HomeMy WebLinkAbout95-00589
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C umvPRIIintJ.
neglslor of Wills uf County, Pel1l1sylv!lI1ln
PETITION FOR GRANT OF LETTERS
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OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
} 88
The petltloner(s) above.named swear(s) or arnrm(s) that the
statements In the foregoing petition are true and correct 10 the best
of the knowledge and belief of petllloner(s) and that as personal
representatlve(s) of the above decedent petltloner(s) NIII well and
truly administer the estate according to law.
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No. 21-'lS-5R'l
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Estate of
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'.' Deceased': n
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GLORIA v. SHARTZER
GRANT OF LETTERS OF ADMINISTRATION A.
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AND NOW Auqust 8 J9~, In consideration of the'petltlon on
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that James M. Shartzer
Is/are entitled to Lellers of Administration, and In accord with such finding, Lellers of Administration
are hereby granted to ,Tames M. Shartzer
in the estate of Glnrla V.Shar.tzer.
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Realll" or wu(.
FEES
Lellers of Administration ..... $ 80. 00
Short Certlficates(4) .......... $ 12.00
Renunciation ... 3. .. .. .. .. ... $ P;. n n
JCP $ "nn
TOTAL _ ~12.00
Flied ....... M1.91,1.Elt..8.. A.D. 19-2.5-
ATTORNEY (Sup. Ce. t.D. No.)
ADDRESS
PHONE
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PETITION "'OR GRANT 01: LETTlmS 01: ADMINISTI{ATION
Estate of
also knowlI os
No.
To:
Reglslet Ill' Wills I'll
D"",'ased. CoulllY of
Sorlal Security No. Conunonwenlth
The p~i1zn of the undersigned respeetfnlly represenls 111111:
Your pelltl~C!'(S), who Is/nre 18 yenrs of nge or older, .nppl ' for lellers of administration
~ on the estate of
(d.b.n.; pendente 1I111: durante Dh\cnllai durante mlnurltalt:)
the above decedent. ',-
"
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Deeendenl was domlelledpt death In
~ last family or prlnCil?~1 residence 01
County, Pennsylvania, wllh
llbl Mn..'ct, number PlILlmulllclpallly)
,
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years of age, died
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,19
Deeendenl 01 death owned property witli"estlmole values os folllows:
(If domiciled In 1'0.) All personal,prop. rty $
(If not domiciled In Po.) Personal pro~r In Pennsylvania $
(If nOI domiciled In Po.) Personal prop' IY In CoulllY $
Value of real estate In Pennsylvania \ $
situated os follows: '.
\
"
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Petllloner_ after 0 proper score hll- useertolned IhPt decedent left no will and was survived by
the following spouse (If any) and I Irs: \
Nome Relollonshlp \. Residence
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THEREFORE, P itloner(s) respeelrully request(s) Ihe grolll
opproprlole form 1 the undersigned.
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of lellers. of odmlmslrotlon
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In Ihe
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21-95-589
G.mk~/A-n./
Register of Wills of flI ," I County, Pennsylvania
Estale 01
RENUNCIA TION
)/fJiYUd. I/. S/JafYA
No. _....... ._._...
also known as
.P.d . f).
?~h~
, Deceased
The undersigned.
~_~t'~~~ ) III
IRel
thu abovu Ducedunt. hotubV runolJllculsl Ihu right to administur tho uslalu .lIlllw!tllm:llullv ruquusllltl thul
Lellel.1'd~ boisslledlU ~/7U~ 4..Jzdr ..~.
Will.ess
hand Ihls
day ul
19_.
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~ft J. ..0.-,-371 ~
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IAddressl
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Swom 10 at nlfirmud UnWdJSCtlbt:d
beloro me Ihls :;:;./ dav ul
,"}., /1 ' 19_.2.5'::.
Nf~!~-~-A
My Cnmrnlsslon Expirus: "l/;1'1;' '17
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NOTE: Runul1ciutiuntl GUllllhltJ uublllu lhl' Olhl:ll 01 RQUUllor III
W.UtllI'U '1I1111IfUd IIIIIUIlIO ,IIIIIIIIIIH. lu II.. lIuhUl/ed.
......,_,......,......._,.. I~.._.......l
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. NOTARIAL SEAL
CATHY J PAINTER. HOllry Public
Orbllollia Boro Huntingdon Counly Pa
My CommIssion bpl"l Slpl 29. 1887
RW-t) CRvod 9/92)
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21-95-589
Register of Wills
c. WI k~;"1X{'
of~n County,
Pennsylvania
RENUNCIA TION
ESlale 01
..-I/~
No, _._.... ._.._~..
t/ S~l4jL~
also known as
.IJ. (), tJ 4df
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S, /9P.s-
-
. Deceased
The under.lgned.
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tho abovo Ducodont, horubv runounculs) Ihu right In admlnislur Iho oslalu iJlIIJ luslulIalullv ruquusllsllhul
Lellor. !' //d'A1f.~~~ ~o IS_"Dd t11-1'l-?XW .4r41~._.
Witnoss
hand Ihl_
daV 01
19_
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ISignn~e!
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IAddres.1
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Sworn 10 ur allirmulJ und sullscubutJ
~elorc me Ihls .:7 '(' dnv III
7<-ry__..____..19.;ir.....
NOla,v Plio
MV Cnmmls51nll .plro5.;...... NoIwlaIIleaI
EM! R"".... F.1A!!quoz, NoIoo~ f\tItl
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r..................I,.,....,1 ..I..~..o'l...~lbpmAug.14,'995 rOTE:
Rtll1l1l1lliuliunll .aullllltllJ UlllliUlu 11111 Olln;11 ul RltUlltn, III
WdltllllU ItHIUIUteJ III !.lIlllllllllllIlIIUto lu hu IIUhUl/Od.
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CERTIFICATION OF NOTICE UNDER RULE 5.6Ia)
NAME OF DECEDENT: GLORIA V. SHARTZER
DATE OF DEATH: JULY 5. 1995
WILL NO.
II
ADMIN. NO.
~/- ~~- s,f f1
To the Register:
I certify that notice of beneficial interest required by Rule
5.6(a) of the orphans' Court Rules was served on or mailed to the
following beneficiaries of the above-captioned estate on
SeDtember 8. 1995:
&ME
ADDRESS
DONALD SHARTZER 408 BOYER ST.. SUMMERDALE. PA 17093
CATHY SHARTZER 408 BOYER ST.. SUMMERDALE. PA 17093
BETTY JANE MARTIN P.O. BOX 117. 206 ORE ST. ROCKHILL FURNACE PA
JAMES SHARTZER 510 THIRD ST.. ENHAUT. PA 17113
Notice has now been given to all persons entitled thereto under
Rule 5.6(a) except N/A
Date: ~.I'2.-~~
- ~~
~c...~ '\\\. ' ~l
Signature I
Name JAMES M. SHARTZER
Address 510 THIRD STREET
ENHAUT. PA 17113
Telephone(717) 939-3472
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capacity:
X
Personal Representative
Counsel for personal
representative
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CDHHDHWUlllt OF PCNNSYlVANIA
DtPAAtHEHt or REVENUE
BUREAU OF INDIVIDUAL tAXEI
DEPt. nD60l
ttARAISIURO, PA 17121.0601
*'
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE NO. 21 95-0589
ACN 95149846
DATE 10-12-95
TVPE OF ACCOUNT
!Xl SAVINGS
o CHECKING
o TRUST
o CERTlF.
In.ndII l" n.,"
EST. OF GLORIA V SHARTZER
5.5. NO. 168-26-3769
DATE OF DEATH 07-05-95
COUNTY CUMBERLAND
DONALD J SHARTZER
408 BOVER ST
SUMMERDALE PA 17093
REHIT PAYHENT AND FORHS TO.
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE. PA 17013
DAUPHIN DEpOSIT BK I T h.. provld.d thl DIP.rt.lnt with the Infar..Uon lbhd b.law which h.. b.an u..d In ulculaUng the
pat.ntlal t.. du.. Thalr r.cord. Ihdlc.t. th.t .t thl d..th of tha .bave d.c.d.nt, yau wlr. . Jalnt awn.r/b.neflcl.ry of thl. account.
If you f..l thl. Infor..tlan I. Incorr.ct, pl.... obtain written corr.ctlon frol the fln.ncl.l In.tltutlon, .ttach a copy to thl. far.
and return It ta the above addr.... Thll .ccount II taMlbl. In .ccardanc. with the Inh.rltanc. T.M Law. of tha Co..on"'l.lth of P.nn.ylvanl..
~.\lwll. ..1 be .,.wand by call1n; (717) 7.'-flSH.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 5332635176 Doh 08-17-89
Edablhhad
Account Balance
Percent Taxable
AMount Subjact to
Tax Reta
potential Tax Du.
To In.ur. prop.r cr.dlt to vour account, two
(2) cop I.. of thl. not Ie. au.t .cca.p~V vour
p.y.ant to the Regl.ter af Will.. Haka ch.ck
pavabla tal ~R.gllt.r of Will., Ag.nt~.
PART
[!]
327.90
50.000
163.95
.06
9.84
TAXPAYER RESPONSE
FAILURl!...O Rl!SPOND \lILL Rl!SUL T IN AN OFFICIAL .TAX ASSl!SSNl!HT, BASl!D ,ON THIS NOTICl!
K
HOTEl If t.M p.y.ant. .r. ..d. within thr..
(s) .onth. of tha d.cadant'. d.t. of d..th,
vou I.V deduct . 5X dl.count of the t.. due.
Anv Inheritanca taM dua will b.cOM dallnqu-nt
nine (,) eonthl aft.r the d.t. of d..th.
T..
x
[CHECK ]
ONE
BLOCK
ONLV
A. 00 Th. abov. Infor.allan IN\d tu due Is corr.ct.
1. You ..v choas. to r..lt p.y..nt to tha R.gI.t.r of Will. with two cop II' of thl. not Ie. to obt.ln
. dl.caunt or Ivold Int.r..t, or vou ..V chack bOM ~A~ and r.turn thl. notlc. to the R.gllt.r of
Will. and an official ........nt will b. I..u.d bv tha PA D.p.rt..nt of Rlv.nu..
