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HomeMy WebLinkAbout79-00680 ~ . ~ ...~ ~ ~ ~ i I . r:. ...0. i ~ Cl) ~ 7i! (,C ~ '0- '0 ~ I - , N i I ~ UI No.21~19~ PETITION FOR PROBATE OF WILL AND LETTERS TESTAMENTARY '-\-" - _ \ _ "0 \ in the Estate af ___~"),.'\...."...'s:~\~\..~~'L------ , deceased. f1a~old B. McLane, Deputy Ta RII.,1,o, J C. AI~eler36n, Register of Wills for the County of Cumberland, in the Commonwealth of Pennsylvania. IS Petitioner(3-l o.r~ ,the execut ~~~'\ .. named in the Lost Wil~ and Testament of ___~_'_\_\s;..1.\L.\S~-~,\\'\Y5 ___ _________ doted.,'j\0:\..~:--S:'\,'D:'i\ Decedent was a citizen of the United States and a resident of \ . \ \\ \ Township ,\..\R';i:\ '\ C! ~~\~,,\i'l _ -Bef€HJgb, Cumberland County, Commonwealth of Pennsylvania. r \' \Sl., ' L Decedent died on ~"\.~"-,,k~- - the .1,:~___--_ day of!i~~'\:U2\-:!LL, A~. 19~, In th, County of ~ ',),,k.~~..__.__._, Stoto of ~~\.\.I...~____ at the age at _'.-:lx~---- years. I'les Ms I3r Decedent has not been married and has not hod children born to him since the execution of the above described Will. Decedent was possessed of personal property to the value of (, 'J - 01, \ tJ.,'c and of reol estate to the value of /fUrl as near as can be ascertaG'ned; said real estate situated as follows _~X-~~~\C\\y-~~y~- - ~~'\(l /1\<,<(' '-- ~ \l "~. \) ~ (' \') l/ ~,O~ __~-\:~~-~~-~--;-\---- -"m'0~\")~;"'9&."''f..)''(\'~\\.\\~ If" Therefore, your petitianer(s) respectfully applies for the probate of the said Last Will and Testament and for Letters Testamentary thereon. '---- Dated \\'0.';. \~. ,'{.\'\\ Name and address of Petitioner(s) ~Yu~4~~~~~.J --) / \ - -~ '\:' \-\: \:'S\0.~",\v ~C\-. \ COMMONWEALTH OF PENNSYLVANIA ~ ss COUNTY OF CUMBERLAND \(~\\,\\\~~ ~~\ \,w \? named in abave application, being duly ~'0..~}" according to law say(s) that the statements set forth in this petition are true to the best of \"''<: knowledge and belief. sworn and subscribed before /.'1ju,i~J3\--;, [,.,{, ~ ! ;, (;/ ,; "'. me ~14 1979 t,:~ ~B _ '- ---- ~:I,o, d [, QE~~~rster ...--""--'---'"-; ------, (~(- / // p .:'L..L.___._J Filed; .;(/.7")-(-J't: /t. )/":-v. /5'"/P'i I "':/0 - '/ ~! . Attorney: . '/ --j--r -/ Ii / ~""'~(~)\I / . , .' -, (/" /-' ... 0 +> ~ 0: QJ e ., < ro vi Z +> OJ ~ ~ t; ~ QJ E-t Cl oJ w ~ >- :: I- II: o Ul 'tl 0 < Iii N Z ~ ~ '" >- :I: K Z ro QJ 0 w ~ o w 0 ,q ~ Z :I: ~ .. ~ .-\ a: ~ ~ W .-\ ro g . oJ 'M P< 111 " OJ :;: Cl .. J 0( +> QJ 0: a: .-\ 0 < OJ l4 111 U ro ~ H Cl . ~ ;- ::: 21.7~ .... ~ , .... ill "' ::l ill 0 '0 to No. "' ~ d ill ............................ "' cr ~. 3 ~ .... '< .... @ Estate No. 21-79-680 ill ;:r p.. 3 ........................... ~ :".1 :~ ~ ill ::l :11 :It ::l 3 p.. : III : III p.. cr ~ :11' :11' @ ill ::l !; .., p.. ''ll " '" 0 p.. 0 :11 :It .., .... a :::1 i5 p.. ;:r :1'1' '" ~ " p.. [ :11I : III .... :11 i8' .... 0 :'< ;:r ;:J "' '" '" :11 .... eo. :0 iii ;:r WILL OF ill ::: !~ "' i .... .... ;:r ill I .., ~ ~ [ ill ill p.. , , ~ ~ - .... ! '< ~ : III ~ U1 ~ ::l :::1' ::l 11' I .... : .... p.. ::I' ::l ill :'0 r p.. p.. .., ..,J '< .... '" MERLE PALMER I ill 0 "' c ! 