HomeMy WebLinkAbout96-00417
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
r~,_, ::'
r'
,
} 58
1)1
: ,'Js
'91) 11AY 21 P 2 :37
The petitioner(s) above-named swear(s) or affirm(s) that the
statements in the foregoing petition are true and eorrectto the best
of the knowledge and belief of petitioner(s) and that as personal
representative(s) of the above decedent petitioner(s) will well and
truly administer the estate according to law.
Sworn to or arrirme ~ ~d subscribed 1')"
before. JIll: this 1 dar.llf _ I
MIIY /' f!}l !:i~
71~'0A( -:,~~'(-r.,. /lL -;l/J/~ mi'Q
RY C. LEWIS Register ~ I
ell;' ,At
Cum:;~",..,u "w., PA
~
on
lI'
..
"
10
Iii,
fii
No. 21-96-417
Estate of
DENNIS E BERTOLETTE
, Deceased
GRANT OF LETTERS OF ADMINISTRATION
AND NOW MA Y 2 3 19~. in consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that JACK E BERTOLETTE
is/are entitled to Lellers of Administration, and in accord with such finding, Lellers of Administration
are hereby granted to
JACK E BERTOLETTE
--. ------ --.----..
in the estate of
DENNIS F RFRTOI FTTF
fJ:J /) (1, f;. n
"/1''('( :'~"/"'''''''_ !?7( r.t;f1.~
. I f I ''1f /J
I i Register or Wills .
, MARY C. LEWIS
FEES
Lellers of Administration ..... S 25 . 00
Short Certificates( 3) . . . . . . .. " S q nn
~'1!),unciation ................ ~ ~ . 88
TOTAL_S 44.00
Filed ....~~y.nl......... A.D. 19~
Robert E. Mypr~ UnQ77Q
ATIORNEV tSup, Ct, J.D. No.)
100 Old York Road. New ClllllhPrland, PA 17070
ADDRESS
(717) 774-3163
PHONE
Mailed letters and order to Administrator on 5-24-96.
21 - 96 - 417
RENUNCIATION
In Re Estate of
Dennis E. RPrtol~tt~
deceased.
To the Register of Wills of
nl~rl;mr1
County, Pennsylvania.
The undersigned
Pnn~ M RPr~nl~~t~
of
the above decedent, hereby renounce(s} the right to administcr the estate and respectfully ask(s) that Letters
nF ^nmin;~tr~t;nn
be issued to
,1;lr-lr ~
Rnrtnlntt,..
.
h;1:
F;lIthnr
.
;mr1
f-h;tt. hn c:nM.II3 t.li thnl1t nnnr1
WITNESS
~'
hand this ~, tl" day of May
96
,19_.
L-'"
/;,,<~.:~ "7t.
cz5Jr/? /?7(,
(Signature)
Subscribed and sworn to before lID
this 2lst day of May, 1996
4o/(c~(I{;{ ^)~ ~/k;/>J7frt' '~
(Addres,)
- G~~ ~ \\J)1 f, \ t;, 1\
Notary Public
(Signature)
Notarial Seal
Enid V. Manin. Notary Public
Fairvlew Twp., York County
My Commission Expiros July 12, 1999
(Addr.,,)
(Signalurc)
r- -::~
.0 t;: 30.;
!!2 N
l:"::; Q. ',' :-,
- (Addr...)
N
>-
.. $
~. -...;,
U Q ~ \.~ E
ma: ~=>
a: UU
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMlliRLAND L;j<c'-L
I
J
u:
Jack E. n~rLol~LL~r
being e1uly
sworn
--~- accoreling 10 law, e1oposos anel ..y. Ihal ho AdmlnlsLraLor
----. -- .-- '"-- --.--- of tho Estato of IlPIHli r.. ~~ HlOrt n I,>, I II
'01. 01 --1,ow~r,/Il1"'(1 Townshtp ~_~____, Cumberlanel Counly, P.., e1.c....e1 enel thet the
wilhin i..n inv.nlory maelo by _.:!~~E.J!.~rtoldL... ____ _~ ,th. ..iel AdmlnlsLraLor
01 Ih. .ntire ..Ialo 01 .aiel e1.coelenl, consisting 01 all Ihe personal prop.rly .nel re.1 ..t.I., exc.pt re.l .st.l. outslel.
Ih. Commonwoalth 01 Ponn,sylvania. anel Ihal Ih. liguros opposil. .ach, item ~I the I v.ntory.. ,r.pre..nt it's f.ir v.lu.
a. 01 the e1.lo 01 e1.c.e1onts e1ealh. j /)i/.../1 , .f/!C..J
1aA'l ,.,
, !t I (;/ ,~. cll. anelsub.cribeel bolore me, (JAcK/E.- BERTOLETTE
U; .-
'<"'1,1.-'1 _, -"~ ,. 'ib 19 _ 9"7 En,ut., . Admlnht,.'.,
.
)~ LI::.~/ /A~ l1'/c"
1601 Carlls1~ Road
- ,
I I.0l""./,L ':L:'~
r,';1r'j 0 'wl'/H.I;._, r. :.11', P..Lt,,;
(j,:)t;~;"l GUI'. 'I",.. C,.n,'
'~~~'''''flr"",'r.';,7';'l'J
--....._----,"-----.,;.-
Camp HIll, Pa. 17011
Addr...
o.t. 01 O..th
6Lh.
O.Y
NAY
Month
1996
V..,
INSTRUCTIONS
I. An inventory must b. fileel within three month. after appointment 01 personal representativ..
2. A suppl.m.nt inventory must be fileel within thirty e1ays 01 e1i.covery 01 aelelitlonal ....ts.
3. Aelelitional she.ts may be .ttacheel as to personalty or realty
4. See Article IV, Fieluciari.. Act 011949.
Q..
\l..l
...!) ..;
cr ~ OJ
W w
~ ~ I- ..
W ~ "
0.. U OJ
0 lI'I "
8 w w 0 '"
J: ~ "ti ..
0.. U. .; 0..
Z I- ..J
U. ..J ~ 0 ~ 0..
W 0 < 4 i-
<J > Z ~
Z 0 "
0 "
lI'I Z 0
0 ~ -:J ~ 0
Z w < ...
0.. ~ "tI ~
"
- ..
, ";:
o;.J' 0 "
Q ..0 " .><
" E
- .!! 0
.. " 0
..J 0 ii: CD
Inventory of the real and personal estate of
Dennis f.. Ilcrlolcllc
deceased
Blue Cross/Blue Shield refund 236. 50
Prescriplions refund 23. 91
AulD Insurance 36. 00
Compacl Disc Player 200. 00
Cerlificales of deposll 20. 00
Nicrophone 90. 00
Television 45. 00
Bikt! 60. 00
Slereo Equipmenl 240. 00
Rt!cords 700. 00
Blue Cross/Blut! Shield refund 25. 00
Lighling Equipmenl 600. 00
Lighling Equipmt!nl 3,500. 00
Brass Cymbals 28. 00
Salt! of tlisc. !lems 599. 25
Capilal One. Richmond, Va. Bank accounl 26. 74
1979 Van 500. 00
1980 Van 75. 00
TOTAL 7,005" 40
n
,.
: 1:1
h(~; ~,~ t~ - 11J: /(~.
.j!
rp.JlM 93-0. C. DIVISIOH
IN THE COURT OF COMMON PLEAS
... OF.
PENNSYLVANIA
ORPHANS' COURT DIVISION
IN RE: ESTATE
OF )
~4 ...&a.J"M!!m., \
(Oecultd)
.2.../- 9c:,OLf/ 7
No ... ..,..,.... of.
/9%
............. . ............
CLAIM
To the Clerk of Orphans' Court Division:
Index and make proper entr)' in )'our official r~ords oC the claim 0(..,...............,.,........,................
,....,.........P.N..C,. .13a.rTL&.. ,.... .. ,. ....., .... "... ..,.
IClalmaotl . . ..,.....................
in the amount oC $...,./ QL5......,lI8.......~.. ~.. ~ against the estate oC the above named decedent.
This claim is filed under Section 732 (b) (2) oC the Fiduciaries Act oC 19~9 as amended,
The said decedent, who resided at .,/lp.Q.3. (!4~tJ,~, /2oa.~ /',.,........ ......
('/) ~ "Iv.ll.. )..Qo,... /70 1/ .died on I1ta.l.f 5..th /.99(....
v..YIJ~ I Add"..) 0
19
Written notice oC this claim was given to ~. ,. ;2~t ~ ..,.....~
,. .. .........on
.." ............ .,_..."
..... "....... .......
I Person:.! reprfuntUI\'f. Ir an)', or coun..ll
/-1 ,t9 90
...,. ..~piimJ~'Y
..' t:.. (2c,) , .4:f..1..C!f......
I manll
,
t'
E
0
~
"0
:ll co.
~j '=' i
\)-..
0-.. ~
'" '" ~
0 ~ a I
w - <;::J ~
!;;; 0 ~
Iii t-- \r) ,
w ~ 0 ~ "'1
Iii ~
c.: 0 ~ '"
:z .~ J! S!
- <l' ~
I 'tl
~ ..... s ~
~ .;; Ii:
0 0
:z
.
, ::.
; ,.: ~,
NOTE AND SECURITY AGREEMENT.
~~{/
~."''''~
,1~'1g
NOllCt~ '...... ,,'.I'd n . \pe ~epar"rf' 1I~.'PI'18hon C! Arro~rt 'U'll1tt(J
ANNUAL
PERCENTAGE
RATE
lh'! cn~t or your (r~C'1
UIIWlylll.
/.5. q %
FINANCE
CHARGE
rhl dollu .rroun! In!
".d.t WI I! CO$l you
AmOlml FU1i1nCtd
'h~ ~""ounI1f ~I.g,f P'(;V,.jIl"
Ie ~nu (If on 'tOUf b,h.ll
I Ictdl ull'i1yrtIC;I:S II
! It" ~llCur.l yr;u .-,;: ha\l! paid ant"
, yf)I. h,'~e rr,dt aI' \C~~d'lltd p'rl1'tnt1
i S0~ 9.J,~'i_J
$ /0 7 rJ. ().3 $ .LIO;?' /.7' I
Your 'lym.nt Schedul. .,11 be: _'__. . _ ,
Numb., o1J;Y""~i\I__uA~~!'JI!JfP:~nl'
-.' (p ,S !.!:IJ...!f.:J..
SttUII1y: YCIJ 'rt ,wlni a S!cuuty ml,lllrst m
o the !CIOd. or proPt'rt/ b~lni purcnllOd,
Dj1br~1 deScllptlon (.of of'l~r P'iJp~rtyl ----N..o-"../&--..... 0_. ,. _0 __..... __... __.___~._.'
flllnl\f"II________
Prepa.ment II rOu p'y off l,lit. YOu '#rl" not hal't to PlY' ptnally
'j ~h!~!~l~~;'~ Are OUt
__ M.o_nlhly, C'iln~lng
, m. IJn~ in estlm.t.
----on. e7jr. ~~~,~~~~-j
~ ., I_~ ~TP?..
See "aur conlr.tldocum!r:h '0' Ir:'i '~rM:on,lll"fr.rmat;t1" .Iho1lI'nnnn:,wrNlnl t\DI~jl,t :Fl~. '''''''4.".-1 .""l.....u... ,,' '.,!' .....1'...... .,....04..1....
.' , -- - . .
..L~':.t:-XC
r'. (',__'': ('('.~'
I I. lte;;;llal/(II; .o(ArilOunt rrn<lryf.ef
IT.Qunl rlOdnctd
'~-
1$ A~II"'.n;Ou duetlly
I'~ -~m~~~a ~;Lou, lccounl 1
r.4,.5.<~~~_. -';,oj
AmounIP!~lonyol!!. CthlllJ
' 10 pub!IC oH'CIII.
I $ ,~_~_
ro InSUlar;t~ ccmp.nr /.
..1__ .
10 ~__~.__~____ __ ___._..
.,J_____ ~~~_ ~ __'~_.
I~o_= I
-' . -- -----.. -..----....~.
~-
-r:--~
.
, ,
. CORRECTION
Previous Image
Refilmed to Correct
Possible Error
, I." .., :Jt.... I,.,-n
NOTE AND SECURITY AGREEMENT.
~111'~
~'II
l, ~.- :1': :u. '
f ' ,('i'.~ L'll,
ANNUAL
PERCENTAGE
RATE
lhl1tMtvi ~ou, t;1\:CII
UI,UI;,ult
/~.q %
FINANCE
CHARGE
'r,Ml',r"1'Ollnffl1!
""d IliIIll' 'Qilyou
Amount fl/'JIle<d
1f1l'.moanliJlrt'd.ltn"v,..kl
II' fl\U tll M ,11'11 h,hall
. IJ Lt /;;l
NOllCt:........ \'It'll n , \Pt \tpanl, Itl''''lIhon 01 Alflnllf'lllll'lfI(td
$ /0 1 r1. iB I ,lfo;? /:"1 /
10u' rljm.nt Schtdult .,11 bl....~___ _.._.
Numbf, of P,aynfnt\ _! ArNlIJnt nf P'ym4nh
_~~~'H~_::3t.P-__IL/d/.1.q ~
Stnufy: Yw 'I' il~tl':l a !f(Ullly II,I...'tst In
o I~I .'lOC, " vrop;rtt b~"i VIJ"hH~d
Otfbu,1 dt\Cllll:lOIi t,t OII1~f p'LlJ,ltlt.'1 _,,_
"1,,~...I_____. -.---
PUplrmenl. II ,Ou P'Y ntt "1',. ~ou "'1'1 nuf hot"" 10 p.y. lltnally
I W.h!n.P~l~~~"M_
I Monlhly, D'i'""'1
~ ~ --~NO~";&---_. ...
~ l
1t'!.,1 cll'dyrIICn.~ I
Irl .tl1curl/'Ju.II.! h.,..,' rlld ant",
_% h.'~t "'o.d" ,11 \(~"r1 Md pllyrr',nt\
111l('lIIlldll~11 ~oIA!l1oU~Uln_aocedi
, '.,.ounllln.tllC~~ I
t' _s_~J),=7LJ~L -'i'
Arnol~t IIVflllo leu dllell1t
I S ~~ A~~~d'2~ur ltC~unl-~ 1
I S.3S,~'.41_'_"'__1
Am.unl Pilli\:.e!lJ~_,-ou~~~II. ~ 1
! 10 "IJO:1C othtl.'~
I S ~
101l'l\UI.n(,. comp.n) I
-~~
,. ,
I
I
I
I
,J
'0(1 9'3. ~4
I nl-l.n$illllllml.l,
~~er;oi': i~?, :99;]
J...._.__.
to _
S
,...-.--
F' ~o ~----_.
10__
S
Set YOUI centr.d tJo(ul"l~nh ll"f jnt ad,j.! onoll ,rfc,m'f'or abiHJ1 nong.lm~nt 13it4il-l. i.'l~ 'PI"'llfl~ I"p-,ynllnlln lu'. tll!lr.I~I"~ s~hpdultd
:f.tlf. .tll' D1tlp4)menl ft1hmd~ in~1lJ(I"<llltl!}
The ..\nnual Perc('nt'F.c H.ate, AmOlln1 Hnanc;cd :md P"ymfnl ~\h,duh'!hou.n :'IbuH' i:t' ('t..., oflhl\ Sl"J~1" ii.nd S 'CUIII)' A&'('~m,.nt {which l'c:;,l:d 'hr"~l"tt'; Y(\u:uc 'he
p:nt,nlo"l'cuClnsl \liho signs .,s "Ollrro..tr"or "Co.SI&I'.fr"brl\)v,' If rn.:l:r lhll"l O"lt rr'\n1, -1gTl\ hlo"., c~~h I (>c\u \L'il: be h^blr.1tp;\r.\ICl~ and logt'lhrr. for.tll of \'oUr
~,u"','" "Ihll ",," ~ C'l"'i'.' "lJ Bank ~,...
