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PETITION FOR PIWnATE and GRANT OF LETTERS
hSla'e of llilH.O'J'llY.._.L_DYMDND____ No. _ __.'IC( z.~::15._n___.. n___~__
also known as __.~_______. .____ .00.__"..___ To:
____._______________..._________..____ Register of Wills for the
________, Deceased. County of .~lJMI\I.':R[,^tl.!2._. in the
Social Secl/rily No. _?~Q.!_::J (i -- .1.<i1.L...____ Commonwealth of Pennsylvaula
The petition of the undersigned respectfully represents that:
Your petitionerCo\), who Is/~l( 18 ycars of age or older anthe exeCULR.IL-
In the last will of the above decedent, dated ,DECEMBER _13,
and eodlcll(s) dated -N.Qti!L_..___~____
named
, 192.1...-
(Slale relevant clrCl1mSlanCest Cl.g. rcnunclallon. death of (':<eeU!af. CIC,)
Decendent was domiciled at death in CU~.!2r:RLAND . County, Pennsvlvanla, with
hEI< lastfamllyorprincipalresldencellt..GIlIlENI<IDGE VILr,AG8, WEST PENNSROf\O,
hlRW\fTT.r E;I_........E.t\_Uh -
(ll~l street, number and nlunclpalilYI
Derendl'n, then --2Q.__. years of age died f)ECE~1BIlR 29 ,19.96__,
at GREENRIGGE VILLI\GE PRESllYTERII\N HO~lE ___'
Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted
after execution of the will off Ned for probate; was not the victim of a killing and was never adjudicated
Incompetent: __.._.____
Decendent at death owned property with estimated values as follows:
(If domiciled in Pa.) All personal property
(If not domiciled in Pa.) Personal property in Pennsylvania
(If not domiciled In Pa.) Personal property In County
Value of real estate in Pennsylvania
situated as follows:
$ .l'12.L900 . 00
$
$
$
WHEREFORE, petltioner(s) respectfully request(s) the probate of th~ last will and codicil(s)
presented herewith and the grant of lellers 'I'F:q'l'IIMRN'I'IIRV
(testamentary; administration c.t.a.j administration d.b.n.c,l,a,)
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OATH OF PERSONAL REPRESENTATIVE
COMMONWEAI,TII OF PENNSYLVANIA }' 88
COUNTY OF .__.cmm!':lll..l\.l'J;1..___._.___n____ "
The petitlolle"(,) above-named s\\'c:;r(:;) or a[firm(s) that thc statements in the foregoing petition are
true and correct 10 the bee I of Ih" """wledge and helieI' of petitioner(s) and that as personal represen-
tative(,) of the ahovc r1ccl'dcnl po;lilionn(,) will well aId tr'uly ndminirt~e/state according to law.
Sworn to or "fI.irllH'd ,,,,,I -'1I:l<'.l'il.1l'd r-- ~~-:.~:~~ '-".- ~ / (f_~._(i( - ~
before me thiS _,' f cj __. day of ..___.___,____.________~.__._.~_____._..u~_._ fJ~
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No ;'1-117.. ,',
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Es.ale of
DOROTHY ~. DYMOND
, Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW _~~Ili" Y 14 19~.l.__, in consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that the instrument(s) dateL[)ECIlM li CR 13, 1. 991
described therein be admitted to probate and flied of record as the last will of DOROTHY L. DyMOND
_i
and Letters T8STIIMENTARY
are herr-by granted to S II SA N S. 1"0 R D
FEES
Probate, Letters, Etc, ",',",' $ ?:1 'l . () 0
Short Certlficates( 1 ~ ' , , , , , , , ,,$ :1 0 . 00
Renunclation ""."",."". $
}\''',l!r"Fj'?'S C).00
,Trl' $ ';.00
TOTAL _ $ 17'1.00
FlIed ,..,. " ~1/~r~.(}f\1~Y, ,'l~"",. ,,~ ?,~?,..
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.,?,ROBERT L. KNtJPI'....D.70fJ3
tJ ( ATIORNEY (Sup, Ct. J.D, No,)
PO BOX 11848, HARRISBURG, PA 17108-1848
ADDRESS
Will Book # _
Page
(717)238-7151
PHONE
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COMMONWeALTH OF PBNNSVl,VANIA I OEPARTMENT OF HEALTH I VITAL RECORDS
CERTIFICATE OF DEATH
~." CIOfNl(".lolcUt,",
I. Doroth Louise D mond
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FIFTH: I give, devis8 and bequeath all the rest, residue and
remainder of my estate, of ~~latsoever kind and wheresoever situate,
to be divided equally between JOYCR SPITTLER, Harrisburg,
Pennsylvania, or her issue if she should predecease me; and SUSAN
S. FORD of Monson, Massachusetts, or her issue if she should
predecease me.
