo on line 2DA, 0, Erl\or Iho lolal olllno 20 and 2M on IIno 20B, This ISlho BALANCE DUE, Make Chick Plyabte to: Rlglato, 01 Willa, AlIInt . . BE SURe TO ANsweR ALL QUESTIONS ON PAGE 2 AND TO ReCHeCK MATH III .. ffii7,;r7~.~ii:'1 vI PII!U'y.1 d/'l~I'flllIlIl hI.... t11'fllln,d 1111' ,.Iu'n, Includlngaccomp.nYlna &Cn.duluand al.I'"I'nls,and 10 the bU' 01 my knowl.dg..nd blll.f, 11111'UI, ;outcl ~ntl c..mp:lll..1 dllCI.tflllht!.lIruIUU1. hu bl.n l.po,l.d.t \fUll marl..t ...ah).. Oe,.Ia'''linn 01 pfllpafll' oltllr 111'11 Ih. pllflonalfllPflunllh".11 b.ud on 1IIlnlorma\lOI1 at whl~11 fll lip IIJ' hu.nYl.now!edge, 'lV, ",\~!I'l~ .IF p[RSmj ~1[9flONSleLf FOil rU.iNll Il[; URN AOOfl[')3 If. " I." t/ I I. " ~.,t... ~. J (t 1.'.1- V.4.,., (.....\, ...... . ("111 j'll ,If f'AEPAfi[R uTtlEFl TtlM4 AEPRrnrNTATlV( .' ~r:i: ~~:lil):!>>.~: ~:~I!~:::::::::::::::::::::: :::::::::: Camp IIi 11 ,I'A 17011 AOOFlF5S Saidis, Guido, Shuff & MaRland 2"169' Mlirke"l:' S"t'reoi"' -........".". - -....".."... -.- cilmp' iiii i',"" PA" 'jjciii" . -..................".. -.. v (}( '. ;;,;,"""! "~'~.m ,"IIW~' coo,:' "'~::;";'W'''''''' 707,31 . None ,. ~', Vi 0 _h (0) 185,908.37 17,785,23 26,322,58 (11) (12) (13) (14) 44 , 107 ,81 141,800,56 None 141 , 800, 56 73,80_ 1,230,00 )( .0611 140 ,570, 56 X ,16. 21,085,58 (17) 21 , 159,38 Inleresl (18) (18) 21,052,63 0,00 (20) (20A) ( ilOB) 106,75 0,00 106 , 75 DAlE ;;"/':;/f /" DATE '"m i ~:(,~,(~ . .. :' ,--' " , l - LAST WILL AND TESTAMENT OF HEATHER J. ADAMS I, HEATHER J. ADAMS of Camp Hill, cumberland county, pennsylvania, declare this to be my Last Will and Testament, hereoy revoking any will previously made by me. I _ I direct the payment of all my just debts and funeral expenses out of my estate as soon as may be practical after my death. II _ I,bequeath certain items of my tangible personal property, not including cash and securities, in accordance with a written list made by me during my lifetime. In the absence of such a Hst or designation on said list, I bequeath my tangible personal property to my mother, Merrily J. Cole. III _ I devise and bequeath all the rest, residue and remainder of my estate of whatever nature and wherever situate, SAlOIS, GUIDO including the balance in my annuity fund (unless otherwise '" MASLAND ~109 Market Slr..l designated subsequent to the date of this will) as follows: Camp Hili, PA A. 60% of said residue shall be paid to my brother, David K. Adams, or if he is deceased, to his issue per stirpes. /}If Page 1 REV,' l!dJ) t~... '''-18) COM7I.\l\l~~~~tW~A~'A eSTATE OF SCHEDULE B STOCKS AND BONDS Pile NUMII!R 21-94-0708 IlEATHER J, ADAMS SS/! 215-64.0787 07/16/94 olnU -owned wtth R , 01 Survlvorlhlp mUI' be dllOloHd on Schedule F,) DESCRIPTION VALUE AT DATE OF DEATH Herri11 I~ncn Account as fo l1ows: 1 470 shares Best Buy 23,625 11,103,75 2 300 shares Callaway Golf 39,875 11,962,50 3 250 shares Chrysler 48,50 12,125,00 4 300 shares Microsoft 48.625 14,587.50 5 505 shares Outback Steakhouse 26,063 13,161. 