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CERTIFICATION OF NOTICE UNDER RULE 5.61al
Name or Decedent. PHYLLIS Cj HAMBURG
Date of Death I JULY 16, 1997
Will No. 1997-00625
.
Admin. No.
219'1-0625
To the Re~isLerl
I certify that noti~e of beneficial interest required by
Rule 5.6(a) of the Orphans' Court RUles was served owor mailed to
th;. (ollowin~ beneficiaries uf the above-captioned estate on
AU.3UST 12 I ' 1997 I
Nall'e Address
JAMES B. GEBHARD, 630 DEVONSHIRE "
DRIVE, CARLISLE, PI'. 17013
VELMA B. G,EBHARD, 630 DEVONSHIRE DR;J;VE, CARLISLE, PA 17013
W.ILLIAM S. FAIRALl" 5050 TAMARUS ST. NO. 46, LOS VEGAS, NV 89119
Notice has now been given to all per80ns entitled thereto under
Rule 5.6(a) except
Datel ;:j I'z../t; 7
.. ..
~ct:/P'. ~
Signature
Name DAVID A. BARIC, ESQUIRE
Andress' 17 WEST SOUTH STREET
CARLISLE, PENNSYLVANIA 17013
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Telephone.l1,l7J 249-6873
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U: I.! n ()'1" Ii;.
capacity.,
x
Personal Representative
Counsel for personal
representative
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FAMILY SETTLEMENT AND FINAL &~LEASE
.I.t:l
PHYLLIS C. HAMBURG! DECmASEQ
KNOW ALL MEN BY THESE PRlllSENTS, that WHERlllAS, Phyllis C.
Iiamburq, late of Cumberland County, I,"ennsylvania, died testate on
JUly 16, 1997, having first made her last will and testament, which
. was duly execuhd on November 29, 19951
WHEREAS, the said, Phyllis c. Hamburg, by theafo~esaid last
will an~ te~tament, named James B. Gebhard and Velma B, Gebhard, as
co-Exeoutors of said ~ast will and testament I
WliERlllAS, letters testaml3ntary on the estate of the said
decedent were dUlY issued by the Register of Wills of Cumberland,
Pennsylvania, to the said lllxecutors, hereina.fter called pe1730nal
representatives.
'WHEREAS, the personal representatives have gathered the assets
of the e'state of. the said deceden~ and the assets oonsist of both
real property and personal p,roperty, to a total value of
$BB, !)03'~ 15, as set forth in lllxhibit A, which is a statement of
acoount of the ,said perllonal representatives, and which is ~ttached
hereto and made'a part hereof, an~ marked Exhibit AI
WHEREAS, the debts and deductions, inoluding the Payment of
inheritance tax in the said estate, amount to $17,127.60, as
fti'rtherreferenced on ,the Irtheritance Tax Return which is attached
hereto, and macle a part hereof, ancl marked as Exhlbit II e", .leaving a,
balanc~ for distri6ution"of $70,562.t7, also as set forth in the
statement, of the said personal representative, which is attached
her~to and marked mxhibit AI
WH it RillA'S , the personal repr.ssentative hasprevio\l~ly made, a
partial distribution of $2/000.00 to William S. Fair~ll as
refleoted in a Release Agreement attached hereto as Exhibit "0" and
, '
inQorporated herein.
WHEREAS, thll balanoe for C\!atribution as shown in the said
" statement marked IlIxhibit A has been J:'educed to ouh and has been
cUstdbuted AS herein indioated in acoordance with the terms of the
last will andt~stament of the said depedentl
NOW, THIlIREFOR1li, KNOW YIlI, thl't ws, Witliam S,' Fairall, James Il,
Gsbhard and Vslma a. Gebhard, being all of the named heirs of the
said decedent/ and heirs unde~ th~ last will and testament, do
hereby eaoh of us, aoknowledge that we have this day had ant;!
