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94-00952
II, ,. It',,: /); '".,' ,'''u. ". ',"u.",' 'i" ,i' 'i,i':,! ',' "'J'!;i ,. _u' lis/Me 11( ._ ~lJe.L._B:lal}teno 11/,10 kl/olY/l as ____.~.. UUnn I'ETITION ...on PHOHATE IIl1d GnANT 011 LE'I'TlmS No, -_.??!:::.'l.'i_ -J..~~ To; .-------.- --. l(c~I.\lcr of WIII~ for tllc --.-u--u--.-,."....--12.-1T1~ 111'('('11,1/''', ('ollllty of ._ ~rl.~9....._._ In the Sol'lll/ Sel'l/rll,l' No, _.:!-_~,J:- --:".."'~. COllllllollwcalt1l of I'cnn~ylvanla Tllc 11etltlollof tllc IIndcl.Ilgncd Icspc~llully ICpll'ICIII.\ IlIllt: Yuur pClllloncr(~), wllolll/llc IN YCIlI.\ of IIgc or oldcr 1I111hc cxccul. rix._ Intllc IlIst will of tile alluvc dCCl,dC;Il, dillcd . !;rW1~. 8, ____ ..__...___ ami codlcll(l) dalcd _.___u____.._.m.. ___ _ __. __..____.___ _. named , 19---22- ----------. ..-.-.".. .~---- "... -_ '__"'___n. ____________ '--'--.-__"._'''_'_n.. .._ __ __....__...~_......___..___... ....--.------...... ---.... .__.'_._..._. u______.____ .__.._ ('lnll' ,deVAIII d/l'llIlI\lnll\'l'~, l'.~. rClltllll'lnlloll, deAth uf (,~(,cUI(1rl Cle.) [)cccndcllt WII,q dOllllcllcd lit dl'1I111 III .C\lI11bE!J:::l./i!14.___________. Counly, I'ennsylvllnlll, with h~_IIISl rllllllly or prlnclplIl rClldclI~C III ...lU2..Charlea..street, Me,\;hM...i..csbur.gl_Pennsylv.w.a 17055. h.. ..__.. .____._.__ "__". (lhl 'IICl'l, lllll1lhl'l nnd IIll1lldjlulltYJ IJcccllllCIII, Ihell_I5 ... ._. YC11I1 of I1ge, dll'd .Sept:~r.Jf________, 19_~, 1I1._.l!.ol V S[J:ixJ..t_H9SP:l iMl ... h _ _... ". .____.______.._. , Exccpllls followl, dCl'cdclIlllld 1I0t1ll1l1lY, \\'II~ 1101 dlvoll'cd IIl1d did not hllvc a child burn or adopled afler excculion of fhc wllloflcred lor I>lOhlllc; WII.\ 1It>l Ihc vlclilllof a killing and was ncver 1I11Judlcated IncolllpclCIII: .------..._.....____n. _...__....._.__.... .____n___._____ Decellllclll al dClllh owncd propclly wllh c.\lllllllled 1'II111CI 11.\ 101l0lvs: (If dUllllclled III I'll,) All pcrsoulIl properly (If nul dumlclled 1111'11,) I'crsolllll prupelly III I'clllIsylvlIlIllI (If Ilul dumlcllcd III I'a,) I'ersonlll plOpcrly IIIl'oullly VlIllle of relll estate III I'cllIIsylvlIlIllI sllualcd liS follows: .--u-___._______n________. $ less $ $ $- than $10,000.00 .._---_..._.._.~- --------- --.--..------.-------- WHEREFORE, pctllioller(s) rClpcctfully 1C1UC,I(I) Ihe prohnte of Ihe last will alld el1lllcll(s) presellted herewith alld the granl of lellel.\.__...~~Qgi~ IICllnll1'11111'Y; I1dll1ll1lS1rl1l1ol1 1',1,11.: odll1ll1l1l,ollol1 d,h,n,c,I.O,) Ihcron, ~~ \ ri\ ,S cvwY '" -1112 charles StreeC-----.---- I .-.----------._._.._..h..._.. 19 -~hanicsbw::g:JA__17'055_____. - II -(]llL6.9.2""fiB44__u.._ . .___.__. t~ iii --------.-----......----..--.