HomeMy WebLinkAbout97-00387
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No. ~1-fJ7-:'H7
Estate of
Mary F. "urgoon
I Deceased
DECREE OF PROBATE AND GRANT OF LEITERS
. AND NOW _ MA Y 1 _ 19..2.Z-.. In consideration of the petlllon on
the reverse side hereof. satisfactory proof having been presented before me,
IT IS DECREED that the Instrument(s) dated OCTOBER 31st 1995
described therein be admitted to probate and flied of record as the last will of
MARY (I. BURGOON
and Lellers TESTAMENTARY
arc hereby gramed to
-
DAUPHIN DEPOSIT BANK AND TRUST COMPANY
~(' .1'" ut;, 1)0" (! ().. 'JACM};. PI D'fkctr
'.sl.ler 01 Villi.
FEES
Probate. Lelters, Etc. ......... $ 80.00
Sh~Jrl Certiflcates(5) . . . . . . . . .. $ 1 ~ nn
~ IlnM.I'AQES..2. $ 6.00
.JCP $ 5.00
TOTAL _ $106.00
Flied ... ~A.X ..,2.. . ~.9.9. 7.. . .. .. .. .. .. . ..
THOMAS A. BECKLEY. ESOUIRE 07144
ATTORNEY (Sup. Ct. 1.0. No.)
212 NORTH THIRD ST, PO BOX 11998
ADDRESS
HARRISBURG. PA 1719.8
PHONE
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MAILED L~TTERS AND ORDERS TO BANK MAY Z, . 1997
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IIEV-I500rXt(Hi4)
I:' I'il, II
INHERITANCE TAX RETURN
RESIDENT DECEDENT
(TO BE FILED IN DUPLICATE
WITH REGISTER OF WILLS
(()(lNIyr;uUf:
f nflO^, Ul (II OIAIH AHUl Il/J 1/l1 I CI![CK HUll:
II II ~lf'(JlI'I^1 r--l
J~.l..W:t~!ltl!l1.J.1JJ.ruMJJ.I..._L.L~___
FILE NUMBER
COMWp~,n;\~.l Hf(MF'~E'\WIl'O~^NI^
IlAf'FlISBa~t,~R~, \ 211-060'
D
E
C
E
D
~
OEr.IWr:NT'!) NAMf (tAnT, rIlHH, AND MHHll,f (NlfltH)
BurRoon , tl,ar II.
SOCIAL HtCUAITV NUMBER DArE or mAlt!
(lAT!' or nlllTtI
Ilf'CUlINT'!\ COMPI.!:Tr AUUIIU\!)
.l?', W""l"y Dr/v"
M(l(ltlnt\jt~HI)ltrg, PA
2. Supplemonlal Roturn
41, Futllrelrllorost Compromlso
(lor dat.s 01 doath altar 12-12-82)
[KJ 8. Daeadant Diad Tastala [~17. Docodont Malntalnod a Living Trust
Altach co 01 WJ!!L._ (Attach 0 copy 01 Trusl)
C pALL CORRESPONOENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
~ ~ NAME COMPLETE MAILING AoonED!:!
R D Mand HIcks Trust OffIcer Dauphin Deposi t Bank and Trust Company
~ ~ TELEPHONE NUM.EA 213 Market Street
- T 717 255-2225 Harrisbur PA 17101
1. Roal Estate (Schedule A) (1) one
2. Stocks and Bonds (Schedulo B) (2) 1,3 , 907.12
3. Closely Held Stock/Partnership Inlerosl (Schedulo C) (3) None
4. Mortgage. and Notes necolvable (Sohoclulo 0) (4) None
6. Ca.h. Bank oaposlls & Mlscellanaeus Personal Proporty (Sch. E) (6) 10 , 186 . 05
6. Jointly Owned Property (Schedule F) (6) None
7. Transfe,s (Schedule G) (Schodule L) (7) None
8. Total Grosa Assets (total L1nesl-?)
9. Funeral Expenses, Administrative Costs, MIscellaneous
E'peoses (Sohedule H)
10. Debls, Mortgage L1abllltlo,. Liens (Sohodule I)
11. Total ooduotlons (Iotal Lines e & 10)
12. Net Value 01 Estete (Line 8 mlnua Line 11)
13. Charitable and Govarnmelllal Bequesls (Sohedule J)
14. Net Velue SubJeot to Till( (Line 12 minus Line 13)
16. Spousal Transfers (lor dat.s of doath alter 8-30-94)
See Instructions lor Applloable peroentage on page 2.
(Inolude value. from Sch.dule K or Sohodule M.)
18. Amount of Line 14 taxabla at 8% rote
(Include valueslrom Soh.dule K or Schedula M.)
17. Amounl of Line 14 taxable at 15% role
(Include valueslrom Sohadule K or Sohedule M.)
18. Principal tax duo (Add tax Irom Line 15. 16 end 17.)
18. Credlls/Sp Poverty Prior Paymenls olsoounl Intarost
+ 4,000.00 + 210.53 _'___
20. II Line 19 Is greater than Line 16, enlar tho dlff",onc. on L1no 20. Thlol'tho OVERPAYMENT.
[[J 0 IChack hera" you are requesting a relund 01 you~varpoym..!oiIl
21. If Line 181' greater than Line 16. ontar Iho dlfforonce on Line 21. Thlsl,lho TAX DUE.
A, Entor tho Interest on tho balance duo on Lino 21A.
B. Entorthe lotal 01 L1no 21 and 21A on L1no 21 B. This Is tho BALANCE DUE.
M.ke Check Po obla to: Re later of Wtlls, Agant
~ ~ BE SURE TO ANSWER ALL QUESTIONS ON PAGE 2 AND TO RECHECK MATH .. ..
Undllf Pftn4rii8s 01 perjury, I l!uC1ll\flllhlll I have 8XllOllrludthl5 fllhHI1, Inr,ludlna accompanying Bchndulu and lllalemllntt, And to the blUI of my knowledQlland beUel, Ilia lillI,
corrlct and complete. I declare that All fllillllsla!8 /la~ llfHW InplHlllrl at trllll markot ."",lu8. Oecl.tration of preparer olhlll than \111 plHII!)nal reprellntlltl....' II blud on IlIlnlormalion 01
~hlohprlp.rllrhll8Anvknowlodllll
al NAIU~': 0.: PEA~~.: AE9PO~~~F;Z'~" R[[lInN
162-36-8] n
(JI,/Ii1/1997
08/11/1903
ClIunty CumhClrlnnd
(IF AflPUCAOl.E) DUf\VIVINO 9f10UBt::'D NAMt (U\ST,FHUH AND MIDfll.F. INITIAL) nOCIAt. m:ClHlITY NlJMflEH
X 1. Original Aelurn
4. L1mltad Estate
Os.
o 8.
R
E
C
A
P
I
T
U
L.
A
T
o
N
(9)
11,538.46
(10)
1,459.27
(16)
0.00 X
1997-00387
YEAI!
NUMBUl
UO~j5
AMOUNT RECEIVED/SEE INSTFlUCTlONS)
0.00
Aamalnder A.turn
(lor dates 01 daalh prior to 12-13-62)
Fede,al Estale Till( Roturn Aoqulrsd
Total Numbor 01 Sale Depo.1t Boxo.
(8)
54 ,093.17
(11).
(12)
(13)
(14)
12,997.73_
41 , 095 .41,
4,109.51,
36,985.90
.
0.00
o . 00 X .06 .
(16)
T
A
X
C
o
M
p
U
T
A
T
o
N
0.00
(17)_
36,985.90 X .16'
5 547.89
'-'-'--
Mandy H1ck", TnlHt Officor
113 Markot Strout
il~-,:i' i;il;i,r'i: - j'ii - Tii6i - - - - -.- -. - -...... - -- -. -.. --
Dauphin DOpOHlt: Bank ancl Trust Co.
213 Market StreBt
il;;':': isi;ul-P:: - i'ii'- 1'/i61 - - -.. - - - - - - - - - - -.. -.. -.. - -.
