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I\I\CISTI.;t\ OF WILLS OF~.1~,l)~.l.UJl'JU1. COlINTY
NO.
PETITION Jo'OIl 1'1I0llATE OF WILL ANI> LETTEIIS O,F AI>MINISTIIA'I'ION
CU~l TESTAMI':NTO A!\:NEXO
L1';TI'I.;t\S OF AI>MINISTIIATIO!\: 1lI': 1I0NIS NON
LE'nlmS OF 1\I)~IINISTII^TIOk Ill': 1I0NIS NON CUM
TEST-IMIWI'O .-I!\:NI':XO
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1. fJ('lltlnnl'l'( WJ~' l\wII1~'.OlH' .\'l'ltI'~ of H!4t' or ohlN II"" i1pplll'~ for 1l't1N" of lltlrnllllstrntlnn
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2. J)"I'."d,'"1 dit'dllll ...n1.\lI:.:>.,.......rdi......Jl.,....l..~!.7~)..".. .. III ..5.;..1.BJ~M. III IIII' C<llIlIly <If
....!;.I1,1]b.~.r,1~IHL........., SIIII.. III ......r.!:1.\lnB.Y.,1..~I:I.\l~A. III 1111' "W' III ........1.0............... Y"''''', hll\'llI~
mild" ..hJ.f,1.... 1.11.,1 11'1111111.1 '1\",1""\1'"1 .1111".1 Ihl' .~..t).L... c111)' 01 ....J:l.Q.vp.m).l.\')X.,........., A.Il: 1117.~...
Wh",,'11I ....no...... IIJlpOIIlI..d ....,Tmli.tn...H......lI.uls.c....l\n,c1...,lo.hn...H.,...J.l.ulaIJ. Exl'lCU.t.O.r.s
Which 1\"", .utars h~llllbM' .:?.:!.11.r.:!:\....r.().T.1.Q.\.\T.1.1i.0.L1....il.nf,1....r:.().U.\J.\}.I;I..tC;lJ~...G0.mm9Xl.w'f:1.fl.Hh
NAtional Bank to be appointA1m ~rlministrntnr, r. T. A.
()lY.XXXXX 1I1lS?(lI: )('y.x~.".~~~.~~~;!I'.X X liD: 9..~.r rxlC1l<1x IOY/I<bf\)!II!.lfrrlIoK lI'J01( ~1t1ll1llY.1IIl ..................
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a. Ll'lIl'lS of A"mlolsll'Hlloo ,..I.". III'<' Ill""!.'" 1)('(',,0.,,' ...J..udith....f.\.....Ulll.s.a....<lneJ...J.ahn
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,/C,......!ln .:>~....'a.y.e....:r.~na)JXl.ca' ....t...O.:l.r. 110.1 pl'1i1iool'r(~ "pplks III .........."IL...... ""p""iI.v ,I'
.:r.!i).g),J.~.(3.~~.\LJ~y....;r),J.gJ.th....~..,.....I.1.l1.+.!?.f'...fl.nr1 ,John 11. 11\11 fl('.
4. Dl'cI'l\"ot die." "omldl..d 10 ......1;.9,.n.I),!~y.J'!.lI!1J.i\.,...,........ With, hi, IlIsl ("mill' o~ ~'I~'CY"\
~t(\t(1 or ('nl}lltr]') ,~~,~'''' ~~rr(~
resldeoc,' "I ...... .19. .?:.... r,;!, .f..!7.n... .C:.9. m.:.t.,...... ;.~.mp.. J.r. .+.1.. ..I.... r.0... .!1.\lY.+..V fl.D.:!. .il.,......:.7.... ...... ..,~. {,-
WllS was
5. (\VlwT<1 de('(.dellt died h'stult') Dt.('(,t!PIl! \Va.', lIot married IInd l\ child WlIS not horn to or
ndoptt1d by decedent after t'X('cutlon of It\(' will (and wlww npp!ic':1l11 is llllegpd SpOllsf:!) 1101' WitS dN.'edont
divorced from npplic'nnt IlftN f'Keentloll of willul1d ut dpath.
6. The snld dllcedt'nt Willi POliS{'ss(,d of Conds, Chattels, Hights Hnd Cn.dits to the l'sthnntcd
value 01 $..1.,..9.9.9..,.9.9..... IInd of HI'"j EsIIII,', III 111I' ",11m" 1('(\ v"h... 01 $.....J:l.0.r.\~........".. liS n""r ns
cl\n In' nsc(~rtnhwd. Thai the suid Heal Eshlt<. ill w far as known Is Jp,c'llh'd in ,,,..,,,,,,,,.,,,,,..,,,,,,,,.,,..,,,,,,,,,,,.,,
.,,,,....,..,,,,,,....,....,.,,,.,,.,,,,,,,'.,.,,,..,.,,",..,..,.,........,.,.".............,.,.,...,.'",....""...,.".",..,.,....",..,.,........,..",.."".,..""""".,,,,,,,,,.,....
7, (Where dce<~rlellt died int(1.~tlltt' as to HIlY portion of this ('slah'). P(.titiOlwr nfter f\ proper
sonreh hns ascertained thnt d{~c('llt'lIt WilS sur\'l\,{-'(I by tht' follo\\'ill~'lH\llled pt~rsons en!lt!{,d to distribution
under the Inloslnto Acl 01 1947:
Name
Hpl!\tionship
RClsldcnce:
1..."...................................................................................................................................................."..."........,..........".........
2..,,,,,....................,,.................,,..............................................................................................................................................
3, ""....",..",.,.",.""."""""..",..""".,.'''''''''''''''''''''"""",.."",..,.""""",,,,,,""""""""""""""""""""""""""",.,.."",."..".,,,,,.
4. ........"."..........................."...............:......"..................."................"................................................"."............,....."...........
5, ....."",.."".",...,.."""",.".",...."".,....".."""",.."""",..""....,,,,,,,,,,,.,,,,,,..""""""...,.",.,.,.""""".""""""..",.".',."".".".",."..
6. ........."..................................................................................................... ........................................".............."........,.........
..."..,'...,...."'..,,,...,,..,,,,,,..,,....,,,,.,,,,,,..,,,,..',,,,,..,,,,,,....,,,,'....,,,,,,,..,,,,,,,..,,,..,,,,,,,,,,,,.,,.....,,,..,,,,,,,....,,..,,,,..,,,,,,,,,,""...,,,,,,..,,,,.,,,
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11lero!oro, p"tilIOlll'r(X) ,,'spadlully nppll..s lor (pl'Oh"ll' or 1111' wll\ p",'sl'lIl,'d 11I'",wlth IInd
( ) I It (I I II II C T ' .~ I J'~' /-~;/
or (' ors 0 lH III n s fit on, ,....", '''''''('\''''''''''''''''''''''''''''''''''''COMMO. 1:tm -r; . ''jT1:'t. ..', ltNK ,
Daled: ...J:~~b.l:'.1.1,;u:y....14.. 1979 Slgna(!. J!.y.,;....,.~"(.,: .,<.:r,I.\.... ", (YO' ...~J.....'r.rus t Offi. ce r
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Ad,hss: 1.~},~....rt..~.~~$r..S.1J.f.f..,..nl' .....:l,.Y.~..I...... 17011
Camp 11.l.L, vennsy.vanl.a, _
C(;M~f()N\I'EALTII (W PENNSYLVANIA \ ss
........................"...............................................................:.... ......c;:\.J.Mm:';B.~iyJn.............Naa~~JI: 'n ~nk I
~Q.lJ.IT R~... .K..... ..Jm..:J:r..?i.!::L..,...~ .t:.1.1:>. .1;....Q ;f..f..1..!;~f,!X. ,..J;:g.J.1:1.ffi0.\1.W.!:\ 1:\1 t;.h............ IIII' \",tltlnOl'r ~ )
In Ill(' ahove application, lwlng liuly ,..,~,V?.9.r..D,,,...,., Hl'l:(lrclill~~ to Illw SlI)'( s) tlmt tlw stutcm('llts sc't forth
In this \"'1111011 ,<II' tnu' 10 till' h..,1 of ....Jt.~.......... knOW),'dg(a'lId I~Jtl;~/);) , .<:I/~U:;~ .
...".$,w.Q~n....".."......"....... uud s lh.~('rnl(.d hf'fon' ....l....;.,.../.,"'I,...,../..:{.,...";r;.~.;if.{:-:;:~".,,"''';,,......"
'~~ r..1.1I:\.l:'y... 14. I. ........,...... ..."...:....::.:.:.:.::.::..:::':..:::.::..:.:::'.':::..:::::::::::::::::::::::::::.:
Hl'gislN
Filed:
l1..
FebruRry 21. 1979
Altnflwy's Nam{~ Ulld Addr('ss
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. t ),1. t, j, Q.\).I 1.. ,1',,1 n.1:.., J\.ui.l r.~j n r.1. ,................. .....
~~('\chFlnir~lhnr'1, f'lpnnny.1vl1nin, 17n~S
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real, personal and mixed, whatsoever and wheresoever situate,
I give, devise and bequeath to John M. Hulse and Judith s.
Hulse, Co-Tr.ustees, in Trust for the following purposes:
(a) To payout of income, and from principal if
the income is not sufficient, the sum of One Hundred
Twenty-five ($125.00) Dollars monthly to my parents,
George F. Hulse, Sr. and Emma II. Hulse, or to the sur'.
vivor of them, in accordance with the terms of the An-
nuity Agreement, made with them on January 2, 1969.
(b) To pay the balance of net income derived
from this Trust Estate, in convenient installments, to
my wife, Judith S. lIulse, for and during her natural
life. In the event that my said wHe should exhaust
her own assets, John M. Hulse, as Trustee aforesaid,
shall have the sole discretionary authority to deter-
mine to use and consume so much of the principal of
this Trust Estate as may be necessary for her oomfort-
able support and maintenance, i.ncluding medical, sur-
gical and hospital or other institutional care.
(c) Upon the death of my said wife, I direct the
surviving Trustee to divide the remaining principal
and accumulated incon~ of this Trust Estate among my
three children, Kathy T.. Hulse, David S. lIulse, and
George F. Hulse, III, in equal shares, provided, how-
ever, all three children have attained the age of
twenty-one (21) years and have completed their educa-
tion. If, however, all of my children have not at-
tained the age of twenty-one (21) years, and have not
completed their education, the Trustee shall continue
to maintain the Trusts set up in this Will for the
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following purposes I
(1) The income, as well as so much of the prin-
c.ipal as is needed, shall be used and ex-
pended for the support and maintenance, in-
cluding medical, surgical and hospital care,
and education of all three children.
(2) As each child completes his or her education,
or is gainfully employed, he or she shall no
longer be supported by the income or principal
of the Trust Estate.
(3) When the youngest child, George F. Hulse, III,
has completed his education, or has reached
the age of twenty-one (21) years, whichever
occurs last, the balance of principal and
accrued income shall then be distri.buted
equally among the aforesaid three children.
If any of said children shall have died prior
to receiving his or her share in said Trust
Estate, the same shall then be held in Trust
by the Trustee for the issue of such child,
if any, until such issue shall attain the age
of twenty-one (21) years, except, however,
that the Trustee shall have authority to apply
such portion of the principal of the share of
such issue for his or her proper support and
education as may be necessary for those pur-
poses. If any of my children shall die wi th-
out issue before receiving his or her share
aforesaid, then Buch share shall be added to
the shares of the others.
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4.
Upon the death of my wife, I direct the Trustee
above named to pay the expenses of the funoral, including
a proper marker for her grave, if she nies without an Es-
tate with funds with which to pay the same, and upon the
death of any of my children prior to the distribution of
prinoipal to such child of his or her share in the Trust
Estate, I direct my Trustee to make the same expenditure
under the same conditions.
