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HomeMy WebLinkAbout79-00628 N.o,21~19. w.:8 PI11"ION 'FOR PROQATE OF WILL AND LETTERS TESTAM~NTARY In thEl"Esta'teof~;A~~L ;J::", ASl41-4--"..~ " , d~cea$ed. i -", ..... ".,' ".,' " " . te " Ha.r91c;'ll3, MOL a a, Doputy .To ,', ',"',' Rogl~ter of Will~ for the County ofCuml,1erlond, In the Commonwealth of Pennsylvania, . , IS ',', Huth m, Blaok died D~C, 16, 1'0174, Petltlonert,h,,", thee,)(ecut~)L-_....L named In the Lost Will and Testament of ~.L-1~l.:e;.I, ~CA!o/-<!.. dated ,;/1,-<<) ~!.'! /9?,~{ . Decedent was ,a citizen of the United State,s and. o resident of 1/' , , " ....../ " ,." /j Township' Lf~~~...(o-, , d..-<.A-4_A-Bo,ough, Cumberland County, Commonwealth "of Pennsylvania. 'Oec~,dentQled on'~k" ,~L-"1,' tho /J..7...-L day of tU~_M..... " A,D. 19 79., In tile Co~nty of dU~.04I'j''.J..~4..t.,J, " State of . ~,..,.~:-~ .J/IM~'~:AJ~ .at t,heh~~e of ~j/ years, .." Decedeht has not been married and has not hod children born ,to "him sinCe the execution of the above described Will. r'" :Pl'Icedent was possessed of personal property to the value of J.,I,./i;"4-",-- 7.A~. "<1",.",4 ,.J,t'j~A.-'i~~ _ and of real. estate to the value.of 7A'--o:'",,-,,- _ as near as con .,be aseertalned;"sald real estate situated os follows Therefore,you~petltl~nl'lr~)re$pectfUIIY :tlll~S f~r the' probate of ,the sold Last Will and Testame,nt and for Letters Testamentary thereon, Doted ~ 1)Q.~ I'll?' , N~~Pe~~10~~~(~~ss \ f/(),'J~i- ,:t1. .~~4:t.A," - ~2 .0..' j, . ::r;,f,l..)..tL;;-U~CA I Ar'~.,p4~ ~'.-li~~) ~. ./~L<__,d~' /,?I>/ " ~~~~N;:A:~~B~:;:DNSYLVANIA\ " . y,u~~, .J8~J~a;~l _ named In' above appllcatlo~,belng duly. viU,f-'t>-1.-,,,- according 'to law $QY(s) that the, statements set forth In this petition are true to the best of ../j_u. j,_'kno~ledge ~nd belief, 'wJ~'~'~-A......... and subscribed before, L 01..-~,'" ~. J."JYl~;lA<-, , ' 17, ' , me, ~.7~\, ~~ 1979, . -~- . >'~I.t.r.. Octo}:ler ~4, 1979 Attorney: ________~;,....__c'. "~ OATH OF SUBSCRIBING WITNESS NWIMW'H OFPmNNSY~V ANIA , OUM13~nLANO HMI / ,,.. ."//, ;, F./F'- " / / ,.. ,/ " , -"F '. . " / Tht~,,,,,,,,,,,,,,,,,,,,,,,,,,, ~,""'!""" ,.",;"."" ,..."", ,.,., dny of, !"," .:'" .."" ":'" .,., """",,"...':::yl;:"""""": A,O" 19"""", ~oforil mo Hlchnrd lD,Andqrson, jloRlllt\lI' .for tho pl'o,llllto ol~ W\11s LInd I!"l'lIntln'g lottul's of Admlnlstl;lItlon '~-. .." .. , .. /' .. , ~ ~. , Inl\nd for 81\1,1;1 Count>, of Cunibll.r1llnd, In tho Commonwolllth of Ponn~y\'vlltlill, pOl'llunlllly RIIOIO ....,..,...... ,. '-. ,- !, .'