HomeMy WebLinkAbout94-00944
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IJETITION FOR IJROnATI~ 1I1ld GRANT ()I<' LETTERS
t:~/(iI(' (!f t//o/d c' ;.}//IIIIIO,UP . No. p.,;},{-:14 ~1Jft.__
uM' knoll'lI 01' _ To:
Rcgister of Wills for Ihe
"-'-"-- .....- , ,9 --1 . /)('(,(,(I.W't/. Coullly of __C\iMllERLNtlJ__ In thc
Social S('c'lIrity No. ..;.. 0 _ - ,xp - (,.,c",,fl3 Commollwelllth of I'cnnsylvllnlll
The petitioll of till' ulllkrslglled respectfully represeuls thllt:
YOIII' petltlol1l'r(sj, who islare IX years of IIge or oldeYIII Jlle e.\ceutc',z,_________ . nllmcd
In thc IlIst will of Ihe ahov" deel'dclIl, dlllcd _.. ._. l1C""tL_....I.f'._______._______, 19~
lIud codkll(s) dllted ._____...._
('Hall' rl'lC\'Ulll drl'lllll'lUm'l"~, q:. rl'Il11Ilc111111l11. dl'illh Ilf C\\,.'I,:t1lor. ell'.)
Deeen.denl WIIS domiciled 1II dl'llIh in ..C'!'-'I? B.'._8.II!~p. _._"___._ r-"-'.' Count,)', PCllnsylvanla, wilh 1 /)
1.lt~:::..:..~.I~I~lfllmlIY or t:rlllelplIl rcsldelll'I'_III.p ..I(;i.[;l'j. __ (?~T~{f:.._ . HI? hlJII; (' I7JZ/;.-;l( m 1701.3
(II" 'lIl'I.'\' IIl1l11hcr and 1ll1l1ll'lPll1i1YJ
Dceol\lknt, thell....?3. ycars olllg", died.. p t,5fjJ.-&.'>I/3rK:, _______,fl,CJ __, 19~,
IIt...____.. p... ".P ... .__...______________.
EXI'eptllii follows, dcecdelll did 1101 mill'll', II'!!S IWI dlvorccd IIl1d did 1101 have II child horn or adoplcd
liner execution ollhe 1\111 olll-red for prohate; was 1101 the victim 0111 kllllllg lIud was ncycr adjudicated
Incomp"tent: . _ ______._..
DecI'lHlent HI dl'alh oWlled property wllh e.'itllllaled value.' as lollows:
(II' domiciled In I'a.) All pcrsollal properly
(II' 1I0t domkllcd III I'll,) Personal propl'l'lY IlIl'enllsylyalllll
(II' 1I0t domlcilcd ill I'a.) Personal property III Counly
Vlllue of rcal estlue III l'ellnSYlvllllia
situllted liS follows:. /lJj1l,
L...k / 9,
$
$
$
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o
WHEREFOIU" pelltloncr(s) rcspcctfully r,Il!lesl(s) the J1rohllte of thc last will lInd eodlell(5)
presellted hercwlth alld Ihe grallt of Iclll'rs....... ri;,S.T~MDnilli.L_ .
(l~'\lll1lll'nliuy; lIdll1lni\lriuinn c.I.II.; udllllnlslrnlloll d,b.n,~.l.n.)
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OATIl OF PERSONAL REPRESENTATIVE
COMMONWEALTII OF I'ENNSYLVANIA } HH
COllNTY OF .... CUMBERLAND..._....__._ "
The 11~IIIIolI~r(s) IIhOI'l"IIi1I1II'd sw~ar(sllll IIffil'lll(S) Ihlll Ihl' sllllemenl.\ III the foregoing pClhlon arc
Irlle IInd COIll','1 lolhl' he,' of Ih~ ~nowJc-dgl' IIlId bdlef of p~liti(llll'r(s) IInd tlull liS personal rcprcsen-
llllll'c(s) of Ihe nhol'l' d~cecJc-1I1 pellllolll'r(s) will wellllnd Irllly IIdmlnlster the c.\tllle IIccordlng lolaII',
Sworn 10 01 lillil'lll'7THilllll sllh"'1 Ibcd .-fi:,j~)<.D :M-'::..(J .')':1!::1'Jt../~L'(.fX:l..:- V>
7ljJ'l'fO I' 1I1l' I hl'M~ClrMBER lli~'401 t .'" . - ... . ". - ...----------, ~.