SIXTH: Should there be any property of whatsoever kind and
wheresoever situate which I have the right to dispose of at the
time of my death, including but not limited to any special or
general power of appointment or both, I hereby appoint the same to
my legatees set forth in Paragraph FIFTH hereof.
SEVENTH: It is my will and I so desire that Robert L. Knupp
of the law firm of KNUPP & KODAK, P.C. of Harrisburg, pennsylvania,
shall act as attorneys for my Executrix in the settlement of my
estate, they being acquainted with my affairs.
EIGHTH: I nominate, constitute and appoint SUSAN S. FORD as
Executrix of this my Last will and Testament and further direct
that she shall serve without bond. Said Executrix shall have the
power to discharge all the debts, liens and encumbrances upon my
estate, as well as any taxes thereon, to pay for the cost of the
final disposition of my remains and final illness, if any, to
receive any and all commissions and other compensation for services
rendered by me during my lifetime and to perform any and all
2
COMMONWEAI.'I'H OF PENNSYLVANIA
SS~
COUNTY OF lUlU Fll ('(fAoA.i(,.tL1IJ/J
I, DORO'I'HY L. DYMOND, Testatrix whose name is signed to the
attached or foregoi11g instrument, having b<len duly qualified
according to law, do hereby acknowledge that I signed ~nd execul~d
the instrument as my Last Will and 'r'i'~tament; ,that'l I signed)l t;
willingly; and that I signed it as my,f.rlilE;i atW'I',' VO,lun'tll'tY'acttrorh (l,
the purposes therein expressed. .;j~" It' /) I /
~ ie' ~J 1" 'J' A, DOR~Y ~./D~Z: ~ Iv r In ~
Sworn and sUbpR,ribed
Testatrix, this ~~ day
L. DYMOND, the
1991.
NOOlIIAI Seal
C>>.18 Jayne Zinn, No1Ary l'ltic
stJiWElf1SOOrg floro, Cumberland CDl,n\Y
My Commission E>q:JrBS May 2;>,1[195
, ilOnsyII no _
to b)0~~ me '} DOPO'rHY
of / J" '-Jdlll-? ,
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Notary Public -
My C nunission Expires I
(SEAL)
COMMONWEALTH OF PENNSYLVANIA
SS.
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We, ('II/,',s//II"_ /I('/7,vtu,r) "I _fl1r7PIj C-(,1;'J(f: ,S'J11,4t1L~
the witnesses whose names are signed to the attached or foregoing
instrument, being duly qualified according to law, do depose and
say that we were present and saw DOROTHY L. DYMOND, Testatrix, sign
and execute the instrument as her Last Will and Testament; that
DOROTHY L. DYMOND signed willingly ,and that she executed it as her
free and voluntary act for the purposes therein expressed; that
each bf us in the hearing and sight of the Testatrix signed the
will as witnesses, and that to the best of our knowledge the
Testatrix was at that time 18 or more years of age, of sound mind
and under no constraint or undue ~~~f~=~nc~:;~
. ) --:T::.~_
t;;~t{d,//L~~(L)
Sworn to ttnd subscr' ed
this I. q, day of
'~ ("~
1.1/111--'-
Public
My onmission Expires:
(SEAL)
befor~ me
-u , 1991.
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CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent: Dorothy L. Dymond
Date of Death: December 29, 1996
Admin. No. 1197-00035
Pa. No. 2197-0035
To the Register:
I certify that notice of beneficial interest required by Rule 5.6(a) of the Orphans'
Court Rules was served on or mailed to the following beneficiaries of the above-
captioned estate on January 23, 1997:
St. Stephens Episcopal Cathedral
221 North Front Street
Harrisburg, PA 17101
Episcopal Home
206 East Burd Street
Shippensburg, PA 17257
St. Andrews Episcopal Church
21 North Prince Street
Shippensburg, PA 17257
Michael Lusk
600 Park Avenue
New Cumberland, PA 17070
Jerry Lusk
256 Brindle Road
Mechanicsburg, PA 17055
Susan S. Ford
7 Old Stagecoach Drive
Monson, MA 01057
Date: January 23, 1997
- ~~~
'1obert L. Knupp, . _ _ '.)
