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\1' I, JOliN 1'. I3I:lHNS, pl'osontlY I'oSidinr, nhd dom:\.n:tlod a.t 2.8110
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'I Sunset DI'iVB, ~a8t Pennsboro Township, Cumbe~land oountYiPonnsyl.
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IIvaniB, deolare this to bo my I.Hllt W:\.ll and her"6bY I'Bvol(G all wHI.S
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1\ whioh J: have pr'0v:\.'oU13IY made,
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P ITE:M I:
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1\ Trust Oompany of' Harr:\.abul'r;, t'onnsylvanill, .BS the J<;xeoUtor of' my
\!I,e~tat0' J: appo:\.nt Dauphin l)epoaH I3fln\( and 'l'r'ust Oornpany and,'
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'~homas D. Caldwell, Jr., us the TI'uatees of any t.'rusts oroated by
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1\ th:\.s wHl. Shoul~l th,e :\.nc1:\vldua1. Trustee be unable to serve fol"
lla"y I"elson then the institutional TI'ustee ~lone shall sel"ve in thi
Ii oapao'i ty.
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1\ TIr~M II:
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1\ the following :\,ndividualfJ:
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llmay have in 'tangible personal propel"ty, inolud'ing but not limited
II to household fUl"niture and fUl"n:\.sh:\.ngs, bool(s. p:\.ctUl"es, .Jewell"Y,
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liwltohes, weal"ing apparel, automobiles. tools, equipment, ahd all
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. 'H'Othel'i,tems of Ii l<enattlro. ' We considel" OU1' household i ti!)ms t6 be I
Ilheld by "' ..h"b.nO ,,' .if', ten..t' bY tho ,n"""'" bot ""\"
II should thel"e be any qui:lst;ion 1.' gi vo whatever intel"es\;' I may, have j;
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"Oli)/e is she sUl"vives me.
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I ~ppoint O/ltlph:l.n Deposit Bank and
My immedIate fam:\.ly is composed of!
Olive Taylol"l3urns, my wHe olive
BenjaMin F~ Burns, 01,11" aon - Ben
Samuel A. Blll"ns. n, our son - Sam
I r;iveto 01:\Ve any interes\; that I
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If my w:\.fe 011ve should predeoease me \;h1s gift shall
1\ be d:ls\;ributed Uo Ben and Sam in equal sh.sres. In this respeQt 'I 1
Ildil"ect that the grandfather'S clock be ~:\.etl"ibuted to Ben and Susal
IB~rns. his w~fe, and Sam shall have some iteM or 'items of comparab!6
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Olivo 1s Donoo~nodl tho'Tr"stoBB shall ho oORnizuht of tho fuot I
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:'that H wou:td be adv.lsnblo f'or hell' to 1:lqu.lduto pr>:lnoipal standing
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Ilin her own name hoL'()t'o I'!ntopt;a:ln'.l.ng any Pl'!ques1,; or hor'S to disM ,
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litl":1.buto Hems of pt'ino:lpal l't'om th~] j;t'uat; eatabl:lshod by thh w:LJ.l
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With thlaln mind, I would not. DOnBidor it advisable
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undeti
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Ithe p!lesent tax laws
to advanoe any substantial portions of RI'in-
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IIdepleted
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but I nqvo1'theleSB want to :lnsu1'o thElt tlie r.uu pt'~.noipl'\l I
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1.n'\;hio t;l'ust wUl' be aV/l:l.lable fot' hEf1' oare and oomfort I
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est;ate I
OliVO unl;11' her own ~nd:l v:ldual estate :Is oonsldet'al;>ly
Ilso lQnl!. as, she 'Uves and pa~t:LoUlat'lY,:t.r her own lnd:l.v1dual
qshould beoomE! e)(hnust(Jd to, meet thes,e needs,'
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, Ii D, Upon my wHo' B death, any )'ema1nl.ng balanoes in the
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Iltrust fund (subJ eat, to the pl"Ovis:l.ons of I'I'EM X he1'ebf) shall be
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Ildistributeel 1.n equal shares t~ Ben and, Sa~l. 'If e1therof, our sons I
IIShO~ld p~edeoease thiB event loaV:l.~g issue (whether born or adoPt~')
!Jto survive, thaissue shall, ta!{ethe parent'B share, ~r.:.'st;\.rpes,
IlshOUld either son predeoease this event without leaving issuEl to I
l'lsurvive the eVE1nt, the shat'e of that' sonahan be d1.stt':l.buted to t~e
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P son of ours who survives ,th'l'! event J ot' his issue tli,,!n 11 ving " per I
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'!,fltirpes, as the oase may be, I
II E'" I grant to my wHEt Oll.ve a spe,ol.al power to appoint IbY
IiW;l.J.'l, and by speo1f:l.o l"el'erence het'sto, te,> suoh of qUl" ohildren or 1
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!Iother, issuo the l'esidual benefHs .I.n thiB truflt fund in Buoh pro-
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ilportions and upon suoh te~ms BS to trusts or o~tright ~lrtB as she
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II deems advisablfJ,'
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IlapPol.ntment the reB:ldual benefits shall be administered and dis-
II tt'ibuted as I have set rOl"th het'el.n.
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ShOUld she not 8xeroise th1s spebial power of
All shar'ee of pJ1:lno:lpal 'and 1.lloome
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iiput'suant toan.Y trust fund 01' rundsoreated, hereIn shall be free
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I r~om ~n~:t.oipation, assignment, nledge ,ot' obligations of the bene-
Iri01a1'y,~nd shall not be sub,Jeot ,to a~y Wt'it of attaohment at'
e)(00ut1011.
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I. the sum of In6,oOO rrom Daul'I1:l.n D(~po~d. t Bank and '1'rust. Oompany. 'J'l1t
I prooee(l~ ofthla 'loan' l1ave 'bQ~1n ent<:I.rely used to 118s11,1t' Benlnoert
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ftll1n Pinanoll1l matters. At suel1 tlmo BS my estate bftoOm~S di~trlbt
II ptl:ib~f'lto our two Bons, there shal.l f,trst be g:\:von to 8en'an amount
Ilof $30,000 an~ this sl1all Pirst be applied agalnst any re~~inln0 :'
iibalanoes on tl10 note wHh ,Pauph:ln DepoflJi; Bank and Tl'!lst Oompany.
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II'If the not:e ls less than *30,000 then thl1t d:U'f~renoe shall be glv$n
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make 1;hls dlreoi-
Sam Bmount~ I
ITH:M ~J~
I bOl'rowed as a OO-IlI11I{ot' w:l.th lilY BonB(~n
to Ben before thed:l.vis:l.on between my two BOns. I
Illon because we have previously g:l.ven our other son
d equat:l.ng *30,000.
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I ITEM XII
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lin trust to
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II which shall
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unY,suOCt;\8S0ri?
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disoretio~
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I autl1or:l.ze the Trustees and
e~ercise the fcllowing po~ers in the:l.r sold
be effective without sourt order or approval I
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wibhOur
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or produotivity. I
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all forms of property without restriotloni
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To ritain any or al~ of the assots of my estate
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'I' regard
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'I 'B. To :l.nvest in
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liar Trustees, and to mortgage or
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II bate estate.
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!Ilease for any period of tlme, any real or personal property, and
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lito glVe opt:l.ons 1'01" sales, exchanges ~~ leases ,all 1'01' such pricesl
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II and upon such terms and Qond:l.tionsas they deem proper.
,I a. To all06ate reoeipts and expenses to prinoipril or
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II income' or partl~to eaoh as they rieem proper.
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Ii. To 8,1 te,r, repa:l.r or impl'oveany real or per~or\al'
to any prinoiple 0,f' d:l.versific,,!,t:lon, rii,ak
investments authbrized for any type of fiduoiary.
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To, oomprom:l.se any c la:l.m or bontrovensy.
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Exeoutorl
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pledge any real 6f' personal proper~y.
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To borrow money rrbm any person, :l.ncluding my
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To loan moneY to at' to purohase property from my pro7'
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To sel~ at ~ublic or priVate sale, to exohange 6r to
property.
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To distribute in oash Or in kind or partly in eaoh at
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I vnluai;;lona rIxod by \;ho.
" J, ~o vurohaBb InvaHt~0nto at pvemluma and to ohav~o
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IpremIums to Inoome or prInolpal or partly to B~oh.
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To oubscrIbe rot' ot' to sxet'olqo options rot' stooks,
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II bonda or othel' :I.nveol;montrll to Jqin :In any plnn or leUlHI, mQrt;gnga
mel'gel", oonsoUdntion, t'oorgunI\~ut:lon, f'opeoloflUl'O"()1' votl.ng tl'4st
and to cleposIu ,seour:l.ti0s tl18rounderl and 1;0 generally exero1.se al
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rights of"uooudty holdel'ff ()l' omployees o.f' any o[)rporatl.on.
L. TO t'egintev,oODuvItioB In the name o.f' a nominee 01' it
suoh manna!' thlll; t:ltlfJ shall paso by de;L1voI'Y.
M. To assume oontlnuanoa'of the status of any benaf1.oia~y
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IWHh l'E).f'erenoe to death, marrlage, divoroe, illnoBs,' :lnoapaoity or
lother change in the a~~erioe or lnfovma~ion deemed reliable, wit~ou,
'!liab:l.;I.ity fOr disbursemento made on suoh assumption. ;
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1 N, To acjd to tho pl'l.noipalo.f' ~ny trust oreated by this 1
linstrulllent any real 'or p\'lrsonal propert,y roooi ved from any person I
IbY dee~, wil~ or in any qther manner. I,
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O. To exeroise all power, (luthqrity and cu'acrf3tion r,:tV~1
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trustl
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I e,state oreated by ,tl11a instrument in anyone or more common 'fuhds
Ifot' g~eat~r oonvenience and flexibility,
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I Q. To employ att'Or'neya,acoountanta, engineers and
Ilother 'persona ,pl'ofeaoional or othel'wiae, 'as tnElY be neo0Bsary for'
lithe prope!'Mtninl.strat1.on of thia eBtate Or tl'U(lt, and to pay
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lioompenaa,t.on from auo unda.
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I' any type or manner or inaul'anoew)'d.oh thp,y deem to be in the beat
interest of the benefioiary or bene.f'ioiaries.
thl.s instrument after thetertnination of any trust oreated
untl.l bhe s~me ia tully disohal'god.