I. [:] Th. abov. ....t h.. b..n or will b. r.port.d and taM p.ld with the P.nn.vlvanla l~.rltanc. T.. r.turn
to b. fll.d bv the d.c.d.nt'. rlpr..entatlva.
c. r=J Th. abav. Infor..tlon I~ncorr.ct and/o~.bt. and d.duction' w.r. paid by vou.
You au.t coaplat. PART l!J and/or PART l!J b.low.
If you lndlC8te 8 dlffarent tex rata, pl.... .tat. your
reht lon.hlp to decedent I
PART
~
TAX RETURN . COHPUTATION
LINE 1. Date E.tabll.hed
2. Account a.lance
S. Percent Taxabla
it. AMount Subjact to TaK
S. Dabt. and Deduction.
6. AMount Texable
7. T8x R.te
a. TaX Due
OFFICIAL USE ONLY 0 AAF'
PADEPARTHENT, OF REVENUE '
TAX ON JOINT/TRUST ACCOUNTS
PAD
1
2
3
4
5
6
1
8
CLAIMED
OF
1
2
5 K
4
5
6
7 X
8
DEBTS AND DEDUCTIONS
PART
[!]
DATE PAID
PAVEE
DESCRIPTION
AMOUNT PAID
TOTAL tEntar on Llna S of TaK Coaput.tlon)
.
facte I have r.ported above are trua, correct and
HOME <'7(/ ) J5/ 251 i
WORK ( ~ l't.. ) I Ie I'
GENERAL INFORMATION
1. FAILURE TO RESPOND WILL RESULT IN AN OFFICIAL TAM ASSESSHENT with .ppllcabl. Int.,ut b.ud on Infor.atlon
,ubIIlthd b., the flnllftCl.l In.Ulutlon.
l. Inherlt~. ... bec~" d,llnquent nlna lonthl .,t., thl ~c.d.nt'. dlt. of d..th.
J. A Joint I<count I. ,..ebl. IV.n though thl dlc.dlnt', "... "I' added .. . ..Ita, of conv.nlenc..
.. AccCM.W'It. IInclucUng tho.. held HtW"" hutbMd III'Id wlf,) which thl! daudlnt put In Joint ".... within OM v..r prior to
duth .t. fulh tl.lIIl. .. IrM,'.r..
5. Account. .,Iabll,hed Jointly bttw.en hu,bMd Iftd wlf. lor. thin on. y..t prior to d..th .t. not ',..al..
.. Accounts held by . dte.dent -In trult '0'. ~ther or other. .t. 'I..ala fully.
REPORTING INSTRUCTIONS - PART
1 - TAXPAYER RESPONSE
1. ILOCK A .. If the Infor..tlon Md c"",'aUon In the notice .t' cornct Ilnd deduction. .t. not baing elalnd, pllte. ~ "X"
In block -".. 0' p"t 1 of the ..hIilP.....' A..pon.... ..atlon. Ilgn two copl.. Ilnd .ub.1t th.. ..lth your chuk for tr- .-aunt of
t.. to tfMI R..llhr of Willi of tM county Indlnhd. 1M PA o.part_ent of Rav.,.,. will I..u. "" offlcl.l ......Nnt
CForl REV-1S41 E~' upon r.c.lpt of thl r.turn frol the R.al.t.r of Will..
2. BLOCK B - 11 thl ....t .p.elfIH an thll noUn hu b.en or will b. r.port.d Ilnd tIll paid ..lth the p.t.nvlvenla InhllrJtenu
,.. Raturn fll.d by the dec.dent'. repre.ent.tlve, pl.c. en ..~.. In block "." of P.rt 1 of tha "'a.pav.r R..pan.... ..otlan. Sign on4
copy and r.turn to tn. PA Dap.rt.ent of R.v~, .ur.au of Indlvldu.1 T.Il.', D.pt 210601, Harrl.burg, PA 17121-0'01 In thl
env.lope provided.
S. ILOCK t _ If thl notice In'oraatlon h Incorract IInd/or d.ductlon. .r. beln, clal".d, ch.ck block "c" and co.,l.te P.rh 2 and S
.ccordlng to the In.tructlon. billow. Sign two copl.. and .ubIIlt the. with your check 'or the .-GUnt of tall pavlbl. to thl Reghtar
of Will. 0' the county Indlcatld. The PA D.p.rtlent of R.v~ will I..u, an offlcl.l .......ent ('or. RfV-I~1 E~) upon rlcllpt
of thl r.turn 'rOIl tn. Ra.l.hr of Willi.
TAX RETURN - PART Z - TAX COMPUTATION
LINE
I. Entar thl data the account orlglnalh .... ..tablhhad or tltlad In the .annar 'Ilhtlng .t data of "uth.
HOTE' ror. decadent dying aftar 12/12/12, Account. which tha d.c.dent put In Joint n.... within on4 11) ya.r of d.ath ara
t.llabl. 'ully .. tran.f.r', How.v.r, th.r. la an allclu.lon not to 'Ilceed IS,OOO p.r tran.f.ra. ra.ardla.. of the v.lue of
thl IICCount or the nuabar of accounh h.ld.
If . dDlAJle ..t.rhk (....) IlPPllr. bafor. your first n..a In the adelre.. portion of this notlca, thl 15,000 nclullon
.Ir.acty h.. been deducted froe the account balanc. .. r.ported by the financial In.tltutlon.
r. Entar the tot.1 b.lanc. of thl acCO\ll"lt Including Int.r..t .ccrued to thl da" of d..th.
S. ThI p.rcent of the eecount that I. t,lllbl. for .ach .urvlvor I. dlt.r.lned .. follOMI.
A. ThI percent t.llabl. for Joint ....t. ..tabll.hld lOr. then ani yaar prior to the d.cedlnt'. d..thl
1 DIVIDED IY TOTAL NUHIU Of
JOINT CMf[RS
Ell...I., A Joint ....t r,,"hred
DIVIDED IY TOTAL NUHIER OF' X 100 . ptRtENT TAllAILE
SURVIVING JOINT OWNERS
In thl n... of thl dacadent and two ather p.r.on..
I DIVIDED IV J (JOINT DWHERSJ DIVIDED IY 2 (SURVIVORS) . .167 X lOG . 16.n lTAllAIlE fOR EACH SURVIVCNU
I. The p.rc.nt t.llabl. for ....t. cr.atad within one y..r of thl decadent'. dI.th O~ .ccount. ~ by the decad.nt but hlld
In trult for another IncllvldueU.' (trult b.n.flclarl..).
1 DIVIDED IY TOTAL NUHIER OF SURVIVING JOINT X 100 . PERCENT TAXAILE
OWNERS OR TRUST BENEFICIARIES
EM.apl., Joint account r,gllt.r.d In Ih. n.., of the dlc.dant and two other p.~.onl and ..t.bll'hld within ani y..r of d..th by
the d'Cldant.
1 DIVIDED IY 2 (SURVIVORS) . .50 X 100 . SOJC (fAllABLE fOR [ACt! SURVIVOR)
4. ThI aaount .ubJ.at to till Ulna U II det.r.lnld by ttUltlplYln, the eccount belenc. Cline 2) by the pareent t.ubl. (lInl 1).
~. [ntlr thl total of the dlbts and dlductlon. 1I.I.d In p.rt S.
It. T.,. MOUnt t".,bl. Clln. 6) I. dltlr.lnad bY .ublr.ctlng the d.bts and d.ductlon. Cline S) frDfl the ..aunt .ubhtct to till Cline ,,).
7. Ent.r the approprlat. t.1l r.t. Illne 7) ,. d.l.r.ln.d b.lov.
A. for d.t.. of d..th accur~lng .fter 6ISOI94, the tIll rat.. for tren.hr. to .pau... ar. .. follallll
1. Dat.. of d..th on or .ft.r 7/1'9" and blfor. t/l/'~ thl rat. I. sx.
2. Dat.. of d..th on or .ft.r 1/l,9S tran.f.r. to .pou.e. ..Ill b. taM.d at a~ t.. rlt..
Hot.. for dat.. 0' d..th prlo~ to 7/1/9" tren.f.r. to .pou." .r. t'llabl. .t 6X.
I. 'ren.f.r. to lln..1 d..cendent. Including f.thlr, eathlr, .on, daught.r. grandchildren, .on-In-I.w,
d.ueht.,-In-IIM, .t.pchlld and thllr I..UI .r. tallable .t .IM percant (6~).
C. T,en".r. to III other. Including brother, .hhr, unci., aunt, nephew end nlec. It. t,llabl. .t I1ft..n perc.nt (1!iX).
D. I' you chInO' the tall r.t., pi.... .peclfy 'lour r.letlon.hlp to thl dee.dlnt In the ar.. provldld.
I. ThelHtoftt of till due (line I) h d.ter.IAId by wltlphlng thl IMtOUnt tulbl. Cline 6J by the tall rlt. (lIn. 7..
CLAIMED DEDUCTIONS - PART 3
DEBTS AND DEDUCTIONS CLAIMED
Allowabl. dabt. and deduction. .r. d.t.ulnad .. followlI
A. You leg.l1't er. r..pon.lbl. far PlYlllht, or \hi ..t.t. .ubjeet to adllnhtntlon by . pe"onel rapr..ant.tlvl II In.ufflclent
to p,y thl dedUctlbl. It....
I. You actually p.ld thl debt. .ft.r d..th of IhI decadent and can furnlah proof of p.yaunt.
C. Debt. b.lng el.11ad .u.t be 1I..bed fullY In Pert S. If Iddltlonel .pee. I, ne.dad, u.. pl.ln PlIPar . 112" . 11". Proof of
pay-.nt ..y be raque.t.d by thl PA D.,lrl-.nt of Ravenue.
