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HomeMy WebLinkAbout79-00332 il ~4\. No. 2\..79. :'~:1::': PETITIO~ FOR PROBATE OF WILL AND LETTER$ T.ESTAM~NTARY In the Estate of__,~Jll~~~~..!I}..._.sw(IJ.~.'!:z....._...... _ "," _. ~....._~.__.., deceased. "To Richard E, Anderson, l<.ugl5torof Wills for the County of Cumberland, .' In the Commonwealth of Pennsylvania Oruco P. Swurtz'I'onOUl)Cod hot' . IS substl.tutod uppointlllont UB [!1<ocutdx. Petltloner(sb:Jlle the/execuLol'.. .. named In the Lost Will and ' Testament of .._hlll.l1j,uLLlo.....S1I'.llrtz._h__ ...._ .........._. dated PQS,.j).,...l.I!JJL_. , . . 'Oecedent was 0 citizen of the United States and a resident of Camp Hill xx~t1X~x. ___-'-~u____..__ Borough, Cumberland County, Commonwealth of Pennsylvania, . Decedent died ~n _~.~dn.l?~~~Lu_._.... the_.~.t.IL _.. doy of..Jl~y__.....u___ .., A. D. 19..79_.., In tho COlmty of ......C.~n~b?rlll..l.d. _.. " State of !o~_n.!..y~!~n_~~...___.._._u~.___._u.. at the oge of ._ ..::L.. YOCln;, .. 1C*~x xxll{~lIX xxlo~xx Decedent nos. not boon married and hqs not hod children born to him slnr.e tho ex'ecutlon of the above described Will. Deced.ent was possessed of personal property. to the value of ,Ullil.~...tim{\.1Q.l!,_._____........._... _,p,,, and of rool estate to the vClILlo of _NolJ.~____..._.._.._.._u.......__ ......._.._. os neur as can be (Jsccrtalned; said, real " estate situated os follows ._u.N9.t.lIPP.USlI.bJ.9.....__ " ""' .__'._,.....___.___.,.._____._..._._iJ . , . xxxm'Xx The/'cforc, your potltloner(16) respectfully applies for thtl. probate of the said Last Will and Testamont and for. Letters Tes\'amentary thereon. Dated _,Ma y_ 2 3 ..L.!~ 79_..__....:__....____...__ N~~~.~~~~~~(:;" ~~2JLLJ'a~1~~;~ Trusf 0 . cer 19Q_ CITIordllJ..LrCJ,llf:L.J2.r i ve....:.._._ Camp' ,'1\ 7011 COMMONWEALTH OF PENNSYLVAN.IA t COUNTY OF CUMBERLAND . \ 5S . . .Robert K. Reitzel, Trust Officor of._TJ':..o~.C.().l1!.m~I!.!..t:b..l>!lJJ!2~_l!LJ3!lnlL._ named In above application, being duly_~~_wol'.tt..._.~_._...._ according t6 law soy(s) that the statements set forth In this petition are true to tne best of __his knowledge and belief, .Sworn .t..Q..___. and sub~crlbed before ~~n C2'1~~~:~~. ,~A~I.~~^N' _ m., :w~_<Lc-----c 19JLQyZlf)~, ----- --r--..-1.k-~j~.c.._....---u..... ...~~o:~~~~~..~~~t~....:~:ust of~:cor Richard E. Anderson, Register Filod: , , May 29~. 1979 c' ,,,,.j'II.- . \.... II "A '; II I Attorney: ,JumoH R. Humor. I;' if , (A)aik. l~ '#r.M.IM"', ,..:..... ..-- . a .. ~ '. ,-, / ?1:J- ,,:-jet...i.:.. " d' -'" " OATH OF SUBSCRI!:IINO WITNESS , , COMMONWIMIiJlllOF PlnNNSYIN ANIA COUNTY Ql~ OUMBl'lR!4ANJ) SHI , 23rd .' May" 19 ThlslIl"" 11111'1'11111111111' II" 1.111111 t 1"111' I'll" 1111" III' 1'11'1 II' dny of I 11111' 111'11' j 1'''11 \I II" It" ,', '111111111" 1'1,'11""" 1IIII11 A,D'I 1911111'"1 bofl1ro mo Rlohnrd rc. AnrlorAon, HOIlIHter for tho Probuto of WtIIH nnd Ifruntlt:lllloUOI'H of AdmlnlHtrutlon In und' 'hr, suld County of' Cumbert,lInd, In tho Commonwoulth of Ponnsylvunlll, porsonully 0111110 ."""",,,,, James R; Humer and ShirleyW. Ahlers, " " 1111""111111'111111'111"11111'111111111110111'11"1""'111111111111111111'1111111111'1'1'1'1111"""'"1111111111"'1111'1'1'111111111111111111'1111"1'11'1.111111'11'.l'l tho Aubsorlblnll wltl\lIBSOB to tho nll:Olloinlf InstrumQnt of wrltlnll purporting to bo tho Inst WlI I und Toatament ,of I'll" III" 11t~~ FJ,f"lnll.l~ l'IIII~W~"t ~ '~II"" ,',',It Ill'" I"'" I" I"'" "., Il,I' "1' 1'1" "' Ontcd ,VIf1.R .~,111R ,~,tl"~III' ,JI~t~,Q... law or '1111,~,~.1t II~~ r,9,H~,~, IR.fl' t ~,.i!-,'R)?",Ht~.~. t.111. ,.1,., 11'1'111' "1"111'1'1' I'll"""" III Cum~rlnnd Coun~)' Pu., dacenRod who bohig, duly '"IlIlHII.~>>,.l?t.};l"j.;~ttl"""ltl' uccordlng to law, dapoHo and BUY, that l"o~JM~X"I\':~,t'~lfHIIII"I't1 present, nnd snw "nd heurd the testu~R.r"..""""";..",,,..;,, II. "., H ~ 19.~nti,\11~" '~'>"~I~ ~I'H'I j. .111.."" 11111" Itt II"., '11' I sllPl, so"l, pUblish, pl'OIl\lunoe and doolure tho said instrumont'ofwrltlnllullundJlIr h.t~......,,,,, "ostament and L"Bt Will, nnd at tho time of 80 doing ..""....""",IO"M""",,,..,,...,,...,,,wna of sound I\nd disposing mind memory nnd undors,tnndlng, to tho boat of ........J,h,QJ,r.."""......"....""",knowlodgo, llbBllrvut.!on /lnd bolioI'. Sworn to d b 'Ib db' ""," I':;HI II II ,....... III....".... ""1 II.. an U" ,BCl e Glaro Mo.-\ !' ,I td::..' . ',' /' _'U. , ' , J, ~ " ..' , ._-. ""'. , '''''''I"..'''lltl''I''-;'~~I'''II''I''''IIt'''''''''H''''''''I'''I'''' Rlohard E" Anderson. Register ('- .. ct_",,;-, .,-/'(, ")-J-~.~... "1"" ..".,.. .'"H'....tt.II".I'H"I".......It"I~'""""II..I't1".., ... . ."~..t2/rL~...".","',,... . ' , .1..11'.....'11.......11' .....1.....'""'''''..''1.......'111''"''''............ AFFIDAVIT OF DEATH COMMONWEALTH OF PENNSYLVANIA ! BBI " COUNTY OF CUMBERLAND III "II" ~""I I'" "....., 1'111"'111'1" 'IUII. .~._r.~.9.~, ..~,'. ,"~~~,r. ~I~I"I""" H' ""'" II It',...", ...""... 11111.. II 111111..;:. .'".. '1'''"I1~'beiTlg duly n..."....ttllll.""..........'""..".....,.. says that 8S nOl\rly us cun be nBc~l'tnlnod tho Buid decodont ".ill..llI!...~;.....I... ....... "11' "" .... to. ;,.~ "",' III It... .."......" "..., '~'~I H ,~.n ...l~.,...,~.~ ~Ir.~.~..... "",: I' ...1" .,.. ... H"I'; ~'""'l'" It "" 'I........lil"'."'" .diod on 't1...I...I~~H",~,~~.~X"..I....'.......1 the ""I....~.~.h.;"I..,.,I....."dny of ......,"~~~.t"I'I.'..."I....'..."'H'..........I,. A.D., 19..??;, at or about .,....Il,..t.~.!i9.~......'I.I'...II.... o'clock, ....M. ......ItIl.I~W9Ith...tIR......".'....II....,.nnd subscribod this ..u\~u.. ~) ~\v<li':i~ ,. '. ..1'."..it.."..I..I.........'.'1~.'.I,"I...1I 1'(/ ""111"""",,,,,,,",,,,,, 1'.....II...I~.~III..I...I"';'II"."...,' ,.... duy,of .....M~,y.,",,,,,,,,, 19,7,R"..., bofore .."....,,~.l~~Q .. R1chul'd E, Andol'Ron. Roglstol' ! C) ----., OATH OF PERSONAL REPRESENTATive CO,MMONWlilAI,TJ-I oIr PICNNSYI,V ANIA } COUNTY O~' CUMnmHI.AND , ' ss: l3oforo mo; tllo ROlllatol'fbl' tho P,'obnto of WllIH nnel I(I'nntlng of' 1.~lttOI'H of' AdmlnlHtrntlon In nnd for " Robort K. RoHzol t 'l'rust Officor of''l'ho tltl! County of Cumborlnnd, )lorHonlllly cllmo ,,,9,~ml)l!m,\l:l'm.U;)~,,,NIIJJ,9,t,\!lJ,,,II,q.I1L,,.,,,,,,,,.,,,,,,,,,,,,,,,,,,,.,,, , -, , w,hot being duly Ilt;ftW,fi'.T.n.lIlllll""'1 doq"''''''l dOPUHO nnd Hny Lhnt (U:l"JJ~t~~J.lttR''\''''ltlltjjl''tllll''"''lIll1illll\'jtlll''l , ' of tho lust Will and Tostamont of ""'I":tI"!t"';tH"n~~'19In".I.