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HomeMy WebLinkAbout94-00827 , " '!~1~ , \ ,'<" 'v';J\'~t 'l',~'I' j" 1 ~ ; /,IJ .'. '.1\',1,1 T \ ~ ~. ~ ~ "( I~l :' \1 , ~I" ,t",,( '( :'/jO'fl . '1:.' I \ ~ 1111,'\,\' I 'l:' . , 111,j,~~j. -,' 'lOr .: Ii ~ - ?' \1',1" . I, . " , Ii' .'. ,\',:- .i,,; ., ." , , " r' : r' ,. " ,. , ,. r, " " '" I, ..}\', . d" , ,. . . I}";' , U105.IURliV.I'M IFU FOR THI9 CEAmlCAlE U 001 WARNING: IT IS ILl.EGAL TO AI.TElI THIS COpy OR TO DUPLICATE BY PHOTOSTAT OR PHOTOGRAPH. COMMONWEALTH OF PENNSYLVANIA OEPARTMENT OF HEALTH vrrAL RECORDS LOCAL REGISTRAR'S CERTIFICATION OF DEATH CERT. NO. 2200656 SeptembVl 21 , 1994' - D/llll 011111111 01 Thl~ C"llhr"Ilon Name of Deoedent C LA I [L._____.__..hh.hh...H.. ...__.______......$T A.&RL__ FilS! M,(l-II" lHI Sex Ma.ie Social Security No.___.J19-.Q?:,6.tJ.L.._..__.__._Date of Death~~J2..h 20. 1994 Date of Birth 02/24/1919 __ BI rth placeP-:Lf f-6b1Ji(!tL y'Qk k..f9ll!1JlILPel!!1.1H1Y.f1,lltll _.___ Place of DeathHoftl SP-<!UJ HO-6))itae. EMt Pe.ill.L~bQl9_J.Q!~!1-!>.I1.{R.'___Cltm.9.~_'t..fand C()ltnJ!l.t..-._------'=-Qlli1svlvanla F4C'iiiIY N.mo (,<>,111/ Cllv Ij')!(>lJlJh Uf T'JIIIlI!l'p RaclCi1UCJl.~_. Occupation lliwiliW!lelLLN,I.!!glH.u.,{./t..f.QIr,C.L Armed Forces? (Yes or No), Ye-6 Decedent'n Marital StatuR WidawQIt ___ Mailing Address UO.l__Un({!I(l,Il!.c;(I1LML.AP-tl_}Jl~. Mec.Mll{~bm.... PA 17055 NLIJlitllH ~oIlo'''! C,ly or 101111 SttlO Informant SIlMn lLMLLIi.__Ir.Cl.IJ--____._.___ Funeral Dlrector.1LJM'ULfQ~~UlL_.lP-.Pl!1}} 1- L Name and Address of Funeral Establishment _CO.cKL1ILJl1NE.RAL/11m~......1LN,_Clte-l\tl!lILSju__PlggkQll!!9.J.L) 7019- 042 4 : I nterval Between : Onset and Death , , , veM-6 ___.0___.___._____.___.__..____..___________---1--1. , , , I- I I , , I , I , Part I: Immediate Cause (a)r. .tJ.P .0. (b) (c) Part II: (d) Other Slgnlfloant Conditions ~p IlfI f F a)J'Il!l p A . S .11.Jl....JLJ..JJ..___m_.__.______ Manner of Death: Natural [) Acoldent 0 Suicide 0 Describe how Injury occurred: Homicide 0 Pending Investigation 0 Could not be Determined 0 Name and Title of Certifier __...cMtC1UL-pf..eat,(lelttr...__.At,V_I________________________._ (M.D., D.O., Coroner, M.E,) Address ._.6.....MMIteL!'JJ\l..It.W!lY. Jle.CJwLZC.,lhltk 9L.P.tL..!1.e.?1.._______._____.. _._____ ..__. This Is to certify that the Information here givon Is correctly copied from an original certlllcate of death duly filed with me as Local Registrar, TIll) orlginul certificate will be forwarded to the StRta Vital Records Office for permanent filing. )J}-<<~_ ~ &J!:'::V.:___~ 7{~q: / ~ ",,,.,,,,,,,,,,,,r.?v~,~,,,,,,,,, o"''''~ ...s"I'\"t,o""'""!'P,'.""l?',.'J~,J,.!l,,,,,2L Ydf/. J ~:1(tZ<~h L~.J.7tJ/)' ~. ,-II." ~,tl,,'ifl'!<1re'1 C'1.11otough QIShl1"' lO/26/69.4IWILLS , f . . '. LAST WILL AND TESTAMENT OF CLAIR 1-1. STARRY I, CLAIR H. STARRY, of Lower Allen Township, Cumberland' County, Pennsylvania, being of sound mind, memory and ,understanding, make, publish and declare this to be my I,ast Will and hereby revoke all Wills and Codicils previously made by me. lTEM I. I direct my Executrix hereinafter named to pay all my legal debts and funeral expenses, including the cost of my gravemarker, and administration expenses of my estate, ae soon as practicable after my death. ITEM ]_~ I give and bequeath all of my automobiles, jewelry, wearing apparel, books, pictures, household furniture and furnishings, and all other articles of household and personal use or adornment, together with any insurance existing thereon, to my wife, BETTY M. STARRY, if she survives me; but if she predeceases me, to my children, MARNITA A. EGGSWARE and SUSAN M. MURRAY, to be divided among them as they shall Bee fit, but if they fail to agree upon such division within a period of two (2) months after my death, then the items with respect to which there is no agreement shall be sold, and the proceeds therefrom shall be added to, become a part of, and administered with my residuary estate, as hereinafter set forth. ITEM I II. All the rest, residue, and remainder of my property and estate of every kind and nature and wheresoever situate, inclUding all lspsed legacies and bequests, and including any property over which I may have a power of I I I , . appointment at the time of my death, I give, devj,ee, and bequeath as follows I _Ii, . , A. If my wife, BETTY M. STARRY, survives me, to her absolutely and forever. B. If my wife, BETTY M. STARRY, predeceases me, one-half (1/2) thereof to my daughter, MARNITA A. EGGSWARE, or if she is not then living, to her issue per stirpee, and the remaining one-half (1/2) thereof to my daughter, SUSAN M. MURRAY, or if she is not then living, to her issue per stirpes. C. In the event that a daughter of mine shall predecease me without issue her