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I)ETITlON FOR GRANT OF LETTERS 01; ADMINISTRATION
Estate oJE)UHJ a ~ oS A, 7h d I-t .4.~
also knoll'n as
, Deceased.
Social Secnrlty No./C1t! ~ / 'f--(7tJ4J?
No. .,2/-91./.--i~7
To:
Reglsler of Wills for the
CounlY of CLMlERl./WD In Ihe
Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petllloner(s). who Is/arc 18 years of age or older, appl I F S
for lellers of administration
on the estate of
(~.b.II.J pcndenle lile; durante abscntllli duranle mlnoritate)
Ihe above decedent.
Decendent was domiciled at death In d tJ M 6,'_ Coun!!, Pennsylvania, with l7. '!J"
~ of!!.Q last family or principal residence at 7/1 S tlJr> L,q 1 tq) wr'1 M~"I:,~Cj', rR-/7a.r:
(list street, number al\d munlclpall1y)
Decenden,!.. then ~ q years of age, died / -:J... < -4 C/. -:? , 19
at/111 ."J ! Al oJ.. b Jot I r:t I {<.:I, /VI.... J., "1. . P'11 1 7oP. <; 1.,-
Deccndent at dcath owncd properly with estimated values os folllows:
(If domiciled In Pa.) All pcrsonal property
(If not domiciled In Po.) Personal property In Pennsylvania
(I f not domiciled In Pa.) Personal property In County
Value of real est Ole In Pennsylvania
situated as follows:
$ 'ltM.tn
$
$
$
Petllloner_ afler 0 proper search haL ascertained that decedcntleft no will and was survived by
the following spouse (If any) and heirs:
Name Relationship Residence
.s
(.>.
'7/1 S (IV <J.t. "" 161 t p-J/
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THEREFOIW, petllloner(s) respcctfully requcst(s) the grant of letters of administration In the
appropriate form to the undcrslgncd.
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OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CLMlERl.N-lO
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The peUtloner(s) above-namcd swear(s) or arnrm(s) that the
statements in the foregoing petlllon are true and correct to the best
of the knowledge and belief of petllloner(s) and that os personal
representative(s) of the above decedent petltloner(s) will well and
truly administer the estate according to law.
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Sworn to or arnr%d
before me this
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I>'AA C. LEWIS
L~'
Reglsler
No. 21 - 94 - 857
Estate of
FRJlJ\ICES A TlJJoII\S
. Deceased
GRANT OF LETTERS OF ADMINISTRATION
AND NOW OCTOBER 7. 19~, in consideration of the petition on
the reverse side hereof, satlsfac~AUPrQ.of Wb~ been prcsented before me,
IT IS DECREED that L U. S
IS/hre entitled to Lellers of Administration, and In accord with such finding, Letters of Administration
are hereby Rrnnted to
PAUL O. THOMAS
FRANCES A. THOMAS
In the estate of
71f70}f2J~~/U-<J @m.&ilL.
R'jlsl" 01 will. . 1/ tI
MARY C. LEWIS
FEES
Letters of Administration ..... $
Short Certlfieates( 1) .. . . . . . . .. $
Renunciation ................ $
JCP $ ~ nn
T9TAL _ $ ?Ii nn
Flied ... 9~.~q~~~.. 01...... A.D. 1911-
18.00
3.00
A TIORNEY (Sup. Cl. 1.0. No.)
AOORI!SS
I'HONE
Mailed letters and order to Administrator on 10-7-94.
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WARNING: Ills II10gnlto dupllcato this copy by photostat or photograph.