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My Trustees only, ma~ oommingle the, assets of'any
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I ~uthoriBe the Trusteos to purchase .f'rom the trust
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ITEM XII I
, I have designated the Trustees Bs
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OATH OP PERSONAl.; REPRESENTATIVE
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CO,',i~~qNW,'HALTli 0, II pnNNSYLYANIA~ 581
CPUN'l'Y OF CUMBHRLAND )
Bofore me! the Re/llstur fpr tho Probato of Wills and llrnntln/l of totters of Admlnlstrntion In nnd for tho
Ill'O\IC\ln H, IIn\lo, Aaa:laCllnC, '('rllaC orf:loor oflJnll\lldn
County of Cumberland, I,orsorally camo ..IWp.I\I;\J.ll..JI1J.\1k .,f1.,~'X,l,(\'i.h..r;m\\V.lllw.......,....".........,......".."..,..........'",,,........
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who. :being duly ....awoxnw"".,,,,,,..; do \-\"'''11;'' depose no" sny that "8 ,.."....,.I~~.Q.9.\\,~,P.1:H''''''..''.":..".,,.....It.,:.II,,~:..j...
f II d f .1ohn\', 111l1,nH 'd d
o ,tho 1l1st Wi an Testament 0 ..,..,."...,,,............,,..,.,;.....;,....,........,.j,"...j;....,.....,....,...,.,..,..,.itt.....,.............. ceoala
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.,......,.................................. wl11 well IInd trulyadmlnlstor tho /loads and chattols, rights and credits ,Qf said doceased
according to law, And also will dlllgontly comply with the provlslQI\s Qf the law rolatlng to Transfer Inheritances,
E!Horn co I b IL-d
.........IIl."...O.jf.'........ uu~ au scr.Ui,;
before me.
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..,....L... o. ........... ..................... ..{......i'.....~.....i........t1ju.~.I...
AsaiaClmc. '['rusC Officer of Dauphin Dep,Dsl.t
Bank & TrUA C Company ,
, ......l'O'~.~AJ\ln.Y.l:,.:l... .......j~......j.........,..,..... A. D'I 19.,~.~....,
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DECREE
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. . lOth' December ' 79
ad it remembered that on the .......................... dllY of .........,........................"......................, 'A" D.t 19........, there
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WAS probated and recorded the last WlII and Teilament of ....;...~.~~.~..:~.~....~~~.~~...."......:..,....................,..............,
.'late of ..........S~.~~"~~.~.~.....................~..."...............,,..............., Cumberland County, Pennsylvania, Deceased. Letters
...............;........!~.~~.~~.~~.~~t.......... were granted to ...,~.~~.~~~,~...~!~.'?~.~~,...~~.~~..~..!f.~~.~...~.?~~~~~..
Witness my hand and QCflclnl senl the day and year aforesaid, . ,
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, RegiSter.
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<:OMMONW~AL TH OP PENNSHVANIA
'" DEPARTMENT OPREVENUa
nURf,AU OP COUNTY CO~~ECTlONS
APPLICATION FOR AND CONSENT
TO TRANSFER SECURITIES
REGISTERl;D IN THE NAME
OF A RF.SIDENT DECEDENT
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.~.~........._-_.---p ---.~. ----., "'"""'~~-'-'--'~" '.... --------,--.< "'~'---_..-~-,.._~....~ ---....--~._h._._a....."_,__'._;_+_..n.,.o__~_.~._,._.__._~_...__....
~ (MUST BE FILED IN TRIPLICATE)
TO THE PENNSYL VANIA DEPARTMENT OF REVENUEI
'Application II horoby modo for COIlsont to tho trans for of tho.fallawlno socurlllos of<< Ponn~ylvanla
Corporation or a National Banking Auoclaflon locatod 111 Ponl1lylvanlal ' ,
(a) 100 8ha. (b). HdB~ I'aun row,~r ~o",Pl\~X.____~_._,___....--:..,__(c).~~::~L2!.Pr{\l!.~ Stoak "_
(NOTEI ,In doscrlblng loourlllos entor In (a), ab Ole, elthor tho nvmboraf shorol of stock or tho face amount of
reglstorod bond., In (b)/ tho name of tho IVulng company an'd In (c) the class of stack or tho statad Intarnt rato
and mnturlty dato of roglstorod bO~lds.) ,
DA TE -'!:1~( 80 ______
ISSUED ON-llL23./.1L~__., andhnvlng a TOTAL MARKET VA'LUE OF$.Jj.~-.:::
(Dolo) . .' ,
as of tho dale of doath of the decodont, John 1'. IlI.l1:'n8 '______, on_~2/3/79
(Nnm. of O...don,Il (Dol. of doolh)
who w'a~ late 01.....110CI' ~l!1rkat St. ~~_qnntI:J:1:!:!.L__.____9~!mborll\I~L2~nnay1v~h;tn
, (51'001 ood Numh.,) (Po.t 0111.01 (Coun1y) (Sloto)
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'rhe IOcurllles are registered as 10110wsl.............J,ohn...E.._JlurulL.-.._______---'-_"
. '(NQme or namo. 'In which oo'tlfll!~htl \'He raul.torud)
~j)M1~~~~) PlIuphin Papos;1t Bl1111~ & l'rustCo,., P.O. Box 2961 lItlrViabllrB, I'll. 17105
EXE~UTOR ') (Nome) .--_... (Add,...)
NAME OF APPLICANT POun1jin PaI1oa:lt Bank & Trust O..QffiP.nll"
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COUNTY FILE NUMBER ,')./. '7? 7,) L ADDRESS OF APPLICANTHarr~abllrll' Pam~a. 17105
BUREAU FILE NUMBER , ' _SIGNATURE OF APPLICANT .'.' " ," ~1.l,d4I.-1J( ilL
NOTIClll. IP YOU PAI~ TO PROPllRLY FILl. IN, ANY PORTION OF THIS APPLICATION, IT WILL N1oifaii'r: iVi. "Ial(rj
COHSIDERllD COMPLnll AND WILL;Bll RETURNllD TO YOU' POR COMPLllTION. ,f\s"I~llln\ :r"U~1 !)tll/lor
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COMMONWEAL TH OF PENNSYLVANIA - DEPARTMENT OF REVENUE
CONSENT TO TRANSFER,SECURITIES 'c...-), I IJID b
. . DA TE ~ tN-.f. 3_ ...ur T7
I hereby conSOn/lo the transfer 01 tho abovo socurltles now roglslored In the namo of theafore'sald
Decedent an'd wolvo the filing ~f a ~ertlllcato certifying t~/hepayment of tho transfer Inh~r1tanco tax to which
thu property ,of sold Decoden,t Is made svbjoct'pursuant to the provisions of the Act 01 June 20,1919, P.L. 521,
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os omended and the Act 01 J,~neI5, 1961, P,L. 373, as omendod. This Is, also In accordoncewl/h tho provisions
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01 the Act ,~f April 9,1929, P.L. 343.
This Consent to Transfor the herelndoscrlbod proporly oporales only 111 reforonce to tho esla/oof the
,abovo.named Docedont.
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Slgnod fotho Secrelary of Rovenue
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,1. . ISI9nolU'tl,i; A
t~~~~~'~~~.~~~;~fr~~,-
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COMMONW.AI.TH O!'P.NNSYI.VAl'4IA I.
COUNTY OPCUMBIR\.ANP I
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~r~.oJ!Qn ..,I<1....~.!l~K~Ldls.s ;sj;<\n~,1'r,lJst. of f iOCilt'. ~U?1l.I,!PlliJL.pep'Q.!!}.t J.nm~.!<_,')!J; \l~j;...g9~.
b,Inll ~~Iy .,_~aw~n"u~__'H alloordlng 10 law, ~opolUand IaYl'that ho "._j,a-1:lKe..Q..Ut.QJ;......~~..~L\....-
_._~._._ ,__,.......,_.c,__..._~'u.u..' .,." 01 tho Elhto 01 .._.r.~lUl_ P. aurn~__.._--'-.~_--'--'_
loto of'_,.Oampli;Lll' bauphinD~1?6aih13i\i'ik" ana 'tf/~~~rJ.~~ ~.!!nty, Pa" do~ouod ondthot tho
within II an Invontory modo by . ,., ."... ,m" ..~_U..H'_._.___"_ u,'_'"' .,~.tL ~" tho uld .-lilXBoutOr-...__.
qf ,tho 0, ntlrll oltoto 01 laid dooode,nl, o~nllltlng 01 011 tho porll/nol prop'~rly ond rOIl 81tO'O, o~oopt rOIl'" ltoto o~hldo
tho Cqmmonwoolth 01 Ponnlylvln1a, and that the IIgurol oppOllto eallh 110m 01 the Invontory roprolont t'l ,Iolr value
01 01 tho date of deoedent'I death, ' Dauphin J)eposi t Bank and 'l'rulilt company
Sworn to , __Ind lublorlbed beforo me, \ B /11 d~ / ' )1 ;;tl
._Y.L.,. .e:..!..k...~&L.......L/L-.; ~-----
Aug\lS/: Z8, 80 Assist 'n I, Smut.,,, MdoltlIlKrur.H TrUSt Officer
, 19__ '
,...,...J'(.I . ,l/l J ' 'J' '," j ..~;J.L!1arkei street.. ' ,
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t [I""hdh I 1.."\' ,;".., ",,1,1,. "Ilarri.~~u~i!.._ Pennsylvania 17101
\ Add,...
t" My {III"', 1,1 Il 1'11'1' "loll! II'
" Hlnl\llIll', 1,1 I ~I,,]f,
Pat. or D.eth __...'l.'h~_.._______~--...-lli!cem!;l.f!.L--
Q.v "Month
1979
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INSTRUCTIQNS
,I I An Inventory mu.t ,bo fIIe~ wlthlnlhree monthl Ill,r appointment 01 potlonel repre..nhtlvo,
'21 A lupplement Inventory mUlt be IlIed withIn thirty deYI 01 dllOOvery or eddltlonellllotl,
3. Additional Iheet. mey be ettaohed .. to petlon~lty or rulty
<I. See ArlloleW, Flduolarl.. Aot or 19<19,
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Inv.ntoryol the r.al and p.r,onal ",tat. 01
JohlLL_J~.llrnL_...__.~..._:"'.__~~,_.,,~,,_ d.c.cl.d,
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~1\SH AND CASH I'l'm~
~1. John r. aurns, Attorney-in-faot aooount date of death balanoel
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-,7-
;-8..
