HomeMy WebLinkAbout97-00564
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COHttOtfW(Al HI Of tlEMHIVlVANIA
Of.PAMf~~f Of REVENUE
IUREAU OF INDiViDUAL lAKES
Df:Pf. 2'10601
HARMlsaURO, pa 111"-0601
*
/ S': / S ? .. ..3
INFORMATION NOTICE
AND
TAX PAVER RESPONSE
FILl
ACN
DATI
NO. 21 - 9 7- ..s-<'o'l
97123759
05-24-97
m.IUI IM~" I''''
TYPE OF ACCOUNT
F,ST. OF EVA SRI CE [] SAVINGS
5.5. NO. 229-32-8867 IX) CHECKING
DATE OF DEATH 03-21-97 [] TI,UST
COUlITY CUMBERLAND [] CERHF .
~EHIT 'AVHENT AND FO~HS TOI
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE. PA 17013
-
-.-
'"
EVA RC~
.I~~WAY
OIlIlL ISLE"
Co\-IISI't..-
, .[:tl.dLvo",J ~~,
PA 17013
FINANCIAL TRUST CO h.. pro",lded tM nlPlrt.lnt wUh thl lnfor..tlon Iiltld bllow whlch h.. bien und In u~cul.tln. thl
potlntlftl tlM dUI. fhelr rlcord. Indleetl th.t .t the dl.th of the abo"'l dlcedant, you wlr. . joint own.r/beneflol.r~ of thl. account.
If ~ou f.ol thh Infer..tlon It inClorrlct, pl.... obtain wrltt.., corrlctlon frol thl flnlMlll In.Ututlon, Itt.ch I cop~ to thlt for"
.,'Y ,W\\1I11 1. l.u UIlII .~"'W 011"...."... 'jhb. ...,;.....,.. .. l.r......"'i. ~""v""'UO"-~. ,,1~1. \11" 'lilt... i;''''I''. 7..... l.......; l.i... :;...~..,I"..; r,..i ....-,,"ul"'.HI...
OUI.tlon. 'Il~ b. ",.Wlr.d bV c.lllng (117) 787-152".
COMPLITI PART 1 BILOW . . . SII RIVIRSI SIDe FOR FILING AND PAYMENT INSTRUCTIONS
Aooount No. 654272 D.t. 11-18-85
Eohb1hh.d
Account a.lance
Peroont T..1lb1.
A.ount Subj.ot to Ta.
Tex R.t.
Pot.ntl.1 To. Due
To In.url proper crldlt to your .ccount, two
(2) (lopi.. of thlt noUel IN.t ICClOllplny your
pIYMlnt to the Rlal.tlr of Will'. Hak. ch.ck
payabll tOI "RI,hter of lUlls, .'Int".
PA~T
[!]
3.876,66
50.000
1.938.33
.06
116.30
TAX PAVER RESPONSE
FAlLUll1 TO IlISPOND WILL Il.SUL T IN AN OF,'ZCIAL TAX A88.S8HIlff IASlD ON tHIS HOTICI
,. ...., ... ........, ,'.' . . ....... . ..... ',... , ..... . .. .... ." ..
K
HOfEI If tll( p.~..ntl .r. .ade wlthln thrll
(5) lonth' of the daudent'. dlt. of d..th.
1I0U ..y dedUot . SX dl.count of -thl talC M.
Any inherltlnce tal( dul will bleo.. dlllnquent
nln. (.) lonth. .ftlr thl d.tl of d..th.
K
[CHECK ]
ONE
BLOCK
. ONLY
A. Th. .boVI lnfor..tlon .nd taM due II corrlct.
1. You .,y choo.' to r..lt pall.ent to the RIgl.t.r of Will. wlth two cop I.. of thl. notlcl to obtain
. discount or ayold Interlat, Dr ~ou ..~ ch.ck bOM "A" and return tnl. notlol to the R.gl.t.r of
Will. and an offlcl.1 ........nt will ba t"Yld by the PA D.part..nt of RI",enu',
8. 0 Th. abo"" au.t has bean or will b. report.d Ind 'ax paid Mtth 'hi P.nn'lIi",.nl, inhlrUano. TeK r.turn
to bl filed by the daeldant'. raprlllntltlva.
