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HomeMy WebLinkAbout96-00340 -..9 0- .. I . ...... ..~ . . o ..:z ..... o ! a .... en. LLI ~ - ~ l/l' ~ l~~ . rat( ~~:z ~ uf~~ i ~~ PdilO 'S..:-;::- It<H - :ci!:- o.CC Z l/l IJ.o iii l!>8"''' o -H 0 [-I ~ N j!!~ ~~i:: H iii tIl :z: e~ SSO ~ ~ 0 0 H Ot! e-o . iii e-o It= IJ.oU l/l l/l l/l H 005 iii r:i e-o OCl.l t( iii ~o e-o~u e-o U It< ~ - .. e-o iii ~ ~ ~ 0 S H~I~ o l/l UIiI~ t( t:) "'!::l: ~ fLlgj Z ~ ~ .g.~..,,,, H CI.l =c.;~~ tIlOli! ;l ... oI~ ~ e-ou ~ ~]tt 0 . ... ...3~!l ZIJ.o 0 < '" u; HO Z CI.l '. 1-, Ci(, 'II .\ , . ."Il~ I u I;.>~\) , " .' '" -." ,', .' IN RE: ESTATE IN THE COURT OF COMMON PLEAS MARGARETTA S. WHITE OF CUMBERLAND COUNTY, PENNA. ORPHANS' COURT DIVISION DECEASED NO. ~/-9(.. -3tjO ORDER OF COURT AND NOW, ~h.~ -\ 1'/ , 1996, upon consideration of the within petition of Trinity Evangelical Lutheran Church of Camp Hill, and pursuant to 20 Pa. consolidated Statute S3102, it is hereby ordered and decreed that John E. Slike, attorney for the petitioner I is hereby authorized to receive and collect all accounts and assets of Margaretta S. white to pay the costs of administration as set forth herein, the claims against the decedent, and to distribute the balance remaining to Trinity Evangelical Lutheran Church of Camp Hill. BY THE COURT, \0 ~cE 0 ':"!" .. M 0- t. - SAIDIS, GUIDO, ., , SnUFF & 1'- .- MAS LAND 0:: ; ,., c.. 2109 Markel SUCCI () .~ "" Camp 1II11.1'^ <: .\ ~ .~ nl ". ~t: ex: - _::I UU / I " III L 1/ '.r"-. I~ J. .. \ ,j ;, 1: , i' 'I II I' il IN RE: ESTATE IN THE COURT OF COMMON PLEAS MARGARETTA S. WHITE OF CUMBERLAND COUNTY, PENNA. ORPHANS' COURT DIVISION DECEASED NO, PETITION FOR SETTLEMENT OF SMALL ESTATE , :1 TO :1 , :1 :1 ,I d I, '[ I, THE HONORABLE, THE JUDGES OF THE SAID COURT: The petition of John E. Slike respectfully states that: 1. Margaretta S. White died on the February 251 1995, :: [ a resident of Frey Village Retirement Center, North Union Street, ,I iI :1 Middletown, Pennsylvania, a domiciliary of Upper Allen Township, Ii Cumberland County, Pennsylvania. A copy of her death certificate II is attached hereto as Exhibit "A." II ,i il i 2001 Chestnut Street, Camp Hill, Pennsylvania, the residuary 2. Petitioner is Trinity Evangelical Lutheran Church, SAIDIS, GUIDO, SHUFF & MAS LAND 2109 Mark" 5'=. Camp Ifill. PA I beneficiary of the Last Will and Testament of Margaretta S. ! White. i II II 3. Margaretta S. White died testate, leaving a will i dated February 14, 1987, which will has not been probated. The I I [ original of the will is attached hereto as Exhibit "B." I Respectfully submitted, SAlOIS, GUIDO, SHUFF & MASLAND ....., (. ) ( Joh I " Slike Cou ~el'for Trinity Evangelical utheran Church of Camp Hill JOINDER AND CONSENT J. STEWART HARDY, states that he is Pastor of Trinity Evan- gelical Lutheran Church of Camp Hill and does hereby consent to the attached Petition and joins in the prayer thereof. ...~~~ /"71. StewartHar y SAlOIS, GUIDO, SHUFF & MAS LAND 2109 Market SIn:c1 Camp Ilill. PA '1'111'" IIIUIIII\ Ih.11 IIll 1I11"llil.ll1\IIIII' II ,,',(!I I. ,":!,. ! I t!'11. 'I' ,,' 'I: \" !Idl, I~! .,1 ,il '~II ,!,;I-, lilt 1 1'.ldl lilt'" I.Ol.dHq:l...l1.11 '1IH'III.j~lll.dlt!ldll,11l \1111\( II.l',',!I,i,,; IT,. ....r.!i \ll,lh", I II!!:., "'f!"11Jlll.I-tI!!1l1l WARNING: Ills IlIegnllo duplicate this COllY by photostat (.r photograllh. Nil ;",'t'~\i"'of"..'f.'~' l'~,r -' : . "1'" 1~.7 ~:..'\~ X 11~1i!;(.:. .. \~'r .... .M. -- i . \.....: j:b. , <::15.~." " IJ' \\~., ~..~.' ~J ",'!I1/i(. . 't>.\~f/ <....:.. Hllq\ _"e' ~~..,,,.~~' /) L~:)~' .I~,.' ~.-' "rl.>'// /0/_ /. . , ., /' / .~:, \,,/.: .... ,i1 111"1'IQl.ll ~"l.''',_.,_ . . , '7 U h't' till lill'. ~I'rldh,111 ~."llil I", 2754:41 lEU 2 j \9J5 (l.lll' COMMONWEALTH Of PENNSYLVANIA' DEPARTMENT OF HEALTH' VITAL RECOROS CERTIFICATE OF DEATH .' a s. white UMlV'l"""" UJC)lIlttw' UarIN 0.,. ttNI ..... DRI OJ....H \Uot...ott"-I .........,.oa._ sa..CII'ClI.gr1CC11.d" lutt.U......." III 5OClAl. KCUAll'Y HU....." . Female .203 10 - 2270 I'\.JlCI:OJOI:RM.c:r.u """"'" _0 .__0 ...0 Dee 15 03 Lebaoon pa OIDtRH 'Aa.ll'YlWlI(lIrd'-- """...w.t~ Middleta.rn - ,au 020 I'brth Union street". .".,()(ClOINtIVlfl. OlClOlHT'lpUCR1ON ullAMlO'Of'CIIf ...0..1lII 1210Ih ........w..TJQ'UI.~ --- -- ~lidOl<<Jd , 0lCI0IHT.........a llDON..C'it_~..... h1COd11 1020 I'brth Union Street M~etown. pa 17057 OlCIDl . """" .""'NCl - ~-- "...... pa ... - .... .........' u.xJ ::..-===.. Middletown YJnc""........~..~ .,...,......... , Elvina Beck ~IMAUClAODM"~~ 702 Alison Avenue Mechanicsbu ,,..,..... Cr....-y th,o _............. .... -Da . pa 17055 .. eo. ....60 _0 OIWCSfu,' ~Oq."-I o February 28. 1995 uca_ ..... 'OU654-L !:J..O rr,fIIlII1l1 ~...............___.................. Do .......-......"'.... I:::=- I............ I PMT.. cww...... ........................ ",--'''''lilfIlIIl'W'IlI_","PMTL l~ MN;MI1tlf'trf'lHOINOI YAHHlI'lOlOlNH ........ ...... 10 a:uollTlOHOI CAUU ;s- O '" llIRH? - - - 0 -- 0 ..~ ...0 ..0 - 0 <:cud NII......-..a 0 .- DRI 01 HJUI'lT ,.....,0.,._, TIu.EOIIK.IURY ""-,,,TRMJMJ 0l1C.f'll8l HOW NJlJRYOlXUI'INO ... 0 ..0 - - cuntPtIRlCNdlortl'ClNt .cunlfn..I'KTIIClAM,.,'-'urVyroOc.IIM..OMiI'l..........