HomeMy WebLinkAbout94-00994
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Qt/- f/fP 1- 355066485
6 1995
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Estate of SUMNIJ/i r. I/lfFi'DV
also known os
PETITION FOR PROBATE Rnd GRANT OF LETTERS
.;21 -q~
No,
To:
Rcglstcr of Wills for Ihe
Deceased, CounlY of In Ihe
Social Semr/ty No, /'7<)-3:J-,;},ci,,? Commonwealth of Pennsylvania
The petition of Ihe undersigned respeclfully represenls Ihal:
Your pelltloner(s), who Is/are 18 years of age or older an the execul/Nt(
In the last will of the above decedel1l, dated . JULY
and codlcll(s) dated
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(1lalc rclevanl cln:lImSlanm, c.,. renunclallon, death or (',reUlor. etc.)
Decendenl was domiciled al death In C{Jm~tf'U1A1ll COll11ty. PennsYI~la, with
hr/E' lasl family or principal residence at~:? "/1* !5'TI?Et:r : t::ARLlStf 1!OU~H
(llsl Slrtfl, nllmber and munclpalll)')
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Decendenl, thcn <;3 yellrs of age, died AldvEm~R l(g , 19 ql/
al ."l'.'?'! W' S7~H7" , r..'I'7~U5LE ,
Except as follows, dcccdent did not 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
Ineompelent:
Decendent at death owned property with estimated values as follows:
(If domiciled In Pa.) All personal property
(If not domiciled In Pa.) Personal properly In Pennsylvania
(If not domiciled In Pa,) Personal properly In Counly
Value of real estate In PeonsylvDnl9 =__ /'_
situated as follows: 33'? ff. ,d[]5J:.r~ LtlRliStf m /7tl13
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WHEREFORE, petitloner(s) respectfully request(s) the probate of the last will and codlcll(s)
presented herewith and the grant of lellers 7FST/1tr-'~tl
(testamentary; adml luratlon c.I.a.; administration d.b.n.c.l.a.)
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,7') S77?II~/F'R DR., ()W.JSLE I'll 170/3
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA } I:lS
COUNTY 01<' CllMBERLAND
The pelilloner(s) above.named swear(s) or affirm(s) thatlhc slatcmenls In the foregoing petition are
true and correct to the best of the knowledge and belief of petilJoner(s) and that as personal represen.
tallve(s) df Ihe above decedenl I'elilloncr(s) will well and Iruly administer the estale according to law.
Sworn 10 or affirmed and subscribed { .dUd ~ .#d '"
beforc me Ihls 22nd, day of . 0;;'
--I'!OVEMBER 19.1!.4- ~
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J'-I ...;l 49 - S
No. 21-94-994
Estate of
SUZANNE F. HARDY
I Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW NOVEMBER 25 19..2.!-, In consideration of the petlllon on
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED thatlhe Instrument(s) daled JULY 18 ,1994
described therein be admllled to probate and n1ed of record as the last will of
SUZANNE F. HARDY
TESTAMENTARY
DEBORAH L. BLOCK
and Lellers
are hereby granted to
'n7n~ C. ~ e" P.h,~
Rralsl., or III.
FEES
Probate, Lellers, Etc. ",."", $ 115.00
Short Cerllncates(5) .'"."", $ 1 <; nn
Renunciation ................ S
xpages $ 15.00
JCP TOTAL _ $ 1<;8:8:8:
Flied..,.... .NQVEMBER..25., 1.994....
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ATIORNBY tSup. Cl. 1.0, No,)
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This is III rcnif)' Ih,lI Illl' iflfllflll,llitHl ht'lt' ~i\'l'I' i~ fllllt'llly nlpu'lllllll11 .11111Ii~ill.lllt'l'lifkilll.' III dt'illlt ,Iuly fil('L1 Willi IUt. .,~
1.111.::11 Hl'!;islfilr. Tlll'lIrigill.11 lTrtilk.lu' will he lorw,ndl,\lllllhl' SLltl' Vil.llllt'\..hhl.. (lflill' lur Pl'l'll1.UIl'l1l filing,
WARNING: Ills Illegal 10 dupllcalo Ihls copy by pholoslal or pholograph.
Fl'C (Of Ihi!\ u:nifkillc, $!.Oll
2665841
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NOV, 1 9 '994
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COMMONWEALTH 01' PENNSYLVANIA. DIPARTMENT 0' HULTH. YITALAECORDI
CERTIFICATE OF DEATH
O..,OI'OIArlO_Oh-.
o,Noy, 16 1994
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LAST WILL AND TESTAMENT
OF
SUZANNE F. HARDY
I, Suzanne F. Hardy of Carlisle, Cumberland County,
Pennsylvania, deelare this instrument to be my Last will
and Testament, in manner and for following I
1. I hereby expressly revoke all Wills and Codieils
heretofore made by me.
2. I hereby direet my Executrix to pay all my just debts,
funeral and administrative expenses out of my estate, as soon as
praetieable after my death.
3. I give and bequeath eertain speeifie items of personal
property to those individuals set forth in the memorandum
which aecompanies this will. To the extent sueh list does not
dispose of any sueh property then I direet that sueh property
shall beeome a part of my residuary estate and to be distributed
in aceordance with paragraph 5 herein.
4. I devise and bequeath my real estate at 333 "A" street,
Carlisle, Pennsylvania and the proceeds of any sale thereof to
the persons speeified in paragraph 5 herein as part of my
residuary estate; provided however, that my daughter Mary K.
Spanos shall have first option to purehase said real estate fr.om
my estate at fair market value upon sueh terms as my Exeeutrix
shall deem proper.
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5. I give devise, and bequeath all the rest, residue, and
remaindel of my estate, real, personal, and mixed, of whatever nature
and wheresoever situate, whieh I may own or have the right to dispose
of at the time of my death, as follows; provided however, that in
the event any herein designated benefieiary shall not
have attained the age of 21 at the time of my death, then the
share of any sueh individual shall be subjeet to the trust
ereated in paragraph 6 herein.
A. To John N. Etter, I give a sum equal to the lesser
amount of either $25,000.00 or One-Sixth of the remainder of my
estate. (The sum so bequeathed shall not exeeed the amount of
the share to whieh anyone of my ehildren shall be entitled).
B. To my ehildren, I give the balanee of my residuary estate
in equal shares as follows:
1. One-fifth to my daughter Deborah L. Block, and if
she is not then living, to her issue, per stirpes,
2. One-fifth to my daughter Lisa Sue Burgin, and
if she is not then living, to her issue, per stirpes.
3. One-fifth to my daughter Miehelle B. Burgin, and
if she is not then living, to her issue, per stirpes.
4. One-fifth to my daughter Mary K. Spanos, and if
she is not then living, to her issue, per stirpes.
5. One-fifth to my son, John K. MeKeehan, Jr., and if
he is not then living, to his issue, par stirpes.
6. In the event any of my designated heirs shall not have
attained age 21 at the time of my death, I give, devise, and bequeath
the share or shares of my estate to whieh my said heirs shall be
entitled as aforesaid to Deborah L. Bloek, Trustee, in trust,
to invest, reinvest and koep the same invested in sueh real and
personal estate as a prudent woman of intelligeney and diseretion
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would do for herself, for investment, and not for speeulation,
giving due regard to the safety of the prineipal and the adequacy
of the ineome, without being limited to the so-ealled "legal
investments" in the state of Pennsylvania. Until my said heir
attains age 25, my Trustee shall distribute so mueh of the ineome
from the Trust as shall be neeessary for their support, education,
and welfare.
In the event my heirs shall need additional sums for
support or edueation over and above the ineome from the trust, I
authorize my Trustee, in her sole and absolute diseretion, to pay
out of the prineipal of the trust sueh sums as are required and
neeessary to meet the need which arises.
I further direet my Trustee to make distribution of the
principal and any aceumulated income of the said trust to my
heirs as follows:
A. One-half (1/2) at age 211 and
B. One-half (1/2) at age 25.
7. I nominate, eonstitute, and appoint my daughter
Deborah L. Bloek, Exeeutrix of this my Last will and Testament.
I further direet that she shall not be required to post bond
to seeure the faithful performance of her duties in the Commonwealth
of Pennsylvania or in any other jurisdietion.
IN WITNESS WHEREOF, I have signed and published this my
Last will and Testament eonsisting of 6 pages in the presenee of
the SUbscribing Witnesses, this /f-JU-day of Ju'r-, 1994, deelaring
it to be my true will and testamentary wishes,
sl:'t"-""~./. Ha-'c.ot<.,:-.
uz ne F. Hardy ~
We, the subscribing witnesses eertify that the Testatrix
signed this Will in our presenee after reading the same and
declaring it to be her Last Will and Testament. We, further
certify that the Testatrix was of sound and disposing mind and
memory and under no nstra nt undue influenee.
Witness
One West High Street
Carlisle, PA 17013
Witness 1 p........ 4' au...J..-
ADDRESS: (lM, f!xH.3""
f.4,;p..lItt. fl., 17~1
ACKNOWLEDGMENT TO LAST WILL
AND TESTAMENT OF
SUZANNE F. HARDY
COMMONWEALTH OF PENNSYLVANIA )
)SSI
COUNTY OF CUMBERLAND )
I, Suzanne F. Hardy, Te~~~~rix, who~~~e is signed to the
within Last will dated this !,f"I-^-day oM 1994, having been
duly qualified aeeording to law, do hereby eknowledge that I
signed it willingly as my free and voluntary aet for the purpose
therein expressed.
A~~..,~ .1. ",in/'"",
'Suz ne F. Hardy
S~~ to and aeknowledged
this \~ day Of~, 1994.
before me by Suzanne F. Hardy
~':"'~(')Cl Q \:')~'
No ary publie ,
NOTARIAL sw.
MICHaJ.E D. RISBDH, NOTARY PIIBUC
CARUSlf IIDROUGH, CUll8lRlAllD CO.. 'A
MY COMMISSION EXPlRfS lIARCH 14. 18118
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AFFIDAVIT OF WITNESSES
COMMONWEALTH OF PENNSYLVANIA )
)SSt
COUNTY OF CUMBERLAND )
We, Edward W. Harker, Esquire and 6r-o-~bC\ ~ . \:u.rq the
witnesses whose names are signed to the Last Will of Suzanne F.
Hardy, dated~~\~~, 1994, being duly qualified aeeording
to law, do depose and say that we were present and saw the Testatrix
sign and exeeute the instrument as her Last Will, that the
Testatrix signed willingly and she exeeuted it as her free and
voluntary aet for the purposes therein expressed, that each of us
in the hearing and sight of the Testatrix signed the Will as
Witnesses, and that to the best of our kn w1edge the Testatrix was
at the time eighteen (18) or more year age, 0 s und nd and
under no eonstraint or undue inf1ue
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Sworn to and subseribed
and5rPS'OI"' ~.~fQ witnesses
before me by Edward W. Harker, Esquire
this \<6\1l--day Of~ 1994.
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Notar Pub I e
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NOTARIAL SEAl. ,
MICHau: 0, RISBOH, NOTARY PIIBUC '
~y coU~\f BOROUGH, CUMBERLAND CO" PA
..MISSION EXPIRES lIARCH 14. 1M
MEMORANDUM
I give the following speeifio bequeaths I
1. Diamond Engagement Ring to my granddaughter,
Britney F. Burgin.
2. Saphire ring to my granddaughter, Althea M.
Spanos.
3. All Bill Elliot raoing momentos, raeing colleetion
items and raeing piotures to my grandson Ryan C.
Burgin.
4. All personal property in house, bass boat in baek yard,
and 1977 Chevrolet Truek to John N. Etter.
5. 1983 Blazer to John K. MeKeehan, Jr.
6. 2 antique fire trueks and 2 yeungling trueks to
Jonathan C. Spanos.
(Direotion to Exeeutrix - that a portion of the furniture,
house goods, and applianees belong to John N. Etter and are
not to be ineluded in my estate).
Date I ~ \~ 1 \<\C\I.\
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SW,o",rn to and sUbser~ed to
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MlCllB.Ll D. .1ClH. NOTARV PUIUC
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CERTIFICATION OF NOTICE UNDER RULE 5.6 (A) Recordnd-O fico of
RegLtcr of Wills
NAME OF. DECEDENT: SUZANNE F, HARDY
DATE OF DEATH: NOVEMBER 16. 1994
WILL NO. 2194 ADMIN. NO. 0994
TO THE REGISTER:
'94 ole 29 All:51
Clerk'::: ~'~'''':: Court
Cumb..,...no (;0., PA
I eertify that notiee of benefieial interest required by
Rule 5.5(a) of the Orphans' Court Rules was served on or mailed
to the following benefieiaries of the above-eaptioned estate on
DECEMBER 23. 1994:
NAME
ADDRESS
LISA S, BURGIN 33 PARTRIDGE AVE. RIDLEY PARK. PA 19078
MICHELLE B. BURGIN 153 E. PENN STREET. CARLISLE. PA 17013
RYAN BURGIN. MINOR 153 E, PENN STREET, CARLISLE. PA 17013
BRITTNEY BURGIN. MINOR 153 E. PENN STREET. CARLISLE. PA 17013
MARY K, SPANOS 1026 N. WEST STREET. CARLISLE. PA 17013
JONATHAN SPANOS. MINOR 1026 N. WWEST STREET. CARLISLE. PA 17013
ALTHEA SPANOS. MINOR 1026 N, WEST STREET. CARLISLE. PA 17013
JOHN K, MCKEEHAN. JR, 1026 N. WEST STREET. CARLISLE. PA 17013
JOHN ETTER 333 "A" STREET. CARLISLE. PA 17013
DEBORAH L. BLOCK 27 STRAYER DRIVE. CARLISLE, PA 17013
Notiee has now been given to all persons entitled thereto under
Rule 5.6(a).