-- . .--"-----"-"'--.-..___..._.l.. ._.._._..... ._ _u ..._ .._..,..__ .. ~._ OATH 01" PEHSONAL IUWltESENTATlVE COMMONWEAI:I'II 01" l'ENNSYl.VAN'A L HS COUN'/'Y OJI _.._._ ~rlC!!19...._'___._h J " 'fhe pelltloncr(s) allov~.nnlllcd Iwear(,q) or nffll'ln(l) Ihlllthc Malclllcnls inlhc furc8uln8 pelltlon are true and corrcclto lhc he.\llJf Ihc knowledge IInd hcllcf of pelltloner(s) and Ihnl as personal represen- tallvc(s) uf the ahuve dl'cedenlpclllloIICI(I) )lJ.li-wl:1I nlld trnly IIdllllnlslcr. thc eslate according to law. (l) , C' Sworll III or. II. [fhllled nllll IUblCrll)C(~t A. ..~.' ;y.v.,.d'0. c<.J(~ !11 before lIle this ----__;._..JllL_ dny of ___.;_.._~f'1es Stteet" __I~' "7'J.h~f~----. ---.-- fJlJL ._1'k;!.Q.@!JJ.csburq, PA 17055 1-'tiJ.&.t"-4UJ.!.w.../~~~,-1..!. .. J[LJZD.l7J.69.7::Q6A.L__ tl'lIR Y C. L EW [S IiIWI.l/I'1' 1...(/_:._._..____..__.. <:! /q -- ~I/(,) - :.;' A', y (, .~"i I' 'I I . .. " , ' ,. , ,\ ,r. .,' . LAST WILL AND TESTAMENT 01' ANNABELLE L. BLANTENO I, ANNABELLE L. BLANTENO of R. D. No.3, Dunoannon, Perry County, Pennsy1~ania, declare this to be my Last will and Testa- ment, hereby revoking any will previously made by me. I - I direct the payment from my estate of all my just debts and funeral expenses as soon as practical after my death. II - I devise and bequeath all of my estate of every nature and wherever situato unto my husband, Raymond Blanteno, providing he survives me by sixty (60) days. III - Should my said husband fail to be living on the sixty-first (51st) day following my death, then I direct that all of my estate of every nature and wherever situate be distribu- ted as follows: A. I devise my house along the river at R. D. No.3, Duncannon, Pennsylvania unto my daughter, Rosemarie M. Evans, and her husband, Edward A. Evans, as tenants by the entireties. B. I devise and bequeath all of the remainder of my estate unto my daughter, Rosemarie M. Evans, or her issue per stirpes. IV - I appoint my granddaughter, Marlene O'Hanley, guardian of any property which passes under this will or otherwise to a miuor or an incompetent and with respect to which I am author- ized to appoint a guardian and have not otherwise specifically done so. Such guardian shall have the power to use principal as well as income from time to time for the minor's education, support and welfare or to make payment for those purposes without further re- sponsibility to the minor or to any person taking care of the minor. Said guardianship shall terminate as to each beneficiary when he or she roaches tho ago of 21 YOiU'S. A'NOU>, IUK8. 8AYl.8Y /,; - II $t Ar""NI.V. AI IA~' t~?4 ~~ if ~.... z:~ "" HAIlIT mm _ CAw, HiLl., r.nMYlYANIA 11011 Page 1 ',,, R~V.IS()(l ':" I 1'.'