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HomeMy WebLinkAbout97-00877 Oath of Personal Representative Commonw.alth 01 P.nnaylvlln~ County 01 OUM81~RI.ANI) The p.lllloner(s) above. named swear(s) or affirmll) Ihatth,s Italemenll In Ihe loregolng PllllUon are lru. aneI correot 10 the bssl of the knowledge and benef 0 PsUlloner(s) and thaI, II personal reprea.ntallve(.)01 the Decedent, PellUoner(el Will well and IMJly m sler the ,&lale aCl:Orcf1ng to law. swom to or affirmed and subsoribed .M11 - c' " before me this 30TH day of October' " 97 ' In .~ I, I'.' No. 21 - 97 - fl77 Estate 01 ImJ,EN II. FLEMING Doell.ad Soctal Security No: 171-38-1036 Dale of Death: 10/20 /q7 "NO NOW, thia 6TH duv of _ November ,19 q 7 , In consldsrallon 01 Ihe Psllllon on the reverse side herson, sallsfaClory prool having been prslsnted before mo, IT 18 DEOReeO thatl.ettersU Testamentary I:) 01 Admlnlslra~on ~1~MICl\l/&n\t~'\I""rl"'liOlt.If4 are hereby granted to Leotu M. 'Nedev and Suzanne G. Griest. Co-Executri CBS In the above es\ale and Ihallhe Inslrumenl(sl dsl8'l Aoril 8. 1997 d88or1bsd In the Pelltlon bs admitted to probale snd filed 01 record ss Ihs lilt Will 01 Deoedent. F11U Lette,. ....,..u."......... . Short Oertlncate(l) "" . Renundatlon If........'1f . Affidavltl ( ) "......",,'. . Extra Pages ~ Q ..."".- . Codicil """flIUU"..I'''' . JCP Fee ................... . Inventory ........"......., . Other ..."..,It"li'"I''''' . TOTAL. '1l1'~:"""1 . 375-.00 . 74,,+ GJ()."~'I:i.';.fJIJ1twlfrlJ . T U MARY CLEWIS 0 ""ornay: SUZANNE H. GRIEST. ESOUIRE LD. NoI . 34362 30.nn 3n.nn Add,.,,: l?"Q l~ARt': Mnt"ltA~ R~t"nnt York. I'ennavlvnnia 17401 5.00 Talephona: (717) 846-8856 440.00 "-aAW.' ,.., all I'raplltcl bl' ". P-.ytf1Na a.. ....1OCli..... ... Mailed letters and order to attorney oh11.6.97 I Iii :;1 Lllii!1 '1Iir: III I ' 1:'11 ill!1 I' , il : : ':'1': ! illl:::1 1':1111 ii' , I 21 : I d r: I ~ q ~ " , , ! [ 1[1 ' I ! ,. 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I 1!,111 I Ii 1'1, i 1,,111 Ii III If I I": II: I 1',1 : li.III:II! I n il:i Ii I, I I: il: iii ';11, II II lillll, I'!ll i: I1I1 1IIIII1 jj:: I i, 1 I l'~"llll....llnfll, U"fIlMtlAlIlIlt1 """."'''411-4. 129114,,)lukll."IH YI.I.""'m~'''n ""ll tu,";;;i,'iii.-&.\ U'" 0, To my friend's daughter, BETTY R, WOLF, R. P. 18, Dillsburg, pennsylvania 17019, or her issue, the, sum of ONIIl THOUSAND AND 00/100 ($1,000.00) DOLLARS. D. To my friends, MR. AND MRS. MERVIN J. SHEAFFER, 1100 Sheaffer Road, Dillsburg, Pennsylvania 17019, or the survivor of them, or their issus, the sum of FIVE THOUSAND AND 00/100 ($6,000.00) DOLLARS. Ill. To my friend, C.C. CAROTHERS, 607 Forgs Road, Boiling springR, Pennsylvania 17007, or his issue, the sum of ONE THOUSAND AND 00/100 ($1,000.00) DOLLARS. F. To my stepson, PAUL FLEMING, 920 West 16th street, New Oumberland, PennsYlvania 17070, or his issue, the sum of TEN THOUSAND AND 00/100 ($10,000.00) DOLLARS. G. To my stepdaughter, ETHEL WALLACE, R.,D. #1, East Berlin, Penns~lvania 17316, or her issue, the sum of TEN THOUSAND AND 00/100 ($10,000.00) DOLLARS. H. To my stepdaughter, DOROTHY DETTER, Box 46, Wellsville, pennsylvania 17365, or her issue, the sum of TEN THOUSAND AND 00/100 ($10,OOO~00) DOLLARS. I. To my stepgrandson, BRIAN W~LLACE, R. D. 1, East Berlin, Pennsylvania 17316, if he shall survive me, the sum of THREE THOUSAND AND 00/100 ($3,000.00) DOLLARS. ~k,\ ~btA-;\ g LEN B. FLE I G ' . (J~.,rt,lhMI.II,U.nit, Ihlnbahl" AfIl.....'141I..l.'" , i~llI.ll"'Ultf".'ll Y.ltt,I'tNJrtnu;",i14t11 1lil";';;'lfl'IU"l"(, I. my redduary sUrpes. J. my rell!idUary 1(. my redCluary L. lilY resiCluary M. my redCluary N'. I qive, devisfil and bequeath 3.1 peroent of thi,s estate to my etepqranddauqhter, TAMMY, WALLACE, per " I give, devise and beqUeath 2.0 peroent of this estate to my oousin, OARLA TAYLOR, per Il!tirpe.. I qive, devise and'bequeath 10.5 peroent, Of this estate to my oousin, WAYNE WENGER, per stirpes. I give/deVise and' be,queath 6.0 peroentof this estate to my oousin, RAY WENGER, per stirpes. I qive, devise and bequeath 21.9 peroent of t~is estate to my oousin, LEOTA NEGLEY, per stirpes. I qive, devise and b~queath 10.6 peroent o,f thb lilY residuary estate to my oousin/ JUNE TAYLOR, per stirpes. tTB~" It is my wish and request ,that the oustom of the reading of the Will after the funeral shall not be done, but that the benefioiaries and distributees hereunder shall be notified personally or by letter by my personal representative(s) or my attorney. t~BM I. I direot that no Exeoutor or other fiduciary named, nominated or appointed in this, lilY Last Will and Testament, shall be required, to post bond or qive any seourity 1.Jtg~/v1 HELlll B. B . ~.~"^"\ ' FLEMI G A.--. 7 I; U,.u"U1\1~,ih"(l11l AltnjlHj:li4il.u,' 11'11!_11 ~luHl ~t_ln '(1*k.I'IH~nH~~(I1HlII tnl"~"Ul6 WHERRAS, the saia personal representatives have gathered the assets of the estate of the said decedent ana the assets oonsist of personal property totaling $ 533,622,53, as sec forth in Exhibit "A", which is a statement, of acoount of the s~id personal representative. and which is attadhed hereto and made a part hereof, and marked Exhibit "A" I WHEREAS, the debts and deduotions, including the payment of inheritance tax in the said estate and specifio beqUests, amounts to $ 257,070.45, leaving a balance for distribution of $ 276,552.08, also as set forth in the statement of the said personal representative, whioh is attached hereto and marked mxhibit "A" I WHEREAS, the balanoe for distribution as shown in the said statement marked Exhibit "A" has been reduoed to oash and has been distributed as herein indioated in aocordanoe with the terms of the Last Will and Testament of the said decedent, NOW, THEREFORE, KNOW YE, that we, PAUL FLEM~NG, ETHRL WALLACR, DOROTHY DETTRR, nRIAN WALLACR, CHERI (SHEAFFER) llRLtlRR, oRnaIE (WILSON) GOODMAN, 'rBRRY FLEMING, CHERYL' YBSCpNIS, TAMM'lWALLACB,. DARLA'1'AYLOR, WAYNE WDNGBR, RAY WlNGRR, ITIJNBLTAYLOR AND LEOTA NHGL1jlY, ;INDIVIDUALLY being heirs under the Last Will and Testament of the said decedent and being those persons entitled to inherit under said Last will 'and Testament, do hereby each of us, acknowledge that we have this day had and re6eiVed from the aforesaid personal " tlIIUI,1l1\ir.t,Il".1It11 "l'HI'~~.l.llI.