HomeMy WebLinkAbout79-00373
No, 21M79
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PETITION FOR PROBATE OF WILL AND LETTERS TESTAMENTARY
in the Estate of _(:1i\lU~t:!C:I'; 1.~,.___,....HIU~{11':~l"t._...._..__._-------, deceased.
To Richard E, Anderson, Register of Wills for the County of Cumberland,
In the Commonwealth of Pennsylvania,
IS
Petltloneds) i'G\r.e< the execut()l~. ..._... named In the Last Will and
Testament of _~L!'f\..l{!':~:~~Lli..r!L___ _.~:I.!B~'.1':.')"I:-- ._ ...._-- dated .~L)l:..lLl.r,;,.I.._L21.o
Decedent was a citizen of the United States and 0 resident of
Township
t~:lddloi.l()X ,n",,,,,,,\I'\"-' C bid C t C 0 wealth
.._'_ .oU<""~l:t'''' um er an oun y/ omm n
of Pennsylvania.
Decedent died on ~..'..lno'J(~I~y"'-__ the _.~~j~~_. day of Mny
A. D. 19JJ..._, In the County of ._glllll\~,rll::.'l0_____..____, State of
Pennflylvnn:l.n at the age af R~1 years,
xtql!l~X X\llC:l!iX Xh~lX
Decedent has not been married and has not had children born to him
since the execution of the above described Will.
Decedent wos possessed of personal property to the value of
:1: 500.00 and of real estate to the value of
$2~i,000.oo as near as can be ascertained; said real
estate situated as follows 3605 Spr:l.nr: Hond U~:\ddlo[1ex 'l'ownsh:tp)
x npplyx X
Therefore, your petltioner(s) respectfully applies for the probate
" of the said Last Will ond Testament and for Letters Testamentary thereon.
Dated June '., 19'{9
Name and address
of Petltloner(s)
)r
dO'let; ri:i... 'Ie);6
</ r;-f'
11. Cr.,Ylm BUHO!':'l"l'
3605 Spring Road
r
carlis 1e, P8.
COMMONWEALTH OF PENNSYLVANIA t
COUNTY OF CUMBERLAND \ ss
]i'. (n,YDI': BUHOE'P'l'
named in above application, being duly E\worn according to law
say(s) that the statements set forth in this petition are true to the
best of
h:tn
knowledge and belief,
Sworn .. and su~scrlbed before
me\'l~tA "., ~..-:- 19.'((:--
~~J -.-----
Richard E. Anderson, Register
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11. CLYDE IJ\fR(mTT
C,l~[)
Attorney:
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la~ Utili aub ~t~mtnt
I, CLARENCE L. DURGETT, of Middlesex Township, R. D, 3, Carlisle,
Cumber'land County, l'ennB:ylv,~nla, do mal<e and publish this as and for,
my last will and testament, hereby revoking any and all wills hereto-
fore made by me.
1. I direct my exeoutor to pay all of my debts, funeral and
dministrBtive expenses as soon as oonvenient after mydeoease,
2. I authorize Bnd empower my oxecutor to sell any realty and/or
personalty owned by me at my death, and not speoifioa11y bequeathed or
evised herein, at either pub1io or private sale or sales and te give
good and suffioient deeds and/or bills of Bale therefor, in fee
simple, as I could do if living. My executor is authorized and
empowered to oontinue to engage in any business, including farming,
in which I may be engaged at my death, for a period of one year after
y death.
3. I give, devise and bequeath my house and farm in Middlesex
Township, Cumberland County, Pennsylvania, ~ogether with all farming
mahinery and equipment, oattle, etc. owned by me, to my wife,
Ethel V. Burgett, for the period of her lifetime or while she contin-
ues to reside iry said property; but not absolutely or in fee simple.
The said life tenant shall not be required to give any bond for the
protection of the remaindermen. Said life te~ant shall have the
rights and powers and be subject to the duties, eto. of a legal life
tenant. Upon the death of said Ethel V. Burgett or upon her failure
to reside in said property for a continuous period of six (6) months,
said roal estate andporsonal property shall be sold. at public or
pr:L va te sale or sales, by my personal representa t i ve, and the net
proceeds thereof shall be divided equally among p. Clyd~ BurRett,
Alioe B. Gutshall and Ruth B. Shaffer. If any of said legatees be
deceased at the termination of tho life estate provided for above,
his or her share shall pass to his or her child or children who are
living at the termination of the lite estate. and if there be no such
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child or ohildren but a spouse who survives, said spouse shall receive
the sum of $5,000.00, free of all taxes. However, the direct~on above
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that my executor ahal1 sell said real estate, ia subject to a
superior option to purchase said real eatate as proVided below. ~or
a period of go days after my death, if my wife predeoeases me, or for
tho llame per'iod aftor the t;orminat;ion of her life estate In aaid
realty, if she survives me, F. Clyde 8ur~ett shall have the option of
purchasing sald real estate for a purchusD price of $25,000.00, which
sum or as much as pessib1e, shall bc debited a~ainst his share of my
estate, if he exeroises ~aid option. Said option shall bo exercisable
lthin said 90 day period by the deposit of a written, signed state-
ent of intent to exercise filed by sald optionee with my attorneys,
Il"'win, Irwln and Irwin. Payment of transfer taxes, proration of
taxes, etc. shall be the same as in the usual property transfer
ransaction. If said option is exel"'cised, I her'eby dlrect that a
eed 01' conveyance shall be made to tho optionee by my other children,
oined by their spouses, if such there be then livinR.
If said F. Clyde Burgctt declines to exercise said option or if
aid 90 day period expires without his having exerclsed said option,
"hen my daughter, Alice B. Gutshall shall have the option for the
ext 90 day period under the same terms, conditions, directions, etc.
as set .forth above.
4. All the rost, residue and remainder of my property, real and
)ersonal, I ~ive, devise and bequeath to my wife, Ethel V. Burgett.
If Ethel V. Burgett shoUld not survive me, then 1 ~ive,
evise and bequeath all my property, real and personal, as follows:
A. $1,000.00 to The Carllsle Sprin~n Lutheran Church;
B. *1,000.00 to eac:, uf my fT,l"'andchildren, 1'roe of any
inheritance or estate tax and said sum may be paid to the parent or
rH\!'cnta, an trusl:oe for said r;randchilcl, if' any grandchild l,s under
twenty-one yoars of age. It is my dosire that said legacy be placed
by said parent trustee in a savinrr,s and loan account for said grand-
child, to be used 1'01" educational purposes before twenty-one or
turned over' to said r;randohild when he or ahe reaches twenty-one years
of age;
C. All the residue thereor to my children, absolutely,
share and share alike, and if any child has predecoasod me, having no
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ohildren living at my death, the $5,000,00 gift to his or her aurviv-
lng spouse shall beoome effective. Said spouse is to receive a
total from my estate of .5,000.00 only and no more.
5. All federal, state, and other death'taxos becoming payable,
Be a result of my death, on the proporty formin~ my ~roBs eatate for
eath-tax purposes -- whether or not it passes under this will --
shall be paid out of my general estate BS if they were my debts, so
that the full burden of them will rall on my r(~siduary estate. Any
ax~s on future interosts may be paid at such time or times as my
xeoutor thinks best.
6. I nominate and appoint F. Clyde Burgett to be the executor
f this my last will and testament without the filing of any bond,
hould he die before my death, renounce or refuse to serve for any
reason, or die leaving any of my estate unadministered,.I nominate
nd appoint Alice B. Gutshall and Ruth B. Shaffer as substitute
'xecutrices with the same powers as are given herein to my executor,
nd also without the filing of any bond.
7. I direct my personal representative to retain the services
f Irwin, Irwin & Irwin, Carlisle, Pennsylvania, as attorneys in the
settlement of my estate.
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WI'l'NESS my hand and seal this ) (." day of April, 1970.
.i.k~c-f '!i- B~SEAL)
Cr.,ARENCE L. BURGET'r . J
Signed, sealed, published and declared by the within named testa-
tor, as and for his last will and tostament, l.n out' pt'eflence, who, at
his requeet, and 1n his presence and in the presence of each other,
have hot'eunto Bet out' names as
""b"r1~""j ~
_i')1~<- /1,. .oi!t~
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OATH OF PERSONAL REPRESENTATIVE
COMMONW~]ALTH OJ.' PJ~NNSYI.V^NJA}
COUN'I'Y Ol~ ClIMBlCHLAND HH:
BofOl'o mo, thu HOl{IRtOI' 1'01' thu I'I'0hllto of Wille IInd l{"lIntlnl{ of l;(ltt.o,'e of Admtnletrlltlon In l1nd 1'01'
tho County of Cunlhorlnnd. pOl'Honnlly cnmo """",E'.,...OJ(.YJH::".IH}.~{Jm"~~r""'"'''''II'''''''''''''''''''''.""..""".....,,,
t I I I I [1"/91")' I Ilf] I ' I '\' I~xoout()l" .
W 10, )0 ilK (\l Y ""'''".:. . . {"",,,,,, (0,,, ..,,,. (OflOHU unt HUY \I lit" UM..........",.........".."""..>I....""I"......'..,.......
h Will I T f. CI,ARENCJi: L. I1lJROE'P'J' , d d
of t (} hu~t n'l( oHtulnont 0 .......,,,........,,,,,,............,,..,,,,,.,,,,,,.,........,,,"......."11..""'...,,,,,,"'''''''''' 0006ao
".""""",\lR""". wlll wulland truly udmlnlRtol' t.hu l{oode nnd chatt.ole, l'il{hts IInd cl'oditR of suld doceusod
according t.o Inw, And nlso will dlllgontly comply wlt.h t.ho pl'ovlalona of tho luw I'elnf,ingt.o Trunafor
Inhoritancos. ",,,,,,"t}.~nT.'.t;\.,,..t nnd subscribed
beforo mo.
June
nA. D" 19,?,~"",,,
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J1'. CrYDTJ: BURn1Vl;;;; ,
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DECREE
Be it romembered that on tho "l""~'~'~~lffll"" day of II..H.llll......~I~n~....I...lill........1I1 AI D., 19~~.lfl., there
was probated and recorded the IORt Will and Tostamont of .....".~.;~~.~.~~'tr,I};'I:".~.~~~.~~~.....'......lf.....lIU..,
1 I' Middlesex Township C bId P , .
ateo .....1.1........111...'........,...1..,....,,,...,.,.....,....,,""""""1 urn or an Gounty, onnsylvnnia, Decoased. Letters
Testamentary F. Clyde Burgett
,.... ......... ............... ...,.. ,..... '1. ,.......... woro grantod to ,.",. ,.' ,....... t...... ."1" II........ .11 "..,..,....., 1....1 I..... I "'( I.........., I...".
I,
Witness my hand and officlnl sonl tho dny and year ufol'oRald.
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"""""''''''~ii~h~;'d I~': A~;I~'r~o~,
Inv.nto,y of the real and pe"anal ..tate of
__c._,,_CLAltb;NCb;.L.UUHQE'.L"I' .. .
... ........~,_.. decoaud.
",_,::;==~~:=,,;;:::;::"::':'.:::-:;-;:~ _____ ...~ ,.-;-";:;.::c,::~..::::..,,::":::-,;;;::!-----;:,::::::::'.~;-,::;;~_-::-,,,::::::_:,:_~";;;,~.";,,;,;,~,:::::::,-:-.-:-:~ .-::=;:-;,;;-.;;;- "~,;;;,;,,-::,,:,:;:;;--;=;;:~-'-'--;;c--"'::=':':='
REAL l'HOPETl'I'Y:
2 1/2 otol''y 1'1'UIlll1 dwollJ.o/,;, 1'l'111110 banl( bal'n, outbl.\lldings,
119,5 aores sluto 1'lll'lI1 land and 119.~) aoros 1'lOoclland. ..
Bitul1t~~ in M:lddlosox 'l'ownshl.p, Oumberland Co., 3605 Spr'ing
aoad, (Jarllslo, I'A 1"(013 reoor'ded in tho CUll1uer1and
Couhty Tleoorder 01' Deeds o1'1'ioe, Daad Book ~C", Vol. 11,
page 192.
