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Home My WebLink About96-00365 ~ . o Z o CD .. o 1;; ~- ,....., '.' .- . I)ETITION H)It 1)I{OnATE und GRANT 01; LETTERS .' -::.l( =- Nn, ,._<:,:,:,)J,,:::~'-- "-' 0 --' . Tn: . 'J (;1'::1' T, IIlrl E.,tall ,if __" ". m ,.' IIbll kIWII'll "" -.-,.- .. "",," ."__ Ite~hler 01 Will- for the .,,_._"" ' . 11<'"(.,,,,'<1, COllnlY 01 1'1IIH\lI'r I """ in the SIlda' Sl'fl"il,\' Nil, _~.L:"",:I).~. J~~l..- __' Cnmmnnwellllh of Pennsylvania The pelitionof the nrllle"j~nell re'llC~lfnIlY repre,enl' Ihllt: Your pelitioner(li), who j_/KIt IK yell" nf ll~e or older llnlhe exeelltr Ix inlhe la_t willollhe llhn,e de~edent. dillell -'- J\ll~'-~.... ------ and eodicil(s} dllted -,,----'''- named , 19.2!i-- t\Hue fch:\'iUll dlt.:lIl11\lilllt.:C\. c.~. IClIllI\diUillll,l.ICi'th of c'(<<Ulor. CIC.) Decendenl wa_ domiciled 01 dellth in 1'1I1ll1", I' \ ,,,,,I his last family, orprinciplll residence al !, lll, I'll rn,1I' (' Ill> II 1>1,' (Roo th ~e\\lt(ln l'm..'11 sh I p) Pl'nns\'l va 11 i:l I 7:~ fl7 (Ii\l \Heel, numhcr and l1lundp"lil)'} County, Pennsylvania, wilh Hn:1l1 ~h t Pl'l'no..;,h!lrll Decendenl, then (,K yellr_ of age, died Al'r II \ H , ' 19 <\(, at cnr1ls1ellns1llal . Excepl as follows, decedent did not marTY, was not divorced and did nol have a child born aT adopted afler execution of lhe will offered for probale; wa_ not Ihe victim of a killing and was never adjudlealed ineompelent: Decendenl al death owned properlY wilh eSlimaled values as follows: (If domiciled in Po,) All personal property (If not domiciled in Po.) personal properlY in Pennsylvania (If nOl domiciled in Pa.) Personal properlY in CounlY Value of real cst ale in Pc sylvlUlia siluated as follows: 1-<,...-/l(<L<. '\' llII.0 ~t\;pr.ltl,bLLn'3' P .. 50n.Oo s s s s z...~ i'/"',,\ I'" WHEREFORE, pelilioner(~ respectfully requesl(s) the probale of the lasl will and<:cudk:il(s) presented herewith and Ihe granl or leuers Tl'" I' ",,"'11 1 " ry (tC!l.lamcnlary; administration c.t.a,; administration d.b.n.c.t.I.) Iheron. I'A Hnnd 17257 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH 01" PENNSYLVANIA } 89 COUNTY OF ClImlll'rland The pelitioner(ll) above. named swear(s) or arfirm(s) Ihal the stalemenls in Ihe fOTcgDing petiliDn aTe Irue and eorrecllO Ihe besl or the knowledge and belie! or petiliDner(s) and Ihal as peTsonal TcpTesen. tative{s) or the above decedenl petilioner(sl will well ak Iruly ad~inisterlhe eSlalc~~:?rding.lo law, Sworn 10 aT allirmed lU\d SUbscribed~. -,. ,(f ,,/1,;' ~/;,: I, l/;/:: '" berore me Ihis 79\ tt day or . ~1\\':\\lHA I.. II!'I.~I / ~' A lr I 19. (, [ !a l'(~ '.1. Yl - ti;. ,t<r S LEWl S Rellisrer' iT ~ ~ \:-; - \ C ,r ..- \ '( , --..' ~-.....,...,- -..'""""""lrIo-b:la"",,-" 41~" 1:. N 71 - 9li - ]li~) o. Estate of (;ENE T. 1IE1.'1 . Deceased DECREE 0..' PROBATE AND GRANT OF LETTERS AND NOW MA Y 6. 19.!1ll-, in eonsideratiDn of thc pctition Dn the reverse side hereof, satisfactory pToof having been presentcd befDrc me, IT IS DECREED that the instTument(s) dated 1111,. 'i 1 qq/, described theTein be admilled to probate and filed of reeDrd as the last will of Cene T. lIelm and Lellers are hereby granted to T(O~t':1mpnl.:\ry Saundra Lynn Helm 1fJ~"o(~;4/l~t1 (W<- tJm(~lf1' Register or Will. (J MARY C. LEWIS P b E $ 115.00 TD atc, LCllcrs, te,.. . . , . . , . Short Ccrtificatcs( 2) . , . .' . . . .. $ Ii nn Rcnunciation ......,......... $ X-Pages JCP FEES Sally .1. tHnder 24705 $ 6.00 5.00 TOTAL _ $ 137.nn Filcd "..,.. ~AX. 9.'