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PETITION n>H PlwnATE IInd (;HANT OF LETTEI{S
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Ymll pl'liliOlH.'It\), \\ho j.../all.,' IS Yl'al' \,1' "pl' Of ollie! iltllhl' \.'\l'1.:t11 ~h,t\lc,.~L" tJi.\._'.J_"_.J___ named
inlh~ la'l \\ill of III<' a\1o,,' ,Ie"',lenl, <Ial~<I. _ 1 , "....." _I. ...,._........ ,_. II)_';!.~L
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(:'.......1'1 <1' follo\\\, dCl.:edenl did nul marry. "ill" nut {.Ii\'nn..:ed \lml did nut ha\'c a child born or adopted
aflt:r .."t:cutiun uf th... will uffereu rur prohate: W<.l!'\ nul the \klim ur it killing. and Wt.1\ never adjudicated
in~omp~l~nl: ~'I-'l/L\__--._-_.._-'---~' -,~..
Decl.'mkllt al dea1h owned property \\ilh c'1imalcd \'aluc' a' follnw..:
(If d",,,idled in I'a.) Allp~N",,,lprop~r1Y
(If not domidkd in Pa.) Pep,unal pruperty in Penn,yl\'aniu
(II nl11 ,Iomi~iled ill 1'",) I'~"''''al prop~r1Y in COIlIllY
\'ahll' ~lr I'l'al ,-,'Ial\.' in Pcnll\\'I\'ania
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OATH OF PEnSONAL REPRESENTATIVE
CO:\IMO:'l!WEAl.TII 0... l'Ei'i:'l!S\'l.\' ANIA !. s:-;
cOt\T\' o.....uG..U]1BERLANO J
11u: pctilinlU.'I('1 ahl1H'-llallll'U \\\l'jut...) ur arnl'nu"'} Ihal thc ..lat....l1\cl\" in lhc forcgoing petition arc
Irw,,' .1I1d ~lllH..~t IUlhe hl"1 01' Ih.... J..lHmkdgc ami hdief of pt:litiul\I.:r(\} and that 01\ pcr\ollal rcprc~cn.
tatiH'blllf till,' ah~"l.' dl,.'Cl'(k'nt pctithmcl(") "ill \\l'1I allll truly .Illmini\t....r tll... C,WIC according. lola\\'.
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M.(l.RV C LEWIS Ik~i,~,F X1
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N ;> 1 - 96 - 761
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Estate 01'
DORIS WOODRUFF afk/a DORIS MAInE THOMAS . Dcccascd
DECIU:E 01' l)nOnATE AND GnANT 01' LETTERS
AND NOW OCTOBER 2. 19~, in consideration of the pelillon on
the reverse side hercof, satisfactory proof hll\'ing been prc,entcd beforc me,
IT IS DECREED thallhe inMrnmenl(s) dlllcd MAY 1, 19B7
dcscribed Ihereln bc admilted 10 prob:llc and tiled of record liS Ihe la'l will of
DORIS WOODRUFF a/kfa DORIS MARIE THOMAS
TESTAN'ENTARY
SHIRLEY ROBBINS BASS
IInd lCllers
are hcreby granted to
fJt~.
MARY C. LEWIS
FEES
Probllle, Lellcrs, Etc. .........
Short Certificates! 3) . . . . . . . ., .
Renunciatioll ................
X-Page
JCP
$ ;>5.00
$---9....oD-
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s 3,00
TOTAL _ s-J.:28-
. . . . .OCTOBER. 2., .1996 . ... . . ... . . .
ATTOKNEl' (Sur. Cr. I.D. No.1
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Mailed letters and order to Executrix on 10-2-96.
PAIlENTS
DEHNR 1112
(Rlvt..dS1t4
Rlvlew2lt7)
VITAL RECORDS
SEAlJ
UOfIIlI r:^"0l1t1~ ou'^nIM[tn or [UIJIROUMftll,llr.Allll. AIm ,lAftJ"^lllr.r.ollHC[S
fUM[ cnlltl1 ron IILAl1I1Afln WVII10tlMrt"^l ~'AIl511C!O - VlT"ll4[CQllDS !.[CIIOfI
CERTIFICATE OF DEATIl
ncgl,I,nlloll 0 33 - 7 0
Dlstrlcl No. toe.lllo.
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1:0 '1'11 .Itllh, "f.l'"
September ~, 1996
J l; ;11M VI llll"lI. M,'., ."
Doriu Mario 'l'homau
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..."~.. ;''''6/20/31
trurTDTiTj'i:i"c
NC
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-r,ouArtrwmm;m;mr
L: '/(,;Wfltyl
otr""''lI"Crnmlry)
'.WiJ.son Co.
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J.nr::ti"tfli:iitJ'iY _ mt:nI
t~...t1J 65 MUIlU"
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50.