Value basod on I,\(lpralual--------------------------..- 205,00 00
PERSONAL PTlOPERTY:
Three oa1ves at $100.00 each-~--------------------------------
Farmers Trust Company-oheoking Aoct. #~~0593-0----------------
sBvings Aoct. #8-20071-8----..-----------
savings Acot. #1-100q5-9 ---------------
CDN 111193-------------------------------
UUfi 2q~3 -------------------------------
Dauphin Deposit - Savings Aoot. #60083----------~------------
State Oap:t.tal tlltvings & Loan Assn. - 'l'erm Oert .1100'2.. :~(J-12861
Oumberl~nd Valley Savings & Loan Assn. .
C D #6688252---------------------------------------------
o D #66855q6---------------------------------------------
o D #66ti55q5---------------------------------------~-----
Cash in decedent's residenoe----------------------------------
Cash in safe deposit box-Farmers Trust Co.--------------------
Cush-Acoounts receivable pd. u1'ter 5/23/79--------------------
U.S. Gov. ~H~ Bonds registered Clarence L. Burgett or
Ethel V. Burgett
$5,000 V3104809H
1,000 M7551251111
March 1970----------------------------
Jan. 1961-----------------------------
U,S. Gov. "H" Bonds registered Olarence L. Burgett
$5,000 V3230073H June 1973-----------------------------
Pennsylvania Power & Light Co. preferred stock
Oert. # N NP/O 373 - 10 shares at 113 3/8-----------------
Ce~t. # 13676 13 shares at 43 3/8-----------------
Agway, Inc. oommon stoolc..C1arenco L & lerank l3urgett-l/2 intere
Oert. #A98565 - 1 share at 25.00-------------------------
Agway, Inc. debenture due July 1, 198q
Cert. .lIC33555 - $2S1~~eiice-I;:-'&-i1'rank-i'JurgetT:.:.'ln-1ii'Eeres
Cumbtir1and Valley Coopel'ative Assoclatlon preferred stock
Oert. #10736 - 1 share at $10.00-------------------------
Oanned Dairy Pl'oducts Inc. - Milk checks 5/7/79---------------
5/15/79--------------
5/22/79--------------
Cash - Proceeds 1'rom publio sale-----..-------~----------------
Agway - dividend check--------------~-------------------------
Cumberland Valley Cooperative-dividend------------------------
Oav1is1e Livestook Market-sale or 2 cows--------------------~-
State Capital Savings & Loan Association - dlvidend ----------
Fred M. Potteiger - sale of 6 cows -------------.-------------
Ernest K. Hockenberry - sale of 1. cow-------------------~-----
P P & L Dividend----------------------------------------------
1948 Plymouth Automobi1e--------------------------------------
300.00
9,211 .26
16,687.18
26,02 .59
ll. ,Ill .67
30,5q .27
1q,60 .08
3,597.98
7,72 .62
10,298.16
8,21q.36
39.58
1,55 .00
Ilq ,25
5.00 .00
1,000.00
5,00 .00
.75
.87
t 1 .50
.00
.00
1, .49
4 .81
3 .67
8,629.80
~.90
.40
1,2311.03
1211.66
3,500.00
600.00
2".88
100.00
TOTAL------------ 372.036.76
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COMMONWEALTlI OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
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,J. / -J (I ,,'~ ') ,-?
RESIDENT DeCEOENT
COUNTY OF _Cl!~JlJl~.ELI\ND
IMPORTANT,
ThiN roturn lIIu.l ho oomllloted In dctnllltnd ri(;;lih'"'('h;l;iic;h~, with ullnt1Rohed, with 0; RCI.illler 01' Will" nf the
County whore docedt'nt u,"Jdcd, ltectum ili dUD within nhlt' 1II111lthM !tClor dlUCI (lr d,'ull" unh!!." UIl ~"lcn"on I. ,rlll1lCd
hy the Seoretaf)' or RO'lel1l1tl. (Soutlull 70:lllf Ihu Iflhel'iIl"II~r. nlltl ENttHI\ Tu Act of 1961,)
u _._~~_ _.
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UlI'u'Ull!lf.-yfr. .L'ctr>~~; 1~" "Fe ~O';;TI-'--"-~""-
Lot. a' ........Q.!.llIl.P~_llins.!.___._....._._....,.__~_.... Caunly
5101.01 l'ennsy lVan;lJ.L_____.._.}
...
Caunly 0' Cumber1llll>L._____,
Jt.....-.C..ly.de Ell I~O.t.t ,_....______,___..._ ...._..
>ttA1ll(DiOl~dtX- a' the ..t_t. of Ih. ohoVl'nllm,tt duedtnt being duly 'WOln. d,poII and ur
Decedent died Mav 2 3 I 191L{IDlln.' ',ovlng a la" willI ClOPV of which I. h.r,to atta~h.d, }
(MONTHI IDAVI {YEAR) l>lo(~
Nom. ond odd,... of allatn.y 0' } Irwln. I~w..:Ln &.. Irw :Ln___..
oth.r outhorl...d tep,...ntnt!vt 10 whom }'I\ 17013
nll.a"..pond.n...houldb.mall.d, ~II .S. Hanover St., CElrl:Lsle,
AFFII1A VIl' OF
EXECUTOR
Mlllllllllrl'KM'l'IJ[
R.ooutor
Thatn' ,uch~QQ,It()~_dcponcotls fllllllllnr wllh thenffalr, of ,nld e.tnle IInd Ihe pruperty cllnstltutlng
III XE CUTe R" tbXIJW\aXK.rM"liDO
the nsscI, Iher.of and th.ir fair mnrk.1 vnlue.
Thatnl Ihe time of d.ath therc IOn' no ,nfe doposll h"x regiNtered in dec.dcnt', IndlvidulIl namo. III Julntly with, Ill'
us ngcuI or depUly of another. ur in deccdoUI" Indlviduulllame. wllh ('ightof uc..ss hy lInother liS ngout or dc'pulY. with the
exeelllluu of thc f"lIowlug: -
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NAME AND ADDRESS 0,.. BANK OR O'H1ER INSTITUTION
IN WHICH DeCEOENT Rf:NTHO A S,~FE DEPOSIT RO)(
-,
Farmers 'l'~13 t W. H:LI~h St.. Car'l 13
THIS SAFfi DEPOSIT AOX RENTED
IN NAME OA NAME~ Of'
,e C .arenDe 3urge'
Rfll.ATIONSHIP OF JOINT
HOl.Oe:R5 To Df.CEOI!NT
That tho .ontonl. of Raid .afo d.poslt bcx or boxos Ill. Itemlz.d und.r S.h.dnlos 13 of Ihls r.turn,
wllh Iho excoptlon.of tho following, for Iho rea,on' hor.lnllner '.1 forth:
ThaI Seher/u/e A attaohed hereto und mado part h....of ,.t. forth fully and In d.lall all the roal proporty
In tho Commonwoalth of Pena.ylvllnla of which d.c.dcnl dlcd having an IlIlcrest thcreln. II alRo sot. forth tho
mortgnge .noumbrnnces upon .noh paro.1 of real prop.rty at thc duto Of death, giving the amounl . till duo at
d.ath, nom. of mortgag.o, date. rale ef IntereRt, and book and pago of r.cord thoroof. It also .ets forth In tho
columns provldod thorofore tho asseSHod valuatluo of "nch uf ,aid parc.ls. Ihe estlmaled market valuo theroof
as of dale of dealh of deeodent.
'l'hnt Sch.r/ul. B attaohcd horeto and mud. part hcreof '01. forlh fnlly and III delall all pet,onal properly
wh.rosovor .ltuat.d owned by the d.e.d.nt at tho time of death; al\ monllY' IeI'I by the d.oodent at tho time of
doath, whethor In d.cedolll" Immodlutu posso"iun, stunding 10 d.cedonl" cr.dlt In bank. of depuslt, savings
banks. Iru.t oompanles, or othor Instilntlons, wholh.r Individually, or in trn.1 for any other person or!'erson.
giving also .oparatoly the aoorued Int.rost ther.on, if any, down to the last Interest day prior 10 dooedent' 8
denth In tho ca.. of Raving. bank., alld to th. dale of d.cedellt', d.olh in all other "asos; all bond.. postal
saving'. trea.ury ourtlftcal.s or noleR alld oth.r evld.nce of Inclebtudnoss of the \Jnlted Stille, 10 Ihe do.
codont; all obligation., whether by 'tlltnte or agreclllont they are de,lgnaled as lax fre., of the United Slatos.
or allY shlto. or poll Ileal subdivision Iheroof. or of IIny forelgo eonntry. which aro owned nt the time of d.ath;
nil wearing apparoL jewelry, Hllvcrware, picturos, books. works of nfl, household rurniturc, horBcs, carrlngc81
antomoblle., hoats, and any aod all olher persunDI chllttcl, of whal,o.v.r, kind or natur., h'ft hy doe.d.nl.
tog.ther with the flllrly eSllmated mark.t vulu. th.reof; all bunds and mllltgng., held by d.e.dent nlld uf all
.Inlms due and owlllg d.cedelll at the tlmu uf dcath, and nil promissory 1It'les or olh.r hIRtrumeots In writing
for lhe paymont of money of which doc.d.nl died po".ssod. of whut,oev.r nalnr.. with In teres I Ih.reon. If
any. giving Ihe face "alue und csllmat.d fnir01arkel valuu thereof, and If such eSllmaled fair mark.t valne ho
Ie" Ihao tho fac. valne. It sol. fMlh hriefly Ihe r.a.ons for such d.proelAtlon a. In each Item; all moneYH
payahlo to Ihe e.,ale frol11 life In.urnnce p"lIcle. oarrl.d by decodenl; all annnlty and endowm.nt eontraet,
tho prooeed. of whloh were pnyahle ul1l1n tho dealh nf tho dec.dent; nil and the corplllal. slock, nnd dlvld.od,
dne thereon and unpaid a. of thc dnle uf deulh. hond. and accrued Intere't Ih.reon 10 tho dAle of decodenl's
d.ath aod nthor IlIvoHlmonl securlti,,, ullncd b)' thl' dccodont ut tho tll11e Ill' dealh. with Ihe market value there.
of at .uoh time.
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In tho I1tlFW nr,litlll(trlt,lttl-l nf' OIOHU HI' I'/tlnlly 1\lll'l"II'IlI,IUlllit t-lIt! \'"lUllR l'nIH.lI't.ort 1I1'f! fiR l'nl; IIH
llllHHII,dll h,III1""\11 It't,(~,t h)' "tltnunlnl f1tlllt:lllllllt,Hq(! t.1I1! 1\IIl'l'"I'IIt,tnukl Hhnwlll~ UIU /llliHuUI ulHlllnll1lll.iuH
tlll'I'uol' lit! Ill' lh llnl,o 01' llnnth. 'I'lto Huhndlllo IIIH(1 tlnl,H ('111'01 tllll Illt-Ol"''''I, nt' ,'oflfHlnnl. 'It {,tIll ll~ln nf'
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kltlll h('llllllnllll ('t"'1I10Iu1 'R't.I\1.11nllllltH HllfJwllH~ flloll""'!!1-H 111111 lllllllllllflH lit' HIIIII I1I1",pllrttwrHhll' III' IHll"llItlH~1
1\ f'1l1'~' or Ilu'f\o"'l'nrtnht'l%tlll\ Ilgl'IHll111111!,l (I fl oi;nl t II Htnl.11lllfllll !'wl IIIH~ "nl'111 till' 1I111-III'fl 01' t.hn 11,1~1'1'1l1n1!1I1)
1 nlll'l hI' I' ',,1111 /I H tn t.llllllllll HIl t I, IIIJ.I, 1'01'\.11 thfl flhu I'/ll! tH I' 01' HII' hUH IIIIlKH, t hi IlIol\ tlllll, IIlHIHIII.1I OUIPI' I'flt' UI
1ll'1'lil'llll,!' 10 U\f' blUtlllOHH 11M t1IUj' hI! !,HI'tlllulIl 10/1 I'ltll' 111111 ,!IIHI. 11)1111'111,,"1 01' U," tllllltlltl!lIl,'H 11111'1'''''11.
tlll'l'l'tllI11Iht tlll!'t\lllmllt.Utt. It MhOIlI" 1\1H(I HI'I ('1I,'{.h In lIHI1Il'lI!l1 1'01'111, ItJHothnl' \\'11,11 thl1 fnl,' Itlltl'kt11, \'n1w.