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CO....ONWEALT" oar PEHN8YUiANIA' DEPART".NT OF HULT" . vnAL RECORD'
CERTIFICATE OF DEATH
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It I Slnc'alr Rd.. Hechenlcsburg
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IlICU1H'1"_"'MlOM"lIII"'~'" tpCallll
711 Slncl.lr Road
..Hechanlcsburg, PA t7D55
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21 - 94 - 857
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IIlEV..-;SOO lilt 111.181
1l~.:J~:~" INHERITANCE TAX RETURN
-.!Ii"" RESIDENT DECEDENT
COMMOI<W,AUH Of PlHHIIlVAH" (TO BE FILED IN DUPLICATE
DEPAIIl MEN' m R~Y(HUI
H..",fJ:& ~~ot'!I2I0601 WITH REGISTER OF WILLS) COUWY COOE
- , I -. ,. futii1fiil{f.;.;;....:::;..c"~~~.._-". ,ufittr'fitli'tnoMPulf-A-OORrb
{J(tJI?Jtt-S F~/lNCcS A. 7(/ .s/l\Jt:Lm/~ RotHJ I
~~'7~e~"~';;~I~00.1 ~~~lh';_I;~I~'~'~; ...Ib'~'~ ;~I~~_, C!,: ~~;: ~~:~;G (UPProt ~ue>JJ
~ 1. OrigInal Return I , 2, Sllppl"rnrntol Relurn [1 3, Remainder Relurn
I'or dOl II 01 doolh prior 10 12.13.B21
I I .In. FUlu'9 Itllfmnl Comproml,,, [] 5, federal Eilal. TaK
llor uol'" of dC'olh nile, 1:!.12.821 Relurn Required
I I 7, O"o"lInl Mallt'ulnod (I lIylng TrUlt _ 8, Tolol Numb.r of Safe a.po.1I BOKII
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~ __ IAlloe" copy 01 Will) ._.___.JAltneh e"l!~ hull)
ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO.
I NAMf _...--_..~._--<--,-- wunnn.rmmcrIlifiRE!lS
~ ~ el{,4-It/.~ IE". .:5H/I:ZDS 7ff' ~ w. /J1AIN Sf.
III z ImmcrrlrnOMl1o ---,.......' ,.. . ..
U ~ IJI/i.=C/f/lNICSSwR6-,
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121 :J.,U'1.s'L_ ,..
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1. Roal Ellolo (Sch.dulo A)
2. Sloeh ond Bond. (Sehodulo BI
3, Clolely Held Slock/PerlnOuMI) lnlnrc\! (Sdu~dulo q
4. Morlgages anel No'o1 Rcttolvuble (Schrdulo 01
,5, Cash, Bonk Deposits & Miscellaneous P"nonnl P'oporl)'( 5)
(Schodulo EI ,
6. Jolnlly Ownod Prop'rly (Sch.dul" II ( 6)
7. Tronlle" ISchod"lo 0) (Scho"ulo LI I 7) ,
e. Tolal Gron AuelS (totallinos 1.7)
9. Funeral fJlpt,nulI, Admlnhtrotlye COSh, MI$Cslloneous I 9) --.
Exponsol (Schodulo H)
10. Dob". Morlgogo 1I0bilillos, liens (Schedulo I)
11. Tolol Ooducllonl(lolollinel Q & 101
12. Nol Voluo 01 Ellole (II no 8 mlooul lin. 111
13. Charitable and Goyernmental Bequost' {Schedulo JI
14. Nol Valuo Subl,,'lo Tax (lino 12 ~Inul !in, ~_
15, Amount of line 14 laltoble 01 6% ralo
{Indude yolu8s frorn Schedule K 0' Schodule M.I
16. Amount of line 14 loxoblo 01 15% rule
(Indudo Y01U01 f,om Schodule K or Schodule M.I
17, Prlnclpoltax dUlIlAdd to.ll. from lil1p 15 and from linn 16.)
18. Credlls Prior Paymonls tJjuounl Inl"roll
---,Q-, + q, ,!,.-,...--
19. If IIno 1811 groolor Ihan IIno 17. onlor Iho difforenco on line IQ, Thllls Iho OVERPAYMENT.
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20. If line 17" grooler Ihon line 1(~. nnlM Ihe differenco On IIno 20, Thil Is Iho TAX DUE.