surviving, her share shall be distributed to my other daughter, or if she is not then living, to her issue per etirpes. JTEM~, All estate, inheritance, legacy, succession, or tranefer taxes, including any interest and penalties thereon, imposed by any domestic or foreign law with respect to all I ( property taxable under such laws by reason of my death, whether or not such property passes under this Will, by operation of law, by contract, or otherwise, shall be paid without any right of reimbursement from any recipient of any such property, wi thollt any right of apportionment, and without postponement. JJ'.E;ILV--,_ Should any person entitled to a share of my estate be a minor, at the time of distribution to him or her, and should the value of such property be more than the amount which may be paid or delivered to him or her or in his or her behalf without the appointment of a guardian or other fiduciary or the delivery of security, such share shail be paid and distributed to my Trustee hereinafter named to be held IN TRUST and managed, invested, and reinvested, together with the accumulation of income thereon, if any, and the Trustee shall use and apply from tims to time such portion of the income and principal thereof as it deems neceseary or desirable for the minor's reasonable maintenance, support. and complete education, including - 2 - . , preparatory, college, poet-graduate, or professional training, or to make such payment for such purposes to the guardian or person wi th whom such minor resides or di rectly to or for the beneH t of the minor without further responsibi li ty to such minor or any person taking care of such minor, and when such minor attains the age of twenty-one (21) years, any principal or innome not so paid or applied shall be distributed to such minor, or if he or she dies prior thereto, to his or her personal representative. .I.~~r~LYL. In addi tion to the powers granted by law, my personal representative shall have the following powersl A. To sell at public or private sale, to exchange, to lease, to pledge, to mortgage, to transfer, or convert or otherwise dispose of, or grant optione with respect to any and all property, real or personal, at the time forming a part of my probate or trust estate, in such manner, at such time or times, for such purpoees, for such price or prices, and upon such terms, credits, and conditions as shall be deemed advisable or necessary under the circumstances. B. To compromise any claim or controversy. C. To invest in all forms of property without being limi ted to legal investment. l~ErLYUJ.._ I nominate and appoint my wife, BETTY M. STARRY, but if she predeceases me, fails to qualify, or ceases to act, I nominate and appoint SUSAN M. MURRAY, but if she predeceases me, fails to qualify, or ceases to act, I nominate and appoint MARNITA A. EGGSWARE, but if ehe predeceasee me, fails to qualify, or ceaees to act, I nominate and appoint DAUPHIN DEPOSIT BANK AND TRUST COMPANY, Harrisburg, Pennsylvania, as the sole Executor of this my Last Will to serve without bond for the faithful perfOl"manCe of dutieEl in any jurisdiction, and I nominata and appoint said DAUPHIN DEPOSIT BANK AND TRUST COMPANY, - 3 - IIW~ 111IU:" a AI\ (HI. fO!lIl"~1 CCllllfIC"ll\HiJl WARNING: IT IS Il.LEGAl. TO AI.T~n TItIS COpy Ofl TO DUPLICATE BY PHOTOSTAT on PHOTOORAPIt, CllMMONWt^LTlI OF I'tfjNSYLVANIA DEP^RTMtNT OF II/'^L HI VIAl. II/!COnlll/ LOCAL REGISTRAR'S CERTIFICATION OF DEATH CERT, NO. 1758713 li~ililiiiJ";,;" "'; /./,~\~\11\ IJ( Pri>:. .i'$;' '.1JY.~ 't~l ',~\' \r.:~\ !~~i' .... \~, t t-l ,~ Ih . \.1 , , c.f '" '". ~J "/ ~. ~\ "~I',! .~~.... . 'I". ,<,,,., \?/,ffENI ~\'t>\;,,~~ ~'!':U"(fI!~,!!!II, . AlIUj.29".I_Q.Q3--._... tWlU ,woutr""ttrl',Nloffl Name 01 Docedent .. ---r;I1;-- amy. /.f... \1,',,,,, ..SJ ARRY. ... l.l\! Sox F~/l1a-ee .Soclal Socurlty No, .Z03-IOc29' 9 . Dalo of Duath OS/28/7993. Dllte 01 Birth lJ/ 15/1920 Birthplace MOil gllll t OWIl, WV Murilal StaWs MMIt~ed , Sp'<W"How<ta.t. CMt PenMb~,~~ JOWII,MI{P. CumbellfW,I~""S9,lmt.V,1 Occupatlun Hou06e W{6e/Home MllReJt Armod Forcos? (Yon or No) Docodont'n Mnlllng Adclross ..P'e'lQsyIY!lIl.!.!! Plnco of Doath Hotl/ Raco CaUCM{lln No Informant cta-llt H.StCVIIt!( Namo ancl AcIclress of Funeral Estnbllshment COCKLIN FYNfRM HQME, II,?,',,,, L{ndlIMl C~,~,ltt, Apt.. N'q~1" j,Mechall{c.tobU{\Q;I Funoral DirtJctor J, LaM!( CQck:f..tIl.. . FDO 1 0331, L PA. (u)Rel.lp-tltatoll!( Fa-ltWt e (b)C.O.P,D. 30 N. CIte.l.ltmd St., P,iU-6bulIg, PA ,17.019-.0424. : Interval Botwoon : On sot und Denth I , ....: pp.YI.l.. , , , YeMI.l ._. ..._.__ .....h..._ ....utn_....__._~.._.-..__,_-. I , I ____ _....._ . .... . '"' . ._. __._.___u_. __ ._ ._._._..___ .___.... ......--...t-n-....... --.------ -.--_.- , , I .___u..',. ..__.._ _.. _ .... __.