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PETITION FOlt PItOnATE IInd GltANT OF LETTEltS
No, _.~J _~g<:.o_:Jj~._--
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To:
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m' __ __ _ Regbler 01 WiI" lur Ihe
..._________ __"'..,__ "'.__ ___. n(.C(''''''''. Counly 01 _LI.\II',_Gi'::K;"'~'JD in the
Sori,,1 Security No. ",,10 ~.'i<..t:':__1.3,,:1~L___ Conllllonweahh 01 Pennsylvania
The pelilionullhe ullllcr>igned respeellully relllesents thai:
Your prtiliolll'r(...), who blare IK year... uf ~c ur older an the cxccul.5:'L~----
in the ""t will ollhe ahol'e deel'dent. daled .:.J_'Jk\---:]_~~I.~_IJ::\
and eodiciHs) daled .--'
'e'eed
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hlah.' 1I:h:\illll dr"ulI\\lilll\:C\, C.l!. rcnundaliull, lkalh (II C\l'I."IlIUJ, Ch:.)
Decendenl was I\olllicilcd al death in C \"I..{\"\:' )-.,,, \\. t...o,,~ ConnlY, Pennsylvania, with
h.J::~ '.- lasl Imuily 0' .prit.'~pal resillence al I I ~IJ c:.;::; ('I i....P-tlJ. ~
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lli'l 'lrecl, II1111lhcr and 1Il1l1Ii:ip:IIiIY)
Deccndelll. Ihen ._ _~.l'ear> of age, died 'In ~ ')-
al_\~~.Jc.~_'\...o-Sl"~ c: r.,f.< \.;'-.k~' \"p.-
E'ceplas follows, decedenl did nOlllla"y. was nol divorced and did nol have a child born or adopled
:'fter e,eeution of Ihe will offl'le~'.2\: probate; was not the I'ielilll of a killing and was never adjudicated
IIlculllpelent: ___ D.1_ ~
,
Decendent al death owned properlY wilh eSlilllated values as follows:
(If domiciled in Pa.) All pClSonalplOperty
(If nol domiciled in Pa.) Personal properlY in Pennsylvania
(If nol domiciled in Pa.) PersonalplOperlY in COUlllY
Valne of real cst ale in Pennsylvania
silualed as follows: f\) I P+-
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19 cr 10
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WHEREFORE, pelilioller(s) respeclfllll>:._p;qu~l(s) Il'eJ!l:obale of the last will and codicil(s)
presellled herewith and the gmnl of lellers -{ r 51 A f'v\'= ()) I A-R Y
t1C\lmncnlmy: admini\lralinn ~.l.a.: admilli\lTatinn d.b.n.c.l.a.)
IhelOn.
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OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OI'I'ENNSYLVANIA 1 'S
COUNTY OF _~~k:...i\j \) J :;
The pelilionor(slabove'lHlllled sw~ar(s) or affirm(s) Ihal the sHllements in Ihe foregoing petition arc
line alld correellO Ihe best of the kllo\.ledge and belief of petitioner(s) and that as personal represen-
wlil'e(s) Ill' Ihe above decedenlpetilionc:(s) will well and IIl1ly adminisler the estale according 10 law.
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S'worn 10 or affirmed] 1II1l\ sll.bscribed 4-)h'\h'P~~\ 0. L,,:.~ !!l
hefore me Ihis _~_::L_. day of ~
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COMMCNWEALtHOF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
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STATE OF GEORGIA
COUNTY OF FULTON
LAST WILL AND TESTAMENT
OF
DENNIS L. STEWART
I, Dennis L. Stewart, of said State and County, hereby
make, publish and declare this my Last Will and Testament, revoking
all wills and codicils heretofore made by me; provided, however, I
expressly decline to revoke any Living Will heretofore made by me.
ITEM I
I am unmarried and have no children.
ITEM II
I direct my Executor to payout of the residue of my
estate, otherwise bequeathed under Item V of this Will, as soon
after my death as my Executor deems consistent with good
management, the expenses of my last illness, funeral and burial,
debts and claims duly allowed against my estate, expenses of
administration of my estate and all estate, inheritance,
succession, transfer, legacy and death taxes assessed or imposed
with respect to my estate, or any part thereof, whether or not
passing under this Will.