'J) .... Q.. .............................................................................. ~ ~ m .., 3 ~ Deceased. 1-* '< (') ~ (") '" 0 :Il 0' ~ ::l ...., .., .... m " 0 m "' cr ...., ~ '" p: ::!.. ~ ~ Gl ::l :X .... Q.. :It III (") :11 a. 0 :.... 1Zi '< '" :11 0 ~ III ::l ''ll ~ and recorded in Will Book # 81 ~ ................................. .:~ 'll ,III ~ ;,,0 : Ii' ~ 'll ::l :11 11 , III ::l :11 ( i ~ I ::- ~ #788 11 ::l . Page ETC. if ffi' ~ ........................ [ I t:I ~ I '" : " .... I '" ~ CD I "' "" '" po. \D , o.s1 1:" . Filed November 15 79 i '" .... ........................................................,19....... "'11' .... ;:r '" ~~ 1t ill \ ~ .., v, ill " Richard E. Anderson, negistcr ...............................................................................:\. AFFIDA VIT OF DEATH COMMONWEALTH OF PENNSYLVANIA I ss: COUNTY OF CUMBERLAND \ ,..................~\9...\I-\9..~...x~\),>.\jL...................................................................................being duly .......S:.)..~\X)...................... saY\~hat as nearly as can be ascertained the said decedent .......................... .......CS...............>.m,~,,~~~~~1L.................(..;,...........\.................................d';" " ..........~~\~,\.,\...... the ........\:....................day of ...\.;~:s:8...\'f.,.NY.L.................... A.D., r9.\\" at or about ......\..~:).D.\.:J...................... o'clock, ~..M. ..................~!~.~.~......................and subscribed this 14th November ................................................ day of ........................ 19, .?~..., before v' /~. ....~<JJ.~r.fif.~\.~~~b.~~:.'::<....................... ~.&~.JJ1~~......................... Kh..luud E. Audt;a",uu, H~~tel" "" COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND 55: _____ _ _____ _(;laq.ys P. _Palmer - --------- ------- being duly __ sworn_______ _____ according to law, doposos and says that fIlo _ __.i._s___ th~._E;)(~cJJtrJ)(____ ____.__________________ __ of the Estate of ~Br.JLJ?A!:.t11tE late of ____ oW_est pennsboro TWp., _ _ ____ ___, Cumberland County, Pa., deceased and that the within is an inventory made by _ _ _ _ __ _ _ __ he.:::_________ __ _ -------, the said executrix of the entire estate of said decedent, consisting of all the personal proporly and real eslete, except real eslele outside the Commonwealth of Pennsylvania, and that the ligures oppo,ite each item of the Inventory repre,ent it's fair value a' of the date of decedent', death. ~\.~ ~:~~~~~ fO:';UI:.::;' .: -. ....,,~'::..' ;-:,:;!JC My C....I.;"....., ' :;1 co. :..:...... I\:.JJ. 10,1:131. and subscribed before me, __/ilac/w- "f !li~ t! Executor. Adminhtretor ~,"-'L.~\",_~~LL-_- ~~~.Q,. - \~\N~~____ Addr." Date of Death ____~th___-_- November, Day Month 1979 Yur INSTRUCTIONS I. An inventory must be filed within three month, altor appointment of personal representative. 2. A supplement inventory must be filed within thirty days of discovery of additional asseh. 3. Additional ,heels may be altached a, to personalty or realty 4. See Article IV, Fiduciarie, Act of 1949. >- ~ .,; ~ 0- W \.< ~ 0 ~ '" ~ 0 .. w . 