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PETITION '-OR (;I~ANT (n- LETTERS 01- AUMINISTRATlON
E.llale of .-::lH..a.~..!Jr:;P]T..sJu4eJ}o, u c:Yt...q1_""d~~~L
also klwWII as ':Z..,~, "",..5#~~~ / To:
___.__"'._u~___..u."m"..__,___r Kegister of Wills for the
-'--'~--"--'."'-'-,-if' Uil~' /Je""a."''', Coullty of . CWM.ll.ER~I\ND___, In the
Sodal Se('urlly No, .:bt?.e.,......,..".,.-.9?7f Conunouw"ahh or Pennsylvania
The petition or the undersigned respeclfully represents thai:
YOUI' petltloner(s). who Is/arc 18 years or age or """'I', applies
_ for letters of admlnlstratloll
.... '.,___' Oil the estate of
-~~_.._,._--~~---_.._" .. .. ....".-
(d.b.n.; pClldcnll' lill'; dlll"Ullll' uhwnliu; dllrlllllC minorlwld
the above deeeden\.
Decendent was domiciled at dealh In ",bc..-?!t/zec.l~d;; COlll!tX, pellllsz.l;:~it\[ 1c-7
h 15 last fumlly 01' principalre"ldenee al ...a._G~eJl . ~~~~~~ .~" r ~
-;It. ~1IJ(.~'1 III~ .
Deeendenl, then ,-_,'i!i'rlyears orjJ8t~lIed Zf~j..'J*-/..... ,,' ----,-, 19.'LL.
at.GJ,...6tlie./f.Jllu _,()t(2.-,IjL.C; .,. ,~~. t-- . - ~- --.,..-------.,'
Deeendent al death owned properly wllh estimated values as rolllows:
(If domiciled in Pa.) All personal property $ ,J~/PJ:!l!2.!12Q
(If not domiciled In Pa.) Personal property In Pennsylvania $--~----
(If not domielled in Pa.) Personal property in Counly $ - ,
Value of real estate In Pc tnsyl nia ~ k $ ~.j ~ t:>OQ....,
re v r
situated as follows: ,--. '1-0. -' -- ----
~ ----, ,-
, ~,--".f /~--'~---
Petltloner_ after a proper search ha_~, ascertained Ihal decedent Icft 110 will and was survived by
the following spouse (II' any) and heirs:
Name
Residence
Kelatlonshlp
. ~~
7.I.1b'JII/dF H. ~ 7!~":'~-~P_-' :_l~/~; ~ ~b
. ~L/4#-~ ' ~- -~. &..ri:.. C";2
--,---__+-__ __ ~@.e~et..._. -7- S L----.. / 7''t..
---~.__._-_._. -,-~--'-"'---------
...--------- --..,." ..,~..~.---~_.__._._'" -~~
THEREFOKE. petltioner(s) respeclfully requesl(s) Ihe grunt of letlers of admlnlstrullon in the
appropriate form to the undersigned,
~~~~~ .~~....
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'I'lli'; is to lTnil)' lhat tll(' ill!nnllillitllJ hl.'Je given is UHllTdr (l,pied 1'11111\ al1llli!~il\;d (l'ndi(,ll(, III lk,lIl1 dtlt~. lill'd widl 1111.' ,1\
L(ll'all{q~isll'''r. T!il' originill u'llillt;l!c williii' IOlw.nd('d 10 th{' St;l!1' VILli !{I'llild" (Hlill' fnl' pl'III1.\I\I;I1\ lilill!'"
WARNING: It Is Illegal to duplicate this copy by photostnt 01' photograph,
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4396525
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No.
ClCllIIItCIM*IALTH 0' ''''''VIlo1MIA ,IIIMliT"'NT Of' ""'LTH . YITAL "'COHIII
" !,,", CeRTIFICATe OF DEATH "
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JUL '0 3 1997
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INHERITANCE TAX RETURN
RESIDENT DECEDENT
COMMONW.AlIH Of IENNSYlV~NIA (TO BE FILED IN DUPLICATE
Of,...ItTMENT Of REVENUE
H~"'S~J:ld~~\"06(J1 WITH REGISTER OF WILLS) COUNTYCgp' YEAR
, 0 (;~N~~~ ~~~';iir~:;:~~'~:IDO~~~'~'~ ,-_...-..~ --- -~'-lm1ifijf"10M(;I;\~~IO"I"I'~I:(;O'" ~, Dr i v~
soclATIffiJiiliNUMfEll:~ \OAlf mtlf....1I1 \1)Alf o/SIlWt Gnrlislo,l)f.\. 17012
,~Q2~..2~9..2.79-. 1>/2h/91 1 2/~/~2 C""'I CumbnrlRntl - ,'-.,..-
I" ..."",,,,,,,"""00 'HOC" ""., I"" "", "" M'",'" ",,'"'' \")( 'AI \EO"'" "',,,,,. I '''OliN I "","0 I'" ,,""UClION'1
'...____ ___ ,MjA MIA
Jf:J 1. Original Rtlurn II 2, Suppl,",,,'al Rol"rn
[J 4, limited Ellale II 40, F'Jlure In"".' Comproml,e
llor doles 01 death aflor 12.1~.821
[] 6. Decedent Died Tellale [, J 7. Decedent Moinloinfld (J living Tru~l
(Mach topy of Will) IAlloch copy 01 Tru.')
.___,___ ALL CORR.I.O"'OINCI A"'O CONPlDINTIAL TAX IN'ORMATIO'" IHOULD II D'RICnD TO,
chli: N'M' .-- ' COMP"T[WilliNOAOD;r,,--~-'~--" --..,.--- ------.---.-
n "yhO!1!!\.,,~h!!:.!f)~L!<dm!_ni5:t.x:~t()r 'l'3'h1 0,m7a~ Itt. RSlildirloYIll
82 mEPliONE NUMBER "OS ~e \1(.
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1. Rtol E.'ale IS,htdule A) 11 ) (, 6, 5()O .00
2, Stack. and 80nd. (Schedul. 8) I 2 I
3, Clo.ely H,ld S.ock/Parlno"hlp In.orOlI(Sch.dule q 13 )
4. Mortgages and Nol" Receivable lSchedule D) (.4 ) -. ..---
5, Ca.h, 8ank Depa.lts & MI".ltaneou. P,,,onal Proper'y 15), ..15, ,_13'7..,37.
ISchtdulo EI
6, Joln.ly Ownod Proporly (Sch,dul. F)
7, TraOlI,,, ISchtdule 0) ISch,dule LI
8. 10tol Groll Auel$ (totallin.. '.7)
Q, funeral EKp."s." Admlnls,rCltlvo Cosu, Mlte.lloneaus
Expenlls (5ch.dule H)
10. Debh, Mortgage liabilities, liens (Schedule 1)
11, "0101 Deductions ItotalllnG' 9 & 101
12. N.' Value of Eslale (line 8 minus Una 11)
13. Charitable and Governmental Bequl'ih ISchedule J)
__--t 14. Net Volue Subi'c~ t~ Tal( lLin. 12 minus LInD 13) __._..~__
15. Spousal Transfers (for dell" of death oher 6-30.94)
Se. Instructions fOI Applicable Percentage on Reverse
Sid.. (Include values 'rom Schedule K or Schedule M,)
16. Amount of line 14 taKable at 6% rut"
llncludo values from Schedule K or Sthedule M.I
17. Amount 01 line 14 taKable at 15% role
(Include valuel from Schedule K or Schedule M,)
18. PrlncipalloK due (Add taK Irom lInet 15, 16 and 17,)
19. Creditl Spousol Poverly Credit Prior Payments
..-..------..-----.--..".- + .--.. ....,-...--.-,,--' +.-.-
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_EV. 1500 flit l1.fHI
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.01 DA'II O. DIA'H Ami 12/31/9\ CHICl< Hili
II A I,OUIAL .
'OYlln CIIDI! II CLAIMID L I
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Remainder Return
Ilor dole, of dealh prior 1012.13.82)
Federal Estate T OK R,turn Required
_,,_ 8. Totol Number of Sale Oepolit BOKel
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(81 _,' 8 '.I_V1...1L,..,----
1111 __.,5..~LO,1?", 71..__
1121 "_~c?'-9J.7-'--6L...,-.,-
113) --,-"-.~~~....-"'~--..
_,___-.J14.L,-~..?-91?17.!6~==
....-._~.._---_.~
1151 -...,--~ ,,,~'-' ..----..-..", ---"
(16) _,~2..9tt,,~)~..---,," ,06"
(171..
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DiscoiJnt
1 795.06
,_. ,...._....._~..----_..
._._.x ,15 =
.. ..'__"__" ..______. .___.-n_"__'
(18)
1 795.06 .
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lnterett
IIql
1201
20. If line \9 Is grealer Ihan line 18, enler the dIfference on line 20. Tnls i. Ihe OVERPAYMENT,
II []I.IftII.II...._..J:ll'_..._....'I"...'IIIIt_.~.~d.T.nll_....T.U...........ILl..
~ 1. II line 18 11 greattr Ihcm line lQ, enter ,he difference on line 21. 1hls i~ lhe TAX DUE, 1211
A. Enler the interlll on Ine balanco due on line 21A, (21A)
8, Enl" .helo.al olllno 21 and 21A on lint 218, Thl." ,ho BALANCE DUE, 12181
Mok!.Ch~~~~oyob)t 10. Rt@l.t.. .,--\ylII'r.~..!nt .__-,u~_"___ .-....--,....--.,..------.
=.--- ~~ II SURI TO ANSWIRALL <<;lUIITIONI QNiiVIRSI SIDI AND TO RICHICK.~ATH ~. '<.,-..;-~.
Und" penahl.. af porjury, I d,c1art Ihall hav, ..amined Ihl. relurn, Including accomponylng "h.dul.. and ,'o',m"h, and 10 .h, h.,. of my knowl.dgt and b.lief,
Ills 'rue, corret! and complete, I declare that all real I1tale nOl been reported al lrue marko! value DeclarallOn of preparer other than Ihe p~rlon~~~p~w-tlve II
balld 0 Illnforrnatlon of whic~~p~~~~I ally~~no~I'!.dge _ _ _ _ __ _ ____ _ - - - - - - ---. 2~ tu._ XL.~-
,,1 Of ,USON IUSI'ONSIIU fOR flllNO IU1UR AOORfSS DAl
_/< . . ~.l1.L7_WOJlt Hj,!!..gO_M., grj,/41'1.h., H>5.PfL. ~ /~/.ti.. /~ ---~
"ONAlURE Of PREPA'" 01H" TH' pm N1AlIV' 'ODR'" ~"r'-
.._-_...-..,_._---~~..