TAXPAYER ASSISTANCE
IF YOU NEED FURTHER INFORMATION OR ASSISTANCE, CONTACT ANV
REGISTER OF WILLS. PA DEPARTMENT OF REVENUE DISTRICT OFFICE
OR CALL THE BUREAU OF INDIVIDUAL TAXES, TAX PAVER INQUIRV UNIT IN
HARRISBURG AT (717) 787-83Z7. TOO' (717) 772-ZZ52 (HEARING IMPAIRED ONLY)
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CQMMONWfA\1H O' P(NNSYLVANtA
O('AIt'MfNt 0' IUV(NUf
01'1. 210601
H.....ISlUIlO.'A 1712'.0601
INHERITANCE TAX RETURN
RESIDENT DECEDENT
(TO BE FILED IN DUPLICATE
WITH REGISTER OF WILLS)
'OR DAns 0' DIATH AnlR 12/31/91 CHICKHERI
I' A SPOUSAL
POVIRTT CRlDIT IS CLAIMED 0
fill NUMBER
UY.UOO (I. IIPHI
15. Amount of I1n. 14 taxable at 6% role
(Include value. from Schedule K or Schedule M,)
16. Amount of line 1.4 IO.llobl. 01 15% rol.
(Include valu.. Iram Schedule K or Schedule M,)
17. Principal 10. due (A".d 10. from line 15 and Irom line 16,)
18. Cr.dill Spousal Poverty Credit Prior Paymenll
+ +
19. If line lB I. grooler than line 17. enler Ihe dillerence on line 19. Thl.l.the OVERPAYMENT.
aD
20. If line 171. grealer Ihon line lB, enler the dillerence on line 20, Thl.l. Ihe TAX DUE.
A. Enler the Intero.t on the balance due on line 20A.
B. Enler the 10101 01 line 20 and 20A on line 20B. Thh I. Ihe BALANCE DUE.
Make Chock Payable 10' Regl.ler 01 Will., Agenl
...... BE SURE TO ANSWER ALL QUESnONS ON REVERSE SIDE AND TO RECHECK MATH....
Under penalti.. of perjury, I declar. thol I have 8Itomlned lhb r.turn, lntluding accompanying uh.dul.. and Ilolemenh, and 10 th. b.., of my ~nowl.dg. and beli,f,
It I, 'ruI, correct and campl.,.. I declar. that 011 r.al ellale ha, b.en reported at true mark.t value. D.c1arallon of pr.parer oth.r Ihen Ih. personal repre.enlatlv. II
ba.ed on 011 Information 0' which prepar.r ha, any Imowr.dge.
I A A R IlL A I IN URN A DA DATE
\\ " s: ~ \ ' 1- It -??
DATE
~
:oe-l:!
ldlf~
olil..
0.'"
0.
0(
m~
0<0
OZ
UO
0.
.;l1'1S - os8'I
YEAR
N,U!-,BE~
COUNTY COOE
~
~
o
1/.
Yo! .80J'~,(! Se-Itt!t:r
Sum"'Mdl}l~ ,11/1
. 'Al1d
o 3. Remainder Return
(for dale. of deolh prior 10 12.13.821
o 5, Federal E.tote To.
Relurn Required
i!... 8. Tolol Number of Safe Cepollt 80xes
6-/~ A!./A
/1 t!/ ;U.,t..-
...
1~9- :llr 3761
I "
1. Original Relurn
't- S'.'S-
O 2. Supplemenlol Relur"
7-6 -..33
COUIlI
o A. lImlled E.late 0 Ao. Fulure Inlerell Compromise
(for dol.. 01 dea,h after 12-12.82)
o 6. Decedent Died Te.lale 0 7. Decedent Malnlalned a living Tru't
(Alloch cop of Will (Alloch co of Tru..)
ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO.
... A
S Ilf~,eT2 E ;e.
'1.31 - 3$17;;-
~- /0 -r-l.llrt/
C.nINlvT ~...
st!-
/7/-G'
JAmp,!,
.
(fl.
:5'" . d"f1'8. no
.
z
o
3
E
0.
:3
...
0<
1. Real E.tole (Schedule A) ( 1)
2. Slack. and Bond. (Schedule B) ( 2)
3. Cla..ly Held Slock/Portne"hlp Inlore'l(Schedule C) (3)
~. Mortgog.. and Nol.. Receivable (Schedule D) ( ~)
5. Co.h, 80nk Depo.I" & MI"elloneou. Pe"onol Praperty( 5)
(Scnedule E)
6. Jolnlly Owned Property (Schedule F) ( 6)
7. Transfe" (Schedule G) (Schedule L) ( 7)
g. Tolal Grall Aue" (Iolollin.. 1.7)
9. Funeral Expen,es, Administrative Co,", Mlscellaneou, ( 9)
Expen.e. (Schedule H)
10. Deb". Mortgage lIabllitl.., LIen. (Schedule II (10)
11. Tolol Deduction. (Ialallin.. 9 & 10)
12. Nel Value of E.lale(lIne B mlnu.llne 11)
13. Chorl.oble and Governmenlol Bequ.." (Schedule J)
1~. Net Value Sub ect 10 To. line 12 mlnu.line 13
tyy.P '.3. y~
)( .06 II
-" -
-. -
-0 -
/.:lOS". S~
- 0-
-u-
7~S't... tTtJ
l!fO~. /1
( B)
~7, ~OS. ~~
/~36;:1. //
Vf/K V.3. f/y-'
-0 -
(11)
(12)
(131
(UI.
~fI"FV3. J7~
~~~/
(15)
(16)
-(J--
-0-
x .15"
z
o
~
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0.
:l:
o
u
~
(17)
.;jt, fa. "I'
Intere,'
Discount
-<l-
(1 B)
(19)
-0-
Chock hero If you aro requa,ling a refund of yaur overpayment.
.;?~?tJ.~/
(20)
(20A)
(20B)
.:7~ 9tJ . t, r
-,,-
.'
AGAPE SUPPORT SERVICES WILLIAM L. DERRICK, APPRAISER
Proper1y Do.crlpllon
UNIFORM RESIDENTIAL APPRAISAL REPORT
F,la No, 5675
'.' , "'i:iiii"i coo. ,10 .,t1lJ'1\ ',aC". 17093
, II . -n::;r Rnnk! 1 A..lI_'i' F.nRt'. Ceo",... CUmberland
6 ......w....'.'N., T..y. q4_95 n, T.. . R/.I.09 '~""~UW!!!Ln~t: IlNn
':~: 110"....., SHARTZER CUrI.RIO...,..., ESTATE O~ ~hnrtzer oU\J!..t!11_Jxlo", n.... nYJ.~
:'J' Pr_"'I,iQhl"DOf....d IYI,...,,"(>I. "'II........... I .... .cIT~~!!!f!n'''.I"'llltlOfVAhr1-1!.!!A.Llilf. lMo
'E: m areA. u....n.' , CJ_l1_'onl)~Ml- .tt.llt...f,.cllO' Hn,,]HO
'<f.; C.I."",.' n.....I..1 n. ,. I lfl(h"D"'(onc:"'lONIO"'"todt,or~ KNOWN
.. . & Kann ........ ?n~~ Rnn.l MI~.' .O^WIl. Pelll\Jl 17057
,.,1; . ..... Wi lliam T. Derrick ........ 1425 Market Streot Camn lIill PA 17011
~:.:.'. bUllon UUdlM ~fkjgb," IV" ".......A._. 1IraN'....,~ ~....&-.,. l....l-.~
~:f.; .!oIl1 up (Xl Dve,"" 0 21.n. Unci.,,.,, ~ PRIer, 10001 AQf Irlll OMllmll, BiL- (i] HocllUlr 0 ~'"
:;~l,': Dt......thllll BRapld lXlSttbl. Itow 000"''''' 85 1~5 low 10 2-4''''''', CO'nproc:...
;'<{. PIOpefl,ul\&l Incl..ing 00 Itllbl. Dtdll1lno 0 TenanC is 1110 U....h 'Ii MUII""""r -:-- Tt:
f.:i~ o.m~" RIMI1IOt [Xj;':~~~ o....euppt" ~VKtnClO'I.I"'-"- .,lp...t.....InMII,-'-,'" COfTIlMIcl.t 5
{,':! u...o... ,~. J&Lu......". ... ", ".. ..0 1 ~n ?n vn~ 10
~,.~~
::'N~- H-= "'-....r.w_...........do..J1.,lNj~...t......._..........,....
rer N-'ahbolhood boI.ntlfkt w UwKt"ltUCI: Enst
rJ;',
'~;: '"IOfIINI l"ocI tlw mtrUlatMIol" ot the PfOpelIIll In tlw ~hbOlhood (po.lmil, 10 omploymlnl end ~III', Implo,mlnt 1IIIId'I,. IfIput 10 mllhl. lle.l;
'B\ Nni d 10 sed Drimo-ilv nf' Droperties reflectinll similar in ql!lllity. mdntenanee
.0; dA~ian nn.l nn.l ....'Hv ~n ~hA .....,ahilitv for this
R: "n' of most ~...H~ ui... ,n access to emD10vment. shQPDinll.
~i nn.l i~ n ..-".- tn ~hA n~ othAr nA No
;0, ,'n u..i.h u~.I.1 .lv IH.v
.0
'..:
',:
,,;; tv
aVAUnhln
M"kol condl.liono In IN '\ItltICI neigt-Oorhood IincIl.,dIl'lO .~I'OI INIbov. concklli_ ,.ltI.d 10 the "end 01 plOpMlr \tolUOl. domvdllUPPlr. .., m.....'~ tlm. . . . 1\,1("" dill 0t1
compebl.w. pr..,rll" 101 ....In INnoigNMwhood, d.",lpllon 01 the plIV"flI"IC' 01 .....It'd hneoclng conc...lonll. .le,l: Tho suoply and demand for th iL-
d is normnl nt this timo Also the market in" time is normal aC this time, -;;;;d
.n "A _A'nHvnTv "ah'e ... .hh Hmn uf.h n ul.ln va_intv nF
nnd .10 not RARm to he .. -. .^- in todavR market,
SI1MMARY "''''''ISAL RF.PORT (STANDARDS RULE 2-2'.
\p\ """"wlnnoIdonr. PtDI at 'pClIlCoblo)-lI'N dI",ltlplflbulldU In conlJoI,t tJw Home Ownot,' ANod.Uon C1tOAlJ U v. lXJ No
~g,';: App",lrnll. 10111 runbIt 01 units In lhe .ub/let Pf"".C1 N I A . Al:JpfOIIm.I. totd runW 01 unit. '01 .tIII In !he ~ICI Pf"'CI
D..Cfobl e~,," .11~ntl 11('utlon" foeK;li".
i:i
:;;
11;\:,
0~....10n y
.......... 15.000 SO. FT. Mil.
S~cillCJonIng cl..llicllion 1M dUCflplJon R..Ol J
Zoning comph~1 IX] LIClII 0 hall nonconrDlmlng la,lt'dhl""" u.., U moo" U No JDI'IIng
"~hetl""-I UII.ImPfo.,1d IXl PlI..m UI. 001'* ",.,..pt"n) SINGLE FAMILY
Corl'llf Lol IX) v.. 0 No
UtilltJo.