CoPvrlghl (el 1994 form 8uflwIlI1l onlv CP9yalllms, Inc.
(18)
5,51,7.89
(18)
(20)
4,210.53
0.00
(21)
(21A)
(21B)
1,337.36
0.00
1,337.36
DATE
( IN I;,')
-+-'---
DAn:
form 1600 (An.... HJ4)
;"~-"~
.....
~'.~
,-..
Page
PRINCIPAL
.0.00
130j701.31 3.4
.
Reoe~ptal Balanoe ot Peiot Aodo~nt
This Aooount
666,71
5.7
Net; Qai,n(ot t,.ou) on Sales or Other :PiilpQsitlon/PrinoiPal
.. .. .. ~'- .'.. _ .; .. ~ '. ..
l~i, 3.68. d8
Lesal Geneeal Disbursements
Fees
84,200. .1.2
0.00 '84,202..12
8
.. .. .. .. .. :~' .. .. '! .. .. .. of ~ .. _ "'.. .. .. _ .. .. .. .. -
47 ,165..96
47,165.96
9
Balanoe before Distributions
Oistrib. to Benefioiaries
..' .. .. ~ .. .. .. .. _ .. . .. ..-
principal Balance on !land 0.00 10
For Information:
InvestmentS Made 11
Ohanges in Investment Holdings
INOOME
0.00
439,955.96 12.52
0.00
Reoeiptsi Balanoe of Prior Aooount
This Aooount
439,~,:\5.96
~80,679.02 53-102
..-..,..,......,...........~
,
Net Oain (or Loss) on Sales or Other
......,...;.""....-~...
I.ess: Disbursements
~9,276.94
59,276.94 103.110
Balanoe Before Distribution
Distril;>Ut!ons to Beneficiaries
..,.;......-..........'..
111
0.00
Inobme Balanoe on Hand
;t
For Information:
Invsstments Made
Ohanges in Investment Holdings
Oombined Balanoe on !land, .00)
,.2-
,~
1988-01-05 517 units FiKed Income
Collective Investment Fund
Net proceeds
Fid. /lCq. Value
5,001. 21
5,41~.15
19?3-04.05 912 unite FiKed Income
Collective Investment Fund
Net proclleds
Fid. Acq. Velue
10,009,80
9,374.61
1993.07-Qq 454 units FiKed Income
Collective Investment Fund
Net pr ocoeds
Fid. Acq. Value
5,010.00
4,666.74
1993-11-03 451 units FiKed Income
Collective Investment Fund
Net Proceeds
Fid. Aoq. Value
5,003.44
4,651.64
1994.10-04 493 units Filled Income
Collective Investment Fund
Net Proceeds
Fid. Acq. value
5,004.18
5;084.83
1994,11-03 994 units FiKed Income
Collective Investment Fund'
Net Pr oceeda
Fid. Acq. Value
10,000.39
10,252.18
1995.03-02, 1,475 units FiKed Income
Colleotive Investment Fund
Net Proceeds
Fid. Aoq. Value
15,005.85
15,213.24
1995.07.05 287 units FiKed Income
Colleotive Investment Fund
Net proceeds
Fid. /lCq. Vahie
3,003.10
2,960.14
-6-
~......,
0.00
410.94
635.19
343.26
43.56
0.00
~ --
1995.10-03 /,80 unite Fllled Income
Colloctivo Investment Fund
Not Proceeds 5,009,62
Fid. Acq. Valuo /.,950,75 58,87 0,00
1996.01~03 940 units Filled Income
CoHoct i ve Investment Fund
Net Proceeds 10,005,05
Fiu. Acq. Ve.iue 9,695.22 309,,83 .0,00
1996-04-01 5,890 unite Filled Income
Collective Investment Fund
Net Proceeds 61,129,46
Fid. Acq. Vaiue 60,749.81 379/65 0,00
1996-07.10 1,022.495 ehares Marketvest
Funds lnc Intermediate US
Government Bond Fund #593
Net Proceeds 10,000.00
Fid. Acq. Value 10,224,95 0,00 224,95
1996_09-10 1,020.408 shares Marketvest
Funds Inc Intermediate US
Government Bond Fund #593
Net Proceeds 10,000,00
Fid.Acq, Value 10,204.00 0.00, 204.Qe
1997.-04-11 208.117 shares Marketvest
Funds Inc. Intermediate US
Government Bond Fund #593
Net Proceeds 2,000,00
Fid. Acq, Value 2,075,59 0,00 75,59
Total Gains and Losses/Pdnoipa1
Less Loss
2'122; 16
1;455,39
1,455.39
.... ~i" .. ..'......... "".
Net Gain
666. 77
------.-.-
.7.
~ .-.
DISBURSEMENTS OF PRINCIPAL
General Disbursemonts:
1987-12-31 Tranafet to Inoome 11000.00
, 19\12-12-18 Eshenaurs Fuels Ino. . Balanoe $9,95
Due
1993-06-14 Transfer to Inoome 5;000,00
,19,94-03.09 Transfer to Inoome 3,000.00
1994-07-05 Transfer to Inoome 5,000,00
1994-10'17 Transfer to Inoome 5,000,00
1994.10-18 Transfer to Inoome 5,000,00
1995.01.19 Transfer to Inoome 5,000.00
1995.03-24 Transfer to Inoome 10,000.00
1995:10.17 Transfer to Inoome 5 , 000 .00
1995.12.18 Transfer to Inoome 5,000.00
1996.03.12 Tranafer to Inoome 10,000.00
1996.06-21 Transfer to Inoome 5,000.00
1996-09.06 Transfer to Inoome 5,000.00
1996.11.13 Transfer to Inoome 8,000.00
1997.03-12 Transfer to 'Inoome 362.02
1997.03.14 Transfer to Income 4,206.68
1997.03.21 Transfer to Income 100.00
1997.03-31 Transfer to Income 335.n
1997-04.10 Trallsfer to Income. 2,001. 76
1997-04.28 Cumberland County Register of 106.00
Wills . Cost of Probate and 5 ......................'.... $4,202.12
Short Certifioates ..:.....................
Total Disbursements of Prinoipal 84,202.12
.,;-.._-~------
-8.
,....,
1997-06-05 Marketvest Funds Jnc
Intermediate US Government
Bond Fund 11593
Interest:
1986-10-03 $23,714.14 Hill Financial
Certificate of Deposit
1/022-1-13-01,502227 11.25r. due
1/14/87
1986-10-03 $6,000 Hill Financial Single
Savings CTF
11022-1-13-05-016914 7.5r. due
6/2/87
1986-10-03 Market Square Cash Manager 1
1986-10-14 $1,000 Dauphin Deposit
Certificate of Deposit 1/14 72
17032 7.25r. due 7/10/87
1986-U-03 $20,000 Hill Financial
Certificate of Deposit
1/022-1-14-10-704242 10.6r. due
7/7/87
19116 -11- 03 $23,714.14 Hill Financial
Certificate of Deposit
1/022-1-13-01-502227 11.25r. due
1/14/87
, 1986-11-03 $6,000 Hill Financial Single
Savings CTF
11022.,1-13 - 05 - 016914 7. 5r. due
6/2/87
1986-11-05 Mark(,t Square Cash Manager 1
'1986-11-06 Mary F. Burgoon PIA - Interest
on Market Square Cash Manager
I
1986-12-02 $20,000 Hill Financial
Certificate of Deposit
#022-1-14-10-704242 10.6r. due
7/7/87
1986-12-02 $23,714.14 Hill Financial
Certificate of Deposit
11022-1-13-01-502227 11.25r. due
1/14/87
-13-
I""'.,
97.09
-......................
223.37
37.61
27.31l
18.29
180.05
230.85
3,527.72
~ ,..-.."
