HomeMy WebLinkAbout96-00459
PETITION FOR GRANT OF LE1TERS OF ADMINISTRATION
Bruit' 01 t\OH^ S ,Y':~IN^N ______
a/so k"o,.'" a.> ___ ________ .-- - --- -- --- .--
No. __G2J_=-fllLJ - 454.
To:
Ilcgbtcr of 'rjlls Wr tl~c d
County nf ___urn pr an in thc
C'ommonllcll\lh of Pcnnsylvllnill
----_._--~_.__.._----'-_._-- ._-
______. f)('C('II\c'll.
Soda/ 5""/1';/.1' Nil. _2.1)1 -lll-JO:J!L-- u__
Thc pctition of Ihc nndcr>igncd rc'pcclflllly Icprc'cnt' Ihat:
Your pClitioncrts), who K/arc 1 R ycars of agc or oldcr. appl v
for ICllcrs of adminislralion
on thc cSlalc of
(d.h.n.: JlCl1dt'111C lile; durill11C "h\Cl1liil; thUillllC lIlinnrllillcl
thc abovc dcccdcnl.
Dcccndcnl was domicilcd al dcath in Cumber l.?nd County, Pcnnsylvania, with
11I'r last family or principal rcsidcncc 1II LD2_1'L-\~est S to, Car 1 isle. PA 17013
111\1 \llccl, nUlllhcr and mllllidJlalil)')
Dcccndent. thcn -B.D_ ycars of agc. dicd _.-JJilrch 2 ,19 96
at Thornwald Home, 4'12 \~a1nut Bottom Rd. , Carlisle, PA 17013
Dcccndcnl al dcath ollncd propcrlY with cstimatcd valncs a, folllows:
(If domicilcd in Pa.) All pcrsonal propcrlY S 36,000,00
(If not domicilcd in Pa.) Pcrsonal proncrlY in Pcnnsylvania S
(If nol domicilcd in Pa.) Pcrsonal propcrl)' in County S
Valuc of real cstatc in Pcnnsylvania $ 27,000.00
situatcd as follolls: -15'1 "r" St., RoroualL.o~_~r! is! e. Deed Reference
34 "r" 444; Tax Parcel No. Ob=Tg=r643:'-;!U9
PctitionclS.- aftcr a propcr scarch hll~ asccrlaincd that dcccdcl1llcfl no will and was survivcd by
the following spousc (if any) and hcirs:
Namr Ilcllltionship Rcsidcncc
-Shir1e L. Gilchrist
-.Dou 1as \~. Lehman
Dauqhter
Son
1S e, PA 17013
ar1is1e,PA
17013
Cleveland Ave. Ashland, OH
44805
npnni~ Tpnman
l~pnr'k>" R. T"hmiln 75 E. Lombard St.
Baltimore, ND 21231
THEREFORE, pClitioncr(s) rcspCClflllly rcqllcsl(S) thc granl of ICllcrs of administration in thc
appropriatc form III thc undcrsigncd.
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PA 17013
OATH 01,' PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA
COUNTY 01,' rll\IIlEHLi\t-':il
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The petitioner(s) abovc-named swcar(s) or affirm(,) that thc
statements in the foregoing petition lire Iruc and ~orrcctto thc best
of the knowledge and belicf of pctitioner(s) and that as pcrsonal
representative(s) of the above decedcnt petilioncr(s) will well and
truly administer the eslate according to law.
Sworn to or arfirmc:.d Tl\nd subscribed JA/;~'7_6,t
before mc this jO H dllY of SIll rl e ..
!/l I . 19 96. . .'
I -,.. I:~I
. (,' 1 ~ I.t..-..~ I'i 17(1: I,r/~.
MA&'t c. LEWIS Register L D'fHlq1as \~, Lehman
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No. 7.1 - 96 - 459
Estate of
NORA 5, LEimAN
I Deceased
GRANT OF LETTERS OF ADMINISTRATION
AND NOW JUNE 11. 19~, in consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me.
IT IS DECREED that Shirley L. Gilchrist and Douglas IV. Lehman
Ware entitled to lellers of Administration, and in accord with such finding, letters of Administration
areherebygranledlo Shlr1ey L, Gl1chrlst and uouglas W. Lenman
------- ---------. ----.----- --
in lhe estate of
Nora S. Lehman, deceased
/ l..~ -
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Regisler or ills
MARY C. LEWIS
FEES
lellers of Administration ..... S 115.00
Short Certifieates( 5) .. .. .. . ." S 1 S . 00
Renunciation ................ S 5 . 00
JCP S 5.00
TOTAL _ S 140.00
Filed ........J.U.~E.J.1....- A.D. 19.2L-
William S. Daniels, 27735
ATTORNEY ISup. Cr. 1.0. No.)
One IV. High St., CarliSle, P^ 17013
ADDRESS
(717) 2'13-3fl31
PIlONE
~
CALLED ATTORNEY ON 6-12-96.
BlUte 01 NORA S LEHMAN
also know" as
No.
21 - 96 - 15.9._____
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERI ANn
} 55
The petilioner(s) above-named swear(s) or affirm(s) that lhe
stalemenlS in the roregoing petition are true and corretlto the best
of the knowledge and belief or petitioner(s) and that as personal
representative(s) of the above decedent peliliOner(~_) w' ~ well and I /J /
truly administer the estate according to law. Gt'l . Wv
-
before me this 31ST day of. J
~ f'1!.l.y. /li 96_ ~'
'7!JfI Ajl . ,~f"11 ( n ,(}rJ (I 1. j lilt -!..- I "-1't~1
· ."0,,, ' .4 .-
MAR C. LEmS .
