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PETITION FOR I)IWIIATE and GRANT Oi' LETTERS
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Soda! S(,(,I//'iIY No, I '14_-:i (;> ..~~,~ Q
Register or Wills I'or thc
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Comnionswallh or I'cnnsylvlInill
Thl' petitioll of Ila' lI/llkrsigncd fTSpl'clfully rl'IHl'\;cllt...thnl:
, Your pclitiollCr(S)1 wl10 is/an' II' ~'l'ars or agl' (II oldcl' HnlllL' l','il'ClIl.
in thl' lasl will 'II' Ihe abol'l' decedcnl, daled No '11m\" , _ .5/!.P
and codkil(s) dated
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htall' rl'll'\'illl1 drl'lllll\l.Ull'l'\, l',p 1\'llllllrii11i(lll, dell I II \lll'\l'l'IUOI, rll',)
Deecndenl \l'lIS domiciled lit dcath ill C.vme...R"'f\~~
IL~.& lastJarllil) 01 prlneip,d Il'l i>\l:.1' L"l' at Ql, 17 L.
.._e.!\ .. __ qt-t:L~)lA1\lSTC>\\JtU::lQRt '
(11\l 'Ill'.'!, 1l1l11lhl'! and 1I11l1l.'ipallly)
__ .., County, PennsylvlInla, with
Wl\.hl\l\JLSr,.."'.l~I/!,.!i_(fttw~J:.1!\<2Jl4.
J)el'endcnt, thcn .'8~. scars "I' age, dled:;>'_fHI~t!>1f/,_" , IS ,_...._,.._, 19,_.._'Jt,.,..__.
lit" ~\O(,'f .._S~rt\r j-\oSPlr^L __, _ ,,_.. .____.____..~,_.,_.,'
E'\l'l'PI as hdll1ws, d~i.'('lk111 did tlnlmarry, wa" IWl c,livon.'l'd and did !lol have a l'hild born or adopted
aflcr c,\Cl'ulioll or thl' willol'fl'rl'u I'm prnhall'; \\Wi not the \'klllll or a killing and was never adjudicated
illl'(lllIPCll'llt: ".... ___.._____'__~____~~,_
Dl'l'L'IHklll al dl'lllh l)\\,lll'd prnpl'rty will1l'SllllHllcd vuluc, (1\ follow\: ~
(II' d"1l1kikd ill I'll,) Alllwrsor",1 pr"perlY $...._~P~','~_._,__
(\1' n"t domkiled ill I'a,) I'ersonal properlY ;n I'cnnsylvallla $.....,.....__,..__,
(111101 dOlllll'lk'd in Pa,) Pl'f"ollal properly ill CounlY $
ValLll' lll' real L'slnll.' ill Pl'lllh\'l\'llllia $ S?J tn7(:)
I,llllated as 101l,,"s:_iJ,liue',_ PII'-tY~f, s..T: .$/fll{tfl11"L~~'''''-~~:.- ~-.:.-~~,
II 1II',RI:HIR1', pctili""l'r(S) rcspeetl'lllly reqlle',t(s) the probate "I' the last wiilund eodicil(s)
presc'11Il'd 11('rl'lIllh alld Ihl' grallt "I' kltcrs _T ~S r:M" t,<.lTAgV ,_ ,.__ "......_..,..........,____.._....,..,
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OATH OF PEI~SONAL REPRESENTATIVE
COMMONWEAI.TiI OF PENNSYI.VANIA I. ">i
(,Ol'NTY OF tvfl16(R(<,\IJ~ I
TIll' lWlrlitHll'r("J ahtl'.l"lI;lI11l'd '\\~'ill'(...llH affir-llt,) Ihal till' ~lall'llll'lll" illlhc foregoing pelitlon urc
[I'HL' dlHll'nl tCl'l l\lll1r hnl III Illl' hilt}" lL'dPl' Hlld h I.kl' ,{\ P.l'lilior~;,.f(~) and lhat as pl'rsollul r:cprcscn.
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WARNING: It 15 Illegal to dllpllcat" Ihlg wpy by photostat or photograph,
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SE.P I 9 IU90
UJR..2117
COMMONWEALTH Of PENNSYLVANIA. DEPARTMENT OP HEALTH' VITAL RECORDS
CERTIFICATE OF DEiATH
" Doris V. Drawbau h
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SUCIAL ~ECURJlY~Ul,l8ER
OMtOt"DfNH,M(;Nf,(lh "''1
. Sept, 1 5, 19~~.___,
NiUlE Of O(CEOENlI~~" 1,4.,..., l"l
, (~unLerlalld Co,
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1L!,roprletor___ Clothing store
OEUDeN1'B 1AA1IINO AOOAfs&(1,lrM Ctr/lowl' SwI.l" Cexll) OfCl(li'H'S
217 E. Walnut Street ~~~~:NCl!
Shiremanstowfl,PA 17011 ~Dlt:r~~
st Pennsooro
1", ~aIe_!,_~'U"lsyl vania
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.)ohn A. Reeser
17lI,COUflty
Cumberland
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Martha Margaret Myers
IN'oH.IAN1'8 WAlLlHO ADOAUS (91".., coty,"';, 9WIe.I'llCoo.l
901 McCollTlick Plac:e Mechanicsburg, PA 17055
1'lAC( Of' DlSPOSrlllJN, PWn411l C_IIf'I', C,1IlIIIOl'y lOCATION. Cl!y;t;;. SI.l., lip COOt
OfOlt*~. 1
St, John's Cetretery Camp lIill,PA 1701
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IN'OfU.!ANT'INI\ME(ln>f<Pi'.)
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KAA!iAHOAOOf\f811OfMC'JUTY
usselman H.-sa! 1b1l3,324 ItJmBl Aw,l.aroyro,ffi17043
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HAM' AHOAllOflEbllOf "EIlSON """"C;O"'''lt'tOCAlI~ OF DEATH
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[ ] r1 Umj,od blClle I I ~CI flJturn Inlnrnsl ComprlJn\iul
(lor dalos of denlfl OltOl 12,1i,621
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ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO,
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I FOR DAIlS OF DEATH AfTER 12/J 1 /91 CllECK Ill.
INHERITANCE TAX RETURN l:fo^v::?yU~:~DIT IS CLAIMED I
RESIDENT DECEDENT filE NUMBER
(TO BE FILED IN DUPLICATE ,}..I 9'"
WITH REGISTER OF WILLS) IUJIIHIY (ODI YfAlI
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2. Stock, and Bond, j5chedule BI
3, CI...ly Held S'ockIPa,'n...hlp Inle,..' ISchedule CJ
4. Morlgages and Noles Receivable (Schodule 0)
5, Cmh, Bonk Doposits & MiwJllonoous Personal Proporty
ISchodule EI
6, Jointly Owned Property lS(hodule F)
7, Transfe" (Schedulo 01 (Schedulo lj
B. TOlol Gron AHeh (Iotol lines 1,71
9, Funeral hpel1'~os, Adminishotivn emlS, Mlscollaneous
Expenses (S(hedule HJ
10, Dobu, Morlgagn liabililies, lions (S(hodvle II
11, Total Doduclions (Iotol Lines 9 & 101
12, Nol Value of Ellate (Uno 8 mil1us line 111
13, Churilable and Governmenlol Boquosts (Schedule Jj
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15, Spousol Transfers (for dalos of deCllh aftor 6-30.94)
See Inslrucllont lor Appllcablo Por<:nfltage an Reverse (151
Side. (Include values Itom Schndule K or Schedule M,)
16, Amounl of Uno 14 IOK(lhlfl (II 6% rolo
(Include valuel from Schodulo K or Schodulo M,I
17, Amount 01 Lino 14 to)((ll>lo 01 150,u rolo
(ll1el\ldo volues from SdlOdulfJ K or Sr,hodulo Ml
18, Priocipollox due (Add I(lK from liMS 15, III (Iod 17 I
19, (foelits Spousal Povolty Clodit Prior Poymnnt\ ()i~r(llJl\1
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1\ Entur lh" !ollll of I ir\o 'J I nod 11 ^ on Lirltl 21 II 111is is !11f' BALANCE DUE,
Mnh Check Pnvoblfl 10: Register of Will., Agont
. 'U',' ,. ,)o~ BnURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND TO RECHECK MATH <(~
.U~dtH pef1ohiol of pllrlury, I c/oclnro Ihnt I hnvn f1xtlrllinod Ihil r('turn, illrltHlinq {I(wrnpnnyioq HhlHlulol olld lI01111110nh: {In(i I(";-Iho bOll (" n;y kl;~win(igo afld bell
II IS Irue, eorr~el ond ~ornrlnln ,I doclwn thO,11l1l rrHll o\lnll1 hm iJOon rnpottocl nt !ruo mur~el vnlllH Dlldnrotion of propClllJ1 olllor !flon tho rnrsonol tnptesnntClliv('
b_oled on alllrlfo/mnllon of Wllll,h prnpwor -"(II rillY klloVlI(>dqo
~~:)t~Ai~'Rt ~'._...1'''((7 5(lt'I,RI~f'{)t~51_~( ro~J,.~~.~~(]JI !llllli ^PORf~~ 0 M Co (JAil 6 -/f.- _".?
.H-l~_4j;(""/ J?~~. ~' 101 I!. I"M"c.k ~d'J !'1H~...ic:.\'...~, P^ \'lDS'.I: ,
S(O~AJt!); Of I'R~~tR l~;~f\:~;~.'t'~6f1"'~:~f /" ^OI'Rt',~ Ol W, 1'Ylc.\,'p\ &t, I ''r\f.A~''r\\e'b'''r~, p" \10rr {If\1[ ..' I"(,.;-7/,'
(.~?'.cLrC, _-....d<:.t'"t::( ~
...
101.CT Wiltrnllly Olwd Sholl f'ollri-/\ct 1909-- Ooulllo Shoet
Hflnry 11..11, 1110" lndlnnlli 1'<1,
','\
t!tb i~
, ,
l\ttb, ...
\,.,
.