__.____.._._._._._.___. __ ___ ..._......__...1-.-___._.,.._..____..._.__ _._.__ _nO Part I: ImnlOcllnto CalJso Pari II: (c) (d) OlllOr Sloniflcant Condlllons ..Sp-<tlaiCMdJIl6aJl.c.t .~..~ ._hN-,__.~ . H!S.H! l>!..... Mannor 01 Dealh: Doscrlbe how Injury ocourrod; Natural fl Homicide [] [J , [nl Acoldont Pondlng Invosllgullon Sulolde IJ Could not bo Dotormlnod LJ Numo and Tlllo 01 Corllllar CARLOS F. DELAFUENTE, M.D, 6 MMRet Ptazll Way, Meclwl-tCl.lbWtg, PA 17055 (M,D.; D.O,nCoronor;'M.E.) Addross Thl!! Is to certify Ihat tho Informutlon 11010 (Jlvon is corroctly copiod from un original certlfloato of death duly filed with mo all Lecnl RO(Jlstrm, The orl(llnlll cCHllficnle wilt bo forwnrdod to the Stato Vilul Records Offico lor porlTlanonllillnll, '2-1 '.' . ,t/? ... .' Z. 4!.<C/!'?.. ':;-;..!>/)"(:1.) 6->7btJj' f/I'l /1: .81({iff1:j;/~f~(. . /~'''''I?t)/t. M",<< I"~l~ ~ "'}1~~.,3111l"" \1It! '.1'",,:,\ Ilr,'" !'d~tJllh IN.,,Jr,P I 'I I,~ 10lDH,., , ESTATE II~FORMATION, L ___ m FilE NUMBER _ , " 81-1994-0ee7 saN 179-0e-6187 m NAME OF DECEDENT IlASTI IFIRST! IMII I;jJ STARRY CLAIR H ~ DATE OF PAYMENT --_ Iii LaLl-'l194 S POSTMARK DATE COUNTY 0/00/00 CUMBERL.AND DATE OF OEATrr--- .... -, v' '... -.. -,~ " . -.- .~_ w... -0... __. _..~ ...~ __ _.. _.. ',- -..~ -. .'- -., '-.. _.. '"e_ __ _. .h. .",. ."_ --. __ . _. "_"',~ ,_. _._ ._ .., -. '-.. -~ -- -. --, --. _.. ___ __ ..._ .,1,... ..._ _.. __. _.. ,. , II N~./fA022605 COMMO~~:~~~~f~: R~~I~~:YLVANIA "V.II6I j, "'" OPPICIAL RECEIPT · PENNSYLVANIA INHERITANCE AND ESTATE TAX, ----= ~'4_--= ..__ '_-.:;;;;_ \' '~Ji;} r.ECEIVEO FROM!" ACN ASSESSMENT 'l' CONTROL 1;1 NUMBER i AMOUNT YET'TER ROBERT E ESQ 111 MARKET STR~ET F' 0 90)( 93 HARRISBURG PA 17108 -- 101 .e.736.00 , -- ..--- -- REMARKS o SUSAN M. MURRAY m TOTAL AMOUNHAIO ____ 'e. 736 . 00 . ",,,~P:Jl?, ~' JiG ONA1VR MARY C. LEW REGISTER OF WIL.LS SEAL CHECKII 10 REGISTER OF WILLS -~--..._---- -----.--...~,~.- ----.---- _. -, ~ --. --. - -----.--.---___.h ____._ _ ._ .____ ___ _ ______ I , , -' .... .........- , ...........~. ",. . .............,....- -.. .....~....4.~ ' IN THE MATTER OF THE ESTATE OF CLAIR H. STARRY, DECEASED, Late of Upper Allen Township IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION NO. 1994-00827 CERTIFICATE OF NOTICE UNDER RULE 5.61al Name of Deoedent Clair H. starry September 20, 1994 Date of Death Estate No. 1994-00827 I HEREBY CERTIFY that notice of beneficial interest required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on January 6, 1995. ~ A9Qress 210 Cockleys Drive Mechanicsburg, PA 17055 641 Erford Road Camp Hill, PA 17011 Notice has been given to all persons entitled thereto under Rule 5.6(a) except: None Susan M. Murray Marnita A. Eggsware Respectfully submitted, .' ." METZGER, WICKERSHAM, KNAUSS w- , , (), -'~ ,. . ) ~~ ~;: C'. : ,/ .. () P)( r; ~" I (C' ".. C', ), . ~/!f Ii - " I " By: \:r ':.1 -" , OJ (" ' :;'!'" Rob rt E. i'e ter, Esqu TJ 1:-~ f'~&:: "-..... -;; , , Attorneys for Personal ~ ~\' , 1'"\ ,:; RepresentatJ.ve Ie:: 1,,>' 1,_1 ':) a: ()cj & ERB re Dated: January 6,1995 P.O. Box 93 Harrisburg. PA 17108-0093 (717) 238-8187 e \. ^, If my wHn, IlF.1'TV M, AT^RRY, nurvlvon 010, I:n hor ohnolutnly nnd fo,'nVM'. B. If my wifn, IlRTTY M. DT^RRV, predoeno"n" me, ono-holr (1/2) tho,'oof to my doughl:ol-, M^RNIT^ ^, f:aaSWMF., or if eho in not thon living, to hnr Innue per ntlrpoo, ond thn romftinln~ ono-holf (l/~) I:hnrnnr to my doughtor. SUA^N M. MURR^Y, or If nhn In not thon living. to her In"uo pnr ntlrpnn. C, In the nvnnt thAt e dRughter of mine ohnll predoeoAno mo without lnnue hor nllrvlvtng. hnr ohue nholl he dintrlbutnd to my other dllllghtnr, or If nhn I n not thon II vlng, to hltr innuo por ntlrpe., !'l:f,M .IV. ^Il ontAte, inheritAnco, lngAcy, nueconnlon, or trAn.fer tAxon, Including Any intnront end pennltio. thereon, impoRed hy ony domoAtle or foreign lew with reApee~ to ell property tnxnhle under nlleh lown by rnenon of my deeth. whethor or not nllch propnrty ponnon under thin Will. by opnrntlon of lew, by eontrnct, or othorwlne, ehell be peld without eny right of I'elmbul-nement from nny I'eoipient of eny such propnrty, wi thout nny right of opportlonmont. nnd without pontponnmont, l.TF.11.V. Should ony pornon entitled to A nhArn of my entAto he 0 minor. ot tho time of diotrlbutlon to him or hor, end nhould tho volllo of nueh property be Inorn then the nmount which moy be peld or delivorod to him or her or In hie or her behalf without tho oppolntmont of 0 gllardlon or other fiduciArY or tho dnllvery of .eclIrI ty, nueh nhere eheU be peld end dlntrlbuted to my Trunteo horolnoftor nomod to be held IN TRUST ond meneged, Inve.ted, ond rolnvontod, together wi th the necumnlAtlon of Income thereon, If nnv, nnd thn Trustee AhAl1 unn ond npply from time