\.'"1l~WR.rlt'~'1I.t1''''tl'''II'III1I'''''III1.i'"'"f1fll-tttdOCOBSUd ",,,,,,,,H,,,,,,,,,,, will wol1 'and truly, admlnlatol' tho ll~odsllnel chuttolH, rlghtH and ol'odlts of' suld docolI~od , according to law, ""nd also will dlllgonUy comply with tho provisions of tho law rolntlng to Tronafor I ' , Sworn to " d , nherltancos, IlItilllll't1'"llll"""lI un subscrlbod before me, Moy 23 ' ~ 79 I""II"'I'I"I'".[HI 1111 Iflll!;"IIlI"'''U;''/' A. .0," t91t1.llPltll \ / " I , ./ .;-_...... HUltt'tllltltl ,........ ,. . fI Illfl""'It'II11llll.'It'I..,I..lI -._~.. l~~I'IIII'II"II"lj"ltlllt'I"I"I""'fll"U"ItItII,.........tl..tll'",..... Richard E, AnderBon, Register ~ J I] LI- 0 I '.J .....I -' . == lQ ~, ~ OIl I":l ,~ 0 CXl Ijj: ~ l!:l ~ 'I ~ ,r ,r:! i "" 01 ~ "" i "" 1 ! ~ ~'l ~. 'd DECREE , , Be it remembered thnt on tho ."".."??.~h",,.. d~lY of ......,.;....".lI..,"~.~),'''.''.H.......''''' A, D" 19 ?I?"itit thoro was probated and rocordod tho ItlAt Will nnd 'PoAtnmont of ""~'~'~~~'"~'~'''~~~~~'~'''''''''''''''''''''''I''''''''''''''' tate of II" .""",.;,~~!!,,~. .~~,~~,~., "....., ,...,.",...,."" ,.""\'.,...... C\unborl(ind County. PunnRylvnnln, Doconsud. Lett.ot'H I , " 'l'estamentary The commonwealth National bank ""'1""'...." """.".."....."".."" ",..., '.. WOI'll gl'nnloel to .....,..,..", ,...... ......'.." ..'\.".(... ,..."..""..iI" ..,......,....,.;.,',',..."..".,.., ' ,n " (,. / , Wltnoss my hand nnd omcl~1 AOllllhu dllY nncl yun;' nCot'oAnlel, \' Y..../lAAeJb\..J (/" '. ,..,;"..".....,,,,,,.,...,.,,,,,,......,. .....;...",."..,..,..,.. Richnrd g: Andorsll", Rcl(lsWI'. , ~{;.Cp(51tll'f fuG' ...,..----- ('r;ll')1 r~ATION rOR AND CONSENT TO TRANSFEI~ SECURITIES REGISTERED IN THE NAME OF A ReSIDENT DECEDENT, *' COMMONWSIIL TH O~ ~SHHSYI.V^HIA DPP^RTM~NTOPRRVEHUU , 8URIl'AU OF COUNTY cOLLECTIOHS ____ ""~'_.".Tnr---.__.~L\-__-"-_ __r_"._."_T~_'_"_ "..H'T._'~ DA TE --6.8.7.9:....._._.~ " ~ (MUST aE FII..ED IN TRIPI..ICATE) ,,.0 THE PENNSYI..VANIADEPARTMENT OF REVENUJ:;1 Application la heroby modo foreonsonl to tho trunsfor of tho following aoeur,itlos of"a,PonnaylvllOla Corporation or a National Bonking Anoelallon loeoted In Ponnsylvunlm ' (a)Jrll~ IIlI, (b)"...-~tt9.tI1IYIU1rQ.tluU.Q,\llll>>MY., ..., _.'U'" .~,.".' (e)n.._.\1_D.___._____~-- (NOTEI In describing aocurltles anter In (a), ab ClIe, oithar Iho 1I11mbor of ahures of staek or the ,loco amount of reglatered bonds, In (b), the 110me of tho Inul,l1g campnl1Y and In(e) tho class ,of stock or the atatad Interest rate and moturity date of reglatered banda,) VM'10"' ISSUED ON 19~~ till'll 127.8..-.., and having 0 TOT AI-MARK eT V A>LUE OF $ _J1,ZJ7.!.ML, (Do'.) aa of the dotea/dealh of the decedant, ~l~.~n f1d'!"_~.~.!'!..m~_..' ,_.' ...... , on_.~.~..;WN (Nama.IDor..d."" (Oa'a 01 .loath) who was late of z6Z7 LoIM, !~~..t .._~..,,,._o.~p~lij,ll.~. ($".., and Ham!>.t) (po.t Oflleo) . i;WJlQ.Qr1"l\IL "n ._._..-I'.IMlL._ , (Counly) (Sta,o) (' ~'M4Ill'~U.CltIR) EXECUTOR ) " The seeurlllu are reglatered as follawsl,..,_m_...~l9.<.I~l\JUI\.i&rtL. -,,+ ...u......._._.._._._______ (Nqmll ot nUn\flI 1M which cnrllfll'1utnll fHO ,nolahlf.d) OOlm,10I\l/onlllll ttlltiOl1i\1. nalll(,. l$~.cutor 1510 U.edlf Ul:l.1'%, llr-iVll <':IWIU nUl, 'PIL. 17011 .___.......__.._.._........... ..._._,'..... ,.... . " ,.~,.., ... .,..__ .... _.......t~.....,.:r__!:I..-!. - (Ham.) (Add,o") NAMt: OF APPLICANT .9.9~M.O~~JH~m,K~nilllAj...JJANf{ ,- COUNTY FII-E NUMBER7.1-?\hlJ:l ADDRESS OF APPLlCANT...nlll\JJI~~_~.~.:~~O'Y.fl~.~........" BUREAU FILE NUMBER~~_SIGNA"URE OF APPU~ANT .l.'l. ~..ti(._, - ) TNI\: NOTICE, IP YOU PAIL TO PROPIlRLVPILL 1M ANV PORTION OF THIS APPLI~-7~'k I~ WI.LL T BE ottlcer C:ONSIOBRBD COMPLaTe AND WILL BE RETURNED TO you FOR COMPLETION, .:._~--<-"..~...- ........------.--...'.:..-.. ,,- ,...,",'--" ...-;-"-"'._'--~. COMMONWEAl- TH OF PENNSY L.VANIA - DEPARTMENT OF REVENUE ' ! ,', CONSENTIR_.'LR.~~.~.E~R.~g,~.Y..RJ1IE.~ DATe-k-=.S)-"'\l I her~~y 'can sent to the tranafer oftheabav,e ~acllrlfla~ now raglstarod In the nama of theaforeaald , Deceden,t and wolve the filing af,acart1fleote cortlfylng,ta tilepaYl11anl 01 tho Har\Sfar Inh,iltancetax to which ,the property ofaald Decedent Is made sublect pursuant to the provisions of tho Act of June 20, 1919, P,L. 521, oa amended and the Act of Jun~,15, 1961, P,\", 373, asol11onded, This Is olao In accordaneo wllh the provlalan~ of the Act of April 9, 1929, P:L. 343, ~_"... __..~_~.._,,_,._____~L_'._ ,___.____ .._._____, '---......__r_.__...< .........,,....__....c..-__ri This Co~sent to Tronsfer the herein dascrlbed IHoparty al'arnloS only In rafarence to the estate of the ~~,' ' ..l 'I v' ' (, ",,' "~;, (Slgntltllt(1) f R~,nua _..-"...~ .. d .L~~~ I1!J'H~;~)I, f.- /;:;',':",,-;:1 -,-:u,j:,lf_ji III \\,1,_1 l'Ui::tli~iji(ltl t1J-.';ll ~ above.named Dooedent. (fltl~i . -ic~""lv)' In~.nto'y of th. ,.01 ,Md pmonlll ..tQt, Qf , !; , ., ,I , Elden H. Swal'tz___~~__~_dtGtQ.~dl ..._....~--~ ;;.=;1 ._- ~ ., . None " 2. None I', 3. . 1 .419 Shs,l S~roeh\1lan Brothel's Company, COll'f11on, N. L, 4. Re1mburll8ment fl'om MediCare f9,r Holy Spirit Hospital Radiology Chars"s ' " 6. Payment from ,Social Security for underpayment due 6.. Reimbursement from Crumay Associates for Medical Charges 7. Claim Payment from Medicare, S. L. Jones M.D. TOTAL PERSONALTV ,I $ i_oj o 00, o 00 17.737 60 96 00 146 60 40 00 23 20 i\ .' 7.. I - '7 '1 .. '~ '~ ,- /- J/~f''' ,.1, . ..ce... u.,,, .' COMMONWEII1:1'11 or PBNNSYI. VANIA DEPARTMENT or IlEVENUE BUREAU or COUNT\' COLLECTIONS, '* i"f '. RUIPINT DICIDII'lT COUNTY OF _~...cllmb.et.lAnd_____ " IMPDRTANTI 'I'hlo lolurn hlllll ho O"IIII,lolod III dOlnl(,,"11 rlh'd ij; 11111;1(;,1110, wllh "II III"'oh.II, wllh Iho Koslotor IIr Will. III Iho CIl,,"ty who,o ,I.uollullt rooldoll, IIUIl"" 10 11110 wilhlll III11u 11I111111" IIf11'1 d,lItO IIr IIo"lh, 111110.. 1111 OKlon.I,,"I. Slnlllo11 ,hy Iho Noorol<\ry III RO~OllllO,. (N"UIIIIII 711.1"1 Ih,' Inho,II,,"uu ,,"11 Ilollllu 'l'IIX^olllr I 9ft I. I ... -"'1----- .-~ "'1"'; IN, Till! M^,' '1'1'HK 01' TIIH HN'I'^TH OF } ^1'I'IIl^VIT 0'1' Elden H, Swam ,___u___u...._._. I'VI'l'II'I'OII ' , IS1'ATl' put..l. NAMU Of' OUCKOllNll .^ . 13 1 b. d M~lIiXoj/j)(mK~ Lata 01 Borough oL.Camp...H, ,.,..Cum arIan ounty Sial. 01 PennsYlvan1a ._._____,} , "' Coonty of C~mberland.....:....._........._.._, ' Manager .Ihs COI1111~ll.t.h.Jillt.:IJ1n{l LB{lnk..by_.RQbel"tP.,_.Conwa'y..~:l.nlLP.re~ i dent...,&...IaL IlKqOllT"r ~.lIK~X.X~X 0' Ih. .,101. of Ih. oboYt'nom.d d.../,nl h.lng duly 'WOIll, d.p... ond oar I lIoo.llont dl.d Mav 9, I'J_1.!l-{I.'IOI' l.o,lng, 10.1 will, .opy of whl.h I. h".IO ollo.h.d, ) "IMONTHI IllATI' IYF.ARI"~X/ilK> Hom. o"d odd".. of ollo.n.r o. } ,J.11UJl.nwonmlth..Nll.tionaLallnk" oth.r authorlltd rtp,...nlatlv. to whom oll.o"...""d."" .hould b. ,..II.d, .10 South Mar.