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HomeMy WebLinkAbout94-00720 l-IE. PETITION FOR PROnATE and GRANT (lI<' LETTERS l::I'IUU' of _~;rk_,,+--- jlu4.( OAL""j., I~)' No, &1~~9+H-: _7~Q___ al.l'o knowlI a.l' _________________mWJ,ENHEIM To: ______________________________u Regisler of WiUs for Ihe _, /J('cea.\('d,. ('ouuty of __C~_'t~.~_L.~..!_'_ In the S(~(~7S~~'l/ri;);-N;)~--~=~r~{L-~ _ _~ /--'H']' ) ('omnHlnweullh of 1'('nnsylvlInh\ The petllion of Ihe undersigned respectfully r('presenls thul: Your 11\'lllloner(s), who is/m-e IX years of uge 'J older unlh,' e,xeeuLQt__________________ nUllled in the lusl will of Ihe lIhove dec,'denl, duted _ 'HH _ (, h __ _I t. ____ ..1.'1__.7 .~..-----____..________,' 19_ und codicll(s) dUled ______ ----_ __________________. (,lUIC H'll'vanl dll'tllli'llllll\", l'.~. rl'l1l1lll.'ialhlll, dl'Ulh 01' 1,'\l'l'\IInr I l'll..',) J)ecendeut \\'US domklled III (kuth inn(.~i.<I1.(~_'_ L?-~I..;;r---'----- ('ounly, I'ennsylvllniu, wlllt ~ Id_L- hy~~~lpcl0i~~~i~7lk\~~I~nc"~" __~-=:~~Y_~l_f~:I~t~~=':=~-:':.=-.1Z.C-l " -~.:.. / 1 ~, dhl 'trl'CI, llIUnlll:r lllHll11UlIl'lpalllYI J)ecendenl, Ihen___3\_o___ Y"lIrs of lIgc, died ._H____ __ ___J ~Jl,,-----2.-~------, 19__..L.'t_, ut ...s."'-..._l--I_;:L.<'-______H_....I.'(d ul',.L_ __, _ _ _J.iA _yL IS _(~_ ._-'--~"_______,_______, Except us follo\l's, demlelll did nolmlln-y, wus not di\'or,'cd und did nol huve u child horn or IIdopted lifter e.xecntlon of Ihe will offered for probllte; \l'lIS nolthe vktim of 1I killing IInd \l'IIS never IIdJudlellted Incompeteut: _____________________. _ _ _ ____ ______ ____________________________ J)eeell<hlllt lit dellth owned property with cslimllled \'lIlues liS follows: (If domiciled In I'll,) All personlll property (If nol domiciled In I'll.) l'ersoulll property in l'eunsyl\'lInill (If nol domklled In I'll,) l'"rsoulll property in Counly VlIlue of relll eslllte iu l'ennsyll'lIuill shullted liS follo\l's: _________ _ _ u _._______ ____u_,________ ________~___ ) "e.., $__~ " "". <"e> $ L $------ WHEREFORE, petitioner(s) respectfully re'lu",lIs) the .lHohlll'> of Ihe IlIst will IInd eodlell(s) presented herewhh IInd the grllnt of lelters_______ ,OF. AIJ~!.N_l~IIl.~I!Jl.ti ~! T ,A. (tl',IlUlll'lIlur~'; udminl\trullnll l'.I.ll.; lIdllllnlslrnllllll d.h,Il.C,I,n.) theron, ^ 11 5 '0_ '~~ o:t " '00 ~.= _'r, ^"' ~~ ~o ~, Iii -idllJ - ~~-------"------ .._$"~_ri__~1Iln.I.l:,..JJL____________ ___..L1(".(lJl.l,~v.((..--.i',A-'-J1~I.';_____ , __IdI2t.JAfcP_ILJ!t.~r.:/1I [l,1IJ, ---.------------..------.-.-. ---_._~~--_._-------~.-._----- --......--._-_." ..-......._-----....- OATH OF I)ERSONAL REPRESENTATIVE COMMONWI';AI,TII 01' I'ENNS\'LV ANIA I HH COlJNTY ()II ,___,_..