YOU PROMI~r Ail U
TO PA\'TO l!S ,\SuhfiJl"ll'YdCc.'\Il~
-.,.; ,
UT 10 our "rJcl, It :lny 11' Ol..T oflu:r.., the "mount Financed, plus intetut:n pr('\~dc~ ~CICllA an Ih(' r.lI"htr of !qUJ\ nlonthly pJymen" ~ho""n In lhr PJ\mt'nl Scht'tilJ:r
V_\\!'11C'nt!o ,ue f1l1t ~"plnrllni! nlll~( d,\lc Indir ,1Icc11n the P;\lmt'nt Srhedulr' :t~lt I)n Iht ,.unfd.l' 01 tach f(llI,,)....lnl month u'l111 \U' .rC' r11d In full '1"01.1 may (lI&)'Il'l .dv.nl;c.1l
(JI rill ,)1 tr.t h..:J,\.:t dut II .a11) I:mt_ ....llhoUI fl(nllh~' or premlUITl
.H::Cl:RITY ,-4GREE.\fE,"O' ", .rCUTlI~ (nr Ibe prnrnpt J'")'mcnt Clfthc \l:m\ )'011
.'''C Mu11h(' plllrrr pcrlorm~na 1)1 \"lUI rronmu In tlll~ ~(M, \-01.1 .1nd .alll'\r
'C".QlAr,eh" ~IGnlnr bdow .I.nl \J~ .
(1) . "e";UTll~ InlC're'" In I\'r InllC1\\in~ J'C'"onlll rropert)', and it) rqulrm~nl 3nd
,1~"o!;r"
mz CARLiSLE PIKE
CAMP HILI, PEN~SYlVA~;!A 170!!
_~Otau.....tI$ mE m~'JlJ,Nct CO"'~"N1, Cff'llS H!I', ,..v t:\."'" 1;:"1::.___,___ . - -----.
THF. ~nn1TIO"~1. HRMS ~"nsrc'URIH "C,RFF\\I" T 0\ lHF "".lllSI. :,Ill! .\01 1',\" 1 Of TltlS :i('lT[
hI ,""I\(, H W. \<)1: INTF"DTO BF LFG'U" RI)\'''I) 01' ~L1 OF I HF HUMS OF1HIS NOTE
\' II I.SO .C~"OWI.EO()f RfCfI\ '\" . ,"~AI'l ETF {J COP' 01. Ill!' "OlE
UJ,';dflJ-~t? I-I./! ~
l'J o/l
("("Sltnff's"I(fi!,)lllr-t-
., PU ____'~... ,__,,__~
All tl1e rroptrt~ v.hich ..reure.. Uu' ~ole j, c.llrd l~t "ColI.leul "Our rlShn :lod
\'(lllr rtsponsibllttirs rCi~,"ding ;\n\' rcn''\n:\l pr.'\prt1! ('oIlIl,Ier:\lll,ft r:o'o'idrd 'n thIS
SC'l'Uflh Agrrrmt'nl ,~h~d, (IJnIJnur\ (In Ih rt\tn~ tide Our r:ghh In ,)'W rtiill
rrnrtrt)' ('(ll1ateral IUt C'nnt~ined m ,he MOTlFlIfC', .\1 ~(lUT C'lren\C', )'{1'J \L,U
('ooptr.''ltt ~nd JOin \lr.II)o1l\ In \ICn1!"ll :lnd 'Ihn, do('un1fnts And In I:\';\ni all] C>lh....
..tcoP\ ~hich \lot' drC'm l"Itl'~"\"T\ to rC'rfet'I, m,iI"ll:un ptrfretlon of, und ~1l11,f~ UJ" FLOOD I~SI1K^;\'C:f, ,\N[) PRUPfR1Y It\Sll RAi'WE MA" HE 08T A1SF.D
ceeuritv intcrect in the f'nlblcral. THRot:GH ,"~'Y .&'G:ST. 8ROKf.R OR OTHf,lt PER~n~ OF VOLA,
IF so REAl OR PF.ItSO:"\Al rl\OPERTY IS IDfNTIFlfl> ABOVE, THIS rUOICF Set I~,ur:tll('tln l'3r3gr.1f1h 2 4 Oflh,. St"nil~ ^Irttlntllt on Ihe: reune:
son IS ll'SECURED "J,
rRfnlT I.\',~tfRA"'r:E: I,', ,\'nr EQI:IREn' ~uhjt'::lln ~'::"'er".ncc h~ the In'UTtl !1:HT,cd h~;.l14. credit i05ur Ince j, :t\:all.lhle throuElh u\ (orlhe tC'rm nl'lhi, NOle: :allhe:
(,'lSllSl ~hn\l"" tlC'I,'lw Slnlllr Cre llik _It\d S;n~C' ('redit Aall~rnt & Ht:\lltllnsl1~i':\tr ,u,. :,,:\11,' (' If :\ny OM Borrov.'cr (lr('o.SI,ner slgnin,l ((lr InSllr:\nec lKlnw, .lOlnl
("redll Lilt In\lLr:lI~('t II.W",IJ tto .11l~'I\l,,'o(lll,'ou ~1'T\lnp: f(l1' UI(" 'Mur3n.!' bl"lo\\ ~ocr,"1'f I r:lnrt """I! ~ ~ro\'ld~d 1111tn the' :ipproprJ3lt s"attmtnltS) lssi,nc,1 by lhc
ptl\(lnh)to bf' In\ur~J ",nJ ,f'u'\h \~\OWl" tI...I(,... ,)rf' int'hH!~ . .\mnunl Fln",ncl'J (St~ ,t' ~nll(,E OF f ROPOSEOCRFOIT INSl.'Rl\SCE O"lhr rrvt1lt Sldt I
By "l~ning, ~('IU v.'..nl SIn r Crrdtl tAr 1r."~H.nr~. ~: "~'l'nF, ynu "",.nt ~i"~,k (re "t..:idrnt & Hr.lI~ I R~,..;snins, ).ou both \loint I')lnt CredIt life Intllr~r.L'f,
which C,'IU S_.._~. ~___.__. InSlJr,l!'1Cf', "hlCh C'O\t\ ~ I Whll;h eos" $ _ Wh.1t"r
I \'our :\In ~
I
Signature of r<<:'Oil i;',. irj'u,(ifi';ll SlnpkGedit i
.".ceident &. U:;ahh In'll .lnL"C
;JON€.
1.
J
Our i.C'rlJrlly Inlrrf'" If'l(\udr, r.rt. (..lied "Jt.,'thll)n,,"" addtd In Ihe f1t'JlO"1II1
IHOrctl~ .1 ..n).lllrl lIme
tll) .. MMlf.:\gtllr,'n _ ,_
+to. ~InJiired'loj.' !\ini:(Cr~ll [ii,
I "hilt Ii \('Iu' "if'
HOlt' 1.'.TF.RF.,f\T IS C'IAHGEO: lht FlnJnrt (,h,lIlf CMmB \)nly of &"Itrl"'ll
,rr.pJied d3:h un H,f. l1U ,landinG botl,&nce of ,he AmOlllll Fm:an('cd .t thl: 4.nnu~1
Percenlolc:e R;tIC, The EI an~e 01luge shown ..bm,1! ..al flgnrrd by ,)uumine that 111
~\;l:' :nrnrs,lr;t~f re~ei\'Pd ':111htlfdLlr dalt), If an)' pJymt." 1\ 10111". }fJU l1'Iujt p.y meu'
F!r'llnet ChJr"t lboar'll' ,Io~r'l btcol1.ae of the .ddlhona.! illtrr~u ,mpo,rd Ir you ply
rill}. lh~ fm.ncr Chtrl,e 14'ill he Ie." The .mount of thc illtfe..,c Of decrcase in
Fi~8ncr rhar~ v. ill be dllr with the IAn pi\~mtnt. which WIll be modIfied to refitet
It'll' JUU~ aMount Ihen (Ut
.\'l'r.O"'F: r~r I.... ;1\'" u.. d flsht o~ 'rl.off tn an) of )'OUf prOl1m)' in QU'
Pl'HCS'ICln at "n~' time. ir cludingderout 3ecount" lhl. mum th,\t.lrvolJ dd:\uh,
":' molY t).Ch'l\t" OLl:' n;hl of i.el.ofr und Ilrpl)' an\' of }'OUI proptrt)' tn C'lur
I'n"r"in~. includinp; drpnil at:tnunU. tn the ,urn' )'nu owe on thl\ Snte.
/o"1.00n 1,\'Sl.'R ",..'rE: Ir chedrd 0 ,inlUr3nrt II re(llured JgJ,"S' not.ld damJf,~
I") lmrrO\CIJ rui rrC\pent. or mobllf hOlne COIIAlU,11
PROPER fl' J/'I/SVRA" CE~ It thl~ ~o)te lj ItCUfrd b\ ('"IIJler.l\ v..ll1("h IS nol in our
DuUtS\I\!ll, 'IHUr.l1l~t at unll phy"rJI dam3'f 10 lht (,1I3tfuIIS rtQ\lIl1d h'r the:
fu I tcrm or the ~l\lt
_YC11\
'rtd:\
I 2 _ _ .. ___ \"n"
l\ a .hllh ~I belh prr'.c,nc 10 bt Inloured
1.1: ,1.,:<1 CmJit lifr ll'..ur.ne~
___. _ rrah
hl\UTfr:
...--- .-
D(lrl~~",:r;~ Sl':Il,llil-r~'
J5C,
\,Idrt'l
\1I1rt".\
,.. -.--.... .---...
~OTlO: TO (O.SIG~FR
You nr. b.in& ..krd 10 &uar.nl.. Ihi. d.bl. Think ra,.lull~ h.lur. ~ou do.lllhe BOlro..., d"..,,1 pi' Ih. d,'hl. ~1l"..i11 haw. 10,
B. '11'. YOII ran afford III pa).if you ha\'t 10. and Ihal )OU lunllo .,...pllhl. ro~ponli,iIlly.
VIlU rno) ho,.lo I,a) "I' 10 Ih. f,,1I RrnOllnl ollh.drbt iflh. RII""" ,,' ,II'" nnl pay. \"1lI m.). .ho ha..lo pay IAI. f.nor roll.clion
co.ls. whith inc"allS chil amounl.
Th. C,.dil", can coll.ellh;, d.ht Irorn YOII "ilhoulli"ll'yiog 10 rollttl I,orn Iht Borre,,,.,. '(ht C,tdllorcan UIf IhHameroll.ctlon i
melhodl ~g~in'llolllh~t un b. u,.d again'llh. 80r,m..r. \mh o"uing YOII. otr. Ulhi, d.bl 1\ ."PI in dtfaull.lhat ract rnnv hccomu '
l'a,l 01 )'our <rcdil r.cord.
( 0.,\'/(1,\ 1.11.\ .\liRf:1.. A(iHF.f,,\/f,\' r: lnu, lh~ pentln(C\f rC'f'''ntlllil"lnJl.'' "r"'~I"ncl.'~e;"v.,I'r('lml.( tn P~\' tout or 10 n\Of mder'" .~lnU!lt Im.nerd.I';\!"
'nlrrr~t JI\J ('!Ihrr rhJffts,:n (H,mdtd ,n lhis ~Olt "('l~1 \nrtnd I.' hI" Itt:J:h btlllni1 h\' JIl t,1" lwn, .11Ih\ ....1I!t \f'('.Jr,"".\' .lnd tot.trtlf'1 lilt 8l1Thlv.tr You ,UI"
ffll6\.IT'1llh" r"''''.\~ 10 lnL1ut, u\ In m.~r Ihr I~." In Ihr ~OIln\l,"', tnn 'hn!,;r~ tt,r prnt'rrl1\ \,0, ,II hr .Jlrd ('Inll '0' 1\',. "",'n", tl\ ~r"'" "g'r,. Ih.l we' m.y \ttl
I i",mC'dlllC r'A.,'tlenl horn \OU ....Ilhnut rTll\int "flY rrinr demAnd!N p1)n1Cnt 1.Irf'ln the HNlil14(f "OIl :lh(l IckMlA'ledilc retel\in~ i cllrnl'hlcl1 eor~ of Ihl' \Jole.
:\,jj~;1
IbU,
t. Numhpf ~. Payn~:l'~
-- ~
---- , (p
~rN)U'\! m P.,I'IolIIll::.
'-Lj!fJ. ::1. q
; 'Ntlpt' ~.,ljl"r:L ..It' DlJt
I ...~.___."
; MO'ln",. !1ef;II"rln;
~1"Et' .-; 6 I J 9,2,. ,
I
SecUllty: Yell ,rt i!\"~2 a S!CUIl:~ -r.I'"restn
o I~~ ~(JOC) m p"ltltl~J b'!lI'!, pWtM\P1
Dtfbll,f dt\tIlll!:on (,I ol'lt!IlJ'Llllf.rtrl --
..11.&\1...1___....____
P,.p.,met'll II ,Ou pa) nff ""1 ,OJ ;w,'j fl(,t h.wl' tn p'Y 4 I"''',tlll
tn j'i\ur' r:C'f' C C r.lj)d ~I ~
.. ..../'J.o!'i&---- ...
J..
10
$
Sf't 'au' contrad dCCUM!rH lrf Jr,t "1,1 ! Ilr~l ,rtr.lr,u~ 0" ~boJul nOngl,mt'nt di'14~ I, ..',~ 'f'''lJ,IP1 rfop"~n"nl'n fu' :,,,,Ir ,"I"~ Vhf'1l:1"~
;1.llt. .ruJ L:'"p4l)menlltllun:l~ ~n:llJt'rAth",
!(\ ----..--..-.
I I
f- - ---- . -_-0.-_-
Itl.l---
! 1
lht "nnu.l Purt"I_"r Halt. "mnllr.l t+'nancr.luld PA\mtlll "i(h'11ull' \t,n"" ,)t'\o.t ....,. 0." III lnl\ \r!l" ..,lIi '\ '(IIIlI~ "t:1,...",,.1I1 (~11i(h 1'(.\ hJ tlit ""fltr' "1\11 :ue Iht
p~',,'n fo'"rtnons) \lIho "r.ns ,\\ ..ltl'~r,."'tt" or "Co,!".<<rrr"hl'l.l\l. If tn,H.-IIIlI" WII' 11("'\'01, I~'t\ hi,,", (';1;11 I' )llU 1,1.11; ht 1",lIlr. ,cr.ll.uch ,\rill fflll.rlhtr.l"r ,111 \)1 \'our
rr'I,-,,\C') t"" tf1a "dt
~ (',(,'I."I~ B.mkv. 4/~! m~:~:f PI~F
\'Ol. PRC)'t1,r : ~
III I'^ \' 10 1'\ \Suh.,jJ\U,'~~';~\Ilu1"P'ntm CAMP 11111, H ;.~Sfl VA:;1l I/II!!
vI h' ul,jr l'llrt .1 ..n~ 11111'" Il!ft(l'~ It:t ""H\Ullll-":lIall~(J.I,lu\ ill~CltH .,\\ f'11'\..h:,~ "r!ll\l, 111'1;,' 1"I~lktr .)1 'qll.\1 "Ionlh:v ~,l\'mf'"" \ho...." in lilt' IJ,I"mtnl "\dl"AlJ:"
",,""('1"'u( 1111t ~C""HjHl" I'll' !~"Il.", Inlllf .lIfr. H\ Iht I',,\m.nt"" I"tllllll. \"111"1\ Iho' .,I!Tl.-,!.1 Illo'lli n '0;1"""11'1 'nnnlh 11,.1.1 \Ill' "".I"I:d 11111111 ','HU 'Ila)' 1'.) I" 1.1"'IIlC(, al;
"I r I" ,.111', 11.1'.1"" IIllt ..1..11\ I nlt 'AIlhuull,<<,nll.h\ IIr rlr,'\lII'"
;JON€.