~et Square. I:lArr.:tib.urg.Jenna,yllAn.ia I- Thill liS Huoh executor =dOPIIIIOIIII. rllmlllllt wllh Ihu IIrrlllr. or Hllld UHlulo Ulllllhu PrOI'~rlY oonHlIllIllnH II1X.CUTOII'XM~I~fMIfXX<<* ' Iho IIHHOI. IholOOr IInd Ihulr rlllrlnllrkol Vllluo, ' ' Thill IIllh" limo ur dUlllh Ihoru \~IIN no NllrU dopoNIt ho,~ rOHINlorud In dooudolll' .'Indl~hhllll nnmo, or Jolully wllh, 01' ns nHonl 01 dopuly nl' IIuolhur, or lu duuodonl'. Indl~hhlnlllnll"', wllh rlHhl 01' IICCUO. by ntwlhur nH nHonl or dupUlY, Wllh,lho oKcupllllU tll' Iho rollowlnH' - ' ~ HAMS 'AND "DORua Of!' DANK all o 'ftl riR INSTITuTION IN WHICH oucuorHn RltNTa:p ^ 8,~P'l! 1)f.PORIT nox The CQIJlJJlO.OlIIealth NationaUl.ank....c. .P.1 ke, Mechani cshurg , J?enns,y.llJ.allta.__~__ THIS &"I1K DHP081T UQ'< nlINTIW 'jN NAMROR NAMliS or enJl, Swart:! ancL_,~ race p, Swa rt7 RUl..ATIONOHIP Of" JOINT HOt.blOts TO 1)P.CROKNT Thill Iho ollnlonlo Ill' .uld NIIl'u dupII.11 hll,x nr hllKDN nru IIDml~,od undDr SohDdul"H N/A 01' Ihls rOlurn, with Ihe oKooptlon',o1' Iho fllllowluH, I'or Ihe rOIlHons hurolUllrlur SOl I'm tit , Thill Sch.du/e A ulIllohod horolll IInd mlldu pllrlhorDof Hol. I'lIrlh I'olly IInd III dolnll nlllho ronli'roporl)' In thoCnmmonwonllh, 01' I'olinoylvnnlu or whloh ducoduUI dlud IIlIvlnH un Illlorool Ihoreln. II niHil .010 I'orlh tho , ' morlSIlSo onoumhrnnco. upon olluh pllrool 01' ,onl prollorly nt Iho IInlu 01' dOlllh" slvlng tho IImounl sUII dllo'lIt dOUih" pllmo Ill' II1nrlsngoo, dnlo, rnto. 01' IUtorOHI. und bOllkllod pllgu 01' rooord thorolll', II 1I1sn oots I'orlh In tho ooluI11ns t'llIvldod Ihorormo tho IIsso.sod vllltllllllln 01' ulluh 01' .lIld 1'l1ruolo, Iho oollmnlod II1l1rkol vIIIlIO Ihoroof us 01' dlllo 01' dllnlh 01' dO,oodonl, ' Thill Schedu/. 13 1I11110holl horuhl IInll mlldu I'nrl horoor suls I'orllt rully IInd lu dolulI 1I11110rsolllll proporly whoro'llvor Hllulllod ownod by tho dooudonllll thu tlmo 01' dOllllt; ullnlUnul'. loft hy Ih" docudonlollho tlmo 01' donlh,' wllolhur In dooudont's Imm"dl.lu I"" OO.SIIlIl , olundlnH III IIouodulll',N orodll III hllnks 01' duposll, SOVIIlSH hnllks, IflIRt Ollll1pnlllos, or olhor Inslilullllllo, WhUlhor hldlvldulllly, or In \filM I lot IIny othor I,ors"" or l'orsons slvlns IItso 'opllrllloly tho lIooruud IntoroMI thoruon. II' IIny, down 10 Ihu IlIsl Inlolosl dny l!tlerlo Iloooduni's clo"th In tho ~lIH" 01' olivlnss hnnks, nnd III Iho dnlo 01 docodonl'x dUlllh In nil IlIhor onsoHi nil hOlldH. Pllsllll' sllvlnss, Irolls\lt,y oortlftonloH nr nolos nlld olhur uvldollco of IIIdohludlloos 01' Iho Unllud SllIlo. 10 Iho do. 'oodollli ullobllgnllollo, wholhol Ill' ollllUlo or "gruomulltlhuy 1110 dOHIHlllllud nM IIIK I'IUu', of tho United Slllloa, or IIny oluto. llr p"lltionl o"hdlvlslon Ihorool', or 01' ullY rorOIHII oOllntry, whloh 1110 oWllud IIllho limo 01' dellthl nil wUllrlllS III'p"rol, Jowolry, sllvllrwllfu, 1,lulllrus, hookM, workM 01' 1Ir1, hOIl.uhllld l'um'llIro, l\lIroOH, onrrlns08, nllloll1l1hllos, hlllltM, IIIId IIny IInd 1111 IIlhor porsollnl chllllolx 'III' whnl"ouvor, klnll 01 nOlllru, loft hy docodonl, losolho' with Iho I'ulrly uxlimntod mllrkul VIIIIIU Ihurolll'l nil hOllds nlld mllnHIIHOS huld by dooodllnl nnd III' nil ollllmH dno IInd owing dooudonl III Iho limo III' donth, IIl1d 1111 p,"mlsoorl' nlllCK or othor InsllllmonlsllI wrlling, for' tho puymont (II' monuy III' which ducodolll dlod Pllooo,",'d, of Wlllltollo\'or nntllru, with IIl10ro"1 Ihoroon, If nny. alvlns Iho fnoo vIIIIIO IInd o"llmlllud I'nl, ",nrkul \'IIll1e Ihoro'lf, IIl1d II' "lIoh oMllmntucl fnlr mllrkol vlllllu bo 100R thllll Iho 1'1100 vullle, II MOt~ I'IInh l!rl.f1y Iho rell,"ns fllr sllch dUPloulnlion ns III onoh Itoml IIl1monoyo pnyublo III Iho oHllllo frum 111'0 III'urllll"U 11IIlIclu" clltrlud hl' dooudulI,l; 1111 ullnlllty nlld ondowmonl oonllllotH tho pmbood. III' II'hloh lI'uro I'"l'"hlo "I"'" tho dOllllt III' Ihu dooodunll IIl1l1nd Iho uorporolo slook, alld dlvldond, cillO IholOOIl IIlid IInpald 110 01 II", dlllo III' IIcuth, hllllll, IIIItI n""rllcd i1l1oloMI thorooll III Ihu dolo 01' doucdolll'S dOalh lI11d .,Ihor invu:llml'lIl HI'Clllil;,'. 1111111'11 hl' Iho dccodclIl III lito Ilmu 01' dOlllh, wllh Iho nlnrkcl vnlllo thoro. "I' nt .lIch 111110, , , " , '\ .oi .' .... h, ~hO,ORIO Or'1l90llrHlol or 01".. lIr f'011l11Y IlllI'IIl,,'"l.1oll., t,lIo Vlll1i08 rllI'Ol't,lI~ IIr" IIA l'~~ IIA "olAlhlo .,Ih81Ill't,I"lo,1 h)'. \'111111101,,1 .lol,ollloln'. "f' th" ""1'1""'111,10118. ah"wln~ I,ho 1I..ll~/I IInl\ lll1hJ1~LlI\/I thl1rfJnl' UK nrulO (\1\(,0 flf donUlIThufWIlOlllIlO 1\1149 Hut.H 1'(It'l,h t,lIu IIIt.ot1f1Mt. nf' l1ril\rulnnl. nt, 1,110 t.tinn ,n"fl donlh III IIn~' OO-\HII'I,nor.!111' "I' ,hl\..llIbaAIIII,,1 1"/I\I\1I'lll~I, lIl' 1,1111 VIII 1\11, IIf' 011011 III~orllll~ UlOl'",1. """0XIII\ I,ll . 0 III .r"",I'11 0, ' f'l nllno 101 . t,ol011lllnt/l AIIIlW Ill~ thn 11..0 t. 01111 Iloh 1111, 10. ul' /1111,1 0".\1111'\,1111 r.hl \I 1'" hll/l111ll801. ^ II"I'~' 01' till' Oll-\lIIr!-IlOl'.hll' 0~~"011l""I" (Ir I1I'~I, It .t,III""III1lt, 0111,1.1111\ l'I11'lh tllo nol.llro Ill'. tho "'II'lII1111ol'U togn\lwl' with" Htll(,\llTlnl\t, Rot.t.ll1A f'nrlih t.11l) 4ibu1'I1t\til11 uf' tllll hllHIIl(lI1H,-ILH 11It'ut.IIHli nnd Hunll ot.llur Tnnl,Fj 1HII'l.jdldl\l~ to tlltt hilS Inn,," UK _11I1l~1 hn 11ort..lIIlHlt, t.o' " f'ntll lI'IC\,1I1Ht npllrnlHltl ul' 1.11(1 fht~lIlflfJlltlM lut.nl11!~1, tlll'I'fll." 11111H,I, \Ill Rlllll1llt,t,llll. It, Rhnuttl olMo Hnt. 1'(I1.t,h- 111 Itonl"It.lId l'n1'"I, 1.0Hlll,IIUI' willi tho t'nlt1 Ilifllil,nt \10.1\\11 thtll'Nd', I\IlY nt-hot' prlllltlrt)' lIW1U1l1 01' llOfI\lnnt.hOlI h)' t.l1O 111111,,1111111. fq. ,1.110 tlmn lit' (,~,ullh Tho Sc/lpdu/p, C nt,t.nnhofl tlut'nto Hull 1nndo llllt'l. 1111\'1101' HUt.",' f'rll't.1l It 1.1'IIU IHtfl,Wlll' t,o 'uII1111 lHCltlI1')' nuntnlnocl t.hl1rl1ln fit'" ill t"n (lURU uli 1.1'f\llHf"If'HOI'11l'O)ltl1't.y'l 1'11111 III', l"tl'HUlII11, iYlUdll t,wu ~'oi\I'Ii.,nfl IhH\Ildontt)4 01011111" III '1(",1,111111'11111011 I1{' ,IIHIIl'\IlIlI.' a ,\uI1I.Il, Ill' \III,ull'\O'\ I,ll I.lIkl1 11,'1,,,,11. 11110,"",10.1011 "" ~1I'"Y"""\l, III "" nrtar .t1lJnUh antel "ohod\l10 "litH f'ur,t.l1 t,tHl Unt.llt'n IIllrl VI\'~tlI nt'Hlwh PI'1l111)l't~'t {,II whlll1l '.!'I\lIUlinl'lll"'. t.ht" I'B1 nUnnHht p n r (,110 t,rn11f;f'Ol'0n~ ,,1.f1 ,t,ho "'OCHHhlll t,t Ow prnpHl'tl Hllll t,u Hhurn 1'(HI(ll vrlll hy ofwh i1'IUlfll,'f1 rot) nwl all othllr rnot.R nf' II port,tnollt. nnt''''o IIUl\nrrtlllp; Iildl! t,1'flIlHf'ul'Rt In UIO nl\Rlt ul' t.,'UIIMI'I)rU tlltoltlltlil III t,nko ol't'uot, hl)l(~R"O'HI1Uf1 ur otl,lnymollt,"ut C"l nf'l,nr IllillUIi t.hlll'o lH nlfw nt;t,IlOhnll' t.o t~lIuHOIHlIhnn II lllHI~ uf', t.llt) d(lt!