HomeMy WebLinkAbout94-00987
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PETITION FOR PROBATE and GRANT OF LETTERS
dll- '14- - qi?
Rimnn
No.
To:
Estate 01 Liley A
also known as
Register of Wills for the
Deceased. County of Cumberland In the
Social Security No. 212-10-0721 Commonwealth of Pennsylvania
The petition of the undersigned respeelfully represents that:
Your petltloner(s), who Is/arc 18 years of age or older un the exeeut rix
In the last will of the above decedent, dated Julv !l_____
and codlell(s) dated Illln!:L
named
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(state rclevant clrcllnuumccs, t.B. renunciation, dealh or execulor, etc.)
,
Decedent WIIS domiciled lit deDlh in .l:J.IIDberland
luu:__ last family or princlpr residence al tiit~ :~~;:rr'l Rnftr'l
PAnnRV]v...ni" 17n~c; Lo\..ueY" J
111"1 !ritrt'f..I, numlll'r. Twp. or Burn. I
County, Pennsylvania. with
MFH..hAni t"'!AhltY"q
-\'
Decedent,lhen 87 )'ears of age, died NnVAmhAr R ,1994
at Holy Spi ri I HnRpit...l r.llmp IH 1 1 PAnnRY' \IAn; A .
Except as follows, decedent did nol marry. was not divorced and did not have a child born or adopted
after execution of the will offered for probate; was not the victim of a killing and was never adjudicated
incompetent:
Decedent at dealh owned properlY whh estlmnted vnlues as follows:
(If domiciled in Pn.) All personal properlY
(If not domiciled in Pa.) Personal property in Pennsylvania
(If not domiciled in Pa.) Personal properlY in County
Value of real estate in Pennsylvania
situated as follows:
$ 198.000 00
$
$
$
WHEREFORE, pethioner(s) respeetfuily request(s) the probate of the last will and eodicil(s)
presented herewith and the grant of lelters I AR t IlmAn t 11 ry
(testamentary; admlnlllrtlllon c.I.a.; administration d.b.n.c.t.a.)
theron.
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in
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA } ss
COUNTY OF Cumberlend
The petltloner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are
true and correct to the best of the knowledge nnd belief of petltioner(s) and that as personal represen-
tative(s) of the above decedent pethloner(s) will weil and truly administer the estate according to law.
Sworn to or arrirmed and subscribed ~.I.AJ. if.~~~->>x) '"
before me this 18TH day of d ~.
- NOVEMaffi'J 'Ill 9 rI- Q
Jlt) 1l'L.'lI. ( L. Y .. 11 'Le. "" '-' Y.. ) /il X;;rf;< I E
rrrRY C. LEWIS ' Rell/Iler 1L{} ~
I L( - ;,)~Ig - II
No. 21 - 94 - 987
Estate of Lucv A Simon
, Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW NnvAmhAr ?1 19!1L-, In consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that the instrument(s) dated JlIl y 8 1 qR6
described therein be admitted to probate and flied of record as the last wlll o'f Luev A. Simon
and Letters TAR t "mAn t '" ry
are hereby granted to M" rv F S I mnn
FEES
Probate, Letters, Etc. ......... $ 235.00
Shor1 Certlfieates( 4) ... .. . .... $ I? nn
Renunciation ..............., $
X-Pages $ 9.00
JCP o.uO
TOTAL _ $ ~61 eo
Flied ... .~QYJ:.I1~~K .~~,. .1.9.!)~. . .. . . ... : .
17/1,: t ((J .~Il n ~ ," " , rj~1J7r:t:a f1'4 '
I U Rc.IIICr ot Will. ',(l {J
MARY C. LEWIS
Yotte & Yotte, P.C.
Ry
AlTORNEY (Sup. C.. 1.0. No.) Norman M. Yotte
07135
214 RAnft"" AVl'mUA R1Ii"R 701 ('!"I1\P Httl, PA
AOOR~ 17011
17171 975-1838
PHONE
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Mailed letters and order to attorney on 11-23-94.
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This h to n:nil)' IIliH Ihl' illfurmolriol\ hell' J..:in'lI i~ 1lI1 In II)' tllj1lnllrwlI ,Ill oriJ...:ill.d tl.ltifir.lll' 01 dC'.1I1t dill)' fik.J Wilh me os
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WARNING: 1118 Illegal to duplicate this copy by photostat or photograph.
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CO....ONWEALTH 0' PENNIVUAANIA' DEPART"ENT OF HEALTH' VITAL RECORDS
CERTIFICATE OF DEATH
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LAST WILL AND TESTAMENT OF LUCY A. SIMON
I, LUCY A. SIMON, of Lower Allen Township, Cumberland County,
Pennsylvania, being of sound mind and memory, do make, publiah and declare
this my Last Will and Testament, hereby revoking any and all Willa by me
heretofore made.
I. I direct my Executrix or Executor, hereinafter named to pay any
and all of my juat debta and fuoeral expenses as soon as conveniently msy be
of ter my deceaae.
2. All of the rest, residue and remainder of my estate, both real,
personal and mixed, of whatsoever kind and wheresoever situate at the time of
my decease, I give, devise and bequeath to my daughter, MARY F. SIMON,
providing however, that she survives me for a period of at least three (3)
months.
3. If my residuary estate cannot be distributed under paragraph 2
hereinabove, I then give, devise and bequeath aa follows, but sUbjeot
nevertheless to the limitations of SUb-paragraph d. hereinunder.
a) To our Lady of the Blessed Sacrament Roman Catholic Church,
Ilarriaburg, Pennaylvania, the sum of Five Thousand Dollars ($5,000.00).
b) To St. Elizabeth Ann Seton Church, Mechanicsburg, Pennsylvania,
the sum of Three Thouaand Dollars ($3,000.00), for aaying of masses in
remembrance of Samuel Simon, Lucy A. Simon and Mary F. Simon.
c) To Immaculata College, the sum of One Hundred Thouaand Dollars
($100,000.00), to be used by aaid college as a scholarship fund for needy
Women.
d) If my daughter, MARY F. SIMON, dios within three (3) montha of my
death, either, before or after, then the devises in subsections a, band c of
Page 1 of 4 Pages
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this paragraph shall be reduced to one-half of the amounts that appear
therein,
e) The entire residue of my estate diatributed under this paragraph
3 hereof, I give, devise and bequeath in trust to Norman M. Yoffe, Trustee,
for the following uses and purposes.
(I) Instruetiona to Trustee, I hereby direct and
instruct my trustee, together with such other persons, if
any, as he may associate with him, as soon after my decease
as practible to incorporate or cause to be incorporated under
the laws of the Commonwealth of Pennsylvania, a nonprofit
corporation, organized and to be operated exclusively for
charitable purposes, to be known as the Simon Foundation.
The Foundation shall have authority, among other such powers
as may be conferred upon it, to take and hold property
abaolutely or in truat and administer, invest and reinvest
the same, and to devote the income therefrom, as well as the
principal thereof if need be, to charitable objecta and pur-
poses which shall be in general scope as follows.
(a) To assist needy children by making
gifts to such persons, institutiona or other
entities as are primarily concerned with the
education, health and/or moral well being of
auch children, or
(b) Where the peraon, institution or
other entity is not primarily concerned with
the objects as stated in 3e(I)(a), e gift to
same may still be to such donee if said gift
is oarmarked for tho purpose or one or more
of the purpoaes as set forth in 3e(I)(a).
(c) Such gifta to such donees may be
conditioned or limited by the foundation as
to its Use or otherwise, in the exercise of
the foundation's discretion, but such dis-
cretion must always be exercised consiatent
with the overall charitable purpose hereof.
(2) Use of Principal Unlimited. The income shall, and
principal of the foundation if need be, may be employed in
furtherance of the foregoing objects and purposes, I place
no legal limitation on the diapositions of the principal as
applied to the foregoing objects and purposes, but I request
that the foundation conaider conserving the principal for at
least twenty (20) years after my death, so that the benefits
of the foundation may extend to future generations.
Page 2 of 4 Pages
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(3) Details Left to Truatee, The details of the
organization, maintensnce and operation of the corporation,
and by-laws, rules and regulations concerning the conduct
of its operations, I leave to the uncontrolled discretion
of the incorporators and my trustee, the aforesaid Norman
M. Yoffe, and the incorporators of the foundation, and the
governing body of said foundation, hereby authorizing them
to carry out such details in auch menner aa to them shall
Boom best.
