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HomeMy WebLinkAbout96-00092 ~ . . ' ,,~,/'4.:" ' ~' :. "," ,\.,! ..,.;::\'.... <:' .',,' ,..-'--^ '.1..- >.' n. ',:,'( ,... ,<.-.:' " ~., '. . - ".,,~:' , :.. "' ~~'- ::. I ~ ' , ' _~,~..t . ',' .,' .,., v S-i ff;j; ~~~1' -/;-:.. .",'.. :,Cl~. "i'l.' ,t!,il~- '~(~j ':0:4' , t;1~J "" (,;)~ .:'."'.:,..~ ";'t' ,,"!' ~'NI ~S'~ '" I i~, ''C_''"'' ~}'l i1> r'=l~l" ~'..4 *; i~!' ' ~, {''':.. 'N-;, ~- ~~1 '.""'. fi: '.., ;rl~ I ~i 2fj <. fd:' ~~ '. -\ o ,~".,....._.~-~-..... t . I , I N'f>t-. \ IIIE~ I I~ .' ijl~c~ ~ }~ ril~ * ~ I~ . "d . Ii. , - .," O~ ., I\)' '/'''00 rl . W- I Q\::!l ...... ~ ....00"'- ~ ....00a1' .. ..,..... "= ll. L:J ~ I I I I III . ,. ; Cl ~ % :n; ~ w ~ c a: ~ " "/ ~ ... ." V o Z g ~ J m' :s .... ~ ~ r.c r g Cl . · ,. ;: 0 o VI 0 tl::j ~ .......,...-'-- -",,-'"---. " r:l o .<:: i:i ~J _ c:r '" IIlSCIl_-= -0"0- :;; u III r-.. : ;;> ::1_ = 'tl 0 - '0 fii-S~ ~ ... -!3 - ~tou= ",..cU'iii : 'CiJ E " := == ~88d :: -~- . . ..-- ~- -'."'- - - - - - ..: - - - - - - - - I . c . . , ! r, Go I [ ; I: I /' ", , ,I , . , . \ 1 I I' I i i ' ~ \, " << .'. " ,', ~ .~ . &, ~ "." '" " 1 ,I .. ' : "'-. . . r,' '.""~ ...\.. " t ..... ,I " -, j ! t, '" , ,'"II .: 0 ,,'" ,l .'" . ,~ ,..' " > ~ . ..a." :. ." , '0 :. . ... .1 . r" I ,i!',f /'l-, . .,. . " , .. . ~ I _ ...' . ,. , '.- - ',. .;, : '~ ,j f' ': ' .. ~. i " I ,: , I' I', \,' '; '. -f;:=:"" ('., .f i ',' .-___-.J...#i- lI!' " ~ I 0, , '0 : . I f~---. LAW OFFIOE Forest N. Msers 10000 Molly Pitcher Highwey Shippenllburg, Pennllylvenie 17257 717/532-9046 Fex 717/532 - 8679 April 12. 1996 Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 RE: Estate of Leslie ], Holtry No, 1996-00092 PA No, 2196-0092 Dear Ms, Lewis: Enclosed is a check in the amount of $2,61 0,00 representing advance payment of Inheritance Tax on the above Estate, Sincerely, - ""\.._+.....}a- Forest N, Myers FNM/rb Enclosure p~ ~ :Il:Il 3 i. 11!!8 0-', <lJ ,- " ;a :a: 0 ..., ,.;.. ~:c ." If "~ 0- -- elf') Ul g'.. ;;1; ia :5io .: (,; =.tll l,;. 0 fils. :oc: J=:. )>~ N PETITION FOR PROBATE and GRANT OF LETTERS B.I- IqqlJJ-q?- No, To: Register of Wills for the Deceased, County of Cumberland in the Social Security No, , n 4 - n 1_ 1 q, 'I Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner/s), who Is/arc 18 years of age or older an the cxeCUI nr In the last wl11 of the above decedent, dated Apri 1 1n, and codicll/s) dated Novpmnpr'6 t 1 q91 Estate 01 ,10hn 1,PA11 p Hnll-ry a/so known as !.PA II p.l no I I- ry named , 198.5- (st8te relevant circumstances. e.g. renunciation, death or CJ;e,"Ulor. CIC.) Decendent was domiciled at death in C'nmhpr I" nn County, Pennsylvania, with h ia last family or principal residence at 4'1 ""AI- Kin.. 1'ltrppt f;;hirrlOnqhnrf) Rnrnngh, ppnnqylv~ni~ , . (list SUett. number and muncipalilY) Oecendent,then 7<; yearsofage,died ,1"nn"ry 17. ,19 96 at 4'1 F,,,,,I- King !':t-rpPI-. !':hipppn"hnrg, PA 17'<;7 , Except as follows. decedent 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 incompetent: ROllll- Oecendent at death owned property with estimated values as follows: (If domiciled in Pa,) All personal property S 30 oon nn (If not domiciled in Pa.) Personal property in Pennsylvania S ' /If not domiciled in Pa.) Personal property in County S Value of real utate in Pennsylvania S fiO.LIH!'Q...Q~ situated as follows: 4'1 ""AI- Ki nq 1'ltrpet, 1'lhippensbur9 t cumberland CQI\l1ty. P9nnsyl "ania WHEREFORE, petitioner/s) respectfully presented herewith and the grant of lellers theron, request/s) the probate of the last will and codicll(s) Tp~t:lmpntrllry (testamentary; administration ,",I.a,: administration d.b.n.c.t.a.) Ii ~ Vid(ot!//b- "c ~ ]:~ '17/; T.i nn""y T,nl- Rn"n -:::.1: 1'lhlpppn..nnr"t PA 17'57 'lr~ r 7/'- 5"~;;.. -9?~;:J.. iii OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA } 88 COUNTY Of' ,"IIMRF.RT,ANO The petitioner/s) above.named swear/s) or affirm/s) that the statements in the foregoing petition are , true and correct to the toest of the knowledge and belief of petitioner/s) and tha as personal represen- tative(s) of the above decedent petitioncr/s) will wCI~and t y administer th ~e ~ording t~_law, Sworn to or af[iID!cd and subscribed f -, before me this ~ day of 00' ~ ~ In.'l\ l//~~'!~~~;) ill d~ I lit I ~ -1;.