5.
I direct that the interests of all beneficiaries
in the Trusts hereby created, whether in the principal or
income thereof, shall be free from liability to attachment
or other legal process issued at the instance of any credi-
tor or assignee of such beneficiary, and I direct that no
payment shall be made by way of anticipation of sums which
may thereafter accrue to any beneficiary.
6.
I hereby authorize, empower and direct my Exeou-
tors, as such, or my Trustees, to sell, at public or private
sale or sales, and to oonvey any real estate which I may own
at the time of my deoease, and to give good and suffioient
Deed or Deeds for the same.
7.
If my wife and I should die in a common disaster
so that it is not possible to determine which one died first,
it shall be presumed that I have predeceased my wi fe,
B.
If any of the beneficiaries of my Estate shall be
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';ALTIl OF I'I';NNSYLVANIA}
'S
COllNTY OF Cl n:m,AND S. ·
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Before nw. the Hegist,~ Ow I'l'IIhute (If Wills und gl'llnting of' Letto..,fc;f' Administl'lltion in IInd Ihr
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the ('I)untv Ilf' ('lllnl)(,,'llllld 1)"""1'1111' '11111" P.OI11m'l' f:. ru~I'r",dr '1'ruB t Offioer,
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OH" IInd HIIY flut. us....l\ctroJ.l1;l..fiI.t;r;.i\j;p.:r...~.""r.,..,!;I.,.........
OATH OF PERSONAL REPRESENTATIVE
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who, being duly .....I'I:.:;,Q/:'I:\.."........ do o.a.....
oft.ho lust Willnnd Tllst.nnwnt of' ................<;i!lDmm".. ....!!.t.l.~~rm.I...~'!.~....r......".............".........,..,.....decllllsed
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......;\..t"............. will weiland t.ruly IIdmi~W good.. Ilnl~t.(11s, l'iA'ht.s IInd credit.s of Hllid decellsed
nccordinA' to law, And ulso will dili ~'tIY comply wit.h t.he prov~t.hll luw minting t.o Transfer
Inherit.ances. .....,..$wP.t:tl......, md subscribed
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before me. //
............k....................... A. D" 19.7.1...,....
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Richard E. Anderson, Register
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-I~obert R. .Re~l:'z".';..Trust Orne
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DECREE
Be it remembered t.hat on the ,,,,,,,)~~~,t.,,,, day of "..".....~~!?r.Hf!,r.~,!,,,..,,''''',...,, A,D" 19'?L.., therll
was probated and recorded t.hll lust Will and 'restmnllnt. of' ......r;,F.\QR<1f.,..l':.,...\m)',..af,.,,,.i1'.~,...,,...................,
lat{l of.."..",,,...,,,,lI.(\ro{;>,ctflP'..?:P;:l,l1.fi1.l:1~f,>....,,..., ,........,,, Cumberland County, Pennsylvania, Deceased, Let.ters
.9.~...M.l)!~.~J!!t,r.~tJR!!...(;.:.'r...,!;..'were !(rnnt.ed t.o ....."r,.9.roIlV?nW.t;'.il.~.t.1l...~1ft.U9.l).n),...l1iJ.l),l,;.,......... ...........
Witness mv hund und offidul Honl \.Ill.' dav und VI'l\l' Uflll'OHUid,
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Hicltard E. A nd<'l'HIll\. HI.'giHh'r.
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ACC-U (..,73'
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COMMONI','E,\LTlI OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BURE/IlI OF ('OlINTY COLLECTIONS
'*
RESIDENT DECEDENT
COUNTY OF
'. C.UMB..ERl.AND.__.____
IMPORT ANT,
~_';"~--'Il!.'k'_"_~___""""""""__~",,, .__...,~... 7_ ~_.. .,.__ ==rte~=-= ___._, ~__~
,(,hh. relUrn I1HJIiI ho rl)fllp,lr;tl1~lltl dl'lililillld flll'd ill duplicatt, I\ilh ullldltll'hl'd, with till' Rqlilitot of WIJl~ flf lilt'
COllntr where'< d('I~('rlt~nf r(,liidt'd; 1t.{'lllrl1 is lIu(' wilhiflllillC /lIOIlI !l'i Hflt'r dlllC'! or .ll'lIlh, Unh'!;1; 1\1\ UXIl"rudoll ll'i grlllllt1d
hy the Secretary of HC\lenuc. (SectiulI 70.1 1)1" tlw 1/llll'rIIUf!l'(' find I.:~;tlltl' TIIX Al'l of 1961.)
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IN Till! MA 1'TEII OF TilE ESTATE Ill'
} AI'I'lIlA\'IlIlI'
I XI ('I lOll
~1il1(l(~WX~
GEORGE F. HULSE
'~--TST-^,T" f lj-I~-I.--~iA'tA'i:-r_.;'f'-t; 1-- (:-~. n ,-: N T I
Lot. of.IQ\ttlShip of Hampden. Curnberland::""'ly
Slol. 01 ~e~l!n.sY1vania \
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Co Iy.1 Cumberl and ..., ,.j
"fne COiffiloiiweaTth NiftHmal Bank. by Robert P. Conway.
YUill R,ret id.Ql1t.a~d Tax Manager. , ._.
Adlllln, It l' 01 Iht' fI"Il'\f' d Il,,, r,br>Y"'!1(lf"l1'n cll"trornl bfllt1~ dIlly ~\<iOIn, depoUl
__'___,.o_____________________~_
ltxecutor
and tOy
llt'locdcnl dll'u _~prua.r1-____,..~~~___, 1[)~79 _{tll&ttlIO InaYlng n 1(1$1 willi copy of whl<:h I. h.r.fo attach'd',}
(",ONTH) (rill'll ('r'1'AHI iKt)(MO(I)(
No", ond odd,... 0' oll"",y,, } .____I.hf;!__COITI[I!QnW.~Jt.O,N_!Itt()naLB~nk,..~_~_._________.___
Othtlf authorlled reprlullnlotlY1;> In whom
oil ""..pood.n<o .hoold b, "",;!,.,I, ---..J9...S.LM.a.rketSqllilr.e..--'i~rr1S.blll'.9LPA...JZl08' .___~._____._.
)
Thut as such_.,_ Execu_~..QJ:~___dcp(}rH'1l1 i'i familiar with thlo lIffnif"i 0/ snid ostat(' !tlld the property cOllstituting
(t.Xt~Cl.)'i (i1~n'K~)(Xf)(i)(I)(K,l
the ltSSl:ts thereof hllll tlwir fair rnlU'~I.H vlllLw.
Thai nttho time of dcuth 1111:1'1..\ was 110 sart: lkposil ho\ rq,tisll:rL'd ill dCCl:dcnt's indi"iduuIIlUIllO, 01' jointly Wilh, 01'
as ngent or dqHlly of Ilnotlll.'r, 01' in decedent's indivldulllllallll', willi right \)f 1ll.:l'l'sS hy ullother ItS IIge-tlt or deputy. wilh the
eXl~cptjon of -I he following: -
---'"".,".=.- ------------.=.=~;;"'-:..<:,"-=--=-=~.
;::-'---~--""-;;-::"~::'-=C;;;-.-';":"-"':::"'- -_._
NAME. AND ADDRESS OF RANK OR OTHER INSTIYUTION
IN WHICH DEcgDENT Rft~TEn I, S~t"F DI:':POS1T BOx
=- --....
THIS 51\FE (Jr-iPOSIT (iOX RENi'lOD
IN NAME OR NAMES 01-"
'=-, -- ........--..~-
~~-=::;o....,..::,.::-"~_=-_,,____
REL.AllONSHIP OF JOINT
HOi-.PgRS TO [}r'CEI~
NONE
.~._-,....._---_._--"~.
That the contents of said safe deposit hox or boxes I\n.~ itemiz.ed, under Schcdules_~~of Ihis rOlurn,
wi th the exceptiOlHlf the folluwing, for the, masons hereinafter set fOI'lI1:
That Schedule A attached hereto und mude Jlurt hereof sets forth fully llnd in dt1tail nil the roul properly
in the Commonwealth (If PCl1l1sylvlltlin of which decedent died having an intercst tlwrl'in. It IIlsil sets forth the
mortgage {.'ncumbranccs UJlon 1'lIch parcel or rl~[\1 property at the date of deuth, giviug the umount still due at
death, name of mortgagee, dale, I'ate of interest, IInu honk and page of record thCf(\llf. It nlso sets forth in the
columns provided therefore the assessed valuation of l'1Ic11 of snid parcch" the estimated mnrket vulue thereof
liS of date of death of dCCl~dclIl,
Thai Schedl,Jle B attached lwrcto und made part herenf sl'ls forth fully and in dctllil nil pcrsonnl property
whereso"cl' situated owned hy the. dl'ccdl.!nt n'l tile time of derllh: all IlHIIIC)'S ld't hy the deeccll\nt ut till' time of
dcath, whethef in dccedl,lnl'siflllllediute possessioll, ,'ilallding to dt:t'udcnt's credit ill hanks of depusit, savillg~;
bunks, trust companies I or other institutions, whl'lhcr indi\'idllully, or in trust for llllY othcr person or pl.'rsons
giving also scpnrutely the llecrucd inlen'st tIWrt'llli, if allY, down to the Ill~t intcft~st Clll~' prior 11\ dl.'ccdt',lIl's
death in the case of sn\'illg~ hunks, llnd to the dllll.' of decedent':,> deuth in ull other cases; all honds, postal
saving:), treasury certificates or notl..'s I\nd other evidence of indebtedness of the lJnilcd Stutes tn the de-
cedent; all obligations, whethcr by stututc or "gfl't'f11l'1l1 lhl~~' an' dt~sigllntl'd us tax free, or the llulted Sltlh:~,
or any state, or political suhdivision thl~rc{)f, 01' uf allY I"orrigll COllll1!'\', which lire 0\\ ned ul I Ill' tillle nf death:
all wouring npparcl, jewdry. ~;il\'crwure, pictllfl\S, bPOhs, works [If un, househnld f'urnilUrc, horses, carriugcs,
i\lltomobiles, hoats, and any and all othcr per~wlIHI l'halfd,'i of' w!Jals(ll'\,er, kind (II' IlUIIHl', left hy dl'l.:edcllt,
together with the fairly estirnatl'd IlHll'kL'l Vttllll' thcl'uuf; nil hUllds and Illlll'tgagL:s held by t1ccl'dcnt ulld of ull
claims clue and owing decl:dcllt ilt tlw timc of dt'llth, nnd all promissfll'Y IInlt's 01' olhl'r instrument,\.' in Writing
for the paYl1ll'llt of 1ll0/ll.'Y of which dCl:l'dl'llt died possessed, uf what....(fc\'l~1' IlUtllfl~, with intl'rc<.;t thUI'tH11l, if
any, giving the fuee valul' illld cstirnnled fair markl,t \'nlul' tht:fl.'uf, lInd if Sill'll ('slilllaled fuir lll11rkcl "ullle he
Ic~s thun the fUel.' vuluc, it sets forth hriefly llw 1't~;Hl(llls for sllt;h dt!prl'cintloll liS to oneh iterr,; till moneys
Pllyablc to the cstnle from life Insurnnt,;c Ilolkics carried by deccdcr1f; all nnnuily nnd cndowment COlltl'llcts
tlla proceeds of which were paynhle upon the <lenth of tIll' den'dellt; all Hnd lhl' t,;tJl'porllW ioitocks llnd dividends
duc thercon lHHJ lInpllld liS of tlw dute of (h~lllh, hnnds fllld UlTf'Ul'd illlerest thereon 10 the dute of dl'l;eclnlt's
denth nlld olher investment ioitH;mlll('s owned hy llw deccdl'1l1 III lh~' liml' of dClIth, with Ihc AllII'k~ll value Iltl'{{j+
of ut such time,
",
In tho case of' seOllrtt.loR of olose or foml1r oorpofationR, the vallloR roportorl nrn ll8 far as
PCillSihlt1 HuhslfUIUnt_tlfl h~' fltllUlohl Alntornolllfl of tho corpol'!~li()nR, Ahowing t.ho asso'tH lll\rt Ituldlitlos
thil,'onf It!o\ of tho dRtn ot' dOllt,h, Thn Iwhodulo 1\1 so ,uts forth tho intol'nat of ItoclHlunt. nl. tho Unit! of
dlHlth ill 111\Y (l(l"JHlrtn~rRhtJl or hUlilnoNR, IInd in support. of tho "little of sunh int.orf1f1t UWl'fJ hi lilltlflXud to
"/lId Al'llflltlllH, "lllflur!ll] AtAtmmmtR showlnK (hnllRfllels and 11tlhtltt.jo8 of Hl\ld r(l"'pltl'l-norshtp or huslllfHHI.