reoeivect" from the aforesaid personal ,representatiVe, in fu:ll
eatisfaotion and p'ayment of all sum or sums of money, legMles,
bequests, and d~~ises as are given, C\eviseC\ ~rid bequ~athed to eaoh
of us respeotively by the said last will and testament, the amounts
due uauhder said last will and testament, which amounts we have
reoeived this ,day, and whioh amounts are in the amount set oppcsito
our t~spective names 1n the table and sohedule of distribution in
, , ,
said statement attaohed hereto and marked JJ:l\hibit AI
AND, each of us does hereby stipulate' that in oJ:'der to, avoid
,the expense andt.tme involved in the filing of a formal aooount and
schedule of distripution, W,e eachagres that no aooount is
neoessary and we do hereby agree that we do dcnsent to distribution
baing made withOUt the filing of an aocount and scheduJ,e of
"
distripution, the same to be with the same,foroe and effeot as if
they had Peen filed and oonfirmed by ,the orphans' Court 'Division of
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the Cou~t of Cumberland county,
THERJIlD'ORE, we and elloh of us, . do hereby r.emise, rClleasel
quitolaim and forever,diacharge the said.personal represent~tive,
~eire, exeoutors, and administrators an~'assigns of and from the
said estate and from all ,aotions, suitE!, payments, acoounts,
reokonings] olaims and demands whateoever for or b~ rClason therClof,
or,for any othClruse, matter, cause or thing whatsoever, touohing
upon the estate of the said decedent I and 'each, o'f us do further
hereby oovenant and agree that should any liability come due to the
estate of the said, deoedent after the signing of this agreement, we
and eaoh of us do hereby oovenant and agree with eaoh other'and the
aforesdd personal representative, that we will oontribute p~o-
~ata, our share of the es'tate to satiSfy any and all oldms,
demands, suits, or causee of aotion whioh may be suocessfully
proseouted against the said estate or the aforesaid per.:sonal
,
'representative after the signing, sealing and delivery of' this
. ' ,
family' settlement agreement and finalrelesse.
, '
IN WITNESS WHEREOF, we have h~reunto set our hands and seals
this 8o-ti-"1 c:Iay Of~rU((t;y 199B,
WITNHlSSl
WiUM' 14(~
~t0 6:..
~t::{;(,
!d~4:.-"J! ~Ua.f/
WILLIAM S. FAIRALL
(SHlAL)
O-(J>J,~t4-4~1; .1fL,?t.Ji.,u.J
;/ JAMIllS. a. GEaliARD, -
(SEAL)
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,~. -' 'Y .' ..- ' } ....--'
l.J ., _ j I I ~_..r,..- It 'j ",,' /L- -
VELMA B. GEBHARD
a...'... ct.", (SEAL)
aLUEi\1EN1' 011 ACCOUNT
J!lt'lTATIJiJ>F fIIVLl.iIS C. HAM.D\lRG
ASSETS VALUE
I. Cel'tlficllte OfDepo~1t No, 122496.1:lonnollll Tru8190. $SQ,405.74
2. Certlficllte of Deposit No. 125058, (1lonnclll\ Trust Co: $15,909.23
3, Checking Account No. 1340007994, Mullon I3nnk $9,085,00
4, Refund trom Cumber\nnd Cr08slngR $1.885,33
5, , ,. Blue Cross/Blue Shield Roftlnd $ 329,56
Totlll:$86,614,86
INTEREST ACCRUING TO ESTATE BE(10RE AND AFTER DEATH
(Portions of which afe Included In the Dnte ofDenth Vntues Set forti, nbove)
,
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Certltlcates ofDepoell:
Mellon Checking Acct, No, 1340007994
Mellon Estllte ChecklnS Ace\. 0002590214
" . . . ,
$4,368.11
$ 108,52
$ 21.76
2,
~,
Totlll: $4,498,39
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DRBTS
1, Carlisle Memorlllt (monument)
$644,88
$168,00,
$387,73
$104,70
$ 45,19
2, ,Westmlnlster Cemetary (pel'petlllll cnl'o)
, 3, " Capstone Phnl'mllcy
4, The Evelllng Sentlnel(ndvertlsomollt)
'5, Cl'esscaroM~dlclI\
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PILI NUMII_
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CO"'\~~.l'lIA '~T01llrJl~WANIA
HAUIIIOJ6, ~A ~llloQ6Ol
INHERITANCE TAX RETURN
RESIDENT DECEDENT
(TO B& PILED IN DUPLICAT&
WITH REGISTER OF WILLS)
21
COUNTY CO e
M
Hamburs, PhylliS c.
r;~~~~~;_~~O IOA~;~O;~'~~~~r~ 15
. GO I, Q,lolnol Rllu,n 0 2. 'Suppl.m.ntal RI.u,n
97
YIAR
005.
NUMIII
1 Longsdorf Way
South Middleton TWp.
c""qarlislll, Pt\ 17013
w 3, R.molnd., R,lUtn
Ifo, dOle' 0' death pllorto 12.\3.821
fedOlol elloll To.