}.11 I ~ - J~~-5' 0di/ rOR MUS OF DEAItI AflER 12/31/91 WICK IIIR INHERITANCE TAX RETUltN ~o~:&fyU~~~DIIII CLAIMID LI RESIDENT DECEDENT iiii NUMiiil.U-.---..-------. COMMOIlW\MlIl Of rfIlHSYIV^IlIA lTO BE FILED IN DUPLICATE 21 94 952 UEPAA MUH 0' R1vENUE IIARRI!IUf.\, ~~19 110601 WITH REGISTER OF WILLS) WUIIIY COUE YEAR NUMBEI DfC<<;IUj:i Ul~iIli rn:-nnr"Allo ~i-ulnrfi1ifijir=.:::==--=:-.:~~;=-;.-=;:=:-==..;= fil~i~mHroti'ffilf Ajjfiiii~; t: llI.J\N'l'ENO, flNNI\l3EL,t,tl I" 1112 ClliIrles street ill i.O.(iiiii.(ii.~i.fijj.ijii~fij.--.-. ...- ....-... Iii". if (Ii j'iAiil jiJ^" j); ftl~ill f'1::!dllltl i cnh~lnJ, Pl). J. '10fj!j ~ Ifl3-12-14 m ')..12..')'1 '1-11-1 ') ("""r' CUl1d!C!!,J.i!I!~! ..V~ ..._!~~~l!!.-'l!E.l~o-'~\.:iI!.o.l co 1'; ..iiii.;,i,.i,;",,,,i; ii':;uii i "'"' ,,,ii i,;" ",i ."",,, '''''''II .. .1'""" li'II;'" ~::~'_ _ . ^MUU'" 10(11"" I'" ""IIU'"U"'I --~-"'i~)f'I'-O~~I;;aIRe~u~; - ---.-----. . -. -. I] 2. SlIppl.m'"1111 ReluIII . .... --. - .. . .--. rCI-3~ Re~,~j;,d" Relurn ~ .. I'.r dol.. 01 d.alh prla, I. 12.13.B1 ~g:B {"'J ~. Umlted (\101& I 1 ~(I. ruhufllnrtH011 COIT1f1rnrnhn [Is. FodolUl Eilal., Tolt Relurn RequIred Of~ 1'01 dlllol 01 dnnll, (Ilrn, 12.12.071 ~ lX 6. Dncedftl1l OIlHI Tlutfllo I I 7. llncndnnl Molnlulnod n living llLlIl ~. Tolol Number of ~ Depalll 80KeI 1^lInch copy of WHlI . 1^IIClCh copy I'll Trutll _ ".. Id ~n m .. _..h... AL1'CORRESPONOENCfANO-CONfioENTIAL' T AjfjNjioRMATlotfsHoUiiljjE-iiiRECTE~~-t .1,: '~ i I iii';i~II~~;~;~ --;-;I~~~'UJ~-,-I;J ._.__. __._. '._. 'liiJ'iiii?'~"';~"li:l't~~111~i~~~,IS~li)~t'II~.(I;e, e,' l:'A.n.- -. ~ T- Uo.. iiiiiHuiiniiii,iiiii.-----...-- ____n.. n:;.....,'..... j' ...J. .7.17_L;I.G.~2 . H.. _. _"nu .uuuu _ _.-" __. 1'1~5 1. Real E11..e ISthedule AI 2, Slockl alld Bond. ISthedu'e B) 3. CI.llly Held SlockIPa"II...hlp Inle'",I ISchedule CI 4, MIIIIBaB" "nd N,II.. Retelvable ISchedule D} 5. Cnth. Bonk DepolllI & Mllcelloneoul Per,onal Propllly (S,hedul, EI 6, Jolnlly OWlled Properly (Sthedul. EI 7. TfIl"l... (Sthedule GI (Sthedule II B. Tulal G,all Allellll.lal LI,Ie. 1.1I 9. Funeral Expennt, AdmlnlllrollvlI Co'"' Mhcellaneoul E,p""" ISchedule HI 10. Debl., Mallgaee llabllllle., lion, (Sthed"le II 11. T.'al Oedutlla" (1.'01 Line. 9 & 10) 12. Nel Value 01 E.lllle (lllle B mlllu' Line 111 13. Cha,lIable and Governmenlal B.queu'ISchedulo JI .___ ~'iel Val~ SubieCI I. To, Ill"'. 12 mlnUl llno .!:Jl__.________ 15, Sp.u,al T,olllle" II., dol.. III dealh all" 6.30.9~1 Su Inllruellonl 'or Applicable P,rcenlaoe on Revllrle Side. (1lIclude valu.. from Schedule K 0' Sth.du'e M,I 16, Amaunl.f LillO 14 lo,oble 01 6% 'ale 1'"lude volu.. fr,lm Schedule K or Schedule M,) 17. Amount alllne 14 taxoble 01 15% tOl8 llnclude volulII f,om Sduulule K or SclHuJulll M.I 18. PrlnclpalloA duelAdd IOK ',omUne, IS, 16 ond 17.1 19, ("dill SpolJlOl Poverty Credit Pdor Pnymenlt Dlttaunl ____._.Q_.