HomeMy WebLinkAbout97-00376
.
'0
'Z~~
~, 0 _ _ -J
, " - - ~
- "0
;--',- --
-'--"
I'"
I;
-i1
. ,~
'~- ~.:
~
c
J
0.:::
"&
!
a
ti
LW
'..~...
,1"
l'hi... I'" III \ nlih' dw III\' illloIIH,lli(ltl 11l'1(' gi\'\'11 I', II1Itl'l 11\, 11111l!'(1 111111\ ,It I 1" q',IILd I nlilll.lh ,d- tI(',llll dld\- lil(.(1 \\1111 !Iii' ,1-.
10\.,i1 Itl'!',i'dlill.' 1'11l' 1I1iglll.1I ('('111111,11(' \\111 hi Illl\\',ndl'd 1(1 lI'l- \\.11 ( \'iLd !z"II>ld.. (111",(\, 1111 j11'1111.11l"1l1 lillll)',
WARNING: It Is IlIogallo dupltcntll1111s copy by photostat or photograph,
No.
21-97-376
lii'"'''''''''''<""
i,i,~(~\l~ OF Pf:t;~<M'..
.'l~.'; 'li',. "~,;,-
i I, ~ -~
i,.~.. ,',.',Ie .~.'. r!...t.." "i!\
'd~~J
' ,e~. o$>i
'~!""fNi ~\~~",.,
tt{j(1(tm1f/J/!tJ1'
,
4.,." ~~!;""r
~PR () ~ _
I'('L' tilt Ihi... Il'nllh,lIt', "l,fll)
4140234
11,1'-t'
COMMONWEALTH OF FENNSYLVANIA . DEFARTMENT OF HEALTH' VITAL RECORDS
CERTIFICATE! OF DEATH
.
'...."''''.kO.....''
&lit SOCIAL$(ClJI!fNNUI,I'lA
J, Female J, 2(1B - 54 -3193
I'\ACI l'A"HICI"<<~OlfY......-....~'....laTotOllOWWltlllfj
tiOtl'l1Al. . OlHl'"
_10 """..,.._ 0 .,.0 ........ 0
12-12-66 Lansdal.e Pa II..- -
,..,.....IloOl'M.MlIt'Cl~1 ...... HlIMNlO
J,.;~II'i;\ ol';\kb"'5l.\ Mro.i"'( Q.A,/'f ::!Il.~':::""'''''
;;J~l~: f~ ~IN DC IlltHl .DurA WAIIllAl. lIl,""'"
".~, "';r"'r~';~' _"',",,-,
~!] IWKJ "1.~....,.., (141;11 " DNotcadlt'~K",l
r
l'I.$lMe Pil. Old 1'.k1.......oMI6ttIl~in.-...-.LowaJ:-.-.AJ..J.Qn-Xw""...-__1fI9
-
....
I""C -Cumber_land........ IOwr\IIIlpf ".0 ~~'::ot.
MOWI!I'r.N.UlI!I'UIMdJIII.l_SU........'
Margaret Ruths
H'OfWAIH" WAi'rHOAOCifiiasl"''', CtyfbHt. SWI, IIpC~1
ON' DfAlH.Montl,Pol'_....l
.,,, rl11, "''''
I'4AJMiOlo' ClOINl".",Modde,lalQ
I,
AOIlL"~
....,
1~l<<ft,""_J
IIII:THfI\.ACI!(.-.,1'Id
""llffOlIo9f\COlINfyl
3lY"
"
i:;:""llJ
Allegheny
Pittsburgh
"-
oI~__~~'::::t~
Da ta Base Mqr. ~ ture Co
OIClOINT..WAltJNQAOOAI.'(SI<IollCty/l;Mn, ....~CoDtI ~~~~H-n
AUIOl!tfCl!
,s..(I!I\.ClWlfII
""''''*tdtl
IlJAVltIiNosroutl
(If"- ~..IT\M.Itft........
5320 Oxford Dr.
" Mech. Pa. 17055
,,q~iN:WEi~.J<II l."'l
lL...JnhlL...--R.-Be.l..f:on t i
lJ\:fQR.l,lAl(l"KAMI(I)"PIIPrn\
~""R_ RAlfnnH ffi""'"
.......[:b(CI_O ~__.....O (r.4orofIOI/.lINfl
_,,'- 0 4-5-97
"RIOHAC''HO'''~. LlC.N8IHUt.Ii&R
IL.!'D-011654-l.
.... doIWlllQCllflldltl,.._,.,........~tI.tl(/
. "'~'''''J'''" /- :t \lAO
.:JGII<t$ >,(?~ 1.:
IltIlWI"N_"~ldby 1loII00004RH ~~'/)OIAOI~Oer"""
-.............- ~. '\'i
_4__ _ If U:~O III I 11'
""""'I ........dIIoioMH.........OI~Il_.tIil;tI~lNIihII~OO!lOlt/ll...IN""""a ~ w:ll...(af~OI,.....,lIOIVllifIll4I#WlCt1Ol'~.......
l_ONtONr_OfINd\w
.
Ot~I'IIc.
'......
,.CftmflOlV
,.
ate of HeavBO Csmet.er
-l,.,...AHOAllOAlUOt1LW.:il.ITV .
~.fJ - \rnAr
LCEHS<<lHWNft
Mech.
Pt.t .
17055
.
......DO'{~OSS ?-
M. '"
",0
...
.
{IoIOlWI Ot~ "'I
ci \ 1
.
