HomeMy WebLinkAbout97-00505
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WAI1NING: IT IB ILLrGAL TO ALTUI Till[; NH'Y Orl
TO DUPLlCAH BY PIIOTO}JTAT Of! PIIOTOOI1APII.
(.oMMONWHI II! 01 PI WI';'(( VMH^
orJ!Atl1MrNl ClI' tll:^IIH VIIM HI t:llflf)';
21-97,.50.'i
I.OCAL REGISTRAR'S CERTlFICAllON (If DEATH
CERT, f\Q, 354 2 3 5 3
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N,m." DOC''''''~~IV 0 ~_
Sex ~oclal ~;(,ClIl1ly No J 11 ,~. 0 3 I. /J ~~Co ~, [~I~JI [)eatlJ~Jt '997
DaloofBirll,!I>Q;tI,3o/ '9' [;IIlliplil<:l' .~ ~ I 171..... 'm'
Plac(lol[)o;l~ ~~ ~nnSYIValliil
.laco . ~C;Lll'ill'OIl ~,rrl("1 rO";:;'(~O'S'~;N~I_" '.'~.' /t()
Milrilal StalLls ~v..ed :~1~)\"'I:::;;"~I(;;,ro,;'; 3{),',,~~....., '/ ~".' ..' m I fA /7"()1
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Inlormanl ....'. ~~ .... FLln(!raIDir~ '.~" ~
~1~~~~~a~r~~I~~~~~;~~o~\m .. =f, #./1#, 'I .srJ(J .... tif., tUj~1 y!/ 17~g
, Inlerval Belwoon
i onsg iIIl::JloulI1,
. _L__...__..___l1)~.____
,
,
,
Part I:
Immecliale Cause
~_. .,t.._~....._-~._,---- .
,
,
..___.________.....___ .~.._._._.._.L.___.~r _.~.___..._ _.~_..._.._~._."_-+L_..__.~__
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(d).. _..__....... "__'."_'" ....._..n..._."_"'_'_,_",____" ...c-.....~-~..__..-:--..,-_.._,--,..
Part II: Olller~p~:01f,oll~n"A. t A.A',.-... J I 1f8P . ',: ..
,.,_..,....._..~I-.""T".~!..!'~i~-,-,- _.....--:'......:. __-L.._...
Manner of Dealh Describe how injury occLlrrod:
(a).....~~..
(b).,....
(c) _... ,~.,
Nalural
Accidenl
Hornicicl(, []
Pending Invosligation [J
Could nOI bo Delonnillod []
N'"," ",d 1iU.", C.""", ~__J:~/!'lJ.lS;_..
Address "._.._..._ . . ~(Jt 'I .'f1170 ~ 0_ ,..
K
II
II
Suicide
(M,D., D.O., Coroner, M.E.)
This is to cortify ti,allllo inlormatioll 110'0 (livfJlI I~i cOllo<:lly ""ploel Irolll an original certificale
of dealh duly filod with 11,0 <If' IOCill 1100lslrar. TI'Il oIlOIl,al,o,I,II<:olo will be forwarded to ti18
SI<1lo Vilal Hocorcln 0111"0 fllr pOllllfllllJlil III(!/j~~ .t1 ~:L7'f-
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J~!~.,{~.91. IJ~.(QP~CWt-, ..
C'" 11-.'-'. j" 1',"'''''1'
CERTIFICATION OF NO!I'ICE UNDER RULE. 5..6(11)
Nllme of Decedent l k;UE.. i-vIL-C!.. !.Jr;-ST
Dllte of Death I 6/1/97
Will No. /197-oos'oS' Admin, No.
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 (allowing beneficiaries of the above-captioned eetate on
GIlt-I'll I
.