. .m?,.,...,......., ATTORNEY (Sup. Ct. t.D. No.) 701 East King Street. Shippensburg PA ADDRESS 17257 (717) 532 - 9476 PHONE nn :nif,1 c r' vi ~ CJ'I 17 (";J n r." " "" -0 ;- ;0 c tl:l r' .- ~. '0 ",,: N <F -a I... 2. )>~ (..Ii --.I Mailed letters and order to attorney on 5-6-96. 00 ~ :0 em :Ilm 3,. <:In c- t(. 0 ~ ) ?Q ~ ~~ " ;0 , ~. , tl:l c " , " c' :~f~ 9 ,'l '0 .;} N U, 9. :oc ill )>~ .... ,.... 5~ - If) ~1Il N 0 .~).- 0- C) ~ .j~ , -' .0 he) Rl ..'. I.) \i ~- '~ (,.~ ..1 ~ j l.1 '"i7. ~ .. c- 0," '" g~ ~ .-G ..J ;ii E a: -:> 00 r '. SAI.LY J. WINnER AI/ortley 01 Loll' 701 E. I\ln~ S"t" Shlp(l<~\burs, P:' 17217 ....., '0." ,\ lN WiTNESS WH~;ln;tlF, l hercunlu "el my hllnd IInd "cnl to IIn.1 Teslmnenl, wrlllen on ~__ "heeLS of 1'"l'er, dilLed Lhi s my I.llsl tillS .o..m dllY Wi II o'~"'-~l---' l'J'JI" _ -:::i;~ v( ./~e.1_ISEAL) c&;"ff" HW1 ~v'~ -\ The pr~c~din~ lnsLrum\Jnl, conslsLin~ al lllis and one other typewritten plltle, ellch idenLified by lhe signaLure ol Lhe tesLaLor, GENE T. HELM, was on the dllY and dllte lhereof siuned, published IInd declared by GENE T. ItELH, the testator 11Ur~ill named, us (llld (or his Lost Will, in the presence oC us, 'fII10, at Ilis rUllucst, in Ills pr~~un~~t 311d in the presence of ~uch otllor, have subscrib~d our nameS as witnessos 110ruto. ~ML.~~~ "-PCll.&Q; c:J ~(QJV~ ~~",,-'-Iwlfv- n- rl!sidin~ nL -----.------- res1.ding at . PI\- COMMONWEALTH OF PENNSYLVANiA: :55 COUNTY OF CUMBERLAND We, GENE T, HELM, the testoLor IInd the unders.gned witnesses to the will, the attached or lor~goinu, insLrulnent I who huve signed thi.! insLrument t having becn qUlllificd IIccording to law do depose and sny: (0) that i, the testaLor, do hereby IIcknowledge that 1 sitlned thd instrum"nt os my will, that 1 signed it willingLy and liS my lrel! IInd voluntary oct (or tho l,urposus Lllur~in ~xprussed; and (b) chat we, the witnesses, wecO pr~scnt and saw tho testator sign and oxeeute tho;! instrument as his wiLt, that he si.gned l.t willin6Ly and executed it as his [ree llnd voluntary act for Lhe purposes therein expressed; tllat oneh o( us in the hearin~ nnd sight of the testator signud the will os 0 witness and that to the best of our knowl~dgu the testotor was at that ti.mc 18 or morc years of age, of sounu mind llnd undur no constraint or undul.! iOllucn":l! '-~/~..~\, i ~~- ~IEI,M ~~''''{v-A\ l. QAOJ...... VY\ wrcn~------ ~ L{)~_~*v~ Witness . " Subscribed to ond subscribed or offirmed and ocknowledged before mt.! by Gl'NI; T. IIEU'I. tho testator and thu witnossus whoso nom~s arc si~nud obovt.! this ~-I~. doy of J., PU--' 1994. tt1 -J UU ,;:d.t1-., Not PubLic .m8all ~ =rdl.I3.~ L CERTIFICATION OF NOTICE UNI)ER RULE 5.6(n) Nnme of Decedent: !lliNI~ T. HELM. Deceased Dnte of Denth: Ap1'i118. 1996 Will No. Admin. No. 21 - 96 - 0365 To the Register: I certify that Notice of Benelicial Interest required by Rnle 5.6(11) of the Orphans' Court Rules was setved on or mailed to the following beneliciaries of the above-captioned estate on August 06. 1996. Name Saundra Lynn Helm AddTess 496 Furnace Hollow Road. Shippensburg, PA Relationsliip Wife Notice has not been given to all persons entitled thereto under Rule 5.6(n) except: NONE, Date: (, IJ I j i l: " Xttt'\K . _ C/ j l/r./i,'------ S. l I Ignature .' SALLY J. WINDER, ESQ. 70 I Enst King Street Shipl'ensburg,l'A 17257 (717) 532-9476 Go l.r.1 , , CAPACITY: _X_ Counsel for Personal RepTesentative ,,'tI11tt"i.lib ..