DATE:DECEMBER 23, 1994
#~//./Pu a~.....Oz.---
Signature
Name: WILLIAM A. DUNCAN
Address: 1 IRVINE ROW
CARLISLE, PA 17013
Telephone: 249-7780
Capaeity: COUNSEL FOR
PERSONAL REPRESENTATIVE
/5 -,;;4'7 - 5
INHERITANCE TAX RETURN
RESIDENT DECEDENT
(TO BE FILED IN DUPLICATE
WITH REGISTER OF WILLS)
IE
'01 DAnl 0' DIATHAml 12/3119. CHICK HI"
If A .,OUIAL
POVII" CIIDIT II CUlIMID 0
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COMMONWUlTH o. PlNNSYlYAN1A.
OI......M(NIOf R\VINUr
Of", 21060
HAUIUUIO..A 1712.-06CIt
.
21-1994-00994
COUHTY COD! YEAR
15
~
o
NUMIER
11-16-94 9-1-41
o 2, Supplomonlal Rolurn
333 uAu Street
Carlisle, PA 17013
c~.. Cumberland
03,
05.
liard
nmArn UN
Suzanne F.
N
1. Ronl E.lall ISchodulo A) (1) 44 , 720.12
2, Slack. and Band. (Schodulo B) I 21
3, ClalOly Hold Slack/Panno"hlp InlorllllSchodulo q I 3)
4, Marlgagll and Naill Rocelvablo ISchodulo D) ( 41
5, Ca,h, Oank Dopa,llI & Mhcellanoau. Po"anal Prapony( 5) 79.695. 30
{Scnodulo EI
6, Jalnlly Ownod Prapony (Schodulo FI I 61
7. T ran.fo" (Schodulo G) ISchodulo II ( 7)
0, Talal Grall Auol. 110101 finll 1.7)
9, Funoral hpon.o., Admlnl'lraUvo Ca.II, MI"ollanoau. (9) 13,120.95
Expon,o. (Schodulo HI
10, Dobl., Mangago Uablllllo., Uon. ISchodulo II (10)
11. Talal Dodudlan. (Iolalllno. 9 & 10)
12, Nol Valuo of Ellalolllno 0 mlnu. IIno 11)
13, Charllablo and Gavornmonlal Ooquo," (Schodulo JI
14, Nol Valuo Sub od 10 Tax (lIno 12 mlnu.llno 131
15. ^mount of lin. 14 taxabl. at 6% ral.
llncludo voluo. Iram Schodulo K or Schod.lo M,)
16, Amaunl of IIno 14 laxablo 01 15% ralo
llncludo valuo. I,am Schodulo K or Schodulo M,I
17, Prln"Dollax duo (Add laxlram IIno 15 and Irom IIno 16,1
18. -:r~cHfI Spoulal Poverty Credit Prior Payment.
+ +
I?, If lino 10 h groalor Ihan IIno 17. onlor Iho dlfloronco on IIno 19, Thl. I. Iho OVERPAYMENT,
illiJO
20, If lino 17 h groalor Ihan IIno 10. onlor Iho dlfloronco an Ilno 20. Thh h Iho TAX DUE.
A, Enlor Iho Inloro.1 an Iho balanco duo an IIno 20A.
0, <n'or Iho 10101 af IIno 20 and 20A an IIno 20B. Thl. I. Iho BALANCE DUE.
Mako Chock Po ablo to. Rogl.lo, of Wlllo, Agont
.... BE SURI TO ANSWER ALL QUUTlONS ON RIVERSI SIDI AND TO RICHICK MATH.....
Under p.nolll" o' porjur)', I dedar. .ha. I have ."amln.d Ihls relurn, Including accompanying "h.dules and .tat.menll, and to the bello' m)' knawledg. and b.II.I,
II it Irue, carr.t! and camp lei.. I d.clar. Ihat all real ..Ial. hal been "part.d 01 lru. markel valu.. D.c1aralion 0' pr'par., oth.r than the p.rsonal r.pr.llnlallve II
basod on alllnformollon 01 which r. Dr., has an knowl.dg..
A 1'1 .~ I A DATI!
I'd
,
195-32-2557
o I, Original ROlurn
o A, lImitod E.lalo
o 40. fUlu,. Inl.,es, Campromlll
Ifar dolo. of doalh aho, 12.12.021
G2.llt Doc.donl Dlod To.lolo 0 7. Docodonl Malniolnod 0 living Tru'l
IAnach co of Will IAnDch co 01 T,ull)
ALL r.OknESPONDENCI AND CONPIDENTlAL TAX INPORMATlON SHOULD II DIRlCTlD TO.
MM'
_0,
William A. Duncan
h t HUM
1 1 rvine Row
Carlisle, PA 17013
249-7780
on
,... ."-
,
-j}i
~ "
464.16
1151
In'J J t.l'J I'
lC .06.
(16)
R,~IR. I R
lC .15.
Dhcount
Int""1
Chcck'hc,e if you'orc rcqut',linn U IdumJ 01 you, OVl'lpoy"wnl
1201
120AI
120B)
Rltmalnd., R.furn
Ifar dolo. 01 doolh prlorta 12.13,021
Fodoral E.lalo Tox
Rorurn Roqulrod
TOlal Numbor 01 Sofo Dopa.11 00...
vi
'..}j
-1:0
.'. C~
"
i:~
"..-j
I
hJ
"J
,. "
( D) ......124,415.42
(\11
(12)
113)
14
13,585,11
110.830.31
6.1~~. 77
1,262,72
(17)
7.~07.44
(10)
119)
7,407.44
7,407.44
~~?-9r
I'V.IS02'~. 1I2"IIO,..I.,~
I' If ~
COMMONW.AltH 0' P1NNlVlVANIA
INH.I"ANC' TA. U"/IN
_!lIDIN' DfCfDIN
ISTATI 0'
SCHEDULE A
REAL ESTATE
J
PILE NUMBER
Suzanne F. Hardy 1994-00994
(P,operty lolntly-ownod with Right 0' Survlvollhlp mu.I bo dl.clolld on Schodulo 'I All '001 o.tato .hould bo ,0po,Iod 01 '01, ma,kol voluo
which II don nod a.tho p,lco 01 which p,oporty would bo nchangod bolwoon a willing buy.. and a wllllngllllor, nolthor bolng compollod
10 bu 0' 1111, both havln toa.onoblo howlod 0 0' Iho tolovont 'acl..
ITEM
NUMBER
1,
"".",
. ~
f.
DESCRIPTION
VALUE AT DATE
OF DEATH
A aingle-family dwelling
333 "A" Street
Carliala, PA 17013
Cumberland County, PA
$44,720.12
TOTAL (Aho onlO, on IIno I, Roco Ilulollon
(II more .poce i, n..d.d, inJlr' addit/onal Ih"'~./~.t 10m. sin.)
S 44 720.12
~
"\l-ISOI"~ 11.111
'*
SCHEDULE E
CASH, BANK DEPOSITS AND
MISCELLANEOUS
PERSONAL PROPERTY
CClMIf.?N:.t:1W. ~~ t',\'.!i\l~'NI'
>>1:IIIDI'" DIC1DiNi
hTATE OF
Suzanne F. Hardy
'"' ~""",'.".."w,."" ..~.. .
Ploa.o P,lnt a, T 0
FILE NUMBER
1994-00994
(All ..'....rfy le.II'''''''''''' with .he .leh. .f .u",lvenhlp ,"ult II. dl.c1...d .11 Sch.dul. '1
ITEM
NUMBER
1.
2.
3.
4.
5.
6.
7.
8,
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
DESCRIPTION
Farmers Trust Company Savings Account
Meridian Psss Book Savings 083388009403
Blue Cross Insurance Refund
Arnold Fuel Oil Refund
PA State Tex Refund
IRS Tax Refund
use Annuity
Jackson National Annuity 036030460
MONY Annuity OB1313-90-86
Farmers Mutual Homeowners Insurance Refund
18 Karat White Gold Oval Ring (App. Attached)
1976 Proof Set (App. Attached)
14 Karat White Gold Emerald Cut Diamond Ring (App. Attached)
Cash in Lock Box Inventory Attached
1977 Chevy Silverado Truck wI cap
1983 Chevy Blazer
Montgomery Ward Refund overpayment
Bill Elliot racing momentos
Antique fire trucks & yeungling trucks (4)
TOTAL AI.o ente, on line 5, RIco
(Ahach additional S"'- x II- .h.... If moro .pac. I. nood.d.1
VALUE AT
DATI OF DEATH
14,557.19
214.16
90.90
81. 57
10,00
110.00
39,803.44
11 . 051. 88
9,465.89
66.00
300.00
7,00
1875.00
95.40
800.00
1,100.00
13.90
22.97
30.00
S 79,695.30
'~IJllU.P'''''
.'
ITEM
NUMBER
-
..._t_.,.._...,____~"
r
~~
tOMMONWIALfH O. IINNlYlYANIA
INHIIIIANCI TAll lIlUIN
I"'.'N! D.e D Nl
SCHEDULE H
FUNERAL EXPENSES,
ADMINISTRATIVE com AND
MISCIiLLANIiOUS IIXPINIIS
PI.a.. Prlnl ar T .
Suzanne F. Hardy
1994-00994
DESCRIPTION
AMOUNT
A. Fun.ral Exp.n,."
B.
4,
C.
I.
2.
3,
4.
5.
6,
7.
8,
9.
1,
2.
3.
4.
Hoffman Roth Funeral Home
Westminister Cemetery Inc. Memorial
Westminister Cemetery Burial Plot
Weatminister Cemetery Interment
5,428.50
1,268.61
405. 32
800.00
1,
Admlnl.tratlve CD.t..
PenDnal R.p...llnlatlve Cammlulanl
Sadal S.curlty Numb.r of Penanal Rep","nlatlYDI
V.ar Cammlulan. paid
2.
A"amey "...
Duncan & Otto
3,700.00
3. family exemption
Claimant Relatlan.hlp
Add...u of Clalmanl 01 d.c.d.nl'. d.alh
St...., Add...u
CHy
5101.
Zip Cad.
Probate Fe..
400. 00
Cumberland County Register of Wills
MI...llaneou. Exp.n....
Univsrsal Physicians (Medical Expense)
135.00
62.40
225.00
65.48
40.00
Farmers Mutual Homeowners Insurance
Diversified Appraisel Services
Evening Sentinel Legal Ad
Cumberland Law Journal Legal Ad
Con-Pharmo (Medical Expense)
33.68
Care Mark (Medical Expense)
117. 40
72,00
Credit Bureau of Central PA Medical Expense
Farmers Mutual Insurance Co, 2nd install ent Homeowner.
TOTAL (AI.a .nl.r an IIn. 9. RecapHulatlanl
(If mDr. .pa.. I. n..d.d. In..rr addltlDnal .h..t. of .am. .1..,)
5 13 120. 5
......11....,....
.'
~
~NwrAll'll or 'INNtYlVANIA
INHllllANCI fAIl liNIN
111101 f 0 INI
SCHEDUU H
FUNERAL I!XPENSES,
ADMINISTRAnvll COSTS AND
MISCELLANEOUS UPINIIS
Suzanne F. Hard
N8::IiR DESCRIPTION
AMOUNT
10. Darlana L. Moyer Tax Collector Reol Estate Tax
241.90
63.26
.
11. Deborah Black Refund Misc. Expenses
-,.;
'''"''"''':'''''1.
COMMONWIAUH Of PlNNI'nVANIA
INHU.U,NC' tAl InUIN
IUIOINIOIC'D'NI
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES AND LIENS
PI.a.. Print or T .
FILE N MBER
1994-00994
,
..
,
ISTATI O'
Suzanne F. Hardy
ITIM
NUMBER DESCRIPTION
AMOUNT
I. Fermara Trust Company Visa Card
41. 30
422,86
2. Montgomery Wards Payoff
.,.