~~~BER~~NO, J . , The petitionl'l'(s) Hbtll'e-nHl11ed s\l','ur(s) or IIffirl11(s) Ihlll Ihe sllllel11enls in Ihe foregoing pelltlon life tl'll" IInd eOlll'ello the he.11 of Ih,' ~no\l'ledge IInd heli'" or pelitioner(s) Hnd \hllllls personlll represen. IlIlil'e(s) of Ihe 1I1111l'" dm'd,'nl p"litionel(s) lI'illllell T111Uly lylrllilNt~1 III<' estllle IIceordlng to IIIII', S\I'llI n to 01 HI I illllt'J 'l,nd sulllellbed I #)j~Jt})(. , - -- - -___ _on ~ '/Jf;hef(~lI" 1I1;,t1('/"^~GUS~T1/-( ,);hl~40lf~' (/ ....__ ~. L ~ ",(.tLl.( Q l' d.J //!r:..[tJ1 f,' .1-(' - [ tV C. LEWI S lIC'ci\/t''( i !^ , 'f - f I( "c;,J ,~()- I " Estate.of No. _ 21 - 94 . 720 S I d '" t' Y A. IN", ~.~ ~.f, ~ , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW AUGUST 1 S. . 19~_. in consideration of the pelhlon on the reverse side hereof, salls factory proof having been presented before me, IT IS DECREED Ihal the inslrumcllI(s) daled JANUARY 12. 1972 described therein be admllted to probale and filed of record as the last will of SIDNEY A. WAGENHEIM OF ADMINISTRATION C.T.A. HOWARD H WAGENHEIM and Lellers are hereby granted 10 . FEES Probate, Lelters, Ete, """'" $~L Short Certlfleates( 1) .. . , , , , , ,,$ 3 ,00 Renunciation ,..,.",.".,." $ x-Page $ ::l,UU JCP 5.ee TOTAL _ $ 36.g9 Flied ,..'...,.. .~UG.UST. .1.8.. )9,94.."" Resl'I" or Will. MARY C. LEWIS ~rt~ h ilfr- AliORNEY (Sup, Ct, I,D, No,) 5\.,,7' (. 7,) ,1.'y 5'("'(1' ;1~'" ADDRESS C" ... (' 1-1, ~ '- (I... I'D'/ '7/7- r,~J-;.,,(j')~ . , PHONE ~. C! 7 ( '1 i~ ...~;. 't: I , ~ , , 'I, I J, \(! ...... ',"J I I I 'fJ i.'" , (J: I"~ I U 00 Mailed letters and order to Executor on 8-18-94~. I '21 - 94 - 720 RENUNCIATION In ReEs\ate of )'IA~'r I..t .. 1 t h~ " '" deceased. To the Register of Wills of (4 'h L. L." )t county. Pennsylvania, The undersigned IV. . , LL, tl. ~ I J'" '1.((<' , of the above decedent. hereby renoullce(s) the right to administer the estate and respectfully ask(s) that Letters J (J ,<' 7:-- ~ \1oJ:JJ' C\ ' ( be Issued to ~/, w · y ) 1"1 Lv A.? ... l\ It ,J) I ...' WITNESS (') 't hand this 1~ ( 6 day of ,A., 5 ,19~ \ (// ~ ~ Ii , ~ (. .i :2 , y f qJ,. '(- .' ,-4- . ...' tAddre,,) C.... ( 1-/, Ll -/. '~"'I 'Ir', "" (SI.nature) \>-,1 , .C , "1 , f.:J ,I ,~() ',' (Addrcts) 1~4' I-j L (_~ , I I \'I(J: ~ "'\ ,_J :'1 tL~ Go (SllInalure) - (Address) v /i/-):W-/ c... REY.1547 EX AFP (12.94* CllltHOHWEALT" 01' Pt:HNSVLVAHU DEPMTIENT OF AEVEIU: IUAEAU 01' INDIVIOOAL TAKES DEPT, 110601 HARRJSIllRCl, PA 1lI1I-0I01 NOTICE OF INHERITANCE TAM APPRAISENE~r, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAlC ACN 101 DATI 11-06-95 FILE NO. DATI! OF DlATH 07-22-94 COUNTY CUMBERLAND HOTE. TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUSHIT THE