~~ Il'll'_II'I>Iukl,'rull \'I"t;.1\"'I\lY.l~111H!ll 11l'jj~?;il"'1!~ representatives, in full satisfaotion and payment of all sums or sums of money, legacies, pequests and devises as ars g~ven, devised and bequeathed to each of us respectl.vely by the said Last Will and Testament, the amounts due us under said Last Will and Testament, which amounts we have received this day, and which amounts are in the amount set opposite cur respective nameS in the table and sohedule of distribution in said statement attached hereto and marked lllxhibit "Ai'l AND, each of us does ~ereby stipulate that in order to , avoid the e,xpense and time involved in the filing of a fO,rmal accoUn't andschedlile of distribution, we each agree that no account is 'neoessary and we do hereby agree that we do oonsent to distripution being made without the filing of an aooount and sohedule of distribution, the same to be with the same force and effeot as if they had been filed and confirmed ,by the orphans' court Division of the Court of Common Pleas oil Cumberland county, pennsylvania. 'THIlJRBlFORIll, we and eaoh of 1.lS, do hereby remise, release, quitolaim and forever disohargethe said personal representatives, r..eota M. Negley a.nd Suzanne H,Gde/!lt, their heir/!l, exeoutors and admini/!ltrators and assigns, of and frcm the /!laid e/!ltate and from all actions, suits, payments aooounts, reokonings, claims and demands whatsoever for or by rea/!lon thereof, or for any other use, matter, oause or thing what/!loever, touching upcn the estate of the sair.\ deoedent, alld eaoh of us do further hereby oovenant 'and agree that should any tlllit"UI\l,t.lhhmf\ M'Il~~'H\lI,\'" IJ'Il\l!\llHll\UtU \1,'~,h"\H\\~I\ 114/11 t;II"'~"M,I~ ')./21/~7 - Fulton Bank . Intereet on Certifioate of Deposit #64~.02580 1/21/97 - Fulton Bank . Interest on certifioate of Deposit #64~-01529 1/21/~7 - Ada~e County National Bank - Interest on Certificate of Deposit . #1~~130 1/21/~7 " Mams County National Bank - Interest on Certific~te of Deposit .#137~54 1/28/17 - MellotiBank ~ Intereeton Estate Cheoking Aooount 2/02/97 - Dauphin Deposit - Interest on Certificate of Deposit #81.40~~418.1 2/02/~7 - Harris savings Ban)(. - Interest on certifioate of Deposit #18592800?4 2/02/97 - Mams County National Bank - Interest on Certifioate of Deposit #137359 Adams County National Bank- Interest on Certificate of Deposit' #139145 2/04/97 - Mellon Bank . Interest on certifioate of Deposit #22-A53661~C 2/03/97 2/04/97 - Mellon Bank . Interest on Certifioate of Deposit #22-A5~717.C 2/05/97 . Mellon Bank. Interest earned on Decedent's, Guaranteed Money Market 'checking Account ' 2/31/~7 . Mellon Bank' - Interest on Estate Checking Aooount 1/15/98 01/26/98 H, Kenneth Myhre - School Tax Proration , ' , . Adams county National Bank- Interest on Certificate of Deposit #139130 01/26/98 . Glenbrook Life #GA108185 - Annuity Payment !5 104 , 11 145.91 11:\..39 96.31 6.90 ~3. 59 107.00 98.14 119.24 74.45 70,56 2,81 21,65 55~.40 145.27 94,76 UIIl\I.lh\II.t,lh"oln 1""'\1" 'II.~ 'l'Il:'II\lllur\lul, l"u.I~~\I\I' '~Ill'hll 111''''~''.'\I~ 1/26/98 - Adams County National Bank - Interest 011 certificate of Deposit #139145 115,40 1/;16/98 - Adams County National Bank - Interest on Certificate of Deposit #137359 94,97 1/26/98 - Mellon Bank - Interest on Certificate of Deposit #22-A53661-C 76,93 1/26/98 - Mellon Bank - Interest on CertIficate of Deposit #22-A53717-C 72,92 1/26/98 - Harris Savings Bank - Interest'on Certificate of Deposit #1859280074 114,38 1/26/98 -Glenbrook ~ife #GA108185 - Annuity Payment 104,94 1/26/98 - Adams County National Bank - Interest on Certifioate of Deposit #139130 150,12 1/26/98 - Agway - Dividend 80,00 1/26/98 - Kenneth Myhre - oil.Proration 45,00 1/26/98 - Fulton Bank - Interest on Certificate of Deposit #643-0001529 174.98 1/26/98 - Fulton Bank - ,Interest on Certificate of Deposit #643~0002580 120,07 1/2,6/98 - Dauphin Deposit Bank & Trust Company - Interest on Certificate of Deposit #8140394181 !l0.p8 154,38 115.32 370,70 11.22 1/26/98 - American Travellers - Medical Reimbursement 1/26/98 - American Travellers - Medical Reimbursement 1/26/98 - American Travellers - Medical Reimbursement 1/26/98 - American Travellers - Medical Reimbursement 01/26/98 - Fulton Bank - Interest on Certificate of Deposit #643-0002580 '124,08 6 lI.n~l,f1l\If.f,lhUIlIlI '"ftl.~U~ if!..,lI- i;1""i\hHII~"ilf ,""t~_~'114fJl 11I1I1~'~rl.thH~.UIt\ 1/26/98 . FUlton Bank. Interest on Certifioate Deposit #643-0001529 1/26/98 1/26/98 1/30/98 of 180,83 on .98,15 on 119.24 2/27/98 . Mellon Bank . Interest ort Estate Cheoking Aooount 3/16/98 - Mellon Bank - Interest on Certifioate of Depo/ilit#22 -A5,3661-C 3j16/98 - Mellon Bank - Interest on Certificate of D~posit #a2.A53717~C . - Adams county National Bank . Interest certifioate of peposit #137369 - Adams county National Bank - Interest certifioate of Deposit #139145 . Dauphin Deposit Bank & Trust Company . Intere/ilt on Certificate of Deposit #8140394181 1/30/98 . Mellon Bank - Interest on Estate Checking Aooount 3/1~j98 3/16/98 3/16';98 3/16/98 - Harris savings Bank - Interest on Certifioate of Deposit #1859280074 . Adams County National, Bank - Interest on Certifioate of Deposit #139130 - Mellon Bank - Interest on Certifioate of Deposit #22-A53661 - Mellon Bank - Interest on Certificate of Deposit #22-A53717 - Glenbrook Life - Annuity'Payment - Agway . Diviqend Harris savings Bank - Interest on Certifioate Of Deposit #1859280074 7 93,59 64.17 3,61 76,93 72,92 114,38 135,59 69.47 65,85 94,76 13,33 103,31 fl.lut, Ih'tll,lh~.t~1J \T1!JI~Il' Ill_I' I;""'" \luUI ~tll~l ';'H,I~""\lI"~11 !1.llo1 'ttll1~,.,jl" 3/16/98 - Dauphin Deposit Bank & Ttust Company - Interest on Certifioate of Deposit 118140394161 93,59 3/16/96 - Fulton Bank - Interest on Certifioate of Deposit 11643-0001529 