82 6 6,354 shares Alliance Northern American . 8,540 54,263,16 Gov't 1nc, Trust I 1,828 shsres Merrill Lynch Developing , .15,070 27,547,96 8 Cssh 8,882,00 " TOTAL Also entor on line 2, Reo lIulallon (II morn spaco 19 nftllded, Insort addlllonal shoets 01 same size,) Copyrlgtll (c) 11l91101Ill'f.lllwlleon1vC.nt.r Pi.ct Solltw" Inc. . 153,633.69_ FOlm 1&00 Soh.dul. B lR...... 4~eoJ REV- UOlllK+ ().1lI1 SCHEDULE F JOINTLV-OWNED PROPERTY COM~Nm1~q~mW~ANIA I!STATI! OF HEAl'IlER J, ;!\DAM5 55#! 21~.64.078" 07/16/94 Jolnll.n.nl(a)r A, NAME ./Il<1k W, Wintera ADDRESS 515 Penn Ayr Road Camp lIil1, PA 17011 8, 0, Jolntlv-owned propertyl FILl! NUMBER 21.94.0708 RELATIONSHIP TO DEOEDENT Step-fathe'c -- LEmR - DATI! DOLLAR VALUE OF ITEM FOR MADE DESCRIPTION OF PROPERTY TOTAL VALUE DEOD'S NUMBER JOINT OF ASSET '" INT, ECEDENTINTEREST TI!NANT JOINT 1 A 10/21/88 Fllrmers Trust Co. 1,414,62 50.00% 707,31 checking Ilcct, 8-81260 " , , , " " , I , , , ,:: , ',' , , , , , , " " , , " , , , " , " , I , , , , " " ' I " I , , , " , , , , TOTAL IAlso enler on line e, Reoeollulatlonl II 707,31 (II moro space Is neo~od, Inson addlllonal sheels of sarno size,) CO/ly,tgh1(dllUUl form .oHw." only Cllnl,rPitc' Soflw.", InCl, ' FOlm 1600 Sch,dulll F (A....., 12~88) j SCHEDULE H FUNERAL EXPEN9ES, ADMINISTRATIVE C09TS AND MI9CELLANEOU9 EXPEN9ES REV-'I&1I EX. IHI) COM\t~l~~~~~AN'A I!STATE Of Please Print or T e P1L.l! NUMIII!R 21-94.0708 07 16 94 DESCRIPTION AMOUNT HEATHER J. ADAMS SS# 215-64-0787 ITEM _~BER A, Fun"lll!Xpen"11 II. AdmlnletraUvl Coe~: 1. Personli Representetlve Commissions 8,400:00 $Oolli6eCurlty Number of Personal Representative: 210-26-9735 Vear Commissions paid I'f'I ') - . 2, Attorney Fees 8,400.00 3, Family Exomptlon Clliment Reletlonshlp Address 01 Claimant at decedent's death Street Address City Stato Zip Code -- 4. Pro bale Fees 261. 00 0, Mleoelllneoull!Xpen...1 1 Cumberland LaW Journal 40,00 2 patriot-Ne'lIs Co, . legal ads ' 59,23 3 Register of Wills . it ling ~Iles 25,00 4 Reserved for taxes and future ,expenses 450,00 5 Account filing fees 150.00 'j " I TOTAL Also entor on IIno Q, RooI Ilulatlon (It molO sp~ce Is noodod, Insort additional shOOts of came sI2e,) oopYllal\t\~} 1891 fQrrn '11"'#11'. only C,nll' rlfct Soltwa'l, lno, . 17 785,23 Form 1100 Sohtdule H (R..... 7.111 (?.4J.I 1:/ E 3' -; 3 P- ( I ,.) ;- () AI -{J /' ()f COMMONWIALTH OF PIINNSYLVANIA COUNTY OF CUMBERLANP } III Jack W. Winters being duly sworn is Exocutor according to low, depolel and UYI that h. 0/ the Eltot. 0/ Heather J. Adams 1010 0/ ___,_ _,~~.J.1.l,P_~e..~_'!'