~RiI c,'iMhs ReI/is 1~ I 2 15-'iJ,-j , - pu (/--- Iua"." kLV '1M This i. 10 (cnily Ih.1 the inlornwion here l:ivcll is Clllll..:tll' fOl'it-d lrom iJn milli.1J1 cenilkate 01 deillh dilly liIed wilh me as Local Regi'lrar, The originiJl cerrilklll<' will he ImwiJrdc,llll Ihe Slille Vil,.1 RefOrd, Oflice Illr pcrmill1Cm liIing, WARNING: Ill. 1II0glll0 dupllcato Ihl. copy by phololtal or pholograph, 1'1'C lor Ihi, (errilic,lll', S2,lXI ~~~/J~ . , -XIl!fsrriJr~ ..t -,ltLf f.~ /~ '[)iJle 3364097 No, " """ 141 COMMONWEALTH 0' ,rNNlYL'AlNlA' DIM..TMrNT 0' HOLTH . VITAL RrCORDS CERTIFICATE OF DEATH (CotOn", 0, ..-.... Lull. oarrOJoruH,_.. r......, L January 11. 1996 J, 1I01try , %04-03-3913 ., j I --_.,-- ,..,.. ::= ~, [1 -, .......,.....,.,-::.~ t.iioiori---" _"!!!'4....-"':':..~.....:"..~... Nov,20, 1920 ~h.p"P"~bMg,rA;:-[1 ._!l .. Pl.uM ...-.,l..... ..'..._...."..__.._. Cuablrland ShlPPPnllbuT<< White '!" ,. ."'" 0_ 1""\" - --- d~ll~~d _I"'"'-"tf .... .... ... ,~... I ( ......=..:;.'::'~ C4II rot" DIU .... ADCN ~Urr'___""<"'" 4% 1 feu t Ktng St.\rr t .. Shippen.lbuJIg, PA 11:11 'ale",,,,,,,,,.. -..,_ llItUUIIII H, HolCII Gu41d l. Holt.\ [J ......til 0-0 ...............rJ - -......... 1/13196 Oll116-l 'I '" ---1'A alll""S ""'~ ..."" !ooo","_roo ........ flUb ",,0..____ .. - .... ""~~~b'Jl14,,d -.. ,,.{)::"'-:':::oI """-.1 ...._____ CWlut Sh 112H ~ . ,-".,. .dg. Crlft.tulI audulmpton Twp..Cwob,Ct.PA , .-l!IlU:kl'!IF.H,II1e"rlJ80.336, 9un:>'l1lh,,!!,r.\ 11m . _u _. ...-- -....-..-,.-. ....,-..- ,. --.....-- --.....-..-- ---...... .........."..... ...,.,...-, -.........., -...-- .1 .. .... N Arrx. ,. .....-. tL_1JJ2LI~... "~lt_!,_II.'!!Y_!2.!_.t~.6 t ._.._..-.___..__.....,........__,........,.... _~.,._...,..~..."._ ......__. ~....-_.._.- ..... ......--~..-... ...-.......--,-.,.-...."', - ~ . .... ..rJ --.CoWII'_ -.- -.....-.- ._____~r~~~~l~_Hyp~ft~dJ"l nur~U"'.~.tl..'''.'..111 ,.- :-- j-....- Inrnr('t tn." -------.-_.._----l__ -..- =~ UWII__...... ~-- -*9"-"Wf ....IOJJ".'.u......~,-;;-;r.,--- our .u...~.,.'...~""...1 ;l," -. . ~- "".01........' .......... .., - . _....""'C)fI1O l'IOOtIll'(.AuII OIDf..., - .. -. I'C. --- IJ ... f) " .. ~. -., , , ... [J..~ ... [J .. .. ..0 -- f1 I-l....~__ '" II ~_~~...._...--...-_. - _D ~_..".- ~....,..~~,"""'""'.._.._-.._,...-............,...,.... .,.,.... "........-..___IO....~__.._ n r.llfonC!f n ':':"W__:~_ _ ~En~:\OIi~~~..___ oWlIAoCIAl '''l.O'~~U~ f'Pl'-M ....,'.,......-- Hichael L. Nor ri II , Coron.r 405 Fairway Drlv. H.chanlcaburR, Pa, 11055 INtIO~~,.__...............__.__......_~_, "...................'--"'.._,-,-....-_.._,~-_..- ~_. ClIo.........................~.""................-.............,....,_.....,......."'............. --.....................,...........,..,..,....."."'..'" '......'.'" '...""."..','..."...'.... ... . " l-1.J..l&JJ5J ._T,,,,,,,,,.,, "':".'::0", .. --- ~ t/?J ~ LAST WILL AND TBSTAMBRT OP JOUR LESLIB HOLTRY I, JOHN LBSLIB HOLTRY a/k/a LESLIE J. HOLTRY, of 412 East King Street, Borough of Shippensburg, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this as and for my Last Will and Testament, hereby revoking all other wills and codicils thereto, heretofore, made by me. FIRST I direct the payment of my debts and the expenses of my last illness and funeral from my estate as soon after my death as conveniently may be done. I direct that my body be interred at the Ridge Church of the Brethren. I direct my Co-executors to improve the plot and have erected thereon an appropriate monument and headstone. SBCOND (a) I give and bequeath the sum of One Thousand Dollars ($I,OOO.OOl to the Building Fund of the Ridge Church of the Brethren. (b) I give and bequeath the sum of Five Hundred Dollars ($500.00) to my granddaughter, Melissa Beecher. THIRD I give, devise and bequeath all my remaining property, whether real or personalt tangible or intangible, together with all insurance policies thereon, unto the following persons, 1 do .