3/16/96 - Fulton Bank - Interest on certifioate of Deposit 11643-0002580 3/16/98 - Adams County National Bank - Interest on Certifioate of Deposit 11139145 3/16/96 - Adams County National Bank - Interest on Certificate of Deposit 11137359 3/16/98 . GPU Energy - Refund 3/16/9,8 Glenbrook I.ife - Annuity Payment 3/16/98 - Adams County National'Bank - Interest on certifioate of Deposit #139130 3/17/96 - Mellon Bank - Interest on Certificate of Deposit #00662086 3/25/98 -, Ful ton Bank' - Interest on Certificate of Deposit #643-0001529 180.83 124.08 119.25 98.14 32.22 108.33 150.12 970.42 163.29 3/31/98 - Adams County National Bank - Interest on Certificate of Deposit #139145 ,107.70 3/31/98 - Mellon Bank ~ Interest ort Estate Checking Account 61..53 . Harris savings Bank - Interest on Certificate of Deposit #1959280074 114.38 4/01/98 - Adams, county National Bank - Interest on Ce,rtificate of Deposit #137359 86.64 4/07/98 . Mellon Bank - Interest on Certificate 6f Deposit #0006713 149.65 8 1I.ll~',1I1\liA,IIIU'J1fl '"'._~Hi,II.\.. 11'11\'11 \hUlI 5111I.1 Yllh.I~~~HI\'~IIIHI1I 'lll"'~"l_ I 'IIi "I'\.~j" 4/14/98 Dauphin Deposit Bank & Trust Company . Interest on certificate of Deposit #81403911181 . Adams,County Nationlll Bank - Inter~st on Certificat~ of Deposit #139130 . Glenbrook Life Annui\:y company.' Interest earned on Annuity Contraot to date of 'redemption #GA108185 11/07/98 . 4/14/98 4/22/98 . Fulton Bank - Interest on Certificate of Deposit #643-0002580 4/22/98 . FUl ton Bank - Interest on certificate of De),'losit #643.0001529 4/29/98 . Adams County National Sank . Interest 011 Certificate of Deposit #137359 4/29/98 . Dauphin Deposit Bank & Trust Company . Interest on certifioate of Deposit #814 03 9U81 4/29/98 . Fulton Bank - Interest on Certificate of Deposit #643~0002580 4/29/98 - Adams ,County National Bank - Interest on Certificate of Deposit #139145 4/30/98 . Mellon Bank - Interest on Estate Checking Aooount 5/04/98 - Harrh savings Bank. Int.eref;lt on certificate of Depof;lit #1859280074 5/04/98 . Ohio Casualty . Refund of Homeowners Insurance PoUcy 5/07/98 - Mellon Bank - Interest on certificate of Depos! t #22-AS3661-C 5/07/98 - Mellon Bank - Interest on Certificate of Deposit #22.1\53717-C 9 84; 54 150.11 30.50 124.08 180,83 98.14 93,60 112.05 119,24 44,63 110.69 79.67 74.413 70.56 .' llIIU1,1I'\lIJ,lh.illlo Mm,,~hl 111.A' IHlt".I.~h;~ll ;lUI1 \It.\,I'l/;~'\Id'I\I'-'m -' fUHl~"'IIIl'\\{~'AU/i SCHEDULE FOR DISTRIBUTION PPROVED as to faot and figure on ~i~/k~~ ~ I 1~98. HELEN B, FLEMING ESTATE $ 2!il, 037. !il,7 2!il,037.!il7 29,037.97 8,573,11 ,8,573.12 8,573.12 8,573.11 8,573.11 8,573,11 5,531.04 29,037.97 13,827.60 60,564.91 29,037,97 B,YI ~Fat~47 BYI '~ W~ BY,S] O:~AL~ " DO ROTH ,OTTER. ~1)-- 21 . , lI~llIl,IlI\IU,III",~" HI<'lt~IUIII.I'Il ll'II'IH~lllUt'"1l1 ""...~I""f1 1111"....' ,1111 \l~ l~'~ CHBCKS TO BB WRITTIllN I Himas, Harrold. reserve H, Griest, Esquire eota Negley aul li'leming thel Wallace orothy Detter dan Wallace heri Sheaffer Heller ebbie Wilscn Goodman erry Fleming, heryl Vesconis ammy Wallace arla Taylor ayne Wenger ay Wenger eota Negley un!! Taylor 23 $ 5,000,00 9,295,00 9,295,00 29,037,517 , , 29,037,517 29,037.517 8,573,11 8,573,12 8,573.12 8,573.11 8,573.11 8,573,11 5,531.04 29,037.97 13,827.60 60,[;64,91 251,037,97 TOTAL $ 300,142.08 IN TH~ COURT OF OOMMON p~mAS OF OUMBmRLAND COUNTY, pmNNSY~VANIA ORPHAN'S OOURT DIVISION IN RIIlI B.tat. of HlLlN B .'LIMING ~ate of Monroe Township, Cumberland County, Pennsylvania county, Pennsylvania NO. 2./.-97"0877 RIlLIIIAS!I KNOW ALL MEN BY THESE PRESENTS, that the undersiqned has this date reoeived of Leota M. Neqley and Suzanne H. ariest, 'Co"Exeoutrioes under the Last Will and Testament of Helen B. Flem~nq, late of Monroe Township, Cumberland'county, pennsylvllnia, deoeased". ths sum of $3,000.00 whioh constitutes a speoific'bequest to which the Sdvation Army is entitled under the Will of said decedent. . "; In oonsideration of whioh payment, the Salvation Army dO,s hereby ,forever release and disoharqe the said' Oo..Exeoutrioes of and from any and all olaims by it for further acoounts; paYments, or dis~ribution oonoerninq said estate or arisinq out Of the 'adminhtr~tion thereof. ' IN ~IT~~S.WHER~OF, this has,bsen exeoUted this J~J-' day Of~r~/~ ' , 199B, intendinq,to ~e leqal~d hsrel;lY. co '\3~ '0 t';' , U) N 0 (,l Q. ,.\,..1 d :/: '~.) Li) i ~ IlilIUI,lIllli_",IIiUulil ,,) .'j .\tt(li~li\~II,._.. .:1\ ! ~ ;'i\ 11'11'111 \!I'U I ~,~'" Y"II~,I'~"~IH~IIIHnI n I ,I (\1 IIl1l'lillMI?ili'l~.~\;' ~' .~~ ~ RIWr8qen a t,tiGCretary ( ~lI11AL) VS Decedent'. Oomplete Addre.e: ~Eee ark Roud liP 17019 Tax plwmente and Oredlta, 1, Tax Due (Page Hlno 18) 2, Credlls/Paymsnll A, SpOusal Pove~y Credil e, Prior Paymenll , C, Dllcount (1) 52,272,60 50.000.00 2l631.58 TOIII Credltl (A + e + C) (2) 52,631.58 3, InlareeVPenalty If epplloa~la D,lnterell E, penally .. TotallnteralVPanelty ( 0 + E ) (3) 4, II line 2 Ie greater than IIna 1 + IIna 3, anler tha dlfferance, Thllls Ihe OVBRPA YMBNT, Chsek ~ox en P.g.1 Llns 1910 requtll. relund (4) 358.98 5. II line 1 + line 311 greeler than line 2, enler tha difference, Thlllslhe TAX DUEl, (5) A, Enter Ihe Inlsrell on the lax due, (6A) e, Enter Ihe lotal of Line 5 + M, Thllll the BALANOE! DUB, (56) Meke Cheok Pe eble to: REG/STiR OF W/~~S AGSNT PLI eB A SWIR T I 0 0 ING Q B ONS BY PLAOING AN "X" IN 1'HIl APPROPRIATB BLOOK. 1, Old deoedent make a tranaler and: Yee a.!,etaln the uee or Income 01 the property tranaferred: """""""""""""""""""""""""""""'" ~ b, relaln the rig hI 10 dtllgnale who shall uaelhe property tranalerred pr lie Income; "'''''''''''''' 0, releln e reverelonery Interesl; or "",,,,.,,,,,,, """"""""'''''''''' ",' """""",,,,,,,,,,,,,,,,,,,,,,,,,,\.,,,,,,, d, receive the promise Icr IIle 01 either payments, beneflls or care? """",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,. 