HomeMy WebLinkAbout96-00879
OATH OF PERSONAL REPRESENTATIVE
()( ,
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF (1:1>('1'1, II<I
} 55
t"
The petitioner(s) above-named swear(s) or affirm(s) that the
statements in the foregoing petition are true Bnd correct to the best
of Ihe knowledge and belief of petitioner(s) and that as personal
representativc(s) of the above decedent petitioner(s) will well and (
truly administer the cstate according to law, 'r
't L f
Sworn to or affirmed dnll subscribed f JC , ': (, ' I '
bef e thi a9 \ day of
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No. 21-96-879
Estate of
"'.,r1" ',,11::
, Deceased
GRANT OF LETTERS OF ADMINISTRATION
AND NOW OCTOBER 31 19~, in consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that BARBARA A. WELLS
is/are entitled to Lellers of Administration, and in accord with such finding, Lellers of Administration
are hereby granted to
BARBARA A, WELLS
-----
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in the estate of
'1Y)1"~lf(I.f."It:' l)}.f~O. jl;;;z.liA-)/~f''9
RcrlSltl 01 Will.
FEES
Lellers of Administration ..... S 18.00
Short Certificates(3 ) . . . . . . , . .. S 9 . 00
Renunciatioll .4.............. S 10.00
JCI' S 5.00
TOTAL _ S 42.00
Filed .q~:r~~~!t..3.\........ A.D. 19.2b-
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ATTORNEY (SUp, Ct. 1.0, No,)
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ADDRESS
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PHONE
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NAILED LETTERS AND ORDERS TO ATTORNEY OCTOBER 31, 1996
UI\l"JI\ kl\' ;..., 2t-<J6-B79
11.is is In ,"nifl' Ih"l Ihis i\ " Irl1e (111'1' lit Iht remrd whicfd"m fiI~-in thrI'Mln'ylyftn;ft ();yi';III1t1fV"dll(l'wr'l, '" "Wlllian,e
wilh A(I (,(,.1'.1.. ~(~I. .11'1'1l"'" hI' ,he (;""rt,,1 ""emhl)'..!"",' .H), Il)~\.
WARNING: Ills Illegal 10 duplicate this copy by pholostal or photograph.
I'l'C fur Ihis (enif;"lIe. $\@
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Sf,lIl'lh.gi"'lr.lr
OCT O' 8 1996
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COMMONWEALTH 0' PENNSYLVANIA' DEPARTMENT OF HEALTH' VITALAECORDS
CERTIFICATE OF DEATH
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i fOR DATlS Of DIArH AnlR 1"31191 CHICK HIR!
INHERITANCE TAX RETURN I' ~o~::~U~:~DIT IS ClAIMID! '
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X. J 1. Original Return
[] 4 limiled E'tale
[J 6,
] 3 RtlmcundtH Return
II0f dohn 01 death prior to 12.13.821
fodefOl Eitolrt To. Return Required
2. Supplrmontal Retufn
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] 40 FUlure Inleff,,1 Complomiie
liar dote, 01 death all or 12.12.821
Decedent Died fellate .] 7 Dlt(edenl Maintained 0 living Trult
[Allach copy of Willi lAUnch copy 01 Trust)
ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO.
__ 8 Tolol Numbe, 01 Sole Deposit 80us
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Grecory J. fatshir,
HUPHON( NUMIU
1lL7f1J-f) 133
I~Gquire
(OM'olOHW(AITtt Of rttH~~ll\lAHI^
Olf'AAIMlNt Of Ilf\lWUI
DrPI ]tlUhOl
tfAAIlI!lIURG, PA 111111 OWl
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1. Real Ellate (Schedule AI
2. Slocks and Bond, (Schedule 8)
3. Clolely Held SIoell/Partnership Infer ell {Schedule q
4. Morlgagel and Noles Receivable [Schedule 01
5. Cosh, Bank Deposits & MilCelloneous Personal Property
(S.h.dule EI
6. Joinlly Owned Property (Schedule f)
7. Tranlf." (Sch.dul. GI (Schedule LI
8. Total Gron Au.1S (Iolellin.s 1.7)
9. Funeral Ellpens.s, Administrative COSlS. Miscellaneous
Expenses (Schedule H)
10, Debts. Mortgage liabilities_ liens (Schedule I)
II. T 0101 Deductions (Iclalline' 9 & 10)
12. Net Value 0' Eslale (line 8 minulline 111
13. Charitable and Governmental Bequo," (Schedule Jl
CO~PLI If MAILltiu "'001"'''
900 ~Qr~et street
},en,oyne I'A 17043
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15,
16,
17,
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21.
Net Value Subjecllo Toll. lline 12 minUlline 13)
Spousal Transfers (for doles of death after 6.30.94)
See lnslrutlions for Ar,plicable Percenlage on Revorse
Side. llndude values rom Schedule K or Schedule M_I
Amounl of line 14 lal';able at 6% role
(Indude values from Schedule K Of Schedule M-l
Amount of line 14 lal';able 01 15% role
(Include values from Schedule K or Schedule M.l
Principallal'; due IAdd tax from lines 15, 16 and 17.1
Crodih Spoulal Poverty Cradil Prior Paymenh
+
,r;i162.44
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(7 )
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:;0.00
Discount
InltHosl
+
(191
120)
II line 19 is grealer Ihan line 18, enter Ihe difference on line 20. This il the OVERPAYMENT.
iii 0
If line 18 is greater Ihan line 19, onter Ihe diffolenco on lino 21. Thil is Ihe TAX DUE. (211 $0.00
A. Enter the inleresl on tho balance dua on line 21A. (21A)
B. Enler Ihe 10101 of line 21 and 21A on lino 218 Thil h tho BALANCE DUE. {2IB} :J,Q .00
Ma~. Chltk Payabl. 10: R._~lstlt__of ~I.~s~ !,g~~!~___ _n ..__._._ ___________
~ ~ BE SURE TO ANSWER ALL QUESTiONS'ON'REVER-SE SIDE ANDre RECHECK-MATlf-..l( ~
Under penoltiel 01 perjury, I declare Ihal I have ellamined this return, includi~g accompanying \(hodu~-i nnd stalemenh, and 10 the be\t 0' my ~nowledge and beliel,
il is true, correct and completo I drclare Ihot 011 rooleslolo hOl brcn reporled otlfuf'l mOl~~t voluo Declaration of prepnrer olhlH than the penonol reprosentative i\
bosed 0 011 information of which proparor has T\~ knowledge
"G"~U I Oop~r ";PO""'"I'l'l"""j",:T, \L~..cjiI\S do) (d~) (_\" V'I~:..\", 1:~1 \ 1 ~)rj '5 o,",..{'(I/-/Y.-l;/-~
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,.___ .,lll'i.('t"" 'fo, N"'~~r . r.",_!- <',.-.1-. ,'.. . 7'" ~ '//~1'l 7
Chet~ hero if you 010 requesllng a refund of your overpayment.
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COMMOHWUlIH O' p(NNnIVANIA
INt4UllANCf U.lIlUUIlN
IlUIOIN'DfClDfNI
L SCHEDULE B
__STOCKS AND BONDS
ESTATE Of -,
Wells I Earl T.
FILE NUMBER
(All propllly lolnlly.owned with Right 01 Survivorship mUll be dl"loled on Schedule F.I
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
1.
None
TOTAL (Aho enlll on line 2. Reco ilolollon)
(II mOrl spac. js "..did, inJlrt addirional.hllrs a/sam. ,ize.'
s
..__no.... 11"1
SCHEDULE E
CASH, BANK DEPOSITS AND
MISCELLANEOUS
PERSONAL PROPERTY
Ploo,o Prinl 0' TYEo
-.. . -
FilE NUMBER
W
COMMONWfAUH O. PfNN"lVAUlA
IHHU"AHCI fA. I"UIN
IUIDIN' DI~IDIH.!_~_
ESTATE OF
'/leI Is, Earl '1'.
tAli prop.fty lolntlyoown,d .lIh th, Right ,f S"fvlnnhlp mu.' b. dlltlo.,d on Srh.dul. '1
ITEM DESCRIPTION
NUMBER
1. Cash
2. Personalty
3. 19B7 Chevrolet Spectrun,
4. 19B2 Oldsmobile Cutlass
5. 197B Ford Thunderbird
6. 19B4 G~:C Caballero
VALUE AT
DATE OF DEATH
$2,369.47
8616.60
S50.00
S50.00
$75.00
$1000.00
(appraisal attached for car values)
s 4161.07
(Allarh additional 8Ya. )C 11" ,h,.,. if mora .poc. II needed.)
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COMMOUWlAUH O' PeNNSYl......NI...
INltUII...NCf ,.... InUIN
IUIDINIDI(IDIN'
L SCHEDULE F I
JOINTLY.OWNED PROPERTY
- -- -_..__._--_._~_. -----_._---~.~
ESTATE OF
~/ells, Earl T.