~ PIP'l'H I hereby direct that all inheritance, estate or transfer taxes imposed upon my estate, whether passing under this my Last Will and Testament or otherwise, be paid out of my estate. SIXTH Any and all sum or sums, whether in cash or in kind and whether for principal or income, payable to the beneficiaries, or any of them, shall be made upon the sole receipt of the respective individual to whom the payment is made and free from anticipation, alienationt assignment, attachment or pledge and free from control by the creditors of such beneficiary. All shares of principal and income herein given shall be free from anticipation, assignment, pledge or obligation of any beneficiary and shall not be subject to any execution or attachment. SEVENTH I nominate, constitute and appoint GERALD L. HOLTRY and FOREST N. MYERS, or the survivor, Co-executors of this my Last Will and Testament. I hereby relieve my Co-executors from the necessity of posting security in connection with their duties as such in any jurisdiction in which they may be called upon to act, insofar as I am able by law to do so. 3 REGISTER OF WILLS OF COUNTY OATH OF SUBSCRIBING WITNESS codicil (each) a subscribing witn to the will presented herewilh. (each) bei law, depose(s) and say(s) that uly qualified according to present and saw Ihe testal . sign the same and th request of testal in IL-- presence. other subscribing wilness/es)), signcd as a wi mess at the IC prcscnce of each other) /in Ihe presence of the Sworn to or arrirmed and subscribed me this day of 19_ (Name) Regisrer (Address) REGISTER OF WILLS OF ClIMRF.RT.AND COUNTY OATH OF NON-SUBSCRIBING WITNESS t ~,c..no.. ~. 4\-o~\-ry , (each) a subscriber hereto, leach) being duly qualified according to law. depose(') and say(s) that they are familiar with the signalllre of Leslie Holtrv codicil will -1\-\..... k. -4.::. \~., testatnr of ~t,..!: Jlf lha IItJhJJr:h:"o prescnl\'d herewith and codicil believes the si!:nalure on the. is in Ihe handwriting of :1...wnw l~~ lhe that th..y ....'ch T,PCllip Holtry "/k/,, ,Tohn T.p"lip Holtry to the best of their knowledge and belief, ~ Sworn to or arrirmed and subscribed before 1~,~'1 rlJ/l (;I(I.? , me this 291;\.. day of 3 S \>12.<",) c;. /!..!J!Ji1L.- J~nual:'-Y~ \ 19,96. ~,",,"'ve'->l>~~ (,LS, '--D..t:\.lj (l ';/.Y I il I .1. () i >t:/~1( JW).) .'. . ---&}~ddress, -MARY C. LEI'/] S RrN~lrr f+j IlUl)( k. l/. CJ . 1\JC<{Jlttlr~ ~~ (Net:}JJJ '? .... (Address) " ,"~'" --'--------_..r".'~_.._" .~~.'1?~~,;.;;" . ;'~. "," .....~~~~~~,"",."......,. tJJ-9& -9...2... RENUNCIATION In ReEstateof Lest ..==- ..1- -%ol.-\l!..-< c:{'rC-Ic- J:.:>I!...l LrduE- %ol.1'e.'1'deceased, To the Register of Wills of 6JM.e.~LA- ":> County, Pennsylvania, The undersigned l-z,~ /oJ' lA-'('e'QS , ~ - (;.~ the above decedent, hereby renounte(s) the right to administer the CSlate and respectfully ask(s) that Letters ~s:~~ be issued to Ge~ L, -4.. \~1 WITNESS ~'1 hand this 29\:1. day of .j~ , 19~, ..... . \ + t-J~ ..l (Slanltu,o, 10=..0 Ma1lr p.~.".... S\,,~~~ ~.... ( d,ess' \\-...y \12.&1 (Slanltu,o, (Add,ess) (Slanlture, (Add,ess) of REV.1100 EX.('...., FOR DATES OF DEATH AFTER 12131/11 CHECK HERE IF A SPOUSAl POVERTY CREDIT IS CLAIMED FILE NUMBER 21 1996 COUNTY CODE YEAR DECEDENTS COMPLETE ADDRESS 421 East King Street Shippensburg PA 17257 06 17 96 11 20 1920 Coun C\lmberland SOCIAL SECURITY NUMBER AMOUNT RECEIVED (SEE INSTRUCTIONS) COMMONWEALTH OF PENNSYlVANIA , OEPARfMENfOF REVENUE DEPT,21010' HARRISBURG, PA 17121.010' 1.5- - 8 ~ -/ INHERITANCE TAX RETURN RESIDENT DECEDENT (TO BE FILED IN DUPLICATE WITH REGISTER OF WILLS) DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) HJL'ffiY, Leslie John CEO SOCIAL SECURITY NUMBER DE ENT 204-03-3923 (I Ll L)UVIVIN U ~IR5T AND MIDDLE INITIAL' CHECK APPRO- PRIATE BLOCKS CORRES- PONDENT RECAPIT- ULATION 1. Orlglnel Roturn o 4. Umltod Estelo (1) (2) (3) (4) (5) 50,000.00 620.00 None None 38,889.00 (6) (7) None None (9 ) 23,970.00 (10) None (15) r 0092 NUMBER 3. Romelndor Roturn (lor d.l.. a' death prior la '2"'3.121 o 5. Fodorlll Eeteto Tex Roturn Roqulrod ...Q... 6. Total Numbor of Solo Doposh Boxos (6) (II) (12) (13) 14 x . . 15. SpouIIIYrln"lr'Cfor dllll 01 death Iftlr 1"30.a..~ 511 In,tructlonl 'at App.cabl. Plrclntlgl on Plgl 2.