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,241-52-2027
WAS utCr.ll[lU H'l.I1Ul
AI1MCUN6CCS1 ft.. ct No)}
.. 1.1 [RlCMllllllnt U 00" OIum 1I Uunlnollome (] nnldlllK'
'A<.;llll....UA {/ t.:ll'1',IO'M',Olll . :ill-CI I
lb. Columbia lIeritage 1I0spit \,1. 'l'arboro ~~~"'M>'Yes
I .till', .", OJ I ..-j .',g"""" I"n'''.'(; a C I (IY' WOf
M,lIIt.d, WdOMd, Ouotud fS,..c~, don. dunnQ nil" oIll1i","llI '01, {lo "'l' III' ,.fr,.d)
to. Divorced \I. '" assemb worKer
1::;1 ., ._ l,;UU LI Y, .0 10 .. I.' , UU
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L1 Oth., (Spwf.",
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... Edgecombe
Il.I . '51\
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".J rui t dealer
n,. PA ...Cumberlanc n, Ht. 11011
s.I .(; I c,; It .tI .,,1 IIP.me 'lI'" f"" ""'"
(YuOINo) No-I!.t". ~{i~cub.1I, Irl'IIc'1\ ",,-,foR/nil,
Yes 17065 .kIUV" N""S"'''~}
n.. IS!, '4.
tiE rs ~ fl'.st .. odd~. hI!)
If. William Howell Thomas
IW-UfIIMW'S rIA E "yr' 'rnt1J
Shirley Bass
tI..
n~ 324 Chesnut st., Apt.
""'lIun n I,n, urClUlUI S lOUCAlI0U,Sp.ctlyOfllyhlghfl.,,,,.d.
DI.ck, 'MIll., tic (~l'rc""J cotrflMltd) rwrren'.ry&cond.tyjt).';J con.".",.".}
White Otn
15. n.
U II. 151<<A Ell Nst Iddl., ,Id'rt Sum.me]
Ruby Elizabeth Ellis
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lLlIlO AWH 55, n.I.na NvtttM' Of Run' UOU/fI Numb,r, (;/1')' Of rMII, .sr"., I' COO,
P. O. Box 204 Macclesfield, NC 2705
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lI.pproprlal., tnw,klCIltco..kotlot, or drugu'l Lblonlt onlUUUon Ilth~. fl'RJNror rYF'Q
PIlMEDIATE CAUSE ---+ /J Q
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5.qu.nbfthlcontUIonI b 6~'1 'C..,...J:t. Ji,uu<,
l.ny,lt.dlnllkJ'm,.dIl1lt llUE10(OAA ,
,IUI. Enle' UtlOERL VIHO
CAUSE (Olsu" 01 'iury
ltlalk\1II1,dlY,nl.
IfllI....I~duIhILAST.
IIUIIJCllIlnp" ",'I""ot Qt...I' rl.
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I. U\hef Ilgndlunl COnd,tlOtll conlll ling to dealh no',eaullmg n II undll 1 nil calla. glnn In 'art, auch ..lobacco, a CO, 01 NO ua.; la Iln, Itc.
2Db.
Oi:J<ib1fYUOINo 11e',Wl!1I tndlOg.tonaidfled nd,lelfl'lnWlgcauII U I ..caal"'''' 10 ,dltal larno" CruOl 0
21a. 21b. 21e. 22. M
NO ICE: 5 AI WIlEQUlUl;5 IlAl^llUtA USOUl: 0 HAU ,tCIUE.N ,tto IClUE,5UIClUE,on UNUt;" SUSPlClOUS, NUSUA ,onUNt4^lUI CI CU tiC
DE REPonTED 10, 1.110 CERTIFIED OY A MEDICAL EXAMltlER ON A MEDICAL EXAMINER'S CERTIFlCA TEOF OEA TH Am DEAtH rAlUNQ ItlTOtUESE CATEGORIES ISWTlI
tUE MEDICAL EXAMI Efrs CTlON REe1^nDlESS OF ntE lEUatu OF SURVIVAL FOllO'MtlO lUE UUOERlYINO INJURY.
SlUt UU: NO II .OfC UIHI t
PA, Tarboro,
NC 27006
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Ii uoo OF UtS SIIIUIf CIi Of $POSI lot (Nan'l' of un.',ry, t:1I1!'lll1oty. 01 olhfl loeA lut CIty Qt own, Sial.. lp ~od.
D~I,' 01>,...1100 On."",.., p'''') stantonsburg Cemetery Stantonsburg (wilsonl,
25a. fJ [)on'linn 0 Oth.., 2!lb. 2!le. 278 3
IlAM~~h~r:;~'ss~Y~l~~~'t~n, POBx3932, Wilson 1:!Ut'f))i'~o'L~"'~\r.l't'RTeford
2&.1. 2Sb.
I ;G15 ..,) Of U
George W. Rouse
2Cd.
NC
2Gc.
LICENsE tlUMUI;;.H
2081
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to certify that the
same as recorded in
foregoing DEATII CERTIFICATE is a true and correct
the office of the Register of Deeds of Edgecombe
S..;;/, i.~ ,
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This is
copy of
County.
Witness my hand and official seal, this the
19...:&.
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dsy of
Gladys c.~elt7n, Register o~;~eds of Edgecombe County.
By: I J .~JVf-'IL - tt It-t,,.,,, ,"'/''''''/----
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Deputy/^~tant
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NORTH CAROLINA
WILSON COUNTY
I, DORIS WOODRUFF, of the County of Wilson and State of North Carolina, do
hereby revoke all former Wills and Codicils heretofore made by me and do hereby
make, publish and declare this my Last Will and Testament in manner and form as
follows:
Item One
I direct my Executrix hereinafter named to pay all of my just debts and funeral
expensea and to erect at my grave such monument as she may deem proper.