-- L 0, I ;:~ c.::'"" '.J ~... ;~ .:J 00 JRD/Junc 30, 1992/17858 REGlsrmt OF WIL..S Cumberland County Courlhouse One CourlhDuse Square Carlisle, PA 17013 NOTICE pURSUANT TO RULE 6.12 PENNSYLVANIA SUPREME COURT ORPHANS' COURT RULES To: Personal Representative Counsel: SAI,l.V WINor:H. I-:SO. RE: Estate or m:Nr: T. Hr:LM , DccCllSed, Late or SOUTH Nr:WTON TWP Estate No,: 21.1996.365 Date or Decedent's Death: d . 1 R. q,; Pursuanl to Rulc 6,12. thc above named pcrsonal represcntativc or thc above named allorney, if applieable, within lWO (2) yeaTS of thc decedent's death, and annually thereafter until administration is completed, is required lO file with thc Register of Wi\1s a Status Report as requiTed by Rule 6.12, in subslantially the prescribed form, showing thc datc by which thc pCTsonal represcntative, or allorney, as applicable, reasonably believes administration will be completed. The purpose of this Notice is lO advise you that unless the requisite Stalus Report is filed with the Register of Wills or Clerk of the Orphans' Court, as appropriate, within tcn (10) calendar days after the date of this Notice that the Register of Wills is required to notify the Orphans' Court Division, Court of Common Pleas of such delinquency and to request that said Court conduct a hearing to determine whether sanctions should be imposed upon the delinquent personal representalive and the delinquent personal representative's counsel, if any. Accordingly, if the requisite Status Report is not filed by 6.1.98 ,19_, you are hereby advised that a request will be submitted to the Court in accordance with Ru 6.12, D ~ . Date: 9-12-98 -I uu. t(1. j,hA o ut RegistcT of Wil s r-t ' Distribution to Estate File tlEI1/!J;{~& T. Decedent's Complete Addre~~_______________ ,,.lI'H 1 ",{Jill ,e, 496 Fumncc lIo11cM P(l , 01)' Shippcnsbllrq m Shippcnsburg "till ""17257 Tax Payments and Credits: 1 Ta< Duo (Page 1 Line 1111 2. Credlls'PaymenlS A Spousal Poveny CIl>(1<! 8 Pnor Paymenls C Discount (1) -0- TO'al Credits I A. 8' C) 121 3. InlereWPenally ,f applicable D.lnlereSl E Penally Tolallnleres~Penally (D' E) (3) -0- 4, If line 2 is grealer Ihan line 1 . line 3, enler Ihe difference This IS the OVERPAYMENT. Check bOI on Page 1 Line 19 to request a relund (4) 5 If line 1 + line 3 is greater Ihan Ime 2, enler the dlfferer.:e ThiS IS Ihe TAX DUE. (5) A Enler the inlereSI 00 Ihe la< due. (5A) 8. Enler Ihe lotal of Line 5 + 5A ThiS IS the BALANCE DUE. (58) -0- Make Check Payable 10: REGISTER OF WILLS. AGENT !lf~i].~~~~~R~~",,~""'.....i...dJlDr--1 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS " Did decedent make a transfer and: Yes No a, retain the use or Income 01 the property transferred: ,............,.......................................,..,.... 0 I!il ~, retain the right to designate who shall use the property transferred pr its income; ..,............' 0 I!il c, retain a reversionary interest; or..............,....,......,..........................,......,..,....................,....,.., 0 I!il d, receive the promise for life of either payments, benefits or care? ........,..............,................. 0 I!il 2, If death Dccurred Dn or before December 12, 19B2, did decedent within two years preceding death transfer property without receiving adequate consideration? If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .."..,."..."."