1.0 t:"<
73 ~
E 'Cl:
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OI(IOIt41~ UAMI IIASI, '111\1, Arm MIOnl( 1~.I"AII
I~- / (OJ '7 - II
INHERITANCE TAX RETURN
RESIDENT DECEDENT
(TO BE FILED IN DUPLICATE
WITH REGISTER OF WILLS)
,,~?~:rC\
.....W.ur
COMMONWIAIII10f PHm!lUVM4IA
orPAlf'Mrw m AIVUWI
D(PI 1110001
---______ ttARNI!lBY_RG. PA 111111 0001
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LJI(HII~jl'S(W""'1( AlllJ'IU
'fhornwald Home
442 Walnut Bottom Rd.
'''O"j Cumberland C'arlisle -PA_
...."'(JU~H IICIP/IO {~II .,HIl..~JCIIO'j\1 ,
~ __ _u_____~__ __ ______
r' J 3. Remainder Return
Ifor dale' of death prior 10 12.13.82)
[J 5. federal ESlole Tall Return Required
lL 8. TOlal Number of Sofe Deposil Boxes
....
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Lehman Nora S.
jQ(i~~i1uii';~U~;~4-6 r;~ ;';~~' r;'~ ~' ~'~'; 5
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[~ I. Original Return
Supplemenlal Return
LJ 2
1140_
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William S. Daniels, Es uire
IfU'HON( NUMBU
'OR OAIISO' DIAIHAnlR "/3119, CHICK HIU
If A SPOUSAL
povlRn CUDII'S CLAIMID I I
'IU NUMIIR
COUN~J CODE
96
YrAR
0459
NUMBER
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I. Real E"ale (Schedule A)
2. S'ach and Bond, (Schedule B)
3. Closely Held StocUPartnership Interest (Schedule q
A. Mortgages and Noles Receivable (Schedule 0)
5. Cash. Bank Depasih & Miscellaneous Personal Property
(Schedul. E)
6. Jointly Owned Property (Schedule f)
7. Tra"fers (Schedule G) (Schedule LI
8. Total Gran Aneh (lotallines 1-7)
9. Funeral Expenses, Administrative COlh. Miscellaneous
Expenses (Schedule H)
10. Debts, Mortgage liabilities, liens {Schedule IJ
11. T 0101 Deductions (tolallines 9 & 10)
12. Nel Value of EUale (line 8 minus line 11)
13. Charitable and Governmenlal Bequesh (Schedule J)
14. Net Value Subject to Tax (line 12 minus line 13)
(I) -27-rOOO-.-OO
(21
fJI
(4 ) _-..l!Q,~..QJl. 00
{51 ---.J.Ljlj 7.55
(61
(7)
(9) 15,759.07
(10) 2,.1117.53
15. Spoulol TronsfelS (far datel of dealh after 6.30.94)
See Instructions for Ar,plicable Percentage on Revene
Side. (Include values ram Schedule K ar Schedule M.)
16. Amounl of line 141 taxable at 6% rote
(Include values fram Schedule K or Schedule M.)
17. Amount of line 14 taxable al 15% rate
I'nclude values from Schedule K or Schedule M.)
18. Principal.ox due (Add tax from line I IS, 16 and 17.)
19. Credits Spousal Poverty Credit Prior Payments Dilcounl
+ -2,-?94_,--2~____
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(11
00
( 8 1 ll.5...1Al. 5 <;
(II) 18,576.60
(12) 126,570.95
(131
(14) 126,570.95
(15) x.__=
(16) _~6, 57_~_~_~__x _06 =
(171 _
0_
_-'!.! 594~26
o
--------____ x .IS =
----
Inlere't
-_._~--
20. If Line 19 is grealer than line 18, enler the difference on line 20. Thil is the OVERPAYMENT.
E! O....:m~II<iI('.I_.J:.I...I(,.(".l'r'Jtll,1:.'.I7Irrr.r:~_'J:..l'I..l."II~''''II'J.l
21. If line 18 is greater lhan line 19, enler the djfference on line 21. This is the TAX DUE.
A. Enter the interlll an Ihe balance due on line 21A.
8. Enter the folal of line 21 and 21 A on line 21 B. This is the BALANCE DUE.
Make Checle Payable fo: Reglste, of Will., Agent
~ BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND TO RECHECK MATH ~ ~
Under pena"le. of perjury, I declare 'hal' h"e e"mlned ,hi, relurn. including accompanying "hedule, and "a'omenll. and 'a Ihe be" of my Lna,,'edge and belief.
i, i, 'rue, ca"e" and camplele_ I decla,e ,ha' 011 reale"a'e ha, been rep",led 01 true mar~el .olue_ Declaralian of prep o'er a'hnr 'han Ihe pnr,anal repre'entDl;'e i,
based on 011 information of which preporer has any ~nawledge,
"ON4IU" 01 ""ON ""ON"", 10' ""NO ",",N ADO'", --------------- ---- ----- -- -- - ___ _ __ ____ 0.',-----------
~" - - fi:~~4i-J-a,~Px.t.~J1P",DOU9:1,.~,,Lehmanr-Administrators C/O. 0,1'-----------
-I/~.;;~~~-:>,~.-e~ ,,2 -~Z _~..
. an1els,-Esq~_,LW._High st. -Carlisle, PA17013 __________
'-
(181.7,.5_9.4.26______
(191
(201
____.7, 59_4. 26_m__
-______0____ ______
(21)
121AI
(2IB)
o
.--____n_.___._
Freddie
Mac
Second Mortgage
Propenv Value Analysil n,pon
9~02 ~H11
,..,..11
"-~.."
/r,II..,.OVi'
r.........,_
o.._.._oc..
1.........."1""-
Mark E. Hilbert & Associates
.
Borrower/Subject Property Information
......... Lehman.Nora S. ~=- 80 -.
"*'...~
"'_I,AoNI_ l\~C Street C....l_ " 0.\10 oc_. a-. """,.
(.t, Carlisle c.....,CUmberland "Il.PA z.c"'; 11m1
~~...~"'" a ". -. c.._'llI_."
"--.... "'" .." '.. --- - -
.....-''''- 1 ",u"2- 101...,,_ 1'......._...... ~~_U.~A"'. ~~:\"'~I ~!:.~~I.. I C_II""
4 1 o v. Ii] In 72 14. fl. one arch D... (i]....
. , FJeld Report"
. .
