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
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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 ' .
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my redduary
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my rell!idUary
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my redCluary
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lilY resiCluary
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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
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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
"
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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
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')./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
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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
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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
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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
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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
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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",~"
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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~
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(,l Q. ,.\,..1 d
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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.
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, ,
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
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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'"~ .,
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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
..
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-=-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
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t. :: :':J 0> ..J ~'r:' ...." 1: ;,4~ t~~ l~. .J :-.~~ .'.... :t: :l: :+' .~:
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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. '