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MARt C. LEWIS . I v . (... .. ...-----------.---- '"'
11-/ ~ L:>({:.i.- II
No.
21 - 94 - 944
Estate of
YIOLET E HAMMOND
I Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW NOVEMBER 9, _ 19_~_. in consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that the Instrument(s) date~8.E~IL 10. 1992
described therein be admitted toprobate and riled of record liS the last will of
VIOLET E. HAMMOND
---rEs IANEN IAIlY
CLARENCE O. HAMMOND
and Lellers
arc hereby granted to
'1$
(,
FEES
Probate, Lellers, Ete, "".,." S lA.OO
Shqrl Cerlirleates( 4) , , , , , , , . " L,l.2JID....
Renunciation """""',"" $
X-Pages $ 6.00
JCP, . - 5.00
'WTAL _ $ q' nn
NOVEMBER 9, 1994 ,.~~
.Flled """""""'" "...."...,.,...,
ATTORNEY (Sup, CI, J.D. No,)
ADDRESS
PHONE
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Mailed letters and order to Executor on 11-9-94.
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This is to fc..'rrify dl.U the illlol'lllatloll IWIT ,~i\'c'll i... mll't'nly /'Upil'd frolH ,III lIt'1gillid It'rtj[kall' oj dc',u.I,I.duly [ilt'd with me liS
1,('(,'l\llh,'gis(~ar. Thl' lldgill,ll u.rtilkillt' will he Inl'\\'.IIdl'd III lhl' SUit' ViIHll\cctll'd.. Of!,U: IIII' Pl'fIllillU'lll ldlll}.:.
WARNING: It la Illegal to duplicate this copy by pholostal or photograph,
Fee (lII' rhis ll'relfi""", $2,(10
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COMMONWI!ALTH or PfNNSVLVArUA . DEPARTMeNT 0' HEALtH' VITAL neCORDB
CERTIFICATE OF tlEATH
VIOLET
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nV.1547 EX AFP (08.94~
COHHOHWEAlTH Of Pf.HHSVlVAHIA
DEPAA'"ENT OF REVF,HUE
!UAEAU OF INDIVIDUAL lAX[S
DEP'. l80601
tlARAISllURO, PA I1lla.06DI
nr-"T!OF HAM~=
DAT! OF DEATH 09-20-94
Jl-I'. J I/~; _1/
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NOTICE Of INHERITANCE TAX
APPRAlSEHENT, ALLOWANCE OR DISALLOWANCE
Of DEDUCTIONS AND ASSESSHENT Of TAX
ACN 1 01
FILE NO.
COUNTY
DAT! 02-06-95
=21 94-0944 -
CUMHERLAND
--
- -
NOTE 1 TU INSURE PROPER CREDIT TO VDUR ACCOUNT, SUBHIT TIlE UPPER PDRHDN Of THIS fORH WITH YOUR TAX
PAVHENT TO THE REGISTER Of WILLS, HANE CHECK PAVABLE TO "REGISTER Of WILLS, AGENT"
REMIT PAVMENT TO:
CLARENCE 0 HAMMOND
1229 RITNER HWY
CARLISLE PA 17013
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 170]3
L A~ount RI'!ill==-:=J
CUT ALONG THIS LINE .. RETAIN LOWER PORTION FOR YOUR RECORDS ~
iiIV': i 547 - ii If"A Fi; - r 0'8-: 94T - iiii'fi Ii r .oF. "iNHEiii f AifcE- 'fAx - iiPPRiiis iiifiiir;. A r. r oWAifcE. OR. - - --. -. - - - -.. - --
DISAI.LOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF HAMMONO VIOLET E FILE NO. 21 94-0944 ACN 101 DAT! 02-06-95
TAX RETURN WASI (X) ACCEPTED AS fILED
( ) CHANGED
RESERVATION CONCERNING FUTURE-xNTEREST . SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL
1, Rill Elt.tl ISoh.dul. A) 11)
2, Stookl .nrl Bond. ISch.dull B) 12)
S, Clo..l~ HIld Stock/P.rtn.r.hlp Int.r..t ISch.dul. C! IS!
4, Hortg.g.I/Notl' R.cllu.bll ISch.dull 0) 14!
5, C..h/B.nk DlpO.lt./HI.c, P.r.cn.l PrcPlrt~ (Schldul. E) 15)
6, J.lnU~ Own.d Prop.rly (Sch.dul. f) (6)
7, Tron.f.r. ISch.dul. G) (7)
a, Tot.l A...t.