Public
Olher
Typa
Publlo
Topography MOSTLY LEVEL
Slfo TYPICAL Fe1l. AREA
Shopa RECTANGULAR
Orolnaga APPEARS ADEOUATE
~aw OF
Lond.caplng ~OR NF.IG
Ollv.lIIl,~tecl~
ApP"lnI E...mlnl. NOTHD tTl'ILITY
"<VIn
o
011.0110
Improvemenl.
Elaculclly IKl T nn ..." SUaat ASPHALT IKl 0
Gu IKl Curb/Gulla, CONCRETE IKl B
I,?: Walar 0 Sldawalk NON\! 0 FEMA Spacial Flood Hazard Arao 0 Va. IKl No
I'F Sonltary Sawa, 00 DltDT Tro St,aatllghta H1!RCURY VAPOR fjlX] fjO FEMA Zona C Map Cata 4-15 -77
1:/ Storm Sowar I I Nom AII.v NON!': OFMA Mo" Nn, 4?OiS9
I 't:;~~ Commlnlll.PIlII.nlldv.II' ....m.nu. .nctOlctrn.nu. .~cl" .....m.nll, Ihdl ",,,, 1111011 01110" nonconlOl'mlflll '''''.--;'1. ",., .lc.1: For t.h is ne: t.he
I:;:' RuhiAr.~ nronertv'a ~it-A' hno ~imilar sl.... improvements and 1andscap'ina and has had simil...
1'<' maintenance. The site also is similar In size and enfovs similar tOD02ranhv to the other sites
" GENERAL OESCRIPTION EXTERIOR OESCRIPTION FOUNOATION BASEMENT INSULATION
:o( No. 0' Unit. 1 Foundation CONC RTX Slab WI: Araa Sq. Fl. 6nn Roo'
:::~.~' No. of Slorlas 1 EXlerlor Weill PP:R'MA ~'T' Crawl Space % Finlshad N I A Celling
,;:~~. TypaIDet./AII.1 Roof SUfface Basemenl Celling N/A WaU.
I Daslgn (Slyle) ~ Oullll." O....,..pt. Sump Pump YES Welle Floar
t,p:.: blllillg/Plllpo..d ~ Window Type Oampne.. SOMF.. NnTF. Floor Nona
,.T., Age (Vr..J llal) Slorm/Screen.COMBO Salllamenl NnNF. NlYI'F. OUlllda Entry N/A Urano....n
t~;- '''.rti.... ArI. tv,., 30 M-.tKllnct H~O nfellndo NONE OTF:.
IN.' ROOM~ ."ya' "vl.n '''n'.n Oon I..mllv .
';,.>'
Prlvalo
o
o
o
o
o
CONCEALED IKl
, n..h. I ."""rv n,....
'0; lav."
'F
;,'.i' lav.1 2
::-'1<:'
M,
'p
,Ri;
,0
'V
E
M
E
N
i,T
6
I '
AR"A
IEAT IN
,
I'
1
....
~OO
1. 293
Finlahed e,ee above nrada conlaln,'
INTERIOR MII.rlllllCordotlon HEATING
Flaa" CAP- UTI"''''' Typa linT A TR
wan. PNT_ DDD "'" Fual OIL
Trlm/Flnl.h t.IIl_ PUNT /tnl c""",,,,_
Bath Flao' UTloIVTJ,UI! COOLING
8I1hW",...COI FI: Central r.F.PIJ'1' A J(';
000(. trn.. Olhe, NONl!
C6nd,IICllt NJA
AddllJonM r..I.... I.~~" _'OY .lhclem 110m', .tc.I:Tvnlcal
5 Roam.'
3 Bed,oomh.'!
KITCHEN EQUIP. A TIIC
Rerrlgaralor 0 None 0
Range/Ovon [Xl Slelr. 0
CI.po.al 0 Orop S.al. D
CI.hwa.har 0 Scullla 1XI
Fan/Hoad IKl Floo. 0
Mic,owave 0 Hoaled 0
Wo.har/D,v", fj Flnlah.d Fi
this stvle. tYpe. age and Drice
1 Bo'h a . 1 293
AMENITIES
flroplecalal ,
Pallo '
Dock
POfch
Fence
Pool
Snuare Feol of Ora.. lIYlnn Aroa
CAR STORAGE
Nona 0
Garege ., of CIII
o
o
o
00
IKl
R
AIIICNcf.
O'I.dled
11...11<1"
L-
COVERED
CHAIN LINK
;~;
for
Carport
OrivoW8V
Droperty in the aren
'.C:
o. C~llon or IIw ~","_omll'll.. d'",lcllllon iPhrlle", fIllCIIOftll. ond 0".f1"'. 'lIIa1t.l'lNdld.lluekly of e_uucllon., flmodolIf1tilIOiUIII_. I'C,I '111 f R hnmA hn.rl hnrt IrV'I~R
M .hAn ~ .. ., .l11n ~n ~hn h~1r n" _.~.,._ _..,
'M
. e/
W
T" Adv",. _lIOfVl'lenl" Condillono l.uch., but not IImhld 10. h""dOl.llllllll.', 10,le ~'II'IC.., 'lc.1 PHlfll Jon 'hi ""Pfonmonll. on IhllI'l. 01 "'Ihe Immed'". Vltlnll, Ir IhI'~I(1
.5, ~...',,: NONF. Tn TII" 'DDDn~"D
, .
"
i
I
I
I
I
.1
,.0 ESTIMATED SITE VALUE. . . . . . . . . . . . . . . . . . . , , . .. . I 15,000 C.",mo",. 0" COol AIIIHooch /o"ch .0 oou,co 01 coo.
,0 ESTIMATED REPRODUCTION COST,NEW OF IMPROVEMENTS: .."mo.o. alia ..Iuo. oq"o,o 100' colculoll.n .nd I.. HUO.
S DW.lllng 1. 29~ Sq. Ft. @II 58.98 - I 76,261 VA. o"d FmHA. .ho """'o.od ,o",olnlng oconomlc Ilfo 01
,"~T BASEMENT -W Sq, F.. @II 10.00 - 6.000 .h. p,opo"vl: ill!!!
-, Covered PorchIFencin2 - 5.000 .,1 L "..u. en.t Se;':;;'~A
'PI G.,.g.ilI:.'PD" ~ Sq. Ft. @II 4 18.50 - 7 .030 'with th;- '".~_ hAV.
P' TOle' Eotlm.,ed Coot New.. . .. . .. .. .. .. .. . _. 94,291 I been use~ tn A"~/V. At ~n.t
/J> PhvolDel ~runDllo"ell E.te,nel Land VA 1;;-;;- h An Ite
'R Le.. 50.00 " 'hA.....' nn th. , ..._'- nl' l"t
:0 D.p,eclellon ~7 'H' I _. 47.146 IAnleA In tho .~.;-
~A' D.p,ecleted V.'u. or Imp,o.omenlo . . , . , , . . . . . . . , . . .. I '" '7 14 ~
/~ "A.."" V.lue of Site Improvement. ................ . . 2. 50n
';H tNDICA,",DVAIUOOYCOSTAPPnOACH. . . 64 645
I,;f;i ITEM I SUR IECT COMPARARLF NO. I COMPAnAOLE NO. 2- COMPARAn, 0 NO 3
408 Boyer Street 134 Bungalow Road 30 West Pine Street 727 Valley Street
~, ., e I.....nl. "'_._. ".._ .'_'
;, - , - J<UillUl
",:' .....~, ." ; ,"", 0 ~ mil a I mil a 0.35 IlIUe
.:,': .".....'" '/:""<"'>,<.1,82400 ,.. ,...,..,.50.50n "., '.."
I;;.r .., '.11_,'", ., r" .~~,~, 1,1f'~':,<,;, L.,.},. 5't.18 111/:',"'", .76.]9
I;'~ Oil. ....11.. INSPECTION HLS/STEB MLS/STEB IILS/STEB
,.... ,,', ,._c. l.n";'AT~..n. C
';:r T""NT. D'''RIP''DN ""'c'.""" ". "'..,~ "'C"'.,'D.. ' ~ , D'''R'.''DN
:'; '.""'- I:"tie FIlA -2472 CONVENTIONAL 0 CONV~~~ONAL
',';' C""'...I.... I"iii','.",;",. . '.06 n lornM. 122 0 'TOM. lOR
I.'i 0... """."(':,ni<i':,"II_I?_Q~ n l1_'n_oJ. 0 l-n~_95
: 1...,,_ STMn,ID 0 AD 0 ~IlAR
S I.......... r.. c_... 'FRR 'FRR 0 FEE <:TMPT" 0 &.Il.. S
AI c.,. H.OOO/avo '53 -17~n 8. ?~O/nva ..1 noo17:'iiQO/Ava
If' "'.w TVPT/'~A. GIt n 0 ^"'TGIl
fi' ::~.::~'" ,I. .".......I~~~n ~Il ,,- Oll-S'J'navJSTMTT
\'!; ... ,n ~- 120 Vl"s 20~ -161.8" '>" VT'. Iny -~o~r ?~ v,.. IO~
'e: .. ,'1- n uSUPI1R 'i SUPRR
tJ: ....... 0,... T.... . '" '.. T.... r"'M.1 .... , T.... I .~.I.. T.,. I ",_, I ..._
:M .....C"'" ~ 11'~ h 11 O.~" II 014 ~' Tf
,'p; ".. ..-.. 1.29'1 .. .2]7 ..." +560'946 Sor. 17'>0 ~ ,.
