HomeMy WebLinkAbout94-00754
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. REV-r37 EX AFP (10-93* NOTICE OF NONRESIDENT INHERITANCE
<""""""'At T1I Of PEHHSYlVAH" TAX APPRAISEMENT, ALLOWANCE OR
~U::::~"':T ,:::;,:r.:i~ TAll[S DISALLOWANCE OF DEDUCTIONS,
OCPT. 11060\ AND ASSESSMENT OF TAX
IIARR1SIURQ, PA 17128-0601
ES AT OF DIXON GEORGE
DATE OF DEATH 08-28-93
ACN
101
DATE
08-29-94
F
.ll.1-~5Lf
TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBHIT THE UPPER PORTION OF
PAYHENT. HAKE CHECK PAYABLE TO "COHHDNWEALTH OF PENNSYLVANIA"
FILE NO. 99 94-0312 ~J . J
DOMICILE NON-RESIDENT r/eJr/tll.,
THIS NOTICE WITH YOUR TAK
NOTE.
REMIT PAYMENT TO:
HENRV W RHOADS
PO BOX 1146
HBG
PA 17108
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
A..ount R...IUad
CUT ALONG THiS LINE So- ~:7A:~ LoWErt PORTION FUR YOUR REconDS ~
iiiV' =S3Y"EX--liFiiTiii:-93j"-Noi'"icE-oF-NiiNREs"iiiEtWi'NHER"ifANcE"-i'iii- ii-P-PRii"isEiiENT;--liiI.iiwANifE" iiif ---
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF DIXON GEORGE F FILE NO. 99 94-0312
TAK COHPUTATION HETHDO ELECTED. (X ) FLAT RATE C) PROPORTIONATE
TAX RETURN WAS. (X I ACCEPTED AS FILED (I CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. R..l eat.l. (Schedul. AJ el)
2. Stock. and Bond. (Schedule 8) (2)
3. Clos.ly Hald stock/Partnership Int.r.at (Schedule CJ (3)
4. Horta_g../Nat.. Receivable (Schedule OJ (4)
5. C..h/Bank Oapodta'Hhc. p.,.sonal Property (Schedule EJ CS)
6. Jointly Owned Property (Schedule fJ (6)
7. Transfers (Schedule tJ (7J
8. Total A..at.
ACN 101
DATE 08-29-94
c',
730.000.00
.00
,DO
.00
.00
.00
.00
(8)
730.000.00
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funaral E~pansas/Adnlnl.tratiYa Cost.1
Hi.callan.ous E~pan.a. (Schadul. H)
10. Dabt./Hortgaga Liabllitias/Llan. CSchadula I)
11. Total Daductions
12. N.t Valu. of Ta~ R.turn
13. C~~rltabla/GoYarn.antal Baqu..t~ ISchedula J)
14. Het Valua of E.tat. Subjact to Tax
(9]
1101
.00
.00
(111
1121
IU)
1141
.00
730,000.00
.00
730,OOU.OO
If an assassment was i8sued previOUSlY, lines
refl~ct figuras that include the total of ALL
ASSESSMENT OF TAX: -
15. A.ount of Lina 14 ta~abla at 6% rat. (15)
16. A.aunt of Llna 14 ta~.bl. at 15% rat. (16)
17. Principal raM Du.
TAX CREDITS:
PAYHENT
DATE
05-25-94
14, lS and/or 16 and 17 will
returns assessed to date.
NOTE:
730,000.00 X.Db =
.00 X.lS =
1171
43.800.00
.00
43,800.00
RECEIPT
NUHBER
866798
DISCOUNT
INTEREST
1+)
I-I
.00
AHOUNT PAID
43,800.00
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST
TOTAL DUE
43,800.00
.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 "CREon" (CRI, YOU HAY 8E DUE
A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. I .1
-,,~--.
