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Home My WebLink About96-00042 I !. '~J t~~ ,~ ~~ ';'( .., .~1 l:1\ I,lt. "j-, ....:<: VJ .... , :r. , t.; ,~\ ::!j , 8:" '. r i" i5: \lla: .) 0:- a: _::l uU . ,,~,';'. 1 ':t.Q> . .:t: ~ . '. $ijt' .... ... ". . -' ,... .......~ ...., e I~ ~ Q ~ S Z I-l i l"l C!l ~ :! . ~ ' I~~ II n .. C 'C ~ ~ . :c ~ 1/1 ~, "",: ~ .. .. . '" fy CERTIFICATE $lit NQTIC;E UNDER RULE Mfa) Name or Decedent: Sara M, Germain Date or Death: December II . 1995 Will No. 1996 . 00042 Admin. No. 2196.0042 To the Register: I certifY that notice of beneficial interest required by Rule 5,6(a) of the Orphan's Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on January 19, 1996, ~ Calvary Independent Church Address 3201 North Progress Avenue Harrisburg, PA The Alliance Home 770 South Hanover Street Carlisle. PA 17013 Mary Harro 6055 Outlook Avenue Boise, ID 83703 Virginia MacNab 1618 Puerto Vallerta Drive San Jose. CA 95120-4856 Gretchen Harro 1618 Puerto Vallerta Drive San Jose, CA 95120-4856 Thomas Harro RRI. Box 255 Briarwood Lane Kankakee, IL 6090 I Dale Harro 10 Sylvan Avenue Delmar. NY 12054 Mary Schnaithmann 710 Hilltop Road Harrisburg, PA 17109 r' J. I Dorothy Hoeflich 4209 Lexington Street Harrisburg, P A 17109 I , I'~, r ., Oeorge L, Harro 12448 West Oraves Avenue Waukegan, IL 60087 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: NONE. January _' 1996 ac, ~ r- vi .- :::J 36 South PItt Street Carlisle, PA 17013 717.243-6090 Attorney for Estate of Sara M. Gennaln (- ~ \~J ~ .-:.... ::-... 0) IIY.UOO.... "." ~ ..:s.. Illf~ :cf9 "":r" 15-7'il-(/ .Z: .01 DATIl O' DIA'H Ami 12/21'" CHICK Hili If A SPOUIAL 'OYII" CIIDIT II CLAIMSD [] nLl HUM.SI * COMMONWUlfH 0' '(NN\'flYAHtA OI....UM(Nf Of 'IVINUI om 1.0601 H"UllIU'O 'A !~!~. ~I N NAIrIlI I'A'. t' AND .....001 INI .AII INHERITANCE TAX RETURN RESIDENT DECEDENT (TO BE FILED IN DUPLICATE WITH REGISTER OF WILLS) 21 C.oUNIY COD.I __ _ o N ""I A . 1996 YIAI - ._._.._..__m_..___ 0042 NUMI!I ! a G unain, Su I tAl ueUltlY NUIrIlUI 710iSouthHHanover Street A 1 ance ome c::rcbg!3t1KAd 17013 AMOUNI IrellYID IUI.NllluerIONSI 203-10-7743 t" "1'\"".'" hJh'f'...o lIeuU t ......., I'." "." .....D ""OOtl '''''''''11 03 Os ,,. ::Jill "'a "'2 82 EX I. O,iginol R,turn [} 2 Suppl,m,n'ol R"urn Q ... Limi,.d E,tat, C"a Futur. In',r"l Compromill (fo, dolo. 01 doo,h aho, 12,12,821 i1l: 6. D,c.d,nl Di,d hila" [~ 7 DIC,d,nl Mainlain,d a Living Tru,' IAlIoeh copy of Willi IAllaeh copy of TruIII ALL CORRISPONDENCE AND CONfiDENTIAL TAX INFORMAnON SHOULD BE DIRECTED TO. HAM! CO"'iI'IIU MAtltNO AOOlln R,maind,r R,lurn (lor da"1 of d,alh prior 1012.13.82) Fad,ral Ettol' To. R.lurn R.quir.d _ 8. Total Numb,r of Sol, D'polif BOIllI 36 South Pitt Street Carlisle, PA 17013 (11 -0- (2) 32.316.00 (3 ) 0000000 (4) 2,017.04 151 44,535.02 16) -0- (7) -0- (B) 78,868.06 (9) 10,011.10 1101 8.540.83 Harold S. Ir win III IUl'HONl NUMlfl 243-6090 z a ~ ::> ... 5 III '" I. Roal E"alo (Schodulo AI 2, S'ack. and Band. ISchodulo B) 3. Clo.oly Hold SlcxlUPartno"hlp Inlo,o,' (Schodulo C) ... Mortgagll ond Notll R'Clivabl. (5eh.dule D) 5. Coth, 8an~ D.posih & Mile.llon,oul P,rlonal Prop.rty (Sch.dulo E) 6, Jalnlly Ownod P,aporty (Schodulo F) 7, ',an"...ISchodulo G1ISchodulo l) 9. TOlol Grall AU'II (Ialollin" 1.7) 9. Fun,rol Eapenlel, Adminislrali'll CaUl, Mileellan,oul Expon.o. (Schodulo H) 10. D.bll, Mortgag' liabililits. li,nl (Schedul, I) 11. Total Deduction, Ilatol lints 9 & 10) 12. N.I Valu. of Elfot' (lin, 9 minuI line 111 13. Choritobl. and Gov.rnmtnfol Bequel" (Seh,dule J) 1... N.t Volu. Sub.ct 10 Taa (lint 12 minu.lin, 13) 15, Spau.al ',an.fo" (la, dolo. 01 doalh oho, 6.30.94) S.e Instructionl for Applieobl. P.rclntog. on Rev.". (15) Sido, Ilndudo valuo. from Schodulo K a, Schodulo M.) 16, Amaunl of lino 14 'acablo 01 6'1(, '010 (16) (Indud. value. from Schedule K or Sch.dul. M.) 17, Amaunl of lino 14 lacablo at 15% '010 (17) (Include volu.. from 5ch.dul. K or 5eh.dul. M.) 18. PrincipallalC due (Add 10lC from linll 15, 16 and 17.) 19. C"dill Spoulol POy.rty Cr,dil Prior Paym.nh + 4100.00 + 20. lllino 19 I. g,oalo, Ihan Uno lB, onlo' ,ho dllloronco an Uno 20, 'hi. I. ,ho OVEIPAYMENT. iii 0 21. 1I11no 18" groalorthan lino 19, onlortho dlRo,onco on lIno 21. 'hi." Iho TAX DUE, A. Enter Iheinl.r'lt on Ih. balance du. on lIn. 21A. B. Inlo, tho 10101 of lIno 21 and 21 A an lIno 218, Thi. I. tho BALANCE DUE. Moko Chock 'ayablo '" Rogl.,.. ., Wlllo, Ago.' 121) (2IA) 121B) (111 (12) (13) (14) -0- x.__ -0- x .06 - 47,498.96 x .15 . 2 co ~ ~ . 