to tlmn olleh portion of the Incomo end prin"lpnl thnreof no it doomn 11ocnnnnl'Y 01' clnnlrn\lLn Cor tl18 minorlg ronn01lAbln melntnnnnc", nllpport, nnd comploto ndncetlon, incllldlng - 7. - IH'opArAI:ol'Y, collollo, "OAt-ql'Adllot., or Pl'OfooAlonAI trAlnlnll, or to mokA nlloh pAymnl1l: (nr nllch pllrpOAAo to tho lIuordl nn or pnrnon wit.h wlwm nlld. II1J IInl' I'nn I dnn 01' <II rnct! V to or Cot' thA hAnnH t oC thA mlnnl' wll:houl rlll'!.hot' ,'ooponnlhllltv to AIICh mtnol' ot' AnV pnroon tAIling "nl'n of nuch minor, And whon nllch minot, ottAlnn tho allo of 1',wnntV'Otlo (7.1) von"n, AnV principal or Incomo not no "aid or oppllod nhnl I bn dlntrlhutocl 1:0 olleh mlnol', or If he or ohe dloA 1'1' I 01' I:hol'o to, to h I A 01' hor pornonol rap"ooonl:A U Vo. .1Tf:M VI. In Addltton to tho pownu g\'ftnt.cl bV low, mv pArAonol ropl'AnonlAt:lvn nhA11, hAvA thn following pownrn. A. To nnll At public Ot' prlvotn OAI., to "XChAnqA, to leane, to plnclgo, to mortqnge, to trnnsfer, or convnrt or othorwlnn cllnponn oC, 01' ql'Anl optlono '11th re.pnct to AnV And all pr<>pnrt:v, I'onl 0" pOl'nonAl, nt the Umo fOl'mlnq n PAl't of mv probAte ot' tnlnt: nntllto, ill ouch mAnner, nt: ouch time at' timon, for Bllr:h ptll'ponon, (nl" nur:h pt'ice 01' pricen, nnd upon nuch torm", crndl to, nnd condl U ol1n An nhA II ho clnnmed Advl AAbl not. noeonnAl'V under tho c1 rC\lmntnlwon. B, To compromlnn nnv clnlm or controverev. e, To I nVnnl: I n A II Cormn oC proporty without hnlng Ilmltnd to loqnl lnvnnl:mnnl, .I1:EM"Vlll, nomlnntn nnd nppolnt my wHo, RETTV M. STARRY, hlll: If nhn prodnconnoR mo, Cnil. to qllollCy, or cnn.e. to oct, I nomlnAto And nppolnt RUSAN 1'1, MURRAY, bllt If Aho prodocnnnon mn, Cntlo to qllollCy, at' conSOn to Act, 1 nomlnnto ond Appotnt flARtllTA A. F:OORWARF., hilt H oho prodocon,.o. mo, fnll. te qllnllfV, ot' connnn to nct, I nominata and Il'ppolnt OAUPIIIN DEPOSIT IWIf: ANIl TRIIST r:nr1PAIIY, IInrrl Aburg, FnnnnvlvnntA, An tho ooln F.xnclltol' of I:hl n mv [,Ani: Will to oervn wlthollt hond Cor tho CAllhCul pnrformAncn of dlltlnn I~ anv jurledlctlon, ~nd I ~omtnal:n n~d nppol~I: /lAid IlAIJPflIN Dr-POSIT BANK AND TRUBT COMPANY, - 3 - ":'!:, " ',II!, ",I , ,." - t:,~'!il.,-" J , :~\ ~~"'~';'~'~": ~l' \~f . 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WIT~ Re.GIST_~~.O!-- ..ILLS) COUNlY COllE . .~EAR ofe'OIN1" NA.M( IIMT,-;IU,:;Ull MIOO"ll itlltlMI ;,=jiICltlliTI7ftOMPITtf AU\l..n-r- Starry, Clair II. 110! l,indham Court-Apt, 304 'rXIAlllCUII1YIlUMifl----' . - . ..\O.l'cifOl;;;if----1i;A1I6fiiilll-. -, 11<\chllnlcuburg, PA 17055 179-05-6127 9/20/94 J 2/211/19 Coo", Cumberland . "'~'~I;" ,....,""""':.....:.':'- '"~:'::""~J .'":''':~:;':i''''"..'.'::..::- QIl \ Original R'lurn lJ 2, Suppl.mental R.lurn I] 3, Remalnd" R.lurn liar dOl" 01 doalh prior 10 \2, \3.82) o " L1mit.d Ellalt lJ 'a, Fuluro Inl"..1 Campramlll 0 5. hd"al E.lal. To. R.lurn R.qulrod (lor dol.. af d.alh oil" 12.12.B2) []l6. llIC.dtnl DI.d T..lal. ['j 7. Oe"denl Maln/aln.d a living Trull (AI/ach capl 01 Willi -- (AI/aeh capy a TIUIII l'l I I 1"'-' !IV,llOl)!X< l/.9ll m ~ co \!! II' iffi fl~ z co 3 :> t:: ~ ~ " , , i 13 Y /1' ~.~9. - z Cl ~ ~ . fl :l ... .OR DATlSO' DIATHAnlR 12/31/91 CHICK HIRI IP A SPOUSAL POVIRTY CRIDIT IS CLAIMID 0 mfNuMiiii '-''l1~91J4-:=O'!lZT----' NU~~~R _ 8, Talal Numb" 01 Sol. Oepo.11 80'" III Mllrkot Street, P.O. BOK 93 l\nrriuburg, PA 1'/106'1-0093 c, ( 1 ) ..._.__............_____. ..- (2\ __,___..____._.~__' -------.,' (3\ _-.------ (A) _------.-----. (5)___52LHL.~.L----. ( 6)--..------- (7) ,_,__--.--.--- (q I__JIJ 214.~..____ (\0) _~2.!1J---- (151 (16)_~,416,18 :.~ '11 '11;" , ..., \(.) " , " , i " , I ,11 IBI ___1l,61U7 (II) . 9,201.49 (121 _ 43,416.l~ (13) -0- (14\ _,43,416.18 .~. = I. Real E.lale ISch.dule AI 2, Sla<k. and Bond, ISch.dule B) 3. ClalOll H.ld SlacklParln",hlp In,,,..1 (Schedule q A. Marlgag" and NalOl Rec.lvabl. (Sch.dul. 0) 5. COlh, Bank Depallll & Miscellaneous Personal Properly (Schedul. EI 6, Ja1nlll Own.d Praporly ISch.dule F) 7, Tran.I." (Sch.dule O)ISch.dul. l) 8, Talal Ora II Aile" (lalallln0l1.71 9. Funeral EllplnllJl, Admlnhlrallvo COlh, Mllcollanooul E.peniOl(Sch.dul. H) 10, Oebl', Marlgage llablllilOl, ll.n. (Sch.dule I) I I. T 0101 O.duclianl IlalalllnOl 9 & 10) 12, Nel Volu. 01 EIIO'e Illn. S mlnUlllne 11) 13, Charllabl. and Gavornmenlal B.quOlII ISchedule I) 14, Nel Value Subl'" 10 To. (lln. 12 mlnUlllne 131 \5, Spou.al Tranllor. (lor dalOl 01 d.alh altor 6,30.94) St. Inslruct!unt for Applicable Per(8nlage on Reveru Sid., (Indud. valulI from Sch.dul. K or Sch.dule M,) 16. Amaun' allln. 14 10. obi. 01 6% role (Includ. ,aluOl from Schedul. K or Sch.dule M,) \7. Amaunl allln. 