FlU NUMBER
Jolnttonontl'I'
NAME
A. Barbara Wells
ADDRESS
22 Rolo Court
~:echanicsburg PA 17055
". u... _
RELATIONSHIP TO DECEDENT
Daughter
B.
C.
Jolntly.ownod proporty.
ITEM LmER DATE
FOR TOTAL VALUE DECD'S DOLLAR VALUE OF
NUMBEI JOINT MADE DESCRIPTION OF PROPERTY OF ASSET % INT. DECEDENT'S INTEREST
TENANT JOINT
1. A. 9/96 Checking account $2,902.60 100% $2,902.60
Financial Trust Co.
#001331434
TOTAL IAI.o onlor on lino 6, Rocapilulolion) S 2 ~OZ:6u
(If mar. spac. is n"d.d ins.rt additional sh..h or sam. sill)
'1V."'OII"II1' .-
COMMONW(AUH Of '(NN\UVAHI...
INHIIIY...NC. r,u .nUIN
InIDIN' DleIDIH'
SCHEDULE G
TRANSFERS
PlEAS!' PRINT OR IYPE
ESTATE OF
'IIells, Earl T.
FILE NUMBER
THIS SCHEDULE MUST BE COMPLETED AND fiLED IF THE ANSWER TO ANV OF THE QUESTIONS ON rHE REVERSE SIDE OF THE COVER SHEET IS VES.
, DECO DOllAR VALUE
EXCLUSION 10!Al VALUE .. OlDECEDEN!'S
OF ASSE! IN! INIERES!
IIEM i DESCRIPTION 01 PROPERlY
NUMBERi Include nome ol'helton,'"", Ih,., ,./al,onlf'"p 10 dec,d,"'. IJot.. of IlIln,I.,
i
1.\
i
2. I
i
Pacific Coast Feather
!~SOF
$10930.80
0%
Co.
SO.OO
Pacific Coast Feather
401K
S18890.01
0%
Co.
30.00
Decedent was not 591/2 at time
of death and could not withdraw
without a penaltyless than 10%
(Summary of plans attached)
TOTAL (Aha ,nl., on line 7, Recopilulolion)
III mOl' 'pOCI II ft..d,d. in'It' odd./ionol,httP' 01 lame ,i,. J
S 0.00
.,vlt"lItl'''j
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SCHEDULE H
fUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES
,.~~~,}
t;OMMOUWUl1H 0' '''m5'''~'~Atj'A
ItIH(RlfANCl fAI .!lUIlN
.(SIOWf O(((Oltlf
ESTAtE OF' ,- ",- ,-,--
'1lells, Earl T.
..Ploa.o. Print 0' Type
fiLE "lUMBeR
DESCRIPTION
-----------------.----------------.- ---------.--
AMOUNT
ITEM 1
NUMBER I
A. ' Funeral Expon.."
1.
2.
B,
1.
2.
3.
4.
C.
1.
2.
3.
4.
5.
6,
7.
8.
\'Ieidrr.an Funeral Home
Gingrich Femorials
,
I
Admlnlst,atlvo Co.I':
Personal Representative Commission,
Social Security Number of Penonol Representolive:
Year Commiuion, paid
I
I
1
iAtlorney Fee, Gregory
I
i
Family Exemplion
Cloimonl
J. xatshir, Esquire
Relolion,hip
Addreu of Cloimonl at decedenl" dealh
Streel Add,eu
City
Stale
Zip Code
Probale Fee, Fetition, Short Certificates, Renunciation
MI.collanoou. Expon...:
Patriot news - ad
Cumberland Law Journal -ad
Zimmerman Auto Service
Boyd Diller, Inc.
TOTAL (AI,o enler on line 9. Recapitulation)
(limo.. .paco I. noodod, In.." addlllonal.hool' ol.amo .110.)
I
I S5723.60
\ $2195.00
$2000.00
$63.00
$95.20
$60.00
$75.00
$53.76
S 10,256.56
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'UIOIN'DIClO.""
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES AND LIENS
. __ _~I.a..._P,lnt_ a, Typ. .
FILE NUMBER
ESTATEO~1clls, Earl T.
---- ---,---~~~--~---_._-------_.
~----_.-----_... -_.--_.,-.-- .__._--~... -------_. ----.-.-. -..--
N~YJ~ER DESCRIPTION
1. ~offit, Pease & Linn (redical)
AMOUNT
'1
'-.
Capital Region BVS
:'36.66
S29.77
3. A,~, Ritzman & Associ3tes (medical)
4. capital Health Systems
5. Good Hope Family P .ysicians
6. Siegalbaum and Gunder Gastroenterology Assoc.
7. Oakwood Center Radiation Oncology
8. Discover
9. Charles Trimmer (rent)
10. West Shore Tax Bureau
$13.22
11. Jones Accounting
12. Suburban Cable
$1553.24
S51.92
$113.20
$89.79
3582.08
$1000.00
$187.20
$35.00
$46.86
13. GPU 3nergy
14. United Water of PA
15. Bell Atlantic
16. AT&T ~astercard
$171.81
17. York Waste Disposal
18. Lester Erb (trash)
19. North Shore Agency (debt)
20. Pinnacle Health System
$137.03
575.81
$200.00
$47.00
$31.28
$23.45
$12.52
TOTAL (AI.o o"ler on Ii no 10. Rocopilulolion)
(II more spac. is n..d.d, ins.rt addjrionolsh..ts 0' 10m, lize,}
$ 4407.44
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COMMO,..... 'l1H 0' "l1t4\11.U11'
1""llnANU .Al IIIUI"
~!"O'"' 01(101"1
SCHEDULE J
BENEFICIARIES
fiLE NUMBER
ESTATE OF
'1Iells, Earl T.
AMOUNT OR
SHARE OF ESTATE
ITEM
NUMBER
NAME AND ADDRESS OF BENEFICIARY
RELATIONSHIP
1.
A. fOlloble Beque,":
Barbara ',~ells
22 Rolo court
Mechanicsburg PA 17055
33 1/3 %
Daughter
~
<<.
Joseph J. 't/ells
480 Loural Run Road
Dillsburg PA 17319
Edna Sue ~/el1s
289 Dorsey Lane
Dillsburg PA 17019
Son
33 1/3 %
Daughter
33 1/3 %
3.
ITEM
NUMBER
NAME AND ADDRESS OF BENEFICIARY
AMOUNT OR
SHARE OF ESTATE
B. Charilable and Governmental Beque,'s:
I.
TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Alia enter on line 13, Recapitulation) S
(If mall .pan I. noeded, In.ert additional .heet. 01 .ame .110)
.m:
ZIMMERMAN'S AUTOMOTIVE SERVICE, INC.
COMPLETE AUTOMOTIVE SERVICE & REPAIR
2234 S. Market St, Phone 766.7656
MECHANICSBURG. PA 17055
GOODjfrEAR
Indopondont Doaler
October 28, 1996
Atty. Gregory J. Katehir
900 Market Street
Lemoyne, PA 17043
717-763-8133
Estate of Earl Wells
932 Nixon Drlv;;
Mechanicsburg, PA 17055
At the request of Barbara Welle
Appraieal of Vehiclee
1987 Chevrolet Spectrum
VIN # 2G3AP47V6C2367586
106,000 milee
Wrecked in right front
Inoperative
Appraised price $ 50.00
1982 Oldemobile Cutlaes Supreme
VIN# 2G3AP47V6C23675B6
137,307 milee
Inoperative
Appraieed Price $ 50.00
1978 Ford Thunderbird
VIN# 8G87S240002
105,914 miles
I~OI'f'~at:l."e
Appraised Price $ 75.00
1984 GHC Caballero (eame ae an El Camino)
VIN# 1GTCW80H5ER502473
148,534 MILES
Inoperative
Appraised Price $ 1000.00
"
frd I"J:I'!i!J,.~~'
Jay M. Zimmerman, Salee Manager
Auto Solee Division
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Elu:lillll rllr lJi!\lrilluliun
I old.UII'" h'd~~ ,cecil" uC Ihe "Spec 1;11 'fa.. Nulil.:c Ih:~a"llIIt; I'IJU PJ)'fHCIIl.~." illCWIlIJtHlI1 .!.hccls.
1,,,11 11\'1 ill"': Checl fll.1 hIlA, """, ,f you till 11111 walll all)' l'urllOll of your helldu dl.lrihulillll au he parl of a
lllll.:d 1I111.1\'l.'r. Chet:l ~l'CIIIHJ inu, , "U", if )'011 lIu \01,':11I1 all or a purtiun uf yuur hCllcfll LlislIihuLiulI ill\'uh'cU ill a
IIIIC~I '1IIhl\'cr .wl! CUllllllch.: lhe rClllOlllliul: illfwlllalilJlI.
Si~1I :11111 relllllllhc cUlllplelcd (onllllllhe mldrc.s hclll\\'.