1\ C'np~' of' till' nn"JlII1'tn01'shlp IlM\'fHlml1nl, (if 01'n1, n f1tntomAnt 8ott.tn~ {'ol'lll OIB tlflLllrn of' thn Ilgr(lOIl\(lnt)
lon:;t'llIPI' willi /\ st.lltt1lllnnt srdtlllg forth tho chl\t'lletol' of' tho hIlHIIlI'RS, ItM l(H~f\tiOllf t1!1(1 MilCh ntllnr f'lllqfl
pl'rUdlllll1J; to tlHI llllNtnfl!olH /If! Ill/Ir hfl )lorUnont. to 11 1'1I11' lllul JURI, npprullllflI 01' 1110 r\1101\(101I\.1 s illt~I'nHt
tlil'l'I'll1 Illll."it hI' Hllhndttor\. It Hhould 111"'0 ROt. fUl'th 1n Itmnl1.nrt f'ot'mt tOJ';nthol' with tho ('nlr nlfll'knt Vltlllll
tlll'rt'ol', 11Il~' oUH11' propol'ly nWHnd (II' llOqllufLlllnd Ily till! do(~nllflllt fit tile t 1m!! nf' rll.uth.
'fll(! .~-(N"lu!t' C nttnohod horoto flnd mMle Ilfli't. hlll'onl' HOt.S forlh II !.run 111H;wnr to ('Hch tUljlltl'Y
COll1ntllPd thnrl!tlllilHlllItlm (~WHlof't.I'lInMf'or~o('pl'oIHlrt,y, ronl or porHonfll, wtt.hln two ,,,HArR of' dooedcntlA
dl'/lIb, III ('0I1tnmplut1on nf' llllncdlllltl R flonthl or Jnt.llllrlnd to tlll.:n oft'ont !n I'OAROHMloll or ('n.l<,ymoTll at or
Itftfll' flflllt.h, Ruirl !w/1f!dlllu ~WUI rort." t.lw Illtturo unci vnlufl of suoll prolwrty, to wl10m {,I'llJlHf'erred, tho
1'011\1 iOllsillp of' tilt' l.r'HlIsf'flrf'I'H to illll Ilneodollt, the Pfof!ol't1onnt.o shnre roofllvort b~' ('l\l,;h trnmd'ore{l nnfl
ILl1 nthur f'IWtR of' II PPT'UIlOl\t TlHturtl l'I'~_nrrllnR Mldll t.r"ns('or~. In tho onAf' of' tr'ItT1/if'{lr~ Intfllldor1 t.o
tflh:fl pff'nd_ 111 IH)!o\sflss1ol1 fII' (l1l,llI,\'lIIont nt. or I~f't,f~r rloflth, t.horo is IllRo Ilttfwlioll to tho scbfyrtuln n collY
of till.' lip/HI, {T'ust flgrN11l1OIlt or 01.1101' illMt.I'lImOtlt. arent.in~ the trllst,. TII{>rl~ tM IIIRo .,(,t f'orth 1n said
~ehfHhlll' /I list of' l~ll prOIH'I'tYI roul nllll pel'Honnl, with ill" vfilllf_', wldnll pH~,sns Ilt, Ill'Ollllonl1 s ,l!'nt.h hy
vlrtuo of' tho C'(('I'c'lRn il~' dO('l!th'IIt., oil.l1or illlllviriull.ll~'t or,101ntJ.v with Illlot.hl'r, Ill' lillY "own!' of' /'PPOlll{,~
mHll!, vostyd Illflf'(1ortent., flLt-horLfHt1victllully or .I()lnt1~., hytho will, df'fHi, or nttHlr IIISIl'llI1lf!llt 01' /llIutllerl
wtth It copy of' tILl! instrlmlflnt crofl.t.1n,'( R\loh power nt.t.nched to tho RcI1f'rhl}o.
T/11I1 Schpr!u!e D nt.tllnllnrl hC'I'oto fin It mnrtc purt hClrf!of' snt.s forth t.ho nlllllOR Hil'I fuidl'('SSI!S qf' Ilj'j
pl'rSOIlS hOllof'teJltllr Itlt.o"€I~t(ld III tllis llAtllte HI, tlio Umo 01' fiecorh'Tlt!f1 rtonth, t.ho 1111tHI'I! of' til(dr ,'os-
f1('I~t1\'t' Inl.fil'flfil,S, t,lwir l'ollltJollfJlLlpl it' fillY, to tho rtnclHlont, t.np;('tllf~r wit.h tI\l' up.;flR fit thn time nf'
rh~cf'rll'n It s (!l'1l til 0 f' IL 11 ml nors, llllt1u1 tnn Is /HId bfHWf'1 n till' i (~R f'o I' 1 i f'o Illlrtor (J(londnn I.' s W111. It nl So
cOl11nlm. IL st.HtOI1l~mt. ~h(lwinp; which of tilt) beneficillrif'R THlInnd in U\l~ flf'cnflollt.'S wi1]t if' HIlYI dlnd prior
to dl!f',edflnt, thl.' rlntoN (If' thoir dO/lt.h, IIII'll' issllot nnd HIP rfllnUlJllShlp 01' sunil iHRIII! to till" lH1f!(1f'iclnry.
'I'hllt. St!'pdu!e [ IItt,tlcllfHl hllreto nnrl [IulIln n pnT't. IHH'(W{' Rl'ts fOT'th /111 pr(JJ1nrt~', I'f'fd unrl pAr-
sOllltl, n....nf'r1 h~' ttlP dN'f'rlnnt .lointly with nnotlwr or othorA, irwlurlinp; tntnn~ihlo, stlll\dtll.'!; ill t.Iw 1\RlllH
of till' dl'l~nflflllt /Inri nth(H'S, plus t.ho dnt.o nnrt plneo of rf!oord or inst.r\lrnnnts ef'f'f'ctll1)!. (,hn "psl,t turl~ of
r01l1 I's1.nlo /lllcl thl' c1nt..l of' Ilcqlllslt.lnn of }If'rSOllfdI.YI plus till' nllme, IlctrtrosH nnd rnlltt 1(l11~lLt)l, if'III1Y,
ot' I~O-nWllf1I'R 1.11 till' decp.(tnnt..
Thill- 5;chf.'du!~ r nt.t.IlClhod hflrp.t.o find ITItl<le Il llnrt horonr RetA f'ol'th f'\I11~. nnd In IlfllllU nlldebts
fwd cll'dunU.OIlA L'lnlrnetl for fillCI nil hohnl r of' t.IlIA r1floortontls tH,1..nt.n, IncllHlinp; f't.lI1orlll nxpollsns ]Htidl
fumlly f'xnmpt.1otl, whf'rf) nppliclthll~i COAt.S or n(lmin1Rt.I'fltton of this pst.llt.rq NIIl1\Rel fIH!H IIntl f'\j(ItCilll,~,IS
('nnulllsslnl\s Pltitt or to 1m )1/dd; rost. flxpOlHlorl for hurinl trustSt tOlnhst.orlfHI 01' Al'HVOmfll'knrRt /ll1rlreli-
AtOlls Sf'l'v!cns, ,Ill f'OIlSnlllll!UCO of' t,hl1 dnnLh or t.he (Isoodent.; fleh!.s lUllt cll\lms nwillp; Hlld 111l(lnitl lit timn of'
cllH\tlli I.nXt'~l neel'lIorl chllrp;ellhln I'nr portoll )IdOl' to r!ocofirmt.1 fi rlf'nt.h (flxel~pt U,osc ul1nwnrl lindoI' (';pet.toll
IH\1 of tllp llllulf'tl.nrH\11 lIutll':st.nt.n 'fIlX Aet)\ tOI~tll.hn!' with II stlll-nmon!' of' oollnl.nrnl plf.'d,l!;IHI for nhI1,1!;1I'.
IlollH, If' Ilny. It. is lL,I!;rf'{lf1 {,hilt Ull' ftrlllp.inry will p"fHHJllt proof nf' SHift n}ntmf'd c\hltglltlnns IIpon rll-
qlll's!. 111111. If t.ho lunOIlIlt. HI~tlllll1~' pnill in Het.t1mnf'nt of nny f'pn, cOl1lmission or 11nllt. iR ltlsH tlllUl tlu'!
oRtlrnat.l!d Illl\Oll111 IdHllI1lnl4 H1Ul nllownd, t.hnt t.htl snmn will hI'! rnptlrtf1rt to thf' Hn~ist.nr' of' Wlllsl 1l1lel tlmt,
till' /l1I101l1lt 01' IIlX IISfWRHfHt f:llIl hn ,'('/lSf\OSSIH\ In nocol'dlU\ce tlwrowith.
'l'tlllt tllll lolllls of' tho Ilppropri/lt.n eolllmnR in Sr.hflrtuioR "A", "B", "e"1 "E"I nnft "F" tlS fit ,'(wtnel tilnrotJl,
IIllvl' \11'1'11 ('Il!'!'-Jr'lt f'llrwllrd [IIUI prop(>T'ly rfl,l!;isterfHl 1n t.ho Sumlllnr~'.
THE COMMONWEALTH NATIONAL BANK
Subscribed and sworn to hefore me thiH
'1 f/7 rI f x! (I.U' .. J, . 1 '2 'I
llY 0 Ire k.11J 0,1.:2..".... 9......."
~~'1!1('') (), ~)~Y H({,J .'.
By'~ .
)'. ' )
".\. ,I \ ' " .
..,.............\...... ..............",............."..,\,.............
(Executor-AdminlBHator )
10 S. ~1ar~!!t$ml~.r!!
(Street Number)
Harri sburQ ~.P~nnsyl ~.ania
(City or Town and State)
Vice President &
.."..lax..Ma.nager
.".." "i"I",
SOTl':: t1l'frll'i' slJl,nlllp; Ilf'f'lliltvil 1111\1<0 RllrO /111 hllll1kN)l/lCnH 111 tho /1l'ftdnvit. fll\fl Hehl1dulfls HlIllf1Xncl urn
fill/'i1 III .,.,.11.11 cln!.ldl~ or t.ho word "NOIIU" , lUll! in CORO t.he URsots incllltle rnrfl nnd un'listlHl snCtlrtUflR,
SCH'lll' I I II'" Iii' cll\!Hl or f'nmlly IWI'P(II'/IlloIlR or /111 \Iltflrost in IlIlY IJo-Pflt.t.I\f.lrFlllll' nl' 11lls1nnsR, thllt tile
dlllll flllll Hl.Iltfll!1t'lltH I'r~qllll'rHI ulldor t.ho l'nl'n'~I'flph Ilhnvo rtdllt.1np; 1-0 Srlll'rl111fl "D" /IN' IIIl.nchflct. Also Ill/Lief'
I'PI'IIIIII 111111 i~lllllmll /11 In tho "Sunnllllry" hilA lJoon prnpor1r romllJolorl liS IdJO\'o-I\trocl,od.
pee -:~f, '
, ,
.,", ,
. .