POBox 11848--
Harrisburg PA 17108
(717)238-7151
Counsel for Personal Representatives
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COMMONW(AlTH Of PUIN$Ylv,\HIA
DEPARTMENT OF REVENU(
[)~PT. 280601
rf~.!':.~SB.Y!.9.!_PA 17~11a.06~_.1
OECeDENt'S NAME (lAST, ~IRST. AND 'w\1-DllLt INIII,ul
DYMOND, DOROTHY L.
; SOCI^ISeCURlTV NUM"~~---JDAjT6T-Df;\J>I"'--T^l[ or ",'111 .
~__ 1".-~;F':O~~v~~;iu'i''.~'Mii';;i..ri":~H';';'::=~]SOil'LS~~~~~~?
~ K-l 1. Original Retvrn [J 2, Supplomonlcll Relurn
~-g;",
rr: ~ ~ 0 4. Limited E~la!e [J 40, Fvture Intoro~t Compromise
:z::;o9 (for datos of death aher 12.12-82)
c-' ~ co ~ 6, Decedent Died TIl~tote [J 7, Decedent MC\intoined a Living Trust
"' IAllcch copy of Willi IAllaeh copy of T 'osl)
.--....,.--..- All CORRESPONDEN'C"f ANDCONFIDEt-mAL TAX INFORMATION' SHOULD BE DIRECTED TO,
tlJl- NAME -, ---"---~-~-~jCOMPliWMAitING^OOlltSS
w:Z: t"
~~ ---.ED.sAN.-S,J'QRllJ EXECIFrRIL....__________ 7 OLD STAGECOACH D~IVE
U ~ TElEPHQNE NUMBfR
_ 41.~._~ 267-4423 ___- ..,~=,=~c _ _M?~~~~. ~A 01057
i fOR OATES Of OF.ATH AfTER 12131/91 CHECK HF.
INHERITANCE TAX RETURN II~D~::fyug~OIT IS CLAIMEDuLI ..
RESIDENT DECEDENT fiLE NUMBER
(TO BE FILED IN DUPLICATE I
WITH REGISTER OF WILLS) iCOUNTygoEn_n__iJ_R__ __:E._Ui,lB
------~-- -- i"jl(7{j[nY'~i~(J/t\Plr:T~ ,\I.)Rf~:J -~~-~_._-'---~-
GREENRIDGE VILLAGE
WEST PENNSBORO TOWNSHIP, NEWVILLErP
17241
1. Reol Estate (Schedvle A)
2. Slo'" and Bond, (Sch.dol. B)
3. Closely Held Stock/Partnership Intere$! (Schedule q
4, Mortgagos clnd Notes Receivable (Schedvle D)
5. Cash, Bank Deposits & Miscellaneous Penonol Properly
ISch.dul. E)
6. Jolnlly Own.d P'operly IS,h.dul. FI
7. Tronlfer. ISch.dol. GIISeh.dol. l)
8, Total Gran AU9h jtotollines 1.7)
9. Funeral Expenses, Administrative Cosh, Miscellaneovs
Expsm8s (Schedule H)
10. Debls, Morlgoge liabilities, Uens (Schedule 0
11. TOlol D.ductlon. 110101 Lin.. 9 & 10)
12, Net Value of Estate IUne 8 mInus line 11l
13, Cheritable and Governmental Beqvests (Schedule J)
1.4, Net Volue Sublec;t to Tax IUne 12 minus line 13)
15, Spousal Transfers (for dates of death after 6.30.941
See Instructions for Applicable Percentage on Reverse (l5)
Side. (Include volues from Schodvle K or Schedule M.l
16. Amovnl of LIne 14 taxable at 6% role
(Indudtt values from Schedvle K or Schedvle M,)
17. Amount of Line 14 tax(1ble al 15% rote
(Include value~ fram Schedvle K or Schodule M.l
16. P,indpollcx du'IAdd lox !rom line, 15, 16 and 17.1
19, Credits Spousal Poverty Credit Prior PObments Discount
__..D...OO____..... +_.1_9-,~_Q. 00 LQ~QQ_..__
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fA-MOU. Nt RfCE!VtO (SU. INSTRUCTIONS)
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[] 3.