8 S (1BI Dileount Int,r.u (19) (20) Chl'(~ III"" ,I yo" 1111' It'lIU,'',IUH) U H lund of your OVl"pllynll'nl . I Z1.fJ' ",., /", ADDIlU - S Arl S~ (~d;) (/ (;0,',0 '~)/i , 7.::.,j 18.551.93 60.316.13 12,817.17 47.498.96 -0- -0- 7.124.84 7,124.84 4.100.00 3,024.84 3,024.84 -0- 3,024.84 n, Rest, residue and remainder of lilY estate I give, devise wId bequeath to Mary Harro, Stewart Harro, George Harro, Thomas Harro, Dale Harro, Mary Schnaitlllllann, Dorothy HoeOich and The Alliance Home of Carlisle, 1) A, share and share alike. C, Should any of the i~dividual beneficiaries listed in paragraph J,n, above predecease lIIe, then the share of lilY estate given to such beneficiary in that paragraph I give, devise and bequeath to such beneficiary's children, share and share alike, the child or children of any deceased beneficiary taking the share their parent would have taken if living, Should any of the individual beneficiaries listed in paragraph J.n, above predecease lIIe without issue, then in that event such beneficiary's share of lilY estate shall lapse and be divided prorata among the remaining beneficiaries in that paragraph. 4, I nominate and appoint George Harro to be the personal representative of my estate, to serve without bond. If he cannot or does not serve, then I appoint Dale Harro to be the substitute personal representative, with the same powers and also without bond. 5. I suggest that my personal representative retain the services of Harold S. Irwin, III, Esquire in the settlement ormy estate, IN WITNESS WHEREOF, I have hereunto set my hand and seal this 'ItA! day of 'h1"A1 . 1995. AlA (t m ljUvrn. a-..:.... SARA M. GERMAIN (SEAL) "V.ISOI.... ,..... '* COMo\lOHl't,IAl.'.~ 0' IINNInVANIA IH1W.b~'Nl.D'~U~~.H SCHEDULE B STOCKS AND BONDS SARA M. GERMAIN 21-1996-0042 (All .......rty Ielnlly..wn'" wllh ."hl .f SuIYlverahlp ",ull be dlocl...d .n Schedul. P.) ITEM NUMBER DESCR'PTlON 1. December 1974 - Series E - $1000 BOND May 1975 - Series E - $1000 BOND July 1975 - Series E - $1000 BOND November 1975 - Series E - $1000 BOND March 1976 000 Series E - $1000 BOND Harch 1977 - Series E - $1000 BOND April 1977 - Series E - $500 BOND July 1977 - Series E - $500 BOND October 1977 - Series E - $1000 BOND September 1978 - Series E - $1000 BOND August 1980 000 Series EE - $500 BOND August 1980 000 Series EE - $1000 BOND August 1980 - Series EE 000 $1000 BOND 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. VALUE AT DATE Of DEATH 3408.40 3340.80 3250.80 3282.80 3194.80 3084.40 1542.20 1515.00 3030.00 2556.80 822.00 1644.00 1644.00 s: .32316.00 D Dauphin ~ Bank and Trust CompalY "AIH O,ooCE 2'J "AAKET STREET. "ARR'SBUAO. ~E"HSVLvA"'. '710' 117 21l1.N' Decedent Confirmation Name: Sara M. Germain Social Securl ty No.: 203-10-7743 Date of Death (DOD): 12/11/95 ACcot.f'lt No. 8100411484 0036954594 Type Certificate of Oeposit Check I n9 DIlte Opened or Issued 10/31/94 06/14/79 ------ Date Closed or Matured 01/31/98 (Maturity) 06/07/96 (Closed) 0094025843,~ Check I n9 12/17/82 01/23/98 (Closed) Date of Death Balln:8 $1,065.00 PU.S Date of Death Accrued Int. $7.78 $11,141.09 $3,275.88 $1. 22 $0.54 Joint OIiners (if any) None None None Date of Joint OlInership Special 0 mta: N/A Addlttonal In'orMttan a.anabla at 120.00 per '-r. Qole hour atnt_. Date Prepared: June 14, 1996 Pr8Pllred by: Cheryl A. Bowers CUstOlMlr Manag.......t Information Dept. (a4I) Page 1 of 2 Telephone No. (717) 255-2054 ,~ 00-020.21' c~ 7/111 D Dauphin Deposit Bank and Trust Company ......IN O'''CE 213 ......AKE' STAEET. HARRISBURQ PENNSVI.'JANIA l,tOt "'25H'2' Decedent Confirmation Name: Sara M. Germain Social Security No.: 203-'O-77~J Oate of Death (000): :2/11/95 Acc:cunt No. 8100411484 . 0036954594 0094025843 Type Oate Opened or Issued Certificate of Deposit Checking Checking 10/31/94 06/14/79 12/17/82 Oate Closed or Matured 01/31/98 (Maturity) Oate of Death Balance $1,065.00 06/07/96 (Closed) 01/23/96 (ClOSed) $11,141.09 $3,275.88 PUJS Date of Death Accrued Int. $7.78 $1.22 SO.54 ----------------- ------------ ---- Joint OiIners (if any) None None None Date of Joint OIIinership Special 0 nts: N/A CUstoaNlr Managlll8nt Information Dept. (041) Page 1 of 2 Telephone No. (717) 255-2054 AclcItttonal tnforuttan avat labIa at 120.00 per hour. on. hour .tnt_. Oate Prepared: June 14, 1996 Prepared by: Cheryl A. Bowers 'ora 00-020-211 (RIV 7/11) " IA~"'~\. Alliance ~r D.' Development ~"'" Fund THE CHRISTIAN AND MISSIONARY ALLIANCE po. BOX J5OO0 COLORADO SPRINOS, CO 80935.3500 PHONE: (719) 599.5999 FAX: (719) 599,5894 February 9. 1996 ~Ir I-hlwld S In\ in 111 36 South Pitt Street Carlisle P.