,00
619,12
.00
.00
,00
~
,00
(8)
619,15
APPROVED DEDUCTIONS AND EXEMPTIONS:
q, fun.r.l E.p.n.../Ad~, Co.t./HI.c, E,pln.l. ISchldull H) (9)
10, Dlbt./Hortg.g. LI.bllltll./LI.n. ISchldul. I) (10!
11, Tot.l Dlduotlon.
12, H.t V.lu. of T.. R.turn
IS, Ch.ri hbl./Gou.rn~.ntol B.qullto ISchldul. JJ
14, N.t V.lu. of E.t.t. Subj.ct to T..
5.323,50
--&II..
Ill)
lI2)
(15)
(14)
Ii.~'~ GO
4, 704,3~:
,00
4,704,35-
will
If an ......m.nt w.. i..u.d pr.viou.1y, 1in.. 14, 15 and/or 1&, 17 and 18
r.f1ect figur.. th.t inc1ud. thl tot.1 of ~ r.turn. a......d to dat..
ASSESSMENT OF TA~:
15, A.ount of Lln. 14 .t Spou..l r.tl
16, A.ount of Lln. 14 t...bl1 .t Lln..l/Cl... A r.t.
17, A.ount of Lln. 14 t...bl. .t Coll.t.r.l/Cl.11 B r.t.
18, Prlnolp.l T.. Du.
NOTE:
115)_
lI6)
lI7!
,OOX,03,
,OOx,06,-
, 00 K ' IS,
ClB!
,00
,00
,00
,00
TAX CREDITS:
PAVHENT
DATE
RECEIPT
NUHBER
DISCOUNT (t!
INTEREST 1-)
AHOUNT PAlO
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST
TOTAL DUE
,00
,00
,00
,00
. If PAID AfTER DATE INDICATED, SEE REVERSE
fOR CALCULATION Of ADDITIONAL INTEREST,
If TOTAL DUE IS LESS THAN fl, NO PAVHENT IS REQUIRED,
If TOTAL DUE IS REflECTED AS A "CREDIT" ICAl, YOU HAV BE DUE
A REfUND, SEE REVERSE SIDE Of THIS fDRH fOR INSTRUCTIONS,)
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RESERVATIONl E.t.t.. 'of d.cld.nt. dvlng on or b.for. DICI.bll' 12, 1982 .- If any f~turl Int.rl.t In 'h. ..tatl I., tran.f,rr.d
In pOI.I..lon or InjoV'lnt to ela..ll teollatlrall b.neflol.rll' nf the d'eldlnt .ft.r th. I~plrltlon of any .It.t. for
llf. or for VI.r., thl Ce..onw~'lth h.rebv .~pr'I'IV rl.lrva. the right to .ppr,I.. Ind ....1' tran.f.r Inhlrlt.nc. T'~'I
at thl lawful Cl... a (0011.t"81) r.t. on any .uoh future Int.rllt.,
PUIIPOSE OF
NOTICE I To fulfill the r.qulr...nt. of SlOt Ion 2140 of thl Inh.rltlnol Ind E.tatl T.~ Act, Aot 22 uf 1991. 72 P.S.
Stctlon 2140,
PAVHENTI D.tach thl top portlen of thh NaUco and lube It with your P'V"'lIt to thl Rlght.r of Willi prlnt.d on thl river.. .Idl.
.-Hlkl oh.ck or .0n1V ordlr pavabll tOI REOISTER Of' NILLS, AOENT
All pIY.lnt. rlc.lv.d shall flr.t b. appll.d to any Inter..t which "V b. du. with .ny r.,.lndtr applltd to thl ta~,
'ReFUNO (CR)I A refund of , t.~ credit. which "'" not requlltad on thl Ta~ Rlturn, ..y bl rlqu..tld by cOIPIIUng an "APplleltlon
for Rtfund of Plnnlvlv.nll Inh.rltancl and E.t.t. TalC" (REV~UU)' ApplloaUon. erl aVllllbl1 .t t~ OffiCI
of th. R.,l.t.r of Will., .ny of th. 2J RlVlnUI Ol.trlot Off Ie.., or by c.lllng th. .p.ol.l 24-hour
.nlw.rlng I.rvlc. nueblr. for for.. ordlrlngl In P.nn.ylv.nl. 1-100-362-20S0, out. Ide P.nn.vlvanl, Ind
within loaal Hlrrl.burg .r., (1111 717-1094, TOOl (7171 77l-22S2 (H..rtng l,pllrld OnlY).
