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HomeMy WebLinkAbout97-00713 I. . --_WI .-..- JJI ......... - - 0 .0 ..0 - 0 .. .. 1::::"':1~ '.............. I 1 I I I .0 ... ....... lYcdlCM..""" ,... ....... ~.WONCt OIICMI """"'"'(lCQIIIltO- o o o - -- CNf......*""'*' 011 ........................... -..- ... *. """.. ~ .. ~ ~ ... 0..0 .:IN1Il. . IL,f)nl 'I', lfl~ ~ :Jj 0 0 ~j U ~ ... ~ .~" 111 ~ I:l i'-I ~ ~ ~ >Cl A '~ ~ ~. ~ ~ <i ~ j ~ ~ (fJ ifi ~ tfl ~ ~ ~ 0 ,,' ,. A ~. '^ 0 1. ~ ~, " ,. ~ V, 0 ~ :i ~ e ~i1 ~ ~ 7 ~, ~ ~ ~ ;. .1 ~ ~ ~. ~ N J m tfl ~ ~ ;II , < , 0 (.I 0 H " 0 L , ,..1 ...] ~ ~ ,-1 r ~, ,.1 ~ 0 " H <' ... V, 111 .-,. 0 i'-I " ~ ,~ ;: ~ H f~ ~ N ~ 3 I-< <: --~ fl.I ill ~. ;,'.':'~ :,,~":'I;:~n'j-:;itt~ .-"j_~"'f' ,. ~, .... . t,'t ~., ~ , LAST WILL AND TESTAMENT OF Ci1RLOU. SHADE I, CARLOS F.. SHAm~, 1I resident of Wormleysburg Borough, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, pub lish and declare this instrument to be my Last Will and Testament, hereby revoking any and all wills by me at any time heretofore made, ITEM I: I direct my. hend.nafter named Executor to pay all my just debts, funeral expenses, administration expenses and inheritance, estate, succession or excise taxes, which I owe or may become due on account of my death, as soon as may be convenient after my decease. ITEM II, I give, devise and bequeath the sum of Five Thousand Dollars ($5,000.00) to each my brother, Paul W. Shade, of 24 Valley Road, Wyomissing Hills, Pennsylvania, and my sister, G1adya Smeal, of 7 Marshall Drive, Camp Hill, Pennsylvania. A. If my said brother or sister should predecease me or die simultaneously with me, then said share shall lapse and be included in the residue of my estate. ITEM III: All the rest, residue and remainder of my estate, be it real, personal or mixed, of whatever nature and wheresoever situate which I may own or have the right to dispose of at the time of my decease, I give, devise and bequeath to Ira C. Mellinger, Jr., of 30 South Front Street, Wormleysburg, Pennsylvania. A. If the said Ira C. Mellinger, Jr. should predecease me or die simultaneously with me, then I give, devise and bequeath all the rest, residue and remainder of my estate to be divided equally between my brother, Paul W. Shade, and my sister, Gladys Smeal. ITEM IV: I hereby nominate, constitute and appoint Ira C. Mellinger, Jr., Executor of this my Last \<Jill and Testament, r!~ld'rd1 6:. t~ ~~d.r ar OB . a e (SEAL) , . CCM!/f~~~tIiT~\(~s".fit.NI'Ill\~ aNla Ha"",.i5~Q,~a '~b.06.1 ',) '- / 'ie;. 'I INHERITANCE TAX RETURN RESIDENT DECEDENT (TO BE filLED IN DUPLICATE WITH REGISTER OF WILLS Al!v.lSOOE)( . (7.\J"1 paR DArES o~ DEATH AFTER \2IJlIgl CHECK HERE IFA'lI'OU!jAt. D !ll.~~_ FILE NUMIER C A I H P L E P 0 C R C K 0 K P S VEAr' q '1 ,/13 NUMBE" B C , OlW60ENT'S NAME (LA9T, FIRST, AND MIDOLE INITIALI Shade Carl DS COUNTYCOOe :.'1. \ OECEOENT'SCOMPlETE ADDRESS 3D S, Fr()l\t Streot Worm1eyabur:g, PA 1701.3 E, SOCIAL SECURITY NUMBER 181.03.6281 DATE of! DEATH 08/03/1997 DATE OP IJlfHH 06/11,/1905 X 1. Original Re~--oz.