2. II death oocurred on or belore Oecember 12, 1962, did deoadent within \WO veara ' preoedlng d,ath tranaler property wllhout reoelvlng adequate conelderatlon? II dealh cccurred alter December 12, 1982, did decedent tranelar property within one year 01 death without reoelvlng adequate con8lderetlon? !!,,,,,,,,,,"""""'"!l!,,,,,,,,~,,,,,,'''''i'''I\,,,,,,,,,,,,,,,,;;,,,,j,,''''''''''''''' 0 3, Old deoedent own an 'In truat lor' or payable upon dealh bank accounl or aecurlly 4. ~tl~l~e~e~~n~:~~:'~' ;~di~id'~~; ';~ii;~~~~l '~~~~~~l:'~~~~i~: '~;' ~;;;~;'~~~~';;;~'b~';~ '~;~~~;;y?:::: 8 No I iJ I 12 P,S, 19116 (a) (1.1) (I) pr6vlded for the reduotlon of Ihe tax rate Impoaed on Ihe nel vlllue of transfers to or for the use 0 the eurvlvlng spouselrom 8% to 3% lor dates 01 dealh,on or altar July I, 1994 and ~sfcre January 1, 1996, 12 r>,S, 191,16 (a) (1,1) (II) provlded,for the reduellon of the rste Impossdon the net velus 01 tranafera to or lor Ihe use 01 the surviving spouse Irom 3% to 0% for dates of dsa\h on or after January 1, 1996, The atatuta ~pes not a~emol a transler to a aurvlvlng SpOuee Irom taK,shd th.e etatutory requlrementa lor disclosure 01 aasels and flllng a la,\ return are etlll,sppllcable even lIthe surviving apouse Is the only bepaflolary, ' FOR tlA TBB OF DElA TH ON OR APTElR JANUARY 1, 1998, Plusa answar the follOWing question by plaoln9 an 'x' In the appropriate spaoe, ' " Old the deoedent create e truet or .Imllar arrangement which la lolely lor the surviving Sp!)use'a benel1llor hie or her enllre lIIellme1 Yea 0 No 0 ' If you answered yes t6 the above question" the tax on the trust or similar arrangemsnlls poelponed untlllhe daalh 01 the eeconrl spouse, at which time It will be lully taKable at lhs rate(s)applleable 10 the remainder beneflclsry(las), Enter the value 01 thelrust on Schedule J, Part II, In order to remove It from tho calculation cf the taK due In this eatate, Yo~ may wish toflle Schedule 0 In order to make the election available under Ssollon 9113, II ths elaotlcn la made, the trusl or similar errangsment Is taKed Ih tha estale of the first decsdent apouse, the port,l!)n of the trust or similar arrangement whloh ~enems Ihe SUrviving apouaele taKed at the ~ero taM rate, and the remainder Ie taKed at ths rate(s) applicable t61he remalndar beneficlary(les), If you chooae to meke Ihe eleotl!)n, you must atlnch Schedule 0 10 a IImaly.flIed taM return, along wllh Scherlula(s) K and/or M In order to shoW the apportionment 01 the trust or similar arrangement bSlween tha surviving spcusa and tharemalnder benaflclary(les). ~ , 1I1l"l.IIIIf,,,Ulnll. 1Il.tl~t1' jllltl \fi!II\'""l,u U'f..I>,'hhIfHtlll \'JIU,I\~~Il\~I'.' If.jjll ftll";",l;ljiiii;.~I'" , , C, To my friend's daughter, BETTY R. WP~F, R. D. #5, Dillsburg, PennsYlvania 17019, or her issue, the sum of ONE THOUSAND AND 00/100 ($1,000.00) DOLLARS. D. To my friends, MR. AND MRS. MERVIN J. SHEAFFER, 1100 Sheaffer Road, Dillsburg, PennSYlvania 17019, or the survivor of them, or their issue, the sum of FIVE THOUSAND ANP 00/100 ($5,000.00) DOLLARS. E, To my friend, C,C. CAROTHERS, 507 Forge Road, Boilinqsprings, Pennsylvania 17007, or his issue, the sum of ONE THOUSAND AND 00/100 ($1,000.00) DOLLARS. F, To my stepson, PAUL FLEMING, 920 West 16th street, . New cumberland, Pennsylvania 17070, or his issue, the sum of TEN THOUSAND AND 00/100 ($10,000.00) DOLLARS. G.To my stepdl\uqhter', ETHEL WALLACE, R. D. #1, East Berlin, Pennsylvania 17316, or her issue, the sum of TEN THOUSAND AND 00/100 ($10,000.00) DOLLARS. H. Tq my stepdaughter, DOROTHY DET'l'ER, Box 46, Wellsville, Pennsylvania 17365, or her issue, the sum of TEN THOUSAND AND 00/100 ($10,000,00) DOLLARS. I, To my stepqrandson, BRIAN WALLACE, R. D. 1, East Berlin, P~nnsylvania 17316, if he shall survive me, the sum of THREE THOUSAND AND 00/100 ($3,000.00) DOLLARS. \ ~~Y\ G r-/~~y(.A.,,'\ '3 H LEN B. F'LEMING i' IU:li",II'Mt.'.U.ml, III'illl'f.AIi'llII'1 ..\tll/llott"III,u l:Vf411MuIll'I.IU '1'11__, l'l~"'''I\ '~1111~1' f111"~~~.~~" AA. To my frien~, PATRICK DONLEY, Oarlisle, Pennsylvllnill, if she shall survive me, the sum,of TWO THOllSAND AND 00/100 ($2,000.00) DOLLARS. , ITEM 3., I qive Ilnc\ bequeath to the Dillsbul:lJ cemetery, the sum of TWO THOllSAND AND 00/100 ($2,000.00) DOLLARSI 's~id , sum to be held in trust in perpetuity by said Cemetery. and the income therefrom to be expended for the oare, maintenance and up~eep of the lot in said Cemetery in whioh I shall be buried along with the oare, upkeep and maintenanoe of the burial plot 'of my late husban~s, LEROY KOSER and BRUCE H. FLEMING. I am ' rtquesting that flowers be plaoed on our graves on Deooration Day, Easter and Christmas. It is suggested that my stepdaughter, ETHEL WALLACE, be contaoted for help in placing the flowers. ITEM 4. I give, devise and bequeath all the rest, re~idue and rema,inder of my estate, real, personal and mixed, of whatever kind and wheresoever situate, whioh I may own or have the right to ~ispose of at the time of my death, unto the following individualsl A, I give, devise and bequeath 10,6 percent of this ,my residuary estate to my stepson, PAUL FLJ;:MING, per stirpes, ';~j1~'~'\FLV~iJ;; 1~'~9 I'"~ ., " 00, O1A, n'lI! JlJl1llKI!II'a (1) ~ I nOli ' UAIIUI (IN l'IIKAl PAlll NIOM IIAIO fl10M II ", 1I011l10WIIfI'S all~~nlf'e PUIIDS I'IIIIIIS .- AT AT SUTlLUMIIIIT SUT1lUMllllt .- -iWlnm17WOi)!;lMIPRlnN..l!:!t[1I 700U.@-"iiIIO\'t~1 IGlo.... III IQLL ---......lJI, IU.UiIlQllllUJU"~"'.J.UUJAI '.U"d..1il~. h 1I1..1.......u", .11 'iUuaiULUlla: 'Qt..JlWTI'~QI.L.Jil.. .Qw.a.u~:U4'WJllIu.jU_ UL.tduJtUI.Mllld'UI.J~Wtuw.ua W....4tlVlWiUJl. Iii nil IIi _~c -- UWtUUUUltfl> ~LMtuslllIlJo'IIl&D.t1-ki'~I'1 liWlIUlUu""U-IllJlJJlllil. iU..!a..UJIllvl,i4U.JUfMtm lal -lilil~ u& 'flY ~II 111.-._ UtliJUul.,n.u1lllj' liilL.J4aJl.OlIlJIU"". lUl.Jk1t...iL"IUlJJU1 10U..JlWlr.lJUIUWtlU JOt', Anlluli,UllInillltl !QPUlaUJ4tIll,nu 00. 11 ml~'h, WI mfnUI "'OiMII "'flllhl" , IlIf/llll,.,. "'fill". ~. III Ih Mnlh 1'" ""/lih .-.f~~lIlh '''' IIlh I mOMIl ~tlmolllh ,.Ilnllllll "/11111" I nlll I llJL...lI.UUtww.