''P.' .-.............. I~~IAL PARTIAL 0 FULL -100~,~~IAL
fR.: ...... '..w 0'... 'NONR NONR 0 0, NO""'
,:' '~"~.II"',.. I..."".,." CRlSTMTT n 0 'AV..Q.C"
$' . lOlL It H HQ/"..'" nl"A" U ..?OOO Ion. II
'0 ""''''''Io,'~. GR ~'STAND CI! 0 S CE 0
;,N. '?"AD ,- +l00 ONE ..?ono Nn~R +?OOO
.\i' P...h......,o.... COVERED PORC COVERED PORG 0 STOOP-PATIO +1000 COVERED PORC 00
Ii\, ,....,...,., I ~n,,",' I NONR 0 0 I Nnl-JR
'N ... .--,... '''''''TN UN!( I.nnr clnnn ..fnonl~"o.ii> dnnn
:t N.,...,"..." 1,:~~_,~~,""~.~~t;""~T: /Xl- ;R .2;;~~~; ;;"'~~N u,g 'K,!f: n:. U1~
iv, "i~''''.".'''';<';~'II~t\ .-.IM. __ ,........"w" ,,;,', _. .u.U. .";1 ._ .__
'.8 .'c...,..~.<,i.e('". ',~c. w -C',,',.,. '7 ?o '.'--.. ;ou,,' 54, Don '", ..'. >0", 'Q to,"
:01:., C"''''.,"II''' s... C.....,.... '''''''''''''ho 'ubI... ......"'.......".,,,,, lho "."....hood, .".1: A th""Ouoh searc"- of all nvn /lnhl A
:S,mark.t dAtA .... ...-... RnlAR USA~ ere c"n"idered tn be the be.t tn~s "F "eIUA All th"ee
,;,;( Sale. W.~A ~nnc tn be Rveroa. t,,;'-; of VAlUA "n';;;;a~.h1e. Usad'Are cl"sed neles.
~;:~~;;
/>:
.~ :,'-"
'--,,='\
AGAPE SUPPORT SERVICES WILLIAM L. DERRICK, APPRAISER
UNIFORM RESIDENTIAL APPRAISAL REPORT
F,'. No. 5675
000
1111" ,
.'.11 ...
",.
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n
o
n
...1?00
o
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.<Onn
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"57'~
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,",:;","
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NEW PARCEL
n/s
,eNO,'
NONR KNOI/N WITHIN 1 YR NONE
n/e n/e
een,."_ l1~nd
,.. 0 '-;- 'Nn. 3
KNOIlN WITHIN 1 YR NONE KNOI/N WITlIIN 1 YR
n/a
;""<F 0'1., PIle. end 0.1.
fl{ Source'Of pl'10f .11_
_~':';(>' wllhinY'Il"'I9PIN"
"<",::-':
, .: -.."., M, ,"".n''''H~.",.r .... ""... .. '".....r 'ho ........ ......" ..... M.,,,. ., M, .... ..... ., ........ ... .~........ ...", ~ ,.w ., 'ho ,".., .......,
,',"".,l-&LsAIi n~ 'l'ltl>~n;, Am nl> TilE' '.BU: SALI!S WITlIIN TilE lAST YF.AJt..
::i'~I!CT WAS~o'" FOR "AT.. .... 'MIl> TTMll' OF Till! INSPECTION. :
:,:..: INDICATED VALUE OV SALES COMPARISON APf'RDACIl. . . . . . . . . . . . . . . . , , . , . . . . . . . . . . . , . . . . . . . . . . . . " . 56 .000. 0lL-
" INO'CATED VALUEOY INCOME APPROACH ,,""........, .."M........"..,..". .N/A ..... ,.......",M.........N/A ~ IN/A
' , Tho .......10 ~... IXJ ....,... 0 ......., ,. 'ho ,....., ."..."..... ....."..... .....,"... I,.,.. IN,.w IT....,...,. '.01",,,,,,,,, .... .... .....'''".....,
.,:' ~;;.:-:::~.....,This e~~r~:~~};:~DO~t ~~;s~~=~ ~:::~~~ r~~~u~~:i ~~Oi~f:vv~rw:;~~n is" conditi~
',0 ,'".......,.."...,'1'11. Mnrknt ADDr"~~h' i~~c~~s!.dered to be the best indicat~; of value for this type of
o nlli! iL!!.!l!en ~t;;;t, _;;';-hht in ehh ,:eDOrt. The comDArable ~ales !!!,e f~l~ Co llrovide
,N .i.'u' nnn"- Fn~ A final estimate of. !Mtl~t v!!.l!!!l....-'Th!l. !!!cQ!!!~ Ap .__L un. nn. ......_
:0. Tho..._.r IN. .......10 ,. 00'.....:. 'ho ~..., '.~.r.ho ,.. .._" 'h.".,ho ........ ."100 ".." ...... on "'" ..... .......".... ""ho .....,,,,,.... .~'....."' ..... ...."...
')1' ......."......... ~..., .... d.,,,,,,... 'h,,~. II.,.. In 'ho ."....... "...,....... '''01 ."IF......... '.m ;00.. IR..Io.. 06-1993 I,
:L' William L. Derrick
it I !WE) ESTIMATE THE MARKET VALUE. AS DEANED. OF THE REAL PROPERTY THAT IS THE SUIlJECT OFTItlS REPORT. AS OF
:A AUlfUSt 8. 1995 lWHICH IS TIfE DATE OF INSPECTION AND THE EFFECTIVE DATE OF TIltS RErORn TO Of . 56,000.00
':li -...- ,uJ. () ..........DClftY__.DNLV " "0'''''01
,d., SI".,~. ...~ L .,b..o-..Il ...,.,~. 0 D~ 0 DOd N.,
,-0, N...WilHam L. Derrick N... I~.... .......,
,N Oil......'...... AUlfUSt 8. 1995 DII.R...".....
I'i'-"" Sill. c.f111IUllon, RL... 303L SI"t PA SI'I. C"II'IClllon,
01 SIIl.lInl'll" St.1I 0, 51ft. lite.... ,
o~..-
,~
SUI'
5,".
,'....
"iIIntt!b JJutm 1Iimmtr1! 1~1 C 641,402,646
. 07 01 95 74 CHICAGO" ILLINOIS
WA188073436 R3 0 3
-
......
Check No.
.'
2093 12879408
"
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08 RR REG ANN
3
GLORIA V SHARTZER
408 BOYER ST
SUMMERDALE PA 17093
$....676.65
VOID AFTER ONE VEAR
.' .
,.. .
~.' .
.,' .
"
.',..1
II' 2o"l3 311'
1:000000 5 ~81: ~ 28? "l1,08 311' ~ 50? "l 5
-
-
TELLER: FACE OF DOCUMENT HAS ONE COLOR BLENDING INTO ANOTHER, TOP TO BOTTOM.
I
00210'8 071488 52040017 3302'6 '68263769
I
coe fUND : OF.PT pnEr DATE VOUCHER WARnANT 10
FULTON BANK
LANCASTER. PA
80.142
313
85
16155954
r.lll.(;t< UUI,IIILn
-
-
, '. ""ollR .11'..,~
_; :Jor.,
tF"'" $'." ,"ANt')' 1',....''''',,,.'''''..
HuriJIM'I.""
"".
DATt
-
07/26/85
-
-
.
rtl~Q
-
-
VOID AFTER IBIl DAYS
.........
-
-
.-
-
--
-
TO THE ORDER OF
$ ............329.70
GLORIA V SHARTZER
OLN 94324199, REV REBATE
408 BOYER ST BOX 46
SUMMEROALE PA 17093-0046
e~ ~~l~
lREAsun~1ENNSYlVA "
===
II' ~!; ~ 5 5"l 5 loll' I: 0 B 30 ~ I, 2 21: ~ 2 ~ a ~8 !; ~ 2 211"
REVERSE HAS ARTIFICIAL WATEnMAflK. WARNING: ANV ALTERATION VOIDS THIS CHECK I '.
(IN ACCT. "-
NO,
WITH ACCT NO. 4-932'1-0207-1
'~"..TE GL CR 1 A V SHARTZEP :LUANO
,
2
3
4
5
8
IFEB94 ******es.oo D ****,,*40.01) 064e
lMAR94 ******es.oo D ******65.00 06'14
IAPR94 ****'*es.oo 0 ******90.00 e14e
3MA'i'9!f u*"*2s.00 D * H tUS.C)!) l)il21
I.1JN9!, HHH2,5. 01,\ IJ~" .:'~I).')O t'JI,<IC'
l.lIJL'/4 HO"'1.'5.00 D .. 16:'.01) e14E'
:Sr;'1':. ..40~-'.":'!..:..t:j(J I ..... . f,'t.CI(. !I::.~~.
;':'1. 0'''' H'''+~.:!:: lifJ '" ,-'v.::
.
7
8
8
10 2sDCT94 *******2.41 1
11 2sDCT94 *****217.41 W
lNDV94 ***'**20.00 0
* * 217.41 0642
****'*'0.00 0642
....*.20.00 0642
I 12
1"'----
1'13
I 14
I 15
10
17
15
PLEASE INFORM US OF ANY
. - .. . . . . . .
CHANGE OF ADDRESS
18
20
21
22
23
24
10EC94 *".*.es.oo 0 '*'***45.00 0368
3JAN95 ******es.oo 0 *****'70.00 0643
lFEB95 ******25.00 D * ** *95.00 3615
IMAR9s ******25.00 o~* 120.00 0642
3APR9s ******25.00 D * * 145.00 0821
IMAY95 ***n*2S.00 * .00 0821
lJUN95 ****'*es.oo 5.00 3615
DauphIn Depoalt Bank and Trust Company
NOTlCI- THIS BOOK SHOULD BI! PRESENTED AT lUST ONCE IN EACH YEAR 80 THAT IT MAY Be'
POlTEDL, THI! INTERUT ENTERED AND THI! PALANCE SHOWN. A CHECK WILL DE ISSUED FOR TUE
&ALANe.: EACH YEAR AT MATURITY.
. COOIII D-DtpOIII W-WIthd"wal I-tftltmt
WL:.lllUV"'.V.
519939
...1,' l' ,",:,' -""1''.i-~/\', l'''MDESCRIPTlON'-lf~ . ..\,"1"," 'l":~"f:'"i. l,\I..OROSS AMOUNT
COUPON REFUND FOR W/E 10/24/9
1180
I
I
I
DETACH AND n~... 'I". .'A"M'NT
THE AnACHED CHECK IDIN P f,lEN' F ITEM 0 :BCnlDEO VE.
IF NOI conn'CI. Pl."'" NOTO' U. pnCl/lp'L Y. t.8~'CEiP' .'E'lllJ,n,o.
I ::,'TOTAI,81:1.:1
~80 i
."'FAI>FrlfrAr.IIUil(lllFt:Aqlllff/\1
DATE
ACCT NBR
AMOUNT
10/25/95
4-9329-0207-7
1111111111112.40
INTEREST PAVMENT
FEDERAL WITHHELD
PASSBOOK CLUB
NON-NEGOTlfI.liLE
....."..