- Supplornontal Return 4. Limited Estate D 4.. Future Interest Compromise (lor dates 01 de.th .Ilor 12-12-82) []] 6. Oecedont DI.d restate 0 7. Oecld.nt Mainfained a living Tru!it (AUach copy 01 Willi (Anach a copy 01 Trust) C P ALL CORRESPONDENCE AND CONFIDENTIAL TAM INFORMATION SHOULD IE DIRECTED .TO: o 0 NAME COMPtET!:: M....llINO "DORE~S = , Earl Richard Etzwel1er Etzwei1er and Associates S TELEPHONE NUMBE" 105 North Front Street 717) 234-5600 Harrisbur PA 17101 1. Re.' Estato (Schodule AI 1 one 2. Stocks and Bond, (Schodule BI (2) None 3. Clo.ely Held Stock/Partnership Interest (Schodulo cl (3) None 4. MMgago. and NolOS Rocel.able (Schedule DI (4) None I, Cash, Bank Doposlts & Miscellaneous Personal Property (Sch EI (5) 4,276.00 6. Jointly Ownod Property (Schedulo F) (6) 20,026.94 'I. Transf.rs (Schedule G) (Schedule L) (7) 69,666.48 ao Total Gross Assets (total Lines 1-7) 9. Funeral Expenses, Administrative Costs, Miscellaneous Expenses (Schedule H) 10. Debts, Mortgago Liabilities, Lions (Schodule I) 11. To'al Doductlons (total Lines 9 & 10) 12, Net Value 01 Estate (line 8 minus line 111 13. Charitable and Governmental Bequlsts (Schedule J) 14. Nit Value Subject to Tal< (Line 12 minus Line 13) 15. Spousal Transfors (for dales 01 death after 6-30-94) Se. Instructions for Applicable P'rcenhlg8 on page 2, (Include values from Schedule K or Schedule M.) 1&. Amount cf Line 14 taxable at 6% rate (Include values horn Schedule K or Schedule M,) 17. Amount of Line 14 ta)(abl, at 15% rale (Include values from Schedule K or SChedule M.) 18. Principal tnK due (Add ta' from Line 15, 16 and 17.1 19. Credit$/Sp Poverty Prlur Payments Discount Inter.st 0.00+ 12,000.00 + 631.58 0.00 20. If Line 19 is groater than llno 18, entor Ihe dlfferonco on lino 20. This is tho OVERPAYMENT. ~ 0 IChock hero II you ora roquoollng a rolund 01 your overpaymon..!:l ~1, If Line 18 is grealer than Line 19, enter the difference orl line 21, This is the TAX DUE. A. Enter the inter.st on the balance due on Line 21A. B. Enter the total of line 21 and 21A on line 218. This Is the IALANCE DUE, Mako Chock Pa obi. 10' Ro letor of Wille, A ant . . IE SURE TO ANSWER ALL QUESTIONS ON PAGE 2 AND TO RECHECK MATH . . Urw" p'r'llIlll.. of perjury, I dcctlle lhllll hive elillm!ned thIs r.turn, InclUdI"1ICComplnylno ,c:nedul.' and :tlltements, .nd 10 the besl of mf knowltd~'llnd blUel, It Itlrue, conK-llnd complell. I dICII'. Ihtl.U 't.l eltltl 1'111 be.n r.polted II true mllk.t value. O.claf.tlon of prep.r.' olher lh.n thl persoflil ,.presentatlvel. b..,d on IlIlnformaUon of whIch Pl'p.,.r hIS Iny knowlldglt, ._ County Cumburland (IF APPLICABll:l) SURVIVtNG SPoU!lF.'S NAME (l.AST,FIRST AND MIODLE INITIAL) SOCIAL sECURITY NUMBER 05. 8. R E C A p I T U L A T I o N (,) 7,677,93 (10) 201.00 (15) 0.00 X AMOUNT RECEIVED (SEE INSTRUCTIONS) 0,00 Remainder Return (for dates 01 de.th prior to 12-13-821 Federal Estate Tax Relurn Required Tolal Number of Safe Depos,t: 80)(85 (8) 93,969.42 (11) (12) (13) (14) 7,878.93 86,090.49 None 86,090.49 0.00 (16) o . 00 X .06 ' 0.00 I X C o C T A T o N 12,913.57 (17)__~90.49 X .15' SIGNATURE OF PFlRSON RESPONSIBLE FOR FILING R~TUAN ? I. - , I / ,. ... ()....' 