(lncludl '1.lulllrom Schldul. Kot Sch.dull M.) 16. Amount 01 Uno 14 texablo at 6"" ralo (Includo vllluos Irom Schodulo K or Schodulo M.) 17. Amount 01 Uno 14 texablo at 15% ralo (Includo vllluos Irom Schodulo K or Schodulo M.) TAX 16. Prlnclpol tex duo (Add tax from Uno. IS. 16 and 17.) COMPUTA- 19. Crodlts Spouul POYlfty Clld.t Prior Pavrnonts Discount TlON + 2,610.00+ 130.00- 20. If Uno 191s roator than Uno 16, onlor tho dilloronco on Uno 20. This Is tho OVERPAYMENT. A;' IllkherO" 'are'", ll<il1ln .,afund of ollr o.e Int' 21. If Uno 161s groator fhen Uno 19, onlor tho dilloronco on Uno 21. This Is Iho TAX DUE. A. Enlor tho Intorosl on tho balonco duo on Uno 21A. B. Enlor tho totlll 01 Uno 21 and 21A on Uno 21B. This Is Iho BALANCE DUE. Meke Check P. able to: Ra Iste. of Wills, A anI o 4a. Futuro InlorDSt Compromlso (lor delos 01 doalh aha. 12-12-02) IH 6. Docodont Diad Tostalo 0 7. Docodonl Malntalnod e Uvlng Trust (Anech copy 01 Will) (Anach copy 01 Trust) AU;CORRESPONDENCEAHD CONFlDENTlALTAX INFORMATION SHOUUO BE! DIRE!CTED TO: '" ,)i,'",,':':',i:: ::1 "1",';,;1:': NAME COMPLETE MAILING ADDRESS Fbrest N rs 10000 t-blly PItcher Highway TELEPHONE NUMBER ShippenshJrg, PA 17257 717 532-9046 1. Rolli Estalo (Schodulo A) 2. SlockB and Bonds (Schodulo B) 3. Closoly Hold Stock/Partnorshlp Intor051 (Sch. C) 4. Mortgegos and Nolos Rocolvablo (Schodulo D) S. Cash, Bank DOpOBlls & Mlscollanoous Porsonal Proporty (Schadulo E) 6. JolnUy OWnod PIOpOrty (Schodulo F) 7. Translors (Schodulo G) (Schodulo L) 8. Total Gross AssOIS (Iollll Unos 1-7) 9. Funoral Expanses, Admlnlstrativo Costs, MlscollanoouB Exponsos (Schodulo H) 10. Dobis, Mortgego UeblllUos. Uons (Schodulo I) II. Totlll DoducUons (Iotlll UnoB 9 & 10) 12. Not VoIuo 01 Eetalo (Uno 6 minus Uno II) 13. Charllablo Bnd Govornmontlll Boquosls (Schodulo J) 65,040.00x .06 . (16) (17) 2,000.00x .1S . Intorost ADDRESS See Schedule attached SIONATUAEOF PREPAREnOTHER THAN REP. ES[NTATlVE ~~ PA15001 N'''B7. ADDRESS 10000 t-blly Pitcher HIghway ShippenshJrg, PA 17257 (16) (19) (20) (21) (2M) (21B) OAT[ \I - ".97 DATE 11-1'-97 i ' ,:;'! i Ii! I ~ :1] : III :: t: Iii I!! l : I i i;I : i i : l!!ii 89,509.00 23,970.00 65,539.00 1,000.00 64,539.00 3,902.00 300.00 4,202.00 2,740.00 1,462.00 0.00 1,462.00 REV-ll102 EX + (12-1lS) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE LeSlie John HJL'IR'l 21-1996-0092 (Property lolnUy-owned wtth RighI of Survivorship mual bt d1acloaed on Schadult F) All real eatale ahould be reported tlfllr mllke\ valUt which la cleftned eo tht p~ct al which property would be exchangedbetwetn a wtlllng buyar and a wtlllng aaller, ntlther being compalled to or ..II, both havln reaaonablt know! of tht relavlnlfacla. ITEM VALUe. AT DATE NO. DESCRIPTION OF DEATH 1 ReSidence, 421 East King Street, Shi~' t\Jrrbcrland Q::IJIlty, PennSYlvania 50,000.00 50 000.00 TOTAL Also ontOf on llno I, Roca ltulalion (II moro spaca 10 noodod, Insort addKlonal lhoOlS olsamo aI1o.) s PAI5021 NTF "" REV-1'" U.(1"II) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES, ADMINISmATIVE COSTS AND MISCELLANEOUS EXPENSES Pleaae Prtnl or Typo FILE NUMBER 21-1996-0092 ESTATE OF Leslie John H:)Lmy ITEM NO. A. Fun.rat Expenaea: DESCRIPTION AMOUNT 1 Foge1sanger-Bricker FUneral Hare 2 Gerald Holtry, reirrb..trserent for paytrent to Martin Reese, grave c.peni.n:J 3 Wcrnens Fellowship, Rid:Je Church of the Brethren, rreal follCMing funeral 5,862.00 275.00 100.00 B. AdmlnlalrlUve Coati: 1. PorIon81 RoprosonteUvo Commissions Sod81 Socllrlty Numborol Porsonlll Rop.osonlallvo: 172-36-1490 Yo.. Commlaslona p8ld 1997 Narre: Gerald L Holtry 4,500.00 2. Anornoy Foes Narre: Forest N Myers 3. Family ExompUon ClllImanf Address of C181manl el decedenra doalh 4,500.00 0.00 RoleUonshlp Streel Address Clty Sleto Zip Coda 4. Probate Foes 0.00 C. Mlacelllneoua Exponsea: See Schedule attached Total fran continuation (s) TOTAL Also onto. on IIno 9. Roc (II mOra apace 10 nelded, InaertoddlUonal aheatl ofaame alze.) s 8 733.00 23 970.00 PA15111 NT' "" .,.," 27 United Teleplx:ne 18.00 28 Fenelec 8.00 29 Boroogh of Shippensb..trg, water/seMer/refuse 79.00 3~ United Telepb:lne 18.00 :'1 Penelec 8.00 32 Sprint United Telepb:lne 18.00 33 Mellen Bank, Nl\, service charge 4.00 34 GPU Electric 8.00 3S Erie Insurance 74.00 36 Sprint United Telepb:lne 18.00 37 Mellon Bank, Nl\, service charge 4.00 38 GPU Electric 7.00 39 Shi~ Boroogh, seMer/water/refuse 79.00 40 Sprint, United Telephone 18.00 41 Mellon Bank, Nl\, service charge 4.00 42 GPU Penelec 8.00 43 Mellon Bank, Nl\, service charge 4.00 44 Sprint, United Telepb:lne 18.00 45 GPU Energy, electric service 14.00 'lUrAL. (Carry fcnward to nain schedule) . .. . . . . 