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ItETITION HlR I)R08ATE and (.RANT (W LETTERS
,:{j. q 7..5'~'i'7 ....-..~
(] J.,,,,L[
No,
To:
Ke~islcr 01 W~II, lor the 1
CO\lnty oICIA.M!.iLj~-.... in the
COll1n;'lIlwculth oll'ennsylvunia
li.l/II/" (~r (j('l~l.,e{<.,
al.l(l kllOIl'1I (/I
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S"dal S"c/trity N()"l7i:~?i~"d'i''t ,..:
The petition of I'll' 1Il1dcrsi~llcd n.'~pl'\,,'lrully rl'tUl''icnts that:
Your pl,titioncl'(s), who i',:/arl.' IX \'l'iHI" of il~(" or oldel an the CXl~L'tlta(.)
In the last will olthc ahoYc dcc",lcnl. dalcd O!:'/i/I..,./.. illf,J /9..!ft
und codkill') dated 9d:~, . ,. ," ., ,..
...._......--....-. numed
._._.._..__,19-
-_...~._-----------'-
.~...._...~~--------
----..-..----.....-------.---
- -... ---....----..----
Ikccmknl wa' dO\llidkd al .kl1lh in ..(L'n~/?J,. 7\" ('o.\lnIY, Pc
hI::(~J}ijtll~l~I~;;..~n"))~~;;en7';~I;J~.~~.~~(~~... ~~r~~~~~~_.
, (1I~1 ~tln'l, ll\llllhl'f <llld 1ll1l1l,IP;IIIIYI
DeCel]\lenl, thcn_~l . V5ars 01 u~e, die.l!? C2c/t,fvu:,..-.?.-.-....--.-, 19 9C> ,
Ill:.. (fY.( r.. . 'Vie-It j[..s/,,'m/ --j C".l..I,~".u'i>t1,^"':7"o.<LM,ilij'?--.--_._-'
F\ccl'l "' roilow" decedelll did nol marry, Wll' 1101 divorced and did Ilot huye a child born or adopted
after c\e.'\llion or Ih(' will orfered lor I'rohate; was nOllhe viclim or a killing ulld was never adjudicated
incol1ll'clenl :._ ,~.HI..4...- .-.--.,. .' ,-,,' - .~.- -, ..----,.-.-..-.---.-.-
Deccndl,.'nl at death owned property with estimated values as follo\vs:
(II' domiciled in PH, l ^" per,ollal properlY
(If not domiciled in Pa.) Personal property in Pennsylvania
{II nol dOlllidl('d in Pa.) Personal property in County
Vailll' (li' rcall'slall.' ill PCllnsylvanin
situall'd a... follows: _,.__. ___.___. --.------.' __n_ ---.. --,-----..----.-----.-~..-.~--_.
{~l1\tl' Tl.kVillll dfl'l\lll~lillll'('~, t,j' f\'IlIIIKiulinn, lIt'lIth (lll'Xl'l'lllnr, l:lc.)
$---
$------
$
$ ~, g j";;/liL-
.__w,_ __.____...~_..__...___~_.
\\IiEKI.HlKE, p.'III,onc'hl re,pCCllully r$Sluesl(s) Ihe p,obate 01 Ihe IlIst will and eodieil(s)
prc\C'llIed Il.'rewilh and thc glanl \)1 kllel' LCS1..~iJ.J:i.-- - ----.-
(ll.~t,'llll'l1\,\l\, ,ldllHnl~!I,IlI(ln;: I .1 , ndmllllSHllllon d h,n l"t.a.)
____ .____.._u_._..._____..._____...
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....-~..._....-"...-..-_..-.-'_.--
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- ....-----...-.------. -,,---,,-'--"-'-'--~
OATH <W I)ERSONAL REltRESENTATlVE
COMMONWEAI,HIOFI'ENNSYI.VANIA I
.J" H:-l
COl'Nn' (W _CUliberland-...-.-.
Till' !1l'lililllH'llsl ab",,'.nal1lcd "IL'arl') or arlirmls) Ihallhe 'Ialemcnl' il\ Ihe roregoing petilion arc
trlle and \'0,,\'\'1 to I ilL' h..,1 01 lire hnow\edge 'lIld hclier or pctilioncrl'l and thaI as personll\ represen.