10-1' 30 S. Front Street iI(;rmi;"y~b;"rg ~. 'PA" -i704"j -.. (18) 12,913 . 57 (1') (20) 12,631.58 0.00 (21) ( 21A) ( 211) 281.99 0.00 281.99 DATE I I' ~.J VI) I i I ..' DATE I!P/'i'{' Etzwei1er and ASSDciates iris - North- -jiro';t' si::r~~;;"""'" -...... -.. -..... Harrisburg, PA 17101 Copv,lght (e) , Form 1500 (Rev. 7.904) .. -..,.. -- ~ST WtL~ND TESTAHE~ QMLOS E. SIWlE ;'.' I, CARLOS E. SHADE, a relid.nt of Worml.Ylbura Borouah, Cumberland County, P.nnsylvanil, b.lng of lound and dilpoling mind, mamory .nd und.rotending. do her.by m.ke, publilh .nd daclara thia in.trument to be my Last W1l1 .nd Tut.ment, heraby ravoking any and .11 will. by m. at .ny time her.cofora mad.. ITEM II I direct my her.inaft.r n.m.d !xocutor to pay all my jUlt debto, funer.l expon.... .dmini.tr.tion .xp.n..1 and inh.rit.nce, a.t.ce, aucce..ion or .xciae t.xe., which low. or may b.co~. due on .ccount of my death, as .oon a. may be conv.ni.nt aftor my daceaoe. ITEM III t give, devi.e .nd bequ..th the oum of Fiv. Thou..nd Doll.r. ($S,OOO.OO) to each my brother, P.ul W. Shad., of 24 Valley Road, Wyomi.aing Hill., Penn.ylvania, and my .i.ter, Glady. Smeal, of 7 Marshall Drive, Camp Hill, Pennsylvania. A. If my .aid brocher or .i.ter .hould pred.cea.. me or db lilll\.lt.neouRly with m., th.n .aid .hare .hall lap.. and bl included in tho ro.idue of my ..tate. ITEM 1111 All the rest, r..idue .nd remainder of my I ',: ..tat., b. it r..l, p.rsonal or mixed, of whatevlr nature and wh.r..o.ver lituac. which t m.y own or have the right to di.poll of at the tlme of my decease, I glve, devi.. and beque.th to Ira C. Melllnger, Jr., of 30 South Front Street, Worml.ysburg, P.nnoylv.nia. ..' A. If Che ..id Ira C. Mellinger, Jr. should pr.dlce.s. me or die aimult.noously with m., then I give, deviae .nd bequ..th .11 thl root, re.idue .nd remainder of my ..tate to be divided .qually bocw.en my brother, P.ul W. Sh.d., .nd my oister, GladYI Smeal. ITEM IV, I her.by nominata, con.titut. .nd appoint Ira C. Halllna8r, Jr" Ex.cutor of this my La.t Will and T.ltament, tP.nA~ Il e.~Afi.~ arLos . ha. (SEAL) ; ,-' -, .~ BRENNER . CADILLAC OLDSMOBILE, INC. I . P.O. BOX 1955 2222 PAXTON STREET HARRISBURG, PA 17105 HARRISBURG, PA 17111 ('117) 238.2552 y~I'.-97 r-- tV p A1 ,..;r ~I// / c O,IV r; P:.,(:,;Ift/: /1f".f ~E~,4'/ C/,jR/~' C; 1f},C.' 1/ Q /,I4~/ V/~ IGt prt/f/liP &l97/13.J z.. F? tlp~ ",-?/,.{,c;-..6 /1' ;:;t'7IC' ~ '" I' ~6 >r .. j~ tit) ~ ;/,4 L t/ ,J If - oJ W", M''',''/'J-- (A/,.;" ',,,-A ~ ',/I ~ / ,7 V .... oJ,... _. ..,,; f t/,-f t t/ # , .) . / ,..// . '1 ~lP(!P#/ -.-----.,-... SALES. SERVICE 0 LEASING 0 PARTS · FLEET BRENNER SERVING CENTRAL PENNSYLVANIA AREA SINCE 1921 "IV. tlonx + 112...1 COlOl1lm~~aM'>>"N" I'TATIO Carlos E, Shade SSil 181.03.6281 Joint tononri.), 08/03/1997 A. NAMI Ira C. Mellinger, Jr. --- ADDRISS 30 S. Front Str.;;~ Wormleysburg, PA 17043 .. c. Jointly-own'" prop.rty' pili HUM.IR RILATION'HIP TO DICID8HT friend ITIM LITTIR DATI TOTAL VALUE DECD'S DOLLAR VALUI OP FOR MADE DISCRIPTION OF PROPIRTY HUMIIR JOINT OF ASSET '.4 INT. ICEDINTINTIREST TENANT JOINT I A 6/14/91 Fulton Bank Cert If icate of lJ. ,956.09 50.00r. 5,978.05 Deposit No, 411.0583640. 