.C;>I>f_n!ll~ ip ... ____ , Cumb.rl.nd County, P." d.c....d .nd HI.t the wllhln lion Inventory mede by _him __ " the sold Executor 0/ the ontl,e .Itote 0/ uld decedent, conlhtlng 0/ all the personal prop'irty .nd reol ....t., axc.pt rOIl ..t.t. outsld. the Commonwealth 0/ Pennsylvania, and that the /lgulOs oppollte uch Item 0' the Inv.ntory r.pr...nt It's 'ai, v.lue os 0' the d.te 0/ decedent'l death, ' Sworn to ond sublcrlbed be/o,e me, I /. , I, "/" I '-"" ~. (~r 1't.'.tt'~'(,Kc..,/;J" F. ruary \.- ~~ _1995 4..<< .it ...:.- en,,'o, . Admlnhl,.'o, ,/ 515 Penn Ayr Road NOT RIAL SEAL THELMA S, McCAUSLIN, Nolary PubliC Camp 111I1, Cumberland Counly My Commission Expiros July 3,1996 - 16 Dote 0/ Deeth Camp Hill, PA 17011 Add,... July 1994 O.Y Month VIA, INSTRUCTIONS I, An Inventory mu" b. /lied within three months o/ter oppolntm.nt 0/ person.1 r.pr...nt.tlv.. 2. A luppl.ment Inventory mUlt be /lied within thirty dOYI 0/ dllcov8lY 0/ .ddltlonll I"''', ], Addlllonollhee" mey b. ettoched II to pmonolty or ,eelty 4, See Arllcle IV, Flduclorl.. Act 0/ 1949. . 01 Ul ~ PI 11 III .b., ~ ~ H :I1 .. . ~ ~ Ul III ~ .. ~ ~ ~ II . H ~ UJ Q III t-1 r ).. j; g: . 0 :. ..I u. .., E-l ,z Ul ~ -' ~ 0 lJ.l u. (l:; Z . ~ , ~ 0 ~ r.r: ~ c.:I f c.:I ... Q "6 o 0 a ~ m ~ " - ~ ~ tl 0 Z toto 0 Go ." .., a III ... t 0 .ll 1 ... .. e 0 ... j U if 0 ... I.' ! "/ 0iEV.1D47 EX AFP (12.94* COKHOHWEAlTH OF PEHHS'LVAHIA DEPA~'HEHT OF ~EVEHUE NOTICE OF INHERITANCE TAK BUREAU OF IHOIVlDUAL TAXES APPRAISEHENT, ALLOWANCE OR OISALLOWANCE ~i:~i.~~::l PA 11IIe.om OF DEDUCTIONS AND ASSESSHENf OF TAX DATE 05 - 0 1- 95 fmi'TOIt=-XCAMS FILE NO. -21 R'-070r DATE OF DEATH 07-16-94 COUNTY CUMBERLAND NOTE, TO INSURE PROPER CREDIT TO YOUR ACCOUNT, suaHIT THE UPPER PORTION OF THIS FORH WITH YOUR TAK PAVHENT TO THE REGISTER OF WILLS, HAKE CHECK PAVAaLE TO "REGISTER OF WILLS, AGENT" REMIT PAYMENT TO: /1.. eV') - :J "1./ 101' vi ACN 101 JOHN E SLIKE ESQ SAIDIS ETAL 2109 MARKET ST CAMP HILL PA 17011-5228 REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 l __ AMount ROM~Od CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS .. iikV=iilcjj"EX"AFP"-m-:94"i"iloi''ir'iiuop-YN'HiififAifc,ri'A'x"XPPRA"iSEHEilr;",U.DiwAifcE"iilin__..."""n..... DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF ADAMS HEATHER J FILE NO. 21 94-0708 ACN 101 DATE 05-01-95 HK RETURN WAS I ( X) ACCEPTED AS FILED I CHANGED n(~l . ." RESERVATION CONCERNING FUTURE INTEREST . SE~ REVERSE Cd 'f' :')-'':' :, ( 'II APPRAISED VALUE OF RETURN BASED ONI ORIGINAL 1, Rool Eototo ISchodulo Al 11) ,00 - ' " 2, Stock. ond Dond. (Sohodulo al 121 153.633,69 :u 5, ~l..oly Hold Stock/portn.r.hlp Intoro.t I Schodulo C I (s1 ,00 I"'~) -..I 4, Hortgogo./Noto. Rooolvoblo (Sohodulo 01 14) ,00 5, Co.h/aonk Dopo.lt./HI.o, Por,onol Proporty ISohodul. EI 15) 31.567,37 6, Jointly Ownod Proporty (Schodulo FI (6) 707,31 ,., 7, Tron,for. ISoh.dulo 01 171 .;. ",00 \11 a, Tot.l AliOto (81 185,908.37 APPROVED DEDUCTIONS AND EXEMPTIONS I 17,785,23 9. Funorol E.pon.../AdM, Co.to/Hilo, E.ponu, (Sohodul. HI 191 10, Dobh/Hortg,go Llobl1!tloo/Uon. ISchodulo 1) 1101 26,322,58 11, Totol Doduotlon. 