RESERVATlDM. E.t.t...f d.c.....t. d,ln. on .. ..f..' Doc..... U, 191' -- If .., futu" 1n.....t In tho ..t.t. 10
t....f.r..d In po.....lon .. ..l.....t t. CI... I (c.llot...1I .-f1cl..1.. .f tho _t .ft.. tho ..pl..Uon .f .., ..t.t.
f.. 11f. .. f.. ...... thO C........lth hO.... .......1. ........ tho .1""' .. ..,..1.. end .,.... ..on.f.. Inhe.I..... ,....
at the lawful Cia.' . (collataral) rata on any .uch futura Intara.t.
pURPOSE OF
NOTlCEI
To fulfill the raqulraaant. of Sactton 21~0 of the I~rttenc. and E.tat. T.. Act, Act 22 of 1991. (72 P.I.
Sactlon Zl~O).
An, p..t. In 1nt.r..t not ..tl.fl... with thO ..,r.I.....t. .11...... .. dl..ll.wonc. .f deduc.lon., .. ....,..ont
of t.. (Ineludlng dl.count .. 1nt.r.." .. .hown on thl. Hotlc' ou.t ..'oc' within .I.t. (6.' d.,. .f ..c.lpt .f
th" Hotlce,
-ObJection. aay be dde byl
_.w.1tton prot..t to th. PA D'P..t.... of R..'nu., lo.rd .f Ap...l.. D.pt. .11..1. H...1.",., PA 171.1-1..1, DR
.-.lactt~. to hava the .attar datar.ln-d at .udlt of the par.onal r.pr..ent.tlv., DR
__appaal to the Orphan.' Court of Dauphin County, Court Hou'" Harrl.bUr., PA 171al.
OBJECTIONS I
ADIUN-
ISTRATIVE
CORRECTIONSI
FDCt~1 arror. dl.cov.r.d on thl. .......ant .hoUld ba addr...ed In writing tOI PA n.part.ent of A.v~.
BuralMl of Incllvldu.1 T.II'" AnHI po.t A......ent Ravl... Unit, Dept. 210601, HarrisbUrg, PA nUI-D6al
PhoM (7171 117-6505. S.. pa.a S of tM bookl.t ..tn.truction. for Inherltanc' hI( R.turn far a Hanratldent
Decadent.. eREV.17S6~ for an 'lIplanatlon of adalnl.tr.tlv.ly carractabla arror..
DlscOUNTI
tf eny tall dUa I. p.ld within thr.' eS) ~th. .ftar the dac.dent'. daath, a dl.count of flv, parcant (SX~ of
tha ta. paid I. allow.d.
A ..fund of . t.. c....lt, which w.. n.t ..ou..t.d on Ih. ,.. R.turn. ... .. "ou,,'.d .. c...l.tlng on -Ap.11c.tlon
for Rafund of ptnn.vlvanl. Inherltanea and E.tat. Tall" (REV-ISIS). Appllcatlont ara .vallebla at tha of,lc.
of th. R..I.t.. of .111.. ... .f th. '5 R...nuI DI.trlct Dfflc" o. f... thO D.p..t..nt'. "-hou' ......In. ...u1c,
~r' for 'or.' ordarlngl tn Pann.ylvanl. 1-100-S62-Z050, out.lda p.onlylvanla and within loc.l Harrl.bUra ar.a
(717) 717-0094, TOOt (7171 772-2252 Uta.rlna 1_.lrad Only).
REflJMO (CR~I
IHTEREST I
Int.r..t I. ch.r..d b..lnnlng with f1..t d.. of d.llnou.ne. .. nln. (91 .onlh, ond .n. (II d.y f.o. th. d.t. .f
d..th to thO d.t. of .....nt. ,.... which ..c... d.llnquont ..for. Jonu.r. I. 1.8. b... Int...'. .t .h. r.t. .f
.1. ,'Xl p.rc..t p.. onnuo c.lcul.t.. .t . d.ll. ..t..f ....1... All t.... which ..c... dol1nquont on end .ft..