--~...._~' "., ./.F/~' " .. ': 11111 t! f 1111 ,t,' I', 'It.; j II ,. ,', j 'I'll q... II t "1 ".' '11,11,,',' ,)-",t'" "'" t 1..1"'''' t ,,' 'I"'..... I~' I: It j,.., ~)'-""""'" ,., I"",'....." ,..." I. j I""" t, II; I H' I',! ,," II ,.., ~ . - ' tho, 8uba9;"lbln~ 'wltnolllloa to tho fOl'og;;lhK Instl'umont of .writing P\U'llOl'tlUI! to 'bo tHo Il\st Will I\nd "'"-.. ' r/' .. " . -. / 'restamont of ',f' I' ;,1 j. '111" III j~1 i j,.,; It; 'I"'..... j.1 10'. ,....... '~:-~l,_~n" 'I" J.--'~~:: I'" "1"'" ,\.. '1111' ,0" Dnwd ,t III' ,:,.." II"'''''' lit!. ""1" "" lit j , ~'. . ,,/ ' " .--..' lato pr ...11 Ii iH,'lIttllllll.,";"I'" ,'....'1..."'11.'."',. "I"I"""",,"I).-i:7~I~h~ ,. 1"'"'" ,...... ..,,,'1 CUll1bottland County PUll deceu,s,(ld / ~"...- who being duly "ll!l"'H,"tl.HtI,,,,,,,,,"..,I.ttllllll 'l:~,oofding''tQ law';--'q~p<lB'O nod sny, that, I<Il,,,,,,,",",,....HIIl"'I,,,llllll / presen~, Rn~ 'saW :nnd hOllrd tho te~tll"'J';::"""'"'''''''''''''''' """'~..:""",,,,,,,,,,,,,,,,,,,,..,,.,,.,,,,,,,,,,,..,,,,.....,,,,,,,, , . . --/ < ~,' ,. Sllftl,sel\l, pub\lsh,pronounce nn~d6~lIro tho al\ld ,Inatl'umont orwrttfits,~llllnd 1'\11'11",,,......,,,,. ,Telltullwtlt u'nd Lust, Will, and at the t~~r 80 doing ,,,,,,..,,,,,, """, ".."",,,,,,,,,...,,,,,,,,,w'is'~nd and disposing mind memory Rnd undoratl\nplhg, to the bost of """,,,.,,,,,,.,,,,,,,,,..,,,,,,,,,....,,,..knowledge, ~seVVI\t10n and belleI', , / ' / // "'" , ~ ." ""...",." '7r.:"''';.,.,''''',..... and subllcl'lbed be foro ,...""".",.",..,..."".,,! ","'"'''''''''''''' """ ,~;.."(~".." """" / ' ' " ,1,1......'.....1......'11111.1..,.11'1,."'11'1.1.'..'...II.'.II.jt...ii.....~~III.' , '" I . . . I ";'1 . , . . .... , 1 , 1 j" . . . . t " " , , . I .. , i . . I' . . I . . . . I , , . I It' ,'. .. .. I t III It . . ~". II Il :;-, \ " !', IUll.'.;..,.tti..."......I'........,..,,''',.!.II.''''.'';l.'"""!"""",ll,.!t 9hal'd ,E. Anderson, Register ,,' AFFlDAVIT'OF DEATH COMMONWEALTH OF PENNSYLV ANIA ~ BBI QOt,JNTY OF CUMBERLAND ,;..., it"'" !,,.;.I~rt.'.~.; ,.,J:J....... "rd.~'IK.~1;;[,-t,~,., ,..,.,.", ,. ,.........."".,.,."".." .,.'.,.,. .."."""