HomeMy WebLinkAbout97-00930
:r: tv 5 0 I... V E N 'T E s if\- TE
I "". -:;J I s- ;;)
INHERITANCE TAX RETURN
RESIDENT DECEDENT
COM"h~Vmn~II'T~ PJrJl~W~NIA (TO BE PIUD IN DUPLICATE
IIARRIIJlU~ ht~b8'0601 WITH ReGISTER OP WILLS)
. Nb Minai! IHili1\ll - . H
SORIGNOr.I I Gina L. 713 ^llenview Road
iOClllil~URllV NUM". ' --mUA OImm---Jiimor'IRliI -...~ Meohani.oBbul;'g, , P^ 17055
_ 196:.48t14Q..6__..______.. J:.1:.L1..Lil..7-1~_.i~/l&&L~ c""'fA,' Cll11bel.,J',~and. .------....-
I" ....'''''11 IVI ,,,"" lIoUl11 ,,,., ''''', ,,'" '"'' .Il"1l ""'"'' ~oC, 1 ,to.,lY HUMIER I~Mouilrnc'Y!V iil'llHmuqlloH'1
I ~] 1: Q,lglnal ROlvrn ..----..-----(jniS~;;,lomen;QI R';I-~'n [I 3, 'Remqlndor R,olvrn
. ! ,llor dalal 0, doalh p,lo, 10 I ~.13.B21
I:l [j 4. lImllod 01101. IJ 40, Fv'v" Inler.,1 COlOproml,o 0 5, foderal hlalo TaK R.turn Roqulrod
I!l (for dalll 01 doalh aft.r 2.12'921
[j 6, Docedonl Plod h"glo r.::J 7, Po~odonl Malnlalnod a Living T,u" ..0.,8, Tolol Nllmber 015010 Popo.1i 80K"
IAllach copy 01 Willi . (A"a,h ,opy a Trll'll '
. -'-. ~ qopiiPONIIJNCI AN' .O"''''''',.'T....INOlI!..'L.RWO.,~i!f'!'. 10, ,-
lilt LJ.&a Made CWe, ~ire 3901 Market Street
! lIUPIIONIN1Jl\i!~ - ---'"------ Camp Hill P^ 1.7011-427.7
____ I 7171 _I37-046L . 'O~'4==='=~~=~=~' .~--'==_
~: :~o:lk~~~: ~:~~:dlv~:h~~III0 81 : ~ : ~___J~gt::~:::::~:~~
~: ~::~~~g~:I~n~a~~~:r~n::;~:bll:I~~:::o~v',~o~t C) :~ : :=...~~~: ~:=~~-=::=:
5, Ca.h, Bonk Popo.lt. & MI"ollanooul POllanol PraporlY 161 _._l1_Ll!o.7.._~O__,___., ,..,_,..,
IS,hodvlo El '
6, Jalnlly Ow.od Propo,ly (5~hodvlo FI 161 ..__.JI/~n(,l_'_~~____'___m......
7, Tranol"'IS,hodlllo Ol15\hodvlo II 17) ......~!':I()~~__.._H~_~..
8, Tolal 0'011 A"oh {Io'al Llnll 1.71
9, Funeral EK~on"", Admlnhlrallve COlh. MllColla.eou.
EKponll' (Schodulo HI
10, Pobh, Morlgago Llablllllll, L1o.,IS,hodule0
II', Tolal D.dll,lIa., 110101 Llnol 9 & 101
12, Nel Valvo of E'lalolLlne 8 mlnu. Line 11)
\3. Cha,ltablo and Oovernmonlal 8eqvllh 15,hodllle JI
14.Nel.~0Iv.liu~"1 10 TaKILI.o 12 mlnll' Llno 131
15,8poV101 Tranlfolll'ar dale. of dOOlh afler 6.30.94)
Su 1"lrv,lIan, for Appllcablo Percenlago an Reve,,,
Sid.. IIncludoyalulI from S'hodvlo K or S~hodvle M,I
16. Amovnl of Line 14 laKqblo 01 6% ral.
{Intlvd. valli" from S~hodulo K Or 5,hoduloM,1
17, Amounl of Llno 14 'a,ahl. a' 16% 'ale
Iln,ludo "alII" from S,hodvlo K a, 5chodulo M,I
18, Principal la, dllo IAdd la' from Llnll, IS, 16 and \7,1
19, C"dlh Spav,.1 Favel1y Crodlt Prlo(Paymonh Ph,ounl
.. + -"-------- + .-.-..