January I, 1912 will bl.r Intlr..t at a r.t. which will varv froe calendar v.ar to cal.nd.r yaar with that rata
announc.d by the PA O.part.ant of R.venu.. Th' applicabl. Int.r..t rat.. fDr 1'02 through 199~ areS
~ Interllt Rat. n.Uy Int.rnt hctor ~ Int.rllt Rata n.llv Int.ra.t FlICtor
1912 .OX .000541 1916 lOX .00n74
1915 I'X .OOOUD 1917 .X .000241
1'1~ 11% .oonn 1'11-1991 m .Doosal
19115 uX .oon~ 199' .X .oonu
19U-19CM 7X ,OOn92
--Intlrllt II ulculltlld .. fallowll
TO REKIT
PAVKEHT I
INTEREST a BALANCE OF TAX UNPAID X NU"BER OF OAYB DELINQUENT X DAILY INTEREBT FACTOR
--Any Hotlc' I..uad aft.r the t.. b.eoe.. d.llnquent will r.fl.ct an Intlra.t calcUI.tlon to flft.an (151 dav'
b'Yond thl d.t. of the .......ant. If plyaant t. .ad. aft.r the Int.r..t c~t.tlon data .hown on the
Notice, addl tlonal Int.ra.t w.t be ulculltad.
D.tech tha top portlon of thl. Hotlc. end .Ubelt with your plyaant to PA D.part.ant of R.venue, .t the Iddr."
shoWn an tha rav.r.. .Ida.
.Hak. chick or ~.y ord.r payabl. tDI cOnnONMEALTH OF PENNSYLVANIA
All........ ..c.l.od .h.ll .. appllod fl.,t to on. In..r..t ohlch ... .. duo with on. ....lnd.. oppll.d t. tho t...
I" I'Hrlll."1
~
COMMONW(AtfH Of '(NNnLVANIA
D('ARfMfNf Of I(VfNUf
INHunANCI fAX InUIN
NONII&IDINf Dle.DIN'
E~'AIf Of
NONRESIDENT DECEDENT
SCHEDULE A
PART 1
REAL PROPERTY SITUATED
IN PENNSYLVANIA
Pl.a'. P,inl 0' fyp. olll"formalion
fiLE NUMBER
GEORGE F. DIXON, JR.
Part I mull Include all ',01 property owned by the d,cedenllndivldually 0' 01 tenanlln common with anothe, parlyll.I), having Itl litulln P,nnlyl.,anla.
(P,ap"'y lolntly.awned with Righi of Survl.,onhlp mu,t b, dilClaled on Schedul, f.1 All ,eal 'Itotl mUll be "ported at fal, market .,alu. which II
d,flned 01 Ih, price 01 which pror,ny would b, I.Itchangld b.lween a willing buyer and a willing "Iler, n,ith., bllng compelled 10 buy or lell, both
ha.,lng realonable knowledg, 0 ,h. "I,vant fadl.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT
DATE OF DEATH
Sheaffer Farm - 129 acres of farmland, improved with a
single barn, Souch Middleton Township, Cumberland Councy,
PA, more particularly described in the Cumberland County
Recorder of Deeds Office at Deed Book B, Vol. 20,
p. 434 - per attached appraisal
$730,000.00
0'-'
.
L::.l
I',;
:,
TOTAllPART II $
TOTAllPART 2) (Proportiono'e Method Only from rove..e 'ide) $
730 000.00
GRAND TOTAL !AllO enler an IIn. I. R.capllulalionl
(If more ,poco I. n.ed.d. in..rt odditlonol .h.." of .om. .1...1
S
730 000.00
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.
Elill/bh/BE'l'II15/5-)" ,85
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LAST WILL AND TESTAMENT
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Q.E
GEORGE F. DIXON, JR.
I, GEORGE F. DIXON, JR., of Fort Lauderdale, Florida,
being of sound and disposing mind and memory, do make, publish
and declare this to be my Last will and Testament, hereby
revoking all Wills and Codicils by me at any time previously
made.