Os
Ramainder RetU(n
(for deltes of dealh prior to 12-13.8'
Federal Estclte Tax Roturn Requirod
_ e. Total Number of Safe Depo~it BOKU'_
11 ) ___..___Q,.OO._______
12) H_.Q.LQQ.___~_
(3) .0.00
(4) .___.
151_..J40,1);>:J.7'\
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17) _.__ 0.00
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19)
10,338.06
(6) _
151;041.78
(10)_.
0.00
III)
(121
113)
114)
10,338.06
141,603.72
2,000.00
139,603.72
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x._=
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(16) __~.D...QQ..__..._x .06 ~ .___Q.OO
117) ..l39.t.6Q.3...22..
x .15 =
20 ,940. 5fi..___
20,940.56
(16)
Interest
0.00
(191
1201
19,500.00
20, If Line 19 is groater Ihan line 18, onter tho dilfert.lnee on lino 20. 1hil i~ the OVERPAYMENT,
foliO
Chock hare if vou oro tequestlng a refund b' your overpayment.
21. If Line 18 is grflotar th{ln lina 19, ontflr Ihe diffornnco on Lino 21. Thi~ is lho TAX DUE.
A. Entor lha inlowll on tho boklnm duo on line 21 A.
B. Enter tho !otcll of lina 21 CHHI 21 A on linn 21 B. Thi1 io; tho BALANCE DUE.
_~_~".,.~.a.~_~_~h_~~~__~~.yablo t~l__~_~_~_I~_t_~_r__~_f_ v.{_!I~~I_ ~~O~!. __________._._..
1211 -,-_..J, ,'14Q, 5_6________.
(21AI ________ ....._....~
(21B) _m"_..__ ..1 1-44Q,5.6________
'--"jO..-j.:-BE'SURE TO ANSWER ALL 'QUEST,6NSON REVERS-ESIOEAND 'fe-RECHECK MATH"':;C:'" ..('''_n_~____
:.Jnder p;~~iI';~-~rp;d~rY:-t-d~~;~l-t-i-i;~;~;J ~';~I-~,-)ir~-;;-~rlhi~--r~-I;~-;l-~r;c')~-(Iing-~~~;n~-r-Hlnying S(ho~j-;:;-i~~;~-d-~;:116meills, and 10 Iho bosl of my k~l~'~T~-~lgo -;-;dbo/i~1
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UV.l.~09 fX. PUll
. .9"J~,Q
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COMMONWEAllH OF PENNSYLVANIA
INHERITANCE TAX RETURN
ReSIDENT DECEDENT
SCHEDULE F
JOINTLY.OWNED PROPERTY
::A;Y~~D' OO;:~Y [~-----==---=_h-:_==~_._~---------JILE~~M~E~; _;;__~~-=:--
Joint tenont(.),
NAME
AD.Q.~ES~_
RELATION~!i!LTO DE~P!.t'!!.._
NIECE
A.
SUSAN S. FORD
7 STAGECOACH DRIVE
MONSON, MA 01057
B.
C.
Jolntly.owned prope'ty,
ITEM LETTER DATE
POR TOTAL VALUE DECD'S DOLLAR VALUE OF
NUMBER JOINT MADE DESCRIPTION OF PROPERTY
TENANT JOINT OF ASSET % INT. DECEDENT'S INTEREST
9-23-91 ..
1. A HARRIS SAVINGS BANK
MMA 01-05-005705 22,B36.06 50% 11,41B.03
-
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.
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_"'_n _T.~~~.':JAI,o_~~.~~lln. 6,!~:~~lIulal~~__ .S__ .ll,416JQL
(If more space is .nt'lfldod jns&rf addilional S1100/S of same ~izlJ)
FIFTHI I give, devise and bequeath all the rest, residue and
remainder of my estate/ of whatsoever kind and wheresoever situate,
to be divided equally between JOYCE SPI'l''I'LER, Harrisburg /
Pennsylvania, or her issue if she should 'predecease mel and SUSAN
S. FORD of Monson, Massachusetts, or her lssue if she should
predecease me.
SIXTH: Should there be any property of whatsoever ,kind and
wheresoever situate which I have the rlght to dispose of at the
time of my death, including but not limited to any special or
general power of appointment or both, I hereby appoint the same to
my legatees set forth in Paragraph FIFTH hereof.
SEVENTH I It is my will and I so desire that Robert L. Knupp
of the law firm of KNUPP & KODAK, p.e. of Harrisburg, Pennsylvania,
shall act as attorneys for my Executrix in the settlement of my
estate, they being acquainted with my affairs.
