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LAST WILL AND TESTAMENT
q,
ALIOI I. '~AQ~
I, ALICE E, FLANAGAN, of Hampden Township, c~mQerland
Co~ntYi pennsylvania, make, p~blish and deolare this as and for
my ~.t Will and Testament, hereby revokinr;r all other Wills and
Codioils hereto tors made by me.
P:J:RB't1 ~ devise and beq~eath all the rl!lst,resid~e and
remainder of my estate of whatever nature and wherever situats,
inoludini any property over whioh I hold power of appointment and
tor;reth!lr with any insuranoe poli~ies thereon, in equal shares, to
my nephew, RO~ERT L,SLUSSER, and my nieoe, MARY C. FEARNBAUGH,
provided that ohou,ld either ROBERT L,SLUSSER Qr MARY C.
l!lARN.BAUGH predecease me, I r;rive anc~ bequeath thl!lir share unto
their issue per stirpelil by rspresentation, and if there be ,a
failure of sa~e, then I give and bequeath their share to my
survivinr;r niece or nephew as stated herein.
SBCONDI In addition, to all powers r;rranted to them by
law and by other provisions of this Will, I give the fiduoia~ies
aotinr;r hereunctsr the. following powers, applicable to all proper-
ty, e~.roililable without court approval and effective until actual
distribution of all property I
(A) ~o sell at pub~lc ~r private sale, or to le&se,
for any period of time, any real or personal property and to r;rive
options for SAles I e~changes or lea..s, for suoh prices and upon
lI\lch terms (inclUding credit, with or without security) or
conditions as are deemed proper, This includes the power to give
legally sufficient instruments for transfer of the pruperty and
to reoeive the procsedoof any disposition of it.
(B) Tc partition, SUbdivide, or improve ,real estats
and to enter into agreements oonoerning the partition, subdivi-
sion, improvement, ~oninr;r or manar;rement of real estate and to
imposl!l or extinr;ruish restrictions on rsal estate,
(~
~
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L)
(0) To oompromise any claim or ccntroversy and to
a~andpn any property whioh i. ot little Or no value.
(0) To inve.t in all torms ot property, including
stooks, com~on trust tunds and mortgage invest~ent tunds, without
restriction to investments authorized for pennsylvania f~duciM
arie., as are d.emed.proper, without regard to any prinoiple Qf
cU,venit1oation, rbk or produotivity.
(E) To exeroise any option, right or privilegeqranted
in insuranoepolioie.or in other investments.
~ ......r.l (t') '1'0' e)Ceroiae any eleotion or privilege given by the
~ & ~ M and other tax laWS, inoluding, ~ut not neoessarilY b~ing
limited to, personal inoome, qitt and estate or inheritanoe tax
~w..
(G) To make distributions to my herein named benefioi~
arie. in oash or ~n kind or partly in eaoh.
(H) To ~orrow money from themselves or others in order
to paYde~tD, taxe., or estate or trust administration expenses,
to proteot Or improve any property held under my will, and for
investment purposes.
(I) To seleot a mode of payment under any qualified
retirement ph~ (pension plan, profit sharing plan, em);lloyee
stook ownership );llan, or any other type of qualified plah) to the,
.
extent the phn or the law permits them to do so, and to exeroise
any other rights whiohthey may have under the plan, in whatever
manner they oonsider Advisable.
'J'HI~I Idireotthat all inheritanoe, estate, trah.~
fer, sucoe..ion and death taxe., of any kind whatsoever, whioh
may ~. payable ~y reason ot .my death, whether or not with respeot
topropetty passing Ul'lder this will t shall be paid out of, the
prinoipal of my residuary estate.
'OUR~HI I nominate and apPOint MARY O. FEARNBAUGH,
Exeoutrix of this, my Last Will and Testament. In the event ot
" .,
the death, .r.siqnatiol'l or il'la~ility to serve for any reason
whatsoever of the said MARY c. FEARNaAUGH, I nominate and appoi~t
::l .
If;~,:;J/~ ~6.
BUREAU Of INOIVIDUAL TAMel
IHlltRIIAHCf lAM OlYIIIOH
O~Pl, 110601
IlURIIIURO. PA 11111-0601
OOHHONWIA~TH OF PINNIYLVANIA
DIPARTHINT OP RIVINUI
NOUCE OflNIIERlTANCE TAM
APPRAlleHENT, ALLOWANCE OM DIIALLOWANCE
Of DEDUCTIONs AND AIIEIIHENT Of TAM
(~/
..
m.11H n _It Itt..,.
MARY FEARNBAUGH
1808 S YORK ST
MECHANICS BURG
DATI
IITA"I 0"
DATil 0" DIATH
FI~I NUHIIR
OOUNTY
AON
OB-I1~98
P~ANAGAN
08-211-97
21 97'0&93
CUMBERLAND
101
Aoou~t RaoUted
ALICE
E
,PA 17055
MAKI OHIOK PAVAI~I AND RIHIT PAYHINT TOI
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
OUT ALONG THII ~INI .. RITAIN ~OWIR PORTION "OR YOUR RIOORD. ~
~W:IIW-i'li"mr'r~Y'''m''NoYf6i''(wmAiR'ffA'flcl'i'YAX-Ajl'~~Afli,"il't"..Att.cl'WA'flcl'i.'Q1f.............. - -.