ITEM I:
All inheritance, estate and
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similar taxes becoming due by reason of my death, except any
taxes relating to generation skipping transfers imposed under
Chapter 13 of subtitle B of the Internal Revenue Code, as
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amended, ("Death Taxes"), whether such Death Taxes shall be
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payable by my estate or by any recipient of any property, shall
be paid by my Personal Representative out of the property passing
under ITEM IV of this Will as an expense and cost of
administration of my estate. My Personal Representative shall
have no duty or obligation to obtain reimbursement for any Death
Taxes paid by my Personal Representative, even though paid with
respect to proceeds of insurance or other property not passing
under this will.
ITEM II:
I hereby exercise all powers of
(1:) appointment which I may have at the time of my death in favor of
G'\ my Personal Represent".tive, and all property subject to all such
powers of appointment shall be included in my estate and be
governed by the provisions of this WillI provided, however, that
Page 1 of 6 pages
I specifically decline to exercise any power of appointment given
to me in any Will, Codicil, Agreement of Trust or other
instrument executed by my wife, LOTTIE IVY DIXON ("My Wife") .
ITEM III:
I hereby declare that all
household furniture and furnishings, books, pictures, china,
silverware and all other like articles of household use or
adornment (but not including my automobiles, jewelry, wearing
apparel and like articles of personal use or adornment) are owned
jointly by My Wife and me. If I predecease My Wife, I give and
bequeath to her my automobiles, jewelry, wearing apparel and like
articles of personal use or adornment. If My Wife does not
survive me, I give and bequeath to those of the following of my
children, GEORGE F. DIXON, III, RICHARD E. DIXON, MARSHALL L.
DIXON and CHARLOTTE I. DIXON, who are living at my death, in
equal shares, all of said articles that were jointly owned by My
Wife and me and all of my automobiles, jewelry, wearing apparel
and like articles of personal use or adornment, in as nearly
equal shares as they shall select under the supervision of my
Personal Representative. If any such articles cannot be fairly
divided or distributed in kind in the opinion of my Personal
Representative, such articles shall be sold and the proceeds
thereof shall pass as a part of my residuary estate.
ITEM IV:
I give, devise and bequeath all
the rest and residue of my property, real, personal and mixed,
not disposed of in the preceding portions of this Will, to the
then Trustee of "The George F. Dixon, Jr. Revocable Trust"
Page 2 of 6 pages
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created by a trust agreement dated the same date as this will
between me, as Settlor, and DAUPHIN DEPOSIT BANK AND TRUST
COMPANY, as Trustee.
ITEM V:
No interest in income or
principal of my estate shall be subject to attachment, levy or
seizure by any creditor, spouse, assignee or trustee or receiver
in bankruptcy of any beneficiary of my estate prior to the
beneficiary's actual receipt thereof. My Personal Representative
shall pay over the net income and the principal to the
beneficiaries herein designated, as their interests may appear,
without regard to any attempted anticipation (except as may be
specifically provided herein), pledging or assignment by any
beneficiary of my estate and without regard to any claim thereto
or attempted levy, attachment, seizure or other process against
said beneficiary.
ITEM VI:
In the settlement of my estate,
my Personal Representative shall possess, among others, the
following powers to be exercised for the best interests of the
beneficiaries:
(a) To retain any investments I may have at my
death so long as my Personal Representative may deem it
advisable to my estate so to do.
(b) To vary investments, when deemed desirable by
my Executor, and to invest in such bonds, stocks,
notes, real estate mortgages or other securities or in
such other real or personal property as my Personal
Representative shall deem wise, without being
restricted to so-called "legal investments."
(c) In order to effect a division of the
principal of my estate or for any other purpose,
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including any final distribution of my estate, my
personal Representative is authorized to make said
divisions or distributions of the personalty and realty
partly or wholly in kind. If such division or
distribution is made in kind, said assets shall be
divided or distributed at their respective values on
the date or dates of their division or distribution.
In making any division or distribution in kind, my
Personal Representative shall divide or distribute said
assets in a manner which will fairly allocate any
unrealized appreciation among the beneficiaries.
