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HomeMy WebLinkAbout79-00498 , ~ ", , ", I' " , " /' " " , , ~ . " _'10 " /, , ! ,,, I " I I , I " " i ,cro- I ....... ..J. '8 N ,'! :i' ~ I,i " I' " ' ' ".' NO, 11-)'9 4~}8 PETITION FOR LETTERS OF ADMINISTRATION IN Tim li,:S1'ATI~ OF J~~,~"',/:\~,~l,,r,I;\r.!!,,~tu,Q,~"~~,,, IlgCEASliIl, To ,'" """ ''''''''','','''''''''''' j,( ,\,(: ),\(1.1: "I", ,l':.", 1\ I.\\I!,',I:,~\ ,1,\ 1.\"""",.""."""""""""", Register of WIIIH fOI' the Counly of Cumberland, in I he Comn\lll\\\'enith of I'IJllI1H)'ll'nnln, Tho Potltion of ",~,~p.~~~" 9.~~~*,~I!."~~~~P~",~r.,,,. ,,""" "" '" ..., '" """""'" "" ,," """"""",. ",,, "'"'''''''''''''''',''''''''''''' ,''',','',' ","'" respect fully Hholl'oll1 I hn t ",I.'I~r.Y:, "~~I'M!/"JU~l'~Q,WA\1\'"""""""""",, Id t f IIalllpden. TownHhlp (' I' 'I I C t, HI to of Ponns"l- was a reR en 0 """"""''''''''''''''''''''''''''''''''''MNt ,11111 J(,I nnl ,oun),. n , van ill, IInd n CItizen of United StnteH, and departed II1IH life IntoRtnte In tho County of JIJ.Ulb,~X',1IM14 "'"'''''''''''',''''''''''''''''''''' and State of J?,~~,~if.;\.:V:~,~~,I;\"""" ""'"'''''''''''''''''''''''''''''' """",',,",",""" "",,,,,,,,,, on "W,!!~~,!!~,~~l,,,,,:,,,,, the """,?~:\H'L""""""", chi)' of """,,:r,\\11,,,,,,,,,,,,,,,,,,,,,,,,,,,, A, D" 10",7.,9,,,, at the age of "'''~,~'''''' yearH, That the Raid ",~~,~;Y:","'~""""IU,",~:tll~,lI",1:"""""""",,, deellaHod, loft HUI'vlvlng tho following nllmed widow or -husband, holrs and neKt to kin, to wll: Name Relat 10nHhlp Slster ."'0''''''''''"....."",,,,,,..,,,,,,,,,, Slster ....,.,,,..........,,,,,,,,,,,,,,,,.,,..,,,, Pranoes M1Uer .,,,....,,,,..,,.........,,....,,,,.......,,,,,,,,,,,,,,.,,,,,.. Mr. M. I. Florenoe ,..,........""""""..""",..,."""".....,.'""..."., ...",.,."",,,,,,,..,,,,.,,,...,.,,,.,,,.,,.,,,,,,,...".,.". .",,,,,..,,..,,,,,......,,,,,,,........,,., Robert O. Blerbower ...,,,...,,.,,,,,..,,,,,,,,,.,,,,,,,..,..,,,,,,,,,,,,,,,....,,.. Brother ."..."...."",,,,,,..,,......,...,,,,,,,, ..,,,..,,,,,,....,..,,,,,,,,,.,,....,,,....,,,,....,,,.,,....,,. ,.",,,,,,,,,..,.,,,,,,,,,,,,,,,.,.',,,,,,.. ..""""..""""."""",,,,,,,..,,,,,,,,,,,,,,,,,,.,,,,,,, "",,,,,,,,,,,,,,..,,,,,,,,,,..,.,,..,,,,,, ."""""",,,,,,,,.,,,,,,.,,,,,,.,,,,,,,..,,,,,,..,,,,...,,.. ".."",,,,,,,,...,..,,.,,,,,,,,..,,,,,,.., ."""..,....,.."",."""""""""."",.""""..."'" """",,,,,,..,,,..,,,..,,,,.,,,.,,,,,,,,, """""""""""''''''''''''''''''''''''''''''''''...",.' .,,,,,,,,,,,..,,,,.,,,,,,,,,,,,,,,...,,,,... Rosidence 489 Bao t 11mwood Ave . ,~",~I:l.~J:l~,~,fiI,P,~~g,., ".f.Irl ",' ,l7.,QS5 ,a~~:~o~~~~:~:ilvanIa .""""".""",.."",.""""",17.20.6",."""