20, If Line 191, g"alll Ihan Line 18, onlor Iho dlffo"n,. on L1n"~O. .Thl.1i Iho OVORPAYMINT.
mtl
21. If Line 18 I, groalor Ihan Line 19, onlor tho dllforon" an Line 21. Thlll.lho TAX 01,11. 1211 _____~-.Q::._._..._....._..~
A, Enlor Iho Inlo".lon Iho balance duo on Line 21 A, (21AI ....,_'_,.._,~___......_..._........'"
O."Enler Iho 'alai 01 L1no 21 and 21A on Lln~ 218, Thl'I. Ih. BALANCI U1,J8. (2181 ~.._._.._..___...__._..,__.__
Muko Chock Payable tOI Revl.tor of~WIII" !ovont __ _ ..... _ ___.
;'~'" ,.,.,..., .." .1. URltO ANIWIRAWCll,UITl.9NI ONIl'V'~" S1l)'ANl)tO R.QHICK/yIATH,-C)o(..., '._m__'
Under ponplllll of porlu,y, I docl"" I all avo o,amlne Ihli ,.Iurn. 1"<ludlng a"ampanylng IC odulll and "ol.mon.., and '0 'ho bo" a'my knawledgo..d bollol.
:Ih truI, correct andcompl,l" l'deetat.that all real "'Q'8 ~a. been reported allrue marke' value. Otc:larollall of prepor., QI~'Hlhan lh. p,IJtumal rtpte.onlallve I.
.aood an alllnfa'mallon b whl,h "aror ha' an.t knowlodgo.
,lONAlUfU oFPiifON'11'iJi i l 0 ILl ~ URN .. AbDRUI . ~_._~~_.n . -;. ,.-.. --, .. -.... o.m..,A......-...---~-----~--
_ == " q b$ ('. J. >1M LJ_.At. ,--~?<JwJ... -P-'!!..:....!..-~.IJ.,~ "2 ~ cJh t...""~H
o Ii R 1Ii N flePllutNT^,IVf. A[)P~~'" ., DArt, 7
REY,II00 l-Kt 17'~41
~k
I
I
i
s
...,~..c
V'r'
rpn'bu.~t DIAfH AnlR 121~~"1 CHICK HUI
POVIIITY CRlOIY II CLAIMIO LJ
PiLiN1iM'lit--~--'''~~~_~_.-m',' ....
2+w97w0930
.~9Ui'!TV C9PE,
VEAR
NU1!IBJl\
"
19 ).~.t~4~4-,~L__~~_~_.
1101 _~..L~19....o.!3..,...._...~
I B l_l!..d!()0.9...O'.......... '.
1I11~_....~~.' 6??_~~3...,__..
1121 ~ll,.88~.J1.L~m~c.. ,.,
None
1131_..nn~~_____._.m.....
114) L7..,88c5.7?
1151 .......,..,_____'u......_,_____)(, __..
1161 ...L'Z_,88:~..,l?.L.._u..._,_.._.u)( .06 .
None
wO-
1171 .,...___.__ ____..__~.....__,..)( ,15 .
None
Inlo',,1
1151 ,.._.__.:.Q,:'u,:~..--'-........._
-Ow"
1191 ___.__...""...............c..,
1201 __......._,,~-..~--.
( IIPC II IWIIl if VUII 1111' Il'lJu....lil1l1 11 11"111111 "' vom nVI'II'UV"H'ut
.> N 'SOl-\JENT e~Ift-Te
"""'11"'1"".*
, COMMONWftALTH OF PEHNSVWANIA
INHERllANC& TAX REIUIIN
SCHEDUl.E H
PUNERAL eXPENses &
ADMINISTRATive OOSTS
SGRIONQr.I ~ Oil\1l I..
FILE NU $8R
2H7-0!l30
D.blt 01 d.clll.nl mUll b. repon.d on 80hedulel.
ITE
NUMSeR
A.
DESCRIPTION
Ino.
\'.