1987.03.02 $6,000 Hill Financial Single 37.61
Savings crF
#022.1-13.05.016914 7,51. due
6/2/87
1987-03.03 Market Square Cash Manegsr, 1 '53.8Q
1987.03-16 $3,000 Dauphin Deposit 147.28 '-',
Certificate of Deposit #35 57
925990 9. 9r. due 9/15/87
1987-03.16 $5,000 Dauphin Deposit 126,37
Certificate of Deposit #35 33
015830 10.25r. due 6/15/87
1987.04-03 Market Square Cash Manager 1 33.15
1987-04-08 $20,000 Hill Finanoia1 180,05
Certificate of Deposit
#022-1.14.10.704242 10.6r. due
7/7/87
1987.04-08 $6,000 Hill Financial Single 31.61
Savings CTF
#022-1.13.05.016914 7.5r. .due
6/2/87
1987-04-10 $1,000 Dauphin Deposit 1U9
Certificate of Deposit #14 72
17032 7.251. due 7/10/87
1987-05-01 $20,000 Hill Financial 174.25
Certificate of Deposit
#022.1-14.10.704242 10.6% due
7/7/87
1987.05-01 $6,000 Hill Financial Single 3.7.61
Savings CTF
#022-1-13-05-016914 7.5% due
6/2/87
1987-05-04 Market Square Cash Manager 1 24:49
1987-06-01 $20,000 Hill Financial 180.05
Certificate of Deposit
#022.1.14-10-704242 10.61. due
7/7/87
1987.06-01 $6,000 Hill Financial Single 37..61
Savings CTF
#022.1-13-05-016914 7 . 51. due
6/2/87
-15-
i"""'I N
1987.06.03 $6,000 Hili Financial Single 2.50
Savings cn'
#022-1.13-05-016914 7,5~ due
6/2/87
1987.06.03 Market Square Cash Manager 1 28.42
1987.06.16 $5,000 Dauphin Deposit 129.18
Certlfloate of Deposit #3~ 33
015830 10.25r. due 6/15/87
1987.07.01 $20,000 Hill Flnanola1 174.25
Certificate of Deposit
#022.1.14.10.704242 10.6r. due
7/7/87
1987-07-03 Market Square Cash .Manage: 1 61. 57
1987.07-07 $20,000 Hill Finanoial 40,66
Certificate of Deposit
#022-1.14-10.704242 10.6% due
7/7/87
1987-07.10 $20,000 Hill Financial $,81
Certificate of Deposit
#022-1.14-10,704242 10.6~ due
7/7/87 I
1987.07-13 $1,000 Dauphin Deposit 18.29
Certificate of Deposit #14 72
17032 7.25% due 7/10/87
1987-08-03 Market Square Cash Manager 1 98.94
1987.09.02 Market Square Cash Manager 1 71. 04
1987-09-16 $3,000 Dsuphin Deposit 149.72
Certificate of Deposit #35 57
925990 9.9r. due 9/15/87
1987.10.01 Market Square Cash Manager 1 51.89
1987.11-02 Market Square Cash Manager 1 61.93
1987.12.02 Market Squars Cash Manager 1 31.94
1988.01.04 Market Square Cash Manager 1 29.00
1988.02-01 Market Square Cash Manager 1 81.95
1988.03.02 Market Square Cash Manager 1. 81.17
1988.04.04 Market Square Cash Manager 1 31. 99
1988-05.03 Market Square Cash Manager 1 30.78
-16.
~ ,,..-..,
1988.06.01 Market Square Cash Manager 1 34.91
1988.07.01 Market Squaro Cash Manager l. 36.21
1988.08.01 Market ,Square Cash Manager 1 39.94
1988.09.01 Market Square Caah Manager 1 47.08
1988.10.03 Market Square Cash Manager 1 45.73
1988.11.04 Market Square Cash Manager 1 48.19
1988.12.05 Market Square Cash Manager 1 46.73
1989-01.06 Market Square Cash Manager 1 46.10
1989.02-06 Market Square Cash Manager 1 49.48
1989.03 -02 Market Square Cash Manager 1 1~9.94
1989.04.05 Market Square Cash .Managar 1 58.51
1989.05-03 Market Square Cash Manager 1 58.72
1989.06.05 Market Square Cssh Manager 1 58.04
J.989.07.06 Market Square Cssh Manager 1 37;62
1989.07.07 Capital Reserve Account 13.45
1989-08.03 Capital Reserve Account 62.46
1989.09.07 Capital Reserve Account 62.62
1989.10.04 Capital Reserve Account 58.89
1989.11.06 Capital Reserve Account 67.94
1989.12-06 Capital Reserve Account 66.65
1990.01.08 Capital Reserve Account 61.47
1990.02.05 Capital Reserve Account 74.19'
. 1990.03.08 Capital Reserve Account 61.70
1990.04.04 Capital Reserve Account 59.55
1990-05-02 Capital Reserve Account 61.77
1990-06-04 Capital Reserve Account 62.78
1990-07-03 Capital Reserve Account 56.48
1990 - 08 - 03 Capital Reserve Account 63.10
-17-
~ ^
1990-09-05 Capit.al Reserve Account 61.68
1990-10-05 Capital Reserve Account 49.94
1990.11-05 Capital Reserve Account 58.00
1990-12-04 Capital Reserve Account 51. 39
1991-01-03 Capital Reserve Account 52.22
1991-02-04 Capital Reserve Account 53.28
1991-03-04 Capital Reserve Account 43.00
1991-04.02 Capital Reserve Account 39.66
1991-05-01 Capital Reserve Account 39.55
1991-06-04 Capital Reserve Account 37.00
1991-07-01 Caphal Reserve Account 31.71
1991-08-01 Cap.t tal Reserve Account 33.33
1991-09-03 Cap i tal Reserve Account 29.03
1991-10-01 Capital Reserve Account 28.00
1991-11-01 Capital Reserve Acoount. 24.14
1991-12-02 Capital Reserve Account 23.09
1992-01-02 Cap i tal Reserve Account ,20.73
1992"02-04 Capital Reserve Account 18.32
1992-03.02 Cap i tal Rese:t've Account 15.75
1992-04-01 Cap i tal Reserve Account ' 13.58
1992.05-01 Cap i tal Reserve Account 10.29
1992-06-01 Capit.al Reserve Account 14.82
1992-07-01 Capital Reserve Account 13.35
1992-08-03 Capital Reserve Account 11.43
1992-09-01 Capital Reserve Account 10.56
1992.10-01 Capital Reserve Account 8.'62
1992 -11-02 Capital Reserve Account 7.24
1992-12-01 Capital Reserve Account 6.54
-18-
,-.., ~.,...\
1993 - 01- ai, Capital Rosot've Acoount 11.93
1993-02-01 Cap i tal Reserve Acoount 11.1.8
1993-03-01 Cap j tal Reserve Aooount 11.22
1993-04-01 Capital Reserve Aocount 5.11
1993-05-03 Capital RfJserve Aooount 22.31
1993-06-01 Cap i tal Reserve Acoount. 23.62
1993-07-01 Cap i tal Reserve Account 25.00
1993-08-03 Capital Reserve Account 31. SO
1993-09-02 Cap i tal Reserve Account 36.51
1993-10-04 Capital Reserve Aooount 22.71
1993-11-02 Capital Reserve Aocount 21. 27
1993-12-02 CapItal Reserve Aocount 33.10
1994-01-04 Capital Reserve Acoount 31.24,
1994-02-02 Capital Reserve Account 32.14
1994-03-01 Capital Reserve Account 27.33
. 1994-04-01 Capital Reserve Aocount 28.76
1994-05-03 Capital Reserve Account 29.06
19911-06-01 Capital Reserve Account 36.69
1994-07-01 Capital Reserve Acoount 34.10
1994-08-02 Capital Reserve Account 33.23
1994-09-01 Cap i tal Reserve Acoount 36.53
1994-10-03 Capital Reserve Account 25.96
.1994-11-01 CapItal Reserve Account 36.33
1994-12-01 CapItsl Reserve Account 60.26
1995-01-03 . Cap I tal Reserve Account 59.70
1995-02-01 CepIta1 Reserve Account 58.47 .