1111 12, Not Voluo of To. Roturn 1121 IS, Chorlt,bl.IGovornMontol aoquo.t, ISchodulo JI 1151 14, IIot Voluo of E,toto Subjoot to To. 1141 NOTE: If an al..I.m.nt W81 illUld praviouIly. linal 14. 15 and/or 16. 17 Ind 18 will raflaot figurel that inolude the total of Ahh returnl a.lelled to date. ASSESSMENT OF TAX: 15, AMount of Llno 14 ot Spou..l r.t. 1151 16, AMount of L1no 14 toKlblo .t Llnool/Cloa, A r.t. 1161 17, AMOunt of Llno 14 to..blo ot Collot.r.l/Cl... B r.to 1171 18, Prlnolpol T.. Du. 4wn7 AI 141,800,56 ,00 141,800,56 ,00 K ,03. 1.230,00 K ,06. 140.570,56 K .15. 1181 ,00 73,80 21,085,58 21, 159,38 TAX CREDITS: PAVHENT DATE 10-06-94 10"14-94 02"21-95 RECEIPT NUHBER MM913046 MM913078 AA022854 DISCOUNT 1+ I INTEREST I - I 894.74 157,89 ,00 AHOUNT PAID 17,000,00 :!l,OOO,OO 106,75 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST TOTAL DUE 21,159,38 ,00 ,00 .00 . IF PAID AFTER PATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST, I IF TOTAL DUE IS LESS THAN fl, NO PAYHE~T IS REqUIRED, IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRI, YOU HAY BE DUE A REFUND, SEE REVERSE SIDE OF THIS FDRH FOR INSTRUCTIDNS,I .,.- ~ I" " ," " " , I RES!RVATIDHI '.1.11. of dooodonll dYing on or, be'O'" Doollbo, II. I'IZ .. If onv fulurl Inll,..1 In lho ..1111 II I'on.flrrod in po.....lon or InJoYltnt to Cll.. . (col1It.r.l) bInIflo1.rll' 0' thl dloldlnt .ft,r the ..plr.tlon a' .n>> ..t.tl for II'. or far v..r., thf t~.lth hlrlbv Dxpr..,lv r...rv'. t,. rllht to eppr.l.. end ...... trln"lr JnherltlnGl T~I' It thl l.w'ul C1I.. B (0011Itar..) r.ta on eny suoh future Intere,t. PUIt'OIC Of' NOTICE I To fulfill thl r"quirllllntl of IIQUon 21"0 of thl Jnheritlna. end Eltatl Tlx Aot, Aot 2Z of 1"1. 71. P.I, SocUon ZI\O, PAVHfNT1 Detach thl top porUon a' thit MoUe. end .utMlit with vour P'VHnt to thl Rltlttlr 0' tUU. rrJntld on thl rlV"" .Ide. --Hll<o ohock or .....v o,dl' PO"'.I 10' REOIlTEa OF MILLI. ADENT All PIVItIf\tI rec.lvld 'hII11 fIrst be 1PP1led to IInV Int.r..t which ..v be dut with any rH.lndlr~1I1d to thl tlX. REFUND eCR)1 A r.fundo' I tax credit, which WII not r.qullted on thl Tax R.turn, ..y be rtqUl.t.d bv cOIIpI.Unt In "ApflIJOIUon for R.fund of Penn.ylv,"l, Inh.rJtenc. Ind E.tlt. Tlx" (REV-UU). APf'lUo.tlDn' .rl IV.Ueb.. at th.Offiol of thl R.ghtlr of Willi, env of thl U R.vlnUl Olltrlot Offic.., or by a.Uing the .peei.1 2~-hour an.werine ..rvic. ~.r. f~r 'or.. orderinll In PtnnlVlvlnl1 1-800-S62-2090, out. ide Penn.ylveni. and within 1..11 Hlr,loburl Ir.. (717) 71701094. TODl (717) nz-zm IHllrl.. 