.
'1~. )joeolop ,N,,,,"
jjullbog '1III.t.lI''''"
PO &t"..........lIuunQ """10\
P1llltff,U,UIIIlQ
DISCOUNT
:00
I
I
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I
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I
\
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\
\00 I
NET AMOUNT
me'
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,
I
,
,
I
I
,
I
,
I
,
I
,
I
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,
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I
,
JJ8(
,
0027764
2.40
.00
''''"''"n..''....
ITEM
NUMBER
A.
1.
d.
B.
.4.
C.
1.
2.
3.
...
5.
6.
7.
a.
-!tk
COMMONWIAlTH o. 'fHNsnv.....l..
INHrllTAHCI! TAX aUUIU
UltDlHT OIClotNf
SCHEDULE H
FUNI!RAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES
P1oa.o Print or T e
.5;f/M rrf''<'
?,/.,,,~ -'4 V
.f/t' tls- - 0 J- f J
DISCRIPTION
Funeral Expo....'
~OJ\~~ ~/~
..kCW4. ~-
1.
Admlnbtratlve Coital
Personal Roprolentatlve Commlnlans
Sadal S_rity Number al Ponanat Repre,entatl"",
Yoar Commlulon. paid
2.
A1lorney F.e.
3.
family ex""'pllan
Oolman! ~0.M. S.h~. Relationship Srn
Add..... 01 Clalmont at deceden~s death
St...t Add.... "Off ~~.L\ ,r::.-fflD.:f
Oty S~d~ State P_lIpCode 17093
Prcbale Fee. - (1"., W""",.L (' ~
Mlleellaneau. Expon.e..
'4~C) -Jv- - Cu,.,., Wo...J.. ~
~().M>-..L - (Gt mui,
(). e.(!~~ '4-.u. - CcnvM.. i<"'fP
'::J . Q....., ":}.AA- - c....",.,W.;.....J G I'~
~r
TOTAL (Aba enter on line 9, Rocapllulallan)
Ilf more .pace I. needed, Innrt odd/tlonol .heet. of same .lle.)
AMOUNT
.!J, 7010.0'0
/)?o. aD
3S'llO. 00
J/;J,.n
ali',66
a~S"'OO
(g ~ O. 66
~S . <nJ
t:.rrd
s 15!i 6, (r1l
GRichardson guneral g{ome, dnc.
~~~,~
~o ROUTH ~:NOI.A 1lJ1IV~:
~:NOI.A. J>A 1711~r.
(717) 7:12,0:;87
MICIIA~:L O. MUIlIIA Y
SUJ>~:RVJSOlI
James Shartzer
510 3rd St.
Enhaut, Pa. 17092
August I, 1995
For The Services Of: Gloria V. Shartzer
July 5, 1995
Total Of Professionsl Services.
facilities And Automotive Equipment---------------------$ 1615.00
Charges For Merchandise Selected:
Casket Gray tone 20 Ga. Protective-----------------$
595.00
400.00
Vault Shsde Regular Gsurdian-----------------------$
Cash Advances:
Flowers--------------------------------------------$
Clergy---------------------------------------------$
Certified Copies-----------------------------------$
Total Balance Due: $
100.00
50.00
10.00
2790.00
}.han~ 10u I". 17 ~
"~J>u~
Michael G. Murrayt!
August 21, 1995
I, Jesse Flickinger, paid $270.00 to Churchhill Cemetary,
Reedsville, Pa, on JUly 7, 1995 to open grave for my sister
Gloria V. Shratzer.
.
r.,~..jv~
D DaU~~~Bank
PAY
lOTH! ~ '-i h I -
ORDEROF--o '^A.L. -1~~~
j w-o l.lumcW.L ~Ja~~ o..--noL .....'Ia-v
~
FOR_~'l
No, 0/ D
_~--'_~19..9r eo.a/.l.
I $ .;l ?o. 0-0
DOLLARS
ESl::::~~~,
1:0:1 ~ :1008:1 ....: ~OIlI:l?O q 2 ?II"
IIV"""""'IW
COMMONWEAltH O' PlNN'nVA.NIA
IHHUIIAHCI1AlIIIUIN
l"IDIHIOICIDIN'
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES AND LIENS
Plea,e Print or Type
FILE NUMBER
;;/~s- as' J"
ESTATE OF
5 /J,e /ZPA:.. &.,/0"" r .., U
ITEM
NUMBER DESCRIPTION
1. n rn~
~. ~ ~ t-..4 - SA""-\",,
3. f'~ ~ 6-a", - (2'. F. 7trf
'/, tr-.)l ~~ f?..-, ~ ..,;-rA..
S". AT '" .,..
~. ~ a.:tJ~
? PP..'/.
8. '1 k.t f~
q Clp~ C~ ~
~ "1'7 9
(frI 7r--O
r!,J/ 7 Fr/
AMOUNT
/ '3 tra . 1-0
I~? .:1~-
7:1.1.07
:loy,/J,
.;2q. 10
,;;s, 1.;1.
'It. . ~~
.;)~ .30
,.3\.. '19
/3i-. 'I'
CJ'I-'i!l
I 0 . O>>-a--
II . c",..,...... . ,~ .J::Jc... ,- --P
1:1. ~ ~o-c..o
t3~~~
IV /f Z ~
/.5' ~ (;....'2f ~/'""~.
I&, //~~ ~~'7?'
v~.tn
'7 I ~ . tr'/l
~~? 9 7
~.ft'.? .Po
8.7'/
S-~. d"O
~/. e1l::)
, TOTAL (AI.o onlor on IIno 10. Rocopllulollonl
(II more 'POct is n"d.a, inser' o~ditionol sh..,s o( some size.)
$ ~i'tJ6. //
..'
IIY.IIII... p_.,.
ESTATE OF
ITEM
NUMBER
ITEM
NUMBER
1.
.,'
'*'
COMMQNwfAl1H 01 "NNll'lVANI"
IHHIIlfAHCI ,.... .nUIM
I.IIDlNIOIeIDIN'
SCHEDULE J
BENEFICIARIES
SI//f.eTz ~,t:.
t1-AJt!/.19
0.
FILE NUMBER
.;:l/?S" - OS",f'?
NAME AND ADDRESS OF BENEFICrARY
1.
A. Taxabl. B.qu..".
"J"A-me.s (Y1. .shA,:T~r'Je..
~,o ,111M s.ctt"r
c" )119"'. I" AI n' .1/ 3
])tln hid. shll ~Tz~.<.
'IdS &ye/C. ~6 /f.tltI/
SI4"''''t"iC,J.,../.. fl+
LL Sht4-I!Tzt"1'2...
C 1'1"..... Y
Yog; /30'lU' s.,"'''' T
SII m,"trttJA I.. f~
.... m lite T"~
l3e7Ty \JA-ne
Po ea" 1/7
.;lOt.. O~e S.e/l.uT
Ra~~'" FI4.~nP;"e. fA /7'idfj
RELATIONSHIP
AMOUNT OR
SHARE OF ESTATE
J
3
If
~5'%
of R....r"e/.,e..
.;:I'$;"%
oiF ..t'.... ",..I"" e
:lS"U
/) ~ .R",s ,11/ U e
.:l s- %
or R...,r...d'...c
B. Charitable and Govlrnmenlal SequII'"
NAME AND ADDRESS OF BENEFICIARY
AMOUNT OR
SHARE OF ESTATE
TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (AlIa .nl.r on IIn. 13, R.copllulallon) S
(If mar. .pac. I. n..d.d, In..,, additional .h.." of .am. .1../
:'~j)~~~<~~~lA"~~;~3;~~~~iJ,;i'.:~-:_'':;'i\:,,~~~~~,~,:';~;~',;(+~:~~';"_""~,-t~';;':-.;~;:_,.~,_.; f.
INVENTORY
FRlntn 01 ,_..G:-:!~.t?I~__l).,~..~h..,,~ T~~~__.._._...._
No.
I 9f'~- t:)()s"S'.7'
J"~/y s", l?fS"
nu.n
niNo known iU,
Ontn or Onnlh
r,,'flOllnl nnrll"lI"tn'ntl""f~1 of Ih" nh""," F.lnle. lhll':nnllnrl, wilily Ihnt Iho hOIlUI ftpt'uJI,lngln Ihn lollowlllU lnvolllory Includ. nil
fl' 1'1'1 """,,11,,1 ".""1,, wh",n"n, "ltllll'" nlllt nil (I' Ill" In,,1 ,,"In'n 1I11ho Cnnllnonwn"llh of rnnn.vfvnnln of tulld Docndon'. tI"tI
Ih" v"funtlnll (llnr.nd n",mflll" nnr:h 11"11I of "nhl hwnllln,y rnlllnllnnlllllll Inh \lntun nil of Ihe dnlo nf ,hI' Oecltd"""1I duth. "lid
Ihnll)nr.II"'tI" t)wllnrf IIn ,"nl ,,"lnln nul"ld"." 1111' Cn'"lUnnwft"llh 01 r"'lIIlyCvnnln ".""I,llhftl whlr.h """'''1'" In II "H'I",o","dunl
nl rh" "lid tI' 'h'" IIw"lllnry. Itw" "'"tHy Ihnt Ihn IIln1"I1UI"'" Innf'n In Ihl" IllvenlfllY "'0 true ""rl nnUool. Itw" underlllnnd 111.1
,,,1,," lllnlnlt1ftulll hn,"ln '''" Illn,l" I1lfhJpcl tn 111ft ""lInlll,," nl 18 r,.. C.S. 5"nllnll 4904 "I"lllIg 10 """WOIn 'n".1fIeAllnn 10
"1'lhnrll1rt".
rnrl'l('If1nl nnr1lfUl"lllnllwn:
~!~;~~i~:fi(O~.__.:;s.~m~~_''''n:'..._~hl!~T?:~~....------ -:s~~~~ .
1.0.111).: .
..-........-..-..-.. .. .. .--.--..-... ...-..... ......-......... -_._._-----~...__._---.__.._..
I.
a...
.d.
t/.
$'.
b.
7.