1 795.06
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J.-t95..~.06~~:~~.,=.:
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. Certificate Nuniber
Expire9
RB-014902 -A
MAY, 31 1998
Isslled To:
. "" ~ - '><< <:-~ ,"OM AS H SHIRCBY
Sl~nllu" T SHIRLEY
3117 WEST RIDGE RD
ERIE PA 16506
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Certificate Number
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RL-000451-L
JtlN~9 1999
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Issued Tn:
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72THOMAS HARRIS SHIRl,llY
3117 WEST RlDOE ROAD
ERIE PA16506
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SCHEDULE A
REAL ESTATE
PIU NUMillR
,.n.m,f}Il~l'hYl"homnD S~ott 1997-00~88 l'e.tl"lh2197-0588
IPI.p.rty ,.Intly-own.d wllh RI,hl of Su.vlvorohlp mU'I b. dl.<I..ood on Schtdul. PI All ,,01,,1010 .hould b. ..po.l.d 01 folr morkol volu.
which I. d.An.d a. tho pllco ot which p"p..ty would b. uchan,.d b.tw..n 0 wlllln, IIIuy.. ond 0 willi.,. ..11.., n.lth.. b.ln,comp.lI.d
!!.~~'tn'I",II,I'.lh hovln, ....onabl. knowl.d,. of tht 1.ltvonl lact,.
ITEM
NUMBER
1.
I
. single family one floor dwelling 251 x 29 2nd J
floor no expansion on a lot 100 x 160, mQrel~r less..
Further and better desoribed in volume book A 33 page
265 . 266 and in Deed Dook S volume 35 .. page 499., .
Property sold of July 18. 1997.Due '~o defective Sopti
syste. sale was not oompleted".
DESCRIPTION
.See Attld Iilxhibi'~s."
"'__.~'.'''''''''-_ ",~..,.....c..-_.~~_.._,.-.n.-~~~' .___.._.,....___.__~_"__u.,_
'n,__"_,",,,__"'"n~"~_U__n__n_" ..'.".. ____T~TA~, (AI~~ .nt.." an lint I. Rtca~Uulatlanl n
(If malt .paco /. n..d.d, InI'" addlllana/ .h.." a/10m. ,III,)
VALUE AT DATE
Of DEATH
,66,500tOO
......16.(l,5.0.0tOO.
,
AGIu:mdl~N'I' .'()1l1'lm SAU: ANlll'UIlCIIASI' m' ImAI. I~S'I'A'I'I';
Thl. fOlm ff((IllI111tnded .lId ,,1\lloved fur, bill flot UIUlct.d 10
, 1.11 by mllUb.lluf Ih. O,eal., Ulm "JUl' ""ol:I.llulI of IUI^I."OKS.
I ~' &:~R~ J [""" '"""""''''''1 M, ;;ilMY"G:;;pl
PA, LICBNSBD DROKB~ -I'A, \.ICI!NSI!IJ qROfl!R CPA, LICDNSBlJ UROKIlI'-;;;
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I. .RINCIPAI.. 1,lw..o.'s'.JLU ~. ..L- .. l ,-,_.
(...Idln," .-'lI!' ~_ _ __,__...______1
htrolnlhtr ..lIod,$jIJor. ,r;l- -:L-I'_' U-:J".Hrl,..-'?lA.---.--'--.--.--
(,aldin, 'I ~ 1..1..1..:1 . u\l!,-F./:J--.. - I
Ihtr.ln"l,' Hlled Buy.r.
a.. 'RO'IRT j hUll Mflb)' I"'" 10"11 ."d CUIIV'Y 10 Ru)'o" who her.h)' ..,.e. I 1wIl..6Jr1.~I\R.1J'I~t9i,o''''''c.
.r , nd " b IIdffl]ndm II. thtr I .d, 1!1rl~ 1JIrl-l-L11~I-Ll~
J.- ZONINOI Unln, ~Ion" lU2
," F.Uu,. of thll AII"mlnl 10 conlaln Ih"onln, c1...lIlclllon uceplln e.m whIr. the properlr. (or ..eh parCClllluu,of, If lubdlvld.blll)
I, lOfted 10"1)' 0' p,hn.,ll~lo permit .In, ..ram~1 dwetlln . .han render ~'~' r.lmen' voldab. al ,h. opllon or Ih.J~Y" and Ir voided
dtpO.lu'lnder.d by the Buyer II, b, Ilurn .to Ihl 1.~~~llJj" -,,,nt q(..ewllJf:\!a!h1 ,...,.. (j-/j/M
4, TERMS, a) Pureh... Prlel J l..WIJl.,! - J.LL-JlLLl~ _W
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peCktl Septic Service
68 P nl School Road
Gardnerl Pa. 17324
(717) -486-5548
BILLING FOR SALB 01' PROPBR'1'Y
order Number *:1966
JACK GAUGHBN REALTOR
1068 ,HARRISBURG PIKB
CARt,ISLB VA 17013
JACK GAUGHBN REALTOR
'Att: JAN VEROW
RBAI.TOR
SITB ADDRllSS
SCOTT SHIRLBY ESTATB
2 GREEN MEADOW DRIVE
CARLISLE PA 17013
BILLING INFORMATION
Date Pumped:
Billing Date:
Service Charge Date:
Pumping Charge,
Labor Charge:
Material Charge:
,
Service Charge:
8/25/1997
8/25/1997
$75.00
$25.00
Total' 'PUM
-lot Added After 30 Days
$iDO.OD
Eval. palling Status YeA or No: YES
l1PA8R or Faill) DwnerR ArA R8QpnnAible for psymant of Bill
II0RK DONE
...,.,........ PERFORMED SEPTIC SYSTEM EVALUATION .......
...."'."LOCATBD AT, 2 GREEN MEADOW DRIVE, CARIJISLEI'.u**..",.*....**
DUG UP ACCESS TO DRAIN LINB, UNCLOGGED, LOCATED END 01' DRAIN
LINE, DUG UP AND INSPECTED DRAIN LINE, 25' LONG, VERY SMALL AND
OLD. PUMPED SEPTIC TANK, CLOSED UP HOLES, SYSTEM ONLY GOOD FOR
1 OCCUPANT, NOT TO EXCEED 50 TO 75 GALLONS WATER USAGE A DAY.
PUPLIC SEWER TO HOOK UP IN FALL OF 1998.
PBCK, S SEPTIC SERVICB, SBRVING TIlE COMMUNITY SINCE 1968
T\lANKYOU !lOR LIlTTING US SERVB YOU.
~ .. I'.
~,
. -.....-. ",... '...",......
"2
,
fXWITICll or oIIlSOOI'l'lc:Jl S'IS'lUh
""" tJ:Mtn'lInt ~nI< ~1
x.. Y.I
No
If 10 did ~rption lyotAln run book into t......tnent tank?
P..t Hrvice record
Y.. .2s.. It>
'''''''n tho tAnk .... laat punpld ""'" tho... conp:>nenU inaplCtOO at th4t tUre?
..15.... Yea
No
SeeP"9" on 10""
Lulh _tetlon
Nlaorption 1)'1_ IAtI.faoto1Y
Yet
-X.. No
....2i. No .n I ",,' -'I. fI'lc\I-
No ..1~.I~t~:.'f "..,I... ~
- "'-~
_ No u''';,< ~c" ~"':)
Y..
v..
My 1nd1cation of pxuvlouc fallw:9 .x. Yet .
11 y" pl_ camvntl
5 lilt ';';Ii' . .~
=.\::-~e 5~~ ...~"qe.:u..::::'I:.I.,~~~u:;~~lsn~~ "- <L ~~ 9Qea~ ~tl~-:-'"
YI~~~.JyoJclb:lNlport effluent to olboorptlon tyltem? .
Yet ..>-r:.. No
11 )'00. it IU'P _ratlnoJ tAt1ofllCtorUy1
Yet
No
C1]otIEIfl'S.
BASID Cll 'mE IHI'\lIlIOO'lal CXNl'A11lED HEREIN CIJR CX)IPAN'( IS ABU! '1'0 CEm'lrY 'IWa'
'nlE SEW/oGI! DISI'06AL SYSTDl IS PRESENl'LY IN WlllPAC10IY lDUUtrl' CQIlmc:Jl
.lL v. No
1Ioo.M..,~<1!!<I correctlY'll _ure., ,5...~4'.i.iSl":I. ""..I"<L-n.:... ",,"\"1,.. .....i.
~.~I"~;~ ~'t:'..r;~Io\~.~r~~ ~:..7..5.."t~tl'~"''':f~t
'ftd. I.tter i. intended only aa . report of tho _ent concIition of tho on-
.it:.e _ dilpollal 1)'l1:AIm, booed upon \<ollat ... ...re able to -.... ard our
CONIlderabl. .xporlen::e in on-81tAO ...."""'tar techoolO9Y. cur ~ hao not
-. ...~1nId to ...rrant or 4jU4<4ntAJe tho proper functioning of tho lyOl:8In for
any period of tloe in tho futw:9. !ledaulU of tho nunerou. facto.. ..tUch ....y
.ffect tho proper _ration of . oeptic Oyl_ aa ...11 a. tho inabiliW of our
t:c1tpny to IUpervll10 or ROOitor the use or lMintef\,lll'Dl oft"" 1)'11_, WI
".port 1h411 not be COIlIttued aa a WO<I'anty l7f our CarpMy that tho 1)'1-
will function properly lor any porticular prospective wl'lr. ord our Ca1t>onY
DISCLAD6 NIY WNUWIl'Y, eltho.r .xprettOO or ~l1ed. arloing fJ:... tho
inopection of tho oeptw 1)'1_ or Wa r1IpOrt.
'lbonk you for allowing uo tho "I'fO<tun!ty to be of ....l.co. If you h..... any
addltionol _UONI t pl_ cb rot htoitete to call.
~ IlOIIpoIlIIible For COI'o,u,Un'l IIlII*'t1on .