."""..,..""...,..,",..,',..,"',.,",..",..",..""..",..,....,"" 0 IRl 3, Old decedent own an 'in trust for" or payable upon death bank account or security at his or her death? .....,..,..,.......,..........,...................,.........,.............,........,.................,........, 0 IXJ 4, Did decedent own an individual retirement account. annUIty, or other non. probate property? ,..' 0 IXJ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN l'.f11J:FfE.:r,r;;1)~~~B:.f.:.~';jf~Ji5TI~!:rffi*_)~~'{1t{tf~$~i:'lSt~r'~dlI- ..-m 72 P.S, ~9116 (a) (1.1) (i) provided for the reduction of the tax rate imposed on the net value of transfers to or for the use of the surviving spouse from 6% to 3% for dales of death on or after July " 1994 and before January '. 1995, 72 P,S, ~9116 (a) (1,1) (ii) provided for the reduction of the rate imposed on the net value of transfers to or for the use of the surviving spouse from 3% to 0% for dates of death on or after January ,. 1995, The staMe does not exempt a transfer to a surviving spouse from tax. and t~e statutory requirements for disclosure of assets and f,ling a tax return are still applicable even if the surviving spouse is the only beneficiary, FOR DATES OF DEATH ON OR AFTER JANUARY 1, 1995. Please answer the following question by placing an .x' in the appropriate space. Old the decedent create a trust or similar arran90ment which Is sol Diy for the surviving spouse's bonofit for his or her entire Iifetlmo? Yes 0 No [] If you answered yes to the above question. the tax on the trust or similar arrangemont is postponed until the death of the second spouse. at which time it will be fully taxable at the rate(s) applicable to the remainder boneficiary(ies), Enter the value Df the Irust on Schedule J, Part 11. In order to remove it from tho calculation of the lax due In this estate, You may wish to file Schedule 0 in Drder ID make Ihe election available under Section 9113 If the election is made. the trust or similar arrangement is taxed in the estate Df Ihe first decedent spouse. the portion of the trust or sim,lar arrangement which benefits the surviving spouse is taxed at the zero tax rate, and the remainder is taxed at the rate(s) applicable to the remainder beneficiary(ies). If you choose to make the election, you must atlach Schedule 0 to a timely.filed tax return. along With Schedule(s) K andlor M in order to show the apportionment of the lrust or similar arrangement between the surviving spouse and the remainder beneficiary(ies). Ii ,I 'I I i " II II !' (G (Q) \P~ Till Pllrrfl fdfnlificlllion No.: ~3 - 0108 - 02( EXECUTOR'S DEED " i! 'I I, i: I! MAnE the _ day of I J hundred ninety-eight (1998), Ii I' . I SAlfN/)RA I.YNN HRHr. OfSoUlh Newton Township, Cumberland County. i; Pennsylvania, Executrix of the Estate of Gh'NE 1: HELM, deceased, late of South Newton :! Township, Cumberland County, Pennsylvania, /I I' I' 'I 'I I: U SAUNDRA 1_ HRI.M. widow, of 5342 Warm Spring Road, Box 17, Williamson, !! Pennsylvania, 17270, . in the year of our Lord one thousand nine BETWEEN GRANTOR AND (11~) SJ!. .'JJ;G ., 'I /1 WHEREA.