." ,~9J.,"~'~3'" 9.r,~~~I:\~,!,:,t,'I-l"'" '" ,.'" rennsyJ.van~a. 1'70~, """",,,.....,,,,,..,,,,,..,...,,,,,,,,,,,,,,,,,,,....,,,,,,, """",,,,,,,,,,,,,,,,,,..,,..,,,,....,,,,,,,,.,,,,,,,,,,,..,, ,,,,,,,,,,,,,,,,,,,,.,,,,,,,,,,,,,,,,,,,,,,,,,,,,,..,,,,,,,...., """""""""""."""""""""',""""'"",."."", ."""",,,,,,,,,,,..,....,,..,,,,,,,,,,,,,,....,,,,,,,,,,..,.. That thoRe above named Include all of the noxt of kin, so far IIH known, The RI\ld decedent WOR possessed of perRonll1 )l1'OpoI'ty to the estlmnted volue of $""""~g,g,~,Q,9"",,,. and of Real ERtote, lesR Incumbrance, to the eHtlmated vnlue of $Ji~~'L"".""",,,,,,,, liS near as elln be aRcertlllned. Thllt the said Reul I';stnte In so fill' ns IH known IH located In '"'''''''''''''''"N.!.~'''''''''''''''''''''''"."".,,''' """""""""""""""""""""""""""",.,."".",."".".".,..",.."""....,.,..,........,.......,.."....".""",.,.".,......"",..",...,...'.",.,."..,... Therefore, your petltloner(s) respectfully lI)lply(les) fOl' LetterH of Admlnlstl'lltlon in the IIbove nllmed eatote, ' . Dllted """""'~~~,~,~~"""'~,~"'"'''''''''' A, U" Ill,.??" Signature IInd AddreHH of Petltlonel'(Hl 'i (\ '-) ^' \' ,_. . '. I~V, 11'1.1 '-I, - . .! __ .' ,,,",', \,~"V~"'"'' JJ ~ !'::\~,\,('"'' r. ,,~Ai:,d, ~,~Ii :~; ,:,,,,, '" '" '" ",9,:).,/+",!:t r.4I ~ :tf,\1IM", , "''',41''-"""""",,,,,,,,,,,,,,,,,,,,,,,,,,,, ",g~~.~~h,~~" ,;,f.. ".~r,l."':V:*.~."f:l.~,~."...~1.9.~7",,, .... ",..,..,."......,...""."",.,,,.....,,,,,,.,,..,,,...,,,,,,..,,.....,,,,,,,,""".. COMMONWEALTH OF' PI~NNSYLVAN(A COUNTY OF CUMBERLAND 1 RR: ""~~ "',~r.~", 9,h,~r.~,~~,,, ~~,~~~,~~!-?,~"""""'" ,,,""'" ",,,,,,,,,,,,,, '" ''',''''',''', ''''',' '''''''' '''''''''''''' "",","", """ named In the "bove application belnll' dub' """"""~,~,r.,~""""""",,,,,,,,,, 1I"col'dlnll' to III\\', RII)' thllt the foctR Ret forth In the IIbol'e appllclltion lire tl'ue to the bURt of ":,,~.~~I',,, k~o\\'lecl~ IInd belle e) , l!lw.rn ' , ) 0 ' V), \! ' """,",,",,,,",,"" """""",,"""",,"""," anel subRcl'ihed 1 "I,,,,,(\.~~,~,',, "",Cr" (1,li",,,,,,,,,,....,lh,LI','''',(,,),,,,,,,,,,, before me, "(i;J,/+,, ,9.r,~~ ~,~"',~" ,!'\,l!IM!."""",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, ,,,,,,, " ~ ,\!,/?,!;""kt "\ll,..7.~,, "'~r.~,~~~,a!!',,,..~,~,~~,~,~~,!,~~,~~,,,,,~.79~,L,,,,,, .....~;... ,6~v Hell'lRlcl' ~'lIed: ""/),\,I.ciO.lll,t"""L~,,, ""l,'.n~L""" AttOI'Ill')': (ovur) N.n. . \ [,1,1 , ", ,,2 -/.3 -1'0 , m ,,., RtV'" R,,,"ORM RtQUIRtOIN m tsTA1UWIlII OROS' A...."UHOlR SlO,OOO, UNDlRl!CTION 701 Of ACT 01 JUNt 16, '961, ."tCTlvt JANUARV I, '962, tllLt IN 'iMJPUCATf WtTH copy OF WIll AnACHEOI / * OFFICE OF'THE REGISTER OF WILLS L:UIf\ he r),11 0<1 61lf lirf.lntham 11oarl. lirnothllnl, i'a. 1'1027 County 