--.-..-...---___.______.___.____. ()ncnn~",l Soclnl Sccurllv No. I/;, 8'-"{,, -d?61
-.-..-..-.--------.-.---
^./."..., ..._...S',!,(J".._Tb.(~.rj".., ~e: ,.,.........._. _ ,,"__
.....cllh.A""T .. ..fo,.,,__./ilJ~ . "_____"n_
tnr."hn".'...J:.D.L7.::>, ..._,@.9._-:._3.Y_1.,~_ ....... _ ...._,._
Dnl.d r-'-~-.....Lf'~--._.-
Dnlli':t1ltllnn
V.lun
1./08 lSoYP/C. 5:6.
SUltlm,,eJ...I.. fA- 17093
(10
-S6, (JO().
.3~9. 70
1'1~.oO
t;tr\ 9 'fa::. '/1'1'1 Rell. 'ReIoAle.
'>. -.- """Ru,oaoS. Acer.
:bA-u..f'h.n 1.)"po~" ~, ,
l{- '1~:J"t-
0;1.07- 7
G.?(" .~S-
Uniled, S-t;F\TE's, "-Rt'fI..s.ury- R,PtlflJ..
..... ....... c\ I, f:\ cc.o...."T
'::bP,\A,1>h '" uCf' O-S l\ U
r"'IR.~Qi'" new.! f?e f'...."c:\.
.;;J.YO
t. ro
lOI 11 't
LOI 7~ 0
LoT if? I
'S.c.o1fscl~r~, ~~l~on Ft
(^IIDCh Addlll"nDI ShcCls,II,.mcc"D1VI
TOlol:
. I ".,
$6"7, ~OS-: S"S-
, . I' ,,~.. #.#.
.....
. .
.'
'..
.. ,
, '.
'H-If 'h,. t.."mnllllllhllll nl ,,.,,1...1111,. lUll "tin .,," f'nl"lUflIlWI'l'lIh nll'''''Il,yh,nnllllll.'Y. "'"1" ,.1,.,.11.." n'lIl1'l r"ltlllllll'''p'''UlllllIll\lft. Indllll'!
II... ...Ih." nl ,,"rh l!run. "111 '"1'11 flnlllf" .1101111111"1 hlll'.I~'lIlrllr IlIln Ih" 1111,,1 nllh~ InwnlllnlV
\
,,- -- ~" .-".
""'-----....;'-'--'-'-- ....;-------- - -....;-_._-- --- ---'- --- - --- - - - - -----
.
~~~~;~:'t;i:~:~';;j;~.~~;:~:.:~ ~O~M~N\yEALrH^ OF PE~msv.:vAN'A
Drg;;~t9!.~~g~t^~/c:"\':"~' ,DlI'ARrMINrO'RIVINUI" ^ '
r'(i':;~lihi1~i'i',~t:^t, 'OF~ICIAL RECEIPT'. PENNSYLVANIA INHERITANCE AND ESTATE TAX
ACN
ASSESSMENT P:'
CONTROL .:I
NUMBER
.,...-.,..... .'-,' ..
,.-........ .,.....-...--
"'..,',.
---,:,-,. -, .... ','
.'.;' ",,"', ,
,', ',-' "0 "
c.......:_...,
,~:;.',>
, .. .. .
RECEIVED FROM,
I
AMOUNT
JAMES M. SHARTZER
~10 THIRD ST.
101
.e.6'i'O.'i'1
ENHAUT. PA 17113
ESTATE INfORMATION,
~ filE NUMBER
(II 21-1991:5-0:5B9
EJ NAME Of DECEDENT (LAST)
II DATE Of PAYMENT
ra POSTMAR E
COUNTY
BSN 16S-26-3769
IflRSTI (MI'
I
I
'04DHIII1
I
I
,
I
,
./
:,
I'
"
i,
,
^,
, ",
,
. .'1~
',>
DATE Of DEATH
'/
"
"
..
'"
,.
JAMEB M SHARTZER
m TOTAL AMOUNT PAID
.2.690.91
PB
REMARKS
SEAL
CHECI<.. 24
REGISTER OF WILLS
RECEIVED BY / i/ "~~N'IU'" ..'. , :_ . /, j
MARV C. LEW~S ,.c.'; .J/';'lj'
REGISTER OF WILLS
,/
=.,-,-,- -----------="".=,== ==-,,....,....,....------ ------ ---~:-:-.---.' ,
;
~. '
....
t
,
't
."
--:=----~~..Jl4.
-~
r. - i
, '.
...... -..'
....---.
1._ .
I I
\.
~ ~~J~J~~~
~ft+
);''\,;. 'y.
~~..~ ~~~~~;:
I'i"
,-
"
b
uu
".
I'IMt'OIl llI'
NOIICI.
To fulfill the r~lr.-.nt. of S~tlon 2140 of the InherltlnC' ~ E.t.t. Tax Act, Act 21 of 1"1. (71 P.I.
aMtlon 1141).
,AMNT.
o.tMh tt. top portion 0' thb HoUe. Md IIUbIIlt with your p.'t8Mt to the Rital.t.r 0' Wll11 printed on the
r.v.,.. .1....
... "Ilk. chHk or MlnIIY ar"'r p.pill. tal MOISTER OF WILLS, ACEHT.
All "YNnt. rlK.lved IhIll first tJ. IIpplled to .,y Inbt..t .....Ich ..y be duI, wi th MY r...lndlr IfIPlled to the tn.
mUND ICJIIJI
A nfund a' I tlx crMilt, .....Ich .... not r.qu..ted on ttM tlx nturn, ..y be r.....t.d by co~I.Ung IIIf'I "Appllc.tlon
'ar R.fund 0' Pennlylvenl. Inn-rltlnc, end E.t.t. T.." IREV-IJIJ). Appllc.tlon. .r. .v.llabl. .t the Dfflc. 0'
thl R.,I.t.r 0' WIll., IInY 0' the 2J R.v~ ol.trlat Of,lc.. or by c.lllng the .peel.l 24-hour an.wetlng ..rvlc.
nw.ber. 'or 'or.. ordering, In Penn.ylvanl. l-IDO-562-2DSD, out.lda Pann.ylvenl. end ..Ithln loc.1
H.rrl.burg .r.. 1717) 717-1094, TOOt 1717) 772-2252 IH..rlnl 1.,.lred Only).
DIJICTIDHlI Any p.tty In Int.r..t not ..tl.fled with thl IIppt.I.lllftt, .llovlnC. or dl..llowene. of deduction. or ......-.nt
0' tn (Including dl.count Dr Int.r'lt) .. shown on thll Hotle. ..y object within .I.ty (60) day. 0' rec.lpt a'
thh Matlc. bYI
--wrltt., prot..t to the PA D.p.rt.-nt 0' A.venue, .Glrd 0' App..II, Dept. Z11021, H.rrllbur., PA 17121-10Z1, OR
....Iectlng to haVII the ..tt.r d.tlr.lntd .t ttM 8Ud1t 0' the .eeeM'lt 0' tht pttlOftllI repr..ent.tlv., OR
--",,"1 to the Orphwl.' Court
..'tlN.
IITR.nw:
CDAR!CTIDNS,
'actual .rror. dl.eov.red on thl. .....lIInt .hould b. tddr...'" In writing tOt PA D.p.rt.lnt 0' A.vlftUl,
aur.au of Individual T.x.., ATTHI Po.t A.....ient A.vl... unit, DEPT. ZID6DI, H.rrlsbur., PA 17121~D601
Phone (717) 717-6505. S.. PIGI J of the bookl.t "Instruatlons for Inhtrltenc. T.x A.turn for. R..ldant
Dectdlnt" CREV.1SOI) for In ..pl.natlon 0' tdllnlltr.tlv.ly correcttbl. .rror..
DIlCot.NT,
If MY t.x due .. p.ld ..Ithln thtt. (5) c.lendar IIOnth. .ftlr the dKtdent'l dllth, . flv. p.rc....t (5~)
discount 0' tht hll p.ld II .Uowed.
INTERE:ST I
Inttr..t It chlrged bealmlna with first day 0' d.llnquency, or nlt'll (9) ItOf1th, and one 0) ct.y
frOll tM dat. of da.th, to the det. 0' P'VHnt. T.... which bee... delinquent bIIfar. J....rv I, 1912
~r Int.r..t .t the r.t. of .IK (6X) plrc....t par ~ c.lcul.tld .t . dally r.t. 0' .000164.
All tax.. which bee... delinquent on or .,t.r J....rv I, 1912 will baar Int.r..t .t . r.t. which will v.ry frOll
c.lenct.r p.r to c.landar y..r Idth thlt nt. ~H by thl PA Dlpert.....t 0' R.v..... The eppllC8bl.
Int.r..t r.t.. 'or 19'2 through 1'" .r.1
uu Int.r..t A.t. nallv Int.r..t Factor xur Int.r.d Aat. Dalh, Int.r..t Factor
l'IZ za. .000541 1'17 .. .ODD2U
19U ... .00001 1'11-1991 11' .DDOJOI
1914 11' .nDJOI 1992 .. .DD0247
1'15 I.. .DODJ56 1995.1994 n .000192
1916 ... .DDD274 1995-199' .. .DlU47
--Int.re.t II calcul.tld .. followll
IICTEIlEIIT . BALANCE OF TAX UNPAID X HVKBER OF DAYS DELIHQUENT X DAILY IHTEREST FACTOR
--Any Notlc. 1..UId .,t.r the tax beao... d.llnquent will r.flect an Int.r..t c.lcul.tlon to"I,t.Ift liS) ct.y.
btyond the dati 0' the ......~t. If p.pant 11 ncM .fter the Inter..t '=::>4MJtatlon dat. ahown on U.
Hotlc., tddltlonal Int.r..t au.t bII calculated.
REV-1S47 EX AFP (12-9S*
COHHOHWfAlTH OF PENNSYLVANIA
DEPARTHEHT OF MV[)'JE
IURfAU OF IHDIVIDUAL TAXES
DEPT. lIOUl
HARRlSllItO, PA 17121-0601
mAT 0 FILE NO.