2,
3,
Memorial Massea
Gravemarker al)d engraving - R & J Mon\J'i\ant6
FUneral Dinner
Resurreotion Cerretery Plot
ADMINISTIlATIVE COSTS:
Pll1Qnal RepmlnIlUv.'a CommbllOo*
Nama 01 Paltonal RaprtltfllalNa (I) NOrtraiean K06h
Boolal Sitlirity Numl>a~,)1 BIN Numllat 01 P,l1Qnal Rapreaantallve(a)
SlIIelAddrtlt 3905Churah Strs'ilt
City Camp Hill Btale PA
Yea~I)Oomm~~nPI~: 199B
Allom" Fees Henry F. Coyne, Esquire
Pamlly BXlmpllon: (If dacellant' ad<lrelS ~ nol tha IIIme II claimant., a\lloh aKplane\lOn)
Clllmanl None
SlIIafAdd~ ______
CI1y Stala
R6Illionahlp 01 Clalmanllll Oec1Idont
Zip
Zip
17011
AMOUNT
83,962.00
100.00
927.00
150.00
1,050.00
600.00
2,000.00.
4. Probata Fees 77.00
D.o. ACKlQunllnh Pe.. . '~" '
8., ' Tp R,tum PreparellFell (H& R Blook " Inoorre Tax Return)
7.
Oleaning Supplie6 for Apartment
Toll Call6 for Adminietratrix
Inheritance T~ ~eturn Filirl9 Fee
B.
9.
10.
postage
St1oker'6 Auotion - Comm1s6ion
Legal Advertiserrant - ClJTIber1and Law Journal
11.
12.
TOTAL (Alao enler D~ lint 9. Recapllulellon)
(II mote Ipaee II needed. Inle~ addltlonallhesl. of the lime 'lib)
60.00
60.00
15.00
10.00
32'.00
1B2.00
60.00
. 9,1'1'1.5"7
Eatll.te of
SGRIGl'PLI, Gina L,
SClmDUr..E H
(Col\t1inued )
B. Admin~trative Coata
13. LegaJ. lIdvertiaemant " Patriot News
14. Mileage Reimburllement for EKeoutrix at $. 32/mile
1~. CeJ:1:;\.fied Mail
16. . mrie Insurance. Auto
17. llllOtate, Cheqldng Account Fees
lB. Cleaning of APAt1:nv:tntand removal of junk
19. Reaerves
.
"
TOl'AL
I~Ue No. 21-97"0930
$ 53.00
4e.00
2.57
H6.00
15.00
125.00
200.00
$9,B4'f. !S i'
uv'uV' I;. 11.'31
om. a,
Nb~~lt
.
,.cOMMONWIM111 Q..'lIm.nVAtilA
lHI1UIIA!-4C1 I~'( lIMN
IIUlolNt O((ID NI
SCHEDULE I
, DEBTS Of DeCeDeNT
MORTGAGe LIABILITies ANb LIENS
'T.~~~
~""~"-.'-
, SClRIOOOLI, Gl.na I,.
,Phla.! Print ,~~ T:tl!.L._
8 "
~1"97"0930
'.
....~.-~~-_....~--~.---......
,..--'".._---~~~~,.'.-...-.,~ .-.~,...-----~...............~---.........,_."'....-
,
PUCltIPTlON,
___-.-'+-.._,~_.~O>_.*~_.... ~_"'_._"----'T~~~_~o--_-""'__~_*~~~'~_'._'_"''--'_~____'.___.''_.~~........~....--:----.-. --.--.-----
.~.~.~-_._-"-~-~.~._-~._~._-~_.~._..-
1. Bell Atlantio
2. H~en Township " Trash
3. Hampden Township " Sewer
4. pp &L.