__........ .. ........0_ ...._... +_____.9_._ ~ ~riP~ z co I z ~ E B S 1'1 _._________O_____~..____. . 121 ----.-.- ~ ----- "J2 S ( 31______ o (~I -.-- -.-..-___ _. .-______ 1,\1 J2~390:64 '1:1 '" (,II C' -, h: !" 161 .0____. ( 71 ._.____.__L________ (91.$ 4,550.53 (101 _$14,073.21 I g I $26,398.64 o (111-118,631.74 (121__t.!,766.90 (131 0 (I~I $ 7,766.90 o X,.Q...D (lll____._ li61..L217.~.~,~.Q___.__..__x .06. _.1 466.01 (llI._.__mm_.O...______.x .15.- ____Q___ (lBI __.--.0__. Inl"OII ___0___.__ (l9) _.____Q. 120) 0 20. 1I11o. 19 II grenl., thon LItle IB, enler IJ", llllfl'lfllllte onllnll 20, 11111 It 'he OVERPAYMENT, liD 21. lIL1no lB II e,eale, Ihan line 19, enl.. Ihe dllle,e"e." II". 21. lhll II Ihe TAX DUE, A. Enl.r ,h. Inllflll on Ihe bolonc. dUI on line 21 A. 8. Ellie' Ihela,al .1 Line 21 alld 21A allLl"e 21B. 1111, II Ih. BALANCE DUE, Make Ch,,~ Pavabl. 'e, Regll!!'.~.~II~,. Ae'''' .... _.h__h.._. ... .~.~.')~.S..l'R.E TO AN~WER;AiL Q~EShONS"ONREvi:RsrsiD(AN~JO.REc.~?K;,fAT~~~.~.._ ._____...~ ~Ith" plnalll", of pnrluty, I dflclcue IIHllllHlve flllClnullOd '''n lohlln, Inclm/inn ClCCon1fl{lny1nn tehodulfll ond tlulttmol111, Cllld to Iho IHul of my knowledge and belle; ~ l'druI, co,',',oc,' and comp,'e"h' I declare ,1101 nil rIal 0110119 heu been reporled 01 IlutI malkol volu!. [)ltclcuollon of p,eparfl' 01110, Ihan Ihe pertanal "pr...nlallvll allan Cl __~~~ollon 0 w leh pfeparer hOI ony knowledge. 10 UOI Of ""Oli:II;omiii'~momijm----AOUim------.------.--.---- .-.---- oq-- 1 A 01 ""'IP^~ IlIi 'AI "'~-~~~i~ii01ilrleS-~~~.e.~-'--~-C~lil~!c:~.bUrg I ~0...-!!055 _ _ -1,3 - 'f 5 , OAlf . 7!4 ~.l'I-,-. Ma!:..n_.~tr.~.t:L /:1e_C!!1l!.r1.i2.f'lI!t!.l:S!L.!'!:I....11Q55_ _.':I.: I .3 -f!{ Clwd!: hi.", If \lOIJ f1kt '(Of U't>,II11U fI lo unci bf VUIlI nVl'Qlllvrl1NII 1211 __L~~.Ol (21AI 0 (2IB) $ 466.01 SCHEDULE H 1 FUNERAL EXPENSES, COMMONWIAUH Of PfNN!VlVANIA ADMINISTRATIVE COSTS AND INI:\;:~~~~'O~~~W~AN . MISC~LLANEOUS E~PENSES __ PI.a.. Print or Typ. bTAU 6r - -... ~I'lllNllMBIR _ _.JINNABELIE ~~~O I. 21~94-952 DESCRIPTION AMOUNT " IIV.IJII III. ",U' . ITEM NUMBER A. fun"ral Exp.n..., MusselJlan I s 1''unera1 1 lane , Inc. Food & Arrangerrents for FlUl~ral Meal, etc. 1. . 2. B. Admlnl.tratlvu Co.t., 1. Pellonol Representative Commllllons Rosemarie Evans Soclol Security Number 0' Porsonal Roprosontatlvo: . Year Commlulon. pold 2, Allarney Fees Charles E. Shields, III (5%) 3, Family Exemption Clalmont -.NOne. Addrell 01 Clalmont at decedont's death Stroel Addrell City Stote __ Zip Code Rolatlonshlp _ 4, . Probate. Fus and short certificateo c. MI.e.llan.oul bp.n.... 1\dvertising in cumberland Law Journal 1. 