NEIGHBORHOOO
~.cfl.'" ~~- OOs....r..... B'" 00.. A., ... ,-
t".!lU, 0... "" o n....u.. UrdtfU" "'_lrC....."4!oL1, D IXI D D
1)0......'''-,. lXJ,,,,,o., D._ D'It.." D- o-ll~._,""_I'" D IXI D B
"'-"......... IX] ,......-.; D.- 0....... ...,...........," D IXI 0
D__~, B-'''' (X) """Ind Bo,,,,,,,,,,,
......'....T_ ~J"'" [i)....... 0..........
~_,...u. lL'"'''E''.''''' '1"'1_ _'C_. L"c_oII 2.-.........1". L..".unl_"
c~......._,_I'" ""M"_, H~'" 0,-.,,- ,,- "
......_Oc__, 0.._ T__ _..Vee....
~,....,...'"".... 25 000 I.. 95.000 .65.000 I'r"'_~_
,.,...,....,. ~,..,,12.L,..I'r...-Aqe 60 r.
NOli: F'ldlh MIC do.. not conlldl' tlCI or 'hI '.ci" compotltion Ollhl nllghborhood 10 bl r,lI.bl, epplllull.CIOI.. r ...... '"
c:__............_IM1...'n.._......n.._."'H""''''.'~II_'..-O.'''*..~. t~. ..1.
~.......-I,..~f................................:....................
SUBJECT PROPERTY
"'-.......u ..2.} ~.. L ~.~_ 2 ",OPUilTVIUllI/1lQ 0- ,.. ,-
,...--'t A.,
f," _w.. ........ _ IMC ,Detached C__" hi.... B IXI 8 0
O"..tt_....t...II..,c_12 StorY C___"...~_t'IMd IXI 0
hl....W......I..'. Frame "............. Hetatl ..............""..1.1' IXI D 0
IIrh1..__'IMI!......"~...'-'II,...."....IiJ". '1'.
:~.: (~~;,i~~.,;.:.:..; N~~' 'Nnf.~,t""""
c__.t1..._.....,r...._~_..'..... l'n1"rh 1"^^' t.
I;:::',;;",\,,~'";,;, .,,~.;~.',.,.;';'~..". ......
. Merket ComperableAnelyals" PrIor To Improvement
.," .
..... -, I
~~~. ~ _ ~tr~~t ~~!t ~ _ ~~r~~t !~~. !.cto~ Street ~~~,~~~t North Street
.....
~. n " ""u n " Mil.. IO.~Mlh.
,~~ T.,,!" I. ".o~ I. 10'~
0........._ .. .-.- ~~Q~' '-~~.
f_"",.._ 10."..& In. .94
. ~
. ,. <n . 50.1.
-... V ve
~,.... AI.. lIm. ._" !" 1 .._ '1'-" I _4'" 1._.- .._ I ,. I...~ .... ' ... j ....
C_...h." & ? j 1 & I ? I, 41 , 1 1 . I , I 1
. ;- ..n -::-;:- <i<'> .., lnnR -.
..
'''-.'_. Porch ~~~~h :.~~h Porch
'_..t(. Non. None
'-'.1_". ~~: None ~~: None
llloe_I._ "".. ".....
Nnft. =
- . . - . . . .
:'!...:...~.... I, 2~,OOO I, 21,00011 I, 30.200
o_.e_.
..ft......__.....""'_I........I........____...,.......~__....II...._._..rhI......,,.....t' _"'.UII_,._ ,...................1.....
..~...._............"'I!_.............~.7L T.....~.....I....I_......__..._I
I MA1"WIl' .L:' , b.............,..v.....27.000 .I!Harch8 ..2L-
. - - If.
..."~E Q ..2L
,. DESCRIPTIVE ~OTOGRAPHS OF SU!UfCT PROPERTY AND ST~EET SCfNE
,,~uM'''~('''.1 I ..c:..I'lodw...."u. 'to'l 12f.I....'ru uC:""II'l'"
UI\IMII~\\'K\I,lllllt' l't:~~~\'I.\'.\~I.\
, t~IIt'Ntl',"I.t: l_\\ 111:1 I'll'
IIK'lIlt:S-II...n:/It'~l
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/IIClRTGM,.:S ANIl NOTES
RH'nVAIIU:
ESTAn:OF
Nora S. Lehmao
FILE NU/IIBER
2t-96-114~c)
(All prupcrt). joillll)'oQ\\lIcd with Highl of SII,,-iIor,hip IIIU\I be di"lo....'tl ml Schedulc F,)
ITEM
NU/IIBER
IlESCRII'TIClNS
VALliE AT DATE
OF DEATlI
I.
Propcrt)'IOC-Jlcd at 7115 North WCSI Streel. Carlislc. PA. CUlllberlllud Counly.
Deed 22 "V', PlIge 754 (see atlllchcd)
$Kll.211lUKI
TOTAL (Also Clllcr on line 4. Ree:lpilullltion)
f!fmore ."plIn' h IIt'c'th.!,!, ;II""t'fl mldllimllllsht't'l.\' OJ.\"tlIlll' .\"i:c!,j
SKll.21KI,flll
.
~~
Freddie
Mec
---.1"____
---t~.~
("..-...-
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.................-
S.cond Mong.g.
Prop'flV Value AnalVI11 Report
95026HlI
Murk E. Hilbert & Associutes
Borrower/Subject Property 'nformallon
..'.....1&hman.Nora S.
"'_1, '-_ 705 North
C,II Carlisle
-......"'."-e
! :::"... ~ :::-;,~.. ~:::.:...
a._.""... 00,....0., II.,. It...., ....
"'_1,\111_ '_.-........ ~
o...._~, SI'.,..,. .......... 0...........,
U..k.....'_ Ur-.,..... Ii] ....... 0.........
..._~_u.. U-.~'.-E~'..'-' ''''-''0. _~c_. L..c_".L..,....."... L'Iiov"'...._..
C,..,........._l_v.. IrlMl_, n_. 0,....,,_ ,.... "
......-_Ou.._, 0.._ 0;....... _ "\I......