UPPER PORTION OF THIS FORH WITH YOUR TAM PAYHENT TD THE REGISTER OF WILLS. NAME CHECK PAYABLE TO "REGISTER DF WILLS, AGENT" REMIT PAYMENT TOI NORMAN M YOFFE STE 203 214 SENATE AYE CAMP HILL PA 17011 REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 = R..Utld J CUT ALONG THIS LINE ... RETAIN LOWER PORTION FOR YOUR RECORDS ~ ifEY:i5W-EX-Aiijf"nZ":m-"iliificE"-OF""iNHiiiiTANCE-YA'in"pjiiiA-iliEHEili'~"Ai.liiiiANCE"iili--"'''''-------'' DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF WAGENHEIM SIDNEY A FILE NO. 21 94-0720 ACN 101 DATI 11-06-95 TAM RETURN WAS I (X I ACCEPTED AS FILED (I CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REYERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. R..l Eat.t. (Schodul. Al U) 2, stock. ond Bond. ISchedul. B) (21 S. Claally Hold Stock/P.rtnerohlp Int.r..t CSchedul. CI IS) 4, Hartgoge./Not.. R.a.lv~l. CSoh.dul. DI 141 S. C..h/Bonk o.po.lt./HI.c. P.r.on.l Prop.rty (Schodul. EI (5) 6. Jointly Own.d Proparty (Schedul. FI 161 7. Tron.f.r. ISchedul. 01 171 a. Totol AII.h .00 .00 .00 .00 1.040.00 ,00 .00 ca) 1,040.00 APPROYED DEDUCTIONS AND EXEMPTIONS' 9, Funar.l E.pen.../Ado. Ca.t./HI.o. E.p.n... (Schodul. HI (91 10. Pobh/Hartg.lII L1.bllltl../Llon. ISchedule II UO) 11.082.26 11. Tatol Deduction. U1I 12, IMIt Value af TIX R.turn U21 " IS. Ch.rltobl./Gav.rnMInt.1 Bequo.t. (Schodul. JI 1151 14. IMIt Vol... af E.t.t. Subject ta TI)( U41 NDTEI If an alleSlmBnt WII illued previoully, linel 14, 15 and/or 16, 17 Ind 11 will reflect figurel thlt include the totll of 61l returnl Illelled to date. ASSESSMENT OF TAX' 15, A.aunt of L1n. 14 .t Spaulll r.t. USI 16, Aoount of Lln. 14 t..obl. .t Lln..l/Cl... A r.t. (16) 17, Aoount af Lln. 14 t...bl. .t Call.t.r.I/C11.. B r.t. (17) la, PrincipII TI. Duo TAX CREDITS I PAYHENT DATE 3,751.00 14.833.?~ 13,793.26- .00 13,793.26- ,00 M ,03, ,00 X .06. .00 X .15. UBI .00 .00 ,00 ,00 RECEIPT NUHBER D~SCOUNT 1+1 INTEREST C-I AHOUNT PAID -1 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST TOTAL DUE .00 .00 .00 ,00 . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS LESS THAN .1, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRI, YOU HAY BE OUE A RF.FUND. SEE REVERSE SIDE OF THIS FOR~ FOR INSTRUCTIONS,) '" " ." Ch I' , .1 ,. ,'" 'f\ " , , , .1 00 RESERVATION. E.t",. of decedent. dYlne on or blfor. oec..bIr 1" 19., ~. If In~ future Inter..t In thI ..t.te J. tr,"lflrred In PO'Hlllon or- ."Jov-nt to ellll . (ooU,tlr,1) beneflol.rl" of tM deoldaut Ift,r the IMP'rIUon of InV ..tit. far 11'. or 'or y..r., the C~.lth hereby txpr...lv r...rv.. thl rllht to IPPr,l.. Ind ...... trln.f.r Jnhlrlttnoe Tax.. It thl lM1'u! Cl,.. a (ooU,'.reU rltl on anv such future lnt.r..t. PUl90IE Of NOTltf:. To fulfill tho ,...I,..,t. of I..