DISALLOWANOI 0" DIDUOTIONs ANb AISilSHINT 0" TAX
IITATIO" llLANAGAN A~ICE E "ILl NO. 21 97,0893 AON 101 DATI 06-11-98
TAM ReTURN WAI, (X) AocepTSD AI fiLeD C) CHANGeD
RISIRVATION OONOIRNINO "UTURII INTIRIST . 1111 RIYIRSI,
APPRAISID VALUI 0" RITURN IASID ONI ORIGINAL RETURN
I, Rael E.tete Clohedule A)
e, Itookl end londl Ilohedul. BI
I, Clol.ly 1I.ld Itook/p.rtn.rlhlp Intar,"t Cloh.dul. C)
~, Hortlll'"/Note. R.o.lv.bl. Clohldul. D)
I, C..h/Blnk D,polttI/Hllo, P.rlonll ProPlrty Cloh.dul',al
6, Jointly Ownld Prop.rty (Ioh.dull fl
7, Trenlflrl Clohedul. G)
I, Totel A...t I
APPROVIID DIDUOTIONI AND IXIHPTIONSI
9, fun.rl1 ENPlnl../Ado, COlh/Hllo, ENplnl.. (Ioh.dull NI 191 7.038,48
10, D.bh/Hart.II' LI,lbl1ltl'"/Lhnl Cloh.dullll 110 I .00
11, Totl1 Dlduotlonl Cll) 7.n~R.411
U, Nit Velua of T.w Rlturn CUI 1.984.18-
U, Chlrltlble/Gov.rn.lnhl Blqu..hl Non-.I.otad 9UI Trult. l..h.dull J) CUI ,00
I~, Nit Velu. of ,lIt.t. lub,llot to T,IN 'C1~1 1,,9S4, lS-
NOTII If Bn BB....m.nt W.' i..u.d pr.viou.1Y, lin.. 14, 11 .nd/ori'l 17 .nd 18 will
r.fl.ot figUr.. th.t inalud. th. totll of ~ rl~urn. .......d ta dati.
AS811SSHINT OF TAXI '
18, Aoount of L In. I~.t Ipoul.1 r.t. (18) , 00 M ' 0 O. , 00
16, AI!ount of Lln. I~ teN.bl. .t Lln..lICI..1 A rlt. (16) .00 M ,06. ,00
17. Allount of, Line I~ hN.bl. et CoUet.r.I/CII.. 8 r.t. CHI ,00 M ,15. ,00
'II, Prinolpel TeN Du. lIB) ,00
TAX ORI nIl
pAYHeNT
DATI
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NOTBI To inlur. proplr
or.dlt to your looount.
IUblllt the upP.r portion
of thll forI! with your
teN p.y".nt,
5.084,30
RECUpT
NUHBER
DIICDUNT C+ I
IHTEREST/pEN PAID I-I
AHGUNT PAID
TOTAL TAX ORIDIT
IALANOI OF TAX DUI
INTIRIST AND PIIN.
TOTA~ DUll
,00
.00
,00
,00
M If PAID AfTER DATB INDICATED, lEE REVERIB
FOR CALCULATION Of ADDITIONAL INTEREIT,
If TOTAL DUE II LEII TIIAN .1. NO pAYHE"T II ReQUIRBD,
If TOTAL DUB II REfLECTeD AI A "CREDIT" CCR), YOU HAY IE DUE
A REfUND, lee REVERIE II DE Of THII fORH fOR INITRUCTIDNI,)
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.-".k. .h..k .r '."'i .tdor p.v.bl. I., REOISTllll OF MILLS, ^OBHT
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f.r ~.fund ., p.nn.vlyjnl. lnh.rll.n.. .nd E.I.I. I.'" I~~Y.III.I. Appll..II.nl .r. ly.ll.bl. .1 Ih.'O,II..
