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" ,; " (' "., I' ~ . m " ('~. CI) 0 hl ~ F,-1 " \7 ~ d; In ~ ,~ ~ '! t.) I gj b {/l . ::. ~ . il:l ~ ttl ~ ~ ~ [z' ,\21 C!J ( II'..... ....-0 . N . 'f}\ 0 i '" ,-1 g Z I.(') IUI No '.t.l-19 () ....,.... PETITION FOR PROBATE OF WILL AND LETTERS TESTAMENTARY in the Estate of g()bert W~ C lr17 on lfl tm: I deceosed, To Ricl1ard E, Anderson, Rcni"tcr of Wills for the County of Cumborland, in the 'Commonwealth of Pcnnsylvonio IS Petltioner(s) r:trNYhe execut 01,' nOlrled in the Lost Will ond Testament of _J~oJ)~r~WLQI1.roniflter dtlted Feb, 1,1.. 1~~..74 Decedent was 0 citizen of the United States and a resident of , Township ,~..._._...North,.Middleton....--- W{J/J/j" Cumberland County, Commonwel1lih of Pennsylvania. Decedent died an ..___S~l':~~X__,.._._____thc-u_2~:\"d day of. Ilel.'.em~).er._.._, A. D. 19_?~-., In the County of _cumher.landn. -, State of ...-J.lr..nn~Y/;!n!.Il...~....,........--~..._.., at the age of ,....?-~-~ years. ~U ,{cis I~U Decedent has not been married and has not had children born to him since the execution of the above described Will. Decedent was possessed of personal property to the value of __~,_...._ un~.!'.::_~~,::~___._._.. and of real estate to the value of .__..__._.__.._li2.l}6... ......n_............-__-_ os near os can be ascertained; said real estate situated as foilows -_....- ___ u____.____......A.'_m__....._._______.._.'____ ,__ ._____...,.._.___._,.,_".~........._....n_ .. , JJp{iy Therefore, your petltioner(s) respectfully appliefj for the probate of the said Last Will and Testament and for Letters Testamentary 1hereon. Dated __. Jf1I'~uary;..2 __..__19?2.._--i'? ,) ~.,. / ' Nome and addr()ss L,:;.~tt;.'.'k..""""'--~, ' . ./.Z:7-..-....-..-- of Petitioner(s) Melvin !!.i. Spa,]: 3501isorina R d ~QI!.r.1..Jl.!l!.!~~!l...L_---'''-'---- .._n._____.~... _ T._.____,.____. ___on --_... -"'--'-- -,...". -.---~ -~-~-_...._-- -_..-------------,-~~----------~---'------_.- u~._, .______~_.___ ,,_."'_________._______._n_..____n..--------.----_ COMMONWEALTH OF p. EN NSYLVANIA ~ . . ss COUNTY OF CUMBERLAND MELVIN E. SPAHR ._n_._________ .,~.____M'...~n__.__H ~.___,~~,..____" __.__.__.H______'_u ___.~_,.n_T_..~__ d. b I' t' b' d I swor.n d' t I name 111 0 ove app Ica Ion, emg u y ..~...__._.._'w..~.---. aecor mg 0 ow say(s) that the statements set forth in this petition are true to the best of _____hi.A ,_.._....~ knowledge anq belief. ~:~: _- and ,ubmlb,d b,la" E1"~~~~_.~ _____.,__.______.__~__"...n~_. __ I. tio I ( -I "'7' , 1'--' u Richard E. Anderson, 'Register \. ___'.__' nT__'__'_ ...-__~_._~_'__'________ '. \ \. .' ' Filed; Janul1ry l!; I 1979 .."2)- 7'1-'.:( r' Attorney, Georg~. TI. Stuort .. ~ . . OATH OF SUBSCRIBING WITNESS COMMONWgAIJI'H OF PI~NNSYINANIA COUN'I'Y 01<' CUMBlmLAND ! HH: '{IiliR... ...." ,,,..;...., H' "...t1,t:.tl... "'" "" "........" "',,, "'"'' dl\Y of... ....J,~,\lM.I,1.17Y, '.... ,,," ,.,,,,, "" 01'''''' ".t!... "... A.D.. tl).:2.9.", hoforo mo Hichul'd JiJ, Andol'HOn, HogiH\.o1' fOl' tho Pl'ohnto of WHIR IInd gl'/lnt.lng lottol'a of Adminlatrlltlon in nnd fol' auid County of Cumhol'lllnd, in tho Commonwoulth of Pt1UnaylvlInlll, IlOl'Ronlllly cluno ,,,....,,,,,.. MarRhall E. Hurley, ann of .........",...."".,.....".....,.",."."",.....,',.'..,.....".'.0""".'....,.,.,...."",................,.........,.....,..,.,......,......"..''',;..11.'..'.....,... tho RuhRcl'lhin!l witnoRRoa to tho Ibl'ogoin!! inatrutmmt of wl'ltlng PIII'I)OI.t1n!! \.0 ho \.ho loR\. WlIl IInd 'roHllunont of .,., ...,l\!'?J.).~?;'J.,.W.f.. ,~hrF!.t;l.~~.~.~1;'t'" to" ........ ,"'l"'" ,....,.t to ..""'0" Duted ,..:f~~.h~.~.li'Y, ,.h.l... ,.+.~7.{+ lufA) of ""~.~,~~;,l.~..tt.~~~.~~~.?~~..~'.?~.r:'.~~~.~.r.'.."........."""..."...",..,....,,,....., Oun\bol'lnnd County Pn., dOCOURUd who boing duly .."".~.~~;t;.~"....."."...."....... uc(:ol'dinK to Inwt dOIX)HO nncl Hny, that "'1~,..~~,E;J...."........."......~. pl'oaon\., IInd Bnw l\nd hlllll'd \.he \.oa\.II.I;'O'1:......"