00 0.. .... ,Q u . '" 0 0 V> III . I w '" w p: l:: 0 '" ,.. l- I .. III ~ <l' 0.. rLI &1 0.. Z 0- ..J LL 3 .. oj - r- ..J < 0 0.. .-l 0 LL I , W 0 < w .;. o :l: .-l ,i > z '" re ::s< N .\J - Z 0 0 0 " 0 III ~ 0 I' V> Z rLI QJ 0 0 '" U z 'I w < ..:I ~ ... 0.. p: i -0 I, ~. 0 il - ~ 0 . .0 -0 -" . E Ii - ..!! 0 .. ~ 0 ..J () u: CD Inventory of the reol and personal estate of MERLE PALMER .._. deceased. ---_.~--_..-..--_...-_..--- .----..--..----. -- . - ._-----------.-- ------_._-..- Dauphin Deposit, checking account #67-19-8465 Dauphin Deposit, savings account Ul-2-00049 495 40 Dauphin Deposit, interest on savings account 2,354 11 14 69 150 00 6 07 255 00 plumbers & pipefitters Local Union No. 520 commonwealth National Bank - Ford Credit Life Ins. rebate Social Security Death Benefit 1976 Ford pick-up - appraisal 2,400 00 Total 5,675 27 I II " tl Flr:.V-464 (6.781 County, Number and Name Filo Numbor Dolo 01 Doalh 21 - CUIIlb.e.rle.nd 21-79-0680 November 8. 1979 SUMMARY Estoto Name ....--J'e.J.mer (LAST NM,1E) Her]" (~'IR5'T ~J""MU (lNI riAL) COMMONWEAL Tit OF PENNSYLVANIA TRANSFER INHERITANCE TAX RESIDENT DECEDENT REPORT OF INHERIT ANCE TAX APPRAISER I, tho undersigned duly appointed InheritancE' Tux Appraiser in and for the County of Cumberland Penniylvania, do respectfully report that I have appraised the real and personal property 06 reported in the foregoing roturn at the values sot forth opposite each item in the last column to the right in Schedule.. IIAIl, "B", lie", and liE", Datod: March 13. 1980 92' , 11'" ,} A /'/"-'(11);' '1'/1111-1 INHl:HITANCE T,II.;'; AI-'PRAI~LI~ REPORT OF THE REGISTER OF WILLS I, the undersigned duly elected Register of Wills in ond for County, Pennsylvonia, do respect- fully report that I have allowed deductio!1~ in the amounts claimed by deponent, Qxc'Jpt 05 to those items where 0 greater or lesser amount is iut forth in the last column to the right in Schedule "F", which greater or IC$Ser amount represents the sum allowed as a deduction. Doled: REGISTE.:H OF WILLS Nnn ADJUSTMENTS ODE (HARRISBURG USE ONLYI 00+ 10+ 20+ 30+ REMAINDER APPRAISEMENT CODE INVENTORY VALUE AS APPRAISED Real Property (Schedule A) Personal Property {Schedule BJ Joint-Hold Property (Schedule El Transfers (Schedule Cl TOTAL GROSS ASSETS Lass Debts and Deductions (SCHEDULE FI CLEAR VALUE OF ESTATE $ 92+ 4(). 93- Valuation of life estates or on"ultles.......... ...........=: $ PRINCIPLE F..=\.CTOR VALUE -- ~ ESTATE TAX ASSESSMENTS _ $ ~ f= ~ TOTAL TAX ~ 2% $ 6% $ 15% $ $ $ -- S $__ E s S COMPUTATiOt", OF TAX FOR USE OF REGISTER ONLY Tax on $ To x on $ To x oJn $ Tax on $ Tox on $ Exemptions Total Estate (,,) As l'videnccd by Charitoble E~emption Cor1iflcotes Issued by the Secretory of Revenue. Less tax prevIously paid BA LANCE Less 50/0 of lox If paid with1n 3 months. after death BALANCE OF INHERITANCE TAX DUE Add interest 01 rate of 6% from 10 AMOUNT OF ESTATE TAX ASSESSED Estate 10l< paId $ $ C: $ L s S I $ S $ I BALANCE DUE Add interest at rate of 6% from to TOTAL TAX BALAtlCE PAID Supplemental Codes: (FOR USE IN HARRISBURG ONL Y) 4B-Adi u.tmonl 49+Adj'u.tmenl 56-Annuity 6O-LiI. E.tote 92+Remoinder Approisol 93-Rcmainder Deduction 93C-Cho,ily 94-Rumoinder Re,idue 96_Succcs!oivc Life Estate FOR USE OF REGISTER O~LY ADJUSTMElns NOTE: Where subsequent adjustments ?re made to the above computation of tax by the Register of Wills, for proper reason, lame ..hould be noted below, With short explanation. l- I>< ..J Z "0 ~ <: .. ~ . ra . .: " ::;; . <: " . ~ ;.. ~ u <>:: '" . Ei 0- - Q <: 0 0- " <: ~ '" '1: 0- L:. ! 