1995-03-01 Capital. Reserve Account 41.51
1995-04-03 CapItal Reserve Account 99.12
-19-
!"""'I ~~"
1995-05-01 Capital Reserve Account 91.07
1995-06-01 Capital Reserve Account 99,08
1995-07-03 Cap i tal Reserve Aocount 76.11
1995-08-01 Cap ital Reserlle Account 85,87
1995.09-01 Cap i tal Reserve Account 79.09
1995-10-02 Cap i tal Reserve Account 65.31
1995-11-01 Capital Reserve Account 83.Z!i
1995.12.01 Capital Reserve Account 66.63
1996-01-02 Capital Reserve Account 5'9:44
1996-02-01 Cap i tal Reserve Acoount. 911:04
1996-03-01 Capital Reserve Account 79.;(lZ
1996-04-01 Capital Reserve Acc ount
1996-05-01 Capital Reserve Acco\\Ot
1996-06-03 Capital Resl'lrve Account
1996-07.01 Cap i tal Reserve Account
1996-08-01 Cap i tal Reserve Account 59..28
1996-09-03 Capital Reserve Account /60.45
1996.10.02 Capital Reserve Account 19.64
1996-11-05 Cap i tal Reserve Account a6;88
),996.12.04 Capital Res erve Accoun't 11.69
1997-01-06 Capital Reserve Account 66.15
1997.02-03 Capital Reserve Account' St.l1
1997-03.04 Capital Reserve Acoount
1\197-04.03 Capital Reserve Aooount 10;:P
1997-05-05 Capital Reserve Aocount J,.:44
1997.06-05 Capital Reserve Account 1.36
1997-06-20 Cap ital Reserve Acoount 2.85
1997-09-03 Capital Reserve Aocount 4.37
-20-
~ f~
1987-04-06 Commonwealth of Panneylvanla 828.32
Retirement Benefit
1987-04.06 Fixed Inoome Colleotive 311.46
Inveetment Fund
1987-04-08 U.S. Traaeury - Soo ial 583.00
, Seourity Benefite
1987-05-0/, Commonwealth of Pennsylvania 828.32
Retirement Benefit
1987-05-05 Fixed Income Col1eotive ~79.24
Investment Fund
1987-05..06 U.S. Treasury - Sooial 583.00
Seourity Benefits
1987-06-03 Commonwealth of Pennsylvahia 828.32
Retirement Benefit
1987-06-03 Fixed Inoome Col1eotive 379.62
Investment Fund
1987 - 06 - 05 U.S. Treasury - Sooia1 .583.00
Security Benefits
1987-07-03 Fixed Income Collective . 314.57
Investment Fund
1987-07-06 Commonwealth of Pennsylvania 821. 02
Retirement Benefit
1987-07-07 U.S. Treaeury - Sooial 583.00
Seourity Benefits
1987-08-04 Commonwealth of Penney1vania 821. 02
Retirement Benefit
1987-08-04 Fixed Income Collective 451.90
Investment Fund
1987-08-05 U.S. Treaeury - Social 583..00
Security Benefits
1987-09-03 Commonwealth of Pennsylvania 821,02
Retirement Benefit
1987 - 09.03 Fixed Income Collective 550.59
Investment Fund
1987-09-09 U.S. Treasury - Social 583.00
Security Benefits
1987-10-02 Commonwealth of Pennsylvania 821.02
Retirement Benefit
-22-
.~
!"-~
1987-10-02 Fixed Income Colleotive 576.85
Investment Fund
1987-10.06 U.S. Treasury - Soc ial 583.00
Seourl ty Benef i ts
1987-11-04 Commonweal th of Pennsylvania - 821. 02
Retirement Benefit
1987-11-04 Fixed Income Collective ~82 .36
Investment Fund
1987-11-05 U.S. Treasury - Sooial 583.QO
Security Benefits
1987-12-02 Commonwealth of Pennsylvania 821.02
Retirement Benefit
1987-12-03 Fixed Income Collective 566.57
Investment Fund
1987'12-04 U.S. Tressury - Socisl 583.00
Security Benefi ts
1987-12-31 Transfer from Principsl 1,000.00
1988-01-05 Fixed Income Collective 590.93
Investment Fund
1988-01-07 Commonwealth of Pennsylvania 821.02
Retirement Benefit
1988-01-07 U. S. Treasury - Social 601.00
Security Benefits
1988-02-02 Fixed Income Collective 560.25
Investment Fund
1988-02-03 Commonwealth of Pennsylvania 821. 02
Retirement Benefit
1988-02~05 U.S. Treasury - Social 601. 00
Security Benefits
1988-03-02 Fixed Income Collective 681.52
Investment Fund
1988-03-04 Commonwealth of Pennsylvania 821. 02
ketirement Benefit
1988-03-08 U.S. Treasury - Social 601.00
Seourity Benefits
1988-03-15 Er Ie Insurance Group - Refund 53.00
on Premium
-23-
- f";
,-..,
.r"-;"',
1988 -04-05 Fixed Inoome Colleotive 797.86
Investment Fund
1988 - 04.06 Commonwealth of Pennsylvania 821. 02
Retirement Benefit
1988-04-06 U. S. Treasury - Soo ial 601.00
Seourlty Benefits
1988-05-05 Commonwealth of Pennsylvania 821. 02
Retirement Benefit
1988-05-05 U.S. Treaaury - Sooial 601. 00
Seourity Benefits
1988-05-16 Fixed Inoome Collective 739.78
Investment Fund
1988 - 06 - 02 Fixed Inoome Co11eotive 780: 19
Investment Fund
1988-06-06 Commonwealth of Pennsylvania - 821. 02
Retirement Benefit
1988-06-07 Capital Blue Cross/Blue Shifilld 69.44
- Medioal Reimbursement
1988.06-07 U.S. Treasury. Social 601.0.0
Security Benefits
1988 - 07 - 05 Fixed Income Colleotivfil 770.69
Investment Fund
1980-07-06 Commonwealth of Pennsylvania 809..09
Retirement Benefit
1988-07-08 U. S. 'freasury - Social 601. 00
Seourity Benefits
1988-08-02 Fixed Income Collective 811.14,
Investment Fund
1988-08-03 Commonwealth of Pennsylvania 809.09
Retirement Benfilfi t
1988-08-04 U.S. Treasury - Social 601.00
Security Benefits
1988-09-02 Fixed Inoome Collective 780.03
Investment Fund
H88.09-07 Commonwealth of Pennsylvania 809.09
Retirement Bensfit
-24-
1''''1 ,..-.,
1988.09.08 U.S. Treasury - Sooisl 601. 00
Security Bfilneflta
1988-10-0/1 Commo\1wealth of Ponnsylv6n!a 809.09
Retirement Benefit
1988.10.04 Fixed lnobmo Colleotive 758.52
Investmont l'und
1988-10-06 U.S. Tr(ja~ury - Sooial 601.00
Seouri ty Benefl ts'
1988..11.03 l'ixad Income Colleot!ve 7(8,.84
Investment Fund
1988-11.04 Commonwealth of Pen\1sylvania 809.09
Retirement Benefit
1988 -11- 08 U.S. Treasury - Sooial 601.00
Security Benefits
1988-12-05 Commonwealth of Pennsylvania 809.09
Retirement Benefit
1988-12-05 Fixed Inoome Collective 763.67
Investment Fund
1988-12-07 U.S. Treasury.. Social 601.00
Security Benefits
1988-12-13 Capital Blue Cross/Blue Shield 79.31
- Reimbursement for Medical
Exponse
1989-01-04 Fixed Income Collective 780.96
Investment Fund
1989-01-05 Commonwealth of Pennsylvania 809. 09 '
Retirement Benefit
1989-01-06 U.S. Treasury - Social 619.00
Security Benefits
1989-02-06 Fix'ed Income Colleotive 780,86
Investment Fund
1989-02-07 Commonwealth of Pennsylvania 907.09
Retirement Benefit