-\ 17013 RE: Sara M. Germain Estate Dear Mr. Irwin: Thank you lor your letter concerning certificate no. 11026 for $500.00, First, for our records we need to have you send us a copy of the death certificate. Second. we need a copy of the appointment letter or legal documentation to support the fact that you have been retained to settle the estate. Third. the original certificate must be returned to us in order for us to process the redemption. Last, the date of death value of the certificate was a principal amount ofS5oo.oo plus $23.63 accrued interest as of 12111/95. I have included a self-addressed envelope for your convenience. Should you have any questions, please feel free to contact me, Sincerely. ;z::t6/ Robert C. Pease Deposit Administrator Alliance Development Fund Ircp Enclosure BUD MAYNARD AIMtIl"II TrtaILIlf OoIlClOt,_Oo_Fur4 JIM BROWN AuodIII DIrIcICW,MMa OI.~II FII'Id -(p III CI - .... :r I ~ ,., .. .... .. . CI K .. "" I .... - C C U Q, -9 g III UI ~~ N Cl- .. . 8 III ... Z ... ~ ""Ill: 0 a CO ;:: CUI oOa .. .. ,... :1:> wW .. .. _N lD "'0 ~-~ N z UlZ -~- , w UCUI -z .,. 5 :::~ ;! .. :... ,., ~ .. -.. :I: III ... ~.d": Ill'" .. f!;:~ C ... 00:;;' - ! 9 "'ClIlI: l;( N W'!!I'" .. ~ Q~':' c,,"c i:5~ a: ;:: IIl,,"U -:p .. - c .. '" a - ... ~ u j II 8~ 8 ~ ~ .. ~ ~ I E! !> ! . u - .. .. - ~ .. ~~ - f :ll ... ... 85 ... ... ... Cl... .. ~ ~ g~ .. -!:! ~ ... !i- 1 88 I !f g ~~ " ~~ ~! .... , - ~~ .. .t,it .. il~ I -... ~I >- ~ ~e !: - ~e ~ - ~ ;~ ~~ ; ;:~.. '#.~ ! ,." g Y4 - ~l 88 .,.~"j' ~~ ',!;....;t ~~ " , .. .< '~l , .~- .< ... fl. 't ~,'; <~ - .. .'.. i~ ',.'" +.>~ " :~ '.n ~ - .I: ~ ~i c - i' ;! ::l '\ .j 3:~' '~ - . III : 0 i..,... ~ on CJ '!'t';, e l.'I:l CJ 'A1~ ~. ct -" ~~ :"'~ 0 ... ,11/. '$:,,' ~ ::I Z~ !Y II ':-l'/t ... ~~ III l!. ~. -' ~ QI ,'~ ~ ....; ;~: ,.... - ,- _. 'fll" !!! ::: c -" ...: In 58 it II> Q:' '11/. - ... .. ~ ~g;~ E ::l .~ ... Q. .. CJ u; .. :J'.t Ill: I~ (II u~ ~~ ;~ .,Ol 6 4} ...: - ~- ... en '.0 ... I, d~~ WI ~I , s '0 h euli!B !!:; to! IE ~_.....-..,-. I I , .. ,'... ,~- -,--"""~'~'. F~:m:R,\n:[)"" S~:RV[CES U C()~II)..\:'I:Y 1\11''111'' UI\I\IO' February 5, 1996 HAROLD S IRWIN ATTORNEY AT LAW 36 S PITT ST CARLISLE PA 17013-3225 REFERENCE: 20146159 LIBERTY US GOVERNMENT MONEY MARKET - A ACCOUNT NUMBER 7306126-7 SARA GERMAIN Dear Mr. Irwin: We have received your correspondence concerning the referenced account. On December 11, 1995, the value of the referenced Trust account, including the accrued, but unpaid dividends, was $1,ala.76. This figure represents 1,211.010 shares at the constant net asset value of $1.00 per share, plus accrued dividends of $1.75. The following items are required for an Executor or Administrator to redeem and/or transfer shares from an account registered to a deceased individual. If more than one Executor or Administrator is appointed, the instructions must be modified to include all the appointed individuals. 1. A signature guaranteed letter of instructions signed by the legal representative(s) indicating capacity (administrator, executor, etc). A signature guarantee may be obtained from any .eligible" guarantor. Eligible institutions include commercial banks, trust companies, savings banks, savings & loan associations, and credit unions as defined by the Federal Deposit Insurance Act. Also, a guarantee by a member firm of a domestic stock exchange is acceptable. We cannot accept notarization by a notary public. If your request will be signed by more than one person, multiple signature guarantees will be required. 2. A copy of the Order of Appointment naming the legal representative(s) of the decedent's estate. The document must be certified by the court, or clerk of the court within 60 DAYS of our receipt. While a copy is acceptable, it must be certified in ink and bear the court's stamp or raised seal. We cannot accept a copy of the certification. ;\ .ul"irliolry III' FWf.R.\rr.o I:-;VFsrOKS ~ .. .. .. ~ "" .. . ~ .. DI 0 . c: ~ c:::5 .. en 0 ... III .. en . 'tl - ~~ . ... c: <;.) . . 0 CD . - . al " ...... II. ... ... " " c: ~ ~~ f ... ... . CD " .= u ~ .. c: "> Do ~~ r7l ~ CD ... ~ ~~ c: ~ 0 CD ~ U > " c: ~ ~~~ Cl 0 ... U ~ CD Cl " CD :s ii 0 >0 0 " .. ~~ 'tl 0 ... 0- CD ~ .~ .c CD u :I Do ~ 0 ... ~ 2 .. ... < " CD Ii; ,.. 11:: > ~ c: C ... CD 00< Z "Z 'tl ~ Z ...'" CD III ...'" ., L oCl ., :s .; " . CD 0 u a: ., " >0 . :J 'tl u II : 'tl.l/ c: " III .. f'! <: ... i l( ~ I III . a: 0 ....c ~ ~ C : ... ...'" :I: = .1'''' CD CD D - 0 III 'tl 0 ... ... c :z: III III ".. " 0 '" c: CI ~ a: .. - " III CD c: . 