~NlPQl'QltUddMlland~.....m ,.-- ......,.............. .....,...... ........~ ...--........."'..,.,.."..".."".." ... ,. .", '" ",",' ,"',' n. Y. 1'\ACI000........,...y.........'-'-.....IiICD'y,.. --- ... "'DlCAa.DA~ Oft1M.....ef..~..........___......,IlplfIIlMI,.._o<<1IfrM..tNtlrM,U.,ltIlIIpIaoI,.......NUIlM4.11/lIIIl Il.~..""_.......,...,.,....".....,...,.."..."'.,.,..,..."..".".".".".,.."..."..,....,.".,....,' NClIlfllWll.lIfQNArVNNfOfIIUUI(" b<v.,l..,/,-I , uClKII NU 0" , L JWC UfO AOCIAIIS OIl'tltlOft.....o COW\.ITIO CAUM 01 l'-"'n.!/P'."" C. . /)/11/ (P t/1fv.hf mac " ;>II' o u. IOu ?oJ U/U"....J 1 tIA.'t1PlttTOlIW'V (M OAlUUD~oe.,-1 '. , jlU t a.AHOeaJIlTInNJ~tftI,-tdlP~......n~lllc.llMfI~ _..........,.".......,....-...................,.......,,,,............-.(1111'III-............".."."'.".'...", ... ~. '..' ) .. ..:_:.x..LIJL~:.: ..._._..._... !l,' ...'....L.'~;;'~..v,.~;)..rI",~; 'I"~I". LAST IVlLL AND TESTANENT OF r.lAHGAltETTA S. HIIITE I, ~lARGARETTA S. I~IIITE. of the Village of Grantham, TOI...nship of Upper Allen, County of Cumberland and State of Pennsylvania, being of Hound and disposing mind, memory and undcrotanding, do make, publish and declare this my Last Hill and Tes tament, hereby revoking and making void all former IVills by me at any time heretofore made, 1. I direct the payment of all my just debts and funeral expenses as soon after my decease as the same can conveniently be done. 2. I give, devise and bequeath all the rest. residue and remainder of my estate, real, personal and mixed, whatsoever and wheresoever the same may be situate, to my husband, A. J. IIDITE, absolutely and unconditionally. 3. In the event that my husband, A, J. ImITE, should predecease me, or should he die at about the same time os I do, such as in on accident common to both of us, or should he die within thirty (30) days of the date of my dcath, then in any of such events, I give and bequeath all the rest, residue and -1- remainder of my estate, of \~hatsuever nature and wheresoever the same may be situate, to TRINITY EVANGELICAL LUTIIERAN CHURCII, of 2000 Chestnut Street, Camp IIi 11 , Pennsylvania, 17011, absolutely and unconditionally. l. . For the purpose of facilitating the settlement and distribution of my estate, I authorize and empower my Executor, hereinafter named, to sell any and all real estate which I may own at the time of my decease, as well as my personal property, at either public or private sale or sales. LASTLY, I nominate, constitute and appoint my hus- band, A. J. IVHITE, Executor of this, my Last IVill and Testa- ment, and in the event that my said husband should predecease me, or should he be unable or unwilling to serve in such capa- city for any reason, then in such event, I nominate, constitute and appoint THE CONNONIoJEALTH NATIONAL BANK to be the Executor of this, mY Las t IHll and Testanent, in his place and stead. IN IoJITNESS IoJHEREOF, I have hereunto set my hand and seal this /L/rh day of February, A. D. 1987. '-' -.' ,,--. , '/". j.-<,.-.~ I ./.'.;- I " "." ... -, / . /'.1 Z' II' . 1..<-<- tit .tV_I.,_~:._ .J . I ,1._._.,-, , /ilargaretta S. I~hite (SEAL) -2- , , Signed, senled, published nnd declared by the above-named l-IARGARETTA S. HlilTE, as and (or her Last \Hll and Testament, in the presence of us, who, at her request and in her presence, and in the presence of each other, have hereunto subscribed our names as witnesses. l .. /) ;' _ r> ' . .~ / c-L/ '-:'1 ~ 77' ;(,. r ! fC". c/.. 1..{., cc;/' / ./ I .. -3- WHJN\<lEAL'11l OF PENNSYLVANIA) )SS: OOUNIY UF Cll~I1IEI\LAIW ) I, NARGARETTA S. WIIITE , the testatrix . whose MII1C is signed to the attached or foreljoil1l'. in.'ltrunent, having been duly qualified according to law.' do h~reby acknowledge that 1 signed and executed the instrUnent as my Last Will and Testament; trot I signed it willingly; ilI1d that 1 signed it as my free and voltmtary act and deed [or the purposes therein expressed, Sworn and affinned to ilI1d acknowledged before me, the //1".0{ day of Fehruary . A. D,. 19..liL' 'I ) ,,_::.:J/ /~~~t&y ~bfi~"''''~ My Ccmnission Expires: 5,<'/,;;'--; d/'''/ / (SEAL) WNJN\oID\L1li OF PENNSYLVANIA) )SS: OOtJNl"{ OF CUNIII':RLANIl ) We. the lU1dersigned. J. Robert Stauffer and /#"" ,{,; /r> cf./;;, ,the witnesses whose names are signed to the attached or foregot'ng instIUllent, being duly qualified according to law. do depose and say that we were present and saw the testat.I~' NAI1.GARETTA S. \.nUTE sign and execute the instrUJlent as :hi.K/her Last \~ill and Testament; that the said testatrix NAnGAIU~TTi\ S. HIIITE , signed the same willingly and that the said !.!AIWARETTA S. WIIITE. ' executed it as~/her free and voltmtary act for the purposes therein expressed; that each of us, in the hearing and sight of the test.ltrix ,signed the Will as witnesses; and that to the best of our knDwledge the testatrix ,was. at the time, 18 or I1lJre years of age; of sound mind; and under no constraint, duress or tmdj influence, //l;;/cj/M:f/~ , / /1/ ) 1./# c #' , I _/ I{ a (.l A:<~ /l (,,,, (' d.-r&~ 9;.rorn and subscribed to before me this f ./ /~'4f day of Fehruarv ' 19 87, //'~4.i~~/" '.,' My ~sion E.'tpires: ..J:.