Name
Address
)I/JP/t /..e--G/hFU'71i.~ It? if/loST ~//Js,r.sT:.; ./]011..1/1/(, SMIVcrS, ~141'7tJd7-9UI
Notice has now been given to all persons entitled thereto under
.Rule 5.6(a) except
Datel
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Signatur (
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0:: 1'-" <P ;:,
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Name ).WPA J.-&E /I1/fti'rlA I
Address 10 tAsrf!R..st Sl.<.rZT
,:J!C)/J,lfUe, S(l,(!/A./6.\ I'A. /?fJ07-'1t,o(
TelePh~I~S-?83!
capacity 1_. . Personal Representative
Counsel for personal
representative
) )-, I ~'~.. - "
INHERITANCE TAX RETURN
RF.SIDENT DECEDENT
C(JMMONWEALlH Of PlNNSYLVAN'A (TO BE FILED IN DUPlICA TE ~
DEPARTMENT Of REVENUE 5-(:)~)
HA,,,,RJlH~om16060' WITH REGISTER OF WILLS) COUNTY CODE J../ . YE.AR (1'7 NUMIIER
6'fC'f "if'NTIS" N^Mi'll;;~i:';;R:~I: ''''NbMTIffith~TiTiATf-- _.-. --....- (ll i:TfiTI~FS-toMPrITfAiI6~gs-.----'-----'----~--'- .---',-, h.___...
l<J t: .J 1Ift"'U.JI1;.Jj tJ"",;/I)G. 1/00/[:
,'O""""L[;,"-'SC'~U' r,'-l~--""'L"M(.l".,.G_& 'I N____.C-' "1 "A.", 0' "".'" [ J.I~.:J (Jtt;. It/L'T" Bt'll"(),,! 1\.' 1>
m. [JA;/l~B~:/llt/7 CIfA't..ISi..l'.Ifi4/7(\t.J t
J7~' P), :~G(J'iJ ..~ '';11~7 (0""'( {I (I"'i31: /i!/-A /J 1:>
'" ...""',,, I",,,,,,,,, ""U\E' ",., ,,," "." "", ."",,, """.., !,,"'lA' "or""" ''''MBf.R ^MOLJN' ""IYHI I"': I"" ")(m,,, II
(iKOri~ln(l1 Return - . ( I 2. Supplomentc!1 Roturn [J 3. ~emCllnd8r Return
(fo( dalOt of death prior 10 12.13.82)
[.J 4. limited Ellole [ I 40, Future Inleret' Compromilll ! 15. Fed."al ElICIts Tax Rdturn Required
-. / (for dOh" of deolh ahor 12.12.82)
r~, Docedent Died Testate [ J 7, Docedont MalntClined Cl L1't'ln~ Trust _ B. Tolol Numbor of Sof. Deposit 80liOl
u IA1Ioch copy of Willi IA1Ioch copy of ',uI11
ALL CORR.SPONDINeE AND CONfIDENTIAL TAX INPORMATION SHOULD II DIRICTID TOj --'--"--...-.
NAME --------------rOMimTi",uNO ADom. .- --- ~---
~H~~;~c~~~~l~l~ 1'1 AJ__:c=, ~=_ '_o~. _=~~7~~c~~~~~:~~:p~:~::~,: 9:'_0: "~...,u
50'l,{:;O
If
~(\/.I~oo.nt 1'-9<1)
~
lIt!iIlJ
~1El:\
ul~
1. Rool Ella" ISchedule AI
2 Slocks nnd Bonds (Schedula B)
3, Clolely Held Slack/Partnership Inloresl (Schedule q
.4, Mortgago, and Notos Recel't'ablo (Schedul., D)
5. CClh, Bonk Deposits & Miscellaneous POrlonal Proporty
ISchedule EI
6. Jointly Ownod Proper'y ISchedule FI
7 Ironlfe.. IS,hedule GllSchedole LI
tl, Tolal Grall Auets (lata I lines 1.71
9. Funeral ExpenI8', AdrnlnlUrallve CoslS, Mlscelloneoul
Expen,o, ISchedule HI
10, Dobis, Mortgage liobillllel, lien, (Schedule I)
11. T 0'01 Oedu,'lonl I'o'al L1n.. Q & 101
12, Nel Value of Estate (Une 8 minus Line 11)
13. Charilable and Governmenlal Bequesh (Schedule J)
IA'uNel Valuo Su.bleet to ~~~.ILlne_~mlnusll~~__!!L_..__.______..
15, Spousal Transfers (for dates of death after 6.30.94)
Su Instructions for Ar,pllcable Percenloge on Reverse (15)
Side, (Include values rom Schedule K or Schedule M.)
16. Amount of Line 14 taxable at 6% rale
{Indude vahlos from Schedule K or Schedule M.l
17. Amount of line 14 100wble 01 15% rote
(Include valuol from Schedule K or Schedulfl M.l
18. PrlnclpollClX due (Add tox from Lines 15, 16 Clnd 17,)
19. Credits Spoulol Poverty Credit Prior PQymonls
~:~$1..
lot...V~
~
;
~~
.,c
cOO
ule
00
c
i=
:5
!