_ of C<lolt>O!\Y ~\l\ Sotfl\',1:. c::...a.V\C~
1ddre01 _1.., ~in. Cr\."'" ,,~
roollA..".. <(0. \"U,~
_ _r '\4~1.'S5'1(
P.S.H.A. HoII>enhip' 3 -110
l~
. .
x"iBmril ''nlAT I ""VIi S'lU>IED '11lE IN!'OOHATI~ WfrAlNED HEREIN NO 'l\IAT MY
ASSIl's>"'m' IS 1DlI!ST, 'lIt:IOGI l\II) 'ro 'l11E IlES'I' CI' MY ABILITY <XJWX:T
_ ~_1r-:-.. (1-) Tltl.
"
"
ChristDpher C,Houston.Esquire
52 West Pomfret St.
Ca,rl1s1e.Pa. 17013
RE: Shirley Estate to Bardo/2 Green Meadow Drive.Carlisle',.. , ,
" .9/19/97,.,
Sir:
, ,
, '
I recently received two packages from the Jack Gaughen,Realtor office post
marked 9/9/97 & 9/12/97 regarding the sale of 2 Green Meadow Dr. Your letter
enclosed in the 1st package now shows merit.lt was briefly shown to me on
9/8/97 while moving furniture at 2 Green Meadow Dr. At that time.1 thought
the loan had not been approved by 0/30/97. . Arter receiving the 2nd package. /
thought someone should say something on my behalf.
My knowledge of tha septic system & sewer installation is this. .Note enclosed
page III dated 8/19/97. .After negative responses from the inspector about the
septic system I suggested he stop. .He did stop & left.Mrs Verow. Seller's
Agent.Mrs Failor.Seller's Agent friend & owner of property behind SUbject
Property'I-717-249-1309.my brother in-law heard the septic inspector's & my
words regarding the defectiva septic system. The fourot us enter the Subject
property.Mrs Verow & Mrs Failor discussed the sewer be,ng installed 1n 1998 &
I should not want these problems & should coritinue the septic inspection./
asked Mrs Verow if the buyer knew about the sewer & she stated that's the
Buyer's Agent responsibility.1 asked again. does the Buyer's Agent know about
the sewer? Her reply.was-I don.t know. .Well. you should notify the'Buyer's
Agent about the sewer installation & septic system problems.Mrs Verow,y/ss
more interested in having the septic system funct10nal. .Therefore./ ~\d not
known about the condition of septic system & sewer being insta"ed"~'ril1998
until 8/19/97..Furthermore. after talking to Mr. Donald Rickards 9111197 he
stated the Buyer's Agency was notified in 5 days.1 asked him if the Att'y
knew this & he said no and I suggested he inform the Att'y & make him aware of
this notice..No response..On 9/15/97 I phoned Mr. Rickards on his personal
hDme line 1-717.766-2972..1 have not heard from Mr. Rickards since 9/11/97...
Frankly. I feel like I' ve been left on the end of a tree limb 100 feet above
ground..1 don't believe I've been fairly represented by the Seller's Agency.
If this prOblem continues my recourse is to file__~
- J - Il..-.-. . I hope then the
truth lIlay surface.
You sir. I thank you for your honesty.. \
Thank You..
Good Luck,.
,
of Beaver Falls, was assessed a $500.clvU penalty
for Incompetency In a real estate transaction for
failing to advise the sellers of property situate In
Chippewa Township, Beaver County, to dlsdose
on a sellers disclosure form, an upcoming seWer
system project affecting the subject property.
(5.20-96) (C&;O) ,
Sincerely.
Thomas H. Shirley
Adminlstrator.of
The T.Scott Shirley
Estate. .File N,o.
1997-00588. .Pa.File
No.2197.0S88. .
. "
,\
~-'
3799
RICK A. LOWHV eo.,Wl!3
KAREN O. LOWRV 6m~
DBA CORNERBTONE CRAFTSMEN ,L.v.J .
178~~~3~~~~E~~~3~WV ".'" .'::'_"V-.?-9.'I7
I ~~~)~~)0~"'..~~__1cJ.,~---_,..__n__J $ 1,700.'?!.\(
I ~~_~u~~~,~-~b_~AKSm~::.,;,
I
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N*m. ..}ick A. Lo'~ry
AODount No 93401806
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DEPARTMENT OF TRANSPORTATION
CERTIFICATE OF TITLE FOR A VEHICLE
920730055000341-001
1B 3XG24 38MG118810
91
DODGE
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POBOX 40
MECHANICSBURG PA 17055
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108
Ac.ount number (.ptIDnal)
ESTATE 0" THOMAS. SHl!kIl 202.42-9979
1099
CORRECTED
I PRS FORM 1099 MISC FACSIMilE I
l' Renlo 12 ROYIlll.. I I
Is I. -I MISCEllANEOUS I
130th.r Ineome . 4161.4'1 INCOME I
IS _1_ -1
14 Foderll Ineome tox withheld 5 FI.hlng boet pro...d. I
I' 1$ _.1
16 Medl..l & H..lth .Ire plymenu 17 None",loyee ....,on..tlon I
I' I' I
18 Substitute payment. In Illu of 19 PlYlr madl dlr..t .alll
IdlVldandt or Int.r..t i.5.000 or morl of .on.umer I
Iprodu.t. to I buy.r
IS Iit!5JDlentl for re.alt
lID .rDp In.uronoe proeeeds II' SUtl Ine.... ux withhlldl
I. 1$ I
1'2 Stlle/Pay..r'. .tate n<lllber I I
.,$ I I
TAX YEAI 1997 VOID
. PAYER'S n..... atr..t adel"... .Ity. .uta. and ZIP .od,
DEfENSE fiNANCE & ACCOUNTINO SERVICE. PE
130 WEST AVE SUITE A, COOE FD
IPENSACOlA. Fl 32508.5120
PENSACOLA. fL 3Z508'5120
PAYER" fldlrll EIN RECIPIENT'S Identlfl.atlon number
~9.'29328' 195-14,4752
PAYIE'S NAME AND ADDRESS.
THOMAS H SHIRLEY
31'7 \I RIDGE
EllE PA '''05
G'J
,...._,To OrIon This Sldo . SlIdo Flngor Undor This Edge
,
.
.
, ,1
FINAL STATEMENT OF LUMP SUM
DEATH BENEFIT PAYMENT
UNITED STATES
OFFICE OF PERSONNEL MANAGEMENT
RETIREMENT PROGRAMS
RETIREMENT OPEH~TIONS CENTER
BOYERS, PA 18017
You Ire entllled 10 I lump .urn. pavmlnl beoause 01 the death of I former
employ... Thlt paymentl ,hown In Blook 5. cov.r. only blntlll' due 110m
the CIY61 8.rvk)e R.Ur.menl and, DI.lblllty Fund and conal.11 0' Iny unU..d
ClO"trtbutlont the 'ofm.r emploV" mid, to thl Fund or any acorued annuity
pay.blt at the 1411'1I of hi, or her d'llh, or fhe aallg Employ.. Death. B,nefft
Plyable 10 a .urvMng 'POUI' undllt the F,d.ral Employee. A,Ur.m.nt
8~Mm, '
1, Name 0: decetltd Ftderill .mp/oy.. 2, ClaIm number
THOMAS 5 SHIRlEV OS~ '7 024912
5. You WIlt recelv, a '\,Imp lurn t~k lor 8, To bt maUed by
$ .l!,798.94 08/28/97
If any portion of thl. paym.nt wa. .ubltot to F"trll looom. we, WI Will
IInd you. Form 108eR In JlnUlI')' of tht YII, "ollowlng the dale 0' thll
paymtnt, If you hav.' qu..lIan. about tax... pi.... contaot your tocaJ
office 0' th. Inl.mal R.v.nut S.rvlc. or your Sl.It, tax C()1~tor'. o"I~, AI
appropriate,
3. Qa1fl 01 birth
. 12/05/52
... Oil'
08/13/97
8, Tax wllhh.1d
'$ NONE
...,~~
': . ,: :;...\,
I ,,'.,"
7, Inl.r..t (IncllJdtd In lI.m 5)
$..:. ' 718.03
,"', '
72035
NOTICE. IF YOU NEED TO CONTACT US
FURTHER ABOUT THIS CASE, PLEASE
GIVE THE FULL NAME. DATE OF BIRTH,
AND CLAIM NUMBER OF THE FORMER
EMPLOYEE SHOWN ABOVE AND WRITE
TO THE ADDRESS SHOWN AT THE TOP OF
THIS STATEMENT.
IyHOMAS' H-'SHiil'Liv ".; -,
. un W IUDGe,RD
ERIE PA 16506
PttvlolJ, edition. ert not Ullblt
L
.J
RI ae-17
....,J.;vl1e4
, '
OFFICE OF RETIREMENT PROGRAMS
Jllli.IMln..l','"
IsfATI OP
I SCHEDULE H
FUNERAL EXPENSES,
, ,A:~~~~~~~Js ~Ox~T~~~~f~L _..PI._a'~,Prlat or TV~!._~_.,_.,. ,
PILE NUMBER
.J_~91",Q.Q~~.__~~.!. ~'ile 2197-0588
~:J~:~~
"ioo:"-l~
COMMONWfAlftl m PENNSYLVANIA
INHUITANCf tAX REtURN
IIIID!NI DIC!O!N!
'-
Shirle ,.L!.~oml\!!,_~_~~.~~._..,."".,., ...._....,_.___
ITIM
NUM.IR
DESCRIPTION
1,
A. Pun.ral Exp.n...,
Crernp,tion Costs
Hemorial Service.,. .St ,Murk ),uthoran Church
in ShnnksvillorPn.
Clerllyman,lo'ood.lnko fron1, togethorness " Hhcel-Cash
Clarion Honuuments ,. Ck,Kos..3325r3333,3361.,
Dntea.,8/5 8/18.,10/2
, Admlal'lratlv. Ca.l..
1. P.nonol Ropro..ntotl.o Com million.
Social Socurlty Numbor of Po..onol Ropro.ontatlve,
Voar Comml"lon. paid _,__......,___,___..
I.
AMOUNT
"120,00
1150tOO
2800.00
Declined
2. Attorney Foo. H/ A.
3, Family Exomptlon
Clolmanl _. Nonl!..--,____ Rolatlon.hlp Fo.ther
Add,," of Clolmanl at doe.dont'. d.oth
4.