5. I\mElrican Water Co.
6. Unoleared c)1eoks fran Members 1st Federal Credit Union
7. Sears Credit C~ Aaaount
a. HOl,lsehold Credit Acoount
9. 8piega1 Credit Card ,
10. Discover Credit Card
11. ' FiI;'st Q'nniaank - Visa
12. Waohovl.a Bank - Visa
13. Miohael Calabrese (Apartrrent)
AMOUNT
~_."""""""'-
~ 27.41
20.47
66.71
88;66
15.70
635.00
780.00'
440.00
555 ,,97
I'
1,145.36
1,493.43
820.64
3,759.50
TOTAL IAl'o .nter on IIno la, R'c~pllulollon)
(II mot. Ip~ce I. no.d.d, In18r' addll/onol.hoo', 01 lomo .,",)
$ 9,849.05
IS. J./ 5.-,~
PUR~AU OF INDIVIDUAL TAK~S
IHIlf,RIlAHCE IAK PIVItIDH
PEPI. 180601
IlAHRISBURD. PA 11111-0601
OOMMDNWEALTH OF PENNSY~VANIA
DEPARTMENT DP RIVENUE
C.-_
'*'
NOTICE OF INHERITANCE TAM
APPRAlaEHENT, ALLOWANCE DR DISALLOWANCE
OF DEDUCTIONS AND AaSESIHENT OF TAM
m.II""'''I...t11
. ,
DATI
I8TATI OF
DATI DP DEATH
FILl NUMBlR
OOUNTV
ADN
OB-18-98
SGRIC3NO~i
11-02-97
21 97-0930
CUMBERLAND
101
A~aunt Ro~Utld
GINA
L
LISA MARIE COYNE ESQ
3901 MARKET ST
CAMP HILL PA 17011
.,
MAKE OHEOK PAVABLI AND RIHIT PAVHINT TDI
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLIS~E, PA 17013
CUT ALONG THIS LINI ~ RITAIN LOWIR PORnON FOR VDUR RIlOORDS ~
ft'W: IAW-Ij( -A~j1- - m-:.,y -RoYilil- -onliAll(if Allei - YAjl-;ipjl~A-i i ll.fiRr- -At ~-eQA'f(ei -b'lf-" - - - - ---.. - - - --
DISALLOWANOI OF DIDUCTION8 AND A8SISSHI~T OF TAX
I8TAn OF SGRIGNOL GINA L PILI NO. 21 97-0'/30 AON ' 101 DATI OS-lS-9S
TAK RETURN HAB I (X) ACCEPTED Aa FILED ( ) CHANGED
RISIRVATIDNOONCIRNING PUTURIINTIRIST - SEI RIVIRSI
APPRAISIlDVALUI OP RITURN BAIID ONI ORIGINAL RETURN
1, Rill Eototl (aonodul1 Al
E., Staoko Ind lando (lanldUII B)
I. Clola1y Hlld atook/Plrtnarlnlp Intlrllt ISonadul1 Cl
4. HartsoSlo/Noto. RIOllvob11 (Sanodul1 01
a.Clln/Blnk Dlp..lh/Hho. Porlonol Proporty (Sonldull El
6. ,Jol"HY,Ownod Proporly lilonlduh Fl
7. Trln.flro ISahadull G)
I. "Tahil A..ah
III
(2)
m
141
III
(6)
171
i oq,
I DO '
,00
.00
11.807.90
NDTEI To In Iura proPlr
yrldlt to yitur ,oaoaunt,
lub~lt tnl upplr portion
of tnlo for~ wUh your
to~ PIY~ont.
.00
.00 '
III
11, B07. 90
APPROVID DIDUOTIONS AND IXIHPTIONSI
9. FUnlral E~Pln..o/Ad~.Caah/Hhl. bpln.1I ISanldull H) 191
10. llabh/Hart.ISI Llobllltl.I/Lllnl IBonodul' Il (10) 9.849. DB
11. Tatol Doduotlonl (11)
11, Nit VIlul of To~ Roturn (111
U. Cnorltobll/00vorn~lntol' BoQUllh) Nan-ollotod 9111 Trulh IBanldull J) IU)
14. Nat Voluo of htatl Bubjlat to TI~ II'll 1,8BB .12-
NDTII If '" ".'llmlnt WII ,1..u.a pr.v1au.ly, l1n.. 14, 11 ana/or 16, 17 Ina 18 will
! r.n.ot f:Lgurl. th.t 1nalua. th. totl1 IIf aJJ.. r.1:urn. .......a to ellt..
ASSI8SHINT OP TAXI
18, AMount of L Ino 1'1 It Bpaul11 rite lIB)
16. A~ount of Llnl 14 to~abll ot Llnaal/Claaa ,A,roto 1161
17, A~ount ,of Llna 14 to~abll at Collltlrll/CII.. B rote U71
11. PrlnolpllTo~ Duo
TAX ORIDITel
PAYHENT
OATH
9,B44.57
lQ .j(Q~ "
7,B88.72-
.00
,OOK'OO.
.00 K .06.
.00 K .18.
UII
.00
:00
.00
.00
RECEIPT
NUHPER
DI8COUNT 1+)
INTEREST/PEN PAID (-I
'AHOUNT PAID
TOTAL TAX ORIDXT
BALANCI OF TAX DUI
INTIRISTAND PIN.
TOTAL DUE
.00
.00
.00
.00
w IF PAID AFTER DATI INDICATED, SIE REVERSe
FOR CALCULATION OF ADDITIONAL INTEREBT.