531.00 FBtate of: Leslie JoM HJL'ffiY SClIECULE H, PART C -- Miscellaneous Expenses Page 4 21-1996-0092 Item No. Description Jl.nn.tnt 46 pro Gas, gas service 35.00 47 ~lon Bank, Nl\, service charge 48 Sprint United Teleplx:Jne, teleplx:Jne service 49 Pro Gas Inc, gas sezvice 50 GPO Enezgy, electric 51 Mellon Bank, Nl\, service charge 52 Erie Insurance Group, hare insurance 53 pro Gas, Inc. gas service 54 Boroogh of Shi~, utilities 55 GPO Enezgy, electric 56 Elva Jane Goc:xihart, Tax COllector, 1997-1998 school tax 4.00 18.00 68.00 6.00 4.00 82.00 72.00 94.00 15.00 502.00 57 Sprint United Teleplx:Jne, teleplx:Jne 18.00 58 pro Gas, Inc, gas service 59 GPO Enezgy, electric service 60 Erie Insurance, hare insurance 61 pro Gas, gas service 62 GPO Enezgy, electric service 63 Shi~ Borough, utilities 123.00 7.00 110.00 133.00 64 GPO Enezgy, electric 65 pro Gas, Inc. gas service 66 pro Gas, gas service 67 GPO Enezgy, electric 68 GPO Enezgy, electric 9.00 99.00 9.00 88.00 65.00 9.00 4.00 'IlIDIL. (Carry forward to mlln schedule) 1,574.00 . . . . . . .AEV-.I.SEX.IJ-1n COMMONWEALTH OF PENNSYLVANIA INHERITANCE! TAX RETURN RESIDENT DECEDENT ESTATE! OF Leslie John HJL'ffiY ITEM NO. SCHEDULE J BENEFICIARIES A. TllClbll BoquollS: NAME! AND ADDRESS OF BENEFICIARY 1 Ger.Ild L Holtry 2376 Lindsay lot Road Shippensburg, PA 17257 2 Nancy A Williams 1425 Gettysb..trg landing St. Olarles, M) 63303 3 Jimny L Holtry 220 East King Street Shi~, PA 17257 4 Bany W Holtry 37 Byers Road Shippensburg, PA 17257 5 Melissa Beecher Roote 9, Box 195A lucedale, MI 39452 6 Jermie R Holtry 7367 Talhelm Road Olarrbersb..u:g, PA 17201 ITEM NO. B. Ch8l11eble and GovefOrrontlll BoquOSlS: - NAME AND ADDRESS OF BENEFICIARY 1 Ridge Olurch of the Brethren 1095 Ridge Riad Shippensburg, PA 17257 FILE NUMBER RELATIONSHIP son daughter son son granddaughter TOTAL CHARITABLE AND GOVERNMENTAL BEOUESTS Also 0010. on "no 13, Roce ItuletJon (II mo.e apace 10 naeded. InDertlddltlonal .hula ofaame alze) PA15131 NTF "'M 21-1996-0092 AMOUNT OR SHARE! OF ESTATE 18,290.00 18,290.00 18,290.00 18,290.00 500.00 2,000.00 AMOUNT OR SHARE! OF ESTATE 1,000.00 s 1 000.00 ~'!:t!tI_l"Ul'm('!~"<'>.'_~:f'~~.7:.f"(':"'--' - \-, LAST WILL AND TESTAMENT OP JOHN LESLIE HOLTRY I. JOHN LESLIE HOLTRY alkla LESLIE J. HOLTRY. of 412 East King Street. Borough of Shippensburg, Cumberland County, Pennsylvania, being of sound and disposing mindr me~ory and understanding, do hereby maker publish and declare this as and for my Last will and Testament, hereby revoking all other wills and codicils thereto. heretofore, made by me. PIRST I direct the payment of my debts and the expenses of my last illness and funeral from my estate as soon after my death as conveniently may be done. I direct that my body be interred at the Ridge Church of the Brethren. I direct my Co-executors to improve the plot and have erected thereon an appropriate monument and headstone. SECOND (a) I give and bequeath the sum of One Thousand Dollars ($1,000.00) to the Building Pund of the Ridge Church of the Brethren. (b) I give and bequeath the sum of Five Hundred Dollars ($500.00) to my granddaughter. Melissa Beecher. ~ THIRD I giver devise and .bequeath all my remaining property, whether real or personal, tangible or intangible. together with all insurance policics thereon, unto thc following persons, c ~ :'.A~~~.~.f<t,J;~,'" " t. ." .:~:" ." PIPTH I hereby direct that all inheritance, estate or transfer taxes imposed upon my estate, whether passing under this my Last Will and Testament or otherwise, be paid out of my estate. SIXTH Any and all sum or sums, whether in cash or in kind and whether for principal or income, payable to the beneficiaries, or any of them, shall be made upon the sole receipt of the respective individual to whom the payment is made and free from anticipation, alienation, assignment, attachment or pledge and free from control by the creditors of such beneficiary. All shares of principal and income herein given shall be free from anticipation, assignment, pledge or obligation of any beneficiary and shall not be subject to any execution or attachment. SEVENTH I nominate, constitute and appoint GERALD L. HOLTRY and POREST N. MYERS, or the survivor, Co-executors of this my Last Will and Testament. I hereby relieve my Co-executors from the necessity of posting security in connection with their duties as such in any jurisdiction in which they may be called upon to act, insofar as I am able by law to do so. instrument as my Last will and Testamentl that I signed it willingly, and that I signed it as my free and voluntary act for the purposes therein expressed. 