000 value of $11,906.07, plus accrued interest of $50.02. Account owned jointly with Ira C. Mellinger since 6/14/91. 2 A 5/6/83 Dauphin Deposit Bank and 1,364.19 50.00r. 682,10 Trust Company . Checking Account No. 76871746, Date of death value of $1,363.70 plus accrued interest of I $0.49. Account owned joint y winh Ira C. Mellinger, Jr., since 5/6/8~. I, 3 A 12/10/90 Dauphin Deposit Bank and 2,087.81 50.00r. 1,043.91 . Trust Compeny . Savings Account No. 4913748785. DO value of $2,083,10, plus accrued interest of $4.71. ~ccount owned jointly with Ira C. Mellinger, Jr., sine 12/10/90. 4 A 8/15/95 Harris Savings Bank . 11,088.82 50.00r, 5,544.41 Certificate of Deposit Account No. (see contn sched attached) Total of Contn Schedule(s) 6 778.47 TOTAL (AI,o ontor on Uno 6, Roc.pitul.llon) 20,026.94 (If mort spacI Is n..d,d, insert additional shilts of same size.) CopyrIght (e) 1114 form IOUwa,. only CPSysteml. Inc. FOfm 1500 Sc:htdula F (A_\!, 12.88) Estats ofl Catlos E, Shado SS# 181.0).6281 08/0)/1997 CONTINUATION SCHEllULE Cant Inuat Ion of Sohedulo F ITEM II LETTER FOR JOINT TENANT DESCRIPTION OF PPTY . TotAL VAL OF ASSET DECO'S VALUE AT DATE % INT OF OEATIl DATE MADE JOINT 09.56.275214, 000 value of $11,034.84, pl.us llCcrued Interest of $53,98. Accollnt owned jointly with Ira C. Mellinger, .Ir., since 8/15/95, 554,97 . 5 A 12/13/94 Harris Savings Bank . Savings Account No, 09-20.028236. 000 value of $1,100,00, plus accrued interest of $9.94. Account owned jointly with Ira C. Mellinger, .Ir., .since 12/13/94, 1,109,94 SO,OOr. 6 A 12/1V94 Harris Savings Bank . Savings Account No, 09-20.028237, 000 value of $1,100.00, plus accrued Intorest of $9.94. Account ~NI\ed jointly with Ira C. Mellinger, .Ir., since 12/13/94. 1,109,94 50:00% 554,97 7 A :1./21/92 Lutheran 8rotherhood 11,337, OS Securities Corp. . LB Income Fund Acct. No. 7082372, 000 Interest of 1,322.876 shares @$8,S7 per share - $11.337,05, Accmmt ololned jointly with Ira C'. Me1-lingor, Jr, since 1/21/92 , SO,OOr. 5.668,53 ..'.................. .. '6.778,47' Dauphin Deposit Bank and Trust Company 1*1 F.\H.,\Ii':lC\ [lANK' \'.\1 LI-,\'II.\SIo.: n"S!.: lH PI',S;-'<'i\'L\'.\N1.\ HOI'I'!'.1t SI\LlIlt\Y & Co" I:-.:e. EASTFllS MORHlM1E SI'.R\'ll:I','i, INC, AUlust 29, 1997 Etzwetler and Auoclates Allorneys at Law 105 Noreh F,'onl Slreat Hanlsburl, PA 17101 , . ---.-""'1 Re: ESlale of SSN DOD Carlos E, Shade \8\.03.628\ August 3, 1997 Dear Mr. Etiweiler: Thank you for your request concerning date of death balance Information for all accounts held by Mr. Shade. The enclosed Ilstiog is for any accounts which may have been held al Dauphin Doposil Bank, Farmers Bank, Valleybank, and Bank of Pennsylvania. We are happy 10 supply this Information to you. Also, If additional information, resoarch, or fIIo copios are . needed, they can be provided for a service charge of 820.00 per hour (one hour minimum) and ,25 per copy. If you have any fureher questions, please call mo at (717) 255.2054. Sincorely, Q~Q.