111""1'1'1\'1 1111\' 111,111"1' prCl(lftl'tr oWfltlfl 0" hfllllll'lllhnd hy UIO ll"l\llftonl III lho Ilml' of' Ihl/dlr,
'l'lin ~J{/'Nlfll(l (. llt.t.llnlwd hlll'lll,o HIIII IllIlI,n 1'1I1'{. hlll'lIol' Hlll,M f'ol'lli It 1!'lIn ""Hwn,' t.u lIftoll Ill'lIlII'Y
t'tllllllllll'llltll'l'ltlll /111ft IIIt.hlt nftRnof'I.I'illHil'l!I'Hol'lll'lIll1l1'1)', 1'llId 01' 1'l!1''';Olllll, wllhlll IWll Ylllil'~ nf' dHOllllnlltlH
111'1'lllt 111 l'tllltl'Ulp1ftttoll of' t1uol'CI(!I1t.'H ,1Il/111I, 01' I 11 1,1' I1dll(1 to l'II(It nl'I'nn!. III pllssllSfilll1l III' 1l1l.luynl!llll III nI'
/tI'U'I' dlllltll, tllIlll Rlllltllllllfl HtltH fort.h t.llo Ilnt.IlI'" It 1111 \'/1111" of' Hllnt! 1"'OPfll'l,y, 10 WhllI111I'flIlHI'llJ'I'I'II, t,!lu
1'0)1\1,11111111,11' nl' t.ho t.r'IlI1H('("I'UBfol to Uln .lnllollt'lIl.t tl,lI pl'upnl'I,llllllll.ll ",111\1'0 t'ot'nlviltl IIY (Illldl, tf'ItIlHI'IlI'llll Illlel
n) I Ot.lllll' flllll,H nf' 1\ pnrl.lflflllt nul-III'" rflJ("f'r1lfl~ HIlIII 1,I'III1Hf'flt'R. In Ihn I1IlH" Ilf' 1.l'lIll1i"llrH 11Itllndl,d 10
t.nk" lll'l'illl,l. III POHHllH'llnll or on.lnymolll. lit. 01' I,ll't.ltl' "nnt.h, UluI'n IH ul,l;(1 1I1.lllnhllll III tllll Hnhnclll111 II 11l11lY
uf' t.Iltl "",illt truHt. /lJo'ool1\flnf. nl' ol.llor Infltrlllll11lll. llrlll\f.lllj~ l,hn U'IIHt.. Thlll"'1 I>> ItlNfI HIll, ('or!.h III IlIlJd
Hohfllhllo Il II!;I, 01' nil II1'OIH'I't.y, 1""'1 1tl\i1 Ilf1rRCllllll, wlt.l, ft.H \'lIlu", wltll1ll JlltfoSllli III. dll',\ltllfllll.'s' dOIlI,1i hy
II 1 r t.\ll' (d' UIll "'Wtl(, I Hn liy clnondllll I., 011.1101' 11lt11 II Idllld I ~', Ill' J n Illll~' Vt'lt" 1\1101.1'(>1', 01' /lilY l'lIW1\(' n f' "11(lld n 1,-
mHtl1 \'(r~t.lldlt1llooodf'l1It., flll-lIltl' llllll\'l(hlull~' fll' .lollll.l~',I)yl.llIl hili, flNt/I, 01' oU,nl' IIlHI.I'tUlIOIIl. of' 1I1\lIUWI',
with II 1'1111,\' Ill' t.lln 1nHt.1'lImtltlf. I1rollt.lll~ HlIn" !lUWlll' Itl,1.tlohptt 1.0 Lhft Hl1llflflllln,
'1'11/11. ,,'cbl'dule D nt.t,nolwl1 11111'01,11 /lilt! mlul(J )Ill"" hm'l'1llf' !'iIlt~ !'ol'lh thn nnmnK 111111 nd,lrmHWfI flf' III I
pHI'HlIlIH hl'llol'lnJnl1y Jnt.nl'UAt.flc1 III this PH!.nl,n Ill. t.l1f! !.llllO of' dl'IH,dl!l1t'R IltlHl.I,. Uln llnl.l1l'll III' 1,lInll' l'I1H-
"~1f~t.l\'o Ild,UI'llAt.H, t.holr roll\t,lntHthlp, If' nll~l !.II 1.I1l1 t!nllntllllll. 10[.I;l'tlll\1' wllh t.llll III~fJ!i 1\1. t.hn fh'll nl'
r!Of!(l{]nlll.'fj dllnth of' 1l'11'm'110rH, nnHull,I\Il!''' IllllllI"llu('ln11IrII1H 1'01' lll'n 1111111\1' f!IHHHlnnt'H Will. It niHil
nont,nll'!; n Rl.nt.flmnnt AhowfnJ.l, wldoh cd' 1.110 hOllof'folnrlmt' Ill1l1lnd III 1.111' dllllllfllll1llS will, If' IIny, Illfltll,l'lnr
tn c1w:ndnllt, t.ho III,t.oN of t.holr Ilnnth, 1.l1ull' lliHtW, Illtlll.1ll' l'nluUIIIIHhlll 01' HIIOb IHHIIIl to 1,110 htHHd'lnlltl'y,
'.
'11111\1. S,:!l(1r1ule [ nl.t.nnhOfI hnrol.CI flllll mlldn n pHI'1 ""I'(1nl' filq~ l'III'llt Itll PI'ulHl1't~', )'I1/d ulH1lwr-
fHJIHtl. nWflofl hy l.hfl Il(loolllml. ,ln11lt.ly with tlunt.hnl' nl' Cll.hnrRI IIWluflil1R Int.nllJ!:lhlp, Rl.fllltltllJ!; lit t.Il(l fllll1lfl
of' t.ho doofHtnl1l ntlll oLhN'f1, plllH Uw "/ll,n nlld plllOl~ nl' rtttHlI'II of' IIIS1,I'tUnfllll.H pt'f'I'oI.1TlJl; thn 'f1Ht,II,lll'tl of'
ronl lJRt.nl.n 1\1111 t.ho dlttn of II(Hltthdt.1ol1 of' pllrAnllll1t.~'t plllH thl' 11I1IllO, Htlll1'OttH Illld l'uIIll-IonRldll, If' /lIlY,
() r nn-n\'/t\llrfi t.o t.ho (1lHJo1111Tl t..
'1'11111. Sr:/1pdule F ltt.l,ochocl hflrnt.o nnet muclo II 111\1'1. hot'nnl' Hnt,s f'flrt.1l f'ully flllfl 1ft IIfll,I\11 Itll Ilnhtfl
Rllft cllllhwtlnltH n}ltllnntl for Hltd nit lwhhl I' nf' tilt" dnOHdt\llt,'s flHI.ltl.n, IlIdlHlIllg "lIl1nl',l! tlXpHIlHIlH plllcll
f'nmll~' nxc'nlI1Unn, whnro nppllonl1101 I1nHI.R or IlflmllltHll'lIt.lnl1 nl' t.IlIR nAllIl.fll IIOIIIHwl f'lltHl Illlt! fillllf'IIll'''''!-l
eommlHHlnllH plttd or t.o hI' 1'IlIlll flOAt. ll,xpnl1flfld "ur hlll'lnl t.I'IlHt.R, t.lIl1lhHtunnH III' v,t'II\'t'mlll'klll'Ht 111111 I'Hll"
~1()\tR Rnl'vJcoR, 1n OOhHOllllfllllHl nl' tho (InnUI of' t.hll ,10oOllllltl.1' dnhl.H IllHl tllnlmH flWlllj.( Itllll unp"ld III t.lm" of:
donlhl I(I'XClH I\COl'llOCI ol1nrp;onhln f'(lr Il1lI'lflfl 1Il'I()~ l.~l flnOllllflf\I,' H .1"I11.h ((lXI"'lll. UloHn 1l11owncl \l1t(\OI' Hopl,11111
ntH 01' t.lln Inhol'lt.flllon H1\rt Jo:!'HItt.fl 'rllX ApI.) I tllAnOI'''' wll.l, II Ht ul.Ufl\/l1t I. 111' 1'1l111,lflf'ltI 1'1f!l1p;lld f'ol' 01111'(11"
t.IOIlF, If' lillY, It 1~ 1lp;'rofHl {.hnl. t.ho 1'I1111('1111'~' will JlI'llRI'nl. P"f1ot' 0" Hulll 1~llIll1ln" flhllf~lltli~UIi IIpllll 1'11-
Cl'lt'H I. , thnl. If' t.ho Ilmuttllt 1\0t.\I'\II:.' pull! lit Hntl.lnmnnt (II' t\lIY 1'00, IHll1lmlHHlnll or c111ht. ,,, II'HR t. It III I t,11l'
ORUmlll,"" HnlOHIlt. elntmhtA IIlttllt11llWf'tl, I,hut. Uln BIlIlll' will llf1I'"p'Il't,nlllll Ihllltl'J(IHl.llI' nf'\\'III~. ItlldUln!.
t.lln nlllOllltt. fll' IIll( ItfiHI'RHtI\1 HIlIl lw "I!IIHSI'HHl1d In llf1nnl"'l\lIl~fI t.ll1'I'nwl U,.
'fht,t thf! l.ol.II1R ilf' t.ho npproprlnl.n t;nl\lJllIlR 111 fipl10lhlll'H ",\", "II". "C"t "E", otICl, "l~" UK Iltl'IHlf.(Hl thorol';~
h"vI' lJflOn Cltl,"tod f'orwnt'd 1\'11l1 pl'nl~nrly rOJ.(lHl.lll'l1cl III U", Htlnlmury.
Subscribed nnd RWOl'n to before mo thin
"I.' ~ dny f @.X'l-J~/'~
'''''''''(~~Yr' I I~'''~'
I 1\1 I II f
" " ' If' I," I I ,,1
,107,9" .
.
({I ,I,~ ,!:i ~, I) I It'
'"'''''''.'''''~;'''''''''''''''''''''''''''''''''''''{.':'''''''''H'''...."..,
(E~&cllt(lr.Admjl\r.trator )
3605. Spring.".Ro.ad..,......
(Street Numbor)
CarUl?ltilJ..P1L.,.UPJ3, ..
(cl/y or Town aIm St414)
.J
'N(ITI';I Unl'llrn HI.u.nll1~ nff'llluvtt mnkn HIII'n 11:11 hl!\I1k ftlltil~l'H III l,hn H('f'lflllvll, Hllft Heltofl\llll~ ltl1lHlXlId Ilru
I't 11"1' In wHit tlot.l\t.1R or 1,110. 'it'nf'" "Noltn", /twl In UilHO Hill III;fi(ll.H 'Iudlllln I'llI'll IIllil 11111 1~I,CIf'RnPtlr1t.lfJMt
HfHHlrlt InK 11f' c,lmto, nr f'ltnllly r.OI'llorllLlnflH 01' 1\\1 11~f,(lI'nHI., 1,11 /III.\' l'n-plIl'UIIlI'Hlllp fir ""HlnnHH, t.ltnt t.ho
f1lltl\ 111111 st.lll.nmflllt.ft riHllltroll \ll1e'IlI' l.hoPllt'tH~"'lpll IIhtlVI~ 1,,,1 ,,1I11J.', to S(J!Jl>llulfl "II" /11'0 nl,t.twhOlI. ,\lMII lnukn
c'f"'''IIII.1.111t1. p.u1llnUl lit In' t.ho ,"'t.II"'nllf'~'" hilA hflf111 I'I'Ol'lll'ly (illlrll'lflUlII IlH 1I1111\'n-dlrn~t.flllt,
RESIDEHT IlECEDEHT
SCHEDULe "B"
PERSONAL PROPERTY
'*
11111-""'111'1-"16)
CDMMOHWE"'~ TH Of I'EHHlY~V...HI...