................, aign, Rtllll, (lubllHh, pronuunco IInd decllll'll \.ho allid inR\.l'umon\. of wl'it.lng IIH IInd fol' h~f/"'......... Tea\.nmon\. .Il.Qber.t"W.. ..c\lr.on.i.a te..t:..,., .......... ".... ,."..,. IInd Lila\. Will, IInd lit tho t.lmo of ao doing ..;~.l?,~~.~L}:I....,,9.h??,'?!1~.~~..WIlH of HOlllld I1nd dlapo!ling mind momory IInd undol'stllnding, \.0 tho hOHt of ""...h1,fl.,........".................."knowlodgo, ObROI'VIIt.lon IInd holief, Sworn ....".....,...,..."...............,.,.,...,.. un SUbRcl'ihed hofore / ' , ,~ / . \. J! / /"..:. ,) l;""" .,,,1.:.., :'. ,;,......C....., /. .'.~.:.",.." ....,..\...,....,... ....,."..........,.,..",..,.,.,.,..,...,.................."....,.'.\............ .,...............'..'11....'.... .H...........,....,...,.......,.,.,.",.................,...',......,.,.,.....,.. Richnl'd E, Anderson, Rogls\.or AFFIDAVIT OF DEATH COMMONWEALTH.oF P~JNNSYLV ANIA ! RS: COUNTY OF CUMBERLAND \ Melvin E. Spahr' . ..... ..'.." .... ".............." j ,., ~..............,..,....,.,...., ,. "".................. ,,,.,..,...,,.. ,................,..,...............,. ,.,... """.. boinS: duly ........"...A~Q;t;}.:\.."...';.."....",.". RnYH thnt us ncurly llA cn'n ho uHcortninod tho Ruld dncodont ..................."..." ........... .~.~~~ ~.t~...~ ..... ,9.h?:.~n.~.~.~.~.~.,...".,.. "................. ,. "'H....'...... ,.,.., ,........,...........;......,........ ............. .died on ............",...... S.unda)l.......,.,... tho .... ,2AtJl."., ....,. ..,... da~1' of ,.'..tl~h:.~b.~l; ......" .......,,'......... ..... A.D" 19.1.6... nL or nbout .......3.:.0.0......"................. o'clock, A..M, 2nd ................"..............,..,.,.."....,. loy Janllllry of .....,..........",..... ':' .n ' . '/ ' , ?' rf:(?' ~/j t.f c........ ....~,,' . ./j /:;I;_~7 " . ?~- /~- .- -1'1'. .-.~ - ./ ..... (,.L: 4.,(0<;"... "<""";f~ ..rt,::r.. ,.",.., ...,........,.,..... .; ..., .......,.,.,.... .....~~.'?~f.l,. ,...,.., ....and RubHCrihl1d th1ft - >. ,........,.""..............., Hlehllrd Jo:. AnOllrAlln, HI,~IHt.1'1' ,,' , ~ OATH OF PERSONAL REPRESENTATIVE COMMONWgALTH 01<. PI~NNSYJ,V ANIA } COUNTY OF ClJMBgHLAND SS: Bofol'o mo, tho Roglator fol' tho Probllto of WIIlH IInd gl'lIntlnH of J,Ol(OI'H of' AdmlnlHtl'lItlon In IInd for tho County ofCumborlund. porAonnlly canto ..",,,~.~).~.1;n...~.,,,,~p'~,1,1h""""''''''''''''H''''''''''''''''''''''''......,,,..... I b I d I sworn I ea I I' 'I t Executor W 10, 0 ng u y """""""""",,,',,,,,, ({) """"" (OPOHO un( RU) "lll, HH..,,,,,,,.,,...........""'....,,...,,."'''...''''............ , Robert W. Chronis tar of tho last Will and rostumont of ,........."...........""..........,."..""....."....,'..,'''''''''''''''''''''''''''''''''''II..."dOCOllsod .....111\'l................ will woilnnd tl'uly IIdmlnlRtol' tho goodH IInd chllttelH, I'iHhtH Ilnd cl'odltil of allld doconsod nccordlng to law. And nlRo will dlllgontly comply with tho !>l'oviHlonH of tho IlIw I'ollltlng to 1'l'lInslcl' Inhoritnncoa, .............!?~p.~.~... IInd aubscribod before mo. 79 04/' (:{)~~ /' ,,9............ @1n.t.t,'~.(,....."............. ~./.-f.1,,,...................... ---~ ( . ,..."".",.........."""..........,...".,.,.".."....................,...... Richard E, i] i . . (.)'\i n I I t.-.: I O'l i "i. i ! !"I i ! '.il ! I u.. if) ! IMIl OJ i ' . ell! 0 ' '1 c:l 'IIi tf'\j ~j P.I ..Ill ,-Ii ' . .....J ~ll ~ 1.J. '.1 , .....J .....: . 1'1 - r..', ".' . r r.:j (I'l! ! - t ,I ~ ~ .,' n'l ~~ I . 'J '1 I I'll .S ,,,j (1'1 "'. ~., ~ (".Ii i I ":'1 n" ~:tl ~ 'i I ~ i ~ 'fl'l J ~ I, J ~ i 1 a'o 1l ~ i ~ fi: DECREE J January 79 Be it romemborod that on thc ......~;?J.n,,,....~. day of "",.""".......""."......,,'.......,,,,,.., A. D" 19......... thoro was probnt.cd nnd rocordod the last WIJI nnd Toatlltnent of "".....~?p.,~.!-:.~".w.~."m).tp.!).~~,~,~F..."...."...."...., 1 te f North Middleton TownRhin C I I d C t [J I I D' d Lc n 0 ...."..........".".....1...."""...""...".""".".\1.."...""..", urn lor nn oun ':I, onnsy vnn at oconec. tters ,............,,:r.~n.tnman~1.\t"y....,....... were grunted to ..., .~~.~.~~~..,~ ,~...~~,~.