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f1nnuull.,., fl.,. nlak.., and rndorJrr 0/ ,hi. nuh' lur,h.., a~rf'f' '" In';l'I' ,/,'//uln41, nufln' ,,/ ",m")(')'nlf'n' ami prorr.,; and in ('asf' .uil .hall
b,. ',ro":1h, /"r ,I... t'ollt'f'tiun hf'tf'ul. fir ,1.,. Jam.. hdS ItJ I,.. ,."II"dl'" "/11I11 ./,.""m" III 'In atrorn,.,.. '0 pay ,ro,onaMr auorn,.)".. /,.,., for
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.EMINOLI ,.ORM P 20
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/Iller dale. lar
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value received,
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-.-DOU,ARS,
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. Florida
u'ilh inlf'rf's' ,hf'rron 0' 11,f' ralf' 01 I'f'r C"'f'IIt. prr annum Irolll un.iI fully poid. Inlrrrsl pa)'ablr s..mi.
nnnuall)'. Thr mak"r and ,"dorsl'r 01 this no'r lurlhf'r aRrr,' 'n u'uin. I/f'trInnl/. nfJ,i('" of non-paym"n. ond prOlf's': and in ('os, suil shall
bf' I,rtll,(,ht fm Ih,. rollr(',ion hf'rf'ol. or lh,. Jrlmr has to IIf' 01111'1"'11 lI,um (/"mllnlt 01 rln dUnrn,.y. 10 pay tf'oJonahlr auorn..,.'s I,f's for
,"akin,; $llf"h wll,.,.,ion. 1)f'/'''f'd inl,.r,.sI pllpUf'nh I" I".,,, j,ll,."-,, Itllm ' annum, para"'" s"mi.
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.EMINOLE ,"ORM P 20
No, 555
-.t'S" 3
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______+ _,.__.._.,._m__..~'~..~'___....._.....__._..._.......~.._..._._~.__.___..__....._. __..~ a!ter do:e ~________".. ._.'_ ..._~.._ promlso to
pay 10 __.I!:!JJ-"1.!i::.._2D!:':?.'::'~!!__._,_~,_,_._.__,_____ or ." ...... asslQn.
_-5"'.'~ 7N~.I;jIf",:J 5'1;:.)"1 ... ~~ ,_....___,._,.,._____,____,___.__"'..__ DOLLARS
without defalcation. with Interest, valuo rocoivod.
And further do hereby authorizo and empower tho Prothonotary or any Atlorncy 01 any Court 01 Record 01 Pennsyl.
vania or elsowhero to appear for and enlor Judgment against ____~_..______~_.._ for tho abovo sum, with or without
declaratlon, with costD 01 Guit, relowo 01 orrors, wllhout slay 01 oxeculio~. and With __~..._..___.__.~. per cont added for collection
leos: and hereby agree not to maie any moUon or any application what!loever to any Court for an lnqulliltlon
on any real eltato thai may be levied upon to collect tho aloresald Gum. and ____._ vo:untarily condomn sarna. and
authorizo tho Prothonotary to cnter sold voluntary condemnation upon tho Writ 01 Executlon n~"_.__"_._._.__...._ further aareo
that any property, roal. porsonal or mixed may be sold through a Wrlt of Execution and lurthor heroby waivQ and foloato all
relief Irorn any and all appraisement!. stay or exomption laws o! ar:y Slola now In lorco or which are passed hore:::zllor.
G S. Roehy Co., 6340 D.rry St., H."hbvrll, 'G.
Phon. 564-0'60
.19B~
Witnoss .____~_____ hand and Geal the day and yea: lirs!
Signed. Sealed and Dellverod In tho prftsenC'o of
above written /..-
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PA DEPA"TMENT Dr "EVENUE ~ .
EST ATE INFORMATION SHEET
Fan nEGlSTEn'S OFFICE USE ONlY
C(~:;/"ln \ q't, 1 'i ;;2n"
mV.\t6u,lIlill
_._-~_._._-~-~. _._,---~
DEceDENT INFORMATION:
Enter data us It will ""peur on 011 documents submitted to the deportment.
---------"~._------+-_.-
Wdl w~~
Ai'ilj}(
Dahl 01 Ooalh I ~
.:.~.. . ;11 (.~:( '/
Name (lOlst)
___u,._JS/E~~( (,.<,})
Oocodonl's Soeml SoculIly Numhm
TYPE FILING: Enter check (,..) mark to Indicate the nature ot the return to
[] Probate Return
IJJOlnl AssoIS Only
ClEslaln Ta. Only
o Litigation Purposos (No Othor Assots)
LETTERS GRANTED: Enter check (..-) mark to Indicate the nature of the proceedings at the Register of Wills
Olllce. (Attach additional sheets II explanation Is necessary.)
DToslRmontary
OAdminlstrnllon
J7j No Lollo's
OOlhar (Ploaso Explalnl
ATTORNEY ICORRESPONDENT
INFORMATION:
Enter all data concerning the attorney or other Individual to receive all
tax Information and correspondence.
NaQl~(Lost)
(First)
(M,ddlo)
Supromo Court 1.0. ,
SlrOCI Addross
C,ly
Steta
Zip Codo
Telephono Number
PEnSONIoL REPRESENTATIVE
INFORMATION:
::')'ecutorl Administrator
Enter all data concerning the personal representatlve(s) of the estate
authorized by the Register of Wills
Nama (Losn
(Firsl)
(Mlddlo)
Social Securily Number
Slreot Address
Cily
SlolO
Zip Codo
Telephono Numbor
(Firsl)
(M,ddlo)
~7
Social Socurily Number L
/ };; '/ -/
I .J ~__
Nomo (LlIS,t)
L )S/f:37CLU~i)
Stroot Address
~_cL~_J.YL_ -
" /' (0 ("-
", /\ 'I
-' '--.:J_______
Slale
Zip Codo
., -'I'
'j
LlJ
~-' ;;~
Y/l/U.
Co.Executor/A ministrator
,
Telophone Number
7/-. /- .;. 7S.5'
I
I
i
I
I
Clly
(M,ddlo)
Social Socurily Number
Name (Lasl)
(Flrsl)
. ______ _____I ________ 1
SUcol Addross
City
Slille
Zip Codo
!ToloPhono Nu-"'-bO~-
1....- .~