1989-02-07 U. S. Treasury - Social 619.00 ,
Sedurity Benefits
1989-03-03 Commonwealth of Pennsylvania 907.09
Retirement Benefit
-25-
~ """
1991.03.05 fixed 111Clomo ColleoLlve 738.57
InvoHtmenl: Fund
1991-03-05 U. S, Treasury - Soo I Hl 688.00
Seourity Boneflts
1991-03-29 Ponn Treaty Insuranoe Co. 700.00
ReiinburHoment for Nursing Home
1991.04.03 Commonwolllth of Peltnsylvania 876.84
Rotirement Bonefit
1991-04-03 Fixed Inoome Colleotive 804 . 89
Investment Fund
19!h-04-03 U.S. TrOll9U ry - Sooilll 688.06
Seourity Benefits
1991-04-26 Penn Treaty Insurance Co. 700.00
Reimbursement for Nursing Home
. 1991-05.02 Commonwealth of Pennsylvania 876.84
Retirement Benefit
1991-05-02 Fixed Inocme Collective '168.96
Investment Fund
1991-05-0" U.S. Tressury - Sooial 688.00
Security Benefits
1991-05-28 Capital Blue Cross/Blue Shield 96.00
- Reimbursement for Medioal
Expense
1991-05-29 Capital Blue Cross/Blue Shield 24.00
- Reimbursement for Medical
Expense
1991-05-29 Penn Treaty Insurance Co. . 443.27'
Reimbursement for Nursing Home
1991-06-03 Commonwfilalth of Pennsylvenia 876.84
Retirement Benefit
1991-06-04 F'ixed Inoome Colleoti ve 83~.33
Investment Fund
. 1991-06-04 U.S. Treasury .. Soc tal 611a.QO
Security Benefits
1991-06-28 Penn .Troaty Insurance Co. - 629.91
Reimbursement for Nursing Home
1991-07-02 Fixed Inoome Colleotive 793.87
Investment Fund
-32-
-, '""'
1992-05-05 Fixed Income Colleotive 773.04
Investment Fund
1992-05-12 Capital BluB Cross/Blue Shield 193.55
- Reimbursement for Medical
Expense
1992-05-28 Penn Treaty Insurance'Co. 700,00
Reimbursement for Nursing Home
1992-06-02 Commonwealth of Pennsylvania 865.66
Retirement Benefit
1992-06-03 Fixed Income Collective 181...96
Investment Fund
1992-06-04 U. S. Treasury - Sooia1 713, . 00
Security Bon~fits
1992.06.15 Capital Blue Cross/Blue Shield 16.68
- Reimbursement for Medioal
Expense
1992-06-29 Penn Treaty Insuranoe Co. - 700.00
Reimbursement for Nursing Home
1992-07-01 Commonwealth of Pennsylvania 844.35
Retirement Benefit
1992-07-03 Fixed Income Colleotive 769,57
Investment Fund
1992-07-03 U.S. Treasury. Social 713.00,
Security Benefits
1992-07-06 Capital Blue Cross/Blue Shield 264.14
- Reimbursement for Medioal
Expense
1992-07-28 Penn Treaty lnsuranoe Co. - 700.00
Reimbursement for Nursing Home
1992-08-03 Commonwealth of Pennsylvania 899.35
Retirement Benefit
1992-08-04 U.S. Treasury. Soo ial 713.00
Seourity Benefits
1992-08-05 Fixed Income Colleocive 782" 65
Investment Fund
1992-08-07 Capital Blue Cross/Blue Shield 116.87
- Reimbursement for Medical
Expense
-36-
~
1989.02-14 AT&T. Telephone Expense
1989.02.16 United Methodist Homes for the
Aging - Convalcscent Home
Bxpense
1989-02~21 Camp Curtin Memorial United
Methodist Church -
Contribution from Mary r.
Burgoon
1989-02-27 Di~ons Pharmaoy - Medical
Bxpense
1989.03-07 Bell of Pennsylvania
Telephone Expense
1989-03-07 Dauphin Deposit Bank and Trust
Co. - Commission
1989-03-09 Pealer's Flower Shop' Balance
Due
1989-03-13 Dsuphin Deposit Bank and Trust
Co. - 1988 Fiduciary Tax
Preparation Fee
1989.03-15 National Liberty Life
Insurance Co. - Insursnce
Premium
1989-03-16 United Methodist Homes for the
Aging - Convalescent Home
Expense
1989-03-20 Camp Curtin Memorial United
Methodist Church -
ContribUtion from Mary F.
Burgoon
1989-03-29 Dh<ens Pharmacy - Medical
Expense
1989-04-03 Bell of Pennsylvania
Telephone Bxpense
1989-04-19 United Methodist Homes for the
Aging - Convalescent Home
Bxpense
1989-04-20 Camp Curtin Memorial United
Methodist Churoh -
Contribution from Mary F.
Burgoon
-64-
13.90
1,008,00
100.00
-, -"""
1992-04-09 United Methodist Homes for the 2,220.00
Aging . Convale8oent Home
Expense
1992-04-20 Camp Curtin Memorial United 100. 00
Methodist Churoh -
Contribution from Mary F.
Burgoon
1992-04'24 Dixons Pharmaoy - Medioal 92.56
Expense
1992-04-29 AT&T - Telephone Expense 19.46
1992-05-01 Ball of Pennsylvania - 48,36
Telephone Expense
1992-05-12 United Methodist Homes for the 2,294.00
Aging - Convalesoent Home
Expense
1992-05.14 Weis Pharmaoy - Medioal 687.4~
Expense
1992-05-20 Camp Curtin Memorial United 100.00
Methodist Churoh -
Contribution from Mary F.
Burgoon
1992-05-20 Erie Insurance Group 54,00 ' ,
Insuranoe Premium
~992-06-02 Dixons Pharmacy . Medical 1.04.96
Expense
1992-06-03 Bell of Pennsylvania - 47.52
Telephone Expense
1992-06-05 Weis Pharmscy - Medical 281.51
Expensa
1992-06-08 Dauphin Deposit Bank and Trust 183.95
Co. - Comml.ssion
1992-06-15 Cowley Associstes - Medical 35'.52
Expense
I
1992-06-15 United Methodist Homes for the 2,220.00
Aging - Convalescent Home
Expense
1992-06-22 Camp Curtin Memorial United 100,99
Methodist Churoh -
, Contribution from Mery F.
Burgoon
-79-
r".
,.......
3:'>.00
1994-01-12 Lower Allan Township -
Ambulanoe Membership
50.76
1994-01-12 Weis Pharmsoy - Medical
Expense
350.21
1994-01-14 Peeler's Flower Shop - l\alnnoe
Due
2,310.00
,199~'01-14 United Methodist Homes for the
Aging _ Convalesoent Home
~xpense
100.00
1994-01-20 Camp Curtin Memorial United
Methodist Churoh -
Contributiml from Mary F.
Burgoon
1994.01-20 Pealer' e Fl.ower Shop - Balanoe
Due
i33.22
12.32
1994-oi-2811ell of pennsylvania -
Telephone Expense
19.46
28.69
1994-02-03 AT&T _ Telephone Expense
1994-02-07 Alert Pharmacy at Bethany
Village - Me,dical Expense ,
1994-02-09 United Methodist Homes for the
Aging _ Convalescent Homfil
Expense
1994-02-09 Weis Pharmacy - Medical
Expense
1994-02-16 Cowley Associat,es - Physicians
Serv ioe Expense
1994-02-22 CS11\P Curtin Memodal United
Methodist Church -
contribution from Mary F.
1994-03-oi Alert Pharmacy at Bethany
Village - Medical Expense
:'>0.49
1994-03-01 Bell of Pennsylvania
Telephone Expense
673 .41
1994.03-07 Dauphin Deposit Bank and Trust
Co. - commission
2,294.00
1994-03-08 United Methodist HomflS for the
Aging _ convalescent Home
Expense
-87-
-.