(11 t.ruNt, l\fJ;roOtnont. fllt' Ut.!lflr IIIRt,r\lmol1t. orl'1\1.111~' t,IIO t,rIlHt,t ,1(lllntIU IH IIlao "'(It, fort.ll If' Hiltll sohoc1\il(1 (I list. of' flU 111'nlHJttt,)', l'ol,ll,nn(' Ilf1rHCll1ul, wltll It,H \lUlll'i", Whlo!lllufdiUH nt, dtHJIIlltilll.lp; ,lullt.11 II,\' vlrllllJ or UlOI IIlIlll'ol." 11~' <10000101'1,,1111.11111' IIlIllvl<lllony, nl',lollI\.1y wIU, Illlol,llor, I1r '"1~' 1'"""1'"" "1'1'01111' m'ollL vufttolllndooo'dont., o1tho,\' lluHvlftuull)' 01' .Iil'llItlYI !JYUIO will, "<Hili, III' ol,hnr ltlttt.rllmollt.lIf'httntl1l'l'l wi Lh n oopy ul' t,ho 1nfltrlllllt!t\t, c,'out~1"1J. R\lOh 111lwn1' uLtllllhUll I,ll l.hn Hu!loII111ll. Tlll\t ~chtJdv'(! 0 ut,t.U01Hlf) hclt'otn IIllr' 111m'" Jlurl, 11111'oof' Hnt,~ f'Ol'Lh tho "lilnnH tlllrl IlltrlrflfiRllf\ nP III I 'pOl'RU"" lJUnot'lu,tullY 1nt.u1'ORt..ml 1'1 t..hls ORt,llt" lit, tho l.1l1\tl Ill' IltllHltlnlll,1 K rlonLII, t,htl 1IId,tll'U nf' t.llot\' "tl~~ 1100UVV 1ntol'tlRUt; t,ht11r rolnUonaldll, if' HUYt t.o Ulll ItnnOlllJlll, l,oJl;f1Lht)r wl!.1t t.hn.I,,~Il~ III, 'tllll t.llnl1li1', .\on(lc'ont,lfl"flunth ()t~ 1l11'lIIfW>1'''1 nntndtnllt,R IIltll"htltlfll'ln1nrtllH f'nll ltl'll Ql111f1I' 111!UlHlllnt.IH WUI, lLtll11U oont,altll\ n flt."to,nont~ KhnWlng wh'uh or t.IlU hOl\oI1.\o'lnl'1oH nitl1Uirl III 1.1111 11(worh't}t.' H willi It' HTl~1 fll011 llr1fJl' \'0 dUO(.1l10nt., thofll\tus or Ulttir rlOl\th, t,lInll' tKfHto, Ili\tl tho ,'oInt.lcIIIHI"p tit' Hllllh tAHltlt t.n I,llI" 11I'1lIi1'lnl1l1'Y, I Thill S.:/1edule C ntt.l\Ohfllt lWI'ot',o flllll ITllH\U II pllrt. hlll'onl'IHlt.H l'III't.h liP 'lIl'(Jpnt't.~', 1'0111 flllll p'Ir"" Honnl, OWIUl,llhy t.ho 110UOllon(, ,Iolnt,l~ wit',h Itllnl,),nr 01' ot.tHH'HI lfHl)lIlltlH\ tnt.nll/!,1hlo, "\.l\n~ltl\g :In Ulll Ilflltl" 0'\ tho clllondnnt.. onll oll\fJfHt plUM tho tluto fil1l1 1I1flun of roonN\ nt' Inst.tllllllIJltl," iJt'f\I()t,lllg t.lI11 \mH.tt,llrl! nt' ronI' OOt,I1tl1 "'''\ LIIll oIlOt,O nf' IOll'i"lnlt11l1l Ill' 1'",'.nll"H~'1 1'111" (,II" llru"O_ 0.1,11""'" nil" ""'1111,\",,,,1111', II""'., ofl oO"U\'fnOI'R t.u tho ctuuolluut, 'fhnt Scf.,du/p F' flU."ohod hfll'lH,(J nlul Innrl" 'n lll\rt.hol'nnf' ftn't,H 1'lIi't\l I'ull" IIlItI tll ,1i'lnll '11'1 .'ohl" nnd tfOfhult,itHHI o)utmoll' f'nr IHIII em hohnll~,(~I' UlfR l!flHOrhmt.IH ,nHl;nl.ojtIlOltldl'lIJ~ l'IIlIUI'I~\ I''''nnIlKlH1 pllH1t ,1'1011111)' oxom"tlol1.wlI""" ''I,\'110IOhlol,,""ln 10.1' nol1ll11118t.1'lOtllll1 nl' t.hln 1101"(", """"".., /""''' ",,,,, 1'''''1,,1'''')'''' 0llnnlll,8Alull8, 1lf1lo1or Lo hu 1'101111 01101. "Xl''''''''''' l'IlI' hl1I",11 t.I'''Ot.O, \."".""""".,, 0" """"""",'1,""'" "".,1 1'''11,- glo'l~ nnl'vlo".' In OOI1AIl'llInIlOo "1' \.ho. ,lulIl.h 01' I.hll ,looOllnl1tl ,Iohl,. "I"I ,,1 "llllO II"h'll "'", 1!"1'" 1'1 ,d. 1,1"1" 01' dooLhl ,~nxO!l 1100'1'110,1 "hnrgoohlll rnr l',"'lllIlllI'lnr 1.1l IloooIIUI1t.'. ""11th (ox",),,1. 1,''''0'' 111 101 W'" I 11,"1':" H",'I,I,," onl Ilr,'thll 11111/"1'11,01",0 ,,"011\~\.,,1" 'P"x ,loll I Ln""q",,' wiL" II " I,ll I","li..' \ ,ii' ",~n',!o..'''1 1',,,01,,,,..1' ",," :,h'I\,,". ~lollnl If' '"'Y' "1. 1!~1'"00l tllllt. tho fllhIOI!II')' will 1<1:""""1. 1'\'11111' III ""101 ..,,,101""\ ",oil "','," "1"",11"'" '1!1o~t, Ihllt., Ir t.1I~ 1011I1lIIIII. not.lIlOlly 1\11101 III onl(l.loIll01l1. 01' o"y I'll", "",,,,,"..1",,- 11\' 11<),,1, I. !,Il"" 11,1111 U,,, ost.tlnl\t,ild'1I111n\llll (\1i\111\'11'~ l\,tUllllh\wnlll UUit t.ltn RIIII\O wilt hu l'ollnl'l,od (.(1 thn Hnp;iHtlll' nl' WIIIM, 1111111,11111 tlln umn(fnt. ot' t,IlX llAHOAHOd (11m '\If! l'IHlRfHJHH11ll In ft(HllJlt(lhlli,H,~, UllII'owl t,11i 'fhl1t th" ~\\t,1l1o of' U,II 1II'I'I'IIl'rl"\," l\ulUIIl". 'i" Ho,,,,,,,,I,," ,,V,. '\I', "C', 'I':', 111\11 "I" "01\11"""1\,,1 Iw'rl1,I",) hnvo hnon cnrrto'tt t'o'rWI\t'f,l, ,'mr11Jl1npnl'lY t'(J~IHt.ol,t1(l III tho HllnUlIl\l'Y' Subso~lbod and sworn to bafora mo thl" .."..",....:..,...,...... M . ..,..""":..,.........."..,..{/,, .." day Of~"'<'~t', ' 10,~~~ ~~O~A~P~"<Lg,f!...., MyC~,"I"lol1 "pitt, 011.11" 13, 1980 Uanlib""l' tA ~ CountY N'UTgl no porn" tJ.\fi Itl~ It rf'tdliV t (, mllkn f4l1l'(1 1\ 11 h1 Hllk "11111111H 'II UII! II 1'1'IIIIIV II. 111\11 ,.wlllldlllnl'i Hnlln~(HI HI'I.' t't'lnrt iu wtUlllntA~tl'" tir, tho' .....Ol'IIIlNnllfJI!, 1111(1 1'1 nllHfl Ltill HHt;f1t.f'; Illlllul\t' 1'111'11 I\tlll Hlll'Rlilll.~i'l'"f','I'f,~! MfH!\trltloR n1' olnHo 01' l'fll111ty OnrllllrlltlnliH nl' '\II IliLt'lltlHL In n,,~' (1f1f"'plIl'tllnt'kldl' nl' 11\1~litl\fU"i \,lllit 11111 Ilnt,o'M\rl Nt.nl-lImollt." rO(1nlrlHl IInrlut' l,ltn 1'/11'li.~t'f1tih ,ltlll\'1' 1~"IIIUI\I~ to He'llutl"ll1 'tIll" /II'H II I. tlllihlltl. ."!-ill IlIiilil' (llH1tldh t,hld. oClllilnl1' III Ii\ tho "Hitt"1HiI.~,11 hnflhlHl1i 1l;I',ul1UI'IY ulllnpll1,1.11Il (1M 1111l1\,fl...IIII'ftnUjil, Th~hC0lll110n\'lealJhNat1onal Bank P'~,.\.",2(~~:~;i'o~:Irri\'i;rr;1;~~x~rl~T:/~:~,~~:~t lOSouth,Mar.ket"SqLlare" . (Stl'uet Numlk;',\ H~l".rj,.~.~~,.rg,.l..,e~,nn!!':llYM1.,!!.", (CIty 01' Town and StAtn) ,,,,,,,,,,,,,.,,'m""'" t f t I , I , , , I I I ,/ P.., 1. Ii"" m (n.", V.7a\, '" -- JIll1I1'~ ,LlYlns In,u.ted '.,' " ,. (FHe wllhFederl\1 Ol1t 1'l\x Roturn, f'orm, 709, M~Y bo f'IIud wllh fedoral E&lolo Tex ReMn. "orm 706, whero Decedent Owned Inauronco gnj:!.!.o 01 ~n~lher) SEOTION A...:..adritrellnformellon \ 34' aOCI',1 ..,u,11l nU,mblr...- , . ,.-1- , '...!..t~..o~~~ 31 rlr.t noml end tnlddll Inlllalol donor (or docodont) , \-33C,,\ na',;u- "'1 A.At'll .__----...-....-SWa.r.U , aD DatI of alft for wlll.:h valuotloddAla ,ubmllled, , , , " .,' all Dall of dleododl'jodeeth for ~hleh v~!YJlllon d~U.tt~.t!l!Ua_<L.-;.. " "..l--'-,":-- aEOTION p._polley Informallon 37 Naml of ,'d.ured Rot !!hdt'l,t A - ~u,~,,_, 140 Naml and addrl" lif Inlurence ootnpany 't'h~ 'P:r'~'dJ~:n~t1~'~' '".,,"~. ,", " _"",0,0. · ....,.. ", .'1":--" ,"'" 41~ ~~~ICY N\JM1l11R\ 42~ KIND OF POL1CY 43 Tace amounl I'" InuI date , 2 -. Youth...Eatnt'A,!\IIi1der...with-the..- _$.S...ooo+o~8-1g,g 48 Gran premium ' Option to purchooe Additiono+ 46 rroquaney of paymenl , ' &13.13 ' Inll.uupoe - uu.tnly - 47 AUlan..'. name 4S 0.t8 n.llned L s~ , I 311 Dall of blnh N~..30.'0~0 .. ~.;~:~~." ,.~"".. .1 "'"",,,'. m.:'" .".. " \ " "~_J " es " other then aim pie dnlanetlon, quoto 1/1 lulI,(AlloCh oddltlonillaheet If naoauary,) , , , Dalo 01 blllh, If ~nown ~ 82 D.to'dlllln,lId . . 'I. rih._...----.- ~----\-:-_-- ::-;-,/;,:,;,;':;';':X~:';;;'//;-~-';'1_,."/~1 84 " polley II nol pOld,uPI "',' ~,;;::;1iY1}P.fit.!