"0"'/.' IfNI 'I H ("AH(;111 1l1r hn.l'ld' ('~,llfr 1(1~,HI. ,11'\1\ "'11!","\1
"'1' -.\I',! \1.l:h ,I" '"" IIIl ,1..n,lllll~ 1I..1.'lI'l' 1.llhl' 4n\lHlltl I"n,l',r:rd II! lhr ""lflU,,1
l'~r, tt1lolrt ~ ollt n,e ",1 Atilt ( ItMiC \'lO'4II.,tlll\t \/lot' I rnrrd by ,IHtlhll'\!: l~"l ~II
I'.., 1tf'llh "'r't tr~f':\f(I, t1lnrlld'lrd..l". If ..n.. rn",o'" 1\ :.111'. \'HI ,tlll.III.' mr,lr
I' nolner l'h.Hlr lt~,,:_ \1 ,.....1'1 ~(.\a.- nllhf' Id.1llt()"I~ 1lI1'fUI '1Il1''''''u II )U\J Ill'"
t"lll.. Ih. ~11I.nt..r Chlll,t ""Ill he Ir'~\ 111(' llIll)\U11 IIf lht" IIlC'eA\t 01 dcr;lr;uc Ir1
1 11 II lid' C"h;Ull" \11111 ht' diU' '''Hh 1he Ijl\1 r"\nttn1. \lohl..h\loll: t-.C 1lIlllhfltli 1nuficl;l
n,,' .IUtMl,I:"INUnf Iher. (U~
\1 tl.'HITl .. (.RI"',\tf"J ,,\ ,r,'U! 110 In' II" I""mpl f'lpn('fIt 1111111' \l;'m \1'1
,'1,1.( .,nl1lhr 1II'lrcr 1'I('I(lII'l,1n., /II \,'111 rfflnn,t\ I" 1:11\ ~(,lf. \'JlJ an,1 .Ii. ''1~
t(,.,U\4~tr.' .I.:".nr l\..lj'..... 1'.',1 ...
.., . ..r,.UIII\ ITllrrr't In II-I' Inl:I',""'o,, l'''I\"nllll'I''ll('rl), ~r.4 It' t'~Jlrl1h'll! ;1!lJ
....,,(\\(I.:C\
J
,\'l'f.()J.'J 1'11. 1'\" 61\'\ Ul . rll\hl o' \cloll 'II M'I, III ~m.1 flIUIl\'I1}' In ou'
1'(,~'<:\~lnn ;., ,'n~' ll:m, II cludlnjC d('f")\ll ,1C'f)Un!'. 'fhl. njt'I~' It..,1 Ir vim drl:\ult.
\for ,n.." tV,,'t'," ()lj~ n~hl of \tltlll ...nd .rpl) :.n\ nl rOut ptOpf'(1)' In our
""'\1'\\;0". llldudlnp: d~ll"il It(l'lunh. 10 Ihe 'UfTl\ }nu nlollor nf! thl\ Snl('
01.11 U"'Utll) In"",.,l 1!"I'ludt, p.lfh '.Iilrtl ".)I',thln."." IIddt'tt In Ihl" pr"'I.."I
I'rol't'If.\ .., .."~ 1.ltl lIme
till ,,~I('ITlf"l(,lll1l\n_
FI.()()f) /,\'SI'HA.\'CF.: If rhtc.ed 0, .nlllr3r.ctn rC(llllttd JlJlnU r.ol\ddotlll,}fr
I,.' H'IIH"H,J .tJ, rfortn. or mut'rllt hOITle' CoIIAltr.,;
Alllhe f"oPt'tt} ""hll:h "('Cl.IFt.. 11'11\ ~lllt i, tlP~d ttot' "C"I:.W.I" <hll rlShl' ,1n~
,om rn~On\'~I:ltJ"I rC'prdi'ig ~n\ f'cu"'II.,l pr"'f'cn\' rol!Alrr:\l.vr r:tl'.'idr.1'" lhl\
5truJI" "'grtrm~r.! ,~h~d,: ,ll~ll"l,;r\ ,)n I~r IC\tu~ \'..11' OlOt rr'-:h In ,)..\' trill
I'r('lrt'1)' r(lI!.I1C'r.1IIUC c-onU1ned In lhe M.HIf'lIfl', ~l ~fl"" t'r(,n\~. )ilJ ....,1.
cOOptr:llt :-nd lOin \1,,," 11\ In \'Jnl'" ;'lnd lrlrlli docun"nH "nd In t;\l;:nf MI~ Nh.'
,Itr" ....ht!.:h \At' drl"M ntl'!'~\Jr'. 10 rt'r!etl, m.w,t:"" pt'!rchon of. U'1J ~lIlh,h t,J' H.n0(11~SIlK^="n'. \~n f'IHJPI-Kl' It\Sl'R,&,:'ll'f \1.-\" !tEORl AI~FD
'ItC~til...iT"lltr(''lI;"I~c('nll.\tcr.1. TItKOI:fiH .~~, _"-G:....L UROt\f-R OR onu.lt PER~ns OF yc)lR
IF '30 Rf^l Olt PEItSO~^L rnorFnT\' IS IDFNTIFIFD A80\'F. THI'\ rlt(W.F Stt 1"\Ut';\I1C"Il't p3tagrar'11"} 4 of lhl" S"IJfil~ ^,rrl'tntn! on the r(\(fSC
~()l[ IS l"SKURED .1.1,
rRFnlT 1.\'SI;'RA,\'t:C 1,\ "or l'QI,"/RF.n' f..tuhjt.:lln a"':(1I.n", h} 1he In'lUrrr 'l.ll'r,td t'l.:;.\I,I.. .:tedit 1f!\Ur Incr 1\ .l\all.\hft (l1lou~h U~ (Ollhe lerm nllhi\ ~ote .lllhe
(,'sml ~t,n'oL'" I1rj,,\o\I Stnplr ('" I llk'\nd Sin!tlr (rcdlt A..c:.4tr.t f,; Hr.'!l~ lnsll","\:" "'. .'\\;\~I.' I( Ic- ;\"y on, HOrlO\loH or Co,SI,nef \lgnill,l tor In\lIr3nct' heh""'. .I01n1
Crtdlllllr In\1I1;\I'C" II .w",IJ f'to,'r\~ t....o .)1 \'OU 't,"I", f(l~ "1' " '''',ur.1nit h..lo~ '\U (I":'" I C;\r1C' \loll! .". ~ro,)'''tdt'd U:"lltU tht .1Pl1tOrfl:)lt ,- 3,ftmtnll ,Ill Sl,.r.t.t b)-.the
rt,)(\nhl 11... ht" In\urtJ Jnd t\l)\li \~i..",,.l\..l(l" .HI' inrllJ'!" . \mnlll'lI Flnolnll'J I.SI:''' ,~"of IrF OF f ROPOSFfH"RF[)1T INSL'R l\srE O~ Ihtrtv..utsrdt I
By 'I"nin~. }C1U 1Io...~1 S.n r Crrdll tAl" 1r:'~lrMn("(' It: . ~"'nf. )ou ""1111 ~i'l~lr ( I~ ! My ";f;n1ng. )'OU bOlh \I.,"l'It ")lnt Clcdlt ll!e (n~urar.(('.
whlrh ('MU S___,___ In\lJr,l~Ct IIohlctl ('0\"" 'o\'hlch ,nl''I ~ Wh.ll aIr
your ;1(Z.n ~
/lJUJJ11-.R [) I.\',".L'RA.\ CE.ll thl~ :-;.\It" Itcurtd tI} ('tIHaler,,: 'I,l,'h,.h 1\ nl)t '" 011'
,v\\tUl\IlltIU1Ir.l11(f' Jf,unil DhIJi,rJI 1ama,t 10 tht Cdlaltr.1ll) rtqUlfrd 1M the
11.11 term 1)1 Ihr ',~tr
.lci~-i-n;iifed.'~r- STng:('Cred'll (ife
$,gnawrt;;i+rm-on \~'t ir;\u,((fto-;S;f;1ki'irdtl
Accider.1 & H:allh 10\\: ;ln~"t
_.___ Ve.ll\
"rah
"to.11 Ii '.Clu' 'li~'-
'r r"':~
._ _ .. ___ \'r.,'I
1\ b ,llliC..:>1 holh ptN.n\ 10 be In.uttd
1.11.'.,;. I CltJi1l.ifr InUfoi'lce
Imultr:
,_.____!~~_nu....,u:; lilt Itl<;:.l.....NCt COIol.'.lN't'. C,,..~ HII'. ,..... ~:\~,,;., ~~:.___.___
~I
Houu....el\ \It-;n..tult'
- Z
ThF. ADDITIO"AI. TFR\lS A"[) SFClrRIH AGRFF'If.'T 0' "tHE "I '.IIlS1 :.lIl, .\RI 1',," I Of nlls :.:lTF
hI' SIC.' 1"'-. EI W '01: INTE"DTO BF UG4U" nl)l',,[) hI" AU OF; HE HR'lS Of THIS 'OTI'
\" 11 I.SO 4CK"OWlEOC,E IlFrfl\I~" ~ (lI~Al'lHf!J COP' Uf flfl' 'OrE
CU. 'rd~DJ.~lW]l' 11// IG.
. L7D/I
:l5C,
\ddltl'
6-oiw~,:r's SI~Il~liUi~'
\.jjrt"..\
,-~'"'--- ~ - ~,..-.
~OTlCE TO (O.SIG~ER
\'ou are bring ..k.d 10 gua,anl.rlhis drbl. Think ca'rfull~ hellO" ~ou du. If Ih. OOlrow., du..n'l pay Ihe d,'hl. you will h.... 10.
B. sn,. yon can afford 10 I,ay' if Y'ou h....lo. and 'halyoll "'ani 10 ..,'.pl Ihl. r..ponsi lilily.
You may h...lo lIlY up 10 Ih.(ull.monnl oflh.d.hl irrh. R",,,.', ". ..0" nol p.y. Y'lII may' also ha,'.'o pay la,.f... or coll..lion
CO'II. which increasri Ihis amounl.
Th. (',.diln, can coll.dlhi. d.hl f,om y'ou ..ilhout fi"tlrying to rollert f,om th. 80rre....r. 'fhe C,.dllor can UIl Ihe same coll.clion
m.lhuds ag.inslyolllhal.an b."srd .gainsllhe Rotro..... s".h ."uing you. .1. .1(lhis debl is .\'n in d"a"II.lh81 facl ma, hecume a r
pul of )'00' credil r.rord.
(f).S1h.\ I.N'\ .\fil0:1 t A(iH/i1.,U[,\' T:' nu. the rrnonlnr rrr\."IM)\'ltnln~.n "rfl.~lsnt,-.tll:;(\'" .I'roml'c 11' pay1nll'l nr lonur nrder l" .~IOU"1 f:1Il.nced, p:U\
lnll'rr~l JliJ \,thtr rllaretl.:n ptlwlJtd In Il1is t\ole \'0'1 lnlrnl1 r,) hI" II'Ca:l\ btlunli h\':l1l !"II" ttflni ,ll ch,\ '\:IM \f'l'l.lr.Vt:\' Jnd IOftlh,' Iht 8orhlv.tr You oUt'
ml,l\'I", th;, 1',...,. '1'10 1nl.'ut'1' U' In m..\.t the I".'ll() Ihe Il"rfo........ t\"~r. 'ho\.t~ tl,!' r'n.~l'd\ .....11 hr .at'd nnl J (nl lh, H'lr'nMtr\ brnrl oi&rrl' If-clll \\ot m...". \It,
1 t."medl.lle i'.\, '11('111 ~rnm \nu ....tlhnu1 makinfl In)' rtifll demAnd for f'1~mcnt UpNI ItlC Ho:rll\l,(l Y011315l\ lekOClwkdllC recei\mg.. ,nml,ll Wi Cnr)' o~ ,hi'" 'la1e,
(O,Slt'Orr, S'I~I..Uurt
u__o~o
:{,i:j;;\-,
iO),'1':
Co,Slr n~, '~'S,tnJIUI~
o\.fJ 1 r'\l
l),l!t
rt).("IU'\TR'S .'if(TRln' A tiRfT.\IF.\' T YI'U. thl" rtf\l\"i lOft' n): ,L\ "C.,.O"'fl~ .. t'r'.)1lo 1,"l~':Tlh, ~lIh rt-t' ROUll"!'r.....t othl"r\l.,llr bn'l~ dil (,I ,tot o..ntn of It-.
CoLd-f.., :,."t U\" ~eruTtI\' 'nlc:rc:\t 1ft :hr Cnllllcra1 h~cnlllle.1 akn)(_ It :t1~ ( .,:1.1t('I. cn"m~'I nl rc:nn;ul iH 'r:rt\, \nu .~rcc: In hoe h(lund h}-Ihc: lerm\ 01 the: Se:C:Utll\
o\~". ",CI,: ,O"I.lll\Cc1 tnthl\ Snte.llthe Cnll.'\tcfll(nnmU n!tC:\' (I~"r'~t\' \ ,'II.'t". ~,' ~t "I'lIlII11 t'I\ II'tICHns t,flllt \1n:1~.'\ge, Y.)u 3rc ~r.'\ntt'I,' IU lIm \tCurll) IRlcreH I,)
",1'1":- ,I' I.' m1~C' ,lor 10:l.n 11'1 thc Rnrt','Io\c:r :\n(lln \(.:urt t!1' I'IA\lt1t"\l b:_ I"" n,,,,,,...tr ,'~ ',t: .11" dill' !I,,:t!n I'~I\ \.\11' If 1:1'1<'''1 def~lllt ,"lnd u:r nl t!ol,. r"U:\lfl"I, Iherr
r.:o~',J.!l' .1'" \1:'1' ..... ,h.:o I" .In 11'f ',\T" ~'Oll ""111 nM ~t t\;,ltiJ'o'd I' rol\ u. ,hJ' ,Vtl
, .~ . ~I' ~ ' '" to: - .. : " o-t'
Jo '! ~, . . )
1 ''':~
:&'.' t...q \f.CI r-,.':I\~ Jo\ ".~, .1'., '> v..
:"OTln. M:E RI:\rRSl slor row 1~lrORl 4"IINFOR\IAlIOS
t'-hl.11 ......:.:.\CI"Hli qrHlCr l'f
, ,.,
.'"
I'
\tJlllllU"'lIUI'I:.
,.L!
!rj'
l.t' H; " lh', ',>0 'f' "01.' \)"...""
, " , !"I ,,, "\01,' ." r"'''P 'f I . .,. ~,,' ,..1 ,'t '''t t'.' 'fn.......' "
'V.. 1"')0,1, <Ai ..,t\ '''' ..,,,..,,....,, O' , '~l'U'" II 1'" , ..-.
1"..l""ffrot',)""ilJS.. ,"''''''''',1,,,1
I ,. ,,'.. J,' n",l r""a'lt11i' ."13 J'll'rtli~ ~"1" '" a"\ " . ...... P''''''''''
"b 'rJl U~I ,n I~" "GII .'''' 'f, 'J"', \" ''''''''1.1/'' ,. ~." 't'l ,'," ,r. .,
",,' .'r ....'..".fl'\l ,.'..1'''" ,.II.f, !'IH' ...1,.":1
, ".. I ....flOl rJl In\ 1" v~~, 4..,. " ".. I ~,... J.'