",K)
..........
--
I............'*'"
.__OW......,....," _ _ , ,
"OVi lO(ORA.S~CotISlOl.EHCE Of), I
I D_~~~~U~tt(j~_..-~-~_._---.----1-.-
,__I~~j.fJLAA'e~L_~---_----------- ,1---
DOl iiQ'fl AS ~ C(OOENC( Cf)
. _, C i\f(', L (o\iS. ___ , _ _'____________.1_.
-M:nll...~llV'lNOINQl 1ll...,.....flOfOtAlH DAr.OfINJUA==C:,II,IlOlIKNAV "-lUAY"WCflI(~0f''lCflj8lttOWJHJl.IAVOCCVflND
.......ll.....U/'P.lOfIlO (~O'YllNfl
COhlf'l.liTlOflOf'CAUM fi/I 0
0I'0fIAfH1 IWIl.O'Il 1"'. 11Qmlr... (J "" 0 NII(]
~... U ~tf\dll>vln"'''''tIUOf'!
\-M [J 11lI t)\ s..... [J COo,oloJOllIIWIltIl'''',..., 0 m:crO;:~.iURY7Ar~"'<..~_I'*'_I;lfiC.JL '--kOCAlIOHIin~-"--" ---------
buiUrli.ll4(~v' ,
Ia., 1". It He. JOt
tI"'''"11ICI''~ IlN'I '''''1 Slt)HMVAlj.t> Tin. Of'Shllf'II"
'C'''''WVIN(l.-tlnICIAHIPl1II~.....{..\trofY,Jr_'''...r'oIIt...aII<At'oIIlfIlloC.-nI'''I<lOlu.ro;'''~'"''\lJClll1f~~''mJJI fJ "....,.. ~.........:"I, ''''0
'*....MIl~""i_...... iIlIltIt_WfIolII........UlpIllllflllN/\/lfIM'lllecl .' . .,. .,.,.....,. ,., 1'0. .._~ a~...'Io.J..\
. LiCiNiji1iii"i:tilili --,---~- 6.iffilO;.i{DjlAu~0I~ ;,-4_-.
"JIlOHOUf,CIHQ AAO CIIUIJlYIHQ 'HVlIeIA,. II'I'I"'.'C.'" lI'<>I>/JolO;;1/IQ1lt<IIl14,.1 ,,,1.1'"'11 ~I,..I'.", alllol6! I iNOO\(~ N!' c;L.. A ,~ \ j l""'"
,.....fMel.....'irou..lHtI.....11tItc.IIlIIld.'......,..." .nlf_lIc.,IIIIl.Illk1"'*....*'i.I~"'.~'..lI.... (lfl Jlll~ _. _ '11. ___ __ ~ Jlt.!1~L! ,_ I ,.tLL__ ____
NAlI' ""10 AAOfIUS Of '.~SONw!J(lC~lnIScAII" Of DlAJH
'M"OICAll.ll:AMIH.NCCHlOHIIl 11"'''/:11'~fiPfll\ll ~t~ ~.~~~t ~P.wr ;va Lofhtop 5
OfII""IN....,..alftl""Ion.""'.,I~w..IIf.,IoIl.In...'tpI/IIoII,II..IIlOGCUIl.d.tIMUfT..,d.U.1!\d pllfl".lI4dw. 10 Ill. UWII/Illnd II l.M.iIiC'll J tf r,'"s~~v. <<{ f\.\f"
~l."'6flfIoHl"ltl"'-......" ,,,. .......""..".."".."...""....... ... ... II ('I It;\JIJrS'"'' I e~~I\I(~i" \5~\,\..~r;8')
-;WOlllltAAfii(iN:\iIiiiniiON\iiiiiii--' .-------~/~ ;'i ---O;:ii'iiio...;,..-:;j:";;;~ -. "-- "--------. ---
'L~-~iL.,./- " _________ . ,-'- L'i_ ~._,qt''..:t'!-t!-~?-___-_-_-__,__
PMi"
OIf'*...............~II...... buI
""l4~In"'~_QM<trlr'l'Jf"
;1 l
I ,I:'
IH' 'I' '. . . , I..
III ,', 'I" I " .
!,i; Ii,,', i', ,I 'Ii" ':i II' Ii Iii I! II Ii,' ,!
ii!':': ' ",',' , , I' , i! i' ii'
, ,: I'! l' ',I, I: ,I II!" I :! l I, (", I !"'I '1'1 : i i J I,!, 'dl . ,
': i ',;i!>:;!iiii.t): " Ii I I 1'1 I ,li ::;!'I'I i '[!I'!'f'" ,I': ili. ';il!1 Ii 'I: )i'l
: ':, i :::: 'II::: l'Ii!: ,!;:~ 1.:i;:!1 i: IJII!i II 'illli,I::;!,i:;:iill!,!,:I ilil!!::III! ii;i!ll:!'lii!: il '
III : II 'i ! 'I!; ,II: ! II! '"d I !'~'III : I : '! I j ,I! [!,I' 'II :.'.; II" i.....:. 1...1.11......1.. i 1.1' 11........1 i i ,..11, II:.: 1.11 ' '1:: ,II [......,....1. ii I:. .'
: , "I 'II ! I! II' ~ ! I , I, 'f II" III : I.. I : . : I III: : '. '.! 111.'11 ',.'I! I. ,I:.' I.. :i111..I'. ': I:. .