~~UI lu ilOUk!U..Ul...ilWlLlU"'I" Ill, Un TlltllUl1lllllUOIIl1l 'tll' tllll,llIutUU IIUIlIII I. UtLll..tUllIUC.l.U,llIiIIOIlIIl UiLJiUtuJlli I. 110'. A1lOilIlH" I'll 10 tiaUlitl,l.J.l!Jlu..ll.talLtlllmblllJ ,,~., tlilt 1.11""IIU 10, GrlO$tl 1111\'105, IIn~kulll' 1~IUJlUlL...u~1 lUJ..J.tnilll'I taulI,t & UJ1..JlrD1C1..w'W1t..-W96 :aao, aD Jill. ' 1"', ~IIUI' lIur'I'old ^QlJlllS ...l (or ~OI'lIrllY JIlID II Iq Ulll.III"I~lfIIIIUI _ l'O. l}i~/CQUII1~ IllIUliriuI If/lJ f1illllllilllmUI 11ot. ;.::tC:1 :i~~:~! " ~~~U 'IIIIU!I, t.. ...._,-, ~iljD WUlt I .l1Q.(, "W.. UI ,U/lr. "00 TntAl SlIJlJlMIttt.OJ.J.lJla ,\ 4.15 I 5 .aa I ""t Ultl",Ut IHI,.,.; lht IIIID', "I!II/l1I~1 IIIUt/nIM t~.; 10 Iht ""I .1 m) ~~OItIU" tt,.; hNeI, Ill, I tlU' ,ft.; newIUI ,UI'fII'ft' oln Itll',I, tllf ell.hrltm'IIU m.... 011 "'r torOllftl \II b, Ill' III 11,1, Hlnll~lIu Ilutlh" ~'HII, Ihll I IIht IU"" . q\lPr II Iii, II"I"{'''I''./II "!lltllltnll " , ~our l. IlJl1llJUl110 /f,' ,v 0< Jtl 4'// tt ' "'" · f~' .' oJ IIttIG'Ii'IU ' '{.fll"lili. _./7 1....1111'1 JL1lil2.ll.. A"~I .:t!. '" ~......."w 11/ ~t>nnuUl t!ylll'Q \ / nl7l 00 Oy, llr fI~ilG"tl','J.' k~-I.:lJ~L" I- 11.111 I/lblDn :::~~IOI .J iJdlH'Clllll II. t!yllI'u I . , f1l1t] I/lfi/on ht'tl 1/lG/OU 110. InilH i,lIl,mlnl Pllltint,,1 ""III'h I hh, PII,,'ltllll . hut Inf UCUlllt 'Qtownl 01 'hil 1/lII,WI "illl ,",, Ulllth,1I1 -- 1111./ " " IroN1JS IUlCIil:tVBD I 1, Mortgage Check 2. Cash 3 . Down Payment $ $ 180,228.40 $ TOTAL $ 180,228,40 CHlIlCK/3 ISSU1llD IN DISBURSDMENT I 1. ReCiorder of Deeds 2 . Recorder of Deeds 3, arieat , Himes, Herrold . Agents 4, Kelly A, Lauer Notary 5'. Helen B. Fleming Estate $ 1 ,!~S3, 50 $ 1,51150,00 $ 1,298,75 $ S,OO $ 174,97S,15 TOTAL $ 180,228.40 ", ,. SOHBlDtnllll 111l" (OON'l'XNUBlD) BlSTATI or HBlLBlN ~, VLmMING rum NO. 2U7-0877 , (OON'l'INi1mD) 13, Agway Mo~eYMa~keb 800,00 14, Glenb~ook L1fe Annu1by #aA108188 24,386.32 16. p~udent1al Life Annu1by #A2013968 2,010,g2 16, P~udenb1al Life Annuiby #A201334g 10,868.36 Decedent Confirmntlon ;.1 NAmo Soohll Soc"rlty No Duto of Douth . Holun B, Flomlng . 171.38.\036 . 10/20/97 DOIerlpllon Aooount Aocount Account No, 8140470,~84 8140394181 Aooount Type Corllfloulo of Doposll Corllfloulo of Doposll Doto, Openod or IUllod 09/05/0(, 07/26/06 Dato Clo!Od or Maturod 01105/09 (M) 00/26/08 (M) 'Date of Duth Oolanoo $11,000,00 $20,000,00 PLUS nus PLUS Date of Duth Aooruod lilt, $26.40 $72.46 Joint OWllorI (If any) Dorothy Dollor Nono Ilonoflolory Dato of Joint Ownership Spoclal ComnlOnlsl N/A Unto I'ropllrodl Dcoomhor 3, 1997 I'rollurod bYI Amy L, Hnlvor (1lov RIJ6/97) P8go1 2 Aooount PLUS .. 'U~i~ :11 ~ ~ <" - r', '"' ~ ;9, f;! ~ ~~~ dU ~ ~ S 8 ~, ~' ~ g ~~~~~ ~ ~ ~ . N - ~ -d ... .., .,. - - - I ~ ~, ~ ~ , ~~ JIU~O~ ~ l"- I _-_:1:1 Ihn~ - s 8 ... !:! ~ t; uHm .... ..IM~ ~ frj 8. 8 ;;iUd ~ ~ ~ ~ - . - ., -d - ~ - = ~ ~ r;< ~ ,~~ ~ ~ f:: If lu u - ii ~ ~ - - Jltl)1 ~ ~ , 9 - ~ - - S ' I I I I , Q K!~vJ~~ I J II f ~~ " i i i i f }lflfl.l ij ~ 1.1 '..( ) , I '} , ,. ~i I J 11 ~ !. I J ! J "t" I. ~ le~~~f~ I I .. .' . ..' -=-ADAMS cOUNIY NNI'ION"', \lANK November 14, 1997 Griest, Himes,. Herrold 129 East Market Street Yor\<, PfI 17401 REI , Estate of Helen 6. Fleming ,,' Dear, Ms. Griestl The followin~ information is being p~ovided as per your reqUestl Account Type flcct. ~Umber flcct. 6alance Acc. Int, ownership Date Joint on 0.0.0. to O.Ci,D.' c.o. 139130 $35,000.00 $38.73 Individual N/fI Rate:5.05% Opening Date: 9-12-97 c.. O. 1.37359 $21,009.78 $79.14 Individual N/A Rate:5.50% Opening Date:2..25-97 C.O. 1.39145 $26,000.00 $107.70 IndiVidual N/A Rate:5./10% open in!; Date:9-22-97 C.O. 13735/1' $21,000.00 $24.85 J t. wi Leota 8;'12~94 Rate:5.40% openin$ Date;;S..12-94 Nesley It' you have any, additional questions, feel free to contact me. SincerelY, i1~o... H~ Lois fl. Kime certificate of Deposit coordinator II" ,.. , I, 'f "'1 o' ;' ~" ,.: ':_1. :::, * ,.' rl~ 1,"-1 , It ,-'I :,' ,0: .n IJJ ~t .l' ;il lJ.' .~ * L, I:J:: ,~t o' '. 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I~~ ~. .C., , ~ ('j ~:c .,. In :1: 'r~ IJJ (.j <I: ;1'~ ... .... ~, ,1'; ,'- 't" ~ (~ I. ~:r. :1' It I ~l: .'~ IJ.! :J: ... :1< ,t; ....,r. '.r:.~~ CI l.1 .l~ :::J <r. 1r'~ u.. Iii ,., * ;i1;"::C.I~ ;.(jl CJ. * ~") Z ';1; ~':l ...J loJ,. :+: . I::' ~~ t: H _':l ',J: ~.- ,.r, :~~ \" .:1: :r: :~i I;.~ <t I', :t: ?:- :+: .' I ...,,'101".1,.,1., COMMONWliALTH OF PENN&I ,VANIA ,INHEMANC& TAX RETURN SCHEDULEF JOINTLY.OWNED PROPERTY .'J,IIMINO, Holen !l., II.n me' WJl m.~elolnt \\1thln on. v..r of the ~Iotden"e ~.,. 01 ~..th, ~ muet be rlpol1td on 80htdull 0, SURVIVINOJOINT TENANT(6)llAME A, Dor~thy Ilottor n. teotn Negley ADDRE66 !lox 46, Wollsvillo Ph 17365 RE(j,1I0N8111P TO IlF.CI!D6IH II tup~dau"ll to r 1067 I,uwhborry Roud, I,uwisburry, PA 17339 oouain a, c, JOINTLY.OWNED PROPERTY: ETTER OAT I1EM FOR JOINT W.DE NUt.lllER TENANT JOINT 9/5/9 DE6CRI liON OF PR ERTV l"'lild' n.me 01 nnllllCl~ InlUlUliOn end bN\k OCOOI/nl number 0111';1" ~.nli~lng number, A11lO:h detd for nli .hG~ leij .lIala, Duuphin Oepos,it Bank Eo Trust oompany 00#8140479284 with acorued intereet 2. a. /12/9 Adams Oounty National. !lank, 0011137354 with acorued interest 1, A, ~ II OF OATEOF OEA1I1 OAIO OF OEA1I1 OECO'6 VALUE OF. , VALUE OF AB6ET INTERE6T OECEOENT'SINIORESl 11,026.40 50% 5,973.14 21,024.85 50% 10,512.42 16148~,56 TOTAL (Also enter cn line 6, Recapitulation) . (If more speoe Is nBOded, Insert additional shaela of the ..me size) . " !IV'"IIPOl"~. COMMOIfflIALTH Of P8HNBVLVANIA , INH8RITANCI TAX RITURN SCHeDULE J BENEFICIARIES FLflMING, lIelun II. PILS UMBeR 2197-0877 RELATIONSHIP TO DECEDE T Do Not LII' Ttult"(I) AMOUNT OR SHARE OF ESTATE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I, TAXABLE DIBTRIBUTlONS (Include oulrlghllpoulal dlslrlbullonl) 1, Lurry J. Sheuffer. 510 fl. lIigh St., Bollofont", FA 16823 6. Paul Flomins" 920 W. 16th St., New Cumberland FA 17070 friend 2,000,00 friend 1,000.00 friend 1,000.00 frienda 5,000.00 friend 1,000.00 10,000.00 plua atep-aon 10.5% of rasiduary " 10,000.00 plua a tep-daugh te r 10.5% of residua~y 2. Lindu M. Stoner. 505 Shuron Avo., lIeritaga Acr a Mechanicaburg, PA 17055 3. Batty K. Wolf, 246 Old York Rd., Dlllabufg, PA 17019 4. Mr. & Mra. Marvin J. Sheuffer. 