DATE OF DEATH 07-05-95 COUNTY CUMBERLAND
HOTE, TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBNIT THE UPPER PORTION OF THIS FORN WITH YOUR TAX
PAYNENT TO THE REGISTER OF WILLS. NAKE CHECK PAYABLE TO "REGISTER OF WILLS, AGENT"
REMIT PAYMENT TO:
15 -;If..f'
"
ACN
NOTICE OF INHERITANCE TAK
APPRAISENENT, ALLGWANCE GR DISALLOWANCE
OF DEDUCTIONS AND ASSESSNEHT OF TAX
JAMES M SHARTZER
510 3RD ST
ENHAUT PA 17113
DATE
101
04-15-96
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
AltOW'It R..ttt.d
e
"
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
iiE"v=is'47"i)f-AFjo--mr:9ifj-iloYicni;;-'I"tiHEiiifANcE-i:Ax-jiPPR'AisEifiilT-,--,m.-ciwAiicrcijfm----m-------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF SHARTZER GLORIA V FILE NO. 21 95-0589 ACN 101 DATE 04-15-96
7,556.00
4.806.11
CllI
1121
1151
1141
14. 1S ond~or 16. 17 and 18 will
rat urns assessed to date.
TAX RETURN WAS' (X I ACCEPTED AS FILED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. R..I E.t.t. (Schedul. AJ (1)
2. stock. ~d Bond. (Schedule B) (2)
3. Clo..ly Held stock/Partner.hip Int......t (Schedul. C) (3)
4. "ortaeg../Not.. Receivable (Schedule D) (4)
5. Caah/Bank Depoalt.'Hlac. Par.onal Property (Schadul. E) (5)
6. Jointly Owned Property ISchedul. FI 161
7. Tran.fara (Schedule 0) (7)
8. Tot.l A...t.
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Fune,..l Expan.../AdII. Coda/Hi.c. Expen... (Schedule tn
10. Dabt./Hortgage Liabi1iti../Lian. (Schadula Il
11. Total Deduction.
12. Hat Value of Tax R.turn
13. Charitabla/Govarn..ntal a.qu..t. (Schadula J)
14. H.t Value of E.tat. Subjaot to Tax
191
1101
NOTE:
I~ an assessment was issued previously. lines
reflect ~igures that include the total o~ ~
ASSESSMENT OF TAX:
15. Aaount of Lin. 14 .t Spou..1 rat. (IS)
16. Aaount of Line 14 t.xab1. at Lin..1/Cl... A rata (16)
17. Aaount of Lin. 14 taxabla at Collataral/Cla.. 8 rata (17)
18. Prinoipa1 Tax Du.
TAX CREDITS:
PAYNENT
DATE
01-17-96
RECEIPT
NUNBER
AA082526
DISCOUNT
INTEREST
1'1
1-)
.00
I CHANGED
56.000.00
.00
.00
.00
1.205.55
.00
.00
leI
.00 X .00.
44,843.44 X. 06.
.00 X .15.
llBI
ANOUNT PAID
2,690.91
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST
TOTAL DUE
. IF PAID AFTER DATE INDICATED. SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
57,205.55
l' .~Iil' 11
44,843.44
.00
44,843.44
.00
2,690.61
.00
2.690.61
2,690.91
.30CR
.00
.30CR
IF TOTAL DUE IS LESS THAN '1, NO PAYNENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRI, YOU NAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORN FOR INSTRUCTIONS. I
'.
2~ ~ :oS'
g.~ t~g
l~! J ;g -,~
~'_~ r.>
t: 'j .;t..lt\
., o.
o. . -- 9,,(;
:; N
b' " --'
;<3 :~, '.)
,1.1 ~(Il
~) <::> Iii 0
~~= h:. -
)>;:1- ~
MSERYATlClh Elhlt.. of dectldentl dvlna on 0,. afan Declllbtlr 12, 1912 .. If ."y future Intl,...t In thl ..ht, 18 i,..,af."red
In pa.....lon Or' .nJo~t to el... I (colll,.r..' beneflclerl.. of t~ dec~t .ft.,. the l.plrlt1on of MY I,'at. for
llf. or for v..r., the C~.lth her.by ..pr...lv r"lrv.. thl right to appr,... ~ ...... t,..,.f.,. tnh.rlt~. TIM"
It ~ l~ful el... . (col1.t.~1) r.t. on IIf1Y luch future lnt.r..t.
PIJlPClIE lIl'
NOTlCEI To fulfill tN ,...,l,...."ta of Section 2140 of the triMlrltMCI Bnd flt,t. 'n Act, Aat ZZ of 1991. 12 P,S.
Section 2140.
PAYItDf'f. ~tKh tt. top portion of thh HotJu and ,ut.lt with your P''PMt to thl hglstl,. of Will, pr-lntMl on tM n".r" .Ida,
--.... check Dr IIOMY ordll,. plv_11 tal REGISTER OF MILLS.. AGENT
All PIYltWltl "Halved sNill flnt b. IIPtIUld to MY Int.r..t which ..y btI du. with My n..lndllr appl1ed to tM t...
REFUND (CAli A r.,Lftd of . tax cndlt, which .... not nqutl,ted on thsi T.IC R.turn, .ay tM rllqUe,ted by cHPhtlna WI "Appl1c.tlon
for R.fund of P~sylv~l. l~rltBnCe ~ E,tlt. T.x" (REV-ISIS). Appllcltlon. .ra Iv.lllbl_ It t~ OffiCI
0' the Regl.t.r of Will., any of tn. 2S R.v~ DI.trlat D,flc." or by c.lllng the Ipeclll Z4-hour
~'Wlrlna ..rvlc. nuaberl 'or 'Qr.. ordering. In P~.Ylvanl. 1-IOa-S6Z-ZD5D, out.ld. P~.Ylv,"l. and
..lthln loc.l Harrl.burg .rl. (717) 717-aa94, TOOl (717) 77Z.ZZSZ (Helrlna IIp.lred Only),
DIJECTlDHSI Ariy party In Int.r..t not ..thfled with the appnls..lf1t, .UOWBnC' or dls.llowanc. 0' deduction., Dr .....uent
of tlIC (Including discount or Int.n.t) .. ahotIn on this Hotlc. lIU.t obJHt within IIMty (60) du' of rH.lpt of
this Notice by.
.....r1ttan prot..t to the PA Dep.rtaent of A.venu., Board of App..ls, D.pt. zalOZI, H.rrlsburg, PA 17121-1021, OR
....leotlon to hlVI the a.tt.r d.t.r.ln.d at .udlt of tha account 0' the p.r.on.1 r.pr.,ent.tlva, OR
....~.I to tha Orphan,' Court,
AIIOtIN
llTRAlIYI!:
CDRRfCTlOHS.
DISCOUNT.
Fectu.l .rror. dllcow.rld on thl. ......lInt .hould b. Iddr...1d In writing tal Pi Dep.rt.ent of A.venue,
lura.u of Indlvldu.1 TaICa., ATTNI po.t A......ent A.vlew unit, D.pt, Zla6DI, H.rrl.burg, Pi 171rl-0601
Phone (717) 717-6505. S.. p.ge S of the bookllt "In.tructlon. 'or Inhlrltsnc. T.IC R,turn 'or. Aa.ldlnt
Decadent" lREV-ISOI) 'or an IICPllnltlon of .dllnlltr.tlvaly correctabla arror..
If ."y tax ctu. Is p.ld ..Ithln thr.. UJ c.lendar IIonthl .ft.r the d.udentl. d..th, . 'Iv. p.rclnt (Sin dbCCM1t of
the tlIC paid I. allowed.
INTEREST I
Int.r..t I. charged b.glnning ..Ith flr.t d.y 0' dlllnquency, or nine I') aonth. and ~ 11) d.y 'r~ thl data of
cte.th, to t~ ct.t. 0' p'v-ent. T.... which bee... d.llnquent blfar. Janu.ry 1, I,az b..r Int.r..t .t the r.t. of
,IIC ,'X) percent par ~ c.lcul.t.d It I dilly rata of .aaal64. All taM" which bee... dlllnquent on ~ I,t.r
~ry 1, 19a2 ..Ill baar Int.r..t at . r.t. which ..Ill vary 'roe calendar y..r to cal.nd.r y..r ..Ith th.t r.t.
~Id by the PA Dep.rtaant of Rlv.,..,.. The appllcMlI. Int.rllt r.t., far 19lZ through 1996 .r.,
~ Intarllt Alt. D.II'1 Int.r..t FaG tar :!!!r Int.r..t A.t. D.II'1 Int.nlt '.ctor
I'll ..X .aDD54. 1917 'X .aDOZlt7
1915 I'X .aDau. 1"1-1991 IlX .aDOnl
1'" IlX .000SOI 199Z 'X .aa0247
1'85 UX .OaosS6 I 99S-1 9'" lX ,OD0l9Z
I'" lOX .Oaor74 1995-199' 'X ,aODZ47
--Intarllt II c.lculet.d .. 'allow.'
INTEREST. SALAlfCE OF TAlC UNPAIO X NUNSER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
uAnY Hotlc. h.ued Ift.r thl till becOMI delinquent will reU.ct In Int.r..t ulcul.Uon to ,Iftlll'l US) d.n
b.yond thl d.t. of thl ......sant. I' p.yaant I. .Id. .ft.r thl Int.r..t coaput.tlon dlt. shown on thl
Notlc., ~Itlonll Int.r..t au.t ~ Cllculatld.
.
-, -~..
STATUS REPORT UNDER RULE 6.12
Name of Decedent:
r:- kll III
Tu/v () ,
, .
I/, SA,8,,('/.2f" .e.
Jfi f'.r
Date of Death:
Will No.
Admin. No. ..?/-fS- StY?
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 estate:
1.
v
State.~hether administration of the estate is complete:
Yes-A-- No
2. I f the answer is No, state when the personal
representative reasonably believes that the administration will be
complete:
3. If the answer to No.1 is Yes, state the following:
a. Did the personal r~esentative 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.
Date: L /~, /1:f~
i7
~~.~ ~A~'N\'
Signature
"Jflmt>.s /17. S,d.q;e7:.:z~/C
Name (Please type or print)
:')/(1 7i1 If't:) .5-(,. ~ IJIllt -r 1?9-
Address
f'J
"
r-_
(ll
-,-;r
~-;
('7/71 139- 3Y'/d-.
Tel. No.
",'\,.
(i:.'
)
rn
)(
-- j ~j
(jO
Capacity:
Personal Representative
Counsel for personal
representative
( MAH : rmf/ AM3 )
1-,~- :~~_..,.~,.,..,..~~---,.."..,.....,,-;'!-_~__~_ ___T