<:iW~ (e) Interpolated lelmlnal reibNe on dalo 01 .ulsnmont or Irrovocablo ,deolariatlon of bonefl, ;D;:~,~jJt:J'ljiiW{;~' . ~ 0 """""/""'''0%//'''1''''<< olary " " """ " , , ,,' -'i'8o.......a~'/1'ii\MjWff.'" (b) Add ,PrOPOtllOn .fsroBa p,remium peld boyond deto of eulQllmanl or Irro"ocoble d.Olana,\ ' ";G"",;,,j,;U$;$,'7,#,1P%w,~ \Ion of beneficiary, .""" ' , " '" . _.....u....5Jt ;,(;jWff{@,J%f~ (e) Add edlullmanl on occounl of dlvldondsto crodll of poliCY , 438. 73 ~ t.;;/!i;.#'.{:;:!{}J",W-"i'j (d) Tolol (odd OIIICU"tl on IlI,ei (e), (b), ond (c)), , , , , " ~, I ~~7 -'L!I- (e) ouhtendlnl/lndebtodno" asalnsl polley, " ----l>lONF (I) Not total "elue ,cf, tho polley (ror Sift cr 0.1.110 lax IHi'pc,o.) (Iubtract amount on II no (c) from omount on IIno' <d)), , , " " ". " ' " , , ee " polley la ellher paid. up or I! Ilnlllopren\ium: (e) Tolal COlt, on'deto of a"lanmant or llrevocnble doslonatlon of benefleillty, of · .Inale, premium pollo{'onlifo of Inlured at a\\Qln.d aso, for original faco amount plUI allY eddltlonal pald'\lp I""u'anca (addltionnl flleo amnunt, $"" ",....",,,,, ,,''',,'',,' ""..",,), " iI IlnRle'Plon\lumIlOllcyr'or thc \0101 loco nmolintlVculd 1'01 hova boon luuod on Iho Ilfl of the IMured,.a of IIl\l detotpeciflod, no"onl,oloil, aslumO that luch Q polley could Ihen htlVO bun purchaled by 'lhO In.ur.d al,d .tolo thO coal Ihereef, yllna for lueh purpoao Iho Uf1\a fotmull\ and bUI' employcd, on thedato sPociflod, by Ihe ec",peny In ealcule\lnB .Inalo promlUmi) , , , , , , " , , ' , (b) Adlulltnl"1 on eooounll\j diVidends to orodll of policY, (0) 'total (Idd amounb on IIno (I) ond IIna (b)), , , , ' , , (d) Ouhlendlna Indeblodn." ASIlIMI polley, ' , , " " ,.",.,,' . Nel lotal "alue of 0110 (for 11\ or ut~lelax urpo,.. .ublroc\ amount on IIno (d' Irom amounl on IIno 0 - The underalanod oHIO.r 01 thu obo"e,nM".d Ineuranel! compllny hereby co,Wi.. Ihal thll .Ielomont e." forth \rue end corrlct Information, ~"5 ~h_~_',-WtffW1q;';~ (@.;,,;z/W.0-""~/L"//X-.~t@ ~(;~;//{;j;ifft:f%'Pi:?~~;o/~ ,I; ,,,_j/.-. tf;,?/h'<<i>';..' ,;.;;~ ~~rnf~~;tt!&k/t~ ~-:-:::~1-r.~-'r#.1~.%:;P(~{{~~ }:~;;,,:-,-rl~:-r,::i4;'0-qr-I!:;::r;~ r~}.I;~ :;rW;Y@;.e;.~:t',-~~;"). \:~:,;;?A(~;;Plf&1:Z",;~,.'1,tl7, ~/:'<""-:'>>P9.':w/"/'y.:':":/'tI. ~:_,;~_,~..:-;;-;>?,';&_:~~'i<<?!:';_;:(;(,~ I~?',_ _.:~<_,z~,;'/,: ':i~-h:<- z (;"/',/IX' I'./;'_':'-','?'~~;'~,r f-'l/~,'&,",/.' }}:,-.Y;;f;;:;::--;}~Xfi:_?:/:'':':r~ '".,z,..,;,0, /,:0.I,^,"'",.Z",:w,-'l;j&m,0., ~~,';'~%" " ~:,:_;.;.'~-'W't({0Jt~.~1'i,~ iM;f~K{!f;(~~f.;ffi~ ;:,'~,.:7/;Z?)~#,.ffi-'ijti1\:0% .-;i:;'~"- 0'>>Z.:t~ 1~'X0j, "." -' ~-,(;,..i~........,;,; 81lnltu'l .. lJ~Q/i;lil' :Jl Tll'.'" 'tf u,,; OQ\oUNMUtf t~11f11~G CJffI~ 1 un"',Q-a~)'u'J '.04lfH10 0410'0' c,",flullon ~ , 2~27.' 079 I ,~ i , ~ ~ El ,,. , j-., a. It ~ I ll-. ~ 'i f ii ~ ~ R.. ';1;1 m .--.- 00/, m ~ ~ ,[ .... ~ \l " ~ ::!. .... I '81 l5' ~ ~ ~ ~ I::l r l:I. g ~ i~ ~ [ ~, ~ I ~ " "" ,,'I $ ',...."..,..$, $ ,........ '$ $ ""$ "......"""""'..'..'..'''..$ ...."..' ..,....,......,,":'........t ..,.., ....,................,.... $ " "",..,......,"'''"............t, '...."..'...."......'........$ .. ..,,, ........':,.."l (polJlll.lilll BV) (T) " , ...,;t,,,,li,,,,,....;,,_.,;"'O."" , '" 0111183 O\911XII.L iWlUP ,,,,..,..,,,.,,,,,,,,,' ".".",_,.,.,..,e,'"___H'..,, .H'.,'''''""",,,,,.,,.,...,,...,,.....,,,,,,,,,,,, """",..",............_"."".".'.._,.."."-,--',',,.'. .", ...." ........ ".. '..,,',..',',,",.., ," ":' "....,.., '(:""" B~QlIUUJ,L """",....,,,..........., '..',........ ,(lJolloJd ,\UUOWJOd , .... , ''', ,,,......,....,..........,,........, ........ ,(1,IOllolel lnoll ("0,, '90S)'........,.. ("11,, 'liDS) (,V 'liDS}'" II II " ^\IVWI~IlS III M .1 ,I , , IU_l':,.Jf1 '* COMM(lNWI'.I\I"TIl 01' I'I.'NNSYI"V,\NI'\ TI~^NH"liR INIlElU'I'ANCl! rAX IWHlllliN'l'Ill'.CWll!NT HCllimlJlAl "HI' JOINTI"Y oWNlm PI~()IIWny INH'I'I\IICTIONHI 'l'hIHHUII,"Il\lumIlHt. dl.oln.u 1111 1',\'ollUrl,y, r01l1 1111,1 I'ol'"nlllll, .!!.!!!"lllhY 1.11011000<\0111, Joll1t.ly wltll'nllllthur cft' t1l.ltOI1ttl tllolwltl1J.\ 11l,t,nngiblnRf Ht.nl1dtng in t,110 f1nmll fit' tho ftO()o!ltlllL mHlothol'ft. Jj.lHt. runl ".I.ol,u 1'11'.1.. II. IInl.ll'uI.II'., ur..!nllll. l,nnllnl,H, Hlvlng'hl'lol' IlutlOrll'Ulll1, II. lnlllolllllll,\lIl1lur Bullo'Il\lo "-A". IliUM UIU,-I'nt,u' _'\lII'-plI10n ntl rnnnrd nf' Jnat,rufI\uul. orroottl1g VUKt.-tt,\'-"OI h"t. (In not 11101""0 Qt\"ttrot,to~ nl' out nt' Ht,nl.ll ,'nnlnHt,fltn vnl\lo tn OHt,ItLU vn~unLlnn,-(1tJl"ml1, 11Ul'HlJI\ul I'rtlpol't,y Rhoul(\ hit 11"LOct "''' 1n 8111101lillo "1\", 1'1110 .1111,11 I1t' lIullnl.HlulI, 111111 t.hu 11/111\", ,,,I.lro.. fllIII rOllll.lunHhlp (II' III1Y) 01' oo-oWllor~ to tho (IOU(II'OI\I,. n0801'lp1.1ol\ Ill' l'I'I1I'"rl,y, nlll.lI I1t' Ao.tIlIHHIOI1, Nllmll ,I,hlro.s IInll IluIIII,lnll.1I1". 01' Cn-OWI10r., IIl1lt 1'11100 , nl' 110(HI .1 111' InHI. lI",olll.Jlloro 1\0111 11,01.111,0. ,o;r. U~~ >0 . >o>o~~~ IJnl I. VflllIO }loruonLngu 1,:Ht..ut,n HIIIII'O . V .llIn 1.1011 llEl'AIITlIllNT VAl,UATION CAUTION-no nol. IVrll,o In 'l'hU.8nIlO('; VII\UO III' V.l\lO 01' I~ tl. ro 1>000(\011 I.' s I'roporty" 1111,OI'oHt ~j ~. (')( 80( rx~ IX ~ D~ 13. " ~ Checking Account No, BB7.344~0 with the Cumberland County National Bank opened 1/16/69. Balance $2B6.80, -O~ NON~ , , 14. Savi ngsAccount No. 006~ 1064BO.4 wi th the Cumberland County National Bank opened 4/24/78, Balance $1.710.69. -0- NONE 16. Interest accrued on item 14 to date of death $2.80. ' , $6.676.00 face ,value United States " SeriesE Bonds various registration dates per attached ,list $6,962.12. 20 shares Mi llerpickingCorporation. Common, Valuation per ,attached statement 21. 16/share Balance $423.20. 21.16 726 shares Stroehman Brothers r.ompany. ~9~~~.o8o+d Ilt $3~,OO/Share Bnlnnce " 3B.00 -0- 'NONE -O~ ,NONE , , 16. ; -0- NONE 17. -O~ NONE 18. f ,J , All of the above items 1 thru 1B were hel d in joint name of Elden H. Swartt and his spouse. Grace 'Po SWartz. '1 19. Savings Account No. 25-0040247-0 with The CommonweaHh National Bank opened 2..8-78 h~ld jointly wHh Richard swartz. son. Balance 1.311.97. 20. 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'. ,. ...... :'. ... ~O;O .',rko' .tr"., Camp ",.11 ,. ponoo,l;on l.. , ,:.; .:,'" : ", (7;1.7) 761-11300 .. ,,' _R~';;:('.;t.~; '.";,,",,..,.,","." 1" 196.9' ,.;" . ,.,.: .- '.~ _ ~. ,.- ,,~.I.'~t", . - . A'ppr~i!3:inE5fainco JanlltU,'Y, 19'72 .. .. ' _ .. A. I. o.ndid". pro~",m, A' 1.'