4. I hereby nominate, conatitute and appoint my daughter, MARY F.
SIMON, to be the Executrix of this my Last Will and Testament. In the event
that my daughter is unwilling or unable to eerve as such, I then nominate,
constitute and appoint NORMAN M. YOFFE, Executor of this my Laat Will and
Tes tamen t .
IN WITNESS WHEREOF, I have hereunto set my hand and seal this 8th day
of July, 1986.
O{{M'-Yi 0....-
LUCY A. S MON
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(SEAL)
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ADDRESS
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WITNESSED,
ADDRESS
COUNTY
COMMONWEALTH OF PENNSYLVANIA,
I 55
DAUPHIN I
OF
LUCY A. SI~ONf the Testatrix, /"", I.. J...I/Jrll/ and
M""l~'" rl1. VA r/" , tho witnessos, whoso namos are signed to the
foregoing instrument, being first duly sworn, each hereby declares 'to the
undersigned authority that the Teatatrix signed and executed the instrument as
her Last Will and Testament in the presence of the witnesses and that she had
signed willingly, and that she executed it as her free and voluntary act for
the purpoaea therein expreased, and that each of the witnesses, in the
presence and hearing of the Testatrix, signed tho Will as witneae and that to
Page 3 of 4 Pages
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the best of her knowledge the Testatrix was at that time eighteen years of age
or older, of sound mind and under no constraint or undue influsnce.
WITNESS.
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TESTATRIX.
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WITNESS.
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Subscribed, sworn to and acknowledged before me by LUCY A. SIMON, the
Testatrix, and subscribed and aworn to before me by AIn,,,,...
f/t,,q)'.
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and 2""
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, the witneases, this 8th day of July, 1'86.
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NOTARY LIC
My Commission Expires I T4~Y S. DOYLE. NoIlry PubU'
IIarrlsllurg. Oluphln Co., PI.
"" commlulon ExplrOl Augul128, lP8P
Page 4 of 4 Pagea
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CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent I Lucy A. Simon
Date of Deathl November 8. 1994
will No.
Admin. No,
1994-00987
To the Reqisterl
I certify that notice of beneficial interest required by Rule
5.6 (a) of the Orphans I Court Rules was served on or mailed to the
followinq beneficiaries of the above-captioned estate on November 1.
1994
~
Addr.!ss
Marv F. Simon
1724 SheeDford Road.
Mechanicsburq. PA 17055
Notice has now been qiven to all persons entitled hereto under Rule
5.6(a) except no exceDtions
Datel
1 'l.. \ 1\"1'/
M. YOFFE, ESQUIRE
214 Senate Avenue. Suite 203
Camp Hill. PA 17011
(717) 975-1838
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CapacitYI
Personal Representative
Counsel for Personal
Representative
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aM3ERJJ\ND t;;
Register of Wills of ~ County, Pennsylvania
INVENTORY
Estato of l.J.q A. Sirrcn
No.
Data of Doath 11/08/94
also known as
I Oeccnsed
Social Socurlty No. 212-10-0721
Porsonal Ropr..entati".l.' of the abolJe EIlalo, dOCIUled, verily Ihat the Itoms appaarlng In tho following inventory includo 011
of tho pOllonal .Ilell whore".' IhU810 and all of tho rool "Iala 10 tho Commonweolth of Ponnsylvania 0' .aid Doclldent, thnt
rho valuation placod opposlto each Itom of laid Invontory faprasonl8lt, fair valuo 81 of tho dale Dt the Decada"", doath. nnd
thai Oecod.nt ownod no fee1..1810 out.ldo of tho Commonwealth 01 Pennsylvania excapt that which appear. in . memorandum
8t Ihe and of thi.lnventory. I/We vorlfy thai tho Ilalomenll mado In this 1""IOIDfY 818 truo and corr.CI. I/Wo undor.'nod thul
'al.. Ita'omonll heroin ero made .ubJOCllo Ihe ponellloB 01 18 Pa. C.S. SecUon 4904 ,alotin" 10 unswo," 'ulsUicalion 10
aulho,l1lo..
Nome of
Attorney:
No= M. Votte
Pellonal Ropro8onlolivo:
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Dalad Februm:y 2~ @?5
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)> A \f;l!ue
~ 1,5mr
$ 3,248
$ 134
$ 6,816
$ 16,388
$ 137,638
$ 6,076
$ 6,598
$ 815
$ 2,553
$ 165
$ 4,510
$ 3,509
$ 22,022
$ 7,112
$ 4,350
$ 791
$ 311
I.D.No.:
0711~
214 Senalo Avenue, SUile 203
Addre..:
Telephone:
c.rrp Hill, PA 17011
(717) 975-1838
DOlcrlptlon
I. 22 Shares Abex 100 @ $7.125 per share
2. 116 Shares Airlouch Camunicalioo @ $28.00 per share
3. 5 Shares lvrer Waler Works 100 @ $26.75 per share
4. 172 Shares lvterllech Corp @ $39.625 per share
5. 300 Shares AT&T Corporalim @ $54.625 per share
6. 1,300 Shares Allanlie Richtield Co @ $105.875 per share
7. 116 Shares Bell Allanlic Corp @ $52.375 per share
8. 130 Shares 8ellSoulh Corp @ $50.75 per share
9. 40 Shares Camal Corp @ $20.375 per share
10. 148 Shares Calsurorn Waler Co @ $17.25 per ohare (Nascb:J)
11. 44 Shares Koll Real Eslale Grp 100 A @ $0.375 per share
12. 116 Shares Nynex Corp @ $38.875 per ohare
13. 116 Shares Pacitie Telesio Gp @ $30.25 per share
14. 616 Shares Rockwell Inlemaliooal Corp @ $35.75 per ohare
15. 174 Shares Soolhweslem Bell Corp @ $40.875 per ahare
16. 116 Shares US Wesl loe @ $37.50 per share
17 . 56 Shares Wheelabralor Tech Ne.oI 9 7 90 @ $14.125 per share
18. 11 Shares I'folX Technologies 100. @ $28.25 per share
19. 4 Shares Wesl VA lvrer Wlr Co (lhare is no price quole tor lhese
ahares as lhey awarenlly are valueless and are linled here al
nanlna1 value)
20. 702 Shares in Dean Willer Aclive Assellobney Trunl F\Jnd
(Cmlinued m Mdiliooal Sheel ot Paper)
IAllach Additional Sheets if neeDsomy)
:5l
:0
:Om
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7'2.
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$ I
$ 702
lolst:
NorE: The Memorandum 0' laalllltalll ouUide tl1ft Curlllllonwr.Atth 01 f'lIIlllllylvanla lI1ay, al the electloll ollhe pill lanaI rllprelicntnlivlI, include
Ihe value olll"ch item, bul ludlliguur. should not be ullllldod mID Ihe lolal 01 thelrWftlllory.
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Continued from Inventory for Estate of Luoy A, Simon
21,
22.
Harris Savinqs Bank, Harrisburq,
Deposit, Number 754237427
Harris Savinqs Bank, Harrisburq,
Number 0705001909
Dauphin Deposit Bank
PA, Travelers Cheoks
PA, Certificate of
$ 10,590
PA, Savinqs Account
$ 3,510
$
Harris Savinqs Bank, Harrisburq, PA, Travelers Chec~
American Express Travel Related Services Company, Inc.,
Travelers Chscks $
Dauphin Deposit Bank and Trust Company, Harrisburq, PA
Checkinq Account Number 42-71514-8 $ 6.650
and Trust Company, Harrisburq,
40
100
23.
24.
25.
200
~
26.
TOTAL
$246,397.
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,D'!.o.AA08.25~9 COMMO~~:~~~T~:R~~:~:YLVANIA
-/.. I.;';... "I','~ ' OFFICIAL RECEIPT. PENNSYLVANIA INHERITANCE AND ESTATE TAX
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RECEIVED FROM:
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ACN
ASSESSMENT P:'I
CONTROL ~
NUMBER
AMOUNT
YOFFE NORMAN M
WEST SHORE OFFICE CENTER
e14 SENATE AVENUE SUITE eos
CAMP HILL, PA 17011
101
.46.9S
-IOtOHftl
IOIDHIII
ESTATE INFORMATION,
r:. FilE NUMBER
Ii'I el-1994-0987
~ NAME OF DECEOENT (lAsTI
~ SIMON LUCY A
II OATE OF PAYMENT
9 POSTMARK DATE
COUNTY
CUMBERLAND
DATE OF DEATH
SSN ele-l0-07el
(FIRST) (MI)
REMARKS
NORMAN M YOFFE
m TOTAL AMOUNT PAID
.46.93
VZ
SEAL
CHECKlI 1700
RBPLACING RECBIPT
AJ\ 082508
RECEIVED 8Y
';jL-,~, /-'JIt.,
MARY C. LEWIS' A -u-; .tfJ"'Aj
REGISTER OF WILLS
REGISTER OF WILLS
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D~p.I!:f} ,08,25QJ, ' " DIPARTMINT OP RIVINUI ' ' C)i!rio~
r,~,,,,,; '~. -/A,:,':"'.' OPPICIALRECEIPT. PENNSYLVANIAINHIRITANCE AND ESTATITAX ,~
IoCf'j \
ASSEtSMENT III
CONTROL ~
NUMBER' -
RECEIVED FROM.