,
Prinoipa1 cash
Inoome oash
Ref.unds' from Medioare
Refund on Amplifier from cummunioaicl
$31,053.24
2,183.88
smCURITIElS
$50,000. u,S; Tr~asury Note~ 12;125~ due 11/30/81
$ 250. Ha~risburg Area Industrial Development Corporation
2.5% 25-year Debenture due 1/1/92
Aooured interest
600 Shares General Motors Corporation, Common
Aoorued dividend
100 Shares ~ersey Central Po~er ~ Light company 8' Cum.
Preferred
2Do Shares West Penn Power Company 4.5%, Preferred
$33,23712
3600
16 00
50,72
30,45
90
14
6,10 00
8 20 00
29 95 .77
IJ', M..? '~'I'"
N(~ '1-449 ll..eol
COMMOMWU~TH OP PftMM!Y~VAMIII
DBPARTMBMT UP RBVBMUB .
TRAMIPER IMHeRlTIIMCC TAX
RIIIDBMT OBCaDeNT '
_p'~ ~ . _~#-~tl"=-~l'"~~...."mf,'l'if\...-m-.!"~~r...:J..!....~~':~~ij..r.'r:-~ ,
'*
_ --- ,--,-......
estate, 0/ _..--i!2hPuPL.JlW;.lUL___.~_.~ ~......_.,
La s t ,Add re.., __~~ ~ Cje r._J'!J.J,L~AB c;LJl'2l\l~... ,.,. .,..;...
........9~mp .lLLt~L.J?1L..__J1.9.1L-...
ICITYI (UTATn tl-1I~1 '
Do to 01 Dllalh .._...J;>gE.~m!?et' 3, 1 ~J.9
,
5\10101 50curlty No, _.....l_U.::2,4.=.J.:i5L_w.~_._...
Burouu Fllo No. _........J,!i,6.9.:i.4..li..:..-,,-~..__...__.-
Coullty Fllo No. c..d?l~2.........7..d...2-..__._,_._...
1, Oecodent dlod:
( ,,) Illtutate (without o will)
( X) Testate (Ioavlng II loetwlll--copy lltto9hacl)
2, I, the filing 0/ 0 fodoral Eslato Tox Roturn roqulrod fllrthl$ astato?
3. (x ) Executor/2x~Jl1OO< ) Admlnll1trolor/Admllllstratrlx
Nome Da uph in..IHlP.QlliLaank...and.,TJ:.uat...cc.':
, Address ~2l3 M.M'l<.~~E.!1fee.t......._,___.._....-,_.___
.liB j:' r i s bur..Q .;-..l',ennay..lY-ania....-J..2l.o..!i-
(CITYI ((!TAltl (l.tI'l
YU".-x_ flu
4, All correepondenco ehould bo mollod to ( ) Attornoy
5. If on attorney Isreprosontlng tho oslato, Indlcato:
Nome I?~ul E. Clouser '
-ca Idwe lr-ClOuller &''""Re-arn B------..
Addrm 112-114 }i~J?~hSe..~~.~9"Ej:E.~~,!::.._..__
Jlll..l,:+ i B bur9.I~flnna::r..ly.a.nJ.a__l1.l.O 8
(CITY) , \!H^T(~I ('tIP!
(X ) Fiduciary.
List allso/e deposlt"bo~es reQls,tered In tho docedent's Illdlvlduabl namohorlolntly with, or oe al\ Ogo,'\t ot,d,eputy
0/ another, or In docedent's Indlvldualllame with right 0/ access y onot or as ogont or deputy, Include the nOfTl/)
and address olthe bonk or athar.tnetltutlon whoro t\lO safe depoeltbox Is located, the nomo (s) In whl~n tho box
Is reg\steredarid the relatlanshlp of tho lolnt hbldere 10 the decedollt. ' ~ . .
, '
~"-;"- ~~~
NAMB AMD ADDRn!S OP'BAMK OR aTtlER ItiSTITUTIOM
1M WHICH o~ceDBHT MAIHTAIMeD A SAFE DEPOSIT POX
__~M.t~_.....
U1t~.d~'---
tiAME OR HIIME! IH WHlclI
SliFE DEPoSIT cox I! REOISTERED
..~=
-
Re~ATlOHSH'P OF ,IOIMT
tlO~DER5 TO OEc~q~l!l..r."",..
None
_....__.--...-_~_..._______._____---. ___________H____ ,.,~
-,~-_._--_.....~- ----.-.-----.......-------'---.-...........--...---
-ro--~' __................~___"..__--1__ ....---
.
U~der ~enollles,of Pllfl4ry, Idoclor~ that I hove examined this relufIl,lncludlllQoccolTipanylng schedules ond,
statements, and to thlt host 01 my knowlodge;and bollollt Is truo, corroct and comrloto.
, pauPlli, n", ,P, e"po, S,it,', '"Bank" and, 'l'rust comp, jY;' ",' '" EX"", ,0" utor
of t H;l),msta.teos: ,JOhj,:l'. Burne "p 1", ..
13~_ill L:AiA.,LjL,:l~t!f..';,;,",,-_.- . /) J (i ,_.
" slaHATu~E OP PIDIIC'....RVi . D^Te
ABsi~tant rrustOff oar
hJ;Ntis.Y.k~tilAlli,.uulIT ANC rr :1' AK Q.EN r.H~L.J.ti[QfJ.M~I!.g~
I. PERSONS RESPONSII3l.E rOR IlETIJllN
*....-.-.._~-.---...............
Sccllon 701 of Iholnhorltilllco ond EslotoTnx Acl of 1961 provldos Ihnlllw following parsons shnll proll/np and,f1lo
,0 rQtllrn: " '
0, Tho porsonal ropr\lsOnlnllvo of :ho oslolo of tho dllcodonln, 10 prnplll\Y of ,Iho docodon\ndmlnlslmod i)y hllll
alld such mldl\lontil propfJlly which Is 01 mny bo subjocllo InlllHIlnllco TilX of which ho/sho shall havo or
nC\lullo knowlodgo;
b. TI\(llransfolao of proporly IIpolllho trnllsfur 01 which IlIhorllill\cO TilX I!; 01 nlay bo Inlllosod by tho 1961 Slnllilo,
Includlllp,'o Irusloo 01 ploporty \liIllslorrod In lrusl, proVido(llhfllllonnpillnlo relurn nll()(1 bo modo by tllo,tlnnsfQreo
of proporly includod In Iho rolulII of 0 pOlsonal rllplof1llnlollvo, , '
,
2, PLACE FOR f:ll.INC)
Tho rolull1ls 10 bll filmlln dllpllca\o with Iho HOl11s10l ql Wills,ol tho counly wholein Iho decodonl roslllml,
3, TIM.~ rOH FIl.ING '
The roturn,ls (Iue IIlnll monlhs i1ftor Iho docodonl'S dooth,unloss fill oxlenslon for filing IHish90n appllod for !Iud
gwnlod Iiytho Secretory of Rovonuo within Iho nlne-lIIonth poriod, " ' .
, '
4, 1:.8Jl.UR[ T.QJllE.gE'fLJll~
Soctlon 791 01 the 1961 Slolulo provld(ls th~11' , , ,~lIy'porson whowilllullY Iillls to 1110 a rulull1 or olhor rellOrl
roquirod afhilu, , .slwll bo porsllllolly lioblo, , ,10 a penally 01 25% 01 IhlJ(llx 1!lllmatoly found to bo due or $1,000
whlchilvor Is lh(llo~lsor to bo rocovored bylho Doporllllont of Hwoouu as dobls of like Olnounl aro recovurablo hy
I~w," . .
5. JAX RATES
Inhpritance Tax Is nilynhlo allho lalo 016% on lrouslors 10 linool doscfilldanls, such as father, mothor, hushand, 1'1110,
so~, daughlor, grandchildren, r~rnndpafenl, son,ln-low ond dnur,htor.ln-Iaw and nt Iho rnte of 15% as to all olllors,
6, pAYMENT OF TAX
Tho lax ossussecl ~nlho trnnslol 01 proporly repOlled ill t1)oroturn I, du09 monlhs after tho decedont's doatll, Interost
nt tho rato 016% pol annum occrpos Ihoroaflor IInlll paymonlls modo, All j)Hymonls rocolved aro first npplled to, any
lliterostwhlchlllaybo dllll wilh any rOlnalndor npPll,od lolhe tax, IF TAX IS f)AID WITHIN 3 MONTHS AFTER TH~
DECEDENT'S DEATH, A DISCOUNT OF 5%OF THE TAX PAYMENT IS Al.lOWED,
All chocks should he modo p,lyablo to Iho Registor ofWlils of tho'collllly wlloroln the docodont rosidudond are
roCelvod subjoct to Iho filial c1olormlnotlon 01 ,the Depmlrnenl 01 Rovonllo,
7, fAILUR.ETO PAY
I: The laxes inlposed, togo\hor wllh any Inlorosl thoreon, aro 0 lion u~on rool'prnporty, which lienromalns In effoclunlll
the taxos and'lnlorosl hnvr iJ30n paid In full. Tllo lnxos !Hay bo 511e(1 101 n~alnsl allY roal proporly 1i,1 lhe (Ioccdent's
estato olar,alnsl any propi'rlv bolo!lp'inp, to 0 transforoo liablo lor Iho to x,
8, FiliNG or FAl.SE,RETUBN
- .'--
Any porson who willfully llIokes 0 lalso rolum or roport roqlllrmt of him $holl, in accordance with Section 793 of tho
1H61Sli\llIlo, bo gullly of n lIIisdollloonorond, on conviction Ihoreof,shali bo sonlollcod to pay a fine not excoodlng
$1,000 or undorgo iinprisollmonl nol oxceodlng ono yent or 'bolh. '
"
.
.
,
to Ol.l.vcl .1.11 (lfJllt,itll'IIUdl. 1,lw '1'1'110,\.0"'11 Hlild.lli\1 (Io(:;n.l.;t,llrd, uf' (.)10 f'H(Jl,
,
\;Ill)\; n \'I(,uil<l 1",adv.lllllld,lI 1'01" Iior Lu :U,qu.ld1t\,u i'1'J 1'I1;.lPH'l. (l\all'lll.l.II,'.