A. Enler Ihe InlorDl1 on Iho bolr.Jnto due on line 20A.
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Fill NUMIlR
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'2.1 - 9 'I
- J>S7
YEAR
NUM8ER
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f7A
/7tJS !:
/l'ME
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tt
(111 _7.. ..7rJ'7. FS
(121 __...J2
(13) _--P
,m__'_ ...'._,_____._.. (14) n, _,..._ 0
115) C>u... . ".. ...X .06 D "...___. 0
116)
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______)( .IS III
1171
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1181 -,-,-
IIQI .__.._.__9____
Chock hore If you oro raquo.t1ng a rofund of ypur over ayment.
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120AI ___.__
(2081 .__.._.__...0.
1201 __.n'
8. Enlor Iho 10101 ollin. 20 and 20A on line 208. 11." I, Ih. 8ALANCE DUE.
Maka Chock Payabl, '01 R~_91sIer af Wills, AU.!!,'
\'.., ,.. . ......BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND TO RECHECK MATH...' '..".. .':',",:: ,'.;
Under penallles o(perjury, I declare t1~all hav~~-~r;;:;j<i'lil-;;;;~. l.,d,;;jinuo7~~.~lr;a-;yT~g"'J;-d~iel and Ilol.menls, and 10 Ihe belt of my knowledge ond belie;'
II II true, corroe! and complul', I declare Ihal 011 rtol pslatn heB heen reparl"d ollrue markel value. Oedorullon 01 preparer other Ihon Ihe personol represenlatlve h
bOlld on alllnforll1ollon of which J'ropOl6r h\J1 ony ItIlowlndg"
~AlUllOrnl!i5NRmo rrfmmj'lrfu'ifr---.bb,m"~7it-'.s).vCl'9:1T't;:!;;;#----- bAl! II' 'Z.1-fY
~o, ,RIP i '0 'ii' iHM", i.II""'" U. Ail,,"!1 ::1~~I[~~~C:-~~~6;..!!.1_n!.?.".~~..- 'un' IW! 11-1/- 'I'
:€;'i~-g~~ 11/..... ,1l1lfC!(.4IVI.CS.~(.I-1A .f:'4...JZI!..~r____
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PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING A CHECK MARK (...1 IN THE
APPROPRIATE BLOCKS.
1. Did decedent make a transFer and:
at retain the use or income of the property Iransferred, .".............,......."...""."...
b. retain the right to designate who shall use the properly transferred or Its Income,
(, retain a reversionary Inleresl or ......,................................."..."."..",.""...."..
d. receive Ihe promise for life of either payments, benefits or carei .......................
2. If death occurred on or beFore December 12, 1982, did decedent within two years
preceding death Iransfer property without receiving adequate conslderatloni If death
occurred after December 12, 1982, did decedent transfer property within one year of
death without receiving adequate considerationV ".......................,.......................
3. Did decedent own an 'In trust for' bank account at his or her deathV"....................
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IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,
YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
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COMMONWEALTH OP PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF 6flltllCES ,(..
SCHEDULE "B"
STOCKS AND BONDS
~Ml/1.S
FILE NUMBER .:11- 9'1- d's.,
CAli fop"tV JolntlYoOwnttd with Right of Burvlvo"hlp mutt bt dllclo..d on Schedule "p"l
ITEM
NUMBER
1.
38 5ho.rc:,s e.II\W\o" ~Dd<
:r.nc.. I .'n"'orpo.....h.J ~Uc.y -H..
weAl\-\. o~ '\'...",n a.
\-lIth
-1/, 815
DESCRIPTION
"po ppe;. :t:n oll.\.st..ies,
,.....oS ...t- +t.a. c., IVIMDn-
VALUE AT DATE
OF DEATH
I.w
1/,2 'S
Otve.
11.5107.5
lI:Jo, 7/'1. 38
TOTAL lAlla enter on IIno 2, Rocapltulatlon)
,
Hf mort 'pICI I, f1,.tI,d In..,. Iddltlonl' ,h.." of 11m. 11"1)
$0I,11~,58
t lIV.UIU'.ll."1
ITEM
NUMBER
A.
B.
4.
C.