I IF TOTAL DUE IS LESS THAN .1, NO PAVHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRI, VOU HAV IE DUE
A REFUND. SEE REVERSE SlOE OF THIS FORH FOR INSTRUCTIONS.)
mmATlDH'
PURPOtE Of
HDTlCE'
PAVNE"TI
REFUHO (CRI,
OIJEOTlDH..
AOMIH
ltTRATlVE
CORRECTlDHII
DIICOUHI,
PEHAL TV I
IHTERUTI
i~ ~ (fW
(I' i!
l;\ .....(,)
(I) HI
i., N -~ (L
(), - q ,)
>,
c.;, ~ :=:\'i-
..: C
)is ~(fj
.bot ~a
Ie
htltt" of dtllld'"'' dvJn, on or blfar. U,4..bt,. 12. 1911 .... If ,U1V future Interll' In thl ..tat.--lI trlnUirr,d
1n pa.....lan-or .n~gv".t\t to Cl,.. a (aoUltlran bln'flolerl.. of thld.o,nttnt ,ft,,. thl IlCpl,.IUO", of .n~ ..tat. for
llfl ar 'or r"r., the Co..onw..Uh htr.bv IMp,.l..lv r...rv.. thl rIght to Ippr,hl .nd...... trln.',,, Inh,rlt.nu hlCI,
a' thl llw,u ell.. . COtHie',raU rate on anv luoh ,utur. Intar..t.
10 luHllllh. "qulro..nh 01 ".Uon 1110 01 Ih. Inh.rlhn.. .nd Ut.l. T.. Aot, hi II ., 1.91. (1E P,I.
..oUon .1101,
Oltaoh thl td~ portion of thll'Notlol and tUb,1t I'lth VOUlI Plv..nt ta tn,- R.,lIt,r"of Willi prln\.d on the rtVlr" trd',
uH.ko .h..k .r ..n.v o,d., p,v.bl. 10' REOISTER OF MILLS, AOENT
A refund af. t11IJC oredit, whloh ".. not ,..qu.lt.d on the TIM Riturn, "v bi r.qullted bV' C1o"pl.'lna In "App1toaUan
lor R.Iund ., P.nn.vlvonl. Inh.,It.no. .nd htol' 1,.- (REV-lIIll. ApplIootlon. or. ovollobl. OIlh. afflo.
01 Iho ROQhlor of WIII,/,onv 01 Ih' II Roy.nu. OI.lrlot 0111..., or by o.lIlno tho .p.ol.III'hOur
,n",.rlna .Irvlol "....b.r. for forll' orcllrlnctl In P~nMvlYllnl. l"SOO-SU-toIO, ouhldl, PIM,Vly.nt. and
within looolll.rrhburo mo m71 781-1091, TOOl (1111 111-UU (1I..rlno Iop.l.od DnIV).
Anv partv, In Int".., nClt ..\llflld 'with the apprlh...nt, l11owlno, or dlllUo..lnCII of alctuotlon., ar ........nt
of hM (lnahldlng d,~IC!ount 'ar Intltut), II 'thown on thl. Notlal .".t obJ.ot wlthl" IhctY (60) dlVI of rlo.lpt of
Ihh Holloo bY,
...'wrJUan prot"t to the PA D.ptd..nt of R,y,nuI,'!ulrd of ApPle'., P,pt. 2aJOU, Hlrrhburl,PA 17U'.'0I1, Oft
".h4th", to hlV' thl ..ttlr d.ter.ln.d I' IUdlt of the .oooun' of thl p.rtone' r.~r...nt.ttYI, OR
"epp..l to thl Orphlnil Court.
"aotull .rror. dllo,oy.rla on thll ..'......nt thould b. .ddr....~ In ..rHlng t!)1 PA'Dlperhllnt of Rly.nu.,
Iurl'u of l(ldlyldull TIIC", ATTNI put ~"""Int Rlyll.. Unit, D.p" 110601, H.rrhburlh PA lHU-0601
PhOno (1111 117-6101. I.. P'O' I .1 Ih. bookl.I,'ln.lruotlon. for Inherlt.n.. TIM Rolurn fo' . R.oIdonl
Of,Oldtnt" (RltY-UOH for"n IMpllnatlon of .d~lnllt,..tI~11V correotlbl. errorl.
