HomeMy WebLinkAbout94-00740
REV-1547 EX AFP (08.94*
COMHONWEAl Ttl Of PENNSYlVANIA
OEPAA1HEHT Of REVENUE
BUREAU Of INDIVIDUAL "XlS
DEPT. lSn601
ItAMRISBUAQ, PA 171la-C1601
ESTATE OF SMITH =----cATIlEll" >> =--====.-- FI"LiNO.
DATE OF DEATH 11-25-93 COUNTY CUMBERLAND
NOTE I TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBHIT THE UPPER PORTION OF THIS FORH WITH YOUR TAK
PAVHENT TO THE REOISTER OF WILl.S. HAKE CHECK PAVABLE TO "REGISTER OF WILLS, ADENT"
REMIT PAVMENT TOI
/
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11./ . /) "II ." /
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ACN
101
NOTICE OF INHERITANCE TAK
APPRAISEHENT, ALLOWANCE OR DISALLOWANCE
OF OEDUCTIDNS AND ASSESSHENT OF TAK
DEBRA K WALLET ESQ
24 N 32ND ST
CAMP HILL PA 17011
DATE 12-12-94
=
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
=nl. Rlnlt.!!~
CUT ALONG THIS LINE .. RETAIN LOWER PORTION FOR YOUR RECORDS ..
iiiV': iilCii' EX - "i=p'i 0 ii: 94")" No'fi ar -Ii f:' INH Eii if AN"c E - 'fAx" XP' PRX is EirE NT~" ii L rliWA ifc E' a-Ii -, - -,., - - -.'" - -"
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF SMITH CATHERINE FILE NO. 21 94-0740 ACN 101 DATE 12-12-94
If an assessmsnt was issued previouslY, 1in9s 14/ 15 and/or 16, 17 and 18
reflect figuras that inc1uda the total of ALL returns aSl9s.ed to date.
ASSESSMENT OF TAX:
15. Anounl of Llnl 14 It Spoulll rill (151
16. Anaunl of Unl 14 h.lblo II LlnlOl/ClolI A rlto U61
17. Anounl of Llnl 14 tl.obll It Collltlrll/Cllll Brill (171
lB. Prlnolpll TI. aUI
TAX CREDITS:
PAVHENT
DATE
08-24-94
TAK RETURN WAS I (X I ACCEPTED AS FILED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL
1. RIll EIIIII (Schldull Al (11
2. SIcckl Ind BondI (Schldull 81 (2)
5. Clcllly Hold SIcek/Plrlnlrohlp Intorul (Schldull C I (51
4. Horlglgl./Noll. Rlell.lbll (Schldull 01 (41
5. Cuh/Blnk DIPcll to/Hho. Plroonll Proplrly (Sehldull E I (51
6. Jolnlly O"nld PrcPlrly ISchldull FI 161
7. Trln.flr. ISchldul1 01 (7)
S. Tolol A..lto
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funlrll Expln.I./Adn. COIl./Hlsc. EXPlnsl. ISohldul. H) 191
10. Dlbto/Horlglgl Ulblll tlu/lllnl I Schldul. II UO I
11. Told Dlductlon.
12. N.I Vllul cf TI' RlIurn
15. Chlrlhblo/Oc.lrn.lntol Olquuto (SChldull JI
14. Nil VIlul of Eshtl Subj.et Ic To.
NOTE:
RECEIPT
NUHBER
MM912861
DISCOUNT (+1
INTEREST I-I
.00
-----6;573.60
AHOUNT PAID
I I CHANGED
.00
.O.n.,
.00
.00
10.00
50,913.00
.00
(SI
50, 9?3. 00
5,858.00
1 ,21,1.00
1111
U21
U51
U41
7.099 00
43,824.00
.00
43,824.00
will
.OOK'OO.
.00 X .06.
43,824.00 X .15.
UBI
.00
.00
6,573.60
6,573.60
TOTAL TAX CREDIT
BALANCE OF TAX DUE
-----.---
INTEREST
TOTAL DUE
6'573'60~
.00
.00
.00
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN II, NO PAVHENT IS REQUIRED.