~~......,..,.,., ,...,.....,.,......'1 ..........".. Wltnoss my hllnd nnd official ROllI tho dllY IInli YOllr IIfm'('Rllld. .".",....".... 'ii i~i~~~ ~:d' i~':' A';,'d ;!';.~;~'~:' i~"'i~~~: , . . . ,".~~ r --... ~- ~ -- ~- .... .ww.'~;I~.~........d>......A "<"f'1 _: _~~..::=:~ !iIll RCC'j4121771 COMMONWEALTH OF PENNSYLVANIA *' NO. 063528 DEPARTMENT OF REVENUE OFFICIAL RECEIPT' PENNSYlVANIA INHERITANCE AND ESTATE TAX I . -c -"-'-..,,~~~-,--~- ........---, ..___ ,.. ......m ...~~.~==~o.=~=..,~-" ; RECEIVED ........-...............----......-FIP"l'urf .1 a--,-....Q....l"IEl-B.._Jltuart.",E4q.",.. ~I' F n,.__(Melv1n fJ. S~.._..n_..' n A 0" 3 SoutlLH..no.!.~~,~l'~..t ~DR~__DO~...:~...~--~~~~~~------""~llar' IlJpro~of\ling Ponnliylvonlo lnhorllonco or hlolo Tm: due hOlll tho followIng oslola: .'".~._.~~_~__..~_~_..K~.. 2'k Tcu( Oil L_n~~___ $. 64i(. To..: 0/1 .t...___....."'_.___ S I Oarl181.,pa. _..__~1''?13_,.... 15% Tall. on $.............-._;...___ Fllo N(l, 21~'79-1i!() Dolo of Ooath .n_~g.~g4_~~.2. 8 IA Tn~ on $_________ Efilalo Tox:, Ad of May 7, 1917 ~ $ I ~~ $ 1,578.95 I Dolo of Paymant I: ROBEl\T.....HL.Ql~Q~.~B':t~ Nome of Docedenl Mu.gh.~..27~__ ( Counly _ OumlJer]lnd. TOTAL lAX CREDIT LOH flv(l porcfJrdunl of lux If paid wllhlfllhrf)o months aher dolo of dOClI" Pha h\lor051 at tho tolu of ~_.......... {", f rDfn'~~_ I(}~.._~-.._----........----,---- s 18.QIj I I :lnrks: PAID ON AOCOUNT. $. uOO ~ ~)[JJ@L~TI'li~ TOTAL AMOUNT PAID ( .. S=~90.-- Rocol\'od by ,~L) (~~/ w .A / ' NOt[ In ncc.ttllng 'hi hornl,r lnh,rllonu tal Or'! fulur. 8'!nll,. l'rlM l(l lhe deoth of the 1,111 'QLlO'd I I.nont or I.non! lor Ylm" 01 hld.neld hy Ihll flelllpl, II " "nd~Hlt(l'J!llhul II.. ClHllIl'('~""HlI!l, ,1'1111 -BlahaI'" ~.d.r.o not b, p',elud,d 01 rH.Vlnltd horn htfaolt'f (I1'e"1f11l ndd,llonnl ll'l/llrlln"(ll In. III Ihfl (jenll, nllhfl 1\egrilt8r 0 lU hf. 'Innnl or I.na'lllo, y.nr. wh.'l...." II apl'llC1r1 Ihol tilth {ldUl110llUllot "HI'( bo IIlU"lly (llillIHld-.-.......~ ... (~_I __~_____ (olf"llbl. lor ally "CUOn WhUUOhOf, _ SEA L NOtH: Thl. Trlpllcatl Rtotlpt to ~ 'IU.lnld lor ,udll PlHI)O.", ',l' Ilf,'I' APPl.ICATlON 1'011 CIIAIlIT AIIl.E I:XEMPTIOII flWM PE~NIYLVAl~IA TI1ANIFI'IIINHf'IlITANCE TAX (Att uf MI1Y 78, 19,1)6, P l. 17!i7, Imil Atl (If .1"",, 15, IUd, P,L, 373, u. nlllfllHll'ldl + ~t~ COMMOt~Wr^Lll1 01 f1tNNSYI.VldllA OF."AllTMI'tH or nr:VENlJf IlUREAIJ OF COUNTY COl.l.Er.TIOIII .u._.___=, , .-- -, ..~ ..- .-..... ArrlkCltlon i!t hereby flh~(1 for tht' al'Pfuyul of (Ill exomptlon from Punnliylvonlu Ttunf.fof Inhorllnnco Tm( an tho trunsfl'r of tlw proporty dOHrlbo" holow: 1. Burouu Fila II 21-79.29 2. I)uto 01 Doath DecembeI 24, 1978 3. Dolo 01 Approval ~~Vv r ,~/", I? \)? .:lL.,N_om.~...!'JJ1.!'~~don 1_.:c~.t?,1?~.!.t.J(~;".C hr 00..18 t; er. 5. Tho Commonwoalth'. apprul..d valuo of tho proporty lor which an oxomptlon I. clnlmod I. st.Q.Q_Q!,Q.Q.___.__.,...., (Nato, Whoro tho p,oporty I. o.hor than a .poclflod umount of <o.h, tho oxompllon cannot bo approvod until tho valuo of tho proporty has boon ..tubll.hod by apprallal by tho Commonwoalth. OKeOpt In tho.o ca.o. whoro tho alllaunt of tho gift 0' boquolt ropra.onh a .latod fractional or po"nntng" porllon 01 tho "nllro a.toto or tho onllro ro.lduo. In tho.. ColO' on tor .uch froctlanol 0' porconlogo amount obovo). 6. Chock tho munnor In which tho tran.lor wa. ollo<tod and .uhmlt 0 copy 01 tho dacumont autha,I.lng tho tran.lor, unlo.. .uch motorial has heon plovlnu.ly fllod, WILL ;f;/; DEED /7; TRUST INDENTURE~~ SURVIVORSHIP /'l; OTHER 17; (If othor, oxplalnl... 7. Corroct Bu.lno.. Namo and Add,... of Charltablo O,ganl.atlon ,ocolvlog p,oporty' NAME Grac.e_Yn~,t.~d..l1e_tl:todist (]hurch ADDR Ess.~45SLWeflt."Strect ,Carl:/.s 1e'1>a. 17013 , 8. I certily that tho Information contalnod horoln Is, to the bo.t of my knowlodgo and bollof, truo ond corroct. .~.. - ~ Slgnatu,o 01 Applicant .,,~&j (.u&)~:'f7'tf;L ,. u. n.u_._.~_.....___._____ 3501 Spring Road, Carlisle, Po. 17013 Add,o.. of Appll(ont ..._.n Offlclol Tltlo .,..