't_ ~_~~e~ J.I~ C'~~lie Holtry ~ ~ - / Testator sworn or affirmed to and acknowledged before me by John Leslie Holtry, Testator, the .j/)'IA day of April, 1985. r1xt (: &.....~ No public JOYCE A. CiOUSE, HOlARY PUDllC sournAIIPlOH lWP.. ra~HlLlH COUNTY 111 COIlIIISSIOH EXPIRES JAH. 5, 1m lI,mb.., p,nn.""nl' Anoellllon 01 N~t"'.. COMMONWEALTH OP PENNSYLVANIA : : SS couN'fi OP PRANKLIN We, FOrld N. ;'.J1'flr5 : and HIJ...,r,il I,) ilia ~llI1 witnesses whose names are signed to the foregoing instrument, being duly qualified according to law, do depose and say that we werepresent and saw JOHN LESLIE HOLTRY, TeBtator, execute the instrument as his Last Will and Testament, that he signed it willingly and that he executed as his free act and voluntary act for the p~rposes therein expressed, that each of us in the ~hH; III ., ., CD ., '" a ., ll' . . . . a ... ... III ... '" a ... ... ,W U u ti II bI ... A U U ......,W :. III .. IlIU~ Ill'" .. '" 0 CD ., ., CD ~ .aJ..... >t ... '" a ., "'CD,&J IJ ~i!1 . . . . A ,W .. A "" ... ... III ... .. U ~ '" '" = '" ~~u CD a ... III . . . . III >t~ i ., a ... N ... ... ... ... U U CD s:I 0 .u -::~~~ III .. X~~~ >e.... M c:J U si~ A 1 ~ . 1 1 III N ., ., ., , . . . Ihh a '" a ., Xuu . . . . . . . . CD ... ... III IIlXOX '" a ~~~~ ... ., X......O '" .. III ... .. ... N II ... U U U .. '" ... ... U I III biOI'" U A U A h~! U ............ .... U ",:.", '" a a a '" ... id.... . ... a a a U ...1Il...) . . . . l>l .. .. '" a a a u... c> g ., a a a UAU CD a a III U ... . . . . 'fl E U E ., a ... N '" P. U ... ... ... :. ... 0 .. o III UIll .. ... A 01ll"'1 I I I . il ... . . . . UIIlU~ . . . . . . . . g U U U U 01ll"'1ll . . . . ... ... ... ... ... II U N .. a III '" fl bI~ bI ~I CD '" ... ... .. .. .. '" '" III A A II A '" III .. .. N ... ... bI:;j N N ... "" .. ,W ... A .. .. .. .. N 'fJ U 're.... u C'l N "" '" ... U II :> U e- :i!ti8.~ti bI'" ,!l ,W ., ... A III 0" .... ... A c> 0 c> NO U ,WO"',QA ""III U U 1 UtlJIIIQ.... ., '" ., '" U ~ III ~ ~ -~ '" . ... III CD I...., ., '" a .. ti III 1 III III a ... ... CD "" III Is 00., a III "" ~ I 1 . I 1 ,........r'I 0 0 a III 1r-tr4!111 I ~ I . . . . N..... 0 0 g~9li!~ ... ~ a ... . '1 ." ... oco.cn ) ., III Ilolllllllll m TOTAL AMOUNT PAID $2,610.00 CW RECEIVED BY /&;~ ~~lIJ'.1! (lvv' MAR V r Ir-WTq ~~1~~ ~~'-~';k'iV" -"'_-.";~,'"t-';j,.,. > . .-, ~1:;'~~;;r,~".~.JF.~~~~.:;;!:~:~~;~;~~I~~~r!:~::::'~ATE_T~;;"""'~';"""""i:.' ACN I:'t ASSESSMENT '!' II CONTROL 1;1 NUMBER RECEIVED FROM: AMOUNT MYERS FOREST N ESQ 10000 MOLLY PITCHER HIGHWAY 101 $c,b1V.VO SHIPPENSBURG, PA 17257 . POlO Hrrr ESTATE INfORMATION, !'IILNMIR U 21-1996-0092 !I NAME Of DECEDENT (LAST) I;i HOL TRY JOHN II DA E Of PAYMENT m POSTMARK DAT! COUNTY 204-03-3923 (Mil CUMBERLAND DATE Of DEATH REMARKS GERALD L HOLTRY C/O FORREST N MYERS ESQUIRE CHECKII 111 SEAL , '. I I , I 15- f'J - / COMMDNWI!ALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE C/ IUREAU OF IWDIVIDUAL TAXES INHEAITAHCE TAX DIVISION DEPT, 210601 HARRISIURG, Pi .'IZI.0601 NOTICE OF INHERITAHCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX FOREST N MYERS 137 PARK PLACE WEST SHIPPENSBURG PA DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 02-24-98 HOLTRY 01-17-96 21 96-0092 CUMBERLAND 101 A...unt Roolthd 17257 *' '''-IklII '" In'''1 LESLIE J MAKE 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 .. REv:is47"Eif-AFii-iii9-:9'iY-iiilYicEuoF-YN'HEiiii'ANcE-Y"i("A'PPRA'isEH€iii'-.--ALi"OWANCE-iiR--mm--muu DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF HOLTRY LESLIE J FILE ND. 21 96-0092 ACN 101 DATE 02-2(,-98 If an assessmant was issued previously, lines 14, IS and'or 16, 17 and 18 will reflect figures that include the total of ALL raturns assessed to data. ASSESSMENT OF TAXI IS. Aoount of Lln. 14 .t Spou..l r.t. 11S1 16. Aoount of Lln. 14 t...b1. .t Llno.l/C1..a A r.t. 1161 17. Aoount of Line 14 t..ob1. .t Col1.t.r.1/Cl... I r.t. 1171 1a. Prlnclp.l T.. Du. TAX RETURN WAS, (X I ACCEPTED AS FILED RESERVATION CDNCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ONI ORIGINAL RETURN 1. R..1 Eat.t. (Sch.dul. Al 2. Stocka end londa (Sch.dul. II S. Cloa.l~ Hold Stock'P.rtn.rahlp Int.r..t (Schodul. CI 4. Kortg.g.alHot.a Roc.lvabl. ISch.dul. 01 S. Ca.h/lank Depoatt.,"llc. Parlonal Property ISchedule EJ 6. Jolntl~ awn.d Prop.rt~ ISch.dul. FI 7. Tron.f.ra ISchedul. GI a. Tot.l A.aoto ( I CHANGED UI 121 ISI 141 ISI 161 171 50.000.00 620.00 .00 .00 38.889.00 .00 .00 lal APPROVED DEDUCTIONS AND EXEMPTIONS I 9. Funeral Expan..I/Ad.. COlts/HiIC. Expan... (Schedule HJ 10. D.bt.'Hortgogo LI.bllltloa/Llona ISchodul. II 11. Tot.l D.ductlona 12. N.t V.luo of T.. R.turn 15. Charltabla/Covarnaent.l Baqu..taJ Non-.lected 9113 Tru.t. 14. N.t Voluo of Eatot. SubJoct to T.. 191 UOI 23,970.00 .00 IllI U21 IUI U41 ISch.dule JI NOTE I .00 X,OO. 62,539.00 X .06. 