2, 1Idv~rtising in Harrisburg Metro-west 3, Reserved for Robert U11berger, close-out 1040 4, Res~rved for Robert U11berger, fiduciary return 5, 1\dditiona1 Probate fee 6, Filing J\cCOlUlt (estim. ) 7. Filing Inh~ritanc~ Tax Return 8, Certified Mail i.ngs of 1\ccolUlt (~stim.) $ 2,747.20 $ 129.38 Waived $ 1,320.00 $. ~O.OO $ 40.00 $ 48.95 $ 30.00 $ 40.00 $ 20.00 $ 105.00 $ 15.00 $ 3.00 TOTAL (Aho enter on line 9, Recapltolatlon) S 4,558.53 (If molt .poce I. n..d.d, Inr.rt addUlonal .h..tl 0' .am. Ill..) ~ ~ 1 ~\ ~ l~\' g ~. o ~ Q ~\ ~\ z .r .;::: ~ .. s u ~ ~ ~ ,. ~~~ ~~~ IJ I'.H)li ~ ~ ~ ~ !l~.l ~~ '<1 ~ ~ ~rh ~ ~~ l ~ ~~ :J ~ ~u ;; = <.I~ i:j .. ~~ Cl (I' a l II II -if jJ ~tn? II ~.!: II "i ,alJ H lm'J .1 Ie; I ~.'! II~h ii ~al Ii !~h ~t IdfH !15) a J 0 ffi a i ~ mH j; ~tfa ~i ; " ~ ~ ~ !.!:H . ~ ~ ~6 : : u~ ~ : : ~ 0 : \...;...2 . : ; ~ cS . , . . "i! . . ~. ; 0 . : eo " ~: ~ g : 6 ~.~:u'~~'" 1, ~ : fi H .~gv. 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Ii '/ " " I ,Ij_, 1-" , JI 1'!i,11 B :, . J III I! 8 :.,{ j I'll hhl Iljlii !! ,: t ~t J I Ih:ltl!I'illt if) ~J. fitl II 11 , It "1 ,i, j. " " . , , I', ".1' " " ',~r ... .1.'.... I .....' J '/' ./,// ,\ I.~ l--" " I',. ,. " , i" , " 'I" '.' , .,k , , '.,' ,', .,'. ' ,: " " lr" ,.. , I , , ," I , ". I : , " "1' ,", '" ," , " ,. " , I .",' . I,"" jj , .,-, " . ,. , , , , ' ,,' "I', ; 1- " " "1. 'I. " .1'" ,! i 1 \." i .' "" , I. I , II' '." "I , I " , .' L. f" t, J', , 1-, : " ,. I' 11 II'. ,.. " " I " '" , " , " , " , " " '.' , ',.1 , ( .. ,.' ~ . , ' . '~~L~ <'\ .l._ 1, \ (,,-,-,--t b f0" . d .(J.e;:, f' <if Y/ ~ + - 15 ~ Q. ~.. 4 (c, ~' , <{ { l{ ( A, l.~ t I SI 3 ~ ~" 1 ~ ~~C.klV\) Qce' ~"'~~^~C'c :)' 0., u\ f\ '\ s Q Cc '" ~L,L.-.. v\(:..~ --- f:j., 0 I J 9 3. d-O h\.'VtJ.Js) ~~. -p ~~k/~ (,rill 'B, /I.s - ~~ ~~ l~dI1 Q..i\~n.tLI_~ Y '5" Q 01'Arl~ I .(/ /~/vt/ u.. Q,t... Y\v-'"""j U"",-,- ,,'d (,,1 ~;~ y&;jt.~). (\ R fL ~ S'- """'\. ~ ~.."'" ~ ( ,)rl'9 "~~;),, I, 1- I/. ~_... ,,/1,1 fu It tk ~+ S~ cL.J( (~,-b ~L('- 3 8~. 0 I /~~~ VJ ~~U~l5>>~ <<~,1)lV-<c.t;""6'I ,'~ h~~~- 'Ji '''"'^'' ~ p, iLl 5 ~(A;~ RJ.Dw....c...I\,,(M ~(P. j ( Y 1v' , y~ ~ ~~ lCv~~lt) fX\~4. 9,:so (fJl::fZ ~ .~ e.4. fl~S Ul~~,~hl~:~:5 {J;tfi ~ Q..dR "~~ ~((vAII.t4~ ~,30. ;;- LIn!i#1 ( fl~lfl1llf~l' ~') ~ r t L s 6 ~ 6l.,t ]) w-.- C:o.-v..tA15-.) 1/1.3. l 5~ ~ A moo . '.1'\ I ^ · '^ (l.~'A..Q.. (~SlJ ~~ UUI~/'t'\(:V~~ ~ ()~~l\"".\"-;'''-- .. 'h'),'YcJ- ~~(~)~~M\f\U1'\~) W:/~g ,51 r;~', '{\ ~/,u..'~ (~, ~1 tv.,~) \~1\'1 '\ 1 So, ~ s <::: ~ ..t~?-\.~ ~ ~.J-. (~<>4~~J ~.I\'I':~ tI7 ~ .39 " ...- 'DATE: 'SUBJECT i TO: I'ROK: I' ........1 I, \. II I' , ,; ,I: I' i, ,1,"'",,' ii' NOVEMBER,28. 