1'lIi..et'l or Ii,,' ab",.' \kl'l'Ikl\t IIOI;liol\er(,) will wdl and Indy admin' cr Ill.. eslatc according to law,
L"fl II /) -)
S\\OIIl In III ,IIIIlI1\1.,:d .lIld "lIh"UltH:d~ ~~'-~-- (/{J .- ._____n__ V)
"";;~'c, ~..)'''' P"~~ .I"tt ",. ,,"-,;j,,~-~=" - i
Ij~. lEd' _ ill MarY C.Lew~ U"~/lI"1 ,-...--...-....- ~
_~;:;:.iiiT"
.._~~~_.;:::..__~,:;;:w=~~~~f'O:-+~'fE'~f.lL!~'F?'i'~F.-'22f':';7.2"-'-;E-"'"
---,., .---- ,- ...- ..-
---..------.-.---'-,-.---
--.--......- -.--"'
!-l1b I Iwrebll nominnte, c(JnsUtl~te /I,,,d appoint Edward B. Jacobs and
Mary Beth Rickards. '
Exeout ors of thi.~ mIl 11M! W'W nlld Testa ment, \
;JIll ;mill1eee ~1I1ere"f.)1 Elizabeth B. Jacobs, \
the Testat, rlx ,/lIII'e to 1111:8, mil Will written on one sheet of paper, set mil hand
and seal, t,his 24th Ilnll oj' October .4, D. One Thou,sand i
Nine Hundred (utd, Eighty-six (1986) \
,,(7e;:.,<~.e,.. ,..c:t,tc'~' ".<..,,~O,""',......~ I',
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c_) , ' \
Signed, Senled., PlI,blislwd 1111 d Deelal'ed by the above named Ell zabeth B.
Jacobs. as and for herlast Will and Testament,
in the presence oj' ns, who havl' hl'I'mwto su,bscI'ibed our names at her request as
Witnesses thereto, 1'.n the fil'e,~eIWI' of the saM Teatat rlx , and of each other.
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Acl '48 of 1994 provld.. for Ih. r.ductlon of Ih. lax ral.. Impolld on Ih. n.I valu. of Irand.r. 10 or for
Ih. u.. of the 'PDU". Th. ral.. a. pr..crlb.d by the .Ialul. will bit
. 3% (.03) will b. appllcabl. for ..101.. of d.c.d.nll dying on or oft.r 7/1/94 and b.for. 1/119'
. 2% (.02) will b. appllcabl. for ..101.. of d.c.d.nll dying on or aft.r 111/96 and b.for. 1/1197
. 1% (.01) will b. appllcobl. for ..101.1 of d.c.denll dying on or aft.r 1/1197 and b.for. 111198
. Spoulal Irand.,. occurring on or oft.r 111/98 will b. ex.mpt from Inh.rllanc. lax.
PLEASE ANSWER THE FOLLOWING QUESTIONS
BY PLACING A CHECK MARK Iv) IN THE APPROPRIATE BLOCKS.
I NO
1. Old d.c.dent make " transl.r and:
a. r'Iain the us. or Incom. of th.prop.rty tronsl.rr.d, .........'..,........,...................,............,
x
b. r.toln the right to d..lgnot. who sholl use th. prop.rty tronsf.rr.d or Its incom., .........,..,..
_x
x
c. r.toln 0 r.v.rslonary Int.r..t; or ..............,..,..,........,....,....,........,....................,.............
d" r.c.lv. the promise for lif. of .ither poym.nts, b.n.fits or cor.' ...............,........,...........,..
2. If d.oth occurred on or b.for. O.c.mb.r 12, 1982, did dec.d.nt within two y.on pr.c.dlng
d.oth trons/.r prop.rty without r.c.iving od.quot. consideration' If deoth occurr.d oft.r
Oec.mb.r 12, 1982, did d.ced.nt tronsf.r prop.rty within on. year of death without r.celving
ad.quat. consid.ration'....".,...",...,......",.".......,.,..",.,..""",...,.....,.....,.,....,.,.....,.,..........
x
x
3. Did dec.d.nt own an 'In trust for' bank account at his or her d.ath..............................,........
x
IF THE-ANSWER TO ANY OF THE ABOVE QUESTIONS IS YESr
YOU MUST Q'9MPLtTE SCHEDULE G AND FILE IT AS PART OF THE RETU~N.