ITEM II I
All furniture and furnishings, including appliances,
rugs, pictures, objects of art, silverware, chinaware and linens,
and all personal effects, including books, ~lothing and jewelry, I
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bequeath equally to my sisters, Deborah Fensterbush, Marion
Matteskey, and Rebecca Mentzer, or the survivor(s) of them,
provided that if none of my sisters shall survive me, then this
bequest shall lapse, and the foregoing property shall be
distributed as part of my residuary estate.
ITEM IV
All automobiles and boats owned by me at my death, and
all insurance thereon, I bequeath to my parents, William Black, Jr.
and Mary Cohill Black, or the survivor of them, provided that if
neither of my parents shall survive me, then this bequest shall
lapse, and the foregoing property shall be distributed as part of
my residuary estate.
ITEM V
After reduction for all expenses, debts, claims and
estate taxes and for all other bequests and devises created in this
Will, I give, devise and bequeath all of the rest, residue and
remainder of my property, real, personal and mixed, of every kind
and description, and wherever located, including all benefits
payable to my estate as a result of my employment and all lapsed or
void legacies or devises, but excluding any property over which I
shall have any power of appointment, to my parents, William Black,
Jr. and Mary Cohill Black, or the survivor of them.
(b) If my neither of my parents survive me, all property
passing under this Item shall be distributed equally to my sisters,
2
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by reference of various fiduciary powers into wills, trusts, or
other instruments in writing (Ga. Laws 1991, p. 810i Ga. Code Ann.,
S 108-1101 et seq. [53-12-230 et seq.]), which powers are
incorporated in and made a part of this will by reference.
(b) If the administration of my estate is required in
any jurisdiction in which my Executor, for any reason, cannot
serve, my Executor shall be authorized to appoint an Executor or
other fiduciary to serve in such jurisdiction.
(c) To serve without being required to make or to file
any inventory or appraisal, except as hereinafter provided, or to
file any annual or other return or report to any officer or court,
or to give any bond, whether or not my Executor is a resident of
the State of Georgia, or, if a bond is required by law, but a
surety is not mandatory, no surety on such bond shall be required.
My Executor shall keep full accounts and shall make and furnish
statements of all receipts and disbursements at least annually to
each person then eligible to receive income from my estate and
shall at any time, upon reasonable request of such person, provide
full information to such person as to the condition of my estate,
including amounts received and disbursements made.
(d) To exercise, grant, write, sell and purchase stock
and other securities options of all kinds, including, but not
limited to, those options traded on or sold through a national
securities exchange.
4
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(e) In the valuation and distribution of my estate
and/or in the division of my estate into separate shares, my
Executor shall be authorized to make such distributions and
divisions in money or in kind or in both, regardless of the basis
for income tax purposes of any property so distributed or divided,
and the distributions and divisions so made and the values
established by my Executor shall be binding and conclusive on all
persons taking hereunder if such valuations, distributions and/or
divisions are made in good faith. In making such distributions or
divisions, my Executor may allot undivided interests in the same
property to several trusts or shares.
(g) To file such returns as may be required under the
tax laws of the united states, any state, any political subdivision
of any state or any foreign country; to make any election permitted
by any tax law, if, in my Executor's opinion, such election is in
the best interest of my estate; to agree to such apportionment of
taxes and application of estimated tax payments, refunds and
credits as my Executor deems equitable under all the circumstances.
ITEM VIII
(a) I appoint my sister, Deborah Fensterbush, as
Executor of this will. If, for any reason, Deborah Fensterbush is
unable or unwilling to serve or continue serving as Executor of
this will, I appoint my sister, Marion Mattesky, as successor
Executor of this will.
5
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(b) All successor Executors shall have all the powers,
authorities and duties granted herein as if originally named
Executor, and no successor Executor shall be required to inquire
into or audit the acts or actions of the predecessor Executor or to
make any claim against such predecessor Executor.
(c) Unless otherwise provided herein, when the term
"Executor" is used in this Will, it shall include the person and/or
institution, whether masculine or feminine, then acting as
Executor.
(d) Each fiduciary herein named and each successor
fiduciary may resign without the order of any officer or court and
without the consent of any beneficiary of any provision of this
Will or of any trust created he~ein upon giving such fiduciary's
successor, and all persons then entitled to receive income from my
estate, or the guardian(s) of such person(s), thirty days advance
written notice of such fiduciary's intention to resign from such
position.