.,
z
51
~
~
II
c
u
~
....
+
c,.
I 'OR DAlES Of DIAIH A"n UI31191 CHICK HIRI
I' A SPOUSAL
POVERTY CRIOI! IS CLAIMIO I I
flU NUMIIR
III
121
131
(41 . .,.,___~..
15111~J'i~1
161
( 71
/81 _.t1; '$o1..'/.'L
I Q I ,~n~L. _____n_
(101~~~_,~__u__c___
I'll iiitU..3/~-
1121 ',_~3.,J~L.,,_
1131 ___,___"..n.
1141 !t_~1~'_IJ.___
r ~-----------_...
m..._._'--_~..._" _..__._....___~._~)(, __=
1161 n~I/-J~.s. Jt..n_'_~___x ,06 =_.1I.:<.~.~I.J'L
1171
..mm..>C: ,15 A
1181
Dlscounl
Interest
+
IIQI
1201
20, If Lint) 191~ greater Ihan line 18, enlor tho difforonctl on Line 20. Thi5 i~ the OVERPAYMENT.
110
CIHIC~ here if you (lUf requosting a rer~nd of your ovcrpu'yhlont. '
21, If line 181, grooler jhon line lQ, unlor the diffarenc(' on line 21. Thi.. is th~ TAX DUE, /21)
A. Enter the inleresl on tho bolClllce clue on lino 2\ A (21A)
8, Enter lho 10101 of Line 21 und 21A on Lino 218, Thil i1 tho BALANCE DUE, l21B)
.. ..._~_~~ke. Ch_~~k Pavable tOI R,til,_ttt, of WUl~, Agent _. ,_..._.. ._.
,u ., ---'-~~!-=-a:~S_lJR.El'().,ANSW:ER-AiCQUESTION~.ot-iRE\iE~sniD,E_A~illT~~RE~itEC!<_ M~!.Il:_~"<:= ..___u..
Under ponohles of perjury, ( doc\ore Ihnt ( helVe eKtHTlinod Ihh roturn, includinq (lcconlponying !chodules und \totelnents, (Hld 10 Iho bosl of my knowlodge and boliof,
II, IrulI, (or reel and complr,'o. I dodoro tho! nil rilol 6sloto hen boon roportod ot truo mnrko! vllluo DoclnrCl!iofl 01 proporer other thcln the personal represenlalive I~
uClled on all Informal ion of which prepolor hm (lily knowledgo
;.'iO~;:j"A.'U..'.'--. ~"Pf'~S.O.-NRE.~PO.-~j.-Si_~l[. 'OR fitlN(; HIt.JR~j A(J[}R[~~
u .. '~~':;<fLlL. )11",:t.,~, Ii) c~.d :;k'..,.I.s!!'"'7)13.,~L,:' ~JJ.""r') 1'!l17(1(1!-~;"1
SION.4.ru 101 PREPARfR OlfiFR UlAN RfPRE5fNfAl1Vf ADORES" U ' DAIf
DAIf
Nt V I'" f ~, I' qnJ
.
SCHEDULE H
fUNERAL EXPENSES,
WMMONWEAllti m PENNSYlVAN'A ADMINISTRATIVE COSTS AND
'N~:.~:::;~~'D'E~',~:~U,'N MISCELLANEOUS EXPENSES. .. ..... PltaI. Print 0' Tvp.
ISTATE or - --.---------------~.-pifi.rNUMBa-R ----
l3:yJ5.~~AJ..4d.2J2c:,1 _ . _ ... n .. J.._____. __________..
ITEM
NUMBER
A.
B.
2.
4.
C.
1.
2,
3."
4.
5.
6.
7.
8.
DESCRIPTION
1.
Pun.ral Exp.n...,
f~mc.li.,'f njeAI..- THe. ('t-lX!J....O~ HlI".~e.-/JA'I(I)O;.Tftl('()/~I7;l18
1.
Admlnl.tratlv, Co.t.,
Personal Repr..entotlve Commlulonl
Soc.lal Security Number 01 Penonal ReprelOntatlvel '
Vear Commlulonl paid
Attorney Fe..