14 la.abl. 01 15% ral. (Includ. valuOl from Sch.dul. K or Sch.dul. M,I Ie. Principal 10. duo (Add 10' from llnOl 15, 16 and 17.) \9. Credlll Spoulal Poverty Credit puor Payments Ohcounl . + 2,736.00 +_J.~OO_- 20, II line 191. gllalor Ihan lIn. lB, .nl" Ihe dllloren.. on lIn. 20. lhll1. Ih. OVERPAYMENT, moo 21. IIlln. lB II gllalor Ihan 1I", 19, enlor Ihe dlllor.nca on lint 2\. Thll I. Ihe TAX DUE, A, Enler the lntlfllll on Ihe balance due on lIne 2 \ A. e, EnlO! Ih. 10101 01 lint 21 and 21 A an lIn. 21 B, Thl,lIlh. 8AlANCE DUE, Mok. ChICk Po~abl. tal R.ghl" of Will., Ag.nt ~_- ~ 1 .. ,~ ~ . BU,UlIE TO ANSWER ALl.QUEsTIONS ON RlVERSE SIDE AND TO RECHECK MATH ' ~ ~: UndO' p.nalilOl 01 porlurl, 1 d.c1are Ihall have ..amlntd 101. rolurn, Including occampal\ylng \Chedula. and Ilal.m,nll, nnd '0 Ih. bOIl 01 my knawledg. and bell.l, Ii II true, carre" and campi.,., I d.c1are Ihal 011 real 01'01. hal boon roparl.d 011"0 marke' valuo. Ooclara,lon 01 proparor alhor Ihan Ih. pe"anol reprll.nlatl.. II baled on alllnformollon 01 whlcn preparer hOl ony knowlodge, "O",~~f Of 'iRiO"Ti.m"~"'IoiII'tHG",lIiR"--'i:~~~clTh"." ......---.-..----- .."..----..". ....-----.--- .,,-..- ,.It 1:~ " II !..~l,.,~,:,~~,:t_ ..'!\;;,;r"W", ".,,,,,,,,,,,,,,, ."-,,OSS -"I'2lf.' ',,,'1-;,,,.,,,. .,,0, ""'.93 '- ",,'.h" '" '^ 1710",0093 J '... / _K .06 Q ,____~,604.97 )(,__a (171 - Inlero\1 _K .15Q (lSI 7, , 604 . 97 (19) 2,88~.oO (201 _-..-112.03 121) __ ____u_._____- 121Al . . ." d._ ".---------.-- (21BI .' .---..........-------- flJj2J.J2--- OAt( ~L19/95 " /' 11\1.1111'" p.", J ,~ COMMONWIAUN 01 HNNIYlVANIA INIIUlt'N~1 !All mURN AlIIOIN! OICIOINr SCHEDULE H FUNERAL EXPENSES, ADMINISTRATIVE COSTS AND MISCELLANEOUS EXPENSES PI.a.. Prlllt or Type Clair II. Starry -- ITEM NUMBER DESCRIPTION AMOUNT A. Funeral Exp.n"'1 1. 2 . Cocklin Funeral 1I0me, head stone Cocklin Funeral 1I0me, funeral services in the amount of $5,124.25 paid by proceeds of insurance of Forethought'Life Insurance Co., Policy No. 001103074. with Cocklin Funeral Home as named beneficiary. 46.79 5,124.25 $ 5,171.04 B. Admlnl.tratlve Coil. I 1. Penonal Reprelenlallve Commlul'.lnl Social Security Number of Penonal ReprOlenlatlve: Vear Commllllon. paid 2, AIlorney Fltl - Metzger, Wickersham, Knauss & Erb 2,630.88 3, Family Exemption Clalmanl . Relatlonlhlp Addre" of Claimant 01 decedenl'. death Slroot Addre" City Slale Zip Code 4. Probate FeOl 112.00 C. MloCtllan.ou. Ex!"en.... 1. lIarry M. Wimer, appraisal of household and furnishings. 100.00 2, Patriot-News Co., legal advertising 55.80 3. Cumberland Law Journal, legal advertising 40.00 4, Register of Wills, file inventor>' 10.00 5, Register of Wills. fils account 95.00 300.80 6, 7. 8. TOTAL (Aha onlor on 11M 9, Rocopllulolion) (II more .pace I. needod, In.ert addltlonal.hoo.. of .ame "10,) s 8.214.72 Uy,ItUU.IJ.l1j , W COMMOHWIAlIIl or f!utHnYAtj'A INHII"ANCI'''. utU1N IISIOIN' ElIUDIN' _J SCHEDULE J BENEFICIARIES J UTATI O. fiLl NUMBER Clair H. Starry ITlM NUMBER 21-1994-0827 .,._--------~..---'---- NAME AND ADORnS Of BENEfiCIARY RELATIONSHIP AMOUNT OR SHARE O' ISlATI A. Taxabl. BoquolllI 1. Marnita A. Eggsware, 641 Erford Road, Daughter one-hlllf. of estate Camp lIi11, I'A C~ 2. Susan H. Murray, 210 ~ n Drive, Dnughter one-half of estate Mechanicsburg, PA " ITlM NUMIIR NAME AND ADDRESS Of BENEfiCIARY AMOUNT OR SHARI 0. ESTATE B. Charllablo and Govornm.nlal Boqu"I', 1. 'iOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS IAI:a onlor an IIno 13. Rocapllulallan) $ (If more .paco I.nooded, Inoo" additional ,hoot. of .ame 1100) DAUPHIN OE:;PDSIT BANK AND TRUST COMPANY, HMfHlSUUHO, PENN"IVLVANIA PA'3 PME No 2 of 3 To Metzger, Wickersham, Knauss & Erb Name: Clair H. Starry SSN: 179-50-6127 000: 09/20/94 AcocQ\t No. 0057686572 5335614692 4301720710688202 ------------------------ ------------------------ ------------------ Type Checking Statement Savings Charge Card -----~------------------ ------------------------ ------------- Date Opened or Issued 06/27/89 06/27/89 09/26/89 -_..,-------------------- ------------------------ ---------- Date Closed or Matured 10/17/94 (Clossd) 10/17/94 (Closed) 09/29/94 (Closed) ------------------------ ------------------------ ------------- Date of Death BalllllC8 $15,886.72 $6,146.16 -0- PLUS --------------------...