....., ,.,.,...., ,.., ,. ...,. .belng duly ";'...;;...,,,.,,...,,,..,,.,,,,,...,,.,,.,,,,,, says ~hutl\s ncal'ly I\S can be IISCel'tlllllOd the said decedent ,:';"'''''''';''''''''''''; ,~,~';;:1.4,.. ." .i!ft.,., '." ,:J:;j,.~?rr,~rrd"i.' """"""""" ".: '..",.. ,.:"", ,.,.,. ,. ,\.: ,,',. "~" .....,.." " ,. .",., ,."., ,i.. ..,.... ... .;dl~d 011 ..(,,(l;;'~/ff,"''''''''''''';'''''' tho ",...(.lii.""".""",,,,,,, day, of ,&..P.:t~'Y.!iTl..."".."":..."...,, A,O., 19,21. ,l.'t orabout'''I,.(.'~t.(:..5:1al'''"11''1Ilj''''''t o'clook,l~"M. ~~Tti~rrft-rn1-trr'i:'t'I'lll""";'I"und subscribed this "" ,/ (").......J. ' ";,,.. .T,. .tml(titl H""; ..IlII.. t .,.It' It!t. dllyof tit;/:, , ..,.{ltii!ti.".....lttt" '" 15 ~'" ". ' ,- - -"", -. -, , ; ". r.') '-. . J. -~:,,-y:;~..t''''._"' -\."pZirTl>llr<......'"""...,,".. ... ..,'"..I..~,;{;.....,::".".,,' 19j .2.Z,betQre ~~~~,,,. OATH OF peRSONAL REPREseNTATIVE O~Mt;1ONWJllA,l.TH'bF Pl~NN8YIN^NlA} , COUNTY OF dUMBEHlJAND BB: , - .. , Before mo, the Hegl~tur for the Probnte of Wills nlld gl'untlnll of J.ottOI'S u,f Admlnlstrutlon ,In 1I1ld fur ,~i", County of Cumbllrlnnd, porsonlllly clImo '''''''JJ.{.1rrf'i1(IhI"",~,,,,,,~r.Md;:d'i''''''''''''''''''''''''''',,,,,,,,, (./ .( - , , ,wh~, bolng duly,~,f~,~;1lfi'''I'''"' do' .."A,w"" dotlOHo nnd yuythut us ltl'I~~t{;~;(..2-:1r:h;~I'IIIlIl"""III11"lfllllt'''''II'' , , ' " . " , J1 '.) '*'~ I' " ~ of the last Will and TORtf\m~nt of l'I'I~nl.i"!'-;~;~~~;;I~t"";'I'j(,~ll~'I:t'I,~,~r:1;'~'lllf'lltllll'I"t'I;"'I'HII'!'11111"'ldecon8~d ~t!n"".",,~ will well and t~ulY admlnlswr the goods und chattels, rights und credit!! of sulddecellsod ,,' -' ,. . ucco~dlng to luw. And also will dlllgontly comply with the provisions of the Inw rellltl~s W Trllnsfer Inherltancee. .l4fM.1r.<';.~l"l~;;". and subscribed before me. . }.;.....&J.,r,I.(........~I"".~.~(.f'.t....:i.......j.,.,',.,.., .'..'.!I..."'.'.."I'."'....""".."lllll.IIl'...."'llll...'..llllltl"tllftl '1 I,~ LL I ~ I <Xl " 0 f .... ~ ~ :...J ,~ '~ .J c&; - Il4 ~ . ~ ~ A ,~ ,E1 "'; N ,I ~' ~,\, i, ~ ~ - ,J Nd 1 l ~ DECREE " ~I 'ell ~ I 11' re B I be 'd h h' 24th oCltober79' h , ,8' t reme~ ' re" t ~t on t e Iflfltl"IlI"".."...ttday of "........"......"ltl;.II"..'"11111....."'., AI 0" 19 """"1 t ere , ' was probated and recorded the, last Will and Testament of ""IP.'~X.~IC;'t"~tHI>>,hfl.91~".hlll"'''1I11'ItIHtI''"''tli''..I' , " lute of ...:.."..1t.9.WIM\..