ITEM IX
(a) References in this will to "child" or "children"
mean lawful blood descendants in the first degree of the parent
designated; and references herein to "issue" or "descendants" mean
lawful blood descendants in the first, second or any other degree
of the ancestor designated; provided always, however, that an
adopted child and such adopted child's issue, whether natural or
adopted, shall be considered in this Will as lawful blood
6
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descendants of the adopting parent or parents and of anyone who is
by blood or adoption an ancestor of the adopting parent or of
either of the adopting parents and shall not be considered issue of
the adopted child's natural parents, except that where a child is
adopted by a spouse of one of his or her natural parents, such
child shall be considered issue of such natural parent as well as
issue of the adopting parent.
(b) A child in gestation at the time of an event, who is
later born alive shall be deemed to be "in being," "living" or
"surviving" at the time of such event.
IN WITNESS WHEREOF, I have hereunto set my hand and
affixed my seal to this my Last will and Testament, initialed each
page thereof and published this my Will, all in the presence of the
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undersigned Witnesses, this ~ , - day of July, 1994.
(SEAL)
TESTATOR
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The foregoing was signed, sealed, published and declared
by the Testator, Dennis L. stewart, as and for his Last Will and
Testament in our presence, and we, at his request and in his
presence, and in the presence of each other, believing him to be of
sound and disposing mind and memory, hereunto subscribe our names
as witnesses the day and year above set out, all of us, including
the Testator, being present throughout the execution of the will.
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ADDRESS -j
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STATE OF GEORGIA
COUNTY OF FULTON
Before me, the undersigned auth~r.ity, on this day
perso);lally appeared Dennis L. Stewart, 5f)~tzl Jb/l/I:>OIL. ,
and fljI-rL/e 111 U. '1eAi!7IJ , known to me to be the Testator
and the Witnesses, respectively, whose names are subscribed to the
annexed or foregoing instrument in their respective capacities,
and, all of said persons being by me duly sworn, Dennis L. Stewart,
the Testator, declared to me and to the said witnesses in my
presence that said instrument is his last will and testament and
that he had willingly made and executed it as his free act and deed
for the purposes therein expressed. The witnesses, each on oath,
stated to me in the presence and hearing of the Testator that the
Testator had declared to them that the instrument is his last will
and testament and that he executed same as such and wanted each of
them to sign it as a Witness; and upon oath each witness stated
further that each did sign the same as Witness in the presence of
the Testator and at his request; that he was at that time 14 years
of age or over and was of sound mind; and that each of said
Witnesses was then at least 14 years of age.
\ .. '-_\. J__d
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TESTATOR
WITNESS
WITNESS
Sworn to and subscribed before me by Dennis L. Stewart,
Testator, and sworn to and subscribed before me by
.5-iIOtZ.; _ltrI/llSO...... and ffli/!/{!,A I-l va/!:l1J, witnesses,
2/ j{;- ay-of July, 1994.
--~
expir s:
Notal)' Public. Fulton COunty. Goorr,l.
MyCommiSlllon Explr.. March 15. 1996
er!~
i fOR DAlES OF DEATHAnlR 12'31/91 CHICK HERE
,,~:A}/!t INHERITANCE TAX RETURN 'I~O~::?yU~:~D\f ISCLAIMID \ :
_'ffJ- RESIDENT DECEDENT I FILE HUMBER
COMMONWlAlIHOIPlNN,,,VANIA (TO BE FILED IN DUPLICATE \"'\ (j'I-. C )'6 :;
O,,'RlM'Nl O. 'IV'N", ,..... "-
H..",fJ:b~~\'!h.-"oo'u WITH REGISTER OF WILLS) C~~NtY COOl YIAR NUM8lR
DtCl3~f~I~~~~iM::_L_~.I'J""I:~I, N..'~ \.~.' (> .J- J..' H'L~OI.~'~...O~~I.'~( \~Il~' ~ /V~ .