.f Ih. ~.DI.I" .f ~1I1., .nv .f Ih. n Roy.nu' 01.\r1.1 o'flo." ~t bV ..lllnllh. ,p'OI.1 ~4-h~ur
.n...rlnl I.ryl.' nu.b.t. ,or f.r.. .rditlnD' In p.nn'ily.nl. 1-'00-111'1010. .ul.ldo P.nn.ily.nl. .nd
.lIhln 1...1 h."lobutD .r.. 17111 1'7-.m, lUO. \7111 77~-UII tll..rlnl 1....lrod Onlvlo
~ni 'p"IY In Inl.r'" n.1 ..IIo!l.d .lIh Ih. .ppr.Io...nl. .Il...n.. .r dl..Il...n.o pf d.dUyll.n.. .r .".....nl
.f ,.. \In.ludlnl dl...unl .r Inlor..11 " .hO.n .n Ihl. h.II.. .ull .b!..1 ""hln .I.IV 1601 d.V' .f r...lpl .1
Ihlo H.II.' bV'
-..rllt.n pr.IO.1 I. Ih. p~ O.""I..nl ., ~.Y.nu" o.ord oLApp..I.. Oopl, 111011, 11."I.bur,. p~ mll'IOII, OR
"'.1'011." I. h.y. Ih' ..lIor d.I".ln.d .1 .udll .f Ih. ....""1 ., Ih' p."on.1 ropr...nIOIlY" OR
.....pp..l to tpl orphlnl!.cour\,
;;
p\lllPOIE oP
~oTle~ ,
~,.p\lMb (C~lI
o'J~CTlOH"
lHnREIl'
P..lu.1 .rr.r. dl..oy.r.d .n Ihl. ........nl .h.Uld b. .ddr....d In,.rlllnl 1.1 P~ O.p.rl..nl .f R'Yonu.,
eur..U .'I"dlyldu.ll..... ~llH' p..1 I.......nl R.yl.. Unl\. o.pl, '10601, I\"rl.bur" P~ Inll.0601
Ph.n. (1171 767'6106, II. p". 1 .f Ih. b..kl.1 "In.lru.lI.n. '.r lnh"II'n.' I.' ~.Iurn f.r · ~..Id.nl
O...d.nl" (R~V'11011 f.r .n,..plon.ll.n.f .d.lnl.lr.lly.IV ..trl.I.~I.,.rror"
\I onv tl' du' I. p.ld'~lIhln Iht.. UI ..I.nd" .onlh. .fI.r,lh' d...d..t'. d..lh, IllY' p.t..nl \lXI dl...unl of
Ih. t.~ puld I. .11...d. .
Ih. \IX I.. ,,,,uIV Mn,p.tll.lp.llon p...IIV II ..""uI.d on Ih' 1.101 of lhO I.. .nil Inl.rul .......d, .nd n.t
p.ld ~.f.t. J'nu.rV 11, 1996, th. fI." d'V .ft" Ih' ..d .f th' I.. .....IV ...I.d. Ihl. h.n...rtl.I..tl.n
p.n.IIV I. ,p...I.bl' In Ih' .... ..nn.r ond In Ih. Ih' .... II.. ..rlod.' Vou ..uld .pp..1 Ih. t.. .nd Inl.r..1
\hlt,h" b..n .......d II 'ndl~.t.d onthU "OUOI. '
lnt....1 \. .h.'O.d bl,lnnlh' .lIh 11,,1 d.v.f d.lI.qu.n.v, .r hlnlo (9\ .onlh' .nd 0" III d.. fro. Ih. d.t. of
d..lh, I. th' d.1I .f p.v.lhl. lOU' oh\.h b..... d.lln""..1 blf.r. Janu"V I, 1961 b..r Inl"..1 .1 Ih.rola of
.1. 16Xl p.r..nl p.r annu. ..I.ul.l.d .1 . d.ll.r..' .f .000164, All I.... .hl.h b..... d.lln,u.nl on .nd .fl.r
J..u.n I, \91' .111 b..r Inl"..1 .1 . r.I' .hl.h 0111 y.r. fr.. o.l.nd" v..r I. ..I.nd.r y'" .lIn lhOl t.l.
...,.""..d bV Ih' PA o.p.rl..nl .f Roy.nu., lh. .ppll..bl. Inl....t r.I" f.r 1911 Iht.Ullh 1991 "..
'!W 1nU....t Alt. p.uv tnt.rillt flator 't.W \.pJ1rut AI" ' PI'lV tnt.ra.t Faotor
1961 lOX ,bDOI4' 1917 9X ,000147
1911 16X .0004" \911'1991 \IX ,000101
1914 IIX .000101 1991 OX .0001.7
\911 11:< .000n6 1991'1994 1~ ,00019!
1016 lOX ,000174 1991'1091 OX ,000147
~..tnt.r." 11 Ul01lhtld .. fOUOWII
INTSRl!aT . SALANOS OF TMI UHPAI0 1I HUMSER O~ 'OAYS OELIHQUENT 1I CAlLY INTERBST FACTOR
','Ani Holl.' l"U.d.."..',lh' h. ~...... d.lIMu.nl .111 roll.OI on Intorlll ..I.ull\l.n 10 flt,l..n 1111 d.V'
b.vond Ih. d.l. .f Ih. ........nl. If .....nl I. Old. .".. Ih. Inl"..lbO.pul.u.n d.l. .h."" on Ih.
HoUCI, add,Uonal lflt.r.at .u.t bi calculated.
AOH1H
1IlRAl1V~
co~~UCl1Oll"
,
01lcQUHT'
.UHIL IV'
Decedent'. OO"!p-'ete Addrell:
^ RE B .
~5 PL'1 N V L"U-'I< SIRI ''f.<',
" (I r,;,
Tax Payment. and Oredltl!