EIGHTH: I nominate, constitute and appoint SUSAN S. FORD as
Executrix of this my Last Will and Testament and further direct
that she shall serve without bond. Said Executrix shall have the
power to discharge all the debts, liens and encumbrances upon my
estate, as well as any taxes thereon, to pay for the cost of the
final disposition of my remains and final illness / if any I to
rece.ive any and all commissions and other compensation for services
rendered by me during my lifetime and to perform any and all
2
COMMONWEAL'I'H OF PENNSYLVANIA
SS.
COUNTY OF ~ lTI< C!tr",A,i(;tlt1tJjJ
I, DOROTHY L. DYMOND, Testatrix whose name is signed to the
attached or foregoing instrument, having been duly quaLified
according to law, do hereby acknowledge that I signed and execuJ~d
the instrument as my Last Will and T!(stament; .that~'I signe~rl& j
willingly; and that I signed it as my.:.ire~ aI)<;17-~O,lUrltti:'tt'act fo~)V 0--
the purposes therein expressed. I ~ > !f f) /-
~ rV 7?-J! ;.) "I'} 17' ;L IJ t-U-. 't (.vi r 1f1- " _
J DOROTHY L. DYMONn
S\vorn and sub~ribed to b7ff,~e me b'J DOROTIIY L. DYMOND,
Testatrix, this /,~ - day of ~t.JYI/II4._ , 1991.
NctlrIaISeaI ~r//1..~7 ~'
CtvIaJayneZinn,NoiaIYP\tJIIc --;J1:EZ -fL,W dr ->
Sh\lllOOSbUrg Boro,CumlJe<\ar<j CooI1!Y Notary PUblic "-.:1
My Commission ExpIres May 22, 1995 ,
emsytvasla 0 My C mmisslon Expires:
, (SEAL)
the
COMMONWEALTH OF PENNSYLVANIA
''''''''''11
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SS.
COUNTY OF B.\BFIIDI t!t<'-/ntYt,tI_fll1f)
We, (!/1rc.IJ-h1J4. ..J1c,4I?d'/lhi) r /!1r)(2/j t.~"q~t SIH..At..1..U
the witnesses whose names are signed to the attached or foregoing
instrument, being duly qnalified according to law, do depose and
say that we were present and saw DOROTHY L. DYMOND, Testatrix, sign
and eXecute the instrument as her Last will and Testament; that
DOROTHY L. DYMOND signed willingly and that she executed it as her
free and voluntary act for the purposes therein expressed; that
each of us in the hearing and sight of the Testatrix signed the
Will as witnesses, and that to the best of our knowledge the
Testatrix was at that tim8 18 or more years of age, of sound mind
and under no constraint or undue i~
~ p' /I
f-:!-:- di:U. - /- hLl/ a0c)
Sworn to ~nd subscri
this /'3't:j day of
befo!)8 me
V / 1991.
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0IMa JaynO Zlnn, Notary PlIhI1c
Sh~nsJ.xJr{J Bora, Cumborl,mcl COlJnty
My Cornmisslon E):r~r(fs May 2.:, 1!:l9S
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BURF.AU Of INDIVIDUAL TAMES
INt '.PITAHCl TAl( IJIVIS!ON
url,', ,'8oMJI
ItAHH{SnwW, PA Ill?K 01\01
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NonCE OF INIIERITANCF TAM
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF OEOUCTIONS AND ASSESSMENT OF TAM
DATE
ESTATE OF
DAre OF DEATH
FILE NUMBER
COUNTY
ACN
MAKE CHECK PAYABLE AND REMIT PAYMENT TD:
REGISTER OF WILLS
CUM8ERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ... RETAIN LDWER PDRTION FOR YOUR RECDRDS ....