\lon mo of tho Inho,II"". and ht.t. T.. Aot, Aot II of 1"1, 71 P.I, Itctlon 1140. PAYHENTI DetlCh thl totl portion of thh NoUel Ind .Wilt with your PIVMnt to thl ReI..tlr 0' "111.1 printed on thl rlVlrH It.. .."",. chock 0' ..... o,do, p....,I. to' REOIBTEIl OF MILLS. AOEMT .U PIYNn" nClllved ...11 fir.' be 1PP1I1d to tnV Ant.r..t "'llch .IV be dlJe with InV r..lnder IPPUed to thI tP. RfFlIGJ (CA)1 A r.'WMi of . tax or.cUt, which .,11 not r~ltld on thl TIX Rlturn, ..y be r.qullttct by cOIIpl,Urtl In "'App1JOIUon far R,fund of penn.vIY."., lnherltence end E.tltl Tlx" (REY-ISIS). Applloltlon. .r. IVIIIIbII It the Offlo. of the Rtthtar of .U11., anv of thl ZS Revenue Dhtrlot Office., or bv ClUing the 'peGIII U-hoYr Intwlrl", .ervlcl nu-ber. for for.. orderlngl In Pann'vlvlnl. 1~'00-J6Z-Z0S0, out.lu. Pann.yIVlnI, Ind .Ithln \0..1 ",,,tlburg .r.. (717) 717.1194, lDDI (7171 nl-llll alN,lng I"".trlll Onl.), OI..cCTlOHII Anv pert';' In Interllt not HtJiflad with thllPPrellMWlt, .110wn01 or dlHllown:e of deduction., or ~'H'lHnt of tax (Including dl.count or Int,re.t) ,. rhown on thl. Hotlnl lU.t object within .Iwtv (60) dlV' of rlOllpt 0' thh HotlcI by, --written prot..t to the PA DeplrtlMnt of A'I/II'UI, latrd of AppHh, Dlpt. 1I10ZI, Hlrrhburg, PA 111Z'~IOZI, OR ~.lllCtlon to MYI the Att.r detlr.lned It IUdIt of the KCCUlt of the p,rsOMI r""ru."tltlvl, OR --IPP..I to the Orphw,I' Court. ADllIN IITRATlI'! CDRRECTlDNS. FlOt",1 .rror. dltoo"ered on thlt IIH.....,t Ihould bI IIddr...1d In writing tal PA Dlptrt.....t of AI"Il"AM, Iur.1U of Indlyldual Taxi', ATTNI POlt A....~t Alvlew unit, Dlpt. 2.0601, HlrrIJbur., PA 17121~0601 Phone (717) 7'7~'505. SIt Pili S of the booklet "In.tructlon. for Inherltancl Tax R,turn for. A..ldent Dtclfdent" CREY.UOI) for an ,xplen.tlon of IdIIlnhtrttlvlh oorrlClttble trrorl. INTERliIT. If MY tex dull II p.ld within tttrH (1) clllndtr IOf1th. .fhr the decedent'. dtlth, . fI"l percent (5~) dhcCM1t of the tlX plld I. I1Jowed. Int.r..t J. charged bltlnnlnt Mlth f1r.t dty of dellnquenov. or nlnt (,) IOf1th. Jnd one (I) dey froe thl dlt. of dHth, to the d.tl of p,~t. TUII which __ delinquent blfor. JlnUlry 1, 198' belr Inttr..t It the retl of .IM (6:() percent par ItMUI c.lcullted It . dillY retl of ,000164. AU t'.I. .,.,Ich bMMI dtl1nquent on and Iltlr Jenuary 1, 1'12 will bltr Int.r..t It I r.t. which Mill ".rv fr.. caltndtr v..r to elltndlr Vllr with thlt rlt. If'InCKmCId by the PA DIp"tMnt of At"....., The eppllelbl. Jnter..t rltll for 19&2 through 1995 "" DIICOlMT , '!!!r Intlr..t A.tl O,11v Int.r..t Ftc tar :!!!! Int.rllt R.tl Dilly Int.r..t Fleter 1911 lOX .000..1 1917 9X .000117 1915 In .0001S' \911.1991 IIX ,000101 1911 \IX ,000501 1991 n .000147 \911 IlX .000556 1991.1994 T~ .000191 \916 lOX ,000174 1991 9X ,000147 ulnttrllt It elleulltad It followtl IHTElElT . BALANCE OF TAX UNPAID X KUftBER OF OAYS OELIHQUEHT X OAILY IMTERElT rACTDR ..Anv Notlel 1.lued .ftlr the tl. bee.... delinquent will rlfJect In lnt.r..t e,leulltlon to flftlln (II) d.y. "Vond the dltl of the ......Mnt. If PIYNnt It Hde Ifttr \tl1 Intullt COIIPUtltlon det, IhoNn on thl Notlc., addltlon.1 Int.r..t l'U.t bI cllcullted, I, . " ) ./.. (.', i.~ I',''" f /'/ J.JO - I INHERITANCE TAX RETURN RESIDENT DECEDENT (TO BE FILED IN DUPLICATE WITH REGISTER OF WILLS) 'OR DATlll 0' DIATH AmR 12/31/91 CHICK HIRI ~o~::~U~:~DIT II CLAIMID 0 PILI NUMIIR :J,! - qlj. J)U COUNTY CODE YEAR NUMBER M L A. RU5 REVoIlOO!X. "'.91, .. I Wagenhnim, Sidney A. SOCi,\['SW)Rif'NUM1IR---1DA1! OTDO.-rn-lOA ! IIR II t 91-18-3'/)5 ./ / 22/94 9/1/ Ll __h._.~.___ _________ _... _~..._________~.__.___ ~ ~~~ ",Ill ~ UO__'_..'_n__.+ I~ iQ Oz V2 'j ,,~'I\J..r. '.~~. I' I~ ",' !~ COMMOfIWEAlIII or PfNNSYlVAt~IA DfPAATMHH Of RfVENU~' 0[PI.280601 ttAARISBURO, PA 17128.0601 ...... . ~-, .Ft' -. --",' A . , c..- Cumberland County Nursing 375 Claremont Drive Carlisle, PA 17013 COllnry lid 1. Original Relu,n [ I 4. lImlled E.lale [1 2. Supplemenlal Relu,n Ilome [] 3. [J 5. Romalnder R.lu,n 1'0' dol.. of deolh prlo, 10 12.13.921 Federal E.lal. Tax R.lu,n R.qulred T 0101 Numbe, 01 Safe Depo.1I 90xe, [] 40. Fulu,e Inlere.' Comp,onll.e (for dol.. of d.alh aher 12.12.92) [19 6. Decedenl DI.d T..lalo 0 7, D.codenl Malnlalned a lI,lng Trull __....JAlloch copy 01 Will) Bee Exhibit "al,6,lIach copy 01 Tru.l) ALL COIIUPONDINCI AND CONPIDINTIAL TAX INPOIMATlON SHOULD III DIIICTID TO. NAM - OMPlETf MAllINOAOORESS Norman M. Yotte iimfioNE 'NUMIER--- ._._u_..___. _9, 214 Senate Avenue, Suile 203 Camp Ilill, Ph 17011 1.).q. J ._975-1838 z o 3 E ~ III ( 6) ___ 0.00 ( 71_.____-9.LQ.lL ( 91 _...L.O.1il..D.Q (11) 14,833.26 (12) (13, 793~_.._.. (131 0.00 (141 0.00 K ,06.. 0.00 _K ,15.. _~,~_____. (171 ---Q.~_.__ (19) __9-:_~.____ (1 q) _---.!l., 00 120) __.~___... (20AI .__ 1208) _________.__.... 8, Enlor Ihe 10101 olllno 20 and 20A on IIn. 208. Thl. I. Ihe BALANCE DUE. ./oIalc.! ~he~k..Payable to... Regl.ter .1 Will., Agent . . BE sun TO ANSWII ALL QUESTIONS ON RIVElII SIDE AND TO RICHICK MATH". Und(;;p;;;;~Tiio7'J"r~~ry~Tdeclartl th";jjThave oxanllned thl. relurn, Including accompanying IChe'duhn and stale monti, and 10 Ihe bell of my knowledge and bollef, II h Iru('l, corrll(1 nncl complete. I declartllhal 011 real Illale hot boen reporled 01 !rue market YCllue. Declaration 01 preparer other than the personal repre.enlative 11 balod on c I informo n of hich preparer nOt any knowledge. SfON,HCRi' Offieiis- 'if(sf t TSlETORfltiNORETURN--ADDkn-S--------------.