2,000.00 X .15. ual TAX CREDITS I PAYMENT DATE 04-12-96 11-13-97 02-17-98 DISCOUNT 1" INTEREST/PEN PAID I-I 137.37 126.35- .00 RECEIPT NUHBER AA112732 AA242463 REFUND AMOUNT PAID 2,610.00 1,462.00 30.67- TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE NOTE I To insure proper cradit to your account, sub.it the upper portion of thla foro with ~our t.. pay..nt. 89,509.00 :>:'1.970 00 65,539.00 1,000.00 64,539.00 .00 3,752.34 300.00 4,052.35 4,052.35 .00 .00 .00 . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS LESS THAN II, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRI, YDU HAY IE DUE A REFUND. SEE REVERSE SIDE OF THIS FORN FOR INSTRUCTIONS. I (')Cj \r :1.1 S ;r:.- :~:I f;', '" (-j r:"- ..." n lC"\ N 0\ c. ::::! eJ " .rl \. (:j -. "". ;- ... N RfSlRYATIOHI Eltat.. of decedent, dying on or bafor. Dec.-blr 12, 1912 -.. .f ~y future Int.r..t In the ..t.t. I. tr~.f.rred In po.....lon or enJo,.ent to Cl... I (coll,t,r,l) beneflcl.rl.. 0' t~ decedent .,t.r the ..plrallon of eny .stata for 11'. or for y..r., the Co.-onw..lth hereby l.pr..I., r".rv.. the right to appral.. ~ ...... tr~.'.r Inheritance 'ax.. at the l~'ul C1... . (collat.ral) r.ta on anJ luch future Int.r..t. PURPOSE OF NOTICEI To fulfill the raqulr.-.nt. of SectIon 2140 of the Inheritance end Elt,t. Tax Act, Act 21 0' 1995. (71 P.S. S.ctlon '140). P''mENTI D,tKh the top portion 0' thl, NoUe. end tublIlt with your PIPent to the Reglst,r of Willi printed on tM nV'''a ,Idl. ...".... check or ..-y order p'Yebla tal REGISTER OF MILLS, AGENT REAICD (CAli A r.,lftt of . tn credit, which .... not r.qu..ted on tM Tax blurn, uy be rltqUll.t~ by capl.tlng -n "App11catlon for A.fund of PennsYlvenla Inherlt8nCa 8nd E.t.t. Tax~ (REV-ISIS). application. ar. avallabl. at the Dfflc. of the Aegl.t.r of Will., eny of the ZS Ravenue DI.trlct Offlc.., o~ by calling the .peelal Z.-hour en.warlng ..rvlc. nuaber. for for.. orderIng I In P.nn.ylvanla 1.800-S6Z-Z0S0, out.lde PennsylvanIa and withIn local Harrisburg ar.a (717) 787-80,., TOO' (717) 77Z-2ZSt (Hearing l.palred Only). OBJECTIONSI Any p.rty In Int.ra.t not .atl.fl.d with the appral...-nt, allowanc. or dl.allowance of deduction., or .....I-.nt of t.x (InclUding dl.count or Inter..t) .1 .hewn on thl, Notlc. au.t object within .Ixty (60) d.y. of rec.lpt of thl. Notice bYI -"wrlttan prot..t to the PA o.p.rt-.nt of Ravenue, Bo.rd of App..I., Dept. 2810Z1, Harrisburg, PA 17121"1021, OR .....l.ctlon to h.v. the ..ttar d.tar.lned at audit of tJM account of the perlonal r.re.."t.tlv., OR ".appe.1 to the Orphan.' Court. ADMIN ISTRAlIVE CORRlCTlDHSI Factu.l .rror. dl.cov.r.d on thl. .......-nt Jhould be ~r.s.ed In writing tal PA Dap.rtaent of R.yenue, lur.au of Individual T...., 'TTNI Po.t ,"..'.ent R.yleN unit, o.pt. Zaa601, Harrl.burg, P' 17128-D601 Phone (717) 717-6505. S.. ,aga 5 of the bookl.t ~In.tructlon. for Inherltanc. Tax R.turn for. R..ldent Decedent- (REY-1SOI) for an ..planatlon of adelnl.tratlv.ly correctable .rror.. DISCDtllTI If anv t.. due I. p.ld within thr.. (S) calandar aonth. .ft.r the dec.dent'. de.th, a flv. perclftt (5%) discount of the t.x p.ld I. allow~. PENALTY I The 15~ t.x .-ne.ty non-p.rtlclp.tlon panalty I. c~t.d on the tot.1 0' the tax and Int.r..t .s...-.d, and not paid be'ore Janu.ry II, 1996, the 'Ir.t d.y aft.r the .nd of the t.. aan.sty p.rlod. Thl. non-p.rtlclpatlon pen.ltv I. appealabla In the .... .anner and In the the .... tl.. p.rlod a. you would appe.l the t.x and Int.r..t th.t h.. bien ......