~.t.MM\. ,~.9.W.l).Il'.M.R.... ".,...,......, Cumberlllnd CO\1nty, Pennsylvlln Ill, Deceased. Letters , Teetamentary Jane Il.Smith flH+l'fI,1t11 tf I'" 1IIfIIl'..', III'tI"I"t" 11f' '1'1' I wer~ granted to '. "1"" '1111.. 'III! "" It ,." ,. .",." Iflt I" It II" II IIltl,..It'I" "" 1'1 "ltl'tt"tUltlt Witness my hand and omcllll seal the dllY and yellr IIforesald, ~al~ ~:b'\,..~ - '-I ' , "1'111.11'1"'" ".f~,;,',Tt.~.~, 'tyl.t ,f '.., ~t\t". . ~,iWiI8UJrl . . JlllnUy Held Property .....- Il1sUm~11Kl Val __ NONE - OJ ,......'.._-----..~----......... .--------,,- ---.-'- ......,....,... ............---..~-- ......-...-~--------------,~-- {.' .~--------r'1""'---':'~_....... " -",-~",__",------,,,,,,,--,---,-"_"""""""'_-o'_---<'_"__"'_"-',;..H'_~______'__""'__''''_'''''~_'_''_ -.---- .~.~.....__~......_...,__~..&_n_~~._.__rri.~~_,.._".,..._,_;_~~'f"O.."',..-..-u-.,~......~"L;,_.,,"_~.c-.,__'_.7'_'"~''''''''''' -+- _........--.......~_. , ...""'....,.~_____.,~_.~__....._...,'"'~.,;'__,;-""'..'1."',...ft~-._,--_~,."___~...c..i..o,~_.,.."_.,...._____""+",,,",'_'_ .......---,~-- _.._""......._____._---.,~.__~.....____..I._'__._~._.__..............__ jJ_''''r"_''''-__'--~-___~'''''-_'__~_'_'_ ...----.. -r-,_~__----"--_~"_;T'~--<""'~"-'" ____~_.~,______________TT. _, _~_.~T_ ....__.<ri_._........... ~__*.4""'-+-_ ,.'0- ~~.---~.",.. Trll\llal1V1lthln TWO VillARS Prior 10 Death " , ----....... ...:.:.--._..._:--....:-.-~__.....---_--'-..,..-L.-.--....._- NONm ..-----.-..---........................ .-..---...-------....-------..- " .~-~--....---------'-'-''_'7'"''----...--.-....-.......-.---.--~-..........-............- -........- __________._..___..._____~..,.__....;.......L.___"~_~.,....__.. ..---------.-.. ..-,.... ~. ..._.<._--<+_~_.n~~~_.._.__.... r__. -0- ~-_._-------_.~...-~--~~-,-~.--~"..'_.~-,--""~----,---.~.",...-,. -...- ----......,..-- ThaI althe time. of death there WM.no safe de~ll 00, ~ roglsteredln dcooclent's Indlvldua, I nl\1tIo, or Jolnllr wllh, or, ns ugenl o~ deplllr or another, or Indecedent's Individual name, wllh rlgl1t or accCIIs by anothor ns agenlor dopu(~, with tho oxcopllotl or lho rollowlnSI-' , . .. ,., ' __ _.--~-=-t.l':t_.-..-.---.m==....-...-.,..:!:-~L-:;'.";">. - -". --._.,-~" NM11I ANll AnOIU:SS Of' \lANK on OTllf:11 INS1'I'l'UTION TllIS SAn: OI':I'OSIT DOX Ilf:NTIIII " lNWllICll OEO~~OENT nENTf:O A SAt'li ntJPoslT no~_ IN NA~tf: on NAMES Of' 1\10t\lln ____,_~~_ -~~. -~-_. IlELATION8111P Ot' JOIN'l' 1l00,llt;ltS TO m:Cl\utiNT .