-~' ,:;'/; .,'7','/ / Register of Wills of Dauphin County, Pennsylvania RENUNCIA liON Estate of -.f)~~RillH S. IVI ~Je.________.__ No. also known as , Deceased The undmslgncd. "IeI/o", (3o",t.) IV. A. I (\tt.I\t~ El;eM.:r:___ tRdatltlllstllpl (C;lpat:llyl 01 Hw abuve Decedent. hurt!hV ftlllOUllr.t!lsl Iht: fl(ltU hi illllllllllsler till! l:!'olilll~ illlil ft~"'IWCII\llly '1'l!IW...ljl->J Ihal Lcllcrs hl~ ISSIWd III --------....-.- --.------.-.-..----- Witness hand this day ul , l~)_ )'I.ldIDl ~1.u,A .)/or~rt<<.eorn~ AJAt1. B,.0:<k, t&t. ;(}!U;u4)IYvI ~~ . J IS_goalu,") tl44A', V,'c.: Pjll.A.(.'~ IAdttrt~"'SI ISIUll.lluwl IAlldft'SS) ISI!1I1aluH:) (AdllwsSI Sworn In Of illllrnwtJ ;IIHI suhscf.lwll bel ore me ttus day 01 ,19 Notarv Puhllr. My Comnusslun EXIUrl!s' . .'~. ~...,. .....1 ~ .. ..' """'-' ., '..,. "" .. r~OT[ H,-"un.:I.,IIO",-, """.'ll"ll ,<t,l-,I.I.' I'lt' Olll. ,- "t "''''.I''".ILI "t .t.......... ,.. ....,........ """'~ .~"... .,.... \\'111..01'1' ""1'1".'01 III ..."1110' '.'''1'111".. t,. I'" ,,,,T,II,/".l ...1.'........,..............,........ RW-1J (Rv.d 9/97) '-. ....,;1 ,--'. , , . . , ~D[ltADjU"''''' ~: ,,_,-':;~~I~, . _...... ," .-..'~' 0 ".'"'' .;.....; 'w' ..,:.~.~..;r..,:'",'f>o: L.v#:~":,..'....'I'q"..."."..:......" , .._ _. __.._ 00.._..-.......--.-.---.- . --' . _f_. ...---.-" :. :" .....--..-... . '",. '.".'," " ." "'II~<:'(..~"'''''' \;;.;.= .,.:,." .,"-~"~~~._' _'''''''''' . ~ ."!",, ". :'. .,..,.;,.,';;'::'::~'~C\"'i":;'-'"'''' "'"..r.,. ,~;,(,' ,', =..:=-_ .~~w,.J ..~.._..I ...,4.. "J'.; ._' ..f. ..",.~.= ," ".-.~. :.,~...".' ("0"; ..,-.. "...... . t:.~~ .' \. 'lh~::F.1'.ii~~'""'~'" .__'4 .... .:: '...'.. .,..,~ ., .1._:' .Lob.:":' ...~ ::...- o;;;J;:....: . J ,..:_ :,-..'. ,1.-'" &-' :e...po...... ............ .' .' '" \ ~..u~Qf) .' '.. ., '.. ..' '.. . _"'-"" '. ~ .." .'.l~ ti,.~..\ ...~r'-'" "........r.. JI(iilI1ji' _"'DlRH DR"""""" ............ ......,,,"""'" _"""......ow-o. ",.,...,....to .' ""'~'. _. ~Oaf.~ ,~,. '.-. .. ....... ...11I..or(.lUlll ,_"" '. .... ... .. 0 ;o."...~..:.~.... ~.\,;' . J '1lj1.HI i . " t ("...... ., 'I 0 . 0 . . .. '." ., 0 ..' 0 ,~,:"'. . ... ;. .0 . ~l . 0 ~.v ::;: :: 0<' ::.:::.. 0 """'.:i::;....;:-.,.:::.:.,- · " . ~ l!! '.... ... ...... 1001-1 .... .' ......' ....T...............--.-..-.-------...--.. .:. ' ' . ....-...---......-...-.-...................................................... " '. . .. .. . ''''. ~..- "".....0.....""-' ._...".................-............._...-........- . : 0 . D 0' ,:<,~~ o! 0...-..... ~, ,,,, t""':'r"---~"--"'~"''''.~-'''''-~-'''''''''''''''''''''''':''' ..........""""............. """""0"",,""''''''' .. " .. . ..' ,.....l...t-..rMt ~".-- . . .,.... ."'- I......::::"~~.~~~~~,:'.',~~~.~.~~'.~~~:~'~:~.~~~~..I.~ 0... _~.I\oIUIoNlr.ll :." ..nll",IU ~trllh' Ih.1 Ihe 11I1"1",.11011' h"r _'"'' h (llIlr<111 wpled fruIlI' an' orislnDI cOlllricDle uf deDlh duly hied wilh me .s ~:' :'\JlcDI Itc_I.lll" '1" ""_11111 crrlill,..lt Will lor ,,,,wlIlI',,1 I" Ihe S~'le V,IDI Itecords Office for pelnlUnenl f1hllll- .J, I .' .. .....", D' ,.:.. . \ . ~;.44!~!' WARN'1tQ11I11 IlIegl' to duplloate thll CoPV bV photoltat or photOgraph, . . " r~' ~ , :: ).,,' .. ,..... " " .~. ..~/?t.~~ " .f LoeR1 Rrgi\uar (f- _,.1,". " i,I {", : I y:.~~\" '" . .-'" f.:.." I \': /~ .,. ~. .;~'. ','. .. '. .,' Dilte ht I'" Ih,. Itllill<ol<. Sl'/I : ; . ~,r . .l.~.;- . DEe 2. I'l&~ ., <i.,' ,:."" . I .. . V:::' _ _.J 06.818.-- N" '. ~. , ---------- -~-~.- ----..._._--~.... -,--- l~....\~..!-t...\ ~::". "j" It.. -....-----. .--..- - ~~- ,- .-- ;1',' " .,~ J ... " . . "". ~. '~," ", -.M' .~';"J" ""'.'. .'. ~ \ ~, ?;-~.;i~;;ll:~ .: r I)...~~': :~~.~;.,. ~(.,~~.:.;:;.'<.. ':>, . ','~'.:; I" ,.'r.,f,' ".~) .",-:. f. ~ . '. .'. . .' . . - ..... "" ~, ... COIIIIOIf'ilEA\.TII Of pEHHBYLVAHIA' OEPARTI/EIIT Of~T~ . ~~ECOROB . :...:' ,',,' I.,~ " . CERT'F'CAT~qF~Q~J~,.~~..lk~.~..i'" . ',' ...... ," ... ..... ..;t..,.. ...,. '''-"~ .,."..;"'.6''''''''''' ....".- . .J'J.--"~ 1CJO"'l~""""''' IllalCl~;r~ LPJl.~.':';:~~''':':'5:!24 ru.ceOl(lUllM ---...........--... ..' -..~\.r.......~<t'\~...\,...I\.-~'~ .'.-'., HIft. _ct".::,_O'", '"",0 .. .......0 . ..~,.,~.,:.:~i,.,..." .I,~. .:,'" ',. ..,.... JI'f~ ......-.-A........IV'C:*I .;'JtA:......, ......~....'.. . I iiiiMHC f . . ,......__. ,-.....,.{-.i,!ll~;~~\'""'......KJ ...0. ~c.,f)II\ llarrisburll llospitaL..'.,~...,;)~~S'i',I; _......,.::-... . W'41 ctDlH ,.... " ~'WU8."""" u...,....o,Of'IC&" . ...........-.....- .'; ",0 ..iii .; r>'" m,' Ni~'... -t';'. H,;r~.. "':"'.,. ,. I ...~ ~'1;'''. ". .I,.' "..... CMUY van .'.:';'~., l~J.m:.O-""""''';' "..,\'." , onuphii .,:"~.~.~~~~~ES.::~;Middlotown '. ~~"'~'1',',.~.';..:,1..;: .~~.;;",'." ..'~" '.. ,~~Mao~Sl:D1~.'~."'" "'I..-.J;' ,_.' l'"I'o ~.., j '1020,onionstroet,'lUddlotown,"l'A 17057 .., .. ,-'---'.- ,'r'. ,'h ..~ :!' ORI.OIOERl4~o." .., .. Dec. 22, 1989 . ...., . ~.- cw.i _0 ,..~~ HDrgarotta Sholly . JI"",per - l . . ,.~ ." .\ I ',.:0." ' .... JI~ insuranco ,,""". "" ..- . ,..*" J~ .-- .... . :;~~., .,' '". :~..l t(".'~~'~/,",...J. .. ......... ..0 H\II HuuMA 01l654-L ...... ............................ ' ............. . '. .' - . , t ,..J .,............~.....-._............. .......'