C. 0 Th. abll"'l Inforl..tton l~ncorr'llt andlot dlbh and d.ductlnn. "er. p.ld by ~ou,
You IUlt coapllta PART ~ end/or PART CD balow,
If you indiclt. a diffar.nt tax rat., pl...a .t.t. your
ral.t ion.hip to dacadent I
OFFICIllL USE ONLY. r.l MF
PA DEPIlRTMENT Oil REVENUE.)
PA~T
I!l
lAX RETURN . COMPUTATION OF TAX
LINE 1. D.t. E.tob11.h.d 1
2. Account a.lanc. 2
5. Percent Taxabl. 3 W
4. AMount Subjoot to To. 4
S. D.bt. ond O.duotlon. S
6. AMount To.ab10 6
7. T.. ~.t. 7 X
e. T.. au. e
PAD
1
2.
3
1'1
5
6
1
8
DEBTS AND DEDUCTIONS OLAIMID
ON JO%N'IITRUliIT AllllOUNTS
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PA~T
[!]
DATE
.,,1
PAYEE
DESCRIPTION
AMOUNT PAID
t-
PAID
-[
',~,
""'l'l
GENERAL INFORMATION
1. fAILURE TO REI'OHO WILL RElUL T IN AN OffiCIAL TAM ASSnSNENT wllh ..,11...1. I.",... ..... dn Infor..lld.
,ubIIlthd bw tht fI"Ilt'lCll'l l".Utullnn,
Z. Inherltene. tlM b.C1o~" dlllnqu.nt nln. Month. eft.r the dIC.dl"t'. dll. 0' d'lth,
J. A Jotnt UClGUnI it hMINI1. 'VI" thouah thl d.ced.nl', nu. Wilt ltctd.d .. . utt" of Clon';l."I.ncl.
1Il. Aooounh IInll Idln. tholl h.let bltw.." hUlb_net "nd wlf.1 which tnll d.Udl"t put In joint nu.. within on. VII' prior to
d..th .r. fulh t.nbl. II I' ..".f.r..
I. Acella..."'. ..tlblhh.d jolnttv b.t...." hu.blnd and wlf. 1I0r, th.,. on. \/..r ,Irlor to duln ar. not t'K~I.,
.. '''"ount. held by. dlcld.nt "In tru.1 'or" .noth.r or oth.r. .,. I">i.bl. fullv.
REPORTING INSTRUCTIONS - PART
1
TAXPAYER RESPONSE
1. ILOCK,.' If IhI lnforll.t1a" IIlnd OOllPuttUon In the "otlCIt .r. Gorr.ot Ind dtdUGtlonl .r. not blt"g cttillld, 1I1lClI In "M"
In block "A" tlf P'rt I of the "hlCp.v.r ...Pon.... l.oUon. SI,n two eopl.. .nd .ub.lt th.1I with your ehlak for thl YOUnt of
tllC to the A.,ltt.r cf WIU. of the countv Indlc.t.d. Th. PA D'Plllrtlll.nt of R'~'nu' will tUUI In offlci.l ......lItnt
(Forll REII-I"'. t:)C) upon rlc.lpt of the ,..turn fro' thl R.ght.r of willi.
t. IlOCJl. I - If thl: ....t .plclfl.d on thlt naUu hi' b.,n or wlll bl r.port.d .nd tllC p.ld with thl Plnn.vlvllnla Inh.rltencl
lilt ".turn fOld by thl dtoldllnt'. rIPru.nt.tlv., pilei .n "I(" In block "I" of P,rt , of the "hxpIYlr R..pon.l" ..otlon. Sign one
oopy tncI r.turn to the PA Dtp.rtll.nt of Rlvlnu., luruu 0' Indlvldu.1 taMIl, DIPt 210601, Hlrrhburg, PA 11121-0601 in the
.nv.lopl provldld.