Item Two
I will, devise and bequeath unto my grandchildren the sum of Two Thouaand
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Dollara ($2,000.00) each upon the fOllowing conditions: I direct my Executrix to
pay said sum to each of my grandchildren at the time of my death unless said grand-
child has not graduated from high school. In the event the grandchild has not
graduated from high school, I direct my Executrix to set up and pay the $2,000.00
bequest into an intereat bearing insured savings account for their benefit to be
delivered to said grandchild at the time of graduation from high school.
Item Three
I bequeath unto my son, William Glenn Robbins, my diamond solitaire ring.
Item Four
I bequeath unto my daughters, Patricia Dianne Woodruff and Shirley Robbins Bass,
all of my personal clothing, jewelry, and other personal items, share and share
alike.
Item Five
All the rest and residue of my property of every Sort, kind and description,
both real and personal, I will, devise and bequeath unto my children, absolutely and
in fee simple, share and share alike.
Item Six
I hereby nominate, constitute and appoint Shirley Robbins Bass, my daughter, the
Executrix of this my Last Will and Testament, and direct that she should be allowed
to serve without bond.
IN TESTIMONY WHEREOF, I the said
.J'r
to this instrument this I; day of
DORIS WOODRUFF, the Testatrix,
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sign my name
, 1987, and being first dUly sworn,
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or
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do hereby declare to the undersigned authority that I sign it willingly, that I
execute it as my free and voluntary act for the purposes therein expressed, and that
I am eighteen years of nge or older, of sound mind, and under no constraint or undue
influence.
m~/A_~RIS ~:;:;fW (SEAL)
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~C.; o4/~~ (1.. 01--u.<... ,/"': {( -fa-vt~:"'" Q'L' ,and
~A:.. e:. J:-:;t~c.,..v'- , the witnesses, sign our name to .tn1s instrument being
first duly sworn, and do hereby declare to the undersigned authority that the Texta-
trix signs and executes this instrument as her last Will and that she signs it
Willingly and that each of us, in the presence and hearing of the Testatrix, hereby
signs this Will as witness to the Testatrix's signing, and that to the best of our
knowledge the Testatrix is eighteen years of age or older, of sound mind, and under
no constraint or undue influence.
;~,? '--f .....1~/::::::, of Wilson, NC
of Wilson, NC
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,
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of Wilson, NC
NORTH CAROLINA
WILSON COUNTY
Subscribed, sworn to and acknowledged before me by DORIS WOODRUFF, the Testatrix,
and subscribed and sworn to before me by 4/.:';/";-<- C. -a-1-U;. ,-fd.
and /'!.t.T/ r. 4un<- ,witnesses, this /~' day of
~M~~ C:.
'/
?71A'J
, 1987.
cS~~~. ~J/ A1~
Notary Public
My Commission Expires:
I~bf/;>O
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CERTIFICATION OF NOTICE UNDER HIJJ,~; 5.6 ( ill.
Name of Decedent: Doris \~oodruff MK/A Doris No.1rie Thomas
Date of Death: Sentember 9. 1996
Will No, 1996-00761
Admin. No. PA No. 2196-0761
To the Registerl
I certify that notice of beneficial interest required by
Rule 5.6(a) of the Orphans' Court Hules was served on or mailed to
the following beneficiaries of the above-captioned estate on
October 30. 1996
~
Dianne Robbins \~oodruff
Address
4237 Yeaton Glen Circle, Win~ton-S~lpmJ N C. 27107-370
C/O Dianne Robbins Woodruff Address same as above)
104 \~att St., Nt. Holly Springs. Pa. 27065
P. o. Box 284, ~~cclesfield, N. C. 27852
William Glenn Robbins
Joseph Glenn Robbins
Notice has now been given to all persons entitled thereto under
Rule 5.6(a) except
Date: October 30, 1996
J6A ~ 10. "" 1L~Q:)n.n.l))
Signature U'
Name
Shirley Robbins Bass, Executrix
Address P. O. Box 284
N
f
Nacclesfield, N. C. 27852
Telephone ( 91fl 827-4530
0'
I
X Personal Representative
Capacity:
(J()
Counsel for personal
representative
REV. UOO (lit l' Q.al
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I ':J I J- S' - r
INHERITANCE TAX RETURN
RESIDENT DECEDENT
(TO BE FILED IN DUPLICATE
WITH REGISTER OF WILLS)
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fOR OATl5 Of OIAIH AnlR 12/31191 CHICK HIRI
If A SPOUSAL .
POVERty CRlOnlS CLAIMIO I I
fill NUMB<~ /
COUN'Y CODE
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YEAR
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NUMBER
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COMMOUW(AllH 0' PrNN5VlVAUIA
DEPARTMENT Of REVUWE
DEPT '80bOl
tlAARI51URG. PA 11U80bO~
OIClOlNT!! UAMlI1A!!1. fll!!l. At~O Ml00lllrflllMl I \r. \ ,~; >.J. jf I'}~' J-
oT IIQfrL~~1r:D9_~'\'.s--~ :'r:1V~-'-'''I!J'-\L
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IJIUOfUl!! COMrllTl AOOlt!!!!