*1 . '~;. , 1~,1,~I/,/1 ,L1D~ ,'" 1'1- ';!-1, 'if .. . ~ ' . Hill, l'A COMMONWEALTH OF PEIINSYLVANIA DEPARTMENT OF PUBLIC WELFARE BUREAU OF FINANCIAL OPERATIONS TPL SECTION . CASUALTY UNIT POBOX 8'86 HARRISBURG PA 17105 Horrell 23, 1995 JOlIN SLIKE ESQUIRE SAlOIS GUIDO SI lUFF' & MASIlIND 2109 ~1I\RKE'l' STREET P 0 IlOX 737 CAMP HILL P1\ 17011 RE: Estate of Margaretta IVHITE Dear 1\ttorney Slike: Pursuant to your letter dated March 21, 1995 regarding the estate of Margaretta IVHITE. Due to the limited annunt of assets availabie and the outstanding claims (Frey Village & Rhoades Phar.) the Department will not seek any recovery pertaining to this estate. If you have any additional questions. please feel free to contact 00. Sincerely. "~'~' ~~ 'H-, ~ . Ronald O. Hill. Mmager I fll', I' II INHERITANCE TAX RETURN RESIDENT DECEDENT (TO BE FILED IN DUPLICATE WITH REGISTER OF WILLS rClll[l,l'[',OI nl",l'H A.I 1[11 t.' II 'n(lIl~:' tl{nl II A '.I'OU'~,ll [- \ .t!)-.tl!.l..!..!..illLlli.!..!..2.l..:L".!!)J~\L -- ,. ----.--~ FILE NUMBER "'I..It,ll""\~.i "llllll"'I"" ,A'I'A !j(' All ~~" '11'1 \ II'" 'I ',' -~ ,'I "A'lll', d I'i 1'1 \ ('. ~ ,'I" I cnu~11 Y COD[ l[,llt ~.UlJn[R lJI.Cr.Ol PI' ~I COlJl'll' [ AOOlllS~ Gnmlhmn Road Grlllll ham. I'A 1707.7 '1 1:'I'I'-.tl"I)IIA',I 'II',' Atlll.II'!) I "j"''', ~ ~ I I,JlI1I I', M.II' C'II I" 1.1 ~;. \IIA!1 .11 iii A'1l 11"11 01 1l'111.. i1,' ;' " ll') !:I '1 'Iltl'\ I -~-,-- C..':'~"'l; 1 I "..,.j Allll . '.11'.,\"1,., ',11,,",1 '.I,A..II : "',!llll',! "'ll' ,),::011 j'~lll,ll ',OCI,ll ',lCUllIT, PjUMBEH AIJOupH n[CEIV[D.~;U IIISTRUCTtONS' '" ,A, ',11 pW',I,l.'l.l11l 'I )' II) .'.' !II Cumlwr I fino D'2.---;;-l;I;II;"llI"~I.11 RclUln o 4a. fllllj'" I!llme<,l COfllprOml~c 1101 d,lloc, 01 deillh altor 12. 12-S2) [X] 6 (JIll mlllnl Ol4lfj 111'~1,t11.l [J 7. Oecedllnt M,llnlmned a liVing Tru!Ot ._. ____ !~~.!!5~Et 01 W~_~ ; Altitch d copy 01 Trust) ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: ------*-- Remainder Rolurn (lor dales of death prIor to 12.13-82) Fedoral Estale Ta. Roturn Required TOI.11 Number 01 Safe DepOSIt Bo.os A 11101, CPt 1";;11. It po' ~ R C K 0 K P 5 C P o 0 R N R 0 E E S N T 1)'''l"11.11 HI'lulI' I ,In,h'lt 1..1,111' 05. 8. tlAIAI ,I ,,11Il I,:. Sllko, !~. It. LI"1l01,L 'lul.tUlH COMPLETE MAILING ADDRESS Saldls, Guido. Shuff 2109 Market Street Carn HIll PA 17011 & Masland R E C A P I T U L A T I o N 717 717.11.05 1. Un,I' E ',lillC! (Schedule A! 1 2. 'jIOt:I<-. ;tnd Bond.. 1 ~Ictllldljl(. B (2) J Clo'illl)' Hold Sloclo./P,HlnfH',hlp Int(>re...t SChl!dulf' C (3) 4, MOllfJilC)Il'. and NOlfl'> R(>(elvilblo SChl'dulf' 0' (4) S. C.I'.ll 0.11,10. Oopo!t'h & MI"CHlt,tnl10U'.. Pfll..OIMI Propt"ty (Sch El (5) 6. JOlnlly Ownod Ploperty (Schudule F\ (6) 7. Tr"fl~tOI"i (Schedule G I (Schedule l \ (7) 8 iotal GrO'i"i AV:iol!o "olal Lines 1.7' 9 rum!!,,' F'rwn'io!. At1m,nl\U.lllve CO',ls Ml';ceU,uH'!OU'i (Ipon'.".. '.5chodult' H' 10. Oohl'i MOIIC},lgO ll.lblllliC!", Llon'i $ch(>dulo I 11. Tolal O~duC110n'.ll{)t.I' line'> 9 & 101 12. 1lt'1 y"lue 01 E~l,lt(.' 1Llne 8 m1nu,;; line 11 13. Ch.l'ltilble .md Governmenlal Beque~l'i Sch('dule J' 14. t~e1 Y.llue Sublectlo Ta. illnc 12 mlnu... Line 131 15. Spou...,,1 Tran'i!er...llor dales of d(',lth .1tt(>l 6-30-94) S('O In'illucl1ons fOI Apphc,lble Perccntilgc on page 2 (Include v.1lues from Schedule K Of Schedule M 1 16. Amount olUne 14 la.able at 601. rate Ilnclude values hom Schedule K Of Schedul(' M ) 17. Amount olUne 14 ta.able at1S'/. rato (Include values from Schedule K Of Schedule M 1 18. Prlnclp,ll lax due (Add ta.trom Line 1S t6 and 17 ) 19. C,edl'''.ISp Poverty P'IOr P,lyn)(>nt'. OI~,COllt11 (19) (20) (9) 1.81.5.01 (8) 11.3.00 573.17 (II) (12) (13) (14) 0.00 X , 0.00 X 06 ' 0.00 X 15 ' 0.00 1,81.5.01 (10) 916.17 928.81, 928.81. (15) 0.00 (16) 0,00 T A X C o M P U T A T I o N (17) (IB) 0,00 Inlerest 0.00 (J.OO 20. tlll"lJ 19 I", 9'Cillcr than line 18 enle! the dlllelellCl' on lme 20 ThiS IS lhe OVERPAYMENT. [IJ 0 Check here if you are requestins a refund of your oyer aymenl. 21. II line 1SI!> 9roalor thiln lIne 19 cnlN tho dlllerence on Line 21 ThiS IS lho TAX DUE. A. Entor Ihe Inle'o'.1 on the l.lal,lIlce du(> 011 Lln~ 21A -- ---.-,*-- (21) ( 21A) (21B) 0,00 0.00 0.00 B. Enlellhe lotal at llm- 21 ,Ind 21A on lme 218 Tl1I'. I'.> the BALANCE DUE. Make Check Pa able 10: Re Isler 01 Wills. A cnl ~ ~ BE SURE TO ANSWER ALL QUESTIONS ON PAGE 2 AND TO RECHECK MATH ~ ~ UM'" r.... .it,., 01 p'llufy I <,,,(I.U! Ih .11 t,.."to ...am'",,(j U""i,..hull ir><:lu(lll1q ,te(o",p.I1,lnq ~(h~dule",tnd sl.lements Al'l(llo th~ best 01 my kno-...1edge and bfol",t, II (s llue conllel,fHI (o"'r~..I" I d",(I.", th.t..1l '....I....I.le h,n b"..n If'pOIIf'\1 at lll-'" mar~,,1 vollue D~cldl.\lOllol prep4rel ottllH Ih..n Ihe ~1~on.1 rep'..s"ntAlt~"... bA~ed on all mlolm.llon 01 <Iot',ehf""f,.II'''I1",..n-tlno...IPdq'' ~;t(.liAl Ull[ Of P[rt.;O'. rl[SPON';lI]l[ J:QH flll',G I'll lunN .J oh" E. S 11 ko, I::sq, P. O. Box 737 Camp H 11], PA 17001 Saldl". Guido, Shuff & 21 09 Market Street Camp' HI i i : . pi' . i Jili i . . . . DAlE ':itGI.At Lnr (H I'r1[I'AIIER OTH[R THAlli R[PRf'i[NT AliVE: Masland CATE .-..--.....-.--..-..-.