'II ,I,: I, ! I, Iplll:1 .1: I :lill" I 'I I 1':11 ;: I Ii II :i1 q. ': II ! :'111 :1111:" I, .
:ii :1,1:1 iii::! l!ill !. i! II 'Ii ['1:1 1:1. III..:.! 11\11 II. I J '. I,.: /111 ::1'1111:.1 1.,.,..1..::"
: I., :I!'I :1'11:: 1:1 III ' llil .II:: 'I :...1. II.: III!..I..II:... .:...:1: I.:. ill 1....:11.1 I :.11 1...'1 Ii' '
I 1 "III; ." ,I III' ,I. II 11111" I!, I' I " 1'111'1 II I' II I'! '," 111'1
'1 !I: :i[:II:: ,l::ll!! :111:"11111,'[1 II, 'II II~ II r:!II~ III ill;! III :; Ii [/111 'iiill'llll 'I:'
Ii:: ': : :11 Ii: I!; i I: II . ii 1'111'1:1 I:' II. '11.:...'....11 1 I:.', I i.:.' .1.1. :'.:.'. "1 :: 1 :.: 'Ill. i,.II~..., 1.1. I. i '
11::[":;1,;1 !:I:I;;:I::;::iitl'tll'jll: ::ill 1'...:.;.1 ',11:1 11'.11111;.!111..1, 'hi,. 1.li 'I' I III I:..'.',.':!::..,.::::.".
,,",I 'lii.:1 ":Iiil"ii:i:i/lilr':ill I:: II [I::r ,1',: :,: :: I ;1 i':: ;' I :;111:1 il!!t!I' '.
'fll'"I'llf!I"II!II'''' I:' II:; :':1. ;: II:: I" 1";1:: 'Iilli:..'
II:: 'I: :::1 I; i I! 1::1 jilll :: II~: ! I ':; i; i; I ~ [j :':11 r: :II! I:! i;'
11,li,TI:WII'III::I!!11111 1:11: I !: !, :: ::.11 I': ,.Iili.. II;
1 i 111:11:' W, I ',; !.~ 'I " Ii I I' I
illll'I[I::I,;,II"II,\1: I:: ./:\ II " ~I ., ;;, :':.1' 11';.'1 il~I:........:!:'......
I J d P: I I 11111 II I III~. j: I I; IF: I:
11!) II ii :1::1 ll'~ 111.1 ;,1 I;': [: f ~ ~II:, 1'111. ii'
! l: ~ ~II !:',I!:, Il. I : 1:1:: '::; 11;:' I. '1 i;i 1 :
1'llilll!,:IIIIIIIII/,'::;11 i ;1 I::l : ,~:: I:: 11,..\lj !h::,.~:,
idl:,' 11'1 ::: ' ': I:: ~1 :i 'i 'I" ,....
111'1".1" 111,..1:',:11.11.1, :,il..' ',i.:, I ~ ~, I,:' I! III:: II :iil:
1111iII:111 II" 'I' . ',I " " ,; .J I": II;,. '.
1.1....'.1... . ' '11,.. · ,"1, I, I I, I',': I '.'.!. I,: I, I: :: !~ ' I" /'1 I .
II!lHI::II'1 "I, iil ;.l",! il Ii [:,1 :: I :",' 'ift,; ,.,
1...1...1. 1.1....1 ::i.I.. .1' ::1,1.. .~....;...':: II :..'!! :: I :: i! I :: . ~ II : . ~ i : : ~ '
!, 'I ! I "I, I.' II " . I, q I ; 'I .::' . :: , ' .; II' i! : ~ .
1IIIIjifllll pll ,Ir:,. (ili I" I Ilill:'1 .I,~,j 'jl I'~ Iii 1::1: 1"'"
llllllll'::;11 1:111 1/1 II; 1 II'!:.I 111[1 If I. ' .i1 illli.':IIII, 1/"1 I I,' I I i 11'1';(" ::,' ,i" ,
lilJialiil1 ".11 :1"111 Ii t I ~II' ii" :,
i;ii11lII!1!.i !i.II!I.' 'I.i.~i..i 11,:1..:.' I... '; /.1.'.:..':.1111:: I, Jill :JI!li:!! 1111:11'11"':11111111 I,:, !I I 1'1 ': 'Ii, 'I Iii; : :,
i: I' i i i. Ii 'II II. ii, I" I ,I ". ::i..! I,. ,':, I. i ,.1. ;'[1
. " 'I "1 '.'" ',: .' ," . . I, " ,I" 'I.! II" '"
,i Iii ,!!. :', I I'd 1 ,'" - I." I '.. j 1'1' I , II'"
j, ij","', :11: ',' 't: I, '1' I ' L".
:1 ! , !'" ': " I, ,
'! I' i
Iii' :Ii\. I'
:'
I"
,
i'L,
, '
I'
E-1
..:::--
CERTIFICATION OF NOTICE UN~R RUI,E 5.6 ( a I
Name of Decedent I ,JILL R. 1\E~rONTI
Death I '. APRIL 1, 1997
Date of
Will No. Admin. No. 119 J ~ eo 3 rb
To the Registerl
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
MAY'/-. ",1- 1
,
Name
Jo k", 12., gc.I~.'I)
~~~
Address
~ 10
5<LII\...Jt. /ivt ' C_~ ~'/I ,tf it-Olf
D"-j1vu....1:-- C,,,,It. ~R'I( i >~vfl\ I rA
-.:T (1'/10
19$'3
Notice has now been given to all persons entitled theret;~ under
Ruie 5.6(a) except
Datel
/11'1 '6 ' I~ 51
,
'1 )' (') ((j/ ,
Sign-:rture (r
Name DPr" I C> p- r;: {;./ E..--
Address z.LlO No!':r-/!' nHR.-~ s r
_ }tA-~~lsgv((..(; fA InOI
.