.3~'f Che.::n f)u.:f- ~I-. Qpt.;
M-f.. Ho~ .spR.\'-J:;rsI,-fA li(JIoS
CO""'f c.....mbe.Jl../o.I\d... --.--.---
AMouuT Ill(IIVlO I~(f 1t.~T~uC110tlSl
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r -1 3 Remainder Return
- (lor dale' of death prior to 12-13.821
[] 5. Federal E\late To. Relurn Required
II 2
Supple menial Relurn
fB'1. Original Relurn
o 4. limited E,'ote [J 40. future Intere,t Compromi,e
(far dote, of death aher 12.12.82)
~. Decedent Died Te,lole [J 7. Decedent Mainlained a living Trust
(Allach copy of Willi (AlIach copy of Trusl)
ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO.
--------_.~~_._- .
_ 8. Total Number of Safe Depo,it Bo-.8'
NAM(
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nU'HON( NUMI(fI
At" )~~".<f5&.>CH)lqlq) &A"'~1:I<:l2>(W
(OMPL(t( MAILltlQ AOOfllSS
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MQ.cde..:s 1='1 c..L'"D ,N 1:... ';"'8s;.1...~
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If line 19 i, greater lhan line 18. enter the difference on line 20. Thi, i, the OVERPAYMENT.
a D.III:?:r:1~iI'H,.I"TI'I'.'I(-.'.I.I",ltllll~...(.Irrr.r:~"TI.III..'\'''>IJ~.~..T.I'1
II line 18 is greater than line 19, enter the difference an line 21. Thi' i, lhe TAX DUE.
A. Enter the intere,t on the balance due an line 21A.
B. Enter Ihe tatol of line 21 and 21A on line 21B. Thi, i, Ihe BALANCE DUE.
Make Check Payable to: R.glst.r of Will,. ~!J.!nl
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1. Real Eslale (Schedule A)
2. Slacks and Bond. (Schedule BI
3. Clo"ly Held Stock/Partnership Inlere" (Schedule q
4. Morlgage' and Nale' Receivable (Schedule 01
S. Cash, Bank Depo,it' & Mi"eUoneou' Personal Property
(Schedule EI
6. Jointly Owned Property (Schedule f)
7. Tran.fe" (Schedule G) (Schedule l)
B. Talol Gran Aueh (totallin" 1.7)
9. Funeral EJltpen,e,_ Adminidrotive Co"'. Mi"eUaneou,
E.pen,e, (Schedule H)
10. Debt,_ Morlgoge liabililie,. liens (Schedule I)
11. Tolol Deduction, (total line, 9 & 10)
Net Value of Estate lline 8 minu, line 11)
Charitable and Governmental Beque'h (Schedule JI
Net Value Subjeclta To. (line 12 minu' line '3)
Spou,al Tran,fen (for date, 01 death aher 6.30.941
See Instruction, lor Applicable Percentage on Revene
Side. (Include yalues ham Schedule K ar Schedule M.)
Amount 01 line 14 taxable 01 6% rote
(Include values from Schedule K or Schedule M.l
Amount of line 14 taxable at 15% role
(Include yalues from Schedule K or Schedule M,)
Principal tax due IAdd to. horn line, '5. 16 and 17.)
Credit' Spou,al Poyerty Credil Prior Payment'
12.
13.
14.
15.
16.
17.
%
co
;: lB.
e
... 19.
::>
...
:E
co
U
>< 20.
..
...
21.
+
.-;;
I') __~30..ne._..~_____.___.
12) --~C\Q!]."'~-----
" ,
(31 ~_~_ODGe '
(4) _ ,~ hOf\~~~__
(5)_.,_.'-l<?i.q~__
"
(6) _._~r\c,)l\... "
(7) __~nUl\f!. 'I
(B)
~ ~o-r.u4
j---
(9)_:l.::1ua,SS___
(101 ~__igQ~Uu-~-
(II) "1,8.3ad~
(12) _U,~~8p-,-51 )
(13) ______
(141
0_
(151
-----)(. -----=
---_..-----------,.~--
(16)
._x .06 =
(171
.x .15 =
--------.. ------ ---_._---
(lBI
Oi"ount
+ ------------.
Intcresl
(19)
(201
(21)
121A)
(21B)
~ ~ BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND TO REC:HEC:K~MATHd -;.c, .(. ...-----
Under penalties of perjury, I declare that I have uomined Ihi, relurn, including accompanying schedule, and slatemenh, and 10 the best of my ~nowledge and beliel.
it i, true. correct and complele. I declare that all real e,lalo ha, been rcported 01 true market value Declaration 01 preporer 01 her than ttle personal representative is
ba,ed on all information 01 which preparor tla' any ~nowledge
SIGUA!UI( O' JI(ISOU I[!!PON!)llll fOi 'lur.G-Q(IU1f4-- u -A'OPg'l !l.~-- .--. _on.._' - ...._______w.. ..,,--- .- OAT( -..---'- ----~----.-
,,~~.i~p~,~i.6-j,1..~f;';'~.?,.,B_. (),~; cJ.8'-t l "'n'\Q..c.c..l V D' i..lJ:J- J lLc. D-1OS"- o']/~llq7~--
IIV-UOI U. (2-11)
.f~
COMMONWfAlTH Of PENNSYLVANIA
INKllnANC. ,.AX IltUIN
lISlOINt DICIDINt
SCHEDULE E
CASH, BANK DEPOSITS AND
MISCELLANEOUS
PERSONAL PROPERTY
Please Print or l' e
FilE NUMBER
ESTATE OF
IhunlCL.S Do"":,S f'vt.