TR...HSf'F.R IHHeRll''''NCf! T"'X
INSTI\\lCTltlNSI This Selwdllh, IIlllkllllscloko 1111 hllllllhh. IIl1d illllllllllhlo ,IO,sol1l1l prupIlfl)' "1I'11.,d !!1~1~1!'!~!lLI!L~':.
dl"'I'dol1l III IIw IIMIlI or hlk dOl1lh. I'rupo'I)' oWllel1 h)' Iho doved"1I1 Jollllly wllh 1I110lhor or "Ihork IIll1kl he IikllHI
iiiiife;-Sjt",',fiilcnil ~i'iiiiil111lhle por"1I11111 pl'ol"'rl)', IIllelllll Ihe IIl1l1lv "I' Ihe dl'I,,'dOI1I, hili pII)'lIhl" III dl'"Ih I" "'II>lhl'l
III "Iher". IlIehllllllH hili 1IOIIIIIlllod I" !'.tI.ll. II.S, SllvlI1U' ",,"ds IIl1d 1011111111'" IrtlNllle"llIll1l", 11I11"1 h" 1I.1\'d, dl"pll,'
Ih" hu,1 Ihlll IIII')' IIro ""1 of Iho IIdlllllll.lorvll 0"11110,
TIII1"lhlo P"I'S"III1I,"'port)' .hollld ho Ii.lvll 1'1"1 (".H. ]l'wdr)'. w"lIrllllllll'l1Illol, h,,""chohl ",""Ik, IIl1d
furnikhhl"H, huokH. l1ulllllngH, tHlllllnohllc~, hUll IN, Ol!'~f)
1I1111111(Ihlu pUrHIIl1111 prnIH,lrl)', SlIl'Il "H hUllllh. IrcltHllr)' ucrllrlclllt'H, (~"l'ih lilt hunt! nIHlln hunk. Nltllo,'ks,
lllllr I l(ll MtlIol , lIoft!H, 11liJllthor with IIC(lfUcd illtonHil \If IllvlduntlH, HulurluH or WllHtlHt IIlNurllnt:t~ rmyuhll' 10 till' ('Hlllh~ Of
t'hllwlllry In Nllid Ulllln(~lly, (1l1rllH~rHhlp IlIhlfONtH, Inlu(UHIIIl !IllY undlHlrlhllllHI tlNtlltc (If ur Incollll! from !lny pfUlll\rly
h"''' III 1111"' "1It1er II", ",111111 "",""11I11111 "I' "",,'hilI, "I'"'' IIIIIIIHh 1""II'od ""I shill IIr Iho SI"ll'. "I ,hI' 1111I" "I' dClllh.
khlllll" I", IIslud 111 lhls " "'lI'dll 10.
I(em
Nu.
I'mM
Lls'"l1d do.crll", 1',,11)'
IINIT ESTlMATlm
VALliE MMU<BT
VALIII(
IlEI'AI\'IMI(NT
VALlIATlON
(1)11 ""1 wrlll' III
,hi" ","I<'lI'
Farmers Trust Oompany
checking account '4-0593-0-------------
savinga aocount , 118-20071-0------~-----
savings account 'l-10045-9-----~------
C D 114193 --~-------------------------
C D '2453 ----------------------------
Dauphin Deposit-savings acct. '60083------
State Capital Savings & Loan Association
Term cert. '002-20-12861---------------
Cumberland Valley Savings & [,oan ASfJoc.
C D '6688252---------------------------
C D '6685546-----------~---------------
C D '6685545--------------------~------
Cash in decedents residence---------------
Cash in safe deposit box------------------
Cash~accountB receivable paid after 5/23/1
u.s. Gov. Bonds, Sories IIHII
registered Clarence L. Burgett or
Ethel V. Burgett
$5,000 V3l01180911 f'ilarch 1970 ----------
1,000 M755l2544 Jan. 1961 -----------
registered Clarenco L. uurgett
$5,000 V323007311 June 1973-----7------
9 ,211B. ;?6
16,687.18
26,O,?6.59
11,410.67
30,5'19.27
1/1, GOl. DO
3,597.98
'(,723.62
10,298.16
8,214.36
39.58
1,551.00
1145.25
5,000.00
l,OOO.OO(
5,000.0
P P & L C~. preferred stock
oert. II N NP/O 373 -10 shares at ------
cert. IITAPO 13676 - 13 shares at. ------
430.75X
563.87
'I J ,d. 1 ,~U,
,
,/
Cumberland Valley Coop Assoc. preferred
stocl< Cert. 1110136 - 1 silaro at -..,----
Canned Dairy Products lno. - Mi~k payments
Agway - dividend check--------------------
Cumberland Valley Coop-dividend check-----
Carlisle Livestock Market - dale of 2 cows
State Capital SavinRs & Loan - dividend---
Three calves at $100.00
Fred M. Potteiger-sale of 2 cows
Ernost K, Hookenberr'y-sale of 2 CO~1fj
P P & L - dividond------------------------
1948 Plymouth automobi1e------------------
Cash - proceeds from pUblic sale----------
10.00
98.97
2.90
. .40
1,234.03
124.66
300.00
3,500.00
600.00
25.88
100.00
_h629,80
IIl"orllhl" 1111111 "1'1'".110 '.'!'crslIIlIIII'''','orty'', Sch"dlllo "II" III
Iho "As l\ol'lIrtod" CIIIIIIllIIlllI Iho IlIsl 1'11"0 lIr Ihl. rotllrn.
xx,
67,014.26 If 14,Il;N1.:a.
MI{'
".Jy l
,
r<llv'..nlltlle711)
I'ml\lllNWIiAI.TII 1ll'I'liNNSYLI'ANIA
TItANSl'l'll INIII'.ItITANn: TAX
IlI'~IIl"'NT ""'I'EIJIINT
Sl'llimULH "Il"
III !NI(FI( 'li\ltll(S
- --- --,.- ...- -, , ~p- . r----'-". ..__...~- ------.--r- -
---.-,~---------,'---...-._"
lIIiNI',FI("tlIlIHS ANIl AIlIlKllJiSf!ll KI!I..\TlllNSIIII'
(Sll"~ rulll1RmOH nnd lIddrOfllfoH or nil whu (II .lop'l'lllldron "r SUIlVlV HI) !lATE lNTEllI!ST OF
hllvolln lnlorc,... Yt1fllod, contingent or olhor- 1110>>11111I" ,. oh Ihlro" IlHCHUHNT 01' IIl!NIlI'ICIAllY
wl.o. 11\ ..11110) IHI,) 1l1yulvud, Hul STATH YJ(,~ IIIIlTII IN HST.ATII
, Innh IhlH 11\01.) Oil NO
-. ~ ...--.:...-.- -, -
F. Clyde Burgett Cln~ ",au. _.-..0-...... ' ~-l1(ll.aJ.c.luo-....--
----.
~605 ~.I2E.~.ng Road ..... nd Real gatato
. .. ......_-~---- -- ----~-_._-
~rHa1e , P^ 1701 '=l -'. --'--
- -- - --~--.__..__._-
ilioc B. Gutahall nAlllf.hbn. ~WL_ '13 l"AR1 n11a___
.35111 Sprinp; Road - --, --,
CarHs 1e. I'^ 17013 --~.
.
.
---- - - - -.--'- ----..-.. ~----
Rut.h 13 t Shaffer -Dlllillll.1&L yea .-- 1 / Lr.e.IJ.;I..dLle__,__
,E....n1\nnY Drive --- .,
HarrisburEU. I'^ . - - - -- ----...--.-.-..-.-.--.. .
------. .. --.. -_.---~---
Car11-s1e Snr:l.nO'B Lutheran C \-11"011 yes .,- - ~:l.nnn.oo , --.--
~.!'inp; Road
Car1isl~. P^ 1701~ -
,
....----. -
Gar.Y gutl;!hall . Orandaon .",,,. $..L..o.o.o.~ n n .
.. . .
s116 Biscayne Ave, S.W. ..
Huntsville. Alabama 1580r- ,. --
-~ ,
~-~_.__._. .-- -
,
h'.Il.ndA 8h n ""n~ "~h~dA ugi", n~ "nh .44nnl1. nn
.---.
2 Sun:IY Drive -
!i.1!rr:lJlburg, r:.^ - -,
""C"
--- - ..._--.
--- . -- ~ ......------.
I ,
~ ----....---- 1-. ,. - .
--------.. -.--- -- - --..--
- -- -.- ---
...QQD tin u e d....Q!l Page ~ . ,
.. ____~__'_i.__. . . -- -- -. .-'--'
--
~----
___-1-<____._._..____..___.__.........__:..::::
De~~!~t furlho, .ay. that all t~bove'named b.lI~flcla'le. a'oll~,lng 0~~1~~~ axcept belowl
__-=-"=--:J
NAME
DATE OP DEATH
RESIPI!NCE
,
--.---
- .--.~--~~.-------
-.
----
, nt;::';~.uta (11.76)
Cn~I\lONWI(A\.TII 01' I'I'.NNSYI,\'ANIA
TRANS!'I,'11 INIWIUTANI'lc TAS
IlFSIIIFN \' ''''.('HIWNT
Sl.'lllmllU\ "Il" .
1\I\Nl\I'I('lAHII'S
. "^n\j' ')
_ ..;....-_....___......+'-..___w___..+.~.__....._~..........-~._b_.~._-._--.....;._---~--.....
----- .....-- -- -- ...-.__. :..:._....""-~.......,.~__""---_ ........_....~~_.:-- _,........._................__~c.... -,._~~~~...---'"...._~.~----......-,.~-
w._,_________.____
IIHNliFll'IAIUHS ANIl AIIUIU~SHS RE\.ATIONSllll'
(Stlllo rulllllHlIL'" llmllHldro"HOH ur nil whu (II UOI'"dllhlfoll III SIII\VIVHIl IM'\'II IN'I'EIlHST 01'
huYU 1111 InlllrchI', "Uti led, lmnlln"ont or utllo,- IIIIIalllllllllO ohllllll'lI 1l\\ClmEN'I' 01' llHNIWICIAllY
WlH61 111 UH~lltO) nUl hIVl'I\'NI. sui STATU "l'li IIIWl'I1 'IN HSTATH
rllllh Ihl. rl\ol.) 011 NO ,
---~- .- -..-..---..- ~-_. --~.-- '. -_....._~-
David Allen OJ.lJiJllLill......___..__ ..QCD-ndsol1__....._ __.~.e.a. Jh.7-52 l..OllO.~.aO__-:_____
Denni~,Jl!:\lE.lL out~.lL-__. O~fl.JldoorL_,___. ' __..Y.Qt\____ _Q.::.'l=.5Jl~ __..l.."O'O"O.."O'Q -
Vicki Ann Gutshall (Ipand(iuIl'hter> .ves 8,-10-r;I; L..Q.Q.Q.....OP .-
-
,9arolY!1 MClrie outshall .~lrandauP;D.W_ _~Q.u..,-_. 6 9 "1- _-4...0o..a...00____.___
- -:l -.-~-
MeHnda Kaye OutBhv.11 Orandaugl1te!'.._ . yes 8-2-60 -- _l....QPO.OO
----
Marl!. Leon Gutshall O"'andBon "'y'es ~-211-~ ......J.....QQ..Q . 00 .-
--.
Andrea Jean Outshall --.--- Q!'_andaUi~hter._ ...J..QlL.... 2-28-..25-. 1,000......0.0..__-,--
11Lresa LQJL,Out sj'lall 0,., n ",4 n" "b..t 1'" .,y..e.fl_._ Ji:,.1-()8 1 ..o.o.a...oo---.---
15J!J Slwinp; Road .- ---- - - -
Carl1.!'le. PA 17013 -- - -- ._-'~
~--- ------- --.- - -
"
-' -.----- - -
;"i' '-
---
--'~-' . - . - . -
, , ,
- .
,
- ---- , .-
, , --
- - -- , -~-
- --.--.-
"
--...- --
, .,
----. .- -
, ,
, ,
, ..-
- - , , ' -
-- -- -
--. , - ---
,
,
--
.- -- --4----'----~-
,
----, ---- ,
.- -_...~~._~
n____ .-' un
- -- ---- - ---
. --- - -- - -- - -. . _._..~._..-
-' ~._--~-
Deponent I011h,r .ay. that all the abelvo.named bonollelarlo, ara living at thl $ tlmo O>leopt bolowl
=----:"-~- ----- -
NAME
---...-----:==.:=::'1
RESIDENCE
DATE OF DEATH
-.-.....