\: the said G1~'NE 1: HEf.M, died April 18, 1996, having first made his Last i I Will and Testament, dated July 05, 1994, wherein he gave, devised, and bequeathed his entire I j estate to his wife, Saundra L, Helm, and I' " 1 i WHEREAS, Saundra Lynn Helm was appointed Executrix of the Estate of(/ENE r. i; Hf..1Jv1 by Letters Testamentary granted May 06, 1996, by the Register of Wills, in and for ;: Cumberland County, Pennsylvania, " I; ! I WITNESSETH, that in consideration of the sum of One and 00/ I 00 Dollar, in hand paid, II! the receipt whereof is hereby acknowledged, the said Grantor does hereby grant and convey to Ilhe said Grantee, I, 'I ALL that certain tract of/and situate in the Township of South Newton, County of ! I Cumberland, and being described as follows: II ; I BEGINNING at old stones comer, said comer being the northeast comer of the Thomas ;; Buchanan Warrant and lying along the West line of the David Walts Warrant, and being common ! 110 lands of Reginald Crusey. lands unknown, and lands herein described, 'I Thence through the David Watts Warrant by lands of Reginald Crusey and lands herein :! described, South 33 degrees 02 minutes East. 73.88 rods to an iron pin comer, said comer being I: within the David Watts Warrant and common 10 lands last mentioned and lands of the I' Commonwealth of Pennsylvania, " II " 'I ! I GRANTEE ',/.ft"~;'I~"'1 (v.:/.ypj~;..'/'" .," ~4-1, '>.~~.. III,." :1lr\A_(..,jI' :)~1( tU,7 Ii i I I Ii I Thence through the David Walls Warrant and the Thomas Buchanan Warrant by lands of the Commonwealth of Pennsylvania and lands herein described the following twenty-one (21) courses and distances: I. South 56 degrees. 58 minutes West. 0,56 rods to a point on or near the centerline of Hogshead Road, 2. North 56 degrees. 02 minutes West, 4,24 rods to a point on or near the centerline of Hogshead Road, I I I , ji II I 3, North 74 degrees, 00 minutes West, 2,80 rods to a point on or near the centerline of Hogshead Road, 4. South 85 degrees, 00 minutes West, 3,56 rods to a point on or near the centerline of Hogshead Road. 5, South 71 degrees, 00 minutes West, 3,92 rods to a point on or near Ihe centerline of Hogshead Road, , 6. South 56 degrees, 00 minutes West. 37,84 rods to a point on or near the centerline I of Hogshead Road, I 7. South 50 degrees, 00 minutes West. 4.40 rods to a point on or near the centerline I of Hogshead Road, I 8, South 45 degrees, 00 minutes West, 17,24 rods to a point on or near the centerline I , of Hogshead Road, i I 9. South 56 degrees, 00 minutes West, 3,16 rods to a point on or near the centerline 'I of Hogshead Road. 10, South 86 degrees, 00 minutes West, 2.44 rods to a point on or near the centerline I of Hogshead Road, I II II. South 79 degrees, 30 minutes West, 22,68 rods to a point on or near the centerline of Big Pond Road, 12, North 20 degrees, 02 minutes East. 10.48 rods to a point on or near the centerline II of Big Pond Road. ,. 13, North 28 degrees. 57 minutes East, 4,00 rods to a point on or near the centerline I of Big Pond Road, , I 'I I, 2 II i I 14, South 85 degrees, 18 minutes West, 352 rods to a point on or near the centerline of Big Pond Road, 15, North 79 degrees. 42 minutes West, 2,64 rods to a point on or near the eenteTline of Big Pond Road, 16, North 51 degrees, 42 minutes West. 2,52 rods to a point on or near the centerline of Big Pond Road, I I I I II II I 17, North 11 degrees, 42 minutes West, 2.64 rods to a point on or near the centerline of Big Pond Road, 18. North 11 degrees, 18 minutes East, 14,84 rods to a point on or near the centerline of Big Pond Road. 19, North 03 degrees, 52 minutes East, 7,52 rods to a point on or near the centerline of Big Pond Road, 20, North 20 degrees. 