(All prop.rty 10In'lv-own.d with I . Rlahl o. Survlvoflhlp mutl b. dlulo..d on Sch.dul. F)
ITEM
NUMBER
DESCRIPTION
VALUE AT
DATE OF DEATH
..t. f..,s.,.oL.j
15<.>.=
I)
C h"c:.K\ ".5 f\cc.t>u..n+. ~,n"-"c..\ a..L "'il..~ u:>A.,p' ~+. H...
\..-
;J. Co..~+ 'D', a..mond ,",-', '''9
I qt.-r f"r\........,. "-'-I C uu.,5"''''
.3 ,= .0""
:0)
b)
TOTAL (Also enter an line 5, Reea itulatian) S A-f '-/ c.f1 . (.,)
(Attach addilional BVJ" )( "" ,h.." if more 'poc. h n..d.d.)
"
,,~i~:~l\
.. ~l:l/.,..
COMMONWEAltH Of PfNNSVWAN1A
INHERI,ANCE lAX .(lURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES
Please P,lnt or Type
L _._...n ...... ....---...-..
FilE 'lUMBER
'(yUlll_.\'''l
ESTATE OF
I ITEM DESCRIPTION AMOUNT
'1 NUMBER
I A. Funeral Expenaeal
! -'-}-.,l.J"..,a...~ 'l,~lvltA+U" r u. ,,0<0.. I .::5e,.p...V'IC.e.-~ (C_ump/e..+e..)
1.
i' . 0 . '2::01< q~.:l..J G,(.,..,.,.c.o
LLl~ N.C. . 3-~ ~q.5
,
MOI\u.mt-n'l- ~.....,.',c..~ "'<..5 .co ~
IOUJIo.l ~. Q 0u..J)'/-fl..,-/ .f:""lo~ ':::'1-101' d..So,OO
B, Administrative Caatll
1. I Personal Representatiye Commissions - 'Boll - 8~4 'In .;1.0.<.>,,-,
Social Security Number 01 Personal Representatiye: c)'4/u }
I '/<I.., <oj.,. "'1
Year Commissions paid _I qq '1
I
2. I Allorney Fees "NO~"""
I
3. Family Exemption
Claimant Relationship
Address 01 Claimant at decedent's death
5t,eet Add,e..
City Stale Zip Code
4. Probate Fees
C. Mlacellan.oua Expensea:
1. ?E -+',-1 ~ 0" fop... ? 1>..., b ",--I-co- GlS .CJu
2. :5hulL.;- Q.-'l.:t., ~', c.o.......... g,O<.:>
3. E.'I.-+A.a. '7~~ 0,&>0
4. JC'...-p F'........ 5.0:..>
5.
6.
7.
B.
TOTAL (Also ente, an line 9, Recapitulation)
(II more apace la needed, In..rt additional she.1a 01 same size.)
S '1,lua..65
\
.~ ~~.<,
IIVUlJUtl''''
-!~
COt,lMONWIAHt4 or ,hm\n\lANIA
INtlIIlIANC11AlI InUIN
lIilDltI,OlelDINI
J
SCHEDULE J
BENEFICIARIES
..
FILE NUMBER
ESTATE OF
-r ho mo..6 'J)oP...'O "-'\
I
ITEM
NUMBER
NAME AND ADDRESS OF BENEFICIARY
RELATIONSHIP
AMOUNT OR
SHARE OF ESTATE
A. Taxable Bequesh:
1.
S-~ o..n I~"J \ \ .)( ,~d.....u.. ~f'
"Ii 3-"1 VI:A-+Of\ Cr..." CJ ALlo:...
\..I..)', n~ <.)" . .0",-10. m l-J. r
. '-- .
bPa.J\d.et:>f"'\
4> 3, Ut...O
,
.::Jc.&<.p.... G. ?-o b b', n,:,
Af*.CJG
;UllIlOl\..9ct.i-l:. ~ pi .
r-oc..lc. '1 Mou.., ,;.-, I\.J.(. al'llCJ~
C,flo.r\d="
a.,UOu
u,S, I L',Q.I''' G. 't\obb',ns
Ie,,\: \..l..)Q.-H- .5l .
1-\+. HuLL'j ~pfJ..:n9s/1'A ',u65
.::un
1"
'Y', a..n nL WoodR..u..fl="
"i i':>-i '1e.o,:;I-on Gle" C', o..c./..
t.,,)",,~-ton. ~"-"', Nt...
'])a.U.3k~e.~
Yo
~
-::Sh'o ...Ie'! :OA..:!>S
r,?Q.:2l...... ~'f
M.O,cdc.SP."C/) N ,c. . .).,8S"-'
,
-!?Jh-l-l:.A.