J. IlOCJC. (: . If the F'"tlo. hlfnrll.ttoF' II Inearrlot """/llr d.ductlon. ar. b.lna 01,1..(\. t:h..clt blook "C" .nco' nouh~. P.rt. 2 ttntf J
aecordlncl to thl: In.truetlon, bilow, Sign two copl.. .lId lub.1t thll with your ohlck for thl allount 0' till. p.vabl. to thl RI,bter
of will. of the county indl"lt.d. Th. PA D.p.,.t.l,..t of R.v.nu. will hlu, .n offlol.1 ........nt (For. REV-l!.'tI EX) upon r.o.lpt
of the r.turn froll thl R.,I.tllr of Will..
TAX RETURN - PART 2 - TAX COMPUTATION
lINE
1. f.nt.r tn. d,t. the llCOOunt orlgln.l1v w.. ..hbIJtn.d or tltI.d .In the lI.nn.r IlClltlng It dati of duth.
NOTE I for. d.c:.d.nt dvJng .fter 11I12l621 Account. whloh th. d.c.dlnt put In Jotnt ne.l. within on. (1) vur of dut" I'"
tllClbl. fullv II trln.f.r.. HONlv.r, tnlr. i. an 'lColu.ton not to .lCo..d '1,000 plr trln.f.r.. raOlrdl... of the v.lut .f
tn. ICIcOunt or the nu.o.r of .ccount. h.id.
If a doubl. ..hrl.k (..) eppllr. b.for. your flr.t n... In the .dd'.... portion of thh notlel. the U,OOO elC~lu.lon
IlraMV ha. be.n d.duct.d froa thl .ccount ballno' .. rlPort.d bv thl Un.nolal lmlUtutlon,
2. Entar tht total b.I~. of the .~count Including Intlr..t .ccru.d to the data of dlftth,
S. The p.re.nt ~f the account th.t I. tllC.bl. for .ach .urvlvor I. dlt.,..lnod at follow'l
A. ThI ptrc6n~ t..tbl. for joint ....t. ..tlbll.h.d 1I0ra th.n cnl v.er prior to th. d.cad.nt', do.th,
I DiviDED BV fOTAL NOf1IER OF
JOINT OWNERS
E...,t.zAJolnt 'l'lt r.gl.tlrld
DIIIIDED IV TOTAL HUHIER OF )( 100 . PERCENT UI(AlLE
SU~VIVINO JOINT OWNERS
In the n... of th. d.e.d.nt Ind two oth.r p.rlon..
I DlVIDED BV S (JOINT OWNERS) DIVIDED BV 2 (SUflVIVORS) . ,161 I( 100 . 16. nc nAI(ABlE FOR EACH SURIIIVQRI
I. The p.rc.nt taKlbl. for ....t. cr.atad within on. yl.r of th. d'oldlnt', d.ath or account. owned by tha dlc.dlnt but h.ld
In tru.t for Inothllr IndlvlduaU,) {trult ban.flcllda')l
1 DIVIDED IV TOTAL HUM.fR OF SURVIVING JOINT
OWNERS OR'TRUST BENEFICIARIES
I( 100 . PERCENT TAMAILE
[KelPlll Joint account r.gl.tlr.d In thl n... of tha dlc.dlnt and two otn.r partont end ..tabll.hld within ana ~'.r of d..th by
thl dectdtnt.
1 DIYIDED BV 2 (SURI/IYORS) . .50 I( 100 . 50:': (TAMAllE FOR EACtl SURI/I\lOR)
~. ThI HOUnt .ubJlClt to hx Uln. 4) Is d.tar,'ned by .ultlp.\Ylnlll th. IIccount belllnoa <I In. Z) by th. plrcant t.lClbl. utn. 1),
~. ~ne'r lnl eot.i or en. a.otl ana a.auction, iiet.o In ~.rt ~.