1, Tax Pue (Page 1 Line 18)
2, Credll,/Paymenll
A, Spoul8l Povarty Credll
B, PMor Paymenll
C, Pllcounl
3, InlerelVPenally If applioabla
p, Inlerelt
a,Penally
(1)
Tolal Credlll ( A + a+ C ) (2)
.
,
'PI '1o~-.o-
, TOlallnlerelVPenelly (0'+ a) (3)
4, II IIna 211 greater Ihan line 1+ line 3, anler Ihe difference, Thla la Ihe OVBRPA YMBNT.
OhlCk box on 1'.;.1 Lln.le 10 raqu.lt. refund (4)
8, If line 1 + line 311 greel~r Ihan line 2, anler Ihe dlfferonce, Thlllllha TAX DUB, (8)
A, anler Ihelnterelt on Ihe tax due, (8A)
a, Enler Iha 10lal of Llna 8 + 8A, ThllII Ihe BALANOB DUB,. (8B)
Meke Check Pe able to: REGISTER, OF WI~~S AGENT
PLBA B A SWBR TH I'OLLO INO Q B TIONS
BY PLAOING AN "X" IN THB ApPROPRIATB BLOOKS
1, Plddeoedent make e tranefer Md: Yel
a, rotaln lhe use or Inoome of the property tranlferrei;l; '''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''~
b, retain the right to deslgn,te who ehall UBI the property trenaferred Slr Italnoome; ""''''''''''''
0.. retain., reverelonery Intereet; or"""""""'''''''.''.~'''''''''''''.''','''''''''''''t'''''''''''''''''''''''''tll''''';"".",'"
d, reoelve the promlle for life of either paymente, benefita or oare? ",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,;,
2, If deathooourred on or before Oeoember 12, 19B2, did deoedent within two yeara
preoedlng death trahefer property without reoelvlng adequate oonalderatlon? If death oClourred
afterpeoember 12, 19B2, did deoedent tranafer property within one year of deeth without
receiving adequlte conelderaUon? 'It,." t'" t, j", '''''''' I""" ,." H"'"'''''' """ ~,. "."""''','' ,., '" I",..""",.t, ,;0
3, Dli;l deoedent own an 'In trull for"or payable upon death bank aooount or eeourlty
4, ~\:I:a~e~:~~~=~:~' i~di~i;;~'~i 'r~'il;~'~'~~t' '~'~~~~~i:' ~~~~ii~: '~,; '~th~;' ~~~~p;~i;~t~ ';;;~~~~~?:::: B
IF THB ANSWBR TO ANY 01' THB ABOVI! QU~BTION8 18 Ylis,
YOl,J MUST OOMPLBTB 80~IBDULB OAND FILB IT AS pART 01' THBRBTU N
72 , ,69 18 (a (1,1) (I) prQvldad for t e reduotlon 0 the tax rete Impoaed on tha, nat value 0 tranafera to or or the uae of t I
aurvlvlng apouae frQm e% to 3% for deteaof deeth on or after JUly 1, 1994 and before January 1, 199,6,
12 p,s, 69118 (a) (1,1) (II) prOVided for the reduOIlon of the rate Impoa,i;l on the net value of trana fer a to or for the UII of the eurvlvlng
apouae from 3% to 0% for datee of death on or after January 1, 1998, The etetute doea not axe mot . tranafer to a aurvlvlng apouae
from tax, and theatatutory requlremlnta for dleolo.ure of ,eeell and filing a tex return ere ItlllaPplloeble Iven If the aurvlvlnglpouall
la the only benefiolary, '
No
I
~
!"
FOR OA TBB OF DBA TH ON OR AI'TBR JANUARY 1, 1986. Pleaaa anawer the following queetlon by pleoln9 an 'x' In the
appropriate epaoe, . ,.
Old thl !leoldlnt orllte. truat or 11m liar .rrahglment whloh II aolely for tHI lurvlvlngapoun'a baneflt for hi, or Her Intlre
lifetime? Yea 0 No 0
If you anawered yee to the above queatlon, the tax on the truetor elmllar arrangement la poetponed until the death,of Iha aeoond
epouae, at whloh time II will be fully taxable at the rate(e) applicable to the remainder benefiolary(lea), Enter the value of the truet on
Sohedula. J, Part II, In order to remove It from the Cleloulatlon of the tax due In thle eat,te, You may wleh to flIe Soh,dull 0 In order to
make the ele,otlon available under SeotlQn 9113, If the eleotlon la made" the truet or aim liar arrangement la, taxed In the ea,ate of the
firet deoedent apouee, the portion of the truat or almllar arrengement whloH benema, the aurvlvlng apouaela taxed at the zero taX ratl,
and the remainder la tlxed at the rate(a) applloable to the remalndlr benefiolary(lea), If you ohoole to make the eleOllon, you muet
attaoh Sohedule 0 to a tlmely.flIad tax return, elong wllh Schedule(a) K. and/or M In order to Dhow the apportionment of the truet or
elmllar arrangement batwllen the eurvlvlng .pouae and the remainder beneficlary(lea),
141'I111'''''11''.