......,....,...0(."..... 25.000 '" 9.5.000 .65.000 .....~v_
Sorv-.,....,.r.o- 2L-'.III122-rl....~. 60 ,.,
NOli: F'edd" M.c dOli nOI con,ida, 'IU or Ihl rlei., compo.ition 01 the neighbo'hood 10 b, raJi,bla apP'li.allaclor..
c___'......h._....h._............._... _~~. Sublect ..Ii L.t..th._=er~
IN;;,;;:.it';;;';"'eii~c .. . qqij,;;;q(jjo'i:.ri'
SUBJECT PROPERTY
:::::at. ull:'. L ~~... 2. S
t,.. loN'"",.... "-'.-''''''C IDetached
D~" .-.......... .......Icl 2 StorY
lu.....W.."'"...11 Vinyl ""'......,. k2m1>Bhlnllle
1.1....,.~'Ioc..IlIIII..,."U()-l.....,...,~.,....."....[i)". 7.
::::. i~~~'I";"~"~' NCni~' 'NO~;;d""""
'.
NEIGHBORHOOD
~...-
.....101'
II u.L.S.t. re e t
- l~~ .il0 ;':""J.l,
C,,"l_ 00.. OI'\lOOc_. U"l,Io".
L-.Cumberhnd Ir...U ,...c_11013
0.._'.10.......
''''''- '"--- .... o!....ltt... -1.....
J'-'.-..... l ~_L......"".. l...:m',...:r-.:.. L"r:~.~_::t:l. I c""...A..
D ,. [i) Jrj. -.1!..916 .. 'I~ Car Gar ~rch/Bal~ lih. 0...
...oflll_
B e
l.........-..
.~ ''"!!!1.-.L_
"."."...
1-1
1"'''';-
RBld Report
...._"c-......."
~~m~
0..... __._... ...._._
"-. II "'..11
....0'.."'..,.""'1/100
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C......_,' II Jrj..,.."...
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C__. "....-.. ""....-....."".......,......1lIIII
3;'."': .>r.I~..I:fjnj'.h..Xiiih
........."'.._--..."..._._1.......... ........"'-PIC._"'.,.................,.......~_..""to.&IrM:,,._" -"'......C-...MIoN '.....""'.,..........._
...... -- ""."'.............."""""........... ............. ''''"I....'.. "" II.... c___... ............._,
. '--- J":: J ., // 1"""'"IlIIII..."...V.... 81.000 .'" March 8 ,.~
-"""'" 0, O. TJY _10, ~nlser
_I. ... - .7 "iL
A ESCRIPTIVE PHOTOGRAPHS OF SUBJECT PROPERTY AND STRHr SCENE
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('_....,tlt.
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a.o....lI('--..
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"-''''OC'..",J04II1..1
In
.
. . M8rket.Comp8reble~8JyaI3ipr'orTolmprovemenl
...1. I c..Z.
625 North Veat Street 512 North Veat Street
CAr'h" JA I CAr'h'. .PA
.1.J!lock
70S North lIeat
I c. r'h', _PA
152 A Street
"" ,..
L2.Jll<!cks
I. F.M.V_ It 79~ I, ~ I, Bl~
10~ ' , ..f<'
~ 9.15-94 .:.l2..:ll.
,v, H &l!O .Am/ .AV2 VRI .AVJl fl.g0C
'Ji0 -6J)./- .to./- ~./-
-3. .:..2., .QQQ.
~ Lo."..J.
..8._ J..Ll:..l..
-"'-'<-
LCent-Mr
[ 3_ c"r_Carue
2 Porchu
None
Jione
I Non.
.. ~
L -'t.-LZ..
.177 Joo.'
.l<ent-Alr
1 CA.l:...2AnaL
Porch
I Brick PAtIo
None
~2u~
.lL J.!
1Lt..... lJ,- I
- BOO ILL ...3_ -Ll . BOO
nnn ~ JU, ~~_50n
IiLOOO ~ _OICSt
+1,000 Porch +1,000 3 Porchea
~. F.n
None None
'Non. _Non,
1.70n~ ~'.lo 1.QQ1t
B~OO .l.! eo 200 ..1' e3.300
DQ.<1LtM
-""'- -'=....Lt..
-'- J
. BOO
I.'.onn
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UC'.""'*lIMr\t. 'lell UUIU'JlU
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nl~t\llI~Wt~\I;m m'I'f.~~S\'I.\'.\SI.\
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CASII, IIANI\ 1U:I'OSrrs ANI)
I\IISCELLAN.:O\lS
PERSONAL I'ROI'ERTY
ESTATE OF
Nora S. Lehman
m.E NUMBER
2t.9(,-414!'i9
(All property joinlly'-o\\nL'tl with Righi of Sun.imrship lIlusl be di!>l:loscd on Schcdulc F,)
ITEM
NUMBER
DESCRIPTIONS
VALliE AT DATE
OF DEATII
I.
2,
3.
4.
5,
C,.
7.
S.
9.
PNC Bank. Sa\'ing5 Accounl # 51.)1l35.31....
PNC Bank. Interest Checking Account # 51-1IlIS.71ll5
Fllnner's Trusl. Intcrest Checking Account # 716961l
Corncrstonc FedcrJI Credit Union. Savings Account # Il I
Cornerstonc Fcdcral Crcdit Union. Chccking Account # 117
Comcrslonc Fedcral Credit Union. Money" Markel. Accoont # IS
Thornllald HOlllc. Rcrund
UnitL'tl Church or Christ Homc. Rcfund
Cash on Person
$ I.S29.12
$ U47.11
$ 1.144,9S
$ ..S1.25
$ 3."S2,S4
$2S.925.SIl
$ 21lA'
$ 71ll,25
$ 5.79
TOTAL (Also cnlcr on line 5. Rccllpilulalionl
(If more .V'lICt.' i.\" IIL'L.t/t'tl. ;II,\'('rl mltliliwllIl ,,""t't't." of same .\-;:(.'.1
$)7.9"7,55
('-~
Ii ~.(' G
.