--- ------------------------ ------------- Date of Death Acorued Int. $3.05 $31.66 Joint OWners (if /lilY) None ------------------------ ------------------------ ------------------------ None Betty M. Starry (Decd) ----------------------- ------------------------ ------------------------ Date of Joint Ownership 09/26/89 ------------------------ -------------------~-- ------------------ ------------- ------------------------ ----------------------- ------------------------ - Special Oolmlents: N/A Additional infOrMation availabl. at '20,00 per hour, One ~lr .ini.u.. Date Prepared: October 27, 1994 Prepared by: Cheryl A. Bowers CUstomer Management Information Dept, (OMI) Telephone No. (717) 265-2054 \, A, If my wife, BEny M, STMRY, Burvlvu me, to her nbnolutely nnd forever, n. If my wlfn, BETTY M, STMRY, predeceaBee me, one-hdf (1/2) thereof to my deught:er, MhRNITh A, EOOSWARE, or If Bhe Ie not then living, to her Innue per ntlt'peB, and the rema.tninll olle-hn If, (1/2) thnroo [ to my dnuqhtnr, SUSAN 11. MURRAY, or if Bhe Ie not then llvlnq, to her Innue per etlrpee, C, In tho ovont thot a dnuqhter of mine nhall predeoe..e me without Innuo hnr nurvlvlnq, hor .hue .hnll be dletrlbuted to my other dnuqhtnr, or if nho In not then liVing, to her heue per ntlrpee. rrgM..l'(., All entetn, Inheritance, leqecy, eucce.elon, or tronefer tnxBA, Including nny Intelent and pennltien thereon, Imponed by eny dom.otlc or forelqn law with raepect to all property taxeble undel' ouch lown by reeeon of my death, whether or not nuch propnrty pnnonn under thl. Will, hy operation of law, by conb'act, or otherwlnn, AhAll he paid without any right of reimbursement from ony l'.ciplent of nny euch property, without any right of npportlonmont, and without poetpon.ment, J.Tgr~1..Y,.. Should nnl' porAon entl tied to . .hue of my entate be e minor, at the time of dl.trlbutlon to him or her, and ehould the value of Auch property be more than the amount which may be paid or delivered to him or her or In hie or h.r b.half without the appointment of a guardian or other tlduciary or the delivery of eecudty, Buch Ahare Bhall be paid Bnd dletrlbuted to my TruAtee herelnnfter numed to be held IN TRUST end managed, InveBted, and relnveBted, together with the accumulation of Income thereon, If ony, nnd the Truatee shall Uee end apply from time to time Buch pOl'tion of the income and principal thereof Be it deemn necnnonry or doolrnbln for the mlnor'B reaBonable maintennnce, Bupport, nnd complete education, Including - 2 - preporntory, collogn, poot-groduote, or profeeeionol trolning, or to mokn nuch poymont (or nuch purpooee to the guoreBon or pel'eon with whom nuch minor I'nnldnn or dirnctly to or fOl' thn bnneflt o( thn nlillO.' wi tholl!: (1II'thn.' I'onponolbili t,y to ouch minor aI' nny pnrAon toltlng co"n of AIICh minor, ond when euch minor ottoin. the ag. o( twnnty-onn (21) yonl'o, ony principal or inoon,. not .0 poid or opplied Ahall be diAtribut.d to euch minor, or if h. or ohe die. prior thoroto, to hlA 0" her pereonal repreoentotlve. l'1'J:tL'lL, In nddltlon to the powern gronted by law, my pereonnl reproAontntive nhnll hnvo the following power., A. To Aoll nt: public or prlvnte eale, to onehnngo, to leaee, to plodgn, to mortgnge, to trnnefer, or convert or otherwlnn dlnponn 0(, 0" gront optlonn with reopoct to nny nnd all proporty, I'nol or poroonol, nt the time forming a part of my probate or trllot nntntn, In nuch monner, nt ellch time or tlmeo, (or euch plll'poeon, fOI' ""ch price or prlcee, nnd IIpen Anch tnrme, oredlte, nnd condi Uone nA nhAlI be deemed odvieable or necoe.Ary under the olt'ollm.tAnc... B, To compromlnn nny ,,101m or controverny. C. To Invoet In nil forme o( property without being llmi ted to IngA I I .",entmont, l1EM..YLIJ, nomlnAto ond oppoint my wifo, BETTY M, STARRY, but if nhn p.'odMoono. me, fAll. to quolify, or ceane. to oct, I nomlMto nnd nppolnt, SUSAN M. MURRAY, but l( .h. predeceoAoA mo, fnlln to qunll(y, or cooeOA to Act, I nomlnot. and appoint NARNITA A. EOOSWARE, but, if eh. predeeeonee me, (nlle to quoll(y, or cnnnoe to oct, I nomlnote nnd IIppoint DAUPHIN DEPOSIT BANK AND TRUST COMPANV, Hnrrl nburg, Pennnylvonla, an the oole Enocutor of thl n my (,nnt Will to oerve wi thout bond (or the (alth(ul por(ormnnco of dutioe In nny jurlediotion, and I nominato ond nppolnt Anld DAUPIIIN DEPOSIT BANK AND TRUST COMPANY, .3- 1\(., I j ;' ,,;, I' , ! r Jll,:;, ~ 1-9 ~ Ri!V"l!147 I!X AFP 112"94* C_AllH Of PfHlltYlYAHIA Ilt:PlIlTHEHT Dt' IlEYEIAJE IUREAU OF INDIYIDUAL TAXEI Ilt:PT, 210601 HARtlIII/JAO, PA 11121'0601 HOTICE OF INHERITANCE TAX APPRAISEHENT, ALLOWANCE ~R DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX ACN 101 DATI! 09-04'95 FILl! NO. DATI OF DI!ATH 09-20'94 COUNTY CUMBERLAND HOTEl TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUaHIT THE UPPER PORTION OF THIS FORM WITH YOUR TAX PAYHENT TO THE REOISTER OF WILLS, NAXE CHECX PAYABLE TO "REgISTER DF WILLS, AgENT" REMIT PAYMENT TOI ROBERT E VETTER ESQ METZGER ETAL PO BOX 93 HBG PA 171 08 REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 r A_t Rul ttod CUT ALONO THIS LINE ... RETAIN LOIIER PORTION FOR YOUR RECORDS .... iliW Uiii'i" EX"-Ai;p"n'Z-:94T"iliific""oP'"iN'HEiiii'ANCi"TA'if 'AP jiR'AisEHEilr;.ALDSWAN-ci-ifri-...