.'
('IlMMIINWI(\ 1,'1'11 (111 1'1,:NN!:>YI,V,\N I ,\
'I'I\,\NSI'VI\ I NIII':IIIT,\Nn: '1'1\\
SCIII':mJI.I': "H"
I'EIISIIN,\L PllOl'lm'l'Y
IN,TI\IICTl1.N,' 'rhlll ,oho<lulo "UIII <1111010110 fill ltnlglhlo lUld ltllltH~lt)lo llUrHonfil pro\,erly OWIII,,1 1IIIIIvldnlll_!1.
!;1.J:!.~~::!"nl., III Iho t,IIllO of' IIlII <lolll.h. 1','opo.'ly oWlwd hy the d.",od,,,,I, Jointly wllh "nolher or olhors
,,,,,"I, Ion 11111.,'<1 ondol' ,ol""lu\" "E'. lntltHy-Il,lo p"rSlmnl prop"rlY, t,ltlod In Iho nnmo of' t,llU docedonl, !Jnl
I'"y"hl" III ,to"l.h In ann 11101' or ot.l",rll, Ineh"lIn~ hilt. nol Il"lt,od 10 p.o,ll. II. S. ,avln1l." Bond II and ",,""a'
Ilvo t,"III1I. " "",,"n III, 1Il1l1l1!JO ] IlIt,,,,I, dellplle I,hn ,'aol t.lmt. Ihey aro nol nf' 1.1'0 lIdndnllltorod !!lIlat.!!.
'r"nv,lllio P,,,"ol1111 prnporlY .hon],1 ho ]I"tod f'lr8t (e.g. .jowelry, wellrln~ apparel, hon"ellOld
good!'l, HIIlI t'\Il'111sI1l11JV'1 hooks, ptdnUngRt lIutolllohllOfi, hOI~tEl, etc.}
Inll\n~,ltJl!! por"O'"'] prol,,'rlY, anol, a" howl8, tr<H'8l1ry oilrt.\l'loatell, oll.h on hand and In hfink,
IIlo"k., ,,,o,'I.I!,II,,,,,", n"lolI, t.oy-othor with fieol'II0d ]nt.OI'Ollt or dlvldendll, 8111111'1"8 or wn~es, In8uranc" p"y-
Hlllo t.o 1.1'" o.llIto or flrhllilllry ]n .lIld ""p"clt.y, pllrtno"lilp Int.IHeRts, tnterest In any IIndl IItrlhlltod
"11 tilt" 0\' 0" ineomo f.'!)1Il III1Y property hold tll t.rllll I. lindoI' tho w1.11 or II~reomont of another, oven tholl1l.1i
10ollto,1 olltll\llll ,,)' t.ll<' HIII!H, III the I1mo of' <I,'oth, 8hlllll<l he Ihte<l In !.t.11I "ohennle.
IIi"Slm:N'I' 11I':(',I':1lI';N'I'
I tom
No.
ITEM
Ll~t 1111(\ (\l'sorlhf~ l\li ly
\IN IT ESTI MA1'Ell
V AUn, Mi\ltKlIT V ABlE
llllPAHTMENT VAJ,\lATlON
(Do nol write 1n
this spaoe)
INTANGIBLE PERSONAL PROPERTY
2 shares International Telephone and Telegraph
Co.. common; N.Y.S.E.
7 shares INA Corp.. common; N.Y.S.E.
Dividend on Item No.2 of $.65 per share declared
1-12-79; payable 2-15-79, to holders of record
1-18-79
4. 6 shares Rockwell International Corp.. common;
N.Y.S.E.
5. Checking Account No. 252-108687-2 with The
Commonwealth National Bank
6. Savings Account No. 002.,11-00123 with The State
Capital Savings Association
7. Interest accrued to date of death on Item No.6
8. Dividend Reinvestment Account No. 0190288555 with
First National City Bank of New York
9. U.S. Treasury Social Security check dated
January 1979
10. U.S. Treasury Social Security check dated
February 1979
11. Lafayette Life Insurance Co. Policy ND. 401274
on life of Kathy L. Hulse issued 8-2-63
Statement attached
12. Lafayette Life Insurance Co. Policy No. 401251 on
life of Oavid S. Hulse issued 8-2-63
Statement attached
13. Lafayette life Insurance Co. Pol icy No. 441216 on
life of George S. Hulse III issued 6-5-67
Statement attached
14. Refund of premium Continental American Life
Insurance Co.
15. Refund from Belvedere Medical Corp.
16. \ Refund from American States Insurance Co.
Medical Policy
I
1.
~
28. 50 ~
40.812' /
2.
3.
37.125/
,
I nSor t. till H tot,l\ 1 oppOIi I \.{l npnrf;lnUn1 Prop6r t.y", Scholhll e "n" in
tho .n^~ I\O!)(lft,oll" oc~lullln Oil tllH 11~!'It. pHg,O of'i,hiH fvt,urn.
x X
57.00 /
285.69 L/
4.55
222.75 /'
384.58 /'
1.009.65 '
1. 04 /'
I
2.92
467.50 -
467.50/
706.09 /"':
701. 61 ~.
501. 95-
517.73~
2.00/
/
380.06'
5 712 62 ,6/' '1//2., (t:J..
. .
rotm 11.' (Rov, fl.-7lll
1',IH'1 2
II;C[~
living Insured
(File with Fedt'ral Gift Tax Return, Form 709, May be flied with Federal Estale
Tax Return, Form 706, whore Decedent Ownod Insurance on Life of Another)
,-".__.._-.._.....__.._-_.._-----~..._-_.__._~_._.----<---.----
Sr.CTlON A,-Gcncral Inlorlnotion
~~.I~:~"~:':O a" (I n]~.~~~_;::: I~~I~~,:IO':(~( o:.~:JC"d" nt) .~--=133-i.,:;~ ~~~~~,c,,)~:,. _ ,. ,~~~=~_13~~~;:~~~~~\'~1\;":~;~:'.,.
35 Date of [lift 10r which vtlluiltlon dillo Mlbmlttod . ....".,_.....,,',..'_., .._.'..._'.',_' __'_. ~.,J-.'.-, _ ~.'__,:.J.;:~I',I~".'.'
~_g~o of tlf!cod~.~~~~.d(lath f.~r,~~1.iE~!Ylllu~1!~!." datil 5ullll,}it.lf!~_~.~._~..~.__ . _ ._..._' ,_ _. ~ . _!:. .. _.
SECTION B,-Policy Informlltion
37 Nilrl1lJ of Insured
_=~=:=:~__~=]38..~~~~-....T~.~~.~~~~~~'~t~~
.._.__..____.I(ULIiLI:.. 11111:30
40 Name and address 01 Insural1co compltrlY
'I'1',e La('ayette LHe Im:Ul'lLll.oe 00, , 2;~0:3 SouLh
41 Hind of policy L42 POlicy number
,Jl', J':st:lte BIll' l' I'll @ 65 1,01271,
-.--.----.------
45 Gross premium
18th
:$t. LuCn"yotte III 1/1903
.!.L_._.:::.L~________.._._.._
43 Faco omount I 44 I..ue dato
. __.. _..JI,~99~~..~_~.2:63__.n_
46 Frequoncy of pflynHllll
^lIlilllll
:ji/!5.58
47 AssigMe's name
48 (Jato assigned
..------- . ..-~---_._._----_.__..._--- ~--~--_._-.--
49 If Irrevac<lblo dcsicncltlon of benoflclary mado, f1alllO 01 60 Sex. 61 Dato of hirth, 52 Dillo dosignllted
~ ,ncficiCHY il known
53 If oUlor than simple doslanationt quote In 1ull. (Attach additional shoot i1 nocossary,)
54 If policy Is not paid.up:
(a) Interpolated torrnlncsl resorvo on data of asslgnmont or Irrovocablo doslRnatloll of benofl.
clary .
(b) Add proportion of gross premium paid beyond dJto of assignment or Irrovocablo designa'
tion of bonoficlJrY .
(e) Add acljur,tmoflt on Account of dlvldonds; to crodit of policy
(d) Total (odd amounts on linos (ll), (b), llnd (C)) .
(0) Outstanding Indebtedness against policy.
(f) Net total valulJ of the policy (for gift or estatotax purposes) (sllbtrilct Clmollnt on line (0) 1rom amount on
Ilno (d)). .
55 If policy is eithor paid'up or a slncle premium:
(a) Total cost, on dElte of "ssir,nlllcnt or irrovocClble designiltiOt1 of hcnoficiary, of a sinr,lo.
premium policy on Ille of insured at ottalnrd llgo, for orinin<ll faco umount plus ony
ocJditlonnl Pllid-up inslIrt1nco (lIddltlollnl 1ilce DITlOunt $.., . ",,,,,,,,,,,).
If iI sinr,lo.promium policy for tllO total filce <1fllOunt would not Mvo been isslIod on tllo
lifo of tho InslJred <IS of tllo <l.1to specified, novertheless, assumo tlwt stIch n policy cOlllcl
thon havo boon plJrChilSod by tllo inSllrocl <1nd stilto tile CO!it thuroof, usirlfl for such
purpose tho !.IJIllO fon11ul,1 ,!lld bnsls employed, on tl10 datI) specified, hy tl10 compilny,ln
ealculatlnri s!nCle premiullls) .
(b) Adjustment on occount 01 dlvidendD to crodlt of rwHey .
(e) Total (adcl ilrrlOunts on line (a) 1111d line (b)) .
(d) Outstanding InclolllmlflQSS nr.,"inst policy. . _ ,....,.,.".",." ___.._.
_~l Not ttltill Vi1IlIt'..~f pollc.t..1!.or 1:lft o~.~:~~~~~~Usubtr;l.~~I.l.!...(lr1lin~ (d) 110m fHllOlJnt on line (e))
Tho undersif~n(>d offlter of tho abo\,f!.nillllecl InsIHiHlt:O compilllY tlOrohy cortlflos that thl!> !-ltalofllont sots forth true and C()rfl;,r.t
Information.
'''-f
(' ....~---,
s,.'",,,,, ~ 'C' I ,'") r "~'r.r--'/
68.:37
.t.O)":'4Y--
706. eJ9
l.!ll1 ~
^;l::rl',. 1]1 rent].
(),llo of CllrtillclItion" 9-;:~'!..?C)
,'r U~. O'WIIUjMl'lT l'flllfllllG OlllLt 1111.(j 1(;1.10') h3-0~O.11!O
['111\" 2
F'orm 71? (ROIl, 9-]t1l
~~ livinr, InsurDd
(File with !'ederal Gift Tax Return, Form 709, May be Filed with Federal Estate
___.-!ax Heturn, f'orl!' 70~ Wl!!l.~ Decodont Owned Insurance on life of-^-nothc~)
SECTION A,--Generallnform.1t1on
32 fifst-;;'~~~;~fld lIliddlo In'itii~1 of ~'i~-~;~(~r doc~~j~;i)--"'---'~"--'-I'-iil:;;~t---'~';;'-;;u",--,---'---~----I "3-4--~~-j~l-;n~;I:~Y,.~!lmlll;r--
(\('01' '0 I". Illllsa ,fro lYO-211-tl;:n
~~___"'J_.__.~__..LL_._~._._ ._~_.~ ._..___.__..~_ ~._____~,.__..._.::::..L.....:.__..__._ .. __.._~__.~_ .___.__,~.__.