1",,"lred Onlv), OIJECTlONSI Any Plrtv in inttr..t not .,U.fied with the IPflrlhHent, l110wlnCl or dhlUONIno. of dIduotlonll, or ........"t of t.x (Including dl.count or Jnt.r..tl .. lhown on thl. Notlc. IUlt obJlat within IJNtV (60) d'~1 of reallpt of thh Notlc. bYI ~~wrltt'" pro tilt to the PA Dlpartaent of RlvtnOI, 10lrd of .PP...., O...t. 211021, Herrhburl, PA 17121-1021, OR UIleotton to h.v. thl ..tter d.ttr.lntd et .ucUt of the aocooot of the Plrson.1 r'Pt....nt.Uv., OR .~apPl.I to the Orph.n.' Court, ADHIH ISTRATlVl! CORRECTIONS I FlOtu., errors dhaaverld e>n thh .""..ent should be Idd"utd In ..ritlnl tal PA o.pertHnt of RIVInUI, lurleu of Individual 'I.", ATTN, Po.t A...."'"t R.vllw Unit, O.pt. 210601, Herrl.burg, PA 17121-0601 Phone (717) 717"6505. 1M P'" S of thl book..t "In.truotlon. far Inherlt.ne. Tax Rlturn for. Rllldlnt Deoldentft CREV"1501) far In axplen,tlon of adllnl.tr.tlv'lv correat.bl. .rror.. INTEREST, If InV t.x due I. plld within thr.. (S) a.ltndlr sonthl .ftar thl decedent'. d..tn, I flv. Plrcent (SX) dl.onunt of thl t.N ,.Id I. allowed. Jnt.r..t II ah.rlld blglnnlng with first dev of dtll~noy, or nlM C'l eonth. tnd OM (1) d.v frOll thl dlt. of death, to the det. of P'valnt. Tax'l which btottt delinquent blfare JlnUlrv 1, 1'82 baar Intlr..t .t thl rtt. of II~ (6X) peraent plr tnnUI c.loul,t.d .t . d.llv r.t. of .000164, All tIX.. which blo... delInquent on ~ .ft" JlnUlrv 1, 1.12 will bl.r Int.r..t .t . r.t. whlth will v.rv frOl alland,r v..r to oallnd.r y..r with th.t ratl ~Id bv the PA Dep.rt.."t of R.venut. ThI IPPII~Ib.. Int.r'lt r.te. for 1"2 through I"S .rll DlltOlJNT I '!!!! lntere.t R.te Olth Inter..t Feotar !!!! tntsr"t R.te Olllv Inter..t F.ator 191Z ZO~ ,000541 1917 ,~ .OeOZ~7 .'13 16~ ,OOOUI 1'"-1991 m ,ooem 19I~ m .00OSOI 1991 9X ,oeozu 1915 Il~ ,OOOSS6 1995-1990\ 7~ .000192 I'" le~ ,ooem 1995 ,~ .00OZ~7 ~"rnt.r..t I. c.laullt~ .1 follow'l INTERElf . BALANCE OF TAX UNPAIO X NU"BER OF DAYI DELINQUENT X DAILY INTEREIT FACTOR .-Any Hotlcl I.sued .,t.r tha t.M b.a0l41 delinquent will r.fllOt an Int.ra.t a,louletlon to flftll" (15) dly. beyond thl d.t. of the ........"t. If P.v.."t I. tlda eftlr thl Int.r'lt ou.putatJon d.t. .hown on the Motlo., Iddltlonl. Intlr..t .u.t be o'louletli. SAIDIS, GUIDO, SHUFF '" MASLAND ~109 Mllkel SIRel Camp Hili, PA " FIRST AND FINAL AcCOUl~ OF JACK W. WIN~IRS, IIICU~OR FOR ~HI ESTA~E OF HEATHER J. ADAMS, DECEASED NO. 19116 - 708 Date of Deat.h I July 16, 1994 Date of Executor's Appointment: August 16, 1994 First Complete Advertisement of Grant of Letters September 2, 9 and 16, 1994 Accounting for the Period: August 16, 1994 to May :U, 1995 Purpose of Account: Jack W. Winters, Executor, offers this acoount to acquaint interested parties with the transactions that have occurred during his administration. The account also indicates the proposed distribution of the estate. It is important