Form for Return of Information from Financial Institutions
Name of InstilUlion:
PNC BANK
Two PNC Plaza, 33rd Floor
Pittsburgh, PA 15222
Address:
Aeeount Number:
51-3035-3114
Account TilfclOwncr(s):
Melvin A. Lehman
Nom S. Lehman
Date Account Opened: 06/10/85 Datc Made Joint:
Amount in Account on 03'()2-96: S1.829.12
Inlerest Accrued room 1-01-96 10 03-02-96:
S7.38
Amount Withdrawn (If Closed):
N/A
N/A
Can be furnished by: PNC Bank, N.A.
To Whom Proceeds Paid: MJ Mall-South Hanover St., Carlisle,
,~Y{?~
Form for Return ofInformation from Financial Institutions
Date Closed:
(717) 243-6021
PA 17013
Dated:
8/1/96
Name or Institution:
PNC BANK
Two PNC Plaza, 33rd Floor
P;~t-C1:hl1""9h. D.ll. '5"""
Address:
Account Number:
51-1018-7105
Account TiUclOwner(s):
Melvin A. Lehman
Nom S. Lehman
Date Account Opened: 10/01/62
Dale Made Joint:
same
Amount in Accounl on 03-02-96: $1,347.11
Intcrest Accrued from 01-01-96 to 03'()2-96:
Amount Withdrawn (IrClosed): N/A
$2.91
Date Closed:
N/A
Can be furnished by: PNC Bank, N.A. (717) 258-3216
~ ~ut; :~~~!j SpE'iR!jS, PA 17007
ture Employee
1-800-762-1775 (#3)
To Whom Proceeds Paid:
Dated: Il/' /96
April 13, 1'3'36
FARMERSm
TRUST_
Shirley L Gilchrist
155 C Street
Carlisle, PA 17013
Re: Estate e,f Ne'ra S Lehrnar, SSN 201-18-3046
Date of Death: March 2, 1'3'36
Dear Ms. Gilchrist:
In answer to your request conCerning accounts owned, either
separately or jOiy,tly, by the above referenced deceder,t ar,d
the balance in each account as of the date of death, we have
checked our records and are sUbmitting the fOlloWing
iy,fe.rmatioy. iYI duplil::'ate. We suggest that yc.u file eorre e.f
these letters attached to the PennsYlvania Inventory forms
(RCCl to substantiate the balance you report.
Ne,te that we have showr, the correl::'t registratie.r, fe.r each
al::'Ce'Lly,t. Alse" ir,terest aCl::'rued to the date of death, if ar,y,
is listed as a separate figure.
Checking aCl::'Ount #716'360 was originally opened '3/1/67 or
before. The al::'l::'Ount was tit led jOi rlt betweey. Mel vi y, Lehrnar,
or Nora S Lehman. The balanl::'e as of 3/2/'36 was $1,143.58
plus $1.30 accrued interest for a total of $1,144.'38. The
aCl::'OLlYlt was earYlir.g 2. (10:( iy,terest at the tirne of death.
We have no record of a safe deposit box in the decedents
Ylarne.
Si y.cerely,
y, ~OYw\~Sr:;n1
Karer, Tornassoy,e
Customer Service Supervisor
~\-\estHighStreet P.OBox220 Carlisle.funnsylVania 170U (717)243-3212
i!j: It) '/ -/1
BUR..U OF INDIVIDUAL TAXES
IHltl:AIlAHC[ fAX DIVISION
DEPr. laual
HARRISBURC, Pi 171:1-0'01
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTtCE OF INHERITANCE TAX
APPRAISEMENT. ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
WILLIAM S DANIELS ESQ
STE 205
1 W HIGH ST
CARLISLE PA 17013
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
03-03-97
LEHMAN
03-02-96
21 96-0459
CUMBERLAND
101
ARDunt Rellltt.d
c
--
.n.lU'U'" IU'"I
NORA
S
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
iiE'v:Ei'4j-EX-AFP--ii'F9&Y"iioT"icE--OF--iNHEiiiiANCE-T"AX-')iPPiijiisEilEiiT~--Ai.DjwAiicE-oR--m___m__m-
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF LEHMAN NORA S FILE NO. 21 96-0459 ACN 101 DATE 03-03-97
TAX RETURN WAS: I X) ACCEPTED AS FILED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. R..l Eat.t. (Schadul. AJ
2. Stock. And Bond. ISchodul. Bl
3. Clos.ly Hald stock/Partnership Int.r..t (Schedul. C)
4. "arta.a../Hot.. Receivable (Schedul. OJ
S. C..h/Bank Deposita/Hilc. Parlonal Property (Schedule EJ
6. Jointly Owned Property (Schedul. f)
7. Transfare (Schedule G)
8. Total AI.at.
( ) CHANGED
11)
121
(Sl
(4)
151_
(61
17l
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expans../Ad.. CD.tl/Mlsc. Expans.. (Schedule H)
10. Dabts/Hortgaga Liabiliti.s/Llana (Schedul. Il
11. Total Daductions
12. Het Velua of Tax Return
13. Charitable/Govarnnantal aaquast. ISchadule J)
14. Net Value of Estate Subject to Tax
(9)
110)
27.000.00
.00
.00
80.200.00
37,947.55
.00
.00
181
15,759.07
2.817.53
1111
112)
lIS1
1141
NOTE: To insure proper
credit to your account,
sub.it the upper portion
of this for_ with your
tax paYllant.
145.147.55
lR.1;76 60
126,570.95
.00
126.570.95
NOTE:
14, 15 and/or 16, 17 and 18 will
ruturns assussud to datu.
If an assussmunt was issuud pruviously, linus
ruflect figurus that includu thu total of ALL
ASSESSMENT OF TAX:
15. Anount of Lina 14 at Spousal rate 115)
16. Anount of LIne 14 taxable at LIneal/Clas. A rate (16)
17. A.ount of Lina 14 taxable at Coll.teral/Class 8 rat. 117)
18. PrIncipel Tax Due
TAX CREDITS:
PAYMENT
DATE
12-02-96
RECEIPT
NUMBER
AA146996
DISCOUNT 1+)
INTEREST 1- I
.00
.00 X .00=
126,570.95 X .06=
.00 X .15=
1181
AMOUNT PAID
7,594.26
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN,
TOTAL DUE
.00
7.594.26
.00
7.594.26
7,594.26
.00
.00
.00
. IF PAID AFTER DATE INDICATED. SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
IF TOTAL DUE IS LESS THAN tl, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRl. YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. I
N
I.'.,
.-r
'.l.