ifi Ii': i 547' -Eif -Po F P- - ((IF 9'1 T - NoT"i c r OF - "Xliii Eii i;: At.fc E - i:"i\ X - ;iP- pilii is EME NT -; - ii L i.:ow A NC E - b-Ii - - - - - - - - - -- - - - - --
DISALLOWANCE DF DEDUCTIONS AND ASSESSMENT OF TAX
DOROTHY L FILE NO. 21 97-0035 ACN 101
SUSAN S FORD
7 DLD STAGECOACH
MONSON
DR
MA 01057-1102
Es'rATE OF DYMOND
TAM RETURN WAS:
I ACCEPTED AS FILED
RESERVATION CONCERNING FUTURE INTEREST - SEE R~VERSE
APPRAISED VALUE DF RETURN BASED ON: ORIGINAL RETURN
1. R.al Est.t. (Sch.dule Al
2. Stookli and Bandill (Schedule OJ
3. Clouly Held stocx/Partnership Int.r.!d (Schedule C)
~. Hortyagas/Not.. Receivable (Schedule OJ
5. CIsh/Bank O.posits/Hise. Personal Property (Schedule E)
6. Jointly Owned Pf'operty (Schedule F)
7. Transfers (Schedule G)
8. Tntal Assets
11-24-9'/
DYMOND
12-29-96
21 97" 0035
CUMBERLAND
101
[~.=_~~:~~:e.Hted
I X I CHANGED
SEE
III
(2)__
I ~I
141
ISI
(61
III
,00
,00
,00
,00
140,523,75
ll,41B,03
,00
(81
APPROVED DEDUCTIONS AND EXEMPTIONS:
9, Funeral Expenses/Adm. Costs/Misc. Exp.~ses (Schedule H)
10. Debts/Hortgage Ll~billtl.s/LlBns (Schedule I)
11. Total neductions
12. Net Valu~ of Tax R.turn
13. Charitable/Govern'lentll Bequests; Non~elected 9113 Trult. (~chedule J)
14. Net Value of Est.te Subject to Tlx
If an assessment was issued previously, lines 14, IS and/or 1&, 17 and 18
reflect figures that include the total of ill returns assessed to date.
ASSESSMENT OF TAX:
15. Amount of L in. 14
16. Amount of Line 14
17. Amount of Line l~
18. Principal Tlx Due
TAX CRf.DITS:
..._-,-~--_..
PAVMENT
DATE
03-27-97
08-06-97
NDTE:
.t Spouul rate
taxable .t lin8Ml/Clsll A r.to
taxable .t Colbt.I'.l/Chss B r.t.
RECEIPT
NUMBER
AAI8532B
AA211619
DISCOUNT 1+1
INTEREST/PEN PAID (-I
732,92
,00
191
110 I
10,338,06
r. '...
~~
,00
1111
112)
11~ I
114 I
IISI
IIbl
(17)-
,00
69,BOI.B6
69,801.B6
M ,00=
M ,06=
X ,15=
1181
Uv,II,1 Blfl (Hill
DOROTHY
L
AMOUNT PAID
19,500,00
1,440,56
-j
OATE
ATTACHED
11-24-97
NonCE
NOTEI To insure proper
credit to your .cc~unt,
~ubmit the upper portion
of this form with your
t.x pay,".nt.
151,941. 78
10,338 06
141,603,72
2,000,00
139,603,72
will
,00
4, 18B, 12
10",70,28
14,658, 40
- TotAL !~_~_ CRED-~cr=-_21.673'48_:J
.aAL~.~C~~!:._T A~_~~____~-",~!.~:~_8~~
:~~=l~;_lL A:~t:~L=:='--~~OI5 ~~~_~L
If TOTAl DUE IS LESS THAN II, NO PAVMENT IS REQUIRED.
If TOTAL DUE IS REFLECTED AS A "CR~OIT" ICR), YOU MAV BE OVi
A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. I
. If PAID AFTEO DATE INDICATED, SEE REVERSE
fOR CALCULATION Of ADDITIONAl INTEREST,
Complalo items 1, 2, ilnd 3. Also complote
item 4 if nostrlctoe! Delivery is desired,
Print your nfltllfl flnd addresn on tilE! revel'So
so that wo Cflll return the carel to you.
Alt8Cl1this (',ud to the bock at 1110 rnailpieco,
or on H10 lronl if spaco permils.
1, Arlicltl Adc!resSf)d 10'
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0, Is dflllvory 3clrJre!1s {Iilteronl from nom I'! [J Yos i
If YES, ontor dollvory {l(jelrnss bolow: 0 Nll ..1
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2, Arllole Number (Copy (rom servioe label) (' 0 c
'1000- OUOO-(FOz..5~ /5 --ILI- "lll
PS Form 3811, duly 1999 Domestlo Relurn Receipt
3. Service Typo
~ertlfied Mall 0 Express Mail
. 0 Registered 0 Aoturn Receipt for Marchandis
o Insured Mall 0 C,O.D,
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4, Aestricled Delivery? (Extra Fee) 0 Yes
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