:I,hllul' DI'1I1 1\111111'1 l>UJ'(II'U <J1,\;ol'\~il.l.I'I:\II": l.t,nY rlJ<IIIOIIL 0)' lla<l'Il' \;0 <1;\I.\~
" ;.'
t,1",1.butu .I. LrJlllfJ oJ' IH'.l.no.l.pnl. f'I'CilH \',110 l;l'Llfd, L!iltubl:tlll,il)C~ IJY \,11.1.0 wP,]
to, hoP, \'11.\;11 \;11.1.11 .1.11 mlntll 1','IOU1ll nul. ()()I\IL!r10l' 'it\: l.lrlv.l.nf\\l]Q L1nd,"
tho pl"CHJ(/n\; (,ax 1l,lV/I.l Lo ,'lu'IVnn()() fillY lju!>iJLlIl1t;Jn), )1O\'I;;tonEI 0[' pl".l.n-
(Jip'al Lo aLl vo 1111(;;1,1 1i0l' O\~;I lnrl:Lv.l.dual ('lI\;nLo ,I,ll ;,IJ\J's:l.dol'ubly
d(Jp1(JLoc;l bu\: :1 novor'tholollll \'Iunt Lo .l.nllul'(J Lhilt, L'hIJ {'ll11 'pl':1.no.l.pll'!
, ., ( .!
l'OSl:Jl'V,IS :In t.ll:tll \;l'Ullt \'1.111 llu avn:l..l.llblGl !'ew hop OIIl"U, flild ootnf'(Jx'~
f)O 10tl1.I, all, f.l)lO 1:\ Ve'D ilnd PIll"t,:Lcl\lurly ;\!' hur Clwn Jr,cl:l.v;ld\wJ. o::;tu\;o
IlhoLIld bOCOlnC" oxl1H1.wtod to InrJ(1L LlwlIo liucdlJ,
1). Upon lilY w1 f'o III CIolltll, [If,y J'()nla:trd.n{~ bulunu<H\ 1n tl'10
tl'LlI'.lt fund (!'JUb\I(~(Jl; Lo tl,o pp,oVlll1bni\ of J'l'Et~ X 'hoJ1o\l(') ::lha:l1 l~o
Cl.I.L\tl':I\;utOl1 :l.n oqual i:hl.ll'dt\ \'.o'!lOI1 and i1111l1. 1.1' o:l.\'.})CJP of OUI' ooni,
u);cluld p,'odoemtlHI tld IJ' OV81'it It,,uv;\ n(~ hwuo (\'I)lOnI01' ,born 01' fJ.(lopt,
i'
to illll"V:\.V01 'Lho Jllf\110 u'ntlll ,tlllw I;bo put'GhL t n uhare, I;>"(::"~ 1:1 t:!,!'J'.!_)!. ,
1.\110\\ 1 r.1 C:!.thOl' son pt'odOCC(HiO Lldl) ovont ,w:lthbut lQav:lncr, :\,flIlU() to
S\\l'v.l.vo Lh0 avont, \;ho shal'o or thut Bon f)hall. lJEJ c\JsVI':!.l'lutocl to t
son dJ' OUI'S Nho ilIH',V:\,VOll th';J ovont,. OJ' h.l.fl ':l.snuo q),'ln IJvJ.ngl E.<~.'.'
,
!! t :UJ!.!!..!!.. as 1'.ho easo Inay bo.
E. JC;punt to my v;1!'o ol:lvd a i:lpoo:lul pOI'I,OI' toaPl'ci;\ I'll
w:Ul1 [lnd by :Jpoc:U'Jo l'of'ovonoc, lwr0to. to u\wh of' out" ch:lldl"on 01'
01,1101' :l.fllJU0 1;110 l'ofJ:lcluf\l bonof'.Ifs :l.n th:lo, tr'Lwt ['und .l.n such 1'1;0..,
,
POl"'t:lOI1D"nnc1 upon lluchtcll'IIlS Wl,to l;l'U~,\~il Ul' vutylcr,h\; (~j.J:tD, ,Hi [\1'11'
doems' aclV:lfH;blC'. Shol\1d lIho not oXOl'o:lso, 1il1lB i:lIJOCI.!f\lpoWt!lt' of
rippoJlituwnt. the l'OI1:tcl\uxl \,>(;no!'.!ta 011111'1 ,lio nc1m:l.n:l.o\'.tIl'C1(l' and (!.ill'-
,
tl'.\.butod fiG l hllVU i.l0t '('OI'l.lY hc'l'o.!r,.
,
JJ:L,~r:L I~.L
fIll (;11111'011 oj' p1':\noipal and inO(II1\ll
PIH'I\,~inl1L to 1111,V \;t'illlt .cUllti 01' ,('lInr)n (~I'olltocl hOl'('!r, (,hull bu ['PLW
f'1'0111 I.qltlc:!.p,\(;:\OIl, u:;t1;\.!Wllli!lIL, plOd";:' 01' I)bl:II'.a~1.':nll' o("tllo lil'pll-
(':\ulnr'y..Hllcl till/ill 'fl(;iL be; ,l:iUb,Jcu'{, lJ\.! ''l-lI'IY''~'Jl~JL 01' ntt:l011IHUIIl. 01'
eX0cut.!on,
3
"~I
........,~r'"._.r~L_ "MfW"""'*t'f'1~M'MlfI'lt"".~"""l\lIIl.1W1 Tf"U'.'
'P ';",!." ", '.:',:Jt;-,i_U.;:,.I,tU,;,-i.",,_H ,', .,:. .',' -';,..
.. '.. " .~1:., ,1('\';
, ,,' ;:__"" }\/;, c.
o \ " _ -+L~,' '_,_ ,I,. ".I'~l,,:t .,'
I I ;:', -," :',~\l,\ ",::,. '; -,I >-, '
I! i ".C !;'i 1,11,,1 I,
I .' '-', __ :: ~ 1: 'i
,
'If-
i ._I l4~"1~'~. :0, . _~_'
)- -:li":"';'!' _. ~-_,-,-1.'!h'- ,:'1;",'
:_'j' f' '--_,\</i-'I:,~-!:,-;:\1;:)"1IfIW,'"
,"j,"\1': \<,;j':' _tf'_~V' ':1 ~~~)_:,;;1;.I,.
t;I('-J,J,t:' 'j\o~hCijl",I~w, ~t~ '1'1';,1',' -',
: :!-;'-'-,,' f'Ud_- ;\',i ;,-,\'-,~ ),_W-;'_~'~,.:;,:'_.l,;\'"
. '/:/ '-i~rih;,~.t .\\,\ ~,),L, j( ";'.:' ,
. ')"I,;--V" t',",' ,-'-"., ,~\,:" \, ,
\ l~\i.4t.lIr
, I" '~, ~ 1'."~'i'(I/('" I J;' ., ,. .
I '"" II ,'ll~it;~lIUJI',n\' \>~, 1\' 'I">
, '.1'/' ,\\\' f~~'jit, . ',11' f, 1'1
" .i ,'I II l,t,!",,',l \,,,,
I ,I r! '\ '111C,if' ',f,,' ,
t " 1 ,~' tvtt ,~... l' T , "
, ..\.." ' I ~
, \~) -,,,\,.' II}, I .V I"
I. I' ~ ' ,.:1 ' f", . ,
,'.-, . I
"
,
"
,
"
,.
lj'I';I:LH
:I: lJI,J)'l'()~wd no n 00-IIILllwl' \'/:\'\:h IllY [wn BOil
" '
tho [\LlIn 01' ':~:)(),.ooo /'r'OIll iJuuphl.n I)OlloiJ:l.\; llnnl, nnd 'j'l'UIJ\; OOIlIIHHlY. 'j'II"
)Jl'oouodfl oI' U1110 loun Iwv(J bO'(H\ ont;:ll'oly \HJ0cl to /,wfllll\; Bon l.no~]ro'.
tn:\.h r:I,nnno:\.l:ll IIlutt(Jl"Il, ^t \1\\011 \:llll\l no rn,Y O(ltll\;O, bOOOm"J(l, diutrib'
..u\;ablo \;0 OUT' t\'lO Bona l tlll'lT'O oh[\ll I':lf,'IJt lHl g:l,von to Bon un ,mnoLln'
or' (p:;JO,OOO and,'th:lu ul1al1 :1''l1''(it b(] app1:\.od urwLnnt any romn1.nlng
, '
~a1ance(J on tIle] notQ ~/;\t11 Dnuph:\.n De,poo:Lt nnnl, aDcl 'I'l'ua,t 'co~npany.
:cr the nota :If) 10:>0 tl)un 4:39,OO~ thon that difi'eroncoB.l'iul:L be g:Lv"
I'
to Bon bof'oI'o tho d:\.v:\.l'l:Loti botl'l\lon my t~lo Ilona. 1 rnal(C) th:\.B dir'",(,~
ion booauuo 1'10 h~Vo proV:LoUDly given our other Bon Sum amounts
equl\tinr{ $30,000.
!rrl.~lUl.L
:r authorl%o the 'l\t'Utl1;OL~J and an~' SUCC(HlflQl'
..
in trLlst to 0*oroi80 the rollo\'ll~g powers in their Halo d:lscret:l(
\'Ihioh shalt be effeot:Lvo \'Iithout cb~rt ordor or cipprovoll'
^. 'j'o 1'otl.\:l.n any or' all of the aBsots of myestlot:o wJ.\;hol
regilt',:1 to,,,ln~' p1":l.nc1p10 of c1:LV\lt's1f:l.cation, 1::1.(\\( or pT'Ocluotivity,
B, '1\) lnvout :Ln ,;11 forms of propel'l',y ,\'/:\.thout X'l~stl'lct:\,l,>"
, to :Lnvestrnl!Jn\:B fluthor:\.%ecl for fillY" typo of f:\.duc:l.ary.
C. To compromise any claim or controversy.
,
D j To bOl'rowmorwy fr'olll anyperlJOn, 1.ncluU;].ng my Uxe~u tOl'
01" 'J:1"UStoOB> fl'nd to rnortl!.al~o or plo,c1go any real or persona1propoJ
B.To lounmonoy \;0 or to purchuso propo~ty from my p1'O-
bato (wtatc.