COMMONWIIALTIIOf' PSNNBVlVANIA
INllERIIANCe TAX RnTURU
SCHEDULe H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
Debit 01 dtotd.nl mUll b. r.polttd on 8chtdull I,
IT8M
NUMBeR
A,
oeSCR/PTION
1.
FUNERAL eXPENses:
!7l /I). H.:7Z1 F/),t/~)Yl). ///'W/tf--
J) j6~,[.jr- (,'1;- 1111J:R.J:;0!/.e('. (NON r'I (II/'ll/die' .
(mflRIiN~.J I?W(?/lll- ,),r;o-",l-l.l 1/':A/;I)fit.7;fJI.:IJltnl-7C'/C:-S)
~,
S, ADMINIBTRA TlVE COSTS:
1, PllIOnal ReprellnllUVI'1 CommllalOnl
Neme of FellOnel ReprellntlUVe (I)
8~ISlCUrily Numbe~111 BIN Number 01 PellOnel Rep"lenIaUVe(e)
Street Addle..
CIIy SlIle -Zip
Yee~11 CommilllOn Feld:
2, Attomey Fell
3, Femlly BKemplJon: (If deoe<lent'e eddren It not the lime II cIalmant'l, eltach 8Kp~neUOn)
Clalment
Slmt Add"..
CIIy Bille Zip
Relellonlhlp 01 Clalmentto Deoe<Ienl
4, Probela Feee '
6, Accountenrl Fill
8, TaK Retum Frep,lre~e Peel
7,
TOTAL (AIIO enler on line 9, Recapitulation) .
(If more apace I. needed, /nee" addltlonallheets of Iha lime "le)
AMOUNT
/_ ",,,~.; .-,/8
..,D fY':;; \.7 ~
/ '16'.0, (JO
lJ,g 8.18
COHHOHW"~l III III' ~lHH'VlV~HU
OC~'M'Hr.H' 01' MlVlHUr.
'UMr.~U Dr IHDIVIOU~~ '~Kr..
OE~l, 1I0UI
IlAHMIIIUMO, ~~ 17111-0601
*
INFORMATXON NOTXeR
TAXPAVB~NRB8PON81
PI\.I NO. 21
AON 97147250
DATI 11-06-97
TVPE OF ACCOUNT
EST, OF ALICE E FLANAGAN ~ IAViNaI
S .11, NO. 1119 -16 - 8808 CHBCKING
DATE OF DEATH 08-28-97 TRUaT
COUNTY CUMBERLAND CBRm,
RBMIT PAYHBNT AND FDRMI TDI
REGISTtR OF WILLS
CUMBER AND CO COURT HOUSE
CARLIS Il. PA 17013
Uf'iUlII mil,,,,
MARVC PEARNBAUGH
C/O 1808 S YORK ST
MECHANICSBURG . PA 17088
DAUPHiN DepOIIT ,8ANK I TRUIT h.. provldld Ihl DIPorlllnl Hlth Ih. Inlorllllon 1I111d .llow Whl,. MI .lIn uud In
lJ.loul.Un._ ~h. PClhnthl '1M dUll Thtlr rUClord. ,'ndllllt, thtlt It thl dt"'th of ~h. above dlced.nt, you wire I Joint owntr/blnlUolarv l)f
thh .coount. 'If yO\.l f..l thlt Infor.,thm h Imll;U'I'.ot, pllatl Clbtel" written oorreoUon 'ro. the fln.nCllel lnltltuthm, .tUflh · .OOPY
to thh, for. end rlturn It to thl .boy, addr.... thlllGOClunt h talCab"ln .gourd.not with th. lnh.rUanol TplC law. of thl CQ..onwlI1th
of ".nt\'~lh'''l"j\', (,h.l~'Uu:;' nl:,' bo 11l1Dworori bv OQUin" (711) '1\1-U3I'I.
OOHP~ITI,PART 1 II\.OW M M M 811 RIVIRSI 81DI POR FILING AND PAVMINT1NSTRUOTXON8
Aooount Ho, 10-66920-8 D.t. 02-10-99
Blt.hlhhld
K
778,41
BO,OOO
386,71
,15
&8. D1
Tt' In.url prop.r arid" to ~our acoounh t..a
(2) oapl~1 of thl. notlol .u.t aooolplny ~cur
Ply..nt ,\0 thl Rlgl,tlr of Willi. Haklehlok
plYlblt tOI "RlgI.tlr of Willi, Aoant".
Aooount l.llnOI
PlrOlnt T.iclbl.
A.ount lubjlot to T.M
T'M R.t"
Pot.ntl.1 T." PUI
K
NOTEI If tlM pa~'.ntl art ~adu within thrl'
(I) tonth" of thl d'Old,"tl~ datl~f d..th;
you .av dlduot . I~ dl'AOU"t of thl tlM dUI.
~nv Inherltanol tlM dUI will blOo.. dlltn~u.nt
nlnt (,) MonthS .ftlr thl dati Qf dl,th.