~OC''''1 !ltCURllY HUMBlll VAll Of IHAItI _ _ . \"'" UI .",,, C r-j \\ l-'::: ') J.J{' f' fl I 7 L: , 3
,J, \ (> _ L\......\ . 332J:)__]-=-'i~--~J l:: 'J. - \ \. ,:,' \ (0""' C ,-'rn \3';: Rut /VD----
I" ,,,,<,,,,,=~::=:~"_:=:~-r:~1 ::"~"u.'" JM~"'" "Cl'''''I::~:''uc''o''''
.\'Sll. O,;ginal Relurn I"] 2. Supplemental Re,,,n LJ 3. Remainder Relurn
(lor dote' of death prior 10 12.13.82)
o 4. limi'ed h'ate [J 4a. Fulu.elntere,' Comprami,e I] 5. Fede.al E,tate Ta. Re'urn Requi,ed
Ilor dOIIl' of death after 12-12.82)
06- Deceden' Died Te,tate [J 7. Deceden' Maintained 0 li,ing Tru"
(Attach copy of Will) (AlIoth copy 01 Trust)
ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
CQMPLtH ,..."nllIG ADOlltS!. Jf/. -
"~"IC>R()~w;l."-3l: R-:J:.lrJ~r.. l-!tv,! . 10S
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21. illine IB i, g,eoter than line IQ. en'er ,he d,lferenee an line 21. Thi, i"he TAX DUE.
A. Enter the interest on tt.e bolonce due on line '21 A
8. Enter the 10101 of line 2' and 2'^ on Lino 218. Thi, is the BALANCE DUE.
Make Check Payabl. 10: Regilt., 01 Wlll~ Au.ent ----
>- ~ BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND TO RECHECK MATH ~ ~
Under peno"ie, a' perjury, I dedo.e ,ho' I ho,e ..amined thi' .eturn, ;ndud,ng accamponying "hedule, and ,'otemenll. and .a ,he be" al my Inawledge and belie',
.t i, ',ue, cwec' and complete I dedo,e tho' all ,..I .,to'e ha' been ..po.t.d al tr,. mo. let ,olue Deda.ot,on 01 p,.pore. ath., than ,he penonal repre..n'oti,e ;,
based on 011 inlormation 01 which p"'porel ho\ ony ~nowledge
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I. Real E,'ate (Schedule Al
2. Stach and Bond, (Sched,le 81
3. Clo\tly Held StaddPartnership Interest (Schedule C)
A. Mortgage, and NOI" Receivable (Schedule D)
S. Cash, Bank Deposi" & Miuellaneaus Penonal Properly
(Schedule E)
6. Joinlly Owned Property (Schedule F)
7. Tra,.'e.. (Schedule GI(Schedule L)
8. Total Gran Anets (lotollines 1.7)
9. Funeral hpen"s, Administrative CosIS. Miscellaneous
hpen"s (Schedule H)
10. Deb", Mortgage liabililiel, liens (Schedule II
11. lotol Deductions (tolollinel 9 & 10)
12. Net Value 01 htole (line 8 minus line' 1)
13. Charitable and Governmental Sequel" (Schedule J)
'4, Net Value Subiect to TOK tline 12 minus line 13)
15. Spousal Transfers {lor datel of dealh after 6.30.94)
See Instructions for Applicable Percentage tln Reverse
Side. (Include values Irom Sthedulo K or Sthedule M,)
16. Amount of line 14 lallable at 6% rate
(Include values from Schedule K or Sthedule M.)
17. Amount of line 141allable at 15% rate
tlnclude values from Sthedule K or Schedule M.)
18. Principal 1011 due (Add tOll from Unel 15, 16 ond 17.)
19. Credits Spousal Poverly Credit Prior Pay men"
+ -~--~--- +-
-"----..-
(151
~~--"_.
___I\J-er-x--=
--
(16)
_D_ X .06 =
_CLx .15 =
(171
.__m__"_~__'_ -
z
o
;:
'"
0-
=>
~
:E
o
....
><
'"
0-
Diuount
Interest
20.
"Une IQ h grea'e. ,han Line 18. enter ,he dine,enee an line 20. Thi, i, the OVERPAYMENT.
aD
(1BI
(IQI
(20)
ESTATE OF
:) T I? \}0,"",~\
ITEM
NUMBER
A.
'1,,')ll'''.I'Ui
1.
B.
4.
C.
1.
2.
3.
4.
S.
6.
7.