A. I I I alii 11111 illlercsll:d ill lIIakill~ a "direcl mllo\'er" 10 eilher all IRA or .1II00her qllalified plall, J( you
dll:dC<! "A:', du IICII eUlllplelC (orlll,
/ IIl11lers'lllld Ill/II 20'1~ wil/ he will./wl,1 for lII.es frolll ,he porlioll of III)' dis'riblllitUl which is elieible for
'O/l'I"L" bill paid dircclly 10 lilt:.
II, I 110m illleresled in lIIalill~ a '..Iiretl rolhJ\'e'" wilh all or pan of Ill)' disuihulioll. (eolllplele lhe
flllluwill~ "dirCl:l mllll\'er" illhlllllalillll).
I Wllllld like d,e (1II1owill~ :1I110ll1l110 he dirCl:lly uonsrerre,110 anOlher plan or my IRA. (colllplele olle of Ihe
lllllllwill~l 1
I. I J $
2, I) olllllll $
3. I ]
(001 less 111:111 $2ClCl)
% o( lhe eli~ible (1Il1ds,
/","/ersll/od ,hal 2010 will be wi,hheld for faxes frolll ,he pOr/iol' of lilY distribution which is elieible for
rolhl1'cr bu/paid direClly /0 lIIe,
a. NOllie of hlSlillllioll or Tlllslee:
b. Telcphollc Nlllllber:
L_l_"
C. Addrts~~
d, Namc of new I'lalllllllllli,'idll:l1 Reliremelll Aceoll",
e. ACCOUIII NUlllb:r:
P,or,iciJl:llu's Si~oalurc
(}Jl.C
1', illllll Tl'P~ Namc
Social Sccurily Numbcr
1'1C:lsC rCIIIIIIIO: P3CiriC CII3s1 Ft:llhcr ClIlllPOO)'
1':I)'roll OCJI:lrllllclIl
('.0. IIl1x H03H5
Seollle, W:lsloillClon ~HI08
51'1.:CI..\L '1',\:'\ :-IOT/C!: H1:GAIWI.'\G I'LA.'\ 1',\ \'.\11.::'\'1'5
This nOlice contains impon;IOt illformallon you will need before you decide how 10 receive your
benelils from The I'acilie Coasl I'ealher CompallY Nest Egg 1'1;10. (lhe "Plan").
You have Ihe right to consider whelher 10 consent to your distribution and whelher 10 make or
nOI nHlke a direct rollover transfer for mleast 30 days aner your receipt of lhe Special Tax NOlice
Regarding Plan Payments, If you decide to make a direct rollover or receive a distribution and
relurn your eompleled election form 10 Ihe Plan Administrator, your election will be carried oul as
soon as administralively reasonable aner receipt of~'our execuled eleelion form.
A. SUM/I1ARY
A paymenl from Ihe Plan that is eligible for "rollover" can bc takcn in two ways, You can
have all or (I/~\' f!O/'l;OIl of your paymcnt cithcr I) PAID IN A "DIRECT ROLLOVER" or
2) PAID TO YOU. A rollovcr is a paymenl of your Plan benelits 10 your illdividual
reliremenl arrangement (IRA) or 10 anolher employer plan. This choice will alTecl the tax
you owe,
If you ehoosc a DIRECT ROLLOVER
. Your payment will not bc taxed in thc current ycar and no income lax will bc
withheld,
o Your payment will be made dircctly to your IRA or, if you choose, to another
employer plan that accepts your rollover,
. Your payment will be taxed later when you takc it (l,ll of the IRA or the employcr
plan,
If you choose to have your Plan benelits PAID TO YOU
. You will receive only SO% of the payment, bccausc the Plan administrator is required
to withhold 20% of the payment and send it to the IRS as income tax withholding to
be credited against your taxes,
. Your payment will be taxed in the current year \:nlcss yo\: roll i: over, You may be
able to use special tax rules that could reduce the tax you owe. Howevcr, if you
receive the payment before age 59-1/2, you also may have to pay an additional ) 0%
tax,
. You can rollovcr the amount by payillg it to your IRA or to another employer plan
that accepts your rollover within 60 days of receiving the payment. The amount
rolled over will not be taxed until you take it out of Ihe IRA or employer plan.
o If you want to rollover 100% of the paymcnt to an IRA. or an employer plan, )'0/1
III/1S/ filld other 1II0/l(!)' to replace the 20% that was withheld. If you roll over only
the SO% that you re:eived, you will be taxed on the 20% that was withheld and that is
not rolled over,
~
II, illOl\l: ISFOlt~I/\TIOS
1. 1'1Ipll~lIt~ 'l'lalll ClIlI/\lIl1 ClIllllullle Hulkll O\'l'r
1';lyment~ from the I'lan Illay he "eligible rollover diMributiolls," This means that they
can he rolled over to an IRA or to another employer plan that accepts rollovers,
Your Plan administrator should be able to tell you what ponion of your payment is an
eligible rollover distribution, The followillg types of payments C:IIIIIO( be rolled over:
NOIl-taxnhle I'OYIIICIII5, In general. only the "taxable ponion" of your payment is an
eligible rollover distribution, If you have made "after-lax" employcc conlributions to
the Plan, these contributions will be non-taxable when they arc paid to you, and they
cannot be rolled over. (After-tax employcc contributions generally arc contributions
you made from your own pay that were already taxed,)
I'aymellls Sprcad Ol-er LOllg Periods, You cannOI roll o\'cr a paymcllt if it is pan of
a series of equal (or almost equal) payments that arc made al least once a year and
that will last for
. your lifetime (or your life expectancy), or
. your lifetime and your beneficiary's lifetime (or life expectancies), or
. a period of ten years or more.
Rcquired Millillluml'uJ'mellls, Beginnillg in lhe year you reach age 70-1/2, a cenain
ponion of your payment cannot be rolled over because it is a "required minimum
payment" that must be paid to YOll
2. Direct Rollover
You can choose a dire::t rollover of all or any ponion of your payment that is an
"eligible rollover distribution," as described above, In a direct rollover, the eligible
rollover distribution is paid directly from the Plan to an IRA or another employer plan
that accepts rollovers. If you choose a direct rollover, you are not taxed on a
ilayme:;; umil you la;cr take it out oCthe IRA or the empioyer pian,
Dircct RolIOlw {() 011 IRA. You can open an IRA to receive the direct rollover. (The
term "IRA", as used in this notice, includes individual retirement accounts and
individual retirement annuities,) If you choose to have your payment made directly to
an IRA, contact an IR.A sponsor (usually a financial institution) to find out how to
have your payment made in a direct rollover to an IRA at that institution, If you are
unsure of how to invest your money, you can temporarily establish an IRA to receive
the payment. However, in choosing an IRA, you may wish to consider whether the
IRA you choose will allow you to move all or a pan of your payment to another IRA
at a later date, without penalties or other limitations, See IRS Publication 590,
. -. ,.. ... .. ...
IIIdll'/d/ltll /I"/Ir"nlL'IIt/lnllll!:l'III<'11t.\, for more information on lIlAs (including limils
on how oncn you can roll ovcr bctwecn 1It/\s).
IJ/rL'C1 /lOl/(JIW /() n /,/(1//, If you arc employcd by a ncw cmployer that has a plan,
,inti you want a direct rollover 10 lhat plan, ask the administrator of Ihat plan whelher
it will accept your rollover, If your new employer's plan docs not accept a rollover,
you can choose a direcl rollover to an IRA.
Dircc/ Rol/ol'cr of a Scrics of 1'0YIIICIII.l'. If you receive eligible rollover diSlribulions
that are paid in a series for less than ten years, your choice to make or not make a
direct rollover for a payment will apply 10 all later payments in the series until you
change your eleclion. You are free to change your election for any laler payment in
the series,
3. P:l)'lllellt Pnid To You
If you have the payment made to you, it is subjecl to 20% income tax withholding.
The payment is taxed in the year you receive it unless, within 60 days, you roll it over'
to an IRA or another plan that accepts roll overs, If you do not roll it over, special tax
rules may apply.
Income Tnx Withholdillg:
MOllda/Of)' Withlmldillg, If any portion of the payment to you is an eligible rollover
distribution, the Plan is required by law to withhold 20% of that amount. This
amount is sent to the IRS as income tax withholding, For example, if your eligible
rollover distribution is SIO,OOO, only $8,000 will be paid to you because the Plan muSl
withhold S2.000 as income tax, However, when you prepare your income tax return
for the year, you will report the full SIO,OOO as a payment from the Plan, You will
report the S2,OOO as tax withheld. and it will be credited against any income tax you
owe for the year,
/'ollllllo/'y Withholdillg. If any portion of your payment is not an eligible rollover
distribution but is taxable, the mandatory withholding rules described above do not
apply, In this case, you may elect not to have withholding apply to that portion. To
elect out of withholding. ask the Plan administrator for the election form and related
information,
Sixty-Day Ro/lol'cr OptiOll, If you have an eligible rollover distribution paid to you,
you can still decide to roll over all or part of it to an IRA or another employer plan
that accepts roll overs. If you decide to roll over, )'01/ IIIl1st makc thc ro/lol'cr withill
60 do)'s aftcr )'01/ rcccil'c thc poymcllt. The portion of your payment that is rolled
over will not be taxed until you take it out of the IRA or the employer plan.