1~1 ,To'soll at pub11.c or ~r1vnte Aula) tb oxchang6 or to
101.11;0 I'or any period of' t;\1II0" aqy l'oal: .or' pOl"sona1 proportY'1 und
to rr,ive optJonl~ ror !Ja1os l oxc,han[,os 01' 10ao06 all for such Pl':lCOi',
and upon Auch torms Bnd Dondit~onu B~ they deem proopOl'.
a, '1'0 allocate 1'00(0:\ ptrl and oXPOIWOr. to p1':1 nil:!.p,ll 01'
incomo 01' put'\;ly to eHoh !,\S' thoy deem 1'l'r'Q'pel'.
H. 'J'o l'\lter, repail' or ~mpl'dlo ariy ref+l 01' j101'80nal
propel't~' ,
I. To distribute in cRsh or in kind 01' partly iri ou~h at
II
-<......~.,;./...J..........r ~..__.
'-i1
rl
I~ ..I
~, "~ ~ g "
rl
! .
" ~
0 ~
~ ~ ~
(q l,q
,"
1 'i' . ~
'" fl.l
~ ''I '~ ~ '-0
~lfO rl 1"1
',-j I"l u <0 ,t
"
,~ ~ ~, ~
0' I d
~ ~ ~ d
i'~ z z
~ ~ ~
~ ~
~
INS TRU t;.l(Q.~ S
To Inaura nropor cradlt to your account, Iho 1101110 of ,tho oalalo and fila numb or ahould ho
oloarly prlntad on tho chock or mOroy order. ' '
,
Thla dotormlnotlon andassoSfilllont ,Ia modo In nccordnn~o wllh S9ctlon 421 nnd Soctlon 732
01 tho Inharltanco and Eatata Tnx Aot 011961,72 P.S. 21185-421, 732.
" ,
, Tho aatnta ta~ Imno~od hy Sootlol1 42118 duo at tho d(lto 01 tho docodont's (loath bU,t aholl
not hocomo dollnquollt until tho oxplrotlon 01 olghloon (18) IlIonths oltor docor/ont's doath nrovhlod
thm ony Ostoto tax occasloilod hY a flnnl cl1<<lIgo In tho Fodornllolum or of tho ta~,duv Ihoreon
aha II n.ot bocomo r/o,llnquont until tho expiration 01 ana, (1) month altar tho porson Ilohlo tOPQY
tho ta~ rocolvo& Il,nol notlco 01 tho Incrooso. C"lculato Intoroat from tho dollnquont data shown
on tho loco 01 thlo 'Inrm to th\, dato 01 Paymont using Iho following Intorost tWOf,
!""........... - ---.-- -- -- -...."".-- --.- --........ -.... -- - -- ":"'''':'' --- ...~.;..-_...- -.... -.... ~ -- - __..;, - - __.... __ ~_ - __......i '__ _ __ "';"__ ___
Il110nth .005 4 month s .020 7 months, .03J 10 months ,050
2 months .010 5 months .025 8 1I10nths .04 111110ntha .055
3 mon.th8 .015 6 months .030 9 months .045 12 I'lontha .060
...r______.__......__.~_..,~'..nu.-. ___'_ .~~.,~__........_
1 day .0,0017 11 days .00186 21 days . . U0352
2 day s .00034 12 days .00203 2 2 do y a ,00369
3 days .00051 . 13 dayS, .00220 23 day a .00386
4 days' .00068 14 days .00237 24 days .00403
'Sdaya' .00085 15 aaya .00250 2,5 days .00420
6 daya .0010'1 16 daya .00267 26 days ' .00437
7 days .00118 17 day a .00284 . 27 daya ' .00454
8 defys .00135 18 days .00301 28 days .00471
. 9 days .00152 19 days .00318 'l!J days .00488
10 days .00169 20 days .00335 . 30 days .00500
~ - ,.~.,...-..,j----------.... --------------- ----- --------....--.-...... --- -----...:.-....--------'- -....---'""!- ---_:..-
..
Any party In Intorest, Including tho Commonwoalth and tho porsoMI roprosontatlvo, not
satlali'ad wlth"the assossmont Inay obi oct Ihoroto within sixty (60) days altorrocolnt 01 this
natlco as nrovlded by Soctlon 1001 01 tho Inhorltanco ond Eslat!1 Tax Act, 011961 (72 P.S.
fi 2465-1001).
,
Maka chock or monoy ordor payablo tal
"Raglslor 01 Wills, Agont" .
\.
Mall to tho addross Iistod bolow!
IlLV..nu (I,nol "H UL" '''''' ~
(10MMONWEAI,HI OF i'UNNIIYlVANIA' , .sO foP ", " . ~' .', ^
DIli'AIITMIINTOP tlEVaNUII ",. STATUMUNTOF (luurs, , X'~., , :X'':f
T1lANRFlltl IImllllllANOli TAX' / AANI) UD, "ION,S, " Ij ii"r'
RaSIDaNT DIIOllllaNT ~. _ V.' I ',?" C'/>(;" . i . '..'<<'i\I)
-.-----..,-- -.:,.,-,,,,_~_~Z.2~(~..:i:t"~~.!./-\i""~'_"~~'''''''''~4_ '__
EsWtn Qf John P. Burns , DullJ of Doath Da2~2L~ (.1:97~ Flln No. ~L.1f.:222_.
WHEN OLAIMING THE FAMILY EXEMPTION, OOMPLETE THE FOLLOWING:
Olplmont
Clnlmont's Aclclro88
-
f.1ulotlonahlp to l)u(loclont
......---.-
----j_...~-...-
-
. ..
-
_0.__.......- _ ___.,~ . ~.,. H_~_"'_~_~' ..1_...... _~__._ '__ __..__.."_..,,.~"~~_._ ,.._" 0__..,"__1..._
i
DATB
~
lmO:"" 7 Richard E. !\nderson, Regis~ Probating Will/I,et.ters 'I'estaman
"'ri-*"""-\'.'~~'_ "..""'-------r.~----..--~l........-...--.......-~......-~,..,..--, '"__""_~"~_'T""'___~~~~____U___'_'_",,_---: ..................--.__~_....._
, tel.' of WillB~ .____._._.:~f!EL~.nU2 Shor.t~rtificates ___.c..._7.l.....QQ.
14 Leader Nuraing Cl;lnter __.__ ~,~la.nc,.g..duq Home ______ ,----5J.Jl. 20
14 larry Mason "Reimbursement clothingaltera~
, -<....__._-~,.~--_.-..-- .--------........,..----' . ...---...........
tiqns . 15.00
~ _..............._~-----~---------r-...........~.._--_....,- ..__..~--.-
Classified, dciath hot ice
- ....
II Reimbursement John,nurns Becuri
_._--~..----_........- ----.-...............-.- ---..........-
n, __._____.Peposit ~};.~er..Ji~ainLCenter 200.00
umberland Law Jo\.!.lZ!la1, Advertising/Pt'Oo~~f pUblioatio ~_-1~
est Shqre CountrY..Qlub _ Restaqran,!: ex~npes on 11/30/79 _~~7.ill
pJohn, HealthClare Nursi.!J.SL~~r...y.~ces .Jl~€!lL_€!"nding______--~
_..~.__.~9.vember. 3QLJJl79 _ __--183.60
Nursin9... services week end in\!..
.___.____._ D~!!1ber_L.; 1 Y 7 9
24 usselman F!:IDeral Home FUner\\l. axpanses and 12 death
certificates
Telephone service to 12/31/79
NI\ME OF i'A vea
ReMARKS
AMOUNT
NO,
---
2
3
--...-..
14
18
atriot News tom an
amuel A. Burns,
6
7
8
18
20
24
9
24
~
10
~
---....-.....
674.00
71.50
n ...............--.-._____
ell of Pen~Y1vania
-In- Reimbursement 4th Quarter ,_______.
pel)nsYIV~D.ia~msti'm~~~d Ta~___.:._. ,~.-1.~:~.Q.Q
13 aster...S_~iil~.________9..1}~9.es f?.E..Noyember-1979 ._____._._~?_~.~79
.14 W_J.!nJl:ed w..!aY___ Contr!.!;ut1;j.g.n-!1.Q.I1n.J>. Burns ___~,?_,..<2Q
~~,~N~\'tiL.CQ/]1);t~nY___._,._._...,_ .MY~l:.j;.iJi~n.g_u CO, ~;~~:~;~~'I'A-~~Ii._-:-=,?~_Q:~'::_~~
I hereby cilrtlly that to the bost of nlY knowlodgo nnd bollol thoforilgolng Is a lust ilnd truo stnlornont of dobts, funorlll
expenses ancl expnrlSOS o~ admlnlstrntlon subrnlltotl to tho osloto ilS doducllons lor Inhorltanco Tax pLlrposos,
- .. _---.-...__._~___.....~~...."'f,if\Nj\"i'Ulj!i.Qf"^1-]:i?J.Hl'i..Y!f!!rHJCII\RV-_ - -~___ [)~;"~~.~n:~'_"_L__L~_'_.~
------.~. OFFICIAL DSEONLY--~ .~.--
DE~TS AND D~DUCTlONSAREALLOWED IN THE SUM OF $.-1.1) 1 U, t!t; . AT~'f l!i- PERCl'NT.
zJt:z1f# v1 ~ . ;
I. ~, /J ,1l1'blr.~1: _--:__~~~-!I
GENERAL INH~""1:ANCE J'AXINFORMAT10l'l
Unsatlsflod Ilobllltlos,lnourrad by tho dooadol1t prior to hls/hor'douth uro doduotlblo Ullnlnst hls/har toxnbloostoto,
In od~lItlol, to dobts Inmlrrod by tho dooaden't or estnlo, other !toms ora ululmnblo Includll1g tho Oost of udmlnl&\rotlon,
attorllay foos/flduolary (oos/ (unor/II 011(1 burloloxponsos Inoludlnll thOOC1Sl of a hurlallot, tombstono or oravomorkot,
.. ,;' .
All dobtsboln9 olalmod a(Jalnst on ostato mo subjebt to tho'opproval of tho 'Roillster of Wills with whom thq .
Il1herltanoo Tax Return Is fIIad, Evldonoo to support tho dooadont's or tha ostnto/s lIublllty for tho dabts baing ololmnd
should be ettoohod,to this sohedu 10.