T S 0
P I~U".ITC1 R,IPON/J WM"18U~T1H AN OP"lCllAI.~~lI AIIlISlHIHT 'A.~1l0N'r 1'~QnO'
[ C~RiK J
BLOCK
ONLY
~, 0 Tht abOYI lnfor"UC)M Ind till du.hoorl".ot.
If YOU.IV ohoo.. to rllllt pDvilllnt to thl Rlallt,r of Will. ..lth'hfO 001'1" of thh "oUO,~ to obtain
_dllooynt or avoid Int.rl.t, or you ..v chtok box "An and rlturn thll notlo~ to thl,MI,I".r of
WUIt and In oU,olal a.......nt will bt 1"\lld by tha PA a.part..nt of R.v.nuI'
I. 0 Tht aboYI "~It hit b..n or will hi r.port.d and tlUI Plttd with thl Plnnl!/Ivlnlt Inheritanol Tax r.t~rn
to bl fllld b~ thl dlcldlnt" riprl..nt.tIYII
C. 0 Thl aboY' .lnfor..tlan ',klnoorr,at a"d/oks(lbtl end d'dUctlonl "Ire paid by VOU,
Vou lUll ..IPloll P~R' l!J """/or P~R' L!J bllow.
P~T I, ~ou Ind 01 .. Ulrln 'M r. ., . .... I I I ~our
~ r.l.tlonlhl. to d.oldlntl
TAX RITURH . OOHPUTATXON OP TAX ON JllINT/TRU8T AOOOUNTS
~INI 1. P.t. B.tablhhpd 1
a. Aooount 8,hnOl a
I, P.rOlnt TIMlbl. I x
4, A.ount 8ubj.ot '0 T'M 4
I, Debt. Ind Dlduotlon. I
6, A.ount TIM.bl1 6
1, TOM R.b 1 "
e, T'M pUP .
-
".PA~'.': .....~.~:':..~.;~~!~J,;~!~D~.~~:~,~~~~, ,.:~::\:;\;!
';:~t:~~r~A~~~t~fI~
,,'.' '. ',"
''':.1 ...., ,';. :':::"'. ..."
"':,Q ...." ...,',"',.. ""." .,."..
Prnr
DATE PAID
I j I~... M ,,~ . .. ,P.._....~: \
Undlr .lnlltl.1 of .Irjur~, I d.ollr. th.t thl f.atl I hlYI rlPort.d .boy. Ir. tru.. oorr.ot and
ooapl.t. to tho b..t of .~ knoHl.d.. and blUlf, HOME ( )
WORK ( )
TELEPHONE NUMBER
PAVEE
DESCRIPTION
AMOUNT PAID
GBNERAL INFORMATION
1, FAILURe TO RBlFONO WILL RelUL T IN AN OFFICIAL TAM AlnnNENT wllh .ppllo.bl' Inlm.t b.lOd on Inlorlotlon
.waltl.d bv tho Iln""ol.1 In.IIMlon,
1:, Inhtrltlno. '11('b.ta... d,Unqulnt nln. lon\h. .fhr thl dlOtdtn(ll date of d,ath.
I, . Jilin' IOOQunt II tlMtbl"'Yln thoU.h thl dU'd,n'l, ""' WII Iddld I' . ..HI,. Itf t/o"Ylnllnot.
I, Aooo..." <lnoludlng Iho.. h.ld b.I...n huib.nd .nd wll.l .hloh Ih. d.o.d.nl pul In jolnl n.... wllhln on. Vllrprl.' 10
d"lh .r. lullV t...bl. .. 1,.n.I.,..
I, AoolUWlU ''''blhhtd JolnUv tlet...." hUtb.net Ind wUe lor, 'hln on. Vial' prior to dlftth II" not tlMlbll.
6, AOClounh htld bV . decldlnt "In trult for" ,noth." or othlr' .r. '1lllbll fully,
REPORTIN~ INSTRUCTIONS . PART 1 . TAXPAVER RESPONSE
1. BLOCI('. If thl Infor"Uan Ind OOlPu,.Uon In thl nOUOitr. oorr.ot and dtduothml ar. not being altl.ld, phot tn'"M"
In ~4aak "A" of Plrt J of thl "TllfpIV'1' Rupon.l- .,aUon, 11gn two GOpt.. and tublltth.. with vuur ohlok for thl ..ount of
h~ tq thl AI,ht,r of Willi of thl qClunt~ 'l'1dtalhd. ThtPA DIPlrt.lnt of '~IVlnu. will 'UUI .n offiClll1 ........nt
(For. RtY-IIII EW) up.n ro..lpl 01 tho rolu,n 1.0. Ih. R"I.I" 01 Wlllo,
t, I~O~K I , II Ih. ....1 ,p..lll.d ,on Ihl. n.II.. h.. b..n ., will b. ,.p.rl.d .nd, h. Plld with Ih. P'IW1.vlVlnl. Inh"lI""o.
riM Alturn fllid bv thl dleldlnt'l r.prl"nhUVI, phol In "X" In block "I" of P,rt 1 of thl "T'MPI~'r RllpOt1.," luUarlt' I'gn ani
oop~ and ,.Iu,n 10 Ih. PA O.p..I..nl .1 R.v.nu.., IU"'u 01 Indlvldu.1 T..... O.pl 110601. H."I.buro, PA 17111-0601 In Ih.