8.
~. :<- V
"'4';-:')'"
:..'1~.;J'r
COMMONWEAltH Of ,(NN!lYlVANIA
INtHAI1ANC[ TAl R[1URN
R(SlO[NT O(CrOUH
-- ..... ~. --.
SCHEDULE H
FUNERAL EXPENSES,
i ADMINISTRATIVE COSTS AND
i ... MISCELLANEOUS EXPENSES I.... Plea.e Print or T~pe
i FILE NUMBER
\)~.r~j'JJ;~_d._~. ..6___J :t \ - ~L(, - ()3S"
DESCRIPTION
AMOUNT
Funeral Expen.e" \-\0 l-\-'" !'oJ\.) ~Rc.1T."",, ---.
\}.s..: c,F STp..FF' -do__o)~C)L'
(1Gkl\.C,II.;).€il<)l:' l""e~JJ CItMs.;I. .,-, C c.
Or.fu::-G\C~f:\'I\r-.-r.rOJ'j. l\9,:!,DU
~Elfrh Cc~T.I..~..I:CA-/t':j (~f) /b.0r)
c: l-I:R~ 'f 50, 0 ()
\ ~ ~b . 0 0
Admlnlstratiye Ca.ts:
1.
Personal Representative Commhsions
Social Security Number of Personal Repre,enlative: --.
Yecr Commissions paid
2.
Allarney Fee, CON~u..I...TPtTi(.\~7' jeJ.~ fJ-CN~ cPtJ.J.5
J{JO. 0 0
3, Family Exemplian
Claimant ~Relalia",hip
Addre.. of Claim ani 01 decedent', dealh
Slreel Addre..
City
Stale
Zip Code
53.60
Probate Fee, \\e~\.':> T e R. '\\j i l \...
~. k, j\J(j' (-e e.
Mlscellaneau. Expen.e.:
TOTAL (AI,a enler an line 9, Recapitulation)
(II more .pace is needed, In.ert additional sheets 01 .ame size.)
s lLI3Q, "
""'''''.''''''*
(OMI,lOt~,^,UUH Of "kNhl"'AN1A
INH'.II..,..(II....,IIUI'4
IUIOINIOfCIOUH
I MORTG~~s:l~~ft~~!~~JD LIENS 1_ ,,~.. M" 0, '...
FILE NUMBER
\)~JY'VE:.~J_____L__ eLl - (}fc, - 032'"3
ESTATE OF
5T~R\
ITEM
NUMBER
-----------------------..
DESCRIPTION
t"
o u,(.:>..l\)\.J:: L\t1'\. RPlD;:c,J.,c,(:) y
1\~lv\:r:-h..TOI'J ~ AC)l~ el~S
ryq.o CJ
/'j'3- '/'-'
AMOUNT
d,.
3. }/2- FJ-Rr:.RS L ()RON'J/r-./:N ItsSI..C
if, ReTrrvA-t OC.V.l-.opAu..snc CC./V5i,J..D
f;O . 0 0
],'-7b-- DO
J (H, 0 c)
) q ~3 I 3 l,
lb. D U
56;j I. qcr
33Q3.3:)
') =-> 3 q . I /=.
~/'^
d.~o. 0 ()
I / '-If, I DO
., 7' (.-'
10../ J '
'7J,OO I
I
I
"
), ThDN\C\,S /:,; ~ c:;'R.p
ro. CARl...I:Stl=' l-I-os~rTft(
? I C f\~~]:5).:e rll-l at) ,'I'\) j
'0. 12 /.;,en.A/,O DRU-j
~' 1\1 ec\.I:cJ:.r0~ CkNI~R
/D. f<\:r:Gi-\ 's ItccOlAi\JT
I J. f\-T"o..l\) '1 (.\- rv L I). f\o{-.{j~J ~
1J. f\)D~\1 51:\,)1: Hc.spr:rffL....
/3 5/v\r:t:~k~r.rJ~ /..ffA
'-""
I~ OA.I<rIU
, IOTAL (A'.'o enler on line 10, Re,opi'ulolio;- S L!:l5()~dS 7
(If more spoce IS needed, Inse,' odd/I,onol sheets 0/ Some s;ze.)