C.
1.
2,
3.
4.
5.
,6.
7.
8.
SI"ot Addr... -111 7
Clly Ed e
1( es t Riclie Roo.d
,.___~Stolor~ 2ip Cod. 16506
Probate Foo. . . Cash
MI.e.llan.ou. Exp.a....
Clerk of Records,inventory . inheritance Ta,
TOTAL (AI.o ontor on Iin. 9, R.eopllulatlon)
(If mOil .pae.l. n..d.d, In..'' Clddlllonal .h..I. af .am. .1...)
.138tOO
25.00
$ 5233,00
I'
"",,,..,,,,,, 1~,j SCHEDULE I l
COMMmjwl'lI'~ DI p~wa'\Y.~Il^ DEBTS OF DECEDENT, ,
~,--=."~;::::~\:o'''i,:::::''', "" ,h\ORTGAGE LIABILITIES AND~IE~Su PI.a_._.~!',!ICI',Ty~...
~::~~',~~i l' ley, T-l~::I:~-;c~'~:-""-'--'._'--""-"-'''''-'--~_.'-~ 9. 9~_~~~.~,NU~:EtR,.~1 il e .~~;';;=~;;8
ITEM:
NUMBER
DESCRIPTION
'lb. l.2.2I
9/22
9/22
T/31
10/1
9/8
9/6
8/29
9/23
'/97
8/18
7/2.3
9/26
9/29
Total closing costs if sulo completed
Verbal agreement for holding tank or sower escrow
" " " ultra ligh't tor water well
)-mortgage paymentB of 476,87 pluB 5,00 fux work
Ok.M. 3321 7131..ck.K.J336-8/27..Ck.N, 3354-9/23
Balance of mortRage ...
Po., Powor oil Light Company-olectric
Ok.Mot 3335-a119.73..0k.No, 3351-140.40
14' truok-2 days 1235,91 Plue a70,OO gaB" 20 Turn
Auto Insurance cancellation balance
!wp. "otUBo billing..,Ok.Ko, 3350-9/23
USA Ya.te 7/97-9/97 to be reimbursed one month
of 132.25 minus 1/3 110.75 = 121,50
aprint..Local Communication..Ck,Mo, 3322.,8/1
Oyernight letter..Cash
Releaee of saleB agreement of July 21,1997
Ck.)lo, 3356 9/26
Additional water test xharges., .Ok.)lo.3358 9/29
Since the dwelling has not so1.d or clOBflthere
will be many more mortga~e payment_,light bills in
addition to eewor oOBts,(I7,OOO-10,OOO) 1-717-
243-8269,.,to consider there will be an addendum
for final inheritafioe tax oharges,.I hope 8Don,..
Thank Iou"
TOTAL (AI.o .nlor on IIn. \0, R.copllulallanl
(If more space is needQd, inser' ar,/dilional ,heets 0' sam. .ize)
AMOUNT
5061.00
2000,00
565,00
143) ,61
36945,74
1 60, 13
325.91
15.00
16.88
21t50
16.94
10,00
150.00
65.00
$46,786.71
S~~~EMENT OF
ESTIMATED SELlJERIS COSTS
Date.Prepared: CJ" j't J ~ I ;c;q 7 Seller:_ ('-ILL I) "J-4!.fA a. ' -:--
Type Loan: Property: J )hurl )}/JlUU-W /J-i-',Of..
Salo Price: , ~ ~. 5 (J(J Mortgage Amount:
.
,
, .
The following ESTlMA TE Is jiven so that the Sellers will understand approximately what costs will be
deducted from the GrOSI Sale Price at the time Clftheir settlement:
1. Broker's Commission: ~% oU (,:1"1 ~;Jo-{) S .3JC-1D ,(f0
2. 1% Transfer Tax..........""..".."......................................... S ~t:5, CO
3. Notary Fees ............,..,....,..,.......................,.......,..,........,... S L"CiD
4. Deed Preparation........................,......,..,..................,....,.... S~' Db
S. RadonCertification,...............................................,..,....".. S -eo
6. Wood Infestation Inapectlon................................,..,..,....... $ ..3S, DD
7. Private On-Lot Sewage System InSpection.................,...~... S, a
8. Water Analysis Report,.................................................. ;,01, f;J ~-
.. RoofCo<tlfl_..................................:.......................... .."
10. Home Warranty Program................................................... $ ~
11. Home Inspection Fee.........,......................................,........ S~_
12, 10K Program,..............,............,....,............"".."....,........" S .0.-
13. Buyers Closing Costs."."."""".".."".."..,.......""......."...... S -1:r
14. ~ort8a8eJ.>~r~~A~U~~~:rj~)~.~~......""........,......".... S G-
IS. Settlement or Disbursement Fee.."..."",....""...",.............. S 35: OD
16. FHAlVA Fees (Total estimate ofS400).....".."...."....."..... $ -e- I
17.' 1J,t) 1(, I -ff'\ !.I~i-h.u:".. (Jqt,!lLf,j,y......"......."".... $ UXKllO'ill, tBonull~tormined
TOTAL ESTIMATED SELLINdBXP~NSES"."".......,............" S by final closing charges"
.
"
,
\
(4~1J&' I.
'PJWV A np\tllODl nquln Iht ttI1. to P'Y oto1aIa JI1M&oat _y......... p,. may WI)' ocoe>nlln.lO I"', Allow Mh_inoludto 1noptoll0000.)'$SO,OO .....
P1ooc1Cct181la1loallIO.OO. Tox Strvl.. PooIS100.00. NolIIy P-'$IO.OO. MiJoolI....... PtttI$30.00 "~'I5"OO $41... " .e \r
Total deductlonsat settlement are estimated as follows: I :; 0 ( fi n:.. i.f ()), 7 tu-'t'
S ' Estimated Selling Expenses ? tU: )
$ Estimate Payoll First Mortgage ./
S Estimate Payoll Additional Mortgage/Liens ,€ f, 1', III lit? r:t
$ TOTAL ESTIMATED DEDUCTIONS C .l (' (I f'
Based on the above estimates, approximate proceeds at settlement may be: v $ 'n
$_ ' Gross Sale Price r"--
$ Less Total Estimated Deductl,ons ...;;l-#.S
$ _ Estimated Proceeds at Settlement
The above flgures Include payolllnformatlon provided by Sellers. and may not Include payoll of all liens, encumbrances,
prDperty taxes or epllOlal asseBBments. All payoffs and/or release of existing mortgages and liens will be deducted from
your proceeds at setllement.
I/We hereby acknowledge receipt of a copy of this Stateme,nt, of Estll11J!Pd SfJlle~s Costs, and understatld and agree to ..-
the charges Indicated herein... ~ ",-'- -~ (/ .' /'
Wlt'!e..: ", _/"7/A. .' ,4 (S'",)
S:..-i,(Ml1 PI ,) Jj jUrI) ) ts'.: . ". (Seller)
~ ' (Seller)
Rev. 9/95 c7-1 97" 0 .J7r
\.
'i"""""
_ _ ;,,,..H........
,-,
y?,~~_~~7'
9/22/97
c/O Lisa
~Ol M~, Donald "ioknrds
Froml Thomas Shirley
REI Shi~ley Estate
Sil'l
.. .-" -.. .' T, '-- '
-
wi thin th" 1I ' U' you I'espond in wri tinH .!1lli that Buyer
~ Att'y foes have beon solved..IJwas under the impression the
septic systom was in satisfory condition l met the standards
for a 2 bodrm ~ bathdwelling..Iet, you let the personal views
of the septic inspector .. Att'y , not substantiRted, prevail.~
lIere's a willing sullor who offer It llcldi tionul sum of 1I2 ,000 -r;;.
a hOldin~1fneoded but not wanted plus ~5()5.00 1'01' u ultra light
~ -
for water well., 1'he \12,000 cOllld have bl!en escrowed for buyor
for sewer costs of 1998.. No resonse...
In the meantime, I would appreciate to known if the loan was or
was not approved' tho namo of the loan originator & Chief
Under1(ri tor..
In addition, I'm not interested in selling S.P. under land
contract.We only discussed this and not agreed to this type of
1'inancing..l"urthermore, I ,wuld lilte H.l,.S, data be ill
advertizing regarding 2 Groen Hendow Dr. " a Hnrket Analysis..
Do not release deposit money, 1 did not sonsent to this nction..
Please respond only in tho written word, we do not seem to
solve p~oblems by discussion -only crente thom...
'l'hank Iou,.
.~
~G . uck,..
. . .~,~~..../.
~~ ^/J
~ ~//
. /lei7/!.-
~ A/llllp:ilfl! Droup
P. O. Box 3139 Mllwuukee, WI ~3201.3 \39
MONTHLY MORTGAGE STATEMENT
Sllllcmenl Dale:
Loan Number:
hllerell Rile;
09/02/91
0370006017
6 . 50000\
PleiN tClfer '0 lhe! rcyCI"lIO ,hie for Hecl MOrl&t.lllC Oroup .ddreucl.
PAYMENT DUE DATE:
10/01/91
$416.61
$0.00
$0.00
$5,00
$0.00
$481.67
0075765 01 AD 0.261 "AUTo TO 0 U247 16506 1
1...11.11...1.1.11....11,...1.1.1.1.11,."1.1....111,,,1,.1.11
Current rllymclIt:
f'lIt ()ue Plyllicnl(I):
Ullpaid 1..le Chftrsel:
()lh.1 Chi'S'"
Cr.dil(I):
TOTAl, IIUE,
IBWNCLNN
710800013Q 040 1"
HOMAS S SHIRLey
eSTATE OF)
117 weST RIDGE RD
RIE PA 16506-2505
See back ror import""l informaUnrl.
cusroMElR Sf!RV1CIJ INQU1RII'S:
'!'HLBCOMMUN1CA11ONS I>UV1Cn
FOR nIB ImARlNO IMPAIRIlD:
1-800-562.)167
ProperlY Addle":
2 ORIJEN MUADOW'DR1VIJ
CAIIIJSIl1 I'A 17013.120'1
1-8OQ.900.9QS I
.
-
-
!I!I
..
..
iM
-
-
~
..