TOTAL (Aho enlor on line 10, Rtcopilulollon) $
(II more 'poc. I. n..d.d, ;nl.rt addifional.h..,. o( .ome III1.J
1.l:lo__''',,",'''''''U~_'~'-'-~'';'''''~'''''__~_'~___'___
""'~'
.._.,.....;.~!:'>;K:,-"J.;~"'.IJ~;.<4"-~f"~.___..:...-_<: ._~'-U
IIV.un tl+ (1-171
'*
~ IWtALfHOfrtNNlftVAHIA
...-rANCI tAX IItWN
--,
SCHEDULE J
BENEFICIARIES
ITIM
NUMBIR
NAMI AND ADDRlss Of BENEfiCIARY
FILE NUMBER
1994-00994
RELATIONSHIP AMOUNT OR
SHARE OF ESTATE
daughter 1/6
daughter 1/6
daughter 1/6
son 1/6
daughter 1/6
companion 1/6
grand daughter 1,875.00
grand daughter 300.00
UTATI O'
Suzanne F. Hardy
A, Ta.abl. BoqU.'11I
1. Lisa S. Burgin
33 Partridge Ave., Ridley Park PA 19078
2, Michelle B, Burgin
153 E. Penn Street, Csrlisle, PA 17013
3, Mary K. Spanos
1026 N. West Street, Carlisle, PA 17013
4. John K, McKeehan, Jr.
1026 N. West Street, Carlisle, PA 17013
5, Deborah L. Block
27 Strayer Dr., Carlisle, PA 17013
6. John Etter
333 "A" Street, Carlisle, PA 17013
7. Britney Burgin
153 E. Penn St, Carlisle, PA 17013
8. Althea M. Spanos
1026 N. West Street, Carlisle, PA 17013
ITIM
NUMBIR
NAME AND ADDRESS OF BENEFICIARY
AMOUNT OR
SHARE OF ESTATE
B. Charllabl. and Gov.mm.nlal BoqU.'11I
\,
TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Alia .nlor an IIn. \3. Rocapllulallan) S
III ma.. lpoC. II nttd.d, Inl.rt addltlanal Ih..tl al lam. lilt)
m.UII P. CI.a71
mATI O'
ITIM
HUM'"
q.
10.
ITIM
HUMBIR
I.
..
COMMOHWIAlnt Of """lnVANIA
_ANQI,Uftwu.l
--
SCHEDULE J
BENEFICIARIES
AMOUNT OR
SHARE O' ESTATE
22.97
30,00
AMOUNT OR
SHARE OF ESTATE
S
".;
Suzanne F. Hardy
FILE NUMBER
1994-00994
HAMI AND ADDRESS OF BENEFICIARY
RELAnONSHIP
A. Taxabl. Bequnlll
Ryan C. Burgin
153 E, Penn St. Carliele, PA 17013
grand son
Jonathan C. Spanos
1026 N. West Street, Carliale, PA 17013
grand son
HAME AND ADDRESS O' BENEFICIARY
B. Charltabl. and Gavernmenlal BoqU.III1
TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Aba .nllr an line 13, R_pllulallan)
(II "",re .pa.. I. n..d.d, /n.." addU/anal .h..t. al .am. .,..,
OUR FILE III: 95-111 LENDER: Farm.,. Tru.1 Co, ,
C.Tbh torm 1e turnhb.d to giva you A Btat..ant ot Actual aattl...nt coatD, AIIount. paid \
to end by the ..ttl..ent Avant are shown. Ite.D marked p.a.e. w.r. paid out.id. cloeinq.
D. NAME OF BORROWER: E, NAME OF SELlER:
John N. Eller Estala 01 Suzanne F. Hardy
G. PROPERTY LOCATION: H. SETTLEMENT AGENT: I. SETTlEMENT DATE:
333 A Slraat DUNCAN & OTTO, P.C, Wednesday 07-Jun-95
Carll. Ie, PA 1 IRVINE ROW 9:00 A,M,
CARLISLE, PA, 17013 at Farme,. Tru.t Co.
J, SUMMARY OF BORROWER'S TRANSACTION K. SUMMARY OF SELLER'S TRANSACTION
100 aRO.. AMOUNT Dua rROH IORROWER 40. ORO.. AMOUNT oUI TO IILLIR
101 Contl'.a~ ..1.. pric. $45,000,00 4., Con era at ..1.. oria. $45,000,00 '
102 'Irlonal nroftAl'ty 402 PIl'lonal Pl'o~l'ty
10' ..ttl...nt Chara.. (11n. UOO) 1415,00 40'
101 100
10' Adjuatunt.. It... Dr.paid by ..1111'1 I
Ad1ulc..nu it... prepaid by ..Uar I 40. Looal t.... to U"Deo-U 137,19'
101 Load t.... to 31-DIO"U 137.19 400 A.......nt. I
107 ........nt. to 0.7 lobool t.... to )O-JUD-U 32.93:
101 sohool t.... to 3D-JUn..'5 32,93 10. !
10' 40'
120 GROSS DUE FROM BORROWER 465B5,12 420 GROSS DUE TO SEllER 45170.12
200 AMOUNTS PAID Br OR paR 10RROW!R '0. REDUCTIO.' rw AMouwr aUI TO IILLIR
201 Depolit or ..rn.at Honay 4000,00 .01 ..0..' dapoait ,
20. .av Hort9a,a Aaountl p.r..r. 'J'ruat eo. 43000,00 '0' Sattl...nt abar,.. 450,00
2.' hiatin, loan. takan .ubject to '0' ..iatla, loaae tatan !
204 500 Pllyoff ht Wlrt,.,. I
20' 50' 'ayoff 2nd ~rt9.9. I
'01 500 :
20' '07 ,
&djun..au for it... unpaid by ..11ar '00 I
210 Loaal T.... to OJ-Jun-" 0.00 Adjuatpnta for it... unpaid by ,.11.1' !
.11 a......_nt. to .,0 Loaal t.... O1...run-U 0,00
212 School T.... to 07-Jun-n 0,00 .11 A.......nt. to ,
,
.u .,. Sohool t.... to OJ-Jun-" 0,00'
.11 ." I
.17 .10 ,
,
220 TOTAL PAID III BORROK!:R 47000.00 ",0 TOTAL REDUCTIONS SILLIA 450.00,
'00 CUR rRDHITO BORRONER 100 CUR TOIFROM ..LUR I
J01 01'0" &aQunt due fro. borrow.r 46565.12 101 01'0" _.aunt to ..llar 45170,121
)02 L... .-aunt. paid by/for borrower 47000.00 602 Raduotion. to ..11.1' 450,00 i
303 CASH FROM ITOI BORROWER: ($414.66 603 CASH TO'TFROMI'SELLER: $44,720.12 !
I have aar.fully r.vi.w.d tbe BUD-l Settlement Statem.nt aDd to tb. be.t af my kDowl.dq.
and b.liet, it ia a true and accurate statement ot all receipts and di.bur....nt. mad. on
~coun51~n my b.balf and I have r.ceived a ooPY ot tbi. BUD-l tor .y recorda.
V"";)", 'J .-~.. i
,""
Jolb N. Etter Estat~ Suzanne F, ~~rdy
A :d,J?~..e.
,
By: Deborah L. Block, Executrix I
- I
, , ~. ~.,..,::r--.:. , ,
.
HA(?..J)
CI
2. SEX
1= A063580
Stale ZIP
;7/1 /701.3
REMARKS \) EMPLOYER
'-BD'd-S
Neme
Relallonshlp
Dale of Birth
POLICY NO,
~Go~OA-G l
.:loclal Securlly No,
Joint
Annulllnt
Section II
The
Benel/cllry
NAME
PRIMARY ChM:lre
PRIMARY
CONTINGENT
CONTINGENT
DATE OF BIRTH
SOCIAL SECURITY NUMBER:
Sulell /l1/1
Anticipated Maturity Age
IRC 1035 Exchange? 0 Yes;5l( No
tSINGLE PREMiUM) I $10,000
or
FLEXIBLE PREMIUM Inlllal Premium
Is this conlract to replace any existing lIIe Insurance or annully policy?
Yes No >( Details
MODE OF PAYMENT FLEXIBLE PREMIUM ONLY
Is
Anllelpaled lst.Year Pramlum I S
Name & Address for Premium Billing
I
C Annually
C Semiannually
C Quarterly
C Preaulhorlzed Check
(Monlhly only)
o Payroll Wilhholdlng
o Annual C Quarterly
o Semlannusl 0 Monlhly
Is this Annully being purchased on a Jx:nonquallfled or 0 tax-qualified basis:
IItax,quallfled - TYPE OF PROGRAlt1ibne per application)
For Tax Year: nlNDIVIDUAL RETIREMENT ACCOUNT
o Regular 0 Rollover 0 Transfer 0 Spousal
C SIMPLIFIED EMPLOYEE PENSION (SEP)
C! Employee 0 Employer
o PENSION OR PROFIT SHARING (iRC 401)
o Corporallon 0 HR.l0
II other than Pro osed Annultanl, Owner musl sl IIcallon)
RECE\Va:.CJ
DEe 2 4 1992
o PUBLIC EMPLOYEE~OOl (tUl.I1"
NOT-FOR.PROFIT E!II Il)'IIIJ 1II01 (c))
o DEFERRED COMPi:'t SAT/ON
(Including IRC 457)
Employar No,
Name
o Joint or C
o Conllngent Na e
Owner m
Address
City, Slale, ZIP Social Securlly No,
I '-_",___ I
Date 0' ullth SOCial t;tlCUrily No,
Relalionshlp
.;, IMP.ORTANTI', MAKEALU.CHECKSi PAY~BI:EONlVtTO; JACKSONINAT/ONAL:..L1fEINSURANCECO'_, .
1. There has been delivered 10 Ihe agenl wilh this application 2, The undersigned hereby represenls 10 the best of his or her
$10.000 payable only to Jackson National Llle Insur- knowledge Ihat each ollhe slalemenls and answers conlalnod
once Company which shall not be considered payment above are full, complole and true,
hereunder unless actually honored upon prosenlallon by the 3, The Owner's laxpayer Idenllllcalion number shown above is cor.
Company In Ihe du course of business, l' lil/ed to be correc!.
Daled:1tn signed al - on ,,//("', /(. 19 (j,.;J,
. " 51.11e
,~e_ .
5'Q".tlul. DI 0"'"111" ..MIoH , ..I<.l. ",..-,t.~l
!.1I11
.,1'"10"'""'01 J'W"1 10,,,,,,1""1
,"GUll TO CO/,lPl[f[ fl[vtllst SIOU
DunCllD & Otto, P.C.
Attorney. at law
One Irvine Row
Carll.le. Penn.ylvania 17013
Wl1Ilam A. Duncan
Su.an J. Otto
January 24, 1995
Jackson National Life Insurance Co.
5901 Executive Drive, P,O. Box 24068
Lansing, Michigan 48909-4068
(717) 249.7780
FAJ{(717) 249.7800
REI Suzanne F. Hardy #0036030460
Attnl Karry Lenon
Claims Processor
Claims Administration
As per your letter of January 18, 1995, we the undersigned
are the only known children of Suzanne F, Hardy.
Deb~~ ~~~# 206-38-9567
159-62-7647
~S. ~':lJlin SS#
{} ") ~11. J
Mi 11 . B in
SS# 167-40-0094
Mary K. S~ SS#
~n.~ 't. .'"'CI"::.
~
191-40-8551
STATE OF PENNSYLVANIA:
COUNTY OF CUMBERLAND :
BE IT REMEMBERED, that on January ry', 1995 before me came
DEBORAH L. BLOCK, JOHN J. MCKEEHAN, JR., LISA S. BURGIN,
MICHELLE B. BURGIN and MARY K. SPANOS, known to me (or
satisfactorily proven) to be the persons whose names are
subscribed to the within document and aeknowledged that they
executed the same for the purposes therein eontained.
ss. :
WITNESS my hand and seal the
day ~nd ~
YL~
Nota
. -r...-:--...._~~_+_~......_.._,~..~.....,..............._.,,~-r."'....-.:..^"""~ ".- .,~ -~
'I:ISG ANNUITY & LIFE COMPANY
P.O. BOX 617, DES MOINES,IA 50303.0617
I. GENERAL INFORMATION
1. A primary benellclary musl be named. If no benellclary Is named, any proceedl wlll be paid 10 the annullanrl/lnsured's eslale.
2. Thlslorm maybe used lor more than one policy only If all policies are on Ihe aame IIle,lhe same benellclal deslgnallon Is desired,
and all policies have the same owner.
II. SIGNATURE REQUIREMENTS
1. The presenl owner ollhe policy musl sign Ihe change lorm,
2, If policy Is Jolnlly owned, bolh owners DlIIAIslgn the change lorm,
3,If policy's corporelely owned, en olllcer 01 the corporellon muslslgn the lorm lor the corpora lion. The olllcer's IIlIe must be
Included and a copy 01 the corporale resolullon giving the olllcer aulhorlly 10 sign lor Ihe corporallon musl also be mailed wllh
the change lorm,
4, If currenl benellclsry deslgnallon 's Irrevocable, changelorm musl also be signed by Irrevocable benellclary.
5,If the owner resides In a commily_propert~ or Marllal properly 81ate, Ihe owner's spouse must also sign the change lorm,
Delo /~o"',J//~) POl/oYNo,_ICo(p'3ss:-
. ~ /
,Annultenl/lnsuffld Jill 1l/l11Jl. ~ r2, {)l i Ownor 5' () I\.H~
1 horeby rovoke oil prior do.lgnoflon. 01 Bonono/ery. Tho now Bon.ne/ary do.lgnatlon .hall bo .. .,.,ed:
PR/~ARY BENEFICIARY: ( (Un/e.. otheMI.. st,'ed, Bleh living ben.nc/.ry will ree.lvo.n equ./sh.,. oflho procHd..)