(d) To sell either at public or private sale and
upon such terms and conditions as my personal
Representative may deem advantageous to my estate, any
or all real or personal estate or interest therein
owned by my estate severally or in conjunction with
other persons or acquired after my death by my personal
Representative, and to consummate said sale or sales by
sufficient deeds or other instruments to the purchaser
or purchasers, conveying a fee simple title, free and
clear of all trust and without obligation or liability
of the purchaser or purchasers to see to the
application of the purchase money or to make inquiry
into the validity of said sale or salesl also, to make,
execute, acknowledge and deliver any and all deeds,
assignments, options or other writings which may be
necessary or desirable in carrying out any of the
powers conferred upon my personal Representative in
this paragraph or elsewhere in this Will.
(e) To mortgage real estate and to make leases of
real estate for any term.
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(f) To borrow money from any party, including my
personal Representative, to pay indebtedness of mine or
of my estate, expenses of administration, Death Taxes
or other taxes.
(g) To pay all costs, Death Taxes or other taxes,
expenses and charges in connection with the administra-
tion of my estate, and my personal Representative shall
pay the expenses of my last illness and funeral
expenses.
.-
(h) To vote any shares of stock which form a part
of my estate and to otherwise exercise all the powers
incident to the ownership of such stock and to actively
manage and operate any unincorporated business,
including any joint ventures and partnerships, with all
the rights and powers of any owner thereof.
page 4 of 6 pages
(il In the discretion of my Personal
Representative to unite with any other owners of
similar property in carrying out any plans for the
reorganization of any corporation or company whose
securities form a part of my estate.
(jl To assign to and hold in my estate an
undivided portion of any asset.
(kl To hold investments in the name of a nominee.
(11 To compromise controversies.
ITEM VII:
In the settlement of my estatel
(al My Personal Representative shall not be
personally liable for loss to my estate or to my
spouse's estate or to any beneficiary of either estate
resulting from my Personal Representative's decision
made in good faith whether or to what extent to elect
on the federal estate tax return prepared on behalf of
my estate to have a portion or all of certain
"qualified terminable interest property" treated as
having passed to my spouse in order to qualify for the
federal estate tax marital deduction; and the decision
of my Personal Representative shall be binding and
conclusive upon all beneficiaries of my estate,
including the then trustee of any inter vivos trust
created by me which constitutes a part of .my federal
gross estate.
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(bl My Personal Representative shall not be
personally liable for any loss to my estate or to any
beneficiary of my estate resulting from an election
made in good faith to claim a deduction as an income
tax deduction or as an estate tax deduction; nor, as a
result of such election, shall any compensating
adjustments be made between income and principal or in
the amount of any gift under this Will to my spouse
intended to qualify for the marital deduction for
federal estate tax purposes.
(cl In valuing property in my gross estate for
the purposes of any Death Tax, my Personal
Representative shall not be personally liable for any
loss to my estate or to any beneficiary of my estate
resulting from my Personal Representative's decision
made in good faith to use a particular valuation date;
nor, as a result of such decision, shall any
compensating adjustment be made in the amount of any
gift under this Will to my spouse intended to qualify
Page 5 of 6 pages
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for the marital deduction for federal estate tax
purposes.
ITEM VIII: I hereby appoint My Wife, GEORGE
."....
F. DIXON,111.-and RICHARD E. DIXON as Co-Personal Representatives
of this will. If for any reason one of them should fail or cease
to act, the other or others shall act or continue to act with all
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of the powers granted to the three of them. All references in
this Will to my "Personal Representative" shall also refer to my
Co-Personal Representatives or to my sole successor Personal
Representative, as the case may be. The Personal Representative
shall qualify and serve without the duty or obligation of filing
any bond or other security.
IN WITNESS WHEREOF, I have set my hand and seal to
this, my Last will and Testament, consisting of this and the
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preceding five (5) pages, this It:. day of
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1985.
Page 6 of 6 pages
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~p 5?~r (SEAL)
George F. Dixon, Jr.