3,
Family Exemption
Claimant
Addrell 01 Claimant at decedent'l death
Street AddrelS _..
City _______~,
.State
Zip Cod,
Relatlon.hlp
Probate Fe..
MI...llan.ou. Exp,".."
TOTAL (AlIa enter on line 9, Recopltulotlonl
(II more .pac. I. n.ed.d, In..rt additional .h.... of .ame .1...)
AMOUNT
j 1M, II
1},s-I,O 0
5 17$', II
/j./fj=-3
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUNEAU OF INDIVIDUAL TA~ES
INttUUUHCf: I^,( DIYISION
!)l Ilf. :80&01
IIAlfltISIIUHG, PI. I1lll.0601
NOTICE OF INHERIIANCE TA~
APPRAISEHENT, ALLOWANCE ON DISALLOWANCE
OF DEDUCTIONS AND ASSfSSHENT OF TAK
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
12-15-97
WEST
06-01-91
21 97-0505
CUMBERLAND
101
LINDA lEE MARTIN
IDE 1 ST ST
BOiliNG SPRINGS PA 17007
(./
~
~'
11~'1..1 II I" cn-",
EVEL VN
C
[---A;'OU!'V..lttoi- l
MAKE CHECK PAYABLE AND REMIT PAYMENT TOI
REGI,TER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONO TMIS LINE ~ RETAIN LOW!:R PORTION FOR YOUR RECORDS ~
it i!V: iS4;. Eif -;. F'ii. i 09'~ 97 Y. NoT" iCE - -6 F - ytiii Eit"i;: ANt Ii - TAX - 'A P PR 'A-is E;.fENT ~ -.;. i. i-6wANCE - iili on - - - - -. - - - - - -..
DISALLOWANCE OF DEDUCTIONS AND ASSESSMEN'r OF lAX
ESTATE OF WEST EVElVN C FILE NO.21 97-0505 ACN 101 DATE 12-15-97
TAK NETURN WAS I (X) ACCEPTED AS FILED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. R.al r:.t.t. (Schedule A,)
2. Stocks and Bond. ISchadula 8)
3. CloselY Held Stock/P.rtnershlp Int.r..t (Schedule C)
4. Mortg.gas/Nota. Racaivabl. (Schedula 0)
S. Cash/bank OepoaitN/HiflC, reraon.l Property (Schedul. E)
6. Jointly Owned Property (Schedula Fl
7. Tran.f.r~ (Schedule G)
a, Tohl Au.t.
CHANGED
Il)
(2l.
(3)
(41
151
161
(1)
509 , u.
,00
,00
,00
4,294.87
,00
,00
(Bl
APPROVED DEDUCTIONS AND EXE~IPTIONSI
9, Funer&! E)(panus/Adl!l, Cost$/Hhc. Expans.. (Soh.dul. H)
10, Oabts/Ho,'tu*ga Liabilitiall/Llonl (Schedule Xl
11, Total Deductions
12. Nat Valu. of rax R.turn
13. Chlrlt.bl./Oov.rn~.nt.l Bequa.t'l Hon~.l.ct.d 9115 Trult. (Sch_dul. J)
~4, H.t Value of eat.t. Subject to Ta.
If an assessment was issued previously, lines 14, lS and/or 16, 17 and 1B will
refleut figures that include the total of ~ returns assessed to date.
ASSESSMENT OF TAX:
15. A~ount of line 14 .t Spau..1
16. A"ount of Line 14 taxable .t
11. A~aunt 01 lina 14 t.xabla .t
18. Principal T.x Du.
TIIX CREDITS I
._~-
PAYHENT
DATE
09-04-97
NOTE:
rata
L. in..l/Cb.. Arab
Collataral/Cl... 8 rlt.
RECEIPT
NUHBER
AA242206
DISCOUNT ('1
INTEREST/PEN PAID (-)
,00
(91
1101_
115.11
HOTEl To in.ure propar
oredit to your .c~ount,
SUbMit the upper portion
of tht, for~ with your
tax p.y...nt.
4,804,47
431 31
4,373.16
,00
4,313.16
.00
262,39
.00
262.39
--- "TOTAL-TAX CRiDi~---l.-- 262. 39j
._----~_......--------- ----.-- .
BALANCE OF TAX DUE .00
-..------.--....-."--- .... . - _.-~_. .....
INTEREST AND PEN. . 00
.__._--~_.- -----. .----.