1'" 'II, ,...a'Ufll ,. j"'l\ t,t};'''l "'I!ll,~'<J Nett..,,,.,.,
." I Th, r",l'tltfll '. 'iJi<t ",..,f,",d 'II"". ,..,.. o'd,;'"'''' ,.. ...,,:t ", ,.
r',1 ','" t."."" ..'hi., ~;.., !tIll" 'I' I"~ 't.. J'I'....~f'M'N~. \1"",,,,,,
l\"r,O/ItIl,.."I..t>t'.....oJ.d'.'Ioo'DJ.._"'p',.t"tld...,',-......,\."
"., ....)lu1,-..I"'..l'..."....IPr.'..'f"'........'I,.
l'I....,,,'\v...p'''p'.I....llJ'''''I...,,,.,..'I..'h-'..,',,,,..,..J
I.~# oft i 1 -&"l) nQII."lU' I'.),."..r 1\' ,l'Ll i! ",,,. fit;..." ,"':r."
"'1\. ,f... r~rC"', . ,:ct'.,~" "I~' ""1""\\ IIf ."" "-"11 ",""...,~.. .... ."" 'cell'
I"f '"I''' ",'"'''U''f .....p.',J to,!,,," u' I"',. \....1 ....,J .""", ,II'"'''''' ...
''Tl'TIf4'"'~ II,,' ''1' f'U!'''' H".tHI. ,f ,~" ~"f I' 'fl,"'., h. 1 \l.."~", .."
',,'dt"I'I'" J' p,...rt...." ~"i.,Ufll, II ',q"'''f,J b~ I... ...! ",'J '..., "",'4\." t l'",f'~
"..;,!' t': ''':f' [)fr,I'1 ~1~""t "'_' "1 \(111' 1,,"1'" C'\l.t I~' ".I,u" I"~ It' I''''
,~'.~,,~.. ,It UI. ''''0'''1 If)" do "C'. tu', ...h," '''f 1,"'_ "",'13 ":";"t:JI,'." .''''
'.'",et ,I... i~.' ,n '(I'i\Il'r..n;itt: 1'tl~vnU l!l fwl'Il:' \GII ,1\0 "',Iff ,., p,n':' v'
c.' (t..'t nlll, I"'" ..."', ..""",tol. 'llo'''o',hn...I:''C{ ...' .,., .",,'<1'1"" n",
",1\1 1/1 '''''tel "'o"!'P; '1 1m rr.~.... ''''Tl:lId ,1llf'"' .".. (\j" I",.."d C"O- .d'd tt,
I"'''' W, ...;' lOnl""" 10 ....11""'.."'''1 d..h 0" ~Il ".....1 O"I.J ',1 ,jttl '1,1 un
,.......:t<oll" 1"'1 '~If 'J'''"", 'e<.t.. pl'lr,'~l 1'1 :,,11 ...~ ,I "r "'''' ,ro'~"U
l""~'" II"'~I h..
Rn" OllOJJ 'eol..,I......a.. "......01 o. tll'l '.I".r"" ,~, (I"I."C"I ,,1"'1
,'rlf- :':I..tI'':'''(''':'..,-:
rr:H'F'IT A\" lU'~"'" \
.~I.'"Vr. ...d .....f... I'l.t :.
'.r.'Ut.,,1 HI ....~&U'(t..
., ,.,. !.'jl'. ..llh. "o'~ I":a" 11\'" II' .~,
.'., \..'d .".. ..,,: ~,','I ~t,.. r..."r~:1
....4'" 1: \ '1.", ." "'" ""~"., <'- '. ,'J' ."",l' ,to.n, '" 1-0
"l'n"""',1"..'.f,"_'" (,.......,......."".C".III'UV'.' ,Ju"',I....
., "f' ~,. . f l',' L' I"
. l' "....J L'U', .'1 .: ,.' ,,~, I". I~~' ..'-.. I'" ""'H'.'
''''..' .! :"a l~' .\.". L' ~"r ", ".,~ r,J '~".'''"I ,. "..,....'
< ,','.' . ,I'.
.':0"" .'.:'. '1....-..' '''' . "..""'.11..'.....' p.If."1
~t'.,.~ ". "I""~\""" ~. r'.II'.~..".I..!..ro1r,'f.~IJ.,I.~"I.I'''.Ioo,1
..~" . '.. . t' "' . ". ."" ..' ......, ''', ",," ." . "'~!t.. ", "0' b, ,I,... ".. ....If"
." '~"l .,~ ~f"".
\', ,,"l1".',.(,~;" 1(1'5 '''f /'1, '11) '4 .,,, M.. ..... ,,' l!'ol I~I'"""", "'Ihowl
,.I,.~, '''~ .,. 11"-' ,,_. . ,'" I .,.. ",I ~\,' (.f ,I\f ( /'1:1'",.
". )a,rlll't,r:_C'OIOI",,'J,.",...toJ ra.t''!'' f'!..."...,."d"::",\dr.lI..
"'......,..:......, u"d"''''I',,',
I". t 't ,j~'L;"P'\. II"',' f~, 1I1.1"'\'~1 ,,1 ..... . ",,,,..,,1 1I..I"f .."<ie, I:'" ....IIf'
"", .H'.... .: I. "I' l'I'''r """tll''''J'''''''~I.'''''" '", D.""" "I rh'r""!\
'0.' ,IJ ,~. ... 'U" if" l""""''' ,'-' r'N'"'' oto "..lC"; U"oIU w,. ,.." ."
,.1'1.11. r',""",",,,,1'0:' "J' 1""""":",rrl"t(,'lt.',. .'
"'l'i TlfLt. r ~;tl1l) II ",n. _, ."'HC lIUf, ", ItJ"O"''' or, \;'11 ''''~C' v' 10M'"
mOrt'CI"!rl't'.,t'1 ".l.>,:I,...",t>"t.t:I"n.'tI,lIlr:O'-""JII [..chll!','''''' ;~""IoIN'
If'''''''''JtId,(',U''u ,.,..:...I.....'..'f"'nl'l",..'.'nl"I',\lrlt
\UI/(.Li 1.'lCl,ll'lIt,...", "Q~,'cd to I... .a.1' .:lrr"'~" (II r..'I1~' "'~" II'"
~el:,~.,ltoo'~,j"C:tet"'''I''V",,,r''''''<I,i,.,<l.t\''''Iot!,tl'JI.!H'I,'.\,.1"",,&,
;',",V'C:t..!'''I'\,\'':O'f (,,-,. r'''' m..H".'I"JJltll h :",'I'r'lh'~"n""t'I"
''',,;'''C'r,,,'I' Ilt'I,)~,,~,".'fl (, ...,.. ""1"l1"ld ,.,,,I,t-, Jrt,M<Jlnt-r 1(1
,,,
i 411 T~'I ,..t, ..,.1 tot' 'O"..(J b, lit I''''' ,.f I~' CO'''''''O'''''Ullh 01
P'I'~O\''''~:l y....u 'Il:f',j .,.. Ippl,
HctIHl\ \l"HU'otl""f
lOir..l'!n.... I I 0-\' "~D('Oll '-rp \l ~"'~':.I~' I" ,""'( I""':" ,'I
"IJ~' 1~1 '~,.,rltl~ 1", "l"'f "'lJU'''!1!l drll':' ~, ....!lIl'". IIlr.r "'I}'''l '10..
~~~'I'Il' "trt'tmt'''lllt'lr::,1 "'n~) \"r,'lr'I",:r.n:W'1wdt1,"t>od Ut"'ollll"",'..lh'
"0'" I'~' .::11'10" '01. ..., 'u..d 1f,lb. roTlo"'''r:>'lh","ul''I'1 )'(1.'.1) """IT'r'I~
.. I'''' '0., ,"'l..d', .1\0 I ^-lI.~H1"II"C f...h.I,'~1
~t~!tl',' ~ "r,11!: nnlf~ \i.l!:rt\'P..TO:;
,~'\Io'. )t, :'l, II C .... ...... I": '':o.lli"t(,~l hIe I' ~ ,"'~I ." '" "ff, ",.~
.'.~' '1' ,...t~t"n ,..,., ;1' ..~,' "II v.....,. Ic=., I"'. J"II"'. C' 01 ~'f":" dUll.'..
. ." r~na"'l: -,..",l,c!". '''~a'' '~'~I ~~...,,~ .~,,'.r" !_"l'l' 1,.~hlC:':\I""
.....:~....... 't.\o ,..j. '1(-1 rw"""" ,~" I,,, ,'" ":1"'" ,,,..,,,. I"'" ftl""'1.,,, 'I-.
" .'r.",:.t..",',I'UI,iI\
:: .....11'. "'I'''v I LIt (", ." Tt ""l "-' "_"';' ' ..., ..,'I "''' "I.." .t-~
,..' .t'~'J ".lr.......,..~'I'''. ,." "\l.I" '1 o~ ...r, r'"'''' '1 "u;~., I......" .:!Ir,.:~
'0... ..,11,...\ .11 uH.....1"....'.."..ro....'..t (.'1,,1'''. \,'''..'',''CIIIU''''
. .: 'l"~II'IC':'I\ n~ !;II ....'"
LlPI'U,11 "l(f)t'~'b II I'" l',,:,'I")1 ",1"';\1\ ,','. ~'r"" ,ao,,"'1 O.
,tp' ''C'''' r' rll=,""'_ .., ....J. .,,1." II) sl'o,," \ 0"'" tlo\, ...,. ..~ \/..,.1 .;, ""I~I1'."
", '~"" Jr._,.., 'I II '''t 1((....1"1 .,' ('tn.fal, ,.ll'l.r...." "'11\:"'1 ...~ :. ,~, "'011
.._ ,... \."l"I'~ .... ",1i 1""(""411rol'-' .t"'1O l!or ~rre"1 I'.'.. I...tl1"" ~f..t)JI l'
,". d..J ", ,h l!~:'-'\.l .r.....,...I'. lI":'" _"I ,~..., "r'" ,":11'1'II,,,e'" ."",,1':
.... .'......11,... ...1......._, T~, ~..,....l drr.. t '''Ill to, Cl,ilt"""'II"f)I~." ",1',.
\tt..',I. "-f"Ult"t~1
~. I,oS.)P.....\,:l .....,1' ,..\ '''1''1 lit .'"",,t :.. I"" ..~I', "0", .I':! -"",
_'~'..II~'" ,~. C',,'IIt',. .....\..., "J' ,.. <14' f"JHIU"" .....'1..' (I", ,,,.r. a..e
. ~"".l 11 l"~ ~.~'.rl ~'!lll C~..ll:~ !l':""\;:I;P:l'UI:l'llt~.,t~! ,,~.. a..,\;~'t I"";
. '.' ,.....c' It..' JtO Ult,fHI-".. III .... T'"r ,d;'l ",...1 "",,'t ~'''' ..,.'tn"
r. . ,~.. r ,Ln ,~'J<I rf~. ,~C 1~1t 1!'\l'II:' t...~, N' ,..'I '1'1 \"4 ,-dl'l '., J: ,'..'
~..'. ,,~~~..:. II "',," ~lte t',o.d, I..a. ., bot '10'''' 1',,' of.. ''I'" Ir'~I\1 f."'.'
..' ,'~, 1'.'1,,' /' ,~. . .~,'II".... ,',' .,~ "I,,.,.... ~r""t' i.., ,., -1\:-'" '_'''~''
..c...., ..'-, .101" ~",v,' ''1, ".:l"("\.It~'..r.{.ltl'" c,".!hloit..,! e' ,,\':'II'-:tl"
~I hll'c 'H"'''' ,"\ "'HCl41'U:,,.;.tltrl,(,II.lr,.' ,(..1'4 It ,........1'.."" "0\;'.
" ," .....I...'J..~ r,'. a r'Ot',)! 0'1'" '''1100, '''1'''''1'' \I.'r I'I"H ',10 . r".-' '.~ l'~U.'
'.".. ~.Io4'r .1 ''''II l.,. "'~! n~' ,'. ".~ 1f. \,\,'. "1', I.I"',!' I"'" ...-. '.. .'~' :0'11
!":'.__ .~,..' ,"I'."'N II', :-1"_"1 r' '''''lr~''~, r'('u,dl'" l"~ fir.' )' .0: ,,'
~''''~t~ l~ L'"' C"lI"t,....' I' I 1 .....'l\l~,..'h IUI,1,::f I" ...., I',,~,I",!~' .."
~I'." ''"' .... ",.",. :,.!It..~. I ~ 'cr:" ,'~ "rl:f' I~. C-CI1I"" r.lh,.... ,r "..'~
,..,', ,~. o.o[,,(h ',' Of..!"., '''I' 'U"'l "..,'"'.... lJ~ .,. \ ....,'
:' ,nTI,r. nl R 'foCIIIl'''' INllAiO:;T II S""'('f"U 'II I'll! ,'II' fC '..'
'..' t ",lIal",' '"y . .I', 111',1 '-I . ,1 "1\ .. ~ {.., I....'II.~' '1"'" ""'f' ,,- .~.
.r ~.'", . , ft.,,!
~. \ '.It I' All Hf)III"" "(11':, 1'1\....1.,1 ,.. J- _..~, ,I "",~"~II ('1\:11 n
",~t ,.... : ~ ~. ..~ ?~. .", .....", ''''''''001', r"fc.1"'\ '0,,' 0' 'P""''l''~J r..'
~.. ~~ " ,"e "1""'" \Iof ..... ~J\l ,~, ."',;....ll .., ..,J....:.' 1"'''' W~.I t~1
II , ......"....h..~.' "'.\ ....." ,... "''''f ~.... '....flll..r ; ~".". I.'. '" e,'e'~ :~ ''''1 ',," 1
,.~ h'", ,,~~.. '.,~. P'f'''''IOIY ",."". 1 ., ,''',,~I ....'''HI M ,ora" l,lin,IIII
111C' ". ,,,, ~Il'." ~.r..u... 'C' 'HIlI", li: ,llI'lll' ,.~".: ''''''''''1'1'' :""' "poll. 'If
,..... ,'''' "I".. t"'3", H'.l"" a.., ,U/l' h'J \),,,",111.1'1(" "'\~J"'rl C\~,UI'.
r:r'",,,,.'"'' .n"lll',a ~"...~... 1.... "F.I' t"."1 ",..".""", t\hU,,, Inco.tllo"
v.<J........~. ." (,~ '.'1" "'1\'" "....'rll 'C'4" ....,,, ',' .:,., ,....,.,",.. ""JI HI\I
..... '" ",.. ,.~". A.-v ~"''''I:''''''' ,,~..."a. '1''''"' totr.,I!..,il fl. ,,1i1,i! In ''''
,:"l."\( ,''''. '",~..., ,'t'"nt r'~l"" C""'~n .11,.. a", II~L t'"o"tl\' '~I ka.' n!1"."
'\oil ,'lJ 1'l11, ".: 1t:~}~"I" 1'1 '"II"'~d.~!t. 'J:,,"I Jc,ns"J ~1I1 "I,~'" ..,1"1 \G1,'
'T'tOIlI"iI :' ~:"lrp'll .'1 II 'I .:t' ,~, ,.J "II'" 'I'll on 'U .I,'~t OIJt Ir".h n!,ll
:"\11'"'' ., . '.' ~,'lJII...11 ..11 .'\ \0'4' ,.~ l'..l~, ""'"'"11 '1'1", "'QmI1U." ll.n
~H~r '.. -\ph"'~!l~
:" ;'(,"F~'"':"1.1' \aJ"" =,,-,...,1 ~'I,','"r''''I''(r,.!I'''~I~'~''' rr..."".':",
I.....'