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1 ~ ~8
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Reel Properly
PerHunnl Properly
TrnnNforH
.TQh:lt
SUMMARY
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(AN Reportod)
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,72.016.7(1
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I GOM','O""',/,L'" Of "'"''''/lV[;N'^l''' II __!L.Jlc_c.c.mbfl.r..-191.9..
1;I.8IUEI'JT 11\11-11:111 I'i\i'JCC TIIX COIJN,y _.J:..\tmI1!11'.t!HUi .__.._
1\'1'1'11^1:;IIVlr~l'r f", "" 2l-'ln-03'l3
-- ~~----~~-_._'''----'---- ~~-~- -.-......,... ~ ~-~-
. !11:v.4!1I (f\.7111
UUPAUTMl::NT OF I1EVcNlJ[
IIUllt,AU Dr FlEW OI'EflAlIONH
P,O. BOX 2Q'/Cl
IlAIHw.;nUltn, I'ENNA. Ulon
WhOI'OnHI -.J;lu'encn 1'.1.._Jl.!:!..~tt _. latc of __Carlisle _.______..._..__ .___
in tho County of C~mhorl}~~~... _"___'__ CotnmomVll~l~h flf 1\'fIIl':,;'I','dt)Ii11 ILl\,? II I,l, dil'd'lll
tho 23rd dilY nf l1a~,__ __ 19 _., !lllh\od IIlld pOHnel;!,,,d 01 ,111 ""Ldn
subject to [nhcritance Tax undor tho I~w!l of tho COIl1Il\'lI'iI'lcnlth of POIlIlr:V'IVilllla;
Thol'oforsl [, Gloria ,J ~__r:.!-ch~.~______ ,;\11 ,WllI':ti'-fll' dulv '1I'POiIlIOd ,"""'J;'rlln'l'o I.,w,
h~vlng been dosignated to make a fillr and cOIlr:cinnahlo "PPl'ainClllollt of tho I"lld O,ll;l\v, alld [0) ,p'nol'" ""d I Ix I it" o;l-:h
valuo of n1l annuities and life ostatos growing out of fJaicl ostato, hOl'Oby filo tho followinq npPI'IlIH0Il10nt:
In tllll OVOllt 'hilt allY futuro IntunJ5t III thlt (IH,l\e It Ir,'Il\lotrud III pllUflUIIl1l 'It U11)lIYIl\illlt to I:olI.,lIn,IIII,"n lIllI,,' d,'t:\lclul\\ ,1I1t1l till'! 'J:<-I,lr,,\1111>
01 /lny u5\lIlo fOlIUet 01' fOf YOIH$,lIl0 CflFnllHlllwollllh llOt'JhY nl(r"o~~ly 1l1S'!IVIi~ \l11l11111l! In .WIHdt!U .111l1"Un$1 if,ll\\llII IflllC,rIl.l!l((' til'>':jl~ ,~III\I1I;I'.'/I\11 ("11,'1.,,,11
'olio UIl any surh hlhHO IllleroU.
-
--_._--~.........-----
or.<,cnIPII(iN OF ^~,~:, 1 --r---nMrr-.....'--7tl;'iit,ir~mj
\-'/\LIll"i I\'\i.dll f'" 11l!,lqll.,,,p'
r "X I'\jr "'l~l'~
V9D' T'a+JI'tA "2..Q..4O;l 00_
PA,.,RnnRl Pt10nortv - _!9.1...llJ1L2..~..
Transfers -- . __lI.2.n..e ._--~~
,JninT1y Owned --. --_.~-~ .2..Q..
Tni'll 1 372 039 Z~
- --..--..--. .. L.~__...I_,_.
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Hnvo boon duly sworn acoordlng to law, I do horaby oertlfy that tho nhovo nppr"isomontl~ mndo In cnnfol';lljlY
with tho law on this ~..h day.of _ DB cBmher _. , J,') -.:...., ,
'J. .'."i-,:~:'i~_
( 1\IIPl1l\Hr
((~lIlllld!J .11101 ',I'/nlll
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!/(C. .1(1.1,1/1
AI'PLICATIUN fOR CIIARITABLE I:XI:MPTIUN
fROM PENNSYLVANIA TRANSfEH INIIERITANCE TAX
(Act of Muy 28, 1956. P.L. 17~7, Utili Au of JIII\tl 15, 1961,
P,L. 373, O. ullItlnde(1)
*'
COMMONWEAL TH OF PENNSYLVANIA
PEPAIlTMENT OF REVENUE
BUREAU Of COUllTY COLLECTION!
Application I. horehy II led for the approval
0' on oumptlon /ram Ponn.ylvanlo Tran,lor
Inherlt.nce Tax 011 the tronller 01 tho proporty
dOlcrlbed bolnw:
1. Bureau Fllo II
:'I..'('I-\'I'l
Mil.'! ;,.~, '1 '1'('1
I\'.QueJ:LI (IrL7~~._
C:l.^HI':NCI': 1.. 1111]1(1Ii:'I"1'
...._-----_.._~~
2, Doto 01 Deoth
3. Date of Approval
4, Name of Decoqont .
5, Tho Commonw.alth'. oppral.od value of tho proporty for which on oxomptlan I. clolmod I. $ 22.~.(~~2....__.___.
(Notel Whore th. proporty I. othor thon a .poclflod omaunt of co.h, tho oxomptlon cannot bo approv.d until tl,. valu. 01
th. praporty ha. boon OItabll.hed by approl.al by the Commonwoalth, excopt In tho.. co'" who,o tho amount 01 tho gift
or boque.t r.pre..nla a .toted /ractlo"al or porcentago portion 01 the ontlro OItOtO or tho entlro r..lduo, In tho.. co...
.nt.r .uch fractional or porc.ntog. amount abovo),
6, Ch.ck tho mannor In whl.h tho tran.lor wa. of/.cted and .ubmlt a copy 01 tho docum.nt outhorl.lng the tran.l.r, unl...
.uch mot.rlal ha. boon provlou.ly /ilod,
WILL l!J;
DEED [l;
TRUST INDENTURE 0;
SURVIVORSHIP 0;
OTHI!R 0;
(1/ other, explain) _._.__.........~._.._......___._.... ..m.... ....~..~--.._.....
._._.__~_._.____n_~._.-.~.
7, Corroct BUllno.. Namo nnd Addre.. of Charltablo Organllatlon rocolvlng praporty.
HAM E _..9..11 P ], 1 n 1 0 '1:,1:\ n 1,';!:I..Jc\i\.I~'.21:~~~1.~,(.:!.1.:l.PC 11...___________,
ADDRESS~rwl:.':'.G....~~~flcl,....(~f.l~~~~n~L" ,_\~0:~!.:liJ::!...1.!fln\ II..X~~J 1.._
8, I certify that the Information cantalnod hor.ln I., to the bOlt 01 my knawlodgo and bellel, true and carr.ct,
t''':: Cl.~ '^~ ?M>
Slgnaturo 01 Applicant _J._._.-;~n___ I -.-~.-----
Addre.. 01 Applicant _1(iO'i'lpr...J~~_~?acl , _.~~~lfJ ~o , ,1'ennsyl van1.a 17013
O/llclal Title _..!:~lC.~<:.\}.!~_.....______.._.
Dote
Thh form mu.t be completed In trlpllc:nteand all three coplel dellvered to tho Rtlghtor of Will, for .hl! Coul'lty In which the decedent
,nlded, or In which I"lten wore luued for a non.ruldant decedent', ulnlo, If the doced,nt was a non.resldant of Plnnsylvanla and
letter. wore not luued by n Penn.ylvanla Rogl.hH of Will., dollv.l- nil thru coplol to the Dlrectof, Buteau of County Collection.,
Penna, Deportment of Rovenue, 26 S. 4th Streot, Hunl.burg, P(l,
__..__~..E~nnt wr!.!.'!Jl".!~.~-,hl. Ilno. For Official U....2.r!!r.
Approved: For tho S.crotary 01 Rovonuo
Rolerred to Bur.au Hoadquarto"
Approv.d 0
For Socr.tary of Revenue
k~tUlY' ~~(:v\,v._.___
,,\S~''X'v~f'...._..-vl R. Ogl~.rt'or of Will,)
_. ((V'i'r\~O~...J__.___
(County)
lx.~Oc:. If 11)1)lj
, (
(Dot. 01 Approval)
Donlod' 0
(11111101.01 Rogl.tor of Will.)
(Authorlnd Signature)
(County)
(Tltl.)
(Dato of Rofo"al)
(Oat. of Action)
.. S" r....er.. ,Id. for r.alOnl
MUH BE Fl~ED IN TRlnlCATE
COMMONWEALTH OF PENNSVLVANIA
DEPARTMENT OF REVENUE
BUREAU OF EXAMINATION
OFFICIAL NOTICE OF
INtiERITANCE TAX
ASSESSMENT
.
COUNTY FILE NO: _ ;;) ( .. r L9.., . > ') ~:l
TO: :) ( I~ . .,1.0 .~j,A/l.~ v{ l
C) ~ (~ . . .\ "J '
'/") Ix.,I.I,'\J-",.J (\)...." AI.. \J ~.'/l.A...N,..A.[l\
I ('i..;l 'q( C'vY',~'J Ji.A.. ....~/i)- \' ,:J.
C{A\tu~,._. n.... ('/(J U
txl/,);f-
DATE r l{Jo.,I'_L:l, /(~I)tll
ESTATe 1,('I"'LtI.-. (.1' ,," ,)J..~',,,, f:l\.
,;) I, (/9 '" ?? 3 ,l
L~~i(~.~lf'ol.J-
DATe OF oeATH'\t)('11. d .3 1(11)?
me NO,
COUNTY
ApprDlsed Velue Df estAtD:
Aeel Estete
Persoll.' Property
. ~.~ Of-I c.Il )1),0 ()
,
+ / c.., 71 0 J 17 ,;.I "-
+ .x d., lsi 0
. 3 '7;..)., (\,'37, 'l {,
3h. 8'.2.:LO I
. 3 3 (:, I 6. II , ').'i
I. UOO,(lO
Jointly Held Property/Transl.rs
Total Gro.s E.tate
Total Approved Deduotlons
Cleer Velue 01 Estete
Lese: Approved Che,ltable Exemptlone
CI..r Valu. 01 f,stat. SubJeotto Tax
, 3:3 (;
..., _Co'
/ c. tj- '?~:
Amount Taxeble @ B% Rate
:1 ;;.!r,"
. .... _'/!.;J
l/,.fl. t7;;;
tex duo
. (}O,..Jo9' 6'!
Amount T.xable @ 1 B% Rete
tex due
TOTAL PENNSYLVANIA INHERITANCe TAX DUE ',~Cl I () It Jr.t
· · · · .. ,A five peroent dleoouhl totellng .
will be g,enlod If the Inhorltanoe Tox Is pold by
Lees Credits:
DATE OF PAYMENT
AMOUNT PAID DISCOUNT INTEREST TAX CREDIT
. J. 0 10(1 ,88'+ . $ . . PIn, 11\9./(5
+ .
+ .
---
I :;. ..; .3 . '7 II
I- ,
Inte,est accrues at the ralO of olx (BI porcenl per annum
on the unpaid halance' 01 Inhorltanoe Tox from_
to dete of payment, Interost d"e If paid bi _ Ie
BALANCE OF PENNSYLVANIA INHERITANCE TAX Due
· f(d, 1;),1' ':7 l'U
I,! iii'
, 'i i...J I:Uu..J
, '} I . 'I ,/ . ~ '/.
"t
"'cV'''' I"''' OED\JC110HS ALLOWED IH
crr ICE or THE
REOISTER or WI~~S
STATEMENT OF' DEBTS TIlE SUM or ___ I ~};.:J!.; qJ
AND DEDUCT IONS. . . . '.. ~.,.A e~::p. A.oveJ'l~.\' L:LJJi.!..4i-
I' . . L:1..^ 11. ./,:,,_Yl1(k~
,I>, /, f ~'L, J,ti'!i'! _. /'X~,~ A~~,:ToP w't.!t.,'O',"T .___
or JlllJ.lIJI<:HLAND COUNTY
AND AOEHT or THE COMMONweA~nl
EST"ra OP UlllI'onoo 1.. BUl;'I.~()L(; . ~ATE OP JUdd] eflpx 'j'ownohlp
vQ"'t", '
DATE or PI~IHG "PPRAISEMEHT .J:jsy. ~i , 19'(9 DHE OP DEATH --.!iB.Y 2 3. 19'79
____.u...__
_.------
-'
1"'1E
NO. or
VOUCHER
HAME or PA vee
ReMARKS
AMOUNT
6-15-'(1I f\or,1.tltor' 01' W1110
._,__,....._._L- .____ ~,_____..._-....