---.- ~ I ('C' t.. n(( 1/1u'::" S') ," 'I ) f -, (1,10"", () I SIGN ReOF R - R Oft eR IlAN" Rf-pfEH.NfATI"r-'--~msd 1. Rool E'lale (Schodul. Al I 11 ______Q.!_O.Q... 2, Slock. and 90nd'ISchodule 8) I 2) 0.00 3, Clo,oly Hold Slock/Po,lne"hlp Inler..1 (Schedule C) (3) _______.....Jl~ 4, Marlgogo. and Nole' Recel,obl'ISch.dule 01 ( 4) _____.._~_,'OO 5, Ca.h. Bank Depa,l" & Mllcellaneou. Pe"anal Property( 5) 1.0~0.00 ISchedulo EI 6, Jolnlly Ownod P,opo,ly (Schedulo F) 7. T ran,fo" (Schodulo GllSchodule II 9, Tolol Groll Anel. 110101 line. 1.71 q, Funeral Expen.e., Admlnlllratl,o COli., Mlscellaneou. ( q) __--h?.'!1.8r'.__ Expo..e. ISchedul. HI 10. Debh, Mortgago llobllltle.. lien. (Schedule I) 11, Tolol Dedl/cllon. Ilololllno. q & 10) 12, ~lel Valu. 01 E,'alolllne 9 mlnu.llne 111 13, Cha,ltablo and Go,o,nmonlal 8equ,", (Schedule J) __._._ ~~ Nol Value Sublocllo Tax IlIne 12 mlnu.lI.. 131 15, Amounl of line 1410xable 016% role I'ncludo ,aluo. Ironl Schedulo K 0' Schedule M.I 16, Amounl of IIno 1410xablo 0115% '010 (Include valu.. from Schedul. K 0' Schodule M,) 17, Principal lax due (Add ladrom IIn. 15 and from IIno 16.1 19. Credi" Spau.ol Poverly Crodll Prior Paymenh Dlscounl Inler..1 .. --'.. -..-- + ---------- +---. - ---- lq. If Ilno 19 II groalor Ihan line 17, .nler Ih. dlKo,ence on line lq. Thl.I. Ih. OVERPAYMENT, m[1 20, If IIno 17 II greole, Ihon IIn. 19, 'nlo, Ihe dlKeren" on line 20, Thl.I.lh. TAX DUE, A. Enlor the intereSl on the balance due on line 20A. (10) ___.J.1Jla~L& (15) z o ~ !; ~ o l,l ~ (16) _____.__ Chock flDte if you ml! 1(.'C]'Je~ling n fc'u\ld 0' your oVClpUVlIll'nt. ,"(, (~ /).. , /,(, Yi DATe - ~~bt 156_. ..__.~_._------._--------------------------- .-. . ~~ COMMONWIAITH O. PlNHmVANIA INHUIlANCI TAl !IlUIN IUIDINT DICIDINT L SCHIDULI H . FUNERAL EXPENSES, . ADMINISTRATIVE COSTS AND MISCELLANEOUS EXPENSES PlulI Pllnl or T . J::.NUM." Wagenheim 1'\4l1l1lh(7."1 bT~fl OP Estate ot Sidney A. ITlM NUMIIER bl5CRIPTION AMOUNT A. .un.rClllxp.n.... 1. Reese Funeral Home, Harrisburg, PA $ 2,050,00 2. Kesher Israel Holy Society tor Burial $ 1,400.00 3. To reserve tor memorial stone engraving $ 150.00 II. Admlnl.trollv. Co.lI. I. Porlanal R.pr...ntatlve Camml..lanl Social S.curlty Number of Pellanal R.pr...ntatlvel - V.ar Com minion I pold 2. "'"arnty Fill Yotte & Yot te, P,C. $ 100.00 3. Family EK.mptlon Clolmant R.latlonlhlp Addre.. nf Claimant at fl.c.dent'l death Street Addren City Slate Zip Cod. 4. Probate Fill Cumberland County Register of Wills $ 51.00 (, Mlle.llan,oul Exp.nllll 1. 2. 3. 4. 5, 6, 7, 8, TOTAL (Alia .nter on line 9, Recapitulation) Ilf mar. Ipae. II nttd.d, Inllrt additional Ih..11 of lam. lIlt,) $3751.00