1994 RHP ~ SOC REQUEST RE: :9LANTENO. ANNABELLE C/R 21-0069362 COM.MONVElL TH OF PENNSYLVANIA JEAN E, GRAYBILL, SENIOR ASSISTANT COUNSEL DPV LEGAL OFFICE ANITA SETTINO. SUPERVISOR TPL -.CASUALTY UNIT PER YOUR REQUEST. PLEASE FIND ATTACHED THE STATEMENT OF CLAIM Al1D RECIPI~'T HISTORY PROFILE THAT YOU'REQUESTED, IF ANY ADDITIONAL INFORMATION IS REQUIRED PLEASE CONTACT HE. ATTACHMENTS " 1"'1' ,. , ,".' I' '" ';\. " iI' ,1'1' 'j"li \1 I' " ,,,. "'" " ""[ ,. " 'j', " " , ,i' ", [. " " " ,. " 1,"1, , I ,. " " (' " ~ i " i' \'1' " I' ,., ., I" I' 'I " 'j" ,. ,. " , ,. , , .- ., , ,. , , I I .1 F " "i , , , " I , , 1 , , I' '. ):, , Hi "; " "j. " j I' " II' " ,. ,JI, " ., I" " 1 .. ". 'I " , ,'. , ,. 'I' " , , ,\' ,. I' " ,,<' L '1 " Ii 'i, h " jj 'j, .,. " I;, ,. 1 ,. , " ,(I " , '.'1 , 11 , , , , 'I, , , .. Ii , , ,. '" " 'I "1< " " .1'- ',. .' oil '" ,. ,1,'1 " I' , '1 " , ! I. -, I, " I' I'. " , I ...t...r.....,....,........ ...., , , '... I ',/ t::-' IJ~~.i:-:~=~~:.~~~I~:~------,---~: _~O: '. : I 'lill\~I''"'"'2,''Om'''''-".I'INNI,,..N..,N''"''''''''..."'''::.. . .' . ~: E IVE RO m ASSESSMENT f!I AMOUNT R CE II F MI If CONTROL iii NUMBER I 'I SHIELDS CHARLES E III I!W MAIN STREET - 10.1 .....'.01 -, M~CHANIC88URG PA l?Oee ---'-- ,'t", , ~~o Hlltt , , !SlATE IN/ORMATION, II IlL NUMB R " . , el-1994-0gee . EJ NAME 0/ DECEDENT (LAST) .11 DA E 0/ PAYMENT 'B POSTMAR E COUNTY SSN .\ S3-1 e':'3488 (/IRST) (MI), -- - UI'IIEI'ILAND DATE 0/ D ATH SEAL RDREMAR.! M EVANS CHECK' 6 m TOTAL AMOUNT PAID .466.01 81( REMARKS REGISTER OF WILLS RECEIVED Byll i" ':1 ('.. :./""." \ [) ~IO~AMI, + MARV c. LEWh.. /'I." "'1 ' 1 REGISTER OF WILLS ." " v.'~ " ,) I l' , " ,,' -, ' i tt , ',.... .. ..--,' , .,~ .', j" ~ - ~\ .T ';~ I . ~ - --.. I --,~ 1'- , ,.':-,""'-~J_ \ , <IV01S117 IX AFP 11Z0911'. V RIC~LTH III' POIIIVLVIHIA DlJIAIlTIOT III' Ill!YI!:II\Jt: IlJRUU lit' INDIVIDUAL TlXES D1!PT, 110101 _11_. PA 17111-0001 I L/.. JL/ft;-lj' " (Vel i V' HOTICE OF INHERITANCE TAK AppRAISE"EN1, ALLOWANCE OR DlSALI.OIIANCE OF DEDUCTIONS AND ASSESSHENT OF TAK ACN 101 DATI! 05-22-95 FILl NO. DATI! OF DIATH 09-12-94 COUNTY CUMBERLAND HOTEl TO INSURE pllQFU CREDIT TO YOUR ACCOUNT, SlllNIT THE UPPER PORTlOll OF THIS FOIIN WITH YOUR TAlC PAVNENT TO THE REelSTER OF WILLS. "AXE CHECK pAVABLE TO "REDIS1ER OF WILLS, ADENT" REMIT PAYMENT TOI CHARLES E SHIELDS III 2 W MAIN ST MECHANICSBURG PA 17055 REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 '-'nt R..tttlld II ( CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS .... itiV; ili'4"'f"iic--Ai:ji'm-:94i""iiiji"ici"'o,-i"NHiiiiTANCi-TA'X' APPA 'AiSiHiiir;."troNAiici.iili............._... DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ISTATI OF BLANTENO ANNABELLE L FILl NO. 21 94-0952 ACN 101 DATE 05-22'95 TAK RETUIIN WAS I (X J ACCEpTED AS FILED (I CHAHIlEO RISERVATION CONCERNINO FUfURE INTERIST 0 SII RIVERSE APPRAISED VALUE OF RETURN lASED ONI ORIGINAL RETURN 1. Roll E.tot. CSohedu1. Al UI t, Stoole. IIlId Bondi (Sohedu1. .1 (21 S. C10Hh Held Stook/Plrtner"'ip Int.r,"t lSohlldu1. CI (II 4. IIort_"/lIot.. RIO.ivlIb1. (Sohedu1. 