1.
2.
3.
4.
5.
6.
7.
8.
,,~:J~l"?l\
-W/ls~
COMMONWfAlrtt OF Pf.NNSYlVANI"
INHunANce '''IC REtURN
""IIDfNT DfCEDENT
SCHEDULE H
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES
Ploalo Prlnl or T 0
rl?lI-NCES
II.
7i-It? I?M.5
.;1../- 9~ - ~S7.
DESCRIPTION
AMOUNT
1.
Funoral Exponl'"
mye.r.s rune,.,"; IIDhtt.
;l S; DP? ZQ
1.
Admlnlllrallvo COlli'
Perianal Represenlollve Commissions
Social Securlly Number 01 Personql Represenlollve:
Year Commissions paid
2.
Altorney Fees CIltU!{IFS E, .:sH/~tAJ ;:71l:
"/.5l). I'D
3.
Family e.empllan
Claimant Patti 'D. ~m.u
Relallanshlp II UJ bt#ld
JI
;J, 000.(WI
Addre.. 01 Clolmonl at decedenl'l deolh
Street Address 711 .s",d,v'r I?cI.
City nft.c.haniCSb14"O 51ale I'll
Zip Code /70 s!O"
f.:l',~
Prabole Fees """ SHl1ll.r CEF(2T/FIOI7CS
Mlleollanoaul Expenl'"
Ca.,.fi'l,'eJ me,'!:?! n: t rt.pl"'cuYlt.nt of2 :.-/D<'kS'.
f,'/"q h;'e,.,'fMI~e ~ t?eC,/lrd/l?efu,.n.
1-.:1,7S
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TOTAL (Also enler on line 9, Recopllulollan)
(If moro Ipoeo II noodod, InlOrl additional Ihootl 01 lamo 11.0.)
5 7. :l. 8'7. 95"
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COMMONWIAltH Of rlNH'nvAHIA
INNIIIIANC. 'AX II1UIN
IIIIDIN' DICIDIN'
SCHEDULE J
BENEFICIARIES
ESTATI or
;:ll,ANCES
IJ,
71(MlIIU
FILE NUMBER
;u - ~~- 351
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N~T~~ER NAME AND ADDRESS OF BENEFICIARY
RELATIONSHIP
.
AMOUNT OR
SHARE OF ESTATE
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A. Taxabl. Bequlilll
I. 'P~UL>>. 7IIDI1IAS
711 "INCUI(1l. ~J>.
tt/ECI{AtlICS t3u.teG; {'tf, rTDSS"
I-!tpdflND
100 %
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ITEM
NUMBER
NAME AND ADDRESS OF BENEFICIARY
AMOUNT OR
SHARE OF ESTATE
B. Charitable and Goyernmentol Beqult":
1.
.
,
,
,
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jl
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TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (AI.o onlor on IIno 13, Ro,oplrulotlon)
(II mo.o .poco I. noodod, In.o.' oddltlonol .hooh of .omo 1110)
s
1~'~3q/11
C--
REV-1547 EX AFP (12-94*
COMMONWEALTH OF PENNSYLVANIA
DEPAAT"ENT OF REVENUE
IUREAU Of INDIVIDUAL TAMES
DEPT. ZlD6Dl
HARRISIURD, Pi 17121-0601
ACN 101
NOTICE OF INHERITANCE TAX
APPRAISENENT. ALLOWANCE OR OISALLOWANCE
OF DEOUCTIONS AND ASSESSNENT OF TAX
DATE 02-15-95
o FILE NO.