" ThI MOUnt t.lCtbl. (11".6) it dtt.r.lMd by .ubtrflctlno tna d.bt, and d.l'tuotlonl (1ln. 5) froa the I.Ount ,ubJlct to t.k (line 4),
7. Entlr tht approprl.tl tllC r.tl (11nl 1) .. d.t.ralnld balow.
A. For d.t.1 of de.th occurring aft.r 6/S0/94, the tlM r~t.. for trentf.rl to ,PUUI.. .r. .1 folloN'1
1. Oltl' ofdQath on or .ft.r 1/1/'4 Ind b.for. 1/1/95 the rlt. I. 3X.
l. b.t.. of d..th on or .ft.r h'll9S ttln.flr. to ,POU..I will b. \fIx.d at OX tl)( ret..
Motl' for d.tl.of dI.th prior to 1/1/94 tr.n.f.r. to IpOUI.. Irl tlxlbl. at 6%.
I. Tran.f.rl t~ I1nall d..clndtnt. Includ.lng fathlr, .oth.r, Icn, dlughtlr. llIr.ndchlldr'n, .0n~ln~IIM,
d~t.r-In-I.w, It.,child end th.lr IlIu, .rl tlxlbl. .t Ill( plre.nt (6XI.
C. Tr.in.f.rl tll III other. InCluding brothlr, .htllr, unelt, .unt. n.ph'N and ni,ol a,.. talC.blt at flft..n Plro.nt nsx).
D, If 1101.1 chan.. the tllC rlt., pl.... ,plclfv vour rlhtlon.".p to the dlc.d.nt In the Ir.1 provldad,
I. TM ..aunt of hit due (line .) .It det.raln.d bv IINlt.lplYlno thll ..aunt t'lCabl, (1111' 6) by the tlx r.tt ellnu 1),
CLAIMED DEDUCTIONS - PART 3
DEBTS AND DEDUCTIONS CLAIMED
Allowlbl' dabt. .nd d.ductlon. .ra d.terllnad '1 follow'l
A. You l.g.lIy are rl.ponllbla for pIWII.nt, or tha Ilt.tl '''bJlct to I"inhtretlo" bw I p.r,on.1 rlpr...nt.t1v. It Inlufflol.nt
to PIV th. daductlbl. It,.,,
I. You ICtuellv plid t". d.bts Iftlr delth of the d.Cldlnt Ind c.n furnhh proof of pIYllln\,
C. DtbU b.lnt olalnd .Ult b. U.alnd f~llly In Pert S. If .delltlon.1 'pICI h noodld, u.. pl. In PIP.r . 112" IC U", Proof of
Plynnt .111 be r.qulltld bw the PA Dlp.rtlllnt of R.II.nut.
:':-:':-;';-;-:':':".'-::.:--'.,
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'....,...-'...'-"..,-'.
. TAXPAVER ASSISTANCE
IF YOU NEED FURTHER INF'ORHATlON OR ASSISTANCE, CONTACT ANY
.. .... .. REGISTER OF WILLS. PA DePARTMENT OF REVENUE DISTRICT OFFICE
...... ... .. OR CALL THE aUREAU OF INDIVIDUAL TAXES TAllPAYER INQUIRV UNIT IN
.. .... ....HARIUSlURG At (117) 7eT-en? TDD' (717) 712-2252 (HEARING IMPAIRED ONL'I)
,
,
/c- /00 .,
'-') -/ tf -,.' ""')
, '-'
BUREAU Of INDIVIDUAL TAMES
lIe'!RITAllCE IlX DIVISI...