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AMOUNT
UTATE INfORMATION,
fa I N MBER
EJ NAME Of OECEDENT
II DATE Of PAYMENT
EI POSTMARK DATE
COUNTY
lASTI
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DATE OF DEATH
REMARKS
m TOTAL AMOUNT PAID
REPLACID VXTH RECEIPT AA 082508
SEAL
RECEIVED BY
SIONATURl
REGISTER OF WILLS
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YaFFE & YaFFE, P,C. YOFFE & YOFFE, p,JTI]l@)]])@
14 SENAlE AVENUE, SUllE 203 LETTER
CAMP Hlu., PA 17011
PH. (717) 975-1838 DOIDh (p /gqS
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To C.u.m~a.rdC.9l.L1\h\I"'jlDt~ ~p LJ~ SUbJDClS-\o..h L.u:y A,
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~o reply necoBsary
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. COMMONWfAUH Of PENNSYLVANIA
DEPARTMENT Of REVENUE
DEPT. '80601
HAUISIURG Pit. 11121.0601
'l/- ~ 4 <;? - / I
INHERITANCE TAX RETURN
RESIDENT DECEDENT
(TO BE FILED IN DUPLICATE
WITH REGISTER OF WILLS)
COUNTY CODE
,
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REV.IS~ he. 1",911
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FOR OATIS OF DIATH AnlR 12/31/91 CHICK HlRa
IP A SPOUSAL
POVIRTT CRIDIT IS cLAIMID D
FILl NUMBIR
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YEAR 9 If
9:n
NUMBER
.
.
1724 Sheeotoro Road
Mochlmicnburg, PA 17055
Sirrcn, lJ.Jcy A.
.
212-10-0721
11/08/94
o 2,
12/06/06
ClItberJ.arvj
t. Real E.lale (Schedule Al ( 1)
2, Slack. and Bond. (Schedule BI (2) 225,307
3. Cla.ely Held Slack/Partnenhlp Inlere.1 (Schedule q (3)
4. Mortgage. and NOli. Recel,able (Schedule D) ( 4)
5. Ca.h, 8ank Oepo.lI. & Milcellaneou. Pe"onal Properly( 51 21.090
(Scnedule EI
6. Jolnlly Owned Property (Schedule FI ( 61
7, Tronofe" (Schedule GI (Schedule L) ( 71
8. Tolol Grall Aile's (tolollines 1-7)
9. Funeral Expenses, Administrative COSIS, Miscellaneous (9) 29,372
Expen.e. (Schedule H)
10. Debll, Mortgage Uabllllle., Uen. (Schedule II (10)
11. Tolol Oeductlon. (10101 line. 9 & 101
12. Nel Yolue of E.lole (line 8 mlnu.llne 11)
13. Charitable and Governmental Bequests (Schedule J)
14, Nel Yolue Sublect 10 Tax (line 12 mlnu. line 131
15. Amount of line 1,4 laxable at 6% role
(Include yolue. from Schedule K or Schedule M,)
16. Amount of line 1,4 10 Kable at 15% rate
(Include yolue. from Schedule K or Schedule M,)
t7, Principal lox due (Add lox from line 15 and from line 16,1
18. Credits Spousal Poverty Cradil Prior Payments
+ +
19. If line 18 Is grealer than line 17, enler Ihe difference on line 19. This I. Ihe OVERPAYMENT.
aD
20. If line 171s greater Ihan line 18, enter the diKerence on line 20. This Is Ihe TAX DUE.
A. tnler Ihe Interest on Ih. balance due on line 20A,
B, Enler Ihe latal of line 20 and 20A on line 20B, Thl. I. Ihe BALANCE DUE.
Make Check Payable to. Regl,'er 01 Will., Agent
.. 8E SUO TO ANSWER AU QUESTIONS ON REVERSE StDE AND TO RECHECK MATH....
Under p.nalli.. of p.rlury, I declar. thai I ha.... examined this return, Including accompanying scho'dules and star.manls, and 10 Ihe best of my knowledge and b.li.f,
It Is true, corred and complet.. I declare thai 011 real ..101. has b..n r.ported 01 true mar..t value. Oodolollon of prepare' other than the perlonal r.pres.ntotl.... I,
baled on all Information 0' which pr.par., hot any knowledge.
I A N 18 OR ILtN R U It. A S DATE
,
COlin'
[i] 1. Original Relurn
o A. limited eslot. 0 Aa. Future Inleresl Compromise
(for dole. of dealh cher 12.12.82)
~ 6. O.c.d.nt Died Testate 0 7. Decedent Maintained 0 living Trult
(Allach co y of Will) (Allach cop of T ru"1
ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD 8E DIRECTED TO.
OMPlfTf MAIliNG ADDAU~
Suppl.mental Return
Nonmn M. Yotte
M
214 Senate Avenue, &lile 203
Calp Hill, PA 17011
975-1838
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Discounl
651.08
Interest
CheCK herl!' if you ora requesting a refund of your overpayment,
1724 Sh toro Road Mechanics
PA 17055
03,
05,
_8,
(201
(20AI
(20B)
Remainder R.turn
(for dole. of dealh prior 10 12.13.82)
Fed.ral Eliot, Tax
Relurn R.qulred
Total Number of Sore D.posit SOKeI
$
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(81 246,397
(11)
(12)
(13)
(141
29, 397
217 ,025
217,025
13,021.50
(171
13,021.50
(18)
(19)
651.08
12,370.42
DAlf
213/95
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PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING A CHECK MARK (".1 IN THE
APPROPRIATE BLOCKS. .
J'EJ_ .!'!O_
,
1. Did decedent make a transfer and:
c. retain the use or income of the property transferred, .......................................
x
b. retain the right to designate who shall use the property transferred or its income,
x
c. retain a reversionary interest or ....................................................................
x
d. receive the promise for life of either payments, benefits or care~ .......................
2. If death occurred on or before December 12, 1982, did decedent within two years
preceding death transfer property without receiving adequate consideration~ If death
occurred after December 12, 1982, did decedent transfer property within one year of
death without receiving adequate consideration~ .................................................
3. Did decedent own an 'in trust for' bank account at his or her death?.....................
x
)(
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,
YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
. .
REV.1502 EX+ (12-851
'*
.. COMMONWI!ALTH 0' peNNSYLVANIA
INHUITANC! TAX RETURN
RESIDENT DECEDI!NT
",
SCHEDULE A
REAL ESTATE
ESTATE OP
FILE NUMBER
Lucv A. Sirron
(Proporty lotnlly.ownod wUh Right of Survlvo"hlp mu.t bo dl"lo.od on Sch.dulo PI AU roallltato .hould bo report.d at fair markot valu.
which I. doh nod a'lho prtco at whIch proporty would bo uchangod b.two.n a wtlllng buyor and a willing .0Uor, noUhor bolng compoUod
to buy or '011, both havIng roa.onoblo knowlodgo of tho rolovant foct..
tTEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
1.
None
if
TOTAL (Also onlor on IIno 1. ROCD lIulallon
(If more .pac. ;. need.eI, in..rt additiona' ,h..,. 01 some dze.)
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REV,150) EX. 1'''6)
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SCHEDULE B
STOCKS AND BONDS
COMMONWeALTH 0' PENNSYLVANIA
. INHUITANCe TAX UTUItN
ReslDfNT DECEDENT
ISTAn OP
w::y A. SiJmn
IAII prop.rty Jotnlly-own.d with RighI 01 Survlvorahtp mu,l b. dl,c1o,.d on Sch.dul. P.)