'II'
, ~ 1 "
"II
"
'I"~
,-
M ADlO 7'/lI0 ,/'1 dl/]I o{
of 0111' L,,,'d 0I1e tlloll81l'/1<1 nilll' 111I'IIIll'cd E.lljhty- tlll'fJU
,
i{ 9'[;;;1 ( 'I
J,\t/
-1 ~ ~,u II, 'u j
in the 1Il!ar
B/OTlVEJo)N
VANCE T. NAILUI<, SR., and IREN!:: H. NAILOR, his w.lfe,
of ths Borough of Sh.lJ'SIllBl1stown, CUlllusl'land County,
PennsylvanIa
Grantora ,
and
RUSSELLO. DRAWBAUGH and DORIS V. DRAWBAUGH, hie wife,
Grantees :
WITNESSETH, tlmt in cOIIBideration of -----F IFTY-NINE THOUSAND NINE HUNDRED------
AND NO/IOBu------------------------- (S59, 900. OO)-------------------Dolu.rs,
in hand paid, the ?'eOei1lt whereof i.~ herollY aoknowledged, the said llranm s do hel'eby grant
and oonvey to the said (/l'anl,ee 8, thlJir hei rs snd sssign8.
ALL THAT CERTAIN lot of ground situsts In the Borough of Shirsmanstown,
County of Cumberlend ~ld State of PonnsylvBnia, boundad snd dsscribsd 8S
Follows, to wit:
BEGINNING st a ppint on the north sids of Walnut Strset at corner of Lot
No.5, Block "A", in the Plan of Lots heroinsFter mentionad; thence eset-
wardly along the north side of Walnut Street, sevanty-Fiv8 (75) fest to
the waat aide of a ten (10) Foot right-oF-way; thance northwardly along
said right-of-way, one hundred forty (140) Fest to a point on the south
eide of Psrish Alley; thence westwardly along the south sids of Parish AlloV,
eeventy-Five (75) Feat to the corner of Lot No.5, eforesaid; thenco south-
wardly along tho lins of Lot No.5, Jna hundred Forty (140) Foot to a point
on the north sIde nF Walnut Street, the place of BEGINNING.
BEING Lot No.6, Block "A", of the Plan of Lota of Clarence G. Stoner,
dated March 11, 1953, and racorded in ths Racorder's Of Fica in and for
Cumbarland County, in Plan Book 5, st Psge ,and revised by Plan of Claranc8
G. Stonar, datad January 2B, 1954, racorded In tha Recorder's Office afore-
said in Plan Book 6, at Paga 44.
HAVING THEREON arectad a aingla family dwelling housa numberad 217 Eaat
Walnut Strast, Shiremanatown, Pannaylvania.
BEING THE SAME PREMISES ldhich Donald C. Meals and Mary L. Meals, his wifa,
by thsir Desd dstsd and racordsd March 12, 1955, in ths OFfics of ths
Rsoorder of Deads in and for Cumbarland County, Pennsylvania, in Dsad Book
N, Volume 21, PaQs 79, granted and convayed unto Vencs T. Nailor, Sr. and
Irena H. Nailor, hie wife, ths Grantora harsin.
Tha abova dascribad lot of ground ia oonvsyed subjact, howavsr, to the
aaaamant granted tD ths Borough of Shirsmsnatown for a right-of-way lssding
to a sink w:rosa the north snd of the sbovs dsscribad lot, aa shown in t,hs
Plan of Lots mantionsd abovs.
B " f '-'(,~~ ""..../.{.-<.,,,
O~011f '0 -
vI;,l,.!, C I., i'a
-!A """, ,.,01.,. "",'l>I~r Td
[,;1;\ 1- J ~J ,'..lill.;" f! sJ
d'57~::0';'''''' 11 ' 1/.....<-"" ,
Cu,,,,,, ...... ~",,, .iJI, Al/.l. If,!,
.roof) .'..1 [' 1('"
~LJII'rr ,) v l't\ It. JtJ
-. rn "'-r.-4t!", ('....f" '/
, &II.ij (lISt. Cum b Co / PI. ~
-''' ftttI Uta,. r~;~, Tax
'l)at.,/-[j <I'" " 9?, 'f)
--.:..- AmI ~ I ~-
't;lt/;,' ,./, v: -, ........ '...
'_:.L!~.__....." tL-,...._~
Cumb, CU, ('IISI. C;;I:;\i(rj;~
IIE~' I $U"I 1)( . ,. 111'1
~, ;'1 y
';I,~'K}.,;,~
(OMMOHWI'Alllt or I'Wm1(VA:IIA
ltHIIII1TMICf 1M, III (UIIN
IIf5HHt-1I (lE(lIH.rH
eSTAte OF
SCHEDULE 13
STOCKS AND BONDS
FILE NUMBER
J)O~15 v' Dr?AW13A-u{j.!-/
.9- \ - q/Q ~ ?, 2 ro
ITEM
NUMBER
(All ~_~opor~vlol~tlv.o~"~d with Right of Survlvonhip n~ull 1.0 disclosed on Scllodulo f,)
DESCRIPTION
--- ., .--
Cvl-l1l\1 011 &>tpc,K 0('
ID (" nl ;l:l,,j2S"
:1:l,tJt.
1. 600 Sht:ll"l!.s of
CU~IP:j\; ,O"lDSI
PoP, ~L
Ib 22
~v't:, .c
01, FIVE(S) (j,S, .$IfVIN6S ,BPItlDs, .s~t?IES .1::-: OCr.O!,,"
~
/97 / ~- ACt? 1//fl-tlG e--'/-" I" CJiPO, ~'" ,IYrCIi:
q,) /11 93 '!()/ 7'13 e:"
6,) /)1 9..3 707 7'1-2 E
c,j lit f..3 Ifn 71f1 E
d.) !J1 93 3f~ .3 2t) E
tJ.) 111 ?..3 .3 J(, .3/f E
3,
.;loo ,share & ot &'It1MPI1 ~-h(.k cl
~. CA.l.s~iP if ;:'
*" II- c.hecl<: w'd~ DetI/\ tv;11-er
" n d ; C(l te.s +hu t HI is 6,bt.k' '16
Co 1-\.\ ~ Dn w~o. 1M,
I<cyf1Olds reSearch dept,
lY11)!>t I'd<e~ woriibs.
, I
VALUE AT DATE
OF DEATH
(t
1"1, ,1/ f, 170
1
3.... '17$'. 4>0
fT
~ P 7S'. ,"0
,..
3~ f?.s-. ~/)
,.
a~ P?5: ~o
".3 P7.5. "0
....
(\b v<tlu.e.
,_, ___._________T~!ALJ:^J'o....~"'_"nBllOl!_ R.co.pl'."!o.!!~nL______,_..,.._ _~_;l7L.!f d. fQ. or)
(If ,"CJre .pacI il noeoed, inlert additional .h..ts of lame lilft,) ____H_~____
'I SCHEDULE E
~.~J"y
~1'lW..:!' CASH, BANK DEPOSITS AND
COMM(H'W[AlTII OF "'<'imVM"^ I MISCELLANEOUS
., ,'N'V.RIIo^'~l'D'~~l/;VRN ..... I PERSONAL PROPERTY". .. ..,...." .PI~a.s~Prl~lorTyr. ...
rSfAfE6r------.--.---..u-....-.~..." .. '" ..'-....----.FiLE NUM'BEC----~-..-.-.
'1) 0 \<. \ s v. -Dr< ~t W loS ft U, (,-11 ~ I .. q to - g 2 B
uVI~on '_I lIell
(All Pf~p~~IV lolnilv.o~ned-~lih"l' Rlol;i-~f Survll/_~!_I~_'lp ,"ull b, dl'clo'~~__o~ ~~_h_~_~,~i...F)._
------,._-,.__._~._---,-_..__._,._..--._------ ..
.
d'
(5ee Ie/ler 4 lIae-hu/)
UCl-l.\f h;" ~OS.I tBa.rJl<
c.t, ~(.l,v;n4~ A-<'..C.r .# 'I'iNlo77o B
1. Int, 4Cc.r, OVl tl,
(.see /eller cdfached)
IJ1 el/OfI I3ffl/ k
Q. ]nc.OtIte cert,'f, #- 1'I-/f29602-c..
j" -::t:n f, A-ccr, M c:z,
c., ::r1l(A>rI1~ Cerf,'{. .;, I'I-A'Z'1603-c..
d. :Jnt, ke/", 011 e.
(s(~ lelltr Ci~c4etl)
4. IHJ fn.J r;,J 1\, VIANI: 3 FAPfl3J S p.~ 1/ 3Jp3, Sold ffI .sf."
__ ~IOW(l.C.\<.I~~~.~__(c...d;lt<4e{~~1l,.".1O. pll~e.)
....__...,__ TOTAL (Also onlor on line 5, Recopllulallon
ITEM
NUMBER
/,
,2,
3.
DESCRIPTION
VALUE AT
DATE OF DEATH
Pt1JC Bank
a, Cerl';! of ~,#'2100/010'17Z.
j,. /hc-r. /nt, Or! a.
,.
10,000,60
,. 1'1(.., cr;
Cel"t.'t. of Def' # ;}.I 001 0101./13
!tel!. r, into on c,
e, Cer+;f. bf lA!.f'. .:If ZlooJo:;Q3ee
Itcc.r, " nt. 0 f1 e,
Cheek"(f CJ.c,et. #" 507"0 7f 383
A-Cc.~, Iflt, on 3'
~(;,'VIIUfS acct. #' S~JOI~/37S
fleer, " ,.d, OM ;,
"
101000' ..-c
~ /70, IS"
c,
d,
.p,
"
~ "J7:5 ~,
. ,
5/.'-9
if'
h,
III
/1, 90,",1'-1
,.
1/, 7 '1
,.
7.3, 'i' 3/, 7:5
lit e:t b ,/, tf'l
,
/,
,.
k>tt, <-/13.73
, '14>,",38
,.
10, 000' <>0
,. fl/. 90
1'ltJ O()o' ,,0
,
~ Iflj.ol,
,,:I
(" Soo'''''
S Dl t.i7, 473.100
l^ttoch addlllonal B V," )( 111/ .h.f1u !f more 'pace I, needltd,l
~hh; '" N '" ...
... .,. N t-
o 0 0 .
M M '" M
'" .,. '" '"
M "' ...
d~; ... N '" i
'"
~~ N .,. '" '"
. 0 . 0 ~~~
.... M .... '"
... C!: '" C!:
'" '" ~ ~,Mf
. , . , ~ ~ ~
ul "' '" '"
.... .... Ul ,~
~~; ....
~~'jt'
~ ,lol H ~
, H ~ ~
lid; ~ ~ u
~ ~ft
... N Cl '" ~ ~ 0 +J
N ... '" Cl ~ ~,<'5 ~
0 . 0 0
.... M .... '" x ~ ~ ~
.,. ... '" ...
~H H t!)
~
~ I
~ . I I
Ul
I . . ,
~ ~ xuu
vi~tD~
~i~o~ ~ ~~
o 0
Cl Cl Cl '" XH....t!>
~ ~~A Cl '" 0 '"
. . 0 .