IF TOTAL DUE IS RlFLECTED AS A "CREDIT" (CRI, YOU HAV BE DUE
A REFUND. SEE REVERSE SIDE OF THIS fORH FOR INSTRUCTIONS. I
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Rr.SERYATlOHI fltetl' of decldenh dvltlA on or blfor. D.o.llbtr U, 1982 .. If eny futurl Int,,"t In thl ""tl II tren,flrr.d
In Po.....lon or InJoY~.nt to Cle.. a (collat.ral) blneflclarl.. of th. d.cldlnt aft.r th. I~plrltlon of Iny ..t.t. for
11ft or for Yllr., the Co..on'lIlUh hll,.by .lcprlllh r...rVII th. right to lI"prolu Ind a..... trlln.fer Inh.rltlnc. h~..
dt th. 1.'1ful Cia.. D (colllterol) rat. on any .uch future Int.r..t,
PUIlPOSE OF
HOIlCE I
PAVHEHI I
REFUND (CR) I
To fulfill the r.qulr...nt. of S.otlon 2140 of thl Inh.rltanc. nnd E.tat. TaM Aot, Aot 22 of 1991, 12 P,S,
S.ctlon 2140,
O.tlch thl top portion of thl. Notlcl and .ub.lt with your pay..nt to thl A.gl.tlr of Will. prlntld on the r.v.r.. ,Id.,
--Hak. oh.ck or Illon.y ord.r payabl. tal REOtHTER OF MILLS, AOENT
All paYII.nt. r.c.lvld .hall f .Ir.t b. appllld to any Interut which I"lay b. due with M~ rlllalnd.r appllld to the tax,
A r.fund of a tll( cr.dlt, which wa. not r.qu,.t,d on the faM A.turn, ~ay bl r.qu..tld by co~pl.tlng an "Application
for Rlfund of P.nnlYlvanla Inheritano' and E.tate TaM" (REV-1313I, "pplloltlonl are Ivallable at the OffiCI
of the Algl.ter of Will., any of the 23 A.v.nu. Dt.trlct Offlc.., or by calling the .p.clat 24-hour
an.w.rlng ..rvlc. nUlllb.r. for for.. ordering, In P.nn.ylvanla 1-800-362-2050, out.ldl P.nn,Ylvanl. .nd
within 10c.1 tlarrltburg .rll (117) 787-8094, fOOl (717) 772-1.252 U1l1rlng tllpaJrld Onh),
OBJECTIONS, Any party In Inter..t not ..thUld ..ith thl appr.I....nt, allowanc. or dlt.Uowllnce of d.ductlon., or ........nt
of taM (Including d).count or Intir..t) a. .hown on thl. Hotlc. .u.t Object within .Ixty (60) day. of r.celpt of
thlt Hotlc. bYI
AOHIN
ISIRAlIVE
CORREClIOHS'
0lSCOUN1,
INTEREST I
"wrjtttn protllt to the PA nep.rt.,nt of R.venu., BOllrd of Appnll, DEPT, 281021, Harrltburg, PA 11128-1021, OR
"'laotlon to hay. the .att.r d.ter.lllld at audit of the ar.count of the Plrsonal rtprt,"ntaUVt, OR
.-apPlel to the Orphan,' Court,
Flctu.1 Irror. dl.cov.rld on thl. a.......nt .hould bl uddr.s.,d in writing tOI PA O.part.tnt of Rlvlnul,
!Iuruu of Individual Ta~.., ATTNI Post hllu.'nt R.vl.w Unit, DEPT, l80601, tlarrl.bura, PA 17128-0601
Phon. 0171 787-6505, S.. page 1 nf the bookllt "In.tructlon. for Inherltanol TaM R.turn for a Auldll1t
D.cldtnt" (REY-150}) for an IMpl.natlon of adlJnlstratlv.lY corr.otabl. .rror.,
If any taM due 11 paid within thr.. (3) callnder lIonth. after the dec.dent'. dtath, . flv. perc.nt (Sin dl.oovnt of
thl taM p.ld II' l'lIIOWlld,
Intlr..t I. eh.rg'd b.glnnlng with flr.t day of d'llnqu.ney, or nln. (9) .onth. and on. (II day fro. thl d.t. of
dtath, to the date of pay..nt. TalCU which blca.. d.lInqutnt b.fore J"nulrY I, 1982 bllr Interllt It thl ratl of
.Ix (6iO percent per annul c"lculat,d l'lt " d.lly rat. of ,000164, All h~.. which h.c.... dtllnqu.nt on and tfter
January I, 1982 will bear Interut lit (I rate which wll1 vary fro.. callndar Yllr to cahndar Yllr with that rat.