ITEM
NUMBER DESCRIPTION
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
22 Shares Abex Inc @ $7.125 per share
116 Shares Airlouch Camunic:alims @ $ 28.00 per share
5 Shares h1er Waler Worlcs Inc @ $ 26.75 per share
172 Shares l'Inerilech Corp @ $39.625 per share
300 Shares ATIoT Corporalicn @ $54.625 per share
1,300 Shares Allanlic Richfield Co @ $105.875 per share
116 Shares Bell AUanlic Corp @ $52.375 per share
130 Shares ....l1~Jlh Corp @ $50.75 per share
40 Shares CaTBal Corp @ $20.375 per share
148 Shares Cals\JrerB Waler Co @ $17.25 per share (Nas<lIo:J)
44 'Shares Ko11 Rsal Eslale Grp Inc A @ $0.375 per share (arc)
116 Shares Nynex Corp @ $38.875 per share
116 Shares Pacific Telesis Gp @ $30.25 per share
616 Shares Rcckwell Inlemalicnal Corp @ $35.75 per slVlre
174 Shares 5o.Ju..sslem Bell Corp @ $40.875 per ahare
116 Shares US Wesl 100 @ $37.50 per share
56 Shares I>lleelabralor Tech lbI 9 7 90 @ $14.125 per aharo
11 Shares t+lX Technologies Inc. @ $28.25 per share
4 Shares Wesl VA hrer WLr Co (lhere ie no price quole tor UlllBO slVlms lIB Lhay
~l1y are valueless am are lisled hsro al nanlnal value)
702 Shares in Dson Willer J\cliw AsseL fobley TrusL f\Jnd
VALUE AT DATE
or DEli tH
$ l,5r.l1
$ 3,240
$ 134
$ 6,016
$ 16,300
$ 137,630
$ 6,0'/6
$ 6,590
$ 015
$ 2,553
$ 165
$ 4,510
$ 3,509
$ 22,022
$ 7,112
$ 4,350
$ 791
$ 311
$ 1
$ 702
TOTAL Allo .nll, on IIn. 2, A.co It.lallan
(II more 'pac. II n..d.d, I...rt addillonal .h.." a' ,om. II...)
$ 225,307
. ,
11\1.1107... "-III
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cown?i..i~lVllrNIA
ISTATI OF
SCHEDULE D
MORTGAGES AND NOTES
RECEIVABLE
PI.a.. Print or l' .
I FILl NUMBER
I.1lcy A. Sinm
IAll-", 10"'''' IWM4 with ... ."hl .. Iunr'-"Ip 01..1 ... 41........ 1ft Ie........ P.I
ITEM
NUMBIR
DESCRIPTION
VAWE AT
DATE OF DEATH
NaIB
TOTAL AI.a enter an Une 4, Reca lIulallon S
(II more 'po," I. nlldld, Inllr! oddillonol .....,. ot '0011 "11,)
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SCHEDULE E
CASH, BANK DEPOSITS AND
MISCELLANEOUS
PERSONAL PROPERTY
Pllo.1 PrInt or l' I
F E UMBER
'.
CClMMONWUt'" A. "NN",VANIA
INHllnA fel 'Ak .nulN
..lloINt DlceDINT
ES ATE 0
Lu..--y A. Siam
(All ".,.fIy 1e1"II_nod with ,ho Ileh' of ....Iwonhl, m.1I IN dl"lo..d on ',hod.lo '1
ITEM
NUMBER
VALUE AT
DATE OF DEATH
DESCRIPTION
I.
Harris Savings Bonk, Il4trlsWrg, PA, CertiHcalo ot DEposil, NI.rtber
754237427
Hm:rls SIIvings Bonk, 1l4rrlsb1t9, PA, Savings fooccunl lUtber 0105001909
DaLPUn OEplBil Bonk me! Trusl Cmpany, Ilarrisb1t9, PA, TravolerB Olecks
Hm:rls SIIvings Bonk, Il4trlsWrg, PA, TrIIvel.ers Olecks
J\rrm:ican Elcpress Travel RelIllod Services Calpony, Inc., TravolerB Olecks
D!I\.Plin Deposil Bonk lllXI Trusl Cmpany, 1Idrrisburg, PA, Olocking fooccunl
NI.rtber 42-71514-8
$ 6,650
2.
3.
4.
5.
6.
$ 10,590
$ 3,510
$ 40
$ 100
$ 200
TOTAL AI.o Int.. on line 5. RIca
~11"qc,
S 21 090
(A"ach addillonol 8~. 1C 11" ,h.,lIlf more .pac.l. n..d.d.)
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COMMONWeAlTH 01 ,eNNSYlVANIA
INHUITANCI! TAX UTUIN
RlIlOfNT DfCfDI!NT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF
Lucy A. Slm:n
Join' "nan'(o).
I FILE NUMBER
NAME
ADDRESS
RELATIONSHIP TO DECEDENT
A.
None
B.
C.
Jotn'ly-awnod pro,.rty.
ITEM LETTER DATE
FOR TOTAL VALUE DEeD'S DOLLAR VALUE OF
NUMB!I JOINT MADE DESCRIPTtON OF PROPERTY OF ASSET '!loINT. DECEDENT'S INTEREST
TENANT JOINT
1. Nane
TOTAL (AI.o onlor on IIno 6, Rocapllulallonl 5
llf more spac. 1. n..d.d in..rt additional .h.." of lam. Ji,.)
IIV,15101l'II"7) .
COMMONW'A"H 01 ~'NNmVANIA
INHIIITANCI fA .nulN
_ "'IDIHT Ole DINT
lifATIO'
SCHEDULE G I
TRANSFERS
------"(1 NUMlliI-
PLEASE PRINT OR TYPE
Lu:y A. SJm:x\
THIS SCHIDULI MUST II COMPLlTID AND PlLlD If THI ANSWIR TO ANV 0' THI QUISTIONS ON THIRIVI.SI SIDI 0' THI COVIR SHIIT IS VIS.
ITEM DESCRIPTION OF PROPERTY EXCLUSION lOlAL VALUI D!~D, 8?blfc~~t~V.\
NUMIER 'n'lud.n...../lhtl'.'''r.....",./',.,-./,;plodond.nl.d...o/l,o"',." OF ASSET -' INIEREST
NcIl8
TOTAL {Allo tnl.r 0" Iln. 7, Rica ltulallon $
(If more .pocel. "Nd.eI, In..rt addi'ional ,b..,. of lam. d".)
.
.
.'\tII1lUtp.",
ISfATI Of
ITIM
NUMBER
PI.a.. PrInt or T .
t!~
. COMMONWIAUH 0' 'lNNIYLYANIA
INHUnANCI! lAX UIURN
aIlIDIN' PfClDINT
SCHEDULI H
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS ANI>
MISCELLANEOUS EXPENSES
Lucy 1\. Slm:n
A, Fun.rallxp.n....
DESCRIPTION
B,
4.
C.
1.
2.
3.
4.
5.
6.
7.
8.
I.
2.
3.
Ml.chael. Halpezzi, f\Jneral Dimclor
n.c-r Gallery tor flooars
Sl. F.l habelh Am Salon 01urch for funeral food
AMOUNT
$ 11,855
$ 382
$ 300
$ 14,250
$ 2,000
$
40
1.
Admlnl.tratlve Co.t..
Penonal R.p.....ntatlWl Comml..lon.
Soclol S.curlty Numb.r 01 Penonal R.p.....nlatlWl.
Y.ar Comml..lon. paid
$
48
2.
Allorney Fe..
Yaffe' Yaffe, P.C.
family Ex.mpllon
ClaImant K>ry F. Slm:n
Add..... 01 ClaImant at d.c.d.nt'. d.ath
51..... Add..... 1724 Sheepfonl Rood
CI.y Mechanicsburg
Zip Cad.
17055
$
261
3.
R.latlon.hlp I>a\91ler
Stal. P1\
Probal. Fe..
MI.e.llan.ou. Ixp.n....
Qrrberland Counly law Journal for adverlining of Lellers
'Il1e Senlinel for advertising of Lellers
CUrberIllnd Counly Reginler of Wills for filing fOO8, soorl cert.ificalen, elc.
Yaffe' Yaffe, P .C. for mise expenses
TOTAL (AI.o .nl.r on IIn. 9, R.capllulallon)
(II mar. .pae. I. n..d.d, In..rt additional .h..t. of .am. .1...)
$
216
S 29,372
(= ~-.Jo --.. .
.
.
II\iUI.U.II,fJl
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. COJ,lMONW.Al1H Of 'INNI"'W.NI'"
INHUII4NCI tAl IUUIH
.UtOtNI DICIDIHI
TATI OP
IJlM
NUMalR
1.