01 t41 I. C.ahIIonk Dopolitl/"i.o. Plrlonll propert~ (Sohedu1. EI (II 6. Joint1~ ~ proplrt~ (Schedu1. FI (61 7. 1ranlf.r. lSchedu1. 81 (71 .. Toto1 A...to .00 .00 .!l ,00 26,398.64 .00 .00 III 26,398.64 I I APPROVID DEDUCTIONI AND EXIHPTIONSI .. Fun.r.1 Expan..I/Aa.. COltl/"ilo. Expen.l. lSchedu1. HI (.1 10. IIIbh/llort_ LiabiUU.l/Lienl lSohedul1 II (101 14.073.21 11. Tot.1 _Uon. (1) 12. NIt Vl1", of Till Rltum U21 15, Charltabll/Govll'Nlll'lt.1 III4Mlh lSoiMldu11 JI USI 14. NIt V.1... of Eotlt. _jeot to T.. U41 NOTII If.n ........nt w.. i..u.d pr.viou.ly, lin.. III, 15 .nd/or 16, 17 .nd II will refl.ct figur.. th.t includ. the totll of ~ rlturn. .......d to dltt. AIIISSHINT OF TAXI ' 11. '-'nt of Lina 14 It SpouH1 rlt. 11S1 16. '-'nt of Una 14 tlllab1. .t Li....1/C1... A rlt. U61 17. Mount of Una 14 tlllab1. .t Coll.t.r.l/C11.. D r.t. (171 11. prinoipIl Tax Due TAX CRI/UTSI pAV"ENT DATE 04-1 '9 4,558.53 lA.'~l 74 7,766.90 .00 7,766.90 .00 K.03. 7,766.90 K.06._ .00 K .15. (111 .00 466.01 .00 466.01 OISCOUNT 1+1 INTEREST I-I .00 AHOUIlT pAlO 466.01 TOTAL TAX CRIDIT IALANOI OP TAX DUK INTlRIST TOTAL DUI 466.01 .00 .00 .00 . l' pAID A'TER DATE INDICATEO, SEE RIVERSE 'OR CALCULATION OF ADDITIONAL INTEREST. . I IF TOTAL OUE IS LEIS THAN .1, NO PAV"INT IS RE8UIREO. IF TOTAL OUE II REFLECTED AS A "CREOIT" ICRI, YOU nAV II DUI A REFUND, SEE REVERSE IIDE 0' THII FO~ 'OR INSTRUCTIQNI, I 'P',.,no'llI .q "hII,"U1JI'Uf ,IUO,UppI f'OnDN ~. 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I44l 0' ,UMAtd JWiA 411" 1Itqn1 puI l'nOM "4\ 'a UGnJod "' MA lfM'lG I!NJNAWd 'om "'11'" 'I'd It '1661 10 ~I 10f ',Of "'I "'1'3 PUO 'OUI'I'~' ~, 10 O~II "'I'''' 10 ',UIII'InbI' ~, 11'11"1 01 li31!OH All iISOdlIOd .'.....'U1 tJRln, ~ _UI uo "1" (fIUI,I"OO) I "'1) tnf"" I4l 'I It>>nll lOUIH"MfUI .11'1""" I,u'r ptJI "II,'''' 0' \'fI'J "Il U^J"IJ At"IJdlCl A.J'4 4UI~3 14' "J"A .10' .10 II" .la' "1"1 ~UI '0 UO",..,d.' ~ ..II'" lUlplOlp 1Mt\ 'A 'I,JI,Ol'lUIq (,IJ',lttOO) . ..11) 0' l~arUl ..10 uo'.....od ~, ptJJI"UlJl ""'1"1,," u, ,"JI,UI 'JRl"' Aut 'I -~ 'V61 '21 Jtqleoeg IJO'tq .10 uo IUIAp I\UlPloep '0 ""l'i IHOllW~" ,,- '<r \':l t" 'C () to :;il ;"lJ 0; .! " . t::.: I , II lD " N :' ',. :- ~. (~ ui Ilj II 'I! . n QICr: ~ .. F Cl: ~d ./ Ii " I' .' .. " 'j i 'I H" .. .1 ,. " " " " " WAAAV OF 4t':lYV. NT, " "', fBINOIPAL 'J' Receipts "', leeS Disbursements: Funeral' Expenses Fees and Commlaalons Family Exemption Mlao, Probate and Admin. Exp. Inherltanoe Taxes DoPts of Decedent To\~1 Disbursement of Prlnolpal I KQ.f. ,. Receipts .11 " ;1' ',. " I' ,. " ,. fa 1 1 '1 1 1 2 2 2. 