A fomlly exemption of $2/000'1110'1 ba olohl-led by 0 spouse of 0 dooedent who cllod domlollod In Pel1nsylvonlo,
If there Is no spouse/ or,lf the SPOUSD has fol'folted hls/hor rlghtsl then I1I1Y ohlld of tho ~oqodont who Is 0 mombor of
the IUlme housohold con olalm tha oxen1l)(lon. In the event thoro Is no sU(lh spOU8a or ohlld, tho exemption con be
dlalrnod by.u p~rol1't or patonts who are members of the samo household as the deoedent,
~ ;'Q 8 8 ~ til I " .~
;lo t!l z z
~ S ~ t:I ;J> 0 p
Z z: ~ F:; ;:;j .
c5 0 >-I ~ ~
. 0
, ~ -0
." ." -.
0
~
~
51
1TI
0
Z
~ S g
'~
"
INSTRuctiONS FOR COMPLETING SCHEDULE /IF"
1, If tho fomlly exemption Is belno ololmod, Indlooto the olollnant's nan1e, address and his/her relationship to tho
dooedent" Enter "famlly exemption" In the remarks column and the amount olalmod In the amo(lnt oolumn,
2, Assign oonseoutlvo numbers to.oocl1ltom listed, , '
3. Enter tho date on W!110heeoh debt was Inourrod ond/or paid,
,4. gn,er the n.ames of ooch pOYoe.
6, Provide fl brief explanation In the remarks oolurnn. for each debt ololmod, \
6, Enter the ~mount of each .debt being claimed, , .
7, Tile form must be signed by the peraoh whohas assumed tile rosponslblllty for poylng the debts,
9~NeRAI. INHERITANce TAX l~eORtx'1ATIQ.N
.
IJnsutloflodllllbll,ltlosll1ourrod by tbo duoodnl1t prior to hlu/her dOllth IIrn (1(J(luotlblo anolnst hls/horto)(ubll!lIstllto,
In ndelltlon to dobts InOurI'od by tbo 1I000llont or uotnlo, otbo'r Itol11o 111'0 ololrnoblo Inoludlng tbo oost of ndmlnI8tr~t1on,
.nttornoyloes, flcluolllry foes, funC/rlll and burlol OXp0l100S Inoludln(1 tho ooot of 0 burlllllot, tomb~tonll or grove markoI', .
All dob18 baing ololmed IIgoll1ot ,011 ostoto oru subloot to tho npprovlIl of thl! Rnnlstor ofWlllo wlthwhom the
.Inhorltonuo TII)( f1eturn Is fllod, Evlr/onllo to oupporl tho doo6dont'o or tho outlltct'o 1I0blllty (or tho dobts bolngalolmed
should bo olt<1ohodlO this oO!lOdulo,
A fumlly o)(omptlon of $2,000 may bo olnll11odby II spouse of lIdooodol'1t who dlod domlollud In pennsYh/onlo,
If therolo no spouse, or If tho spouse,hos forfeited, hlo/her rights, then ony ohlld of tlHl doo/jdent who Is 0 mumber of
the somo housohold oon ololm the ox emption, In tho ovont thoro Ifno suoh spOUSo or ohlld, tho o)(omptlol'1 oen bo
ololmod bye PMon! or pllrents who 01'0 mombors of the sQlnl! housohold o~ the uooodont.
t:: ~ 8 8 l; ~ ~
Z Z .~
fi1 ~ ~ 1;:;1 p
'Z Z ~ rn ~
0 p
" Vl 0
Z 0
0 'T1 'T1 -
, 0
~ ~.
.Z .~
~
0
~ S g
.~
1.
INSTRUCTIONS FOR COMPLETING SCHEDULE "F"
If t~,e family exemptlpnls baing olalmod, Indloeto the olalll1ont's mimo; addl'ess end his/her relationship to the
decodont, Entel' "family o)(ornptlon" In tho romarks oolumn and tho amount cllllmod In the amount oolumf).
Assign oonsecutlve nllmbers to each Itom IIstad,
Entor the qato on whloheooh de,bt was Incurred at)d/or paid,
Elltor tho no'mas of 000/1 payee. ' '
ProVlclen brlefoxpllil1otlo[l In tl)e romarks column for eaoh debt clelmod,
Ental' 'the amount of daoh dobt baing olalrnocl.
ThO .form must bo sinned by tho paroon wllo hils ~osllmed the responsibility for peylng tho debts,
2,
3;
'4,
6,
6,
7,
COMMONWEALTH OF PENNBYLVANIA
l)EPARTMDN.T OF REVENUe
BUREAU OF EXAMINATION
OFFICIAL NOTIOE OF
INHERITANCE TAX
ASSESSMENT
*'
- I _ ~
'0 ~-~/I-(ff)A',-/.(J_l~~;t_{-I f
'c' .J'/
(...
,', .7//-,' f)
, .
....,~
) ,'I /i'/
'--/t~,Jh,t. - 1 / S '/
" . ! ;,'
",'../ /.'.."'. ,/') ;;.t)''_.__.-, )
ESTATE I' " .:.)-1//"',\.:7 I' ....z;;;",,>t:-',,/
FII.ENO, (/ '1~>',,;79...7.';? '/
COUNTY /(//~t(/~'l4r1,'~?"(;_'.
, , I' ) ," . 11'('
, ",j ._. _ ,,; _) " i f. {_.
DArE OF (lEATH, ./,/1/ /'.,.Ji //(,.l ...,1,. I I
COUNTYFII.~ NOli'! :7 '/ /.<"2-_
TO:, (;;~~j{j.;. /'((/';Uo'.U,j 1.:\';;( i~
I "/ ,j /) ..' ( //;,."..,... j...
)/"1 . //'/ ',>/, /1r}1,) ",J ''''''~'',:(/I>(:L"
. . '
.
...,/~
" IL'
,'.>
DATE' '
Appr~l.ed Valuo of E.lalo:
Aoal hlalo
per.onal Proparly ,
Jolnlly Hald properlv/Tran.fers
e "",,,","' .-'..+.....-~.._.._--..
/ ,) (/ 'j) ,'/ j; . 'J ,./
.. /~ I ._ ~... "4/
.'
.._,,_,._.._r~._""""'_'_"""'~
+
I.e.i: Approved Cherllsble Exompllon.
/~)~,., '/'/,' ;;J. ? '7"
'C" - __,.I, ."1 .
.
" "/ /<lr' r/ ((
. 'f
,'/i;'l J:I i); .:(1
( '? '
T). t,1~ 1:1 /'../J
." '1' /, I {..
I
, .. "/
i/ 'I /J"i'- ,.
0/"( /1/,/1_
TOlel Ora.. E"ato
TOI8I Approvad Deduollanl
~leBr VelUQ of E"ale
Clear Vslue of e"ale Subjeollo Tsx'
I
A(l1ount Texsble @ 6% RSle
1
Amounl Taxeble@ 16% Rato
, /// V7.!.J;'.2 /
/
/ ',-"l)-'O, i'()
ISX due
,
/ '/'../, (/
Co:',/, /./ .", )";
"
tox duo
/,,),'/1 {"L-o
/- I~- , ......
, r;.; j?(j-; j", :'J ,',/
/ J,17
~.........~_._--.-
,. "<Iff' /, .J"
" ,f'1 ,d'"
/t, Ii' I' ,...
/
.'
· · · · · · A five
will be" granled If tho Inherltanoo
TOTA~ PENNSYI.VANIA INHERITANCE TAX DUE
\ . - -
( ':;~/;"'P 1'/' /l ":!j . d ,/ () I ,7
pe'roenC dlsoounl tote ling t
Tex 18 paid by
I.e..' Cradlts,
DATE OF PAYMENT
,:j ~I/, 0'
I
AMOUNT PAtD DISCOiJNT INTEREST TAX CREDIT
$ !t.,,f"/,!,/,)' + $ ,'<;'11. /1
$ - 0 e ~>,/.' ", (
+ 0
+ 0
---~- ...-...._-
In,ere" eooruti et the rOle of six (61 percen! por en"um
(In the unpeldbolenco of Inherllsnoe Te~ from
to dale of payment. Inleresl d\le If peld bv___ I.
BALANoe OF PBNNSYLVANIA INHERITANoe TAX DUB
llif.QIl.MAIJ.('!N..
, To Inouro prOl'or orocllllo your otioOUI1I, 1'111 ntlll'" of Iho oolnto nnd fill> numbouhoilld I", oll'nrly IHlnl'
od on Iho ohook or monoy ordor,
This ossoooll\onl Is ",odo In !lcotlrcloneti willi Unnllll" 70U of Iho Inhor 1I0neo ond USlolo TnK AliI of
1961 (72 1',9, ij 2486. 7061,
To Iho OKlonl Ihol Inhorllol\Oo IOK 18 I'old wllhln Ihroo (3) l11onlll!1 !lfI", Iho Uoolh of Iho dooodonl, 0
dlsoounl of flvo (6)poroonlls ollowod i'l2 p,S. 9 2460.716),
Inhorllonoo TOK, olhor Ihon 10K on II fulUro In(iuosl. Is cl\lo oi Iho,dolll of Iho dooodllnl'o doolh ond booomes
delinquenl el Ihe oKplrolion of nino 19) tn~nlhj oflo, Iho duoodon!'. doo\ll 172 P.S. Y 2466-711), Inherllenoo,
Tox on 0 fUlu,o Inlo,o81 Is payahlo wllhln Ihruo (3) 1110nlhs ollor \110 \ronolo, wkoa of(oCI In P088088lon and
enjoymonl ondls dollnqllonl \1101001101 172 P.S, 9 2466.712}, Cnloulolo Inlolosl from Iho dollnquenl C1elo shown
on Ihe'fooe of Ihl, form 10 Iho dalo of 80luol pOYlnnnlu,lna Iho following Inlo,ooIIOblo;'
.;.----~_..---- -...... ...,................ ...-..-............ --... -........... - -...---..- - - - - '",-~.... ......- ...;,;... -- --- -- -- - - - -... - '-
" 1 monlh ,006 4 monlh8 ,020 7 "'011\118 ,036 10 mumhs ,060
2 monlhs ,010 6 monlho ' .026 8 monlho .040 11 monlh8 ,066
3 monlhs ,016 6 months ,030 9 monlh. ,046 12monlh8 ,060
.-_..~--
1 deys .00017 11 doys .00180. 21 dsys ,00362
2 days .00034 12 doVs ,00203 22 doys :00369
3dsys ,00061 13 doys .00220 23 doyo .00386
4 doys ,00069' 14 doya ,00237 ,24 days , .00403
6 doys .00086 10 ,Iaya .00250 ,26 daYS .00420
6 days .00101 10 cloy& ,002U7 26 days ,00437
7doys .00118 17 doys .00204 27days ,00464
8,days ,00136 1'0 doyo ,00301 28 doys ,00471
~ days, .00162 19 cllIY8 ,00310 29 dsys ,00490
10 days ,00169 20 doyo .00336 30 doys ,00600
...- ---'--....--- -_.............--..... ---- -......-... - -........ ...-....... ----~<... --.. ----.....- -" - -.... -- - -........----- -............