, \
Lucy A. Ilinm
None
.''', ~ ;~'~$"<':-;.'
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES AND LIENS
DESCRIPTION
PI.a.. Print or T .
PIU N MaER
AMOUNT
TOTAL IAI.o onlor on IIno la, Rocapllulallon) S
(If moIW 'pac. I. n..d.d, In..rl addifional .huts ol.am. liz..'
. . T ~.
,c'
..
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nv.uUlhl).l'l
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COMMONWl4UH Of "NNIYlYANIA
INHIIIIAMeI 'AI .nUI"
'.II01N' OI"DtN'
SCHEDULE J
BENEFICIARIES
ISTATIO.
FILE NUMBER
t.u:y A. Slnm
ITIM
NUMBIR
AMOUNT OR
SHARE O' ISTATI
NAMI AND ADDRESS O' BENEFICIARY
RELATtONSHIP
A. Taxobl. B'quII"1
"1.
Mary F. SUmns
1724 Sheepford Road
Medlanicsburg, PA 17055
D>ughler
100\
ITEM
NUMBER
AMOUNT OR
SHARE OF ESTATE
NAME AND ADDRESS OF BENEFICtARY
B. Charltabl. and Governm.ntal B.quIIIIl
1.
TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (AI.o onlor on IIno 13, Ro,opllulotlon) S
III more ,poco t, noodod, In,o" additional ,hu" 01 ,omo ,In)
/
I~-;)Y~~II
(joy... /
./
CUT ALONG THIS LINE ~ RETAIN LOIIER PORTION FOR YOUR FILES ~
iiE'y:i6jj'j"ix"AFP-nF9Sr-----iiiiii-iiiifiiiiYliiii:rTilx-ii;'liTiiiENT-jiF"ilcciiuiir-.-iii-------mm--m---
DATE 02-20-96
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT, 04-24-95
PRINCIPAL TAX DUE 1.__ 13.021. 50
REV"1607 EX AFP 02-911*
CQMftCWMALTH Dr' PfHHlYlVAHIA
Dt:PARTf1[HT Of' R[v[h\IE
IURUU Of' INDIVIDUAL talln
DlPT. rU6I'
HARRIS.URa, P' 171"-0'01
ACN 101
INHERITANCE TAX
STATEMENT OF ACCOUNT
DATE 02-20-96
DATI OF DEATH
SIMON
11-08-94
LUCY
FILE NO. 21 94-0987
COUNTY CUMBERLAND
A
NOT!' TO INSU~E P~OP!~ c~EOIT TO VOU~ ACCOUNT. SUB"IT THE UPPE~ PO~TION Of THIS fO~" WITH VOU~ TAX
PAV"ENT TO TH! AOO~ESS SHOWN. "AKE CHEcK PAVABLE ANO ~E"IT PAV"ENT TO' "
NORMAN M YOFFE
STE 203
214 SENATE AVE
CAMP HILL PA 17011
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE. PA 17013
Aooount ~_ltt.d
ESTATE OF SIMON LUCY A FILE NO.21 94-0987 ACN 101
THIS STATE"ENT IS P~OVIDED TD ADVISE Of THE CU~~ENT STATUS Of THE STATED AcN IN THE NANED
ESTATE. SHOWN BELOW IS A SU""A~V Of THE P~INCIPAL TAK DUE, APPLiCATION Of ALL PAVNENTS,
THE CU~~!NT BALANC!. AND, If APPLICABLE, A P~OJECTED INTE~EST flCU~E.
PAYMENTS (TAX CREDITS),
PAYMENT
DATE
02-06-95
RECEIPT
NUMBER
AAD22805
DISCOUNT (+)
INTEREST (-)
651.07
12,370.42
AMOUNT PAID
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST
TOTAL DUE
13.021. 49
.01
.00
.01
. If PAID AfTE~ THIS DATE. SEE REVERSE
SIDE fO~ cALCULATION Of ADDITIONAL INTEREST.
I If TOTAL DUE IS LESS THAN .1,
HO PAVNENT IS REQUIRED.
If TOTAL DUE IS REfLECTED AS A "cREDIT" Ic~J,
VDU NAV BE DUE A REfUND. SEE REVERSE SIDE Of THIS fO~" fO~ INSTRUCTIONS. J
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00
PA\'tENT.
Detach the t-. portion 0' thl, NoUn and ....tt with rour ,.,...t ... PQ8bl. to the n.. end 8ddr...
printed on thI rO"I,... I.de.
If RESIDENT DECEDENT uk. cMck or -"'w order parlllal, tOt REGISTER OF WILLS.. AGENT.
If ,......'E.IOOO' DECEDDfT ..... Check .r __W orde,. p.ntll. tal cotItOHWEALTH OF PENNSYLVANIA.
All PltYMnh recl.v" 8hIIll Hi IiPPUed fir.. to ... Int.r..t Which ~ be .... with MV r_lndtr ",UN to the tax.
RUUaI (CA). A ,.dund of . tu crMfU, Wllch .... not r~.ted on tM hlf Return, NY be ,...,..ttld br c....l.U.,. M
"Application for R.fund of Penn.vl"~I. Jnherlt~. ~ rlt.t. Tax- (REV.lSl)). application. .r. ...11...1. at
tho Dfflce of ~ _"'Itlr 0' Will., ~ 0' the 25 Ae,,~ DI.trlct o"lc.. or 'r~ the o.plrtlent.. 14-hour
enawerl"l ..rylc. ~r. 'Dr 'or.. Orderlhl' In Penn.w1venl, .....-561.,01., out.lde Penn'wlvanl,
~ within local HerrJ.bur. .r.. (717) 7.7-.094, TDDI (717) 771-IZS1 (Heerlng 1~llrld onlw).
REPLV TDI
Due.tlon. r...rdlng .rror. cont.lned on thl, noUce should be Iddr...... tOI PA Depart.....t of A.v..-ue, lur....
0' Indlvlduel Tlx", ATTN. Po.t ,.....-ent A."I.. unit, Dept. '.".1, Herrllbur., PI 17121.0'01, phone
(717) 717-'501.
I' enw t,. due I. p,ld withIn thr.. (5) cllendar ~th. I't.r the decedent'. delth, I fIve percent (5~) dl.count
of the to peld Ie .llowed.
DllCOlIfT'
INTfRl:ST,
Inter..t I, chlrged beginning with first d.y of dellftqUlncy, cr "1M (9) ~th, end one (l) d... 'r~ the det. 0'
death, to the dltl 0' pl)"Hrlt. r.... Which bee_ dllInquent be'orl JMuerw 1, 1912 ".r Int"..t It the nta 0'
.h (~) percent per wn. c.lculatlld It I delh r.ta 0' .000164. All tlxlI ....Ich Me.. delinquent on Ind ,ft.r
JanuarW I, 19., will b.lr Int.ra.t at I r.t. whIch will ".rw 'r~ calender ,,"r to cllendar w..r with thet r.t.
~Id b.. the PA Dep'rt,,"t 0' A.venue. The IPPlle~l. Int.r..t r.t.. for 1911 through 1'" ar'l
Year Int.rllt A,t. DIlly Int.n.t 'eo tor
V'lr
Int""t Aat.
0.11.. Int.r..t 'eotor
1911 2U .00054t 1"7 OX .000147
1915 U% .0004301 1911-1"1 11% .000SlI
.,.. III .ooun 1"2 OX .011147
1911 In .4100556 1995-1994 n .000191
.,.. IU .000174 1991-1"' OX .001147
....Int.r..t I. c'lculat~ " follow..
INTEREST . BALANCE OF TAX l/IfPAID X HVnBER OF DAYI DELINQUENT X DAILY INTEREST FACToa
-"An)' HoUe. IliuM .ft., tM tllX Hco.. delinquent ..Ill nflNt '" 1n'.....t AloullU., t. Uft..... UI) _.
bewond the dlte of the ......-.nt. If p.~t h ... .lter the Inter..t ~tatlan at. Mown on the
Notlc., edcUUonel Interllt .,.. be cIlcul.tltd.
... -, ~_......' .., - .
~------------------------------------------------
. .