~.., Executor ".,... Dalo..J_u~Y..1,Q.L~J.J9 Thh fnrm nwlt he cOllllllnlnd In tllplltflln unci {III th,utl eOl'llu dnIlYI,,,,,,1 tn III" Roolllor cd Will, fOf the County In which tho doeedent rnlded, (11 In which Intima Wtll~ luuod l,ot II lIon-ro,'dunl dotJ'df1nf" flltuln, If thn docollonl writ U non.,otldo"t 0' Pnnn.ylvonla and lotton worn nnlluuod t,y u Pllnfl'ylvonlll RuolllM of Will., drdlvAI all IlltCHt copln to 'ho Dlruclol, Butoau of Coun'Y Collections. Ponllu. O(lrClflmflnf of Rnvflnun, 26 S, 4th ~""1I1, UnHI.huro, Po. '.',/ /\ .__~-J\I'JI(A,~:r Lv.r.\k~l\;-~'- (Slgnaturo o' Regl.tor of WIII~-7~1l I:' 0," "11 r /,::f1! "":.' -----_._--.---.........-........"'~.~~._..._----_. - --. ..-- I Donlod' .'7 (lnltlnl. 01 Rogl.tor 01 Will.) (Authorized SI9notu,0) (C'o~htW . '... __ ._._t1~~9J<)2.~__ (Doto .1 ApplJvlll) (Counly) (Tltlo) (Dolo of Ralohol) (Dato 01 Action) j So. reveu.. ,ide for ,.alonl MUIT U~ FILED IN TRIPLICAH RCC.9J 14.131 COMMONII'EAI.T11 OF I'ENNSYI. VANI,\ IlEI'AllTMENT OF IlEVI'NUE IIlJlWAU 01' COUNTY COLI.ECTIONS *' RESIDENT oeCEDEHT COUNTY OF _~~MBERLA;~~~_ - ~. IMPORHNT, - ~~-- - ~_?~ .~ ThtH fe'Urn mUMI bl,l ~nl1lplcHCd I;, dctnlllllld rlll1~t in duplil.:nle, with 1I111\lII1Ch~d, with tht\ nt'illlte; (If WHIR uf thC! (;uu",y whuro Ltocodullt fCHddodj HOlum IN due wlthlllllll1(' monlhH "ftN dntt of dl.lllth, unlcfHI "" cxu.\l1l1lun IN lIrlUUNI bV the Sccrotnr)' of I\O\lCIIUO, (Scotioll 70J uf tlw InhofllllllCC "ud ElllUtu Tux Act uf Itl(.l,) ,.."~_ _ ~_~_, ._~_._"._.r _~ n"'"~ ~-:-_._---~- ~ ~. - - IN 1'lIh MAl TEll 01' TIlE ESTATE OF } AFFIIlAVIT OF RQll~ll:~_ w.!..J!lnl.ON:t~'rE.r.~__.__ ____._. EXEl'lITOR ISTAru rut-I.. NAMf OF DECePENT) N. HIDDLETON 'J'HP. XX1~~la{il(iA Late of .___~.__~_u_._rn_nT__~__'_'_ ___..._._,~"..,_~._.,,__~~ County St.,. of __l'ENNSYLVANIA -.---..----,} , J' 'J ANl) ." County.f_ LUMll !,R ~ ...._______' HELVIN E SPAIIH EX'CUIO' XU~~XtXr "~_._'---'~'j"'h;~~lot. of th. Qb;;~~'d;;;d;~;b;~g duly .warn, dlpou A Qrtd ,oy C I December 2lf 78 {;; } UOC(Jd\~1I1 tiled - t lll~. t"tat. IHvlng a 10.1 will, copy of which II h.rt1a aUoth,d, !MON1'I-O (PAY) lyeARl ~~kK ' Hom. And nddr... of ollom... ')I} George n" Stuurt oth.,au,hod..d,..r."n'a",,".h.m -'--3-'So~;-th"HllnO~' St. ,--cii':rfis1c. Pa. 17013 all CO',..pond.n~. ,hQuld Uti nlOllod. _,.__,____~._._____.-.--+H..............._ Thill "" "UCh_._n:X~9!t:O~:"'.._depllnollll. I'UI1\IIIIII \l'lIh Ihe III'1'nll" IIf snld oslnlo nud Iho p"'porl)' ellnslllnllng ll'; 'f, I! CU TO Ic' AI/MINI S 1 r~ II 10 ~J Ihe lINSol' IhOI'''1I1' nud Ihol, fnl, nHllkol I'lIluo, Thlllnl Ihe Illlle III' denlh Ihell. WlI" nil snfo d"l1O"1I hll' regl'lol'od lu doc"lonl" Indll'ldnnlnlllllo, 1lI jnlnlly wllh, 111' n, lI~onl IIr dopuly III' nnlllhol, II' In d"",donl'" Indll'ldunl nnnw, \l'idl rlghl of neeo.. hy nUlllhcr I" lIHonlm dopulY, wllh Ihe ..cepllllnllf IIIl! fllllll\l'lng, - ===-:=,=~=~'=-"'="'=""""""-:;ii;'-ri.",,,,=,,..--=-~==;; ----;t===:-o..;~..".._'"...:.:;....,='_=_.=- _. - .. - N/l.Mf: Mm Alll'HtlHt 01' l,^t~K on QTtlffl INSllTU'-'ION IN WHICH fJ~;.!il~rtH HIHnr_o ^ fl~",I'IH"I()!lIT nox ........l10na..__ _c_..___ hIlS S,d' 1-: IH:l1lH!T I\OX Rt::~Tl:P IN NAME 011 NAMUi Of' - Rlrl. ^ tlOtHlllt' 0 r JOlti T HOI~DtRS TO DECEDFNT -.~ '- Thlll Ihc ell\11C1l18 III' sllld SlIfe dCplIHl1 hllx or hllX08 lire IIOml7.ed IIndc, Sehodlllos_.._of lhls ,ctu,o, with Iho exccpllonllf Ihe follllwlnH, 1'0' Ihe "osons horclnnfl" Hol fo,lh: Thlll Sehodulo A n\ll;eh"d herelo IIlld 1I\IIde 11I\I't he,eofscts forth flllly IInd 10 deloll nlllhc 'olllprnperlY in Iho COl1ll1lllnwolllth IIf 1'1'1I1I")'ll'lInill of Which ducedeol died hllvlng I\n Interesl Ihereln, II 1I1,,0 ,ct, forlh Ihc n""IBIIBo ooellmhtllneus III'''n en"h IHllcd "I' 1'0111 p'"perl)' III Iho <llIlc of dOllth, glvlllg thc 1I11\0llnt 'till duo III L1cnUh nllmu or l1lurlgllp.ct'l dutl\l fute Ill' intcrcfil, ondhuok Itlld pugo of record IhcrcoL It nhnsctH rorth in the columna pruvlded thurdOl'o the nSHOhscd vnlulttion of clu.'h of suid plUcclH, the cstimntcd mllrkct vllluc thcrfJor l\!i Ill' dale flf dCRlh uf dn'l'dent, Thlll Se/,odulo B IIltllChed herelll IIl1d 1I\IIde 