0 Cl CL .g " 0 'tl ,.. z !!l <: OJ .: ~ - <: . ~ ,.., ~ ~ i= .: v: I- ~ rl " l- e ~ :I: '" <: '" " ~ Z l- e l- i '" " 0 L:. '" .... ~ 0- 0- ~ " 0 '" ~ ~ ~ 30 0 0 <>:: <>:: '5 .!2 ~ OJ '" l- I- " = ~ :< <: 0 u: 2 ~ " '1: 0 ,.., ~ ='s ~ c " e ._'" " 0 0 "'<: ..J u U 0: 00: ai J'i. ,{R: 0-.' :fI \D: - >, ?- m w ~ z ~ "" e: w u ::> '" :; '" :.: ~ ..-I: 2 8 q Q I: ! w E-! "'1 w ~- ~ '" > <i d 0: ~- 61 w 61 , a: f.< ..-Ii II: 't:; ~ c.. ~! Q ~ ~ 1:i' c.. 1 Ll. ~ ~! c( ~ 0 '" ~ 1 cj ~- e '" .~ , X 'iil I '0 fo- ~ ~ '0 .. I: :::. !;:: "",' 0. 5. ~ <: 00: 2 0. i3 I : '" il '" ~ I: ~ 0 ",- w '" a. \)..i w ~ ~ ti ..-I: '" '" :;: '" 't:1 (,) :s ..;j ..-I; g -'" 't:1 't:1 E ~ z ~ ... f0- e: ~ e l'-... 'tl: lit '" ~ co: '" >: II: "' Q 't:1 3; q ~ "" ... s::: ~ '" "' <l: ] .0 ~ '" I aI: a: ~ 's, ..... "- 1:i' "' 1 Ii; ..-I: w "5 61 '" Q W ~ ,5 '" ~ ........ 1-<: :I: O'l e::: ~ 0 E ~ rij '1S .81 E <:: 'OJ Q ~ ~ q ,5 "' ~ ~1 '" '" u ~ I- '0 ,!!l '"0 Q '" 01 z ~ ~ '" ~ e::: w ~ - c ~ 'r:: en Cl '" w a: COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF EXAMINATION OFFICIAL NOTICE OF INHERITANCE TAX ASSESSMENT '* COUNTY FILE NO: TO: ..~~, ,v, ,., d ,: :11 ~ r7 w. - II r b).tJ.(1 ;;./ /' '') ').. ( /,"j) DATE J,'),'..1.. \ . \'{\ d:J .;;!. '7 I () J-iJ /"/1 ~ 11"Vf\r~, :I" , 1\' -. I, I ,; "1 ,(.:. ,\J.j { Ifr \ ~ ~L 4i \ \I~ ) 'J II I .;,' '1 , ESTATE " I /' I f.") FILE NO, ,-x .) \~ _ ,..:r I COUNTY (^ I 'w-~" ) "f ( \.\., .-) (i. DATE OF DEATH 'r Ill\j I\', ~ 'l ~ Appraised Value of Estate: Real Estate s "-. ------ Personal Property + 51fd.(),..2..0 , Jointly Held PropertylTransfers + Total Gross Estate $ ,r.:: (/. II J () -"" 7 ........, _>. --, Total Approved Deductions I.), ~/);-' If b.!~ , Clear Value of Estate $ 5 -.3 '..) (J ~j, Less: Approved Charitable Exemptions Amount Taxable @ 6% Rate .L: " !.,.)., $ . ' .- 'j -~-":"l $ ~ .:so (~! ') $ 31. Vll ..-'.. tax due tax due Clear Value of Estate Subject to Tax Amount Taxable @ '5% Rate TOTAL PENNSYLVANIA INHERITANCE TAX DUE $ 51 flj * * * * * * A five percent discount totaling $ will be granted if the Inheritance Tax is paid by Less Credits: DATE OF PAYMENT AMOUNT PAID DISCOUNT INTEREST TAX CREDIT O(-~ -}-O $ '1- 0-" I) r + .. <' / $""\,,,":I:J- $ = $ I./-~l / if + = + = Interest accrues at the rate of six (6) percent per annum on the unpaid balance of Inheritance Tax from to date of payment. Interest due jf paid by . is BALANCE OF PENNSYLVANIA INHERITANCE TAX DUE Assessedby: . . . " A~e f r he om OhM Itht See Information on Reverse Side. ,",., _ _'" .__ , "'< I" , 1 , " l..,._ I{~~<,V ~ ~ I r'J.)" .., ~ \ \ - ''"''-'Y""\ ~(,.. '.,~ '~ i, " INFORMArIO~ To insure proper credit to your account, thn "lime 01 Iho estolO ilnd file number should be clearly print- ed on the chock or money order. This assossment is made 1n llccordilrlCe with Soction 708 of the Inheritance and Estate Till( Act of 1961172 P,S. ! 