:,[('11\1'.:' 'IIi '(j"~ C" :toll/HI::' T'" ~,., J.1'"'' C:,:y"" -"r"'"''''
0:'1)\ to, .,,,..~,.,..; ~ll';f'" ,. "../1,,, nr "'''...t J b. 111 .,u"..'1 ",O"~' .... .'1 ,....
'f'" (,.1,..., ....., _~, .~~ ,'. .Clt.... ~". ~"I"" 1'1''''('1'''''1. l>b1,,"ftJ w"~"lt1.
"l'H .....I! 1;'1 ~.'d"\ 't'~~ul \l1!'.t~t .'. ,.:.. IF "~..,, '1'1 ..., t./llltlf'!"!
~r('TIO'1 l\tF...\lT ..rhllJ:,'....e" ,",...,...ht\..r"t'W.1Y"dtfth"
~"I" \ .. 2IU...."~.' '" .J~tJ.Io\on '" 1I1111t "111'\ I~i! It~tl'" <II 1 ~\l"'U': ta"~
"r."'~ !;!,II.III ..~..." ".t tlt)"jt., ,,''''1 ,roc 1."'0.1'11 LII"'I,,,ul...l (ro.1'. Ur'" 0..,
~"'t'" I.' \'., .....It...... ...,,,,,,,,,,'.1. l'I." .1'11 ;,~,'lr
..' .\PPll'=,'71()'if,.I~Utt't.ISIT!rl ....C".hJj'I="\,"l.Jt"u~,h,n.tll"(l''''..,
(e, .Lf'l J~J'.:i' 1'I:\""!lllh n"."'",e' .:..~,,'n !I 'I '.'1' I; l"l,rI'lUal,'..I,on'l~h
..f . ll:'~ et~.", .... U.,U'tll, ul ,h."">' Vot I'I"~\ "..."....u I"'. uq""" NI(,"
"'..'\l"" .,. ,,'e.' '.' .'4htt ,.. '''t -'::o~lalt'.1 I; \It lfIU,,>i,,'r ,pc d,r.t',,1 If'"
,,/,!.!-.\., .,/IUfI"''''':' JI',"r"b1c I... ,,\\ ..01,"1t II\.l' 10'. I"'''''', loJ').Ift'l":'
...."11", ,."r IH ~""\ ..,,~,(Jt."'II.'
oJ.' ~\ loIr<f,r,J'D 01" C,,~t,,-,t I'l..t ',0' ft', r..:".." WII'" "",,H:t. '~:
r... ",f,1 ,(' ~I I... ,,".,t,.'''''' ,,,..,..,, fOIl f\1..a ..~ .J~"\I ~If
~, t't'l".f.r~t ;:fPr)..,r:'~'O" I, ....1 '."lu,'U"I"rr,'", 1.<I;,,,ll'.. ,/\ I"
... "':0 'a", IH'utll.V" ,.: ,I .. "".' 11'10.4..1 ,'~...I r'''''.1I ..' ".IH,U'U ",~"I,..
'.~ 1......."I."".~rH:HIo', ,"I" ..:\.1'11',' ".....".,'....'.'Ir,: C", .h,,,,nh" ('I-
>,"r"f~ fn.I~' ..",,,c,. ~ 1 ,.., ,1'0: r..,.'....Io'..".1! ..",,,.,011' '1
0101 P\l"t..~tt."'lrlH"rc'''~H~I~'' -\':l$TO"'~~t \\'1 1'1... ,'I1Vr.' ,r.'
.",r "Hn014"1....~"...,'" 'r~\,H'I'I..! u:.., ,'''11''[ oU,..,l'" .1t'1l'" ,..:! "d,of
1~.1" ""','11'" In.,' 1\1"" .." ,'......d r' I".
.&\ (^L[OC-COl....fl"" \l,,''T......tl al1.~~.',..(...~"~..fo ~1t"'.1
"~ ". .'1(," r.,"II: ('P r','.I" ..~.\ .", ""I t" I,." 1t1'.:I~.,,':lrl .,'...." "I ",.. I,m'
:'.~ r'llt:, ..,f ""1"-" r,,""1" \...C,'...I.... I 1""1\.1" ".,.r "I'. "."'1,111\
n. "i 1 "r',t .,..:'...., \t\i-n "~H ,1'1 rlt_. ~('II!C".I Vo,..oI: a~"I. Lh, l),',/H':'. ."
t~ , ;,"11.1 ,." l,,~ ",.1 , J', l ,"~;'\ In .~., , ...,. 'I\~ (I"'''....... .'0... (,-, H,I' "I. y,.
...,Ii r..I.'..f' 1'1" ..~IC' \ .~.. 1'" '....." .'C ...""J :"..' I~.~ "'.HIn..;;. ..n",..~ ,:"tn:
"I'..,.... '0/"'"
----_....--.~ .,------...--- .--. - -.--.----. .._._._~
.. - \(11,''::'.1' ."/H~Fll.tF'.,,-~'''',;'''I.,H ft.\' l
~" 11,,......., .',t '. "-"'rJC~', '.~..." ..".-. "'~'l"" l' e""'l hr. ,..........rrH'...' '1-"' ,"J '.',~"r eft,.'. J:;'~'" ~..".., J'l'o ,.,., '.\"UCilltf.c. .. ,I b. 4"'1./\11""
''',', '" ".,., 'e -1"'01 Cl"l~f ; ".'''1' I,ll" , '~'f ""'1'" .., .' ,."., 1'" .., r/l""~'''' ,'I ". """',.10, "... " ,~,., ,., (0)...:,"1' "I""'" I". ,.....,,, \:t \..II'.~' It, ..rup" "'.' I"
,'t. "..'. '!. \ ,'.' ~ '. ,.. :Of"'."". .'t:"'~ ~ I", "oJ.' .11,,' 1 J_ I> a.,,,,. ','" i,.........' ~':..' ~" '.. "~'. .':J l' ,~:." c,; [to':,. ,,,..,.....~. to. r,.r;:h: .:.1 T ". hll '
",,~ 'O!\."~:~" ':O-...,~.. ,. "" ,.., ",I. I ,t OI'tl,.~'t", ru "'.;Y"f~,,'~"I"" J.." "'_I"."""'~ '-"~',,'r' .' ~'~J." "Mf"..::..f 'I,,,:,. ""1..;.011,'."" ,I' ,,.
." . , , ,. '. oJ :: ,l'~' ".... <I II. ....,~. ~ <I..... t... " C. ~ ftl ,..." I' rll" ~{~. . ., '. ''''!' 1".1 ..,'..... \'hlt II I""C'" H "t II' '. "oJ III"" ,~., "..~.' cn ./It, I" l '. r, . ..."
.' . '-~'1":' _ J" ~.. I. 1'......b'..'. lloof ''''~.J'''' ,..11'1 .''''~' ,.I r..rl"......' ..: '''. ,.. Ub't',.t\1 I "'y~.' Or .-.~'.":~ ,1\i1t1\ \0 .ll'lt ""1"'1 ..II!'. "wI
.., ~(,;' '. ..1. , 1,;. II ... :" ~ ,. \ .,
_.__. ._... .__.._____.___~____ ._--..----..-------.-n.. ...__"_"___. -----~-.-
'UTICl Hl t M'l" ~lOr HIJlI\trnAT '.'T 1:,>~l)k\UlI0'
I Jq (q
TI:;'H~ f>.O.~
RllCOi.(.' d
F' ",.'!II'.'
IV ;
'97 MAY -2 r 1 :28
Cle: .
('u,.... ,
, II',.
. ',,~.l
. or
'.J.t 1'\
'\
.'
L
t ~ ~
~, III
.l1<~ t-
~~i~ CI: ~ -
Iii III jO<
>- < =: gJ
:!! !( g ~ ':<
~il)1 III :.:3 ..
~igei !:
~Ih E
III ~8~ c.
~~iw = -8
0<
~ ~~ c..w ~ " ~
"'a
!c..I: ..~...~~
ll!..,Ze c
iSl)~l)~ ~
...0 Z
!l
3
.,
'UllllO \X9U JO JI04
'Al810U9Uoq 'J01IPDJO II 919119 941 UIl19J91UI U8 Wl810 JO 9^84 01
$U91unOOOllIlI/l ell UMOUll UOSJlId J9410 AlBA9 01 PU9 lU8WIUIO
Pltdun AllIIIlI ell UlIAID UlIlIq 114 ,un~ PI" 01 IUOII09!qO
U9UIJM 1111) ell AlIp 188191/ll0 PU8 UOl18WJIlUOO JOllJno:) 941 01
pIIIU98llJd 1Iq lIIMlIWIIlI941 U94M &:l81d PU8 9WII'918P 941 10 PU8
. 'IUn,o:xlV 814110 DUll I) 94110 9:111OU U9UIJM 1841 A!11J9:1 Aq9J94 I
.
{-. .
. ;.
ROIIElrf E. MYlmS
AnORNI!Y AT LAW
100 YORK ROAIJ
NHW CUMllliRI.ANIJ, I'A \71170
.'
z
00'011 ~uno~~e leu13 ~ ~s~13 al1J 's111M JO '6aH
00'01 ^~0~ua^u1 al1J 'Sl11M JO '6aH
00'01 u~n~a~ xe~ a~ue~1~a4u1 al1J 'sl11M JO '6aH
00'61 ue^ uo al~1~ ~aJsue~~ VVV
OS'~~ PloS 11~un a~ue~nsu1 ue^
OO'OL xe~ awo~u1 9661 ~Je~p - ~aP1as 4~aqez1l3
OO'OL xe~ awo~u1 S661 ~Je~p - ~ap1as 4~aqez1l3
00'91 ales ~oJ sal~1~~e aS1~~a^PV
LO'Ol s~~a4~ a~e~sa - ~uea s6u1^es s1~~eH
S~'~9 a~e~sa aS1~~a^pe - lau14uas
00'09 a4e~sa aS1~~a^pe-leU~no~ Me~ puel~aqwn~
OO'~~ saaJ a~eqo~d
OO'OSS aaJ s,^au~o~~V
OO'OSE $ aaJ s,~0~n~ax3
:P1ed s~uno~~e 6u1MOll0J a4~ ~oJ ~1pa~~ sW1el~ ~ue~uno~~v
^~~VNaSH3d - ~Nlla~~V ~N3W3SHnaSIa
O~'SOO'L$
OO'SL
OO'OOS
~L'9Z
SZ'66S
OO'SZ
OO'OOSE
00'009
~V~o~
ue^ OS6t
ue^ 6L6t
~uno~~e ~uea "e^ 'puow4~1H 'aua le41de~
swa~1 snoauella~s1W JO ales
sleqw^~ sse~a
~uawd1nb3 6U1~461~
~uawd1nb3 6u1~461~
Ilt:rm I:; ~:. IIEllTOI,I':'I'n: 1'::lTAn:, NO. 21-'1(,-01011
SGIIIWlll," IINI'M II CR~:llI'I'ORS
1. Americnn "Kpreon
PMSC ColLection Servlcen
1'.0. 1I0K 84851
Phoenix, AZ. 85011-4851
2. Bell AtlnnLic Compony
P.O. BOK 28000
Lehigh Valley, I'a. 18002-8000
3. Blair CloLhinK
Warren, I'n. 16366-0001
4. CrescenL AccepLnnce Corporntion
5LO EasL Mnin SLreet
Carnegie, I'a. 15106
5. Central Credit Control
916 SouLh L4th. Street
lIarrisburg, I'a. 17104
6. CrediL Bureau of lIarrisburg
249L Paxton Street
lIarrisburg, I'a. 17111
1. Credit Mnnagement
17010 Dallas I'nrkway
Dallas, Texas 7524B
B. Mr. Denny Burd
4 8riar Lane
Camp lIill, Pa. 11011
9. tlr. Dan Schubert
4LB 7th. Street
New Cumberland, I'a. 17010
10. Dil and Dixon
ALLorney at I,aw
Executive 1I0use Suile 1
101 South Second Street
lIarrisburg, I'a. 17101
11. Douglas and Sanderson MOPC
205 Grandview CorporaLion
205 Grandview Ave.
Camp'lIill, I'a. 170Ll
12. 1I01y Spirit 1I0spital
503 N. 21st. Street
Camp lIill, I'a. 11011
13. Internal Revenue Service
DepartmenL of the Treasury
Philadelphia, Pa. 19255
IlImNIS ~:. m:RTOI.t:'l"n: ImTAn:, NO, 7.1-1)(,-0'''7
14. Mr. Joy Kirsson
C/O Downlown Sound
Renr 370 Mnrkel Slreel
Lemoyne, Pn. 17043
15. tlr. Lorry Snd ler
528 Renlon Slreel
Harrisburg, Pn. 17104
16. Nollono1 Credll Audl.l CortJOrllll on
P.O. Box 3800
8512 Allen Rood
Peoria, 11. 61612-3800
17. Northporl Mnrkeling, Inc.
320 tlnin Slreel
Norlhport, New York, 11768
18.
PP&L Compnny
P.O. Box 3500
Two North Ninlh
Allentown, Po.
SLt"t.!t.!l
18101
19. PNC Bonk
2730 J.iberty Ave.
Pillsburg, Po. 15222
20. Security Pacific Financin1 Services
P.O. Box 1869
155 N. Emern1d Drive
Visa, CA. 92085-1869
21. Stale Wide Tax Recovery
P.O. Rox 752
100 North Third Slreel
Sunbury, Po. 17801
22. Symphony Press
P.O. Box 608
Tensf1y, New Jersey 07670
23. Theatre EffeclS
642 Frederick Streel
Hagerslown, MD. 21740
24. Wrny Music
326 Markel Slreel
P.O. Box 419
1.emoyne, Po. 17043
25. 360 Communicnlions
5626 Frnyl? Road
P.O. Box 7431
Dublin, OH. '.3017
,
r
pnOOF OF l'lIJ1I.JCATION OF NOTICE
IN ClJl\1J1EIU,AND LA W ,JotJnNAL
(Under Acl No. 5117, npprnved May I r., 1 n'l), 1', L.17114
STATE OF PENNSYLVANIA :
~~.
COUNTY OF CUMnERLANO :
Roger M. Morgenthnl, E~qlllre. Ellilor of lhe CUlllherlalllll.aw Jllul'llal. of the Olunly
amI Stale aforesaid, being duly ~WOIll. according 10 law. depllse,~ and says Ihal the ClIIl1herland
Law Journal, a legal periodicnl published in lhe Ilornugh of C:lrlislc in lhc Cnunly allll Stllte
afore~aid. wa~ eSlnblished January 2, 11)52, nllll designalcd hy the '"cal courls as lhe IIfficial
legal periodical for the publicalion nf 011 legal notices. aod has. silll:e January 2, 1952. been
regularly issued weekly in the said County, alllltlmtthe printcd nlltice or puhlication attllched
hereto i~ e~llctly the some as was printcd in lhe regul:lr edilillns mill issues III' the said
Cumberland Law Journal on the following dales,
vb;:
NOVEMBER 22. 29. DECEMBER 6.199(i
Affiant further deposes that he is authori7ed to verify lhis slatement by lhe Cumberland
Law Journal. 0 legal periodical of genernl circulatinn. and Ihat he is nllt inleresled in the snhject
matter of the aforesaid notice or advertisement. and thllt all allegations in the foregoing
statements a~ to time, place nnd charncter of publicatilln arc lrue.