0 0 III CD ...... >- CD..... ... III ... B D III a: DOC - 'tl >0 .c'" a: CD III 'tl " u " III ~~o< DlCD CD Do ~, g ~~ ~ Z C:">llo III 8 ... D 0 o CD !"'ij u... ... > 0 . i z . = .; CD ... U 0 9 D U ... t; ~ C:.ll Z III CI ; . III '" III >0'" II Ill'" III :q "'" ... CD II "... 0 ... ... .c II t; .! ~ " rll:o!~~ .. 'n.'...." "",:~, -', , , . WI Cu"Uulllhll'Cn,,' Inlo,"",,,,,n .: ':. . l\'nn5~h'Unlllllhll'Shll'ld '.800,958.5558 .,..'. HARRISuURO. PA 17 '7~ ~r..c.......,;J1"'8~ :"J.' ..,,~Si.It ~..,,,,,.,,...IO" , ' . --- ESTATE OF SARA GERMAIN 36 SOUTH PITT ST CARLISLE PA 17013-3225 ::= ~.;IS S7A~EMENT FOR YOUR RECORDS .'.;::it- ~i-e ;)tner Side lor Inlormahon abou: thl5 statement. PROVlOER OATES 0< SE'MCE From To TOTAL EXPENSES , , RX DRUGS '10: 17 95 10: 17 48.41 RX DRUGS 110: 17 95110: 17 10.25 RX DRUGS 110; 17 95110: 17 10.50 RX DRUGS 10:21 95 10:21 50.44 RX DRUGS 1,10,23 9510;23 3.25 RX DRUGS 11: 11 95111: 11 40.75 RX DRUGS 11; 13 95,' 11,13 48.41 RX DRUGS 11: 15 95 11:15 6.50 RX DRUGS 11,15 95 11: 15 18.00 RX DRUGS 11: 16 95111: 16 18.75 RX DRUGS 11: 17 95 11: 17 50.44 RX DRUGS 11:17 95 IIi 17 38.25 RX DRUGS 11;20 95111;20 38.81 RX DRUGS 11:20 95 11:20 23.16 RX DRUGS .11 24 95 11:24 60.00 OUR RECORDS SHOW THE 1995 DEDUCTIBLE FOR THIS PATIENT HAS BEEN SATISFIED. BENEFITS PAID FOR PATIENT IN 1995 TOTAL '1,802.59. TOTAL PAID TOWARD PATIENT'S LIFETIME MAXIMUM BENEFIT OF '1,000,000 IS '14,206.10 ......; EXPLANATION OF MAJOR MEDICAL BENEFITS C:::.- C 486 106 CHECK NUMBER ' ->A_ ...."ENTS ......E GERMAIN SARA , AGREEMENT NUMBER 203107743 CLAIM NUtJlBER PA,vMEf,r O"~E 9602918000802 02/0J;..l.?6. P1e.1se feter fa the Information shOwn aOOve when InQuirtno abOut your clJtm GROUP NO. 025653000 PAlO BY INEUGIBLE I INEUGIBLE CODES EUGIB.E BASIC PLANS EXPENSES .Ift~' betOwl EXPENSES 0.00 0.00 4B.41 0.00 0.00 10.25 0.00 0.00 10.50 0.00 0.00 50.44 0.00 0.00 3.25 0.00 0.00 40.75 _ 0.00 0.00 48.41 0.00 0.00 6.50 0.00 0.00 18.00 0.00 0.00 18.75 0.00 0.00 50.44 0.00 0.00 3B.25 0.00 0.00 38.81 0.00 0.00 23.16 0.00 0.00 60.00 TOTAL ELIGIBLE EXPENSES Un ,. lnIufance .00 Lea. Deouctil:)le .00 LESS 20X COPAV OF 23.33 4.67 , LESS OX COPAY OF 442.59 .00 CHARGES NOT SHOWN ON THIS EXPLANATION OF BENEFITS ARE BEING PROCESSED SEPARATELY TOTAl. oUAOIJNT 01' ....YMENT . , , ., Copltal U1ucCros\ InlOfmalOOl'l l'ennsyh'onlo B1ucShlcld 1.800.958.5558 HARRiSbURG, "'" 17177 ~.~ iOI,1t Lc~ Of ftw B'-te CtMI .af'llJ B~ s"..-: A""'.'..... f ,,, ,:...... " i.........~ "\,..\" \ .~\: , I" \.... EXPLANATION OF MAJOR MEDICAL BENEFITS .' ,. ESTATE OF SARA GERHAIN 36 SOUTH PITT ST CARLISLE PA 17013-3225 ." 'L' , ,., 486107 CHECK NUMBER 04861 C 7 i PATIENTS NAME GERHAIN SARA AGREEMENT NUMBER 203107743 CLAIM NUMBER PAVMEt~T :lATE 9602918000803 02/05/96 P1ease refer to the Inlormahon snown abOve when inQUIring about yOU' claim ~::~ -HIS STATEMENT FOR YOUR RECORDS - J.e see other sIde lor Information aOoul IhlS slafement. GROUP NO. 025653000 PROVIOE~ OATES OF SERVICE TOTAl. PAlO BY INELIGIBLE INELIGIBLE CODES ELIGIBLE F_ To EXPENSES BASIC PlANS EXPENSES ISH Remarks belOwl EXPENSES , , , DRUGS .11 ; 24 : 95111 : 24 20.50 0.00 0.00 20.50 DRUGS 111: 28 :95 11: 28 5.99 0.00 0.00 I 5.99 DRUGS 12:06:95: 12'06 4.25 0.00 0.00 4.25 DRUGS 112: 08:95112: 081 11.00 0.00 0.00 1 11.00 DRUGS 12'08,95 12 08 9.81 0.00 9.81 811 0.00 I : : I I 1 I I I I I I , I I I , I I I ! , I OUR RECORDS SHOW THE 1995 DEDUCTI BLE TOTAl. ELIGIBLE EXPENSES FOR THIS PATIENT HAS BEEN SATISFIED. Less Or."lef Insu'ar-c~ BENEFITS PAID FOR PATIENT IN 1995 TDTAL Un Ot<h.ctlOle .1,844.33. TOTAL PAID TOWARD PATIENT'S LESS 0" COPAV OF 41. 74 LIFETIHE HAXIHUH BENEFIT OF U,OOO,OOO IS U4,247.B4 rtmI. AMOUNT OF PAYMENT 4 ON THIS EXPLANATION OF BENEFITS ARE BEING PROCESSED SEPARATELY CAN BE OBTAINED WITHOUT A DOCTOR'S WRITTEN PRESCRIPTION ARE UNDER YOUR AGREEHENT. -:',5 CHARGES NOT SHOWN 0811 DRUGS WHICH NOT COVERED .------- ...---- -- ---- ,. -- --- -. - - ---.....- . , , STATEMENT THI ALLlANC! HOME no 50 HANOYIft IT. CARUSLI. M '70'3 1.717.2...'. ,I', ofl.':,DA:n' ~ .; 01/01/96 TOTAL AMT, DUI! 628.66- SM;;A M. GE'kMAIN kOOM NUMOER: 01:-P - DETACH AND RE~URN UPPER PORrtDN WITH IIEU/TTANCE- DATE DESCRIPTION DEBIT CREDIT BALANCE llALANCI: FORWAFW: .2/04/95 CKP PI::R::lONAL C ,787.09000 80.00" :I ,.I ?2/95 HAiR CARE 5.00 75.00- .:l/lll-12/Hl F'/C I'I~B PRIVATE PAY 450.00 375.00 :>/Ul-12/:S1 PIC R&!'c PRJVATE PAY .395.00- 1.020.00- 2/02195 HAIR CARE 5.00 1,015.00- :::~5i95 1 kANSPORTAl' 1 ON 3.00 1.012.00- DR T110I1PSUN IIIWG -- f'ENkOSE. 