'" 0 0 0
0 '" '" 0
0 0 0 0 +J
. . . , III
"' "' 0 0 ~
.... .... ~ ~ H
~ +J ,+J ~
III t!\ III +J
.~,~.~ ~
~~ u .... l>....
U U u '€ III.~ .
H H H H Ul t: .
~+J~g
'" N N ~ Ii 'i
'" '" '" '" e ~ g ~
~I .... .... .... ....
0 t- M N ClVl....'
N .... N N
.... .... .... .... , I , .
... ... ... '" H
0 0 0 0 . . . .
u v, U II:
. . . .
.g, f t ClUlHll<
~ IIIRl +J
III III
~Rl ~~ ~ ~
~ H
III ~ $1 ~ t!\
l:l~ .. H
Q . A ~. III ]
I'l
. . . 0 il ,~,~ u
~ ~ o.l ~ ~ ~
~ ~ III l> ill
,~ .t' 1Il,<:! III ,~ is 0 III a
,~ PI ,~ ~ II: ll< Vl
~ H U .. ~ H ~
o ~ o .J 0 tl1 AI '" .w III
A III AVl A Ul ~ 0 en
,~ ~ ~ .8 ill
U U .w 0 ':;j ~
U II) 1I).r-!
I I ~~Vl~~
.. N M
'" "' '" '" .. is II< I !Xl
~ '" '" '" '" I
'" '" '" (>, , I . I I
'" .... 1 N III
.,. "' .( . I , I
U .... M I HUAVJU
~ '" '" .,. .. el ~o.:ui~M
'" '" ~I ....
'-O~I,\i(Hr.'il.\(ill (If rHIIi,,\\'A1I1Il.
ItHlI~'I^IIU I^( ~{III~'1
k!~I(JIUl {J\([!JHll
i
,.___,_,....,,,..L...._
SCH~DUL~ F
JOINTLY -OWN~D PROP~RTY
I
i
I
I
I
I
I '
no --- i mENUM8E~
I :2/-9(;.,-828
~r., ''''I l', I-l ~N
ESTATE OF -n
o '0/<,1:; 1/,
Dicit tJ81nl &1-1
Joln""n""'I."
.~_____~___.liI\ME__~m_~_~~ ,
A, 'PoR-l:; "'D. 7Hfii'/tL.
ADDRESS
_ ___R!LA TI(Jll.SI.UP TO DECEDENT
AII~'CG
'lOI 1J1e. (!ol'nlic.K Kd,
tnech4f1icsbl-ll"f_ fJt1 170sS
B.
\"
Jolntly.ownld property,
-- .___w___.___ .___.... ___.w_ .___..._._____._..__.__'u_"'__
LETTER DATE
ITEM FOR TOTAL VALUE DECD'S DOLLAR VALUE OF
NUMBE JOINT MADE DF.SCRIPTlON OF PROPERTY OF ASSET % INT, DECEDENT'S INTEREST
TENANT JOINT
---------- _.____..__,____.._,_...."'___'"w,
1, i/o, IP-if-9o 7)a<i,P/'/n Otpfit C, Po '* !?oo'ttJo
6(,,9 ~o, 6Rr, 31( 1S 'I- _
p,.;I1,,'p4/ 10, 'to? 09 0-0 5;~S,3,S~
II-aI', il1t ),2.:,1:5'
.ii, 1/, (".,.,t Pti",(}/"'11 i.lefl()S it C,j), # Soe,",
'fo1(,,1'I
prine/pal '-'/ 0, ~C!O. ~(J ~ ~S, DID? oS'
A-t.'c r, Int, ., 13 If. II 10, /3'1.11 Sl:J
(0ee !eller (JlIlIchul Ii, .sckd6-"
3, If. /1-1,.9, 12'f2,,)~O('(S fL> IItlliPI/ slDck of
PNe. P,'rl4l1c!p,( r!J;rp, ~
~ 8, 12~ I. ;17,'6 .3r.i (){)~. oi fJ'1J ~
hi Aye, '" I'll 06 'I. li7--
11 ~7,87
II, ~. ,3'1/3-eg 11.92- .shaf'(.S ~#IIIIM f>f~d. pf
{J11lt. F/nllllci4/ &rf'
.$qme 116 I1bove ; 5lJ %1" N'/,O:J,
3~) oot; O~
TOTAL IAI.o enlor on Iln. 6, R.copltulallonj
(If mot" 'pace is needed Imerl odd/lional slleels of same file)
S 1-/(" 5'.:/8, (,.3
.._..____.1.___.. ,. '..
IHY, I '.010 I 'f. Ii 11,')
,~i&9~
'..' ~l/"I<>-
CUMMOf-l\'-<'tAI III Of l'fllt-lc,YI \'J\t-IIA
INHfRITANCf TAK RETUf:N
RUIOUH OECfOHH
SCHEDULE G
TRANSFERS
(,[EASE pRINT OR TYPE
ESTATE OF
voRIS
FILF. NUMBER
V, 'J)rZ7 A. wE 1\ U 6 H
;1. 1- C;~ -8,28
THIS SCHEDULE MUST BE COMPlETED AND !'ILED IF THE ANSWEH TO ANY OF
ITEM I DFSCRIf'TlOH or PROPERlY
NUMBER IlldtJdilllUn1e of fhe If(/rllh,rco, IIwir (e/o/lolII/lI/! 10 d11(rn/QIII, (Ju/e 0/ Iwm(lIr
J,
/l1tll.~ :Bw./( ;II\,C, Cer+"~, 1i> ()o/ll'iBMJ
JTw 11.03 d;b,...i~ \I, J)""w b",...,," -d '&~ky
L., "T11t"f, he.... ()Mnd
1i1a.oIe Jt. 011 4-~- 91.
:rA ter<!st 0'1 J:' Jelh' ,
HE QUESTIONS ON THE REVERSE SIDE OF THE COVER SHEET IS YES.
DECO, DOLLAR VALUE
% OF [)F.Cf:[)Et~l'S
INT, INTEREST
100% "..,0&0,1>0
~.. tA..<.. Q~UlS,
(XClUSION I lOd{~t~t~E
I
~31()t)a,ctI- ~()lJ{)l_eJ
a. 1f1e.llo~ 'BMI'/< :j:>1c.. C"-rh',f,:(/: Ob 3:5/b
JTwr<!oS ~""I.s \I. b~o.wb"'''jl, u..J ~ '1
R. 1~\, h~r d,ra,nd-nqJhet.u.
lYlQ..d<. J/;, 011 7-/7-1(,
:r" ht-t.st 0>1 :r.!em. .3
. /fX>% ./(/.2.'/
'11,31(.
~,ooo' ~ Joor~ JIl.:;> 000 .OD
:5i O()O, 6C I
.(1;,. t...... tUs.,s,
;j,
Lj,
/f8.z", Ib~!;
'(.3..1.'1
l ~ fi1d(on k&r ClII-AtkJ f>> .scheJ.
f:.)
"~'----""~~--'---'--+~~'----"'-T~-'-~~'.'~_~~--'----"----+~~~_m.."~ ,...,.
___.._.._~..___.____,__....,~_.._~,____,~..~~._ un.. , ,."T.OTAL IAI,. ,",,, "lIno !, RlCOpIIUla".n) S Ifi, t:'e 1. '1$
(f(mrJrf 'pace-,. ".~ded, Inl~rl~ddi/i~~~;';K~'~I~--~f;;;;;;.--'JI~~~~'-..~'__'_m- _.~-~-~-- --... ,
~,
10.
1("
II."
a.
1'1-
/!!;
I',
11-
Ie,
19.
~.
~.
~ . - ~~,
..'
';/J.
t)If, '
c9S:
~/o.
J7,
~~.
af.
,go,
J;.
3;,
33-
J1.
:35;
2>~ ,
(1'1'-";1'2_ 1-
E57. ot:'.Pot<./S v. DKA-U)EliiiGH
f,f.4L,
SC/(ti]) II uYlf, 21-'16-8/..8
1'1,0:3
;{erin}ursemtl, t 'h' :.Jbl";~ 7h~cr! for eXfNl1ses ~f he.
1r;/lffl'/llt~1 t:tZ.,
&11 IIlkilfhc.
,
L,'f/tz lJ1u.h(QI .1i-,Sl.(r,ec,
tJq,-~, N4fe-r Q:>.
,L,h/er /11IM a<i;, - $ewer
.&./Il!t/qIlAc.
P. ;? ',L,
/.ale,. /11. lit6 &.; :J;,c.,
1/;,-IM1, NOller ~,
;J.;1.!,t.,
Leslc,. W. ,fr6 a.'1 ;t1u.,
atll 11f/tt.II f,'c.
flt ,-if;", It/altr fR,
/1I1t.sti lIIa11Pj€llfMt ~I &~1rP1 ~,'
Ju.t/'! {', ~#'eI (tfenl E:sl: 7i:X(6)
ie.$1cr tv. 1:1'6; In<:-,
(.J,~ 4 L,
,Bell fif/rMh'c-
l(e./f/lj;l(l<5ll//tIl6 -j ..)b/'l'-r lJ, 7lzellll.,,.:
q .) It! /II. /J?I(I-dt'l"~ IA /1) h /13
6) /}1,'c4Ifd J~lce I tPem~v41 "I &t';Jth'l1J
oj C/soI1 f:oj/fleu.f bltlll, tJ!Sh'l(c/u1'C1 dIYlGk',''1/v,,11
mlll'/('.e. 1!//~t't; ;PM! Est. !fp!'I'ItI'.sa1
/.ts/(;t' Iv. Ef'~ M~.
lit ' -An!, /wicr ~.
~Wtr' II/1M ?WfI. -$ewer ifaa-f;
to. I. <: L,
,Bell Iff/tlnl..
~flmM #. G,,'r~"ich l11el1ttlt';Rls
~,-' ilm. Wahl" {Ie-.
(~~I/fd PI1 lI..uJ,t. fa.7e).
,c
ya>,~
~/'i'.SI
.-
, ,57-""
If
1.1./~ "
~ :~;:> r. ,,"
.r-19, ~
?>I!J ,(16
,.
, !().S": 61.
'iJ$>
~ r.S:r
,"IO't.IO
'19,01
, ~s:. p~
1t .5~. S1
,. oaf 3. &,1(
f;IB.I5"
~.;>,a6
,.