2485,708), To the extent that inheritance lax is pllid within lhree (31 months after tho death of tho decedent. a discount of five (5) percent is allowed 172 P.S. 9 2485.716). Inheritance Tax, other than tax on a futuro interest. is due at the date of the decedent's death and becomes delinquent at the expiration of nine (9) months !liter tho decedent's death (72 P.S. 9 2485.711). Inheritance Tax on a future interest is payable within three (3) months after the transfer takes effect in possession and enjoyment and is delinquent thereafter (72 P.S. S 2485- 712). Calculate interest from the delinquent dale shown on the face of this form to the date of actual paymenl using the following interest table: -------------------- - - -------- - --- ---- - -- ------ - - --- - --- -------- -- -- - - - -- -- 1 month ,005 4 months .020 7 months .035 10 months ,050 2 months ,010 5 months .025 8 months .040 11 months .055 3 months ,015 6 months ,030 9 months ,045 12 months ,060 1 days ,00017 11 days .00186 21 days ,00352 2 days ,00034 12 days .00203 22 days ,00369 3 days ,00051 13 days .00220 23 days ,00386 4 days ,00068 14 days ,00237 24 days ,00403 5 days ,00085 15 days .00250 25 days ,00420 6 days .00101 16 days .00267 26 days ,00437 7 days ,00118 17 days .00284 27 days ,00454 8 days ,00135 18 days .00301 28 days .00471 9 days ,00152 19 day. .00318 29 days ,00488 10 days ,00169 20 days ,00335 30 days ,00500 Any party in interest, including the Commonwealth and the personal representative. nol satisfied with the assessment may object thereto within sixty (60) days after receipt of this Notice as provided by Section 1001 of the Inheritanco and Estate Tax Act of 1961172 P.S. 9 2485.10011. Make check or money order payable to: "Register of Wills, Agent" Mail to the address listed below: Ul . ..:..: r4Z HZZ 8 0: ~r40 2; ~H 'Cl r4 -. <( Z Ul OJ :;: ui :: z o -H III " r4 r4 <( ~><:> III .' H ~ ~ S f- :; 8HO OJ "'" 8 " OZO'" r.., u G- 8 E-' " >- ~ ;; UD ID 0 OJ :.... r4 Ul ::J ~ f- N III 081 0 Ul [iI . Z " r..,U ~'" [iI o >- , x Z ,) 0 (; 0 Dr- ~ - ~ H o w ~ m W " ;: .. :: 001 ~ \ 0 ~ Z 0 8Z U..-I 8 [iI I'< u.: a: ~ w p:;,,: N Ul :;: 0 ~ ..J D~ Ul [iI ~ ~ Z Ul w t: , III N o Z' --..--: 0 C) <( :i U[iI ~O p., " H ~ a:: a: [iI~ ~Z .. 8 0 " \;l [iI - H I'< U tI::D ~ , 8 0 W " t:) 8U 0 ..~ [iI Z ~ ~ ZI'< H ';'~ HO LETIERS TESTAMENTARY COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND tf;-~~ '../.....'\......._,. ~'.."'4 . .. .... ,.....~ - .~. "-' ",'" "'..... ..:.....;...~~...,.',".. . .', /. 1,,_:'" '.. .r','''' € ," - I /0--- .~~ \:.~ oh /' ."....: '.......,. ( ~.....~:,.. ,>,., ~," :: ,:;~ ~ '..'~ - I" '....'- . : ,........".,~. " :..:>. "" ~.',,, ",::----' ,.-' ,: ~.::... .. . ....A '.- -~.~ "', -"'_~l-;"';. ~. , .... --:;../' - of....., _, I ~ - '.. - ..:.,;. .i:. .,' . .. .~~. c';' L...,", .........._... ,,)~ ~..~~:~..... - ~ ~..... Vf"'\Ior.~v......."'" 8S: lIY THE TENOH OF THESE PHESENTS I. .,.,"',.,..,',....",~i!.;~~,,~~~"~::.