... ~. ..- ... ~ '.
You can roll over up to 100% of Ihe eligible rollover distribution, including an
amount equal 10 the 20% that was withheld, If you choose 10 roll over 100%, you
must find olher money within the 60.day period to contribute to the IRA or Ihe
employer plan to replace the 20% that was withheld, On the other hand, if you roll
over only the 80% that you received, you will be taxed on the 20% that was withheld,
Example: Your eligible rollover distribution is 510,000, and you choose 10 have
it paid 10 you, You will receive 58,000, and 52,000 will be sent 10 Ihe IRS as
income tax withholding, Within 60 days after receiving Ihe 58,000, you may
roll over Ihe entire 510,000 10 an IRA or employer plan. To do this, you roll
over the 58,000 you received from the Plan, and you will have tq' find $2,000
from other sources (your savings, a loan, etc,). In this case, the entire $10,000
is not taxed until you take it out of the IRA or employer plan. If you roll over
the entire 5 10,000, when you file your income tax return you may gel a refund
of the 52,000 withheld,
If on the other hand, you roll over only 58,000, the 52,000 you did not roll over
is taxed in Ihe year it was withheld, When you file your income tax return you
may gel a refund of part of the 52,000 withheld, (However, any refund is likely
to be larger if you roll over the entire 510,000,)
Additiol/al 10% Tax if YOII Arc VI/dcr Agc 59-1/2, If you receive a paymenl before
you reach age 59- 1/2 and you do nOI roll it over, then, in addition to the regular
income tax, you may have to pay an extra tax equal to 10% of the taxable portion of
the payment. The additional 10% tax does not apply to your payment if it is (I) paid
to you because you separate from service with your employer during or after the year
you reach age 55, (2) paid because you relire due to disability, (3) paid to you as
equal (or almost equal) payments over your life or life expectancy (or you and your
beneficiary's lives or life expectancies), or (4) used to pay certain medical expenses.
See IRS Form 5329 for more information on the additional 10% tax,
Spccial Tax TreallllCl1l, If your eligible rollover distribution is not rolled over, it will
be taxed in the year you receive it. However, it qualifies as a "lump sum distribution",
it may be eligible for special tax treatment, A lump sum distribution is a payment,
within one year, of your entire balan~e under the Plan (allo certain other similar plans
of the employer) that is payable to you because you have reached age 59-1/2 or have
separated from service with your employer (or, in the case of a self-employed
individual, because you have reached age 59-1/2 or have become disabled). For a
payment to qualify as a lump sum distribution, you must have been a participant in the
Plan for at least 5 years, The special tax treatment for lump sum distributions is
described below.
Fil'c-Year AI'C!ragil/g. If you receive a lump sum distribution after you are age
59-1/2, you may be able to make a one-time election to figure the tax on the
payment by using "5-year averaging". Five-year averaging often reduces the lax
you owe because it treats the payment much as if it were paid over 5 years,
T.'II-}'.'ar Alwaglllg If }'CJ// Wm: /Jam Brfor<' Jalll/ar)' I, 1936, If you receive
a lump sum distribution alld you were born before January I, 1936, you can
make a olle.time election to figure the tax on the payment by using "IO-year
averaging" (USillg 1986 tax rates) instead of 5-year averaging (using current tax
rates), Like the 5-year averaging rules, 10-year averaging often reduces Ihe tax
you owe,
Capital Goill Trcatmrlll If YOI/ Were Born Before lalll/ary J, J936. In
addition, if you receive a lump sum distribution and you were born before
January I, 1936, you may elect to have the part of your payment that is
attributable 10 your pre-1974 participation in the Plan (if any) t~ed as long-
term capital gain al a rate of 20%.
There are other limits on the special tax treatment for lump sum distributions, For
example, you can generally elect this special tax treatment only once in your lifetime,
and the election applies to all lump sum distributions that you receive in Ihal same
year. If you have previously rolled over a payment from the Plan (or certain other
similar plans of the employer), you cannot use this special tax treatmenl for later
payments from the Plan. If you roll over your payment to an IRA, you will not be
able to use this special tax treatment for later payments from the IRA. Also, if you
roll over only a portion of your payment to an IRA, this special tax Irealment is not
available for the rest of the payment. Additional restrictions are described in IRS
Form 4972, which has more information on lump sum distributions and how you elect
the special tax treatment.
Employer Stock or Secl/rities. There is a special rule for a payment from the Plan that
includes employer stock (or other employer securities), To use this special rule, ])
the payment must qualify as a lump sum distribution, as described above (or would
qualifY except that you do not yet have 5 years of participation in the Plan), or 2) the
employer stock included in the payment must be attributable to "after-tax" employee
contributions, if any, Under this special rule, you may have the option of not paying
tax on the "net unrealized appreciation" of the stock until you sell the stock. Net
unrealized appreciation generally is the increase in the value of the employer stock
while it was held by the Plan, For example, if employer stock was contributed to your
Plan account when the stock was worth $1,000 but the stock was worth $1,200 when
you received it, you would not have to pay tax on the $200 increase in value until you
later sold the stock,
You may instead elect not to have the special rule apply to the net unrealized
appreciation, In this case, your net unrealized appreciation will be taxed in the year
you receive the stock, unless you roll over the stock. The stock (including any net
unrealized appreciation) can be rolled over to an IRA or another employer plan either
in a direct rollover or a rollover that you make yourself.
.. ~. ~.. ~.
If yt1U rccei\'c cmplo)'cr stock in ~ p~ymelll lh~l qu~liflc~ as ~ lump sum distribution,
the spcci~ll~x trc~lment for lump sum distributions describcd abovc (such as 5.year
a\'eraging) ~Iso m~y apply, Sce IRS Form 4912 for ~dditional information on thesc
rules
4. Sun'ivilll; Spouses, Altcrnatc Payecs, IInd Olhcr llcllcliciarics
In gcncral, thc rulcs summarizcd abovc th~t apply to paymcnts to cmployees also
apply to payments to surviving spouses of employees and to spouses or former
spouses who are "alternate payees". You are an alternate payee if your interest in the
Plan results from a "qualified domestic relations order", which is an order issued by a
court, usually in connection with a divorce or legal separation, Some, of the rules
summarized above also apply to a deceased employee's beneficiary who is not a
spouse. However, there are some exceptions for payments to surviving spouses,
alternate payees, and other beneficiaries that should be mentioned,
If you are a surviving spouse, you may choose to have an eligible rollover distribution
paid in a direct rollover 10 an IRA or paid to you, If you have the payment paid 10
you, you can keep it or 1'011 it over yourself to an IRA but you cannot 1'011 it over to an
employer plan. If you are an alternate payee, you ha\'e the same choices as the
employee. Thus, you can have the payment paid as a direct rollover or paid to you.
If you have it paid to you, you can keep it or roll it over yourself to an IRA or to
another employer plan that accepts rollovers. If you are a beneficiary other than the
surviving spouse, you COIIIIOI roll over the payment yourself.
If you are a survi\'ing spouse, an alternate payee, or another beneficiary, your
payment is not subject to the additional 10% tax dcscribcd in section III above, even
if you are younger than age 59-1/2,
If you are a surviving spouse, an ahernate payee, or another beneficiary. you may be
able to use the special tax treatment for lump sum distributions and the special rule for
payments that include employer slOck, as described in section III above. If )'ou
receive a payment because of the employee's death, you may be ablc to treat the
payment as a lump sum distribution if the employee met the appropriate age
requiremems, whelher or not the employee had 5 years of;>ar.icip3tion in the Plan,
SPECIAL TAX :-;OTlCE REGAlUlI:-;G PLAN I'A \':\IE1'\TS
This notice contains imponanl information you willllced before you decide how to receivc your
benefits from The Pacific Coast Feathcr Company Nest Egg Plan, (the "Plan").
A, SUMMARY
A paymenl from the Plan that is eligible for "rollover" can be taken in two ways, You can
have all or allY portioll of your payment either I) PAID IN A "DIRECT ROLLOVER" or
2) PAlO TO YOU. A rollover is a payment of your Plan benefits to your individual
relirement arrangement (IRA) or to another employer plan. This choice will affect the tax
you owe.
If you choose a DIRECT ROLLOVER
o Your payment will not be taxed in the current year and no income tax will be
withheld,
o Your payment will be made directly to your IRA or, if you choose, 10 another
employer plan that accepts your rollover.
o Your payment will be taxed later when you take it out of the IRA or the employer
plan.