announc.d by the PA V.partll.nt of R.ytnul. lh. ftPpllcabl. Intere.t rat.. for 198Z through 1994 ar'l
'!!!! lnterllt R.te ['11111'1 Interut FMtor ~ tntlllr..t Rat. Dally Intlrest FtlCtor
1982 20% .00051+8 1986 10% ,000274
19U 16% .000438 1m 9% ,000247
1984 11% .00C3Ol 198'-1991 11% ,000101
1981 11% .000356 1l9Z 9% ,000247
1993.1994 7% ,000192
1995 9% ,u00247
--lnt.re.t Is cllculatld lI' follow.,
INTEREST . BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
'-Any Nollce I..u.d after the talC b.~o.'. d'linqu,nt wltl r.fllct an Int.r,.t calculation to flftl.n (15) d.V.
b.yond the date of the n........n\, If paY"lnt II Mlde aft,r the Intor..t cOllput"tlon d"t. .hown on the
Notice, additional Inttrlilt Illu.t bl calculat.d,
, '.
,
RII"'SOO t~+ 111-18}
~'J~'~ INHERITANCE TAX RETURN
...\V1~ RESIDENT DECEDENT
COMMONWfAllHO/PENNSYIVANIA (TO BE FILED IN DUPLICATE
Of PART ME NT 01 R\YfNUf
HARRIS~J:6: ~~t'!1280601 WITH REGISTER OF WILLS) COUNTY CODE
----.-----i"CEOfN-I~i' N""iiA"l;"",si, AND M'OOt! INli;Aq--- - ----.----.-----n--D'c-c,EN1;.,7&mm-Aoo'rs-s
ffi Smith, Cathedne Luc.i.lle, V'lK^ C. Luci Lie) 4:-9 ^ppletree Road
J_'!':';:~~'::~:':-== T7~;~~; ~ T:' I'; ;~',;: ,:,:P,:::,::; 1 :~,_ 170 1 ~ __ "'___
~ ~g It) 1. Original Rolurn 0 2 Supplemental R.'urn [! 3, ~~~d~;~,e~f~I~~;h prior to 12-13.821
"," [J 4, li",lled E'lole [J 40, FUlure Inl"." Compremilo 05, Fed.,al E,lote To,
C l?... Ifor dote, ef deolh alter 12,12.82) Rulurn Requir.d
~1Il l{J 6, Dlced,nl Dlod Te'lole 0 7, Decodcnl Moinlolnod 0 living Tru,1 ~ 8, Tolol Numblr ef Sofo Dopo,11 Bo,e,
c( (Allach copy of Willi IAlloch copy 01 Tru'II
---- ALLCOriRUPONDENC! AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO.
I ~ ~NAM - :=]COMPUil MA"'NG:;;OOOnr--
~ Q Debra K. Wa.l.let, Esquire 24 NQr~h 32nd Street
S~ rIiffifONfNUMBrr----- , Camp IIlJ.1, P^ 17011
u..
-L~~ 737 -13 00 _'_______ _
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1. Real E"o" (Sch,dulo AI ( 1) __________
2. Slack. and Bond, (Schedule BI I 21 ___._________
3, Clo,ely Hlld Stock/Porlne"hip Inlerl" ISchodule q I 3) __.
4, Mortgogo. and Ne", Rlceiyoble ISchedule D) ( ~I _
5, Cosh, Bonk Dopo,i" & Mlscellonoou, Pe"onol Properlyl 51 .
(Sc.edule E)
6, Jointly Owned P,oper1y ISchedule F)
7, Transfer, (Sch,dule 01 ISch.dull l)
8, Telol Grall All'" (tololline, 1.7)
9. Funeral El<penses, Adminislralive COlli, Miscellaneous ( 91
E.pense, ISchedul, HI
10, Dobl', MOrlgoge liabllltio" lion. (Schedulo I)
11. T 0101 Doductio", Ilolollin" 9 & 1 0)
12, Nel Yolue 01 Ellolllline a mlnu,lIno III
13, Chorltobll and Oovor"m.nlol aoqu.", ISchedulo JI
14, Nel Yoluo Subjl" to To~~u'lin' 13!