Rllu,n R.qullld
Tolol Number 0' So" D,pOlII 80...
:: ", Limited E 1101e
o 4a, fuluII InlO'''' Camp,omlle 0 $,
Ifo, dolO. 0' dlolh aflll 12.\ 2.821
I]!, 0.' Docld.n, Died T..tolO 0 7. O.Cldlnl Maln'alnld 0 LI'lng T,ulI .a.. 8.
I~op, a' Willi " . (AlIo,h ,op, 0' T,ulll
ALL CORRESPONDINCI AND CONflDINTIA~ TAX INFORMATION SHOULO BI DIRICTlD TOI
~cl A. Baric, ESqUir~COM'~'I';~~N:~:O"~larid& ~rer
, 17 West South Street
Carli81e, PA 17013
1111 $10,314.54
1121 J75, 300.32
1131
1141
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$86,614.85
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1. R.al ellOlO (S,h.dule AI I II -0-
2. SlOck"ond londl (Schedull BI I 21...:.9..:_
3, Clo,.I, H.ld S,o,k/PoMnltlhlp In'lII" (Schldul. 'el (31 - 0-
-0-
4, MOllgog.. and NolO. Rocllvabl. ISchldul. 01 I 41
$, COlh, 80nk Dlpo.11I & MI".lIonlou, P.nonal P,oplllyl $1,
IS,nldul. el
6. Joln.ly Own.d' ProPll', (Schldull FI I 61
7, Tranl'"' (Sch.dul. OIIS,h.dul. LI I 71 -0-
8, TOI~I 0'011 A.II" IlolOllInll \.71
q. funOlol Io..nlll, Admlnl'I/Ollvl COlli, MII..llon'OUI I 01 $ 1 0 , 314. 5!:!
IopI'.II. (Schldul. HI
10, Debl., MONgogl Llobl/ltlll. LI.n. (S,h.dul.11 1101 -O-
Il. TOIol D.duCllonl 1i00olllnll q & 101
12, "III Volu. of e"o'. lline 8 mlnu.lin. 111
! 3. Cho,ltobla ond OomnmlnlOl a.q~I'" (Sch.dull JI
14, N.I Valu. Sub ICI '0 To. II!,' 12 mlllullinl 13)
15, Amounl of lin. 1'4 la.oble 01 0% '01'
Ilnclud. ,o/u.. ',om Sch.dul. K or S,hedule M,)
16, Amounl 01 IInl 14 lo.obll al '5% 'a'.
Ilncludl ,01ulI ftom Scnedull K 0' Sch.dull M.I
8 17,P'I~"pal'a. due (Add 'a. f,om IInl 15 and f,om IIn. 10.1
$ ! l~','-C'Od'I" P,IQr P~ym.nl' Ohcovnl
~: ~_":.O_., + -SAQ.Q...s.B___ _
8 I 10. IIII~. 18 I, g'.ol.' 'nan IIn. 17, .nll, Ihe dlff.renco on IIn. 1'1 Thll II Ih. OVERPAY MINT,
. m~:
a '20. IIlInl 17 " g"OIIl Inon lin. 18, 'nll, thl dilll..nco on line 20. Thlll'lh. TAX DUI,
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',',', ' '.',',',., , 8 enll, 'h. 10101 o'lIn. 20 ond 20A on IInl 208. Thl, IIlhl BALANce DUI,
, '.', , ',',',', " ',: Moka Chock Pavobll tal, RI I.,., II Wille, A Int
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',', , . ',', , . .. 81 SUAI TO ANSWIR ALL QUUTIONION RIVIRIIIID AND TO RICHICK MAT ...-
',', " ....' i I :("'''OIlIU 01 plqurv, I declar. thai I have ,.omlned ItllI "Iurn, including accompanyin", I1:h.dultl and. Uallm.nl" and 10 Ih. bit' 0 my knowl.dg.and bill,;'
I' 't', 'r ,r..t, (o",el and comp,,",. I d.clar. Ihal 011'101'''01. hal'''''" ,.porl.d at !tv. Mark" val".. OlClo,ollon of pttpar" olh" Ihon Ih,p",onal rtp,...nlcUlv. I'
I ',--'U.tfd on 0111"'0'''"0110" 0 which prepa", 'feU 'an., know/.dg,,; _
, " ~'''A'UIII o. '(1\011 tnn:JN',.U 'Oil 'IUNO II11UII,.. -.' AODRlU OAII
. ,.,'~ ~1t t '- 'f:! . ( -.