~/f/(f)1/L-
Roge M. Morgel1lhal. Editor
Iklltolollo, Doool. E., de.'d.
"nle nf Comp 1111I.
E.e..."'r: ,'o.k ""flnlen., 160 I
Corll.t. Rnod. Comp lilli, I'^
170tt,
AlInrnt)': I1nl><rl E. My.,,", 100
York lIn"d, N..... Cumbrrl"nd. I'^
17070.
SWORN TO ANO SlJllSCRIOEO before me this
-Ldnyof DECEMBER. 1996
L~:,;;,~~
NOI/J11A1. SUI.
~EntEN~ U/J1IIEI'XA. NoIII'fI'lN.
c.."'~. c..m..\Irtl Co'''I, r.
tJrrMII''''lonfllllht"~
-.....- ..... ....-.---. -.---
Dt:NN [S t:. m:RTOI.t:Tn: t:STATt:, NO. 21-96-0111 7
14. Mr. Jay KirSBon
C/O Downtown Sound
Rear 370 Markd Street
Lemoyne, Pa. 17043
15. Mr. Larry Sadler
528 Benton Street
Harrisburg, Pa. 17104
16. National Credit Audit Corporation
P.O. Box 3800
8512 Allen Road
Peoria, 11. 61612-3800
17. Northport Marketing, Inc.
320 ~Iain Street
Northport, New York, 11768
18. PP&L Company
P.O. 80x 3500
Two North Ninth Street
Allentown, Pa. 18101
19. PNC 8ank
2730 Liberty Ave.
Pittsburg, Pa. 15222
20. Security Pacific Financial Services
P.O. Box 1869
155 N. Emerald Drive
Visa, CA. 92085-1869
21. Slale Wide Tax Recovery
P.O. Box 752
100 Norlh Third Street
Sunbury, Pa. 17801
22. Symphony Press
P.O. Box 608
Tenafly, New Jersey 07670
23. Theatre Effects
642 Frederick Slreet
Hagerslown, MO. 21740
24. Wray Music
326 Market Street
P.O. Box 419
Lemoyne, Pa. 17043
25. 360 Communications
5626 Fraytz Road
P.O. Box 7431
Dublin, 011. 430[7
:.
I'ROOF OF l'llllLlCATION OF NOTICE
IN Clll\1IlERLANI> LA W ./OlmNAI.
(Under ACI No. 51l7, npproved May Iii. 1929). P. L.171l4
STATE OF PENNSYLVANIA :
COUNTY OF CllMIlERLANI> :
ss.
Roger M. Morgenlhnl, Esquire, Edilor of the Cumberland Law Journal. of the Counly
nnd Stale afuresaid. being duly swom. according 10 law. deposes :md says Ihatlhe Cumberland
Lnw 10urnnl, n legnt periodical published in Ihe Borough of Carlisle in the County and Slute
nforesnid. was eSlablished Jaml:lry 2, 1952, mill de.~ignated by the local COUrls as the oflicial
legnl periodicnl for the publicnlion of all legal notices. and has. since January 2, 1952, been
regularly issued weekly in lhe said Counly, amI thallhe prinled notice or public:lIion aUached
herelo is exaclly the same as was prinled in the regular edilions and issues of Ihe said
Cumberland Law 10urnal on the following dales.
vb::
NOVEMBER 22. 29. DECEMBER 6.1996
Affiant further deposes that he is aUlhurized to verify lhis st:lIemenl by the Cumberland
Law 10urnal. a legal periodical of general circulation. :lIId Ihat he is nol inleresled in Ihe .~ubjecl
malleI' of lhe nforesaid notice or advertisemenl. and that allullegalions in Ihe furegoing
slalemenl~ ns to time. place nnd character of publicaliunare lrue.
BertolOllo. 00001111:,. dec'd,
1..,le or CAmp UIII.
Exeeutor: JA.k IlertoleUo, 1601
CArliSle ROAd. CAmp lilli, PA
17011.
AUomoy: Robert E. Mye"" 100
York Rood, N.... CumberlAnd, PA
17070,
~1-~
Ruge M. Murgenthal. Edilor
--..
SWORN TO AND SUBSCRIBED before me lhis
-Ldayof DECEMBER. 1996
Lm()~ {J '~ ~~\jJ1J:-1~
~Nlll:lry -
H01ARlIlSEAl
lIERlENE IIAAAE\IXA. HoI.,., PIbIc
c.rII~'~IlIfCoII'I"r.
_ lI'r....""....E'llhu.~?l
-- ._--. ..------. - ---
" ,.
,
,
, ,
"
i,
1\
r t
I.,
I'
i I
I I
j ~
i'
: I
1 ;
'I
7
I
, .
!
\
,'I'''.
.
SECURITY PACIFIC FINANCIAL SERVICES INC.
and Affiliated Companies
P.O. BOX 1869
VISTA, CA 92085-1869 29
TELEPHONE: (619) 63Q.1990 . (800) 727.7732 ,., ("
..0
o.
:D
:I:l(ll
I ' .-J
:P
lB
July 18, 1996
-'
N
u
-
VI.,
,.
Register of Wills
Cumberland County Court House
1 Court House Square
Carlisle PA 17013.3307
.,.~
'1'..-
.~ .....
"-.:J
..,.
RE:
ESTATE OF:
DATE OF DEJ!.nf'
ESTATE DOCKET/CASE NO:
ACCOUNT #:
DennIs E Bertolette
5-5-96 ,/ J- q & L( ( 7
397686
TO WHOM IT MAY CONCERN:
Enclosed, plesse find an AFFIDAVIT IN PROOF OF CLAIM for filing with the above named estate.
Please acknowledge receIpt and filing of thIs claIm by return malt to the address listed above. A self
addressed stamped envelope Is enclosed for your convenience.
Thanking you In sdvsnce for your attention to this matter.
nn
c-
='!g;
c..-
c._
F
N
'"
-n
0'
:D
::0(1;
,T. ~>
::-'.:::
.
~).
)
:)2<:
.....~
;a
-'
::.. r.:
:-."
cnQ.
b
-'
cc: File
SECURl71' PACIFIC f'lNANCIAI. SI:R17Cf:S INC.
... aM Op~rol;nt AJ]iualts
SrcllrifJ Podflc FI...c"" S,,,Icu. 0 Di.u/o. of &orok .J Amtriea FSH. SttUrifJ Pociflc l'I...tloI S",lm I.c., SttUrif] Poc/flc FI...c""
S",lm oJCalif.....", loe, SttUrifJ Poc/flc ErttUllttWn>J",l....I S",lm I.c, SrcurifJ Poc/flc C....Ilmtr II"""'''' C""'fH'''1. SttUrifJ P.c/flc
1'1..." CttJU Owp., SrcurlfJ Poc/flc FI...c/o/ S",Im oJ NtwJJo I.c., SttUrifJ pocific fl...dol S",Im oJ W,,, Vi"I./o I.c., SttUrif]
Poc/flc 1'1.."",,' S",lm of IHS Mol... I.c.. SrcurifJ Podflc l'I...dol S,..Im oJ Mloo,toIo I.c, fln1 f,.wick Morlfl"l' C"'I"""'lo..
SttUrifJ Pocific fl...c/o' S",lm oJ Ntw fori I.,. SttUrifJ Pocifl' Realt] COtf'.. SrcurifJ I'odfic AulD 1'1...". SttlIrif] Pocific IIowlor
S,,.,ictJ Inc.
A IIANKMI1:RICA COMPAI""
INHERITANCE TAX RETURN
RESIDENT DECEDENT
COMMO~~A':.I,~',',': ::,"!;~','~,'0""'" (TO BE FILED IN DUPLICATE 1\ QI.
ItA,,,,rJ:~ ;'~";:JKOWI WITH REGISltR OF WILLS) icOUNIVCOOE ViA.
OICl;;:;'~~.~'~~';~-'~ '''OOlp~'~ N \ S _ G . . JOllt~~~; u;~~:~~~~ Rl> ~
'OC~~~:'~U~;'b'l _ I ._ [~l' :;~:'c. 1\ r;;'L':~ 1._ __ C,~~"'~:~:~1.~~~1~ II
'....""= ':'~:~~'~,:~' ''''~ ..,..,.,., .',1 "' '" _ ,oc'" _'_ICU'~"'U:I~ _ rou." 'IC:~:O IS" ~~"uc"o"l1'
r0. Original Rolurn f ] 2. Supplemonlal Relurn r J 3. Remainder Return
(lor dalln of deolh prior to 12. t 3.82)
o d. limited Edolo [ ] 40. future Inlereit Compromiic r-J S. federal E\folo Tax Return Required
(for dolel of death alter 12.12.821
o 6. Decedent Died Te,loI" i 7 Decedenl Maintained a living Tru"
(Alloch copy 01 Will) (Anoth copy 01 T fU")
ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO,
NA""'( ~ COMPLlH MAILING "oallESS
.AE:tt1_t_Bv.ePwL------ lDo) :'1O<<.lC ROA~ 0 .7' '" "
"'''HO''Nu.''' / PI("tfj clA~e..Liil~D)j^ . u,"
L11:J~1~1Jrf-::3l~:L--~=,=====~c, 0-
111
121
(3)
I A I
151
RE'I-1500 [II. l' <;1"1
0-
Z
...
"
...
u
...
"
...
0-
",,"'"
ua::M:
"'....,
",,,0
..,,,,-,
....
..
..
,...
"'z
......
",,,
"'z
8~
~.'~ ~
".. .'. '\\
.~ .ft-
z
o
S
=
...
c::
..
..,
'"
'"
1. Real estale (Schedule Al
2. Slocks and Bond, (Schedule B)
3. Cl01ely Held Sloc~/Portnenhip Inlerelt (Schedule q
4. Mortgages and Notos Receivable (Schedule O)
5. Cosh, Bank Deposils & Mi\Colloneou1 Penanal Properly
15ehed,le E)
6. Jointly Owned Properly (Schedule FI
7. Transfers (Sthedule GI (Schedule II
8. Total Gran Aueh (tolallino, 1.7)
Q. Funeral e...pensos, Administrolive Costs. Miscellaneous
hpensos {Schedule H)
10. Deb Is. Mortgage liabilities, lie", (Schedule II
11. TOlol Deductions (Iolallino' Q & 101
12,
/5 - /('I) - q
fOR DAnS Of DEAlH AnlR 12/31191 CHECK HERE
If A SPOUSAL
POVERTY CREDIlIS CLAIMED I
filE NUMBER
~~~;1
.as. 10101 Number of 50fe Deposit Boxes
-
-
-
:i1
Net Volue of estate (line 8 minus line 11)
13. Charitable and Governmental Beques" (Schedule J)
14. Net Volue Subject 10 Tox (line 12 minus line 13)
Spousal Tro",fen (for doles of death aher 6.30.Q4)
See Inllruction' for Applicable Percentage on Reverse
Side. (Include valuos Irom Schedule K or Schedule M.)
Amount of line 14 taKablo 01 6% rale
(Include value" from Schedule K or Schedule M.)
Amount of line 14 taxable at 15% role
(Include valuos from Schedule K or Schedule M.I
PrincipolloJt due (Add loll. from lines 15. 16 and 17.)
Credits Spoulol Poverty Credit Prior Payments
+
15.
16.
17,
z
0
~ 18.
... 19,
=
..
S
0
..,
>< 20.
..
...
21.
._ -7 "05'.... 0
00
- ~..
~(;'
\C
-J
( 6)
( 71
"'\
r-,
~J
18) _-!_'ZvO~.4Cl
l:>
19) ..
./ <J 1/05 ,7f
o
(10)
:l1ll. .-ij3Jd;;;1l
1121 D..eflC.1T C~n'ITe
(13)
(1 A)
(151
- ------~-----)(. --=
() ..>,
(16)
.~-)(
.06 =
fl,i)O
{),OO
(171
..__.x .15 =
(18)
Discount
1nlera"
+
(19)
(201
If line 19 is greaT.r than line 18, enler ,h" difference on line 20. This is Ih, OVERPAYMENT.
a D'4It:r.n"iT.U,.I"'1'11.'U'.I'I'I'I,.tllll~.'.I<lrft":T:~"Tj'I'I.'l.',L'lJ~'jlllo..lll
If line 18 is grealer than line 19, enter the difference on line 21. This is Ihe TAX DUE.
A. Enler the into"'" on the balance due on line 21A.
8. Enler the 10101 of line 21 and 21A on line 218. This is the BALANCE DUE.
Make ChICk Payabl. to: Rlglat., of Will., Ag.nt
r >- >- BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND TO RECHECK MATH
Under penahies 01 perjury. I dodore lhat I hoye Iltom;ned Ihis return, including occomponring schedules and "olemenh, and 10 the best of my knowledge and belief,
it i. true, correct and complete. I declare that 011 realln'ole has been reported ottrue market value. Declaration 01 preparer otner lhan the personal representative is
based on all infarmotion 0 which preparer has any 'mowledgll,
SIGNAtURE O' PfRSON IUPON I~.l~ 'ORt\N~1UII'\ rl' ADOllfS~ , CAlf . -' ...,
~.0.'l.. _J }{L1lL,-::: fife" '..... ,-.,L If
SIGNAl , 1lt,,UfR 01Ht 1HAN Il( QfSfUlA11'Ot AODQfS~ r i J .., CAn
/tJ/CrMlt{l, Jt."' ("}I"1{1.1l1 :,1 IHf/ /0,".'t7
:;L-lvVI,.rl"~I~-~~ - 7~ --
121)
121A)
1218)
"'II~tll" I: '.1
ESTATE o"F
,,~:J~'~
~~
J
SCHEDULE E
CASH, BANK DEPOSITS AND
MISCELLANEOUS
mO ~~~So~~~l PROPE~!!____ ..._0 __..~I~.?~'!.!r.!~I~o~Y"! - o._oP
..._0' __- -oo----o-.filE""NUMiliT------o.-
CO'''MOUWfAUH OF 'fNN~'l'lVMUA
INHUltANCI 'AX InUIN
IIIIDIH'DICIOINf
21~96-0417
DENNIS E. DERTOLETTE ." . . -- .. . .
iAiii;;-~;.-;tifoi~liy.ow_.-;.d;;ith.'-h. Right ~i.s;;~~~~fth~lr_~_~!!-~.~ .d~~~t~:'!.c!...~~ S.th..du~" .'1
---- - .
ITEM
NUMBER
VALUE AT
DATE OF DEATH
DESCRIPTION
---. -.----.-...----- -..... --.-----...
.--.--.--....-.-- -_.-
l.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
Dlue Cross and Dlue Shield Refund
Prescriptions Refund
Auto Insurance
Compac Disc. Player
Certificates of Deposit
Microphone
Television
Dike
Stero Equipment
Records
Dlue Cross and 8lue Shield Refund
Lighting Equipment
Lighting Equipment
Capital One, Richmond. VA., Dank Account
1980 Van
1979 Van
Urass Synhols
Sale of Misc. Items
236.50
23.91
36.00
200.00
20.00
90.00
45.00
60.00
240.00
700.00
25.00
600.00
3,500.00
26.74
75.00
500.00
28.00
599.25
- .--....-.'- .-----.-.----....-- . .._.... ~--
TOTJl.ll^_I'o enl,,' on line 5, Recopitulotion) S
7,005.40
-.--. -.-..----------.....-..-
tAllnth ntfrf,liCl"",IIW," ... ".. ,"""'\ ,I "'"'" 'Il",tr> i, """Ii",. I
IIV.IIU".I'11I
,.