Any l.ar1V In InlUlost,lnoludl,l1o Iho 'ConHtionwool1h ol1d Iho 1'018011111 roplo.onlollvo, nqt 5SII.lIod with
Iho,,0880S8tnOIlI moy'obloot Iherolo wilhln olKlY, (601 cloy. of.llll reolllpl 01 "111. Nollno 118 provldod by Sooll6n
1001 of thlllnhorllonoo lInd Elllelo TOK Ani oll~Ol ("12 1>,9, ~ 2466.1001),
Mnko r.hl1q~ or monoy order payable tf>:
"Roglsler of Wills, Agont"
Moll 10 tho adOto9S IIsIdO below:
11110.1(.\>1-1;
, '
APPLICATIONPOrl CIIAIlITAIlLP eXQMPTION
PHOM f'flNNSYLVANIA TRANSPflR INIIURITANCQ TAX
{^ol nf MIIY 2H{ \956{ P,L. 1151{ Ulld ^cl (,f JIHle Hi. 196L
P,L., 3la, III um,,,"I~11l
COMMONWI',AI.TII or pnNNIYI.VAtIlA
Onl'AllTMr-NT or flnVIlNun
8u~nAu 01' cOUNTY oOLLnCTIOHS
1. ButuUII Plio /I ?:\,.'(9'.0'(2.9
2, Oulo 0' Ouuth f)l'lOOlllbOT' 3. 1'9'(9
3. Outo 0' Applaval ~vnt/).;(I )fli'~ ~.-..
4. Namo 01 Docadon I .U?l1.l1 I I. J~)J.f.1UJm.'...' ... -.,
, 5" Tho Com",onwoalth'. uPPlol.ad vullio of tho ptopolty lor whloh ,'n oxomptlon I. ,oi~lmod I. Jl......9.Q.Q..,.Q.Q.__~~.___..,
(Nolo. Whuro tho ptapDtty I. oth., than a .poolflod arnount of ca.h"lho axomptlon oannot ba ~pprovod unl11 tho \loluo of
,tho praparty hat boon o.tabll.hod by opprul.al by thoCommonwaullh, o>(oapl In tho.o ca... wl,oro tho amount of tho ulft
a, bOlluo.1 r.pro.onh a .tatoel/raotlonal ot poroontauo port!oll al tho ontlro ollalo or thu ol1t1ro ro.ldu., In, tholO co...
ontor .uoh fruellonal ot porcontuuo amount abovo),
Appllcallan I. I;oroby fI'lod"ur tho approvol
of an oxoolpllM Irol11 POlln.ylvonlu Tion,'ol
Inhnrltonoa Tax on tho 'rtltl'.fot 01 tho prollO.ty
do.otlbod bolow;
6, Chouk Iha manno, Inwhloh tho tran.for was o/footod uod .uhnllt '1 copy of thudocumont outhorltlnu tho tran.for, unlOl~
.uch matotlal has boon pr~vlnu,ly fllod,
WILl. 6(,
DEED 0.,
TRUST INDENTURE 1.71
SURVIVO~SHIP 0.1
, OTHER 0.,
.
(If oth.r, oxplaln)_._~,_..__..._.~_.._......._.._..u
_'__----;-~~'_._.,~...: ,.._._._,~n'._._.~__~__-"_"'~.~."
7. Corrool r.u.l~op Namo and Addro.. of ehorllablo O,uonl.allon rO,oolvll1g proporty'
, '
NAME 2~!.llt..~~~he ~,~.~_ On t h.Gdl'!1 l__.....~__m..._~,_~n_-_~-.~
ADD R E SS . Hal' l' 15 b Ul'EiJ.. P e!lJl~y..~Y..EJ._lJ.t~:L._,~....._-_.~_..._.....~--~_:,~_.. .
Cil, Soo listing Otl rO,vors,o sldo lor adclltl()nal chatlt(lblo mgonlxallons covored:
8. I cortlfy that thalnformoHon contalnod horoln.J', ,10 tho b~.t 01, my knowlodgo and bollol, truo and oorroct.
SI' IA 110 t l(~)~d' r<', (<6.~".~<f,~,"J, .. .
gnaturo 0 pp on __"__m___._.~~_..~..:__..__,____...__~_..n_.-- ,
P.O. Box 11611 '
A~dro.. of Applloont -*.12:.:.U..!L N()J~Jih,-,~_EHL9nd Si;J~QSl.b,.Jll1X'E;!,.eb..Yr4 P^
11;1.08
, Official Titlo _1\.j;J1.C?j1.ng~LJ'gr_'~th~L.!G.xQQ:utQr.__..n- Datol'lm~__UJ 19B1
Thl. form ",u.t bo co"!plo!.d In "lpUcc'o cncl1111 throo coplo' dollyorod '0 tho Rool.tor ol,WIII. lor Iho County In whIO\! thO d.codont
I'Uldod, or l"whlr-h lotio,. woro ,..vad.fat a f1on.rluldont,t!tIOl)(liml'. (utcllo, ILlho clCI~(tdont wal 11 nOI1.ro.ldont of Ponn1ylvanln ('lI1d
lotlor. worD nol'fuuod by a'Ponl1lylvanln Raul.lnr of Willi. dollvor nil tluau euplo.IO th~ Dhc)(:fOlt l\~ranlJ,nfCounfy Oolluctlon',
Ponnth D(lptHlm~nt of RoyunuQ, 26 S.4th ~lruol, Hartl.burg, PlIi
____'-~_~t w.!i.t!',~~l~,V{jI1l~J!l!~" F.r~9,H.!~!nLY_~!.Q.,~1
APPROVED' F~r th.Soclototy of RovUl\uo REPERRED to Buronu H~?dq"n'tor~
... ~f:,~ :__ (~'~:~:~~HI~- ..
~'. ",., , .' (count,y, )"" " (County)
~ .uLM7' / 'I j?1 ___, __~_.~.._~_.._,-~.__..-~-_.
. (Dato.f Approval) (DatI' of Rolortal)
AplltOvod 0. '
FOI Soorotary of Rovo,nuo
DOlIlOd' 0
-,
(Authorl udSlunaluro)
--.--.-------'-'-------
(Tltlo)
(Deilo"f Action)
. 'Soo tovono .Id. fat roa.on.
MUST ue FI~,ED IN TRIPLICA TPo
Of "_--",,,,__~,-~:-; ,.c;",-~--'-ki>-,"'H-~-." --e-____'-_'-='-_~_-'-'oC<""'-"""';'~_~_--""',,~,,- ..--.....
COMMONWEALTH OP PENNSVLVANIA \\)~'~f.O~~Jb'I~L ~ll~i'dE.d~~'II~,Il\ cJt:n ,\
DEPARTMENT OP REVllNUE INliURITANOE TAX
BUREAU OP EXAMINATION _._,,:O\(Jy,~~,~~rS~.NT______
DATE ('
COUNTY FILa NO: ;{ I '7 9 .', 't,~ '1 _
'J' I ".~
",:2 ~J,i,_ :1, I~M(l)!,A -;::.. 'J, <"'1,
, 1/':; ,/) I) ')L JJ) (; I'll ,~-",J)_
""'\011 11,;,1" ~ I '!i.,.) '5
-
Approlsod Voluo of BSIOlo'
Roal ESIOle
~
, ,$
POIsonol Plopolly
/ ., '1' "J "J )
i p( _ _ _ _J I ,) I,?"~
...--..-...------
J,olnliV He,ld P,opolWITlons/ors
Tolol Grou Bslote
t
Total Approvod DoduotlonG
$ / ";ct '} "73 ~~ Y
1/9. 'jc4(15'O
, '?C) ~; /1.1 11'/
=-_ ~, 0 ()O ,00
1- ~7 I,? l< "l~ 'J '1
pleor Value of Betote
Lou' Approved Chorltablo EKemptlono
Cleal, Volue 0/ E81010 Suble.1 10 IoK
Amounl Tuable @ 6% Rote
$ ''7 (0 t; I(,-j. ') '1 10K duo $
"
I (I /J() 6(/ tOKduo
"
TOTAL PENNSVLVANIA INHERITANCE TAX DUE $
Amounl TeK8ble @ 16% Rolo
. . . . . . A five poroenl dl800unl toto ling $
will be glenlod If the Inhorllonoe TOK 18 pold by
Lou 9,edlle:
DATE OF PAYMENT
INTEREST
TAX CREDIT
$ G Ii' '(l i) I 17
.
AMOUNT PAID
DISCOUNT
9 ...1/ ,XC) ! (;, g 'Ii) /'7 + .
. $
~
+
c
",
+
c
-......----
Intel8l1 eootu08 ot the ,101, of 81K lal peloenl por onnum
on lho Unpold bolence of Inhorllonoo TOK from
10 dole of poyment, Inlero81 due If pold bV 18
BALANOe OF peNNBYLVANIA INflERITANOI! TAX DUE
See Inlormnllon on RO\lOr'9 Sldo
1:1 Cl::- f,! j-, ' I ,\\ii; 1
*'
. II- ~ ) 0, (,3
ISO 00
(I -7 c:;"O. (~'.<)
ll~.rio.aMtl.UQ."i.
To loauro prol'or orodll 10 your 1I000unl, Iho onmo 01 11111 Oallllo IIl1d filII uumbor .houl<l bo olonrIYllllnl.,
~d 00 Iho' ohook 0' 100nOY ordor. .