. E.A" Phi"d.'phi. .ChaP'.'" (6/7, l " " ~ oi'1ents I:' ' " ' oommo~wealth N~tiona~, Bank and Tl'uat'Oompany , Market J;lquaro,Ra.rri,abupg , ' . Y ~ational OentrcU. B.a.nk and. Trust Oompany , , ,821 11a;r,\lcot stre at, Ra:r:dsU\U'S ' OUlllbodand County Nat1.ona1 J3ank ~OONB) '. " . ".lihir4 street (B'l,:\.de;o stroet), NoW oumbl;lr1anp. ,FJx~oubl'al1a , ",' . , Nor'wpl,k Tc>wer, NOrwa1.k ,oonnec1;ic\.lt Employee Transfer' Oorp,ol'at:\.On' Wacker Dri va.l Oh:l.O<1go ~ Illino1.a The 111l1uitab1a Re10(\l1t:\.on parv:l.ca Bridgewater '.l'ownElh:l.p, NoW Jorsey " Re1oont:\.on Real.ty Servicll Oorporuti.on . I ' ~ludiElon Avenue, Nelo/York, NeW 'YorK. . I3omellult;Y IFloloori.ca. ,,' ' . " " 'Dallb'l'~'yRoad.j W:\J.torl, Oonnectiou\: " . ": Me'1'11:\.11. Lynoh Relocation l"ano.6\lment oo+,pOl'ut:1.on' .~ ,Bn111 Oynwyd',' PennF.ly1.Vl1n:l.n . , . , .' FNI1A!FIlIX10: Fl'lt..,A 11107-2,/00 Refel'enOeElj' . , John 61 Br1,en.' Pl'e~3:1,dfJnt,' Oent~J1u1 Pen.nsyl\ll'\n:l.a Savinge & Loan . AJ.yin Huwbl't'r:Ol', Roal~CJ11, S~,l.lta 0011e[1;e t ponnay1Vfl1lia ';.. ," ' ," 19'1b Pr(H.1Jdent - Boa:l.'d of RO<11.tol1e ' \.! ",p~ POllo, , M. ^. I., IRon1 t,,/In,tr~. to>.. .,di.. P?nn.t.1 y!"'i. " .' , ;' " " , ".' ,... '.. ," " .. " , ' . ,.'. "\, .'~ ". ~.' :,',. , . " ' ., :: :,~ i__.. ," I '; '.' ,.",." ,.' I ,,)'.,', >,:0:' '. , . .' . " " ; " : '. ! , ' i, -: :li1'. "~_~__'O''''"_ ~----, '. , , ",'.. ...... ....... , . , , " , , I' f t l.:~~j~l'l!f!'\" " , .' """; ,~ "..,', : ",,: ;},;J~,~,\"f~\:1",'?\'~'\';'i I.I~.',.!,-, k"..<:, ~'-", 'I, \ , , , ", " ,./,',' " SII\V WMh~r dr'l3r l1'rQn:lIlr .. L/.. ~' ,', "!~ , '/" ,-....t .. :1~ 1I,\~l~MI1NT - - TorA/. , '. I .I \,." \.,/,..L_..., , ~"'i' \,c (\1\.M~ Col. Hnrry ~I. 1#11l1lt' ^lIctiCJIlQ'V: I.t,d ^pprn.lJ:Jl' ..J.."" " " ;,\,t. b,lj" j, 1'','';'-;'' ","-.'.'~'i ~.,',11.. ~..?:.'f4,,';r{:~ 1!,:,~;;j/,'J,1;r'A"v;\"-f'i'.~~X,.tl'-~"..;i,1'~J.:.v,'\'V-~.~. . "- .. - .-,.,.,_.1."".,.".-,._",.",,;;;,;,'.'1 ,;,:':~-... S 10.00 2.'3.00 ~as .00 50.00 $1,.5:3::1.00 ',,' ., ji~;.I""~ f;v 't',,".\tji:flIf,~"1'4\1, L,'""',, , , , .1hWW'1~.ijj{')~I';;;i'f!,-.i;".", i: _'//j .,'1.',1-' ~ll" ;,::',\t,i?<', " ,-,,:,;' ;-,;:<,~"N_",_/ . ",",' .' '~"~, (,.4:-:_';;' 'f -\,,;?,,;i'~~;:~-~;4i!"~f:.,f~~k1,i,~~..~;\:,~:~:~vfV~~{~.~\I~n",~,I~*~,~ ,.:11".' t \'_; (1~",";'~'~..r"", ,_,~::-;N -,'i.' ("" 'q., f'i' I ,-. r'" ""':<\\t,.,." " DONlllhANK, N,A, , , MAIN o~"IOB 331 ~RIPOB STRUT NEW oUMnBALAt'lp, PBNNSVLVANIA 17010 11171774.7000 . ' Do.1;e ~ June ,29. 197!l ,'rOI COlT1ll\onwea!th Nll,tionll,l D!lnl~ 1?10 CedarOl~rf Drive 'Clamp UU1, 'PA 1701i A'J.'iJ.'N I' LOW B. COl>lllLANO REI Eat ate of Elden II. Swartz Name 01', Deoedent &S or The follow~nG is a oomp1ete reoord 01' the o.bov$ deoedent's aooounts May 9. 1979 ' Date of Death '. No. Type 01' Aooount , Balano~ on Date o1'Oellth, PrinciPal Aoorued Int. Names on Aooount (A~l OwnQra) Date 01' C~eatior 01' Joint Owne~8hfll , 'Cheo king $285.80 None " IDlden II, aWl\l'tz Graco ,1', Swartz 1/1;/09 Bavinga , $1,710.69 $2.00 Elden II, 8wartz Grace P. 8WU1't z 4/2417a . R. S. Stephana A\tt, I " ,,~ I, -~;L,fj~".\~~tJ!l.~;~Wj\~"!t"~'~t~.J\ l,', -""_'/,'~' "_', , , , : " i, , ., _'... '''. _ ~ '.1,1'.; ; i"J,"li,,,,, ;'; .' - ~'';:,'H -+l';o:i' ;-.,~';., ~j,'.,..:- ~'- f, ',tv,' i\';~'?Lt~;! ~:~,;,~ ;,~-~:;,,:~:t~i-'?(;(," , , The fol~owinv United Statos'Series E Bonds re regi$tored' tD MI'. Elden IL' Swart:: 0'" ,"':" GI'UCEl F', SWbl'tz Face Va lull Reoistratibn NGmoer Date _...~... ~_'~ ,.11 ~"._'._"~"""~''''~.''''''''''''''''''H''~________ $ 25.00 Q5137539873E January, 1974 26,20 $ 25,QCJ Q5158058136t f eprua ry, 1974 25,20 S 25',00' Q516C611356t t~arth;, 1974 25.20 S,25.00 QS17Z251442E April. 1974 25.20 S 25,00 QS1721'i94271E "la~'. 1974 25.20 S 25,00 Q518332p1l2E June, 1974 23.67 S' 25;00 Q5183321567E July, 1974 23.67 S, 2!i .00, Q6198523371E August. ,1974 ,,23157 ~ 2f"OO Q5198525405E September,' 1974 23.67 ~ $ 2f" OC' Q5198524630E ' September. 1.974 23.57 $ 25,00 Q5218332510E October, 1974 23.67 $ 2!i,OO Q5218333466E November, 1974 23.67' $ 25, 0Ci Q.5231608457E December. 1974 ,22.97 , , , ,$ 25.00 Q5231609232E January. 1975 22.97 $ 25,00 Q5231608937E Janu~ry . 1975 22.97' $ 25,00 Q5231609782E JanlJary. 1975 22.9..7 $25,00 Q524886043SE February. 1975 22,97 $ 25,00 Q524a860612E FebrUar{ ,1975 22 .'97 , $ 25,00 Q5250524121E March. 975 ~~,97 '$25,00 Q5250524582t March, 1975 22.97 $ 25,00 q52!iQ523029E April. 1975 2Z.97 $ 25,00 Q5250523479E April. 1975 22.97 $25,00 Q6009770059E May. 1975 22.97 $ 25.,00 Q6009770558E May. '1975 22. \1,7 $ '25,00 0600(1771054 E June. 1975 22.31 $ 25,00 06009771565E . June . 1975 22.31 $ 25.00 Q6011076477E J~l'y,' 19H 22.31 $ 25,00 Q6011 0768B5E Jul~ , 1971) 22.31' $ 25.00 Q60110f725gE Jul~'. 1.915 22.31 $ 25,00 Q6011077557E August. 1975 22.31 $ 25,00 Q6011078063E Augus t, 197~ 22.31 5 2fi,OO Q6026014142E September .1975 22.31 r. 25,0C! Q6026014641 E Septembel'. 1975 22,31 , J25,O(l Q6026014993E Octobel' . 1975 22.31 S 25.00 Q6026015508E Odobel' . 1975 22.'31 ( 25.00 Q6036124863E Novernbet. 1975 22.31 "loo< $ 25,00 Q6036125344t November. 1975 22.31 $ 25;00 Q6036125891E December. 1975 21. 71 $ 25,00 0603(.1,G390E December, 1975 21.71 $ 25'; 00 06()l;14Y910n Janulp',Y'i 1976 21.,71 $ 26.00 O(iOb 1498507 E Jan~ar,}' . 1976 21.71 $ 25,00 Q605149850!lE Junua 1',\'.' 1976 21.71 $965.91 -~- " '....',;~~~Vi r .; ., " H:"i~.w.:l:J.,\;\'1 ',.' 'I I,'"j '';'!,'~,J' i\' ':',' Ii, 1I<I,d' I. A' , r, <tlllllW.\l;.' ":",, "r., " , . ::JT""''''I)TI''~'<.I~\'':,'''Jr)'U-!'I_I.Jt, ';'.! ;f. ,'r ,I/t ., \ , ' ' , - " ' . \ ,J' ~1:~." '.'\" i/I!,{,",'/'4,',.\.1 ~~~,'N;'Ilf' ',""~"';I~'~","I\f/il;'l\~~'~"'.I....l"~'.f'I"'''",'''''V4f.."Jty..,..\,-(1ji,'_'Jl:VJ,U.,~~.., 'l.;. :\ t,'.t.\i ',(' ,".1 1,1 <:'~\'~;,I:IJ,,"",_~, :" \. The following United Stfttes Sel'1e~ E Bonds are registereci tCI I1r, Elden Swartz or Mrs, Grace p, Swartz: Face Value R'![! s tr_~.tiqJ].; Number DatE!. $ 50,00 L201 91 851 30E Febl'uary. 1976 43.42 $ 50,00 ' L20191S5576E March, 1976 43.42 $ 50,00 L20245!l~216E April. 1976 43.42 $ 50,00 L2024584703E I~ay, 1976 43,42 $ 50,00 L2027683740E June, 1976 42.28 $ 50,00 L2027684196E July. 1976 42.28 550,00, L2044765336E August, 197.6 42.28 $ 50,00 L2044765725E September, 1976 42.28 $ 50.00 L20276B4485E October. 1976 42.28 $ 50.00 L2048022051 E November, 1976 42.28 $ 50, 00 L2048022516E " December, 1976 42.10 $ 60.00 ' . L2048023106E January, 1977 41.92 $ 50. aD L2048023372E February, 1977 41. 74 $ 50. DO L2060014152E i March. 1977 41.56 $ 5'b ,00 L2060014475E April. 1977 41.38 , AAB829 $636.06 \~~~,('\'" .....- -~.....-... " '. '; .1 ',' ,t' 1;, J~ ~'tifl~ U:,:;~!""",,:"ii'f"":' , .' !";. ",!,"'.f.t,Lh'.\IJj,L" ";'(,"',,1: ia,.M'iK~~i\~.;~;;li;"'~b",j :::\,~\",,:,,\.,'(:,;~, t~'."1 ~,',' ,;:;<.';~;d'e; ;''1~~:'Yf)X!!';'i"'')!'