(151
$38,150.16
$38,150.16
M.U .
(161
Inl'fI"
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Ct..de "... II you .... ,.,.u.stlnfJ a ...'ut..t of ynur OWII'f1Uyment.
1201
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$76,300.32
$ 2.289.00
$ 5,722.52
(171 $ 8,011. 52
(181 $
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AOO.58
$ 7,,610.94
$ 7,610.94
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5CH.DULl H
PUNeRAL expeNses,
ADMINISTRATIVe COSTS AND
MisceLLANeous expeNses
21 - 97 - 0062!J
PI.al. ,Print 0/ T .
DISCRIPTION
Punl/al,hpen.u,
CA~LISLEMEMORIAL
Mon\lment
WESTMINISTER CIMETARY ( Porpet\la1 Care
1.
Admlnl.tratl",. Coli"
Pe..onal R.prllentot've Cammlulon. V. B. ~.
50~lol 5.~urlly Number 01 Perianal R.pr~.ltnIHlrv.. .
Vear CO(nmllllonl paid 199 B
20 - 4626
09 -4971
202
189
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AI'/OIney pe" 0 I Bri en, Baric S. Scherllr
3, Pamily hemptlon NOne
Clolmont Relallonlhlp
Add.." of Clalmllnl of decadenl'. d..th
St.." Add""
Clly
, 51 ole
Zip Cod.
Prabollf pae.
,
Register of Wi118
MI,c,lIanlOu, IMp.nll"
CAPSTONE PHARMACY
CRESSC~RE MEDICAL
THE SENTINEL (Advertisement of letters)
CUMBERLAND LAW ~OURNAL (Advertisement of letters)
SYMPHONY MOBILE X"RAY
TOTAL (AIIO enler on line 'I, Recopltulotlon)
(1/ mOil IpO"," n..ded, Inll'! additional .heats oham. "11)
AMOUNT
$ 644.88
168.00
$4,330.74
$4,330.74
$
226.00
$ 367.73
$ 45.19
$ 104.70
$ 60.00'
$ 16.56
$ 10,314.54
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IIV, 1500 IX+ 117.111
15- ,q~- II
INHERITANCE TAX RETURN
RESIDENT DECEDENT
c04,~~~I~~~Wl'Wlm~ANIA (TO BE PILED IN DUPLICATE 21 97
ItARRllmtb; ~A 19h..06Q1 WITH REGISTER OP WILLS) COUNTY CODe YeAR
~. ...-. " ,..,. .~. "~"'trr== ."".m,unnnnrlli'iir'i1!oMPlirr'Aif6RIIr ..- .....
. I ....IJ.~W,~~.tim-~h'.Ut. fu""..,- r"....~ 1 1,0,,, '0" W.,
___m_.:_.. ..u~~~B 9 ~~9 - 4 ~,~Om..'_. J, 9.2=.!~~~?.7n.,,].~,:'~~~nl~Jf~~~~!.l~,t;::.~: ~.~.~ 7 ~it________
l!! 1X!1.0rlglnaIR.lurn . L ',1 2. Suppla,manlnl Ralu,n Ln. RomalndarfR'Iu'n 11 )
I~ .' IIor dnlal 0 d.alh prlo, 10 2. 3.B2
~ [14. Llmllad Bllnle [J 40. FUIU"alnle'.OII comprom."a ' [:I 5. Fada,n,l ellall Tax
! . (for .dalo, of doalh a'Iar 12.\ 2.B2) Ralurn.Raqulr.d
r::J 7. Dacodanl Malnlalnad a Living TtUII .0... B. Tolal Number of Safe Dapollt Boxo.