~
ITEM
NUMBER
NAME AND ADDRESS OF BENEFICIARY
AMOUNT OR
SHARE OF ESTATE
B. Charitable and Governmental Bequests:
1.
TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Also .nl.r on Iln. 13, R.copilulollon) S
(If more spac. Is needed, Insert addll1onallhee.. of lame Iln)
-roo
'~"".~., '''C'' .
A""'h~"r<-.'
,
HERITAGE HOSPITAL.
111 HOSPITAL DRIVE
TARBORO He 27886
. TJoMl~'DORIS 00001000888300614000000190002
.~
. . fl l PAGE 1 OF J l
. f Iii :"A'tE~'
i.r.eil!!'\...J;P...~c..
FORWARDINO & ADDRESS CORRECT/Oil REQUESTED'
~1!~~(A.tiW[~M~ . .
MAIL PAYMEIIT TO
00' ',' d
THOHAS DORIS
PO BOX 284
HACCLESF/CRISP NC 27852
HERITAGE HOSPITAL.
111 HOSPITAL DRIVE
TARBORO IIC 27886
pLEASE PRlIIT CHAIIGE OF ADDRESS OR PHOIIE IIUMBER ABOVE
TO RECEIVE PROPER CREDIT, PLEASE RETURN THIS PORTION WITH YOUR PAVMENT.
TO PAY BV CREDIT CARD. SEE AUTHORIZATION NOTICE ON THE BACK.
_...._-.....-...--~.-.=......,"=...=~~".=...~~~~=~~.~~===..~.,~".===~~~=.==~~..-.=......=..-.-..---.=..,=....
0~ :s~~
I
c{) d~cQ
~
~..
d~
~ . flQj
-~
pc~
.
--/."1 \? (/'
/....') - "'" /1 .... tJ
COMHONWEALTH OF PENNSYLVANIA
DEPARTHENT OF REVENUE
BUREAU Of INDIVIDUAL TAXES
INllfRl IANC[ fAx DIVISION
D[Pf. :aOtlOI
HARRJSBURC, PA 111~8.D601
NOTICE Of INIIERITANCE TAX
APPRAISENENT, ALLOWANCE OR DISALLOWANCE
Of DEDUCTIONS AND ASSESSNENT Of TAX
SHIRLEV BASS
PO BOX 284
HACCLESFIELD
DATE
ESTATE OF
DATE OF DEATH
FILE NUHBER
COUNTY
ACN
09-09-97
TlIOHAS
09-09'96
21 96-0761
CUM8ERLAND
101
NC 27852
Amount R.",itt.d
(!- ~~~\
lI;.fii..., .
11,-1\.' U I" 111.'11
DORIS H
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 ....
iiEW iS4"7" EX-AFP--fiii-:97rNOYicE--OF-XNHEifiTAiiciryA'x-'A -ppR'A-isEifiNT-,--,UXciwAiicE-ijii-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF THOMAS DORIS M FILE NO. 21 96-0761 ACN 101 DATE 09-09-97
TAX RETURN WAS: t X I ACCEPTED AS fILED
RESERVATION CONCERNING FUTURE INTEREST . SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. R..I Est.t. (Schedule AI
2. Stocks and Bondi (Schedule 81
3. Closely Held stock/Partnership Int.r..t ISchedule C)
4. Hartg.ges/Notes Receivable (Schedule DJ
S. Cash/Bank Deposits/HIsc. Personal Property ISchedule EJ
6. Jointly Owned Property (Schedule FJ
7. Transf.r. ISchedule G)
8. Tot.l Asset.
CIIANGED
III
(21
(31
141
(5)
(61
(71
.00
.00
.00
.00
4,407.04
.00
.00
(81
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Fun.ral Expenses/Adn. Costs/Hisc. Expenses (Schedule H)
10. Debts/Hortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax R.turn
13. Charitable/Governnent.l Bequ.sts (Sch.dul. J)
14. Net V.lu. of Estat. Subject to Tax
(9)
IlDI
7,702.55
190.00
(111
1121
1131
1141
NOTE:
If an assessment was
reflect figures that
ASSESSMENT OF TAX:
15. Anount of Line 14
16. Anount of Lin. 14
17. Anount of Lin. 14
18. Princip.l Tax Du.
TAX CREDITS:
PAYMENT
DATE
NOTE: To in sur. proper
cr.dit to your account,
sub.it the upper portion
of this forn with your
tax payn.nt.
4,407.04
7.897 ~~
3,485.51-
.00
3,485.51-
issued previously, lines 14, 15 and/or 16, 17 and 18 will
include the total of ~ returns assessed to date.
at Spousal r.te
taxable at Lineal/Class A rat.
tax.bl. .t Collateral/Class B rate
1151
1161
1171
.00 X .00.
.00 X .06.
.00 X .15.
I1BI
RECEIPT
NUMBER
DISCOUNT 1+1
INTEREST/PEN PAID (.)
AMOUNT PAID
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
· If PAID AfTER DATE INDICATED, SEE REVERSE
FOR CALCULATION Of ADDITIONAL INTEREST.
.00
.00
.00
.00
.00
.00
.00
.00
If TOTAL DUE IS LESS TNAN $1, ND PAYNENT IS REQUIRED.