If you choose to have your Plan benefits PAlO TO YOU
o You will receive only 80% of Ihe paymenl, because the Plan administrator is required
to withhold 20% of the payment and send ilto Ihe IRS as income tax withholding 10
be credited against your taxes,
o Your payment will be taxed in the current year unless you roll it over. You may be
able to use special tax rules that could reduce the tax you owe. However, if you
receive the payment before age 59-1/2, you also may have to pay an additional 10%
tax,
o You can rollover the amount by paying it to your IRA or 10 another employer plan
that accepts your rollover within 60 days of receiving the payment. The amount
rolled over will not be taxed until you take it out of the IRA or employer plan.
o If you want to rollover 100% of the payment 10 an IRA or an employer plan, YOII
mlls/ filld olher mOlley 10 replace Ihe 20% Ihal was withheld. If you roll over only
the 80% Ihat you received, you will be taxed on the 20% that was withheld and that is
not rolled over.
11, I\IOHE I~FOH~IATlO.""
I. I':IY/lICIIIS Th:1l C:l1I Alld C:III11Ulllc Hullcd O\'cr
I'aymcnls from thc Plan may bc "cligiblc rollovcr distributions," This means Ihat they
can be rolled over 10 an IRA or to anothcr employer plan that accepts rollovers,
Your Plan administrator should be able to tell you what portion of your paymenl is an
eligible rollover distribution, The following types ofpaymer.ts cannot be rolled over:
NOli-taxable Paymems. In general, only the "taxable portion" of your paymenl is an
eligible rollover distribulion, If you have made "aner-tax" employee contributions to
the Plan, these contributions will be non-Iaxable when Ihey arc paid to you, and Ihey
cannot be rolled over. (After-tax employee contributions generally are conlributions
you made from your own pay that were already laxed,)
Paymellls Spread Ol'er LOllg Periods. You cannot roll over a paymenl if il is part of
a series of equal (or almost equal) payments that are made at least once a year and
that willlasl for
· your lifetime (or your life expectancy), or
. your lifetime and your beneficiary's lifetime (or life expectancies), or
. a period often years or more.
Required Millimllm Paymell/s. Beginning in the year you reach age 70-1/2, a certain
portion of your payment cannot be rolled over because it is a "required minimum
payment" that musl be paid to you,
2, Dircct Rollover
You can choose a direct rollover of all or any portion of your paymenl that is an
"eligible rollover distribution," as described above. In a direct rollover, the eligible
rollover distribution is paid directly from the Plan to an IRA or another employer plan
that accepts rollovers, If you choose a direct rollover, you arc not laxed on a
payment until you later take it out of the IRA or the employer plan.
Direct Rollover to all IRA, You can open an IRA to receive the direct rollover. (The
term "IRA", as used in this notice, includes individual retirement accounts and
individual retirement annuities,) If you choose to have your payment made directly 10
an IRA, contact an IRA sponsor (usually a financial institution) to Iind out how to
have your payment made in a direct rollover to an IRA al that institution. If you are
unsure of how to invest your money, you can temporarily establish an IRA to receive
Ihe payment. However, in choosing an IRA, you may wish to consider whether the
IRA you choose will allow you to move all or a part of your payment to anolher IRA
at a later date, without penahies or other limitations, See IRS Publication 590,
1I/(//I'Idual IIcllfl'lIIl'/11 Arrall!:clIIl'/IIJ, for more information on I!lAs (including limils
on how oOen YOII can roll over between I!lAs),
Din',,/ RoIIOl'l'r 10 (/ I'lall, If you are employed by a new employer Ihat has a plan,
and you want a direct rollover to thaI plan, ask Ihe administrator of thaI plan whether
it will accept your rollover, If your new employer's plan docs not accept a rollover,
you can choose a direct rollover 10 an IRA,
Direct Rollover of a Series of PaYllle/llS, If you receive eligible rollover dislributions
that are paid in a series for less than len years, your choice 10 make or not make a
direct rollover for a paymenl will apply 10 all later payments in the series until you
change your eleclion. You are free to change your eleclion for any later payment in
the series.
3, Payment Paid To You
If you have the paymenl made to you, il is subject to 20% income tax withholding.
The payment is taxed in the year you receive it unless, within 60 days, you roll it over
to an IRA or another plan that accepls rollovers. If you do not roll it over, special tax
rules may apply.
Income Tax Withholding:
Mal/datory Withholdil/g. If any portion of Ihe paymenllo you is an eligible rollover
distribution, the Plan is required by law to wilhhold 20% of that amount This
amount is sent to the IRS as income lax withholding. For example, if your eligible
rollover distribulion is SIO,OOO, only S8,OOO will be paid 10 you because the Plan must
withhold S2,OOO as income lax. However, when you prepare your income lax return
for the year, you will report the full $10,000 as a paymenl from the Plan. You will
report the S2,OOO as tax withheld, and it will be credited against any incon'e tax you
owe for the year.
Volllllfary Withholdil/g. If any portion of your payment is not an eligible rollover
distribution but is taxable, the mandatory withholding rules described above do not
apply. In this case, you may elect not to have withholding apply 10 that portion. To
elect out of withholding, ask the Plan administrator for Ihe election fonn and relaled
infonnation,
Sixty-Day Rollol'er OptiOI/. If you have an eligible rollover distribution paid to you,
you can still decide to roll over all or part of it to an IRA or another employer plan
that accepts roll overs. If you decide to roll over, YOII mlls/ make /he rollover withil/
60 days after YOII receil'e the paymel/t. The portion of your payment that is rolled
over will not be laxed until you take it out of the IRA or the employer plan,
You can roll over up 10 100% of the eligible rollover distribution, including an
amount equal 10 the 20% that was withheld. If you choose to roll over 100%, you
must find other money within the 60-day period to contribute to the IRA or the
cmploycr plan to Icplacc the ~O% Ihat was wilhheld, On Ihe olher hand, if you roll
over only the 80% Ihal you received, you will be taxed on the 20% Ihat was withheld,
Example: Your eligible rollover distribution is SIO,OOO, and you choose to have
it paid to you. You will receive $8,000, and S2,000 will be sent 10 Ihe IRS as
income tax withholding, Within 60 days after receiving the S8,OOO, you may
roll over the enlire SIO,OOO to an IRA or employer plan, To do this, you roll
over the $8,000 you received from the Plan, and you will have 10 find $2,000
from other sources (your savings, a loan, etc,). In Ihis case, Ihe entire SIO,OOO
is not taxed unlil you take it oul of Ihe IRA or employer plan. If you roll over
the entire $ I 0,000, when you file your income tax return you may get a refund
of the S2,OOO wilhheld,
If on Ihe olher hand, you roll over only $8,000, the S2,OOO you did not roll over
is taxed in the year it was wilhheld. When you file your income tax return you
may get a refund of part of the S2,OOO withheld, (However, any refund is likely
10 be larger if you roll over Ihe entire $10,000.)
Additional 10% Tax if YOII Arc Ullder Age 59-1/2. If you receive a payment before
you reach age 59-1/2 and you do not roll it over, Ihen, in addition to the regular
income tax, you may have to pay an extra tax equal to 10% of the taxable portion of
the payment. The additional 10% lax docs not apply 10 your payment ifit is (I) paid
to you because you separate from service wilh your employer during or after the year
you reach age 55, (2) paid because you retire due to disability, (3) paid to you as
equal (or almost equal) payments over your life or life expeclancy (or you and your
beneficiary's lives or life expectancies), or (4) used to pay certain medical expenses.
See IRS Form 5329 for more information on the additional 10% tax.
Special Tax Treatmellt, If your eligible rollover distribution is not rolled over, iI will
be taxed in the year you receive it. However, it qualifies as a "lump sum distribution",
it may be eligible for special tax Ireatmenl. A lump sum distribution is a payment,
within one year, of your entire balance under the Plan (and certain other similar plans
of the employer) that is payable to you because you have reached age 59-1/2 or have
separated from service with your employer (or, in the case of a self-employed
individual, because you have reached age 59-1/2 or have become disabled). For a
payment to qualify as a lump sum distribution, you must have been a participanl in the
Plan for at least 5 years, The special tax treatment for lump sum distributions is
described below.
Fil'e-Year AI'cragillg, If you receive a lump sum distribution after you are age
59-1/2, you may be able to make a one-time election to figure Ihe tax on the
payment by using "5-year averaging". Five-year averaging often reduces the tax
you owe because iI treats the payment much as if it were paid over 5 years.