If.nv talC d\ll I. plld ..lthin thr.. (I) a.lendlr "onthl after the d.ced,ntl. d..th, a flYI 'Plroan' '(I:U dltoount of
Iho I.. p.ld It .llowod. '
Thl U)( ,aM a.nutvno!"",,,rtloiputon pI"al W h cOlput.d on the ,0Ul of thl '1M .nd Internt .......d, .nd not
p~ld b.for. Jonu.rv II, 19O~, Ih. IIr'l d.V .ft.r Ih. .nd 01 Ih. Il. 'ono.lv Porl.d. Ihl. n.n-porllolp.t1.~
pln,it" h IIipp..llbh in the ill.. ..nnlt Ind In thO thl .... tll' PI"hld I' vou would IPPlil the tlM end Intlrllt
thlt hi' bit" '..,"Id .. IndlOl\ld on thlt notlol,
1"I.r..1 h oh.rD'd bOII,,"lne with IIrOl dh of ,dullnqu.nov, or nino (.1 oonlh. .nd ono (II d'V fro. thO d.1O Of
dl.th; tCl thldet' of PIVllnt. '1M.. whloh b.Oi.. dlUnqulnt b.far, Jlnulr~ 1,' 19U b..r In\lrllt It the r.ta of
'he (6lU 'Pltfllllt p,r annul ollaul"t"d at I dlUy ratl of .000164. Allt1MII whtoh bloil.. aIUnq","t ...nlN\d .Uar
J.nulrv 1, 1941 wi 11 bill' Intlr..t'.t . r.tt whloh wlU, varv fro. nle"d",. Yllr to Qlltnd.r VII" 'HUh \hlt nt.
,.""ounOld bv' th, PA DIPart.,nt of RIYlnul., Thl .ppllolbl. Inttrllt rlltll for "at' thrQUlh 1~" ,r'l
tu.t' lnhrut Rat. Dil1l1 Intll'lIt f:'aoto"
Intlnlt fI.ta
Dath lnt.re.t ~'Icito"
~
1917
1911-1991
1.91
1991-19'1
1991-1991
9X
llX
.X
1X
.X
.000l~1
.000$01
.000117
.000191
.0001\7
IOU !PH .0001\1
I.U 16X .omlt
lOll m .000101
1.11 m .000116
19D6 lOX ',000171
..-thur.., II o.loul,t,d .. followlI
IN~EREIl1 'SA~ANCE' OF TAK UNPAIO ,K NUHSER OF OAYS DBLINQUENT K DAILY INTE.EIT FACTOR
-.Anv HolIOl I"u.d oft., tho 11M b...... d.llnqu.nl will '011101 .n Inl.r..1 OOIOUI.llon \0 Ilfl'o" eIIl d.V'
b.vond thl dlt" Qf thl, u'~".lnt.. if ply..nt It "td' Iftlr tht Intl,...t co.putltlon d.t. Ihown on the
NOtlOI, Iddltlon.l'Int.r..t IlIUU bl olloulfttidl ,.
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STATUS REPO!!~LU~DER"..B!JLE 6, l~
of Oecedent. " ~, .J';aJ ,..,..~'
Name (:i.tNII
Date of Death.
WU1 No. If"'- ()() (f.lC Admin, No;
Putsuant to Rule 6,12 of the Supreme Court Orphans'
Court Rules I lrepor!; the following ~ith respect to completion of
the administration of the above-captioned estate,
, ,
1, State whether administration of the estate is complete'
Yes"; Nb_~
2 . If the (inBwqrl.s No, eta te when the personal
representativereaBonablybelieves that the administration will be
compll\lte" '
3. If the answer to No, 1 'is Yea, state the fo'UowinQI
Il. Dic;l the persona! representative f He a final
account with the Court? Yes)4. No
b. The ~eparate Orphans' Court No. (if any) for
the persona 1 represen tll t i ve' s accou nt is I
c. Did t.he P'ilrsonal t"epresentative state an
account informally to the parties in interest? Yes "No
, d. Copies of receipts, releases, joindets anc;l
ap~rovals of formal or i~formal accounts' may be filed with the
cer~ of the orphanl I Court and may be at; tached to thh report.
~1~7
. ot.". '."
Lt..", ~~Id" ~IV"
Name (P ease t pe or print)
, , \.3'/11/ ~rl../- $I. t"';' .l(1I11f /~ t'/
Address ' "., r,'
(l{7) 1, '7-0 'I, 'f
Te . No.
Date I lo~ '1- 0 tl
In
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CapacitYI
Pereonal Representative
X Counsel for personal
representative
(MAH lrmf I AH,3)