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COMMONWfAlTH 0' PrNN&VlVANIA.
INHUITANCI fAil: UTl.hIN
~IIIDINl DICIDINl
SCHEDULE P . L
JOINTLY.OWNED PROPERTY _.
-=~~___ -=-----.___~ fill NUMIER_
m...n Of
Elizabeth B. Jacobs
Joint tonontld.
N...MI
.... Mary Beth Rickards
~i~;;;~;'f~:~OII:,:iO::~~::~Oii"''''-
I.
c.
Jolntly.ownod proporty.
ITIM LInER D",TI
fOR TOTAL V ALUI DICD'S DOLLAR V...LUI Of
NUMIII JOINT MADI DESCRIPTION OF PROPIRTY Of ASSGT ~b INT. DICIDiNT'S INTEREST
TENANT JOINT
1. A 3/1/90 PNC Bank - Checking Acct
*5140124606 $ 1,917.31 50% $ 958.66
2. A 10/21/94 PNC Bank - Savings Acct.
*5080040856 $ 332. "/2 50% 166.36
3. A 10/21/94 PNC Bank - C.D.
*21001018313 $ 511. 79 50% 255.90
4. A 11/13/92 PNC Bank - C.D.
*31400018749 $ 1,532.36 50% 766.18
5. A 11/13/92 PNC Bank -C.D.
#31900018783 $ 6,651.51 50% 3,325.76
6. A 11/13/92 PNC Bank - C.D.
#31900052635 $ 6,045.89 50% 3,022.95
(Se Sched le F, Exhibit 1, attached heret .)
.
TOT"'L (AI.o Inll, on IIno 6. Rlcapltulotlonl S 8,495.81
-
(If ma,.. jpOC' I, n..d,d 1'1$.rl additional ,h,.h 0' som. size)
J SCHEDULE H j
-e@;} FUNERAL EXPENSES,
COMMONw'Al!H ,,, "NNSV\.AN'A ADMINISTRATIVE COSTS AND
'N~I~:1~7Noi~',~I~~': __.. _ MI~CELLA~_~~~~_E~PENSES _ PI.a.. !,Ini or TVp.
InAff Of piLI NUMI..
Elizabeth B. Jacobs J..
ITEM T--~------- _________H_.______
NUMBER DESCRIPTION
.-..------,...
A. fun.,al ..p.n....
1. Myers"Harner Funeral Home, Inc.
1903 Market Street
Camp Hill, PA 17011
(See Schedule H, Exhibit 1, attached hereto.)
lUVI51Irhl',"1
B.
4,
C.
1,
2.
3.
4.
5.
6,
7,
8.
AMOUNT
$ 4,863.00
2.
50.00
125.00
Rev. Demeng
3.
Grave Marker
1,
Admlnl.t,atlv. Co.ht
Pe..onol Rep,elOntot;.e Commlulonl
Social Security Number of Per.onol Repre.entotl.e,
Year Commi..lon. paid __~__
2,
Atlorney Fee.
550.00
3.
Family E.emptlon
Claiman' Mary Beth Rickards Relationship Dau\1hter
Addre.. of Claimant 01 decedent'. death
Street Addre.. 1907 Kent Drive
City Camp Hill Stot"-~_ ZlpCode~'pll
326.60
Probate Fee. 51 . 00
MI...llan.ou. ..p.n....
Register of Wills - filing fee, Pennsylvania
Inheritance Tax Return
10.00
TOTAL (Also enter on line 9, Recapitulation)
III mar. .pa.. I. n..d.d, In..'' additional .h..t. of .am. .1...)
S 5,975.60
""u" ,,,.,. ",.,.,."" ,u",,,. ,," .,00 '" ,.. .... "" .,
CUSTOMER SERVICE CALL 1_800-555-8111
PREVIOUS BALANCE DUE
DEC 10 96 PAYMENT - THANK YOu
TOT AL AMOUNT DUE
... STATEMENT OF ACCOUNT ...