01 llohert L:harles I iterhower (Ham.) 01 (Add"..l J_dllltntl3trator appotntarl being duly I'lary Jo.ne 01 tho e,tat. 01 Neohanloabur~, Va 17055 ICllv, Borough ot TownsMlp) conal,tad at: according to IRW, doposea and a8ya that 110 la tho I\iorhmler 521f1 ~artfp'tfo~m~~\fI:'~~lrlbcld whoso laHt rosldence was ---- INo J 1811"f _ 2 5-79 docaased, and that tllO whola ollho oatolo of aald decedent, who died (D.,., REAL PROPERTY REAC PROPERTY IN "f.NNSYI.YANIA, WITH STATEMeNT or MORTGAGE ENCUMOI.ANCI!5 u"ON eACH l'ARCel. AT oeATH OF DeCEDeNT, WHeRE ,,"OPHITY HELO AS JOINT TENANT OR TENANCY SY eNTIReTIeS, DIVE NAMes, AO'iOEOS". ANn flel.ATlONSHIP OF OTHeR OWNeR.. , .- ~_._--- Estimated Value Real Estalll rlona -------.- ..---------,._.._._~ ------------ ...----... ----- -- - 'i~2612. 25J.2.'f'1.5i'd 'I~ 210.86 Personal Property t~ut1.ona1 :;toolt fund .tf1,'I{,,~""(~@ [',1./ L1 fe lnsuranoe 11'0 and ,Jo01s1 Jaour1ty death Mnef1 tn =,:\,100,.00, Net vn.lue ;:Jend' u1reotly to l'unera 01l\0_Joe and ueduot10nn". Ilousoho1l~ l!.ffeotn ~o- ~~1707 .00 ,II; 39 . 40 ,~ '1'56~ 00-- -- 1"edioa1 lleoe1.pt ,_ -r- (lash - NOTE: You may expedite the processing of this return by filing wtth It. and liS a part of the return. letters from financial Institutions or mortgage holders, cert Ify I ng to amounts on depos It or owed by the decedent as of the date of death. Such letters must be elgnell by n responsible officer of the financial institution 01 mortgage holder \l.lId Indlcato clenl'll I\mounts of principal and Interest In the decedent's account nt the <latr! of death and the type of account, account number 1lI111 the exact name or nl\mes In which the account Is re Istered, ZL " ., . , . , . ' , , ~ ] , . i . , . , , , , . I , . , s I' , , , , il l a ~ a ~ ~ cl ! ~. ~ J\ Q;, 3- .-l' 1\ 'S !Xl: I s i~ 1 I . ! II: . 1';. Ill, 'S J . os J i\, ; ~ J ! . . .... H I \"~~.\ In./ dl CO;'!,ty, Numb.r ond Nnmo___2.L~__Q.l!mh!!r.lill1\L_______.____..... r 110 Num".r ....______.?J,:7.9_~Q'J91L_...___._.._._.______ Dnto 01 Doath_____ .J.\\1yZ.5I_1979_ _n.......__~____.__ E.tat. Nom. .._ ....!H!lx:bQ....Ol'_______._..M!\!'y._....m~__.. . .._Jr.___ (l.AWl NAl.U:) IFlnfL'r NAMI,) II~lIIIAl.1 SUMMARY COMMONWEAL HI OF PENNSYLVANIA T1lAN5FEllINNEIHTANCE TAX RESIDENT DECEDENT REPORT OF INHERIT ANCE TAX APPRAISER I, tho und."lgn.d duly ap"alnl.d Inharllanc. Tax Appral..r In and for Ih. County 01 Oumberland P.n,uylvanla, do ra.p.ctlully r.port Ihall hay. appral.ud II" r.al and p."onal praporty a. roportod In tho lorogolng roturn 01 th. valuo. ..t larlh appo.llo oach Ito'l' In tho 1001 column 10 tho rlg"t In Schodulo. "A", "B", "C", and "E", O"tod,_ Maroh 13. 