15, Ameunl of Ilnl 14 lo.able at 6% rotl
(lncludo volu., Irom Schedule K er Schodull M,I
16, Amounl el line 14 'o.oblo 01 15% rOle
(Includl volu" from Schodulo K or Schodule M,)
17, Princlpelte, due (Add 10' Irom line 15 and from linl 16,)
18. Credia Prior Paymenll Discounl Interelt
----, + ------ - -------
19, If Ii no 18 i. great., Ihon line 17. .nl.r Ihe diHorence un line 19, Thills Ihe OVERPAYMENT.
E!o Iwmn.~I'.I_Tl'J'.ill""II~!JI}HI,r'.!.r.1m':TlI'I.'L'lIl. 'l'll.lIb'lJlhIUG
20, If line 171s groole, than line 18, onler Iho dlffor.nee on line 20, Thi., il Ih. TAX DUE.
A. Enter tn~ interesl on tho balance due on linfl 20A,
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'ILI NUMBU
t5(/-
9'1
74./0
VEAR______,_NU~BER
J 0 00
I 6) -----5-0. 913 . 00
( 7) ___._
5... 85 8. 00
I 8)
50.923.0~___
(10)
J..24J .00
(II) 7,099.00
(12) _43,824.00
(131 0
(14) __ 43,824.00
(15)
.----
__~,0611
---------
(161 -----.! 3 , B~.~~ ___ ~ 15 II
6 , 5lhPL_._
(17)_ 6.573.60
(181 .
(19)._______,___
1201 6..2l;LL9.Q._____
(20A) _________
{20BI ----u-,..5..:l-3-.-6-0-____
B, Enllr tho 10101 ef line 20 and 20A on linu 20a, Thi, " Ihe BALANCE DUE.
Makl Chick Povobll 101 RIollllr 01 Will" >:uenl
.. "BE SURE TO ANSWER ALL QUESTIONS ON REVIRSE S1DEAND TO RICHICK MATH... ,
Undo, penollio, el perlury, I doclere Ihol I ho" u,ominod this ro"'rn, including accompanYing "',dulo, and uelemenii:"Ond to 'he bOIl 01 my knowledgo and beliof
"I, IrVl. cerro" and completo, I doclore thol 011 real "'010 hot boen reporl,d ellrul ",orko' voiuo Coclorellon ef preparer ol'er thon Ih. perlonol rep,ol.n,olive i.
ba,ed on 011 Information of which preparer hos any knowledge.
SlOt<oi'luR' OIP/EON. S'ONSli" FO' ,iiliNGri'juiN----,;EiiiiW-- "--- OAT!
};d/M-plP1 ,-, /j~?L 42~_,^P!?~tr~~_~~cJ..'_,c:.c:'!1.!J lIill, P~OJl __. 9(~3lq..,
Sld",lUif~m I r, HAiI'i!\PRESENl.\t,vI AllOr:ESS OAT!
-~1(<' :to / ~-----'--h_"__.2~_ _~~ 2 n~~~_'h~_~~I'.1l:.Ji~~^ 170 J J ---i1ill1i__
"
LAST WILL OF C. LUCILLE SlofIT~
r 0.. Lucille Sllith aad/or Oatherine Lucille SIl1 th
ot 429 App19tree Rd., Caap Hill. Cuaberland Couaty, PenasYlvania
17011, being ot souDd and dispoeing Mind. aeaory aDd undorstand_
ing, do aake, publish aad decl~re this to be ay last Will and
testaaeat. hereby revoking aDd aaking void any aad all wills or
codioile by ae at any tille heretofore lade.
I direst that all debts and tuneral expenses be
paid by ay Executrix h9reinatter naaed, as soon atter .y decesa
as practicable.
Alb the rest. residue and remainder cf IIY estate,
,
real, personal and lIixed. whersoever the Sallie bs situated I I
give, devise and beqeath to IIY sister Martha Jane Smith.
I nOIDinato, constitute and appoint Martha Jane
Saith as Executrix ot this ~y will and testament.
In the event that Martha Jane SlIith should predecease
ae. I give. deviso and bequeath my entire estate to my niece Ellen
Marie Coggins and my nepher John P. Herllan Jr., absolutely and in
tee aimpley in equal shares.