I.D
We, the undersigned, hereby certify that the foregoing
will was signed, sealed, published and declared by the
above-named Testator as and for his Last Will and Testament, in
the presence of us, who, at his request and in his presence and
in the presence of each other, have hereunto set our hands and
seals the day and year above written, and we certify that at the
COMMON~IEALTH OF PENNSYINANIA
COUNTY OF !J(}I Y').'I/; ,I
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We, GEORGE F.
..JIrr,d'f/ II <>.\mil-J. J , and I ,
and the itnessos rospoctive y, WIOS names re signed to tho
foregoing instrumont, being first duly sworn, do hereby declare
to the undersigned officer that the Testator signed the
instrument as his Last Will and Testamont and that he signed
voluntarily and that oach of tho witnesses in the presence of the
Testator at his roquest, and in the presence of each other,
signed the Will as a witness and that to the best of the
knowledgo of oach witnoss tho Tostator was at that time eighteen
or more yoars of age, of sound mind and under no constraint or
unduo influenco.
t. .~ ~, l~
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oV'(':..,-, .' ,~', " ~ t' I . .
George' F. Dixon, Jr. .
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Witness (
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On this, the J(;-Ilo.n_ day of l;r)(lJj' , 1985,
me, a notary pub~the undersigned/officer, personally
d GEORGE '. I? XON, JR., f;,.'( OIJrJi s 'rh~. 'tW ,
. ., and ("JI(/'I'E.~, () Ft-;J1; known to me
or sat sf ctor y proven) to be the pe ~ons w ose names are
subscribed to the within instrument, and acknowledged that they
executed the same for the purposes therein contained.
IN WITNESS WHEREOF, I hereunto set my hand and official
seal.
4Ll'U"VlO I" IHi OlllCI'\l ifU:OttO) tiOOIC
VI 8!ONI,RO cou~l\. IlURIIl~
CUll 1m ~nMI~I,IHMUR
V?/M{I~ tJOL',f{fl"t.kJ
Notary P lic~ :.
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My commis~ioJ}Expiresl
(SEAL) '. NANCY LEFn"lICH
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HllHbbl,. \:, ~:,~':}:,in \..OlOnty
Mi C.:rr,iliii.:..1l Ei~U:!G (J;L 3, ~:l37
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Po .tlAlLY CIRTlfY tt.o ..""In ond .......... II . _
rid cr.I,.tl CCP'r O. Ih. Oflgh,tI at tt 'ppMI'I en NCIDf'd
nd Ill. in th. oHk. of 1M CItCl.ltt CoUlt ca.rIc alllrowMI
CounlV. f1o,Id.. .nd that ..... ~ In lull ..... ond -..
WITNLSS ,., hand.nd 0lIIdII ~_. ..
flo,ld..lf1I. ....~d.y.. :~~
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IJoputr CIoolJ
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF ~
On this, the.$c..l day of ~ , 1995, before me, a Notary Public, the
undersigned officer, personally appeared LOITIE IVY DIXON, Personal Representative under
the Last Will and Testament of George F. Dixon, Jr., known to me or satisfactorily proven to
be the person described in the foregoing instrument, and acknowledged that she executed the
same in the capacity therein stated and for the purposes therein contained.
SS:
IN WITNESS WHEREOF, I hereunto set my hand and official seal.
NOTAf\IAL Sr:AL
YVONNE II DunHAM. Notary Public
H.1ni'iburn. O,:hJphin County
M C('.IIu.,ir.1ion ["M .1111'1 7. 1997
--.,e
ry Public
M Commission Expires:
EAL)
STATE OF ~
COUNTY OF ~
On this, tho.:k.< day of~v ,1995, before me, a Notary Public, the
undersigned officer, personally appeared GEORGE F. DIXON, III, Personal Representative
under the Last Will and Testament of George F. Dixon, Jr., known to me or satisfactorily
proven to be the person described in the foregoing instrumenl, and acknowledged that he
executed the same in the capacity therein stated and for the purposes therein contained.
SS:
IN WITNESS WHEREOF, I hereunto set my hand and official seal.