DATE OF DEATH 12-02-93 COUNTY CUMBERLAND
NOTE. TO INSURE PROPER CREDIT TO YDUR ACCOUNT. SUBNIT TNE UPPER PORTION OF THIS FORN WITH YDUR TAX
PAYNENT TO THE REDISTER OF WILLS. NAXE CHECX PAYABLE TO "REOISTER OF WILLS, ADENT"
REMIT PAYMENT TO:
CHARLES E SHIELDS III
2 W MAIN ST
MECHANICS BURG PA 17055
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE. PA 17013
AMount Ra..ltt.d
CUT ALONO THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
iiili=iiir.-j-ijf-jiFP-n2"=94Y-Noi"iciuciFuiNHiiiii'ANci-i:Ax-j('pjjjiiiiiiiHiNT-,--,U.i."ciwAiici-iilimm--m---m
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF THDMAS FRANCES A FILE NO. 21 94-0B57 ACN 101 DATE 02-15-95
TAX RETURN WAS. I X I ACCEPTED AS FILED I CHANDED
,
RES~RVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL
1. R..l Eat.t. (Schedule AJ III .00
2. Stack. and Bond. (Sch.'lul. 0) 121 2 . 719 .38
S. Clo..ly Hald stock/Pertnarlhlp Int.r..t (Schedul. C) l31 .00
4. Hortgag.I/Hot.. Racf,jvabl. (Schedule D) e41 .00
5. C..h/Bank Deposita/Hilc. Parlonal Property (Schedul. E) e51 .00
6. Jointly Owned Property (Schedul. f) e61 .00
7. Transfara (Schedul. 0) 171 .00
B. Tot.l A...t. ISI 2.719.38
APPROVED DEDUCTIONS AND EXEMPTIONS:
7,287.95
9. Funeral Expan.../Ad.. Coatl/Hll0. Expan... (Schedula H) (9)
10. Dabt./Hortgaga Llabllltla./Llan. (Schadula X) (10) .00
11. Totol Doduct1on. ell1
12. Nat Valua of Tax Raturn (12)
13. Charltabla/Govarn.antal Baqua.t. ISchadula J) (13)
14. Hat Valua of E.t.ta Subj.ot to Tax (14)
NOTE: If an assessment was issued previously, lines 14, 15 and,or 16, 17 and 18 will
reflect figures that include the total of 6lb returns essessed to date.
ASSESSMENT OF TAX:
IS. AMount of Llna 14
16. AMount of Lina 14
17. A.ount of Lina 14
18. Principal rax Du.
TAX CREDITS I
PAYNENT
OATE
7.?A7 qC;
4.568.57-
.00
4.568.57-
at Spou.al r.t.
taKabla at Linaal/CI... A rat.
taKabla .t CollataraI/Cla.. 8 rata
.00
.00
.00
.00
.00
.00
.00
1151
1161
1171
X .00.
X.06.
X .15.
CUI
RECEIPT
NUNBER
DISCOUNT e-I
INTEREST e-I
ANOUNT PAID
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST
TOTAL DUE
.00
.00
.00
.00
. IF PAlO AFTER OATE INOICATEO. SEE REVERSE
FOR CALCULATION OF ADOITIONAL INTEREST.
IF TOTAL OUE IS LESS THAN tl, NO PAYNENT I~ REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREOIT" fCR), YOU NAY aE DUE
A REFUNO. SEE REVERSE SlOE OF THIS FORN FOR INSTRUCTIONS.)
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AESERVATlDHt
PURPOSE OF
HonCEI
PAYHENTI
AEFUND CCAII
OIJECTlONSI
AllIUN
lSTRATlYE
CORRECTIONS I
DIICOUNTI
IHTEREST.
E.tet.. 0' dlc.d.nt. d>>lng on or b,'or. Dacl.b.r IZ, 19'Z ~- l' en>> 'utur. Int.r..t In thl e.t.t. I. tren,'lrrld
In po.....lon or enJoYllnt to ell.. B Ccolletlrll) beneflel.rll' of the dlcldent .ftlr the e.plr.tlon of enw e.t.te far
11'1 or for y..r., the Ca.-onwI.lth h.r.by ..pr...lY rl.lrv.. the right to ,ppr.I.. and ...... tren.,.r Inhlrltence T..I.
et the lew'ul CI... B Ccoll.tlrel) rltl on any .uch future Intlrl.t,
To 'ulflll the r.qulr..ant. 0' Slctlon 2140 of the Inh.rltlnc. end E.tete TIM Act, Act 22 of 1991. 72 P.I.