1100 Sheaffer Rd., Dillaburg, PA 17019 5, C,C. Curothera. 507 Farge !ld., Boiling Springs, FA 17007 7. Ethel Wallace, 19 Bentz Mill Rd" float Herlin, PA 17316 II. 'ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 11, AS APPROPRIATE, ON REV 160Q COVER SHEET NON,TAXABLE DISTRIBUTIONS. .' A, SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1, B, CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. Franklintawn Unitad 8rethren, 10 N. Baltimora St" Franklintown, PA 17323 $ 5,000.00 3,000,00 2. Salvation Army. 50 fl. King St., York, FA 17403 '3. DillaburgCemetery Aaaociution, P. o. BOK 424, Dillaburg, FA 17019 2.000,00 TOTAL OF PAflT II. ENTER TOTAL NON.TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET . (If more Ipace Is needed, Insert Oddlllonel shests.o the lama slU) 10,000,00 "" .""+11 SCHlliDULE "J" (CONTINUED) ESTI\TE OF HEL~NB. FLEMING ! (CONTINUEP) J. TI\XI\PLE DISTRIBUTIONS FILE NO. 2197.0877 22. Al\llll SpaJlsler, 1052 Rhoan nlvd., Meohnnlosburs, PA 17055 friend 1,000,00 23. Curvin T. "Junior" Spllngler, 1052 Rhoda Blvel" Meohanlcsburg, PA 17055 friend ~ ,000,00 24, Rllym(lnd & Patrlotll Knec~t, 1081 York ~d" Dlllsburll. PA 17019 friends 2,000,00 25, Patrlok Donley, 402 P~tersburll Rd" Cllrllsle, .pA 17013 .frtend 2,000,00 INSTRUCTIONS 1, This form Is draltad 10 moet the lequlromonto of Beotlons 3301.3308 of tho p.p'.p Code, 2, Baa Bootlon 3301 ao to Iho neooultv for filing Bupplamontallnvanlory and elter.dlaoovorod property, 3, Real Boteto ,ltuata anywhere In the Commonwealth must be appraleod but noed not be desorlbed by met us and bounds, Bee Beotlon 3301(01, 4, Raal Beteta eltuate outalde 01 the Commonwoelth shall be sohoduled but not appraloed, Soctlon 3301 (bl,' 8, Additional eheete may bo Inoerled whare speoa Ie found Insufflolent, fi~E i a ' ~ T ~5i .. J i"~U , 9 I~ N .. j~rSJ CD ~J i ~r . ~ ~ ,a ' [., ~ .. ::l .. I i Ii HAKI CHICK PAYADLI AND RIHITPAYHINT TOI REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT AI:DNG THI8 L.INI .. RIITAINLOWIR PORTION FOR L'iDUR RIOORDS", " fliV: IIW.i'l/'"A~'JI'.C&";"1""NO'ft'6i..6'F.liiAi1(ffAllDi.Y'lix.;ilS~ftAYilmrll";.Att1SwA'f(cl'i.bif.......~... .....- DX8ALLOWANOI OF DIDUCTlON8 AND A881188HINTOP TAX IISTATI OF FLEMING HELEN B FIL.l NO. 21 97.0877 ACN 101 DATI 09-28-1998 TAM RBTURN WAB I I X I ACOEPTBD Ae PILED I, ) CHANGED RII8I1RVATXo~ONCIRNXNO FU1'URI XN1'IIRII8T . 811 RIVIIR81 APPRAI81D VALUII OF RII1'URN BA811D CNI ORIGINAL RETURN 1. Reel Eatete (Sohedule Al 2. Btooka end Bonde eSohedule 8) I, CloaelYHeld 8took/Pertnerahip Intereat eSohedUl, C) 4, Hortoeo,a/Notea Reoelveble eaohedule D) 8, Ceah/8ank Depoeit,/Hiao. Peraonal Property (eohadule EI 6. ~ointlY Owned Property (aohedule PI 7.. Trena1ere ISohedtlh GI e. Total Aaaeta APPRCVIID DIDUCTICNS AND IXIMPTION81 9, Puneral swpenaea/Adl, Coata/Hiao. Exponae, (Sohadule H) 191 10, Dabta/Hbrtaaae LiablUU../Liena 180hadule II UO) 1.112.63 11. Totel Doduotlona (11) 68 .Ql>~ .32 12. Net Velue 01 T.X Raturn (12) 494,42B..54 lB. Charlteble/Govern.ental Sequ..ter Non-ahoted 9111 Truate (aohedule J) (181 10,000.00 14. Net ValV, 01 htate SUbjaot to Tax 'U'\) 484 ,42B, 114 NOT II I If an ......m.nt "'I' ~..U.d pr.v~ou.1Y, l~n'l 14, 18 and/or 16, 17 .nd 18 "'~11 refl.ot figurll th.t ~no~Ud. the totll of ~ rl~urn. .......d tD date. A88188HIINT CF TAXI' , lS. A.ount of Line 14 at Spoua.l r.te 1181 16. Aaount of Line 14 taxable .t Linaal/Cl.aa A rata (16) 17. Alovnt 01 Line 14 tax.ble at Coll.taral/Cl.aa 8 rate (17) 18, Prlnolpal Tlx Dill TAX ORBDn81 PAYHENT DATs '(/ 7// /1 I ) . ,., ...' BUREAU OP INDIVIDUAL TAMse lHlleRITAHCE TAK PIVI8IOH PEI'T, 110601 IIARRIIIlJRO, I'A 11120-0601 OOHHONWIALTH OF PINN8YLVANIA DIPARTHINT OF RIIVIINUI NOTICE OP INHERITANCE TAM APPRAIeEHENT, ALLOW~NCE OR DISALLOWANCE OP DEDUCTIONS AND' ABIESSHENT OF TAM .. '-- \ ill \ DATI 18TATH CF dATI OF DIIA1'H FILII NUHBIR CO~NTY A~1t 09-28-1998 FLEMING 10-20-1997 21 97-0877 CUMBERLAND 101 AlIOunt Rlli HId 'I" :\) 'f}',; ,.",1 SUZANNE H GRIEST aSQ 129 E HARKET ST YORK PA 17401 Chi. \',\JI'\\' 1- U) leI III I'll (81 (6) 17l 196IDOO~OO 2.633.32 .00 ,00 328.232.98 16 J 48!;' 86 .00 (e) 47,813,69 ,00 M ,00. 2a6,569,20 M ,06. a57,856,34 ~.15. (11) RICUPT NUHBeR DIeCOUNT (+) INTEReST/PIN PAID (-) 2,6 .6 AHOUNT PAID , T01'AL TAX CRlIlln BALANOII OF TAX DUll XNTIRI8T AND PIIN. TCTAL DUI M IP PAID APTeR DATS INDICATeD, aEE REveRse POR CALCULATION OP ADDITIONAL INTIRE8T, ". UYoIWU"',m.m HELEN B NOTE I To Inaure proplr oredit to' ~our aooount, aUbftl~ ihl upper portion of thia for. with your taM ply.ant', 543,361. 86 .00 13,894,18 38,678,~6 52,272.60 52,613,63 341.03CR ,00 341,03CR ( IP TOTAL Due IS LEIS THAN .1, NO PAYHENT Ia REQUIRED, IP TOTAL DUE IS REPLECTED AS A "CREOIT" ICR), YOU HAY IE DUE A REPUND, lEE REVERSE BIOE OF THIB FORN FOR INSTRUCTIONS,) RIBIlRVATllltll PtJfIPOBIl Of' NOTICE, PAVlttNT, Il\lFUHD ICRII DlJECTllltll, AlIHlN IITR4T1VE CORRECTlONII DIICOIlHT I PENAUV I INTIMST, Elttt., Df d'o.~nt. dvlng on or blfar. n'Qllb,r 12, 19ar .. l' In~ future 1nt.r..t In thl ,.t.t. J. 'ren".rr,d In po.....lan or enjov..nt to 01111 II (caU,tlnt) li,nIUal,rl.. of tht dtoldtn' .'tlr thl Illplr'thM1 of IIlV "'Ite for Uf. or for Vllr., thl Co..onwl.lth h.r,bv IMPr...lv r...rv" thl right to Ippr,hl, ,nd ...... tran.,.r lnherltanol TIMIt It ,thl IItW'ltl c..... II (oall,ttU!) rlt. on any luoh 'ut~r' lnt.rllt. To fulfill thl r,quir..'"h 0' 'loUon '140 of thl Inhtr1tlNloI Md E,t,t, TllC Aot, Aot 21 of 199&. (72 P,S. , looUon 9140), I Dltloh thl top portion of thl. "otlol tnd tUbI" with vour Plv..nt to thl R.gI.t,r of Will. prlnt.d on thl r.v.r.. lid.. --Hoko ohook or .ono~ nrdor po..b1o 10' RBOISTBR OP "1~L8, AOSHT A r.fund of I '1M or.dlt, whloh WI' not r.quI.tld on thl ,.w Mlturn. '"~ bl rlque.tld by oOlPlttJng en "Applloatlon for Refund of P.nnlylvenl. Inh.rlbnol and Bltlb Taw" (REY-UU), Applloatlon. arlavallebl. .t thl OHlol of u.. RIghtlr of NUh. In~ of thl U 'hiVlnul Dlltrl01 OUltIIl, or b~ DIlling thl 'PIolll l4"hour In.Hlring 'IrYlo. nQIb,r. for for.. ordirlngl In'Plnn,Ylv~nl. 1-100.162.10&0, out,lde P.nn.