NlIIJli , .. \L, ~6(l !. Ro/aUonshlp ))(:1 II ('> / p
'Ar/drosll"'+;;:l7-n '-e. S/,(>f1f(~il :Dr C1=liC':S e..., 14-"Soo,S~No.'"lt''oi~(}ip-3P-';';'1.s-~'T'
NIIIJlO /,,:\,,1;', .~_ ~ I) Ro/aUonsh! l\nl.c ('f,,:J
Addfflss.i.~ /)/I,:t.,;",Ji<.:... JIt., ~,rlll'll (i~I'I{"dl Soo.Seo.No. /01_~t)-OC:lfj.S-
NlII'Ilo { ,h \ \, " \; LA. ~ ; IU Ro/aUonshlp L> Au 'I -\ e '
'Addffl" 1~..3 (i', I~"',()~;' /11':15 e., -,4. Soo.Soo.No. /&7-(/0- 009$"
Namo I, . ',\ '(l " I, c';' Ro/aUonshlp .\)l:\l\(ih \,' I_~
Addffl.. III, ,', j ,', Soo,Soo. No. ) '/- -Y'O . J'-~~-/
,~'J! BENEFICIARY: (JI-no Prlm.ryBene'loll/J I. Ihh.v, f',u~_.dt IIWI to :;>.'d IQ IhHhM-llrirrg'ConUnpnl fI"n""e"'ty.}
NIIIJlI; :To . 1. l!::e (lil, Ro/aU~nshlp ..son
Addffl's/I:t.J' .J)o'!.7/aS .DI"'./ car/Isle; Soo,Soo. No./Sr- 6.:1- 7
Namo Re/aUonshlp
~" ~-~
SURVIVING ISSUE PROVISION:
If a (- opptop<lolo boa) 0 PI/mary Boneflclary: 0 Flrll Conllngonl Beneflclory: 0 Second Conllngont Boneflclary dies belore or
al the same time as the Insured or bofore receIving Ihe onllre proceods due that beneficiary, any proceeds Ihat would have beon paid to
him sholl be paid In ono sum to his surviving Issue por stlrpos and nol per coplla. If Ihore ale no surviving Issue, such proceeds shall be
"ald 10 the surviving benoflclarles, U any, 01 his same beneficiary clasl. 'Issue' shall Include adopted children,
TESTAMENTARY TRUSTEE
The dUly eppolnled, qualified and acting T,uslee 01 the Testamenlary Trusl Cloated In tho Lasl Will and Teslamenl 01: (N_ 01 P..... Who
M.d. WiI) , or the successor In Trust Is namod as
(cI1adlopptopo\alobo.) 0 Pllmary Benoflclory; 0 Flllt Contlngenl Benellclary: 0 Second ContlngentBonoflclaryoflhepolloy(s).
If USG Annully & Ufe Compeny Is nol furnished evldenco ollhe appolntmont ana quallllcotlon 01 such a Truslee within one year oller the
dealh 01 the Insured, the procoeds 01 the pollcy(s) sholl be paId to the benellclary(s) named In Ihls form as conllngenl benaflclary(.) to the
TeSlamentaryTrulleo In the order shown. If no such contlngenl benellclarles are named or none 01 them survive the Inlured,tho proceeds
01 the pollcy(s) shell be paid to Ihe owner 01 tho pallcy(.), II living. olherwlse to the execulors or administrators ollhe owner's eslate.
TRUSTEE OF AN EXISTING TRUST
NameofActlngTrustee:
AddrossolActlngTrusteo: Trusloe,
or Ihe BUCOSlor In Trust under Trust Agreemenl daled enlerod Inlo by
(N_0I0'.....) A"t!t~.,T~sI99!clc llO(t1....."f'Il'1ljlrialobo.) CJ Prlmery
. ElenelUo,y; 0 Flrsl Contlngont Bonollclary; 0 Socond Contingent Boneflclary,
I agree that arlV change loquel.shall be subject 10 t~e provisions of the contract and approval by the Company.ltla aIao agreacl thai any
addlllonallnlormallon required by Ihe Company to effect the requestad changes will be lupplled upon requesL FoUowtng completion of all
requ~ements,the requesled chango. made by the lorm constitute a supplement to the original application lor tho ContrBCI and shaD lorm
a part 01 the Contract.
X .~.r((.,;:> ;''',(, ,J /,1,1.' '(',1_
Owner'a Signature ~ Jolnl Ownor Slgna/ure (IIony)
-"r-
Irrevoc.ble 8enollclary (N ony)
Spouse" Slgna/U/8 (Rsquhd' "Commun/Iy/AtorlloIPropotty" Stolai
, ,
thIs raques! has beon lIIed wllh Ihe Company and recorded allls Servlce Office,
Dale
(Whllo. Servleo O",ce, Yollow. Client)
ALlFlED TAX DEFERRED RETIREMENT PLANS
8 IRA I, the Owner, CClrtlfy that I have rK8Iv8d,
and underltand the IRA DlscIoaure Statement and
Chill the malUrIt)' data wll be no latar than Aprfl1 01
endar year following the year I attain all' 70112.
(b) TSA I, the Owner, CClrtlfy that I have received,
and undorwtand the SalaIy Reducdon Agl'lNlment
IIIU that the maturity daw wll be no latar than AprD
the caklndar year followlnll th. par I attain all'
/2.
OF PLAN
Employee C Non.Worklng SPOUIe
CONTRIBUTION PLANS
EP-IRA Rollover C TSA RoIlovllr
IRA RoDov... from Quallfted Plan
NUINa CONTRIBUTION PLANS
IRA C TBA C SEP IRA
7, Ia thl. Annuity ntpIace or chanll' any existing
1If,lnaurance or Il(Vee C No
8. It Ia und and egnNld ~ (1) Th. 8tatnlenta
made IhaII form . a:lUIIve buIa 01 an)' Annuity
Conlractl or laauecl hereon; (2) Only an
oIIJcerolthe can make, modify, dIIctwg., or
Wllveanyolth. ompany'. rights; and (3) The Annuity
ContnIcD or .... md etract1V8 until the
purch... payma II I'IClIIved by the Company.
'ZoO
staw ZIp 11011
NlllTllofannulty phdfor_-;:t '"""'" m
SEN~PUCAll0N AND CHECK TO:
..rCEWED usa NUlTY. UFE COMPANY
n'" LOCUST, SUITE 201
, SEP 18 - DES' C:N~s~~~:1~817
166355
....... ~-"'.,..........~-
....... .....
'.
----- .-
~:.:.-:::::':.:~~-=-:.::.;.--_._"~._..__.._.. -...
I-NtIY
I
"'7'6 FEll, 14 I, 1995
MONY Ufe In.urence Compeny of Americe
P,O, Bo.4720
Syrecu.e. New York 13221
,f,1':i:R M 091068
60,937
2/3
tAl'
I
I
ONE"THOUS.A~D 1 EIGHT
":'. A~OUNT$1,a93.1ellll
HUNDRED . N I NETY-TIiREE AND '1 e/1 e&" -..:----------------.---,--
,. .,' . l '.': " _;!,'. ".' , - '''''- ;.... _J
'":
; - t.'_~
"
."
-,:
MI~HELLE BURGIN
X ILL lAM DtlNCANkESQUIRE
DU CAN ~ OTTO,P.~.
ONE IRVINE ROW
CARLISLE PA 17013
;i ", i'
::(is,')~'\)' 'V.P)' ,',\ J 'I'; -r~':; "",
,l.':::~ J:' I' ' ), I"): J} : 1 ) ;
Ie "':--: " ,I" ' , I
,1',';..,;,'1 \.. -~(,;;,,~\;;,""" '
':~'f"':: ..J~,\\..,J..-,-,.,~ ,"- ,
DDB 1 314 ge a~F':N;/~A~:JkI'HS f, ;;.tJJrVr/Ri'plq P/~RE, MLOA '
~Oq~O~8~ I:O~~~Oq~7q~ ~0~w~rn~7~~5~
:E CHASE MANHA TTAN BANK
LOA O'SBURSEMENT ACCT
YRACUSE. NEW YORK
.... .-......~..-....,........
. .. ,. . _____.._....___.__...... ,.,.....~....~.,..._... ._.......a....__
1-t,l1~~~J~~~~tl~~~~;, ~:'~L:t~~~f iJ4i~t;:~;i'~~!f~,~ i~:~~,i;r;~~~oo'~~~~:~~;Ji :/7!~~1!
,,;':;';";,;,', .."',590\'Bi.cUlly.Drlve.';;..'~,,:..:..,'''' , ~""..;,.',,:":";:''',';;,:::'''(C:,t':, ~',s;,.,";;,;;:::;;" No ,,3,06,15684
.," , Lanslng,Michlgan48911 -,.... '.. ..~'-", '.~,.., ,.':~ , ' '.c....',' . ' ,
::,:"~,p~&~i~~~~Jf::citJt'~~,:'~'~: o~Dt!~~.z~l~~,~'.~A~ {;2~~:~L19~r' ",'
PAYoooMnj:: 37/ioaoO\.;i;'ARS':'" :,,:,.:,';: ',::;, ';,;;, ';'11;:;:' Fi:: ~'i", '~:,;: DbttAlliil,,".f,'zio.37
';,- . '>.;/~\,;;,",;.;i;:,;;;~,'>,it "~" ':~\ <:\:, .~;~:,':;:;,: ,,'}~h;;~:;,:f:J~~t~;r~tt~~t~~~!~~,;'i"::' ' "
TO
TIlE,
DaDa" ..
','})F .:~:
....:. :"::~;
" ;~;~:,:
MICHELLE B BURGIN
,',.::'\!i3:;,E PENt~'ST"\"'" :,":,;,i,,: ',.",;:i," ,..'(:~' ;'" :1.,
<' C'A'R' LT'SLE" ",: ,:;;'i " 'P"A,,"::17'Ol'3 ,(,;' t;,:: ..,,:";.,',;.:,
",', ~ ',' ..... ' . '. ." ',,'" '.~- ,..,. "....,.. .~,....
"~... ,. !~'~ '::: .:<~. ~.t '. ~~~~ ~;;/ ',.;t /~{~ '.:.~~ ~j
....' '. .:';.
... ';:. ".~'r:~'.' 'f:
"" 30~ ~ 51>81011" 1:0 7 ~q ~ ~8 ~81:O 30 ~~12 5 ~12"
........._,_..~-,'..~....-,.
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..
~.:JNY:, "
MONY U(e/nsurence Compeny o( Amerlce
" P,O, Box 4720 ,
'Syrecuse. New York 13221
CHECK
NUMBER
M 091069
"'.
"
60,937
213
DAlT ; FEP 1.4 I 1995
....cl.
./;':'" il; .1 "
liAY "
,:;...
~I'J . - .'. ..
.~. '_~ ,-f') '..' , .. ~I.
\<< .;..! ;,,/ ;., AMOUNT ';:$1',893.1811l<
f'~r ~J\ "'-;<'~\;',',;:". f":' .' :",..j ,- ,
'AND' '18/" f)0 " -;..;.------~';.;----..;--,.----
..: \:ll\ " ";""~ ..' '~.:;.. ':. . . 'f::~;' . ;,' !
. -.. .
d.',.'"
. ~.
ON~"rHOU~~,"!~' EIGHT I-lUNPRED NINETl;:.II-!REE
MARY K SPANOS
X WILLIAM DUNCANL ESQUIRE
DUNCAN ~ OTTO,P,~,
ONE IRVINE ROW
CARLISLE PA 17013
THE CHASE MANHA "AN BANK
MLOA O'SBURSEMENT ACCT
SYRACUSE. NEW YORK
NOT VALID
DDD1314 90 8~FnRSIXMONTHS
"'!t', p'
'+;,;";~,1t~\. ''1'';\\:\",
',':;, i;1iJ:):",X)' '\', \) i \ 1,1,1) );.)' ;'("-/'1'; 1
-,.,1., .'.tn~J -"~ 'iJ. . I, :,~/ ;': ;:','.'~.'
;l;,::i~~~i~~~;';~~~~ :
TO THE
ORDER OF
11"0"11001;"111" 1:0 i! 10 :10"1:1 ?"II: 1;010'" i!"'a.? i!1; Sil"
'~~:t1~f.~r~~~1iw4t;~:~~~t; '~.;~:. \t:~:i~{p i\L~!~i;'f:;.~~l~t l,r~,,~~ ,'~~(~~:~~jp;OD~~~~~,~~!'.,;F;,,~~i2
<""" S90IBicculiveOrlv.,,""" ",' '" . ','.. ..,.., "'..'"..,.. No 30815885
,,'" 'Lanslng,Mlchlgan489U ".... '''' ., ~'~. ,',.," ,"'" ..,.', . ' , ,
C;::,i;,' ''::''';''Ho.nuiil~':llwSTroM.~~V'::;'' ";,~:;",;,,..,.':ti:;' ,,::' i , ,,,,"',,', '~~";;';'" ",:;:;:;~i:rL, .'.PATE F.EU;):139 1995"
':"L\~..-~~~i~~1i8ikfMj:H5~J~E~:\.i~, o~iJt~Jt4!:t;~~~ ~~t;7r~'i,"~1~:~k,::h :.