. .
0--
CONSUMER I.EASE SERVICES
-
-
1.45'
1.45CR
.O(
--
~ -17- -- --
--
-
1523
-
&Q-121313,3 \02
BETTY JACOBS
1907 KEN1 DRIVE
CAMP HILL, PA 170"
\ \ - )-~
19'1!:L
J $
ILlS
1'^vTO 11 lie VIle ~-,
ORI1fRO! n
~ ~~:io;':~~ ~%~=--=-
PNCBANK'
PNC Bank. N.A.
So.'h,e.'''' FA 040
m'fl;"'~ltll~'"
291-1 A..R5 liJ:tjl,'''I'
Priority (\ \
"'L--------'--- _.o\\<>"\ 1. L 6t."b ·
,:031 ~ 31 ~ 2'7 3181: ~S B II'S ~"O ~ 2..t;,0t;,II' ."0000000 ~"SII'
~ 11~~,~1lt> ,.....
Schedule I, Exhibit 1
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COMMONWEALTH OF PENNSVLVANIA
DEPARTMENT OF REVENUE
'U~IAU OF INDIVIDUAL TAMIS
IHHtRITAMCE fAM DIYltl~
DEP," 210601
"'MMI'.URO, PA llltl"06GI
NOTICE OF INHERITANCE TAM
ArrRAISF.HENT, ALLOWANCE OR DISALLDWANCE
OF DEDUCTIONS AND ASSESSHENT OF TAM
IIHUlI. ,,,(fl-'"
10-21-97
JACOBS
10-07-96
21 97-0557
CUMBERLAND
101
r:-~,=~~:~,,!o~I!.,!!!.1 I la~__ -'l
l_______.______
MAKP. CHECK PAVABLE AND REMIT PAVMENT TOI
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, FA 17013
CUT ALONG THIS LINE .... RITAIN LOWER PORTION FOR YOUR RECORDS .....
itiV: ii'4-j - EX -AFp.m' :97"1" -iiori CE" "Oii-YNHEit-ifANcE -'fAx - AiiPRA i sEM'iiii' ",- -Ai:. i:6iiANCi. oli. ...." -.. -.. - - --.
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ELIZABETH B FILE NO. 21 97-0557 ACN 101
THERESA L SHADE WIX
WIX ETAL
4705 DUKE ST
HARRISBURG
DATI
ISTATI OF
DATI OF DEATH
FILE NUMIIR
COUNTY
ACN
El IZABETH 8
PA 17109-3099
EITATE OF JACOBS
DATI
10-Zl-97
TAM ~ITU~N WAS I I X I ACCEHED AS FILED
( I CHANGED
REIERVATION CONCERNING FUTURE INTEREST . lIE REVIRSE
APPRAISED VALUE OF RETURN BASID ON! ORIGINAL RETURN
1. ~aal E.Iala ISchadula AI
Z. SIock. and lond. (Schadula II
S. Clo.alY Hold SIock/'artnar.hlp Inloro.I ISchodulo CI
4. Horl,o,o./Nol.. ~acol.obl. IScho.ulo DI
i. C..h/lank nepo.ita/Hilc. Perlonal Prop.rt~ (S~h.dul. E)
6. Jolnlly Ownad rroporly ISchodulo FI
7. Tranlflr. (Sohedull Q)
I. Tolol A..ol.
HOTEl To Inlure proper
credit to your aGcount,
.ub..1I Iho uppar porUon
of thil for_ with ~our
tax PI>>'ttant.
,DO
.00
.00
,00
326.62-
8.495,81
.00
III
III
(ZI
(51
141
ISI
(61
(71
8,822.41
APPROVED DEDUCTIONI AND EXEMPTIONS!