that the account be carefully examined. Requests for additional information or questions or objections oan be discussed with: John E. Slike, Esquire Saidis, Guido, Shuff & Mas land 2109 Market Street P.O. Box 737 Camp Hill, PA 17001-0737 (717] 737-3405 SAIDIS, GUIDO, SHUFF '" MASLAND ~109 Markel Street Camp 11111, PA " Federal and State ~.xe.: Register of Register of tax due Wills, Agent - inheritanoe tax payment $ 20,000.00 Wills, Agent - balanoe of inheritance ' ree. and commi..iQall Jaok W. Winters - Executor's fee John E. Slike, Esquire - attorney's fee TOTAL DEDUCTIONS ADVANCE DISt8lBU~IONS Michael Flannery David K. Adams David K. Adams Merrily J. Cole - personal effects in kind per codicil to will Michael Flannery - use of car for one year . per oodicil to will Michael Flannery - 1993 BMW automobile - value as of one year .after date of death TOTAL INCOME AccOUII~ RlCEIP~S PNC Bank - interest ~arned on _state cheoking account to 4/13/95 Merrill Lynch acoount TOTAL 5 106~ $ 20,106.75 $ 8,400.00 8.400.00 $ 16,800.00 $ 63,930.94 $ 1,500.00 1,500.00 5,000.00 1;230.00 4,000.00 20.000.00 $ 33,230.00 $ 45.79. _ 4.965.43 $ 5,011.22 INVBN~ORY OF ~HE REAL AND PBRSONAL ES~A~B OF HEATHBR J. ADAMS, DBcEASBD Merrill Lynch Account as follows: 1 470 shares Best Buy 23.625 11,103,75 2 300 shares Ca11away Oolf 39,875 11,962,50 3 250 shares Chrysler 48,50 12,125,00 4 300 sharea Microsoft 48,625 14,587,50 5 505 shares Outback Steakhouse 26,063 13 ,161. 82 6 6,354 shares Al1iance Northern American, 8.540 54,263.16 Gov't Inc, Trust 7 1,828 shares Merrill Lynch Developing 15,070 27,547.96 8 Cash 8,882,00 ~ 1993 BHW 325I 24,000.00 10 Jewelry and personal effects 1,230,00 11 Blue Cross/Blue Shield reimbursements 6,337,37 " 'IDl'AL 185; 201. 06 " ", ," " ,. , " , , d. " " " LAST WILL AND ~ESTAMEN~ OF HEA~HER J. ADAMS I, HEATHER J. ADAMS of Camp Hill, Cumberland County, pennsylvania, declare this to be my Last will and Testament, hereby revoking any will previously made by me. I - I direct the payment of all my just debts and funeral expenses out of my estate as soon as may be practical after my death. II - I,bequeath certain items of my tangible personal property, not including cash and securities, in accordance with a written list made by me during my lifetime. In the absence of suoh a list or designation on said list, I bequeath my tangible personal property to my mother, Merrily J. Cole. III - I devise and bequeath all the rest, residue and remainder of my estate of whatever nature and wherever situate, SAIDIS, GUIDO including t.he balance in my annuity fund (unless otherwise '" MASLAND 2109 Market Slreel designated subsequent to the date of this will) as follows: Camp Hili, PA A. 60% of brother, David K. Adams, or stirpes. L- \ said residue shall be paid to my if he is deceased, to his issue per Page 1