1'1\1'1 herellf ""H fllrlh filIII' 1IIId In dclllll .11 pCI'NolIlIl p'"pOl'l1' where""l'e, .lllIlIlod o\\'n",1 hI' II", dcccdCl1t 1I1 Ihc limo of dOIlIlI; 1111 I1IIInl'I" Ion hy Ihc dccedonl lit 111l' 111110 of dcntllt whelher in decedent's illlll1ctlinlc IHlS!H'ssion, stllndinl.llo dect~delll'~ crc-dlt In hunks or dCPONit, HaYings hunks, IfUHI cnmllllnieHI nr olher infilitU'lionsl \\hl,thel' individullIIS'. or in IUlsI rnr any other pCftiOl1 or per/H)(Ui ~i\'ll\p. nhlO sCIHunhdy the Ill'l'fUcd i"len'st thereol1, lr nny, tllIwn In the Inst IntorcNI dllY prior 10 decedent'!I .tcnth ill Ihe CIlNO or tln"ings hnuks, Itnu to the dntc of dCl'l~dl'nlls dl'llth in 011 other CO!oiCN; nil hond"" l1Ostu1 Snv,hlltN. lrcnsllry curtlricntes 1If nolCs nllct tllher ~v'hlcnce of indchlt~dllt'Ss nl' Ihe tlnitl~d Sllllch 10 I Ill' dc~ l~cdcl1t: 1111 nhll~ntltlllH, whl'lhN hy stlllull~ 1If llj,tll'CI1Wnl they arc du..ignulud ns luX free, of Iho tlnited Stall.~s. or Iln~' slnlt'. or polltlclIl suhdlv'ision tlll'fcllf, or or ltny fmdgn l'Ulllltr\', \\hk-h IIle owtlctl Itl the lime or deUlh; nil wcutin" I\pl'lIfcl. .It.'welrYI sil\'CTWlHt'l pil'lurcs, hllllks1 Wlllk" fir lul, Iwuschold fmuilurc, hurses, l'nrril1gl's, autonlllhllcsl honlN. nntl IIUY lint! ull nlltl'r l'crslll1ul dHlllcl~ or whllh"lc\'t~L kind nf !llttufe, left II)' decedent. InglJlhuT with tIll' fnlrly esliml\lcd IlllHkl,'l' \'uhw thctl.ol': 1111 houds IInd IllllrlgUgl'!<j hl'ld hy den~dc.'111 Ilnll Ill' nil c1nlllls tim' nnll owllllt dun'lIl'nt lit thc tillH' of dClllh, lIud nil pwmh'dinry nolcs or olhcr insHtll11Cllth in writing fnf the IHlyrncnl or money of whkh Ih'cellelll died IlllSSl'Ssl'd, or wlmtsCll','cr unlure, with Il1lt'fl',td thereon, if lln~'l "i\'ln~ till' fllee \'nlne ulltl ('stllllllll'd fair mArkol \'allll' tIUHCllf. nnll if !\1H..h ehtinlAtcd fnh IIIl1rkCI vAlue he ICSN tlllln fill' fUl'd \'Ulllt', il sets furth hricfl~' thc rC"''flOS for sudl t1c.'prccllllitlfl liS to cnch item; 1111 muncyI'! pny"hlc' 10 Iht' t~stnH' fl'l1l1l lifl.' hhllf.\l1l'C pulldt's cunil'tl hr den'delll; all Anllllity and endowmenl l~C1ntfiH;ts the (lTlu'ctHls 111' whlch W('ft' llilr',hll~ "1'011 IIH' dunth or Ilw t1l\Cctlcnt; nllllnd Ihe (;ulIlIIfntt.' slocktt find dh-'iLluIHJI'I dill' tlll'r(1(u1 l\"d 1111l1l1id UN uf iht, dllH~ lIf Ilc/IlIt, hOlHls nlld Ilcl,ruc.'d inlint'st thcwnn tn (he dntc or decedent's dcnlh 111\11 olht,'r it1\'C~lmln\t s(.'I;uri1\l's owned hy the deccdcl111l1 IIw lime llf dClIlh, wllh the nll,rkcl \'lIlue lhcfe~ Ill' nl filldl tlllll'. 1ft tht' {'''HI' of' HIHIIll'tctOH (If' olnHD or f'Ull1l1y cur'pnrnllnl1K, UIl' vnl1lflft rllplll'tofl !lI'f! Uti fur IHi pOHRthlo liuhtlt.I\III tntnll h~' f'Jllltllotnl !1t1lt.f1IlHlIllH of' thl) IHII'llIll'nltulltl, ullOwln~ 1.hu uHIil'I.>> /lud 111\1J11il.1tlH tll"'I'OIl" II" Ill' UHf clllt(1 ot' ItOl\th. 'l'h(1 H(~hcJ(lllln UlHlJ HutR flll'th tllll tlltoroRt nf' Ilu(l(Hlol11. 1\'" tIll' Umll nf' lInnth In "uy rHl"'pn1'tl1tlrHhtl' 01' hllHlluH\Ht 1IT111 tl1 HUPllflJ't. (If' tho Yflttlfl nf' f1\1nh IlItHI'i1Rl. tiJnl'i1 1~1 IlllllnXi'r1 In filltll Rl'tWlllllfll l'il1l1ilolul Mlnln01fJIlIH Hllolfl'lul-( th(lll!ifWts' It1\ll llllhrlttlofl of' M/llit cn"pIII.IIII!I'Rhtp Ill' llltHlnilKH. A t'Ofl~' (If tl\fl nn"'pt\rtnol'Hh1ll 1\lt;l'IHlmf1lltJ (1 f' 01'1\1, f\ Httltn/ninll Hott-lltA I'ol't.h tl\f.l I\fltllru of' Ollt tUn'flOwlllt_) top-lllhnl' with II tdnt.omt1llt t1ntthlj.(f'ol'l.h tll(] ohnl'llot.ot' of' t.lIn \nUdIlIHiR. Itlt lnonltOlh nllil Hunll othor fnota 11lll'tntlllllA, tll tlll1 IlllltlllllHH Hti ItlltY lln IlllrlltUlItI_ tll 1\ f'hl,' Illlll .IUMt Rlll'rulHltl nt' tllll dnollllul1t1a Int.ttl'llHt Ihl'I'11111 In\lflt ho HuhOlttt.nct. Jt "110\1111 nIHil Hot flirt-II In JtfJml7lJd fOI'I'Il, ttlgntlwr with tho "l'I\lr nllll'lwt vnl\ln thlltllllf', nll~' utllllt' )1I'IIJ1nl'l)' (lWllod fll' hn1lunut,hnl! 11)' tho dlloi.1clollt .flt thn 11010 0(' duntlh 'fho Scl1vtlulfl C II t. tnoltotl 110 rn tn /luil 11111110 I'n I' t, 1ll'I'ou I' lin tN, f'1I I' III II t. rllu lH1H'fI'Ul' 1.0 oudl II1/lUI l'~' "OTlt/lIIlOlt t.llnrtltn 