TOTAL DUE ,DO
--.-.-.---- ---_..._.__._~._-,-----
, IF PAID AFTER DATE INDICATED, SEE REVfRSE
FOR CALCULATION OF ADDITIONAL INTEREST,
256,20
Ill)
(12)
1131
1141
(15)-
(16)_
(11)
,00
(.,313,16
,00
K . DO,
K ,06,
~ ,15,
llBI
IF TOTAL DlIE I~ LESS THAN II, NO PAYHENT Is REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CRlDIT" ICR I, YOU HAY ~E DUE
A REFUND, SEE NEVERSE SIDE OF THIS FORH FON INSTRUCTIONS. I
AHOUNT PAID
262,39
, ;-;-:\
i),
" ~,I
/. J (',
RESERYATI0NI E.tete. of d'old'nt"d~lng on or b.for. O.c..b.r;12; 1912 .- If any future Int.r..t in the ..tat. I. tran.f.rr.d
in po.....lon or .njov..nt to Cia.. . (ooll,t,r,l) b,n.floAarl.. of the deoe~.nt after the expiration of an~ ,.t~t. for
life or for y'~r', the Co~.onw.alth h.r.bv .xpr...lv r...rv.. the right to .~prals' Ind I"_SS trln,f.r tnh.rltano. Tax..
at the lawful Cla.. B (collet,ral) r~t. on any .uch futuri Intere.t.
PURPOSf: Of
NOTICE: To fulfll1 thl rlquir..ents of botlon 2140 of the Inh.ritanc. and Elht. Tax Act, Aot 21 of 1995. 17t P.S.
S.etlon '140).
PAYMENT I O,tloh the top portion of thll Notlo. and 'UbMIt wUh your paVII.nt to the R,ght,r of Willi I'lrJnt.d on the r.",rll .td,.
--"ak, chlok or .0nlY order payable tOI REGISTER OF MILLS, AGENT
REfUND lCRJI A r.fund of e tu credit, Which was not r.qUlst.d on the Tax: Rlturn, nav b, requ'It.d by oOIlJlI,tlng In "Applloatlon
for Refund of P.nn.yl"lnla InherUanc:. and E.tetl Tax" (REY-1313l. ApplloaUon. ar. avaUabl. et the Offloll
of the R.gl.t.r of Will., any of the 23 R,".nu. DI.ttlot Offlo.s, or by oalllng thl .p.olal 24~hour
en.w.rlng 'Irvio. nueb.r. for for" ord.rlngl In Penn,ylvunla 1-800-362-2050, outsld. P.nn.Vlv.nl. end
withlf' \ocII Harrltburg at.e (711) 717-8094, TOOt (17) 772-22S2 (Hutlng lepalr'd Onlyl.
OBJECTIONS: Any party In Jnt.r'lt not .ltJ.fl.d wJth the appralsIM.nt, aJlowanc. or di.a!lowanc. of dldyctlon., or a.....M.nt
of ta>l (Inoluding dhoount or Jnt.,ut) II Ihown on thh Notlo. MU.t obj.ot within s1xtv <601 day. of r.'celpt of
this Notln bYI
.-wtlttan prot..t to thl PA D.partM.nt of RIV.nuI, 1I0ard of App.al., Dept. 211021, HarrllbUrt, PA I11ZI~1021, OR
'-II.ctlon to have the ,"litter d.terMln.d at audit of thl aoc:ount of the plr,onal r,p,,"ntatlll', OR
"eppul to the Orphan,,' Court.
ADMIN
JSTRAlIYE
CORRECTIONS I
raotu.! errors dlsoov.red on thlt u......nt .hl)~lld b, addr....d In writing to: PA n.partM,nt of RI".nuI,
lurllu o)f Indlvldu.l Tax.., ATTNI Po.t Ais""'nt R.vlew Unit, Dept. 280601, tlarrlthurg, PA 171Z8-0601
Phone (17) 717~650!i. S.. page S of the book lit "Ir\ltruotlon. for Inherltanc. Tax R.turn for a R"ld.nt
O.o.dlnt" <kEY-ISOl) for an .xpllnatlon of ad.lnl.tretlval~ oorr.ctabl. Irror..