In the event that Hartha Jane Smith should prodecease
me, orin the event she decline or tor any reason be unable to
qUalify as Bxecutrix. I nominate, constitute and appoint my
niece Ellen Marie Coggins Executrix and my nephew John P. llerman
Jr,Executor as this my last will and testment.
\
'J'i
IN WITNESS WHEREOF, I, C. LUCILLE SMITH, testatrix
have hereunto set II,Y hand I~ day of April, A. D'I 1992
.
~~
........,.. SIGNED, AND DECLARED by the above nailed C. LUCILLE
SHITH, the testatrix, as and her last will and testament, in the ".
pre,senoe of us who have whereunto subsoribed our name at her re-
quest, as witnesses thereto, in the presenoe ot said testatrix
and each other.
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BSTATI 0'
Smith, Catherine
\ JOINTLY~b~~~~Ep~OPERTY . i _ ~
~:fl ~~ AKf\___~~~,--~-~~le)u___-_J P1Le_:UM~IR
Uv.\$09IK+ tn.1I1
~
COMMONWI~\'H O' .eNNmV~NI~
INHIRI'~NCI ,~x RIlURN
R1!IDINT Dice DeNT
Joint tonont!.l'
p' . ..' ' NAME' ADDRUS RELATIONSHIP TO llECEDINT
--------------- ------------.---.---- --- -
A, Martha Jane Smith 429 Appletree Dr. Sister
Camp Hill, PA 17011
B.
C.
-
Jolntly.ownld p,o,orty' '
---
ITEM LeniR DATI
'OR TOTAL VALUE DECD'S OOLLAR VALUE OF
NUMBE JOINT MADE OISCRI'TION 0' PROPERTY 0' ASSET % INT. DECEDENT'S INTEREST
TENANT JOINT
.------------ -'---~---
I. A. approx Dauphin Deposit Bank 2,259.26 50% $ 1,129.63
1992 Acct #0028855264
2. A. 1956 Real property - 429 97,300.00* 50% 48,650.00
Appletree Rd. I Camp
Hill, PA
(orig. owned by 3 sis-
ters/ Alice H. Smith
died 12/13/73)
See attached Deed
3. A. more Defense Activities Fed- 2,266.97 50% 1,133.49
than eral Credit Union
10 yrs 5275 E. Trindle Rd.
P. O. Box 40
Mechanicsburg, PA 17055
*Valuebased upon assess-
ment of $7,590 and recog
nized ratio of 12.82 for
Cumberland County
___ _..____________....._ __.____..... _."n_'." __ ..------ .-,-.--------..--~
TOT AL (AI.o enlo' on IIno 6, Rocepllulotlon) S 50 , 913 . 12
________._.+___.._...--....~.. ..___________________~____ 4 .-
(U mora spoco I. noodod Insort oddiliono/shoolS 0/ sarno Sil.)
-
DOUK X 1'j p/\(i(Z56
~o... No, 11-0DBO PROM A CORPORATION. A" 1901.
" '''1Il
I:,,.HI'
.~: :'~'":\"r:~l1t~. ~nbtnture,
Ilj"f"fll
. ~',',
.,'t
'\/'.'
.ldl, I~t "'.~ .111)' "e July A. Il. """ tllo"Hllllllllllle
hundred lad FiftY-Beven (1957) 1,!'lIYCCII tile CorJlo,"l1ol1 hy tile 1I01lle,
'1111e and UlIe ol CAMP H140 D,lWELOPH1!lJT CO., INC., 01' the Oity 01' Harrioburg, County of
'Dauphin, and State 01' Pennaylvnnia, GRANTOll, party
of the one Jlarl and
,! ALICE II. SillTH and O. LUOlLLE SHITII ,and NAH'l'IIA JAN/\ SHl'fII, an' jo~nt
.;' i,,,~enanto with th~..,l\ig~t, ,of" surytvorDI,lip and not aD tonants in cOOlmon, of the Uorough
, .. . 'Iof~ CaOlp lIill ",',':Q: 1" 1,"" .. CooIII)' of CUOIberland :',.:' :
I , I , \',' , 'I' I '11 \' , ~ I
, I'" ,,' ,l!(I '
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In Ihe Slote ol Penneylvnnia, GHANTEES, partieo
of Ill. oU"" Jlllrl .Ul1l'll1ll't~
That the laid Camp Hill Development Co., Inc.,
Ilderallon of the lum ol Three Hundred Seventy and No/loo (:t~70.00)- - -
lor and In COli
_ _ _ _ _ _ _ _ _ _ DolIlI"',llIwlul lIIoue)' 01 th. Ulllled SllIle_, to II In hond Jlllld hy the laid
par~ies of the second part
. .