1,', " , , , I, " 'IIi "1,', q .. '.'ii j! ,I.' " p,. "" " 1 I I, ,. , I " , " '~ $ 28,398.64 2,878.68 $ '1,320,00 N:N: $ $ $ $ .$ 361 ,96 486.01 14,073.21 19,097.76 $ NONE Ii, ,. :" :/- " ",'" ,,' " I' ,. .. " , I'. ,'I "..il'll L,; , , " I, ')' ,,' I' .'1, 1,;',1', If ' I' ,"" " " " , , ,. ,;/ 'I ,u, " .,., I:"~ ,. 'I " , , , , " " ' 8. Certified Mailings of Account (satlm.) , &. 9.00 $ 361.95 , , . Inhorltanoe Taxes & 488.01 $ 466.01 " DAbllI of rw-Ient ~.Relmbursement olalm to Dept. of Publlo Welfare $ 10,076.61 2. Reimbursements to Rosemarie Evans for costs .' advanced: a,) Blue Ridge Nursing Home $ 2,675.48 b.) Capital Blue Cross $ 342.30 0;) Blue flldge Nursing Home $ 650.74 d.) Blue Ridge Nursing Home $ 30.00 3, Charles E. Shields. IlI,Attorney . Deed preparation, review surveys, Real estate sales contraots. materials on mobile home, attendance at selllement, eto. , 250,00 4. Holy Spirit Hospital , 12.27 5. West Shore Advanoed Life Support $ 33.81 S 14.07~.21 TOTAL DISBURSEMENT OF PRINCIPAL $ 19,097.76 " ",RECF.IPTSOF INCOME , NONE DISBURSEMENTS OF INCOME $ NONE INCOME BALANCE ON HAND $ NONE RECAPITUU\TI~: , , TOTAL PRINCIPAL RECEIPTS $ 26,398,64 TOTAL PRINCIPAL DISBURSEMENTS $-19,097.75 TOTAL INCOME RECEIPTS $ NONE .. TOTAL INCOME DISBURSEMENTS $ NONE BALANCE ON HAND FOR DISTRIBUTION $ 7,300,89 PropolAd Dlatrlbutlon Booordlna to terms of will. parBClr..ph two: AU to Rosemarie Evans , , 2 , , , . 'I I AINOto. alII. IAYlIY "A"I.~Y'AfU.. , t'" ".u." mM c.-........'.....INll ,,, v . I ",'point mv hIIDhn"d, Raymond VInllteno, 6xocutor of till,., my Idlnt WJll ntICl TOBtnmollt, 8l10llJrI ho tnl1 to qUitJJfll or cnltlfS to "I't I1n RUt'll, l.h"n I /t/'/Jolnt. my cfltuy/ltur, ROllornilrJ, H. 8\1""1,1I, 1iIHH.'llt.r1K tit thiH, lilY '.,ut. ,.,,11 "lit' 'l'6Rt"mont. Holtl1of of mv IlorRollill l'ol'fvnollt.ntlvoR ~llnl1 bo rnquJrod to post bUIld in tIll. or ltny JurlRdlctln'I, IN 'rIlTNr:.9S NIl,.'R1WI', 1 hllve hereunto liCIt. mv hand and laa! on '~"; tIlls, tll. ___f &:II _ d.y 01 ,.--) ......4.'~ . un, r cZl_ll..4..t.C(dIf J~.o-( ~...~/Sl:AL) ^,,"ohol1o L. Dlal'tDno SJgn.d, ..aJod, publJallod alld docJared by ANNARBLU L. SLANrINO, TestatrIx thufe'" .Iamed vn ti,l. and ono (11, other sheet of pap.r ~ft and for hor La,t Hill and T.stament. In our presenae, who, In h.r preSGnco, at hor request and in the presence at each other hdVB hereunto Bubncribed our namo. .. atte.tlng wJtnn8ses. - r;;;"!.!:A!Ir;~--- 'I1"W .__('11:..1 1("4" ~ . 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