~ Cheryl A. Bowers Cuslomer Management Informalion Department ~ab P.o. lIox 2961' HARRISIlt:R<:, .P:\ 17105.2961 TEI.r.I'HONE 717 255.2121 . http://www,,,nytimcbank.colO Dauphin Oeposlt Blink and Trust Oompany and Hopper Soliday & Co., Inc. are subsidiaries 01 Dauphin Deposll Corporation, Bank (If Pennsylvania, flarm.u. Sink .nd Valleybank are divisions 01 D8uphln DlIpOSl1 Bank, Member FDIC. Eastern MOrlgage Services, Inc, Is II subsidlaty 01 Dauphin Deposit Bank B~~~l~ Operations Center 635 North 12th Street Lemoyne, Pennsylvsnia 17043 7171731-1440 AJ.1;p9t 15, 1'HI ~iler ard ABaXi.at:es 1a; N. Fro1t st:reet HarriEbJrg, PA 17101 The.in!ormntion which ~ou requocten on the ~ccount(n) ~ 0;0a;Sed (lJocinl Sncurity Humb",r 181-03-6281 Heme of Joint Owner, if o.ny C9-2J-0282.."'6 C9-2J-02B2:-"7 Savir'gs Savir"gs - 12-13-94 12-J.3-9Il $l,lCO.CO $l,lCO.CO 9.94 9.94 1,1<:9.94 1,1<:9.94 Joint Jo.mt [o\;turity rate: N::m N::m I1:a c. Mellirger:, Jr. Selre Account llumber(lI) ClaslI of Account tlo. to Opence:! Principal Uo.lance Accr'Jed !ntcreGt Dalance at Dllte of Death Account Owner:lhip Adc:!itiono.l !n!or- mlltion Refll\nr.te~ 12-13-94 12-13-'94 8-15-95 Year to rete interest: $9.94 ~_ Ckt (.0'" CQ P100se have the ro:vi.voc COTp1ete the erclcea:1 w-9 fcxm ard ret\JI:n it to lfEl in the p:Mckl envelc.'f2. 'll"an'< p,l. Dllte Owonrshir 'Wns tstnblinhod ~y, .. (j.;::rzL.......~.~~ . G:'etd1en (,. cale Sr. clep:5it Dx:urentaticn Services Pep. FEE SIMPLE DEED THIS INDENTURE, made the 7th day of April, in the year of our Lord One Thousand Nine Hundred Eighty-Nine. '. BETWEEN. CARLOS E. SHADE, single man, of the Borouglt of Wormleysburg, Cumberland County, Pennsylvania, Grantor, Party of the First Part,. A N D .' . IRA C. MELLINGER, JR., of the Borough ot Wormleysburg, Cumberland County, Pennsylvania, Grantee, Party of the Second Pan, WITNESSETH that the said Party of the First Part, for and in consideration of the sum of One Dollar (S1.00), lawful money of the United States of America, well and truly paid by the said Party of the Second Pan to the said Party of the First Part, at and before the sealing and delivery of these presents, the receipt whereof is hereby acknowledged, has granted, bargained, sold, aliened, enfeoffed, released, conveyed and confirmed and by these presents does grant, bargain, sell, alien, enfeoff, release, convey, and confirm unto the said Party of the Second Part, his heirs and assigns, the remainder Interest In the premises as hereinafter described with Party of the First Part reserving a life estate for himself in said premises. ALL the following described lot of ground with the improvements thereon erected situate in the Borough of Wormleysburg, County of Cumberland, Pennsylvania, being parr of Lot No. 7 according to the Plan of Wormleysburg, the same being bounded and described as follows: BEGINNING at a point on Front Street and the dividing line of the houses; thence along said line West one hundred fifry feet (150') to alley; thence aiong said alley South twenty-three feet (23'), more or less, to Lot No.8; thence East one bundred fifty feet (ISO') to Front