Telephone !llll Z 5 i. L{ rOO
'-
';'J
'lIi
'(r-t
.,
(~,J
D. '
"; ;,C
CapacitYl
Personal Representative
X Counsel for personal
representative
<.CJ
I
<:1
f,lJ
,:~
:'~ . I
'II'
C" 1,L.
.C
f"-,
p,
-, {,:
'II "'1
(30
lev. 1.500 u. 17.1911'
~
;1=
UI~
it
I
..
I ~)
/lh 1/-1
..
'*
INHERITANCE TAX RETURN
RESIDENT DECEDENT
(TO BE FILED IN DUPLICATE
WITH REGISTER OF WILLS)
.0.IlAns 0' DIA," Ann 12121191 CHICK HII
" A SI'OUIAL
I'OVIlln ClIII" II CUUM.II 0
flU MUM".
:' 1 'J! 11'1'/1,
YeAR
.. .,-
NUMB
I
COMMONW'A~H O"lfNSYIVAN'A
OE'''. M H' ~~ vnlU.
01 ,2'
HAUISlU t'... 7 21-0601
A . I ,A
IIEJ.JlONT I. ,II LL H.
~ II UR' Y NUMIU ~-mOlDil H
I.IIH 0,/, 'li'J'S _---1:,.(11 II)~I
",.\mICA"'" Iol.Ie'IMHG tI'OUM.. ~ ~II, ""'''' MlOOlIIMtfWI
'Al "CU., '1 N!J"'IU
II'JI)
11110,',
II
.....In"'" .......
(lOt cia,.. 01 cloath p,l., ,.12.13.8
F.d...al estate Ta. R.turn R.qulr.d
_ 8. To,.1 N.mbo, of 5.10 O.po.I'lo",
.
LJ .P
$16,720.72
$941.47
--
$947.47
$56.85
$56.85
$0,6.85
21. If Un. 18i. 9reuta, than Un. 19, .nl.r the diH.renc. on lln. 21. Thlt Is Ih~ TAX DUI,
A. En'.r ,h. inl.r.,' on th. balance due on line 21 A,
6. Enlar Ih. 10101 (If lln. 21 and 21 A on line 216, Thit I. the BALANCE DUE.
Male:. ~~!.cll..Pay~hl. tOI R~ghflT of Willi, Ag.nt_
~ ~ BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND TO RECHECK MATH -< -< -
Under p.noltiet of perlury, I d.c.lofl tho' I ho...o 'Komin.d ,h.. r.lurn, if'c1uding accompanying .eh.dulls and .tol.m.n'., and 10 Ih. b..t of my ~nowl"dg' and b~li.
It I. Iru., corrlcl and compll'fL I d.dore Ihnl all r.ol ..10" has bun r.port.d ClI true mark.t "olue. O.c1aralion of prepar.r olh.r Ihnn Ih. penonal r'pr...nfahv".)
bQ.ed On all infurmation of which pr.parer hat any kno.....t.dg.,.
., 0l1S0N Ilf,V~' :~ 7NG~!,WIl~---AOO.rrr---"
I." '~L'}' 0_'.- ... ,._, j(;) U0.~'!~L_I...:'!!.~'::':.L~l,--_L ./,.'{'.jJ1'j"(L .
7~7f~NAru"f m ~"''',l.'!~R 'J . IH,Uj Rf'.IH~lfLr',~ ~i;t1l!~5 (
,.'-. r
~ _..~.... - ..-l._.-..-....__._--~.. -----. -"....~-- ..__(u.__~~LU\l.:t.. ..._.__n_"'_ ....-.-..---..----......--.---.. -~_._---..
COU"!TY COO~
M'
, 1111.
H' .
t>'l:~( I 0,'.: I () I dIll i VI'
~ll'{'h(lllil-.,;hllrg, 1);\
11".,1,,1111
MtOUN I.ClN I ....,
..riIOi'll"if1l
Ii. 1:>---1 'H,I,
03.
OS,
o 1. O,lglnal R.'.r" 0 2, S.pplo...",ol R.M.
o .. Limited e.ta'. 0 .40, future Inl.re.t CompromIse
(10' do'.. 01 d.oth ok.. 12.12.821
o 6, D...d.., Dlod h.,.,. 0 7. DIC.d.., Maln/al..d 0 llvl"ll T,.II
(Allo<h copy 01 Will) (A"ach copy 0 T'..'I
ALL COIlllISH)NOINCI AND CON.IDINTlAL TAX INH)RMATlON SHOULD U OI.lcno TO. '
N"~ "I illWllNG
David R. FIliP, I':sq. Kirkpatrick /I, Lockhart
'" 'liON' HUM'" _ Llill NoT! h Tit i I'd Str""L
'117 2OlJ-4c,OIl'ls!Jurg. I'^ 1'1101
!!i
5
I
..