1980 fi.i/.c .'1 ~ d ) 1If'/,'A.J f .J...) Itm l~ III T A.N l: r~ T A X API' Ii "PH': H -0 ''':':!.:::'::::':-'';;':;::;::"i...---' = REPORT OF TIlE REGISTER OF WILL~ I, tho undo"lgnod duly oloclod Rogl.t.r 01 Will. In and lor, County, P.nn'ylvanla, do r.'pocl- lully raport that I havo allawod doducllan. In tho nmounh clalm.d by doponont, oxcopt a. to Iha.. Itom. whoro a groalor or I....r amount I. ,ollorth In tho 1011 column 10 Ih. rlghlln Schodulo "F", which groat.r or I...or amount ropro.onl' tho .um allowod a. a dodu.tlan, Dalad, RLt)tHTUt m' WII.L.fl AD.IUSTMENTB - ODE (ItARIlISDURO USE ONL VI nEMAINDER APPRAISEMENT CODE INVENTORY Rflft' Property (Schodule A) !lofl0I1111 flroll8rty (Schedule Bl Jolnt""tld PrOfHtt1V fSchndulo E) Tron,fe" (Schedule C) TOTAL OROSS ASSETS l.uu OnhU pml Deductlom ISCHEDULE FI CLEAn VALUE OF [STAH DOt lOt 'D. 30+ + 40- 03. Voluuthlll of IIfo flltatu or ~ unllultl.I.. ""I" It" ltt .t.t "_ $ PRINCIPI-1'! 1"8QIQli VAI-UE :=1= ESTATE TAil ASSESSMENTS _ $ E t=. TDTH TAX ~ 2% $ 0% $ 1M. $ $ -- $ $ $ -4= $ $ COMPUTATION OF TI\!' ESW US~ 01' REGISTER_~ TUll: on $ Tn" on $ TOll 011 $ TIIK Oil $ . lUll (Ill $ __ [:)(fIl111'Iloll' Tolol Eidola (') A. IIvldtlltcvd hy CharIta Ills E!xl1mpllnn COfllflcotClI1 luu(ld by th. Seer.fory of Ro...enullI, Lit.. tux prevlCJully Iln1d OHANCE Lnu ~I% of Inll: II f1t1ld withIn J "'llntll!! uflor dnulh BALANCE OF INHERITANCe TAX DUE Acid hlhHllli1 lit rota nf 6% from __~___ 10 AMOUNT OF ESTAH TAX ASSESSeD $ 1~1;!f1lo Ii" pnlt! $ , UALANCE Due AtllllnloHlRl 01 rnle of 6% from t. ,= , _1- $ $ b. $ $ $ TOTAL TAX OALANCE PAID Supplomontal Cod..' (FOR use IN HARRISBURG ONL Y) 40-Adlu"monl 49tAdlu.tmenl 56-Annuity 6O-Lllo e.tato 92i Remainder Appral.al 93-Remalndtr Deduction 93C_Charlty 94-R.malndor Re.ldue 96_Suacolllvo ' Life E.tat. FOil USE OF R EGIST ER ONLY ADJUSTMI;I'lTS NOTE: Where .ublOquont odlu.tmanto oro modo to Ih. abavo computation ul tux by tho Revl.lar 01 Will., lor proper roa..n, \nme .hould bo notol holnw, with shott r.<kplnnntlCln, " 'll ~ ~ J ~ ;.. i ' III Q., ~ !5 i 'il ~ ~ III ~ ~ ~ 1 ~ ~ . j j i t2 0 i!i ~ ~ .., z ~ ~ ~ Q, '5 IIa ~ i I:) 0;1, ,~ 'B E '" '0 '0 i, 'S j' ~! .!l ~ j 0 {"I '1i1,V"I'i~ (/l.Il\) OI!I'AHTMENT or- REVENUI, IlUREAU 01' I'll!lll OI'ERATlIlNS P ,0, no)( ;t070 HAIIHISIlURCl, I'ENNA, 1"I10S COMMONWEALTH OF PENNSYL VANIA RESIDENT INHERITANCE TAX APPRAISI:MENT DATE COUNTY I'lLI' NO, Mat'ch 13. 