If TOTAL DUE IS REfLECTED AS A "CREDIT" (CRI, YOU NAY BE DUE
A REFUND. SEE REVERSE SIDE Of TillS FORM fOR IN.;'UCTIDNS.I
r.
RESERVATIONr
.) (j
E...t., 0' dleld.nt. d1Jna on or bator. Dlc..ba,. 12. 1911 -- If en~ lutur. Int.r... In thl I.t.t. 1_ transllrred
In .......Ion o. .nJo...nl 10 CI... a (.011.1...1' ban,'I.I..I.. ., Ih. d...d.nl "1.. Ih. .,pl..II.n 0' an. ..1.1. '0.
II'. .. '0. ""', Ih. C...on."llh h...b. "P....I. ........ Ih. 'Iahl I. opp..I.. and ...... I'.n.,.. /nha.II.... T.,..
at t~. lawful CII'I I (co11at.ra.) t.t. on ."~ luch tutur. Jnt.r..t.
PllIlPOSE Of'
NOTICE,
To fultlll thl requir...nt. of Slctlon ll~O of the Inherltancl and [,t.t. Tax Act, Act 21 0' 1995. (72 P.S.
Section 91ttD J.
PAYHEHT I
D.lach lhe lop P..II.n 0' Ihl. H.II.. ond .ub.11 .llh ..u. P....nl I. Ih. R'al.I.. 0' NI/I. p.lnl.d on Ih. ....... .Id..
.'Mall ChIck or 'on.~ ord.r payabl, tOI REGISTER OF HILLS, AGENT
REFtRrtD (CR),
A r.fund 0' . tax crldlt, which wa. not r.qul.tad on the Tax Rlturn, .ay ba raqua.tad by coapla'tng an "ApplicatIon
for R.fund 0' PennsYlvania Inheritance and E,t,t. Tax" (R[V-131J). Application, ar. Ivellable at the O"lcI
of thl Rlgl,t.r of Willi, any 01 thl 23 Revenue Dlltrlct Olflc.., or by call1ng tha ,plcl.1 Zit-hour
enlwarlng '.r~lc. nu.b.r. for far.. ord.rlngl In P.nn'YI~anle l~aOO-]6Z~Z050, out. Ida Plnn'YI~anla and
wIthin local Harrl'burg araa (717) 787-1094, TOO' (717) 77Z-ZZSZ (Haarlng lapalred Only).
OBJECTIONS I
Any p.rty In Intara.t not .atl.flad with the ftPpr.lla.ant, allowanca or dllallowanc. of d.ductlon., or a"'I..ant
of t.x (Including dl.count or Int.r..t) a. .hown on thl. Notlc. lU.t obJact wIthin sixty (60) day. of rac.lpt of
thls Notice by:
ADHIH
ISTRATlIJE
CORRECTIONS I
--..IUan P..I..I 10 Ih. PA D.p..I..nl 0' R...nue, I...d ., APP"II, D.pl. ZalOZl, H...llbu.., PA I7IZI-/OZI, OR
.-.llctlon to ha~1 the .attlr dlt.raln'd at audIt of thl account of tha par.onal r.pr"lntatlvl, OR
~'apPl.1 to the Orphan.' Court.
OISCOUNTr
r.ctual .rrors dl.covlr.d on thIs al""'lnt .hould be addr....d In writing to: PI. O.part..nt of Rlvlnue,
'~rllU of Indlvldull Tax.., ATTN: Po.t A.....a.nt R'Ylaw unit, O.pt. Z80601, Harrl'burg, PI. 171Za-0601
Phon. (717) 787-6505. S.. P'g. 5 of the bookl.t ~In.tructlon. far Inh.rltanc. Tax R.turn for. R..ld.nt
O.c.dlftt~ (REV-1501) for an ,xPlanatlon of adalnlstratlvlly corr.ctable .rrors.
PEHALTYr
/' an. I., due I. p.ld .llhln Ih... III ..I.nd.. '.nlh. .,t.. Ih. doc.d.nl'. d..lh, . '1.. P"'.nl ISX, dl'..unl 0'
the tax paid Js allowed.
INTEREST:
ThI lS~ tax lanesty non-p.rtlclpatlon p.n.lty Is coaput.d on the total of the tax and Int.r..t a......d, and not
p.ld bafor. January la, 1996, the flr.t d.y aftlr thl .nd of the tax '~esty period. Thl. non-participation
pan.lty Is appe.labl. In the .... aanner and In the the .... tl.. p'rlod a. YOU would app.al the tax and Int.r..t
thlt has b..n .......d a. IndIca tad on this notlc..