111111 111 (.till on",o of' tl'nnHf'nrH Of'p.'lll'ot'q', t'unl 01' pill'Hnwtl ,I'll thin two ~'(lllrt4 of' rllltHl<lont.1 ft e1t1ntlt. In {lnntnml'ltltltlll nf' IInoolln,,!.' H rlulltll, or tllt.flwlnll to j,nkn nf'fuet, III ptHH4ilARJoll nr' on,1u~'mnnl Ill. nr nft,ol' (Iontll, Rnld Kohn""lll HI_H,R f'ot'tli t-ho nnllll'" Itllll \'/\lun IIf' f!l.ltnh I'I'OpOI't.r, to wllntn' tl'lUls"ol'ruil, tho rolllt.lmlHltlp nf' I,ho t.rl\IIHt'nrtlOH to Uw dOtlOllnllf" t1'fI Pl'upnrttol1/\to Kllll1'lJ l'oootVlIcI ,,~' 01\"11 l.1'IlIHI('Uroullnd Ii]] uthnr "IUllH of 1\ pnrlttlt1nt. flftUI1'O rUI-f;/lrdttlg ..ul" t1'uIlfH'OI'HI 111 UI(1 nl\RII of' t.l'/IlIft('urH lo1.011l1ttl1 tn lnkfl nf't'oot In pnKf;lO"ft1oll 01' .flll,lllymlll1t III bf nl'tt1r rl.,llth, thnl'olR l\l~o uttnollfHI tll UIl) HI,I1('lhlln 1\ (lnll~' of' tho IInnd, U'UHt 1\~r(!Omnllt tit' olllnl' IflHt.rllmnllt,- {}rold.lflA l.hn t.r\IRt, Thorl' IH 1\1ftn ~flt ro"thln Hl\td NoliOlt\llu II liNt nt' nIl pr(l"(II't.~., r{lul nl\II IIflrHlIttnl, v.,tl.h it." \'l\lul1, wlllnlt 1'1t~-K(!>> III. llolltldt1nl'H (l"nt.h hr \'trl.\lo of' thu IIlw,'ntHo h~' lIfllHlclllllt, "llllol' hlll1vltllllll1y,' OI'.1l1il1tl~' with IUlOt.hf1I', III' Ilnr I'OWI1I' (Jf' 11l'l'oll1t- mOTlt VU6f,ullllldoOIHlf\l1t, flJt.h(lr JlHliv-1dUl~lJY 01' Jointly, h~' thn Will, ,Inlld, Ill' lJUlOl' tllHI-t'umont nt' IllHlthol', wlt.h II QUpy of Uu'. tmlt.rllm/lflf, ornf\ttll~ 9110h pnwut Iltt.flOhod t.o Uw RolwIIIl]O. Thnt Sc/Jpdv/e D fll,ltlllhnil hnl'ut.o hnrl IIlIuln purl. IlOl'ollf' ROt.H "nl'th l,hn 1I111110~ flllfl 1\lhlr(lH~WK flf' "1 J )lflrHOI1R htllluf'lolnll ylnl.orllflt.ntl III I.hIH flAlllto nt, t.lln t,tOlo Ilf' Illllln(trml,l A dontt't t1lo 11I1{,11I'O (If' 1,llnlr l'IlK,:" pOI1t.tVIl Illtol'ORtH, t.hull' rnllll,lnl1Hltlp, If' "Il~', to till) ItlHlniloll"t t.op;nthor wlt.h I.Itll /"~f1R nt UII' UI1l0 of cltHwdfll1t.'f] flolllh nt' nll mlnol'H, HllIHltt.nnt.K ullrt tJllllllf't(llHrlnH f'clI' 111'1' 1l1lllor It(1IHlIlnllf,'H \\'111, It niHil aUIlt.nlnA II fttnl.fllllOtlt. HhnwtllA: whlnll of' Uw tlOl1(Jf'lulllrl11H 11ll","11 tll t.hl! tlllCwll11lltlR ~ll1,1f' lillY, cltnll prior t.o i1flf}flflul1t., Uw ilntoH (If' t.lIutl'dnlltllt Uwlr IIHIIIII, ftlllll.hfl rolllUulIHhl1' Ilf' RIIIl!l hRlltJ 1.0 t.ho hOflfll'lntnr~', 1'lInt. S':/I(ldu/Ll E ,ftU_llOh~1I hornt,n nllfl mllltll n IH\I'1 ltnronf' RotH f'ol'1.h 1111 tll'otHII' I-~'l l'llul IIIlII pnr.. Ronnl, oWl1flfl h~' I,ltl' Itof)flI1nnt. ,1nillt.1y with fHHtt.hnr or ot.hflrR, tllol1Hlll1~ tllt.flup;tlllo1 Hl-Ilfllltl\~ III t.lw tH\lnl~ of tlln IIOCHHhllll nnd nthor", 11111H tho (11IIn !tllll plnco of' TWilorlt uf' IIlRtrll1l1ollt.H nt'f'l.'(lUIII~ 'tho \(!HU t.uro nl' ,'on) 'lft~.nt.n nlllt t.ho dl\tl.l nf' IltlqUllilt.toll of' l'urHoflnl't.y, plllR tlllI II/lillO, 1\lIilI'(lSR /llll! rnllltlnllHhlp, 1f'IUlY, of (In-nWIlOtR to Lllu duooclollt" Thnt. SC!1fldvl" F t\nlwl/oll hornt.n /ltld mlulo fl pnrt hONIC'" RotA f'nI'I,h {'1l11~' Ill1d In (Int,fll1 1\\1 IlohtH Itnll t'''ihtoUnnH oll\lmtJII f'nrltllfl llflhohnl f' of' t.htH clnool1ont.'H oHt.nf.n, IIWllllllilf,l; t~1I11l1'ld (!Xpf'11HOR pnll11 r"mll~' O)(O~lpt,tnll, wl\nrn npJ1lll~illll(11 eCIRt.A uf' IlflmIIlIA(,I'nt.toll of' t.litH fHolt.Ut.1l1 eoull!iol "fH'H ultll f~lfllflll\ry' A (\()mmIHHtnI1H THlli1 or to tl(l p'd"l fHlKt. (J)[110nlln1l 'l'or hlll'I-IlI ll'IlHt.Hj t,nmhKt.Of1(lfl 01' j.('t'"V~lmnrkol'R, IUHI N'll- ~IO\lH Ror,ilCtlH, hi OOltSfllllIOIUHJ (1(' Uw chl/ltll nf' tho "oculton!'1 Iltlhtfl ilI"t 01 ntmH IIwtllA IIl1f1 1I1lflltlll fit, tllno nf' rlUfttltl f,f\)[ilR ROCll'III111 ohnrp;olth1o ('or JllJrlort p,'tnr to ,IOf,'olhmtYfl ltnnUI (mCIHlpt UlI1HIl f\llCtwnd \Il1dtH' HUlI1.tnll nnl of' thn 11l11lH'lt.fUHHl H1\1I,t';foitfltll 'rnx A1l1)1 1.IlJ~{",tH'r wit.h Il Htuf.nmnnt"of 1101111tnl'n1 p1tHII-(fltl 1'01' qhltJf,u" t.tUUA, If' l\1t~" n, Is It)(rnlul I.hul,Ulo f'lttlwl/lI'Y will prl1Hunt. pronf' or HIlIII olnllllnil nhl1'~/It.lOI1H Blinn rn.. (lunKI, I.hllt. tl' t.1I" f\lllnllflt. nolulll1y pnt" tn Hi!t.t111flltlllt. of' IUl~' t'ulll l'onlllltHHlnl1 or ili'h!. II; InHH t11111l t.ho HHttmul.nllllmllllllt fllntllllllP; f11ll1'f\llllwod, tll/lt t.hi! HIIOI(I will h(J l'npnl'l,lI11 to thu I\H~1Htol' (If lrlllflt 1\1111 trtmt tilt! I"nllllllt nf' 1.11'< IIflHHRHtHt (JI\l1 hil "PI'~HllHHII(I III HIWIII'i!IIIHHl t.!lornwll.lI. 