35 Dato of r,ift fa, r W,I1ICI1 v.luiltlon d.t""...i1l1lllUed ',', " . , . . . , . . , . , " . , , . .... 1-"?1l-'7T--~
~!"'Q~~..~~~~~;I.~!~~ ~_~t~.ll_tl) fo~_~hISJ.1.~_III.u..~t~.!!.-cU!.!~_.tI!!_h,I!~I_t!.<!~!...~_,,--~~_~~_~~_~...'-_~._.-!...-~~_L_~__::..... ____. ~__
SECTION B,-Policy Information
31 Name of Insured
138
139 --Dilto'9fl~;II;"
7-]-03
__ ~_h.__.____...
j)llvld S. llulDa
Sex
M
40 N('InlC llrld address of insurance company
_,,-:!:!.!:::..!:ufayettc I.lfe_ Insuranoe Co., 2203 South 18th St.,
41 Kind of policy .. ~, I 42 POliCY number
.2E.~_...!~!t!\te 131~.!)U @_~.. 401251
45 Gross premium
____....... :1:/,3. 3~j
47 Ass/gnon's name
Lafayet'bc, IN 47903
43 Faca amount --14-~~~;.~~~i~t~.
$1,000.00 11-2-03
-~--~,. . -- -------
46 Frequency of payment
ruU1\lU1.
48 D,llll DS~luned
49 If irrevo"oble deslgtlalion of benAflclary made, name of 50 Sex
bcnefic;lalY
151
62 DIlle dcsif(llated
Ost, of birth,
If known
53 if otl1er than simple designation, quote In full. (Attach additional shoot If necessary,)
--O;'7"".~--:-"::-"----'- -
54 If policy Is not pald.up:
(8) Intorpolated terminal reservo on date of assignment or Irrevocable designlltJon'of benefi.
clary. ,_ 531,.97 _
(b) Acid proportion of gross premium paid beyond dElte of asslgnmont or Irrevocable deslGna.
tion of beneficiary.
(c) Add adjustment on eccount of (IIvldends to credit of policy
(d) Total (add amounts 011 lines (a), (b). and (c)) .
(e) Outstanding Indohtednoss agninst polley,
(I) Net total value of tho policy (for gift or estate tax purpos.s) (subtract emount on line (e) from amount on
IIl1e (d)) ,
55 If policy Is either paid.up or a slnr,lc premium:
(a) Tot~1 cost, on dJto of assignment 01' IrrC!vocablo desicnation of beneficiary, of ,\ single.
premium pOliry on life of insured ,1t attainod .:lgc, for orl(;inal face amount plus llny
additional pald.up Insurance (additional face amount $... ."...........__).
If a singlo'premium policy for the total face amount wOllld not llilVO beon Issuod on tllO
lifE'! of tile Insured as of tho date spocljjml, ncv0l1holess, nssumo that such a policy could
then have boon purchased by the insured rind state 'tho cost t11Neof, uslnn for such
purpose tho same fcmnulilllnd h,15i5 cmploycd, on ,tho diltc spocifled, hy 1110 company in
calculatlng sinclo premlullls) .
(b) Adjustmont on ilccount of dividends to credit of policy.
(c) Total (add amount, on lino (0) and lina (b)) ,
(d) OutstandIng Indohtodnt!ss against policy. ... . . . ., ..,. ____.__._
(0) Not total \/illuo of policy (for !lIft or estato tox pllrp050~) (suhtrM:t [ImolJnt onlino (d) frolll nm~~nt on line (e))
Tho uncllJrs:iunod officor of tt10 nhove.rHH11ed 1I1slJr<1ncf! company horeby r.ortlfios thL1t this. statement sC'!ts forth tHIO unci CUt lect
lnformntlon.
65.03
101 :"6't" "
'-"10l.(,[
---0'::-'''--'
'/01,61
(
SIRnntUlo ..'-~.___
T,tlo'" Aost. Trow:::.
Oillo 01 Cortlfication ....
9-n-'I'J
* U,S. GOV~RNM[NT I'ltINTJNG orfIC~ j 1111-0'2(11-]1)<:1 56-0.1l-1 1 10
fOf!!1 11;'> (Rnv. 1)-1A)
._.~~
1Il1:'r.1~
living Insured
(File with Ferleral Gift Tax Return, Form 709. May be Filed with Ferleral Estate
tax Retllrn, Form 706, where Decedent Ownerl Insurance on life of Another)
SECTION A.-Genemllnformation
32--rirs-t-namo and -;-l~ldui~li~~of-d~~or (O~~Jocedor;t) .---- . 33"- C;~-t--M~~----~ ~- ----.- --\34 S~;I.I-;~CII'i1iy lIU~lb", ' .".
_____~eo)~I:c F', Hl.l1s~_J~_____. .1.90-2H-(~))') _ _
35 Data of gift for which vi1lufltion dat~ sub;~ttod :----.-. , , ~~-:-;-I--=~~-~'~,:;:'~"',.-,:
~~ Dato of d~~ed~~~~__d~at!l.Jo_~_~h~~~Il!!~t~~!~!!~I~~!!t~_~. .:.._'--!._-:...._~__~__'~_'.._ .'___~~____._...:::.__'-~~__ _ .,
SECTION B,--Pollcy Information
GeG1l'[;O F, Illlloc, III
----.
40 Name 1II1d addross of insurance company
The Lafayette LJ.Co Insurunce 00" 2203 South
41 Kind of polley I 42 Polley number
Jr. Estat.e BIdr PU @ 65 L~~216
18th S t , ,
1-~8~;-~1 39 Dat;-of-i;ilt-I~~
_ ~.~_. __i'=-6~6~,-__
Lafayette, IN /,7903
43 Faco a~lOun\ f44ISS;;-~~I;,te
_-E, 000, 00 L._J'.~.~ ~.6'~
46 Frequency of paYlllont
Nllll1111
37 Namo of Insured
45 Gross premium
~;LrL'r' Lt?
47 Assignee's name
48 DaIl111ssii:ncd
49 If Irrevocable deSignation of boncficiary mado, name of L50 $eI< 61 Dale of birth,
~~~ U~M
-- ._~----~-~.
52 [1ate designated
53 If other than simple designation, quola In full. (Attach additional shact If necessary,)
54 If polley Is flat pald.up:
(a) Interpolated tDrminal reserve on datv 0' assignmont or Irrevocable designation of bonof].
ciary . , . . .
(b) Add proportion of gross premium paid beyond date of assign,ment or irrovocable designa.
tlon of beneficiary ,
(e) I\dd adjustment on f1CCO~Jnt of dlvldonds to crodit of policy
(d) Total (add amounts on Iinos (0), (b), and (c)) .
(e) Outstan~Jjn[llndobtodness against policy.
(f) Net total value of the polley (for gift or estate tax purposes) (subtract amount on lino (e) from clmount on
Ilno (d)) .
55 If policy Is either paid-ur or a single premium:
(a) Totlll cost, on d<lto of assignment or Irrevocablo doslerlntion of llcl1l~flcl.1fY, of fl &Inglo.
premiunl policy 011 life ,If insured Ht attained nge, for originill faco funount plus llny
additional pnid,up Jnsurnncc (ndditional f,leo amount $ .... . .... . ... ......;),
If \l sinelo-premium policy for ttlO total f<'lce <1l11otlnt would nrJt h;1VO beon i{,slfod on tllo
life of tho Insured llS of tho dllte spocified, nevertheless, nssullle tllclt such n policy could
then havo boon PUtcl1"scrJ by the Insured flnd staIn tho tust 1II0loof, lIsing for sucli
purpose tho SJme fornwl,ll1nd basis employed, on the date spocifiod, by tllo COllllHlny in
calculatln(i single rrOIll)urm,) . ,
(b) Adjustmcnt on llCCOIJnt of dividends to crodit of polley.
(c) Total (odd amounts on line (a) and Ilna (b)) ,
(d) Oulstnncllng inclobtodllcss analflst policy,. . " '" ' , . , ., "
(0) Not tot,,1 valuo of policy (for p,ift or ostato ta\( pllrrosos) (sl,!?trilct il/HOtlnt on lino ((I) from .1Iliou!:l1~J1!lO (cl)
The unclcrslcned officer of ttlC abovo.nomac! IfI'itlr,lnCO cornpnny 11Oroby certifios that tills stiltolllt'nt sels forth 1wo QIHI Wtrccl
lnformlttion.
/'
t' _'"),
l '} '-)1 )
Slgni'lllJro ...."---. ,.... (~ ,,>>07.............
387, 30
, ---..--.-""""'"---
59, 2.5
55,/,-0-
1111(1 ...
ABot. 'l11"10ns.
O,lln of Curliittlll,Qn ....
9-?'7-'l()
l~ us. GQVrH~MrliT rR)flTlNG l'rfICC liIJ-Q-'lil-1lj" 56-0<401110
nrr ,:"',
i'll~l\!ll\',\ I,' \ I ,'I'll (\j
i'll \\:-;1''\''11 I \I'I'!, (
1'\'\\"\ 1\ ,\ \ I
[."_\('\- 1\'\
~.: (' 111'1 H '1.1< "("
I': \\"'1 I!""
I'....
'"' " ''',
'li~!'" ~~~'
,-' .-Pt
I', .~\,ttt,.,.. _~
(_", .1~",i:1 ";>
'. '
!;\~l:li-'\l [WI "IW\'j
-~-,,-~-'---'--"- ~..~-_.._..~.-..-._-~....".~'-''''~''~-'
~tJ Ill.! dt't'l'dl'lIl, \\liliill III!) _,"d'''.lil'dl'lltlll !lldl.,' ilii,\ 11'1111;;1'1'1' .)1' ,'flY 111.'11"1'1,,1 P'l!'! Ill' III', "'.lil!P, '~ltlllltl(
I'l't'J'lvlrll-t il \Illllllhll' Illid !\!ll'qlllllP I'(III',i<l<'I',111\111 tlll't'l'l'nl".' (,\'P-iWI'1' ,\1' ",' 1I11)."Yes
(~!'i Illd rlpl'l'll,I'lll, \\Illtill 1y,(J .,"1I1'h 01' dl!dih, I l'i1II'" f'!' I' Pl'iJPl.'I'I,\ !'1'OIll hi)il~d'll' 1'1 hllW.I'lr Illld Illill\II"l' 1'1
(,tIWI',", (l'Il'llldIIIJ-', il 'ill(lll!ii') IH.J!ll11t',.I"I\OI'hlilp? (.'\II~WI'I' ,\'Ph 1'1' Ilo).~Ho_
(:1) II' Ihp 11I1':iW/II' III (I) UI' (~) ,'111111'1' Jh III Ill.' Id'i'II'lilidIVtl ;illllo'
(11.1 A'~I' 01' 111'1'.'111'111 III I flllt' of' II'Hll.,]'.'J' .._.41
OJ) Stllll' ill' dl'I'I'dl'llt I h IinlLl (II n t I, I Oil' U /' 111'11\ I Hi!, IIII' I.I'nll" 1'1'1'. (Noll' 1).
(11) C/lll!>W {II' d.'L'I'dntd' h dllHll1, (SIII(' 1).
(,I) IIld cIN'o,lon!, III lll~ Ilf'Pllllll', 1I11L1,1' IIIl,\' 1-1'1111:\1',,1'
t1Hlll'ildul'/Itlflll 1,1li'I'ol'oJ' whll'lI \\H~ II' fliltl' l,j'!,I'!'!.
(AIIHWI'I' ,\,0:-1 OT' Ilfl) _No.