363.57 648.43- PHONE -- UNITED OF PA -- 19.77 628.06" n A,2 ~ '~>) -!J sIP C .1J1- vf/' t#.J/ ~ 120 DAYS' ." .' .0" THE' ALLIANCE HOME :/Z- ~y,< 30 DAYlI .00 628.66- . CORIlENT ,';, 628,66- TOTAL DUll ~ . I. , I I , \ I I I 0. . \.. en 0 1II . ~ - . en !:? Cl ~I~ Ln I/'l 0- lIO , ... Z , -l M Cl 0 Cl =. lU .. .0 .:"'1 '" l- . ~ . 1~ N Z . M 110 .. . ~ /'II Ig II: . I IlC ~ ... Ul ~ 00# I- 110 ~! N .. '" .. .0 ~ 0 A- 0 I- " Ul t'- = 0 CI '" CI .. ,I .0 z = <JI .' 0- = - 0 ~ . I!!J. '" I .. :~ lU '.'~ ; .. C!lN IlC = 111 "~ , - z I = ."~. . C :: .. 11'I .. Cl . - '1 - Oft .. J . . 00# 111 ':~ ' I 0 /'II 1 0 .. .. I-Cl , ~ 0 110 III"" 0 .... .. - .. I CD: ~ Oft .... IlCUl - Cl C>C .; 0 = " '"ClI 1II0A- . " ~ i~ z I .CUl z:~ . " = " .... ~: .. UI 1 '" CUI" II . Oft Z ~ = V 111 IlCClIlC .. .. 0- lU,,"C J ~~ 0 11'I U1,,"'" ~ Oft Ii Oft .. ra ell r: Oft ei " .. I:! " It II'; li ! '- " J" .., ... ...~._....__,___ a .. '... . t:/3 f '. I "0'110"'1""'* COMMONwSAlIIt 01' rsHHmVAHIA IHHlllTAHCS w mUSH '''IDlNT DlCIDIHT IUATI 0' . GERMAIN Jelnl Ilnenllsl. NAMI A. NONE I. C. Jelntly..wned property. SCHEDULE F JOINTLY-OWNED PROPERTY ADDUSS PILI NUMIIII 21-1996-0042 IlILATlONSHIP TO DICIDINT ITIM LITTEll DATI FOil TOT,t.L VALUE DECD'S DOLLAII VALUI 0' NUMBlE JOINT MADI DESCIIIPTlON 0' '1I0'ERTV 0' ASSET '" INT. DECEDENT'S INTEREST TlNANT JOINT 1. TOTAL (AI.o Inler on II.. 6, RlCOpilulollon) S -0- (1/ more 'POCI i. needed in..rt oddillono/ ....." of .ome sin) . '. ~ "WItIlU..'''' . ~ 5CHIDULI H FUNERAL EXPENSES, ADMINISTRATIVE COSTS AND MISCELLANEOUS EXPENSES (OMMQHWIA\!H O. 'INNSYlVANlA INHI."A,HCI IAI IUUIN IUID'HIOICIO'HI Please P,lnl 0' Type SARA M. GERMAIN ITEM NUMBER 21-1996-0042 DESCRIPTION I. A. Funeral bpenlls, Hetrick Funeral Home, Inc. B. 1. 2, 3, 4, C. 1. 2, 3. 4, 5, 6, 7, 8. Administrative CoslI. George L. Harro P",onol Rep..senloti.. Comminions 209 - 12 - 5333 Sociol Secu,ity Numb" of P",onal Representati..: Veor Comminion, poid 1996 A"orney Fe.. Harold S. Irwin III Fomily exemption Claimant Add..n of Cloimont 01 decedenl', death St..et Add..n City Relotion,hip Slale Zip Code Probata Fees Letters Testamentary Mlseellaneous bpens... United Airlines - Executors Travel Expenses Notary - Harold S. Irwin III Death Certificates - Hetrick Funeral Home Hetrick Funeral Home - Cemetary Charges Hetrick Funeral Home 000 Clergy Honorarium Register Of Wills - File Inheritance Tax Return TOTAL (AI,o ent" on line 9, Recapitulation) (If mOil spacI Is n..ded, Inll" additional Ih..tl of laml sin.) AMOUNT 3,442.00 1,971.70 3,943.40 121.00 316.00 12.00 30.00 100.00 50.00 25.00 s 10,011.10 . . , '''"'''''II'~ *' (OMMOHwIAUM 01 ""HI".HIA INMlI'WCI W IUU" 11110I"' OIClotH' SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES AND LIENS ~. , SARA M. GERMAIN 21-1996-0042 ITIM NUM". DUC.IPTION 1, Carlisle Hosp! tal 2. Thompson Eye Associates 3. Penrose Place Pharmacy AMOUNT 5,976.92 64.50 1,171.81 1,327.60 4. Weis Markets 000 Pharmacy TOTAL (AIIO onter on lino 10, Rocopilulollon) 111010/'1 'POct i. noodorl, inSlr! oddi,iona' ","Is 0' .ome si...) $ 8,540.83 'I~flt'\ .... I"" ISTATI OP ~ COIlUlllOHwIAl'" A. "~N'fl~.JojI. INM.lnAHC. 'AI I.NIN 1."otHt IICIOINt SCHEDULE J BENEFICIARIES PIU NUMBIR SARA M. GERMAIN NAME AND ADDRESS OF BENEFICIARY 21-1996-0042 AMOUNT OR SHARE OP UTATE ITEM NUMBER I. 2. 3. 4. 5. ITEM NUMBER 1. 2. RELATIONSHIP A. Toxobl. B'qultll: Mary Harro 6055 outlook Ave. Boise, ID 83703 sister in- law 11.25% Virginia Macnab 1618 Puerto Val1erta Drive San Jose, CA 95120-4856 niece 5.625% Gretchen Harro 1618 Puerto Vallerta Drive San Jose, CA 95120-4856 niece 5.625% Thomas Harro RR1 Box 255 Briarwood Lane Kankakee, IL 60901 brother 11.25% Dale Harro 10 Sylvan Avenue Delmar, NY 12054 brother 11. 25% ***Continued*** NAME AND ADDRESS OF BENEFICIARY AMOUNT OR SHARE OF ESTATE B.. Charltobl. and Governm.ntol BlqulSlI: The Alliance Home of Carlisle, PA 770 South Hanover Street Carlisle, PA 17013 11. 25% Calvary Independent Church Of Harrisburg 3201 North Progress Avenue Harrisburg, PA 10.00% TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Allo .nltr on lin. 13, R.copitulotion) (If more .poc.l. nood.d, InlOrt additional .hoot. of .am. .1..) S j ,. r I f "'. ---.--.....-....-.... '- , ---- ---- - -- "-"-"- - -- .-_..-- --- .._-- --- -- .-- - ------- - - ----' RECEIVED fROM. & ACN ASSESSMENT P:' CONTROL 1;1 NUMBER AMOUNT JRWJN HAROLD S JIJ 36 S PJTT STREET 101 .4,100.00 CARLJSLE, PA 17013 J SSN 203-10-7743 (fIRSl) (MI) CUMBERLAND I>>i e DeATH fa TOTAL AMOUNT PAID .4,100.00 VZ REMARKS HAROLD S IRWJN JJI ESQ SEAL CHECK" 2304 RECEIVED BY /,;1,1 i, fe, ;~.LI /_:1.1 /~/<J . -/ SlGNATUU,./ . MARY C LEWJS "~ ,'\/(bt~ /}7+J REGISTER OF WILLS REGISTER OF WILLS (/ .