~ .. Indicated on thl. notlc.. INTEREST I tntar..t I. charg.d beginning with flr.t day of delinquency, or nine (,) .onth. and one (1) dav froa the date 0' de.th, to the date 0' p.y.ant. T.... which bae... d.llnquent bafore Janu.ry 1, 1912 bI.r Intar..t at the rat. of .1. (6X) p.rcent p.r ~ c.lcul.t.d at . d.lly rata of .000164. All t.... which bec... delinquent on and aftar January I, 19.2 will bI.r Int.r..t at . r.t. which will v.ry fr~ c.land.r v..r to c.landar yair with that r.ta announced by the PA Depart""t of Rlvenue. The app11cabl. Int.rllt t.tll for 1912 through I'" lral !!!! Int.rllt Rlt. Dlllv Interllt Fector !!!! Intar..t hta Dallv Inter..t F.ctor 1912 ZlX .0ODS48 19.7 OX .000247 191J IIX .DOOU' 19U-I991 IIX .00DSOI I9A6 IIX .DIDSn 1992 OX .DOD2U 19.5 IU . ODDSS6 1995-1'" 7X .ODonz I'" lOX .OD0274 1995-199' 'X . OD02U ulnter..t II calculated a. follow'l INTEREST . BALANCE OF TAX UNPAID X NUHBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR "-Any Notlcl Illued a't.r the tax becoae. delinquent will reflect an Int.r..t c.lculatlon to fifteen (IS) d.YI beyDnd the etat. 0' the .......ent, If paYNnt It .ade after the; Inter..t cOllpUtaUon date shown on thl Notlc., ~dltlonal Inter..t "".t b. calculat.d. _...,..,.~~...~..).,...~.>,."t>'...... .,..,~ -"'.~."'""~-' '\ PA't'tIEHTI Detach the top portion of thl, Notlc. and ,~It with your p.yaent a~' p'rlbl. to the n... ~ addr... prlnt~ on the n....r'. ,Id.. If RESID[NT D[CED[NT aek. chllck or aon., ord.r plrllbl. tos REOISTER OF WILLS, ACENT. If NON-RESIDENT DECEDENT aak. check or aone, ord.r par.bl. tal COHHONWEALTH OF PENNSVLVANIA. REfUND (CR)I A r.fund of a ta. cr'dlt, which w.. not r.que.t.d on the Ta. R.turn, a.r b. r.que.t.d br co.pl.tlng an "Application for R.fund of P.nn.rlvanla Inherltanca and Eltat. Tax" IREY-1313), Appllcatlonl ara Ivalllbla at the Dfflc. 0' the R.gllt.r 0' Will.. any 0' thl l3 Rav.~ua DI.trlct D"lc.. or 'roe the D.partaent', 2~-hour an,werlng ,arvlc. nuab.r. 'or 'or.. ord.rlng1 In P.nn,yl...enla .-aOO"36l-20S0, out. Ida pannlrlvenla and within local Harrl'burg ar.a (717) 7'7-'0". TDD' (717) 77l.22S2 CH.arlng lapalr.d only). REPLY TDI OUe.tlon. r.glrdlng .rror. contllned on thl, notlc. ~Id b. .ddr..I.d tOI PA D.p.rt.ent 0' R....~, Bur.au 0' Indl...ldual T...., AIINI Po.t A.'....ant R....I.w unit, O.ot. 210601, Harrl'burg, PA 17121-0601, phona (717) 717"'S05. DISCCUth If enr t.. due I. p.ld within thr.. (3) CII.nd.r lonth. .'t.r the d.c.dant', d..th, a 'Iv. p.rcant (S~) dl.count 0' the t.. p.ld I. .llowed. PENALTYI The ISX tl. .-ne.ty non'p.rtlclp.tlon p.nllty I. co.put.d on the tot.1 0' the t.. and Intar..t ..I....d. and not p.ld b"or. January I'. 1996, thl flr.t dlY a't.r the .nd of the t.. lan..t, p.rlod. INTEREST I Inter..t It cherg.d b.ghV1lng with flnt d.y 0' d.llnquancy, or nIne 191 aonth. and one III dlY 'roe the d.t. 0' d..th, to the dlt. 0' par.ant. T.... which bac... d'llnquent b,'or. January I, .'Il baar Int.r..t at the rat. 0' .1. I'X) p.rcant p.r annua c.lculat.d .t . dIlly r.t. 0' .00DI6~. All t.... whiCh b.ca.. d.llnqu.nt on and aft.r January I. I"l will b..r Int.r..t at a r.t. whIch wIll v.r, 'roe c.l.ndar y.ar to cal.ndar y.ar with that rata ~ad by the PA Olpartaant of Ravenu.. Ih. .ppllcabl. Int.r.,t rata. 'or I'll through 199. ar'l Yllr Inter..t Rat. DailY Intar..t ractor Yllr Intlr..t R.t. Dall, Inter..t hctor 1912 'OX .000S4I 1917 OX .OOOlU 1913 IU .OOUJI 191'-.991 ll~ .0aUGl 191' IU .00UGl 1992 9X .0aOl'" 1915 ISX .OOUS' .993-.99" 7X .ODGI9' 191' lOX .000274 .99S-.991 9X .Oa0l47 ....Inter..t I. calculat~ a. follow.1 INTEREST . BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR ..Anr Hotlc. 1.lued a't.r thll ta. b.co... d.llnqu.nt will r.'I.ct an Int.r..t calculation to 'I't.an IISl d.r. berond thll dlt. 0' the 11.....ant. I' pI,.ant I. aad. .'t.r the Int.r..t coaputatlon dlt. .hown on the Notlc., Iddltlonal Int.r..t au,t b. calcul.tld, ! STATUS REPORT UNDER RULE 6.12 Name of Decedent: JO~.J l..C.-S L.\ E: Date of Death: l-i\-Glo Will No. 21- \9l}b- 00'1-z... \-\-0 '-~'( Admin. No. Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes ")( No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. I is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes No )< b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes ~ No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Cerk of the Orphans' Court and may be attached to this report. Date: C:;.,;)?-flJ . ~'"" ,..~ Signature .~~ . ~ " ", ~'.~ I.G~ .........."1~ Name (Please type or print) \"!., f'.....~.. :Fl. ~.... ......es-t"" S~\P~se~ r...... \'hS1 Address N I ~ c. (;. ",.l.. '- '-J .J' ~71 ",-nO' 9c:M~ Tel. No. -..:-' uc.; Capacity: Personal Representative ~ Counsel for person~l representative (HAH: rmf! AM3)