OlPl. 1'0601
HARlIIIURQ, PA 11121.0'01
COMMONWEALTH OF PENNSVLVANIA
DEPARTMENT OF REVENUI
(>*
NOTICE OF INNERITANCE TAX
APPRAIIEMENT, ALLONANCE OR OIIALLOMANCE
OF DEDUCTION t. AND AIIEII"ENT OF TAK OM
JOINTLY .ELO OR TRUIT AIIETI
....II<<U!.,'lu.m
EVA R COOPER
1 EASTWOOO DRIVE
CARLISLE PA 17013
DATI 11-10-91
ISTATI OF RICE EVA S
DATI OF DEATH 03.21.91
FILE NUMIER 21 91-0564
COUNTY CUMBERLANO
SSN/DC 229.32-8861
AON 91123159
L_-=t RPltted =i
MAKE CHECK PAVAILE AND REMIT PAVMENT TOI
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINI .. RITAIN LOWER PORTION FOR YOUR RECORDS ~
Riiv:iiiri-iif.Apji-ro3i:"j.......-.-...........................................-....-.--.-...-.-...-....-.-.-.
NOTICI OF INHERITANCE TAX APPRAISIMENT. ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS. AND ASSESSMENT OF TAX ON JOINTLV HELD OR TRUST ASSETS
DATI! 11-10-91
ESTATE OF RICE
EVA
S DATE OF DEATH 03.21-91
COUNTY CUMBERLAND
FILE NO. 21 97-0564
T AX RETURN WAS.
S.S/D,C, NO. 229-32-8861
(X) ACCEPTED AS FILED () CHANGED
JOINT OR TRUST ASSIT INFORMATION
ACN
91123159
FINANCIAL INSTITUTION, FINANCIAL TRUST CO
ACCOUNT NO.
654272
TYPE OF ACCOUNT. () SAVINGS (lO CHECKING ( ) TRUST ( ) TIME CERTIFICATE
DATE ESTABLISHED 11-18-85
Account Belenc.
Percent Texeble x
Amount Subj.ct tD Tex
Debte end D.ductiDne
Texeb1e Amount
Tex Rete X
Tex Due
3,876.66
0.500
1,938.33
.00
1.938.33
.06
116.30
NOTEI TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER PORTION OF THIS NOTICE
WITH YOUR TAX PAYMENT TO THE
REGISTER OF WILLS AT THE
A80VE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE TO.
"REGISTER OF WILLS. AGENT."
TAX CREDITSl
PAYMENT
DATE
07.08-91
DiSCOUNT (+)
INTEREST/PEN PAID (-)
,00
AMOUNT PAID
116,30
RECEIPT
NUMBER
AA211 508
TOTAL TAX CRIDIT
IALAN~OF TAX DUI
INTERIST AND PIN.
TOTAL DUE
. If PAID AfTER THII DATEI.~EE REVERIE FOR CALCULATION Of ADDIT ONAL NTEREI..
C If TOTAL DUE IS LlIS THM U, NO ,AVHENT 11 REqUIRED,
.. If TOTAL DUE IS REfUClED AI A "CREOIT" C C~).l yOU HAY IE DUE A REfUND.
I" IIEVEIlIE IIDE Of TNII FO,", FOR IHlTIl\ICTIUIIlI. I
116 . 30
.00
.00
,00
-.:
"
PllIIPOIl!III'
NOTler,
,10 ,ulflU th*i ....llr....h af 'M"Dn 2140 .f the, IntMr1tMCI. Ind E.,.,. hI( loot, AotUof 1"1. (71 P.'.
...t1on.14.1.
".-T,
..'em t~ 'Of! ,orUon,o, }'Mt MoUo. Md .uNlt witt! your Plyant to tht Il"htor of NUh prlntld on the
r...,.rll ,'de. " , J
._ ..... cheok or HMY orde" plvlb., tOI REDJlTU OF MUll, AGeNT.