~~~------------------------~~~~- -'); ~ .l . I c " . P, ~ .. . .f Y' . ...----- 1 -.~ r'-- ., ----..:.J J -~ .". ~ - ,.. ______ u__ . . .- ...--;'--.....-.--- , . J...- _ _ _...0.- _ _ _ --,.-- ----- --- - - -- - -'- :,:,.<":"":; .' . i , .J I \ RECEIVED FROM. & ACN ASSESSMENT P:I CONTROL i;I NUMBER AMOUNT IRWIN HAROLD SIll 36 S PITT STREET Iv1 .3,ue".S4 CARLISLE, PA 17013 lOUIH'" ESTATE INfORMATION. !IIINMIR iii e 1-1996-004e !II NAME OF DECEDENT (lAST) I;i GERMAIN SARA M II DATE OF PAYMENT ... POSTMARK DATE ,-.3' C NTY SSN e03-10-7743 (fiRST) (Mil CUMBERLAND DATEOFDEJJH REGISTER OF WI LLS m TOTAL AMOUNT PAID .3 , Oe4 . 84 " VZ (t I . RECEIVED BY j j'li :1lI (,/('I,J';I . I" .'lIb~"9" I "/ . 'I' - MARY c. LEWis . i REGISTER OF WILLS' REMARKS HAROLD S IRWIN III ESQ SEAL CHECK" 2612 ...- --- - --. --- -_. -..- - -,- -- .....~.....-.,.-- T-..~ .. ,0 . I.' f /' ' . . ! " .. '".\ . I .... ~ .f , ' . ...... i~ r-.....--.-.~.JJII~- ~ . ....,.o-!"! ... " - 15- 7?Jj COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES INHDIITAHC! TAX DIVlIlDN D[JtT. IIUIl HARlU..... Pi 17UI"0601 HOTICE OF IHHERITANCE TAX APPRAISEHEHT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSHEHT OF TAX HAROLO S IRWIN 36 S PITT ST CARLISLE DATE ESTATE OF DATE OF DEATH FILE NUHBER COUNTY ACN III PA 17013-0505 11-Z5-96 GERMAIN lZ-11-95 Zl 96-004Z CUMBERLANO 101 AIoount R..it ted * r 10.114111"'111."1 SARA M HAKE CHECK PAYABLE AND REMIT PAYMENT TOI REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE . RETAIN LOWER PORTION FOR YOUR RECORDS ..... iiE-Y:isW-EX-AFji-COY:9fii-iioi"icE--ciF-YNHEiiii'ANCE-i"AX-A-ppRA'isEHE'ii'r-;-liLrciiiANCE-ijli---------------.. DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF GERMAIN SARA H FILE NO. Zl 96-004Z ACN 101 DATE 11-Z5-96 If .n .llell.ent wal illuad previoully, linel 14, 15 and/or 16, 17 and 18 will reflect figurel that include the total of ~ raturnl al.elled to date. ASSESSMENT OF TAXI 15. AIoount of LI~ 14 .t Spouoal r.t. (15) 16. Aoount of LI~ 14 t.xob1. .t Lln..l/C1... A r.t. (16) 17. AIoount of LI~ 14 toxob1. .t Co11.t.r.l/Cl... B r.t. 1171 lB. Prlnclp.l Tox Du. TAX CREDITSI PAYI1EHT DATE 03-11-96 08-Z1-96 TAX RETURH WAS, (X) ACCEPTED AS FILED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ONI ORIGINAL RETURN 1. R..1 E.t.t. ISchedul. A) III 2. Stock. ond Bond. (Schedul. B) (21 S. C10oa1y Hold Stock/P.rt~rohlp Int.r..t ISchodul. C) ISl 4. tlort_./Not.. R_hob1. ISchodu1. Dl 14) 5. CoohlBonk Dopollh/Hhc. P.r.on.l Proporb (Sch.dul. EllS) 6. JoIntly Ownod Proporty ISchodul. F) 16) 7. Tron.f.r. ISchodul. 0) 17) I. Tot.l A.oat. APPROVED DEDUCTIONS AND EXEMPTIONS I ,. Funar.l Expon.../Ado. Co.t./HI.c. Expon... ISchodul. HI I') 10. Dobt./tlortg.g. Llobllltl../Llon. ISchodul. I) 1101 11. Tot.l Doductlon. 12. Not V.luo of T.x R.turn 13. Charltabl./CoY.r~.nt.l Hlqua.i. (Schedul. J) 14. Hot Voluo of Eat.t. SubJoct to Tox NOTE I RECEIPT HUIlII E R AA11 Z59 5 AA146643 DISCOIRIT 1+) IHTEREST I-I Z15.79 .00 ( ) C_ED ,00 32.316,00 .00 Z.017.04 44.535,OZ .00 .00 II) 10,011.10 8.540,83 Ill) 1121 (13) 114) .00 X .00. .00 X .06. 47,498.96 X .1S. 1111 AItOUIlT PAID 4,100.00 3,OZ4.84 TOTAL TAX CREDIT BALANCE OF TAX DUE IN1'EREST AND PEN. TOTAL DUE . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIOHAL IHTEREST. NOTE t To Insure proper credit to your eccount, .ubolit tho uppor portion of thl. for. with your tax PlyltMt. 78,868.06 lA .1;1;1 q~ 60,316.13 12,817.17 47,498.96 .00 .00 7,lZ4.84 7,lZ4.84 7,340.63 Z15.79CR .00 Z15.79CR I IF TOTAL DUE IS LESS THAN f1, HO PAYHEHT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRl, YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.) ....-~...- -'"..... In '" (;,j -. ., r~ ~-.... ,~ '" ~... \ .:: ..:l UU RESERVATlONt E.t.t.. of deadent. dvl,... on or Mfar. DK8IIber 12, 19'2 ... If eny future Inbr.1t In u. ..t.t. 11 trend.rnd In po.....lon or ~Jo~t to Cl... . (call.t.r.l) bInI,lol.rl.. of thI dlcldent .,t.r thI ,xplr.tlon of ~ ..t.t. far Ilf. or far Yllr., thI CGIIOnWe.lth hereby .xpr...1y r...rv.. thl right to appr.I.. .nd ...... tren.f.r Inhlrltanc. T.... at thre l_ful CI... . (coll1t.rtIlJ rat. on In)' wch future Intar..t. PlIlPOSl 01' NOTlCEt To fu1f1l1 thI rlClUlr.-.nt. of S.ctlon Zl40 0' thre lmarltanc. and E.t.t. T.. Act, Act 2Z of 1991. 