-,
, .
~::-
~
r;;
,-
..
,-
:)'\
2:5
uu
a:
RESERVATION. Eltat.. 0' decedent, dyIng on or be'ar. Dec'~r 12, .911 -. If any future Inter..t In the ..tet. I, trentflrrld
In po.....lon at enJo~t to Cl... a (ca1la',rel) beneflclarl.. of the decedent .ft,r the Ixplr.tlon 0' any ..tat. for
11'. or 'or Y"t., the Coa.onw.alth her.by Ixpr..,lv ta..tv.. the rlDht to appral.. and ...... tran.f.r Inheritance Tax..
at the lawful Cl... a (collet,r.l) rat. on any such future lnt.r..t.
PURPOsE Of
HOflCEr
To fulfill the reqult..,nt, of SectIon 2140 of the Inheritance Bnd Elt,t, r.x Act, Act ZI of 1991. 72 P.S.
Section ZUO.
PAVHEHTt
~t8Ch the top portion 0' this Notlel IInd lubIIlt with your ply.."t to the RIght,r of Wllh printed on the rav.,... lid,.
.-Hak. cMck or toney ord.r payable tor REGISTER OF HILLS" AGENT
All pa,.."h receJved shaU first b, appUed to any Intl,.ut whIch lIay b. due with any uaalnde" eppl1ld to the tax.
REFUND (CRh A ref~ of a tax c"adit, which Will not raque.t~ on the Tu A.turn, aay be uqu..ted by co.I.Ung an "&PPl1c.Uon
for R.fund of Penn'Ylvanla Inherltanc. and E.tata Tax" (REY.I]I]). Application. are avallabl. at the Offlc.
of the Aeal.t.r of Will., any of the 23 Aavanua OI.t"lct Off Ie.., or by calling the .paclal 24.hou"
an....rlng .e"vlc. nuab.r. for :or.. orda"lng: In Penn.ylvanla 1-800.]62.2050, out,'d. Penn'Ylvanla and
within loea!. H8rrhburg a"a. (7:7) 787-8094, TOO. (717) 77Z.Z2SZ (Haa"lng lapalrad Only).
OBJECTIDHSa Any part~ In Intar..t not .atllfl.d with the appral.aaant, allowanc. or dllallowanc. of d.ductlon., or a..a..a."t
of ta. (11 eluding dhcOIIIt or liI""a.tJ .. Iho"," on thl. HoUca ault objact within .bty (60) dau of rac.lpt of
thh NoUcl. bYf
AIlIIIN
ISTRATIVE
CORRECTIOHSI
--wdtt." prota.t to the PA Dapa"t.ant of A.vw.u., Boa"d of App.als, Dapt. 281021, Harr1lburg, PA 171U"1021, OR
--alactlon to hava the aatt.r d.ta"alnad at eudlt of the account of the p.r.onal r.p"..antatlva, OR
.-~al to the Orphall.' Court.
Factual arror. dllcovar.d on thl. a..a.saant should b. add".s.ad In writing to: PA Dapa"t.ant of A.venue,
Bur.au of IndivIdual Taxal, ATTN, Po.t As.a'laant A.vlaw unit, D.pt. 280601, Harrl.burg, PA 17128-0601
Phone (717) 787.6505. Sa. paga S of the bo~lat "In.trucUons 'A" Inhe"ltanc. TalC R.turn 'or a A..ldent
Decedent.. (REY-ISOI) for an axplanatlon 0' adalnl.tratlv.ly correctabla arror..
DISCOUfTa
If any ta. due Is paid within th"a. (]) calandlr aooth. aft.r the dacadent'. d.ath, . 'Iv. parcant CSX1 dl.count 0'
the ta. p.ld II allow.d.
PENALTYI
The ISX t.. aanasty non.partlclp.tlon penalty I. coaput.d on the total of the t.x and Int.r.lt .I'all~, and not
p.ld b.fo". January 18, 1996, the flr.t day .ftl" th. .nd of the tax aan.lty parlod. Thl. non-participation
p~lty I. .ppealabl. In the .... aannar and In the the .... tl.. p.rlod a. YOU would app..1 the tax and Intar..t
thet ha. bean .......d a. Indlcatad on thl. notlc..
INTEREST I
Inter..t 11 charged baglnnlng with first day of d.llnqu.ncy, or nine (9) aonth. and OM (11 day fr08 the data of
d.ath, to the data of payaent. Tax.s which bee..a d.llnquent b.for. January I, 1982 baar Int.r..t at the rata of
Ilx (6X) pa"eant par artnuII calculated at a dally rata of .000164. All tax.. which bac... d.Unquant on and aftar
Janu.ry I, 1982 will b.ar Int.r..t at a rata which will vary fro. cal.nda" yaa" to calanda" y.a" with that rata
announcad by the PA c.part.ant of Ravenue. Th. appllcabl. Int.".st rata. fa" 1982 th"ough 1997 ara:
!!!! Intl"..t Aat. Dally Inta"..t Facto" !!!! Inta"..t !fat. Dally Int."..t Facto"
19A1 lOX .000548 1987 'X .000247
198) lOX .0004111 1988.1991 IIX .0003D1
1914 IIX .000301 1992 'X .0002,.7
1985 UX .000356 199].1994 1X .000192
1916 lOX .oaaZ74 1995.1991 OX .000247
ulnt.ratt 1. calculat.d .. 'ollow'l
INTEREST . BALANCE OF' TAX UNPAID X NUN8ER OF' DAYS DELINQUENT X DAILY INTEREST F'ACTDR
--Any Hotlea luued .ft." the hx baco... dellr\ClUWtt will refl.ct an Int.".u c.lcul.tlon to 'Iftaan US) days
beyond the data of the .I.....ant. If payaant I. .ad. afta" the Int.ra.t coaput.tlon data ~ on the
Notice, additional Inta"a.. IN.t ba celcuht~.