X,ol,tor'!:,. eto.
3'1 00
-.--,...-----"'- ----.-. -.
6,:,.2..6.-3.9_ .... _..._~_ Q.l.unll.o..rl/J,ncl l,uw ,T.Q.1\r.J1Ul
t 1. ol..ru;.
.-..lJL J.lJL
1I.f\. Gl!.~fJhu11. i3011f\
'rr>llctOl' 'l'lre_ L'ix~d
:rlJ3..ono OJ 1,_~I.Ql...)Ll.co
1'- "1 oJ]
'( ,. 'r.' n
-=-;.>.:.. ........
C( ,. '(' n
-;:.2::'_..:.1______
Ul1.C-M.ud.1..c Dl...ca.u .
Qur'1:!.13 lo-llildiolo "
1'lOUl':11 L111:1.ol1
X-rDVG
~
Ill.orOUlle burn ino uranoe
7..",..".7.9._
. insto.l'__f..&lli..e..''''
., Ql'iul enl".~iruJ:-
Sunday's M:l.ll Co.
l"arlll supplies
162 20_
126 85
,:/--f,j-+9.-
C(-5-72......__
7 - 5.':J.L..
L-:5.-.. 7.5L.._, _.
CarHule 1I0fJp:l.till.
Med1cal serv1ceo
"
19'18 Jncomo tax
13 91
24...1:!JL.
.2
16 6'
._~-
.J.i. "I
...l2, ll!L
P l' & I, Co.
.-.----~
Eleclric SOl'vlce
1.:::.1.0-::...7.9_ tal. Dtat'lotioa.. Death GorU !':Loate
7::::.?J::.79_ ___.. rhe I':von :l.np; .Jent :l.nel. advertJ.l1 :1.ng ~_
(1.,.)..'7..,..7..9... > Dont of.J.\.\LlU'!l1uQ ~c{!L6-'1q S(11es, Use tall..
i (i:::.l,'(.,. .:r.!L..._____ l'._l' & Leo. . lJ;.lQ.Q t l' 1 C 13 e r' v.;l.OJ,,-__
tbl'l='(,9-- _.. _.. 11. M.cflo,v...-- ., .
8.-.1'(..,.7.9_.______ '-_1lQ.ll.1LRo.tL....,_._..__. lUl:'1.l.1-CX!.l-Cllilell__
(1", 17.,.'( .9,_,..~,__._. ....&..JU1J.\.t.llhall_..._...____ s pr ay in g
8""17,...79..,....____ QA.Y-'.Jl...J!J.ilL.Q.Q.'-____,_~,. . QU
Q::l'(-'(.9...........___, 'lat.1.on.w.i.dQ_Mu.l<.uo.L...lu.U.. G(l. l'.J::.elnlum L'o:'.J;..r.llil.k......____.._
8.,.,.17::::1.9 _....,.... ....n...... . .e.Lll.j.la.hI'_...__,_........___. <11'1)1' Ii i.s.al_____......_...~_,_.,___._..l5.
., . .. n . ...,_",,""~ ;!lJ.,JJ.1i.}S.~.l:gEms!];)L~l1Lll'l,,-\~k~,~,.,,"J!;:?lJY,.~rQr..~l3.~ II U.oc-:IUDO ~"~.X~l..~.~....c~~,,,,:,G~ })~ __
. .
. . ..
HhV.'ll\n (I-at
I'^UI-: ;,
DEDUCTIONS ALLOWED IN
orF IC! D~ THE
HEOISTER Of WILLS
STATEMENT OF DEBTS
AND Di:DUCTIONS
HU! SLIM 0" __._~__..... $ .~I/ () 0'., I 01
, \ {\l' i i (II Ii t.
VA E ^;{fZVEV ,..:..:;.. ~ _..., _,./ 1
\,) J"~ /' T
J.. ..J_:-., I C1J~__
( IH,:ulflll,rfofWI,LB,AUftH
_____,_____ Nj~ ' ___,_.._..,_
OF _ CUl1LiJ.\1lL.lUiL~ COIINTY
ANIl AGeNT OF TIlE COMMONW!ALTtI
ESTATe OF -.lJL^HENOI'.:......J.,....._JJ.J.lliG].:'I"J'
LATE or MlI)/)Lb;::Ji.lLXpWNIJIi.ll'
-~_..
--..-.---
_.._._.._,__.~w
DATE or rlLINO APPRAISEMENT .J~!l.1L.-...!i..,_~9:L!J DATE OF DEATH Mil)' (!".,...J.;ln___.....___
m__~ - - - .. .. -
- -- -----.
NO, or NAME O~ rA YeE REMARKS AMOUN r
VOUCHEH
. - h__..__~.~..... .. - .~_. r"'--
--.,~. ._~~-_.~- l'__..L_L L Go I Ji 1. () 0 t; .!:'.1.2__!:!2J~ v :I. ~9-..___~.___ _......:.1J_ . <;').-
-~-~----_.~._-
'''puok . .CllL
-..-....-.-- liu.t.iQmi.1,U.lLl.llil....... 00 . 1 n U u t.illJ.c.l1 Adlustn.umt "
.~-- .-'-"
.... - ___~. __.__n__~__. )!;IJJ.~L J.:........Jl!J_\:!!illlL .jXlJ.Q.lL.iM p 0 0 t; 1 0 n '( 112
.
9. lkg.Lat.llJ:!......o.f....W..LU.u..__ ' llhoJ:t.......o..orl......._ ? nn
___ _,__'_,'n'n."_ -----
.7.9.. 1--- _'1110 Evonlnj~ Sont;l.llel ua:lJL.J!gvort;:lll:[ Dn: ---- 42 00
9_ -----_.~_. II . R.1._llilli_Qluill.. houo & bnttOI':loll Xl II" -
I9. Morr:luon '0 oJ..L___, Gusol:lne 100 1"
--.----. .J
'l.2. -- [) D Guts hull HauJ.:l.ng animals 12 00
7.~_ p p ...L r.. Co. Elootl'lc sorv:\.oe 9 93
L Dean Shall Auot;loneor-publ:lo sale 336 00
,-.--- -
9...,. -----'--~~ _.. Dean Shal L Advert 1s lnr(-pub11c '3ale 286 00
L.. C. Ott;o Clerj,-publ.:\.c sule 268 00
c IR(,H'or B. TI'wln '.'r.tary rees ;J I~ nn
~-_._~_..
c II~AO' oLWills ),' l.l.jJ]E-Lill P . & Inv. 6.00
.- -- -
.- Rer:. of W.Uls -- el~l.l:lnr; . D & D 3,00
~.
.
- 1Roe. oj' \Vi llll.....- -- 1Ij'I1.IH: Account I-- ,'7 ,00_
--- ,-- IRecOl'c1or of' Doeds - Hccord:l1lE releases Ij9 00
,-
-
....- -...--.- ~:" Clvde J3uI'n:ct; t b:x~,quj;o!'s 1'ee 14 161 lCL
....- '---.--- .Irw1!h. Ipl1:ln.....!..L!:~I:ln at ~,ornoy 's roo. H.l161 10
;rl'W 1n ,_,~ PW lrL_LI~D.....,_ l'1'cparat:lon !;'ed. l!:ot. '1'0 x _500 00
--.- ._,~,,----- --
I\eturr 2 ..ita.a.
_.~- --"-~--_...- .b'.r.a.n1ulllllJlc.._...._.._____.._.._ ..E,urnu.c..r--l~opn '11' jL.QJL.
-- ..__._.._----~.. , ---- .--,-.--....----.- -._~ ---
....-:.:...,.-;;:;;:-"~~._......,.....--- , . _. .... - .. - - ... --. J2... 8 '~~ O..k
DATE
9::.9....n
,9.-6,.75
9-,6-:(9
ID,..3-'(
U:::16",
1Q",J. .0:::1
L.9.:-.1 6....
lQ.::X~.::.
.lQ.:::!' ~:
'!O-f!,:-::L
1 0 -,g--:.'1.
;LQ:::.6..-_7
lO-=G~7.9
1)...-: "-7.9.
~,.. "~._'--.'-'
---...---
COMMONWEAL TH OP PENNSYLVANIA I SS,
COUNTY of_vJl.MI,'Kt'L^ND_
I. ._...li.~ (~I.XDILUUlWE.'J.'n' _u.____..__.__~___ HEREBY CERTlry, THAT TO TIlE BEST OF
MY KNOWLEDGE AND BELIEF. THE f'OREGOING IS A JUST NiD TRUE, TATEMENT OP DEOTS, I'UNERAL EXPENSES AND
EXPENSES or ADMINISTRATION SUBMITTED TO TIlE ESTA' E OF ---!<hCltlb;N.CI~..l,u,.....ill)lWI~'l'T _______
DECEASED, AS DEDUCTIONS FOR INHERITANCE TAX rURPOSES. . " (-;2
_{- {1J.ipLl. J:J-v,.. i"1>1A.
I c/
(L.S.)
,t'
SWOI\N AND S'f-SCRIBEO BEFORE ME THIS.
-- (J.Q C~Sl" ~ ,~" 19-1.2.
___ c__"'''_~~ ).--_ - ':'J (..(;: UL
1(: ) ,I
Ud;II~+-I''', ',(' ',1 (\\lUII'(
MY I()~,;,','ii ,10;1 I ,',I'IIi!:: (j, I. :1, l~jW
DAY or
Hr.! 'U l\l,t-III
COMIWNWEAL.TlI 01' PENN~YLV^N'^
DEi'AIlTMFNT OF RI:VENIIE
IIU~EAU OF COUNTY COI,L.ECTlllN~
AI'I'L1CA TION /01< M'IlIlHI'.Frll
TO TllANSFFr< SEedlillllS
IlEGIS1H~[1J It~ Till' I~AMr:
OF A RFSIDl'tn DFrFDENl
'*'
AfPLlCATION (MUST BE FILED IN TIlIPLlCATE)
TO THE PENNSYLVANIA DEPARTMENT OF REVENUE:
Application In horuby modo for cons",,1 10 Ihe If""sf., of Iho r"llowl"u Gocurltios of 0 Pell"sylvonlo
Corporotlon or a National Brlllklng AssoclollrHl I!)cnlod I" POlln,'/I,,,,,,,,,
DATE ~Y>?Y~l
(aL.JJL,__,_....(b)j'.f .&L 00.. . (c)..4 l/il~ p&>e.f'liI'1'8d--.-...
(NOTE: In doscrlblng socurltlos olltor III ((I), nb (~e, o'Iher Iho "umhor of shuros of slock or tho foce omount of
roglstered boods, In (b), the Ilome of the Issulnu COllllHlIlY olld III (c) Iho do,s of stock. or the stoted Intorost roto
(lIld maturity dMe of reglstored bOllds.)
Ivtr'~ i.3, (1V 'I" .
ISSUED ON -~ . AJ,I....L,., olld havlllg u TOT AI. MARKET VALUE OF $.43.3.. 7~ '.m nh .._....._____
(00'0)
us of the dote of death of tho decedent, ....QlIU..enQ.!.l..L..lJv.l'uett
(HI'mll of Ducudlll\l)
.., onla~m2.3t--J.~.19-..____
(Doto of doath)
who was late aLJ..~.QJ...!h'+':~HIL n(NI'\. q,wU,.:\.e.