>'\''i;'I.,,'I,;i,, ,~;'Y'." ,c,' ':" ;," 'P , " ;.;'".', i'." ,i"~';""':":"."',I?,.' ':: ,VY. ,,,"'~I,O\I''''~!'(''.''\l'''.''/I'II'~;~'''.f~/'''''''i,,,,,,,,.,(~.'#1t,W'J.I\i'W\o\ ." ., " The fo1'10wll\9 LJn1tud ;tat(!"Sel'1er f. bCllidr, are registene9 tQ MI','; Grace P. Swartt (wEldon li,,5vlal.t."i . Face Value ReC11 stl"atlon NlJmber .!?ate ~._.- ~"'. *4""'~_<---< _.~ ri~ ..,-~ -,---,..'...-.. " , $ 60,00 U025290342E January. 1973 54.26 $ 50,00 Ll025302702E March. 1973 52.68 $ 50,00 L 1037544 309E June. 19,73 52.aO S 50,00 Ll037544600E August, 1 973 51. 40 $ 50,00 L1037544637E Septelllber. 1973 51.40 $ 5Q,OG' Ll045600654E October ,1973 51.40 $ 50, 00 Ll046600570E November.1973 51,1tO, '$ ,50,00 Ll055145182E December. 1973 60.40 $ 50. 00 Ll058069656E January. 1974 60.40 150,00 L 1058069667 E January, 1974 50.40 50.00 Ll06822B756E February. 1974 50.40 $ 50, aD L1058228762E Februa ry . 1974 50.40 $ 50,00 ' . Ll05822B770E Ma rch. 1974 60.40 $ 50,00 Ll063728274E March. 1974 50..40 $ 50.00 L 1 064085462E April. 1974 50.40 $ '50, OG L 10640854 78E April. 1974 50.40 " $ 50,00 L 1 Q640B54BBE May., 1974 50.40 $ 50,08 L1074n24061E June .1974 47.34 $,,50,00 L 1074824071 E J~ne . 1974 47.34 $ 50,00 L 1 0748240BlE July. 1974 47.34 $ 50.00 'L 1 074824094E August. 1974 47.34 $' 50.0C! Ll074824120E September. 1974 47.34 $ 50 .00 Ll074824337E October. 1974 47.34 l" $ 50,. dt; Ll099546529E Jallua\'.I'. '1975 .. 45.94 $ 50. 00 Ll099546547E FebrlJary, 1975 45.94 150;00 Lll0Z661417E ~\arch. 1975 45.94 50,00 L 11 05B97 337E May. ,1975 41\,.94 $ 50.00 L 11 05897343E May. ,1975 45.94 $ 50;00 L 11 0589734 9E May., 1975 45.94 1 50. 00 Ll105897371E July. 1975 44.62 50,OC L n11904946E August .'1975 44.62 $ 50, 00 L111190495H September. 1975 44.62 $ 50.00' L2017635051E November. 1975 44.62 $ 50.00 L2017635064E Novembel' . 1975 44.62 $ 50,00 L2018337206E Decampo\' . 1975 43.42 ,$ 60. 00 L2018:l37246E Decelnper. 1976 43.42 , , ,$1 .7311.!1E. I' " '~~'t".;,~"il;;,"'~;';'~U"jj\''',~:,\~:ill,,,_,__,;, . ,.' j ',. I , .. .. i'.,.f .:. I, "', .- ,. ,'.w'l~~\~.,W:,,:q~\,-.,..:~, ."'I":;,\'~_;" -,'-"';,'-1'" '. .1, ','" " "", , .-'" '-J, ";0 . ,"1".' I,: ,':.1 '. '. ~ '~':'-.1.-,,\.,,~~1 1\"'flHI ~.,)r"~I;'II4,,';~!'r.'-l-<~!:t;l\'.~t,.lM~I"\f;f~' ',/' ..' ' :.'- .;; ','1 --- ,. .'.'..'1".",......",..,.... 1-.;+'1\,;" :..,' , ' !.iLc;CL VaJJ.Le. ri(Hlistration '~ul1lbel' [).~g.' ..-..,..---.-----.-....... ..... $ 50.00 L2018337284E January. 1976 43.42 $ 50.00 L2018337298E January, 1976, 43.42 $ 50, 00 L2025973242E February. 1976 43.42. $ 60,00 L2025973224E February. 1976 43.42 $ 50, 00 L2025973286E Harch. 1976 43.42 $ 50. DO L2032760858E ~larch, 1976 43,42 , '$ 50. or, L2032760893E Apri 1, 1976 43.42 ~ 50.DO L20327M1917E April, 1975 43.42 5,50, 00 L20327li0947E May, 1976 43.42 , $, 50. 00 L2043395433E ,May. 1976 43.42 $ 50. 00 L2043395445E June. 1975 42.28 . $ 50.00 L2043395463E ' June, 1976 42.28 f 50. 00 L2043395481E Ju1y.1976 42.28 50,00 L2043395493E July. 1976 42.28 $ 50. 00 1.2043515a05E September, 1976 42.28 f 50.00 L2043615819E September, 1976 42.28 50.00 ' , L2053800252E October, 1976, 42.28 i 50. 00 L2053800298E November 11976 42.28 50.00 L2053800332E November, 1976 42.28 $ 50,0(1 L2061 90611 1 E ,January, 1977 41.92 S 50, 00 L2061 9061 29E January, 1977 41. 92 $ 50, 00 , L2067853502E February, 1977 41. 74 $ 50,OD L2057853513E February I 1977 41. 74 5, 50.00 L2067863538E ~la rch. 1977 41.56 $ 50, 0Ci' L2067853573E April, 1977 41. 38 $ 50.00 L2067a53588E Apri 1, 1977 41. 38 $ 50. 00 L20n10623lt May, 1977 41. 20 $ 50.00 L2073106256E May. . 1977 ' 41. 20 f 50.00 L207 3'1 06297E June, 1977 41.04 50,00 L2085302i14E July, 1m 40.8f, $ 50.00 L20B5302725E July, 1977 40.86 $ 60..00 L2087980602E Augus t I 1977 40.70 $ '60.00 L2087980612E Augus t, 1977 40.70 $ 50, 00 L2087980613E September. 1977 40.54 ' S,50,OO L2087980640E September. 1977 40.54 S 60,0(; , L20879806iOE Dc tobe,". 1977 ,40.36 $ 50,00 ' L2087gB061::2E Octobel', 1977 40.36 $ 60.00 L20879B0700E. Octobel", 1977 40.36 $ 50,00 L20879807Hr. November', 1977 40.20 $ 50. 00 L20879B0735E November, 1977 40.20 $ 50.00 L2087980749E Docelllber 1 1977 40,04 AA19513/5271 $1\715.51 " TOTf\L s' 5,9~a,12 ! ;' ., " ,'I . , , '....'.,_.,\-, ".,,' .. .,}" , ','" \",' ,"OJ -"-r',':"",'-'.,:..",. .'/1 4, i:. \, i -, I,: .iI, 1,':'" '\1:',. -';':'(:"",") ,~/.',\~~';',f:.r .\{'(f,~ ;~l'l:, .--- ..\i\N\II'~flf\i'I~", f.l'lC'!lj!:,ti,IWjj , Itill.li'IIJlm,l'-llt\f!li\T,'_I'; Il/!tQ!'\~ rll!uinnf i'\I,j"I-'PJI r:~ ' .,\....,"~), ' " .-JJil"- ttl . 'M I L.LI1R.. plOI< I '" ClI Q Q FI PCl F1ATI CI N 1l0M IUU,IICHNIITOWN, .f:$It'NNflY~VAN'A '.~07. PHONE ~1~'4'1"'4QAa JUl10 26. 1079 Graoo P. Swartz 2~~7 LOSijl1 Street Ol\rnp, Hill. PA 17011 D~ar Mrs. Swartzl , ~ was talking with Joe Sobieaki this mornil1S, and ho had mentioned that you needed sorne idea as to ,the fair market value of Millel'-piolting corp- oration Stook, " Ollrstook is not lis ted on MY of tho o~ohangos" and tne only .mai'ket value of olli' stook is whatovel' arnount a shlli'eholdet' solls, or wishos to buy /It. " ,,' I hav,b hotod Ilomo of ~ho past trllllaaotiona,\'Ihioh you oall use as fair market vlllue I Maroh 4. 1977 420 shares wore haded at $18.00/sharo Se(ltembel' 12, 1977 151 shares WOI'O trild ed at' $18.00/ahaI'0 Maroh 10" 1978 471 shlll'os wore tnadod at $18.00/ahare Juno 1, 1978 242 shm'os wore traded llt $18.00/shllre May 3, 1979 139 Shlll'OS WeN) trlldod lit $21., 18/shlll'0 If you ha.vo allY quostiolls or neod !IllY lldditio~Hll inforl1l!ltioll, please oontaot .me. VOUI'S truly, xt~,~ Glen T. Karim Ao\:tntJ Soorotnry , Its ;tf,,:,'I.__4-r..,.H,;,',_': i"",-f' ij' ~i,'_;~~H\,.,.r ;Ji . - ,",.' ",-':_~ :(-.' ,._11M '" " ',~' ' ' l~~i1m""'~l~,:""jiV,'" ""~~ .\I'IJ...'I'Il"''',..'":1'''''''....:,,',. ,,../1""',,,., '"" ,.,.'. ,j, 'I,...:.,....'."', , ",', '.",. ,;_,."",_"~,\"""j"","I'''\'''''''M'''I"":....j,,,,,:,,,,,,,, ,"., ','" ,,/1;',,-'---:'1;,;,,1,\, -";i ,,1 '_:__; '",""""!,"'" ' ",--,'-"!""', -, ',' - " " ' ' , " -" - , .' ' '---, '" '", .. --.., " Th~ fOllowing United States Series E Bonds are registered to Mrs, Grace P. Swartz or El den 11. Swartz; Pace Va 1 ue Reg1s trationNumbllr Date - $,50,00 Ll025290342E January, 1973 54.26 150.00 Ll025302702E March, 1973 62.6B 50,00 Ll037544309E June, 1973 52.BO ;j~ '50.00 Ll03764460BE August,1973 51. 40 I'" 00 Ll037544637E September. 1973 6l.BO lio.OO Ll04li600664E Octobe~, 1973 ' 6 .ao " 50.00 Ll04,G600670E N9vember .1973 61.BO 60.00 Ll0651461B2E December. 1973 60.40 50.00 Ll05B069656E ' January. 1974 60.40 60.00 L 105B069667E January, 1974 50.40 \i0.00 Ll05822B756E February. 1974 50.40: 50.00 L 105822B762E Februa r,' 197.4 60;40 60.00 "Ll058228770E March, 974'. 