'rhllt l.hu lntlllf\ or tllll- Ulll'l'oprtlltn I'oluhlllff In Hnllo{hllilH tI,\", "II". tiC", "l~", flIlII "I<''' IlH' tlll'Iwtnd t.IlHI'ltlll, hnvH 110011 11lll'rlorl t'nl'wnrtl "wi prnl1fll'ly "f'J.(tHtnl"llil In tit.. Htlnun/lry.' Subncl'lbed Rnd sworn to hoCore me thin )', /,/ ' . (, ," ~/ /:<c" J;,,?,l~t(, .I (,IllY 0: J:/~,<,((.~ 1IL..79 '{';;C::<..' W~';;;"i~~t~~~:i:2,..,,,......,... A~~I~l:;t;( i:l~~~~~L6-"l (;15Q~ SP;~~~~~~l~';;ba~) """""......., JILL L ' Q..! A...\.l" "111'''-''4:,l/,- /9?e-L, Clll"H~llc.,,1)Q.17D13 ,J ,-, 'I""h~"<l'" rf v (Cltll or Town .QlItl Stille) NOTI':1 lhlj'nl'll "h~III11~ f1f1'ltlflVII- mll~1' HlIl'f' 1111 11111111, ti\!{lPI>i-. III tllll I\t'f'tilllvlt IlIlIf hl'llPdlllJl'" 1I11"f'XfUl Iltfl 1'1111'11 III \'!iUlllt!lldlN 01' Ulil \'1'111'11 "SIIIIi'''', IHld 111 I'llkn Illfl tlHhtllk 1111'111111' l'III'1! Illl!lllllll"ilflll HI'I'lIrttlt1H, HIH~lll'lllnH Ill' l'lmll! ill' f'/\IlIllr 110t'1'01'IIIIIIIH. III" 1111 1IIlIll'I!'it 111111'~' f'O~plll'I"l!I'",ldi' III' htl~f11l1'H;. Utllt. tllll lln III 111111 RIll 1"rnl'ItlH l'pil1lII'C'11 1!f\lIi'I' I hi' I'll I'IlJU'II(lh f\ lJo"t. rl' I t1IIIH~ t (I Sl'llllllt11" II nil 111'1' III 1_IIl'\rttrl, .\1 >>n mllkll f'ut'!ulll lhlll "'1I11Iflll' 1/1 III 1111' "Htll1'lIi1I',\'" hilS hl'lll1 1'1'(lll1'f'l~' 1'(11I1pl,'1,,1I I'''' IdHIVll-dt"l'l1lll,l. ----- --- .. ~ ~ .~ .... t'l I:f II ~j fi .~ '.l! ..~ eo 't 1:'1.1..1 ..: e ....'. ;; I ovi' 15 t~ 't ~ ~ g, >j P l1i "" ~ S{I~f~lAIn' (Sl'h. "A") (Sdl, "II") 111".1 I'rul'llIl>' I'ol',ollul 1'1'01'''l'ly, '!'IllIlS(tII'S (~d1.I'C") UI'OSS 'I'mil\hl(' I~~;tlllf' I . I ,., f-< ~i ,II I'i ~ rJ f,;' ..l ~ '" ~ r-. of. '" ,~ ~ 0, ~ c; " ~ N t1.. ~; 1-1 '5 lO. t ll. 0 1'-1 r;: " Il. Ci' '~ ,ll. ~ (5 ,.1 ..i:: of. '" ." ~ g-j I~ ~ e. '" I I.\.l n a Q .-l d i\ ~ ... g U H ~ 0 ~ .~ N~ . ~ ll. -..."-- t1.. ,-" IS 'C I- 0 ~_.. - = 0 ~' 1;-. ~ u ~ 0 0 I~ 0 lO. '~. ~. z .. ~ " c ~ CI: 1; l'l ,tJ ." 0 '= .i;. i c ;;: ~ .~ ~; ~ r::"":l 3 ::::~ 0 u (I) (As 1I1'1'01'11'd) $-0- $ 24;q24.19 $ -0. S $ $2/1,024.39 I ~) (As nl'!I'IIIIilll'd) .~ $ $ $ $ $ . HLV.4!I" (11-711) DI'I'AIlTMENT OF IlEVIlNIH! I1UIlEI\U or l'IIlLO OI'EllI\T1llNH 11,0. nox 201(1 HAnnlf;lllIHO.I't2NNA, fl1U!i COMMONWEAL Tit OF PLNNSYLV/,:JIAJ 1",., _.JU...J..li...7Q RESIDENT INIIFlIITANCE TAX t:OlIN1Y Cumhu.l'lll!!.!!.___. _:Pi'11AISI MEN1______, ...:.~~:~,~~.._~:~~~~--:-~-... WhOI'Ollfl, Robel"t l:!..-.Cbl"onisl',,,,' ___ IlItool' ___,Jlnl"l'h .)llddlntan-'I'WV. ill tho County of Cumlilll"land COI1lI11011lVoilltiJ nf l'olllHiylvillllil, 1111\'111<1 dl"d Oil tho ~ II th d[lY Df -#-&eetl\k~y 19 ~. i;ni~<od nnd 1J(,li;;ie~iilod of illl 0:;1.110 flulljoc:t to InhOl'llollC:o Tax nndol' tho lalVB of tho COlllll1onwolllth of l'onnBvlv.1I11i1; Thol'oforo, I, _ 1,80 Fulni nit i , (Ill IIppl'i1luol' duly ilpPolntod i\CJeol'(lInq to 1"1'1, having boon denl\Jllatod 10 IIlllko il filiI' and cOllf'c!onablo IIPPl'alsonwnl of tho Aald olltalo, find to ilI~IOHB and fix tl", nidi value of i111 i1nnulllos and IIfo 9BliltOll gl'Clwlng ottl of Raid olltttto,.hol'oby fllo tho following appl'alr.ol1lont: 111 tllu 01/0111 Ih"lllny fuhuo InlUtoS! In HII~ ust.lto h tlllf1\fOlllld In prlHilUllI1\ 1/1 1I1l!tlYIl\cnl 10 {:1,Hitlul.lt 11111" flf IlHI iluftl/iOlll .llh', 1111' IjXlll!ill!<lII tll any lllllltn lilt 1110 or fn! YIIIIII, thQ C:OIIllllllllWIl<lIIt\ hnrohY !IkPfllUly 10SI1''o'IIS UlIl Firlht In IIp!l!;llln r'Hltl itUO~~ Ir.llltlnl illlwrll.1l\(1J t.1ll.f\l <lIlIH11;lWlid C/liir'llrll,11 I"to Iln <'lilY Slitl' lillI/to Intu/usl - ""_H_ ... UL!iCHIPTION 01 MHil-'T .. vlA~.\T,,-~, I\PI'I.11~"lllr'tll ,.'l.1{/lr'rlllllll,"II,lIlr" Till<. PIIII"'~I'\ . I -pia D 1 P......a...o " "'.., P"Y'lRnnA1 PY'lnp"Y'l'ty ".!I..." " " ,,, "'T'nnsfa't'\l:l .. .Tn" n+ 1 J' nUnAn .. - or""'A' t>"" ""u , Q --- +--. . . -- - --- , -- - . . , - . - - -- -- . . - '-'- - 1-. - Have boon duly sworn itccordil\g to law, I do hOl'eby C:~lifY tllill.lho above appraisomol.'t is roado In conformity with tho litw on lhis , "'th __ day of Mil ~- .. 