DISCOUNT I
If any tax dUI I. paid within thr" (1) a.l.ndlr lonthl aft.r the d.c.dlnt', dlath, I fivt plrclnt (5Y.) di.oount of
the t.M paid I. .llowld.
PENAL TV I
Th, J5Y. tlM ..n'st~ non-p~rtJQlp.tlon p.n.lty I. co~utld on the toto 1 of the tlM and Int.rl.t .......d, and not
paid b.forl January II, 1996. the flr.t day Ifter the end of thl tal( a..n..ty pltlod. Thlt non-partlolPltlon
p.nalty I. Ipp.Il.bll In the .... .ann.r IInd In the the $..' tl.. plrlod a. you would IIPPI.1 the tax .nd Int.r..t
th,t h.. b..n .....v.d a. Indlcat.d on thl. notio..
INTEMESTI
Interllt It c:har(tld b.,lnn!ng with flrlt day of d.lInqu.ncy, or nln. 191 lontt'1I1 .nd :Jnl (1) day froe the date of
d..th, to th_ date of p.y.."t. Tans which beOI.' d.llnqulnt b.fore Jenulry 1,1982 bllr Int.rllt at th.tlt, of
.1>1 (6Y.1 perolnt plr annUM oalculatld at 0 daily rat. of ,000164. All tax.. which b.08M. dlllnqu.nt on and .ft,r
January I, 1982 will blnr Inter..t at 8 rat. which ~Ill vary froft oallndar ye~f to cal.ndar y.ar with thnt rat.
announoed by the PA Otpartft.nt of Revenu.. Th" appllcabll Inter..t rat.. for IlJ8Z throygh 199& Ir.l
!!!r Int.rut..!!!!! Dally Int.rut factor ~ Intlr!,!t Rat. DailY lnhtrllt rlultor
1982 Zny. .000548 1987 11% ,000247
lCJU 16Y. .000438 1988-19111 l1X .000501
1984 llY. .000!.01 1'192 9X .000241
19l5 13Y. .0003S6 1995-19IJ4 7% .000192
1'116 lUX .000274 191J5-191JI 9% .000247
--Inter..t h c.lculated .. follow'1
INTEREST' BALANCE or TAK UNPAID K NUNBER OF DAYS DELINQUENT K OAILY INTEREST FACTOR
--Ally Notice luu'd IIft.r the tax bleo... dlllnquent will refl.et an lntlrllt oaloulatlon to f1ft.." (151 day.
b.yond the date of thll 1I.....IIt.nt. If payllt.nt It Mad. after thl Int,rut eoeputllUon del. shown on the
Notlo.. Iddltlon.1 Intlr..t ~u.t bl celeul.t.d.
COMMONWEALTH Of PENNSYLVANIA
COUNTY OF CUMBERLAND
UI
.L /.v PA
being duly
,l"bt. mAtI/tV
. .~oeAl
. accordln9 10 lew, dopo..s end says thet $he _1s..-,;,j'g(1l!.L21._~.__
01 the Estelo CJI _~~.l/ALa.,,-~T_.~__u...__._..._____. ,""_
lelo 01 t'1l~'ISLt., tJ/IIIov6J1 ..._....._......, Cumberlend Counly, Pe., deceued and that the
wllhin I. an Invenlory made by. ,1..//JIlIf/..fC.tJlflJn1lJ......._..., tho sald.E~l&lL.r1'lJ.K~ ....._
of Iho enliro e"ele 01 said decedonl, consisling of ell the personal prop.rly and reel estate, e~cept real estete outside
the Commonweelth 01 Pennsylvania, end Ihet Iho IlgurOl oppo.lte oach Item of the Inventory represer,t It's lelr volue
u 01 the dato 01 deoodent's death.
S'&f'T'~,^ 6f.e
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S k.l 0 R lJ ...__ end subscribed belore me,
_.&c...aLl%t_~__.____. _
$~~~..-,; flII1700'1:'.2f&.L._
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D.te of D.ath _...._._._J.__'-__~_~.__JillJ.~__ -.---__m7
Dav MontI, Vu,
INSTRUCTIONS
I. An Inventory. must be Wed within three months elter eppolntment 01 porsonal r.pralontatl\l~.
2. A .upplamont Inventory must bo Wed within thirty dey. 01 discovery 01 additional u.....
3, Additional sheets may be atteohed 8\ to personalty or realty
4, See Artlclo IV, Fldu.larlOl Act 011949.
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