G-
NOTM\tAL SEAL
YVONNE n OURIIAI.1. Hotary Public
Ha'Ibburn. OalJphin County
t1Y_ Ccmll1i",'k~n r, );rr"l.lul'" 7. 1097
Vi ;e'
ry Public
Commission Expires:
EAL)
STATE OF g~&'v<~':-
COUNTY OF ~
On this, the~ day of ~, 1995, before me, a Notary Public, the
undersigned officer, personally appeared RICHARD E. DIXON, Personal Representative under
the Las( Will and Testament of George F. Dixon, Jr., known to me or satisfactorily proven to
be the person described In lhe foregoing instrument, and acknowledged that he executed the
same in the capacity therein stated and for the purposes therein contained.
ss:
IN WITNESS WHEREOF, I hereunto set my hand and official seal.
NOTAlifAL SroAL
YVONNE n. DunIlAM, I~olory Public
H:1fI1~burg, Dauphin County
M Cvm",I~,'kt.'!LHr.rl:r. .I~ 7. 1D97
'-:e ~
N ry Public
y. Commission Expires:
AL)
72556
. .
PETITION nm 1)lmUATE and GI~ANT OF LETTERS
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Tin,' pc "linn ul' lhl' 1II1lIl'r,i~ml'd rl"pl'l.:lfully rClnC\Cl1h Ihill:
""11I1"-'11 '11I1CI(\). whn j';llIl' IN year\ of Ul!l' OJ' uldL'r ullthe c:\l't,.'tlL__
in IIH.' hl'l \\il ,r I Ill' ahuH~ dl',,'l'L1cllI. d:lIcd __ ._n"._
uml ,-",Ikill') 'lIed ,____.__________
nUllled
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Ilc~l.,U.ICIlI \\U~ ..tumidh: I ill Lh.'mh ill
h_____ la\1 fnmily or ('I H.:ipal rc,idcl1cc al __._"
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Ik~~IIlI~III. Ih~n ___.__ ___ .19
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(:\",'1,.'111 a... ""lIm\s, dl..'....I....h..l1Il.lid 1101 Hlrry. Wa\ nnt di\,nr\.'l.'d . nd oid ntH ha\'e n child born or adopted
nlkl e'e~llIil1n "I' Ihe \\ill "rfeled 1'", I' hme; wn, ,wllhe vi' nllnf II killing und wu, ncvcr BdjudieBled
Ilh.'Olllpl.'lcnl:
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(If "nlllkil~t1 in I'n.) All pe""'HII "pen)' $
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(II nnl domidlcd in I'n.) 1'~"llIHII plOl'en) i COlllII)' S
VUhh.' llf 1'1..',,1 ....!oolalc ill PCIlI1\yl\'unia S
...iIlHlh,'d n... 1'0110\\\: ________
WIIEKI,nIKI'. p~lilinncr(\) rc\pc~lfl )' ,clllle\H') II . prohule or Ille IB'I will Dud codiell(s)
pn.~'cllh:d hctc\\ith nmllh..: l,!rtll1I uf h.'lh.' S.__
. tl\"lal1l~'III;H~: . lImllli\llillilll1 ",",'.01.: ndmlni\lrnllon d.h.n.c.t.a.)
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OATH OF PEI~SONAL Iml)lmSENTATIVE
CO:\I!\10 'WE,\ I.TII OF I'ENNSY!.V ANIA I. <l<l
- OF .u~___.__________ J
1111: 'L'liliUlIl'lb) &lho\'l,,'.II;11I1I:d '\H'llle,) ur affirm(\) Ihill1he \1:111.'11I1.'111' il1lhc foregoing pelitl 1 arc
lillI..' lid ,,'11111..'\..'1 10 till' "l',1 01 Ihl.' ~IH)\\kd!!c alld hclkf or Pl.'tiliOlu:rh) und Ihut ", personul rcprc. "n.
lal \,'l'.llll Ilu,' uho\C..' dl'I..'l'lIl'11I111'titiom.'I(\} will \\"1,.'11 U1ullruly mlrllini\ll'f the estate nccording 10 In
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