1&.&0
"
~z.fjo.~
"I.:?S, 00
"9.1,7::'-
"'~~.iJ()
, N,5'r
J4(S:&7
"&,f.oo
"7. B 7
"19, Be
',. -rS". 01)
"
I'.. 71
RfY.lsOO EX... 1',9<11
INHERITANCE TAX RETURN
RESIDENT DECEDENT
COMMONWEALTH OF PENNSYlVAN'A (TO BE FILED IN DUPLICATE 6 /
DEI'ARlMENl OF REVENUE 7 (0
HARRlSm:6J~o~l28o,ol_WITH REGISTER OF WILLS) COUNTY CODE YEAR NUMBER
DEceOENl'S NAME IlASr FIRSl. AND MIDDLE iNiiiATr-.-~~--- - .- [1r't[,6r't~!'f'-f,-((5I~plffft[mRfS(,--';'----"':"--'----'---~':"':":":"-~':"";:;;':";";';'';;;'='==
.... IJR.IfWBIfIJ.6-H; -;[:loR-IS V,
! SO~!~Z~1~-~~~~;~60 r'~O~;;~'9? j"~::';I~'_IO
___, _~<_ ''':'''''''' W'''''~y;' ".., "'" "'" "," "","" "'"'''' 1'''' ,At \[( '~~/;M","
[J 1, Original Return !Xl '), Supplemental Roturn
[] 4, limited Estate [ ) 40. Future Inlerost ComprOmiH!
(for datos of d6l;'llh oller 12,12 -82)
~ 6, Decedent Died Testate r J 7, Decedent Maintained a living Trust
(Allach copy of Will) (Attach copy of Trusl)
.ALL (:C)RRISPONDEHCE AND CONFIDENTIAL TAX INFORMATION SHOUI,D BE DIRECTED TO.
NAM'CI-/ 11-(2. L~f E;. SH ;GZD.S .71L -~--~[COMZi[ M';;~~~~~ ~D~-'-
TELEPHONE NUMfjEi--~--'~-'
717 1]6" -O'Zt>,Lu fvl F.C-HItr..!/(!SBI.02u-, PA- 17CJSS"
------ '--f$C;O~~7;;~$;-----'~--~-' , -
( 11_________ UU. '" ,
( 2 I __"37; ,5 :2!>' 0 "
131 _____ u 0 ,.___
141,i-n. Q-,--------
(51_dLlJ-J__'i1.1,_J2___
~
(61, 'f"JuS.2.S,~__,
( 71 --~-'L- 0 e /1 /18__.
( 91 __!__i?-.2;_.if .sB, 88
" I .3 ~_'i.'l_
1. Real E.,o" (Schedule AJ
2, Slack. and Bond, (Schedule OJ
3, Closely Held Stadt/Partnership lnlore$! (Schedule q
4. Morlgoa8s and Noles Receivable {Schedule OJ
5. Cash, Bonk Deposits & Miscellaneous Personal Property
(Sch.dule EI
6, Jalnlly Owned Properly (Schedul. FJ
7, Transfe" (Schedule 0) (Schedul. l)
e, Tolal Gron Anets (total lines 1.71
9. Funeral Expenses, Administrative COSh, Miscellaneous
Expense" (Schedule HI
10. Dflbh, Mortgage Liabilities, liens (Schedule I)
11. T alai Deductions (total lines 9 & 10)
12, Net Value of Estate (line a minus line ll)
13. Charitable and Governmental 8eque~h (Schedule Jl
_____ ~4. Nfl! Value SubjfJct to Tax: {~~.a 12 minus line 131
15, Spousal Transfers (for doles of death after 6.30.94}
See Instructions for ApplicablE! Percenlag" on Rev8n8 (15) ~_.~.,~____".. '"
Side, Onclude values from Schedule K or Schedule M,)
16. Amount of Line 14 taxable at 6% rale
(Indude values from Schedule K or Se;hedulo M.l
17. Amount of line 14 taxable at 15% rate
(Include values from Schedule K or Schedule M,J
18, Principal lax due (Add ta)( from Unes 15, 16 and 17.)
19. Credits Spousal Poverty Crtldit Prior Paymonts Dlscoun! Intarfl$l
____tJlli- t'f',.3/:J.,!j7J + ;1,,:3 2.(..." _NfWE-OVG(IIfID(l91
+ - 1'1 'i U,U> tvtlfr(tiliflLY
20. If li~e 1 It gractar lhan lina 18, enter the difference on Uno 20, This is the OVERPAYMENT, (20)
a_
21, If l.i 01811 greater thcm line 19, ontfH the differenco on tino 21, This 'S Ih6 TAX DUE,
A. Enter Ihe interest on tho hnlClncf! due on lino I: 1 A,
B, EnhH Ihe 10/01 of Una 21 Clnd 2 \ A on lino 21 B This is thll 9.AlANCE DUE,
Mok,' Cb,de Payable tOI Rltals'.., nf Wills, Agen'
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FOR llATES OF DEATH Ann 1 ~131191 CHECK HERE
IF A SPOUSAL
POVEPrY CREDIT IS CLAIMED [I
FILE NUMBER
0\1
BzB
~11 E;, WA-L!\JlJ, T ST.
SI-(Ir<'./2ly//j./'JSTbt.J!J, f.'I-I 170/1
Cmm' eLl 1f1 B f::leL.ItN b
_[""''''''' Rlc.f";V;; ";;"UCjjO~;1 ,---------.-----
! J 3, Remo(ndfH Relurn
(for delles of doalh priQr 10 12.13.82)
[--] 5, Federal Estate TOIl. Return Required
__" 8, T 0101 Numbor of S~fG Depos1tBoxG$
,
(81 ~2S; 883.Z.~_
1101
(11) ,-!_J?S, 39/.37
(12) ..1!iPP..--lffJl. a 7
, 0
(13) -,_____''"'
114) f-q()~_.'r'f/. R~
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1161
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.~o 7J 78
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~ ~o 07.3.78
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(171 ufo /of,!':?,"" 1~8 '1
'-m X ,15 =
(101
p,
· 3
,
072.3f.,
D 7:2.3"
C lech hCfC If ydV ore requesting 0 re-fund of your ov rpilymcnt.
(21)
{21 AJ
(210)
o
o
o
==.__===~')-.~~BE'sljiifTO ANSWERAliuUESrioN-SONiliVERsiStDE'ANo-ro-ilECiiiEK-MAYH .. -c: -<
~~dfH perlC111ies of pl'Hjury, I rlnd~ll(llll('lt I huvn clHHllirwc! Ihi~ -rnll;rn, incllldinq f1(rompor\yinU ~(h~;f~j(l-\- ~~i ~1~h;~I;~I~t~. fl~a I;; Ih~ [;~~l- ~f~;y..k-I~-~-~-l~';;ig-~"~-~d"b~l-i~T
II IS Irub, tonne! nnd cDmpllllu I dmlnrfJ Ihnl till I(H_d 11\101" h(f~ bl1llf' Ulf1(lJl(l(1 ot jIlin mnrkol \lullln Doclorotiofl (Jf plOp(JIftl (lther them thll rlH~onQI roprClsonlCltivo is
beU8don oil inlonllf"tioll of which prop(HfIl h(l\ (lll~' klwwlodO'l
~1(iN^fllRf or rrU<;OH Wf',f'(~~IBlt f()lilllllh'''.lIIUII.. '\I>I'~"', 9/)/l/(c{!ot/tI/C!<' Rd,
.rx~",,~f/.1. _/1'1 t4t1;<J/;~~/
,10 tJ1't [l~UII'~~[ III 11111 ;)IY"II 1/1 PHI (\II1/,j','I.. ,',[;[,HI ',;
jt.<<taf',):-/,{.<,,/t~, -&
me(lh~(1I'tsbu~ PI/ _ r,."
(j 17055
{'''II
!Jlf'(,I1t1n'{sb'<lJ 1'19 l7or;s
(." ('/O{<u,,, Kd,
IO-.:i'.Y-??
Act #48 of 1994 provides for the reduction of the tox rates Imposed on the net value of transfers to or for
the us. of the spouse, The rates as prescribed by the statute will be:
. 3% (,03) will be applicable for estatos of docedents dying on or after 711194 and bofore 111/96
. 2% (,02) will be IlPpllcablo for ostates of decedonts dying on or after 111196 and before 111/97
. 1% (.01) will be applicable for estates of decedents dying on or after 1/1/97 and beforo 1/1/98
. Spousallransfers occurring on or oftor 1/1/98 will be exempt from Inheritance tax,
PLEASE ANSWER THE FOLLOWING QUESTIONS
BY PLACING A CHECK MARK (v) IN THE APPROPRIATE BLOCKS.
1. Did decedent mrlke a transfer and:
a. retain the use or Income of the property transferred, """"..""....""""""."",,,,,,,,,,,,,,,,,,,,
b. retain the right to designate who shall use the property transferred or its income, "..,,,,,,,,,,.
c, retain C1 reversionary interest; or ...."".......""""...."......,,,,,".,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
d. receive the promise for life 01 either payments, benefits or care? """.""""""...."""."""",
2. If death occurred on or before December 12, 1982, did decodent within two years preceding
death transfer property without receiving adequote consideration? II death occurred after
December 12, 1982, did decedent transler property within one year 01 death without receiving
adequate consideration?... ".."........" """...", ,..""", ",..,.. ....".".... """"""".".."""" ",,"""
3, Did decedent own an 'in trust for' bank account at his or hM death?.."""".."......"......"""....
YES NQ
><
:x-
X
X
-
X
><
)<
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,
YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
,\E, I i fOR OATES Of DEATH AnER 12/Jl/91CHECKHERE
1I~:~i" I INHERITANCE TAX RETURN j~o~mn:~DITISClAIMED Ii
'~"~-I 'RESIDENT DECEDENT i Fill Nil/liftER
WMMO>lWEALH, Of PfNNmVA""A (TO BE FILED IN DUPLICATE I '1) 9 I
DEMRTMENT?f RfV~NlJt (?w 10
HA"IS~J:!J 1,\Oj~:"060' ,WITH REGISTER OF WILLS) COUNTY CODE YEM
:;~f~~~~~}:j~r;~~~ . r;~;:;-;o [~:r~;~:~~~;, pi, '::"_
",""K''''''~~?'';'-'''';'' ,,,,; ".",;";,;;",, "';'^~I--];oc""'::5/~ ~'U'\BE' ...",] A"6U""~("?V~EI::UCf~ON;I-.."'.'-- _ '_______
~ 1 OriginClI Return /-] 2, SupplemonlClI Return [---J 3, Remaindor Return
liar dcHe$ of death prior fo 12.13,82)
[] 4, limited E$tate [OJ 40, Futuro Interost Compromise [J 5. Federal Estate TO:lli Return Required
(for dola~ of doath after 12.12.82)
~ 6. Decedent Died l'EUtl1tO [] 7, Docedor,t Maintained a living TIlIII .1.,8, Tolol Number of Sofe Depo$il Boxes
(Attach _:.~fY of WillI ...~(~tto~~ copy ~Trusi.,_.~_"..,._,_,,__,_~_____~__,_~_..__~
ALL CORRESPONDeNCe AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO,
NAM'.-'----'--,.-'-~---.".-'-,.--,.---..---{MPm[MAiliNOW6RE;S-"'---'--
Cf/II-t<t.E'S ;:::, ..:5/{IE:U)S III A w, mfl/N ST.