*. rOil., 1500 n...... 1.9~; c.l'll'."I'" " "N4 '('l""..oll...,,,..onl,.rp',,"i,..n,.. \'>'; Act #48 01 1994 provides lor the reduclion 01 the tax rates Imposed on the net value ot translers to or lor the use 01 the spouse. The rates as prescribed by the statute will be: 03010 (.03) will be applicable lor estates 01 decedents dying on or after 7/1/94 and before 1/1/96 02% (,02) will be applicable lor estates 01 decedents dying on or after 1/1/96 and belore 1/1/97 01% (.01) will be applicable lor estates 01 decedents dying on or after 1/1/97 and belore 1/1/98 o Spousal translers occurring on or after 1/1/98 will be exemptlrom Inheritance tax. PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING A MARK (X) IN THE APPROPRIATE BLOCKS. YES NO 1. Did decedent make a transfer and: x a. rotaln the use or income of the property transferred. x b. retain the right to designate who shall use the property transferred or its income. ......,. . x ...... . c. retain a reversionary interest; or . .............,.,. . x d. roceive the promise lor lile of either payments. benefits or care? . ....... . ...... . 2. It death occurred on or belore December 12. 1982. did decedent within two years preceding death transfer property without receIving adequate consideration? It death occurred atter December 12, 1982. did decedent transfer property within one year of death without receiving adequate consideration? . . . . . . . . . . . . . . . x ........ . x 3, Did decedent own an 'in trust for' bank account at his or h,r death? ............ . ............... . IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Form 1500 (Re... 7.941 CopvrltJ~II(, ,qq, In"" 'nll......,.. nn'''' CP~V'\I","' 'nr REV. 1!lotl rl . 171ft, SCHEDULE H FUNERAL EXPENSES, ADMINISTRATIVE COSTS AND MISCEllANEOUS EXPENSES Pl.... Print or T . FILE NUMBER co"rN~.lt~~~{~m~~ihr'NI' ESTATE OF Mar'lIrotta S. IIhlto ITEM NUMBER A. Fun.rll Expen...: SS!I 203.JO.2270 02 25 95 DESCRIPTION AMOUNT B. AdminIstrative Costs: 1, Personal Representative COmmissions Social Security Number of Personal Representativo: Year Commissions paid 2. Attorney Fees Saldls, Guido, Shuff & Masland 300.00 3. Family Exemption Claimant Relationship Address of Claimant at decedent's death Street Address City State Zip Code 4. Probate Fees C. Miscellaneous Expenses: 1 Register of IIllls - filing fees for petition 18.00 2 Landis Jewelers - appraisal 25.00 TOTAL (Also enter on hne 9. Recaprtulation) (II more spece Is needed, Insert additional .heel. o' .ame size.) Copyl1atll 'cl 1994 tOlm !loth....'1t only CPSY'lIl!m!l Ire s 343.00 Fo'm 1500Sctlf!dulf' HIR"v 7.8e\ REV. 1St] EX'. {Z-871 . SCHEDULE J BENEFICIARIES cO"~N\l\1rtitl4'bo:~~jht"lA ESTATE OF FILE NUMBER SS/! 203-10.2270 02 25 95 AMOUNT OR SHARE OF ESTATE Mar oretto S, Whlto ITEM NUMBER . , " I I , i i , I ,I 'I i ,I I I I ITEM NUMBER NAME AND ADDRESS OF BENEFICIARY RELATIONSHIP A. Taxable Bequests: NAME AND ADDRESS OF BENEFICIARY AMOUNT OR SHARE OF ESTATE B. Chantable and Governmental Bequests: 1 Trinity Evangelical Lutheran Church 2000 Chestnut Street Camp Hill. PA 17011 1007. s TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Also enlel on line 13. Reca Kulalionl (If more space is needed, insert additional sheets 01 same size.) Copyrlqht Icl1994 form solh"'''. only CPS,;,stems.lne Form 1500 Schedule J IP@'i Z.871 ,.-'" .,"",~_._....----..----..----~ -- 0.00 " 737-8024 2129 Market Street Box 481 Camp Hill, PA 17011 Volumetric calculations are approximate, based on estimated measurements. The actual weight of any stone(s) can be considerably different than the estimate by formula. When items are marked with the fineness of the metal, the appraised value is based on that marking unless otherwise stated. When there is no marking on the item, the method used to estimate the metal content is the nature and appearance of the material as well as any testing as noted. These pieces have been examined without the stone(s) being removed from their settings and are appraised on that basis. This is a fair market value at which the property would change hands between a willing buyer and willing seller if both had reasonable knowledge of relevant facts and neither was under compulsion to buy or sell. Barry R. Landis Page 2 of 3 INC. ,; c--- D E C E D E N T I ' J ( ) \ . ) ron O"T[!J m OtAHi Af nit \lI.l11ljl Cll[ClC.ll[n[ INHER1TANCE ~Ax RETURN ~tv1\;~~~~'tD" IOCLA''''W 0 RESIDENT DECEDENT FIl:E NUM~R ,/ (TO BE FilED IN DUPLICATE ILc J)e..~ -f~ WITH REGISTER OF WillS eaUNlfeaDE 0/1 ,[AA b NU"'OEA .0 Y.b DECEDENT'S NA~EtLAST ,FIRst. AND MIDDLE INITIAL) OECEOEHtSCOMPlEtE: AQOfl[SS Whl to. Mar 'orotto S. Grnnthum Road SOCIAL SECURITY NUMBER DATE OF OEATH DATE OF BIRTH Grantham, PA 17027 203-10.2270 02/25/95 12/15/03 REV - I!lOO EX . (7-941 cAB H P t E PO C R C K 0 K P 5 C P o 0 R N R D E E 5 N - T ea"'~FPltMh! Wl,'l.fM:'ilMANIA HAARISB5~t.~\Z8'()('OI Cumburlllnd Counly f1emaindor Return liar date. 01 dealh prIOr 1012-13.82) Fedoral Estale Tax Return Required T atal Number of Sate Deposit Boxes ,IF APPllCABlEISURVIVING SPOUSE'S NAME 'LAST ,FIRST AND MIDDLE INITIALI SOCIAL SECURITY NUMBER AMOUNT REC[IY[OlSEE INStRUCtlONSI 2. Supplemental Return 4a. Fulum Inlorest CompromIse liar datos 01 death aher 12.12-821 []] 6. Decedent Died Testate D 7. Decedent MaintaIned a living Trust IAnach cop 01 W,II) (Mach a cop 01 Tru.t) ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: X 1. Original Return X 4, limited E.tate o 5. 