. ..;...,..'..-.'..... \
D.... AA02' 2'8"0..5 COMMONWEALTH OF PENNSYLVANIA
NO. . .. . . . DIPARTMINT OP RIVINUI
r..~i"I"I""1 O,f1CIAL RECEIPT. PENNSYLVANIA INHERITANCE AND ESTATE TAX
..
y. t
" ~
RECEIVED FROM,
&
ACN
ASSESSMENT P:'
CONTROL Ii:,I
NUMBER
AMOUNT
YDFFE NORMAN M
WEST SHORE OFFICE CENTER
e14 SENATE AVENUE SUITE e03
CAMP HILL PA 17011
101
.U!,.:.,O.4e
- '010 HUt
lOIOHUf
ESTATE INFORMATION,
ell ILE NUMBER
U el-1994-0987
EJ NAME OF DECEDENT (LAST)
SIMON LUCY A
II DATE OF PAYMENT
m POSTMARK DATE
COUNTY
SSN ele-l0-07el
(FIRST' (MI)
CUMBERLAND
DATE OF DEATH
REGISTER OF WILLS
1':1 TOTAL AMOUNT PAID .1 e . 370. 4e
,,,,,,,,~.t"a ~
MARY C. LE S
REGISTER OF WILLS
REMARKS
NORMAN M. YOPP, ESQUIRE
SEAL
CHECK. 1167
----------------------------------------~-~-~----
II ...,
.. "It: .. ".>:
. ~ ..
.
..
. ,"
"':
...,.
'.
,
,
I
~, '
",'
t
"r
..
. ~ *-
--_'-~---...J
, --.
~~
~ - ... i:-. -
,
y--
1'1- ;;J 7' J- //
REV-1547 EX AFP 112-94*
COHHOHW[AlTH OF PENNSYLVANIA
OEPAATtEHT Of RfYEfrIJE:
BUREAU OF INDIVIDUal TAXES
DEP'. za0601
HARRISBURG, Pi 11121-0'01
ACN
NOTIcE OF INHERITANcE TAX
APPRAIsEHENT, ALLOWANCE OR DISALLDWANCE
OF DEDUCTIONS AND ASsESSHENT OF TAX
DATE
rJo'l-
V
101
05-01-95
S FILE NO.
DATE OF DEATH 11-08-94 COUNTY CUMBERLAND
NOTE. TO INSURE PROPER cREDIT TO YDUR ACCOUHT, SUlHIT THE UPPER PORTION OF THIS FORH WITH YOUR TAX
PAYHENT TO THE REGISTER OF WILLS. HAKE CHECK PAYABLE TG "REGISTER OF WILLS, AGENT"
REMIT PAYMENT TO:
NORMAN M YaFFE
STE 203
214 SENATE AVE
CAMP HILL
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
PA 17011-522B
AMount R..Ut.d
CUT ALONG THIS LINE ... RETAIN LOWER PORTION FOR YOUR RECORDS ~
iiEii=i54j-ix-iiFii-iiZ':94Y"NCi'rICiuli,,-i-tiHiiiifAifci!-YA'x-jiPPRA'isiif€Ni'-,--,UrliiiAifci-ilii-m-m--m-m
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF SIMON LUCY A FILE NO. 21 94-0987 ACN 101 DATE 05-01-95
TAX RETURN WAS. (X I ACcEPTED AS FILED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL
1. R..I e.t.t. (Schedule A) (I)
2. Stocks and Bond. (Sch.dule 8) 12)
5. Clo..ly Hald stock/Partnership Int.,...t (Schedul. C) (3)
4. "origlg../Not.. Receivable (Schedull OJ (4)
5. Ca.h/Bank Deposita/Hilc. Pa,.lonal p,.opedy (Sch.dule EJ (5)
6. Jointly Owned Prop.rty (Sch.dut. Fl (61
7. Tranafa,.a (Schedule OJ (7)
a. Tot.l A...t.
CHANGED
0(")
C iT \r-i
'3. .. \.II
.00 'ti
225.307. DO ;<:.
.00 t--l
. DO -.J
21.090. DO ;~l
.' .00
)> ;:1.00 fft
(BI
APPROVED DEDUCTIONS AND EXEMPTIONS:
29,372.00
9. Funa,.al Expen.../Ad.. Co.tl/Hl.c. Expan... (Schedu1. H) (,)
10. D.bta/"ortaaaa Llabl11tl../LJen. ISchedula J) (10) .00
11. Tatol D.duatlon. (111
12. Net Va1ua of Tax Raturn (12)
15. CharJtabla/GoverNlent.l a.queat. eSchedu1. oJ) (15)
14. N.t Valu. at E.tet. Subject to Ta)l C 14)
NOTE: If an assassmant was issuad previously, lines 14, 15 and/or 16, 17 and 18 will
reflect figures that include the total o~ ALL returns assessed to date.
ASSESSHENT OF TAXI
15. AMount of Lln. 14 Mt Spou..l r.to U51 . DO X .03.
16. AMount af Uno 14 to....I. .t lInoMl/Ch.. A r.t. U6I 217.025.00 X .06.
17. Aaount of Line 14 taxable at Collaterel/Cl... 8 r.t. (17) .00 K .1S~
18. Prlnclpel Tax Due US)
TAX CREDITS:
PAYHENT
DATE
02-06-95
REcEIPT
NUHBER
AA022805
DISCOUNT (+ I
INTEREST I-I
651.07
AHOUNT PAID
12,370.4Z
PAYMENT MUST BE MADE BY 08-09-95M.
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST
TOTAL DUE
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
;;JJ
:Ocu
"I (1
,r 1 (.
,"
~- sa.
246,397.00
;>Q,:'In nn
217.0Z5.00
.00
217.025.00
.00
13.021. 50
.00
13,021. 50
13,021. 49
.01
.00
.01
IF TOTAL OUE IS LESS THAN '1, NO PAYHENT IS REQUIREa.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRI, YOU HAY BE QUE
A REFUND. SEE REVERSE SIaE OF THIS FORH FOR INSTRUCTIONS. I
"
1../
I '/-.;,1 'r' .r7.~ //
REY-1548 EX AFP (12-95*
COt'tOHWULTH Of' PfHHtiYLVAHIA
D[PARnEHT Of' R[Y(NUE:
lURtAU QIII' INDIVIDUAL TAXEI
DEPT. 210601
KARAI.IURG, Pi 111"-0601
NOTICE OF INNERITANCE TAX
APPRAIBEHENT, ALLOHANCE OR OIBALLOHANCE
OF DEDUCTION to AND ABBE8tHENT OF TAX ON
JOINTLY HELD OR TRUBT ABBETS
ESTATE OF SIMON
DATE 01-02-96
LUCY
A DATE OF DEATH 11-08-94
CUMBERLAND
FILE NO. 21 94-0987
S.S/D.C. NO. 212-10-0721
MARY F SIMON
1724 SHEEPFORD RD
MECHANICSBURG PA 17055
COUNTY
ACN
95101565
"
c...
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS .....
FiEii:is4-i-ix--AFP--iiz-:9Si------------------------------------------------------------------------------------
NOTICE OF INHERITANCE TAX APPRAISEMENT. ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS. AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 01-02-96
ESTATE OF SIMON
LUCY
A DATE OF DEATH 11-08-94
COUNTY
CUMBERLAND
FILE NO. 21 94-0987
TAX RETURN WAS,
REMIT PAYMENT TOI
REGISTER OF WILLS
CUMBERLAND CD COURT HOUSE
CARLISLE, PA 17013
Aao..-,t R..l tted
S.S/D.C. NO. 212-10-0721
(X) ACCEPTED AS FILED () CHANGED
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION. DAUPHIN DEPOSIT BK S TR CO
ACN
95101565
ACCOUNT NO.
0079182569
TYPE OF ACCOUNT. () SAYINGS (lO CHECKING ( ) TRUST ( ) TIME CERTIFICATE
DATE ESTABLISHED 11-08-78
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST
TOTAL DUE
IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. .
IF TOTAL DUE IS LESS THAN '1, NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLEcTED AS A "cREDIT" ( CRI, YOU HAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. I
Account Balance
Percent Taxable X
Amount Subject to Tax
Debt. and Deduction.
Taxable Amount
Tax Rate X
Tax Due
1,506.76
0.500
753.38
.00
753.38
.06
45.20
TAX CREDITS I
PAYMENT
DATE
RECEIPT
NUMBER
DISCOUNT (+)
INTEREST (-)
INTEREST IS CHARGED FROM 08-09-95 TO 01-10-96
AT THE RATES APPLICABLE AS OUTLINED ON THE
REYERSE SIDE OF THIS FORM
.
NOTE. TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER PORTION OF THIS NOTICE
WITH YOUR TAX PAYMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
DR MONEY ORDER PAYABLE TO.