Street; thence by the same North twenty-three feet (23'), more or less, to the place of BEGINNlNG. SAID PREMISES hereby conveyed are improved with half of a double frame dwelling house known as 30 South Front Street. BEING the same premises which Carl W. Geiger and Mary M. Geiger, his wife, by their Deed dated Nvoember 18, 1969, and recorded in the Office for the Recording of Deeds in and for Cumberland County in Deed Book "L23", Page 777, granted and conveyed unto Carlos E. Shade, Grantor herein. TOGETHER with all and singular, the tenements, hereditaments and appurtenances to the same belonging or in anywise appertaining, and the reversion and reversions, remainder and remainders, rents, issues, and profits thereof; Ai.'ID ALSO all AlII.. lOll EX + (2.'7) COM.nm~.MhY'NI' ISTATIOF SCHEDULE J BENE ICIAFlIES Carlos - ITEM NUMBe.R E. Sha~SII 181.03.6281 D8/03 1997 RELATIONSHIP AMOUNT OR SHARE OF ESTATE NAME AND ADDRESS OF BENEFICIARY -- A. T oxoblo BequosI" No individual aeeete available for distribution after payment of Estate debts. ITEM NUMBER NAME AND ADDRESS OF BENEFICIARY B. Chot~ablo and GOl/ommonlal Bequosls: PILE NU"'IIR AMOUNT OR SHARE OF EST~ $ 0.00 TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Also on,e, on lino 13. Roca lIulallon) (If more space 15 needed. jnsen additional sheets of same size,) Copyr1llht (c) 1994 for"' lloftw.reonlY cPSytt.ms, Inc, form 1500 Sehedule J (R''', 2-81\ /5'-199 'i BUREAU Of IHDIVIDUAL TAMEI IHHE~ll.NCE TAM DIVISION Dl:PT. 21"01 HARRIS'URa, P. 11121-0601 COMMONWIALTH OF PENNSYLVANIA DI'ARTMIMT OF REVENUE *' l:_.... NOTICE OF IHHERITANCE TAX Ar'RAIIEHENT. ALLOIlANCE DR DIIALLOIlANtE Of OEDUCTIOKI AND 'IIEISKIHT OF TAX ~I'H'U II ." l"om 04-06-98 SHADE 08-03-97 21 97-0713 CUMBERLAND 101 EARL RICHARD ETZWEILER ETZWEILER . ASSOCIATES 105 N FRONT ST HBG PA 17101 DATI ESTATI OF DATI OF DEATH FILE NUMlER COUNTY ACN CARLOS E [~llOunt R..ltt_ MAKE CHICK PAYABLE AND REMIT PAYMENT TOI REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ... RETAIN LOWIR PORTION FOR YOUR RECORDS ~ ii'i'V= ifti'7- fi-APji - ili9':97Y"iioTi cr-o; "iMHiiiiTANci- Y AX .'APiiitAiiiMiiir; -m.-oMAMci -iii--.....---.-. - -- -- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ISTATE OF SHADE CARLOS E FILE NO. 21 97-0713 ACN 101 DATI 04-06-98 TAX RETURN WAI' (X I ACCErTED AS FILED RESIRVATION CONCERNING FUTURE INTEREST . SEE REVERSE APPRAISED VALUI OF RETURN BASED ONI ORIGINAL RETURN 1. x..l Eot.t. (Io~dulo AI 2. Stqoko _ Iondo ISoMdul. II 5. Cloo.ly tt.ld stooklr.rt..rohlp Int.r.ot lSohtHlul. CI 4. Kort_o/Hot.O RIlO.lvob1. I SOMdul. 0 I 5. C.oh/lonk Depoolto/Hloo. r.roon.l 'rop.rty (Soh.dulo II 6. Jointly O~_ rroporty ISoMdul. FI 7. Tr~oforo ISoh.dul.01 I. Tot.l Aoo.to ( I CHANllED NOTE. To Inouro proper arlMllt to your aooount. o...lt tho upper portion of thlo for. .lth your t.. P.y_t. .00 .00 .00 .00 4,Z!LJ1. 20J026.94 69.666.4L III 111 121 III 141 III 161 171 93.969.42 7,671.93 APPROVID DEDUCTIONS AND EXEMPTIONS. 9. F~r.1 EMp.no.o/A~. Cooto/Hloo. E.p.nooO (SohtHlul. HI I" 10. Dobh/Hort_ LlobIUt1.o/LI~o ISohtHlul. 