Tell-Year Averagillg if J'ol/lI'cre Bom Before Jalll/ary 1, 1936. If you receive
a lump sum distribution and you were born before January I, 1936, you can
milhc .1 onc-limc e1cction III figurc thc tilX on Ihc paymcnl by using" 10-year
ilveraging" (using 198(, la~ ratcs) inslcild of S-year avcragillg (using current lax
rales), Likc thc S-year avcragillg rules, 10-year averaging ollcn rcduces the lax
you owe,
Capital Gaill Trea/mmt If rou Were /Jom /Jefore Jalluary I, 1936, In
addition, if you receive a lump sum distribulion and you were born before
January I, 1936, you may elect to have the part of your paymenl Ihat is
attributable to your pre-1974 participation in the Plan (if any) taxed as long-
lenn capital gain at a rate of20%,
There are other limits on Ihe special tax treatment for lump sum dislribulions. For
example, you can generally cJeclthis special tax trealment only once in your lifetime,
and the eleclion applies to all lump sum dislribulions Ihat you receive in Ihat same
year. If you have previously rolled over a paymenl from Ihe Plan (or certain olher
similar plans of the employer), you cannot use this special tax treatment for later
paymenls from the Plan. If you roll over your payment to an IRA, you will not be
able to use this special lax Ireatmenl for later payments from Ihe IRA, Also, if you
roll over only a portion of your paymenl 10 an IRA, this special tax treatment is not
available for the rest of the payment. Additional restrictions are described in IRS
Fonn 4972, which has more information on lump sum distribulions and how you elect
the special tax treatment.
Employer Stock or Securities. There is a special rule for a paymenl from the Plan Ihat
includes employer stock (or other employer securilies). To use this special rule, 1)
the payment must qualify as a lump sum distribution, as described above (or would
qualify exceptlhat you do not yet have 5 years of participation in Ihe Plan), or 2) the
employer stock included in the payment must be attributable to "after_lax" employee
contributions, if any. Under this special rule, you may have the option of not paying
tax on the "net unrealized appreciation" of the stock until you sell the stock. Net
unrealized appreciation generally is the increase in the value of the employer stock
while it was held by Ihe Plan. For example, if employer stock was contribuled to your
Plan account when Ihe stock was worth $1,000 butlhe stock was worth $1,200 when
you received it, you would not have to pay tax on the $200 increase in value until you
later sold the stock.
You may instead elect not to have the special rule apply to the net unrealized
appreciation, In this case, your net unrealized appreciation will be ta.xed in the year
you receive the stock, unless you roll over the stock, The stock (including any net
unrealized appreciation) can be rolled over to an IRA or another employer plan either
in a direct rollover or a rollover that you make yourself.
If you receive employer stock in a payment that qualifies as a lump sum distribution,
Ihe special tax treatment for lump sum distributions described above (such as 5-year
averaging) also may apply, See IRS Form 4972 for additional infonnation on these
rules,
ma~e a one-time election to figure the tax Oil the payment by using" 10-year
averaging" (using 1986 tax rales) instead of 5-ycar averaging (using currcnt tax
ralcs), Likc the 5-year avcraging rulcs, 10-ycar averaging oncn reduces Ihe tax
you Owe,
Cupilul Gaill Trealllle/ll If rIm Were IJom IJefore Janllary I, 1936, In
addition, if you receive a lump sum dislribution and you were born before
January ], ] 936, you may cicCI to have the part of your payment Ihat is
allributable to your pre-] 974 participation in Ihe Plan (if any) taxed as long-
lerm capital gain al a rale of20%, "
There are olher limits on the special tax treatmenl for lump sum distributions. For
example, you can generally elect Ihis special lax Ireatment only once in your Iifelime,
and the election applies to all lump sum distributions thaI you receive in Ihat same
year. If you have previously rolled over a payment from the Plan (or certain other
similar plans of the employer), you cannot use this special tax Irealment for later
payments from the Plan. If you roll over your payment to an IRA, you will not be
able to use this special lax trealment for later payments from the IRA. Also, if you
roll over only a portion of your payment 10 an IRA, this special tax Ireatment is not
available for the rest of the payment. Additional restrictions are described in IRS
Form 4972, which has more information on lump sum distributions and how you elect
the special tax treatment.
Employer Slack or Securities. There is a special rule for a payment from the Plan that
includes employer stock (or other employer securities). To use this special rule, 1)
the payment must qualitY as a lump sum distribution, as described above (or would
qualitY exceptlhat you do not yet have 5 years of participalion in Ihe Plan), or 2) Ihe
employer stock included in the payment must be allributable to "after_lax" employee
contributions, if any, Under this special rule, you may have Ihe option of nol paying
lax on Ihe "net unrealized apprecialion" of Ihe stock until you sell the slock. Net
unrealized appreciation generally is the increase in the value of the employer stock
while it was held by the Plan, For example, if employer stock was contribuled 10 your
Plan account when the stock was worth SI,OOO but the stock was worth S1,200 when
you received it, you would not have to pay tax on the S200 increase in value unlil you
laler sold the stock.
You may instead elect not to have the special rule apply to the net unrealized
appreciation. In this case, your net unrealized appreciation will be laxed in the year
you receive the stock, unless you roll over Ihe stock. The stock (including any net
unrealized appreciation) can be rolled over to an IRA or another employer plan either
in a direcl rollover or a rollover that you make yourself.
If you receive employer stock in a payment that qualifies as a lump sum distribution,
the special tax lrealment for lump sum distributions described above (such as 5-year
averaging) also may apply. See IRS Form 4972 for additional information on these
rules,
e
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
II:
,_,__.1>I:\l'.~(!L~'..lJ_~_- --- ., ----.. ---
being duly _i.....~--_ eccording 10 rew, dopolO' ond ,oy. thet 'ho
"6...",,, ".jl~t:'~~~. _u___ _ ___ _ _ _ of tho estato of __. Wc.llu.,~l_.x....---_._--------------
lote of _J":onroe Tvl p. _ __ __ ,_. _., Cumbo,lond County. Po., decu.od ond thot tho
within i. on Inventory medo by h'IH\COi'~.L"_"._'m_ __,_._ __ _ _. __ ___, tho .eid . ,I...., .1, f, '.
of tho entiro estoto of .oid docodent, con.isting 01 oil tho porsonol propdrly ond reol ostote, excopt ..01 ..toto outside
Ihe Commonwullh of Penn.ylvonio, ond thot tho figu,o, oppo,lto ooch Itom 01 tho Invonto,y ropro,ont it', foir volue
0' of tho doto of decodont', dooth.
4 \ 'Z t:j
19 "1
N2. , (l
'Uc.J. <t""
,----~
~..cutor . Admtnl.tu'or
01 \ \. I,!\,G
. ------._---
ond ,ub.cribod bofo,e mo,
2. 2- liel" Icc" L
.______.____....L.' __
Notarial Soal
Tmcy K. Katshlr, Nolaty Public
Lomoyno Born, Cumberland County
My Commission Expires Juno 2 t. 1909
j
._i:'--1IJllh:.!2...f:~1' l: I'Ji 17(:', (-
Addr...
Dote of Oooth
'2 ~)
'\
CJb
Doy
Month
Vu,
INSTRUCTIONS
I, An inventory must be filed within threo month, ofter oppointment of personol repre,entative.
2, A ,upplement Inventory mu,t bo filed within thirty doy. of di.covery of odditionol o..ets.
], Additionol ,heets moy be ottoched 0' to personelty or reolty
4, See Article IV, Fiducio,ie, Act of 1949.
Q)
"
'01
I c1
I 0'
Ul
rl-~
I .
m ~ ,; "
" ,01
r- w I ~ Ul .c
co ~ "" ..... "
w ~ (_;1 " -< Ul
0 ... U AI ~
0 0 lit P "
0 w C Q) '" <1l ,...
I "" w ~ ~ " "
\D I- J: ... I ... ... c
..... ...J LL ,,; ~
0' Z <( 0 "I ... 0
0' LL ...J =:
w 0 <( w " OJ ,;. '" <(
.- > Z "" <\l' 0
f'l\ -
Z 0 " c >,
c >:: ~ "
- lit Z 0
0 "" ';1 0 u 0
z w <( F .... till
... ......, ~I ." Q)
C I
......' " I "
Q) : - -.: I '-'
.- 0 "
~ . ; .., ...
" E ."
- ..!! 0
~ 0
" U u: II>
...J
Inventory of the real and personal oslalo of
\'Iolls. Barl 'r.
docoased
---~_._....._.-
------.--.-
1 . Cash $4531. 91
2. Personalty S616 60
3. 1987 Chovrolet Spectrum S50 00
4. 1982 Oldsmobile Cutlass S50 00
5. 1978 Ford Thunderbird $75. 00
6. 1984 m,c Caballero IS 1000 00
7. llinanc ial I
Trust Co. Cheching account 1(12902. ' :69
( join t account w/daughtor - totul value - 32902.60)
TOTAl,
~'9226
11
)'Y/}{, -/'1
c.....
COHHONWEALTH OF PENNSYLVANIA
DEPARTHENT OF REVENUE
i*
BUREAU OF INOIVIOUAL TAKES
,,.fLAIlAHer IAlI DIVISION
DEPI. :10.01
UAARJSIURG, PI 1I11a-0.01
NOTICE OF INHERITANCE TAK
APPBAISEHENr, ALLOWANCE OR OISALLOWANCE
OF DEDUCTIDNS AND ASSESSHENT OF TAK
IU.lh' III" III.'"