---............'""--'-- .~---_...--+-- -_._----~~----- ~___~ .~._ - __.u...."""'~~_.__.n:'-'J BENEFICIARIES ~ -,. SUllv\vt'O' "Mt;m;i:in: , ' ., 11t:I,ATIONSllII' UENEFICI/lRlES ANll ADllltt:SSES l'r ,lop'.hUdron or nE('f'PENT ., TENANTS OIl INTE\IEST ot', (Sill. full nlm," of.U and Ihotr .ddl"'",,' who hm"n In. lI.gllhll.t. .hlldIBP T I',. ANNUITANTS DENllt'ICIAI\ V t.r"I, vested, con,UI1(l.nt 0' othll:wlRe,l" '""1'.1 ".1""11,,<1,..' S ATt. n.S AT DEATll ot' IN ESTATE ,. ' rmlhllll" r..i." 011 NO__ ' ptx~t:nIlNT , ' " - -- " Jane B. Smith Child YES N/~......._ 1/3 ~ , 2016 MilUown Road ' , , I . -* -----"----'- , , Camp Hill, P,A i 7011 , -~_.. , '., , - , " ., .-'-- -... . - Riohard P. alaok:' Child ,YES N/A 1/3 , -'- . . . .. " 146".Hawthorne Avenue , " , - ,.~-- ---.- __~---'I- --- ., Oerpy" Connebtiout 06418 " - " -- , , , - . Will1amG. Blaok Child yES N/A 1/3 , , - - 1746 Hazelwood Ddve , -j--- ----.. , SE "'''";"'- . , - Mariet'i;.a. Georaia 30060 , , , , - -- , " ~ --. - , , , " , " " " - --' - --- .- I, , , , * ~ , .....4_.._________1 , - - ..."..............--._- --.,.... - "~,' . , ," " . " , --'- ____00_- ---"7, , " H ,i, I, ' " ! ,= I\. '" U'\ c::> ""' ~r-l lll'l1 mp< u . 4)"~ , t . ~ 4). , . . ] ~ai , ! . lH' I : Q1 ':El; . , IX! ' . . . . . . 'tl: loot..: . J . 'tl: . ~ ' ONI . Ill' ~ \D' ~: . ~' . ~ ., a ~: H: . ~, ~ ~ o-i. . . , ~' ji . tt' (1) . ~ ,.t. ~ ~ IX! ~.: a;. rc1 r-t: 'IS ,~ .~ 'e ,: u: 1 J III A' I ~ A Pl: III : os 1 .. '. ; , os ! J I j . ... .''-' " . ~ ~" ~' .~. ..lo: ~ u ! III r- c:: CQ OJ 'l:l ~: r- c:: . r- fIl "" < t I 'l:l ~ OJ .~ ell ,Q ~ :. ;II: E N III 0 "'" Q ,.J l.) \'\J C/'o ~ ~ d i z d ~ i ~,. i i z, i ~ ~ ~ , ~ I' II< ;" " 'I " ,I' fHW-4l'l1l <<'-11' ,~ I ~.~r) 9, (:.,,) ,I(' DeDUCTIONI ALLonD IN THe IUM Df " !Y'N, .Jr,. , DATI AFPRoVe\l.....2.- t:. /oJ' (' , . l~t,,\(.ld //(U;.", I ('It.;o,., '\1 i:h. '1', 1!1WV JVI,/, ~liOlarnn 9' Wlt/.I, ^,IHHTI.,J J3roolc1ine Manor Retirement Centera "ATSDP R.D. 1. Box 62, Mifflint:own, PA Dff ICE Df Tile REOISTER Of \tILLI Df _. Cwnbetland' CoUNTY AND AGENT Of THe eQMMllNWEALTH STATP-MENT OF' DEBTS AND DEDUCTIONS .~ ,t\ ~ /\%I\.~ I$TATaOF. Dll-vi,4 . p/ln OF. PIL!NO APP RA!SltMENT fiL. oATBO" QBAlH OO~Qber 12/ 1979 8a - AMOUtH 15',:) -en - ,167 50 22 50 42 96 76 50 50 00 - - 23 21 ~. 20 00 "~ 571 24 . 