P;A,)'oOOAlJD: 311ioOUOLlAR'S': ,,', ;):,' :,;::; '~:: ,'L:'.::! ed'it :'i;, )?; ,;; DOLi.AU,c)oOoi~2iD.31
.,\.< .:::r .. :~--.~~\;{~~':.: ,(:./ '::';~~:..~~':~'::::~~:._~;-Y:~:~:'~::L~:~)'~} ~~"~: ~-~:'<"-~.,,:/' '~~'~;;'~~~;~;;dlf" .: '\,:~:;.;~~.~~~ ~1~~'~~~~~;~~'~" ~::~.
.~.:: :,,:'. ,. ,', .':: .:'.~ ?,:~:;::~.'~~.~:',~:.:~.,
'~PN 17013 ':,: ,:,' ,',', ..
:';,,' ,:t, .., , : '" '~ ::~.:; X? ';fj:iH
. :::. . .- ~,,~ .'-' <, ..:
i;rE. ..!:IARV K SPANOS
l!RDQ', i;"1'026 N WEST, ST," ;"{
,or " ' . ' , ,..
":. '.:i~ <'~ CARLt'SLE:'" :',X
:;.;~, ~':S ".i:.- .~':.:., ,,:,..:~~'. "~~
',., "-, .,'
~:l0~~5I;a5~ I:O?~qi!:lai!al:o~olo~~slol;~
":1IIY..,~,.':.g":,,~~-h"t,urtln.tlcomPtlnYD'Amer/~tI;<;':j ':\' . NC:::ffR M 091067
:"'1'" ,", '" ..,il'..,' 'Sy,.cu...NtlwYbrk"322r. ""..' '" " " , ",.."",';' ~',:'60-937
' ... \",., 't,~.. ',r: A'.;,' "". !,'" '.' ',',' ""~' _',~.d..",J '-',", '"" ,,";, ~~It J,'..,"',.- '.
.,."" '''-.oj; ,'" .. . ,('. . ,i. .,;...,';,' ':213
I D~,Z';,;~: [y~:: 't~~~ .J'{!'f ., ,~: ~,::'!.t';l ':; "~.:: '~'~ :~'~A"O;";u.'N' 'r i':"'~:" 09";3' '1' all
' .<", ""t ...~ 'r" ,,~. :~ .... " '.' , fl .,'}1'> h.' ~ ;';i\.' ~_;p. '.l;1" ..
! ,oAr ' .. ""', , " ',' ',' '" ",), i ", ,," '''.
!.: ,:,"/ ON,E, THOUSAND, "EI GliT HUNDRED. N I NETY~,THREE AND' :,8/100 _"'~_________-'_..,_______.
',' ,. . !Il',",,; .:".tlo>"';--' "",.0',. '\<'-:':,-,.f'j ...,'~_;' .f'".j::" ;~'\'." 'J:, .".'
.. .......,.. '.--'--
.' --- ------
TO THE
ORDER OF
LISA S BURGIN
%UWILLIAM DUNCAN~ESQUrRE
DNENCAN ~ OTTO,P.~.
o . IRVINE ROW
CARLISLE PA 17013
11"0 q ~O 10 71'"
':0 i! BOQ3 7Q.:
,:';.t:";:~\ ;;:-,~~';' .!:~t ?~; :'J:,
:,\'r ~lt, ..;r ~":;:'t~;"',~;C':'::~.r~,;-~: ;~>. ,~_:. :.i
~t~~ji;r:J'-,l)" I'li:' '1' II) l..j}'~r::{:::r;'i
~;. 'tli...f~l' tJ I' I'''' ,"'., r. . r;, ,
'!'\l(;;'~;~:..~~~~,.::;i;;:":~' 'I
, . ,";~L1fl,m~~/~~RE.MLOA ,
lOa ~III i!1II1o 7 2105""
THE CHASE MANHA "AN BAN/(
MLOA DISBURSEMENT ACCT
S'flIACUSE. NEW YOR/(
DDBI314 90 a(l.,.':3~/~1';~~TH.
--.. - ...--
:t JMiKkON NA}dokALLIFIJ~: .~;r;, 'f. :W' ;~J' ~r {ili.f,ij;l r~ :% ~~~ ;i'~~~hoo~'12~,'}4' 'l' ~,:7D;:~u
. ,..:....-( \,. "'1 .......... . ,.,., '. , . "'~' '..... . .:;: ..'t::t -"WfJ ',ri,,,. '.i" ~ "'1 ~ .....~. vt.".: 0( "',' . .
:. '.\":,':' ,.'r: . nsUa"nce:~omp'aDY ",~w","'J ~\l t.>',,': ~..;.. ',..r, \\.::, ,. i"'~~ .':.,',' '(-:.:. 'j\l, ..:.,'......~. .~;:n l':"', '", ....
'~, ,,,,'~,,..'''; ...":~""l';;f'.. Ii"';''''''' ".",.,'!.;:..,?V ,~':,~,.<,:: ':';;;":.c:::",\~;" 'f(l"<.l<11 ';~':,;,~:':'~...:;'t; N ":':)06'15682
... ':(' ;.'~ "~:rv llAecu "-tJIlve ..", '" .....- . "~' ,," ~r".' "11"'" t~~.~. _t'~" r"" 0 0
':'''' , Larulns. Mlchlpn 48911, .".... '..,' , ,~ ,~.., ,~, , .. " ." ,.', " ,
J.. ..., . . -f'. .. '.",.~ "... .. ",,:J "",. "......._..\,... " ..:; .. . .. . ,~ .
'..'..... ,'..,'... ,"...., "...,,,....,, '."'"....' ....",..,'.., ',pATE ""ED'...... 1995
'....~ . "':1RI)<bnlP.aN-"ST~"""Y'" '" ...., ..\~ ....'~ ...t'".... ,{..:...,.~,~~~:,.._,::,..',..' :'.[.'.,.:,,-;,".~~,..'.~,...,....,' ""~"'!"":~'::-':"':~lY'"':~""~"'';'''''''':''f
'( l:: .....
,';:;~:~"" :;;:; ,'" "K!' ~~C';':'~;,..: ;;.~...:~: ,;:':;":",~:'":',:~;,,:. ;'.~. - _'" ".~~ ;':" ;f'.";;::, "~"_ '..:c.." ,".
,.,~....:,;\.....-..._=_.~. -'NO.~:..~..~!.!~.;.;m....';.;.~\..OO'..c', ';,'" ",:, :<\~..I:..~.~ '/.\.\ t,.'.). ,,'\\' \"1 :.'\' fl', ,';,.\"''';, ,', l:::"''\ '....:; .~\. ':"'W"'\""
':', ....
~ .~~.: :.'r_,_ . '-__uYI".\.IM " ""N' .., ,,,.' "ttN'" ..ii::............ "" . ,"', 'r ..~ .... .... '.f:i: ~ :'1. ' .
'_iAi," ~1:WO:i THOUSA O,iflf ;;,HU O~ED ",:.0; oo~,,!,,~~O!,9~o!:O!_Oe:"!~,.;; ;~;i ,~'~;.' ,'," ,'" ""
,: r:n;--oooANi'F 3'i3iioo "OOl:llA'R"S"" ".;,\ ;"i, ';,'~ .-~(' :,'-r i ~'~:. -;~,'~,!\)(r' ~.\'q?i. ;;;",1'1: D.l;>1:LAIl&4l02,210.311
t:::ts;jj~' . "'<~;f~:$;f '~:~,~;i';~~~~{?!i '~L'~ %i~!t,;;fiV';: ":, '~*~~;;f~~w.: ';;~~::~;;~~~\~,:;~i;::-\,
~& ,LISA S BURGIN
oam:li:"'3"'3' .,.... V 'c<",.",'H,; ':,".". ,..,..'. ".' "".
;.'.~. .t:O"I.?::.c.~l-;\ ...~:'r/~RTR~P~~ A:.E:::.'" ;J"r' I.:', '" "
":', "':', ''I,; .":R'l'Ql:EN PARK';; ,:~ ~:'.. ::PA',' " '19o.~;'~~,;i,:::~,~,~,:,t ~,~"~.,~:,:":::.~":;""::,,,,,,,,:,',,,,',:'.',.,'_:':~".,.,':,:,~':"','~;"~,..,:~:.~,,,,.':.,:',;:,,;;,.:;,',,:_.,
,;.~~~ .
~}~~%' f! '{~i~:}~~i~::::~~\::':;.{)i2)ji~}';%::+;~~~~f ,;:,- . ".".
II" 30 10 ~ 5!;8 2n' ':.0 7 I. Q i! 38 i!81:0 3G~'S-~'&II"
.
" ~-,
n'''....'.<h'.,_..~._
........ ...........,~"!
.._.....i~.,,_~~..,..:....,.Ulb....,.Il,..u;a......~~.
~~.. I:: .~.!~~~~~.~.NJ.
..
,
.'WY
MONY Ufe fnsurence Company of America
1'.0.8004720
Syracu,e. N.w York "322'
\
CHECK
NUMBER
'\ .
M qS1G7,O
80.931
213
DATE
FElt 14, 1995
'"
'"
,
'.. ',: .
'AMOUNT;$I', a93 ~ 171"
,
AND 1 7/,1 ee '--------'"-.;.--'"--.-------
....... I ......._...;~.,.., '+- , ..-',.'
PAY
ON~; THOU~.~,~D, EIGHT HU~DRED NINETXr!I~REE
TO THE
ORDER OF
JOHN K MC KEEHAN,JR
:t ~ILLIAM DUNCAN...ESQUIRE
DU CAN ~ OTTO,P.L.
ON IRVINE ROW
CARLISLE PA
';1 ,,,i;)' :r, ,,'
'.. ..,~ ~ f- i ~,.',
J : ,,'i-l- v '"
I ! " ~ j; :' Ii.' ':.j-.
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.;" ;',j ~ I' J .,,)/., t"',,, I
~, ';:~::~.r " '~'i;\;,":!.,::
,)'........" ).,.:iFJ~'~' ~ ,,'-,' ~ ,
NOT VALID .t~-r': " ..." . ~-:..tft(J,/,.. ~,~~JrirJ .. ~ I
DltB 131 4 ge 8<.FnR SIX MONTHS I:, (.~~'!~~7-, ~~OA '
11"0 ~ ~O 7011" 1:0 2 ~ ~O ~ ~ 7 ~I: 1:.0 ~'" 2111'" 7 21:. Sil"
i:' ~;
17013
THE CHASE MANHA TTAN BANK
MLOA DISBURSEMENT ACCT
SYRACUSE, NEW YORK
',) ;.~.;: '::: ..'~'; :.t..A~: .,':.'. ~~.;;.' ,,,~, _.~'" ,,':; -:": .,'..':...." 'n~.', :..":, ~~\ .....,., ~"\ ."'j; .'::t' ;:'/ ~~.~. ,','''1 "r:: "J~ "':',.-';A ...~~ :..~;.: 'OI,.~"...':".;
",
; JACKSON N'AnoNAi/trFE'..'. .". ,,;:;..\' ..', ,:;,' ,,<'" ~" ~," '",; :~'i~G""64J0061i993 .,,.; ,,70.2302
r. ,;t/,~,~~/~~,~,~iirah,~'q~nip,aIiY<j;";:<,,..i ~C\~T.;ff" '~;i1:,.::S~~~:{f:~1(f{ ~~ c~; {h +.~;:~{ffY ~i)"F",:y,.'m ,
.. ,':,,;;,;",,';' "':'590fIliOculi',);;'oi!vc ..,:::;,:,..;;:;;:,:":,, ,'0:,":;(;' '<;;:i;,:it::',;;\:,' '(E,;",~r: '''i;,:",;",::;:/t No ',3 06,15681
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P.O. Box 4720
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~y ONE THOUSAND. EIGHT HUNDRED NINETY-THREE
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AMOUNT f.l,S91.1F.1l1o;
AND 18/100 -------------__________
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DEBORAH I. BLOCK
X WILbIAH DUNCANkESQUI,RE
DUNCA ~ OTTO,P.~.
ONE I VINE ROW V\\
CARLISLE ~. PA 17013
'E CHASE MANHA "AN BANK ~\r;..~~
LOA DISBURSEMENT ACCT l(
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EQCTr~:Il
OB1OW'ACOMPANIES
U9G.."".,,4 LiJi C..,.
EqIIiIMlI LI/I /Ill.'" COlIIJIIIIl1 oflawtl
.:July 24, 1995
w.
To I cindy
Re I US 1663!l5-Suzanne Hardy
The value of the contract as of March 24, 1995 was ,39,803.44.
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Sincerely,
~W~
cnig Wigton, PIlII, ACS, ALBC
Claims DBputmlmt
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LAST WILL AND TESTAMENT
OF
SUZANNE F. HARDY
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I, Suzanne F. Hardy of Carlisle, Cumberland County,
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Pennsylvania, deelare this instrument to be my Last will
and Testament, in manner and for following:
I. I hereby expressly revoke all wills and Codieils
heretofore made by me.
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2. I hereby direet my Exeeutrix to pay all my just debts,
funeral and administrative expenses out of my estate, as soon as
praetieable after my death.