GREGORY J KATSHIR ESQ
900 MARKET ST
LEMOYNE PA 17043
DATE
ESTATE OF
DATE OF DEATH
FILE NUHBER
COUNTY
ACN
07-21-97
WELLS
09-28-96
21 96-0879
CUM8ERLAND
101
T
EARL
Anount Re.ltt.d
MAKE CHECK PAYABLE AND REHIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS .....
iiE"v:E;'4TEX-"Fi'--ioi-:97T"NOi'YCE--0j1uftiHEiiii'ANCE-"fAX-A-ppiiiiisEifENT-,u"i.i-oWAN-CE-iilinm-mnmm
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF WELLS EARL T FILE NO, 21 96-0879 ACN 101 DATE 07-21-97
TAX RETURN WAS: I X I ACCEPTED AS FILED
( 1 CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Rod Estoto ISchodulo Al III
2. Stocks and Bond. (Schedule BJ (2)
3. Closely Held stock/Partnership Intar..t (Schedule C) (3)
4. Horta.ga'/Nota. Receivable (Schedule DJ (4)
5. Ca.h/Bank Deposita/Hilc. Parlonal Property (Schedule E) IS)
6. Jointly Owned Property (Schedul. fJ (6)
7. Transfara (Schedule G) (7)
8. Total A...t.
.00
.00
.00
2 , 162 . 44
4,161.07
2.902.60
.00
(BI
HOTE: To insure proper
credit to your account,
subnit the upper portion
of this fora with your
ta)( pay..ent.
9,226.11
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expen,ea/Ada. Coat./Hi.c. Expan.e. (Schedule H) (9)
10. D.bts/Hortg.go Llobllltlos/Llons ISchodulo II 1101
11. Total Deduction.
12. Net Value of Tax Return
13. Cherit.ble/Govern..ent.l Beque.t. (Schedule J)
14. Not V.luo of Estoto Subjoct to T..
10,265.56
4.407,44
Illl
1121
1131
1141
14 .~73 on
5,446.89-
.00
5,446.89-
If an assessment was issued previOUSly, lines 14, 15 and/or 16, 17 and 18 will
reflect figures that include the total of ALL returns assessed to date,
ASSESSMENT OF TAX:
15. A.ount of Line 14 .t Spou.al rate 115)
16. AMount of Line 14 taxabl. at Line.I/CI..a A rate 116)
17. AMount of Line 14 t.xable at Coll.teral/Cla.1 8 ret. 117)
18. Principal Tax Due
NOTE:
.00 X .00=
.00 X .06=
.00 X .15=
llBI
.00
.00
.00
.00
TAX CREDITS:
PAYHENT
DATE
DISCDUNT 1.1
INTEBEST/PEN PAID I-I
RECEIPT
NUHBER
AHOUNT PAID
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
.00
.00
.00
.00
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
I IF TOTAL DUE IS LESS THAN '1. NO PAYHENT IS REQUIRED.
IF TDTAL DUE IS REFLECTED AS A "CREDIT" ICRI, YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FDRH FDB INSTRUCTIDNS.I
I
" '
."-'
RESERVATIOH~ E,t.t.. of dlcldant. d~lng on O~ bllar. nlc..bar 12, 1981 -- If any future Int.r..t In thl ..tat. I_ trenlf.,rld
In POII..,ton or .njoy..nt to ct... . (col1_t.,.1) blnaflel.,l.. of thl dlcedlnt aft" thl ..plratlon of any I,'ata for
II" Dr for Y"'" the Co.-anw..lth hlr,by Ixpr..,ly r...rv.. thl right to appr31.. and ...... tran.'" Inheritance ,....
at the lawful Cl... . (col1a"'a1) rata on any such future Int.r..t.
PURPOSE OF
HOTICEI
PAMHTI
REfUND (CR) I
OBJECTIONS I
ADHIN
JSTAATly[
CORRECTIONS I
DISCOUNT t
PENALTY!
INTEREST I
To fulfill thl rlqulr...nt. 0' Slctlon ZI~O of thl Inheritance end E,t,t, Ta. Act, Act 21 of 1995. (72 P.S.
SectSon 9140).
D,tlch thl top portion of this Notlu and sub.1t with your ply..nt to thl Rlghtl,. of Willi printed on thl rav.r.. IIde.
--"eke ch.ck Dr eon.y order p.yabl. tD: REGISTER OF MILLS, AGENT
A r.fund of . tlX crldlt, which WI' nDt requ..tld on thl Tax Raturn, ..y ba raqua.tad by co.platlng en "Appllcltlon
for Rafund of Plnn.ylvlnl. Inherltanca and E.t.ta T.." (REYaI515J. Application. ar. .vallabl. at tha Office
of thl Rlgl.t.r of Will., any of the 25 Rlvenul DI.trlct Offlc.., or by cllllng the .p.cl.1 Z~-hour
an.werlng .arvlca nuablr. for for.. ord.rlng: In pann.ylv.nl. la8DO-56ZaZOSO, out.ld. P.nn.ylvanl. end
within local Harrl'burg ar.. (717) 787-80'~, TDD' (711) 77Z-2252 (H..rlng Iapalr.d Only).
Any party In Intlr..t not ..tl.fl.d with thl appral...ent, allowancl or dl'.llowanc. of d.ductlon., or ........nt
Df t.x (Including dl.count or Intarl.t) .. .hown on thl. Hotlc. au.t obJlct within .I.ty (60J days Df r.cllpt of
this Notice bYI
-.wrlttan prot..t to tha PA Departllnt of R.venu., Board of App..I., D.pt. 2810ZI, Hlrrl.burg, PA 17128al021, OR
--allctlon to h.ve tM .attar d.t.raln.d .t ItUdlt of thl account of thl p.r.on.1 r.pr..lnt.tlvl, OR
--app..l to the Orphan.' Court.
F.ctual .rror. dl.cov.rad on thl. ........nt .hould b. .ddr....d In writing tal PA D.p.rt.ant of Rav.nue,
Bur.au of Individual T.x.., ATTH: po.t A.......nt R.vl.w unit, D.pt. 280601, H.rrl'burg, PA 11128-0601
Phone (717) 781-6505. tl. p.g. 5 of thl bookl.t "In.tructlon. for Inh.rltanc. T.. R.turn for a Ra.ld.nt
O.c.dent" (REV-1501) for an axplan.tlon of .dalnl.tratlv.ly corr.ctabl. .rror..
If any t.x due I. paid within thr.. (3) c.l.nd.r .onth. aft.r the dac.dlnt.. d.ath, . flv. p.rc.nt (5~) dl.count of
the t.x p.ld 1. .llow.d.
The 15% tlx .-n..ty non'plrtlclp.tlon panllty I. co~t.d on the tot.l of the taM and Int.rl.t a"I..Id, and not
paid baforl Janu.ry la, 1996, thl flr.t day aft.r the .nd of thl taM lan..ty p.rlod. Thl. non-partlelp.tlon
pan.lty I. .pp..labl. In the .... lannar end In the the .... tl.. p.rlod al YOU would app.al the tax end Int.r..t
that h.. bean .......d .. Indlcat.d on thl. notlc..
Int.r..t I. charged beglnnlna with flr.t d.y of delinquency, or nine (9) .onth. end on. (II day fro. the d.ta of
da.th, to the data 0' P.y.."t. '-xu which blc... d.Unquant b.for. January I, 1982 b.ar Int.rut at thl rat. of
.1. (6%1 parcent plr ennu. c.lcul.tld .t . d.llv rat. of .DDDI6~. All t.... which b.c... d.lln~nt on and aftlr
January I, 191Z will baar Intar..t .t . r.t. which will vary fro. c.l.ndar y..r to c.lendar y..r with th.t r.t.
announc.d by the PA Dap,rt..nt of Rav.nu.. The appllcabl. Int.ra.t t.ta. for 1912 through 1997 at.1
~ Intlrut Rat. D.lly Int.r..t Factor !!!! Int.r..t Reta O.lIy Intlrut Factor
1912 ZOX .DOO5U 1987 OX .0002t,?
19U 16% .000418 1981-1991 m .OOOSDI
1981\ IU .000301 199Z 9X .OOOlU
1985 UX .000556 1993-1994 7X .000192
1916 lOX .DDOZ1~ 1995-1997 9X .DOOZ"
--Inter..t II c.lculatad .. follDWIf
INTEREST = BALANCE OF TAX UNPAID X NU"BER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Hotlc. I..ued .ftar the tax baeo... d.llnquent will raflect ~ Intara.t c.lculatlon to flftaan (15) day.
beyond the data of the .......ant. If Ply..nt I. .&da .ftar thl Int.t..t coeputatlon data shown on thl
Hotlc., Iddltlonal Int.r..t .....t be celculatad.