E.q'l'l\'I'.E _!>J;:T'I'I.EM E.NT. A(1.1lEEMENT .TO I NlJEMNI f'X.,.
R),;~[,:JI''I'_Mm REI,EI\SE
THIS AGREEMENT by and between Shi~ley L. Gilchrist of 155
"c" StrE'et and Douglas W. LE'hman, o[ 705 Norlh WE'st Street both
of CarlislE', Cumberland County, Pennsylvania 17013, individually
and as Administrators of thE' EstatE' of Nora S. Lehman, DeceasE'd;
DE'nnis W. LE'hman of 705 ClevE'land AvenuE', Ashland, ohio 44895;
and WE'ndell B. LE'hman of 1752 East Lombard SrE'E't, BaltimorE',
Maryland 21231,
WHEREAS, Nora S. LE'hman, who residE'd in thE' Borough of
CarlislE', CumbE'rland County, PE'nnsylvania, at Thornwald HomE',
died March 2, 1996, without lE'aving a last will and testamE'nt.
Having died intE'statE', a PE'tition for LE'tters of Administration
with rE'nunciations by sons, DE'nnis W. LE'hman, and WE'ndE'11 B.
LE'hman, in favor of daughtE'r, ShirlE'Y L. Gilchrist, and son,
Douglas W. LE'hman, was filed on May 30, 1996 with thE' RE'gister of
Wills of CumbE'rland County, PE'nnsylvania.
WHEREAS, ShirlE'Y L. Gilchrist and Douglas W. Lehman were
duly appointed as Administrators of thE' EstatE' of Nora S. LE'hman,
DE'cE'ased, on June 11, 1996, and such letters of administration
filed to Estate No. 2196-0459 rE'main in full forcE' and effect;
WHEREAS, the parties in intE'rest undE'r intestatE' succession
of Nora S. Lehman, DecE'ased, are:
(1) ShirlE'Y L. Gilchrist,
(2) Douglas W. Lehman,
(3) Dennis W. Lehman, and
(4) Wendell B. Lehman;
WHEREAS, each of the above identified parties in interest
are entitled to equal distributive shares of the nel residuary
estate;
WHEREAS, each of the parties to this Agreement has been
furnished with a complete listing of the estate assets, receipts
and disbursements as set forth in the Pennsylvania Inheritance
Tax Return, accepted by the Department of Revenue as filed,
attached hereto and marked as Exhibit "A"; and in the Informal
First and Final Account summarization attached hereto and marked
as Exhibit "B;"
WHEREAS, it is the desire of the parties to this Agreement
that final distribution of this estate be accomplished without a
formal accounting to the Orphans' Court Division of the Court of
Common Pleas of Cumberland County, it being the desire of the
parties to avoid the expense, delay and publicity of a formal
accounting;
WHEREAS, the parties to this Agreement each acknowledge to
having received a Schedule of Distribution included within
Exhibit "B," attached hereto; and
WHEREAS, each of the parties to this Agreement does
acknowledge having received from the Administrators the
distributive gifts set forth in said Exhibit "B."
NOW THEREFORE WITNESSETH, in consideration of the mutual
promises, covenants and agreements recited herein the parties do
2
agree as follows:
1. Each party does hereby acknowledge receipt of the
gifts described as distributions of principal and interest shown
in said Exhibit "B" hereto.
2. Each party does hereby waive the filing of a formal
First and Final Account and Schedule of Distribution.
3. Each party to this Agreement does hereby release
and forever discharge Shirley L. Gilchrist and Douglas W. Lehman
from any and all liability which may from time to time arise in
connection with their services as Administrators of the Estate of
Nora S. Lehman, Deceased; and the parties do further agree to
indemnify and hold harmless said Shirley L. Gilchrist and Douglas
W. Lehman, Administrators, from any and all liability which may
arise against the estate from creditors or other claimants.
4. Each party does hereby agree to be jointly and
severally liable for any proper liabilities of the estate which
should hereafter come to the attention of the Administrators or
any of the other parties hereto.
5. Each party to lhis Agreement acknowledges that this
Agreement may be executed in multiple counterparts and one shall
be indexed and recorded in the estate proceedings; and that the
terms hereof shall be binding upon all parties, their respective
heirs, successors, administrators and assigns.
This Agreement shall be governed by the laws of the
Commonwealth of Pennsylvania.
IN WITNESS WHEREOF, the parties have hereunto set their
3
-'r:' ,
. ....".' .-,
,,^ ..,.... ./-..1.1
.
hands and seals with intent to be legally
bound, dated at
, 8"
.'-(';":'/A", 191. '
Carlisle, Pennsylvania this (~
day of
WITNESS:
Shirley L. Gilchrist, individually
and as Administrator of the Estate
of Nora S. Lehman, Deceased
Douglas W. Lehman, individually and
and Administrator of the Estate of
Nora S. Lehman, Deceased
Dennis W. Lehman
fJ4~
Wendell B. Lehman
(/
COMMONWEALTH OF PENNSYLVANIA:
COUNTY OF CUMBERLAND
SS.
On this day of , 1997, before me, the
undersigned officer, personally appeared Shirley L. Gilchrist and
Douglas W. Lehman, who declared the foregoing Estate Settlement
Agreement to be their true act and deed, and desired that the
same might be recorded as such.
IN WITNESS WHEREOF, I have hereunto set my hand and seal the
day and year first above written.
Notary Public
4
CUMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BURE.\U Of IIHVWIAl TAXES
IHtltRllAHCE 'A~ Dlvl~ION
D[P1. 210'01
ItARRI~'UR:, ~I !/UI'ObOI
/-~
NOTICE OF INHERITANCE TAX
APP~^ISEHENT, AllDWAN~E DR DISAllDW^~CE
Dr DEDUCTIONS AND ASSESSHENT OF TAX
DATE
ESTPTE OF
DATI:; OF DEATH
FILE NUMBER
COUNTY
ACN
EXIIIIlI'I' "^"
WILLIAM S DANIELS ESQ
STE 205
1 W IlIGH ST
CA~LiSLE PA 17013
03-03-97
LEHMAN
03-02-96
21 96-.0459
CUMBERLAND
101
Anount Ren! thd
-*
'1f.I'U lI'" 1I,.tU
NORA
S
MAKE CHECK PAYABLE AND REMlT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HDUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS .....