Allach eo 0' Trull
....u........_ II D II
II
'ILl NUM'"
-
~~
00625
NUMBeR
----'1:':':
. TCh,"
- - -.-; ;_._,~~,,- ,~/~~-('l~-IHi:~>>LtUi~li-~%-~'"{ ;, .;
O'Brien, BQric &Scherar
17 West South Street
,Oarlisle, PII 17013
( .ml.-2...~ll.1,) _J=~__.._~=,"","=,"'=C q~~.~_
1. R.al B'Ialo (Sch.dulo A) I 11.. :.9:-:.......................,. ,"; ~" . If::
2. Slack I and Bond, (Bchodule B) I 2) ~.-O"-~u_.~~m..'-...~..~. . ,
3. Clo.ely H.ld SloeklPorlne"hlp 11'10,".1 ISchadule CI I 31 ....:2..:......"...n....n~~.._......... ~':
4. Morlgogol and Nole, R.calvobla (Schedul. DI I 41_,-=P..7:_~.._....,."c~,._,._...._ ,.[.
5. Cqlh, Bqnk Dapo.1I1 &.MI"ellonooul Pe"onal P'opo"yl 5) mt~.QI.~_~JJHL..u......_.
15c~edula B)'. _ 0-
6, Jolnlly Ow nod Proparly (Schadulo FI ( 6) -c~u~'~-~-""~,"'"
7. Trdn.'." ISchedule GI (Schedulo LI I 71 ....=:9.:, "".'U"'___'''''''''''''_',
B, Tolnl Gro.. A"ol' (10101 line, 1.7) . ( Bll~_~L~.!..1~.~_:".m__u
9. Funeral Bxpa",o" Admlnlllrollvtl Colli, Mhcallonaoul ( 9).3).Q.l.U.1..tJ3A........... ""
Bxpan,o' (Schadule HI
10, Oobll, MO,Igage Lloblllllo;, Lien, (Sch.dulal) 110IH~.':'..._..._.."...~..._,...__._.
11. T alai D.dvcllon. (Iolalllnol 9 & 101
12. N.' \lolua ole.lole (IIn. B mlnulllna 111
13. Ch~,lIoblo and Govarnmanlol Baqva.tI (Schadul. JI
'14, Nil \lalueSuble" 10 Tax (line 12 mlnulllno 131
15. Amounlo' II.. 14 .Ioxobleol'6% ,ale '
(Inelvdo valulI ',om Sch.dule K 0, Schadul. M.I
16. Amovnlof IIno 14 loxable 01 15% roll
(Inclvde valulI from Schedula K or Schodulo M,)
17, Principal lox duo (Add lox from IIno 15 and from IIna 16,)
lB, Cradlll Prior Poymanl' DIICaunl ,. Inlerlll
._~""O_"'...._.._..m_ + ...$.4 00.56 U' ,,,0,"'''-'-
19,.11 line 18 I, g/eole, Ihan IIna 17, anlo, Iha dlfforonca on lina 19. .Thl'I'lho O\lBRPA YMBNT.
mo "
20, II li~. 17 hgraolor Ihqn line IBi onlor Iha dlff"oncoon IIn. 20, Thll h Ih. TAX OUB. (201 l ,IL6.J.()...,,~_4,_..........
A. en", Ihe Inlera'l on Ih. bolanco duo on line 2QA. (2MI ..".. .._.".. .."".,,,. ............"
D. enla' Ih. 10101 0' lina 20 and 2M an IIn. 20B. Thl, I"h. PALANCB DUB, (20BI $..7,.!31Q151.4.__._..
Make dhuk povable'to!J!!!!!!.fer O,l\yJl'l, Age~L...__. ."..m.".m. . .. ...
~1~~~::~;~~;:;~,€~~&1;;~~~~;~I~~";T~:~~~~~I~~t:~~~.~~;~r~~~~C~~~I~~~~I:~~PuJ~:~~rIJ~:~l~~!~~~~~I~~t~~'~li~~;~:l~:~~~J~a~
!l~fll~ all i.Wt"~~~I.A~D1:jji~~.Pffl"f~;i~;.~hu~~k~0.wla,'266ml." .....". ...n...." .-..... .u__......_~. li}Jr~--...~ "
IR~MiJfi; I .~t/(.~.-!m"u~l'r~:;/u'A.CJ'("f"'~':' ... -"" OAIII.(l-,-.z..:.~q]
~_~_L . n ... :m_._____JLj!~..!.....___._____Jf..!_~'4-1__..!ttfl3 __no .~!~i..?I.iL__.
David ~. Baric, ES9ui~!......__........"_~
l'llf1'ROm:ml1.lnr-
""'l"--~
Ii
I
\.;)
I
, ~
..
,
1111 .HQ,L~J_1.. 54..___......m
112)17.h~.Q.Q .!.n......-'-__m..u.
(13) .~.._~......~~u~.......~._.._'
.____,_J.!.41...Jll11-.300 tJ~=--- _u."-
(15).,.$U,lg,Q..1GnuHnnnX .06,', .$..~IAll.9."OJL~~......n
116)...~},BJ)..~Qd~. ,..~.u"X ,15. .~...,5_!.7.~~'!~_~..,_..,__..