althe tllIIO 01 the elecuUon he,rol, Illo rccelpl "hcreol ). hereby. leknowlcdgcd, hllH granted, bllrgalncd, 101d,
olloned, onlooffed, roloa.cd /lnd l'OII",mod, alld b, theao p,,,ollta doe. granl, hll,glllll, aoll, IlIcn, enfeoff, '0.
le.ao Ind confi,m unlo Iho aald parties of the second part, thoir heirs
IIl1d alllgnl,
~lIlhal certain I!lece or parcel 01 lalld, alluate in the Borough of Camp lIill, County of Cwnber1e.nd
and state 01: Pennsylvania, more particularly boundod and described as follows, to
wit I
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BEGINNING at n point on the East side of Apple Tree Road at the Southwest
comer of Lol:, NI). 42, Section "BII on tho hereinafter ment~oned P11n of Lots; throce
along the Southern line of Lot No. 42, Section "BII, North 75 degrees 49 minutes
~st, a distance of ninety-nine and six hundrodths (99.06):fee~ to a point; thence
North 12 degrees 15 minutes Hest, a distance of ten (10) feet to a point; throoe
South 75 degrees 49 minutes ~Iest, a distanco of ninety-nine and six hundredths
(99.06) feet to a point on the East side of Applo Tree Road; thence along the
East side 01' Apple Tree Road, South 14 degrees 11 ndnuto3 ~ast, a distance 01' ten
(10) feet to a point, the place of BEGINNING.
BEllIG the 1J0uthern tsn (10) feet of Lot No. 42, Hevisod Plan 01' Section liB 11 ,
Country Club Hanor, said Plan being recorded in tho ClUl1berland County llecorder I s
Office in Plan Book 8, page
'"
BEING a part of the sarno premises which North Bridge Development Company
by deed anted June,,29, 1954 lInd. recorded in the Cw1ilerlond County Recorder's Offioe
,.in ,Deed !look "VII Vol. 1,5, page 445, grantod and conveyed \Ulto Camp Hill Development
Co., Inc., party of the first part hereto.
:~~~: UND)'i'..R AND"SuBJElJT, novortholeso, to rootrictiollll contained in Hioc Book
113, pago 204.
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CAMP HI LL SCHOOL DISTRiCT
REAL ESTATE T~ANSfER TAX
::1~~'1~~~~7
. Y . AGlNI
.
UV.ISH '.'l""1
SCHEDULE H
,,~~*:~~ FUNERAL EXPENSES,
COMMONWEA'I;'; o;~EIINmV^NIA ADMINISTRATIVE COSTS AND
IN~\~:b~~~!oi~'[W~RN MISCELLANEOUS EXPENSES Plla.. P,lnl 01 Typ.
ESTAT~_~PS~-~t~,.-;a.t.~~.';_i~~;~:_~.~~~~l ~~_i_~;~_.~~~.u: i~~_LUM8EA -- ___.__
N~~~ER DESCRIPTION AMOUNT
A, Funllal bpln..ll
------- ---.-- -.--._---'_._._._---_.~--._-_._----_..._--_._-_._------
1.
Spencer W. Arnold Home for Funerals
32nd & Brisban Sts,
Harrisburg, PA 17111
(Comprehensive fee for funeral)
$ 5,343.14
8,. .
1.
Admlnl.tratlvl Co.lI,
Personal Represenlatlve Commllllons
Social Security Number af Personal Representative,
Year Commissions paid _______
2.
Alloranr Fees Debra K. Wallet, Esquire
500.00
3. Family Exemption
Claimant . __..__.. Relationship
Addrell of Claimant at decedent's death
. Street Address ___
City ----~..-
4. Probate Fees
C. Mllclllanloul Explnll"
1.
2.
3.
II.
5.
6.
7-
8.
Stale _'--- Zip Code
.15.00
',.
TOTAL IAlso enter on line 9, Recapltulatlonl
(If more Ipace II n..ded, Inllll addltlonallhoell of lame 1111.)
$ 5,858.14
.'