SICtlon 2140.
Dlt.ch the top portion 0' thl. Hotlc. and .ub.lt with your plyaent to thl A.gl.t.r of Will. prlnt.d on thl r,vlr.e .Ide.
~-"Ih chick or sonlY order PIYlble tal REGISTER OF MILLS, ADENT
All p.y'ant. r,cllvld .hlll flr.t be IPpllld to Inw Interl.t which ..y bl due with any r..elndlr eppllld to thl tlM.
A rlfund of e tlM cr.dlt, which w.. not reque.tld on the T.. R.turn, 'IY bl re~.t.d by co.,lltlna en "Appllcltlon
'or A.,und of Plnn.Ylvanl. Inhlrltsnc. end E.t.tl TI." (AEV-ISIS). Appllc.tlon. .re ev.llabl. .t the OffiCI
of the Rlgl.t.r of Will., eny of the 2S R.v.nul Ol.trlct O'flc.., or by cllllng the ,plol.1 '4-hour
en.werlng ..rvlc, nu.blr. for 'ors. ordlrlngl In P,nn'Ylvanl. 1-100-S'2-2050, out.ldl Penn.ylvenl. and
within locII H.rrl.burg .rl. (717) 717-1094, TOO' (717) 772-2'52 CHllrlng 1.,.lrld Only).
Any p.rty In Int.r..t not ..tl.,I,d with the .ppr.I.I.ent, Illowanc. or dl..llowsnc. of dedUction., or .......ent
0' t.. Clnoludlng dl.count or Int.r..tl .. .hown on thl. Hotlc. lU.t obJlct within .!xty (60) d.y. of r,cllpt of
thh Hotlc. by.
uwrltt.n protut to the PA D.pert..nt 0' R.VIlf1U., laird of AppIII., D.pt. 211021, H.rrhburg, PA 17UI-U,I, OR
~-.I.ctlon to hlv, the ..ttlr d.t.raln.d .t .ud!t 0' the .ccount of the p.r.onll r.prl..nt.tlv., OR
--.pp..1 to the Orphln" Court.
F.ctu.! .rror. dl.cov.r.d on thl. ........nt .hould b. .ddr....d In writing 1.01 PA D.p.rtllnt of A'Venul,
Bur.au of Indlvldu.1 T...., ATTHI po.t A.......nt Alvl.w Unit, D.pt. 210601, Harrl.burg, PA 11121-0601
Phone C7111 117-6505. SII pig. ~ of th. bookl.t "In.tructlon. for Inh.rltlnc. T.x A.turn for. RI.ld,"t
D.c.dent" CAEY-ISoII for an a.pl.natlon 0' .d.lnl.tratlv'ly corr.ct.bl. .rror..
If Iny tl. due I. paid within thr.. (SI c.llnd.r .onthl .ft.r the d.cldlnt.. d..th, . 'IvI p.rc,"t C5XI dl.count 0'
the t.M paid I. Illow.d.
Int.r..t I. ch.rgld blglnnlng with flr.t dlY of d.llnquency, or nln. C91 .onth. Ind onl CI) day fro. thl dati of
d..th, to the dlt. of ply..nt. Tlx" which b.c... d.linqu.nt b.forl Jsnu.ry I, 1912 b..r Int.r..t .t the r.t. of
.1_ C6X) p.rc.nt p.r ennu. calculatld .t I d.lly r.t. of .000164. All t.x.. which b.c... dlllnquent on .nd .ft.r
Jsnulry I, 191' will baar Int.r..t .t . r.tl Which will vary frol e.llnd.r y..r to cIllndlr y..r with that r.t.
announc.d bV the PA D,plrt.lnt 0' A.v.nu.. Th. .ppllclbll Int.r..t r.t.. for 191' through 1995 Irll
~ Int.rllt A.t. O.lly Int,,"t rlctor Ya.r Int.rut A.tl D.lly Intlrllt F.etar
1'12 ..X .000541 1917 'X .000247
1915 16:< .000451 1911.1991 11:< .00OSal
1914 \IX .000501 1992 'X ,000247
1915 UX .000556 1991.1994 7X .000192
1916 lOX .000274 1995 'X .000247
"Int.rllt h cslcuht.d .. 'allow..