72 P.S. S.ctlon 2140. PA'nENTt Dabch thre tap portion of thll MoUc. III"Id SYbIIlt with your P'YMnt to the Regllt.r of .,Ula print... an thre reVlr.. .Iet.. ....... cMck or .....y order papbl. tat REGISTER OF MILLS, AaEHT All P8YMnll rK.lvld shalll first bI -..111d to In)' Int.,..1t Nhlch ..y bI ctu. with .,y r...lnde,. .,,11... to thre tu. REfUND (CA)t A r.flnd of . tax credit, which .... not r....tld on thre T.. R.turn, ..y bI r~.tld by cOllPl.Ung en -AppllctlUon for R.fund of Penn.ylvenl. lmarltanc. and E.t.t. T..- (REV-ISIS). application. .r. .v.II~I. .t the Offlc. of the R..I.t.r of .,111., In)' a' \hi 23 R.v~ DI.trlct Of'lc.., or by c'lllng the .,.cl.l Z'-hour .,....rlna Mrvlc. ~r. far far.. ordlrlngt In Penn.Ylvanla l.aOO-S6Z-ZD5D, out.lda Penn.ylvanl. and within local Harrisburg .rll (717) 717-1094, TDDI (717) 77Z-2Z5Z (HI.rlna 1~.lrad Only). DIJECTlClCSt Any p.rty In Inbr..t not IItllflld with the eppr.lI.....t, .llowanc. or dl..llowanc. 0' dlducUan., or .........t of tax (including discount or Intlra.t) .. shown on thll MoUc. ....t objKt .,ithln IIxtv (60) dIIys of rKllpt of thll Motlc. b'lt .-wrlttan prot.1t to the Pi Dep.rtllnt a' RIVInUI, Io.rd a' Appa.la, Dept. Zl1021, Harrlsburll, PA 1712'-1021, OR ".lactlon to hwI thI uttar detlralned at -..:ilt of the account of thI personal reprellnt.Uve, OR .......1 to the Dr""',' Court. ADltTH lSTRATlVE CORRECTIClCSI Fectual .rron dllcavlrad on thll .........,t should bI edd,....ed In writing tOt PA DIlp.rt.....t of Rtv~, Bureau of Individual T.x.., ATTNt Po.t A..........t R.vl... unit, Dept. Z10601. Harrllburll. PA 171ZI.,601 Phone (717) 717-6505. s.. P'" 5 of the bookl.t wln.tructlon. for Inhlrltanc. Tax R.turn far a R..ldlnt DacadentW (REV-ISO.) for an .xplanatlon of ....Inl.tr.tlv.ly corrlCt~l. .rror.. DISCCUCTt If In)' tax duI 11 p.ld within thr.. (5) calendar Itonth. .ftar the dlCldlnt'. dIIth. . five parcant (~) dbcount a' the tax p.ld I. .llowed. n. lU tax __.ty non-p.rtlclp.Uon panal ty 11 c~tld on the tot.l of u. tax and Int.,...t .....aId, and not p.ld bafor. Januar'l II, 1996. the 'Ir.t day .,t.r the and of the tax __.tv period. This non.p.rtlclpetlon penalty .. ...,..l~la In the ... ..".r .nd In the the ... U.. period .. you would .....1 the tax and Int.,...t that hi. bHn ......... .. lndlc.tld on thl. noUc.. PENAL TVt INTERESTt Inhr..t I. charged beginning with flnt day of dllInquanc'l. or nlOl (,) Itonth. and OM U) day frOll the dlt. 0' lilith, to the dlt. a' papant. Tax.. which b1c.. dllInquant bI'ora January.. I9IZ ba.,. Int.r.1t .t the rat. of .be (U) percant par ...... c.lculated .t . dlUy r.t. of .01t0164. All tUII ....,Ich btM:aH dllInql.Mftt on and .n.r January 1. l'IZ will belr Int.r..t .t . r.t. which .,111 vary 'rOIl c.land.r Y'lr to c.landlr yair with that r.t. announcld by the PA Dap.rteent 0' R.vlftUl. ThI appllcabl. Int.r..t r.t.. 'or l'IZ through 1996 .r'l !!!!: Int.r.1t R.t. D.Ilv Int.r..t Factor !!!r Int.r..t Rlt. O.IIY tnt.r..t FlOtor 191Z ZOX .000541 1917 9X .ODDZU 1915 16X .000411 1981.1991 llX .ODOSOI 1'14 llX .00DSDl 199Z 9X .000Z47 1915 ISX .000356 1995-1994 7X .000192 1'" lOX .000Z74 199501996 'X .GODZU --Int.r..t I. celcul.tld .. 'ollowlt XllTERElIT . IALAHCE OF TAX lIIlPAXD X HUIlIER OF DAYS DELINQUENT X DAILY XllTERElIT FACTOR __Any NoUc. J.1UId .ft.r the tax bIcoM. dallnquant wlll r.nset an Int.rllt c.lcul.Uon to flftlln US) d.1'I beYOnd the date of thI ........,t. If P..,.."t 11 ... .ft.,. thI Int.,.lIt coaput.tlon dlt. shown on the Hotlc.. addItIonal lnt.r..t lU.t be calcul.ted. /5-7Y-9 COMMONWEALTH OF PENNIYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT * .,OEAU Of IHOIVIDUAL TAMES lNlIUlIA*:[ 'AI DIVIlI3H DI'" ,.".. HAIIIIIUtG, PI 111'...... II,.I..,U'''II','" HAROLD S IRWIN 36 S PITT ST CARLISLE III DATI ESTATE OF DATI OF DEATH FILE NUMBER COUNTY ACN 01-06-97 GERMAIN 12-11-95 21 96-0042 CUMBERLAND 101 SARA M PA 17013 A.aunt R..ltt.d MAKE CHECK PAYABLE AND REMIT PAYMENT Tal REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE I To in lure proper cradit to your account, lubait the uppar portion of thl1 for. with your tax pay..nt. CUT ALOND THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS .... iiE'v :ifjiii"Ex-Aj:ji-nF9r.y---m.iiii-iNHERI'TAiicE--Tiii("sTAfEHIriT-(j,;-iic:"coUiif --i-..-----.-.-----m-- m ESTATE OF GERMAIN SARA M FILE NO. 21 96-0042 ACN 101 DATE 01-06-97 THIS STATEHENT IS PROVIDED TO ADVISE OF THE CURREHT STATUS OF THE STATED ACN IH THE NANED ESTATE, SHOWN BELOW IS A SUHHARY OF TNE PRINCIPAL TAX DUE, APPLICATIOH OF ALL PAYNENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT, 11-18-96 PRINCIPAL TAX DUE. 7,124.84 PAYMENTS (TAX CREDITS), PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST (-) 03-11-96 AA1l2595 215.79 08-21-96 AA146643 .00 12-18-96 REFUND .00 It' -c:4: - ':'t ~~o. o!!). .