-
ACCOUNT ACMvrrv
IJdt ()pllonll
Po..It..lon Pltn,I..1 Int.,.., ~'crow Q!Mll!!. 11roducts JI'H,,/OCh., TOlII
Pe/05/97 PAYMENT 132.68 263.59 60.60 0.00 0.00 0.00 416.87
beml91 FEE 8ILL FAX FEE 0.00 0.00 0.00 0.00 0.00 5,00. 5.00.
P9/02l97 PAYMENT 133.62 262.65 60.60 0.00 0.00 0.00 416.87
, Prirlclpal DIIIllCO on rfl107.f17
Ea<row Blltn<o on rfl107.f17
S36.945,74
SS49.45
hUcrtal Paid Year 10 Date
TIlIICS Paid Year 10 Dlllc
S2.397.12
SI37,')9
IMPORTANT MESSAGES IN BOX-PLEASE READ
Ac~ording to th6 Fair Credit Raporting Act, you have the right to notify us if we report
any inaccurate information ebout your account to tha credit bureaus. Such notices should
be sent in writing to us at Fleet Mortgage, Attn. Credit Corrections, PO 80~ 100500,
Florenc6, SC 29501.0500.
... Introducing Fleet'S new E~press Information Line (000)' 333.9999 ...
This 6utomated s6rvice is for immediate access to loan information such as verification
of pay~ent receipt, current loan balance, and payment of taK and insurance bills. This
11 an automated information line only. To speak to a customer service representative.
please call our re9ular customer 5ervice phone number at the top of this pageand
press '0' to speak with our staff.
q~t3!fl
I
..... "'...... .'........"...................... ,,'.......... ""...,.h H,...,. ,,'......................... .'..... .....................
lID Ponnsyl....ln Pow" & Light Company
Electric
Service
I
I
For:
T SIIIRLEY
2 OREIlN MIW)OW DR
CARLISLE PA 17013
Customer Senlee
1',0, Box 3500
AllelltowlI PA
. 18106-0500
1.800.342.5775
_,,__For V m..-
,I~IUOR IIILLlNG
\ 01111 frolll Ln-'lllill
IlIymenl Rllceived Sep 2 . 'll1l1nk Youl
IInlullce IL' Orsel) 17, 1997
CIJRlmN'I' CIIAiHT '
Reslde!ltilll, Rule: RS' ~S .AII~ 15. Sep 16
BMIC Sllrvlce
Use: ~W1 K'SWWIIIIIIl\.l\45~ per KWII
~ 1111 7.l\47~ per KWJ 1
Chnrgl's for Electric Serv ice
Your Cuslunwl' NIIJJlIH'1
524 1552 202
UKt' wi..." t'ullinu or \\, illlll:
$ 119.7.1
-119.7.1
$ O.lKJ
M7
17.61)
16.24
$ 40.40
IrQ<'!~<A""<,^": '
,\riO,,, ..f,\m<(l#l1tN!!J~19tifl.)\~'l~h8,j9~<7 ',' . "
,I, "., ", "1
.li;,.'H~,~O,fq
.....-._.......'(..,-'".
1
..(n~'...lnT:lmllld,.~tnm8
am Pennsylvania power & Light Company
,
EleCtric
Service
For:
"SIlIRI.IlY
, 2 GRBEN MBADOW DR
(~RLlSLB I'A 110!3
Customer Sel'vlce
P.O. Box 3,500
AllenlowlI!'A
18106-0500
I'S00.J42-577S
.-
For Y O\lr
Information
N.X\llleIOI
reading
011 01 al,oul
Sep 16
Ouesthllls aboul
IT,ls b\1l7,
!'Icllse cOlIlIICt
us by Sep 3
I'RIOIl U1LLlNG
Tolal from Last Bill
Paymentlleceived Aug 7 -1111lllk You I
RellllllCd Che\\k Amollnt
AI\1U\IIlt YO\l Stili Owe
CIJRREN'I' CIIARGI~S _JII\1Ii. A\lg IS
Residelllial Rute: RS .
Busic Service
Use: 2(10 KWH ull\,845~ pcr KWH
303 KWH al 7,847~ per KWH
Cllul'gcs fm Electric Service
~1\d~J:l\ll~~y~~,~f~~ S,ep,.~i~~~7.';
524 1552202
l)"t' wht'U 4'nUh..~ UI' wrUinl(
$ 71.79
-71.79
7\.79
$ 71.79
6.47
l7.W
Z3.78
$ 47.94
, ,':- ~ . .c.
.,,:.;,:}\,-.,
....'::.:$'ii~
1)011'1 ~a'l your \llOJrmos\:lllllwcr thull normal whe" V(H' '"'" 011 y"lIIl1ir
conditioner. It will NOT cool f,.,tel. It WIl.1. cool 10 " lower temperllture
IlIml you need "nd wI.,le "l1ergy,
~,
t 3'~
~.~'.
, A RENT.A.WRECK SYSTEM FRANCHISEE
l';U.rnJR,'l ",1;'\, '''I v,. ,/. ~,; )r.l. INt":. li'lil
FlOO'..A.Wf"!f,Ct: O~' ~li:
4340 WIl$l ~Ih ~ool
Erlo. l'oIl(Icytvanl'.l \ ,',(xlli
111'4193..1 ~41
flOURS: ~
"'Noll"'''''
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,1 ('7 mr.~--~'
C '.' 'SI! {, y I,,, . -1 -in,," ft.,
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LOYf,n
VEHICLE NOT TO BE
DRIVEN MORE THAN
MILES RADIUS
FFlOM'-RENTAL OFFICE,
~.
........:':::""'_/DAV
'"
I WEEK.
WCflK 1I:l
l AlAC){)fltSG
1ii!iAT~
II AlAENllR
ONLY PERSONS
LISTED ON AGREEMENT
OR OTHERWISE
AUTHORllED BY LAW
MAY DRIVE VEHICLE
,. \i
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H "
WOll(lH
,\,\ ..Q[l,
STATt
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soc Sf.C,
lNIIN$C~A . illt:-.~-
1(....,( ....-i.- ..J.\.Ll,
00\ Fll!NunS~NS C"RAIlA
POlICV.
Omf'EAT
o REPAIR SHOP
o WAlK.IN
.j 0 'tPAOES'
. .:":' 0 '~EFEHAAL.S
)1 0 OTHEA
'<>'v,..'''' :,;;":: ........
; ." ,. ,l'~ ,. '. 'f""",, -'ft,''''
.mage W. II.' W} - . _ ...' IHI'(,)",JIo \'bi+'lll~,.
By I'lillllrog h:cepCl, you 19'" 10 P.Y 1 1..:ol,'~__/d~j s.AiL ' ,j" . ''(week,' I':'~ lmonth;
In l.tNngl we ""I 10 WIlV. aIItlall1ft'IOihl' ;UU;~(i.teu ol"'~.\" II: 101' 'damAge 10 IhetVF.HICLE.
'4'*" Vou vloltte the termt,on the b.ck ollhll ..;..m.nt.l lJ,.,(t ',;l!1Q d )'I~; ....,....
\1 nUllIng Dedlntl, you clef;:h OW Ind l'IUmII\~f.tMf{ltflillMIY 101', *MBIItf,.,I',~IH'i.NIiI)OI" ql,ulIG ,nd
lothl\lttQ"lIlOwtdby~w. 10' "'''. \ \\
:1'"
POlleT'
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iliiJ:it.'lliJii'*Utc\Ill'4U\[O/(,O'/o,fM j'~;~' I'il,., ",;
1m n.'''''~~1Q u~llmurad :nolo~:,l r,lJ\'I'lInG~ I;n~lrthl~ ;~rml or :mn ,W!\'c~,.... \, 'I: iI.."" ot l;l,\UrnMlI
uII.inlwrhnct h'lllllll uo1e/ OKS A~IOOI~ tOf lT1',mt'11 ~"d ~II ol~N '! "~:W.q~I~I, ' 'Wr.';',,: J"'~5I1rsd
"'...... ,"",.,., ~'A "~_.g\If1Ilolll."IIr.cl'io! 1~'lI'II!') "I\IlIl'!1ll ~ 1II1l1l1tW'lwYIIClllUlll
lilt ~ fJI a~... who 0031 noll\llisllll)' inllurNlCf 10 pay It! MillS an(. '!.lm!lQlil;
1l-D9IT
o<<llWIi
,,/___...n
/ \
- /,',', , )
- .~" ,) ~" .,
I';,y(~.' ..-:--' I
~ TOTAl. DUE
I IWvMF.NT / i
RECEIVED
f'AYMHH /
RECEIVW
-,'f eALANCE
\0:;:. Due
REFUND /~
RECEIVED ~
'You are bound b~ ,me tftrmsllnd condition. on both tides 01 this form. 'You mUll retufn
the Vehlclfl to the S8rne loc::a,1on at which It was rented, unlell olherwi.. noted 8bo"e,
on or b$fore lhe Indicatud due dale. There will be an additlonall.. If lhe Vthldt II not
returned as specllled, There will be a $20.00 pm check (,harge lor aU returned checko.
Wh..re permllled by law, you authorize us to prOCOIS a credit oard voucher {llappllo.bIel
in your nama for all charges. includinO the retaU fair mal1tet vlllue of lOy vehlele no
returned 10 \,IS, aU UIlClS, towing, booting e!l:pensas, oourt costs, penallles, lorlllture. or
ndmlnlstrallvo lees that we k1cur 'or parklno. IralUc and other VIoli;Jllons Incunod by you
during thO Renlal Period, and 10 apply payments towards chargeBln whatevft' orOOr we
~~~:;h~)~cossmY~vour tur". ,below l';O'\S~Ilf'~ made 01\ ,he" P!>~c.,,", "edilce,d
,..../ . "'_"~.:-,,.l f,.w"~.
Rentor's SignA r~~. ;/-.1. ;>::".I~;/I.,;;J;I '....,,' ",. ~ './":'. c./.;~
Add'l Ronter's Slgnat~~'o ,. ~~-:"
CREDIT CARD (IMPRINT)
~X
MC
VI
DC
CD
OS
OTHER
RENTAL ~OENT
OUT,
AUTH" _~.___ Oil. rE .___ AMOUNT._
,
I
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IN
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.
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H.A.#..l.OU- J. J. ~c)J.