I. R.al ellOll ISchod.lo AI 11 )
2. 5'0<0' ..d lo.d. (Schodul. 81 ( 2 I
3, Cla..ly H.ld S'ocklPortn",hlp 1.11'''' (Sch.dul. c) I 3 I
4. Mot'909ei and Not" R.celvabl. (5th,dul. 01 ( 4 1
S, Ca,h, Bank Oepa,its & Mh,.lIoneouI Per.onal Property {5 I
ISch.d.lo EI
6. Jol.'ly Ownod Pr.p.rty ISch.d.l. fl ( 6 I
7. T,a..III, ISchod.lo OJ ISch.d.lo II I 7)
8, Total Oron A"e', 110101 Unes 1.7)
9, Funeral Eltp.n..s, Admln/'Irollve COtts, MIK.llon,ou. ( q)
ExpO.II' (Sch.d.l. HI
10, O.b.., Mortg.go liobillll.., li." (Sch.d.l. II 1101
11. TOlal O.duc1lon. llolalll",. q & 10)
12, Ntt Volu. of es,alellln, 8 mlnu. lIn. 11)
13. Charllable and Govtrnmenlol a.qu.." (Sch.dule Jl
14, No' Value Subeet 10 Tax (line 17 minu.lln. lJ)
I':;, ':ipOlllOI Trond,,. (for dot.. of d~lh aft... b-3o.9.4'
S.e I"slructwnl for Ar,plkable Perc,ntog. on R.vette
Side. (Indude voluet rom Sch.dul. K or Sch.dul. M.I
16, Amount of lint ,.. 10 lobI. 01 bilMl rat.
(lncludlt vt-lu.. from Schodul. K or Schedull M,)
17, Amount of lln, 1A tOMabl, 01 15~ tat.
(Includ. 'o'lJluel from Schedul. K or Schedul. M,I
18. Princ.pallQK due (Add tall from Un., 15, 16 and 17.)
19. Credll. Spousal Po....rty Credit Pdor Peym.nt.
+
20, If Un. \9 II or,all1 Ihon lint 18, .ntor Ih. diH,,.nc. on lIn, :ZOo Thill' I'" OV..PAYMENT.
Ii1D
(19)
120)
$1'1,1,64. 'Jl
$4,203.88
$9.143.68
$7,577.04
(11)
(12)
(131
(14)
II
~
~
.
8
a
(15)
(161 $947,1.7
1171
Discount Inl.,es.
+
lC._-
lC .06-
. .15.
(18)
Cht>(k hVIl' If you PH} n'qul'\flntJ " ,('fund of your OVl'fpnymNlt
1.1)
(21A)
12181
, " DAII$"". ;;
1ii::.I;./.I/2,/j~J..cy, ZL '
',Aft
((. /(/u.
, f--1-I-
'",,"1',"
iT~3' j!~l 7rJL
1M /11.. B4t(A +s
tv..'tJI~'''Dvl'A.<.i'f7.J ~,~","'Ih
II,,. .l}~7 0 Xfp\o f~""""~
{'
<to.
:l,z. ,11
2.~ 7.'t .
~I'f' cb
~ iP H 3 -;'
)810 101
J '1~1 '6,
J~i ~ 91
.e'
DlOCBSt! or Hanieburg
tm Post OOIce Box 3661
Han1sbu'g, Pennsylvania 17100
Office of Catholic Cemeteries
,-
cPt11- lJJ-t!J~
t iALES CONTRACT AND
TEMPORARY I.HJRIAL AGRF.EMENT
01\ TE_.f/Iil2Z--H-----'--.N:---..12-9-1-
CEMETF.Ry([47L ~~&{J;.!.rJ._ NO. . 6ld___d_'
SALESMAN NO. __,_______ A/N X- PIN --,
EASEMEN1 NO.
AIR ____
NAME dOI/tV,{!, t5G"L ION7;
ADDRESS c1/~ ..S'6NI'17'/:~ .4t1d""
(i;ill Ii,"; ,/,1. It-
CITY
. PHONE (
, .
1_~YtJ-'fo39
_ F,I\MIL Y PROTECTION
){/
'P ' ZIP CODE / 70/1
...sTATE
3. Unpaid Balance (1.2) ..'... ,',............
./tJ7CJ.oo
//J7tJ. 06
-S-
Int.rm.nt Spece, . . . . . . 0
.
1. Price, . . , , . , . . . . . . . . . I . . . . . . , . . . . ,
Bronze M.mcwl'I". .1. . ." 7~5 -; DO . 79.5'e:
Slz. ~t/,(IY
/ a 7..(" a:t ..:< -:if. (I()
Fnund.tlon'.....:~~;,..CIl . -. '-
c:?~/UI7"€"
Burl.l Vaultt . . . . . . . . . It _ .
2. Down Paymllnt . . . . . , . . . . . . . . . I , . . . . .
4. F Inanee Charge , . . . . . . . . . . . . . . . , . . . . ,
Crypt Space. . . , . . . , . . .
$.
6. Doferred Paymont Amount (3+4) . . . . . . . . . .
6, Total Prlco (1+4) . . . , . . , . ' . . . . . . , . . . . .
7. Approxlmato Monthly Peyment . . . . . . . . . . .
6, Number of Monthly Payments. , . . . . . . . . . .
9. Flnt Monthly p.ym.nt Du. ...,.........
10. Annual PorCllntage Reto ...,............
L()7{;,CV
Other........o...."............. $
Section
\.3
Lot /()9 Grav.(s) c2)
~(j I ~ r
Term':
Cash
!07CJ.a:J
90 Day,
Block
Crypt(,)
Solectloll mutt b. mad. within 30 days or c.m.te", will m.ke oholco.
lnttallment
_ Tho peym.ntl, due on tho dete stated .bo.... and tho remaining paym.nts on the same day of oaoh succeeding month.