3. I give and bequeath eertain speeifie items of personal
property to those individuals set forth in the memorandum
whieh aeeompanies this will. To the extent sueh list does not
dispose of any sueh property then I direet that sueh property
shall beeome a part of my residuary estate and to be distributed
in aeeordanee with paragraph 5 herein.
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4. I devise and bequeath my real estate at 333 "A" Street,
Carlisle, Pennsylvania and the proeeeds of any sale thereof to
the persons speeified in paragraph 5 herein as part of my
residuary estate: provided however, that my daughter Mary K.
Spanos shall have first option to purehase said real estate from
my estate at fair market value upon sueh terms as my Exeeutrix
shall deem proper.
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5 ~. I give devise, and bequeath all the rest, residue, and
remainder of my estate, real, personal, and mixed, of whatever natur
and wheresoever situate, wllieh I may own or have the right to dispos
of at the time of my death, as follows: provided however, that in
the event any herein designated benefieiary shall not
have attained the age of 21 at the time of my death, then the
share of any sueh individual shall be subjeet to the trust
ereated in paragraph 6 herein.
A. To John N. Etter, I give a sum equal to the lesser
amount of either $25,000.00 or One-Sixth of the remainder of my
estate. (The sum so bequeathed shall not exeoed the amount of
the share to which anyone of my ehildren shall be entitled),
B. To my ehildren, I give the balance of my residuary estate
in equal shares as follows:
1. One-fifth to my daughter Deborah L. Bloek, and if
she is not then living, to her issue, per stirpes,
2, One-fifth to my'daughter Lisa Sue Burgin, and
if she is not then living, to her issue, per stirpes,
3. One-fifth to my daughter Miehelle B. Burgin, and
if she is not then living, to her issue, per stirpes.
4. One-fifth to my daughter Mary K. Spanos, and if
she is not then living, to her issue, per stirpes,
S. One-fifth to my son, John K, MeKeehan, Jr., and if
he is not then living, to his issue, per stirpes.
6. In the event any of my designated heirs shall not have
attained age 21 at the time of my death, I give, devise, and bequeat
the share or shares of my estato to whieh my said heirs shall be
entitled as aforesaid to Deborah L. Bloek, Trustee, in'trust,
to invest, reinvest and keep the same invested in sueh real and
personal estate as a prudent woman of intelligeney and diseretion
. ....
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wpuld'do for herself, for investment, and not for speeulation,
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giving due regard to the safety of the prineipal and the adequaey
of the ineome, witllout being limited to the so-ealled "legal
investments" in the State of Pennsylvania. Until my said heir
attains age 25, my Trustee shall distribute so mueh of the ineome
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from the Trust as shall be necessary for their support, edueation,
';
and welfare.
In the event my heirs shall need additional sums for
support or edueation over and above the ineome from the trust, I
authorize my Trustee, in her sole and absolute diseretion, to pay
out of the prineipal of the trust sueh sums as are required and
neeessary to meet the need whieh arises.
I further direet my Trustee to make distribution of the
prineipal and any aeeumulated ineome of the said trust to my
heirs as follows:
A. One-half (1/2) at age 211 and
B. One-half (1/2) at age 25.
7. I nominate, eonstitute, and appoint my daughter
Deborah L. Bloek, Exeeutrix of this my Last Will and Testament.
I further direet that she shall not be required to post bond
to seeure the faithful performanee of her duties in the Commonwealth
~ of Pennsylvania or in any other jurisdietion.
~ IN WITNESS WHEREOF, I have signed and pUblished this my
Last Will and Testament eonsisting of 6 pages in the presenee of
the SUbseribing Witnesses, this Idf~day Of~~, 1994',declaring
it to be my true will and testamentary wishes.
~:t/'-~'/ ~
Suz ne F. Hardy
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"",~_,,,,,,,,,,,,,o,-,-,.;.'; "."~~fi.__J r. .,,'.J;.; ,"''f
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We, the subseribing witnesses eertify that the Testatrix
signed this Will in our presenee after reading the same and
deelaring it to be her Last Will and Testament. We, further
certify that the Testatrix was of sound and disposing mind and
memory and under no nstra nt undue influenee.
Witness~ One West High Street
Edwar Carlisle, PA 17013
Witness: [}t...... .j I~....JL
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ADDRESS: /'//J" I I.!l:."''l>;.-
:"oJ1;".'.'.". ~. t 70/7
ACKNOWLEDGMENT TO LAST WILL
AND TESTAMENT OF
SUZANNE F. HARDY
COMMONWEALTH OF PENNSYLVANIA )
lSS:
COUNTY OF CUMBERLAND )
I, Suzanne F. Hardy, Tes~~~rix, Whose~me is signed to the
within Last Will dated this /f"I'^-day of,b 1994, having been
duly qualified aceording to law, do hereby eknowledge that I
signed it willingly as my free and voluntary aet for the purpose
therein expressed.
vL~(?....,yj _4. .ilnA-.ey
-suzq. ne F. Hardy
S~orn to and aeknowledged
this' 6ct--day Of~~, 1994.
before me by Suzanne F. Hardy
~Q.~QQ.~ ~~~}..)
No ary Publie
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NOTARIAL SEAl.
MICHau: D, RISBON. NOTARY "'BUe
CARUSlE BOROUGH, aJM8Sl1A/ID co.. rA
MY COMMISSION EllPlRD MARCIl I.. 1811
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AFFIDAVIT OF WITNESSES
COMMONWEALTH OF PENNSYLVANIA )
)SS:
COUNTY OF CUMBERLAND )
We, Edward W. Harker, Esquire and "_)\~a.~t:.1\ f\ ,~fq the
witnesses whose names are signed to the Last Will of Suzanne F.
Hardy, dated~~\~~h, 1994, being duly qualified aeeording
to law, do depose and say that we were present and saw the Testatrix
sign and exeeute the instrument as her Last Will; that the
Testatrix signed willingly and she exeeuted it as her free and
voluntary aet for the purposes therein expressed; that eaeh of us
in the hearing and sight of the Testatrix signed the Will as
Witnesses; and that to the best of our kn wledge the Testatrix was
at the time eighteen (18) or more year age, 0 s und nd and
under no eonstraint or undue influe
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Sworn to and subscribed before me by Edward W. Harker, Esquire
and'~,I-P.'ClI", fl..\:ufQ. witnesses this \~ ""-day Of~~ 1994.
.
~::t~\kU.~ ~ ~ ~~\ tD'k
Notar publ e
NOTARIAl. SfAI. ,
...!:,ICHEW D, RISBON, NOTARV P1/SUC
"""USLE IlDROUGH, CU&lSSllAHD CO AI
MV COMMISSION EXPlRts MARCIl 14, j'gga
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MEMORANDUM
I give the following speeifie bequeaths:
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1. Diamond Engagement Ring to my granddaughter,
Britney F. Burgin.
2. Saphire ring to my granddaughter, Althea M.
Spanos.
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3. All Bill Elliot raeing momentos, raeing eollection
items and raeing pietures to my grandson Ryan C.
Burgin.
4. All personal property in house, bass boat in back yard,
and 1977 Chevrolet Truek to John N. Etter.
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5. 1983 Blazer to John K. MeKeehan, Jr.
6. 2 antique fire trueks and 2 yeungling trueks to
Jonathan C. Spanos.
CDireetion to Executrix - that a portion of the furniture,
house goods, and appliances belong to John N. Etter and are
not to be included in my estate).
Date: ~ \~ I \~C\l\
~tk~trd~
Sworn to and subser,\~e~~~o
J;l1e'this \~~ay of ~
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, 1994.
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IIClfMIAL SEAL
MlCltlJ.l D.1lIS1OII. HOTAIl't Pl/BUC
CAlUIU 1llllOUIlI. cuM8IIIWID co.. VA
In CllUIIlSSlGIl WlRD 1IAIlCtI14. I.
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Register of Wills of CUMBERLAND County, PennsylvAnia
Certificate of Grant of Letters Testamentary
No. 1994-00994
ESTATE OF HARDY SUZANNE
\ l.IAb'J.', t J.Jt::J'J.',
PA No.
F.
M.1lJUL.lt.}
2194-0994
Late of
CARLISLE BOROUGH
~UM~~Jt~NU ~UUN~X,
,
Deeeased
soeia1 Seeurity No. 195-32-2557
day of November
192i An instrument
WHEREAS,
dAted Julv
was Admitted
on the 25th
18th 1994
to probate as the last will of HARDY SUZANNE F.
(LAb~, tJ.Jtb~, MJ.UUl.I~)
,
CUMBERLAND County, who died on the
late of CARLISLE BOROUGH
16th dAY of November 12ii and,
WHEREAS, A true eopy of the will as probated is annexed hereto.
THEREFORE, I, MARY C. LEWIS , Register of Wills in And for
the County of CUMBERLAND in the commonwealth of pennsylvania, hereby eertify
that I have this day granted Letters TEST.~ENTARY
to DEBORAH L. BLOCK
who ~ duly qualified as Exeeutor(rix)
And ~ agreed to administer the estate aceording to law, all of which fully
Appears of reeord in my Offiee at CUMBERLAND COUNTY COURT HOUSE,
CARLISLE, PENNSYLVANIA
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seAl
of my Office the 25th day of November 1994.
"n1(ln~ (!" ~' MAbt
KegJ.s~e W \
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Date 21st January 1995
We certilY that we have this day carefully examined the following listed and described articles
of the property of:
M rA,A aat-At-a n-f ~1'7:,"na R'Amy
Address
Q1e ladies 18karat white gold oval filigree ring with an 18; x 15!nm Oval
carved bezel set with one 14; x 11-!mn ovallOOl.ll.dlid blue glass with etched
cameo design of a fenale head and shoulders. '1he ring has a tapered shank
with filigree at the shoulders and a hAA~"'Cl design t:cMards the back of the
shank (Smn wide to 2mn). . '
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','lUl'AL APPRAISED V1ILtlE.... $300.00
Q1e ladies 14karat white gold IOOIlIltinq Set, with:
1 @ 0'.65ct* !:blerlild O1t Dilll1lCl'ld
oolor.........~.....G
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clarity.............VS2
'!bare are two matched tapered diam:md baguettes set into the shoulders
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of the ring IOOIlIlting, They measure: 4.2 x 1.2 x 1mn.
'lUl'AL APPRAISED V1ILtlE....$1,875.00
*
Weight approximate as mcnmtin3 pemdts measurement
Center stone measures 7.22 x 3.20 x 2.6mn
We Cllimale the value u Ibled for lmurance or other purpose, al the ,,"'senl cu
YllY up 10 25", Neither thI, firm nor any of ItJ employee, wum.. any
llatillity with respeCIIO any aclion thaI may be taken on the bill, of lhlt
al'Prilial. Thil approach I, for "'placemcnl evaluation only and I, nOI an
olfer 10 purchuc.
n zing value
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DEPARTMENT 01" TRANSPORTATION
CERTIFICATE. OF TITLE FOR A VEHICLE
921080016002~35-001
1JLllll15CAOO15~~ I ,~2 I BAS:,,~,~~:ER I 3~2~6,::,?0~ ET
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lOGY TV" .... OV'"' OCW' tm.IlfIlAHOl
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DISCLOSURE EXEMPT BY FEDERAL LAW
"GlIT'lMD QWNPlI.
JOHN NETTER
333 A STREET
CARLISLE PA 17013
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JOHN NETTER
333 A STREET
CARLISLE PA 17013
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CttIOlaol
The ~,..., ~ ~_1Dr c.... III r.. all h.....___
....~IIIN~..........IIoJIII~..IDrIl'l--
.- ,,,...,- "
....
,.
, .
PAYLESS AUTO SALES
915 Newville Road
Carlisle, PA 17013
Phone:
(717) 245-9170
July 5, 1995
STATEMENT OF VEHICLE VALUES
IN THE ESTATE OF SUZANNE P. HARDY,
333 "A" STREET, CARLISLE, PENNSYLVANIA 17013
1977 CHEVROLET TRUCK VIN' CCL147B131384
1983 CHEVROLET BLAZER VIN' 1G8CT183D0171681
$800.00
$1,100.00
~~
CHARLES BITNER
PAYLESS AUTO SALES
915 NEWVILLE ROAD
CARLISLE, PA 17013
....
"Y.4IHIt li.'11
..
SAFE DEPOSIT BOX
INVENTORY
c()MMOHW'IAU" OIPlNHnlVAHIA
Of'........N' 01 ".,'NUI
INHIIn'ANCI fAX OMIIOH
01" 110601
HAlII&lUIO.'A 1Pl1I.0601 Plea.. Prfnt or Type
MUST IE COMPLETED IV REPRESENTATIVE OF FINANCIAl INSTITUTION WHERE SAFE DEPOSIT lOX IS lOCATED AND RETURNED TO AIOVE ADDRESS
COUNTY COOl FLU NUMBER SOCJAL SK;URITY OR DIATH CERTIFICATE NUMBIR
~ \ C, C::l 1 Gj',S"" ) ').. 7-f /7
lLAst. rlUT. MIDDUI
~ ()..r J
ADDRUS o. DICIDINTJSIIuq IOTY)
'3"3'3 'S') Crw-/IJoc... p"... 1")01
NAMI AND ADDIIIS O' PERSON IIQUUTING THI OPENING Of THI SAFI DE,OSIT 1I0X
INAMEI
oS OJ "'- c:'
.- V ;II
/1- I , - "1 Lf
ISTATI)
Ill'COO'1
ISTun AOOUUI
IOTY)
ISTAIlI
Ill'COOII
"
I NAMI, ADDRUS AND RILATlONSHIP II' ANVI TO DICEDENT, O' fIRSON(S) PRUINT AT THIIIOX OflNING
0, INAMII IULATlONSH'p)
t. Bloc:.k ~e-c..tJ~X
IClTYl .