19Bo _ Cumbol'lll.nd __ 21-79-o49~_____ -- Whol'oa!!, Hal'Y J. Bierbowel' IlIte of Hampden 'l'ownr;hip in tho County of OumbQrJ,'l.nd Commonwoalth of I'onnsylvonia, having diod on the 25th __ dilY of .JulY 19 .:J:}.. , !!olzed and pos!!essod of an efJtato subject to Inheritance Tax lIndor the laws of the Commonwealth of pennsylvania; Thorefore, I, G1 nri a J. Riohard , an appraisor duly appointed according to law, having beon designated to mako a fall' and conscionable appralsomont of thn said o~tato, and to ar.qess IInd fix the Caflh value of all annultios and life estates growing out of said eBlato, horeby file the following appraisement: In tho Ilvont tllal .lIl\' fuluflllnllllolit In thl' oll"lo Is 1t.IllSIOHUd in !loUIIUllltl {If unJoyrnont tn (;olllltor.llllol" ollho <1t1cotlor\\ llIltH ttll) lJ)(pJr.111'1I1 of /lilY OItllto for Illu or for YUAn, tho CnlllflHJI\wlI,lltllllorotly O)(IH{J~!ly rlnUIVlli 11111 flyll! \t. .1\lprilISu .11ltl "'Iun trMlSfor InhorHilllcll 1.IXllli ill Ihlllt1wful Cll!lillul,,1 rain 011 ~IlY such futuro ,,,t"ro" Df:r,~rHPTlllN or f\Sf,t'T )A~.'Jt:f; I\tIH~h(!lllt'l1\ MMjl1 or lnlH'lll.HlI_ll 1(1)( l'llIl1(1\O\ $ tJn~O Real ProtJortv Personal Propertv 4.<;88 ;1 Join1=Held Property "'n~o ..- _ 'rranefere . None ,-- ,",,"'. T . .....r...~. 114 <<AA .3.L., ~ ,,- - - - - .- .' ,- ----- Havo boon duly sworn according to lawd I do hereby certify that the above appraisement Is made in conformity with the law on this nth ay of M..rqh 19 ..-Eo, f" ' J d'l'r' ,l-y-- _ ,III 'uJ -' JULIN .../~ ^Pl'l"!'.,,, (NlIll111or ,'II(J ~;lr(tnll llarrieburr; , Prlllld. n'Cl\\ nfflenj i I, It , , \, " "I t- .. /" ~I I I I '/1 t I .. " . Ii : ~ ~I CIl w I, II/ I, ~ ::l ~ J, ~ I d I : I ffi '8 .1 ~ ~j ~ I fJ: ':.=; ! I IX: I I .1 .~ ,) s ~I 'Cl "II ~ I ff ,/ u. w $ .../ 0 ~ ~ ~l $ N... I If.1 VI' s ilIl II , J t'--.] i i! ~ I j ~ i.o Ill' I - I I ,14 .g ~ : I ~ I .~ I' "" a: I w , 'Q j ~~ I if ... . ~ I . "C . :c ~ j I i I I J 'tI ~ I & ~ i: ~ I fa !i ~ ,I '~8 Q 1,1 I w : J I J ~l 1 Q I I ~ I ~~l,~~ . ~ I ~ a: I P~OUCTIONS ^~~OWI~l> III I C)"> orFICP or THE STATEMENT OF DEBTS TIlE SUM OF I ..'t<lll:___ OF ~!~':.:~:~~~I:':~l WI~I.S cOllm AND DEDUCTIONS ~WJ~:~~~~'::\~I~/~r.i1L" ANI) Aom Of THE COMMONWEA~TH t\t~,~~~:,.:,t~~~:,~".~l~=. -..--......--...---..-..-- .'- " 1)21+1,~mj):~:-;:,()'~r,V Hond '. Ik"\f,A I ,'. ESTATE OF J:l!1n..~..lii()rbOW(\1" I_ATE OF ..!Wl.a.h.!ln.l..o.ahw::JJ;, \'".-..1.7.(l!j!i-.-{~~.qfr-.' ',ljO,'L./'~ {~l ['V DATE DF FILING AFPRAISEMENT 9 ,~'P.t'!'l\f>I.p;v-..J..911{'hE OP llEATH ? ~ Jll.lY...l2.Z2...--.....-..-.....-.--. ----':':;.:-':::':::-----'-- .~ -_. -- ---.. -===.::::..-:::=--..:,:::::=.:.:::-..:::.::..-:-==---::::==:.:.:=:::=: .;===--;...::-.=:::::~.~=~:": .~ HI-.V.41111 (II..-,el DATE NO, OF VOUCHER ----------------~.~-_.- ,-~-~.. --,,_--...--.-~-~._--....._----....----_._~.-_.. -.---.--..- NAME Dr PAVEE RPMARK5 MOUN T _._---~---- ---..- .~-:-'2":}9..___l!.1:1.1L!:!:. JiO blDZt.Q.L,jii p:1:bow.I).I:...,....