(Straet and HumIHH) (Po.IOIfIC'-I)
Owul:ierland .... h. .fa ..1'T-DJ.J--
(County) (Statn)
Tho socurltles are registered os follows: Olareno\~ L. BUl'gett
(Nnnlll nr nnmnl In which COrflflrlll/ls urn r"ol.tarod)
I
I
I
I
I COUNTY FILE NUMBER_al~7.9,.,..313., ADDRESS OF APPLICANT 3(jO~ Spl'1ng .HQ. Oarl.iale"I,e-b
I I 'J
i BUREAU FILE NUMBER ~~.~__._.... . $IGNA TUR E OF APPLlCANT~ ( (IV, I IJ' /"'1'.. t. 't:.~.~--'-__
I HOTICE: IF YOU FAil TO PROPERl Y Fill IH AHY PORTION OF THIS APPlICA{iON, IT'Wlll NOT BE
. L_______~OHSI[)ER~~.~,~~PlETE AHD Will BE RETURHED TO YOU FOR COMPI.ETIOH:
t---'---"'''''----COMMONWEAL TH OF PENNSYLVANIA.- DEPARTMENT OF REVENUE
I ~.9N.SENT TO TRANSFER SECURITIE_~ '.."Y\). 1(iJ S~
I DATEh(av~.o;;;.L)'
I I hereby consent to the trans for of the obavo socurltles now reg/slerod III tile 1I0mo of the of ores old
~M~lI.~)_1<'..._.Qlyg~.Hl.lrg~j;j;. ..3605 BD1'1111.' Ild.
EXECUTOR (N","o)
NAME OF APPLICANT 11'.
Olil"J.1(41il. PA
(Addrllu)
. \;:!.YUtl ;JW.'q,lilli.t
. 17.0J..3
Decedent and wolve tho filing of 0 cortlficale cortlfylng 10 the pUYl1l0nt of the lransfer IlIllerltance tox to which
the property of sold Docodont Is modo sublect p1lrSuollt to tho provisions of the Acl of Juno 20, 1919, P,L. 521,
as amonded and the Act of JUliO 15, 1961, P,L. 373, os o01olldod, This Is ulso In occordonco with the provisions
of the Act of April 9, 1929, P,L, 343,
This Consont to Transfor tho horolll descrihod proporty oporotos only In rofe,enco to tho estate of the
above-named Docedent.
~I~p~. t\
.' \'..",P
t' 6( ".
. ,."., I..L"
Si900d..frr I.hO ~eCletory of Rov.en. u.. 0
\ d ... nil . .. 11'\ \ I
By..( Cl ~ ~\.l, '~~.~)Y'JPJt~:.._..
i'l~~',. ,(,I~'(~;~\:":It.,"~ W~~~).. (~~~~~~
\ ~o '{ (CO'llty)
,
, ,
, ',"
(O".'\ONW!Alltl Of' I'~NNSYLVAllIA
rJll'AR1MEtH Of REVENUE
aUIl f. All O~ COUN TV COLI U:TIONS
APPLlCA TION FOR AND CONSENT
TO TRANSFER SECUfllTIES
IlEGISTERF.D IN THE NAME
OF A RESIDENT DECEDENT
*'
A~~J..ICATION (MUST BE FILED IN TRIPLICATE)
TO TIlE PENNSYLVANIA DEPARTMENT OF REVENUE:
Application Is heroby modo for CQ150nt to tho tronsfor of tho following securities of 0 Ponnsylvooio
Corporation or 0 Notional Bonking Assoclullon locotod In Ponnsylvonlo:
Ij (b) p , ),. ( ) /1 1/:' 1'1'(01'01'1"(,<1
(o)__c,._u,___....... ..KNNS.'iINI\NI/\ 1. OWER & LIGHT. COMPANY.__.. c ,.._-~.......,.. .-,...,...----.
(NOTE: In doscrlblng IOcurltlos ontor In (0), ob ""0, olthor tho number 01 shoros 01 stock or the lace amount 01
roglstered bonds, In (b), the 110100 of tho issuing company ond In (c) tho closs of stock or the stated Intorest roto
and maturity dote 01 ruglstored bonds.)
DATE....
ISSUED ON ,1)(~l1omb"I' ..~o, ,1.')~I') , olld having 0 TOTAL MARKET V AWE OF s.. ~?63 .~_8 ---,..,...~_..-,....
(Oatn) ,') ..
os of tho dote of death 01 tho decodollt,.. ur.~.H1':N(;j':.],. BtIHOJoiI'I' .. , on.,~cl:r...'.:.~~...~~l..'<)__.____.~
(Harne of Decodonl) (Oattl C)f death)
who was late 01 3(,01 Spl'lng HotHl,
...., ._. _._._____~. .....H'__ .__
(Strllol and Humbef)
UIll'I.1ll1u
(po.,Offl,e)
C:umbol'land !'onnlJyl vnnl a
.. _< <w_'__ , ,. ."r~___. _ _..'n '".,__.__ ___~,~_
(Coun'Y) (S'o'.)
The sucurltles oro registered OS follows:
C:LJ\I\EI~CE ]" BUHUj,n'!'
(Namo af namUl In which c:ortlflcatu art! feglltor,d)
YI;l')YMt:<<S.l~~~~X ,.l'>_..C..I~)?!\,_13UHCll<il!I.....]~O'.) ..~lL'T':lll[" Hoad '. ..~'1I'11.:1.~, 1_~:r~~I~~:~.~::~~lt~_:'~~,l~..__._~_,~.
EXECUTOR)" (Namo) (Add,...)
NAME OF APPLICANT .~.. !"!....c:L~YDl': l~lJHC.lJ~lfl'_u....__ ......,. ...u
COUNTY FILE NUMBER_2~,:-'l~':',R? ... u ..u ADDRESS OF APPL.ICANT _;360.5_ f,pl'lnr; ,~d..,Jg~lTllf1~e,,_r:.^_J]~L3
BUREAU FILE NUMBER___~___... .. "'u' SIGNA TUR E OF APPLICANTj~...(LU;.."t'c_J,?~~~-'<> ----,-~..
NOTI';E, IF YOU FAIL TO PROPERL Y FILL IN ANY PORTION OF TIm APPLICATiON, IT WILL NOT BE
CONSIDERED COMPLETE AHD WILL BE RETURNED TO YOU FOR C(lMPLETlOH,
.,,----_. ---~.._"--_.. ,,"...
COMMONWEALTH OF PENNSYL V ANI A - DEPARTMENT OF REVENUE
<:.QN.,SENT TO TRANSFER SECURITIE~ "'\ " .~ () I fl.J'!>'
DATE 111.\.1,......+..f.
I hereby consent to the trollsler of the ullov" securitle~ 1I0W registered In the namo ol tha oloresold
Decedent nnd wulve the filing oln certiflcnto certifying to tho payment 01 the tronsler inheritance tnx to which
thq property nf sold Decodont is mode sllbiect pursuollt to tho provlsiollS 01 tho Act 01 June 20, 1919, P.L. 521,
os omondod nnd tho Act of June 15, 1961, P.L. 373, o~ Ulllonded, This is also In accordance with tho provisions
of the Act nf April 9, 1929, P.L. 343,
This Con~ont to Tronslor the horoln described proporty oporotes only In relerence to tho estoto 01 tho
obove.nomed Decodent,
'*'
.
~f . . i
1,,1"
Sl~l~ t tho :o:r:tory :f~e~onu:
I~(h;~~l.~ ~;~~ ~:it\^"':~'~ w^ I
l.\ IT tie) \ '..\ t (Coun'y) \
Jo'lfW'.I' ANIJ,I"lN^" AOOUUN'.I' ()Io' I". UJ,YIJ!-: HUIl(II';'I".I', EXI;;C'tJ'I'OH 01" '1'111': I';:J'I'A'.I'I!)
(JIr' o J,Ml i':N 01'; I,. BUHOJ';'I"J', I.,A'l'I'; Oi" '1'111': 'l'o\'lNIlIIlI' (lio' filllJl1"i':III':X I OtJMBI':I\l,ANI>
CutJN'j'Y, "i':NN:lYl,VMH A, 1l1;;OI';Mil.;D.
n~.!r;.J2!L,[).Iij^,J'II,: May ;?3, JI)'(9
J)A'l'H: 01" :i.nr3lJANCH: ai" J,J':'l'~'r1IW 'l%"I'J'AMI';N'l'AHY I ,Juno .115, 19'(<)
-~'"-"-_U~+-_._-""''''''-''___''''___+~''__'"''-C_._..........._....~__,"","""'""t~,_.___n
1)A'J'i';S 0]1' AI)yJi;I{'1118n:MIi;I~'J'iJ Oi" l,g'J"i'f!:IW 'I'Jo;U'I'^MI1H'J'MW I
-'-,.....-............-~-~....._':...............-.__.---.._~--,~-+"+~....-....-_._. .'1......~~......... '-.-'..........-irll__d.....____
Qymb~l?,;till.!EU:al'!...'l,!Uu.'ml)cl July (" 13 nnd 20, 1~'(9
'rho J~.y!llijJ1J4..E(On\J.J)s~}..1 .Ju1..Y;', r) Hnd 16, 19'(9
!L i'; ..B _L..'J~_.!.J.
"H 1Ji9..:[J;.ML(l,,!:...l' WW l?..!iil.!.L.!MJ J):Ij',/fl.
'l'he Aooountant; Oh'Ul'gefl h.Lmiiolf' \~ith l'oaelpt 'of' Homoo!'
I'rl.no;lpal o,t' PCH'sol1a1 I(,)\;ato J'ocolvc;Hl Ij.y t.\lOm {Hi f'olloWElI
6"19-79
6-19-'(9
6-19~'79
6-19-79
7 - 3-'{9
'(-6-'19'
'(-6-'19
'1- 6- '(9,
'1/10I'{9
'(/10/79
'(/:lO/'19
'(/10/79
'1/10/79
7/10179
'(/10179
'1/2 '117 9
]0/15/79
10/15/79
10/1!i/'(9
11/'{/79
u/'( 1'(9
12/6/79
:1131(80
3/31/80
,046h in p0sideno0--------___________________~.
OUlllbOl'lund 'Valloy Elav;lngs & l,c)all: Hodomptlon
o.l'1
39.58
S,:tvingB' Oort. (166882~i2----.;.___~________...
~uv.l.np':s Gut.!;. (/66855111)-----------_______
SavingB OOl'\;. ff6G8554G-"------___~--~-......
FB~1II0rs Trus!; Do. - Oaoh in 3a.l'bty Deposit
Box"'-- 1,551.00
~. Olyde Burgot!;-Acuoun\;s rooeivablo
' 5/231'(9'" 6/:i.9119--------~--~----~___~_____
Oanned Dalt'y J't'oduot;s, Inc. - M:\ll< oheolw ___
p P ,& L Go. "- IUv:\.dond--------____________.___
Cumberlbnd ValloyGoop Assn. - dividend _____
,]!;uto Gapl\;<\l Suv:lngsand Loan - dlv:ldend----
'Stato Onpl tal S & I, 'l'et'lII Gcl'\;. 11002-20-12861
DauphIn DopcHJ:\L-AooQunt 1160083--;',------------
Farmors Trus\; Go. - Acodunt '1-10045-9-------
1"ar1ll01"fl 'l't'UBI; 00. - Copt. Dop. /1111193-..----..-
FB~nopfl TpuBLOo. - Suvingn ~cot. ,8';'20071-8
!"m'It\(H's 'J'r'unt Go. - GOl'\;. Dop, 11211'53--------_
!"ul'mm's '1'I'I.IS t Go. - Aoot. (tll-0593-0-."--------
^gwu,V,- D:l.vJd.ond----;...--_____...___,____...._______...
Bolvodol'o ModJoal OOl'p.... Rorund------_____..._
Oolt\mOljJ ty Groen t Oor;p. -[Jot an 1118 'payment.-,.,.---
I". 01yde BtH'gott - Publ;LlJ BUle. pl'Qooedu
Commonwoa1 t;h oJ', l'onnElY 1 van;!.o ,.;. f{ol'Ulld ..
'!1POBSUl"Cfl or tll() U,S .-rAoplos "!till 110domp.
'7-551-254 and #3-J04-809
'llpeuBupor or tho (J,:J. -F~cpJ (~D "Ii;" l'odotTIfJ.
(/3-230-03"( ---------------------"----,,---____ Ij, 000. DO
Dav;ld (lu\;Jlhal1 ':' :.Jaln or P I' & 1, ULool<
10 QharoB ut 35-------------------r~--.---- 3ljO.00
CumbD!'larld VIl.1.10,Y Coop. MlIH!. -lJn.l.o 1 nllup.(, I' " .