~r.,~t~~r.;,:,"'~,~,~~~.. Eaq,. Register for the Probate of Wills and Granting Letters of Administration in and for the County of Cumberland. in the Commonwealth of Pennsylvania, do make known unto all men that on the ."................,,~,~,',1;',~..,.......,......,.. da, NOVEMBER 79, of ..........................,......"....,......................". 19......... at Carhsle, before me was proved, appeared and Insinuated, THE LAST WILL AND TESTAMENT OF MERLE PAUtER;' LATE OF .. . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . ~ . . . . . . . . . . ~~~ :~~~~,~~<?, ';l'~~~~~~ ~. , ,~~~~ ,99P'm,. , ,~~~Xr,.y~;t1()ECEASED, (a tl'ue copy whereof is to these presents annexed), having whilst. , ,~ , . lived at the time of', Ji;Il>death divers goods and chattels, rights and credits within the Commonwealth, by . reason whereof the approbation and insinuation of the said Last Will and Testament, and the committing the Administration of all and singular, the goods arid chattels, rights . and credits, which were of the said deceased, also the Auditing the Accounts, and Calcu- lation and Reckoning of the said Administration to me are mariifestly known to ,belong, And that Administration of all and singular, the goods and chattels, rights and credits of the said deceased, and way concerning .~~~, . Last Will and Testament, was committed to .. ~~~ ,~~, ~~~.. .. , .. .. .. . .. .. .. , , .. .. , , .. .. " in the said Testament named , , ~?C;E,~~~~. . , . . , , , , , , , , , , , , , . , , , , , , . . , , , , , . , , , . " having first been duly qualified '''All "..rl h",h, tn ~(]mini!;tp.l' the l!'oods and chattels, right.. ?n~L~I~~!ts_ of the deceased, - ...=~.)Io-ua:~IiIII.- r:::::;o.........~_II.n A_ 'Yl1&...--.~.u"~n::::c...~../iI""""",,,,,"""""'~.lI':=:.'.- t( RCC4(1~78) COMMONWEALTH,OF PENNSVLVANIA ~. ~~~.... ~ ~ NO,J 0 J 4356 DEPARTMENT OF REVENUE "~,,-:,,t'~ ~ OFFICIAL RECEIPT. PENNSYLVANIA INHERITANCE AND ESTATE TAX V,~;Mi}i..~K\ It- ~fv'BJ;~ 0\ ~ RECEIVED ______________________FORTY-FOUR & If = From, i ~ Addre.. 27 W. High Street .., II ~ File No. 21-79-680 Georqe F. Douglas. Jr. Esq.,. 78/100----------------------- doll." representing Pennsvlvanla Inheritance or E,lolo To, due hom Ihe following e.lole: 2% To, on s s carlisle. Pa. 17070 6% To, on $ $ 11-8-1979 Dole of Doolh 15% Tm( on $ s Dole of Poymenl February 7. i Name of Decedent MERLE PALMER Cau nly cumberland Remarkl: t "PAID ON ACCOUNT" 1980' % To, on $ E,lole To" Act of Moy 7, 1927 $ s TOT Al TAX CR.EDI! less five percenlum of lax If, poid wllhln three months ofter dole of deolh Plu, Inlere.1 ot Ihe role of _%from to s 47.14 2.36 s s i @OO~@~~&[b 44.78 SEA L TOTAL AMOUNT PAID s '--'1J':1I,~J\~ )r~~~ Harc(~n<l!lJteiMCLa e D t , . epu y Reg1ster of wills (Title) NOTE: To be delivered to tppay<< Received by NotE: In octtpling Ihll Itansl.r Inheritance 101( on lulur. lulole5, prior 10 Ihe dealh of Ihe life lenont or lenonl lor yearl, 01 evlden(ed by Ihil retelpt, it II undorslaod that th. Cammanwflallh Iholl not b. pr.cluded or pr.vented from her.allor oll.uing addll10nal Inhorltan(e 10. 01 tho death of the Ill. I.nanl or I.nanl lor y.ars wh.n.v.r II oppears Ihal luch addlllonolloll may be legally due and (olledlble for any r.050n whatloev.r,