Ii
..:;:;.-
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent: \)~t\)N-c.S
Date of Death: 1"'\Cl.~C " ()..)4
I
I-. ST~' ~\) fl R T
, q<jC,
Admin. No. ,) I '1 (; - c 3 s- -:s
Will NO./c)('H.-06:';~~
To the RegisLer:
I certify that notice of beneficial interest required by
Rule 5.6(a) of the Orphans' Co~rt Rules was served on or mailed to
the following beneficiaries u( Lhe above-captioned estate on
IfuJll.. ~ \ '1, I"" C\ ~, :
Name Address
~~jI,R1:(',1\') j.( M ~TT~'>I("j
I
''-,{''d<,') ~\t'~)TZ'l'p.
~;. \...~ i 1\."" ) \J"\,-,,, ~
j\~f':RY r. G.)h,I.~ P)I-c\d<_
c( l.l-C'~ (~
fJ \'., (\c,.
,,-
--.>)
C A IH,;S ~ f'
P J.n ; Ji, J"::,r"A..1L
C~/ll.. /<;J.r
C J?-/(J.. ,J .{('!
'J'( .
II \'~)('''{) /"UII)/!
II L\.k,cO ~JY!/~
Notice has now been
Rule 5.6(a) except
given
"Ii rt
I
to all persons entitled thereto under
~ 'j tf C-
Date: ,') ~ \ '
tr\ !:.:...-(
-
.. . ""L
" ~. ') ~
e.-
N
~
:s
"
IIlcc ", ~~ 5
a: P' L>L>
\) ~ ~ )-(M.,t r-.L~-h\ ~ l
'5-!gnature
Name Dr\\{.R(\Ur'l\J~rr'Rhu ~.H
^ I"" . () ,', ;:t;: .--"
ArIclress_";'),1v., tUJf}t:R Jf/IN IL)')
. I
C r+RL i '> i.. e p (.} ) 7 (J / i
Telephone ("Jin rJ-lj~ - 0 '7 i c)
capacity:~ Personal Representative
Counsel for personal
representative
,
REV-1S47 EX AFP 112-9S~ "
CDHHOHWULllt or PlHHSVlVAHIA
D[.A.'"["' Of .[V[HU[ NOTICE OF INltERITANCE TAX
BUREAU Of INDIVIDUAL furs ' . APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
~~:~is~e:~~l'A 111'.-06" ., 'I _ OF DEDUCTIONS AND ASSESSHENT OF TAX
ESTATCOF sTE\/~T DEtmlr-L- =""- --. FILE ND.
DATE DF DEATH 03-05-96 CDUNTY.
C-...-/
ACN 101
DATE 09-23-96
2196-"0"38-3
CUMBERLAND
NOTE: TO INSURE PRDPER CREDIT TO YOUR ACCOUNT. SUBHIT TIlE UPPER PORTION OF THIS FDRH WITH YOUR TAX
PAYHENT TO THE REGISTER OF WILLS. HAKE CHECK PAYABLE TD "REGISTER OF WILLS. AGENT"
REMIT PAYMENT TO:
DEBORAH FENSTERBUSH
2536 RITNER HWV 105
CARLISLE PA 17013
REGISTER OF WILLS
CUMBERLAND CO COU~T HOUSE
CARLISLE, PA 17013
Anount Renltted
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
ifEV:is4i-EX-AFP--nZ:9sT"iioYicEuOF--iNHEii'iTAiicE-YAX-APPRAisEHEii:r-;-AL.L"OWANCE-iiR'-mm-m------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT DF TAX
ESTATE DF STEWART DENNIS L FILE NO. 21 96-0383 ACN 101 DATE 09-23-96
TAX RETURN WAS: (X I ACCEPTEO AS FILED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED-ON: ORIGINAL RETURN
1. Re.l Estet. (Schedule A) el)
2. Stocks and Bonds (Schedule OJ (2)
3. Closely Held stock/Partnership Interest (Schedule C) (3)
4. Hortg.ges/Note. Receivable (Schedule OJ (4)
S. Cash/Bank Deposits/Misc. Personal Property (Schedule EJ IS)
6. Jointly Owned Property (Schedule FJ (6)
7. Transfers (Schedule G) (7)
8. Tot.l Assets
APPROVED DEDUCTIONS AND EXEMPTIDNS:
9. funeral Expenses/Adn. Costs/Misc. Expenses (Schedule H) (9)
10. Debts~Mortgage Liabilities/Liens (Schedule 1) nO)
11. rotal Deductions
12. Net Value of rax Return
13. Charitable/Governnent.l aequests (Schedule J)
14. Net Velue of Est.te Subject to r.x
CHANGED
.00
.00
.00
.00
876.33
.00
.00
(81
876.33
1,439.00
14.814.57
1111
1121
1131
114)
1~.?~3 "'
15.377.24-
.00
15,377.24-
If an assessment was issued preViDUsly, lines 14, 15 and/Dr 16, 17 and 18 will
reflect figures that include the tDtal of ~ returns assessed to date.