COMMONWUlIH Of "NNSnVAN1A
INNIIIIANC' fAI InUIN
'''IDlNf D'CIDtNf
SCHEDULE J
BENEFICIARIES
ESTATE OF
fiLE NUMBER
DENN I S E. 8ERTOI.ETTE
21-96-0417
ITEM
NUMBER
RELATIONSHIP
AMOUNT OR
SHARE Of ESTATE
NAME AND ADDRESS OF BENEfiCIARY
A, Ta.ablo BoqulI'I:
I.
ENDA M. BERTOLETTE
1601 Carlislu Rood
Camp Hill, Po. 17011
Mother
50X
2.
. JACK F. BERTOLETTE
1601 Corlisle Road
Csmp Hill, Pa, 17011
Father
50X
ITEM
NUMBER
NAME AND ADDRESS Of BENEfiCIARY
AMOUNT OR
SHARE OF ESTATE
B. Charilable and Gavernmenlal Bequests:
I.
TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS IAha onlor on I;no 13, RocapHulaHon) S
III more .pacI II n..dld, Intlrt addltlonallh.... of lam. Ilrel
\
INHERITANCE TAX RETURN
RESIDENT DECEDENT
COMMONWIAI1" '" ",,,m'VAt'1A (TO BE FILED IN DUPLICATE
Df',UIMWlor R(V(UU( 1 \
'''''l\fJ:U~o~l,,0601 WITH REGISTER OF WILLS) COUN1YCOOE
0(((0'" ",.,;;;r 11"'\1, 'IUT, ""lOMIOtllf 114111.&'1 OIClII"lI \(01,11'1111 100111'\\
_ll~D~ l.,:'oT1:E_ Prt.lN\'>- (;. 00_0___ ___ J"6~ CMl\\SLl': R~Ci
\Q(h'ftUuii,l,~uMll1' - · OAIf Of (I'A'Il IClAIr fU ''''II t,..p.".", 9 t\ 'Ll. . t'1\ \1 b' \
_1~'l~01 '!..5$1.:L__ _U_~ogD'~ '1__ - 1i'~1..::'\ I.___m ~'~"(- _C."'1'\..68 .L~Nl'\o
I" ""<"'" "",,,,m ,"'",.. ....".., "'" ..., .,~~, "'''''''__ ~()(I'" 'lieu,,, filUM'" _ '~~U'" "",,10 ,,,, ~;;"u,,,o,,lT"
[i. I. Original R.lurn [J 2. Supplemental R,'ur" Ll J. Remainder R"ur"
(lor dol.. 01 doo,h prior 1012.13.021
o 4. limited E'lal. (] .to. Future 1nlerll' Compromilll 0 S, F.d'fal ellal. To. R,'urn Required
(10' dol.. 01 doolh oltor 12.12.021
o 6. Dtud,nt Died Tllloll [) 7. O.cedent Maintained 0 living TrUll
(Allo,h 'opy 0' W;1II (Allo,h 'opy 01 "uIII
ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO.. .' "I :\:,.,. , : Ii .)11.' I'! <{.'
UAM (OMPUI! MAIllNG "'OOIfIU
~
..:5..
IllEI1
:09
u~..
~~'~~dl\
0."..', ~~ I.N
15
fil
u
w
..
,},>-
wi5
"'''
"':0:
:3~
UUPHO
IA r:,R.1-~....J1'JeM
( NU~(I ,/
b?=1lt.:1U
1tJ.) ~OlllC ROA() 0
IVt'ltl CIA ~S"L__ND ,1ft.
liO?\)
:0:
o
;::
:5
~
III
'"
1. Rool E,'ol.(S,hodulo AI
2. 510,10 and Oond, (S,hodul. 01
3. Clo..1y Held SlocUPorlnl"hip Inl"I" ISchedule C)
A. Morlgog" and Noll' Receivoble (Schedule 0)
5. Cosh, Bonlc Depoli', & Mile.lloneouI Penanal Prop"'Y
(S,hodul. EI
6. Joinlly Ownod P,oporly (S,h.dulo fl
7. Trondor. (S,hodulo GI(S,hodulo II
8. Total Groll An." (10101 L1n.. 1.7)
9. Funeral hp.n.... Admlnhlrolivl COlh. Miscelloneous
e.ponlO' (S,hodulo H)
10. D.blt, Mortgog' LIabilities. Utns (St".dula I)
11. Tolol Doduclio", (lololllnOl 9 & 10)
12. Nt' Value of ellal. (lIn, 8 minUI line 11)
13. Charitable and Govlrnmental a.qullts (Schedule J)
U. Nol Volu. Subjecllo To. (lIn. 12 minu.lino 131
15. Spoulal TransFln (for dol.. of dtolh alt., 6.30.9")
S.. In,'ruellons for Arplicoblt Percentage on Revene
Sid.. (Indud. volu.. om S,h.dulo K or S,hodulo M.)
16. Amount of line 14 laxoble 01 6% rol.
(Include ...alue. from Schedule K or Sc.hedule M.)
17. Amounl of lIn. 14 laxabl. 01 15% ral.
Ilnc.lud. ...alulI from Sch.dul. K or Sc.h.dule M.I
18. Principal '0. du.(Add '0. from Un.. 15. 16 and 17,1
19. Credill Spoulal Po....rly Credil Prior Paym.nh
+
-
fOR OATIS Of DIAIH A"I~ '2131191 CHICK HUI
If A SPOUSAL 0-
POVI~_I!~oIDJrJ!oC!~!.~llIJJ
flU NUMII~
Y~^~
~Iit\d
III
121 -
(3)_ -
(41__~_________
(51__7005'.80__u_
(61__~0
(7) ___u______
(91 _--'_'1HOS.:J_L-
(101
(15)
(16)
(17)
:0:
o
~
,.
:3
a
Dilcounl
Inl.rlll
a B. Total Number of Safe Depo.U Bou.
r~
'r,
~
::n
:~j t,)
~ I :::
+
20, II Un. 191, groolor ,hon Uno 10, onlor ,ho dilloron" on Un. 20. lhto to Iho OVERPAYMENT,
aD
21. II Uno 10 I. gr.o'or Ihon Uno 19, on'''lho dill.ron" on lino 21. Thi.l. Iho TAX DUE,
A. Enler Ih.lnl.rlll on Ih. balanc. due on line 21A.
O. E~'" ,h. 10101 of Uno 21 ond 21A on Un. 210. Thto illho BALANCE DUE,
Mok. Ch.ck Poyobl. '01 Rogh'" of Will., Agon'
Ch~c.k h~fl..' If you or~ requcsting a refund 01 your ovcrpaymcnt.
.,
r-,-,
..;,.:.'
-"
(0) _
7tJo5'. 40
" ,
..
,.
(III ~1_9..Y.o'5~'j
(121 D..eflC.IT ESf1lTe
(131
(141
)(._1I!Il o v~
)( .06. f'J.i)O
)( .15 a t:l,oO
(101
(191
(201
(211
(21A)
(210)
Under penolll.. of p.rjury, I d.clar,'hat I aye examln.d Ihl. relurn, Including accompanying Ich.dul.. and ,'alem.nh, and to Ih. bell of my knowl.dge and beUef,
It II true, corr.d and complet.. I declar. Ihat all tlal ,,'ale has b..n reporrea at Irue marle,' ...alu.. Oec.laratlon of prtparer olh.r Ihan the personal repr...nloll.... I.
balld on alllnformallon which r. arer has any knowledge.
SIONAlUU O. PlUON 11$'0 III 01 'NO TUI ADoIUS '\ DAlf ,~
&"ltd" I'~() 'If
c;ifl1r;.' tJ1 Od.,1 ('):/t1f{41IJ fn I ? 0 1/
, Iv-/ ,....h.J?. t <- r?t>7 0
,
,
DAlf
/. ~.'t7
I ~ SCHEDULE E \
~~ CASH, BANK DEPOSITS AND
(O""onwIAI'" O' PI",,"lV."'A MISCEllANEOUS
'''Hl:ll:r"Wt(~::~~'H PERSONAL PROPERTY rlno,o r,in' or typo.
- - -_.=--=~",.,..-.=,- --~"".-=-'"'"~ :,=~=-~=-..",---=~~-=-=--.--"
ESTATE OF rilE ,-lUMBER
"'f.se.... 11111
21..,96-0417.
DENNIS E. DERTOLETTE
i;.irp;-~;~;'ii.i~,i;.;.;.;.d;'\1i.ih'lriii.i ;'S;;vlv.,;h"r ;.~;, b,'di;.....d on ~.h,dul. II
--------- --...--..-......-...-..
.. . \. .---.-...- .' - .._"" - . ...
VAlUE AT
DATE OF DEATH
,...-' ..__.__.-.~.--_._--. . -'.-
236.50
23.91
36.00
200.00
20.00
90.00
45.00
60.00
240.00
700.00
25.00
600.00
3,500.00
26.74
75.00
500.00
28.00
599.25
DESCRIPTION
ITEM
NUMBER
--- -------------.....--....... ......- .. .--.,
1. Blue Cross and Blue Shield Refund
2. prescriptions Refund
3. Auto Insurance
4. Compac DiSC. plsyer
5. CertificateS of Deposit
6. Microphone
7. Television
8. Bike
9. Stero Equipment
10. Records
11. Blue Cross snd Blue Shield Refund
12. l,iKhtinK Equipment
13. Lighting Equipment
14. Capital One, Richmond. VA., Bank Account
15. 1980 Van
16. 1979 Van
17. BrasS Synbols
18. Sale of Misc. Items
\
\
I
I
----------- _.... --- - ....... .. .-. . -- .-".
7,0\>.5..49
..-'--
.... ~~..!~~J~~~? ~~~n.l;ne 5, Recopi'ulo'ion!.. ~
-----.- ~..
.._n_----
(A"n'" n",Jilin,,"' R'/," .. H" \",~..I' il ""ro'" 'I,nrlll i\ ".."rf..,t,
. .
11'1.111111. ,..,,'
.
COMMOf.lW'AUH Of "NNSnWlN1A
IHNlllr"NCI ,.... _nUl"
'"IDfHf DtChlH'
SCHEDULE J
BENEFICIARIES
ESTATE Of
FILE NUMBER
DENNIS E. BERTOI.F.TTE
21-96-0417
ITEM
NUMBER
NAME AND ADDRESS OF BENEFICIARY
RElATIONSHIP
AMOUNT OR
SHARE OF ESTATE
A, Taoabl. Boqu..h,
l.
F.NDA M. BERTOLF.TTE
1601 Carlisle Road
Camp lilli, Pn. 17011
Mother
50%
2.
. JACK F. BERTOLF.TTE
1601 Carlisle Road
Camp IIill, Pn. 17011
Father
50%
ITEM
NUMBER
NAME AND ADDRESS OF BENEFICIARY
AMOUNT OR
SHARE OF ESTATE
8. Cha,ilabl. and Governm,nlal aequIIIs:
I.
I
TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Aha .nlo, on lin. 13. R.capilulatianl S
IIf mo,. .pace I. n..d.d, In'lrt additional ,h.." of lam. till)
,
- .
COHHON~ALTH OF PENNSYLVANIA
DEPARTHENT OF REVENUE
BUREAU OF INOIVIDUAL TAXES
IMIlAIlAHer TAlI: DIVISION
D{PT. 180601
HARRISBURG, Pi 1111a'ObOl
NOTICE OF INHERITANCE TAX
APPRAISEHENT. ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
05-26-97
BERTOlETlE
05-05-96
21 96-0417
CUHBERlAND
101
ROBERT E HYERS
100 YORK RD
NEW CUHBERlAND
PA 17070
Anount RanHtad
*
....\U'U.'" 111."1
DENNIS
E
HAKE CHECK PAYABLE AND REHIT PAYHENT TO:
REGISTER OF WIllS
CUMBERLAND CO COURT HOUSE
CARLISLE. PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
iiEV:i5Cjj-Ei[-"FP--io3":97Y"NCii'-icniFuiNHERiiAifcE-YAic-iiPPRiiisEifENT-,--"LLOWANCE-oli----------m-m
DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX
ESTATE OF BERTOlETlE DENNIS E FILE NO. 21 96-0417 ACN 101 DATE 05-26-97
TAX RETURN WAS: (X) ACCEPTEb AS FILEU
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. R..I Est.t. (Schedul. A)
2. Stocks and Bond. (Schedule B)
3. Clos.ly Hald Stock/P.~tn.~shlp Intare.t (Schedule C)
4. Hortg.gas/Hot.. Receivable (Schedule OJ
5. Cash/Bank Deposits/Hisc. Parsonal Property (Schedule EJ
6. Jointly Owned Property (Schedule fJ
7. Transfars (Schedul. G)
8. Total Assat.
APPROVED DEDUCTIONS AND EXEHPTIONS:
9. Funeral Expen.../Adn. Costs/Hisc. Expans.. (Schedule H)
10. Dabts/Hortgage Liabilities/Ltans (Schedul. I)
11. Total Daductions
12. Het Value of Tax Raturn
13. Charit.ble/Govarnnental aaqUests (Schedule Jl
14. H.t Value of Estate Subject to Tax
CHANGED
111
(21
(3)
(4)
(5)
(61
(71
.00
.00
.00
.00
7.005.40
.00
.00
(BI
HOTE: To insure proper
cradit to your account,
sub.it the upper portion
of this for. Kith your
tax paynent.
7.005.40
19.40, 78
12.400.38-
.00
12.400.38-
NOTE: If an assessment was issued previOUSly, lines 14, 15 and/or 16, 17 and 18 will
reflect figures that include the total of ALL returns assessed to date.
ASSESSHENT OF TAX:
15. A.aunt of L1n. 14 .t Spous.1 ..t. 1151 .00 X. 00: .00
16. A.ount of L1n. 14 to..b1. .t L1n..1/C1... A ..to 1161 . 00 X ' 06: . 00
17. Allount of Line 14 taxable at Collataral/Class 8 rate Cl71 . DO X .15: .00
lB. p.lnclpol Tox Du. I1BI .00
TAX CREDITS:
PAYHEHT
DATE
RECEIPT
NUHBER
DISCOUNT ('1
INTEREST/PEN PAID (-I
. IF PAID AFTER DATE INDICATED. SEE REVERSE
FDR CALCULATION OF ADDITIDNAL INTEREST.
1'1
110l
19.405.78
,00
(111
1121
1131
1141
.00
.00
.00
.00
IF TOTAL DUE IS LESS TNAN .1. NO PAYHENT IS REQUIRED.
IF TDTAL DUE IS REFLECTED AS A "CREDIT" (CRI. YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. I
AHOUNT PAID
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
,.
RES[RYATlOH: [.tat.. of declMtant. dying on or before O.uab.r Il. l'fez -- If MY future Interut In the utat. II transt.rrad
In po.....son or ."joy.."t to Cl... . (collat.r.U beMtlclarl.. of the dK~llf1t aftar the uplntlan of any utat. for
lit. or for y..r., the Co.-onwa.lth her.by ..pra.sly t.,.rv.. the right to appral.. and ...a.. trM,'.r Inheritance Tax..
at the lawful Cl." . (collateral I rat. on any luch future lnt.r..t.
PURPOSE Of
NOTICE I
To 'ul'III the raqulr...nt. of Section Zl~a of t~ lnherltftnCa and [,tata ra. Act, Act 21 of 1995. (12 P.S.
Section '(40),
PAvttENT :
D.tach the top portion of this NoUn lII1d ,ub_1t with your p.,.."t to the Reglst.' of Willi prlntad on the ra",ars. sid..