DISTRIBUTIONS OF INCOME TO BENEFICIARIES
1986-10-01 Mary F. Burgoon - Inoome 300.00
Distribution
1986-11-03 Mary F. Burgoon - Inoome 300.00
Distribut.lon
1986 -12 - 01 Mary F. Burgoon - Income 300.00
Distribution
1986-12-05 Mary F. Burgoon - Income 100.00
D.lstribution
1986-12.05 Mary F. Burgoon - Inoome ' 50.00
Distribution
1987-01-02 Mary F. Burgoon - Income 300.00 '
Distribution
1987-01-08 Mary F. Burgoon - Income 100.00
Distribution
1987.02-06 Mary F. Burgoon - Income 300.00
Distribution
1987-03-02 Mary F. Burgoon - Income 400 , 00
Distribution
,1987-04.01 Mary F. Burgoon - Inoome 400.00
Distribution
1987-05.01 Mary F. Burgoon -' Income 400.00
Oistribution
1987-06-01 Mary F. Burgoon - Inoome 400.00
Distribution
1987-07-01 Msry F. Burgoon - Income 400.QO
Distribution
1987-08-03 Mary F. Burgoon - Income 400.()(),
Distribution
1987-09-01 Msry F. Burgoon - Income 400.00
Distribution
1987-10-01 Mary F. Burgoon - Income 400.00
Distributicn
1987 -11- 02 Mary F. Burgoon . Inoome 400.00
Oistribution
1987-12-01 Mary F. Burgoon - Income 400.00
Distribution
-103-
""'" r~
1993-11:30 Mary F. Burgoon - Inoome 600.00
Dtstribution
1993-12-23 Mary F.' Burgoon - Inoome 300.00
Distribution
1993-12-31 Mary F. Burgoon - Inooma '600\00
Distribution
1994,01-31 Mary F. Burgoon - Income 600.00
Dtstribution
1994-02-28 Mary F. Burgoon - ' Income 600.00
Distribution
1994-03-31 Mary F. Burgoon - Inoome 600.00
Distribution
1994-04-29 Mary F. Burgoon - Inoome 600. 00
Distribution
, 1994-05.02 Mary F. Burgoon Income 1,018.00
-
Distribution
1994-05-31 Mary F, Burgoon - Income 600.00
Distribution
1994-06-30 Mary F. Burgoon - Income 500.00
Dtstribution
1994-07-29 Mary F. Burgoon - Inoome 500.00
Distribution
1994.08-31 Mary F. Burgoon - Income 500.00
Distribution
1994.09-30 Mary F. Burgoon - Inoome
Distribution
1994-10-31 Mary F. Burgoon - Inoome
Distribution
1994-11-30 Mary F' . Burgoon - Inoome
Distribution
1994-12-30 Mary F. Burgoon - Income
Distribution
1995-01-31 Mary F. Burgoon - Income Boo.bo
Distribution
1995-03-24 Mary F. Burgoon - Inoome
Distribution
1995-05-11 Mary F. Burgoon Income 5QO.00
Distribution
-108-
~
r-
AFFIDAV!T
Dauphin Oepos I t Bank and Trust Compnny, Trustee under Agreemont
with Mary F. BUl'goOn. decolt"od, horeby deolar:os under oath that said
Trustful has fully and faithfully d180harged tho duties of its offlo""
that the foregOing AccolHlt is true and corraot, and fully d18cloe6saU
a!gnif,ioant transaotions Ooourring during the "OCOunting pel~iod; that
aU known olaims against the Trust have been paid In full I that, all
' to its knOWledge, there are no claims now outstanding against tha Trust;
and that all taxes presently due from the Trust have been paid.
the trust have been paid,
--~7
- / L' '-- /0 ~(/I' 'rt
Dauphin DepOsit Bank and Trust Company
Subacribed and sworn to by
before me this/~ay of
"'~~J I. /1
Notary Pu~
[ a..../l =:=IYPlilIo
flam.oolg, Dll4>Nn Counly
My CClmtnIoaIoii ElCpIrtIl Sip, 25, l!OOO
Mlmber, ~anla AIooOiiltln Of NoIMii
\
I. (Settlor) of~__ '
, hereby transler to Dauphin Deposit Bank and Trust Company (herelnCllter
oalled the Trustee), a Peftnsylvania bank and trust company, the property described In the
attached Sohedule, to be tlald In Trust as follows:
FIRST: DI.po.llIve Provisions For My Banellt - During my lifetime:
A. All of the net Income shall be paid to me at least quarterly or shall be paid or accumu.
lated and added to principal. as I may direct In writing;
B. As much of the principal as I may from time to time requeslln writing shall be paid to
me. or as I may otherwise direct;
C. If, In the Trustee's opinion, I am at ilny time unable to act or to apply 1t1e payments to
my own best Intarest and advantage, the Trustee may apply directly 'ror my benefit as
much of the Income and/or principal as the Trustee may. from time to time, deem appro.
prlate for ( ) welfare. comlort, support or emergency needs and may add to prlncl.
pal as much of the Income as the Truatee deems advisable,
0, Trustee shall keep true and correct books'of account. Wlllch books of account shall at
all reasonable time be open to the Inspection of Settlor or his duly appointed representa-
tive. Trustee shall also quarterly render Settlor a detailed siatement Showing all receipts
and disbursements on account of the trust estate and the manner and form In which the
trust estate Is Invested at the time of the rendition of such statement.
SECOND: Dispositive Provisions After My Death-Upon my death while the trust continues.
the Trustee shall pay the then.remalnlng prlnolpal and Income to my Executor or Admlnlstra.
tor for disposition as part of my estate,
THIRD: Right to Revoke and Amend: I reserve the right to revoke or amend this trust. In whole
or In part, at any time and from time to time by an Instrument In writing. delivered to the Trustee
and Intended to take effect during my lifetime; except that the duties. powers and liabilities of
the Trustee shall not be changed without Its written consent. The Trustee reserves the right. at
any time upon thirty (30) days advance written notice to me. to resign the trust and deliver the
trust estate to me. after deducting therefrom Its fees and any expenses then due and payable.
FOURTH: Additions to Trust: Subject to the approval of the Trustee. either I or any other entity
may add property, real and personal. to the principal of this trust.
FIFTH: Tl\I8tH's Powers: In addition to the powers granted by law, my Trustee shall have the
following discretionary powers, applicable to principal and Income; which shall be exercis-
able without leave of court and shal~ continUA until distribution Is actually made:
A. To accept and retain any or all property, Including stock or other securities of the
Trustee or of a hOlding company controlling the Trustee;
B. To Invest In all forms of property (Including. but not by way of limitation, real estate,
all types of stooks, bonds. options. and participations In common trusl funds arid money
market funds); without being confined to Investments prescribed by statute and without
being required to diverSify;
C. To buy Investments at a premium or discount;
D. To hold property unregistered or In the name of a nominee;
E. To give proxies. both mlnlstorlal and discretionary;
F. To compromise olalms;
G. To Join In any merger. consolidation. reorganization, voting trust plan. or other con.
oerted action of security holders. and to delegate discretionary duties with respect
thereto;
H, To borrow from Dauphin Deposit Bank and Trust Company or from others, and to
pledge real or personal property as security therefor; to loan cash or securities upon
such terms and conditions as trustees deem appropriate,
I. To sell at public or private sale for cash or credit or partly for each. to exchange, to Im-
prove. or to lease lor any period of time. any relll or personal property; and to give options
for sales, exchanges, or leases,
,."
J. To. allo.cate any praperly received or charge incurred to. prlncipel or Incame ar partly to.
each, wlthaut being abllged to. apply tM usual rules o.f Irust accounting;
K. To. distribute In cash ar In kind or partly In each;
L To. retain any part or all af my buslneSfl Intureets held In this Trusl as long all the
Trustee canslders it advisable 10. do. sa; and to. canduct, alo.ne ar with at hers, any such
business In which I am engaged. with all the powers af an awner or with respect thoreta.