19 -7..9.. . i', -, :,'_,; . l .;.. . -. {\P,,,,l!',irr {NllffllWI Mill ~lt'(lltlJ _ll..arrlab.ur-ll-_ (l'llq (l/llll'l Penna, . " <Xl ~ ~! 1 i 1'-, j 0\ , , , I i ffi "" r-; , 1 i ~ M: 1 i . 1 I 0- i I 1 I 8 i!5 1 ~ 1 i "~ , I i I ! ! I I CIl "'i:l . i I I < fJ' ~ ,L)i ~~ I Ul i I : wi lit l>l i ::l . I j (" ! et: 'MI I-oi QJ: In i "- I'll u; 'II ~ i ffi I "1'_.., I ~ I & i i i I \\,. j 0, I'li <O! , > j i I I ~ ~I ~ i !. i 1 '\ ; .:t! ~ 1 i Ul i 'Cl .<l, a: I i ..t I +-l' CJI ~ . I 'Cl N ~ u. I Iii I ~ I w J!l .1 I " I 11' ! u ~ IKI J!l 'tl: i ! ~ ~l 0 ~ 1 fl" ('"'i Z 'tl' ~ I ~ i ..)". $.4 ~ .~ .... i5 fJl I '" I (5 I '[ i I I " llJ j g ",' , ~>a a: .VI '" Ul 'I I 1 w ~I i:l C', .t 'tl ~ j '" ~ ~ I X ,<1' ~ if g j I JlI .... .~ a: 'tl z i i ~ 15 i J I 'l;1 " I ct & .... ~ ~, . ffi I ~ '" i fil (. i 0::; 0 'ti 'l;1 .8 i " ! I ! .... Ul '" I l 0 '8 , ,S 3 Cl ~ ,~ '" 'ill 1 u; '~ ~ '" I J!l ",' 11 0 .... ~ I ~ w I j "" ~ , i j a: r$ '~ d'l ~ ~ I ~ ,".llln lit' ('lO .. '/ (lUll/{~llONS "I LUWI.II Ip.j orrl!.., 0" 1141<', STATEMENT OF DEBTS AND DEDUCTIONS 1111 W~ Uf ~ ---.....------.....------ :::"-.,---=---,,,",~ - - . ----- -_---.-............-..~....~-~ ...~......~.-_.. , O"H- tlll I.'" N,J"Mt: 0" I'~yn: IH!M~nl(' A, lItotl rn VOIICIU,IiI ----~------ --. - ,_._---,-- RC1gi,l~ tt,;r of \'11111' Lot: t:ern Ten t'lltnClll:llry 22. on ----- ---- -. - ---- -'- 'I'hc:Evonll)1; S'31lt:I,ncl. 11 d If ({r Lin 'till; Letlcnl _..2J)~ 1.5.-.. --- --- .c~\mborlulll: 1.11\'1 .J om:nfll. Advcn:t i8 1.1lh...!,(11t~r.H 1 R nn. , NI1l: fi lw 11 1" lI\1r ley H:l.tnusr. fee In. )0 --<-- " - <- .-- -~- ^101;111\ Bergnn)" -- ~j J t ~ t!!1!.~f U (J _J.O J() -- -- .._-,- 11.oglil.1nL,o( HIlli,' qI1111:t: L~jfjl'/lh'H .. _..,__2+ ),0..,,, ----. ~ -- Iihy Gl:nn.fte l'lode Cut Clng ,...!l.l.. lL.. Nnl.vlll l~~_~llllr 1\.(\.-1 tn. nf 1)1\1: "Uf-pllC J:d', f!lml'ir lit. .LL" -- ----. Q 1:!ld(llc.trJ.1 'l~~li'i,rp Ct!..!_ 1l!L~bLlll1 '11.'1' l~LI. 10,_ 'J> - n Hnnl, )1,,1"\, III"""'" 1 1I "on" j;''1II1''..\<nl n"~n(\\\I~p 1 p~l, If\ R (.nln to y Kit lIlJtlgh, H.D. Hud ieul expcnse 406. )0 . Haaland AflSOC. , Inc. NcdlcLll c.xpenne 95. )0 - ._-- ~_. . llL1n:J.n ASI.lOefl. P ,A X~rLlv ('XIH~n Re 28. )0 .. OClorgo n. Stum:t: 1\ t I'o):ney [ell! 1,20l. 1 Hclvln Spn hr , 1,20l. 1 E. E~{t'('ut:Dr [ee .-.--..- -. -.. .'".,...._.".._-,..~- --~ -----_.. \'J:L t h(' 1 c1 [nr clDfdnl; costs 100. )0 - ---- --~.. Belvedere Medica 1 Corp. Medlea1 e)\:penses 263. )0 - .- - Carlis 1e Hosplta~_____ Hospital bill . 204. .0 Tota 1 5,554. J7 '-~.-- -, - -- -- --_.. - ~-~ -- --- _.- ---- ------.. ~- --.. -.- - . --.-.. -~- -<-- --.- ----.- - - ._--.-- . - .- -- - , . ,. . 'J1'/),I.II/.' / tl,'J'lL_.,.o '. . C" i ""<:.:.,,,,1'1(')' 'J/. 1 (l'ln n,J"n 01 t'lllNa ^,.t'n"'wHlI,~,. . .yu-"1."'T~.__-..---+L. :J~ ~l 0"11 ",I ........l..UoO - ,~._#..-~"_._- COMMONWEA~TH OF P1tNNSY~VANI" } COUNTY Of' CUNllERLANIl .., -.--- --- I, _ Ml.;WlIN ]I. _Sl.'A.l.llLu' . ~.~ ~-------~._.--_H&.RnY ctATU'Y, THAT. TO THI! 11I:IT or MY KNOWLt:Oc.li: ANn btLn-~"', THE ,oni:uoINa Is '4 Jua, "NO THU I IfATlflttNT or DEBTfI, f'UNEnAL tX,.ENU;ft ANO EI(rt.Nflf.'tl ll" Ab!04INIDlf.!A'ION flUlIMITT1i.o TO Hl~ UT,,-n OF -R()r+1i:-J..~.'l~-.ClJ1:~OIlI~!;tl~R--::--,- atCI^~IO. ". OlDU<:;TIONa rOil ItH-l l!:11 I T-'I N(,;5: T4)(I'UUPUfll".. ,/).of /'F~ ~ C.~~' ;". ._,/ 1/ r"l' P':Zlvt""u~':......;.,(/.:~t::L.__.~. ....'.., 'WORN ~j.UlUIC'UtlID ner--ol1l: Mt 'nwl_______PAV 0'/ . \. II -"Ji--': w.....:....v.:-.-~.-n"_...- 1.151.._ / /' _./.'.d..'.U,ll-_.l::.~ _J;~~ ft_LL.c!.Ld::lYL..:..,_. ....~~.._~-_,,__,___.~_L. 11,'(ille( ..J. t(\-f~ ; . (/~1 {t\.'v('t< , (if, ,. .. ,. j I " , ")/')(11/'~'~ /'/" , ./)),i(,'l/)llr..._.to.,JU.(..}, '(!FY.il... ,11'/' ,-'r..-{ , 't/ ' " " " " it., " 00 ~. ~b ~~ ' ~'~.~ ,~~ ~Il'i ~~~~A ~ . ~ H ' .ZU., 0 ~ ~ ~ ~ ~~ ~~ U. 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