"REGISTER OF WILLS, AGENT."
AMOUNT PAID
.00
45.20
1. 73
46.93
PlOIl'OU Of'
NOTlCEI
PAYJtEHT I
REfIJllD ItAh
a.ACTlONSI
ADttIN-
lIT.ATlVE
CORRECTlDHSI
DIICDtltTI
INTIHlr I
,':.'
'"
'"
I
n:'.-
~.
.,., c.l
00
To fulfill thl r~lr..-nt. of Seotlon 1140 of ~ InherltlnC. Ind Eatat, ,.. Act, Act II of 1"1. ell P.I.
heU.", 11401.
o.t~ the top portion of thl, Notlel end ~lt with your p.~t to the RI,lat.r of Will, prlnt.d on the
revlnl ......
.. "'1 CMck or MlMV order pavllbl. tal RutlTE. OF' WILLI, AGENT.
All pIYMf\h received Itulll Un' b, .,UMI to MY Int.r..t which _y be due, with .,y r...lncMr .."Ued to the tlX.
A r.'und o' . tlM oredll, which .... not ,.....ted on the tax nturn, ... be r....ted by caplaUng en "Application
'or A.fund of P~,Ylv~J. Inherltencl end E,tat, ,.... (REV-1S.SI. Application. .r. IVIllabl, at thl afflcl of
the Real.tar of Willi, ~y af the IS Ravenue Dlltrlct Offlc.. or by cIlllng the ,peela. Z4-haur .n.werlna ..~Jc.
nu.ber. for 'Of" ordarlngl In P.nnl.lv.,tl 1-'DO-162-1050, outllde Penn,ylv.,l. ~ within local
Harrllburg .ra. (717) 717-1094, TOO' (717) 77Z-11SZ ("-arlnt l.,.lr~ Only).
Any p.rty In Int.r..t not ..tl.fled with the IPPr.l..-.nt, .Il~. or dl..llow~. of deduction. ar .......ent
of t.. (Including dl.count or Int.r..t) a. shoMn on thl. Hotlcl 88V obJlCt within .I.tv ('OJ d.~. of rec.lpt of
thl. MoUe. bYI
--written prot..t to thl PA Deplrtaent of RIYIftUI, Joard of appell., Dapt. Z1101l, H.rrl.burg, PA 17121-10ZI, DR
--.llCtlng to have the ..tt.r detaralned at the audit of ~ ~count of the par.onal r.pr...ntltlv., OR
--.,.11 to thl Drph.n.' Court
Faatual .1'1'01" dl.cov.r.d on thl. ......eent ~Id be eddr..aed In writing tOl PA Dep.rt-.nt of Revenue,
lur.au of Individual Tlxa., ATTNI Po.t A......-nt Ravlew Unit, DEPT. 2'0'01, Harrl.burg, PA 17121-D'01
Phone (717) 7.7-6505. S.. p.ge 5 of the booklat ~ln.truatlon. for l~rltanc. Ta. R.turn for a R..ldant
Decedent" CREV-ISOI) for en ..plen.tlon of ~Inl.trltlv.lv corrlCt~l. .1'1'01",
If ~~ taM duI 1. plld within thr.. ()) c.land.r .onth. .ftar thl dec.dent'. d.ath, . flv. parcent (IX)
discount of the tllC p.ld II allowed.
1nt.r..t .. charged beginning with flr.t dlY of dellnquency, or nlM (9) ttOnth. ~ ana (1) dey
frOll tt. data of ....th, to tM d.ta of p.v....t. ,.... Which bac_ dtiUnquent p'ora J,,..ry 1, 1'1'
but Intar..t .t the rata 0' ... (6iC) p.rcent per .... calculated at I d.Uv rat. of .DOal".
All t.... which bee... delinquent on or .ftar J~rv I, 1'.2 will ba.r Intar..t at . r.t. which will v.rv 'rOIl
clland.r y..r to c.I~lr v.ar with that tlta announced bv thl PA o.,.rt.-nt 0' R.venue. ThI IPPllc~l.
Int.r..t rat.. for 1912 through 199. .tal
'LIlt Inte,a.' Alta 0111" In'''.'' F.ctor
In'',.'' A.t.
Oall" Intar..t Faa tOt
Iur
1911
1.15
1914
1915
1'1'
--Int., a"
,n
lOX
IIX
UX
In
I. calcul.tad ..
.GOD541
.OODUI
.0DUOl
. GOU"
.00az14
'allow. I
1.11
1'11-1"1
199'
1"5-1994
1"5-1996
.X
\IX
ox
n
ox
.000241
.000SOI
,000241
.GOal9Z
,000241
IIITEIIEST . BALANCE OF TAX UNPAID X NUIlBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any NoUc. I..uad afta, the t.1C baco... delinquent will ,.Uact WI Int.,..t ulcul.tlon to 'If teen CIS) dav.
IMvand tM d.t. 0' thl .........,t. If ,.pant II Ade aft.r thl Int.,..t coeputaUon ...t. IhDwn an thl
Notlc., IIddltlDMI Int.,nt !IU.t be ulculatad.
REV-1548 EX AFP 02.95*
CClMttOtMAL TH (If' PENNSYLVANIA
DlPARTtIlHT OF R[V[NUE
IURfAU Of' INDIVIDUAL Tun
DEPT. U06Dl
HARAI'IURa, PA 111,1-06Dl
NOTICE OF INHERITANCE TAX
APPRAISEMEIlT L ALLDMANCE OR OISALLOMANCE
OF DEDUCTION. t. AND ASSESSMENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
ESTATE OF SIMON
DATE 01-02-96
lUCY
A DATE OF DEATH 11-08-94
CUMBERLAND
FILE NO. 21 94-0987
S.S/D.C. NO. 212-10-0721
MARY F SIMON
1724 SHEEP FORD RD
MECHANICSBURG PA 17055
COUNTY
ACN
95101565
l,
(>
REMIT PAYMENT TOI
REGISTER OF WIllS
CUM8ERlAND CO COURT HOUSE
CARLISLE. PA 17013
A.ount R..1tt.d
CUT ALONG THIS lINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
Rifv=i54-S.iif-AFP..iiz.:9S)-----............------..-....-....--...--.-...-.....-...--.--........---------------
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANr.E OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 01-02-96
ESTATE OF SIMON
lUCY
A DATE OF DEATH 11-08-94
COUNTY CUMBERLAND
S.S/D.C. NO. 212-10-0721
(XI ACCEPTED AS FILED ( I CHANGED
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION. DAUPHIN DEPOSIT BK 8 TR CO ACCOUNT NO.
FILE NO.
21 94-0987
TAX RETURN WAS.
ACN 95101565
0079182569
TYPE DF ACCOUNT. (I SAVINGS ()O CHECKING ( I TRUST C ) TIME CERTIFICATE
DATE ESTABLISHED 11-08-78
Account Balance
Percent Ta.able X__,.
Amount Subject to Tax
Debt. and Deductions
Taxable Amount
Tax Rate X
Tax Due
1,506.76
0.500
753.38
.00
753.38
.06
45.20
TAX CREDITS:
PAYMENT
DATE
RECEIPT
NUMBER
DISCOUNT C+)
INTEREST C-)
INTEREST IS CHARGED FROM 08-09-95 TO 01-10-96
AT THE RATES APPLICABLE AS OUTLINED ON THE
REVERSE SIDE OF THIS FORM
NOTE. TO INSURE PROPER CREDIT TO
YOUR ACCOUNT. SUBMIT THE
UPPER PORTION OF THIS NOTICE
WITH YOUR TAX PAYMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
DR MONEY ORDER PAYABLE TO.
"REGISTER OF WIllS, AGENT."
AMOUNT PAID
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST
TOTAL DUE
. IF FAIO AFTER TNIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. .
I IF TOTAL DUE IS LESS THAN II, NO FAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" I C~_I.l YOU IIAY SE DUE A REFUND.
SEE REVERSE SIDE OF THIS FOR" FOR INSTRUCTIONS. J
.00
45.20
1. 73
46.93
~/
PI.IIll'OSl!'"
HaTlCEa To fulfill the requlr.-.ntl of IlCtJon Zl~O 0' the I~rlt~. ~ EI'at. ,.. Act, Act " of ."1. (72 P.'.
boUon. Zl4D).
PAvtlEHTI
DetMh u.. top portion of thh Notlu Md autMllt ,dU. vour p.~t to the R....t.,. of WUh prlntMl on the
reve,... ,Ide.