_ Buy.r m.y prepay In advance the full emount due without ponaltv and will be entitled to a proportlon.te rofund of tho unearned
finenco charge.
_ Upon dofault in the payment of any In't.llment due hereunder for a poriod in excess of ono hundred'twenty (1201 days, Seller
may. .t ill option, void this agroemont and rot.ln .11 p.yments modo by Buyer as liquidated damages, .
_ Buyer horoby acknowlodge, recolpt of an exact executed copy of this agreoment at the time of exocution hereof.
_ Before any burial I, permitted In this lot. or .ny memoriel placod on this lot, tho price of the gr..... .nd memorial must be paid
In full.
_ The Purch..or(,) agree(s) to .blde by .11 rules and regulations of tho cemetery now in forco as well as any rules and regulations
which may hereafter be adopted, Said rules and rll\lulatlons loW be sern upon roquest at the Seller', office,
_ Upon fulfillmont of tho cOllditions of this agroement ond receipt of all tho above described payments, Sellor agreos .nd binds Itsolf
to convey to the Buyer, by Its cemetery easement, for Intermont pUrpOSOl only. the abovo mentiened numbor of sites,
_ YOU, THE; PURCHASER, MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD
BUSINESS DAY AFTER DATE OF THIS TRANSACTION, SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR
AN EXPLANATION OF THIS RIGHT.
//~ //. . ~!
BY '/???1V~'C~ ____ ....
(Authorized Re;';~
/2. )V~~~-
(Purchaser's Slgn~ture)
..rco:purchaser's Signature}
BP/!l9OO
~'-_-'___4 __,_..."
Keystone FinanCia~
PO, Bo, 1 J84
Pottsville, PA 17901
Phone: 1.800.895.9304
FaK:717.828.9231
May 22. 1997
Attomey, David R Fine
Kirkpatrick & Lockhart
240.N. 3'd Street
Harrisburg, PA. J71 0 I
RE: Jill Belfontl
Dear Attorney Fine:
Enclosed you will find the payoff quote for Account No, 34787.20000. whlchet1cumbers
a 1995 Oeo Tracker. This payoff quote is valid through May 2i. 1997.
::::> Current Principal Balam:u $6,513.00
::;. Interest $ 128.65
::::> Late Charge $ 8.80
..........~..~...............
:::> Total Payoff $6.650.44
If you should any further questions, regarding the above mentioned accoUnt. please do
not hesitate to call me at 1.800.895.9304. Extension 9374.
Sincerely,
MuULX ~,
S~ndra L. Slane '
Administrative Assistant
Keystone Financial Inc.
..
COMMONWEALTH Of PENNSYLVANIA l
COUtUV OF CUMBERLAND J
Ul
.Johll R. 1\1'1 fOllt I
b.lng duly SWorll eccordlng to lew, doposes end soys thet h. is udministra~Q!.--':"'-.:....._
_ of the Estlt. of .J III R. BeHonti
rJJ20 Oxford 1lI',lv" #99 M"dlflnlcHbllrg
lot. of ---..---,-. ,------- .....--_.,__. , , Cumb.rlend County, P.., d.c....d end th.t tho
within II en Inv.ntory mede by .John R. Bolfon\. i ._ _.__,' the sold administrator
of tho .ntlt. ostet. of seld decode nt, consisting of ell the porsonel property end rool ..teto, exc.pt rut ..toto outside
th. Commonw..lth of Ponnsylvenle, end thet tho figures opposlto ..ch It.m of the Inv.ntory ropr...nt It's f.lr veluo
.. of tho deto of doc.dont's dooth.
19__
~t ,... 12, /3rt/~~ ,
eucutor . A.dmlnllt,.tor
end subscrlbod bofor. me,
I..~,:;l ?U?-S'r M/'e'.w Srr:U:'cP'-( ~
L ,/-frVC!--1-.f1 (e'~ P4:, I' 7~&3
Add,...
1
April
1997
Ooto of D..th
D.y
Month
Vu,
INSTRUCTIONS
I. An Inventory must be flied within three months efter eppolntment of personel repr..entotlve.
2. A supplement Inventory must be fII.d within thirty deys 01 discovery o/eddltlonel ..seh.
3. Addltionel sheets mey be eHached as to personalty or realty
4. See Article IV, Fiduclerl.. Act 011949.
01)'
...
::1
"'"
<II
U
.ri
]
U
~
~
~
H 1i
~ ~ <l!
w > .. <l!
'< ~ 'ri ..
.0 ~ ~ .. r:I
'" a- .... u .ri
"" ~ 0 ::l w .. 8.~ ...
9 w co: '" 'd Q .. .
:r a- ... a- ~ E
'" .... ~ u. 0 .;
~ ...J 0 '" 4-< D- o
W u. " "" ~
H > 0 ~ co: ~l 0 t- .ri
N ,...l >
Z 0 Q H 0 c dI1
...., N ~
II> Z tl
0 co: '"
Z w <( Lt, ....