DlJECTIONSI Anv p.rty In Int.ra.t nat ..tl~flld with tho oppr.i....nt, alioWlna. or dl..llow.nr.. 0' d.ductlon., or ........nt
of t.M (Inoluding dt.count or Int.r..t) a. .hown on thl. Notlc. "u.t ~bJ.ot within .tMtV (60) ~IV' of rlc.lpt of
thll NoUe. bVI
--wrlttln prot..t to thl PA o.part..nt of R.v.nu., Bo.rd of App..ll, DEPT. 2'1021, H.rrl.burg. PA 17121-1021, OR
W411.ctlon to h.v. thl .Itt.r detlr.tnld .t audit of the .ccount of thl plr.on.1 r.pr...ntattvI, OR
--app'll to th. Orphan.' Court.
AIItlIN
ISl~ATlYE
Cotl~ECTlON"
DISCOUNT.
Faatu.l .rror. dl.covlrld on thl. ........nt Iho~ld bl .ddr....d In wrlttng tal PA D.part..nt of Rlv.nu.,
8ur..u of Individual 'a~.., ATTNI Po.t A..o....nt ~Ivl.w Untt, DEPT. 210601, HarriSburg, PA 1712840601
Phon. (1171 717-6S0S. s.. pig. J of thl book lit "Inltructlon' for Inh.rltenc. T'M R.turn for I RI.tdent
Dee.dlnt" (REY-1SOlJ far .n I~phn.tlon of ad.tnhtr.UvIlv carreot.ble errors.
If ,nv t.~ dUI I. paid within thr.. (31 o.tlnd.r lonths aft.r the d.c.dlntl. dl.th, . 'Iv. p.ro.nt (SX) dl.caunt of
thl t.~ p.ld I. allow.d.
IN1E~EI' .
Jntlr..t I. charg.d blglnnlna wtth ftr.t alV of d.1Inqu.nov, or nln. (9) lonth. Ind on. (11 dlY fro. the d.t. of
dl.th, to th. dlt. of p'v'lnt. TI~" which b.c.., d,llnqu.nt b.for. Jlnu.ry I, 1912 b.ar lntlrl.t It the rlt. of
.l~ ('X) p.rolnt p.r .nnu. o.lcu..tld .t . d.lly rat. of .000164. All tIM" which blcft" dlllnquent on tnd .ft,r
Janu.ry I, 1982 will bolr Int.r..t at ~ rate which will vary fro. c.llndlr V'lr to oll,ndar v..r with thlt rite
.nnounold by the PA O,plrte.nt of Rlv.nUI. Thl applloabl. Int.r..t ratl' for 1912 through 1995 .r'l
'!!!! Int"..t R.t. O.llv Intlr..t r.otor !!!! Inter..t Rat. Ually Inttrllt FlGtor
191Z !OX .00m& 1987 9X ,000247
I9aS 16X ,OOOU& 19&&-1991 llX ,000501
1986 llX ,000101 1992 9X ,000247
ltaS llX ,OOOlS6 1991-1994 IX ,000192
19.. lOX ,Doom 1995 9X ,000247
ulnt,,"t I. ellcul.tld .. fotlow'l
IHTEREIT . IALAHCE OF TAX UHPAID X HUHIER OF DAYI DELINQUENT X DAILY INTEREIT FACTOR
.-Any Notlcl I..utd .ftlr the talC blao..1 d.llnqu.nt will r.ft.at In Intlr..t a.laut.tlo" to flft,.n (15) d,VI
b.vond the dlt, of the 1""'ltnt. If pav",nt I. ..61 Iftlr thl lnt.r..t aOlPUtatlon d.tl .hOwn' on the
NoUo., addU lonlt Int"..t IU.t bl a.lcul.t.d.