.nvft1op. provldld. "
I. aLOCK C "U thl nettlel Infor.,UCln h Inoornot Ind/or d'd~,othml II'" btlng tlhl..ld,'Clhlatc; blaok "e".neloo.pll', PI..t, I and I
.ooordlng 10 Ih. In'\'~ollon. b.low, lion Iwo oopl.. .nd .ub.lt Ih....llh vou, oh.ok '0' Ih. ...unl 01 I.. p.~.bl. 10, Ih. R'oltlor
.1 Wlllo <rl Ih. oounw In~lo.I'd, Th. PA Poporl..nl .1 R...nu. will I..u. .n 011101.1 ........nl (Po,. RtY-II.1 EH) upon ro..lpl
.1 Ih. r.lurnlro. Ihl R.ol.l.r 01 Will.,
TAX RETURN 0 PART ~ . TAX COMPUTATION
~INI!
1. Sntlr thl dl'l thl 100000\ Dr1glnl1h ..If "tlblhtt'd or' tltlld In thl ..nner 'Mhtlng It dlt. of d.,tt"
HOTE, Po,. ~...~.nl d11no .ft" 111111111 Ao.ounll .hloh Ih. d...d.nl pul In jolnl n.... wllhln on. (l) VII' .1 ~,.Ih .ro
tlMlbi. fullv .. trin,flr,.UDw,,,,,,, th.re h In Il'lclu.lon not to txo'ld U,OOO pI!" trlnlflr.. r,g.rdl... of thtvIlu"af
thl 1000unt ar the nU.blr Of 10ClO...,," hlld. ' ,.
If . 110001, IU"rhk (M") ,ppllrl blfo!,:, your Urlt n.." In the Iddrll' portion of thl' notloe, the U,OOO 'Molu,lon
11r'ldy hi' bl.n dlduotld fro. th"ooGun' bl1,no, I' rlport,d b~ the fln.no~l Inltltutlcn.
I. ~"\lr the \otll'btllnOI of thl 100llunt Inoludlng Int.r"t .oorUld toth,-dl!llh IIf dnth,
I. Th.'p'rolnt ,of the .o~C)un\ thlt' II bXI~l' for ..ch illrvlvor II IIltl".lnld Iii foUo"I' .
A, Th' p"..nl I,.'blll.r J.inl .,..\. ..I.blhh.d '0" Ih.n on. ~.or prlo. I. Ih. d.o.d.nl'. d..lh,
I DIYIDED ay TOTA~ HUHItR OF, DIYIDED ay TDTA~ HIIHItR OP H 100 . PtR~EHT TAHAILt
JOIWT DWHERI aURYIYIHO JOIHT OWMERo
IhCI"P1'i' A joh,t ....t rl"II\lr.d In thl n'.. of th, dlaldlnt ,nd two othlr plrlanl,
I 'OIYIDllO av S (JOIHT OWHER.l OIYIDED ay I (IURYIYDRI' . ,167 H 100 . 16.7~ m~AI~E fOR tACit IURYIYORI
I, Thi pI"unt bKablt fqrluttl orllt,d wUhJnoni VIII' of th.deold."tl, d..th or tOOOl.l"tt oW"11I bv thtd'Oldln\but'hald
In Iru.1 I., .nolh., Indlvldu'I(.1 ("u.1 b.n.llol.,I.." '
I OIYIOEO IV TOTA~ HIII1ItR Of aURYIYIHO JOIHT H ,100 . PER~EHT TA~AI~t
OWHlRI OR TRUIT aEHEfltlARI.1
EMe...ll' Jolnt looount rllllltlrld In thl 1'1111I' of the dlold.nt Ind two athlrPlrlcm. Ind ..tlblhhld wUhln ani Vaal" of dllth by
thl dlCldlnt.
I plYlDeD IV" I UURYIYORII . ,10 H 100 . 10~ (1AMAI~E FOR EA~H IURYIYDRI
A, TIlI......I ....1..1 I. I'M (Il(ll' A) hd.lor.ln.~ bV .~llIplvlng Ih. ....unl b.l.n~. (lln. Il bV 111I, p",.nl 1..ObI. (lInt II.
a, tnlor,lho 10" .f Ih. ~.bl. .nd ~.duollon. Iltl.d'ln P.'I,S. "
lit. Thll' ..nunt "'Mlbl, (Un. -n 1i d,\,r""'d ,by _ .\.I"-tr., otl",*- th, debh ~nd dldl,.laUnn~ Utn, s) frelY thw ,Iount -.utti.ot to hK -n In- 4).