TH'PH6Nf"'UM'''-.-'----.--------..--.--'-,---- MECHl/tV ICS Bu/(c", ,all /7CS!'-
71.[ 1 7' '" ~ ~1.o. L_____________________......
1, Real E~:~'e (Schedol:AI .-.-....-(~I:~;.;O~;~:--io1, (JOO:""f;;;;''m~
2, Slocks and Bonds (Schedole BI 12 1 ___~::-_7,_-2.~.~,,()O_,__
3, Clo1-ely Held Stock/Porlmmhip Interest (Schedule C) ( 3 ) _____..__,_____53 .__... ___~__
4. Mortgages and Noles Raceivable (SchedLlle 0) { 4 ) -,__' ________.r?_... ,,__________
5, Cash, Bonk Deposits & Miscellaneous Personal Property (5) ___~_'d.1., ~'-I~__~_~_q___"_______
(Schedole EI -,l
6, Jolnlly Owned Properly ISchedole fl 16 J 'iB.". 5 018, ~_.;L_
7, Trons'e" ISchedole G) (Schedol. LI (7) _ !'_~_t'~"I..'l'8____
S, Tolo! Gross Auets (Iotol Une~ 1.7)
9, FLlnoral Expenses, Adminhtrative Costs, MlscelloneoLls (Q )--~-~5":t,-R~!.~8...
Expenses (Schedule HI
10, Debls, MOrlgoge Liob;I;';e., Lien. (Schedule I) {lOI,_..,__,__..!.J}_~,_'l.i..____,
11. Tolol Deductions (10101 Lines 9 & 10)
l!tv I;,(JO !:X+ I',",\)
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-==_.::::.~~~ j;:-=~(suti.e..T6E~swe~!'LL9UESTlONS ON REVERSE_~IDE ANDTORECHECK MArHn~ ~__._____ ...__
~~der ponoltios of porjury, I declare !~at I hovo flJiomilltHI thi~ rOlurn, indlJdinCj o(ComponYll1g Hhodulo\ (1~d Ittltomnr1I\. C1nd To tho bOlt of m~' knowl6dgo Cltlcl belief,
It IS true, correct and cornplotll, I dodoro thot 011 rnal 0"016 hen bOfll1 rf'porll1d (11 truo IlwrkfJI value [J(lclmOllor1 of prOflorM other thon tho plHlonClI r~prlHonlCllive i,
~~.s,~~, on~~~_~~~()!i~.n__(}L~_~ic.~_ P!Opo'~~_hosony kno:W'<'rd90_
510NATU or ~t~50I'1 J{(5POr.J5IBlf tOR fllll~G Rt:TUP.H- A(lD~I~5-
_.c::~-t7;?r,,5..e
)i(;N~~ofP:RI-r"llfR OH1fR ftf^.H ~fP};;':'!jfifii\'r. ":\[)[lRf~S _"" \,. 'r.L. L' I. ().
~ /. /~ __.?'z ~,- ---'7~'1'''<U'' "'tC.".n,eh""~, en
~c:C&.-.f::- .K-LI~CI/,,;::2.-' ~ (!,4.~M. ..
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12,
13,
14,
15,
16,
17,
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~ 20,
...
21.
Net Value of Eslate (Une 8 minus line 11)
Choriloble and Governmental Bequosls (S(hedule Jl
Nel Value Subject to Tax (line 12 minus Line 1~)
Spousal Transfers (for dales of death after 6,30.941
See Instructions far Applicable Percentage on Reverse
Side. (Include values !rom Schedule K or SchedLlle M,)
Amount of Una 14 taxable a! 6% role
{Include values from Schftdule K or Schodule M.l
Amount of line 14 taxable at '15% rote
(Include \lolues from ScneclLlle K or Schedule M,)
Prlndpal tax due (Add tax from lines 15, 16 and 17.)
Credits Spousol Poverly Credit Prior Payments DiscQunt IrllOre5t
_._.......J!/I1.m_ + 'l.L,)l2, .:r7,') + ;dJZ.~7> _..P_u__
If Une 19 is greater than line 18, enter the diHerento on Une 20, ThiS is the OVERPAYMENT,
r.ilO
115} --.-----f1/A.-_____, X
----- ~_____, .. x ,06 =
(17)_!Ii~LL22!, ~~
(16)
C~ec~ here if you ore requesting 0 refund of your overpaymont.
If line 18 is greotM thun lino 19, enter the differonco on linl;l 21. Thi5 i~ IhEl TAX out
A, Enter the interest on tho bCllonce dUil on Lino 21 A.
B, Enter the total ollino 21 Clnd 21A on lin€1 21B_ rhis i~ thfJ 8ALANCE DUE,
_ ..,~~!!!"~~..ck__P_a)'~blo,,I_~_:__~~glstef of Wills, Ago"'
=n ------t!/A ____
_x ,15 =
o
~ ~ 3 I~ 120
. -----,---~,..J_------__...._ . ____
U 183.2()
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(19)
1201
121)
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(21 BI
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qol M~Cc~M'c.lc. "Rd" MU~..idb"'~, p~ \1OSl:
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, VI, y
f!<(,\W,~,'"
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(OMMO~jWr:AtTH OF PENtI~YlVAN!A
l~lHERITAfKf fAX REHlf(~l
__ _ ,.f~~~IP,f!'}L~~t~~ti~:-~:--=-:::-",.-,;,
ESTATE OF
SCHEDULE B
STOCKS AND BONDS
. upTCIiN'DMsER
'Dot=l.\S v' D~AW13AUGH
c?,\ ~% -; ~21b
iA11 p~;;;~-rtv-I;;I~,iV'Qwn.d with Rlgh;~i Su,vl~Q"hlp mu;i ho disclosed o~s~h~d~I~F,)-~-----~____-~n_-___~
=~~t'" T .~- S'''~C;~-i#~~;, .r~-;[L~-- l'^~~t" -
C~(.I?;jb ,0'1D51 10(" \-II :1::l,12S' Ib 22 "v" '" I $1-;,'4~,=
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I
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~
/'17/ - RCCi' 1//fL.ttG cF ? 0<'0, ~p .-t-"l'fCN:
1;,) f/1 93 '107 7'13 ~
b,} /}1 r.3 '#7 7't2 E
c,) 111 93 "In 7'11 Ii'"
J.) /J1933tf" .JUJ E
(I,) Ii1 13 .31e. .3/'1 E
3.
.;lOO ohAres of CcIl1r\10/1 ~-hc.k of
~, C-u~~cP if ?
*',f chec.j.:: w',M De.at\ 0', H-er
'I Y1d; co.te.s 1~At ~i.s ~-bc:.k' '16
0,1\.\f\1 on l!;J~C\H~.
Reynolds reSell ro), dept, I
I!\Db+ \'I\<e~ wor1ibs, I
:'
3" 97.5"'. ~o
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3" PI'S: 60
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3" 97$".,j,0
(\b vo.lu.e
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_..____...___..____,___,__'...._,____,_..,_...~. TOTAL (AI.o on'or on lin. 2, RocopilulCllionl Is 37, .5J.. h, 00
(If more ~paC9 js---;'~-~d~d, ".;-~"~~~f~dditi~_,,'~-i~.h;~.;;~~f'~~';~ile ~)--,.._---_.-
~EV i ~iN E ~ + [J 86)
(OMMONWl'AlIH Of H~I~I$YlYAlliA
l~lHERllAN(f lAX H!lJ~N
~E~IDHH oraOEHI
SCHEDULE F
JOINTLY -OWNED PROPERTY
e-STATE OF, ~. , , "'~'=="~---"--~~""''''''-''-=~-''~'''''4FILE-NUMBER---'-'--...----
VO_~!_~....!...'-- D~~iJ13~U~~__ un_ ._nl., ~/ - PC; - &28
Joint tonantl.I,
_._~ ,______ ____~D,R,Es..s..~__,' ,,_n__i___R~L.1\ TI9.N,S.,HIf'TQ.DECEDENT
Y'tN IIlI!. Cot'mlc.K Kd, I A);~CB
rnechanicsbu/I'I' tJl/ 1705.S I
'l---~~--'." ,--"'---"- --- r . I
~~~~. DESCRIPTION OF PROPERTY I TOJ~~~tiTUE I ~/~T~? I Dg~i6MTYll~~~mT
10J_:~:ODa/,({i/II" ~$:t-c:-:D.-';?OOi--;,~~-"-----I- '11
6("Q,. I ~ I ~ _
p~in"PQI /0, 6R'I. 3'1 I 10, 'to?,09 : 5b .s; ~S.3, ~ t(
;k,c.~, inl .7.2.t.7$" I I
(.,"H '"j:)aufl/./1/ iJeflc:s,'t C..!). #' rOO'" I' I
1(0/(" /if
pr/nc,'f'Ol 'io, coo' 0<' I ~/O, 13'/,1( 'I $V
I A-CCr, ;nt, ., 131(. If i
I (See leller al!richul Ie sckd~J I
11.IIi.-9z 1/292 .:5hares (;L;IItI/'INt sll'cJ:of'l I
(JAil!. F/n4nc/al &rp, II
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Sqme 46 Qbo'le
NAME
A. 'PoRI::' 1), 7H€:IU.
B,
,_..~---I-~-- ,..,_.....