. ,we () () .L......,..,. .,.0'" 00
'7 ,'{Glj. 98
8,253.9'1
10.353.J~
lill'5.25
219.32
25,88
.I!O
1211.66
3,503.'JO
11!,689.5~
26, 18r. 26
11,'508.86
16,8'7'1.68
30,'(63.ljll
9,0611,26
2.90
51. 60
1.09.20
8,629.80
1!!S.30
6,000.00
'l'O'l'AL 1------_ flGl, !lGI;I,I)B
LI[i,~ m, I,\t.!, L99
_~)J~.!~~!! L',I'L:,
i:J1':U'j'g ANt) ADM III Ul'I'UA'I'JOI~ 1';XI'I':IWI';~l
_~~~__.p _<~ ~., _ ___.. ... ,_.,- 'H'~'_~__'~'_' ~.~"._._,_"...~"._O'"-._u _..........._._
'J'l1o ^ooollnl; ulu1111n of'edlt J'C)l' Itf!llll)'"t' Deb\'1l IInd A,lmln.l,IJtpnl"loil
1,:xponflBf\ paid LJy 1,11011I/111 ,'ulT(lWI1:
6-26-79
7-5- '(9
'(-5-'l9
'7-5-79
'1 N 5- 79
7 - 5- 79
'(-1)-'79
7-5- "(9
'7-5-79
'(-5-'(9
'(-')';''79
"(-1.0-79 .
'l-23-'l9
8-1.7-'79
8-1.7-79
8-1'7-79
8-1'(-'79
8-1. 7 -'(9
8-17-79
8-17-79
8-17-'(9
9-6-79
9-6-79
9- 6-'79
10-3-'(9
10-1.5-'(9
10-15-79
10-1.6';'79
10-16N 79
10-1.6-79
10-16N79
ION 1. 6,- '79
10-1 '(-'79
11N~)-'79
11-7-79
.\ "-1"'-79
..(.. J
12-13-79
1~-1.3-79
12-24-79
2-11-80
2-11-80
2N 11- 80
2-21-80
CUmber'land r.LIIY ,10111'1'111] - ^'lvot't1tllnl"-----..~"--:r.
H. R. O,utut1l.111. 1J01IIJ, ''lrIO. - '1.'1'110\'01' t.lp()
, popa ll'-l-...'---
MOT1pJ.Bon ()1.J ServJ,o'o _'fluo] ()1]~--~-~---~----
l301Vod!)T'(J Med1nul Go!'!). - ModJonl lJel'V.I Of)rJ-"--
Cari1slo Rad1010gy Auun. - X ray horvlooll ---
Plough & L:ll11nl\ - 1)[lpnlnlluJ'an(JO"N---N-~;'''---
Woatm1nstor Cometary Ino. - MOII~I':lU]'
InsoplJ)tj.on-----------~----~~---~~--~~-----
bBl'l:lfl1.e Hosplta1.----Modluul sorvioon--N-----
Sunday's Milleu. - ~uP~ Buppl10B------------
p rJ & f, Co, - 'I~lootrllo ::.\{)r'vloe-----------~---
T R S - ]978 1n60m8 Tux--------------------.-
BI.tr'0UU ".1' Vita1. Sl;ntilJLluo-DoflLh CH'I'\;il':lc)ul;G'-
'J'ho I~vening Son\'ino1. - ^dveJ'l;in.1 ng..;--------..:-
Pa. Dop\;. or Hl.lVtJl'lIW - Slllos lIno '['IlX-..-------
p r & 1.1------~-~M------------~---------------
Jamos D. MoOoy-Heul ~Btato TaxOB-------N-----
a. Book RoLh-~unoral ~xponuos----------------
D. D. autshul.l-l'lantlng & Spl'uy1.ng-----------
Sunday B [~il.l Co. - II'urm s uppLlou------,;.------
Nut:\'onwiclo Mutunl Ina. Co. - I"rom1.lIl1l---------.
Mol Spuhl' - apPPH:lnal---....--------------------
p p & [, (Jo. .... 1~],ootrj,(J 801'Vj.(!0-~~-~----------
NatJ,onwic1t, lnIHIl'iHlCO 00. - PremIum qd.lllfltmollL
[';ar1 1'. Oarmun-tPl.wl< lnnpeoL:l.on,;.-------------
Hogis\;01' 01' WIlls - flhorl; eo.T't. ---..----------
D~in Bhq1.1-ullcl;1.ono0J' [oj' ualo--------NN--~--
Cy Otto.... c]:(lrlc fop Aa]o-----~----~---~----~~
'1'ho Ii;ven:l.ng Sentinel - Sale ndV('J1,t1Blnl~ -..--,-
H. R. Outahull - HOBO I buttoP:lOB----N~------
MorT'ison'u 011 Sorvlno - aaBol:lnb-~---..------ '
D. D. Clut~lhu.ll - lIuullng. bu1.1 _________NN____
P P & t.- E].DoLrio S01~Vlco ---~--------~----~'
1. 1 :r. Cout ^col;. -Hog. ')f Wllls-I.,O!;t01'f:l, el;a.-
Ree;. 0(' l'i:\'] h1 - F:ll:ln,r. Inv., appr'u.lHal---~---
P I] 1& I~ Co. - I~]n{~t;plo Bcrv1.cB ---------,.----
P I' & ]_, c6, ... El.Bot:f'lc aervjo(J--~-~~--~--~---
Heg:lutcr' 01' WJlls - [".IIII'll:' Deb Lf> nnclDed. ----
,Re~:lflt0t' or Willa - PA Inher:ltanoo TuXw~-----
p p' & It 00. - oloetplc, fH:~l.v:1.ep,.....--..:----...-----
D. D. Outt1ha1.1..----'------N----------------,;..-
p P & L ,00 t - 'clon l_pJ n U UIIV J uo-..-------...-----
P". Depl; 01' Hovon ue .- ,I.,lcon'f:)o ---------------
Tnternh1. )'(ovonue 1)()I'V.1.0(? - 11'(!d . Ellt; . Tfl.X. ----
(' ,. . lJJ \r'l
Llc~K ~J\) lntlE , u~
18.oo
69.!lo
uti,13
G'I.OO
IIS.OO
32.00
10.00
162,20
126.85
13.91
211.110
;'.00
16.6')
6.2/1
12.011
501. 92
1.51/11.00 '
1.33. 50 I'
6.2'7
30.00
1')0.00
11. 9~)
2.00
'7.112
2.00
622.60
26B.60
112.60
3'7 . Ij "
... ~ j)
100.15
1.5.00
9.93
311.00
6;O(J
i.l. 25
10 .,?2 ,';
3.00
20.109.88
~j. 611
l82.00
(i.OB
, 1.;?,01)
55.6'(8.00
INSTRUCTIONS
To Insuro propor crodltto your account, Iho numo of tho oslulo nnd 1110 numbor should bo .
clourly prl nlod on the check or mOlley ordor.
This detormlnatlon ond ououmellt Is mado III occordunco wllh Soctlon 421 and SectiOn 732
01 tho Inherltanco and Estato Tax Act of 1961, 72 p, S. 2485.-421,732.
The estate tox Imposod by Soctlon 421 Is duo nt Iho Illlto of Iho docedont's doath hut shall
not bocomo dellnquont until tho oxplrotioll 01 olghteen (18) monlhs altor decodont's dO(lth provldod
that allY ostoto tox occoslonod by a IInol chango In tho Fedorol return or 01 Iho tax duo thoro on
shall not bocome dollnquont until tho oxplrallon 01 ono (1) rTlOllth allor tho porsoll Ilablo to pay
Iho tax recolvos IInal notlco 01 the Incroaso, Calculalo Interest Irom tho dollnquont dote shown
on the lace 01 this lorm to the dote 01 payment using tho Inllawlng Inlorost tah'el
----.--------------------- --- -- --- ----- --- -- ----- - .....- - ---- ---- ---- --- -- -- - -- - -- ---
I rronlh .005 4 month s .020 7 months .035 10 months .050
2 mOllths .010 5 months .025 8 months .040 11 months .055
3 mallths .m 6 months .030 9 months .045 12 monlhs .060
---_._-.._.--..._._.__.,-,~_.__..._----.~--,-
1 day .00017 11 day s .00186 21 days .U0352
2 doy s .00034 12 days .002U3 2 2 do y s .00369
3 do y s .00051 13 day s .00220 23 days .00386
4 doys .00068 14 days .00237 24 days .00403
5 days .00085 15 duys .00250 25 days .00420
6 days .00101 16 days .00267 26 days .00437
7 days .00118 17 day s .00284 27 days .00454
8 days .00135 18 days .00301 28 days .00471
9 days .00152 19 days ,00318 'l9 days .00488
10 days .00169 20 days .00335 30 days .00500
,-----------------------------~---------------------------------------------------
Any party In Intorest, Including Iho Commonwoalth and tho porsanal roprosentatlve, not
satlsllod with tho assossmenlmay oblect thoroto within sixty (60) days alter rocolpt 01 this
notice as provided by Section 1001 01 the Inherltanco and Estale Tax Act 011961 (72 P.S.
~ 2485-1001)
Make check or money order payoblo tal
"Rog Istor 01 Wills, Agont"
Moll to tho addross Ilstod bolow!
IN 'J'IlI';' C()\JI\'l' 01" OOMMOI{ 'l'I,II~AS CW
oUr1Blml,ANn ,(JOllN'I'Y,' PltiNNflYI"VANlA
OHPIMNB' COUIW lllVIa:rON
:, NO".:! I . 7 ,/ H;,"j ':I
IN Rffil ffiSTATE OF
cr,MlmNCE 'I' B\l1Wm'J",[l.
DGHlOlHWd
Db:C1~IW: ()\I' I)lB'l'IUr.\IJ'J'10N AWM{lnNU
_._._.~_.mG.(\I, lW'L'^~'I'!..__......,
AND NOW,th:l'H \(J~ day or ,Tunp. '1980. at q I'd r.o'nlool<.
/>OS.. M.. purlJUClnt to t;!1O i1\;al.omO!lt 0[' l'1'opouod DluU'.I.butJon 1n tho
EHtute of' C1arenoe L.Bu1'gottj upProvod b1 tho Court on MBy Gth~ 1980.
tho f'\')J.lowlne; N.,n1 (Hll;uto :\ U hel'oby HWl1l'dodl n oonL'or'm;\.I',yw.\th the
provlo1ons of' tho LUBt Will and Toatamonj; of' 01111'onoo L. B~rgBtt ~o
1". Clyde. 13Ul'f!;el;t. In ree aimplo.
I'
ALL that oertain trnot of' land with tho lmproveffionta
theX'eon 0reotedj u1tl.lato 1n Midd1eoox,'I'oW,\1sh:lp. C\lln!Jel'J.'and
Cbunty. PsnnuyJ.'vnnla, boundod and de~oribe~, ao f'ollowsl
BEO:rNNINO at fl poet, 1n Lh0 pubHo road lOHdlhg' f'yom
Oar11s10 Spr1nga to tho State Hoad fl~ ~1no at lU\1dB 91'
Oh.r108 Jaoobol thenoe by landa of' anld Jdooba and H,B.
QU,tshall, i~orth 1'( 1./2 d(l[~rOOIJ I Well\; 3811 porohsa to a
ohestnu\; .l.n \;ho N(?l'th ,Mountri:l.rll thonoe by \;110 aa:l.d North
Mqunta:l.n. North ?'( 1/2 dORrosR ~aRt J.J.6 po~ohoo to at9noal
thence by Bo,mo and lundf\ now of' DavId Hay. and !Dd I ]):l.ok,
.South 12 1/2 c10[~1'(leB I';anl; 110'( .'3, p'nrOhOB 1;0 flt,'l)nOfl at
pu\)liI.oroadl 'tlwnao u:iong pl.lbl:1.o Jio'ad f'lro\; mont;101,\ed
leadlng to 00,r11810 Sprlngo, N01'th 85 degreeo WeBt 86.
porchea to tho ?laoo or BEGINNING. OON~AININa a39 aores
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