----------------------------------------------------------------------------------------------------------------
:::..... l:~"; :}.; .~";:r ::.:: ~(" ::~T~~F: or- ~:;:i::n:TAt~C:: 'r:.^ :'r:"':-:"I=::;'~i.::,;", h:":"O~A~:~~ m~
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF LEHMAN NORA S FILE NO. 21 96-0459 ACN 101 DATE 03-03-97
If an assessmEnt was 1ssued preV10uslY, 11nes 14, l!; and/or Ib, 17 and 111 W1~~
reflect figures that include tho total of abh roturns assessed to date.
ASSESSMENT OF TAX:
15. AMount of Line 14 at Spousal rat. (15)
16. Anount of Line 14 t~x.bl. at Lin..I/el.le A rat. (16)
17. A.ount of llno 14 to.oblo ot Collot.rol/Cloll B r.to (17)
18. PrincIpal Tax Due
TAX CREDITS:
PAYHENT
DATE
12-02-96
TAX RETURN WAS: I X I ACCEPTED AS FILED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. R..I Eltot. ISch.dul. Al
2. Stockl and Bonds (Schldull B)
~. Clos.ly H.ld Stock/Partnlrship Int.rlst (Schedule CJ
4. Hortglg../Hotl. Rlclivlbl. (Schedule D)
S. CI.h/Blnk DIPosits/Hisc. Parsonll Property (Schldull E)
6. Jointly Own.d Property (Schldule F)
7. Tran.flr. (Schldule C)
8. Totll ...".t.
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funerll EXPlnsls/Ad~. Costs/Misc. Explnsl. (Schedull H)
10. Dlbtl/Hortgagl Liabilities/Liens (S~h.dull I)
11. Total Dlduction.
12. Nit Valul of Tlx Return
13. Charitabll/Covlrnn.ntll Blqul.t. (Schldule J)
14. Nit VIlue of Est.tl Subjlct to Tlx
NOTE:
RECEIPT
NUHBER
AA146996
DISCOUNT
INTEREST
1'1
(-I
.00
III
121
(3),
141_
151
161
171
191_
C1P~
CHANGED
27,000.00
.00
.00
80.200.00.
37,947.55
~
.00
181
lS./59.0"
il.817.53
Ill)
1121
1131
1141
.00 X .00=
126,570.95 X .06=
.00 X .15=
1181
AHDUNT PAID
7.594.26
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
NOTE: To inlure proper
crldit to your ',.a~ount,
subnlt the UPPII' portion
of this forn with your
tax plynent.
145,147.&
1 R. Ei7i\ 6D
126.570.95
.00
126,570.95
.00
7,594.26
.00
7,594.26
EXHIBIT "A"
7.594.26
.00
.00
.00
. IF PAID AFTER DATE INDICATED. SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
IF TOTAL DUE IS LESS THAN .1. NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRI, YOU HAY BE DUE
. ..__...... ...._ .............. ....... .... "I'." .....n... .....D .'II'TDII"TTnu~ ,
EXHIBIT "B"
ADJUSTED
principal Receipts
INH.TAX
~ETURN
$145,147.55 $145,238.91
(1)
12,107,91
(2)
1,747.71
(3)
1.59.094.53
Life Insurance Proceeds
Income Earned
Total A_sset!;l_
18,576.60 19,552.09
(4)(5)(6)
Less Disbursements
Inheritance Tax Payment
7,594.26 7,594.26
48.94
27,195.29
PA Fiduciary Income Tax Paid
Total Liabilities
N~~ ~:~tributable Estate
131,899.24
140.97
(7 )
$132,040.21
plus correction to reconcile Account
Total Sum for Distibution
Distributions to Beneficiaries
SMrlel Dougii5 :~::.:s :,/....~,
Casb 1,000 21,000 21,000
Lile Ins 1,50\.15 1,50\.15 1.501.15 1,501.15
Lile 1115 1,525.82 1.125.11 l,m.ll 1,125.81
cash 1,500 1,500 1,500 1.500
In.~ind 21 ,000 20,050
Final 1,l8l.0! 1.433.01 1,411.01 l,m,01
Total 13,010.06 13,010.05 13,010.05 11,010.05 WM~2~
EXHIBIT "B"
FOOTNOT~S.:
(1) Proration property tax to Estate
(2) Life Insurance proceeds (non-taxable)
(3) Forms 1099 total accountable
(4) Add'l property taxes plus proration
to Shirley
(5) Harke:. second installment
(6) Reserve, less filing cost for Agreement
($17), unused
(7) Difference between cash balance on hand
and estate credits and charges
EXHIBIT "B"
$ 91. 36
12,107.91
1,747.71
752.49
366.00
-143.00
+140.97
EXHIBIT "B"
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STATUS REPORT UNDER RULE 6.12
Name of Decedent: /\/Od /"j
Date of Death: ? - 2- - ?(.
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Will No.
'- ')' /6 <,,/&'1--7/1/
/
Admin. No. 2/ '1G. - Ci'<'/S-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 No ~
2. If the answer Is No,
representative reasonab~ believes
complete:r - ,'10- 7'
state when the personal
that the administration will be
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 No
b. The sera ra te Orphans' Court No. (i f 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 attache to this report.
Date: Lf - 2>1- Cj r:f-
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Signature
~ '. S, lfl.-7.?v'/6c-:5
Name (Please type .or print)
cd. 4!;~ S'7.
C>Jld'-r.r 6, ~/ /7<7/.J
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( 711) ;1-''/.3 - :;l F 3/
Te 1. No.
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Address
Capacity:
Personal Representative
I~unsel for personal
representative
(MAH: rmf/ AM3)