11 1101 201.00 11. Tot.l DtHIUotlono (111 12. ...t V.I.. of Tax R.tum (121 15. Ch.rltobl./Go..r...,t.l ....ohl Hon..l~ttHI '111 Truot. lSoMdul. JI (151 14. ...t V.l'" of Eot.t. SubjllOt to T.. 114 I NOTE I If an ........nt W.I illu.d prlviou.1Y, lin.1 14, 15 .nd/or 16, 17 .nd 18 will refl.ot figur.1 th.t inolud. the tot.l of ~ r.turn. .11..lld to d.t.. ASSIIIMINT 0' TAXI 15. AaoUnt of Ll~ 14 .t Spou..l r.t. (151 16. AaoUnt of Ll... 14 t....l. .t Llho.l/Cl.oo A r.t. 1161 17. AaoUnt of Ll~ 14 t..obl. .t Coll.t.r.l/Cl... I r.to (171 11. rrlnolp.l T.' 0... TAX CREDITII rAVHENT DAlE 1 -30-97 01-13-98 7.A7A Q~ 86.090.49 .00 86,090.49 .00 X .00. .00 X .06. 86.090.49 M .1S. 1111 .00 ,00 12,913.57 12,913.57 REcurT IRJI\IER AA242418 AA242659 DISC_T (' I INTEREST/rEN rAID (-I 631. 58 .00 AIlOUHT rAID 12,000.00 281. 99 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE 12,913.57 .00 .00 .00 . IF rAID AFTER DATE INDICATED. SEE REVERSE FOR CALCULATION Of ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN tl, MO rAVHENT IS REClUIRED. IF TOTAL DUE IS REfLECTED AS A "CREDIT" (CRI, VDU HAV IE DUE A REFUND. SEE REVERSE SIDE OF THIS FDRN FOR IKST~UCTIOHS.I .1 :.Ii C\ (~\)\': REIlRY.TloM. Eololoo .f dtGodOnto dvl.. .. .r bof..o ooo....r lZ. 1"Z .. If any '"Iu.o Inlo..ol In lhe 0.1010 ,. I.an.forrad 1n po.....ton or ."jOYMn' to ch.. . (OOUlt,,.1) "",flctld,. of ,he _lIMn' ,ft.r tM Illpll'.Uon a. ."y .,t". for 11ft or far v..rl; the C~.lth hereby IKP,...lv ,...rv.. the ,ilht to .",,1,. tnd ...... ,ren.f.r Inhlrlttnal TIMI' .t ,hie l_W. Cl... . (oouat.tlll r.t. on env .uch future Int.ntt. ~Of NOTtCEI To '\lUlU ttMl requlr..-tltt of S.aUon Z14D of the Inherltenct end E,t.t. TIM Aot, Act 21 of 1"1. (12 P.S. SHUon 9140). p.YllEMT. DoI_ lhe lDO ....Uon .f Inll NoU.. .... ._It .ltn ,our ,0.-1 .. lhe ...,.1.. .f Millo .rlnlad on lhe r...." .ldO. ~...... ~ or 110M>>' or.r PIy.lt tOI REGIlTEI OF MXLLI, AGEMT REfUMII (CR). . .of_ .f . 10M .rldlt. ....'.n .oo nol r_.tld on lhe 'OM '.Iurn. .., bo ro_'11d b, ._l.U.... an "",II.oU" for R.fund of ~.vlY.n..lnhlrltenc. ~ E.t.t. rill" (~V-ll1S). Applications ar. Ivallebll .t the OffiCI of t~ ~..l.t.r of WI. 11, InY of t~ZS Revenue 01.trlot Of~lo.., or by oll.lnt the ,pacla. Z4.hoUr .",..,Int ..rviol ~r. for for.. order'nll In penn.vly~l. .-IOD~S'2~2DSO, out.lde pann.>>l~lni' .nd wlthin .0CI.1 ..rrhbUr. .r.. (7.') 761-'094, TODI (111) 112-22SZ (Head", 11IP.lred On1>>), OIJECTlOMSI any p.rt>> in Intlra.t not ..u.flad wUh the ...ral...."t, aUololano' or dh.Uowanc. of dlducltlfln', or ..........., of t.. (Inc.udl~ di.count or Int.r..t) " .hoMn on thl. NotIel .u.t object within .IMty (60) dlY' of raoel,t of thit MoUoa bYI -~wdttan prot..t to tha P. _art.."t of Ae,,"""', loard of ~a1t, Dept. 211021, .-rrltbur., PA 17UI-IDII, Oil ~"e.Mtlon to haY' the ..ttar daterllnld .t ...It of the _oount of thll PlrlonIll r."Hnt,U"I, O. -~.....1 to the OrPhln" Court. AllIUM IIT.ATlW ~_CTIllM1l PEMALTVI 'Mt.... .rrorl dlsoov.red on thit ..........t shOU.d bI Mdr."M In wrltlnt tOI PA Depart.."t of "a"MUI, IUr.-Y of lndlvldua. TIM", ATTHI po.t ,......-nt ".