~lv,"l. end within 10..1 lIorrloborg or.. (717) 711-1094, TOO. (717) 772-21&0 III..rlng Ilpolrod Dnlv), An~ Plrt~ In Int.r..t not .,tllfled Mlth th. .pfir.l....nt, .UoMlnol or .dltallCtwano,'Ctf dlduotlon., or ........nt of tlw (lno1'udlng dltootlnt or lnt,r..t) II .hoMn on thlt Hotlol .ull obJlot wHhln .he:t~ (60) dav. of rlollftt of Ihlo Noll.. bVI ' .""rUbn protISt to thl PA PIPlrt..nt of Rlvlnul, loard of App..h, Dlpt. 211021, Harrl,burg, PA 17128"l021,. OR ....l.otlon to h.". thl "IUar d.ter.tn,d at .udlt of thl aonount Ctf thl plrlonll rIPrl..ntIUv., tJR .....pp..l to thl Orphln,' Court., Platu.l .rrorl diloov.r.d on thh ........nt 'hould bt .ddr....d In wrltlna tal PA Dlplrt.,nt of R.Vlnoe, lur'lN of IndlVldul1 Tllell, AnH, Po.t b......nt R.vl.w Unit, D.p\, 2.0601, H~rrltburg, PA 171U"06DI Phone (717) 711".6&08. ... pIgI a of the book..t "In.\ruotlonl for tnhlrUlnol TIM. Alturn for. Auld.nt Dtold'nt" (REY-1&01) for In .wplahatlon of Idllnl.trattvll~ Qorrlct.bla IrrOrl. If If1Y hK due 11 p.ld within thrll (3) olll.ndar lonth. ,ft.r the d.o.dant'. dllth, I flV, pero.nt C&,,, dltoount of lho I.. pold It oll..od, Th. llXt.1e ~.tY non-plrtlolpltlon p~n.ltv I. oOllput.d on th. total of thl t'M and Int.r..t ......Id, Ind not' plld b.for. Janu.r~ 18, 1996, thl ftr,t daY aftlr thl .nd of the tlM ..n..tv plrlod. Thl. non"partlolpltlon p.nlltv I. IPp..Jabl. In the .... ..nn.r and In thl the .... tl.. parlod I' you Mould 'PPIII th, tlM .nd Iht.r..t thlt hll bt.n .......d e. Indla.t.d on thlt noUOI. tnter..t I' oh.rgld b.glnnlno Nlth flr.t dav 0' d.llnqu.nov, or nlhe (9) lonth. end ant (1) dav frol thld.t. af d.lth, to thl data of plva.nt, Talelt wtlJoh blo... dlUnqulnt bifore JlOUIrY I, 19a2 b..r Int.r..t It thl rltl of 11M (6_) Plro.nt plr annUlI o.lauletld It . daUv rat. of ,000161\., All tile.. ~hloh blo..t dtlinquent an end ,fter JtnUlrv 1', 1982 will bltr lnter..t It . r.tl whloh will Vlry frol ol'lhetar Vial' to alhnder v.ar ~lth that r.t. WW\ounoed bV th, PA n,plrt.,nt of Rllv.nu~. Th. appllolbla Inter..t rat.. for 1982 through 1998 1"1 tw Int.r..t Rat. b.ll1/' tnt.r..t Iflotar !Dr Intlr..t Rite pllhl Intlr..t F.ator 1981 EO~ .000141 1917 9~ .000147 1981 lt~ .000418 1918-1991 11:< .OOOJOI 19S4 ,000101 1992 9~ ,000147 1981 1S~ ,OOOUO 1991-1994 7~ .000192 19S0 lOX ,DOOm 199&-1991 9X ,00021\7 "-lnt.r..t It aaloulat'd II follow. 1 IHTSRB8T . 8A~AHDB OP TAX UHPAID X HU"BSR DF OAYS DS~IHQUSHT X DAILY IHTBREST PACTOR ~.Anv Hotlo. ll.utd Ift,r thl t,1e bloo... dll1nqu.nt will r.f110t an lnttrl.t aaloulltlon to flft"n (IS) d.~' bl~ond thl dati of thl ........nt, If ply.ent I. lid. .ft.r tht Int.r..t oo.putatlon dati .hewn on thl MoUat, adcllUon.1 Int.r..t lU.t bt otloul.tld. OENERAL INFORMATION 1, FAILURU TO RUIPoND WI~L REBUL r IN AN afFICIA~ TAX AalEB8HUNT ~lIh .Pllllp.hlo Inl"..1 h...~ on lnlDr.,lIon .....II\.~ II~ Iho fln""ol.1 In.\llull.n, I. luh.rUlno. tIt( blaHII d,UMU,"t nln. ..onUtt aftlr the dlo,d.ntl, dltl of dutlll I, " Joint IOGount h t.wllbl. aV..n thbUlh th. ",old.ntl, "'" ..ft. ~dcl.d '" II I.H"r ofOOIWI"hmoll, It. Aooo~\t C Inoludltll, tho.. held bit...." hu.band lf1d NUt) Which the dlclde"t put In Ju1n' 0.'" within 0111 V'." prior to death It. fulh' tlMlble '1 tranlf.rli t 8, Aoao,,"\I ..tahlbIM". jointly b.t...." hU,band fmd NU, lor_ Ullm on_ v..r prior to dlfttl1 ara not '''Maldl, 6. Aocounts h.ld bv . dlCldlnt "In trult for" W10thlr or,oth.rl IrQ tQMelba. fullv. RUPORTINO INSJR~CTIONS . PART 1 . TAXPAYER RESPONSE 1. ILOCK A . If the Infat..Uon and aoltPut.Uon In thl nutlo. ate aortlct and dllduotlonl '1'. not belnll ohl..d, plaol In "W" In baook """ of Part I Ofth. "ltucPIV.1" R..peml." ..oUem; Glol1 tNO oopl,. Mil 'Ubalt th.. with your ohlok fell" th'.Gunt of tlM to theR,..btar of MUll uf the OO""t~ Indiolt.eh ,1h" PA h,p"rt..nt of fhlv4Im'4I will h.uI 1m offlolal .......ent IPot. ftttY..1648 lUO UPOIl rlo.lpt of thl r.turn frol th.Rlghtl.. ()f WUlI. ' l. nOCK I .. tf thl .,..t ,plalflld, on tht. notlol h., Uti" or will b. r,porhd .nd teN ,,"id with the 1'.nn.~lvanla Inhlrltano. TIM R4Iturn fU,u bv thl dn.d.nt'l r.pr."ntaUVI, pha. an "1<1' In bloat< "I" of P.rt 1 of thl "TaM"'~lr R..pon.... ..bUcm. 810n on, oop~ Ind return to thl PA OI"I"t..nt of R,vlnul, lur,"u of Individual '1M.', U,pt za0601, IllrrhbUt", PA 1112'''0601 In th, 'nv.l~' provided. I, BLOCK (I .. If thl noUo,' I"tor.atlon h InooN'.ot Ind/nt dlduation, II'" h.ll'1l1 o1all..d, ch.ok blobk tiC" Ind ablIUI" Plrb I: .nd I acoordlng to the inltruoUonl bilow, 81gn two oupl.. Ind ,UUIU th,.. wUh YOl,lr ohllok for thl .Iount of t.M PlY,blt to ttUI Rt"S-t.t of WIU. of thl caunt~ I"dlo,tld, lh, fJA PIP.rt.."t of RIVIIlUI NUl 'nul In offlolal a.......nt (Fori RUY"U48 'UO upon rtollpt .1 Ihl r.lurnlr.. Ihl Rlgl.l,r .1 Will.. TAX RETURN - PART 2 - TAX COMPUTATION UHl! L Enter thl dltl th. "OOOU"t originallY NIi' Ilt.bUsh.,1 or UU,d In thl .nnner IKhUng et dati of dAftth. HOTEl For I dlo,dlnt dving "ft.r 12/12/&21 Aooou"h..~loh th. dlo.dlnt flut In Joint n.I.1 wHhln on. (1) y."r of d.nth e"l tlMebll fully ".tr.n.hr., thtw,v.r, there h"m IK01l.1I1o" not to '''Cllld 13,000 plr trlo"lrl. rugarda,n of thl vllu, ot th, aooount or thlnl.Mlblr of lloQounh hlld, ' If;. doUbl, IIt.risk (Nil) IPPJlrl ~Ifar. YO\lr flrlt n"I' In thl addr'" portion of tlth noUo'l the U,OOO uMoluUon 11rlldy hI' b..nd.duot.d traM ,thl loonuot ballnClI .. reported by th. flll~mol"l In.tHut1on. I, Entlr the tqt,Ltl,hnol uf thl Ilooount InolUdlno Int"lIIt looruld ,to thl dl" of duth. S, lhl plru.ntaf th, looouot that I. tlKlbl. for eaoh .urvlvor i. dltlr.ln.d II .o11oWII A, lhl perol"t tlM.ba. for Jolnt .,uib ..tablhh.d "or. than ani ~lilr prior t('l the d'G.dlnt'. death I I DIYIDED IV TDTA~ HUHl~R OF DIYIDED IV TDTA~ HUHIHR OF, X 100 . PHRCEHT TAXAILE JDIHT DWHERS, aURVIVIHD,JDIHT OWHERS IiMHphl "Joint ....t tlahhrld 1n thl na'l of thl dloldAnt Ind two other plr.on.. I DIYIDID IV a (JOINT OWNERS) D1VIDHP SV I t8URV1VDRSL- .167 X 100 - 16,7X lTAXAI~H FOR HAC" SURYIYOR) I, ]hl PlrOII1t.. taMabal tor ....te art.ted within ani v,ar of thl dlald.nt.. unth or 1I0CO\,"" owned b~ tht dloldlnt but htld n tru.t fat enothlr Indlvldual(l) (tru,t bln,flolllrll')1 1 OIYIDED SY TOTAL NUHI~R OF SURVIVINQ JOINT DWNIRS OR TRUeT IHNEFICIARIES Ih"lpll' Joint .aoount rlal.tlred 10thl "... of the dIO,td.nt Ind two othlr Pirlon. Ind IItablhhltf within onl Ylar ofde.th by thl deOldl"t i . . ' I DIYUSD IV I (aURYIYORS) . ,80 X !nO - 80W ITAIIAI~E FOR UCII SURVIVOR) 4, Tht ,.ount..ubl1ot to t.k UJ"I 4) h d,tlrlllllnld by lulUtlhlna .thl aooount lnilanot ,Uin. U by thl Plroant texablli (line S), I, 1010r I~' 101. .1 Ih. dobl. .n~ ~ldu.ll.o' 11.lo~ Ip P.rl S, .. 