7. Inlor Ih. .pp,op,itt. I.. rot. (I n. 7) II ~.Itr.ln'd b.low.
AI 1'01" dlt.. of dilth ooourrlnll IHit' 61S0194; the tllC rat.. for trlntflre to IPOUIII II"I .. followlI
I, Oil., .1 ...Ih on,o. tltI,'71II91""d bOlo'. 111111 Ih. ro" h S~,
I, Dol.. .1 dI.lh on or ./tor 111/91 ItIn.for.l. ip..... will b. I...d .1 ,OX II. r.lI. '
H.III Por dll., of d.,1h prIOr \0 1111" 1t"".lIrt 10 .pou..i .ro 1..ObI. tt IW, ' .
I, Trantftrl tolln'''''d..otnden'lnoludlnll '.'hir, lothlrt' Iqn, d.ullhtlr, ar.ndohlldr.n, 10",-1"-"'"
dl\lOhl"-in-I"'t'ltPOhlld Ilnd Ih.l, l..uI Irt 1..RbI.. .IM p"..nl (6~'.
C. TrlnUlre tOil -0 hirilncllJdlng brothe"; lithr, un,ll; "-'nt; n,phl" end 1'1110" .rt hXlbl. It flfte.n plrotnt (1I~),
O. II vou Oh_ 111I II. rol.. Pi.... 'Ploll~ vour ,.I.II...'hlp \0 Ih. d'O'd""l In Ih. .ro~ p,.vld.d,
I, Tho......1 '01 ,.. duo (lln. I) II dt\".I".d bv ...1\lpl~lno Ih. ...unt h.ObI. (lln. 6l b~ Ih. I.. ,,,. (lln. 7),
CLAIMED DBDUCTioNS . PART 3 0 DEBTS AND DEDUCTIONS CLAIMED
Allowobl. Dlbl. end ~II.... .r. dol.,.lhtd .. 'oil...,
A. You 1...111 '.r, .t""",.lbll 10' p'~IlInI. o. 111I "1.11 ....j..1 I. ....lnltl'.lIon b1' ",,,,,",I ,oprllonl.\ly. I. In.ullldonl
10 P.. tht .......1 III. It.... "
t. You ..luollY paid 111I dlbto '/lor ..Olh 01 till d....""1 tI1d .on lurnl.h p,ool 01 P.Y_I,
C, lIIbll b.l", .11 tld ....1 b. 1I..IIRd lulh In P.rI I, If 1Id~lIlon.1 'P... I. n..d.d, UIO pl.tn pop" I III. . II", P,ool of
p._nl II~ bo ro~'I.d b~ Ih. PA ~.porl..nl 01 Rov.nut,
:~:'!ii~~f[~~~ff."'l~..i~I~llmtlt!11
.. ..'HARRl$BURG 'AT I (711) t'e7oe321 ;~tfg~ c'ilh 7~2.1l2li2. CHltA~~NG IM~~lRlill ONlY) ,
:;::I,S': :.:::
ST~TUB R~poRT UNDER RULE~l
Name of Decedent I /) j )(' [ J< 1/11PA(;II~)
Date of Deathl Jl;)(~,{)r;/ ,::j{ij'/Y?
? ,..,
W ill No. J q C)? ~ () () R CJ 3 ~_ Mmi n. No" )?/9 'i. .tJ Ii (/ ::j
purluant to Rule 6. (2 of thw BuprAmA Court Orphans'
court Rules, I repnrt the foJlowln9 with re,.p.,ot to oompletion of
the adminiltr~tion o~ th~ above-oaptioned ..tatel
l~ State whether adminintration of the estate il complete I
Vell-L_ NO.e~"__'_
2. If the a'illWlU~ II! Nq, 1l1',l\to when the personal
representative re8llonaply,blllievu that the adlniniltration will be,
complete I ________
3. If the anllwer to No. 1 ill Yell, Iltate the followingl
a. Old, the, perllon,1l11',rnentatiV8 f Ue a final
account with the Court? '1'1.'18,__ No~ . .
b. The Baparltta OrphanA' Court ~o. (if any) for
the pe~sonal representative'" Itccpunt iSI
c. Did the parsonal l:epl:ellentative Iltate an
account informally to the pc'H'Uea j n lntan'at? Yell v' No
el, copies of receiptll, relea.81, joinders and
approvals of formal or informal account~ may be flled,with the
cerk of th~ Orphans' Court and may be attached to thi~report.
15$1
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11l"m~" t~ ~)O())'Ulth('YCJf;
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/1/1/1\1,/, (7 r; f1j()f(dIWC;,1I
Name ( 1,aautyp. or pr nt) , .
,/}/) ',.::1
ltJ/'JcS') rJt<("III' Yt>~K .{tI. Jhc'([I/,rJf
Al "flUUl " ,/ "/(J~?
.eM, nL. 1-/ ({q;, 1.3 7'/
'J'e r,~ No I .
Datel.5~/",1:- 913
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CftpaullYl ~'P9rlonal Repre$entlltive
Counsel for personal
reprelOntat.ive
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(MAH' rmf/AMJ)'