192 75 22 00 OATH NO.Df VOUCHeR NAME Df FA VU , orville 1< rnme1 REMARKI e 00 ifflin Fire De t. No.2 ited rre1 hone Co. counsel \l'~es ^dve~tift1ng of ~stllte Mvertisinl1 of Estate Ambulance Ambulanoe Final lUll , 2/13/BO -iLn.-- .. -9~n , Angino/ P.O. , he pcu<ton Henld News"Hewa Co. II, M.D. Final Bill B \)'i al Dill 78 00 ,......----. rrO'J'AL v j) '-"~.,.,) I J:. ,! l! " ,:, i i.> It! f. .;) , hO ,lie, d 5,1,71 6' 1/tJ' '( ti.fJ.l!..' (<7,: 'v ry , ~ ;I ~') '/r.'/('.er"! dJ.; ;r, t' I / -- Ie I, -~ C 1/ COMMONWEALTH Op, PENNSVLVANIA I COUNTY DP Cumberland $S, . " I,-:r~qll ,,'l.~ ' S' In ;iJ, ' , " HER'eIlY CERTlPY,'TIjM 'tll THEO!ST OF /IIY KN~WLBD,OB AND 8BLIBP, THB PDliiOol~O IS A:JUST AND TRUB STATEM.ENT OF.BOellTJ. PU~BR/lLBXPBNSBS AND expeNSES DP ADMINISTRATION SUBMITlBD TO THll esTATE OP caviaR, lad", DeceAseD, AS OBoUCTIONS POR INHeRIT,\NCll TAX PURPOses, .. ,- Q1..,,_..... ;1iJ. .<f..."yufl- , (L,S.) DAY O~ ' SCRIBIlP RBPOR! Mll THIS I fit...: , . 19 I'/"'{y ,:;t, c - - """""'''!' r,~Glmn OF WillS CUM. ',"lMll> :fJ I . PI'IIN' " C II ' ~ "t' ", ", my .olllmlulnn bplroa 10 11r^' l.ir;l1d"v In J...-n, l"Ui " " " INP()R~AYION To Incure ploper o,odll to yOUI aooount, Iho nam~ 01 tho IGlala end IlIe ,number ehould be olUlly pllnl. ed on Iha oheok or mOney Older, Thle uuumenl II made In aoooldanoe wllh Sacllon 70S of Iha Inherllanee ond Ellalo Tox Aol of 1 oel (72 P,S, 6 2486.708), To Iheexlenl'll,al Inhalllanoa lax II pal'l wllhln Ihloa (3) manlt1l nllal Iho ~oalh ,01 Ih. dooodenl, a dlloounl of flval6) peroonlle all~wed (72 P,G, 6 2486.7161, Inherhance Tax, othalll1en lOX on 0 IUlula Inlalall, la due ollho d"ool Iho daoedanl'e ~Ift'h an~ beQomae dallnquenl a,l Iha explrellon of nine (Ol,monlhe eher Ihe dooe~anl'e daalh 172 P,S, 6 2486.7111, Inherllanoe' Tax on a futura Interael Ie ooyebl. wllhln Ihree (3) monlhl allar Ihe \Ianllel inkol ollaol In pon.nlon an~ enJoymanland Ie ~ellnquenllhereallel (72 p,S, ~2406,112), Celoulolo Inlotall flom Iha ~ellnquant ~"e ahown on Iha feoe ollhla form 10 Iha date 01 aolual paymanl ualng Iho folloWing Inloroll Inble: ----................- ..--......-...--- -...----......- --- --"!'-- .....---- ---...... ---... -....... -......--...-"'....... -_...- --.......- 1 month ,006 4 monlhl .020 1 monlha ,036 10 monlha ,080 2 monlha ,0\0 6 monlhl ,026 8 monthl .040 11 monlha ,066, 3monthl ,016 8 monlhl ,030 9 l\1Onll1l ,046 12 monthe ,080 1 dayI ,00017 . 