8. COMPLETE MAILING AQDRESS Saidis, Guido, Sht'fh& 2109 Markot Stree~ ,7 Cam Hill PA 170fl R E C A P I T U L A T I o N NAME John E. Sliko, Es . TELEPHONE NUMBER 717 737-3405 1. Real E.tatelSchedule AI 1 2. Stock. and Bond.ISchedule BI (2) 3. Clo.ely Held StocklPaMe..hip Interest (Schedule CI (3) 4. Mongage. and Note. ReceivablelSchedule 01 (4) S. Cash. Bank Deposits & Miscellaneous Personal Propeny (5ch_ El (5) 6. Jointly Owned Property (Schedule F) (6) 7. Tran.le.. (Schedule G) (Schedule L) (7) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses. Administrative Costs. Miscellaneous E'pen.e.ISchedule HI 10. Debts. Mortgage liabihties. li~ns (Schedule I) 11. Total Deduction. (total Line. 9 & 10) 12. Net Value of Estate (line 8 minus Line 11) 13. Charitable and Governmental Bequests (Schedule Jl 14. Net Value Subject to Tax (Line 12 minus Une 13) 15, Spou.al Tran.fe.. (for date. 01 death aher 6-30-941 See Instructions for Applicable Percentage on page 2 (Include values from Schedule K or Schedule M.) 16. Amount of Line 14 taxable at 61/1 rate IInclude value. from Schedule K or Schedule M ) 17. Amount 01 Line 14 taxable aI1S'/, rate (Include values from Schedule K or Schedule M.) 18, Principalta, due (Add ta, from line 15, 16 and 17,) 19. Credits/Sp Poverty Prior Payments Discounl (19) (20) 0,00 0.00 Masland :0 ~~ .n ,'" ," (9) - . ~ ~ C'I 1,845.01 ~r, \ "- r-:: ,. 0 (8) 343.00 573.17 (11) (12) (13) (14) 0.00 X , 0.00 X ,06 = 0.00 X ,15 ' (18) Interest 0.00 " 1,845.01 (10) 916.17 928.8/, 978.84 ~l.OO (15) 0,00 (16) 0.00 T A X (17) 0.00 C o M p U T A T I o N + . 20. If Line 19 is greater than LIne 18. enter the dlllerence on Lino 20 This is Ihe OVERPAYMENT. [I] 0 Check he,e If au are reque.tln a refund of your over aymenl, 21. If Line 18 is greater than Line 19. enter Ihe difference on Line 21. This is the TAX DUE. A. Enter the interest on the balance due on Line 21A B. Enter the lotal of Line 21 and 21A on lino 21B Thl5 15 the BALANCE DUE. Make Check Po oblelo: Re 1s'e, of Wills, A ent .. .. BE SURE TO ANSWER ALL QUESTIONS ON PAGE 2 AND TO RECHECK MATH · · Und~t pl!nJiIlI~sol perJury, I declJifl' that I have eumlned thiS return. Il"Ctuctmg accompanying schPdutes and slat~meots. and to th~ best 01 my ~no....tPdge and belief. Ills true. cOII~c1 and compt~le I dKlare thlt aUrt'al estat~ hn be~n r~poftPd at true mar~el value O~claraljonol pr~parer othl!" than the pefsonalr~pr~senlalive Is based onatl tnlor~ttonot which prepare' hn aITj ~now'Pdge. (21) (21A) (21B) 0.00 0.00 0.00 E OF PERSON RESPONSIBI.E FOR FlUNG RETURN ,John E. Slike, Esq. P. 0, 1I0x 737 C;.n;' iiii i:PA.i'liirii...... Soldls, Guido, Shuff & Masland 2109 Market Street C;.n; - 'iiiii': 'PA" .i'liiii.................. DATE .5 Jj!If., 5'() L\.. CATE N REPRESENTAl1VE . (I , .j;,' 1994 formsoltwa," only CPSystoms, Inc 't"'" REV - ISOB EX. (2.87) SCHEDULE E CASH, BANK DEPOSITS AND MISCEllANEOUS PERSONAL PROPERTY Ploase Pllnt or T 0 FILE NUMBER cO"~N\\1~~{\'W~~'NIA ESTATE OF Margaretta 5. White 5511 203.10-2270 02/25/95 musl be disclosed on Schedule F) DESCRIPTION VALUE AT DATE OF DEATH 1 2 3 4 Mellon Bank checking account Blue Cross/Blue 5hield refund Tangible personal property Two diamond rings - per attached appraisal 1,196.81 93.20 75.00 480,00 TOTAL (Also enler on line 5, Reca ~ulalion) (Anach add~ional8 112' x 1 r sheels W more space is needed,) Copyrl;hl (Cl1994 form sollwlI. ant)' CPSystems, Inc:, $ 1 845.01 Form 1500 Schedule E {Rev. 2-871 REV. 1&11 EX. (7.88) SCHEDULE H FUNERAL EXPENSES, ADMINISTRATIVE COSTS AND MISCELLANEOUS EXPENSES Plo"o P,lnl 0' T 0 FILE NUMBER CO"~N\l\1~c\\,~~r'Nl' ESTATE OF Mar uretta S. White ITEM NUMBER A. Funer.1 EJlpln...: SSII 203.10.2270 02 25 95 DESCRIPTION AMOUNT B. Admlnlsl,"tlv" Cosls: t. Personal Representative Commissions Social Security Number of Personal Representatiye: Year Convnissions paid 2, Attorney Fees Saidis, Guido, Shuff 6. Masland 300.00 3. Family Exemption Claimant Relationship Address of Claimant at deceden!"s death Streel Address City State Zip Code 4, Probate Fees C, Mls.elllneous Expenses: 1 Register of Wills - filing fees for petition 18.00 2 Landis Jewelers - appraisal 25.00 TOTAL (Also enter on hne 9, Re.aprtulahonl (If mo.e IPI.ell noeded,lnserllddillonll Iheels 01 lime Ilze.) Copyright Ie) '994 lorm SOltwlf' only CPSyst.ms,lnc. s 3/.3.00 Form 1500Sehedul. HIRe~. 7.88) RE\' ~ 1&12 EX. 0.1)) SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES AND LIENS Pl.... P,lnl of T · FILE NUMBER cOMrH~l~\~~Oftl~~~r'tYAHIA ESTATE OF 02/25/95 Mnrgaretta 5. Whito 551! 