(Il) \\'H~, tllI'!'I' /lilY pn'4slldlll,\' f,hnl IIII' 11l'OI'I'I't,\' 11'1l1l!,iI'lll'l'll!lllI,II~III, l'utlll'll In J;1'IIIH;/'OI'I'I' nl' 111-,
l'!.illilo Ill' III' sul"I('ol- tll 111'-' Pll\H'I' Ill' dlqpol'dllllll? (,\11:-1\\'1'1' \1',", 01' "(I)___I'!Qi..._~....
(Ill Wllllt WIll-, llll' LI'HIISl'l'l'I'I,1 H H;~n Itt. lilliI' fll' c!n{'r'd('lIl", dP/LI,Il',' i....."N.lA..~.._
(t\) !JIll df>e\~tlollt. IIIIIIH I I ('"LIIIII' 1II1lk" IlIlY I.I'all~,f'ol' wlt.llollll'/H't'I\'11lj!, II viLlllllhlt'lllldildf'lIWltn c'('1I1';1111'1'1I11011
thnrl'l'fll' IIlld"I' \'rbiI'll Il'illl"if'I'I'Llr l!}'I'I'lIs~l.v 01' 11II1'11i'dl.\' l'I'S/lI'V';-'!-j f'ol' lll~; Ilf',' 1.11' ILlI,\' IU'l'jlll1 whll'll dlll'-,
tloL III l'nd, 1'lId IInl'o,." 11111 t1nllth:
(Il) Till' pOfj:-'I'H~I(j1l flT' 1!1J.J()~'IWIIlL(lJ' 01' U\I' 1'lgllI to Illl'Oltll' 1'1'11111 till' ['I'l'llt'l'I.,\ tl'llllHf'I'I'I'lld'I'
(,\II-;WIH' ,\"'''i IIr' Illl) _,_~Q'_"H___'___'
(Ii) Tlti' l'li!;ht IiI d!'~I'~IIHI,I' t.11l' pi'!"H1ll'; "i10 sN.'hltll JlIl,'iSI'HS 01' I'lJ.lII,\' IIII' JlI'Ojll'l'L,v II'ansl'l'l'!'I'>! ;;j
11WOU\I' Illt'l'I!J'I'OIl\',' (An~;wlll' Y('li III' nil) _,...,Q________ _,w
(eJ) II' tlip IlnSWfll' \.11 (en (II) Illlu\,I1I!-i11l tlll\ li('j'II'lHtttl\'II, stiliI' wlll't.I)['1' tli,' I'll~hl- ....IPi I'n~w,'vl'd III dl!l'pill'lll
IIlnllf' of' (It.hl'l'H _N/A___.. _._--..~-----_._,
(7) IIld Ilol~(!d{lnt. 111 Ills 11f'I'tllllf' fJ1llh"1l L!'Ii!I!;f'!'l', t.llI' ('l111stdi'J'111.11J1I 1"11' whll'l1 ''''is 11'ltllhl'l'l'I't'I" prollll~,!' t.l
pH)' IIlO(JlJl(' 10 (II' I'll I' t.Ilt1 1I01lnl'l L oj' l'III'to (11' II'lIll'il'f'l'OI'? (..\IJHWiq' .v_'l'. 01' !lId >_No.~...
un Did dIH~nflt'llt, 111 I\I\~' l,lmo, 11'IlIlHl'I'!' prop/'I'!.:,', 11111 \l11l1l'l'lf'lnl 1'11,1 n,\' 1111'11 I lit' wlill'l1 WHfi fiuh,ll'pt 10 1'lllL I 11.',\'.
h(1('<lIIHI' Of':1 1'''~ol'\,l'd pOW!' I' 1.11 HI!.I'J', 1l11l1!11d, ur l'I'VoliO, Lll' IIh I 1'\\ ('(lllld I'IlVI'!'1 10111'1,,,,11'111. lIudl'l' 1I'I'I!\'';
of' t1'H!lsf'('J' 01' by opPI'IlLloTl Ill' Illw'/ C\lls\\"'l' ,\T'~ nl' 110) _tio_
(It) If tilt' iLllSWI'l' to (H) ahovl' IH 111111\1 1lf'f'II'llIlItI V{', 1'lItS till' pn\H'l' t,q III (1'1', !l1Il1'nd, Ill' 1,'(1VIII\" tho 11111'1'"
e::;t of Lhu 11I!IlI'f'ir'\ILI'\' I'PSI'I'\'I',-j III 1111' dL'PL!I\t'llt illolll' 01' LlII' dl'l'l'dt'llt /llld Idlll'l'S?
(Answl'l' Yi'S 01' 11/)) _NiA..___.,___
~O'l'l': 1: '1'1,(' IlllhWOI'R 1.0 1,111'1';1' 1[111'!-it11l1lS ~iliqllld IH' ~;Il\lpnl't,l'd II,\' H1'f'ldnvll l.y tIll!' IlU.t'llllllll-!, pll~'HII'1111I liS
wl'11 liS II .:opy of' t.ho df1utl1 (~f'l"l.l 1'11'ilt".
~(J'l'J<::J: If' HIlSW,,!' to IIIlY 01' 1.111' I1I10v" qlll'stll1l1s 11; ,VI"S, sl'j "\lI'Lll IIpl\J\\' U dI'Sel'I}It.lnll 01' till' PI'lIll1'I'ly
trllllsf't'rJ'l!d, It's i'IlIT' 1I111I'k,,1. Vllllln III dnL(< of' 111"11111, dlttus ot' I.1'HIlsf'l'r:4 IIl1d 10 WiHltll 11'1111."('01'1'1'<[,1'11111
fi'l/1t.tom.h1l1 oj' l,rIlJJ:iI'f'I'I'I'H to d\lel1thnil,. li'lIl1.\', l-lllhllllt. (~tlp,\' !If' 1I11,\" 1.1'1l~'il, 1[,,/'1\ nl' IIlSLI'UfIlI'lIt, II' j,I'IIIIS-'
f'l'fS /Iff! dldmt'd 1.0 hfl nOll-IHxltldi>, also sllhmlt dl'l,:t1I,'d'sIHlI'IIIPlll- of' t'llf'tH Oil vd"(~11 ~iltld ('I..1\Ul is h.'ISf'd.
~t'ITI': ~I: List ilppl tl~lIldl' pl'o!lI'ri,\' 111110\\' III 1lI111lll('I' III wlll('h 111'0\'11\1'01 III Sl'h''IllIll's ,\, /II OJ'I<.
(I f' PI'ol'" I' I ," 1'0' Ithoul 1'1'1'1' I \" dg II
III II/L'i~i!' ~,h 1 {I II t. I' /'1\'; 1I,VIllI 'III ill. {/ I'
\'ldHidill' nl' Ildl'ljlldl"
nl'Ll'1' III S dt'ld,II'/
~-----
---..-'..
-----.--.--.. ,-~---
----.0____---
ITEM
111':SCHII"I"llN
\111\1(1';1' V,II.[iE
(EsLll\llllod)
Ill-;,,'I', V'\LllA'l'IH~
(lh'\lL, IJIII.\')
1.
Decedent transferred 248 shares of Hulse
Associates, Inc., a closely held corporation,
to his spouse, Judith S. Hulse, on 5-10-78, who
subsequently sold the stock to John M. Hulse,
decedent's brother, on 5-10-78
36,721.36 (
2.
Decedent transferl'ed one-half of funds recei ved
from redemption of Certificates of Deposit to
his spouse, Judith Hulse, during 1977 and 1978.
Remaining one-half of funds were used for medical
care for decedent's benefit.
List of Certificates attached
21,896.54 .
~_..,_,.______..,_.___c__~ _w__,~~,__~ -_.
fllfwrt l.Ii1s !-(lUIl ol'Jlflsftl' "'J'I'lIl1';!'fOl"I". St'lll'dlll,' flC" III I iiI'
"As Hl'llIIT'H'd" 1'011111111 !Ill ,11,'III'd III:Y 1'1' I Ill!, 1..1 I !I'll,
58,616.90
.68, &./(. ?()
.,
....'.
, ....;." ". '"
, .,~f ," .', '.,,' ..',..;'" ~,I ".'/ "",.,",0" ',', " I p
L1\ST InLL 1\ND TESTlIMENT OF GEORGE F. HULSE, JR.
I, GEORGE F. HULSE, JR., of the Township of Hamp-
den, County of Cumberland and State of Pennsylvania, being
of sound and disposing mind, memory and understanding ,do
make, publish and declare this to be my Last will and Testa-
ment, hereby revoking and making' void all former Wills by
me at any time heretofore made.
1.
I direct the payment of all my just debts and
funeral expenses as soon as conveniently may be after n~
decease. All Estate, Inheritance, Succession and other
taxes imposed or payable by reason of my death with respect
to all property passing under this \'li.11, or otherwise, shall
be paid out of the principal of my Residuary Estate as if
such taxes were administration expenses, wi thout apportion-
ment or right of reimbursement. I authorize my Executors
to pay all such taxes at such time or times as they deem
advisable.
2 .
I give, devise and bequeath to my wife, Judith S.
!lulse, that fractional share of my Residuary Estate which,
~/hen added to property owned by us us tenants by the entire-
ties, and to proceeds from life ,insurance policies on my
life passing to her, will caUl'le the total theroof to qualify
for the marital deduction allowable in determining th,-, Fode-
ral Estate Tax on my Estate.
3.
1\11 the rest, residue and remainder of my Estate,
-1-
5 ';-
....<-:
L~
.~ t.=
'6 -.. e
..: s.
,;. o.
QUI1
Eg[
~8&
Heal Properly
Persoll"l Proporty
Transfers ,.......... '"
8UMMAHY
",,(8d1,"A")
(Seh, "8")
.,(&h,"O")
..",-,-,.;..,......,..
Gr(ll;s TRxablo Estate
,- ;;;,."....,,_....
... J
~ z
~ j
-
i>-< ;;;
~
'"
~ ~ .j!
~ ~ ~
~ ~ ~ ~ i'
~ =
0 r.l 1= ~ ffi ~ ~
Z ~
\L, "5 I
-."- 0
" a:: .s
c 1l
.., ~ "
E 'll ~
"
.!Q ~ 'a J::' ~
" -
~ 's .', ".J.: 9 8
.... ...... .:3 e 0
::..;:: u
-
(I)
(As H,'ported)
$
$
$ ,
$
$
$ ...."
.......,.",._,...
(2)
(As D<'!I'r1oliwd)
$
$
$,
$
$
$
f'll \'1(1171)
C<luuty, Numbor and Home__
Iii" NumhoL..
(.2-1 )_ C UlIl p.w.l.uul"..------.,.---..---
?l-7Q-Ol ?~I
. ,._,,,. -- --- ----.-. -... ---------._-
SUMMARY
UIII" (,f Doolh... February 8, )979
("totll Nomo _ tll!he.
tt A',I ~. AfAl )
_Geo f!je
I f tf~'>! NAMI:)
, _-f._.
liNt 11 AI.I
COMMONWEAL TH OF PENNSYL VANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
REPORT OF INHERIT ANCE TAX APPRAISER
I, Iho undorolgned duly appointed Inheritance Tax Appraiser In and far the County of rumherland
I'(nll',ylvunlo, do re.pectfully report that I hove appraised the real and personal property a. repart.d In the foregoing return at
till' vollies !lot forth oppollto oach Item I" thelolt colunln to tho right In Schedules llA", "B", "e", and IIE".
5 December 1'1'/9
Dntnd:
;; I
__X./t/1d/j II) v:J//y I ( )
IN1HfHTANcf; TAX AI-'PRA!St-'R
REPORT OF THE REGISTER OF WI.LLS
I, tho undersigned duly elected Regl.ter of Will. in and for County, Pennsylvania, do respect.