.- "lie. check Dr MMY order plrable tal MOIITER CIF' WILLI, ACE"'.
AU 'lYNn'S reoelvN ...11 flnt ... ."..1111d to WlY lnt.r..t which ... M w., ..ith eny ,....Jnde,. .".11" to the t...
REFUND (CR)I
A refund of . tl. credit, which .... not r....tMl on lM tllC return, ..y ~ ,......tlld by c.,.bUno ., "AppUcetlon
for A,fund of Penn'vl""" I~rlt~. ~ E,t,t, T.... (REV-ISIS). application' ar. .v,llable at the OfficI of
U,. _....h,. at Wllh, ....y of the 25 Alvenue Dlllrlet O"lc.. or by clUing the ,peel.. Z4~hour WI....rlng ..,.vlel
~r' 'or for.. ordert",1 In Penn,vl".,I, 1-100-56Z-Z050, outside P~.ylv.,l. ~ ..Ithln local
~rrlsbura .r.. (717) 7'7-'094, TDOI (7171 77Z-'ZSZ (He.rlng I~.lrlld Only).
OIJECTIOHII
Any p.rty In Int.r..t not ..tl.fl.d Nlth the eppr.I....nt, .110N8nC. or dl..llowenc. 0' deduction. or ........nt
0' t.x (including dl.count or Int.r..t) .. shown on thl. Notlc. ..y object within .Ixty (60) dey. 0' rec.lpt 01
thll HoUc. by.
~~wrltten prot..t to the PA o.,.rt.-nt 0' R.venu8, Soard 0' Appeal., Dept. ZlloZI, Harrisburg, pA 171Z'-IOll, OR
n.lecUng to hey. the ..tt.,. det,".lned .t the eudU 0' U. eccount 0' the per.on.l repre.Wlt.Uv., OR
nappe.1 to the OrphWl." Court
ADMIN-
ISTRATIVE
CORRfCTlOHS.
Fectusl .,.ro,.. dl.cov.red on thl. ......-.nt .hould be eddr...ed In writing tor PA Dep.rt.ant 0' Rev~,
lur..u 0' Indlvlduel Ta..., ATTNI Po.t A.....-.nt RevllM unit, DEPT. Z.06ol, H8r,.l.burg, PA 171ZI-060.
Phone (717) 7"-6505. S.. Pave S 0' the boo*l.t .'n.tructlon. 'or Inherlt~. Tax R.tum 'or I R..ldent
Decedent- (REV-I.DI' tor en I.Plan.,lon ot .aalnl.tr.tlvaly correct.ala arror..
DIICOUrtTI
I' sny tax due I. p.ld within thr.. (S) c.I~.r ~th. a,t.r the dIc~t'. death, . 'Ive parcant (~)
discount 0' the taw paid Is allowed.
INTERUTI
Int.nll II charged be8IMing .Uh flr.t d." 0' iMllnqusncv, or nine (f) Mnth. ~ OM (I) d.y
'rOIl the d.t. 0' de.th, to tM d.ta 0' p~t. b... which bee... delinquent bafor. January I, 19.Z
baar Int.r..t at the rat. 0' .Ix (6~) parcent per ~ calculatad at a dallv rata 0' .0aal64.
All t..a. which ~... delinquent on or a,t.r Jenuary I, 19.2 Nlll baar Int.ra.t at . rata which .111 v.rv 'rOIl
c.lend.r va.r to calendar v.ar ..I th that r.ta ........-.e.. bv the p, Deparbent 0' A...,.,.... The appllcabl.
Intar..t rat.. 'or 19'Z through 1'" ar.,
bit tnt.,...t Aata O.lIv Int.r..t FltCltor
Intara.t R.t.
Oallv tnt.r..t Factor
1Ur
191Z
I'as
t,..
191'
19"
ulnt.r..t
2'X
IU
IIX
IsX
lOX
I, calculated ..
.911
nil-I".
1992
."S-I994
1"5~1",
9X
IU
9X
n
'X
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INTEREST . BALANCE OF TAX UNPAID X HUHBEA DF DAYS DELINQUENT X DAILY INTEREST FACTOR
uAnv MoUc. luued IIft.r the t.1C bacOll8' dlllnquMt .111 raflect an Int.,.nt ulcul.Uon to ,1ft"" ell) day.
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ESTATE OF LUCY A. SIMON,
Deceased
: IN THE COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY. PENNSYLVANIA
:
: ORPHANS COURT DIVISION
:
: NO. 2194'0987
ESTATE SETTLEMENT AGREEMENT
This agreement. made this January 11. 1997. by and between the
undersiqnedl
Witnesseth:
WHEREAS, Mary F. Simon as executrix of this estate has fully
administered same, paying all debts and collecting all assets, and
WHEREAS, Mary F. Simon is the sole legatee of said estate, and
WHEREAS, all death taxes have been fUlly paid;
NOW THEREFORE. for and in consideration of the mutual agreements
herein contained, it is agreed as follows:
1. No formal accounting need be filed by the personal
representative.
2. All assets of the estate shall be distributed to Mary F,
Simon (now Staub) for her to hold and own absolutely,
IN WITNESS WHEREOF, we have executed this agreement.
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ESTATE OF LUCY A. SIMON
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MA F;;Y SIMON
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MAR SIMON
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Cumberland County - Register ot Wills
Hanover and High street
Carlisle, PA 17013
Phonel (717) 240-6345
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Datel 10/29/1996
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YOFFE NORMAN M
WEST SHORE OFFICE CENTER
214 SENATE AVENUE SUITE 203
CAMP HILL, PA 17011
REI Estate of SIMON LUCY A
File Numberl 1994-00987
Dear Sir/Madam I
It has come to my attention that you have not filed the Status Report
by Personal Representative (Rule 6.12) in the above captioned estate.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103
SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after July 1,
1992, the personal representative or his counsel, within two (2) years of
the decedent's death, shall file with the Register of Wills a Status Report
of completed or uncompleted administration.
This filing will become delinquent on 11/08/1996.
Your prompt attention to this matter will be appreciated.
Thank You.
Sincerely,
~1l8-~L/C'~l~ r-~J/rh1~J:L%~
MARY C. LEWIS v~lr-
REGISTER OF WILLS
CCI File
Personal Representative(s)
Judge
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STATUS REPORT UNDER RULE 6,12
Name of Decedent I l'-\c.r f1 )\'Ic ,,~
Date of Deathl '\ \'1. l:l 1
Will No. Admin. No. ';H9"i ... c;qg;>
pursuant to Rule 6,12 of the supreme Court orphans'
court Rules, 1 report the following with respect to completion of
the administration of the above-captioned estatel
1. State whether administration of the estate is complete I
Yes No ><
,
2. If the answer is No, state when the personal
representative reasonably believes that the administration will be
complete I ,,, l.;:ll I 97
3. If the answer to No.1 is Yes, state the following I
a. Did the personal representative file a final
account with the Court? Yes No
b. The separate Orphans' Court No. (if any) for
the personal representative's account is:
c. Did the personal representative state an
account informally to the parties in interest? Yes No
d. Copies of receipts, releases, joinders and
approvals of formal or informal accounts may be filed with the
cerk of the orphans' Court and may be attached to this report.
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signat.ure
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Name (Please type or print)
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Address
Date:~
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personal Representative
Counsel for personal
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STATUS REPORT UNDER RULE 6.12
Name of Decedent I L ~ c y ,..1 t:11,. D4
Date of Death 1 II ( '8 l 91'
Will No.
Admin. No.-2..1 Y 'I ~ CJ <;' (J 7
Pursuant to Rule
Court Rules, I report the
the administration of the
6.12 of the Supreme Court Orphans'
following with respect to completion of
above-captioned estatel
State whether administration of the estate is complete 1
Yes;X No
2. If the answer Is No, state when the personal
representative reasonably believes that the administration will be
complete 1_
1.
J. If the answer to No. 1 15 Yes, state the followingl
a. Did the personal re~esentative
account with the Court? Yes No .
b. The separate Orphans' Court No.
the personal representative's account iSI
c. Did the personal representative state an
account informally to the parties in interest? Yes X No
file a final
(if any) for
d. Copies of receipts, releases, joinders and
approvals of formal or informal accounts may be filed with the
Cerk of the Orphans' Court and may be attached to this report.
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Signature
jl/O ~t1A tV A Yol'f'~
Name (Please type or print)
J.IY 5<~t"".: t1v~
Address
Datel~
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Personal Representative
Counsel for personal
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