Jolntlv-own.,d property:
LETTER
ITEM FOR
NUMBER JOINT
TENANT
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(If more spaco is needed insert addilional sheets o( sarno sile)
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TYPE 01 LOAN
[ } -TiiA -2, (JfrntiA- 3-. -(~XJ 'Corw~ ums~]6~ fiLE NUM-iii:R"" --- - J7' lOAN NUMBER ,"-- "I-a-. MORTGAG'(' 'i'i.!'s'-cisE--NUMBER
[ ) VA \, ( ) COIlV, Ins, FR11l197
N01E :lhl S -fo,:; 'I; -fur;nishcd-T09lVo-youo--statcmcn-t -o-~'~-tl;~Gl.tttcment cost-a: Amountn pnld-t~ n'rld-by' t'ho'.s'o'tt'temont~'ngcn8t-
nre shown. Items marked lI(POC]1I wcr'c paid outsIde the ClosIng; they <Ire shown hOl'c for InformatIonal purposes and arc
not inc[lIded In the tote[&, 5.0 10,96 (6/FRI13197.IIUO/fRI1l197l
o. NAME Aio',;,oo'RiiSG Or'BclRROwiiii"-'--- E.NAMF. ANOADDRF.Ss'6F SElL(ii~" ,,,"um F.' NAME' AND iooiiESSQF-iENo'ER.-----.
MARY M, FRITSCtl and
S. FRANK fRITSCl1 IIER IIUSBANO
ESTATE Of DORIS y, DRAWBAUGII
ATLANIIC REGIONAL MORTGAGE
CORPORATION
G, PROPERTY LOCAT ION
217 EAST WALNUT StREET
SH I REMANSTOWN , PA 17011
CUMBERLAND County, PA
--...---..----......,....-..-,.....,~ ----.."'.'-'.--r'--".-..-'--.,...-"'...-..,...
H. SETTlEMENT AGENT 25 1619Bll I, SETTLEMENT DATE
TRI'COUNTY ABSTRACT SERVICE
PLACE Of SETTLEMENT
3414 CIIESTNUT STREET
CAMP IIILL, PA 17011
August 15, \997
J, SUMMARY Of BORROWER'S TRANSACTION K. SUMMARY OF SElI.ER'S TRANSACTION
::: ~~"~'~~":;::,"_.'"""'-: r";~"o;" :::-i;",::~:.~~,:,;"'''' _:~t ",'..00
102, Personol- Property 402. porsonnl Property
103~'-Sot'tTe~tChargcsto- Bar rc;wer----rrne-1400 ----+3)3"-:7:6 ~03:~- -~~,-_.- '...,-~.~- ---,.-
, , ..~..,_.._-- ..--'_._~------,-- .- --._----
'104:- 404,
~5~-'''----'---'-'----'-'------''-- 405~---'----'--'---------- --~
. .-..---- -.------- -,-,---
=~AdT~stments fO"rltemg _paid by Soller in nd~Dnc~_,_,,_,.__ _.~+,Adjustments for i terns paid b~~:~~~~.~_~~__
106, COUNTY/MUN TAXES 08.15.97 to 01.0',98 133,54 {,06, COUNTY/MUN TAXES 08,15,97 to 01,01,98 133,54
-. ,------ -,---..,_...._- '...-.-----,-'-..-..-.----.--.-
107,--County laxes to 407, County Taxes to
--'-'-------.-..--'-----...-.-.-,,~ -...-------,---~--....,.--.~-"..--,..-f----....-.-..,___..
~a.:.-SCIIOOL TAXES 08,15,97 to 07.01,98,_____E~.:!.~ ~08. SCHOOL TAXES ._.._~!.5~~ 07.01,~...~_._._874.T:I_
~~~: ~.~~97 to_'.1l..:E.1.:.~.....:~.-v__ _._,_-----'~:,.~. ~i~:.OB~~.~..:~ 10,01'97 'S,~ .....,..oy___+___~.2~_
-- . ---..-.--. ..-..- ._-,------,- '---'''------''---'''-
11~. --~__ ~~_ ---f-.-----
112. 412.
120, GROSS AMOUNT DUE fROM BORROWER 100,757.99 420. GROSS AMOUNT OUE TO SEllER 97,020.53
--
200. AMOUNTS PALO BY OR IN BEHALf Of BORROWER
500. REOUCTIONS IN AMOUNT DUE TO SELLER
',OOO,o~u :01. Excess Ocpos;~_ (see instrllctlons)
76,800.00 502. Sot t l amant Charges to Se II or
-- --------.
503. Existing Loans token subject to
_u_~_ 504-:-'Payof+f" of first mortgage loan
,-~ -----
50S. Payoff of socond mortgage loon
..---...
506.
507. (Oeposlt disbursed es proceeds)
50B.
509,
[ Ino1400
C-~
7,747.74
-.--
--
-- ~---
201, Deposit or cornest money
202. Principal Amount of New Loan(s)
---
203, Existing Loan(s) Taken SUbjoct to
---
204,
205,
-~~.
206,
207.
20B,
-----,---,_.
~.
Adjustments for items unpaid by Seller Adjustments for
210. COUNTY/MUN TAXES to 5'0~COUNiY/MUN TAXeS
..
211. County Taxes to 511. County Taxes
212, SCIIOOL TAXES \0 512, SCHOOL TAXES
,
213, 513.
214. 514,
----
~: 515,.
216. 516,
-~-'----'-~_ '_u___._
~---~-~-__ 517,
7.1B, 518,
219. 519.
220, TOTAL PAlO BY/FOR BORROWER 77,BOO.OO 520. TOTAL REOUCTlON AMOUNT OUE SELLER 7, 7{,7, 74
300, CASH AT SETTLEMENT fROMITO BORROWER 600. CASII AT SETTLEMENT TO/fROM SELLER __
30i~"Gross Aml'Ou. from Borrow;':-------cTIno 120)--------;00.757.99 60T:iirossAmollntouC"to'Se[ [er '""'TiTn. 420)' -97;"ifiD:5r
f..-... , - '_.___.. ..___._. . ....___-'- ~,---.:~
~22, Less Amt Paid by/for Borrower ([Ine 220) ( 77,800,00) 602, Le&. Reductions Olle Soller (11"0520) ( 7,747.74)
303. CASH (Xl fROM (l TO BORROWER 22,957.99 603. CASH (Xl TO (l fROM SElLER 89,272.79
Items lInpald by Seller
to
te
to
..---
--"--
--
..,-.--!--...----
---
lhe undarfilgncd hereby acknowledgo receipt of 0 completQd copy of pngcs 1&2 of thilt\ statfopment & any Ilttachmcnts referred to herein.
I HAVe CAREfULLY REVIEWED THE HUD'I SETILEMENT STA1EMENT AND TO TilE BEST Of MY KWOWLE G!liNOt.llELlEF, IT IS A TRUE AND ACCURATE
STATEMENT Of All RECE.IPT.S AN.D OISBURS, EMENTS MADE ON MY ACCOUNT OR BY ~E"IN,rIlIS. S Tl'r1~.' "" '~ ,TlIAT I HAVE
RECI'IVED ~ COPY O\,TH~ ,HUD'1 ~TTLEMENT:...s.rA1EMENT/ ",,"" /f:t? '" 1
1 AA (" 1i' '"'' (/,1/0 J I ' . . ~' , ~ I
BORROWER MART~li'sc!~';'LC;:.-~"l.-I--,--------.. SElt~--'"--6'~iS'-''' D BAUGH'" ~_..-....--
,r--,f~, -~ -- ~ I'h./ 'i:::f'~
BORROWEK'IS, fR~NK .fRITSCH'..'--.---------.--.... SEltlR -. ,--- ---- '7C{:;;;" " ,
Y KNOWLEOGE, TilE HUO'1 SETTLEMENT STATEMENT WHICH I HAVE PREPAREO IS A TRUE AND ACCURATE ACCOUNT Of THE fUNDS
VED ANO HAYE~N OR WILL BE OISBURSED BY THE UNOERSIGNED AS PART OF THE SETTlEMENT Of TillS TRANSACTION.
G<:ENDA M. WETHIN6oN--~ .. '-'--,
WARNING: IT IS ~ CRIME TO KNOIIINGLY MAK ALSE STATEMENTS TO THE UNITED STATES ON TNIS OR ANY SIMIL~R fORM, PENALTIES UPON
CONVICTION CAN INCLUOE A fiNE AND IMPRISONMENT. FOR DE1AII.S SEE: TiTlE 18 U.S, CODE SECTION 1001 & seCTION 1010.
!
SETTLEMENT STATEMlNT PAGE 1
..-_-~- -- --
t. SUTLEMEllT CHARGES
100. TQ!OI .olo.iiii.Ql<iit,"CQniilj,"IQn. O..oli;'nl'r~a - -- -.-,. -----. -.---.------- ---"-- "-.~--.---.
$ 96. QOQ. QO . 6.00WX" .5..lfJ.0..00_ PAID fROM PAID fNOM
Diy i ~ ion .vf CQIIIl\i" Lvn(UOlL]'OOLn .IollvHiL. u -- ',_.,-~____c emrROWER 's SELLER'S
7Ql. ~. ,,9Q5 .00 10 (Q,OW.I.LeANK.RJIQt\~SAlL~.KV ms___ ... . ----- -. .. -- .---- .....n fUNDS AT fUNDS AT
m,.. .~ ..G. 5~5-.0IL1o..~IlA.ANOlliQJLR~^UllA If.__ __. .__._ ....______. ..........._. ___________._ _.__....>f.llW'l~NI .__ ____.>f.UI.OON.L __.
1.05. .Conml &iiQnPJl.ld. UI..so~llol!MlnL.____._______..__.___. ________._ n' ___" __ _' .._.__.__. ___,.____., .u<'...._.___ _._______.h161LJ10.
70/,.
-
6Q.Q .mMSJ'Al'Aa,U.N.J;QNN~C.llQNJ/llJLJ.QAN_ ___ -_. _ ___no. ._...____.._______... ...____..._..___.. _____...n__.____._
eo!. LQQn..QJ:ls!ooHQU J...__LJLQQQ.J'--_..__.lo_.AtJ.ANUC. R~lliiN.AU1QRIQAQ~. _. _ __ _'___'___'___ _.._______165..20 __ .____~__
eQ,.L J,QQ[\ O.l-iC.QUoL.__._________X.___.to_..__.__.m.___ _____.. _. . ...__.__..________:oQ: __.___.____.___ __....______.__.__.__._._..