6. Th' .ount tIK~l,. Olne 6) h dtt.rllntdby 'UbtrftOtl". g thll dabt. antl dtduot1oni UI"I it) fro. thl ..ount lubj,ot to teM (II". 4), 1, Ent,r thl IPprOprit, taw rett (llnl 7) .. dtt_r.ln,d bIlow, ,. ., ... ' . A. For dltl' of dl.th ooourrl"8 "ft,r 6/10/94, thit taN ,.a\l. tor tl"nlter. to' .pous,. ara I!iI folloWl1 I. 0.1,. 01 do.lh 00 .r .lllr 7/1/9~ .od 1I,lor. 1!1/9~ tho r.11 I. ax, i,.Olt'laf da,th on or Ift.r 1/1/9& tranltlr' tOIPOU... Mill bl tlHld ,t OX tlx r.t~, "atli '~or ~.t'l of dl.th prlorto 1/1/94 tr.n'flr, to .pou.e. '1'1 tlxnble It 6~, a. nln'fl.n, ~CJ Unili d.'~.nd'. nt' .Includlng flther, loth.r\ .on, dln;8hhr., grandahl1drtn, 10n"ln.lI1WI "IUfhtl~.in.leW{ .tlPchlldand th.lr I'IUI II'" tlxab11 a IlK plra_nt (6~), tt lrlrilflt" tOIl oth'''' in01Udlnll bra h.t, .lIter, unal., aunt, "Iplllw and nl.ol ar. tillable at flft..n perolnt (1&l(l, n., u ~ou oh.n... the t.M rat., Pl.... ,plalh your rllaUcm.hlp to thl deCldlnt ln thl ar.."rrwldld, a, Thl .."un' of '1M dUI (Unli 81 11 d.tlrlllnld by llult1plYlnll tht ..ount taxlbll Olnl 6) bY thl titx tet. (1lnl 7). X 100 . PERCENT TAKAILI cLAIMED DEDUCTIONS - PART 3 D~BTS ANO DEDUCTIONS CLAIMED AllCJwlbl, dlbh .nd dlduoUonl '1" dltlrllnfldl" foUow., A. Vou l,gl11y .re t..pon'I~I' for p.Y'lnt, ar th. I.'ate .ubj.ot to .~Inl.trltlon by I plrlonsl ropr.l.n\fttlvl I. Inluffla1tnt to p.~ th, d.duot1bll I .1tI1. ' . II. You lotual1Y p.td th. ditbtl after dllth (If \hl d.oedant and o.n furnllh proof of PG~.int, e. P.bh bllng ollh"d .lIlt bll St,.llId fUllY In P~tt,5. If addltlanll1 'ploe It nelldld, UI' plein papII,. a lie" H 11", praof 01 plY.lnt .a~ hi r,quli.tld bv the p~ Dtpart'lnt of RflVlnua, ;;::':~:I~i,.::::;i\;:? ::;:"':'::,~~~~$~U~WrlIUL~T~:~~l t~~~'~'Xo~~wjfl~C}.!xIST~~\~CD1'~i!\~E' ,'" ',:' : '''H'A~~iBIJR~ 'A,T~~i',~R'l=7. gsd7~ rft"vA (1i'~~~hi!!~2Ii~VfnEIR!HiR~M~~I~E~NONCV) !:;:i:i!U PlJRPOII Ill' NoTlCI' To fulfill thl requlr..'nh of ..atlon UQO of 1111 lnherltlnol and Bit... TIM Aot, Aot t1 of 199&, (72 P.&. 1..lIon 0140). PAVHIlNTI O.I,oh 1111 top porllon of thlo No\lo. .nd .ub.1t wlthVou, p.y..nt to thl RI,llt.r 01 NIlIo prlntld on the r.v,r.. .1., .. Hok. ohlOk or ....y ordlr Ply...ll tOI ,RDOI8TER OF NULS, AOENT, RlPUHD {efnl ,~ rtfvM of . tete oredlt, whloh Nil not' requ..t,d on thl tlIC r.turn, ..~ bt ,..qullt.d b~ oQ.pl,Ung an "AppllolUon for Refund of PelM'1."h1nll Inh.rltlno.' Ind Elt,,, 'tIC" (REY-UII), ApplJoIUonl Ir. Iv.Uablt It thl Offiol of the AI,htt.. af N11h, .nv of tht ,'Mlv.nul Olltrlot Offlol. or b~ olUlng thl ,pial.. I:q.t!~ur fln'MlrlnD lI,.vl01 ~.r. for 'or.. ord,rln.. In P'~I.~lY.nl. 1.aOO~S6e.20ao, outllde P,nn.vlvlnJa 'nd within 10011 1~'rlobU'o Ir80 17111 787-8094. TOO' (1171 77'-1111 (H."ln8 IIPllrld Onlvl. OIJlOTl()ttlI Anv Plrh In lnt.r..t not lIIaU.fl.d NUh tht .ppr......"t, .Uowlnol or dh.lloN.no. of dlduoUon' or ........nt of tlH (Jnoludino dhoount or Int,rl,t) .. .hoNn on thlt Notlal ..~ objlotNHhln .hctlf (60) dlY. of r.o.lpt of ~~~~ ' ""rUt.. ~rotl.t to the ~A h.~.rt.lnt of A.vtnu., laird of App..lI, hlpt. UlOn, Harrhburg, ,PA 17l1e.1021, OR .....l.aUng to hlv. thl ..tt.r d.t.r.lnld at th. audit of th. aooo\lnt of thl p.r.an.1 rIPr..."ttUv., OR n'PPlel to thl orphen.' Court AIlIlIN- I8TRATlVli CORRECtlONal-flatull Irror. diloaYlrld on thll ........nt shoUld bl Iddr....d In writing tal ~APlp.rtlllnt of RIYlnUI, lur.IU 0' IndlvldUll T...., ATTN. POlt A......."I Rlvl.. Unit. O~PT. '80601, It,,~hbu,o. PA l7ua-0601 Phon. (717) 117.6105, ... plgI I of the book lit "In,truoUan. far Inhlritlno. IBM R.turn for a Rt.ld.nt Dlo.dlnt" (Ally-uOi) felr In IMpl.naUon of td.lnhtraUVlh qarr.atlb1t .rror.. DI8COUNTI If an~ tlM due 11 paid Nlthln thr.. (3) oel,nd.r lonth. aft.r thl d.cld.nt'. d.ath, a flvi p.rolnt (IX) dl.oaun~ of the tllC Plld II allolf'~1 peNALTY, ThI 11" tlM ,",",.tlf non.parUolpIUo" pI"I1t1f It aOlpUt.d on thl tot.1 of th' tllC end Int.r..t .......d, Ind not p,ld btfare JttnUlr~ 11, 1996, thl flrlt dllf aft,r thl .nd of the tlM .."..tlf p.rlod. Thie n'on"p.rUolpIUon ptnIIU~ I. ap",11tbll in .thl .... .a"n.r ,nd In thl thl .... U.. per lad I' If au NO\,ld app..l tho tl1II Ind intlrl.t thlt hll b..n .......d I' indio.t.d an thlt.notto,. INTERIIT' Int.r..t h ohlrold b.ol""lna ~l\h llrot day of dlllnqulnoy, or nln. Co) lonthl,.nd on' CIl doy frOll tht dtt. of death, to th. dlt. of peVI,nt. T'M" whiOh blOIl. dcUlnqUlnt lIefort Janu.rlf 1, 1982 "b.lr Int.r..t It ttll rite of 11M (6~) pero."t plr ennUi a.loulated at,a d.lh rat. of ,000164. AU tlICU ..hioh bto..' d.Unqu,nt on or 1ft.,. Jnnulrv 1, 1982 NIU b,.r Intlrtlt at , rlt. whloh Nll1 vlr~ froll a.llndar Yelr to all'ndlr VI.r Nith th.t rib Innaooo.d b~ thl PA D.p.rt.,nt of Rlvlnu.. Thl IPpllo.bll Intlr..t ,.1.. fo, IoU Ihrouah 1098 .,.. ' ~ Intlrl't Rat, Pllh Int.r..t faotor Veer Intlr..t Alt. Dallv Int.r..t Plator - loBI 20~ ,ooma 1987 o~ ,000047 1981 16~ .000458 1088-1991 II~ ,000101 loS4 IU ,OOUOI 199' o~ ,000047 IoU n~ ,000166 1991-1994 7X ,000190 loS6 1O~ ,000274 1998-1998 oX .000241 ...tntl,.IU it olloulltad ., folloNII INTlRBlT . BALANDS OF TAM UNPAID M NUKBSR OF DAYa DSLINQUBNT M DAItY IHTSRBST FACTDR "An~ Mbtlol IIIUtd Iftl,. thl tllC blao... ~.Unqu.nt "111 refllat .n Intlre.t atloUI,tlon to flftl.n (1) dlVI Hlfond the dltl of thl ........nt I Jf ply""t 11 .,d, Iftl,. the Intire.t aOllPut,Uon dlte .ho"," on the ,HoUoI, .,ddIUDMllntlrllt .....t bt aldoul.ted. '