C-
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
, ~ . '
,
IN RE:
)
)
)
) NO: 1996-00879
)
ESTATE OF EARL T, WELLS
Deceased
RECEIPT AND RELEASE
I, Barbara Wells, do hereby acknowledge that I am
receiving the sum of $6,181,18 as payment of any amount that I may
be entitled to receive for any and all entitlements, due to me from
the Estate of Earl T. Wells and acknowledge that this is full and
complete satisfaction of any and all devises, bequeaths, rights,
entitlements or claims of any kind that I have against the above
referenced estate,
I further acknowledge that I accept this distribution,
full disclosure of all administration of the estate, and
acknowledge that this does not include any funds in joint bank
accounts.
I further hereby release Barbara Wells, Administratrix,
from any claims and liabilities which may arise against her as a
result of the administration of the Estate of Earl T. Wells, and
agree to hold her harmless and reimburse her my pro rata share of
any such expense incurred by her as a result of the administration
of the estate, should a charge be imposed.
;,0..
...
~-
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
IN RE:
)
)
)
)
)
NO: 1996-00879
ESTATE OF EARL T. WELLS,
Deceased
Name of Decedent:
CERTIFICATION OF PUBLICATION
Earl T.Wells
Date of Death:
09/28/96
To the Register:
I certify that the grant of Letters of Administration
have been advertised pursuant to Section 3162 of the Probate,
Estate and Fiduciaries Code. Proofs of Publication are attached
hereto.
Date: ~fl'l/fj7
. I
Name: Gregory J. Katshir, Esq.
Address: 900 Market Street
Lemoyne PA 17043
Telephone: (717) 763-8133
Capacity:_ Personal Representative
--X- Counsel for Personal
Representative
t~i
q
L~ I....
a:
1.,\
. .'
r ~G
~roof of Publication of Notice in The Patriot and The Evening News
and The Sunday Patriot-News
l'ndf" .~('t No. lJ87, '\I'lu1U'f'd May 1ft. I~.
Cmllmonll'rn/lh of pr,msIIII'''"i'',} .
COII"tll of f)oll/;hill""
............................J\tc,;.I.l,{19.J..J\!!.r:,~,~'.~.........................,beln!: duly RWOru accordillg to law, depoRes lI11d RaYR:
^S!Jt. Controller
That he Is the ............................of TilE PATRIOT -I\I-:\\'S ro.. a corporation orll'lInized allll existlllll'
under the laws of the Commonwelllth of Pellnsyh'lInia, with its Ilrinclpal office alld plllce of bURlness at
812 to 818 Market Street, In the City of IIl1rri-llIIr!:, County of DIIUphill, State of PenllRylvanill, owner
and publisher of THE PATRIOT and Tim EVI-::-1ING NEWS alld the SUNDAY PATRIOT - NEWS
newspapers of Il'eneral clrcullltlon, printell allll publish,'d lit R12 to 818 JIIarket Street, In the City,
County and State aforesaid: thllt TIII-; I'A TItI0T Dlul TilE EVENING NEWS alld the SUNDAY
PATRIOT _ NEWS were estllblished MBrch 4th, IRM, IInd Fcbruary 15th, 1917 and September 18th,
1949, respectively, alld all have heell continuously published ever since;
That the printed llotlce or publicatloll which is securely attacbed hereto Is exactly as prlllted and
bl'hd' hi I I" d' hlh d h 5th, J.2th, and lYth
pu IS e In t e r regu ar e< ltaons an ISBues w c apP<'are on t e ..........................................................
days of November 19Y6.
........................................................................................................................................................................................
That neither he nor sllid Company is interested in the snbject matter of said printed notice or adver-
tising, alld that all of the allegations of this stlltemcllt as to the time, place and chllracter of publication
are true; and
That he has personal knowledge of the facts IIforesald alld is duly authorized and empowered to
verify this Btatemellt on behalf of The Plltrlot-News Co. IIforesaid by virtue and pursullnt to B resolu-
tion unalllmouBly paBsed and adopted severally by the SICk holders IIIllI board of directors of the Raid
Company and subsequentiy duly rc.:orded III the olllee fOrr e(keCOrdinll' of Deeds ill and for sllid County
of Dauphin in ~li"....II.",'",,, Bnnk "~I". \'nlolll" II. I'.~., :11.. {\ /' 'ftlt!, (.-"11
Copy of Nollce or Puhllcallon ........................... ,.,' ..~...~..\L!.:...:.~:.:.~:....................................
Sworn to and subRcrihe~be. fore me thi8,.;.7'~1.~.!;.1.!.....day of
/.>1 . /,J' ,
N.\~y,\-!!)!!?\-!,7 A. ] Y 96. /1" II/> I., ~ ". / "'"' '/t7,/
.............. ,itll.9~.."..".'....;. ....(;......r...............
TO'OI L. All'.';!, NQ(ary Publ,c olary Public
. . 11..111.~t)i.Hfj. OaUp1l111 C..,unly
lily comm! :fil)tClIltllinl:S,EAplIIl..,lullu6..l9lJ.. ............
StatemenfOfAJVinfsTng Costs
Estate Nollees
L.ft.rs or Administration hove bttn grant"'
Inthl Eltat. ot Earl T. W.l', to Barbara A. WIlli
onOc'Ot)tr29.''''.Mr. W,ulwolorCumbt'rland
County. All PInons who whiSh to make 0 claim
ooalnlt "",,'ot. DrwMOfllndtbltd 'aiM "'at.
thaU mokt ""Ir POIlIIon .nown by conloctlnll:
GrtftryJ. Kcmhlr, I.~ulrt
fOO Mortl" I"'"
Lemo..... PA IfIU
(17) 76).11U
Gr,e.g ur.y. ..,.1..... ,1:.:1 J:.ti h Ul:.. ........ ............. .... ..... ..........
Ll'1;)l?y.!J!,:,c......!?(\.:.......U,H.1J...................................
To TilE PATRIOT-NEWS CO., Dr.
For pllblishlllg the notice or pllblicatlon nttached hereto on the
above stnted dates . $........~.~,:}~........
Probatillg same $..........~.....~.~........
95.20
Total $............................
Publisher's Receipt for Advertising Costs
THE PATRIOT-NEWR CO., Jlllhlisher of 1'111' PATH lOT 111111 TilE EVENING NEWS and the
SUNDA Y PATRIOT-NEWS, llew'paperR of gelll'l'Ul dreulat;oll, hereby ackllo",led!!,e receipt of the
aforesaid notice alld Pllblication costs alld certifies that the same have been duly paid.
TilE PATRIOT-Nr:\\'S CO.
By .,'.."....""...,'..""."..,...,."""".,.,'..,........,.....,."'....",,,...,
,
RENUNCIATION
In Re Estate or
~ '. I 1,1 '~l
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deceased,
To the Register or Wills or
(:t"i. ly!rl:,n(l
County,l'enllsylvanla.
The ulldersigned
"dl)'.' '{'lll'-;, rl::11pLt-..'r
or
the above decedent, hereby renounce(s) the right 10 administer the eSlnte and respectrully ask(s) that Lellers
:,c11..iniGtr~~ tion
be issued to
1~;'1rh'-r;1 "(-,11 !,
WITNESS
hand this
day or
,19_.
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(( ,,(, . J."- "'-Q. ! I . ( \
(Signalure)
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(Addr.."
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(Signalure)
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(Signature)
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(Addr.."
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PLEASE ~'llE nus REPORT Wl'lHlli lW YEARS OF ~ OF DEAlH Rm\RJ)~S OF 1HE STA1US OF '!HE
ESTATE. IF ESTATE IS oor cnn>IETED, FILE A 6.12 FORM YEARLY UNl'IL <XX1PIEl'IOO. CJ
V
STATUS REPORT UNDER RULE 6,12
Name of Decedent I ";',r1 'i'. ',',<'11 ::
Date of Deathl 9/2U/96
Will No,
Adml n, No, 1 '1',t,-flOH7Q
Pursuant to Rule 6,12 of the Supreme Court Orphans'
Court Rules, I report the following with respect to completion of
Lhe administration of the above-captioned estatel
1. State whether administration ot the estate is compleu~:
Yes x No
,
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2, If the answer Is No, !l tate when the personal
representative reasonably believes that the administration will be
complete I
], 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 x
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b, The separate Orphans' C~urt No, (if any) for
the personal representative's account iSI
c, Did the personal representative state an
account informally to the parties in interest? Yes v No
d, Copies of receipts, releases, joinders and
approvals of formal or informal accounLs may be filed with the
Cerk of the Orphalls' Court ilnd may be altached this. report.
~-AJ 7.' ~
Signature
Date: 7/1/9P
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r.""('IoL'n,..." T .T"1tr::::hi'r T:'f.:nlli,...n
Name (Please type or prrnt)
900 I'Hr!~et street T,emoync PA 17043
Address
, ;
L!~2l. 763-8133
Tel. tlo.
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(MAH I rmU AM])
CdIJaC itj':
Personal Representati~~
_:x ..,Counsel for personal
representative
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