503. Am1UI'IlI_f OJL_________~._____l.Q...fAlRLCIC!lCCAR1tlL __ _' .____....___..P.QC.llio. ___~.__.__ _._~.___
aQ4 ,.k[o<l iUl'OPPr.L_____________._____.....JlI_.MtL____.________ . ___.___ _____.__eQC-6~,.IlIl. ._.~...~_._..._ _.______.__..._.____..
eQ~.'O[1<iQI'.'___~ .I nVQ~lai.Qn.J'~lL. ______._~.__....ll.__... ...________... __. '__'_'_' ......__.......__._.___...._.__ -_._--~_._- ._~~-
ao~ ..MQL!!lllJllLlllv....J\PP..loo___.. .______lIL._______._. ....__..____.._.____________~. ----.....-..-
ell? ....Au'-umalIQn.J.~Q______..____.___u__....1l!_~___________.__...~._____...____._...___.______..___._. .~m-76<-M' -
eQa. .QQ(;UM~~LR.Yl~IU~L. .-.l.o...j\HAN1IC R.QIQNA,_MQRlJIM~.__._____.____.____ 60.00
a09. .IAK.~.KV.l CLLllL..........__.___.....lll...QJllnJiAV.lHlliL_...____..._..... -- - .. ----
1il0, J1QOO...cEIl.Lm,._________.._.____.1Jl_f.llJL____.~____......._..__. -- -- 34.50 --
elJ...c~RlER..EEl.- to Al ,AN llc..RfiULONIlLllQKlGI1QE.___..___.-== ...,.-n,;-.
m:~:..:.~=:::.:::.===:---._----~.-.~--~----..._.-.--.----- _::.~ ---- .-.-----
m..._______. -- -
.m.,. .n__. -- -. -.-------.---- --
el6,__. -----.---------- . _.-
~:~~-~..~~~----_._---=-._~ '- . .-
u______
820.
-
900. ITEMS REQUIREO 8Y lENDER TO BE PAID IN ADVANCE
~.~ro.t from~15'97 to .22-01-97 Q$ 17.330000/~11 dRYll. -Xl- ,o,-:L<
- -- -
Q{c...J~Qt~.Jnt\Jr8nce Promium for ,months to _ .- 4'Tiin ------ 1------
~6i,---IIQllL\LlJ1sur.nca Praml "'" ..fM......J.&.y~~Il~CY POC --.
.2.Q!t.. tL-__ . --- 1----.--
905.
~SERV,S DEPOSITED WITIU./iNDER - -- .. . ..-
lQ.Q.t..Jlu.ll.L\Ll=nce ---.3...QQQ..mQnlbL...1U..... 36.17 pe Ullllllh. " --
1Q.QL.M~l11i!la I nsurl\llce montb.i.......Jl $ per mOtltIL.
J 003. COUNTY IMUN TAKES months Q $ DDr~ 2" 7< -
l1oll.!t..._C2lmlUw<as B.OOO months Q $ 29.22 oor month
~~JCJIQQ.L1ms 3.000 months Q .L- 83.15 PllL.JIlQ[llh,. ..-. _..lli.& -
illK~~ -- months @ L- oor month
l.~ monthj . Q $ -- .-J2l!J: month
1008. AGGREOA1E ESCROW ADJ. -294.65
11Q1L..lllJ.E CHARGES --.
illT. DisbuU.enJmlt fee to -- .
~stract or Title Search to
..Jj_l~ination to -
]]]I~tle Insurance Binder 1L..
ill~~.uroo.m rrecaration to
tl6.I..Ji2.1f1rv Fees to CAlli.... ESQU'" -- . Dnr --
,1107. AttornevlLf.u.& to CHARLES SH I ElDS III.
~- C I ncl udes above itam numbers: l ~
U08. 1 I tie Insur8~ to T r I ~Countv--.Ab.i.tr.act Sorvlce
~"' .ti.ncludes abovE! item nunbers: E IlL1QQ 300. 8.1 ANO 710 \
.il.[~LendaC~i:Jlllll......$ 76.800.00
~rw:.'...i....c.ovcraae s 96.000.00 --
+*- -
.llU~ .
--
,,;7. n.;-llnillhLllll i I fees to lrl County Abstract Sor. 15 <n -'-
IllS. .
iliI:
'''7 -
'1118.
1<00. GOVERNMENT REkQKOlN.O AND TRAN~
"n1 D"cordlna Fees: Dead $ 24.50 :Mortaa!:lB $ lUO :ReleBses L-__ <n nn --
~. Cltv/Countv Tax/Stamos: Deed $ 960.00 --o:.Mortosae $ 960.00 --
""' <t. ,"- ,oUiJ'<>" Deed S 96Q..QQ.. .l.M2r.19uB s .. 060.00,
ZO!t...... ..
1205.
11QQ,...l\OD IT I ONAl SETTlEMENT CHARGES --
13QL......s.w:vBV .- to -- H
11QZ........Eti1. I nscBet i lID-- to PENN PEST INr..
llQhJ.22l...ill.Q\lJ..1AK tq JUDY C.~L-
13.0... . - ---
1305.
1/.00. TOTAL SETTlEMENT CHARGES (Enter On Linea 103, Scct i on J and 502, Sect10ll K) 3,737.46 7,747.74
By signing page 1 of this statement, the signatorlos acknowledge rocoipt of 8 completed copy of pago 2 of this 2 page st~tement.
(6IfRI13197.HUO/FRI13197)
Cartlfled to be a trua copy
~NC;;- ~~
Sattlement Agent
02-02-98
DRAWBAUGH
09-15-96
21 96-0828
CUMBERLAND
101
f=-:- .~~~~!.. Ro~ill!-d-- -I
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 ~
R 'EV; i sc;i - E if -A j: p - i 0'9- .-m-. NO Y iCE --ci F - YN"H E if i;: iit,ic E. "fAx - A"P P ilii i SEM ENi'", - -A [, rciwiitic E. eiFi - - - - - - - - - - - - - - - --
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
DORIS V FILE NO. 21 96-0828 ACN 101
, .J ),) ,)
( I /
BUREAU OF IN~IVIDUAL TAXES
INtlEQllANC[ fAX 111'11SlON
OEPI, 280601
HARRISBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT. ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
CHARLES E SHIELDS III
6 CLOUSER RD
MECHANICS BURG
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
PA 17055
ESTATE OF DRAWBAUGH
('/
TAX RETURN WAS 1 (
I ACCEPTED AS FILED
( X) CHANGED
SEE
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: SUPPLEMENTAL RETURN NO,
1. Re.l Estate (Schedulo A) (l)
2. Stocks end Bonds (Schedule 8) (2)
3. Closely Held stock/Partnership Interest (Sch.dul~ C) (3)
4. Hortgages/Note. Reoeivable (Schedule D) (4)
S. Cash/Oink Oeposits/Hisc. Personal Proporty (Schedule El (S)
6. Jointly Owned Property <<Schedule F) <<6)_
7. Transfers (Schedule GJ (7)
8. Tobl Assets
APPROVED DEDUCTIONS AND EXEMPTIONS:
9, Funarll E~p.ns.s/Adm, Costs/Hisc. Expens.s (Schedule H) (9)
10, Dobls/Hortgogo Llobl11tlos/llons (Schodu1o II (10)
11. Tobl Deductions
12. Net Value of Tex Return
13. Charit.ble/Uovernmental Bftquastsj Non-elected 9113 Trusts (Schedule J)
14, N.t Velue of Estate Sub,ject to Tex
01
90.270,53
,00
,00
,00
,00
,00
,00
(8)
,00
,00
llll
(12) _
(13)
114 )
,*
IH.1S.1 fllfP IQt."1
DORIS
v
DATE
ATTACHED
02-02-98
NOTI CE
NOTE: To insure proper
credit to your eccount}
submit the upper portion
of this form with your
tex payment.
90.270,53
.00
90.270,53
,00
400.491,87
If an assessment was issued previously, lines 14, IS and/or 16, 17 and 18 will
reflect figures that include the total of !b1 returns assessed to date.
ASSESSMENT OF TAX:
IS. Amount of Lin. 14 at Spousal rate
16. Amount of Un. 14 hxah1e .t Un.e1/Chllll A rat.
17. Amount of Line 14 taxable at Colleter~l/C1.ls 8 rete
1&. Principal rax DUI
NOTE:
llS) , 00 X ' 00:
(16) ,00A,D6:
(17)_ 400,49~x,15=
(18)
TAX CREDITS:
-----.
PAVMENT
DATE
12-11-96
06-16-97
DISCOUNT (t)
INTEREST/PEN PAID (-)
-.--Z..437 ,50
2,80-
--.-----.---.~-----.l
AMOUNT PAID
-----(.-{,'II2~-
14.433,20
RECEIPT
NUMBER
Aiu'84939
AA211416
,00
,00
60.073.77
60.073.77
---
BALANCE OF TAX DUE 3.106, 63CR
~----- ~ -. - - -----.---------.-----
INTERESl AND PEN. ,DO
___.___T.'lTAL DUE_ __.._~-,--IO~,.63CR
IF TOTAL DUE IS LESS THAN II, NO PAVMENT IS REQUIRED,
IF TOT'Al DUE IS REFLECTED AS A "CREDIT" ICR I, VDU MAV BE DUE
A REFUND, SEE REVERSE SIDE OF THIS fORM fOR INSTRUCTIONS,)
. IF PAID AFTER DATE INDICATED. SEE REVERSE
FOR CAI.CULATION OF ADDITIONAL INTEREST,
09-29-97
DRAWHAUGH
09-15-96
21 96-0828
CU~18ERLAND
101
1_=~::::~~~nr~R_.~~I~~:~~=~:j
MAKE CHECK ~AYABLE AND REMIT PAYMENT TOl
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE. PA 17013
CUT ALONG THIS LINE .. RETAIN LOWER PORTION FOR YOUR RECORDS ~
R tv: iS4Y" E i{ - AF P - - f oi-: m- - Noi'i c E" -6 F - "INHEif i i' ANC E - 'fAx - ;ip p il;i i is Et.fF.N T -; -A ['"Low ANC E - 'OR - - - - - - - - - - - - - - - - -
OISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
DORIS V FILE NO. 21 96-0828 ACN 101
r'i;,~. /
BUREAU Of INDIVIOUAL TAXES
INlll ~I tAlKI f"K DIVISION
orrl. <'80Ml
IIARRI!i8U~G, flA 1/116-0flol
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE Of INHERITANCl TAX
APPRAISEMENT. ALLOHANCE OR DISALLOWANCE
Of DEDUCTIONS AND ASSESSMENT Of TAX
CHARLES E SHIELDS III
2 W MAIN ST
MECHANICS BURG
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
PA 17055
ESTATE OF
DRAWBAUGH
TAX RETURN WAS:
) ACCEPTED AS fILED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ONl ORIGINAL RETURN
1. Real Estat. (Schedule A) (1)
2. Stocks and Bondi (Schedule B) 121
3. Clos81y Held stock/Partn.,'ship Interut (Schedule C) (3)
4. Mortgages/Not., Receivable lSchedule 0) (4)
5. Cash/O"nk Oepos! tt/Misc. Personal Pr'opert" (Schedule E) (51
6. Jointl)' Owned Property (Sohedule F) (6)
7. Trans1ers (Schedule G,I (7)
8, To'tel Asslts
APPROVED DEDUCTIONS AND EXEMPTIONS I
'), Fun_rilll Expenses/Adm. Cosh/Miso. Expenses (SoMedule H) (9)
10, Debts/Mortgage Lhbllithll/Liens (Schedule I) (10)
11. Total Deductions
12. Net Value of Tex Return
13, Ch.,'ibble/Government.l aequeSih (Sohlldul. J)
1';, Net Value of Est.t. Subjeot to Tllx
NOTEl
at Spouu1
taxllIIble .t
taxlllble at
rat.