__ .t.qj;~l_('.iU.;;...::i,19114. dO .-- -. ,,0;9.7.9.-. _liD... Hoo'cI llnton f~nrl ;looifll __. '.._ ..__ _____._ .. ._______:.""._ ________...~______________..................~...__.._.. ~lJ1O..l.u~i..t..Y-....uenA r 1. t'.R .t.o.tn 1 \ n r( ...___.. --.-. ;11005.00 (rlf\ath 'lonAf\ti1) ...-.-....--.-.----.... ...------.-.....-.- _~....__~._._m_' ___~._~_______.r. _~_. .___._. <-_"'_' m,.. ______~____~...._n_..-..~-. ...~-~.-----.-. ....--.- ,~g,J~79.. _OK.I.l__ Jl.QoQXL-.I.l.c..l.liftr.hQW!U'-..--..".. "lJr_~O~lm. ..... ...... ..----- _,W-.. ~..-?.2..-::Z9__ Ukll;>, J!..obe rJ.. C. l\illrl:o~ll'r.____...m_ __~'.mbull\nc.e__..._....___._... ..;i.-.).S.-.. !L-:? )-:-.12_. U\Ui...J_ 110 b!!.r'!:" U LJ::.i O)'bol'l!1.L____._ ~\r.rir1"llr'T X_rav .1.J...a 0.0.... 2..S. ')-36-::.7-2... _t,;!s.i_i!-. J!Q):1Q.rL~\ifLrlvlw.Q1'_.,,_.._. <"n'_ ...J.lPJl.fU'_uJ.l.cn....llm11111 aWlll.__. 'l=1-.'l.~Z 9_. iJ.kiL.2.. 11-~1~Z2_UklLL1 9-1h-79 Clfll 5 .li9t>flr.t_.J,;......J~1e rhowe.x....__.__....... '1.. \ cJ ] A l'jJ31ll0r l" l..t~l.-\:4I.:},.- Jip h ~..Q . 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(JU!.1!1_.....!i<?h..l:'l}~~_ C 'u.~.~..()r~~C:!:I!'.!._,_..___. ...!..~or.~~~rtl CiOR tM '-.-'- ....:}-~ ,,;; (, 00 Crow h ...... -.--, itohert U. l\iArhowor i-Iall, -..- -.-....- ~_._........_.. --~_.__..~-_._".~_._~_.._~ ----- .--- :~ 9 I' 15 00 00 .ll.. t 5- 79 UrlAh aohert U. hlnrhl)Wor'lJ,l\tterR of /lrlminiAtrntion ...~. _..~H_'_'_'_'____'.____~"'_._. .....~___... .___ . ..____..____.,__ __.r_._....._____.___.._. _,_____._.__._. ._..._... ..-----.._.__.._____..~_.___._,_.. r_ ___ .__..m._.."__,..____.__~_ .l:.( f;/ 1- -~~ '_n_+- ._......._..__ _.__. -.-- _ .. .~_.......a.____~+............__.~__.,._,,_.~____~...,_..,_.._______._. ~-------<---~~----~--_.- :;:o,--':.t.:;;-;~.;;;: :c_'':.c ~-=.,-;-_-;c;::.:.::..; :;.,,:;;.;.:;.-;~:o~_ =....,-J~;.; c:, -.;_~~..:;2=,O:";;;.--:;.-:.:;;~.'-~::;:.--:;-. ,,::-..,'.;;.~_'_"L:::---.:~:~~.:..""'l'=-:~..;;:;..~~..;...,.,j:.:.;:===':....... .... ,.. COMMOHWEAL.,TH OF PENNSYLVANIA I 55. COUNTY Of'.(,;wnbll~'1anL-,.._ I, _ltQ.bc.rt.. (;bEU'.le.I.L;.Jicrbo.w.er...n..'. "___________......___ HEREay CERTIFY, THAT TO THE !lEST or MY I<NOWI.EDGI'. M<l\ IIEl.lleP, THE rbRCGOING If, A HlSt AND TRUE STATEMENT DF Dears, FUNERAL EXPENSES ANl! EXPENSES or AOMlfll!,TRATlON SLJRMITHD 1'0 nile EH,ITE DF....!:!LlrV JaDo 'li.!.1.rl)OVIOL_~, DECEASED, AS Dr DI 1(; TIl)NS rOR INIIEllITANCI' TAX PUIII'OSES, ,.-'). \ "-J' ,.' '\ \) f,.... (, ,~c l' > ~-,7 I '),\01( ~ _~' (/ ....1\('''- 'f~'(_\.C~T (L.,S.) SWORIl AND SfJll~CRI!lED IlUORE ME Tllls--Ll .....~/". \9 ~", ~~--~::~:r9t%~~iit7ii}J].f!~t DA V or