~ieN Unit, DePt. 2'0'0., Harrl~r., PA 11.ZI~0'Ol Phone (111) 11'-'101. Sea pili S of thl bOOkl.t "In.truetlon. for Inherltanc. '1M _.turn for' ..,Ident Deoadant" (REV-liOl) for an a.,.enation of ~lnl.tr.tlv..Y corrlOtab.. .rror.. If WlY t.. due .. p.ld within thr.. (S) e.l....' Mnth. .fter thll deo...,tl. ...th, I fly. ,.roent (IX) clllO....t of th41 'a. ,ald I. .Uowed. Ttw Ule tlM ..,.aty non-partlclpatlon penalty .. o~ted on the to". of the t.. ... Int~r..t ......ed, ... not p.ld blfor. J.-.a'y .', I"" thl flr.t day .fter thl! .... of thl tlM ....ty ,.dod. Tha. non~partlolp.tlon ,.wlty It ......... In the ... .-mer and In thl thl ._ UM pIIr hid .. you ..uld .....1 thl tu and lnt.r..t tMt he' Men ........ .. lnilowtld on tl\l. noUOI. In'.r..t I. oMr.... bellmiN with flret day of dall".,.ncy, or nlM (.) "",th. .... one 0) day fr_ the da" 0" elMth, '0 thl dIIt. of p.YIIIft'. TI... lIIhlch bIcI_ daU~t ...for' Jerulr, ., 191' balr Int.r..t .t thl rat. of .1. ('~) ,.rcant per ~ c..cul.ted .t . 0.11, r.t. Df .0001'_. ... taMO' Which beo_ dlli~t on tnd .ft.r J~rV ., 1'" will ....r Int.r..t .t . r.t. Mhloh will v.rw frDl oa.endar velr to c.landlr w..r with thlt r." announced by thl P. Depart....' of A.venue. 'lW ...110..... Inter'" r.t.. for 191' thrCM.llh I'" arll '!!It lnt.r..t .at! DlI.w Int.r..t FlOtDr !J!r Int.r..t "" Dallw Int.rllt FMtor I"Z ZOX .000141 1'" .~ .000241 1..5 ..~ .00001 ""~1"1 m .OOOSO. I'" 1l~ ,000101 I'" n .0002.'" 1'" UX .0001" 1"'-1_ 7~ .0001'Z I'" IO~ .000Z7~ .""-1'" .~ .0002'" u lnt.rllt I. c..cu..t" .. foU..... INTEIlUT . IALAllCE OF TAM UHrUD M NUHIER OF DAVI DELINQUENT M DAILY XNTEIlUT FACTOR ~-Anv Motle. hsued ,ft.r 'hi '.M blOOM' daU~lnt will r.flect lltl Int"..t o.loulatlon to flft..., US) da~" ba.OfMI thI dat. Df the .....lMnt. If p."..,t It HdI .U.r Uti Inter..t ooaputatton at. thown on tM Motlol, addltlona. In,.r..' ~., bI o..cu..ted. DIICtlRfT I IIfTtREITI STATUS REPORT~ER RULE 6.12 Name of Decedent. (l ( I. 1(' Date of Death. (;; J , ~/ , Will No. \' \ (\f (>C... I I ) , ) :,I\(lfL Adm in. No. Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the admInIstratiun of the above-captioned astate. 1. State,phather administration ot the estate is complete; Yes~ No , 2. If the answer is No, state when the personal repr.esentativo reasonably believes that the administration will be complete: 3. If the answer to No.1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes_____ No~_. b. The separate Orphans' Cr)urt No. (if any) for the parsonal representative's account iSI c. Did the personal representative state an account informally to the parties In interest? Yes X No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Cerk of the Orphans' Court and may be attached to this report. ~ O~~. j.@-:" fl Sign-a-ture "":: ~ Ear~ Richard Etzweiler, Esquire Etzweiler and Associates Name (Please type or print) 105 North Front Street Harrisburg, PA 17101 Address Date: S c- ." 15 iS~ I".."" 1- ( lei 'f ~ ~ liS' >, Il> 'lil II (MAH I rnll,1 AM3) C\ l.-' ( i In t'? ~~ ,~) :' '0 () .... ~ '1 Ai ( 717) 234-5600 Tel. No. Capacity: _____Personal Representative _~_ ,...Counsel for personal representative RW-Z7