~-------- -
RATEI DO NOT INCLUDE FUEL ~i7~JM
OUT [l~ili F 'lilt
IN [gEl 'A ~~ '1/ % y. 'ill[J
--- -
lllJl
lMON1H
[In
ICl
''''HI, 'l
~LL,",RD '.
fN1[il'''i','1I
MILES'" ;\' I' 11 '11.,1
"",,
!lOURS it
3
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ERIE
INSURANCE
GROUP
ERU;
"'" ,._ "..__.~. u .___ _.. - -
NAKED INSURED COpy
p, 0, BOX 1699 ERIE, PA 16630.
CANCELLATION NOTICE
[MAIL DAYE 08/25/97
BALI $15.00
NAMED INSURED
1".11,11",1,1,11""11,,,,1,11
ESTATE OF T SCOTT SHI~LEY
:U17 W RIDGE RD
ERIE PA 16506
[ CANC ELLA TION EFFECTIVE
08/20/97 12.01 AM
SI ANDARD TIME .
POLICV NUMBER Q05 0904832 E
POLICY EFFECTIVE DATE 05/09/97
PIONEER FAMILY AUTO POLICY
WE ARE NOTIFYING YOU THAT THE ABOVE POLICY IS CANCELLED AS. OF THE CANCELLATION
EFFECTIVE HOUR AND DATE SHOWN AflDVE. IF WE HAVE BEEN ASKED TO PROTECT OTHER
INTERESTS, WE ARE REQUIRED TO ADVISE THEM OF THIS CANCELLATION.
,THE REASON FOR THIS ACTION :
ASSURED DECEASED
<t!?flfl
ad &1~j~
***FORMERLY - SHIRLEY. T SCOTT
PREVIOUS BALANCE
UNUSED PREMIUM
PRERENT BALANCE
$303.00
$288.00 CR
$H.OO
PLEASE PAY WITHIN 10 DAYS
00016
KIIP THIS PDRTION 'OR YDUR RECORDS
.. ~.1,~'rt\i,'\IIJ'OIlII!TLQ~r!lWtti\lwM,iij~J,!:~\,~\';':'M i\'~~~Mo"'NTilfi'\~
PREVJOUO BALANCE .......,..... 32,26
PAYMENT II1ANK YOU 32,26.
TRASlt fJERVICE
07/01/97 . 09/30/97 32,26
------.-,
rl.-',,--~. ':"="70:~"."'" E ',':':'''''~
lffcJ\-'Q, \ii!
\.'- -
, .
04/14/97
07104/97
, ;"'"
~;). ,2-- S
6403063
32,26
4J. a .1&
, C~.0$'
06/20197
32.25
P.ym.nll ,rod Charo.. M.dt All" Due D.tl WIN Ap~.r On N.., Stalll\"llnllln'iQlce,
PLlAII RITAIN TNII PORTIOH ~OR YOUR RICOROI
1'-
MAKE
OHECKS
PAYABLE
TO:
V728 (6li71
USA WASTE
CHAMBERS OF PA
P,O.OOX 820466
PHILADELPHIA, PA 19182.0466
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B N V I R 0 NM II N T A 1.0 . II R V I 0 . . AN II 0 II U 0 T. , IN C .
1738 N, 3'"Sueel. Sle, ^. Hlrrlsbura. M 1710Z TDleJ{7171 Z]).61.. fAxl (7171233.2699
Statement
[ DATE'j
nUl
-------
I' BILL TO
Thomas Shirley
3117 W. 26th Street
Erie. P^ 16506
9123/97
This is ILn ILtl(l.IIHlum to ~'ILX lottor (1lLtod 9/25/97.. I hope
we IIro in a8roo~uJ\t with this letter. This ILddondum shows
tDtlLl costa to bo 1825 not 1760 . hlLve plLid moro than 1/)
of my ehllro t ,.
TERMS
}~.O~~==E~M~~:'
__ ...""~_._ Q~ RA~~
AMOUNT ENC,
. " ' _ ~'1 -I I
'~.' ..
.I' I,;' :;.,1,;,:
DATE DESCRIPTION
08/1 5/97 8alanee forward
2 Green Meadow Drive-
08127/97 INV'3473
09/23/97 PMH3349
AMOUNT BALANCE
0,00
120,00 120,00
-55,00 65,00
Plyable upon reeelpl . 1,50/, Ille d Irae Iddad 10 II payment' afta 30 daYI, 18% nnually,
. lale ehlraa; ollppllelble If paid at sDlllam I.
^ddlllnnll collection ehlraos may bo lIIellDd It n 1 paid within a ealonable time period.
Make e locks payable 1 Envlroquell,
'r ,.
0.00
T~3'a'o~Ys PAST' :f1-60 DAYS PAS" 6'1. O'DAYS'PASI-oVE~9 7<<1- _____~n'_
DUE DUE DUE PAST DUE AMOUNT DUE
------~-~M-<-1.-- -~+ ~ ,. ~~-- + + .,- ~._..~ ~ _ +_~~ ______-l.__, _._~_"__ __.~ .
,
65,00 0,00 0.00 0,00 565,00
. "--,-.~-~~_.___ ~___"_h__~_ _.._.__ ~__'~_"_
OURRENT
..
1.0/..
GRUGHGEN REALTOR 3800 TEL:1-717~761-0g23
Sep 26 97
12:40 No,003 P,OL
RELEASE AGREEMENT
At the request of ThClmU$ Shirley, it is herein under8tood lInd agreed thftt the Exclusive
Right to Sell Agreement dfttcd July 21, 1997 regarding the properly situated at 2 Groen
Meadow Drive, Carlisle, Penn~ylvl\nia is horein tel'lninated and 1111 cClOditions aro null and
void upon the signing of thill Release Agreement.
Dated: September 2(;, 1997
c:-
Convenient looatlons serving VOIl In Control Pennsylvania
I'" "
GAUGHGEN REALTOR 3800 TEL:I-717-761-0923
Sep 26 97 12 :40 I~o ,P03 P ,03
GENERAL RELEASE
FROM AGREEMENT' OF S/\LE
Agrccmentls made thlR _ day of __ , 1997 by and between ThOlllftS
Shirley, Administrator of the Estate of Thomas S, Shirley, he,cinaftl.\r known a8 SBLLER, and
Gary E, Bardo, hereinafter known as BUYER and lack Gaughen Realtor. hereinaRer known a$
(AGENT).
Wheress, the aforementioned Seller and BUYCI' did eOler into an Agre,emenl for the Sale of Real
Estate dated the 18th day of July, 1997, for the ~ale of the premises situate at 2 Green Meadow
Drive, Carlisle, Pennsylvania, which Agreement is Incorporated herein by reference; and
Whereas, Seller, Buyer and Asent de~ire to declare said Agreement null and void, and mutually
to release one another {tom any and all obligations thereunder: and
Now, therefore, in consideration of the premises and the sum of One ($1.00) Dollar, paid ill hand
each \0 the other, receipt of which is acknowledged, the parties agree that:
Buyer(s) and Sellers here,by mutually release, quit-claim and forever discharge the other
from any and all obligations, complaints, liabilities. claims IInd demands whatsoever by
rea$on of the aforementioned Allreement of Sale, and further the parties do jointly Rnd
severally release, remise, quit.c1aim and forever discharge the said JACK GAUGHEN
REALTOR, its officers, agents, representatives, cooperating brokers and sub. agents, as
well as any Buyer's agents, from any and all obligations, complaints, claims and demands
whatsoever, Agent(s) likewise and reciprocally release Buycl'(s) and Seller(s).
Jack Gaughan Realtor is herein instructed by Seller and Buyer to make payment of the
deposit under said Agreement of Sale to Buyer. in the amount 0($500,00,
In addition, Buyer acknowledges receipt of the sum of $475,00 paid jointly by Seller and
Agent to Buyer as further eonsideration for this General Release, which is accepted in full
consideration of any claims Buyer may have now or in the future against Seller or Agent.
In witness whereof, Seller, Buyer and Agent have hereunto set their hllnd$ and seals the day and
yeRr first above Wollen,
WITNESS:
~_.._.,---
~- ~.~-
Seller ' Date: _
~,~ ::r: ~ ~
If) Iff7~
Buyer Date:_
\, "
---........--
Allcnt
,_ ti f'
GAUGHGEN REALTOR 3800 TEL:I-717-761-0923
Sep 26 97 12:39 No,003 P.Ol
FAX
1".--
~.
I D.to 9 .(~....j- - 91
L Number of p.pt!s Includlnp covlr ,lle,t " 3
FROM: Karen Slonl1
J.cl< Gaul'1hon Rea/lor
3800 Markel S,,..,'
Clmp Hili, PA 17011
TO' -#_ ./
, I, (!:. ~ )'1..// ,e 1..,6V
Phone
IFoIK Phon.
......._.......
Phon. 717.612.5080
F'K Phone 717-761.0923
---~ -.------
I.c.~~
REMAJKS: 0 Urgenl 0 For your review 0 Reply ASAP 0 Ploue Comment
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IURRAU Of INDIVIDUAL TAXES
INHlRIIAMCE TAX OJYII1ON
Ot:PT., '....1
HAAR1RIUftO, PA 11U:I-0601
COMMONWEALTH 0' PENNIVLV^NIA
DEPARTHENT 0' REVENUE
-
l../
NOTICE Of INHERITANCE TAX
APpRAISEHeNT. ALL,otIAIICE OR OISALlotlANCE
Of DEDUCTIONS AND ASSESSHENT Of TAX
H~;I";"'" ,"-"I
10-12-1998
SHIRI.EV
06-26-1997
21 97-0588
CUMBERlAND
101
t _-A~t R..ltt.d _,J
MAKE CHECK PAVABLE AND REMIT PAVMENT TOI
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE .... RITAIN LOWER PORTION FOR YOUR RECORDS ~
RIV: Ui;j-ix-AFji- iiiii:i7Y-iioYicr-oF-Ytiiiiiiii'ANci-YAX-iiPjiiiA'iiiiiiN'r;-Ai.LoiiAiici-iili---------- - -- ----
DISALLOWANCE DF DEDUCTIONS AND ASSESSMENT OF TAX
THOMAS S FILE ND,21 97-D588 ACN 101 DATE ID-12-1998
TAX RETUIIN liAS' I ) ACCEfTED AS fILED ( X) CHANOED SEE ATTACHED NOT1C~
THOMAS SHIRLEV
5117 W RIDGE RD
ERIE
DATE
IIBTATE OF
DATE 0' DlATH
FILE NUMBER
COUNTY
ACN
THOMAS
PA 16506
ESTATE OF SHIRLEV
RESERVATION CONCERNING FUTURE INTEREST . SEE REVERSE
APPRAISED VALUE OF RETURN BASED ONI ORIGINAL RETURN
1. R..l E.t.t. (Sohedul. A)
2. Stock. .... Bond. (Schedul. II
S. Clo..ly Hold Stook/f.rtner.hip Int.r.tt (Schedul. CI
4. Kort_t/Not.. R....1vlbl. (Schedul. D)
5. C.oh/lonl< Depod b/Hhc. f.r.en.l froperty I Schedull E I
6. Jointly o.nod property (SchedUl. fl
7. Tron.fort (Sohedul. 0)
8. Tobl Au.to
MOTEl To lnlur. proper
or.eli t to your 1lO0ount I
.ubII1t the _r porUon
of thh foro with your
t.. pa_t.