/ II -
RfY.flOOEX. 1/.9<1 ~. 'POADATIIOPDIATHAnlA 12/31/9t CHICKHIAI
~ ", INHERITANCE TAX RETURN ~ctv:~~umD!!I~CLA_I!IIID_JJ_'__n_._
..... RESIDENT DECEDENT PILI NUMBIA f 'I' J
COMMONWEAl1l1 0' PfNflliLVAfl'A (TO BE FILED IN DUPLICATE dJ ,/ 7
OEPAfUM!NT Of RfVfNUf 7 '1
IIARRlSm:&, ~~l'Jb0601 WITH REGIS1'ER OF WILLS) COUNTY COOE.).I YEAR . NUMBER
O!C~OW '5 NAM! II;~I, Pllt '-'~~NO MlOOtf l~mlAq -. _____n__H -. - ~-- _ u - .-+ ..Ur-Of-iEOf-N"~ COM,(-iif AOO.ESS u_.__ '4 h
I:: .Jl}lljjlljo.t.J1?----------()IIClkI--n--JI;~--.----. 12.2.9 'IKrf(./,?ER /1'1 1-0r':;7
m SOCIAl stMilY tIUMB!R DAn Of OfAlt1 OAH m IIWI C 4f 116 € /(.:) . \ 1 () I ~
~ ....2..DZ.::...l.(~.:.L~/J. 3___ .4 (Z,-o !9.YI,. __~_.I.J..o/; / u C~~Im('J."J1'\~. ~hlJ:L_____.____
Q (" U'I'(AIUI ~UhIVI'W \'Oull' 'WI! (lAt!. "HI "4D ...It.~;;,II.(?;'--~ 50CIAl5tctJtilY ~iifR AMOUNT U~!'VWTSu IN5UUCflONSl
---- i:I.clmry.wD_Cj1:J.g~~KL...D____ /__f_L.Ej..::..'iC()X,__ _.. (' ~:I ~~.J
~ ~n, Original ReI"n [I ~. Supplemenlol Relutn ["13. Remainder R.I"n
M!l~ - . ~ l'ardal..aldealhprlarlat2,t3,821
lill!:\,! [] 4. lImiled Ellol. [ J 40. Fulure In"rell Compramhe [] 5. Federal EIIol. Tax Relutn Required
:Z:~::l I'or dole. 01 d.olt. after t2,12,82)
uo~ '
[J 6, Oecedenl Died Te.lal. L.I 7. O",de"l Molnlolned a \.I,lng Trull -L. 8. Talol Number 01 Sale Oepa.1t 80...
.- (Alloch tOpy a' Will) (Allach copy 01 Trulll
---. e,COIIISPONDtNCUND CONPlDIMTIAL TAlC INPOIMATION IHOU.LD al DlRICTIDTOI ,. i,', ,\!, ...:.:.:..:...;. ..,.--
t.3 m , I OM lEU MAILING DO_US
f1il!~ .1!.LIJIf:..€..~c.f,,____.Q___.--Lt~JL;)/IIJ?~.D_____ /r'I.:{) R;/;Vf"f " /-tj/hw?.; 1
.. IfL!"O'" "UMIf! {' '~/, -f {, ;<-~
-IJ: l..c~~=.:l._-1.3:;.__rQ,,_(g:L_c,====~~~_"'/' I~_/.. _ ",/ /7cJ/3
(.;f
111 ..... ..___,.....' c. ......_.u.. ""_"
I 2 ) ... .__<'>_l<L.J.5~___._.__
13 )______~_---...--".
I 4 ) .---, --;1._____-----,-
15 )----,1?!..------
16) -.L____
17) ~:..____
20, II line 19 h Brealer Ihon line t8. enler Ihe dlllerence an line 20, Thh l'lhe OVIAPAYMINT,
riD
21. II ~Ine 181. greol" Ihon line 19, enlO1 Ihe dlll"ence on line 21. Thh l'lhe TAX DUE, 121) ___ ~
A. Enler II.. inl.",1 an Ihe balance due an line 21 A. 121 AI z;r
8, Enler 11..10101 a' line 2t and 21A an line 218, Thl. h Ihe BALANCE DUE, 12181
Make Check Payobte 101 Ae;I.'er of Will.. _~;enl __
~," , ..,;;. ~,.. II lUll TO ANIWI. ALL QUIITIONI ON IIVI.IISlDt AND TO .ICHICK MATil <II( <(, " "",:
Und.r Plnchl.. of perlury. I dedar. thai I have IKomlned ,hi, rfllurn, including accompanying Ich.dul.. and lIel.mlnh, and 10 ,h. bllt of my ~nowl.d9' and b,ll,f,
II II Iru., correct and compl.'e. I declare thai all ,eollllal, hal been reported allrue market value. Declaration of preparer other than the penonal r.prelenlallve II
haled on alllnformatlon of which preparer hal ony knowledge.