Dr CArv'"U .5./-f.
(Of LATIONS HIp)
,
,
~oC"o..l-\
ISTlm AllOUSSI
~I ~1T~l..I<"""
Otr
ISTAIlI (II' COOII
,,01,'3,
~, (NAMI'
IsnllT AOOIISS'
IOTY)
(STAIII
(ll'COOII
c. INAMII
IOfLATlONSHIp)
ISIIIIT AllOIISS'
IOTY)
ISTATI)
Ill'COOII
NAMI AND ADDRUS O' FINANCIAL INSTITUTION WHEII THI SAFE DEPOSIT 1I0X IS LOCATED
INAMI'
1=!A-.,-tV\, 1..'" ~ iru c "/
ISIIm AOOIUSI , , t'
, t...s JCr', "'\ L.. ... 'J
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I NAMI O' flRSON MAKING LAST INTRY
L')e..b"" L ~trdL
DATI O.CONT1IACTTO liNT 1I0X NUMBIR 0.1I0X
I'-.r~ f"/ ~ ',;;,.5'
NAMI AND ADDRUS o' PIRSONIS) HAVING ACCUS TO 1I0X
0, INAMII
,,? u , ~
DATI AND TlMI O' LAST INTRY
t ,- ~ - C; '"' w...(.l(
TITlI UNDIR WHICH IIOX IS RIOlmllD
~...... - - L-.I..
1&.-1...
~, INAMII
ISTRUT ADDIUSI
ISIIIIT ADDUUI
IClTY)
ISTAIlI
I,,"CODIIIClTY)
ISTAIlI
Ill'CODII
NAMI AND TITLI O' IMPLOYl TAKING THIINVINTORV
WAS A WILL IN THIIIOX' ovn ONO If YO', o. Dat. of will.
b. Na..... and o..d,... of penonol ,.,,...ntatl.., If named In the will
INAMI'
ISTRUT ADDnlS)
IClTl)
ISTAlll
IllpCOD'1
c. Na..... OM .d.... of aHom.Y', If any
INAMII
(S'AUY ADDIUSI
(CITY)
ISTAIlI
111'COOll
SAFE DEPOSIT BOX INVENTORY
INSTRUCTIONS
(11 Ca.h, Report 10101 only.
(2J Stock.. lI'lln dolo II eyory cammon or pr%rrod CO"iflcalo, warranl or a,hor rlghh /aund In box, Slack I are
10 bo dellgnaled by name 0/ company, certiflcalo numbor. dOlo of corlificalo, namo In which Itack II reglslo,od,
and number 0/ Iharol and dOli 0/ Itack.
(31 Obligation. of U. S. Gavemmenlt Number of lIeml, da'o of Inuo, /aco yaluo, namel In which reglllorod
and Iype 0/ ownorshlp, I.e" falnlly held, payablo an dea,h, olc.
(41 Band., oellgnalo by name, amount, lorlal numbor, or a'hor dollgnalian, (Bearer BondI)
(5) Bank and Saving. and Loan POllbook.. 51010 namo of dopalllar, numbor 0/ book, 1011 da'e appearing In
book, name 0/ bank and branch, and balance,
(6) Jewelry, Cain., Stamp., Manu.crlpt., etc, lIll and delcrlbo 01 /ully 01 pallible.
(7) ooed., Mortgage., Curront 'n.urance PalldOl or ath.r evldencOl of Indebtednell' List and dOlcrib. 01
/ully 01 palllble.
(8) All ather content..
'" ,
Pogo of
ITEM
NO.
IIEM DESCRIPTION
pr.;>>up ~ _
r s:.I.,c:.r
7.1'" au.....cz;. 2_)"...
"
'"
~ 'S v <==- &A ..It.. 1i4"-..
c:.U'N~ I 0 "
Ilnerc '-1"1-""11-
""''4-\'1v,..J OS '3 A 51 8,"("'0)'""'1" ~ CArI..!. tc. tL..4.llhcl
,I> p '2.7 P.73
Lf
d..
I CERnfY UNDER PENALTY 0' PERJURY THAT THE ABOVE RECORD IS PERSON RECEIVING COPY 0'
COllECT AND COMPLm TO THE BUT 0' MY KNOWLEDGE AND BELIEF, SAFE DEPOSIT BOX INVENTORY,
A ~..-..- 1
A ,
OeJlleCUlotlllla} OAdmlnhttOIOl("laJ
DEltal. Aepre..ntative 0 Join' awne, of lof. depolit bOll
NOR. Attach additional 8 Va II X I t II .heel ('111 necellary or u.e duplicate. of 'hi. page of form.
/-Z.l:'o/ B.,F CvI(lJc:n.',./
LL .-
-r~""'N"1
..
RIFE'S RV'S
RACING COLLECTABLES
MJ MAU.
CIItIIIe. PA 17018
(T17)24Hl5Sl
No I'IMcIL M.... ftnIj,
CUltom,", ~NO. DI"
:::1.", ~ "4 ~ l:!. a:.f>>.fe. .....( /, !18C!S'.
801A~
c~ S l.)','Z.~ ~H a ,1-l:~l1...o"
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I Y..,). -{ JI.? <f CI<V\-'
, _CrJ 1_CL
a ,-tl
jdJ. 71
AI ..........
R.c' .
BV
1- II- '...JffJ
CC.ll: C'J'IIIlS SUPPLIEt
l:5nTr.S pur~C.'/tStn
.'LD ';OIl,S
:OUCtlT - S~LO. "1j.'rn.',I::r~
IJ " I
I;" . /..,:.
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'EL. CllS. l~:.ma
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"Ann" E. OONSOII
't. II. A. M. ^. H. ,.
()~'~ I~?~S
P ~ fr-il )4--""-7,:!!-
C'~~~
J-;rJ ~b~
~~~~
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oOB ROWE
-k'f:,;"i-',: .~ - . .' .. . - - - - --
u JI.tlm~'i-~~~~~~~~-::-; '----,:.'.--- -,. " '. ~-,"."
_ ~fI,"....~,i""'-+:,~,.-"""...-""""-."""_,,,,_,..;,,,,,,,,";;":4t,~,,--,,. :_.""~}.~~"h~,..1tt.~~~"1H.'i~~~~.f,.,'..;--'::';----' ---~;j2ir,";_}:
AIlTIaaoua ON nIB RmlU
ImlBI HIGHWAY
tcllWVIIU. PA I ml
(117) 77647011
-rlw ,qA.~S~ l: "1"ul,\ -Z '\, ('N~ 0 f 'T<<'i:' rr",,<t.~
O~ %U~. N ARO( .
:r ~A lJ ~ "5C;- "/ e fll~ S (:) ~ ~ cJ'Ci l,v~ S-'2:t\.It\./') PIN}?
fI-{lfR,q'Sffv7 '2'Kp"'te/fWC? 1M -ff/e;:. !4/(f/{S pi
AN4t ~'Z..rl t.;t.'/V'S I TOi S -"/1-10 fl5:{f/.-{.~D :r,..frGittS,
:r 1f7Y114/So rI- !>o,lI'/.f?cfitNO LfCf'iU%P ~d{of.J~~
(PI; tc 1/ v1f/ fJJfJ.7bL ).
.:7# tII1(!; or,v(",,) -&HZ: ~r/"-d {'fit;"
fJ? Ii leki!! 14! I)?i () f' -6 lIe.s e ,:PtF/f't s' d 1<'2
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t5A-N\<. 19d.~ seA r;R~(/2S'.0'/ ,
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,
.r .... ._ __.' '-... ,_'.'
, ~
1'_ --- ---,:~---- ______,_ .__ __ _ _ _____ __ _ _ _ ____ _ _____ ___ _ _:.. _~_i
D. AA048062, COMMONWEALT,H OF PENN,' SYLVANIA,'
NO.. ,c' , , , DIPARTMINT OP REVENUI , ',. . .
"'''62 "I'~"'" J OFFICIAL RECEIPT. PENNSYLVANIA INHERITANCE AND ISTATE TAX
r'o' ,
.:".
"',:'
RECEIVED FROM,
"CN
ASSESSMENT P:'
CONTROL i;I
NUMBER
AMOUNT
&
llt'I:'JltHfILLIAI4. A
l' ri#.tNE'd
101
.7,407,44
CARLISLE PA 17013
ESTATE INFORMATION,
!II FilE NUMBER
g 21-1994-0994
II NAME OF DECEDENT (lAST'
II DATE OF PAYM
m POSTMAR
COUNTY
'040..,.,
SSN 1915-32-215157
(FIRST' (MI)
DATE OF 0 A H
REMARKS
m TOTAL AMOUNT PAID
&7,407 _ loll
SEAL
DEBORAH L BLOCK
C/O WM A DUNCAN ESQ.
CHECKII 31
"I ' " ,,'
RECEIVED BY J//(J/f" hi< ~I.", , /., ,"
~ 0 A"j'rlfOi'l-t.J:1'-
MARY C. LEWIS V
REGISTER OF WILLS
00
REGISTER OF WILLS
- - ---- --- ----------- - ------ -'--- - -'------ --,---.-. ---- --.-,-
I
1',
.
-
,
"
,
.
,,--' p~""""-
~...........A. _ _ "
",- .-
-'- - -- --.-
\
1'/' ,~)4(I-S
REI~'154B EX AFP (12-95*
COHMOHWEALTH OF PENNSYLVANIA
OE:PAATHEHT OF REVENUE
BUREAU Of INDIVIDUAL TAXES
DEPT. '10601
HAARUIURQ, Pi 17ua.0601
NOTICE OF INHERITANCE TAX
APPRAISENENT. ALLOMANCE OR OISALLOMANCE
OF OEOUCTION51t AND ASSESS"ENT OF TAX ON
JOINTLY ELD DR TRUST ASSETS
_./
DATE 01-23-96
COUUTY
CUMBERLAND
ESTATE OF HARDY
SUZANNE F DATE OF DEATH 11-16-94
ACN
95104199
FILE NO. 21 94-0994
S.S/D.C. NO. 195-32-2557
JOHN NETTER
333 A ST
CARLISLE PA 17013
REHIT PAYHENT TOI
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
ESTATE OF HARDY
SUZANNE F DATE OF DEATH 11-16-94
AMount R...t U.d
CUT ALONG THIS LINE ~ RETAIN LOllER PORTION FOR YOUR RECORDS ....
h-EfIi=is4-i-iif-AFpi-Ciif:9Si---.--.-.-------.-----------------------------------...--...--------.--..-------.-.-
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE DR DISALLOllANCE OF
DEDUCTIONS, AND ASSESSHENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 01-23-96
FILE NO, 21 94-0994
TAX RETURN WAS,
S.S/D.C, NO. 195-32-2557
(X) ACCEPTED AS FILED () CHANGED
JOINT OR TRUST ASSET INFORHATION
FINANCIAL INSTITUTION. FARMERS TRUST COMPANY
ACCOUNT NO.
COUNTY
CUMBERLAND
ACN
95104199
6-4B299
TYPE OF ACCOUNT. () SAVINGS (~ CHECKING ( ) TRUST ( ) TIME CERTIFICATE
DATE ESTABLISHED 07-10-85
Account Belance
Percent Taxable X
Amount Subject to Tax
Debt. and Deduction.
Texable Amount
Tax Rata X
Tax Due
1,677,68
0.500
838.B4
.00
B38,B4
.15
125.B3
NOTE. TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBHIT THE
UPPER PORTION OF THIS NOTICE
WITH YOUR TAX PAYMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS, MAKE CHECK
OR MONEY ORDER PAYABLE TO.
"REGISTER OF WILLS, AGENT."
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTI!REST
TOTAL DUE
IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. .
IF TOTAL DUE IS LESS THAN 'I, NO PAYNENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" C CRI, YOU HAY BE DUE A REFUND,
SEE REVERSE SIDE OF TNIS FORN FOR INSTRUCTIONS. I
TAX CREDITS:
PAYMENT
DATE
RECEIPT
NUMBER
DISCOUNT (+)
INTEREST (-)
AMOUNT PAID
INTEREST IS CHARGED FROH OB-17-95 TO 01-31-96
AT THE RATES APPLICABLE AS OUTLINED ON THE
REVERSE SIDE OF THIS FORH
.
.00
125,B3
5.22
131.05
l
I
I
PUIIPOSE If'
MOTlCEt
PAYtIEH1'.
RU1JHD cat) I
OIJECTlDHSI
ADMIN-
ISTRATIVE
CORRfCTlDHS ,
I1ISC~TI
INTERESTs
~
In
V) ;.:: rJ:
r~
lr"\
('....
tf1
,:;.:.