1ll'_IUll
" nftA1d .. . to. credit, ""Ioh .... not r......ted on the tl. r.turn, ..y ~ reque.ted bv OMPlItlNI tin ""'1I0I\lon
for a.fund of Penn'vlvlnl. tnt~rtt~. ~ E",t. TIM" (REY"ISIS), AppllcltJonl ere IVIIIIbI. .t thl O'flr.1 of
the ...1.'0.. of Willi, ~v of the 25 a.venut Ol.trlet O,flo.. or bv Cll11ng the .~1.1 24.hoUr InIWlrl", .t..vlc.
nl__" for far.. Dr...."" In Plnnlvlvllnlo ..100.162.2010, ou,... PlnnlVl"'lnlo end wUhin lOCI.
Horrhbur. or.. (117) 111-IOM, TOOl (111) 71Z.ZZU (....ring ....lrod Only).
OIJECTlOHlI Anv ,Irtv In Int.ro.t not ..U.fled Nith t'M ..,...1......', .Uouenco or dl..U",eno. of dMuoUont or .....lMnt
.f t.M (Inoludlne dltolUnt orlnt.r..t) .. IhoNn on thl. Notlo. HV oajtot within .I~tv ('0) daV' of rec.ipt of
thl. Notlc. bVI
......rltton ..rot..t to the PA _.rt....t of ..venue, lo.rll of ""'.11, IMpt, ralOU, Kord.bur" PA 17UI-1021, OR
"'o1HUnt to he"o thl ..U.r det.r.ined .t thl _It .f the 101lount of the ...r'OMI r.r......t.U"., OR
.....,..1 to the Or,ttM.' Court
ADMIN.
IITRATlVI!
_nlOllO'
Peotu.l .rror. dlnov.r" on "'It ........t thould be addr.."" In ..rIU", tOI PA Depart..,t of Rlvenue,
lurl~ of Indl"l~l TaM.', ATTNI pa.t A.....ient .Ivi... Unit, DEPT. ZIO'Ol, Horritbur.,PA 171'1."1'
Phone (111) 717-6111. S..,... I G' thl book!., "In.truatlon. for Ihhlr1tlnClI 11M Mlturn for. ...Idlnt
Decadent" (~V.ll'l) for In IM..I~tlon u, "'Inl.tr.tlvolv Clorrectlbll .rrorl,
alIC0UN1'
If any t.M CkM .. p.ld with'n thr.. (J) c.lendar ."th. .ft.r thl d4IClldtnt'. ...th, . Uv. P41rclflt (IXl
llltoount .' thl taM ,old I. .'lowed.
Pf.IIALTVI
The 1I~ t.M ....tv non-p.rtlolpaUon penaltv 1. cOIIfl'Utld on thl tot.' o' thl t.. and Intar..t ......ed, InCi not
plld blfor. ,lenu8rv II, ."', ttMI flr.t dav .U.r tho ...... of thl t.M .....tv ,..rlad. Thlt non-p.rtlo"",U,,"
,.,.., tv It .....11b1. In the ... HfWMIr tnd In the thl .... UM per loci .1 yOU lIIOUld .....1 thl taM and Int.r..t
thot: he. ..... ........ ., IndlootM on thl. noUoe.
INT_IT,
Int.r..t I. ohIr'" .....nnlnt with flnt ..... of "1I~w, or nlM (,) IOnth. and OM (l) dav
fr. the .,. of .Ith, t. ttw _t. of p.YMftt, TIM.' IIItllch bIc.. "'1I~t M,or. JMul;ry I, lMI
boar 'ntar..t .t thl r.t. 0' .IM ('X) peroent par ~ oolculotld .t a dlllV roto of ;000164.
All '..0. wnloh bIG... "II~' on or Ift~r Jenuarv 1, 1"2 will boor Intlr..t It I rIte whloh will Ylrv fr..
.alondlll' WHr to .al__r vo... with thlt r.ta IIfIMUftClH bv tho PA Dep.rt...,t 0' ..YtnUI. Ttw ."lIc_l.