Linelllll/Clas9 A r.te
Collateral/Cless Brat.
115)
11&)
117)
c-
~~~...~
r~l':.:.'
~1, .f.;
U~.lhl (I If' IGI.ln
DORIS
V
I X 1 CHANGED
SEE ATTACHED NOTICE
DATE
09-29-97
,00
37,526,00
,00
,00
247.473,60
46,528.63
4.084,48
18)
25.258,88
132,49
Ill)
112)
113)
1141
,00
,00
310.221.34
X ,00=
X ,06=
X,15,
118)
NOTE I To insure proper
credit to your account,
SUbMit the upper portion
of this form with your
hx payment.
335.612,71
~~.391 37
310.221.3'!.
,00
310,221.34
will
,00
,00
46.533.20
(16,533.20
TAX CREDITS I
F PADYAMTEENT'~fll ----.-RJu~~i::T-- -":NT~:EISSTC~pUENNT pIA'I)D I--~:-' ----~H-OUNT PAI~~-'--l
-12-'1--1-9-6 -.--AA.184--939 ---- J
06-16-97 AA211416 ----~-;326-:gg -----.---'lnrU~
I~~~r.:~~.~~~~~:~:_~~
If an assessment was issued previOUSly, lines 14, 15 ana/or Ib, 17 and 18
reflect figures that include the total of A6h returns asselsed to date.
ASSESSMENT OF TAXI
15. AMount of Line 14
16. Anount of Line 14
17. Amount of Lina 14
18, Prine lpal Tex Due
. If PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION Of ADDITIONAL INTEREST,
If TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED,
IF TOTAL DUE IS REfLECTED AS A "CREDIT" ICRI, YOU MAY BE DUE
A REfUND, SEE REVERSE SIDE Of THIS fORM fOR INSTRUCTIONS,)
,
ft)
I
,
i.:)
. - . \
RESERVATION, E.t~t.. of decedent. ~y'~gJon or before OaCftmber 12, 19&~ -- If any future inter.lt tn the 88tato 1_ transferred
in pOlso.Ilon or e"jOYM~n1 to Cia.. B (collatoral) blneflclarlol of the decedent after the expiration of any .,tatl for
11ft or for Year., the Com.onw.a~th her.by expre..ly reserve, the right to appraI.. and aIS&.8 tranlfar Inheritance Tn~..
at tt'l41 hwful Clan a (oollaterall rate on ony such future Interut.
PURPOSE OF
NOTICE I
PAVMENT I
REFUND (CR) I
OBJECTIONSI
~OHIN
IS'fRATIVE
CORRECTIONS I
DISCOUHT,
PENAL TV I
INTERES'r1
To fulfill the feqlllromenh I)f Section lt40 of the InherJt,mc8 and Estate hk 40t, 40t 21 of 1995, (12 P.S.
!l:eot Ion 9HIO l.
Ollltlloh the top portion of this Notice ond sub",U with !l/our pllyment to the Register of Wills printild on the raverIQ sida,
~-Make check cr money ordor payoble tCI REGISTER OF HILLS, AGENT
A refund of 1!I hlx credit, whIch Wft! not requested on the Tax Return, mflY be requested by completing a" "Appl101'1tlon
fcr Refund of PennsYlvania Inheritanoe end EstatQ Tnx" (REV-HI3), Applications &r8 8vellllblo at the Offlce
of tho Regl$ter of Wills, lIny of the 23 Revenue District GfflcDs, or by calling th~ speolsl ?'4-hour
answering servioe nUMbers for forms orderlngl In Pennsylv8nia 1-800-362-2050, outsIde Pennsylvania and
within looal Harrhburg .!Ire!! (717) 787-809(1, TOO II (717) 772-2252 oturinlJ hpflIred Only),
AllY party In Jnterest not satJsfllld with the apprl'lJselllGnt, a110W8nOD or dl&al1owemce of deduction./ or aSSQ88ment
of t.!lX (includIng dIsoount or Interestl 8S shown on this Notice mUfit object within sJxty (60) days of receIpt of
thh Notie..e bYI
uwrHten protut to the PA Department of Revenue, BOllrd of Appeals, Dept. 281021, HorrJflburg, PA 17128"1021, OR
-'eleotIon to haV9 the mutter determined at ftudit of the acoount of the person~l repre~entatlve, OR
--appeal to the Orph~ns' Court.
Faotual orrors di.ooverad on thIs as~e.s~ent should bo ~ddrolsed In writing tOI rA O.Pftrt~ent of Revenue,
Bureau of IndlvJdual Taxes/ ATTNI Post Assoss~ent RevIew UnIt, Dept. 280601, HarrIsburg, PA 17128-0601
Phone (717) 787-650S. S.. pagfl 5 of the bookht "Instructions for Inher1tanoe Tax f?eturn for II Resident
Oeoed8nt" (REV-lS0l) for an ol(plsostlon of admlnistratlvGI':l correctable orrors.
If any tal( due 1& paid within three (3) c81endar month. ~fter the decadent', del'lth, II f1",e percent (5%) dlsoollnt (If
the tax paid Is allowed.
The IS% tax tllIlnlllty nOli-participation ~en81 ty II oOlllputod on the total of the tax and Interest 8S1e.ud, and not
paid beforo January la, 1996, thq fIrst day after the Qnd of the tox 8~n.sty perIod, Thi. non-particJpation
p,nalty is appealable In the sllme~ann.r and In the tha salll8 tIme periOd as you would appelll the tax and Interolt
that has been IIlsessed as Indlcatod on this notlco.
Intor,st I. ohargod beginning wIth first day of delinquonoy/ or nino (9) Illonths nnd on. (1) day frolll the date of
death, to tha date of pay..nt, Taxes whiCh beel"ulI dollnquent before January 1, 1982 baar Inhrlllt at the r(!lt. of
six (6%) peroent par annUli calcuhttad at " dally rllte of .000164. All taxIS which booa.A dollnquont on and after
January 1, 198C will be a,. lnterolt at a rete which will V8ry frolll calendar yellr to calendar year with that rate
announQed b~ the PA O,partlllent of Revenue, The appIIcabl. Interest rates for 1982 throuQh 1997 arel
'!!!r Interblt Rate Dally Intere.t fUctor ~ Intlilrest Rate ~Inhr..t Factllr
1982 20i( .000548 1987 9% ,000247
19B! 16% ,000438 1988-1991 11% .000301
1984 11% ,000301 1992 9% ,000?4?
1~8S 1"3% ,000J56 199~-199(1 7% .000t92
1986 10% .000274 199~'1997 9% .000247
~-Inter..t II ottlcuHthd .. follow'l
INTEREST " BALANCE OF TAX UNPAID X NUHSER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
'Any Notlce t,.ued aftRr the tax boco~o. dellnquant will reflect an interolt oalculation to 'Ift..n (IS) diY.
b.yon~ the dat. of the n.slS&IllenL If fHty..nt Is IIIade nftGr U" 1nt.,ut COllpututlon date shOWn on the
NotJ~., additional Intere.t ~Ult b. calculated,
1l1'.0IHT"1l OF \'/ILI.H 01' CUMII"IlLANIl CoUNTY
ItlWOlt'I' 011 HTATIJH 011 ^,lMINIHTIlA'110N
(For 1l(J~;I(hJflt IllJ(.c<lellts lJylll!: Mter ,July I, 19111)
"HTATl\ NO. ?lqiL~-- SM .
Nun!l! 01' lleomlelll:)':!Yfl\) fIo-L.WU..;t'//(jf;>/(
800101 SO(Jur!Ly ^lleO~1111 NO':.JJ!J_:2lL.tJ.C2.Jf.IL,_.
llute of Doull11 q;s 9(fz_q______c.....
Gu
Name of Persollul Hep['esollllllivo(s):
._~1r11jf: t.,. 1l1~ Idt l.-
.. RKJ 1l._~"_.____
Capae! ty Exoeutol' X Adlllllllstr~tor e.t.a.
-----
(cheek one) Admllllstra tor Admlnlstrutol' <.I.b,n.
Is the admlnlstratloll of tho estate uomptoto'l Yos --- No X
If "yes", how was tho administration oll<Jod'l (oheek one)
By oourt, uecountlllg
By Booount slutod to purtles In Interest
Did thc pol'lles releaso the
porsonal I'opresentatlvc?
Othor (oxplulll)
I
I
To(ul iUllount puid 10 dole 10 erl)dlto['s und 1'0[' fllnel'ld und
admlnlstrutivo "xponso
$ JfL&4. 51
If UUllllllisll'UtlOll IS lIot {'Olllpll'tC', esti!11l1torl vlllue of flHsnts
stilt in llllllli nisll'u 1 iUIl
$30.5~~6
$ i(jl.,_O~Q. ,.EO
'I'otul vnluc ot' dj~t['ilJlltiollS lo !.lulu to hO/l(1fieiHrl{~S
HOTE: This stutus rel><lrt Is oue 110 luter thulI the due oato for rilll1!: tho I'CllIlh-ylvOlllo
Inheritance Tax Iloturn or, if 110 Inherltallce Tux Return Is required, nlllo (9) months
after the date of dellth; if the aominlstratlon of the estate has not been coneluoed,
a summary report shllll he filed ullnually therenrter until the administration Is complete.
------~
I eot'tlfy unoo[' pellully of pel'j[JI'y IIl11t tlie fO['Clloillg IlIforUllltlOlt~'S f'prreet 10 l€'"
best of my knowlcdl(C, illforlll/llioll /llItI "CIICf(] (j /f! /l //~ / ')
nil to:_JJJ).fiUST 19 _ _.' l!l 9? . _:lu/JllJ__'t__d!..j~ .;151
, Pers( uul Hepl'esentutlve
CiIARJ..ESk, fllliJ.16IIl.,A Itorney for Estute
'I'his report must bo slllllcd by the I'ersollul represlJnlatlve, or one of thorn when morc
than one, or by counsel for lho oslnlo.
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