- . ) rj ~;) r;:; E: '.J ~.. ..J r- 0 (- '_0' .- , 2 " r - ,;:.; ':"".. .., -' :::,.:';'; .n o :..n ~ .::C Cli Q)=, 0: AMOUNT PAID 4,100.00 3,024.84 215.79- TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. 7,124.84 . IF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. I IF TOTAL DUE IS LESS TNAH f1, HO PAYNENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRI, YDU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORN FOR INSTRUCTIONS. TOTAL DUE .00 .00 .00 - - ':U-N9(c -42.. Inventory of the real and personal estate of SARA M. GERMAIN deceased 1. Liberty U.S. Government Money Market Account (#2-7306126) 2. Dauphin Deposit Checking Account (#36-95459-4) 3. Dauphin Deposit - IRA - (#0195528001) 4. Dauphin Deposit - Money Market (#94-02584-3) 5. Dauphin Deposit - CD (#81-0041148-4) 6. Family Life Network - Note Of 4-15-93 7. Family Life Network - Note of 5-6-92 8. Christian & Missionary Alliance, Alliance Devel. Fund (#11026 9. Federated Services Co. - Money Market Account (#20146159) 10. Woodlawn Memorial Gardens - Prepaid Funeral Expenses 11. Hetrick Funeral Home - Prepaid Funeral Expenses 12. Union Central Life Insurance Company (#3008466) 13. Capital Blue Cross/Blue Shield - 20% Co-Payments 14. State Farm Insurance Co. - Car Insurance Refund 15. The Alliance Home - Refund 16. Minico Inc. - Renters Insurance Refund 17. Prudential Securities - CD 18. December 1974 - Series E - $1000 BOND 19. May 1975 - Series E - $1000 BOND 20. July 1975 - Series E - $1000 BOND 21. November 1975 - Series E - $1000 BOND 22. March 1976 Series E $1000 BOND 23. March 1977 - Series E - $1000 BOND 24. April 1977 - Series E - $500 BOND 25. July 1977 - Series E - $500 BOND 26. October 1977 000 Series E - $1000 BOND 27. September 1978 - Series E - $1000 BOND 28. August 1980 - Series EE - $500 BOND -......----......-. ~-..'_.~.~.., COMMONWlALTH O' .INNSYLVANIA L COUNTY O' CUM'ULAND J II: -- George L.--Harro b.lng duly sworn .ccording 10 f.w, dlpOl1l .nd uy. Ihlt h. is the executor of Ih. EsI.I. of Sara H. Germain 1.1. of ~ar!.is!.~L_____..._ .___ , Cumberl.nd County, P.., d.c....d Ind thlt the wllhin I. In Inv.nlory mid. by him , Ih. uld Execu tor of Ih. .nfire .st.l. of uld d.c.d.nt, consl.ting of .11 Ih. p.rlon.1 pro".rly .nd r..1 .st.I., .xc.pt r..1 ....I. ou..ld. th. Commonw..llh of P.nn.ylv.ni., .nd Ih.1 Ih. figurll oppo.lt. ..ch It.m of Ih. Inv.nlory repre..nt It'. fllr vllu. II of the d.l. of d.c.d.nl's d..lh. Sworn To and sublcrib.d b.fore m., D.I. of oi.lh 19 96 ~.~ Exleut., . Acl",rnr",at., George L. Harro 12448 West Graves Avenue Waukegan, IL 60087 Add.... December lot.nth Iq9S Y.., INSTRucnONS I. An Inv.nlory mu.t b. fll.d wilhin Ihr.. monlhs Iffer Ippolnlm.nt of p.rlontl reprll.nllllv.. 2. A .uppl.m.nt Inv.nlory mud b. fil.d within Ihirly day. of di.cov.ry of Iddlllon.II...... 3. Addltion.1 .h.... mlY b. .I"ch.d a. 10 parsonally or rufly 4. S.. Arllcl. IV, Flducierlll Acl of 1949. N 'l' o o I ID 0\ I ~ N o Z 8l!! Do~ &lJ 0 :3 ~g:-,u. u. ... ;ti 0 0<<11: Z o c II) z ffi < Do ~ e z w ~ - z .... 0< X 12: ~ Cl . X 0< 12: 0< III QJ ... III .... ... ... III U .,; .. .. . . u . C .,; Do :f c: " (J ." c: . ~ Jl E d .... .... .... I'l .. .... I ~ f ui~ 'tl ... o ... III :c .... - o .. .. j ." .. if ... g .. _._.___~..",,-~.., W.'C'___'. ,".-'p-, COMMONWlALTH 0' PlNNSYLVANIA COUNTY 0' CUMIULAND } III bllng duly according to law, dapol" and UYI thd h. 0' tha Est.t. of lal. 0' ___.___.____...._ -____ , Cumb.rl.nel County, Pa., el.c....d and th.t th. within Is .n Inv.ntory mad. by __ _ , the uld 0' the .ntlr. .st.t. 0' uld d.c.d.nt, consisting 01.11 the p.rsonal prop.rty and r..1 .st.t., exc.pt r..1 ast.t. ouhld. the Commonwlllth 0' P.nnsylv.nia, and that the IIgur.. oppollt. IIch It.m 0' the Invlntory r.pr...nt It's f.lr v.lu. al 0' the d.t. 0' d.c.d.nt's dllth. and subscrlb.d b,'or. m., Exleutor . Aclm'nhtu'or 19 Add,... D.t. 0' D..th Month Y.., D.y on 5~ - I. An lnv.ntory mud b. fll.d withIn thr.. months aft.r .ppolntmlnt 0' p.rsonal r.pr...iitatlv.. ~ 2. A luppl.m.nt Inv.ntory must b. fiI.d within thirty days 0' discovery 0' .delltlonal ....h. lB 3. Adelltlonal Ih..h may b. attach.d .. to p.rsonalty or rlllty ~ 4. S.. Artlcl. IV, Relucl.ri.. Act 0' 1949. INSTRucnONS '0 (" :II ~'ll .:: :.; .. (' -u ,-.) :':.". ~il 0 - -po ). ~ ;1. ~ Cl ~ w 11 . ~ ~ . . Go .... U . 0 :a . ~ w C ... ~ '" : . i5 Go -' ... oi E -' ~ 0 Go 0 &L ~ W 0 < i- ~ z '" 0 c C " II> Z ~ 0 '" Z w < ... Go ... C - ~ 0 ~ .x ... ... . E .. . 0 . c3 ii: .: -' \lv,' III f,.:" . ' " q,~ . .,'lld '97 jiJtl 11 P2 :04 ell,l ' ~IJit CurroL "j",j (,u" PA