Int.r.st I. chargld baglnnlng with flr.t day of d.llnqu.ncy, or nlnl (9) aonths and ani (1) d.y fro. thl dltl of
de.th, to the d.t. of P'Y'lnt. 'axI. whIch blca.. dallnquent bafore January 1, 1"2 b.ar Int.r..t et the rata of
six (6~) p.rcent p.r annu. calculat.d .t a dally rata of .000164. All ta.I' which b.ca.. d.llnqulnt on and eft.r
January 1, 1'82 will b.ar Int.r..t at a rat. which will Vary fro. calendar y..r to cal'ndar Ylar with that rat.
announc.d by the PI. OIPart.lnt of R.vlnu.. Th. appllcabl. lntare.t rata. for 1'82 through 1'" ara:
!!!! Inter..t Rata Dalty Intarl.t Factor :!!.!r Int.r..t Retl Dally Intar..t Factol"
I'll ZO~ .000548 1987 .~ .0002"7
1'13 16~ .ODDU' 1981-1991 IU .DDOlln
1914 lU .000101 1992 .~ .000247
I.as 15~ .000556 1995-1994 7~ .000192
1986 10;( .OOOU... 199!i.-l997 .~ .000247
--Interest 11 calculat'd .. fol1owlI
INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Hotlca lS.Uld .ftlr the ta. blcoa.s dallnquent will rlfl.ct an Int.r..t calculation to flftlan (IS) day.
blYond the date of the ........nt. If paY"nt I. aad. aft.r the Inter..t co~tatlon data .hown on the
Hatlce, additional Intlr.st au.t be c.lculated.
'..
"
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,
w' .
,"
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'.
.;
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. ctJ. " . .,<~. \
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,
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JRD/June 30, 1992117858
Estate No.:
21.1996.0761
ORPHANS' COURT DIVISION,
COURT OF COMMON PLEAS OF
CUM8ERLAND COUNTY
PENNSYLVANIA
1996.0761
No
In Re: Estate of WIUS I'oQODHUFF
Late of MT HOLLY SPIUNGS OOHOOGH
NOTICE OF FAILURE TO FILE STATUS REPORT AND REQUEST TO
CONDucr A HEARING PURSUANT TO RULE 6,12, SUPREME COURT
ORPHANS' COURT RULE
Personal Representative:
SHIRLEY HOBBINS BASS
Counsel for Personal Representative:
Date of Decedent's Death:
9.9.96
Dale of Delinquency Notice:
10.22.96
The undersigned, Mary C. Lewis. Rcgister of Wills. in accllrdan,c with Rulc 6.12, Suprcme
Court Orphans' Court Rules. hercby notifies the Orphans' Court Divi5ion. Court of Common Pleas of
Cumberland County, that neither the abovc named personal represenlative nor the abovc named counsel
for the personal representative have filed with the Register of Wills or Clerk of the Orphans' Court his,
her or its StatuS Report required by Rule 6.12, Supreme Court Orphans' Court Rule and that the requisite
notice, pursuant to Rule 6.12, Supreme Court Orphans' Court Rules, was given by the Rcgister of Wills
on 11.9.96 ,19_, and that the ten (10) day notice to file the Status Report has expired.
Accordingly, in accordance with Rule 6.12 the Court is hereby notified of such delinquency and the
undersigned requests that a Court conduct a hearing to determine whethcr sanctions should be imposed
upon the delinquent personal representative or counsel for the dclinquent personal representative.
"-1)Ultl {7'~L" u~Lj-
Mary . Lcwis, Rcgistcr
Date:
11.16.96
Distribution: Personal Rcpresentative
Counsel for Personal Represcntative
Estatc File .11). ... I. II
A HFAHING IS SF.f FOH ~tU/IJ JI
couj{rHCXl'l NO.3. IF THF. STATUS HEroHT IS
WTI.L MJTCMATICALLY BE CAN(.'F,\,!,ED.
I tJ ~ eJ AT
FILED PHlOH TO THF. HFAHI
~ 30 IN
DATF., WE HF1,iUNG
GFO'
. "
.....
JRDIJune 30, 1992(\1858
In Re: Estate of JX)iUS \'UJDHUFF
Late of MT HOLLY SPHINGS OOHOUGll
ORI'lIANS' COURT DIVISION,
COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY
PENNSYLV ANIA
Estate No.:
21_1996-0761
1996-0761
No.
NOTICE OF FAILURE TO FILE STATUS REPORT AND REQUEST TO
CONDUCT A HEARING pURSUANT TO RULE 6.12, SUPREME COURT
ORPHANS' COURT RULE
Personal Representative:
SHIHLEY HOBBINS BA55
Counsel for Personal Representative:
Date of Decedent's Death:
9_9_96
Date of Delinquency Notice:
10-22-98
The undersigned, Mary C. Lewis, Register of Wills. in accordance with Rule 6.12, Supreme
Court Orphans' Court Rules, hereby notifies the Orphans' Court Division. Court of Common Pleas of
Cumberland County, that neither the above named personal representative nor the above named counsel
for the personal representative have filed with the Register of Wills or CierI< of the Orphans' Court his,
her or its StatuS Report required by Rule 6.12, Supreme Court Orphans' Court Rule and that the requisite
notice, pursuant to Rule 6.12, Supreme Court Orphans' Court Rules, was given by the Register of Wills
on 11_9-98 ,19_, and that the ten (10) day notice to file the StatuS Report has expired.
Accordingly, in accordance with Rule 6.12 the Court is hereby notified of such delinquency and the
undersigned requests that a Court conduct a hearing to determine whether sanctions should be imposed
upon the delinquent personal representative or counsel for the delinquent personal representative.
DK" 11-16-96_ '-/htHI {I.;I,;." '.... u~'I-
Mary . Lewis, Register f Wills
Distribution: Personal Representative
counsel for Personal Representative
Estate File .ill . . . I. . (/ .
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