----......... DISALLOIIANCr. OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF STARRV CLAIR H FUE NO. 21 94-0827 ACN 101 DATI! 09'04-95 TAX RETURN WAS I (X I ACCEPTED AS FILED ( I CHANOED HESERVATION CONCERNINO FUTURE INTEREST . SEI! REVERSE APPRAISED VALUE OF RETURN BASED ONI ORIGINAL RETURN 1, R..l E.t.t. (Schedul. Al (II 2, Stock. end Bond. (Schedul. II (21 s. CloHb Held Stock/p.rtnerahlp Int....t (Schedul. CI (51 4, Mortgage.IHot.. R.c.lyabl. (Schedul. DI (41 S, C..h/lenk D.pollh/Hho, Per.on.1 Prop.rty ISehedu,\. EI (SI 6, JointlY o.n.d Property (Schedul. Fl (61 7, Tran.f.r. (Schedul. g) (71 I. Tot.1 A...h .00 ,QO ,00 ,00 52.617.67 .00 ,00 (II 52,617,67 APPROVED DEDUCTIONS AND EXEMPTIONS. 9, F_r.l ex""".../AdoI, Co.h/Hhe, Expen... (Schedul. HI (91 8,214,72 10, Debh/Mortllllllll LlabUltI../LI.... (Schedul. II UOI 9S6, 77 11, Totol Deduction. (111 12, Het Value of T.x R.turn U21 IS, Ch.rltabl./Goy.rneent.l I.que.t. (Schedul. Jl (151 14, Net V.lue of Eatota Subject to T.. U41 NOTEI If.n ........nt w.. i..uld prlvioully, linl. 14, 15 .nd/or 16, 17 Ind 18 will refllct figurl. that includl the tot.l of ~ return. ......~d to date. ASSESSMENT OF TAXI 1&, AlIClUIIt of Line 14 .t Spoua.l rata (151 ,00 X, 03. 16. _t of Line 14 taxabl. .t LI....I/C1... A r.t. (161 43,416,18 X ,06. 17, _t of Line 14 t..abl. .t Coll.tarel/Cl... I reto (171 ,00 X ,15. 18, Principal T.. Due UII TAX CRI!DITSI PAYHENT DATE 12'19-94 Q ,:>01,49 43,416,18 ,00 43.416,18 ,00 2,604,97 ,00 2,604,97 RECEIPT NUHIER AA022605 DISCOUNT (+l INTEREST (.1 130,25 AHOIMT PAID 2,736,00 TOTAL TAX CRI!DIT BALANCI! OF TAX DUE INTEREST TOTAL DUI! 2,866,25 261,28CR .00 261. 28CR . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST, ( IF TOTAL DUE IS LESS THAN fl, NO PAYMENT IS REQUIRED, IF TCTAL DUE IS REFl ECTED AS A "CREDIT" (CR), YOU HAY IE DUE A AEFUND, SEE REVERl.E SInE OF THIS FORM FOR INSTRUCTIONS,I IIUPYATlOlh E.IaO.. 0' _0. clvl... '" .r boloro _r U, INI .- II lIlY "'tvr. Inl"..O In tho ..0,0, It O,...lo..... In PO'Hlllon or enJOYMl'lt to ClI.. I (caU.,....U benefiol.rllI of the dtoedInt IU,r the ,xp'rltton of MY "'It. for lIf. or for Vllr., the C~1th hlrliy ,xpr'lIb r...rv.. thl right to ."r.... Ind ...... t,.,I"r lmerit... TIXII It the l...fu1 e.... . (ooUI',r,U r.te on In'l NOh future lnt.rllt. _llI' NOIICl!. T. Iulllll tho ,,,,,1,_0. ., 10011011 1110 0' tho lr/ltrU..., tnd E.O,O, T.. AlO, AG. II ., 1"1. 7E P,I. IooU", 1140, PAVIOT. OIl.... tho 0... porUon 0' thl. 11011" ond II.IloIU with ....r p,.-I I. lho Rllltl" 0' Will. print. '" tho ,_rPl .Ido, ..""" .- ., ""'. .rdo, po"",l. 001 aJlQJlTER OP NULl, AIlEICT All pt.-" '10,1.. tholl II". be ...11111 to tn. InO....1 ""loll DlV be WI with tnV ,_Indor .....11111 I. .ho ..., It!fUND (aI)1 . rllft of . tlX credit, which WlI not r....tect on the Tax R.turn, _'I be r~.ted by oo.pl.U", In "AppUoeUon f., R.,..., ., !'om.vl...l. Ir/ltrlt..... ond E.tol. T"'. (IIEY-ISISI, AppUOIIIOII.... ...1It111' ,. tho 0111.. ., tho RIII.I" 0' Will., tnV ., tho II R...... nlt',I.. 0111..., .r bv 01111.. tho _1.1 Z4.hour .,....'1"1 "rvlc. nuItMIrt far forll orderlngl In PIm.."lnnl. 1-100-141"20", outside PlMlYlwnl. Ind dthln I_I 1tt..ltb"'1 .... (7171 711-1094, TIlDI (7171 nl.ztsl (Ittorl... 1....1'. Clnl.l. DIJICTJOHII Atr1 "rtv In Int.rll' not ..thfled with Uw ."r.l.....,t, .UDMWIM or dlllUowno. of dltUUonl, or .....-..nt ., ... (lnoludl.. dl.....,O ., Inl""U II _ '" thlt IIoUOI ...1 DIll'" within .IM.. (101 ..... .f ,_Ip. of thl. 11011., b., ..wrlll" prol... '0 tho PA 1ltp"I_t.f R......, lo..d 0' Appoolt, Doll', mUl, HI..I......, PA 17l1....U1. O~ ...INUlIn to hIVe ttM _ttlr at.r.lned It IUdAt of the MComt of tt. pertcnl ,epr...,,'IUYI, O. --."..1 to the ar~.' Court. AIIIIIW IlTUTlVl! COAMCTIOHIl '.hIIl .rror. dllOOverld on ttlll ....llIIftt Ihould be eddr..Hd In NrU'nt tal PA OIpIrtNnt of AIYIhUt, lureeu of Indlvldull 'IX", ATTN. Polt ......-ent Rlvlew unit, Dept. "0601, Hlrrllbur'J PA 1711'-0601 Phone (711) 711-6105. ... P'" S of the booklet "lnltrUGtlonl for IMirU.1Oe TIX btum for I Rllldlnt Deoedlnt" (REV-IIOI) for en 1XP1lnltlcn of edllnl,tr.tlvllW correotlbl1 .rror.. DIICClIIT. If lIlY I.. duo I. pold within th,.. (Il ",1_' ""th. ,fltr tho _.'. dootn, , II.. po,_, (1X1 dl.-... .f tho .'" pold It '11_, INmlIITI In...... It ....,..... boIl",l.. with llrot .... ., doll......v, .r nino (91 _th. ... _ m .... f'.. \hi doO, of dMth, to the d1t, of ,.v-nt~ 'IXI. Nhloh beoIM ddl"",,*,t ~for.. ......rv 1, 191' bMr Int.r.., It the rite of tI. (1X1 po,.... por ""'" 011...111111 .t . doll. roO. 0' ,010114, All ..... ""loll _ doll...." '" tnd ,ft" ........rv 1, UII will belr Int.r..t It. rlt. which will wry 'rOIl eel..., ",r to alendlr yeIIr with thet r.t. IftnOUnOId bv the PA o.plrtlent of A.v~. The 1PP11C8blt lnt.r..t r.t., for 1..2 through I". .r" ~ tnt.r..' lhItl Dilly Int.r..t FlGtor !!!r IMlrllt bt, Dallv Intere.t FlGtor INI lOX .000Mt 1m 9. .001147 1911 IIX .001411 1911'1"1 II. .000101 19M lit ,000101 1"1 9. .000147 INI IIX . QOOIII I"I.I~ 7l( .00om 1911 lOX .010174 1"1 9. ,000147 ulnter..' I. oeloullttd I' follow.1 JItTBIBIT . IALANCE OP TAlC VllPAIO H IlVIlIEI OF DAVI OBLJHllUIIIT H DAILV JHTEIIIT PAero. '.AnV IIoU.. I.."