203,10,2270 AMOUNT ITEM NUMBER DESCRIPTION 1 2 3 Froy IIlllago Rhoads Pharmacy Joan Thomas _ reimbursement for U.Haul charges 375.72 117.55 79.90 TOTAL (Also enter on line 10, Recap~u\alion) (II more space is needed, insen add~ional sheets 01 same size,) Copyf19h1 (c) '994 form sol1w.r. only cPSy,t,ms,lne. S 573.17 Form 1500 Schodule I(R.... '.11) 737-8024 2129 Market Street Box 481 Camp Hill, PA 17011 February 1, 1996 John E. Slil,e 2109 Market street Camp Hill, PA 17011 concerning the jewelry estate pieces of the Estate of Margaretta S. White, the following items have been examined and appraised. The enclosed report, in duplicate, has been undertaken to determine an approximate estate value for the items as described. Each item has been examined to the best of my ability to determine fair market value only. The procedures, wording and values would all be different if this report was undertaken for other purposes. This report or any copy does not carry with it the right of publication without prior written consent nor may it be used for any purpose by anyone other than the above named, and as such, may only be used in its entirety and with this cover letter. The specific description of the gems or jewelry is for the sole purpose of identification in order to determine the parameters for valuation. The description is based upon grading and other techniques and equipment availalJle to, and used oy Landis Jewelers, Inc., at the time of examination. The description may reasonably vary from other descriptions of the items listed, and may vary in the future as a result of changes and improvements in grading techniques and equipment. Unless otherwise stated, the weights of all mounted stones are estimated by formula. Many mountings restrict examination of details of the gemstone; unless specifically stated that stones were removed and graded, statements referring to color and/or internal pureness are provisional; approximate weights are determined by volumetric calculation; estimate replacement cost is based on assumed species, size and quality. Page 1 of 3 INC. 737-8024 INC. 2129 Market Street Box 481 Camp Hill, PA 17011 Volumetric calculations are approximate, based on estimated measurements. The actual weight of any stone(s) can be considerably different than the estimate by formula. When items are marked with the fineness of the metal, the appraised value is based on that marking unless otherwise stated. When there is no marking on the item, the method used to estimate the metal content is the nature and appearance of the material as well as any testing as noted. These pieces have been examined without the stone(s) being removed from their settings and are appraised on that basis. This is a fair market value at which the property would change hands between a willing buyer and willing seller if both had reasonable knowledge of relevant facts and neither was under compulsion to buy or sell. Barry R. Landis Page 2 of 3 REV-ls47 EX AFP 11Z09S*L :1 COMHOHWfAllll or PIHHSYlVAHIA ACN 101 DIP"I""IN' Of U(VIHUl NOTICE OF INHERITANCE TAX BUR[AU or INDIVIDUAl furs APPRAISEHENT, ALLOWANCE OR DISALLOWANCE ~~:~is~~:~~. p, 1"'....01 _,OF DEDUCTIONS AND ASS~SSHENT_ DF UX.. _~ATE ~O,9_~~Oc~:~' ESTATCOF-j;jHITE .~ -5 FILE NO. -21 9'F03iiOc DATE OF DEATH 02-25-95 COUNTY CUMBERLAND NDTF.: TD INSURE PRDPER CREDIT TO YOUR ACCOUNT, SUBHIT THE UPPER PDRTIDN OF THIS FORH WITH YOUR TAX PAYHENT TO THE REGISTER DF WILLS, HAKE Ct(ECK PAYABLE T'O "REGISTER OF WILLS. AGENT" REMIT PAYMENT TO: JOHN E SLIKE ESQ SAlOIS ETAL 2109 MARKET ST CAMP HILL PA 17011 REGISTER OF WILLS CUMBERLAND.CO COURT HOUSE CARLISLE. PA 17013 AJlount R."Ut.d CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ ii"iv:i5'4i-Eif"AFP--nF9ST"NOi"icE--O,:uiNHEififiiiicn'-AiDippiiiiisE'if€N,..;-.H.l"OWAiicE-iiri-mm----mm DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF WHITE M S FILE NO. 21 96-0340 ACN 101 DATE 09-10-96 TAX RETURN WAS: (X I ACCEPTED AS FILED CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. R..I Est.t. C Schedule A) (1) 2. stocks and Bonds (Schedule 8) (2) 3. Closely Hald stock/P.,-tn.,-shi.p Interast (Schedule CJ. (3) 4. Hartg.g../Hot.. Receivable (Schedule DJ (4) 5. Cash/Sank Caposits/Hise. P.rsonal Property (Schedule EJ IS) 6. Jointly Owned Property (Schedule f) (6) 7. Transfers (Schedule G) (7) 8. Total Assat. .00 .00 .00 .00 1.845.01 .00 .00 (BJ 1.845.01 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expensas/Adn. Costs/Hisc. Expense. ISchedule H) 19) 10, Debts/Ho,tgege Llebllltle./Llen. (Schedule II (101 11. Total Deductions 12. Net Value of Tax Raturn , 13. Charit.b1a/Govarnnent.1 aeque.ts ISchedule J) 14. Net Value of Estata Subjact to Tax 343.00 573.17 lIlJ 1I21 1I31 1I41 q16 17 928.84 928:84 .00 If an assessment was issued previOUSly, lines 14. 15 and/or 16. 17 and 18 will reflect figures that include the total of ALL re~urns assessed to date. ASSESSMENT OF TAX: 15. Anount of Line 14 16. Aabunt of Lin. 14 17. Anount of Lin. 14 18. Principal Tax Due NOTE: at Spousal taxable at taxable at .00 .00 .00 .00 .00 ,00 .00 X .00= X .06= X .15= lIBJ rat. Lineal/Class A rate Collateral/Class a rate 1I51 1I61 1I71 TAX CREDITS: PAYHENT DATE RECEIPT NUHBER DISCDUNT ('1 INTEREST ('I AHOUNT PAID TOTAL TAX CREDIT BALANCE OF TAX DUEl INTEREST AND PEN. TOTAL DUE .00 .00 .00 .0,0 . IF PAID AFTER DATE INDICATED. SEE REVERSE FOR CALCULATIDN OF ADDITIONAL INTEREST. IF TOTAL DUE IS LESS THAN SI. NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRI. YDU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FDRH FDR INSTRUCTIONS.. ()l RESERVATION I E,lat.. of decedent. dying on or before Dec..b.r 12. 