.. funaral EliCpen.../AdtI. COlt./HiIO. E)(p.n... (SchaduleH) (9)
10. Dobh/Hort,o,o UobU1U../Uon. ISch.duloll 1101 194,99
11. Tolal DoducUon. 1111
12. Not Value of To. ~oturn 11Zl
lS. Chorl1oblo/Go.orn..ontol 10quo.I. ISchodulo JI 1151
14. Hot Voluo of E.toto 5ubj.ct 10 To. 1141
NOTEI If.n ......M.nt w.. i..u.d pr.viau.1Y, lin.. 14, 15 .nd/ar 16, 17 .nd 11 will
r.fl.ct figur.. th.t includ. the tot.l of ~ r.turn. .......d to d.t..
ASIEIIMENT OF TAX!
11. A..ount of Line 14 01 Spou.ol
16. A..ount of Llna 14 to.oblo ot
17. A...unt of Llno 14 to.oblo 01
11. 'rlnclp.l TI. Duo
5,975.60
ii..17R liQ
2,651.82
.00
2,651.82
,..t.
Llnool/Clo.. A roto
Coll.t.r.l/Cl.~. I r.t.
11S!
116l
1171
.00 M' 00.
2,651.82 M.06.
.00 M .15.
nIl
.00
159.11
,00
159.11
TAX CREDITS!
rAYHEHT
DATI
o -07-97
DISCOUNT (+ I
INTE~EST/rEN rAID I-I
.00
AHDUNT rAID
15 .11
~EcurT
NUHIE~
AA211497
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
159 . 11
.00
.00
.00
. IF 'AID AFTE~ DATE INDICATED, SEE ~EVE~SE
FDR CALCULATION DF ADDITIONAL INTE~EST.
IF TOTAL DUE IS LESS THAN .1, NO rAYHENT IS ~EQUIRED.
IF TDTAL DUE IS REFLECTF.D AS A ~C~EDIT~ (CRI. YDU HAY IE DUE
A REFUND. SEE ~EVERSE SIDE OF THIS FORH FO~ INSTRUCTIONS. I
~ .
.
IU!lElWATlOlh
IUPOII: llI'
NOTICEI,
PAYMENT I
REFUND (CRll
DIJECTIONSl
AIlI4IM
IIIRATlYt:
CORRECTIONS I
DISCOUNT I
PlNALl't1
IMTERtiII.
pCI
;r-~-j
N
"
,.
\."1
1,'lt.. of d'G.dent, dvine on ot b.for' Dec.~.r lZ, 19'2 -. If ~v lutur. lnt.r..t In thl It,.t. I, tr~.f'rr"
In pOlolnlon or enjoy.,n' to C1... . (coll.'.r.1) ben,floA.r'" of th. dlG.dlnt ,ft,,. thl tllpJ"Uof1 of -nV utlt. for
11ft or for v..r., thl C~.lth htr~v IIIPr"'IV r,..rv.. thl right to tppr.t.. end ...... tr~.'.r lnh1rltlnGl Till"
It tn. l.wful C1I.. I (oQll,t,r,l) rlt. on ~v IVQh lutur. l"t.r..t.
To fulfill the rlqulr..,nh of .'ClUD" 2111. of thl InhlrUanClI W\d Eltot. TIM Act, Act U of 19n, OZ P,I,
SICtion '1"0),
DetltOh tM top portion of thlt Notlu .00 .ub,tt with your ,.tV.l"t to thl R.,ht.,. of WUh prlnt.d on Uw rllllr.. 11e1e.
--MM' Clheck or .on.v order ",vUlt tal REOISTER OF MILLS, AGENT
Ai r.fund of . taM ct-IIdU, which WI' not r.qu..ted on tha leM Return; .ay ba raqu..ttd by aOllPlaUn, en "application
for M.f~ of P~IVlvlnl. Inherlt~a and f.tlt. TIM" CREY-ISIJJ. Applleltlon. ar. IVllltbl. at thl Offlo.
of the "..I.t.r of W11It, an... of the U Aavenue Dittrlct OHio.., or by 01111"1 the IP"lll 21't~hour
Inlwerl", ..ryle. n~rl for for.. ordarlnll In Pann'Ylvanla 1-IOD~J'2~20S0, out. Ida P.nnlyl".nll .nd
within 100.1 Hlrrllbur. .r.1 (711) 711-I09~, TOO' (111) 112-2252 (He.rlng t.,.lr.d Only).