1.;t.I/I! Of mlo" 'WO"III~'~!,."}'''O mu." .. _ AO~~f~1 " / :/../~ om
-t:' ' 1!-O'tO~(? C 1/-a-1'YV)t~~ /,//,/; ,<:-~f.v..,.t.' ,d.,j-'<Jtu_..i..'''i/,si- J'j,
:IONtUIU Of PIt('AItU OI~U H\,4,H Rf'ItE5fNT1IVE AODRESS t I )7 /'''>C;;
72I1L':/,L;(.~0Q'/ot!""/~2,-,--.___3Jy")&-~,,,!'?-:tt:,.;t. ,;'....).! ~,/^.y, ;.~'/+-; /4
(
1. R.ol E.lol. ISch.dul. AI
2, Slack! and Bond, ISchedule 81
3, Clo.ely Held SlockJPorlne"hlp Inlere" ISchedul. CJ
4, Morlgage' and Nol.. Recel,obl. ISchedulo 01
5. Ccuh, 8\Jnk Depollu & Mlscellaneoul Personul Properly
(Schedul. EI
6. Jolnlly Owned Prop"'Y {Schedul. FI
7. Tra"'e,, (Sth.dul. G) (Schedul. L)
8, TOlal Grall All," I'clolllne, 1,71
9, Funeral EKpenlel, Admlnlslrallve COlh, Miscellaneous
Expenltl ISch.dul. HI
10, O.bls. Morlgoge llobllille., Lien. (Schedule I)
11. Tolol O.ducllo" (10'01 line. 9 & 10)
12. Nel Value 01 EllolO 11Ine 8 ",lnUl line t 11
t 3, Charllabl. and Governmenlol 8.quell. ISchedul. JI
14. N.I Value Sublecllo Tax (line 12 mlnUl line 131
15. SpoUlal Trani'''' ('or dole. a' d.olh aft" 6,30,94)
Sit InstrucHonl for Applicable Percentage on Reverie 1151.
Side, Ilnciude ,olu.. Irom Sch.dule K or Schedule M.I
16, Amounl a' line 14 loxabl. 01 6% role
Ilnciude ,alu.. from Sch.dule K or Schedul. M.)
t7, Amounl a' line 14 loxable 01 15% role
(Inciude ,alu.. froln Schedule K or Scheduie M.)
t8, Principal lox due (Add lax from line. 15. 16 and t7,I
19. Credill Spousal Poverty Credil Prior Paymenh
.---------. + -.._----, +
z
o
5
~
~
~
~
.
fI
S
.-"
/ I - J,t..;!:J
t:
(Q )_5.J4..5-,-...~__
i5
(81_~
I.S-
(10) _
S 3.?:?, 50
X5
jZf
jO
0'
.6
,5
/
if
1111,
1121
1131__
114)
g-
1161 pr' " ,06 ..
1171 .__~ __" ,15.
X.__c
1181
Discount
Inlerell
t2..
~,,-
1191
(201
Cllt'c;~ hl'lt' ., you Clll' I('ClulI..hll~1 0 fI"und of YUill OVI''1IUY"1l'1l1
ef'
11-, /(1- 9</
DATE
...!..!...::..-:o-9y
.IV.lm"."'''1
.'1)
J SCHEDULE H
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISC~LLANEOUS EXPENS~ PI.al. print or Tvp.
---rm"NUMIIR
{/)t)j/ ("") -L-_
.
COMMONWM\TH 0' 'ENtlSYLYANIA
tNH!RlfANC! TM. RETURN
RIlIDINT DmD!NI
1ST4T1 O~
ITEM
NUMBER
DESCRIPTION
AMOUNT
1.
funeral EMp.nl.ll,
f;;fl.s-H,UCO/ d'.t"It"'.(~A: jl~A....-,e';I/
~))ltIll:-(.I-hIt'...'i C'SC,.e'I'I"'S/ CW,:;-,/}/ .!"I.l-il)
CK#t/J: o!-XC/./tI/I~~~
1/9 .!.;I. :::10
A.
35ti. N.J,
B. AcImlnlltratlv. COIIlI
1, Perianal ReprolenlollYe Commllllonl
Social Security Number of Perianal ReprelenlollYe:
Year Commllllonl paid
2, ' Attorney Fees
3,
Famll't Exemption
Claimant
Addrell of Claimant at decedent'l death
Street Addrell
Relallonlhlp
City
4, Probate Fees
~/()cJ
C. Mlle.llan,oul bp.n"I',
1.
2,
3,
4,
','.5.
6,
7,
8,
State Zip Code
" /!/. OC:J
, I:
TOTAL lAlla enler on line 9, Recapitulation) S $,32,3, $t'
(If more Ipae. II n"d.d, lnl.r! additional Ih..1I of lam. 111..1