198Z -. If any future lnter..t In the ..tate I. transf.rred In pa.....lon or enJoy..nt to tla,' e (collaterall beneflclar..' of the decedent aft.r the I.plratlon of any .,tat. for Ilf. or for y..r., the Co..onwealth her.by ..pr.s.lv re..rv., the right to apprals. and all." tran,f.r Inheritance ,.... at the lawful Cia.' a (collateral1 rat. on any such future Inter..t. .. PAYHENTl Detach the top portion of this Notice and subelt with your pay..nt to the Reghter of wills printed on the re".ru sid.. ..Hake check or .oney order payable tal REGISTER OF MILLS. AGENT All pay..ntl received shall first be applied to any lntor..t which ..y bl due with any r...lnder applied to the tax. To fulfill the requlre..nt. of Soctlon Z140 of tho Inheritance and E.tate Tall Act, Act ZZ of 1991. 7Z P.S. s.ction Z140. PURPOSE OF NOTICE: REfUND (CA): I rofund of a tall crodlt, which was not requ..ted on the Te. A.turn, .ay ba roqu.ltod by coapl.tlng an RAppllcatlon for Aofund of ponnlylvanla Inh.rltance and Eltat. TallR (AEV-1313). Applications aro avallablo at tho Offlc. of the Aoglster of will., any of ~h. Z] Aovonu. DI.trlct Offlc.i, or by calling tho sp.clal 24"hour answ.rlng s.rvico nu-bor. for for.' orderlngl In Ponnsylvanla 1-800-36Z-Z050, outside Ponnsylvania ,nd within local HarrisbUrg area (111) 181-8094, 100' (111) 11Z-ZZSZ (Hoarlng I.palred Only). OBJECTIONS: Any party In Int.r..t not .aUsflad with the apprah...nt, allowanc. or disallowance of d.ductlonl, or an.....nt 01 ta. (Including discount or Int.r.st) a. shown an thl. Notlc. .u.t object within .Ixty (60) day' of r.calpt of thlt Hotlc~ byt --written prota.t to the PA nepart.ant of Ravenu., Board of App.al., napt. Z81021, HarrisbUrg, PI 111Z8-1021, DR --alectlon to have the .attu detar.lnod at audit of tha accQW1t of tha pusonal npresontatlve, DR --appaal to tha Orphan.' Court. ADHIH ISTAATlVE CORRECTIONS I Factual error. dlscov.rad on thl. ass..s.ant should ba addressed in writing tal PA Depa-t..nt of Revanue. Bur.au of Individual Ta..', AnHI Po.t An.....nt Ravl.w Unit, n.pt. 280601, Harrisburg. PA 11128-0601 Phon. (111) 181-6505. S.e pago 3 of tho booklet "InstructI6n. for Inheritanc. Ta. Roturn for a Ae.ld.nt n.c.dent" (REY-ISOI) for an e.planatlon of adalnl.tratlv.lY correctable .rror.. If any tax due I. paid within thr.. (3) calendar .onth. after tha d.c.dent'. daath, a flvo parcent (5~) discount of the ta. paid I. allow.d. The 15~ tax aanesty non-participation penalty la co.put.d on tho total of the ta. and Intor.st a.ses.ed. and not paid bofor. January 18, 1996, tho first day .ftor tho ond of tho t.x aanosty porlad. Thi. non-participation ponalty It appo.labl. in the .a.. .annar and in tha the saaa tI.. parlod a. you would app.al the tax and Intarut that ha. ba.n ..s....d a. lndlcatod on thl. notlca. Intora.i I. charged bag inning with flr.t day of delinquency, or nina (9) eonth' and one (I) day fro. the date of death, to the date of pay..nt. T.... which baca.. dallnqu.nt bafore J.nuary 1. 1982 bear Int.r.it .t tha rate of .Ix (6~) percant par annu. calculatad at a d.lly rata of .000164. All ta... which bec... dalinqu.nt on .nd .ftor January 1, 1982 will b..r int.r..t at . r.ta which will vary fro. c.land.r yaar to calDndar ya.r with th.t rata announc.d by the PA Oepart..nt of Ravenuo. The appllc.ble Int.rost rate. far 198Z through 1996 .re: ~ Inter.st Rat. Dally Interest rltctar !!!r Intere.t Rllta DIllly Int.ratlt rllctar 198Z 20X .000548 1987 .X .000241 1985 16:C .000438 1988-1991 1I~ .000301 1911" IU .000301 1992 'X .000241 1985 13:C .00n56 1995-1994 1% .000192 1986 "lOX ,00021" 1995-1996 .X .000241 ~-Inter..t Is calculated os followlI DISCOUNT: PEHALTYl INTEREST: INTEREST = BALANCE D~ TAX UNPAID X NU"BER OF DAYS DELINQUENT X DAILY INTEREST FACTOR ~-AnY Hotlce i.tlued after tha tax beco.etl delln~u.nt will refl.ct an Int.ra.t c.lculatlon to fift.en IIS1 day. bayond the date of tha a.s.....nt. If p.yftant I. ..de .fter the lnt.ra.t co.put.tlon data shown on tha Hotlca, .ddltlonal Inter..t .Ult b. c.lculated. n(, e:, STATUS HJ:POln:..11W)FJ1..HlLLEJ!.12 '''-, Date o[ Decedenl: Cf%:u.(j~tTa- (J./-I-- Deillh:__ '.LI-~f~ ,;21- '1(, - .3ID ,.), t-12t:-~ Name o[ Will No. Admin. No. '-'"1 hl Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the (011 ow i nC] w iLh respect to completion o[ the administration o( the above-caplioned estate: 1. state whether administration o( the estate is complete: Yes v 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. 1 is Yes, state the [ollowinC]: A. Did the personal representative file a final account wi th the Court? Yes No../ B, The separate Orphans' Court No. (i[ any) [or the personal representative's Account is: C. Did the personal representative state an account informally to the parties in interest? Yes~ No_ D. Copies o[ receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk o[ the Orphans' Court and may be attached to this report. 1/~/ft 1\ 1L",t... ,C') SiC]?l1ture ..!.h,1I ^' E. Name (Please ot3,)<. 7a7 Address . . , Date: i.tL .s/../~ E. type or print) {!~hljJ JI~t. .;!; . 17~/,o7.37 ( 7171 73 7 - .3 t/o~-- 'l'elephone Number Capacity: Personal Representative ............. Counsel for personal representative RW-23