Anv p.rtv In Int.r..t not .,tl.fled with the .ppr.lla.ent, .110w~a or dl.allowanca of ~duatlon" or .....,~t
of tlX (Including dlloount or Intar..t) .1 .hown on thll Notltl. ault objlct wUhln sixty (60) dlY' of rte.lpt of
thIt Motlc. bYI
uwrtUen prot..t to thl PA OIP.rt..nt of R.veoua, loard of App..". o.pt. 211021, H.rrhburl, PA 171Z'~1021, OR
....IIeU'" to h.v. the ..ttar det.r.lned at .udlt 0" the aClClount of thl p.r.on.1 rlpra..,t.U"., OR
..~tpplll to the Orphan.' Court.
FlGtutll arror. dllcoy.r.d on thh ........"t .hould b. .ddr....d In wrltln, tOI PA Dapart..,.t of ",v'nt..,
lureau of Indlvldwll hM", ATTNI po.t A........,t R.vl.w Unit, D.pt. 2'0601, H.rd.bur" PA 1'12....01
Phone (717) ","650i. s.. p." S of tha bookl.t "tnltr~tlon. for Inherltlnc. ,.x R.turn far I ...Ident
Dec""t" UtEY-1501) for'" .MPlanatlon of IdtllnlttraUvlhl corract..l, .rror..
If .,,~ tlM due II p.ld within thr. (J) cal.mlr IIOJlth. aH.r the deC.cMnt'. ..th, a flv. p.rcant (nJ dhcount af
the t.1C plld II .11aw.d.
The 15X t.M e.na.t~ non"partlelpltton penaltv I. coaput.d on t~ tatll of thl t.M ~ Int.r..t ......ed, and not
p.ld Mfor. J--.n 11. 1"', tM fI"t d.v .ft.r thlt Ind 0' thlt tlM MM' tv perlad. Thit Mfl",.rtlclp.Uon
PlMltv It ...,..Itbl. In the ... MlnMr and In ttMI ttMI .... tI.. period.. YOU would ....,1 thll tllM end Int.,..t
thllt h.. bHn ......ed I' Indlcatld on thlt notlCI.
lnt.r..t Is ch.rted be,IMIMII with flnt dlV of dlUnquM\Oy, ar nine (,J IIOnth. lilnd one (1) ctty fr. the data ft'
....th, to thl d.t. of paVHnt. "M" whlch blo", dllInquMt blror. January 1, 1911 bear Intar..t .t thl r.tl of
.IM (6~J parcant per ~ ollcu).ttd .t . d.llv r.t. of .0001'4. All t.M., which beG... delinquent on and I,tlr
JlnUlry 1, 1'.2 ..III be., Int"..t It . r.tl whlc',h will Yli'V IrM cll4M1d.r v..r to Ollendtr v.ar wUh thlt r.t.
ennounctd b... thl PA Oap.rt""t of Alv.nu.. Thl appllcebl. Int"..t rata. for 1912 throutl'll'" Irll
~ lnt"..t R.t. Oallv Intlr..t F~tor ~ Intar..t R.t, U.lly Int."t1.l!2!!!:
It.2 20X . O..S~. 1'.7 t~ .000241
1'.5 16~ .GOa4S. 1'....1"1 lliC .000501
It" m ..00501 1"2 t~ ,000241
19.1 m .OOOU' I"s"n~ n .0001'2
It.. l~~ .OOD27~ 1995-1'" t~ . OD02~7
....Int.r..t I. calcul.tld a. f(lIl""'1
INTERElT . IALANCE OF TAX UNPAID X NUNIER OF DAYI DELINqUENT X DAILY INTEREST FACTDS
~~'"v MoUat lu,*, after thl taM bIo.... dllInctl*lt wlU "fleet M 'nt.rnt nlculttlon to flft.." CUJ "VI
bevond thl dlt. of thl ......""t. If pI"eant II .tdl 1ft.,. tM Int.r..t IlCMIpUt.tlon d.t. .hown on the
Notlo., .adltlonll 'nt.rl.t .u.t be clloul.tad.