60.40 50.00 Ll06372B274E ' March,1974 ' 60.~0 50.00 Ll064085462E April. 1974 50. 0 60;00 Ll06408547BE Aprl1. 1974 60.40 60,00 L 1 064085488E May. 1974 60.40 50.00 Ll074B24061E " June. 1974 '47.34 50.00 Ll074824071E June, 1974 47.34 " 50.00 Ll074B24081E July I 1974 47.34 60.00 Ll074B24094E August. 1974 47.34 50.00 Ll074B24120E September, 1974 47.34 50.00 L1074B24337E October. ,974 47.34 50.00 Ll099546529E January. 1975 '45.94 50.00 L 109954654?E Februarf 1975 46;94 80.00 Lll02661417E March, 975 45.94 80.00 Ll105B97337E May,1975' 46.94 50,00 L 1108B97 343E May, 1976 46.94 80.00 Lll05897349E May, 1975 41i.94 50.00 L 1105897371 E July, 1975 44.62 50.00 L 11 11904946E Au gus t,,197 6 44.62 50.00 Ll111904951E ' September. 1,976 44,62 80.00 L2017635081E November, 1978 44.62 50.00 L2017635064E November, 1975 44.62' 80.00 L2018337206E ' December. 1975 43.42 ,50.00 L2018337246E December. 1975 43.42 j1,73B.96 " " '!;-, ".,,_-.'Yi,i"'-Il.... "i '. II;':'L.f'" _':;'~'T:'~Jlt.{I-'\ 1-" ,',,-~r}~r1~Wwf,.W--~.:.. 'L, ;-'t ,,_; t, ... :/: i '-,;,' ,'." 'I .."~ . , --_;:,:-;I>,;i,;,:{'\\~~j.v,J-I"I..f.l,b'II"'",'.Wf.Wl'!'1"lt"''''..~;.t,~';.........!tit~~lW, ',_'.-','",./,,-.' r_;''''..'r,.-,.'_._,.,__......_";,_...''!''I!.,f,,,~.JI1l1II;,l''I'',.'''I'''Jl'f'f~"...\.~ , ' 1,-' ~- 2 .. .E!ce Val ue Reg1strl!.iion Number. !late 60.00 L201133372134E January, 1976 43.42 60.00 L20183372913E January. 1976 43.42 60.00 L2026973242E Febr4ary, 1976 43.42 60.00 L2026973224E February, 1976 43.42, 60.00 L2026973286E March, 1976 43.42 50.00 L20327601358E March, 1976 43;42 60.00 L2032760893E April. 1976 43,4~ 60.00 L2032760917E Aprl1 , 1976 43,.42 50.00, L2032760947E May, 1976 43,42 60.00 L2043395433E May, 1976 43.42 60.00 L2043396446E" June. 1976 42.26 50.00 L20,43395463E June, 1976 42.28 60.00 L2043395481E July, 197(1 42.26 50.00 L2043395493E J41y. 1976 42;28 50.00 L2043615805E' September, 1 ~76 42.28 I 60,00 L2043615819E September ,1 76 42.28 50.00 L2053800262E October, 1976 42.28 60.00, L20531300298E November. 1976 42.28 '$ 50. 00 L2053B00332E November 11976 '42.28 Ii t 60.00 L2061906111E \January, 1971 41. 92 60.00 L2061906129E \Janua ry. 1977 41..92 50.00 L2061853502E " February., 1977 41.74 50.00 L2067853613E Februar~, 1977 .:41.74 60.00 L2067853638E March, 977 .. 41.66 , ' 60,00 , L2067853573E April. 1977 41.38 50.00 L2067853588E April. , 1977 41.38 50.00 L20731 06231 E, May. 1971 41;20 60.00 L2073.106256E May, ,1971 4l. 20 ' 60.00 L2073106297E \June, 1977 41;04 50.00 L2085302714E July. 1971 40.85 50.00 L2085302726E \July, 1977 40.85 60.00 " L2087980602E Augus t, 1977 40.70 50.00 L20879130612E Augus t, 1977 40.70 60.00 L2087980613E September, 1977 40.54 50,00 L2087980640E September, ,1977 40,54 50.00 L2087980670E October, 1977 40.36 60.00 L2087980682E October, 1977 40.36, 50.00 L2D87980700E October I 1.977 40.36 .. 50.00 L20879B0714E November, 1977 40.20 50.00 L2087980736E November. 1977 40.20 50.00 L2087980749E December. " , 977 40.04 , AAl~,6'3/627' .$1 .715.52 TOTAL $ Rt!V.41Sft t..~.) "I ., ('Jr' "J b ") /-.. ", I . 'S;) <;.. OIOUCTIONS A~~OWBO IN TNISUMOP S ,,?/~::/,lJ9::1:':I ~, ~};1~, ~JOV~D.~uJ" I q tv V- . ~u~~ ~aln'R a~'wl ~"V o~Nr' - OPf ICI OP THI AlOllTlR Of WI~~S OP Cumber) ang COUNTY ANO AoeNT OP THe COMMONWIA~TH STATEMENT OF' DEBTS AND DEDUCTIONS (...,,- j), ,(' UTATI 01' glden H. Swartz DATB 01' m"MO APPRAISBMIHT C' ~ATI 01' Bor\lugp of Came Hi] 1 ~ CumberlAn.!j C9untv D,ATI 01' DIATH. Mav 9, 1979 OATI HO.OP V\lUCHIR NAMe Of PA YU RIMARKS AMOUNT s 3 s 6 177 2 463 00 Estate Notice Professional Services 20 67 368 70 o e P Fi S 3 Bank - Mortga~eNO, 609 1.333, 31 ee 2 e:OMMOHWIA~TH O/' PINNn'~VAHtA I e:OUNTY ol'..J)allObin ", ' f IS. , 'V'lce President and Tax Manager We ~~ The Commlln~ea1th National Bank bvRQbert P. Conway. .' HIReBV e:UTlPY. THAT TO THe lIeST 01' MY KHOW~IDOB AND 1I1~IBP. THB POHeOOIN\l1S A JUST AND TRUB JI:~TlM~.HT 01' DIlITS, P,UHBRA~ ,IXPBNses AND eXPBNSB~ 01' ADMINISTRATION SUBMITTBD TO THB BSTATe 01' ~.liWl.Jj. Swartz DBCUSBD,AS DBDUe:TIOHS 1'0RIHHIRITAHCll TAX PURPOseS.') , ')., ( \ i' ~'c<;_', \ \ _0_ '-..'~~l ',ll-"'~_I . ~. , 24 259 53 SWORN AHD aUBse: DAY 01' .. (~.S.) ~ (t1mmh,ltln b~ltt' allobl! 11, "80 Y, DMf\llIIo CMII' Hanl.b~I;, M \ \ ' ..~ ~ ~" ~' ~ I <if> to . m ~ ~ i:tl ~ ,~ E ~ I '0 ::t '&. .-I ('oj I ...... ~ 9 ~ ~' i ~ ~ ~ d d ~ ':2; :2; i i i ~ ~' ,~ ~ ~ 8 Po< .. , \ ,\ INSTRUCTIONS To In.ura propor crop It to your account, tho name 01 tho oatato and 1110 numbor ~~ould bo olatirly prlntoa an tho ohook armonoyordor. . . " . , , ;!' , , Thl. detormlnatlon Qr\dos.onmonll. maao In accordanco with Soctloll 421 and SocII on 732 or tho Inherltanco and e~talo iaK Act, 011961,72 P.S, 2485-421, n2, , Tho ..1010 taK Imllasod by Sootlon 4211. dllo at Iho data 01 tho docodonl'a daath but ahall' not bocomo d,llnquollt until tho oKplrallan 01 olghtoOn (18) months altor c1ococlonl'a aodth provl(loa that any.,oatalO (OK acca.lonoa br' a IIna,l chango III tho Fodoral rotum or of tho laK dua,tharoon .hall not, be como dOllnquon,t unll thookplratlon,of ono (1) mQnlh altar tho poraan liable to pay , tho taK rocelvos final notice of tho Incroa.o, Calculnto l,ntor06t from tho dollnquont ,dato shown on, the faco of thla form to tho aoto,of paymont using tho following Inloroat tnblol ~...~_._......... ....__..._~ ________.~__ _ __..._... _.,.. _".___ ..,.~- _'--:0 -- ---- -....- ---.....-- -""11- ---- ---, -- -- -,"!""'.... -"""_....._- lmonlh .005 4 months .020 7 months ,035 10 montha ;050 2 mohlh. .010 5 monlha .025 8 months .040, 11 months .055 3 man tha .01$ 6 montha .030 9 months .045 12 montha .060 ------"~_. 1 dny .00017 11 day. .00186 21llays ,00352 2 day s .00034 12.days .00203 22 doy. ' .00369 3 daya .00051 13 daya ,Q0220 23 aaya .00386 4 days ,00068 14 daya .00237 24 day. .00403 5 days .00085 '15 daya .00250 25 aays .00420 6 daya .00101 16 doys .00267 26 (lay s ;00437 7 days ,00118 17 day s .00284 27 days ' .00454 8 aays .00135 18 days .00301 28 days .00471 9 daya .00152 19 days .00318 'l9, days ,00488 10 days ,.00169 20 cloys .00335 30 days .00500 . ' 1_"'_ ______ .,.,__ ___":"___,-,__ ____ ___ ___ __ -..,---..... __ -- - ---- --... --- ---... ---- -... --... _...- -........- 't"-- --- " , Any party In 'ntorest, Including thoCommonwoalth and tho por~onol ,roprosentallvo,nol .dllsflell wllh thoauoument may obloct thoroto within .IKly (60) days alter rocelpt of this notice as,provlaea by Soctlon 1001 of tho Inherlt,ance and !:stat'o TaK Act, of 1961 (72 P,S, .' ti 2485-100,1) , Make c,heck or mon'oy order payable tOI "Reglstor of Will., Agont" Mdlllo tho aclaross IIstod belowl