ASSESSMENT OF TAX:
'15, Anount of Line 14 .t Spousal
16; Anount of Line 14 texabl. at
17. Anount of Line 14 taxable at
18. Principal rax Du.
NDTE:
rat.
Lineal/Class ^ rate
Collateral/Class a rate
.(15)
11&1
117)
'.00 X .00=
.00 X .06=
.00 X .15=
I1B)
.00
.00
.00
.00
TAX CREDITS:
PAYHENT
DATE
DISCOUNT '(+1
INTEREST I-I
AHOUNT PAID
RECEIPT
NUHBER
TDTAL TAX CREDIT I'
BALANCE OF TAX DUE
INTEREST AND PEN.
TDTAL DUE
.00
.00
.00
.00
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
IF TOTAL DUE IS LESS THAN ~I. NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRI. YOU HAY BE DUE
A REFUND. SEE REYERSE SIDE DF THIS FORH FOR INSTRUCTIONS.)
.,'
~' -I
,-
".
",
"lO
RESERVATION: Estate. of dacadants dying on or bafor. Oac..b.t 12. l,a2 -- If any future Int.r..t in the .state I, transf.rred
In pOI...llon or enJoy..nt to Clall B (collaterall beneflclarle. of the decedent .fter the 8.plratlon of any ..tate for
11f. or for y..t., the Co..onw..lth hareby ..prossly ro.orve. the right to apprals. and ...... tranlf.r Inh.rltance r....
at the lawful Cla.1 B (collataral) rata on any luch future Intor..t.
PURPOSE OF
HonCEI
To fulfill the requlr...ntl of Sactlon 2140 of the Inheritance and Estata Ta. Act, Act 22 of 1991. 72 P.S.
S.ctlon 21...0.
PAVHENTI
aetach the top portion of thl. Hotlee and lubalt with your pay..nt to the RagI.t.r of Will_ printed on the tavar.. ,Ida.
"Haka chuk or .onay ordar payable, tal REGISTER OF MILLS, AGENT
All pay..nts racalvad shall first ba appllad to any Intarast which aay ba dua with any r..alndar applied to tha taM.
REFUND (CA): A rafund of a taM cr.dlt, which was not requI.ted on th' TaM Raturn. ..y bl rlqul.tld by coaplltlng an MAppllcatlon
for Rafund of Penn.ylvanla Inharltance and E.tat. TaMM tREY-I1Ill. Application. are avallabla at tha OffiCI
of tha Rlgl.tar of wills, any of tha Zl Rlvanue DI.trlct Office., or by calling the special Z4-hour
an.warlng sarvlce ~bars for for.s ordering I In Pannsylvanla 1-600-16l-Z0~0. outsld. Pannsylvanla and
within local Harrl.burg are. (717) 767-8094. TODI (717) 772-Z25Z (Haarlng I.palrad Only).
OBJECTIONS I Any party In Int.rlst not satisfied with the appralse.ent. allowanca or dlsallowanca of d.ductlons. or a.......nt
of taM (Including dl.count or Intar..t) as shown on this Notlca .ust obJ.ct within SIMty (60) d~YS of racalpt'of
thIs Notice by:
DR
.-~rlttan protl.t to tha PA Dapart..nt of Ravanue, Soard of Appadls, Dapt. Z81021, Harrlshurg, PA
--llactlon to hava the .attar dat.relnad at audit of the account of tha par.onal r.pra.antatlvl.
.-appaal to tha Orphan.' Court.