.~"ak. check or IIOMY ord." pllyabla to; REGISTER OF MILLS, AGENT
REFUNDCCRh
A ,..fund of . tax credit, which .... not ,eque.ted on the 'ax A.turn, ..'1 b. reque.ted by co.platlna an -application
for R.fund of p~'Ylvanla lnh.rltnnc. and E,tat. tax~ (REV-ISIS). Appllc.tlon. are av.llable .t tha Offlc.
of thli Raglstar of Will., any of the lS R.vltf'lUe Dlstrlct Dfflc.., or by eal1lnQ thl ,peclal Z"-hour
an....rlna ..rvlea nullbars for for.. ordering; In p.,.."ylvanla 1-800-S6Z-Z050, out,ht. P.lInnlvllll'lla and
Mlthln loc.l Harrl.burg ar.a (717) 787-aO''', fOOl (717) 71Z-ZZ52 (H.arlng 1~.lred Only),
OBJECtiONS I Any p.rty In Intar..t not ..tl.fled with the appr......nt' .Ilowanc. or dl.allowanc. of deduction., or .....saent
of tax (Including dhcOlllt or Int.re.t) .. shown on thl. NoUn .u.t Object wUhln .lxty (60) dayS of rec.lpt of
thl, Notlc. by:
UMrltten prot..t to the PA D.p.rhlent of R.v.nue, Ioerd of App..", D.pt. Z81021, Il.rrlsburg, PA 17IZ8-ta21, OR
".Iectlon to h.v. the ..tt.,. det.,..lned at IlludU of the KCount of tha p.rsonal reprnentatlv., OR
--appe.1 to the Orphan,' Court.
AOtUH
ISlAAJIVE
CORRECtiONS:
F.ctu.1 .rror. dl.cov.red on thl. .,......nt shoUld be addressed In writing to: PA O.p.rt.ant of Ravenue.
Bur..u of Indlvldu.l t...., A"NI Post .......ent Revl", Unit, Dept. Z80601, tt.rrlsburg. PA 171Za'0601
Phone (717) 787-6505. s.. p.g. 5 of the bookl.t -In.tructlon. for Inh.rltanc. fax R.turn for III R..ld.nt
O.cedent- (REY-ISOI) for an ..plan.tlon of IIId.lnl.tr.tlv.ly corr.ctabl. .rror..
DJSCOUHlI
If any tax doe Is p.ld within thr.. Il) c.l.nd.r MH1th. .ft.r the d.cadent., d..th. . flv. percent (~:() discount of
to. 's. ~.io i. allUNvu.
PENALTY I
Th. ISX t.x ..na.ty non-p.rtlclpatlon p~lty I. coeputad on the total of the t.x ftnd Int.r..t ......ed, and not
paid b.for. Janu.ry la, 19'6, the first d.y aft.r the .nd of the t.. .~.ty parlod. Thl. ~on-p.rtlclpfttlon
pan.lty I. appe.labl. In the ,... .annar and In the tha ,... tl.. period a. you would nppaal the ta. and Int.r..t
that h.. b.an a'.....d .. Indlc.t.d on thl. not Ie.,
INTEREST:
Int.r..t Is ch.rged b.glmlng with flr,t d.y of delinquency. or nine (9) ltOI\th, Md one (1) day frOll the data of
daath, to the d.t. of p.r-ent. t.x.. which bec... dellnqu.nt b.fora Janu.ry I, 1981 b..r Int.r.,t .t the r.t. of
.Ix (6X) p.rc.nt p.r 8nnU8 calcul.tld at a dally r.ta of .00016,.. All ta..' which blca.. dallnquent on and .ftar
J.nu.ry 1, 19a1 will b..r Int.r.,t .t a rat. which will vary fro. cal.ndar ya.r to c.lend.r y.ar Mlth that rat.
announced by the PA D.part..nt of Rav.nu.. fh. appllc.bl. Int.r..t rat.. for 198Z through 1997 .r.1
'!.!!! Intarl.t Ret. O.lIy Int.r..t Fllctor !!!! Int.ra,t Rllt. O_lly Int.r..t Fltetnr
198Z 10iC .0005,.a 1987 .~ .OOOZU
1985 16iC .00D4S8 1'83-1991 lIX .0UlDl
198" llX .000301 ...2 .~ .000Z47
1985 13iC .000S~6 1993.199lt n .00019l
1986 1D~ .000Z7" 1995-1997 .~ .00D247
--Int.r..t II c.lculatad .. follow.:
INTEREST = BALANCE OF TAX UNPAID X NUNBER DF DAYS DELINQUENT X DAILY INTEREST FACTDR
--Any Not Ie. I..ued aft.r the tax b.co... delinquent .111 r.fl.ct an Intar..t c.lcul.tlon to flft.en liS) d.y.
b.yond the d.t. of the .......ant. If pay.ant I. .ad. aft.r the Int.r..t C08PUtatlon date ahovn on the
Notice. addltlon.1 Int.rnt .u.t be c.lculated.
, I \ I
I ) -1/ .' ./
BUREAU Of INDIVIDUAL TAXES
U..IUIAJrKl In UlvlSIll~
01111. :.0.01
IIANNISBUNQ, IIA III:a-OMI
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
,
l.......
*
NOlin Of INIIlRITANCE TAX
API'RAISEMlNJ. AllOWANCE OR DISALLOWANCE
Of DEDUCTIONS AND ASSESSMlNJ Of TAX
In-I'" II." 111.111
ROBERT E MYERS
100 YORK RD
NEW CUMBERLAND
DATE
ESTATE OF
DATE OF DEATH
FILE NUHBER
COUNTY
ACN
E
05-26-9]
BERTOLETlE
05-05-96
21 96-0'.17
CUMBERLAND
101
DENNIS
i--:-c~A:.~~nt:'\..~f~d=~:~. j
HAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER DF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE .. RETAIN LOWER PORTION FOR YOUR RECORDS ~
iiE"v: m-j-Ex--AFP--i'oj-:97 Y -Nor-icE --0"- i"NHEiii TAN-C E - i:AX-APPRA"isEifiNr-; -Ai. rOWAN-CE -iii--m--- --- - - - - --
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF BERTOLETlE DENNIS E FILE NO. 21 96-0417 ACN 101 DATE 05-26-97
PA 17070
TAX RETURN WAS, (X) ACCEPTED AS fILED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. R..l Est.te (Schedula AI
2. stock. and Bonds (Schedule 81
3. Closely Held stock/Partnership Interest (Schedul. CI
4. Horta.a.s/Not.. Receivable (Schedule 01
5. Cash/Bank Depoaita/Hisc. Personal Property (Schedule EI
6. Jointly Owned Proparty (Schedule FJ
7. Transfer, (Schedule GJ
8. Total A...t,
CHANGED
.00
.00
.00
.00
7.005.40
.00
.00
(B)
III
(2)
l31
(4)
151
(61
17)
NOTE: To in.ure propar
credit to your account,
subeit tha uppar portion
of this fore Mith your
tax pay"ant.
7,005.40
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funaral Expen,.s/Ad". Cost,/Hi.c. Expens.. (Schedule HJ
10. a.bts/Hortgage Liabilities/Lians (Schadul. IJ
11. Total Daduction.
12. H.t Value of rax Raturn
13. Charitabla/Gavern.antal Baqua.t. (Schedul. JJ
14. Hat Value of Estata Subjact to Tax
(9)_
1101
19,405.78
.00
III)
112)
113)
1141
19.40G 7R
12,400.38-
.00
12,400.38-
NOTE:
If an assessment was issued previOUSly, lines 14, IS and/or 16, 17 and 18 will
reflect figures that include the total of ~ returns assessed to date.
ASSESSMENT OF TAX:
15. A.ount af Lina 14 at Spousal
16. A.aunt of Lina 14 taxabl. .t
17. A.ount of Line 14 taxabl. at
18. Principal Tax Dua
TAX CREDITS:
PAYMENT
DATE
rat.
Lin.al/CI... A rata
Collat.ral/Cla., 8 rat.
,00
,DO
.00
.00
.00
.00
.00
X .00=
X,06=
X ,15=
llBI
115)
1161
117)
RECEIPT
NUMBER
DISCOUNT 1'1
INTEREST/PEN PAID (-)
AMDUNT PAID
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
.00
,DO
.00
.00
· IF PAID AFTER DATE INDICATED. SEE REVERSE
FOR CALCULATIDN OF ADDITIDNAL INTEREST.
I If TOTAL DUE IS LESS THAN '1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRI. YDU HAY BE DUE
A REFUND, SEE REVERSE SIDE OF THIS FORM fOR INSTRUCTIONS. 1
.-.- .
,
I~)~'"
RtS[AVATIOHl E.tat.. of d.cedent. dying on or before o.ceab.r 11, 1981 -- lf any future Int.r..t In the ..tat. I. tran.f.rr.d
In po.....lon or enJoy.."t to Cia.. B (collateraU beneflclarl.. of the deudent after the ..plratton of any ..tata for
llf. or for yaar., the Co-.onw.alth h.r.by ..pral.ly r...rv'l the rlDht to appral.a and al..I. tran.f.r lnh.rltanca T....
at the lawful CI... B Icollat.r.l) r.t. on any .uch future lntar..t.
PURPOSE Of
NOTtCEl
PAYHEHT I
REfUND I CA) I
OaJECTlONSI
AlIMIH
lSTAATIVE
CORRECTIONS:
DISCDUHT:
PENALTY:
INTEREST:
To fulfill the r.qulra.ant. of S~tlon ZI40 of t~ Inherltanca and [.t.te Tax Act, Act 21 of 1995. 172 P.S.
s.ctlon 91'10).
Dat.ch the top portion of thl. Hotlc. and .ubalt with your payaant to tha A.gl.t.r of will. printed on the rav.r.. .Id..
.-"aka check or .only order payabla to: REGISTER OF MILLS, AGENT
A rafund of . ta. credit, which w.. not requ..t.d on the Tax A.turn, ..y b. raqu..ted by coapl.tlng an ~Appllcatlon
for Aafund of Pennlylvanla Inh.rltanca and [.tata Tax~ IAEV-ISI1). application. .r. available at the Office
of the Ragl.tar of will., any of tha 21 Revenua DI.trlct Offlca., or by calling the IPlClal l~-hoUr
anlwerlng .arvlca nuablr. for for.. orderlngl In Pennlylvanla 1-800-16Z-1050, out.lde Penn.ylvanla and
within local Harrisburg araa (117) 787-8094, TOO' (717) 77Z-Z2S1 IHearlng Iapalrad Only).
Any party In Intar..t not ..tlsfl~ with the appralsaaant, allowance or disallowance of deduction., or a......ant
of tax (Including dl.count or Int.ra.t) a. shown on thl. Hotlc. lU.t Object wlthln .Ixty (60) day. of rec.lpt of
this Notlca by:
--written prota.t to tha PA Depart.."t of Rav.nue, Board of Appeal., D.pt. Z810ZI, Harrl.burg, PA
.-alectlon to hava the .att.r dat.ralned at audit of the account of the per.onal rapr..."tatlvl,
u~al to tM Orphan.' Court.
17IZS-I021,
OR
OR
Factual arror. dl.cov.red on thl. al.....ent should b. addr.l.ed In writing to: PA O.part.ant of Rlv.nua,
Bur.au of Individual Ta..., ATTH: POlt A..e...ent R.vlew unit, Dapt. Z80601, Harrl.burg, PA 171Z8-0601
Phone 1717J 787-6505. 5.. P8g1 5 of tha booklat "In.tructlon. for Inheritance T.. Return for a R..ldant
Decadent~ (REV-lS01) for an e.planatlon of adalnlstrativ.ly correctabl. .rror..
If nny tax due I. paid within three (1) cel.ndar aonth. aft.r the dec.dant'. death, . flva parcent (S~) dl.count of
the tex p.ld II .1Iowed.
The 15~ tax MnI.ty non-p.rtlclpatlon penalty I. c~tad on the total of the t.. and Int.r..t ass.ssed, and not
paid b.forl January 18, 1996, the flr.t day aftar the end of the ta. a~.ty p.rlod. Thl. non-participation
pen.lty II app.al.bl. in the su. aanner fthd In the tha .... tI.. p.rlod as you would app.al the tax and Intlr..t
that ha. b.an a....s.d a. Indicated on this notlc..
Int.r..t Is charged b.glnnlng with flr.t day of d.llnqulnCY, or nlnl (9) eonth. .nd onl (I) day froa the d.t. of
dlath, to the data of pa~lht. T.... which boca.. dllln~nt b.'ore January 1, 1981 b.ar Int.ra.t at tha rata of
.Ix (6~) p.rcant p.r annua calculated .t . dally rat. of .000164. All t.... which b.c... delinqu.nt on and aft.r
January I, 1981 will b.ar Int.r..t at a rat. which will vary fro. calendar year to callnd.r y.ar with that r.t.
announc.d by th. PA Dlp.rt.ant of A.vlnue. Th. appllcabl' Int.r.st rat.. for 198Z through 1997 ara:
'!!!r Int.r..t Rate Dally lnt.rnt FACtor :!!!! lnternt Rate Dally lntere.t FACtor
198Z ZU .000!i48 1987 'X .0002'17
1985 16~ .00008 198&-1991 11;( .000101
1984 11;( .000301 19'1' 'X .000Z47
1985 1l~ .000556 1991-1994 7X .oooln
1986 10;( .000Z74 1995-1991 'X .000Z41
nlnt"l.t II calculatld .. follow.:
INTEREST = BALANCE OF TAX UNPAID X NUKBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
.-Any Hotlc. I..ued .ftar thl tax b.coae. dallnquent will rafllct an Int.r..t calculation to flft.an CIS) day.
b.yond thl datI of tha a".,sllnt. If pa~ant I. lad. aft.r the lnt.r..t coaput.tlon d.ta .hown on t~
Hotlc., additional Inter..t .u.t b. calculatad.
STATUS REPORT UNDER RULE 6.12
Name of Decedent: D!:-NNlS ~. 13ER.fOLFTTI':
Date of Death: .5- /.J. - l/u
Will No.
Admin. No. :L/-tJu-I-/I'7
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 1- 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 representative file a final
account with the Court? Yes Y 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.
~)L I~\ L \ I L.., f I.. I L
Date:
/. '>1 'r
I . / '. _._...
i /.. I .
I /:.~/;.. " 11.:.~1/--'_"'__
Signature )
RcBIi:R.f E. m'/r'R~, SSQ.
Name (Please type or print)
IDO CoLl) '/OiZK.. RD" NEl'li Cum B~l-ANb
Address PA. .
I7C / (J
-
C ef)
tn
~-~r~
--
~
0,
,
:3
.~
( 1/1) 71 0+ . ..31 l.lJ .3
Te 1. No.
.,j .:.,
QJa:
a:
. ..:..;
.....:&=
"'-
a8
~
Capacity:
Personal Representative
~ Counsel for personal
representative
(MAH: rmfl AM3)
I'
h
t",,,
\ .
I
,
\
I
1
I
I
I
\
i'
"----
\.
'1
, -
-~, T"
,
\1,
.:~.."",...4.. .
"
,
_,_t
.:t
,. ~.
," 7"
I
..5
<r
~.
,
r
I
1.
..,:
~
R
'-
. '
;
,
,
~
I:'
\.
..
,
\,
r'"
i .
I
.
\
I.
!~~
'v'd '." ~ qUJIlO
llno~ ...,.)peIO
Ul " g
I ". g
!W ~ .-,
! >-~. ~
, ~ I- 0 . .
i . ,0:; 0:0'
, l1l<~z'
t ~o5
- ~i€)o 8 ffi
. 111~_~
m~ ::l
~ ~
z
l V. ll~ v- 83] L6.
SI\!M IBaH
10 0:: J;... ..'JooeH
t' ,
,.
----
. - .---
-............-lllI~..._ _n....r .::::.