11 dnya ,00186 21 dayl ,00362 2 d'aYI ,00034 12 dllya ,00203 22 daYI ,00360 3'~ayl ,00061 \ 3 dnys ,00220 ' 23 dove .00388 4 d~yi .00068 14 dnyl ,00231 24 d"YI ,00403 6 ~aYI ,qoo88 18 dey' ,00260 28 daya ,00420 o ~ay. ,00101 16 daya ,00261 " 28 day. ,00437 7, ~aY. ,00118 17 daY6 ,00284 27 dayl ,00464 " 8 day. ,00138 1 SdaYI ,00301 26 day. ,00471 8 daya ,00182 19 deya ,00318 29 dnya ,00488 ,10 daye ,00168 20 dnYI ,00335 30 day,1 '00600 ..- ---------..--...----..... --- - .~- - --,--- -...-- ---......-.. -....,....-.--- -- - ----...-.....- - ........... Any par\V In Inlelo", Including Iho commonwen,llI' end the palao081 10pralan\n\lve, '\01 anlt'lfle~ w,lIh .. .' .' . I. Ihe ana.emsnl mey obJeol Iheralo wllhln Ilx,ty (001 doya ellel laoell\l of 1I11a NOlloe ae provided, by aeolian 1001 ,of Ihelnharllt~oenn~ Ellatn Tnx Aol 011961 (72 P,S, ~ ?405.\ooll, ' Make chook or money order payable to: "Reglstor of Wills, Allenl" Mall 10 lho add less IIs1ed ,l1eloWI .-.,' I', J ~__i"~ "'-r W I'll! IT JII!' ~ -~fPII> ~lf r ~ I',. , . . t , , ' , , ., OMMONWIALTH Oft IIINN8YI.YANi h ' No'~0830,a '. -, ""', 'DIPAftTMINU)""IVIN\lI'" " fi:":';:;"".':'- ~: ",,:.~F,,!q, "i ii .~~.I"I_"'~'~,N'~~V.~~~A 1~~~~lf~Na.. ~~~,,~I!A~1 ,~~' ~ .~-__.~_____~~__._._.IGItY_THIII iA 11/100~---_._.-M.~._~-~-~--~d II i RECElveD~_ ' - 0 or. II' ,eplo..ntll1g Penn.ylvonlo Inherllol1ce 01 Flom, .71M a. .Id.'" ___. E.lole 10. dva from Ihe 'following e.lal., Idl... 1016 Ml11'OWft,aaad a... Hl1~, 'a. 11011 FII. No, U.1'~'" Dale of 0.alh:__10-12..1" May 11, 1"0 ; Oala 01 PaY~lanl Nome 01 Decodenl ,'DA!p~. lLACIt a"'~lanO ' Counly Remalk., -'AID I' $LL~, ~'OO~[f)[~@&TI'~ seA l 2~ 10' on $- $ 1>'i!,lo. on $,- $ I ~'A' I", on $. $ ~ 10' Oil $ $ e.lala lo~, Acl 01 May 7, 1927 $ IOIAlIAX CR~OI1 $ Lou live percenlum 01 10~1I pOId'wllhln Ihtu' monlh. ollel dola 01 dealh $ Plu.lnlerall 01 Ihe ,role of _'i\oflom 10 $ TOIAL AMOUNT PAID $ 'J t l' I) ~ 11 - NOTE, Thl. T'Iplle.Ie Aoeelp\ to "" ,ei.I~.d to, ."n~p,!'PO"" ,". ' , "Received hV NotE! in btcfpUt\Q ,~, hant'.r,"lnh"jlanc. 'Q~D"lulu,. .tlol... prIor 1(1 th. deQlh 01111. Ill. 'Inan! or Ilnanl Ivr y.qr'r DI ,.vld.n(,d by hit l"fipl,U '. und.nlood thcj\'th. Ccmrnonw.qllh'JhoH nol b. p,.dvdtd or 'r.,."tnt'd Itom h_rtClfl.r Qu.Ulng addlllonullnh.rlh'HI~l! 11.111 allh, d.alh ollh. lilt llfHlnt 'Of' Itnql'll' or 'f' at,' wh.n.....~. 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