;; ~
. ';~ ::l
00
To fulfill thtl '..,1,......'. 0' IeGUan ZIU of the Inherlt.-.c. Met E,tat. 'IIC ut, loot II of Inl. (71: P.I.
s.ctlon 1140).
a.t8Ch tN top portion of thl. HaUel Met ....It with !fOUr p.~t to tM _..lah,. of WIU, printed on the
rew,... aide.
... HIlke chtck or .one)' orde,. pnllbla tal REOISTER OF MULl, "!:ENT.
All papenh ,Hllved ..11 flnt be .".11_ to 8nV lnt.,...t Wilch .._ M due, ..Ith 1In)' ,,_Inder .,UeeI to the tu.
A nfund of I t.. Or-Hit, .....Ich .... not ,......tMl on tM t.. raturn, nw be ,...,elt. by cDllpbtlng WI "Appl1caUon
for Raf'-"CI of PIM.vlv",., IntMlrltMMlI Md btat. 'IIC" (REV-UIS). Appl1"tlona .r. l"IUMll. It the OfficI of
the A..l,tl" of .,Uh, WlV of the U Rlv.nue Dlstrlot O"le.. or by CIUlnt U. .,.ahl Z4-hoUr ......'lnt ..rvlcl
~r. for fo~' o~rlngl In P~lYlvenl. 1.100-541-'050, out,lde P~.Yly."l. ~ within local
Harrisburg .r.. (717) 117-1094, TDDI (717) 77Z-ZZSZ (He.rlng 1.,.lred Dnl~).
Any p.rb In Int.r..t not nth"" wUh thII .,r.....-nt, ,UOWMC' or dl..UOdnC. of deduction. or .........t
of t.1C tlncludlnt discount Dr" Int.r..U .. shcNn on thl. Hotlc. ..)' object ,"thln .hctv (60) dIl)'. 0' r.c.lpt 0'
thh HoUca bYI
......Itt.. protut to tM PA o.p...t""t of R.venue, loard of Appea", Dept. 211021, H.....hburll, PA 17121.1111, OR
"a INti". to have the ..U.r Mtaralned .t thII Mldlt of tM account of tM par~1 repn.ant.Uv., OR
.......1 to the Orphan.' Court
F.ctUIII .rrors dlscov.r" on thh ...........t should be Mldr...ad In wrlUng toa Pi o.p...taent of R.venue,
Buraau of Individual T.x.., ATTN. Pc.t A.......nt Revl... unit, DEPT. 210601, Harrl~rll, PA 17121-0601
Phone (717J 717~6S0S~ S.. p... J of thl bookl.t "In.truatlonl for Inharltll'lC' Tlx btum for. R..h.."t
Decadent" (REV-1SDI) for an .xpl~tlon of adalnlltratlv.ly corractabla '....ora~
If any tax dua II paid within thr.. (S) cal~lr IIOnthl aft.r tM dKadant'. duth, . flva p.rc..t (5):)
dhcount of the talC paid II allowed.
Int.....t h ch8reed beglmlng Nlth Urat d.~ of dellnquanc)', 01'" nlM ct) -.,ntha and OM (1) d.)'
fr_ the data of duth, to the .-t. 0' P'Y8Wlt. Taxa. .....Ich bee.. dell"..,t befo..a Januarv 1, 191'
bier Int.ra.t .t the rata of al. (6):) parcant pa.. ~ c.lcul.tad .t a d.lly r.tl of .000164.
All t.... which bee... d.ll~t on 01'" aftlr January 1, 19.2 will b..r Intl...at .t a ratl whIch ..111 VII"')' fr_
cll__r y..r to calendar yaar with that r.t. annoI.ftCed IW thII PA Dep.rt..,t of RevllnUll. The 1IPP1lcMIl.
Interllt 1"'.... for 19" th..ough 1996 '1"'"
'tilt tntere" Rate D.llv Inter'lt Feeter
Int.r..t Rate
Dally tnter." FlClter
lur
1911
1.15
..14
1915
....
ulnt.r."
Uk
10
IU
ISX
IOk
h c.lcullt" ..
lta7
1911-1"1
'99'
I"S-I994
1"5.1'"
ox
'U
'X
n
'X
.OODZU
.0005n
.OODZU
.0001"
.00DZ47
.0005"
.000ltSa
.00OSOI
.000S56
.000Z74
follow..
llITEIlElIT . BALA/lCE OF TAX UHPAID X HVIIBER OF DAYB DELINQUEIlT X DAILY INTEREBT FACTOR
--Any Notlea I.~ .ftar t~ tax bac~. d.llnquent Mill reflact an Intlr..t calculation to flft.-n C1S1 dewa
"yond tM d.t. of the ........,.t. If p.~.."t Is ..... a"ar the Inter..t cOIIPUtaUon dIlt. .hotIn on tM
NoUc., 8ddltlonel Int.nat ...,.t M ctIlculatM.
PI ,':ll\l\_1j
RE~~154a EX AFP (12-95*
COHHONWfAlTH OF PENNSYLVANIA
DEPAIITftENT Of REVENUE
BUREAU Of INDIVIDUAL TAkES
DEPf. UUIl
HARRISIURG, Pi 171'1-0601
I.>
NOTICE OF INNERITANCE TAX
APPRAISEIIENT. ALLOWANCE OR OISALLOllANCE
OF OEDUCTIONB., AND ASSESS"ENT OF TAX ON
JOINTLY uELD OR TRUST ASSETS
ESTATE OF HARDY
DATE 01-23-96
SUZANNE F DATE OF DEATH 11-16-94
CUMBERLAND
FILE NO. 21 94- 0994
S.S/D,C. NO, 195-32-2557
JOHN NETTER
333 A STREET
CARLISLE PA 17013
COUNTY
ACN
95105205
REMIT PAYMENT TOI
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
Mount s..Ut...
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
Ri-y:isiri-i)f-AFP--riz-:9Si--------------------------..--------._------------.--------------------------._-----
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLONANCE OF
, DEDUCTIONS. AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 01-23-96
ESTATE OF HARDY
SUZANNE F DATE OF DEATH 11-16-94
COUNTY CUMBERLAND
S,S/D.C. NO. 195-32-2557
(X) ACCEPTED AS FILED () CHANGED
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION. FARMERS TRUST COMPANY ACCOUNT NO.
FILE NO.
21 94-0994
TAX RETURN WAS.
ACN
95105205
6-48299
TYPE OF ACCOUNT. () SAVINGS (lO CHECKING ( ) TRUST C ) TIME CERTIFICATE
DATE ESTABLISHED 07-10-85
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 TH Nfl, NO PAY"ENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" C CRI, YOU NAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FOR" FOR INSTRUCTIONS, I
Account Bahnce
Percent Tsxsbla X
Amount Subject to Tsx
Debt. snd Deduction.
Tsxsble Amount
Tsx Rste X
Tsx Due
1.677.49
0,500
838,75
.00
838,75
,15
125.81
I
I
,
I
i
,
I
I
1
i
I
-1
I
"
TAX CREDITS:
PAYMENT
DATE
DISCOUNT C+)
INTEREST C-)
RECEIPT
NUMBER
INTEREST IS CHARGED FROM 08-17-95 TO 01-31-96
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
OR MONEY ORDER PAYABLE TO.
"REGISTER OF WILLS, AGENT."
AMOUNT PAID
.00
125.81
5.22
131,03
"- -'-~--.-
,.
If'
"
Ir
\ ,~
:>
lO
PIJIlPOU DI'
NOTICE.
To fulfill the requlr..-nt. of Section 2140 of t~ Inherlt~. ~ E.t.t. ,.. Act, Act 2Z of 1"1. (72 P.I.
hClUon 2141).
PAYIEHT.
DetKh the top parUan of thl. NoUc. ~ .ubaU with your p.pant to the Aegl.t.r of WUh printed an the
raver.. .Ide.
..- ..... check or RfMIV order p,yMI. tal RfGISTER OF WILLI, ACEHT.
All p'YMnb recalv.d "11 first be applied to anv Intar.st .....Ich NY ~ ...., with anv r...lnder appUed to the t...
REfl.HI(CRh
A r.fund of . to credit, which .... not r.....ted an the tax r.turn, ..v ba r~.t... bV caepl.Ung an ooAppUcaUan
far R.fund of penn.vlvanl. Inherltanca ~ E.tata T.x" (REV-1313). Appllcatlan. .ra .vallabl. at the Office of
the Regl.t.r of Will., any of the 23 R.venue DI.trlct Offlc.. or bv calling the .pealal 24-hour .".w.rlng ..rvlc.
nuaber. far fa,... orderlngl In Penn.vlvanla 1-100-562-2050, out.lda Penn.ylvanla and ..Ithln lac.l
H.rrlsburg .r.. (717) 717-1094, TUD' (717) 71Z-2ZSZ (~rlna I.,alrecl Only).
OBJECTIONS. Any p.rb in Intera.t not .aU.fled with the appr"h..."t, allowanca or dh.lICMfMCa of deduction. a.. ...........t
of to (Including dl.count or Int.r..t) .. shown on thl. Hatlc. ..v object within .l.tv (6G) day. of ..ac.lpt of
thl. Notlc. by.
-.wrlttan p..ot..t to the PA Dap.rt.-nt of R.v~, loa..d of App.al., P.pt. ZIlG21, Herrl.burg, PA 17121-1021, OR
....lectlna to h.v. the ..tt... det....lned .t the .udlt of the account of the person.l .........ent.tlva, OR
u~l to thl O..phan.' cou..t
ADttIN"
ISTRATlY!
CORRECTIONS .
F~tu.l .rra... dhcov.rad on this .........,t lhauld be addr..... In wrlUna tal PA o-p...t8ant of R.v.....,
Bur.au of IndividUal T...., ATTNI Po.t A.......,.t R.vl~ unit, DEPT. '10601, Herrl.bUr., PA 17121.0601
Phone (717) 717"6505. lea pegs 3 of the bookl.t "Instruction. for Inherltanca 'ax R.turn for. R..ldant
Decadent.. (REV-1SOI) for an 'kPl.,..tlon of adalnlatr.tlv.lv co..ractlbla .rrar..
DISCOUNT I
If any t.. due I. p.ld within thr.. (3) c.lenda.. ~th. .ft... the dac.'-nt'. ~th, a flv. p.rcant (5%)
dla~t of the t.. p.ld I. .llowed.
INTEREST I
Int.....t .. ch...ged ~Jnnlng with first dalv of d.Unquency, or nlM (,) Mntha ~ ana (1) MV
frOll the data of de.th, to the data of P'YMnt. r-x.. which bee... deltnquMt bafor. J....ry 1, 1912
bea.. Jnt.r..t et the ...t. of .I~ (.x) p.rcant P'" annue calcul.ted .t . dallv ...t. of .000164.
All tax.. which bee... delinquent on a.. .ft.r Januarv 1, 19.2 will b..r Int.r..t .t . rat. which will very fr~
c.land... v..r to c.landl.. v.... with that rate annouw:ed bv the PA lJep.rt....t Df R.".,... The ....Ucabl.
Int.r..t ret.. fDr 1'12 through 1996 ....,
bII: lllatU1.Jll1l D.llv Inte....t Feet",. lIIr Int.,.... R.t. Dallv Int.r..t Facta,.
1912 ..X .000541 1917 OX .00OZ47
1915 16X .00Ollty 1911.1991 IlX .000501
1.14 IlX .00nOl I'" 'X .000147
1915 I'X .00n56 199'-1994 n .000192
1916 lOX .000274 1995.1996 'X .IOOZ41
uInta,...t Is calculated .. foU.....
INTEREST . BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
.-Anv Notlc. laauad .ft.r the tax ~. delinquent will r.flact an Int.r..t c.lcul.tlon tD flft.... (15) da~.
bevond the data of the .....~t. If p.pant Is Ade aft... the Int.r..t coeputaUon d.t. IhoMn on the
Notlc., additional Int.r..t au.t be c.lcul.ted.
.
..
~
.
STATUS REPORT UNDER RULE 6.12
Date of
Admin. No.
'Name of Deeedentl
Will No.
Pursuant to Rule 6.12 of the Supreme Court Orphans'
Court Rules, 1 report the following with respeet to eompletion of
the administration of the above-eaptioned estatel
Stat~~ether administration of the estate is eompletel
Yes No
2, If the answer is No, state when the personal
representative reasonably believes that the administration will be
eompletel
I.
3. If the answer to No. I is Yes, state the followingl
a. Did the personal representative file a final
aeeount with the Court? Yes No
b. The separate Orphans' Court No. (it any) for
the personal representative's aeeount is:
, e. Did the personal representative state an
aeeount informally to the parties in interest? Yes ~NO
d. Copies of reeeipts, releases, joinders and
approvals of formal or informal aecounts may be filed with the
Cerk of the Orphans' Court and may be atta~d to ::i~~eport.
Datel//;6"'O~ ,Al d)A~~
qa ~re
.hl..l-'\'Il~ 11.. !)U(){l1rV
Name (Pleas~'type or print)
j -T/Z.J I VH?J?o w fa eL, s l.e fa.
Address I
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Te l. No .
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Capaeity:
Personal Representative
L/ Counsel for personal
representative
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