1nt.r..t r.t.. for I'll thr~ l'" .r.1
~ Int.r..t lII.t. Oellv Int.r..t f~tor ~ ~~ D.llv Inter..t F~tor
I'U lOX , ."... 1..7 .~ .UU47
INS In ....41. 1....1..1 \IX .01OSt1
1014 \IX ...rslI ."1 'X ."0147
1t0l UX ....S.. I"S.ttM 7X .ODo19'
I'" IU , ..n74 ."1-1"7 'X ,1001_7
n Int.re.t II c.louletad .. fOUOW.1
INTIIIIT . IALANCE OF TAX UNPAID X NUNln OF DAYI OELINeUEHT X DAlLY INTElUT FACTOI
--anv MoU.. 1.1UId oftor tho tu: bee.... dtll~t will roflKt M 'nterott calouletlon to ,1ft.., nlJ MVI
bevend tho det. .f tho ..........t. If PIVMnt II .ado .ft.r tho Interllt ClNIPUt.Uon .to thown an thl
Notl.o; additional Intor..t IUlt be oalculttld,
,,_..,
,
":
t.mount
$ 153,66
$ 78,06
1';1 59,40
$ 62,00
$1.555,11
$ 25,25
TOTAL $1,933.48
In addition, the funeral bill of$3175,00 owed to Myers Funeral Home has received
a partial payment of approximately $1,675.00 leaving a balance owing of
$1.500,00 which will not be paid due t.o said Insolvency.
NOW. THEREFORE. KNOW YE, t.hat I, Nanette Lock, being the mother of
the said decedent. and being the only person entitled t.o Inherit undt~r the Intestate
laws of t.he State of Pennsylvania, does hereby acknowledge that because of the
insolvency of the estate there are no funds for distribution:
AND. I hereby stipulate that In order to avoid the expense and time Involved
In the filing of a formal account and schedule of distribution. I agree that no
account Is necessary.
THEREFORE. I do hereby remise. release, quitclaim and forever discharge
the said personal representative, Kenneth G. Burry. his heirs. executors. and
administrators and assigns, of and from the said estate and from all actions,
suits. payments. accounts. reckonings. claims, and demands whatsoever for or by
Name
Fabrl1.one Cleaning Systems
1V Cable
Dillsburg Family Dentistry
Erie Insurance Group
Sears, Roebuck & Co,
Sprint
Page 2 of 4
"
reason thereof, or for any other use, matter. cause or thing whatsoever touching
upon the estate of the said decedent. and I do further hereby covenant and agree
\hat should any lIabl1lty come duc to the estate of the satd decedent after t.he
signing of t.hls agreement, I do hereby covenanL and agree with the aforesaid
personal representative that I will conLrlbuLe pro rata my share of the estate to
satisfy any and all claims. demands. suits. or causes of action which may be
su~cel!!sfully prosecuted against the said estate or the aforesaid personal
representative aftp,r the signing. sealing and delivery of this family settlement
agreement and final release.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this
!I <X day of January, 2000.
""/"(41.4.L:d:> c~l-/
Nanette Lock .
lOr ' '.n ".) /
7'.-:,...L"1-..t.-t'....,~~ .,' )'r _ ., ,"'~ )tJ.'\.~-
Witness
COMMONWEALTH OF PENNSYLVANIA
: SS,
COUN1Y OF CUM8ERLAi'lD
On this. 1c;J~day of January, 2000, before me, a Notary Public, the
undersigned officer, personally appeared Nanette Lock, (known to me/satisfactory
proven) to be the person whose name II!! I!!ubscrlbed to the within Instrument, and
acknowledged that she executed the same for the purposes therein contained.
IN WITNESS WHER~~OF, I hereunt~tlmy hand,and ~~Ial seal.
C~-+--) ~~
NotlU)" Public
PlIge 3 of 4