("lly reporl that I hove allowed dedoctlon. In the amounts claimed by deponent, except as to those Items where a greater or
1"",,,1' omount I. .et forth In the lost column to the right In Schedule "F", which greater or le..er amount repre.ents the sum
ollowod QS a doductlon.
Dolod: ..-......
REClISTER OF WIl.L!!
INVENTORY
VALliE AS APPRAISED
one
5 712 62
None
58 616 90
3
4 984 77
59,344 75
ADJlISTMENTS
onE IHAARISBLlRO lISE DNLVI
00+
10+
20+
30+
REMAINDER APPRAISEMENT CODE
92+
H.lnl ProplJrty (Schodulo Al
POlsonnl Prllflorty ISchodulo 91
j')tnl-Hold PrOI}nrty (Schodule EI
Tmt\\f(lr~ ISchlldulo CI
TOTi\l. GROSS ASSEl'S
1..11:;<' DlJht~ I1ml Ooduoti@nt
ISCIIEDUl.E FI
40-
93.
GI.r.:ldl VALUE OF ESTATE
V,.!uclIhm of Ilfa 61tOtfll or
~
PRINCIPL.E
PACTOR
VAL.UE
,-
(lnnuitl,,<;.... ......,...~......__ $
t
E=
ESTATE TAX ASSESSMENTS _ $
t::
TOTAL TAX
9PM
2% $
6% $
16% $
$
$
$
J=
COMPUTATION OF TAX
E9-B..J.!1'E OF:_REG1STER ONL..Y
1'1;1X ~,n ~ .___.___
T(1~: Clll ~ _._
Tn/( on ~, _.
'1 (1)( on ~ _
Tn" on ~, ____
Er.I'J1lpllnns
T otClI E~;tato ..
(*) As evidenced by Charitable
ExemptIon Certificate. luued
by the Secretary of Revenue.
l.on!; 'al( provlously paid $
BALANCE $
Lf1H~; sri;, of lox If flold withIn
;l rl1ol1fh~ aftnr doath $
"^LAHCE OF INHERITANCE TAX DUE
I\lld illk!(\~t ot ratn of 6% from
_.u.__...... ___._ to.
I,MOWH or ESTATE TAX ASSESSED
f:~, 10 Ip Ill)( ['0 In
$
$
1=
$ f-
$
$
$-
$
$
BAI.ANCE DUE
I\dd 111""..,<;1 {II mln of 6% h",m
(0
TOTAL TAX BALANCE
PAID
:,lIpplolnontol Code'l (FOR USE IN HARRISBURG ONL Y)
4i1-Adiu.tment
~9IAdlu.tment
~ll--Annulty
6O-Llfe E.tote
92tRemolnder Approl.al
93-Remolnder Deduction
93C-Chorlly
94-Remolnder Residue
96-Succe..1 ve
Life Eltate
rOlllJSE OF REGIST ER ONLY
NOTE: Whore subsoquont adjustment! arc modo to tho ahovo computatton of tox by the Reghter of Will" for proper reason,
!i.OITlU s.hould be notod below, with flho,t explanatlon.
ADJUSTMENTS
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<:t; P:::
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
51:
William H.
a Vice President & Trusl Manager of
Commonweallh Nalional Bank
Bogel ,'"_ .......
being duly sworn , according to law, de pale. and laYI that COIlJllonweallh Nalional Bank
as Adl1li ni s t I'a lor of the Eltat. of GeQrg(LF., Hul S!;1_..c..__
lato of ___.Ham!l.~~!~~.~~iE.c_. ._____..____.. _.. ." Cumberland County, Po" decealod and thatth.
within II an invontory madn uy Comnonwea Ith i'{a liona I Banb. ..._, the .aid_.Adml,nis l ra lOI'
of tho onllro oltate of ..Id docod.nt, conllltlng of all tho potlonal pro petty and t..l e.tate, except t.ol e.t.t. ouhldo
the Commonwoalth of Ponnlylvanio, and that tho figurol oppolile oath item of tho Inventoty teptelont 11'. fair valuo
01 of tho dato of decodont'l doath.
._ and .ub.crlbod before mo,
COMMONWEALTH NATIONAL BANKras Admini sUator
of,lhQ t~~';.e~~!gC:F.~SC by:
,_VLccYrJ:I.lil~oriI:t,T.rla-r. ~~gO ,." ,
executor. Admlnhtutor
-~.2?-l4:(/ -'~;;-#f-..__-19,1.:.~-
,L' T', (/
. . . I J
' \,' I / l "j' f
--t--+-- ( .' I" r . l' (I" r . -
t.nll A. Orou. No~afV Pnilla
Lower AliGn 1wp" CUlilbtl'rl.lIld County P(I,
My COinflllulon I~KPlr., JulV G, tau
__,_J5.LQ...CliJdIiCClif f Dr LV.l4..J:lIDlp.JiiLl ,f A 17 0 II
Add""
Date of Death __n_n___~___.._ ...c..__,____.Jebrc~~~._...___.____.____J.9j.9
O'Y Monlh ru,
INSTRUCTIONS
I. An Inventory mUlt be filed within three month I aftor appointment of petlonal representative.
2. A lupplement Inventory mUlt b. flied within thirty daYI of dl.covory of additional a..els.
3. Addllional Iheels may be attached 01 to petlonalty Or realty
4, See Artlcl. IV, Fiduciarle. Act of 1949.
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Id: I ',i [F: i i; !Ii i ! I I<ld!, E
01 ;. Id: r-.!i)[U I lilU!!! In
APPL)qTION (MUSl BE r ILED II~ lIW'L1CATE)
TO THE PENNSYL VANiA D[F'AI\lMEWI or HEVENUE:
Applicntion i5 he.reby mt,de for C U'Gont to tho 1111ndel of tht. following securities of 0 Pennsylvania
Cotporlltion or (] Notiollol BOllkillq Associolion located in Penllsylvania:
DATE (:,)"'\"'~ \'\\\'\r;,C,
(0).3 ,1,:;, .tbL JL NLAL Corporation m .... ,a..,. (ct, f&mnQn um.._
(NOTE. IrI defierihing seturities erlter ill (0), ab Ole, ellher the number of shores of stock or the face amount of
reQistelod bOlld~, in (b), the name of tho i>Sl,in,g compnn)' and In (c) the closs of stock or Ih. stated interest rote
end ma,urity dnte of registered bonds,)
ISSLlED ONH 5-80.
, and i,ovin\i 0 TOTAL MARKEl VIILUE OF S, Not appLic/lblc
(Dnll')
uS of the dole of death of the decedent, Ji.'?o.':.99_.J.~~HLJh~JlL..
(NO!lllJ or Decodcn1)
u_" , onmLcb..8, uJ980___.
(Dolo of dpoth)
who wos late 01.. 102 B i rcb. C'<?l!.f,!,., .... .__.J:.~nlp_~.jJ.L_______
{SII(lClI (Inti Number) (PO\'lt Office)
,k ymh \)LLiLn.Q...___ _~.P.MI ns.yJ_'i ania
(Caunty) (StOlfi)
The securities ore r~gistercd as follows: .,.,..Q()(),r,99J._I:LuJA!'L JL,. " ,..______ ____._.___~__._____________.._.._
(N(tff11' or nom6s In whieh c;l'rtlflcotes (HO rugltlh'Hed)
ADMINISTRATOR) C()nJl1QQw~'ll,\hN.ii t i QQiiJ Biink... ..J 510 Cedar CLiJLDd.\le.,.--Carnp.JiU.L,.P-<l~
:ttOC~~~) IN""", NAME OF APPLICANT __CDrtTn~rl~&~rf~"Nat i Dna I Bank by I. _
Vice President & lrust Mana~er
:::::: ::~: ::::::~I:I~j-<5 :'::~~R:F O:P:~;~:;:N~51D~;~::,~:~ '
NOTICE: IF YOU FAIL TO PROPERLY FILL IN At<Y PORTION OF THIS APPLlrnfof.(fT\.HEelN8T'9d'~S{ al ager
CONSIOERED COMPLETE AND WILL BE RETURNED TO YOU FOR COMPLETION.
Pa.
,.. ... .-~ --.:=-_-:-.-:-=~-==-=-:-"~.=--=~--- _._~:=::.-:.:
COMMONWEALTH OF PENNSYLVANIA -- DEPARTMENT OF REVENUE
<=,ONlENI__1"(UR.~NSFERSg(:tJR_ITI_E1 A I _~ D ) CI r i
DATEU_.CA_':..~~L( 0
I hereby consent to the lionsfel ~f the "bovt secl!lities nOW registered in the nome of the aforesoid'
Decedent and waive the filing of 11 certificate COtlilyinl1 te. tho parlllont of tho lronsfer inheritclI1ce tax to which
the property of said Detedent is made subiecl p"""ont to the provisions of the Act of June 20, 1919, P.L. 521,
as om ended and the Act of June 15, 1961, P.L, 373, or; o!nended. This is olso in occordoncewith the provisions
of the Act of Aprii 9, 1929, P.L, 3q3,
This Consent to Tronsfer tlit herein neseribed prop"'ty ope'''tes only ie. reference to the estote of the
"hovo.nomed DHedent,
\'h.
'.,"1. 'o.N J.'~
\ "f7" .......,"~
,",'\,:';-- ::1'1',\
) " "__ ~,' \ I"" r' '0, "
It,,;,Z:'C;'. o\:~~)/}
...:',:1i1.;S"C:'~~:";t~.~
(/;6 .,t;~J~~~0"'''l~J t\ ) (~'N~l~'~{ll\\
J\':t~Jr) \ l~um)') .~. \
..) ,-I \
fll'nl Ilr (' 10
Of.DUCTlONS AU..OWfO IN
orTICI' 0" Hili:
IItI:G'8nl': or WILl.I
STATEMENT OF DE.BTS
AND DEDUCTIONS
THI bUM (J~
, till ,I'! {
''''1'' 'Ill \'0,~( ( . If; (11')1
('I, 11' L' \\V' J. "
f. (,i lj~ , II .1\",,-..
n'llllhr 01 1111, AU",1
'1 'I
0' ~_. CU~1IJE~L.^NO__,~~ COUNn'
llA TF
AND AGIN1 01" 'HI COMMONW....l.Ttt
GEORGE HULSE
ESTATE OF ____._h___._..._~._~_
1....__,-_,. _.
- - .. - -- -- -- .. . ..
---
DA.n H(l "I' N...MI ,,, ,.AVU n[M""~K. ...MoUN1
....nuC..1l1f .-.------ l--...-. ~-_..-
-
Feb. 21 Cumberland Law Journal Advertise Letters Testamentary ~8~ 00
--. -- --
Mar. 21 Cumberland Publishers, Inc. Advertis~ Letter~ Testament~L-_ !-.._1Q", 15
Mar. 22 Stuard Derrick Real Esta te, Inc. Appraisal fee 160. 00
.- . .,-'-
Mar. 27 Harry M. Wimer Appra i sa I fee 30. 00
~r'__h 1-. 16 Reg.1 s'tT~n~f r~~,l I~ n, ., ~as..ts.-.___.___ 1-.__JJh. illL..
f----, . -
May 14 Carlisle Hospital Professional services 19. 60
- n_ -----
May 14 Myers Funeral Home Funera I expense 229. 60
May 14 M.G.M. Pharmacy Statement 164. 50
1---. ' - - ..
July 17 M.G.M. Pharmacy Statement 1. 97
-
July 17 Presbyteri an Home, Inc. Profess ional services 493. 07
-
Sept. 10 Forrest Park Nursinq Horne Professional servi ce,s 38}1.'1ill...._
- .-_.
RESERVES:
-
Judith S. Hulse Family exemption 2,000. 00
--.