INTEREST . BALANCE OF TAX UNPAIO X NUNBER OF DAYB OELINQUENT X DAILY INTEREST FACTOR
--Any Hotlcl I..u.d ,'t.r the tlM b'~ol" d.llnquent will rlfl.ct WI Int.r..t c.lculetlon to flftlln CI51 d.y.
blYond thl d.te 0' thl ........nt. If Ply..nt I. .Id. If tar thl Int.r'lt co.put.tlon dlt. lhawn an thl
Hotle., ,ddltlanll Int.r..t au.t b. calcul.t.d.
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CERTIFICATION OF NOnCE UNDER RULE 5.6(a)
Name of Decedent: RIINCE:5 J.. '7i{Mlt1J-S
Date of Death: 1:1.-2..-9.:3
Will No.
Admin. No. 1?!'I-()O~S7
To the Regis Lers
I certify that notice of beneficial interest required by
Rule 5.6(a) of the Orphans' Court Hules was served on or mailed to
the (ollowing beneficiaries of the above-captioned estate on
I
Name
~".I.P D. ~p~
Address
1// ,.A...;..~ Rot 'J;/~7J11. (1ct;):
Notice has now been given to all persons entitled thereto under
Rule 5.6(a) except
Date:
/ - 3 -r6
af&E~~~
Signature '
Name .2- tv. h~ )'1-.
Address )I/~~,# /'ld'S'r'
Telephonet1/11 1~('-t?Mf
Capacity: Personal Representative
X Counsel for personal
representative
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IlIl00STI1Il 01' WILI.S 01' CUMBERLAND COUNTY
RllI'ORT 01' STATUS 01' AUMIHISTRA110H
(J'or Ilcsldenl Ueeodents Ilylng After July I, 1984)
IISTATI! NO, 21-Ji- oofr7
v"" II
Namo of UOlledont: !i1J~ .4. 1!1.1I?J/, S
Soolal Soourlty Allcount No.: /r' -ilf -0"31/
00 to of Ooath:
/:1-2. -73
Namo of Porsonal Ilepresentatlve(s):
;tJ;; ?L-.
Capacity
(check one)
x
,
Administrator e.t.a.
Administrator d.b.n.
Exeoutor
Administrator
Is the administration of tho estate eomplelo'l
Yes )L
No
If "yos", how was the IH.hnlnlstratlon ended? (cheek one)
OY court neeountlng
By account slatcd to purtles In Interest X
Uld the parties relcase the
persollal represelltatlve?
Other (explain)
Total IImount pllld to dnte to creditors Ilnd for funcral alld
admlnlstratlvc cxpcnso
$ 7. .2.P7. 9 r
$ 4 7/9. :U
$ . )(
Total vlllue or dlstl'ihlltlollS 10 uale to heneflularles
If IIdmlnlslrlltlon Is not eOlnplete. eslim/ltod vlllue of /lssets
stili In /ldmlnlstratlon
HOTII: This status report is due no later than the due dato for fllillg the ('ennsylvanla
Inheritance Tax Return or. If no Inherlta/lee Tax Return Is required. nine (9) months
after the dote of death; if the administration of the estate has not been concluded,
8 sUlllmary report shaJll>e filed a/lnually thereafter until the administration Is complete.
I certify IIl1der pennlty of perjul'y 1I11lt the forellolng Informutlon Is correct to the
best of my knowledge, Informlltlon 111111 hellef.
II/lte:_ L.-:3_L. 1!1.7'.5 ~ ~~ ;-
.,-Personnl U"l'roc:nntnllllu
, A llorney for 115tlltU
'nlls report must be slll/led I>y Ihe persollul reprcsentatlve, or ono of them when moro
thall OliO, or I>y counsel for the estate.
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