24 minutes West. 7,68 rods to a point on or near the centerline of Big Pond Road. 21. North 32 degrees, 40 minutes West, 17.80 rods to a point on or near the centerline of Big Pond Road, said point being along the North line of the Thomas Buchanan Warrant and being common to lands of Rosenberry, lands of the Commonwealth of Pennsylvania, and lands herein described, Thence along the North line of the Thomas Buchanan Warrant. by lands of Rosenberry, lands herein described and lands of others, North 53 degrees, 25 minutes East 63.52 rods to old stones comer, said corner being common to the Warrant land mentioned and also being common to lands unknown and lands herein described, Thence by a line common to the lands and Warrant last mentioned. North 73 degrees, 30 minutes East, 9.48 rods to the place of BEGINNING. II CONTAINING, 33 Acres, 96 perches, more or less, I /JEING the same property which the Commonwealth of Pennsylvania, acting by and through the Department of Forest and Waters by deed dated May 25, 1970, and recorded in the RecoTder of I! Deeds Office in and for Cumberland County. Pennsylvania, in Deed Book "S", Volume 23, Page I 558, granted and conveyed to Gene T. Helm, single man, Gene T. Helm died testate April 18. 1996, On May 06, 1996, Letters Testamentary were granted to Saundra Lynn Helm, Executrix and Granlor herein, 3 I uy,UClt IX. P"" ~~ COMMONWfAlTH Of PlHNSYLVANIA t"HIIITANCI TAX InUIN IISIDINI DICIDlHI SCHEDULE E CASH, BANK DEPOSITS AND MISCELLANEOUS PERSONAL PROPERTY Ploa.o Print or T a FILE NUMBER 21 - 96 - 0365 ESTATE OF (All p'.,.rty leI"tly-ewn.d with 1M Right .f Survl'lOrlhlp mull be dlul...d on Sch.d..I. '1 C.ene T. lJEI11 ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. 1979 Mercedes automobile titled to Decedent. transferred to wife as sole heir and beneficiary of the Will ' ' . ' . . . . . , $ 3,000.00 TOTAL AI.a ontor an lino 5. Reea s 3,000.00 (Anact. addillonoI8V,- )C 11- .h.... if more .poc. h n..d.d.1 1If\l1"'tl'l"~ .~~() . . ~ COM~AllH or PENNSYlVANIA lN~jERlrANCE TAX RETURN RE~IOfNT DfCEOfPll SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF rcne 'r. liE! J.I FILE NUMBER 21 - % - 03(,", Debts of decedenl mUll be reported on Schedule I. ITEM NUMBER A, DESCRIPTION AMOUNT 1. FUNERAL EXPENSES Foge1sancrer Puneral 1I01rC, flUleral bi 11 1,748.(,0 B. ADMINISTRATIVE COSTS: 1, Personal Representative'. Commission. Name 01 Pel>Df1a1 Representative I') Social Securrty Numbe~s) I EIN Number 01 Pe""nal Representative(.) Stre<IAddress Cily State Zip Yea~'l COmmission Pad: 2. 3, Altomey Fees Sally J. I-linder, Esa. Faml~ Exemplion: (If decedent. address is no! the same a. claimant'.. anadlOkptanalion) Ctaimant Saillldra lIelm Stre<tAddress 5342 I-lam Sprin<;J Road Cily Nilliamson Stale Pl\ Zip 17270 wife Retalionship 01 Ctaimanl to Decedent 3,500.00 500.00 4, PlObale Fees 5, Register of l~ills, Letters Testamentary Accountant. Fees 132.00 6, Tax Retum Preparef. Fees 7. Register of I-lills, Pile Inheritance Tax Return Reoorder of Deeds, rcoorc1 deed dlarrbersburg !\IS, ambulance Pennsylvania IX>pt. of Revenue, ina::rnc tax Internal Revenue Service, federal inoorre tax due Deecher's RarodelinCJ, damage to house 14.00 23.50 1,210.00 2,340.55 19,100.42 1,109.00 8. 9. 10. 11. 12. TOTAL (Also enter 011 line 9, Recapitulation) S 29, (,98. 07 (If I110Ill space Is needed. insen add'!lonal sheets of Ihe same size) - . co t::4: 0 ~ ~o. ~1 0- , C '~) l""I N n< S2 ) ,) .:.J " '" CO _. ~ <L.a: 9' i15 a: rJt.,i