66.50!Lll.
.00
.00
.00
15.437.37
.00
.00
(8)
(1)
(2)
(51
(4)
(51
(6)
In
81,937~
APPROVED DEDUCTIONS AND EXEMPTIONS I
9. Funerel Expen.../Ad.. Coate/Hilc. Exp.n... (Sohedule H)
10. o.bt./Nort.... lilbilitia./Li.n. (Schedul. 11
11. Tot.l Daduotien.
12. Not Value of T.. R.turn
15. Cheritlbl./oo.arnoental I.que.t.l Non-.l.ctad 9115 Tru.tt
14. Not Value of E.t.t. Subj.ct to T..
5,233.00
(9)_
(10)
41.725.71
en)
(2)_
US)
(4)
Ii' .QliA 71
34,978.66
.00
34,978.66
(Schedul. J)
If .n ........nt w.. i..u.d previDu.ly, line. 14. 15 .nd/Dr 16, 17 .nd II will
r..l.at figur.. th.t includ. the tDt.l Df ~ r.turn. ....s..d tD d.t..
ASSESSMENT OF TAXI
U. A_t of line 14 .t Spcutal rot. US I
16. Aoount of Line 14 t..abla at Line.l/Cla.. A rata (16)
17. Aoount cf Line 14 t..ebl. .t Coll.tar.l/Cl... I r.t. (17)
18. Princlp.l T.x Duo
TAX CREDITS I
\ ..::;!."
L-.
INTEREST IS CHARGED THROUGH 10-27-1998
AT THE RATES APPLICABLE AS OUTLINED ON THE
REVERSE SIDE OF THIS FORM
NOTE I
.DO )( .00.
34,978.66 X .06.
.0l!.x.15.
U81
.00
2,098.72
.00
2,098.72
RECEIfT
_IER
AA242321
DISCOUNT 1+)
INTEREST/PEN fAID (-I
.00
AIlOUIlT fAID J
1,795.06
TOTAL TAX CREDIT
BALANCI OF TAX DUE
INTEREST AND PEN.
TOTAL DUI
1,795.06
303.66
16.13
319.79
. If PAID AfT~R DATE INDICATED, SEE REVERSE
fOR CALCULATION Of ADDITIONAL INT~REST.
I If TOTAL DUE IS lESS THAN .1, NO PAVHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU KAV IE DUE
A REfUND. SEE REVERSE SIDE Of THIS FOIIN fOR IN$TRUGTIONS.I
S
,
RESERVATlOHI Ett.t.. of dH-.nh d~.", on or b.tar. o.a"r 12, 1912 ... If MY future lnt.,...t in tM'lstet.'... trln.t'rrH
In po.....Son or ,"jo~t to Cl... . (0011."r.l) bentflo1.r... of ,he decedent,'ft.r the 'MPiretSon of InY I.t.t. for
Uf. or for y.,r" the (~.1th hereby .xpr...hl r"erVI' 'the rJllht to tlPpr,h. Md "M" tflln.f.r, Inheritance T.KI.
.t the .,,'ul Cl... I (0011.t.r.l1 r.te on InY .uch tutur. Int.r..t.
~IIF
NOTICE I To fulfill the r~lr..-nt. of S.otlon Zl~O of the J~rltenc. .nd Ett.t. T.~ Aot, Act 21 of 1995. (12 P.5.
s.cUon 9UU.
PAYMENT, htlKlh the top portion of thit: MoUe. end .ubIllt with your p.v.nt to the Rqht.r of Wllh printed on ,hit uv.n. .....
~-tWt. oheotl or HOeY ordll,. plyebl. tOI REOIBTSR OF MILLS, AGENT
RIf\ItD (CR)I A r.fund of . tax ored1t, which WI' not nqtMlt<<l on ttw llx R.turn, IIY 1M r~.ted by a_l.tlne ..,'"AppUo.Uon
for R.fund of P.""ylv.,.. InherltMOI Md E.t.t. hx" (REy-un). Appl1c.Uon. .r. ..,.Ilel. ..t the Offic.
of the R..I.t.r of Will., ~y of the 23 R.venue DI.tr!ot Offl~.., or by calline the .psol.1 24-hour
~...rlng ..rvloe ~r. for for.. orderlngl In Penn.yl.,enl. l.aOORS62-2050, out. Ide Penn,yI.,""I, end
within locIl Halrrltburg Ir.. (117) 7a7-a094, TOO' (117) 772-2252 (....rlng 1.,llred OnlY).
DlJECl'JOHSI Any parb In Intar..t not ..thfl~ with the apprlta...nt, .uowenc. or db.llwance of cNducIUonl, or .....NtIflt
of tlX (Inoludlng dllGount or Inter'lt) .. .hoNn an thl. Notloe .u.t ob1ect within .Ixty (60) dlYI of recl.pt of
thl. NoUc. bYI
--written prot..t to thl PA Depart..nt of R.venutl, loard of I\ppuh, o.pt. 281021, HerrtabUr" PA 17lZ1R1021, OR
..lllcUon to hlv. the uttar det.r.lned at audlt of thl IKIcount of tM par.onal repr..antatlva, OR
--."..1 to the Orphen.' Court.
AIIIIIN
IITllAn""
COIRECTJOMSI
Fetotu.l .rror. dllGov.red on thh .....uent .hould bs addr....d III ..rltlng tal PA o.p.rtlMl'lt of Ra.,.,.,.,
lureau of Indlvl~1 'axI', ATTNl po.t A.....eent R~vlew Unit, Dept. Z10601, HerrJ.burg, PA 17121.0601
pt~ (717) 711-6505. See p... 5 of the booklet "In.truetlonl for Innerlt~. 'IX R.turn for I R..ldent
Decedent.. (REY-IS01) for 8M explanation of adlll1l.tr.tlvely ~orr.etlbl. .rror..
DIICOUIfTI
If ~y tlX dUe I. p.ld within thr" (1) cllandtr ~th. after the OIe~t'. death, a flva peroant (5X) dl.oount of
tM tlX paid It allowd.
The lSX tax _.t)' non.perUclp.Uon plf\lllty It cOIIPutld on thl total of thl t.x and Int.r..t .....Hd, end not
paid before ~rY 18, 1996, the flr.t da~ .ft.r the end of the t.x .-na.ty period. lhi, non.p.rtlclpatlon
penalty II .....Iabl. In tM .... HnMr and In the the .... U.. parlod a. YOU would app..l tM taM ... Int.I'I.t
thait hat bMn .....ud .. Indlc.tad on thll noUc..
PENAL TVI
INTEREST I
Int"r..t It ohllrpcl ..Imine with "Irst day of d.l1nquenoy, or oint (,) ItOnth. end OM (Jl day frOll thl .t. of
dHith, tc ,,'hi date of PIYNnt, '1M.. which bae... dallnquent blt'or. Janulry 1, 1982 bur Int.ra.t .t the rat. of
.Ix (6X) percant par annua ~Ilculatad It a d.lly r.tl of .000164. All t.XI. which bee... dallnquent on end .ft.r
January 1, 1'81 .111 balr Int.r.st .t a rata Nhlch will v.ry froa Clland8r yaar to cal.ndar yaar with thlt r.t.
.nnounced by the PA o.p.rtMnt of R.yanu.. ThI appllcabll Int.r.,t rltl" for 1982 through 1998 .ral
l!!!: Intlr..t RlIt. DIllY lnt.r..t Factor !!!r lnt.ra..t Rita Dally lntara.t fector
1981 20X .DDO~8 1981 ,Yo .000247
19&5 16X .000418 1988-1991 m .000501
I'" llX .000301 1992 9X .0001tt7
19&5 15X . DOesS6 1995-1'" n .000192
19.. lOX .000214 1995-1998 9X .000241
....Int.r..t I. oaloulat.d .. follow'l
IIITERBlT . IALANCE OF TAX UIl1'AIO X NUHIER OF DAY8 OELlHQUENT X DAILY INTERER't FACTOR
....Any Nottoa t.~ .ft.r the tax bec~' ~llnqtMNlt will r.fl.ct In Intara.t o.lculatlon to flft..n (IS) d.y.
beyond thl ata of thl ......Mnt. If ".VHnt It ... .ftlr the l"t.ra.t COIIput.Uon dati shOWn on thl
Notlc., additional Intara.t .u.t be c.lculated.
10-12-1998
SHIRLEY
06-26-1997
21 97-0588
CUMBERLAND
101
~ A....unt R_. U.d 1
I ,:gJq, 79,a"'--.J
.
MAKP CHECK PAYABLE AND REMIT PAYMENT TOI
REGISTER OF WILLS
CUMBERLAND CD COURT HOUSE
CARLISLE, PA 17013
.. RETAIN LOWER PORTION FOR YOUR RECORDS ~
"."" ,. ~ ,"'""q',~'T.~.'!J~~"""!;>!=-O-'-"h'C-'-''''~'-;-'---'- - ~ '-'_-':'~"~""''''.''''''''''''-''''''''''''''''-'''''''-'''''''''''''''''_.....~~~:''"''!''''....._-:..._~."':,_.."':-"'i.~--.-..:-
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BUREAU Qf INDIVIDUAL TAMES
INHERITAMCE TAX DIVISION
DEPT. Z80601
HA~IRIURO. P~ 1112&-OAOI
Ii ore!:;
'l)tl OCT 13 1\11
THQMAs SHIRLEY
3117 W RIDGE RD
ERIGI ;
CL bu "
CUT ALONG THIS LINE
_....--_..........-...~
_.;_._....., -'on .""#"..-,, .,..'"