... ,II" lho 11M *OIt. doll_t will ..,11101 on Inl....1 OII...I,U", 10 1111_ (Ill dov. be_ tho dol, ., lilt ....._1, If po.-I It _ ,II.. tho Inl....O _I,U", dol, _ on tho Notl.., Idl1ltlOMl Jntlrllt w.t be Clloul,.tld. PAVlENTt Dotooh tho lOll portion of thlo Notlo. and .\ll>01t with your PIV...,t _ p.VOIIIt 10 lho n_ ond oddr... printed on the rlv.r.. .Ia. II Rt!111lfNT DECEDENT 0"" chook or .....y ordor .nytlll. to, REGISTER OF WILLS, AGENT, 1I11011.Rt!IIDOlT DECEDENT """. chook or ...... ordor .tVtIll. to, COHllONWEALTH OF PENNSYLVANIA. All P'PIn" rM,JIJH .hlll tM IPPllld flr.t to IN'IV lnt.rut whloh '1>>' bl due with ,"V r..llndtr 1fIfI1Itd to the taM. Rf1UNO (e.t) I A r.flM'd 0' . tlJC cr,dlt, Ithlch "II not r.qullted on thl tOle R.turn, MV bI reque.tld bt cHpI,UntI en "AppllolUon for RI'\ond 0' Penn,ylvlnl, Inh'rltlnel and E.t_t. TIM." CREY-lSU), Appllo.tlon. Ir. Iv.U..1' at the OfflO1 of the Rllht.r of Willi, WlV of thl ZS RlvtnUI Dhtrlot OffiCI' or 'rOIl thl o.p'rtlMnt" Z4-hour en.werlnt ,.rvlol nulbtr. for for.. orderlngl In Pennlvlv~l. 1-800-56Z-Z050, out.lde PIOn'vlvant. Ind within 10C11' H,rrhburg tr.. (111) 711-&OM, TDO. (717) 77Z-2Z5Z CHearlng I..lred onlY), RfPLV TOI Mlttont rl..rdlng .rrorl contllned on thh noUol lhoUld be Iddr...1d tal PA Pep.rt'."t of R.VInlJI, BurMU of lndlyldull Ta)(II, ATTNI po.t A.....""t R.ylew Unit, Dl9t. 210601, H.rrhburg, PA 1712'~0601, phone (711) 71NIOS, DISCOUNT I If MV tllC due It paid within ttir... U) caltndtlr "nth. .ftlr the tMcIedent'. cltlth, I flvl p.rcent U~) dhoCK.f1t of the t.1C Plld II JUowtd. INTEREST I lnt.rllt I. chlrged bealnnlng with flr.t dl)' of dlUnquenoy, or nine (9) Rnth. end OM (1) dlY frOl the det. of ~.th, to the d.t. of Plv-ent. rllC,' which bee... dtllnqutnt before JlnUlrv I, 19a2 bllr lnt.r..t It the rat. of .IIC (6X) Ptrcent p.r ennui calculltld It . d.11Y rat. of .000164, All tlICI. which beu... dlllnqutnt on end If tar Jenuary 1, 19.2 will bI.r Intlr..t It . r.t. which will varv frol c'ltndlr y.,r to c111nd.r y..r with that rlt. ~Id b)' thl PA Dlp.rtllOt of R.vtnUl. The app1lelbl. Int.r..t r.t.. for 19.2 through 1995 Irll Vllr Int.rllt. A.t, D.lly Int.r..t Factor Vllr Interllt Rlt, D.lh Int.r..t FltOtor 1911 EOX ,OODl41 1917 9X ,000247 1911 16X ,000411 19"-1"1 IU ,000101 1914 IIX ,000301 1"2 9X ,000E47 1911 lSX .000116 1"5-1994 7X ,000192 1916 lOX .000174 1"5 9X ,OO0E47 -~Intlr..t II naloulltld II followlI ImlElT . &AWe! OF TAK UNPAIO K NUMBEI OF OAYS OELINQUEHT K OAILY INTEIE8T FACTO' ....Any MoUat IIIUId Ift,r the tI)( becNMII dll1nquent will r,f1Mlt W\ Int.rut ellouhtlon to flft"" UI) den blVoM the dltl of ttt. ......""t, If P'VHnt II aMII Ift.r thl Int.rllt ~tlUon dtIt. .hcM1 on the NoUel, edcUtlontl Int"e.t lU.t be cllcullted. ..., - I" <( - I PLFASE FILE l1JIS REPORT WIl1lIN 'M YEARS OF DATE OF 0&\111 RmARDLFBS OF 111E &'TA'l'US OF 1lIE FSI'ATE. IF ESTATE IS tm <nfPlEI'fD, FILE A 6.12 ~l.lRM YEARLY UNI'IL <n1PlEl'IOO. 6 ~.TAT!!.e...Rl';l'oWr,_Y.!!!?f!L RULL-L.g Name of Decedent, Clair Jh-~JaJ;_!:.L_____ Date of Dllatlll-.Sept~!1!.l?_~L~_QJ__~.2.9_1.._, W ill No, 199 4::.llll1l21__....,._______ _....__.. AdmJ n. Nil, _._1~.1~,::9.9.~1.L____ Purlluant to Hulu 6,12 of t.he SUpl'Hme Court Ol'l'hllnfl' Court Hules, 1 roport tlw followIng with l'OR!lfHll t,o cOn/ploUon of Lhe adminisLrllUun of LIlA rlbOVll-CllpllOlllld UAt.lllol 1. Stllte whethel: adminl.fltl'aLlon ot t.he eslat.e i8 compleLe, Yes_x-_____ No..__.-. 2. If the IInRWlJl- IA Nn, At.ilt.a whfln lha purRnn.ll representative reasonably bel1eves that the administration will be complete, J. If the answor to No, 1 is Yes, state t.he fOllowing' a, Did the personal representative file a final account with Lhe Court? Yos No.~, b, The S(!(l.l I'll La OrphllnA' CUllrt No, (I f any) for the personal representative' 8 account is, nla c, Did t.he per80nal representative state 6n account l.nformally to the parties in interest? YosJ_ No___ d, Copios of receiptfl, releases, joinders and approvals of formal or informal accollnt.s may be filed with the Cerk of t.he Orphans' Court and may be attached to t.hia report, ..--) (-.. Dot.. DMombo, " 1995 __~:! ..Li;~ - ~_ Sign'ilttre , Robert )i:_...1sJJ;.t;gtJ_J;!Lq,U.!.L~ Name (Please type or print) Metzger, Wickersham, Knauss & Erb __l.iLM.~,t:g.LStr_~!l!L,_,~_____._ AdpnHIBBox 93 Harrisburg, PA 17108-0093 L_1.l.L~.1e_,:~lU___. ________.___, 'I'el, No, (MAHlrnll/AMJ) Cdpllclty' ___rel'sonai Represent.atlve _.x "Counsel for personal t'epreBent.aL i vo /lW-27