George M. Hauck, Esquire Attorney fee 300. 00
-. ~---
The Commonwealth National Bank Co-Executor's fee 286. 00
The Commonwealth National Bank Tax preparation 70~~ 00
.. .
Closing costs 150. 00
--
.
-- ..- -"-.
TOTAL 4,984. 77
-- _. -
-~--
- 1---- --
-- -
.
,)'(. ,; I(i ')\1 r.!:llllll"DV D '070
("lATE 01" "lL,rNa AP~,....t"fMINT _.~....'....,l-~_...~LL,_~~__lJA.TIi OF DlATH _.--LJU.llliU_ll\L.._!a!.J._~-.A...2.Lz.........__..___~.___..._
COMMONWEA~TH OF PENNSYI.VANIA }
COUNTY OF _....QAUPHIN ..,
We,. The Commonwealth Nation~1-BankL~80bert
Vice President and Tax Manager,
P. ConwdvlLHIRlfI"" CIRTI"''''', THAT. TO THI IUT or
'UNIRAL UflllNUI AND ItKPf,NnW 01"'
~y kNOWLIDGI AND .i:LIEI'", THE 'OREQOING II A JUST >\.NO TI':U I ,1fATIIM}:NT OF DIITI.
ACfo1IlNIBTRATlON IUBMlnlO TO THl u""n OF ~_.._lieorge r. HU I se
INMIR1T,t.NC[ TAX PURPOIII,
. J , Ii ..
IWORN "NO IU.8CFt/U:D IUfORl: Jotl THIt _~ DAY 01"
--.,.. ..:)1Ll'.L!J).f.!.!:..~ ,.:14- -
fJJ...lL.." ), , , ()( " Iii (. _
OIOIAIID, A' DI.CUCTIOHI I"OR
'I'
\
_~___.... __.____(L.' I
, . f ,) /
. ". " /, I
TOLJlJ_:...:!J.~JIJ\: 1"",1, V I
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... , I I. ~ '.
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/I'V('
"
1w
_~_"~"''''''''~'..~n -., "'~1l'~---"-~'''----''''",''~'-~'''''''-'~--~--
f
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\ '\1 '1 I.. / "} ,1 !Ai (", /
ESTATE ;r l,LJ f,'..f ...,.,-.-___ --.-:t.FJ'}~..!.
""-!\\ fC[:j'"
.:-J.9_' - :_~-,
(;,,),(yq \". - .<J' "L-
DATE OF DEATH_ ) [~, t I il ~~(!
,
DATE
COMMONWEAL TH OF PENNSYI.VANIA
DEPARTMENT OF REVENUE
BUREAU Of EXAMINATION
OFFICIAL NOTICE OF
INHERIIANCI' lAX
ASSESSMENT
COUNn fiLE NO.,
il'/ 'L I' .
(-".,' .,,~I ' ,
._. __~:.___.~_....___ ..~~~_._.__~'N~__'__~"'_
I.. L
. ~~-j (jv~). I"
FILE NO.
COUNTY
..' " (/,1',) i )'~)~\ 1NI (
Appraised Value of ESlete;
Roal ESlate
rut..
-,,-~.
Personal Proporty
.
L-. (i. 1;/ ,::). l. ,,,)
+ 6 ~, ("/(:~l ()
LL'/. 3~1, r;eoi
4 V,kLI
,.
& ":-, 9,. :l'I( V i).E
r;)i,/
Jo,nliy Held Properly/Transfers
Total Gross Estate
TOl81 Approved Deductions
Cluaf Value of Entate
Loss; Approved Charlteble E,emptlons
Clear Value of Eetate Subject to Ta,
. 6, 9' y V. '1::'::
Amounl ra,eble @ 6% Rete
. b q ,.;:, V 1/.. '7/~
." ' r '
lex due
. .3 j; (" (), c..!L
Amount Toxable @ '6% Rete
tax due
TOTAL PENNSYLVANIA INHERITANCE TAX DUE
. 3 5 (~() (,9
. · · · · · A five percenl dlecounl totallno .
will be orented If the Inheritance Tax Ie paid by _
Less Crodlts:
DATE OF PAYMENT
/1 . 'I. il ~
AMOUNT PAID DISCOUNT INTEREST TAX CREDIT
..3S(,(J (Jj + . . = $ ~'J, r~h (i. h r;
+ =
+ =
---
Interoal accrues el the rate of sl, 161 percenl per ennum
on Ihe unpaid balance of Inherltenoe Tax, from __.._____
10 data of payment. Interest due If paid by__..__.___.___ Is
BALANCE OF PENNSYLVANIA INHERITANCE TAX DUE
--:.r;) ~ C}. 1 ~::J ~ a J
=tf=i* ~ , =f ~
.. '''JX+'. " Ij
..' l. -;")(} .\.. ,I
Aase..edby:, '~" .j,_
Seo InformAtion on Roverso Sldo f,.. e forthe om ~1n .lIh } )/1 '..,
" 'Jj:'\/11 '\ll\bi~\({\~J ~l U); (X.r.l..J
INSTRUCTIONS
To Insure proper credit to your uccount, Iho nOllW of tho ost(IIe und filo nUl11ber should be
clearly printed on the check or money order.
This determination and assesslMnl is mudo in nccordl1nco wilh Secllon 421 und Soction 732
01 the Inheritance and Eslale Tux Acl of 1961, 12 P,S, 2i185.~21, 732.
The estate tax imposed by Seclion ~21 Is duo I1t Iho dolo of thn decodent's death but sholl
nol bocome dolinquent unlil the expiralion 01 eighl(l('" (18) monlh, I1flor docodenl's death provided
Ihol any ostate tox occosiorled by a final c1lC1nge in Ihe Foderol ,eturn or 01 Iho lox duo Iheroon
shall not become dellnquenl until tho oxpir"tion of "nl, (1) menth "fter Ihe parson liable 10 pay
tho I"x receives linal nolico 01 the increase. C"leul,,'e inleresl frOI11 the delinquent dote shown
on the I"ce 01 this IorIO to the dote of payment using the following intolest table:
----.-----------------------------------------.---------------------------------.-------
1 month .005 4 1110nlh 5 .020 7monlhs .035 10 months .050
2 months .010 5 month s .025 8 months .O~O 11 months .055
3 man Ihs .015 6 months .030 9 monlhs .045 12 months .060
.n_____._.,.__.__._~__., .. .,.....-..---..----....-
1 day .00017 11 day s .00186 21 days .U0352
2 day s .00034 12 days .00203 22 days .00369
3 days .00051 13 do y s .00220 23 day s .OD386
4 days .00068 14 days .00237 24 do y s .00403
5 doys .00085 15days .00250 25 days .00420
6 days .00101 16 days .00267 26 day s .00437
7 days .00118 17 day s ,00284 27 days .00454
8 days .00135 18 days .00301 28 days .00471
9 day s .00152 19 d"ys ,00318 ?!J days .00488
10 days .00169 20 days ,00335 30 days .00500
,--- --_....-- ------------- --....- -.-- --- -- ------- - _._- ------ ---- ---- ----.., - --- --- ---- -- - .---
Any party In Interest, Including the Commonwealth and the porsonal reprosentative, not
satisfied with the assessment may object thereto within sixty (60) days after receipt 01 this
notice os provided by Section 100101 the Inhorltance and Estate Tax Act of 1961 (72 P.S.
~ 2485.-1001)
Make check or money order payable to:
"Register of Wills, Agent"
Mail to the address Ilsled below:
flMI,',n~~w[^\ Hi or ['tNNHL V Mil 1\
1'1 I'AR'IMfNT Of ~rv(NU[
UI'[AlI Of COllNl Y COil rC1ION\
APf'LICA T ION FOil M.ID CON5Un
TO TRAtj5FF/\ SEClJf\ITIES
f~EGI5'f[RED IN THE NAME
OF A f\[SIDrtn DECEDEN'\
\~
~,rJ"~~~
... ,__.1
I ~ ~l;~~ t\
~,\M,~,1."
'JI",.;~,,,,,,...
DATE
May 7 t 1980
APPLICATION (MUST BE FILED IN TRIPLlCAlE)
TO THE PENNSYLVANIA DEPARTMENT OF REVENUE:
Applicalion is hereby mode lor CQ1Selil 10 ,h,. trnns'er of the following 5ecurities of (I Pennsylvonio
Corporotion or 0 Nationol Bonking Association localed in Pennsylvllnia:
(ol..._~..I~J.lh__._.(b)1 N,A Corporation.. . (c)CooJllOI1 ".. ,.
(NOTE: In describing securilies enter in (a), ab Ole, eilher the number of shores of slack or the lace amount 0/
registered bOl1d~, in (b), Ihe name 0/ the issuing company ond in (c) the closs 0/ stock or the stated ioterost role
and maturity dote 0/ regislerod bonds.)
ISSUED ON____.J..9~.13..__..____, ond having 0 TOTAl. MARKET VALUE OF $.285.69
(Date)
os 0/ the dote 0/ deoth 0/ the docedent, __.9..e.~~.9~L~.HuL~e...Jr..
(Nome of Decedent)
. I on
, Feh..S,._l9B(L._..___.
(Dale of death)
who wos lote ol._!.E.~~J.r:.cJ1. Court_____._.9~I1le.JiU..1
(Strnt and Numbtu) (POI' Office)
, ....Curobcrli3!ld....., ,...---E.enns.y.Jvan.La___
(Coonty) (State)
The securities ore registered os follows:,__....GElQDlElf.Ltl~lse,Jr.
(Name or names In which certificates tire 'i'lglslercd)
ADM I NI STRA TOR)~oom()n_we~l..t~...fI.a.~ i of1ill Ba nk .1510 Cedar C 1 if LD 1"; Y!:. .C"mpHiJl..._f'.a.______
!';xron:~X) (Name) COllTTlonwMrf}Jl'Il'National Bank by:
NAME OF APPLICANT., -\lite PreslClenr&Tr"LlsCRana.ger---.---
COUNTY FILE NUMBER-&::17'~_125~ADDRESS OF APPLICANT. J51.Q__Cecl~r..Cl iHJlLLv _,~_"I])P..tliJl. Pa.
. CO~~~1 t.h " 'onal ank by:
BUREAU FILE NUMBER___~___... ".... SIGNATURE OF APPLICANT V1~ePres-ident&. ts-t-Manager.
IF YOU FAIL TO PROPERLY FILL IN ANY PORTION OF THIS APPLtCATION, IT WILL NOT BE
CONSIDERED COMPLETE AND WILL BE RETURNED TO YOU FOR COMPLETION,
COMMONWEALTH OF PENNSYL VANIA -- DEPARTMENT OF REVENUE
CONSENT TO TRANSFER SECURITIES '4JJ..// _
I hereby consent to the trons/er o/-;h-~-ab:::~::~~iti:~n.o.:-;egis:orod in the nam~~/Tt{~-C:ti1:;;/j'f~t!
Decedent ond woive the filing of 0 cerlificote certifying to the payment 0/ the Irons/or inheritance tox to which
the property 0/ soid Decedent is mode subject pursuant 10 the provisions 0/ the Act of June 20, 1919, P.L. 521,
as omended and the Act 0/ June 15.1961, P.L. 373, os amended. This is also in occordance with the provisions
Act 0/ April 9, 1929, P.L. 343.
This Consent to Tronsfor Ihe herein described property operatos only in rolerence to the estate of the
obove.nomed Decedent.
Signed for Iho Secretory of Revenue
By f7l;'2'~'f (? ,1~e't:4-". ,.,,"-..-
/'} (Slg~lurl') 1
i':f; -d (';..1;:,-" {~<' "~,,,,it, t ^.~
/ ~:' lln) (Counly)
,