1171 J,."B..1.9J.1.~~~"_~_._...
(1 B) J., .....'!.Q..Qj'!3.IL ...........
119) ,_uu..u___.. _ ..__........__..,
UV,tan .x. I"'~'
5CH.DULI H
,,~~,;~. PUNIRAL IXPBNSBS,
C<;>MMON,~'~LIII onl~NIY>>,AN'AAPMINISTRA TIVI COSTS AND 2 1 - 97 - 0062!5
i1H,.\;;nT~Nlllllll\'I~WI~~DlmR ..,.... MISC."~~~~~US_ 1~.~~_N.~Il~.]_ nmm ,PJ~a.~!!l!n' ~-,JU. . ' .
UTI'TI Or ,. , -, IL* NUMlh"
-----.~ ___....,.....~__n-+~__~.<.=~ _..~__u___~~ ~~, ~~ - - ---- ... -~ ~.~. -.. -~- -~, ....... ",",,- _.."~ ~... - .~----,....",...,..,.....~-
N~T~~IR DISCRIPTION AMOUNT
_,",~~~~~~n~__~_.~,_~.,._.2~~--'-_'_"~'<'__~<'___~~__'~~_~'~_..__~-',<_.~nn_~~'_~~'_~~' .---~-.-'~~---"""''''''
1.
PUn.rallxp,n'.1I
O~RtISLE MEMORIAL ( Monument)
WUSTMINISTER~EMETIIRY ( perpetUal Care
$ 644.1.10
168.00
A,
2.
1.
Admlnl,'ratlv. CO'1I1 ,
P IR I'C'II V.B,O.202.20-4B26
.rlona .pr...nlot v. omm II onl ,T B 0 1 B 9 - 09 .- 4971
Social Security NUfb.roIP.rsonol Reprillbntlllrvo. ..~-_._..__........_.~~.._,
V.ar Commlulonl paid __1.9.9.a.__..._,__
$4,330;74
8.
2,
Allarn.y F.o' olBrien, Bario & Soherer
$4,330.74
3, Family ex.mpllon None
Claimant __.___'-.~'___'__'_ R.lallonlhlp -,_.._~..~.._~-~..
Adllr.1l of Claimant at clecellonl', cl.alh
Street Adclr.I._.....~_..,._---.........n'-..,........._-_.....~....._---.....
, ,
City ___~...,.......c..._....__._.m..m...........Slal. ...........-.. Zip CaclL.._...__.,_,..
Ie' '4. Probate FUI RegiSter of Wills $ 226.00
e, MI.~.lIa"..u. INp.n....
1. OIlPSTONE PHARMIIOY " $ 387,73
2. ORESSCIIRE MEDICAL $ tl5.19
3. TIUl: SENT:tNEL (I\dvarti sement of letters l $ 104,.70
4. CUMBER'[,AND JOURNAL (I\dvert:isemen t , letters l *
LIIW of 60.00
5. SYMPHONY MOBILE X-RIIY * 16.56
I
__ j...._........~_____.........._....;..~----..,<._~.---.--'-<~_._._~'.'.~'n'._~-~~---_...;'-~~~~.,-.._~~,"-------,,_..,-~-~--""""----+- ......_-~-...--.-------------
TOTAL (Allo onlor on 11.1\. 9, R.capIlUlatlon) $ 10/314.54
(If more ;;;a~. I.'n"d.d, I,n",' addltlonClhh'''h oloam. .11.)
, ' -, j
,
HAKI OHIOK PAVAILI ANP RIHXT PAVHINT TO.
REGISTER OF WILLS
, CUHB~RLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THX8 LXNI ' ~ RITAIN LDWIR PORTXON ~CR YOUR RICDRPI ~
~W:!iW.il/'.A~p"r&':nY.Hgi"f6i..d~.'Yil'AiRmltci.VAX.AjI'''~Aiill1iilr..Att..CSWAltoi'..b1i........... ......
, DI8ALLCWA~clnF DIDUOTlONS AND A88 ..HI~T OF TAX .