17128-1021,
OR
AD"IH
ISTRATlYE
CORRECTIONS: Factual arrors dl.covarad on thl, a..a...ant should ba addra,sld In writing tot PA Dapart.ant of Rlvanua,
Buraau of Individual TaMe'. ATTHI Po.t As....a.nt Ravlew Unit, Dapt. 260601, Harrisburg, PA 171Z8-0601
Phona (111) 187-6505. Saa paga 1 of tha bookl.t "In.tructlon. for Inh.rltanc. TaM Raturn for a R..ld.nt
D.c.dlnt" (REV-1501) for an I.plan~tlon of adalnlstratiyalY correctable errors.
If any taM dua I. paid within three (ll calendar .onth. aftar thl daced.nt'. d.ath. a flYI p.rcant (SX) dl.~ount of
tha taM paid I. allowad.
DISCOUNT:
PENAL TV:
Tha 15X taM aan..ty non-participation panalty I. co.putad on the total of tha taM and Intara.t as..ls.d. and not
paid b.fora January 18, 1996, tha first day aft.r the .nd of tha taM a.n.sty parlod. This non-participation
panalty I. .pp.al.bla In the sa.. .ann.r .nd In the tha .nae tl.e plrlod a. you woutd ~ppeal the taM and Intera.t
that ha. b.an as.es.ad a. Indlcatad on this notice.
INTERESTt
Int.rlst Is chargld blglnnlng with flr.t day of dallnqulncy, or nlnl (9) .onths and ana (1) day fro' tha dat. of
dlath. to tha date of pay.lnt. Ta.ls which bee.'. delinquent blfora January 1, 198Z baar Intare.t at tha rata of
,1M (6~J perclnt p.r annua calculatld ot a dally rata of .000164. All t.... which beca.a d.llnquant on and aft.r
January 1, 1982 will b.ar Intlra.t at a rata which will vary froe cal.ndar year to callndar ye.r with that rat.
announcad by the PA Depart.ant of Ravenue. lha applicable Int.re,t rates for 198Z through 199& ara:
'!!!! Intara.t Rllta Dill tv Intarast Fllctor !!!!! Intor.st R"t. OIlIIY Int.,ad Factor
1982 2QX .000548 1987 .X .000Z47
1961 16X .000458 1988-1991 11;( .000301
1984 IIX .000lDl 19lJZ 'X .00OZle1
1985 IlX .000lS6 191J3-1994 n .000192
1986 lOX .000274 191JS-191J6 .X .000Zle1
--Int.,..t is calculated as follows I
INTEREST = BALANCE DF TAX UNPAID X NUNBER DF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Notlc. Ilsu.d aftar the tax baeo.as d.llnqu.nt will r,flaet IIn Int.r..t calculation to fl'taan 11SJ days
bayond the data of lha aSla'I.,nt. If pay.ant is 8nd. after tho Interast co.put.tlon date shown on the
Hotlc., IIddltlonal Intarelt lust b. calculated.
STATUS REPORT UNDER RULE 6.12
Name of Decedent:
"r' , ,"
\.J \',\" i I '\
L
(")"Tt-"\lnP-J
Date of Death:
" . ~- - 7 (1"
'1 I ( . (1,,:: "S>'."","
Admin. No. ,-/ (( , .,
Will No. \CI'qi.o - C. C', -:1,~'~
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.
Stat~~hether administration of the estate is complete:
Yes-A.- 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 following:
a. Did the personal r~esentative file a final
account with the Court? Yes No .
b. The separate Orphans' Court No. (if any) for
the personal representative's account is:
c. Did the personal representative state an
account informally to the parties in interest? Yes No )(
d. copies of receipts, releases, joinders and
approvals of formal or informal accounts may be filed wi~h the
Cerk of the Orphans' Court and may be attached to this report.
Date:~
,,~~t ~~\\~
~nat.ure
\)('\\(,0())-., I::' r-;-u(\l,~ftJP.hll'~)'
Name (Please 'type or print)
'7, -, "'J' \ \ Cfj'?),)l .'
,_ ) ) c' ~~ l-,'J t' ~ - I ~..:N L
Address '
(l n l ~JI-.\,) C 7 ::) 0
Te 1. No.
Capacity: ~ personal Representative
'(1
u(i
Counsel for personal
representative
(MAH: rmfl AM3)
..