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE Of INHERITANCE TAM
APPRAISE"ENT, ALLONANCE OR DISALLONANCE
Of DEDUCTIONS AND ASSESS"ENT OF TAM
.1
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
PA)6506
f- ('.
\Jhf~
*
HV.II41'.""("_"1
THOMAS
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T, SHIRLEY. REALTOR
3117 W, RIDGE RD
ERIE. PENNA, 16506,2505
814.838.7526
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IUlllAU UPIIIIIVIIlUALTAlCI.
I_lUlU TAll DIYl.ID14
1lI1'T.....1I
._1_, PA 1111....11
"vnnwT'I".n...'.... . _......-._...~--_."
D.PARTNINT OF RIVIHUI
XNHI!UTANCI! TAX
ITATI!MBNT OF ACCOUNT
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT, 10-D5-1998
(
,.
nv-,."C.II,m.."
THOMAS SHIRLEV
5117 II RIDGE RD
ERIE
DATI
IITATI OF
DATI OF DIATH
FILl NUalR
COUNTY
ACN
11 ,. 50 -1998
SHIRLEV
06-26-1997
21 97-0588
CUMBERLAND
101
_t R_ltted
THOMAS
S
PA 16506
I
MAKI CHICK PAYAaLI AND RINU PAVNINT TOI
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE, To in...... pr_r 0...11 t to ,our ..........t, ......it the _r portion of thh fo... with,...... to ..._t \
CUT ALONG THII LlNI ~ RITAIN LOIlIR PORTION FOR YOUR RICORDI ~
iti'v:U,li'f-ijc--Ajrji"-CiiY:nr------...--ij:'iiiliii'AHcrm--i;'A'fiiiIN,-'OF-AccoUiif--ii..------'---------------
18'l'ATI OF SHIRLEV THOMAS S FILl NO.2l 97-0588 ACN Ul DATI 11-30-1998
THII ITATIHENT II I'_IDED TO ADVISE OF THE CURRENT lTATUS OF THE STATED AtH IN THE NAHED ESTATE. 1- IELOII
II A _RY UP THE I'RIIlCIPAL TAM DUE, APPLICATION OF ALL I'AYIIENTI, THE CUllIIENT IALAllCE, AlII, IF AI'I'LICAlLE,
A PROJECTED INTEleST flIUlE.
PRINCIPAL TAX DUE'_.__"".._____".__,____
2,098.72
.......-""--..-.---..........-...----..-.-------.
PAVMEN1S (TAX CREDITS),
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
10-06-1997 AA242321 .00 1,795.06 .
AA296765 14.85- 51~?f9 .'
10-10-1998 \"'; ----I
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TOTAL TAX CRIDIT 2,100.00
SALANCI OF TAX DUI 1. 2eCR
INTIRIST AND PIN. .00
p IF I'AID AFTER THII DATE, SEE REVERSE TOTAL DUI 1. 28CR
IIDE FOR CALCULATION OF ADDITIONAL INTEREIT.
e IF TOTAL DUE II LEU THAll II,
NO I'AYlIENT IS REllUIRED.
IF TOTAL DUE II REFLECTED AS A "CREDIT" eCRI,
YDU NAY IE DUE A IlEFlIII. SEE REVEIISE lID!! OF TH18 FotlIt FOIl IH8TIlUCTIOHI.
~y,M.',t,i~,'1!".,-..-
'A_'
Ii"'" the top partlon of thll MOtto. ... ....It with voqr ,.~t ... ,.yllblo to thrI .- Ilnd Iddr...
",Int_ on the rfWlf''' ,.-.
If IEllbE111 Dt:CEIlENT ..... _ 0' ...... 0'.' ......1. to, REOISTER OF "ILLS, AgENT.
If MDIl-llEllbE111 IIECl!DEHI _. _ 0' _. 0'.' ......1. to, CottHOHtlEAL T" OF PE_VLVANIA.
... (CRl1 . refund .f . teM ored't. whloh .... not ,...,..tttd on thI 11M Return, ..y tMI r....ltlld by ~l.U.... In
~_ll_t1en for Refund of Penneyl.,.,.1a Inherlt..- Md Eltot. '11)(" (lIEY~lS15). Appllqtlona .r. IlVIIUlbl. at
tM Off'" of tM hI..t.r of Willi, ...y of ... n Revenue DlItrlet Office. or frOll the __,,"-'tt. 14..hoUr
.......rlng ..,.y.l.. ......r. for tONlI 0,..1'11'411 In P<<w1.ylvlnla 1*....,.562-2050, nut,'de Pennlll'lvenla
Md ..Ithln local ~rl~r. .r.. (?Il) 7.7."", TPOI (717) 77Z.2252 CHaIring J.,.lr~ onl~).
_LV TOI
...Uon. ,.","dlng orror. GOntalMd on thll noUce should" IMtdr..'" tos PA Deptlr~t of R....., Iu,....
of Indllll_l hlC." ATTHI POlt ,....-.nt Revl.., Unit, IMpt. 2Ilftl1, Harrhbur., Pi 1712.....01, phoM
(7171 7I7"'SIS.
DIKCIUNT I
1f IIW tax ... b paid ..Ithln thr.. (5) oal...rl,. IMN'Ithl .ftar the dHedent', dMith, e fin .,.roent (IX) dllOOUnt
of tt. tax ,..ld .. eUow.d.
PlMALTYI
thll lIX hx ......ty nDftw,.rUo1peUon ..-.1 ty 1. ClCMlPUtMl on tM tot.l of the t'M ... Inter..t .....Nd, end not
,.ld "'fDre ........ry 1&, 1"', the fint dey .fter the Met of the hx ....ty pIIr lod.
lNtQf:lt ,
Int.r..t .. ahIIr.... _Imine ..Ith fir.t MY of delinqusnoy, Qr nlM (9J IIOnth. end OM (1) MY frOll thl dIIt. of
..Ith, to the dIIte of ...~tn '.M.. Mh.ch bee_ delinquent before ....ry 1, 1912 beIlr l"tere,t et the rete of
.Ix (6)C) per""t per ~ caloulet_ et e delly nte of .0001&4. All taxes WlIch bee_ dlllinquent on Ind .fter
~ry 1, 1912 ..111 ~r 1nt.r..t et . rite which wl11 Vlry froe celendsr v-er to cIlendar ~r ..lth tn.t r.tl
ennounoed by the PA Dtpert..nt of Revenue. ,.. -..11olbl. lnt.re.t r.t.. for 1912 thrOUlh 1991 Drel
V.., Inter..t It.t. Dellly Intere.t feator ..., Intere.t H.t. Dally Intere.t Feotcr
1M2 20% ....543 1.81 'X .100241
1915 16lC .IIMsa 19aaMl"l IIX ."0501
19M Uk ....JI1 1992 'k ...OZ.7
1915 1Sl< . '''J~ 1993-19M n .101192
1... l.k ....U. 1995Ml991 .k .IOOZ47
.wlntere.t 1. oeloullted .. fallOWII
IImlUI'I' . BALANCE ClF TAlC UNPAID X IMIIBI OF DA YB DELINqUENT X DULY IIITBIIBT FACTOI
--Any Nott., 1....... .ft.r the tax beooM. .1I,",*,t will refl_t In lnter..t aalculation to flftilln nl) _W'
beyond the dltlof the .....lMnt. If pav.nt 11 ... IU.r thl l"t.r..t OOIlPUteUon dlt. IIhoYn on the
Motl", additional Int.re.t .u.t be aeloul.tld.
....-.-..-~,--~.
STATUS R~PORT UNDER RULE 6.12
.Name of Decedent I
Date of Death I
Will No,
No Vill
Admin. No. 1997-00588
Pureuant to Rule 6.12 of the Supreme Court Orphans'
Court Rulee, I report the following with respect to completion of
the admlnietratlon of the above-captioned estatel
1. State whether administration of the estate is complete I
Yes X No
2. If the answer is No, state when the personal
representative reasonably believes that the adminietration will be
complete I NIl.
3. If the answer to No. I is_ state the following I
a. Did the personal representative file a final
. NIl. account with the Court? Yes No
-.._--
NIl. b. The separate Orphans' Court No. (if any) for
the personal representative's account is:
c. Did the personal representative state an
account informally to the parties in interest? Yes-1l__ No
d. Copies of receipts, releases, joinders andl ~ather-
approvale of formal or informal accounts may be filed with the/only
NIl. Cerk of the Orphans' Court and may be attached to this report./survivort.
~ -//.' P~.J
Datel,5/10/99 ...u~-~"'~
. S gnat"" ' 7-
Thomas Harris Shirley
Name (Please type or print)
)117 Vest Ridae Udt,Erie,Pat,
Address 16506-2505
(814 I 838-7526
Te I. No.
Capacl t y:
yyyy Personal Representative
Counsel for personal
representative
(MAH I rmt! AM))
1l~,;\!',,,,"'!I
C~~b.rland Co~nty - Regi.ter Of Wills
Hanover and High street
Carlisle, PA 17013 .
Phone: (717) 240-6345
Date: 4/27/1999
THOMAS H SHIRLEY
3117 WEST RIDGE RD
ERIE, PA 16506
REI Estate of SHIRLEY THOMAS SCOTT
File Number: 1997-00588
Dear Sir/Madam:
It has come to my attention that you have not filed the Statue Report
by Personal Representative (Rule 6.12) in the above captiqaed e8tate~
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103
SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after July 1,
1992, the personal representative or his counsel, within two (2) years of
the decedent's death, shall file with the Register of Wills a Status Report
of completed or uncompleted administration.
,This filing will become delinquent on: 6/26/1999.
Your prompt attention to thie matter will be appreciated.
. Thank You.
Sincerely,
\/)((WI(l.)f.lU~Jut!1)1AA)
MARY C. LEWIS ' ~~
REGISTER OF WILLS
,
ec: 'rUe.
!eYRe 81
.11111,.