IITATI DF HAMBURG PHVLLIS C I'XLI NC.21 97.0625 AON 101 DATI 01-19-98
. TAM ReTURH WABI I X I ACCIPTlD AI fILID' e I CltAHOID
RIIIRVATXDN CCNOIRNXNG FUTURI XNTIRIIT . 8URIVIRII
APPRAI81D VALUI OFRITURN BAIID q~1 ORIGINAL RETURN
1. R..l I.t.t. lloh.dul. A)
e. .took. .nd Bond. Clohadul. B)
I. Cla..l~ Hald It~k/P.rtn.rohlp Int.r.at ll~h.dul. 0)
'~. Hort...../Hot.. R.o.ivabl. e'oh.dul. 01
B. C..h/B.nk D.po.it./Hi.o. P.rlon.l Prop.rt~ lloh.dul. I)
6. Jolntl~ own.d Prop.rt~ lloh.dul. P)
7. Tran.f.r. l'oh.dul. 01
.. Tot.l A...t.
AP~RDVID DIDUCTIONS AND'IXIHPTIONI.
~, Pun.rl1,l~p.n.../AdoI. Co.to/Hho. IMp.n... Iloh.dul. HI 191 10,314.54
10. D.bh/Hort.... Li.bU1U../L1.n. ISoh.dul. Xl ' 1101 .00
11. Totll, p.duoUon. ' m'l 10, 1114 . R4
18. H.t V.1u., of T'~' R.turn, nu 76,300.32
11. Ch.r1bbl./lIoy.rnMnhl8aq\l..hl Non-.l.ot.d 9111 Tru.h lloh.dul. Jj IUI .no
14., H.t V.1U. of lat.t. lubj.ot to T.~' n41 76,300 , 32
NOTII If.n ......m.nt W" i..uld preViou.1Y, lin.',14, IS.nd/or 16, 17 .nd 18 Will
r.fleot fiGl.\rll th.t inoludethe total, of AlJ,. r''l:urn. .......d to d.t..
AISalSHINT 01' TAXI .
11. A.ount of L1n. 14 .t IPoU"!.' r.h \111 .00 M' 00. .00
16, AoIo4l1t of Lin. 14 t.Mllbl..t L1n..l/Cl... A'r.t. (16) 38,190.16 M .06. 2.289.00
17. A_t of l.ln. 14 t.Mabl..t coU.t.rIl/Cl... I r.t. (17) 38.150,16 K .15. B,722.B2
11, Pr1n01p.l TaM ll\I!I nl) B.,01l.B2
TAX ORaDlTSI
PAVHIHT
DATI
/5,"/(/.3-//
OOHHONWIALTH OF PENNSVLVANIA
DIPARTHINT OF RIVINUE
HOHCI oP XHHIRXTANoe TAM
APfRAXBIHENT, ALLOWANCE OR DISALLOWANCE
OP oBDUCTIONI AND AIIEIIHENT Of TAM
.URIAU Of XNDIVXDUAL TAMIl
I,"RITAIICI lAX PIVIUIlIt
DltPT. UUOI
IIARRIUURO. PA 11110.0001
DAVID A BARIC ESQ
OBRIEN ETAL
11 W SOUTH ST
CARLJSLE PA 17013
DATI
UTATI OF
DATI OF PlATH
FILl NUHIIR
OOUNTV
ACN
01-19-98
HAMBURG
07-16-97
21 97-0625
CUMBERLAND
101 '
A.ount R..1U.d
I
III
III
lU
I~)
Ul
161
17l
.00
.00
.00
.oq
86,61tL86
iOO
;00
lal
AICUPT
HUHleR
, DXlCDUHT C')
XHTlR8IT/PIHPAJD I")
AHOUNT PAXD
TOTAL TAX ORIDIT
BALANOI OF TAX DUI
INTIRIST AND PIN.
TOTAL DUI
'.
m. uu II UP ut..,.
PHYLLIS
c
HOTEl To 1n.ur. prop.r
'or.dlt to ~oUr .ooount,
.u~.1t th. UPP.r 'port10n
of th1. for. w1th your
t.~ P'YMtnt.
86.614,86
0,011.52
.00
.00
,00
M If PAlO AFTIR DATE XNDICATID, lIe REVERSI
fOR CALCULATtON OF ADDXTXONAL XNTeREIT.
XF ToTAL DUE XI LIla THAN .1, NO PAYHENT II RIQUIREO.
IF TOTAL DUI II RBPLEClBD AI A '''CREDIT'' ICA" YOU HAV BE DUE
A REfUND. lEe REVERIe SIDE OF THU PORH paR XNSTRUCTIONS. I