,
\J fUASE FilE nus REPORT WI'llUN 'M YF~ OF DATE O~' DEATH REXJARDLESS OF 'mE STA'llJS OF 11IE
I(.} ;{'1 ESTATE. IF FSrATE IS oor <nIPLEI'ED, FILE ^ 6.12 FORM WARLY OOn. aJ1PlEflOO.
"
~T A 1'Jl~.J~~_r.Q.!l:r._U N !!~!LR U LE ~g
Name of Decedent I
~~b~!::!!.~.~..2S'bs___
Date of Deathl_,-.lQj2.L2.L----------.-.
w U I No.
'II - IlL.. ~ll -, _____._______ Adm j rl. No.
---_."._~------
pursuant to Rule 6.12 of the ~';upl-eme COUl.t Orphans'
Court Hules, I report t.he following with respect t.o I.~nnlpletlon of
the auministrath1n of the ilbove-clll'Lioned "Btllt'~1
1. State whether administration 01 the estate is l'omplete;
Yes ______ No _,_K._.
2. If the answer is No, stille wllPn t.hfl personal
representative reasonably l>elieves that the administration will be
completel Upon ac~~~ce of LnherlLance Tax Return
J. If the answer to No.1 is Yes/ state the following'
a. Did the personal representative file a final
account with the Court? Yes No
b. 'rhe separate Orphans' CI.-urt No. (if any) for
the personal representative's account is;
c. Did t.he personal representative state an
account informaily t.o the parties in interest? Yes No
d. Copies of receipts / releases, joi nders ami
approvals of formal or informal account.s may be filed with the
Cerk of the Orphans' COlll:t and may be attached to this report.
Datel~1
-. - ',1,\
,,",
/q'l'/
,~'10,tU,!~,.~ .,,~~{~QR:J!l~~
Signature
,
"
('-,)
\.
,.
.1'.hE'!.Fe s <l._Je_,-.11.!.1a qlL.!'liJC..L E Squ i re
Name (Please type or print)
WIX, WENGER & WEIDNER
4705 Duke Street
Addr8s s.'--.--- ...------.--
Harrisburg, PA 17109-3099
L2U...6.5~-:U~....
Tel. No.
I"j
I
'[;il
ll: ..
r'-.
P\
if) \.;
iJO
Cd)Jar,:ity I
Personal Representative
x
counsel for personal
representative
(MAH Itm 1/ AM3 )
RW-27
~,!,^~US _~_~~Ql\.'tJINDE-~..J3!l!--E:_..LJ-~
Name of oecedent 1__...!.!:.~~il.l?~th_.iLacob.!!....__
Date of Death 1_lQ.L14 / 1.L- .-.----.---
.Will No. 1997-00557 Admin. No.
-_..._~_.--------..__._. ,.~---_._--_. ,..---
pursuant. to Rille r,. 17. of the Supt-eme Court Orphans'
Court Rules, I report t.he following with respect to completion of
the admin1st rat ion of tllA above-captioned estate 1
1. State whether administration of the estate is completel
Yes x No
2. If the answer is No, st.ate when the personal
representative reasonably believes that the administration will be
complete:__------u--.-..- _.._...__._n_
3. If the answe. t.o No.1 is Yes, state the followingl
a. Did t.h', pel:sona I representative file a f lnal
account wlth the Court? les No x
b. The separate oq,!lans' ('"urt No. (if any) for
t.he personal representative's acc"unt is:
c. Did t.he personal rAiH'esentative state an
account informally t.o the p,uties in i.nterest? Yes2_... No
d. Copies of rece i pts, re leases, joinders and
approvals of formal or informal account.s may be filed with the
Cerk of the Orphans' Court and may be attached to this report.
Date: 9/23/99
0n, lj) (J;j . J' [:'
\..J ~1(J.~,,?,,~IlL1 C )<j, C~.
Signat,ul-e =+---'77
Theresa L. Shade Wix, Esquire
Name (Please type or print)
Wix, Wenger & Weidner
_4705 Ouk."._St!:eet, Harrisburg, PA 17109
Address
L7.!...?Ll?2-8i~_____
Tei. No. --
(MAHlrmf/AM3j'
Capadty: __.personal Representative
x Counsel for personal
representative