Including the pawllr to. delegate discretlanary duties to. others and to. PI1Y adequate cam-
pensatlan to. any such persan; to. invest ather pro.perty In such ~usinesB, and to. incar-
perate it ar change its farm,
SIXTH: Comp41nutlon: The trustee shall be campensated In accerdance with Its standard
schedule af Charges in ellect fram time to. time during the perl ad af Ita services. and this cem-
pensatlen shall be paid from principal ar Income or partly from each In the sale dlscretlan af
the Trustee.
SEVENTH: Non-Assignment: No. part af thelncame ar principal af the property held under this
Trust shall ba subJect to. attachment. levy ar seizure by any credltar, spouse. assignee ar
trustee ar recalver In bankruptcy prlar to. actual receipt thereaf. The Trustee shall pay cver the
net incame and the principal to. the pemans herein designated, as their Interests may appear,
without regard to. any attempted anticipation (except as specifically pravlded In this agree-
ment), pledging or assignment under tho Trust, and wlthaut regard to any claim thereto ar
attempted levy, attachment, seizure or othor pracess against fIlO.
EIGHTH: Law G10vllTllng Trust: This trust Is created and accepted In the Cammonwealth
of Pennsylvania and shall In all rsspects be gavernod by Its laws and shall have Its situs at
Cumberland County, Pennsylvania.
Executed on ~~ ')-, , 19 J~,
NOTE:
Before executing this decument you may
want to. consult with yeur Attorney to as-
sure that yaur wishes are being set farth
accurately and In proper legal farm,
WITNESS:
,
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Settlor
J
The for.eoOlng trust '~_~~ accepted,
Executed on ~ '........ ,.,...
,19 f-t,
DauPh~B8n~n~TrU~pany
By ~y ~~
(TItle)
A..lstant Vice PreSident and Trusl OWeN
COMMONWEALTH OF PENNSYLVANIA }
COUNTY OFCumberland
On this, the 2nd day af September ' 1986 . before me, a
natary public In and for the said Cammonwealth and County, personally appeared
Mary F. Burgoon , known to. me (or satisfactorily praven) to. be the persan whase
name Is subscribed to. the foregaing Revacable Living Trust and acknawledged that he/she
executed the same far the purpases therein cantalned,
WITNESS my hand and natarlal seal.
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My Com miss Ian Expires:
(SEAL)
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o Dauphin Deposit Ba~
and Tlust Company
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
/.1) //( 1/
BUREAU Of INDIVIDUAL TAKES
IHIlUUIAHcr lAI< IJtVISION
IJI.J1T. ;>80601
IIAIUUSIlUIfO, fill 111i'1I-0601
NOTICE Of INHERITANCf TAK
APPRAISEMENT, ALLDWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT Df rAK
05-04-98
BURGOON
04-14-91
21 97-0387
CUMBERLAND
101
E _~_~nt R~ t:Od --~
MAKE CHECK PAYABLE AND REMIT PAVMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE. PA 17013
CUT ALONG THIS LINE ... RETAIN LOWER PORTION FOR YOUR RECORDS ~
if!' V: iS4-j -iif -AF P - iilF 97"1" "NoYi ci""eip - "iNtiiii if At.ic E - YA X - iiP'PRA"i S EHENT-; -A i:. i"ciWANCE - b"R' - -.""" - - - - -" - - - --
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
MARY F FILE NO. 21 97-0387 ACN 101
DATE
ESTATE OF
DATE OF DEATH
FILl NUMBlR
COUNTY
ACN
MANDV HICKS
DAUPHIN DEPOSIT
213 MARKET ST
HBll
BK & TR
PA 17101
ESTATE OF
BURGOON
TAK RETURN WAS I (X) ACCEPTED AS fILED
RESERVATION CONCERNING FUTURE INTEREST " SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. R..I Est.t. (Schedule Al
2. Stooke end Bonda ISch~dul. 8)
3, Cl05.1y tleld stock/Pedn.rstdp lnt.r..t (Schedule C)
4. Harig.g../Not.. Reo.iv.ble (Schedul. D)
&, C..h/Bank nepos! ti/Hinc, f1.r.ond P,'opert),l I Schedule E)
6. Jointly Owned Propftr~y (Sch.dule fJ
7. rr.nlf~r' (Sch.dul. OJ
8. Tot.l Ass.t.
I CNANGE~
III
121
151
(41
151
(61
(7)
.00
43.907.12
,00
,00
10,186,05
,0.lL
,00
(81
APPROVED DEDUCTIONS AND EXEMPTIONS:
" Funeral Expens.s/AdM. co,ts/Hiao. Expen.es (Sohedule H)
10. Oebt./Hortgage liabilitias/Lians (Sohadul. I)
11. Totel OaduCit ionl
12. Nat Value of Till( Return
13. Charit.bla/GovernMent.l Beque.ts; Non-clected '113 Tru,ts ISchedul. J)
14. N~t Value of Eltate Subjeot to Tax
11,538,46
1.459...zl_
1111
1121
(151
1141
(91_
1101
( -
'*
1(Y.114l1l In IU HI
MARV
F
DATE
05-04-98
NOTE I To in'Yr. proper
oredit to your eoooynt,
sub..U the upper portion
of this forn with your
tax pay",.nt.
54,093,11
12,997 n
41,095,44
fl, 109, 5f,
36,985,90
If an assessment was issued previouslY, lines 14, 15 and/or 16, 17 and 18 wilJ,
reflect figures that include the total of ~ returns assessed to date.
ASSESSMENT OF TAX:
lE. AlIlount of Lit,e 14 .t Spou..l ret. Uti)
16. AlIlount of Lin. 14 taxwbl. at Lin.al/Cl.., A rete (16)
17. Anount of Line 14 tex.~le at Collataral/Cle.. 8 rat. (17)
18. Principal Tax Due
NOTEI
TAX CREbITS:
PAYMENT
DATE
01-09-97
01-14-98
RECEIPT
NUMBER
AA211509
AA242649
DISCOUNT ('1
INTEREST/PEN PAID (0)
210,53
,00
. IF PAID AFTER DATE INDICATED. SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST,
,00 K ,00,
,00 K ,06.
36.985:90" K ,15=
(18)
I
AMOUNT PAID
4,000.00
1.337.36
,00
,00
5,541,89
5,547,.89_
5,54-7 '~89
.00
,00
,00
If TDTAL DUE IS LESS THAN II. He PAYMENT IS REQUIRED,
If TOTAL DUE IS REFlfCTED AS A "CREDIT" (CRI. YOU MAY BE DUE
A REFUND, SEE REVERSE SIDE OF THIS fORM fOR INSTRUCTIONS. I
TOTAL TAX CREDIT
BALANCE OF TAX DUE
-.--
INTEREST AND PEN.
-_.~------
TOTAL DUE
RESERVATION I
PURPOSE OF
NOnCE I
PAvtlENTI
REFUND (CR) I
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E,t.t.. of dlcldlnt. dY1ng on or blfor. D.c.~b'r 12, 1982 -~ Jf any futur' Int.r..t 1n the a.tete rrJtran.flrr.d
1n po.....lon ar .njoY'lnt to Cl... B (ooll.ter.1) bln.flolnri,. of the deoldlnt aft.r the expiration of any e.tet.
IJf. or for y.ar., thl co__onwlftlth hlrlby .xprlllly rl~erVII tho right to appraJ.. and 8'le.. tranl'er Inheritanol
at the lawful Cla.. B (oollateral) rnte on any such -Iuturl lnterut.
~~~~
Chst
I.,
Tftx8t
To fulfill the rlqulr..enh of Sletlor, 2140 of th, Inheritaneo nnd E.tftt, TftlC Aot} Aot 21 uf 1995. (12 P,S,
Slotion 9140),
DetAch tho top portion of thls Notice Rnd SUbMit with your paymont to the R9gllter of Will, printed on the rev.r.. ,ide.
uHllke oheok or 1I0noy order payable tal REGISTER OF HILLS, AGENT
A rofund of a tel< orltd1t, which Wl'lll not rClquuted Oil the Tax Roturn, lIay bo ruquuhd by cOlllPleUng an "Appllcation
for Refund of i10nnlylvunla Inherlhna. and Eshte Tax" (REV-1315). Appllcat1on:t are 9VllllBblll at the Offloe
of thll Registar of WIlls, any of the Z~ Rovllnuu DistrIct Offices, or by calling thll spo~lal 24~hour
lmsworJnQ sorvIce nu.bers for forMS ordl\lrlng: Ir\ f1ennsylvan18 1-800-362N20S0, outslda P_nn'YlvanJn .!lnd
withIn looal H8rrhburg llri~a (717) 787-8094, TOO~ (17) 772~21S2 nlRarJng IllpaJr.d Only).