D-
-
0
1.').:;;<5, j-f/
BUREAU OF INDIVIDUAL TAXES
INttERITANCE fAK OIYJlIOH
DEPT. l806Dl
HARRISBURG, PA nUI'06Gl
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE rAX
APPRAISENENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSNENT OF TAX
DAn
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
03-23-98
8ELFONTl
04-01-97
21 97-0376
CUMBERLAND
101
DAVID R FINE E5Q
KIRKPATRICK & LOCKHART
240 N 3RD 5T
HBG PA 17101
[
Alllount R."tithd
Q,.,
*
UY.IU1 (II" In.tll
JILL
R
l
MAKE CHECK PAYABLE 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 'EV: isi'ii -Elf-AFP - i 0'9"=97 T -NOne r -OF - YNHE iff i' Aiie E" Ylix- i\-p'pilA"i sEHENT -; "A i. rowA"N-cE - bii--...... -- - - - - - -.. - --
DISALLOWANCE OF DEDUCTIONS AND ASSESSM~NT OF TAX
ESTATE OF BELFONTI JILL R FILE NO. 21 97-0376 ACN 101 DATE 03-23-911
T^X RETURN WAS: I X) ACCEPl'EO AS FILED
RESERVATION CONCERNING FUTURt INTEREST - ~rlE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
I. R~.l f.st.t. (Schedule A)
2. stock, and Bonds (Schedule OJ
3. Closely Htlld stock/P.rtnarship Interelt ISchedule C)
it. "adgIlA../Not.a R.c.l~/.bl. (Schedule DJ
5, C.~h/B.nk D.po~its/Mlsc. Personal Property (Schedule E)
6. Jalntly Owned Property (Schadul. Fl
7. Transfars (Schedule G)
e, Total As.ats
( I CHANGED
(1)
(21
(Sl
141
(~)
(6)
(7)
.00
.00
.00
.00
13.464.31
4.203.8B
.00
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Exp.ns.s/Ad~. COlts/Hlsc, Expans.. (Schadula HI
10, Dabt./Hodg8gtt LhbiliUa./Uana (Schadula II
11. Total Daductions
12. Nat Valua of Tax R.turn
15. ChBrit.bl./Governftent.l 8cqu.st'J Non-el.ct.d 9115 Trust. (Schedule J)
14. N.t V.lu. of Est.t. Subj.ct to Tmx
If an assessment was issued previously, linas 14, 15 and/or 16, 17 and 18
raflact figuras that include tha total of Ab1 raturns assaesad to data.
ASSESSMENT OF TAX:
IS. Anou~t of Lina 14 .t Spous.l rat. (15)
16. AMount of Lin. 14 t.xable .t Lin..l/CI... A r.t. (16'
17. Amount of Lina 14 taxabl. .t Collat.ral/CI... e rat. (17)
la. Principal Tax Dua
NOTE:
TAX CREDITS I
PAYNENT
DATE
12-23-97
RECElPT
NUNBER
AA242596
DISCOUNT (+l
INTEREST/PEN PAID (")
.00
. IF PAID AFTER DATE INDICATED. SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
9,143.68
7,577.04
1111
(12)
nS)
114)
(9)
(10)-
.00
94'/.47
.00
X .00=
X .06=
X .15=
1181
NOTE I To insure proper
cr'.di t to your aeCflunt,
.ub.it the uppar portion
of thil forR with your
tax paynant.
17.568.19
16.non.
947.47
.00
947.47
will
.00
56.85
.00
56.85
56.85
.00
.00
.00
IF TOTAL DUE I~ LESS THAN $1, NO PAYNENT IS REQUIRED.
IF TOTAL DUE IS RF.FLECTED AS A "CREDIT" (CR), YOU NAY BE DUE
A REFUNO. SEE REVERSE SlOE Of' THIS FORN FOR INSTRUCTIDNS. I
ANOUNT PAID
56.85
TOTAL TAX CREDIT
BALANCE OF TAX DUE
,--
INTEREST AND PEN.
TOTAL DUE
<:-;,
'-;J
.,
t'
Cl
1"1.
I."
::t~
i-j
iil
.:1 S
0(:.
RESERVATION, E.t,t.. of dec.dent. dving on or before o.o.tbvr 12, 19'2 .~ if any future lnt.r..t In the .,t". I. 'rln.f.rred
In po.....lon or ,"JOy.."t to Chu I ((loll.t,r.1) b.Il.flol.rlu of tM dlc.dent .fllr the Ixplr.Uon of .ny ..tit. fnr
Ii'. or for v..r., the Co..on....1th h.r.by Iwpr...lv r...r\l" thl right to Ippr.h.. and ...... tran,'.r IOO,rAteno. TaJ<u
It the llwful CII.' I (0011.t.ral) rtt. on any luoh future lnt.r..t.
PURPOSE OF
HOTICEI To fulf1l1 th, rltqUlr...nhof hotton 2140 of thl Inh.I'ltlOO' and Elt.t. Tax Aot, Act 21 of 1995. (72 P,S.
SeoUon 91~O)'
PAYMENT I D.tach thl top portion 0' thl. Hotlot end .ub,lt wi'h your ply..nt to the Rlgl.t.r of WIAII prlnt.d on t~ r.v.r.. .ida.
".Hah check or ItOn'y ordllr Plvabl, tOI REGISTER OF MILLS, AGENT
AEFUND (CAli A r.fund of . telC cr.dit, which tIll not t'.quut.d on the TIIlC R.turn, ..~ ba r.questad b~ cOlIPl.ting an "Application
for R.fund of Pann.ylvlnla Inh.t ltanc' and Estat_ TIIC" (REV-U1S), Appl1catJon. Ir. aVIHabl1 It tha Offlol
of thl Algl.t.r of Will., any of the 2~ R.v.nue Ol.trlot Offlc.., or by call1ni the .plclal 24-hour
an.werlng .arvlot nuab.r. for- for.. ordarlngl In P.nn.~lvanla l-100-362-l050, out,lda Plnn.ylvanll and
within 10011 H.rrl.bura ar.a (7171 717~8094, TOO' (111) 712-2252 (Halrlne 1~llrld Only),
OBJECTIONS I Any party In Int.r..t not 'Itl,fl.d with thl appralsa.ant, allowlne. or dl..llowanceof daductlon., or ........nt
of t.1C <Inoludlnu di.oount or int.r..t) I' .hown on thl. Notlc. .u.t objeot wIthin .1ICt~ (601 dlY' of raoelpt of
thh Hotlc. bYI
~-wrltttn prot..t to the PA DIPart.lnt of Rlvlnul, BOlrd of App.II., Dlpt. 211021, Hlrrl.burg, PA 17128-1021, OR
--Illetlon to havI the 'attar dltlr.lnld It audit of the ~oount of 1h. Plr.o~! rapro.lnt.tlv., OR
--appa.l to thl Orphan.' Court.
~D"IN
ISTRATJVE
CORRECTIONS I
f'IGtua! .rror. discovar.d on t!lis ........nt should be .ddr....d In wrltlni tOI PA Dlpart..nt of Aevenue,
Bur.au of IndlvJuual TaICI., ATTNI Po.t A..I..I.nt R.vlew Unit, Popt, 28U601, Harrl.hurg, PA 17128-0601
Phone (717) 737-6505, Soe pag. 5 of the booklet "In.tructlon. for Inheritance hlC Rlturn for a RUldlnt
DeGldant" (REV.lSOl) for an olCplltnlUOIl of ad,lnlstratlvlly oorr.otabh .rror.,
DISCOUNTI
Xf an~ tlK due I. Paid within thrl' (3) calendlr .onth. Ift.r the dlcadlnt's de.th, . ftve Plro.nt (5~) dl.oount of
th. tllK paid h allow.d,
PENAL TV I
Tt~ 15~ talC .-natty non-plrtlclpltJon p.nalty I. eOMpUt.d on thl totll of thl tllC Ind tntlr..t a"."ld, and not
paid bafor. Januarv 18, 1996, thl first dlY Ift.r th. .nd of thl tlM lInI.t~ period, This non-particJpatlon
Plnalty I. epp..labJlI In the ...e ..nner and In th. the .... tl.e plrlod a. ~ou Nould app..1 the tllC Ind' Int.rl.t
th_t hI' baen a......d a. Indlc8t.d on thl. not leI.
IH'rEREST I
lntar..t is charged b.glnnlng with Ur.t day of dlllnqulnc~, or nine (,) IIJflth. and onl 0) day froll thl dlt. of
d..th, to thl d.tl of pavalnt. TalC" which b.caa. dtllInquent b.forl Janulrv 1, 1982 blar lnhr..t It the retl of
.IM (6~) pere.nt p.r annUl calcut.t.d at a dally rate of .00016~. All tllC" which blca.1 dallnqu.nt on and after
Januar~ 1, 1982 will b.ar lnt.r..t It a rat. which will vary frol calendar ~e'r to etllndar y.ar wlt~ that rat.
ennouneed by t~ PA Depart,ent of Revenu., Th. appllcabll lnter..t rate. for 1942 through 1994 are'
t!!! Int"rut Rate Oalh Inter..t Factor :!!!! Inter..t Ratl Oally Int.,..t Flctor
1912 20:< ,000548 1987 'X ,000lft7
1'13 16;: ,000438 19811-1991 m ,00OSOl
1914 11~ .000301 1992' 9X ,0002lt7
1985 15;: .on0356 ,993~1994 IX ,000192
1916 10;: ,000274 1995-1998 ,;: ,000247
--Interllt I. oal~ullt.d a. followtl
INTEREST . BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Notle. I..uea .ft.r thl talC bleo.l. dallnquent will r.fleet an Int.re.t r.llculatJon to flfteln <IS) de~'
bl~ond thl d.t~ of the a,..,...nt, II pI~aent 1. .ad. after thl 'nt.r~.t co.putltlon date shown on the
Hotie., Iddltional Int.rut au.t be calcuhted,
STATUS REPORT UNDER RULE 6.12
-----........-
Name of Decedent:
.1:111 R. Bolfoll!l
-
Date of Deathl
Apri 1 I, 1997
wi 11 No.
Admin. No.
1997-00376
Pursuant to Rule 6.12 of the Supreme Court Orphans'
Court Rules, I report the fOllowing with respect to completion of
the administration of the above-captioned estatel
1. State whether administration of the estate is completel
Yes X No
2. If the answer is No, state when the personal
representative reasonably believes that the administration will be
complete I
3. If the answer to No. 1 is Yes, state the following I
a. Did the personal representative file a final
account with the Court? Yes No X
b. The separate Orpha ns' COllrt No. (if any) for
the personal representative's accollnt iSl N/A
c. Did the personal representative state an
account informally to the parties in interest? Yes X No
d.
Copies of receipts, releases, jOinders
Datel March !;!6, 1999
l,l,.
r.,
(....1
f'i:;
",
'I' 0\ .:1J.~
'" P'
0.: ~.) t.~
I
1......---,
David R. I'ine
Name (Please type or print)
240 N. ThIrd Street, HarrillburBI PA 1710J
Address
( 717 I 231-1,500
Tel. No.
(HAM I rmf lAM 3 )
CapacitYl Personal Representative
~___Counsel for personal
representative