OBJECTIONS I Any party ln Intornt not satisfied ~Ith thg apprnlsellunt, allowance or disallowance of dllduotlonl} or alslln.ent
of tax (lndudlng discount or Inter'lIt) as shown on thh Notice !!lust objeot within sIxty (60) day. of receipt of
this Notlo_ bYI
ADMIN
ISTRATIVE
CORRECTIONS I
DISCOUNTl
PENAL TVI
INTEREST I
Hwrltten proto.t to tho PA lJupnrhlent of R8vonuo, Board of Appuls, Dopt. 281021, HarriSburg, PA 11128-1021, OR
N~lIleotlon to have the mattor dut8r"lnod at audit of the nccount of the porlonal roprosentatJve, OR
--app8al to the Orphans' Court.
factual err/Jrs discovered on this BSSatlSlIlent should be addreuod In writing tOI PA Depllrtllent of ReYlInuo,
Burol.llu of IndIvidual Ta)(85, ATTNI Po~t AsseSSMent Roviow Unit, Dept. 260601, Harrisburg, PA l1lZ8.0601
Phono (717) 787-6505, S.. pBge 5 of the bl'\oklot "lnstru(ltlons for InhRrltanco Tax Return for a Ruldont
Docedllnt" (REV-l'.:iOl) for an e)(pl~nat1on of adlllnhtratlve1Y correctable .rrors.
If any tax dUll Is pnld withln thr89 (5) calendAr Months aftgr the deCRdent', dl8th, 8 fiv. p.rcent (S%) dhoount of
tho tax paid Is allowed.
Thll 151. tax aMnuty nan-partlolpatlon ponal t... Is callputod on the tothl of the tax anel InhirOlt 9U9ued, and not
paid bafora January 18, 1996, tho first day lIftQr' thfl end of the tax minettII' fler1od. Thls non-participation
penal ty is appuhtbla In tho S81le lIannar and In tho thQ 5a~o Ur." pur lad 8S you would llIppoal the talC Bnd lnter..t
that has bllen aSI.llad al Indlcatad on thls notice,
Interut is chargod heglnnlng ,lith first clay of d"lInquennv, or nlnta (9) IIIoroths nnd one (1) day frail the data of
death, to l;he datil of paYMant. lalCGlS whIch bOCA~. dttllnquent before January I, 1982 beflr Inhrest lit the rat. of
11)( (61.) peroent par annuli c81culatRd at II dlllh r8to of .1l001Mt, All tlllCliHI whloh booau de1Jnquent on and !lftar
January 1, 1982 wIll bur Intltrost 'It Q rate which 101111 vary frOM calendar y"or to calenda" YII8r Iollttl tl1ltt rata
lmnouooad by the flA D61partllOnt of Ravenue. The IIppllcablo Jntarut rat... fer 1962 throllQh 1998 Qrel
'i!.!!: Intarallt Rato DallY Inturut fflCtor ~ Interut Rata Dally Inhrast Factor
1982 lOt. .000548 1961 9% ,000241
19&3 16% .000458 1985Nl991 11Y. .000301
1984 11% ,000301 1992 91: .000247
19&5 111. ,000356 1993-1994 1% .00tJ192
1986 10% ,000214 199!iM1998 9% ,000247
"'lntirelt 11 calou18tftd .. f\]l1otlll
INTEREST = BALANCE OF TAX UNPAID X NU"BER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
nAny Notloe luued afte,. th' tax bacolI" daUnqul1nt will reflo~t an lntRrut Ol!lloulatlon to fifteen OlD delli"
b.~ond the date of th. n....G.ont. If pay..nt I, .ade nfter the Interelt QOIIPutation det_ Ihown on the
Notloo, addltional intoro.t .u.t b. calculated.
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RECEI PTS OF INCOME
Dividends:
1997-05-28 'Ml,lrketvest Funds Ino 6..09'
, Intermediate US Government
Bond Fund 11593
1997-09-15 Marketvest Funds Ine 2n.49
Intermediate US Government
Bond FUlld 11593
1997-09-15 Marketvest Funds Ino 97.09
Intermediate US Government ..........................
Bond Fund 11593 374.67
Interest:
1997-06-05 Capital Reserve Ac,oount 18.82
1997-07-03 Gap i tal Reserve Aooount 159.93
1997-08-01 Capital Reserve Aooount 159.89
1997-09-03 Cap i tal Reserve Aooount 155.81
1997-09-15 Capital Reserve Aooount 1.44
1997-09.15 Capital Reserve Aooount 1.36
1997.09-15 Capital Reserve Aooount 2.85
1997-09-15 Cap i tal Reserve Aooount 4,,37
1997-09-19 Capital Reserve Aooount 2.41
1997-10-02 Capital Reserve Aoo oun t 177.57
1997.11-03 Cap i tal Reserve Aooount 180.88
1997-12-02 Cap i tal Reser.v8 Aooount 164.97
1997-12-31 Capital Reserve Aooount 196.67
1998-02-02 Cap i tal Reserve Aooount 184.42
1998.03-02 Capital Reserve Aooount 162.16
1998-04-02 Capital Reserve Aocount. 178.77
1998-05-01 Capital Reserve Acoount 172.76
-8-
DISBURSEMENTS OF INcOME
1967-],0-21 Dauphin Deposit Bank and Trust 24,67
Co. . Commission
1997-07-22 Dauph~n Deposit Bank and Trust 15.61
Co, . Commission
1997-12-31 Dauphin Depos it Bank and Trust 17.29
Co. . Commission
1998-06-03 Internal Revenue Servioe . 238,00
1997 Fiduoiary Income Tax
1998-06.03 PA Department of Revenue - 47,00
1997 Fiduoiary Income Tax
1998.06-04 Dauphin Deposit Bank and Trust 44.07
Co. . Commission .......................' 386.64
'00'.........................
Total Disbursements of Income
386.64
.....--..--...--
\"
.10-
$TATlJS REPORT UNDER RULE 6.12
Nume ofDecedenl: Marv F.Durnoon
Dale ofDeath: ..4LI.ill227.
Will Ne,.I.2il7-0038'l
Admin, No. 2197-QO~S7
Purauantlo Rule 6,12 of the Supreme Court Orphans' Court Rules, I reperlthe following with
respect to completion of the administration ef the ahove.captloned estate:
I, State whether admlnlstrotion of the estate is complete:
Yes X No____._._.
2, Iflhe answer Is No, state when the personal representative rensonably believes that the
administration will be complete:
~, Iflhe answer to No, lis Yes, state the fbllowlng:
a, Did the personal representative liIe a f'inal account with the Court'!
Yes_X_ No
b, The separate Orphans' Court No, (if any) fer the personal representative's
aceount is:
c, Old the personal representative state an account Informally te the parties In
Interest'/ Yes_.X__ No_
d. Copies efrecelpts. releases,joinders and approvals of formal or infennal
accounts ,nay be llIed with the Clerk of the Orphans' Court and may be attached
to thl~ report,
Date: 1k'''11 2. 00 l>
----7 ,/"
---~~-~ ~t" _
<...- ~ c-./' ('::u-v /1
. Signature
Rebert L, Keck A VI' ~ TO
AIIOfst Trusl COl11DUnV efPA. N,A,
Name
213 Murket St. HUfflsbur. PA 17101
Address
('/17) 255,2148
Tel.Ne,
Capacity: X Personal Ropresentative
_ Counsel for persenal representative
Ul 't;!'2f,
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