" I
Till. OS.1I881110111 I. mn<lo IfI 1I<""fllnfllll! WI\,I Hooll"o 'IOB 01 thn IfltlOlllofloO afld ~.lols Tnx Aol ,01
1961 (72 p,e. g 2466.700),
To Ihs 0~18nl Ihol lohorllnnon In. 18 pnld wllhln Ihlod (3) m(lolho ollor Iho donlh (If Iho <Iooodonl, 0
dl800Unt of flyo (6) I'oroOnl18 ollowod (72 P,5, 0 ~406. 71, 01, '
lohorllonoo To., o\hor III~n tox on 0 fUluro Inlo,oSI, Is Uuo 011110 <1010 of tl10 doo.donl'8 donlh ol1d bOOOm08
qolloquonl '01 \!10 o.plro\loo of olno (01 mOI1\h. ollar Iho duolldonl'; dOlllh, (72 P,5, g 2406.71 \I. lohorllonoo
Ta. 00 0 fUluro 11110ro61 I. poyoblo wllhln Ihloo'(3) !lIlln'I1I8 0110, Ihn Iron.lor Inkos 0110'01,10 po..o88loo and
eoJoymonl nod I. dolloquonllllo"onllor 1'12 p,e. b 2466. '/12). Cnlouloln Inlor081 from Iho dolloquool dOlO shown
001110 fooo of Ihl8 form 10 Iho dllo of nOHlnl pnymonl 'u8100 1IIIIIollowlou Inlor,08110blo:
...~________'__ -.~____..._...... __.,_...,... ..._... _-... __...... _ ........_...._ __........... .....-.... ...-t- -- ............-... -- -........... - -... --
1 monlh ,006 4 monll18 ,020 7 rTHmtl1a ,036 10 monlh8 .0&0
2 monlh8 ,010 6 mOl1lh8 ,026 6 monlh8 ,040 11 monlh8 :0&6
3 monlh8 ,016 6 montl18 .030 9 monlh8 ,046 12 monlh8 .060
,--'--
1 daY8 ,00017 11 dnY8 ,00166 21,daya ,00362
2 daya ,00034 1 ~ <lay" .00203 22 daY8 ,00369
3 daY8 .00061 13 <IllY. ,00220 23 daY8 ,00366
4 doya ,00066 14 daye .00237 24 dOY8 ,00403
6 daya ,00086 16 day. ,00260 26 day8 .00420
6 daya .00101 10 dllY. .00207 26 <IaY8 ,00437
7 d8Y8 ,00118 17 <IllY. ,00284 27 <IOy8 ,00484
9 deya .00136 1,0 daye .00301 26 daY8 .00471
9 dOY8 .00162 1 a <laye ,00316 29 dOY8 ,00469
10 dova ,00169 20 <loye .00336 30 daY8 .00600
.. _ _ ........___....-._ ___ ......__....._ _.",.._ ,__ ........_ _. _HM. .,,__._ ~......... ~.-." .....-.--..-.... - - -... _...._~_........ -...- .....
Any pallY In Into,oht. Inoll/(lIng Iho cnmr"onwoolih nnd Iho poreonnl ronro.ontoIIYo, nol .0118110d with
Iho 0080&8monl mny ohJaol Iho,olo wllhln 81xly (001 dny. ollar ,ooolpt 01 IlIla Nolloo 88 provldo(1 Ily 8001l0n
1001,01 tho Inlwllnnoo and eslalO TnxA.!.ol 1001 172 1',8, fi 2466. 1 0011 '
Make ohook or money ordM payable to:
"ReglstfH of Wille, Agent"
Moll 10 the addreAo II0led bolow:
" #'..
ReY,48B ex, 13'801
OOMMONWEAL TH OP PENNBYLVANIA
OBPARTMBNT Of ReVBNUe
"AANBfBR INHeRITANCB TAX
RUloeNT DeCeDeNT
IJU i'l' IJli:MI<; WI'A f.,
SOHEOULE "f"
8TATaMBNT OP DBIlTS
AND DBDUOTIONS
, EstBte of, ,Tnhn' p, BUl;'nn .... Deto of Deeth. 12/1/'19
~HEN OLAIMING THE fAMILY eXEMPTION/OOMPLETE THE, fOLLOWINGI
File N~,-i~ )-'? r-. '/<-l (;")/
I
Clolmanl
RolotldhBhlp to DoclIclllnl
Clolm0l1t'8 AclclrllBBo\ tlmo of DoclIclont's Dootli
I
I
\
I
I
I
I
I
'\
I
I
I
I I hereby certify 'that to'the best of my knowledge end belief tho foregoing Is a Just elidtrue statement oldebts, luneral
i expenses and, expenses 01 administration submitted to the estQ.~.~,deduct~~~~ I, I~ erll,ance Tax 'JUrp~~es, , ,
I (: cldo c, . ,"(1'ZA.eoU."1 ~ rellg (
j' ' - SIG <JIU: 01 fl ~JCIARY" I>AT~
OFFICIAL USE ONLY
".J /.. 'J :~ / I(.I(
DEBTS AND D~DUCTIONS AREALLO"YED IN THE SUM OF $ ,~).'5 ." "AT
I' .
" ,
I~~~ DATI NAMe OP PAyee REMARKE " AMO\lNT
1 2~~I~EnR ~eB~~~~ n~;'lnl< I\i 35,131./'"
mh", 'T)"', "A ,_I; WHfI (; 00-111111(01' 'on two demand loansaiven bv
.' Dauphin Depos it' BanI< Ilt\d Tr> wI; OompAny w:lth hlll son. ,
Bon.l amin 1973, 1n " ,
1~ t Burns. One Not. was dated, April 17.
, 11\ 36,,000 md the , elated
the face amount of other 'Note was
, 11,,1975; 1n tho flOe umount of *6,000. The loan
Deoember
-
wOTle delinnuent /ind tl1fL~:5lOm nero 1.al department of Dauphin
, nonosit BanI< und 'l'r'ust Cotnn 'lIlY demundod paymen"t, fro'm I,he
eAtate funds; Payment 1n fl11'o1' the oba~at10n, was under' ,
t",!<en , 1980 a" folloWs:
, on Januarv 31. "
Prinoinal , , * 33,893.26
, , Interost I\i 1,238.21
- ,-
Copies of the two Notes are attaohed her>eto.
-
, , . ,
- ..
,
" , , ,
, "
"
, ' ' ,
, , ' '
,
,
,
, ,
-, - "
"
-- - TOTAL I
. ~ "",'111,lill
~~/
% TAX RATE
f--It...Y/
{JAr!!
GENERAL. INHERIT ANCE TAX INFORMATION
--
Ur\satllllod Ilahllltloa Incurrod hy t1\o docodont prior to-hls/hor dooth' oro doductlble agolnsthls/hortaxoblo
ostato. In addltlon,to ,dobts Incurrod hy tho docodont or ostoto, otlllH 1I0ms lIro 0I01111(lhlo Including ,tho coat of
a~mlnlstratlon, attornoy loos, fiduciary loosl funoral llnd hurlol oxpOnSU Inclu~lng tho cost of a hurlallol, tamhst,ono
or gra'vo l11arkclr and othor ralatod hurlal, o~pensO&, ' " '
All,dobtl bolng clalmod against an'oatato 010 subloct to tlie approval 01 tho Roglstor 01 Wills with whom tho
Inllllrltanco Tax,Roturn l,sl1lod. Evldonco to support tho'docodont's or thu ostoto's Ilullll1lY (0' tlio dohts ~olnu
clolmod should 1)'0 attochod to this schedulo,
Alan,i1yoxomptlon moy ho claimed by 0 SpOUBO 01 a uocodont who dloddo~llcllod In Ponnsylvanla, 1/ tl\oro Is
no apouso, M I I tho spou so hOB Iorio I ted hi s/hor rI ghts, thon any chi I d 01 Iho docodont who Is 0 momber 01 ,tho Bamo
housohold con claim t1\o- oxo-mp\lon, In tho ovo-nt thoro Is no such spouso- or child, tho oXllf11ptlon cafl ho clall110d hy
aparont orparonts who aro mombors 01 tho sal110 houlohold 'as tho dO,codont, Tho family \lXOnlptlon Is allolYablo only
against assots which PaSS by 0 will or by tho Ponn'sylvanla Intosto,lo l..aws, "
, '
NOTEICamponsallan paid to anestato roprosontatlvo; namoly, on OKocutor or administrator, la'r Borv'lces
porlormed In admlnlsterlnp an os tate Is reportahlo lor Pennsylvania Incomo Tax purposos, This taxablolncomo
Ilem should,he roported on lorm PA.4D.lndlvlduallncolne Tax Relurn,
~ ~ 8 8 E; ~ z I z "~
fTl ~ ~ ~ t:l ~ 0 0
Z ~ , .
Z
P 0 ~
. Z 0 Ul 0
r',~ ! P 'TI 'TI
..
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r.J.! !,I 0
'':\ Z
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",I - ',-<
...... ), ~,r
'.1''' :~; :':1
::-,l~' !:~ r';:Jt,
~Hj v:; .~:QJ)
<'1-'
w a~;3
(l: ~ !lIt.)
_I
W
~ ~
INSTRUCTIONS FOR COMPLETING SC~EDULCf"
1. I,Ilhe lomlly exemption Is'belngclolmed, Indlcato the claimant's namo, addross and his/her rolatlonshlp to
the docedont, Entor "family oKomptlon"In the r,emarkscolumn and Iho amount claimed In Iho amount colunln.
2; Assign c.onsocutlvo numbors to oach Itom Ilstod. '
3. Enler tHI! dato 0'" \Vhlah ea,ch dobt was Incurredand/orpald.
,4. Enter Ihe na'11,~s 01 eaehpayeo,
5. ProVldo a brlol oxplanatlon In tho rqn,orks column lor oach debtclalmod.
6. Entor tho amount 01 eachdabt being clalmod,
.7. Tho lornl must be signod by tho porson who hos assumed tho rospOllslblllty lor paying tho dobts.
IF ADDitiONAL SPACE IS NECESSARY USE BW' x 11" SHEETS.
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f' '!1 ..
C/:J .J 'f.J f' ~o ,U'tJ u
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S-i ,. ~ t;'j .') P: 91.'
~,
=
,.
, ..
198Cl
,~lInt
F'eb.
Maroh
April
May
'June
July,
Aug.
Sept.
, Dot.
...
HIOClMIl RlioIlIP'I'S
3 Interllatl llardabyrll Aroa Induatdal DotieJ.Opnlllnt Oorporaq.on,
2 J./2% 1'Wen~y-five YI;\llr, I)Qhan~ur.es d,ue 1/1/92
'3 Interest I U, S. 'I'roasury Da:l.ly Repu):'chal;le Agreemel\t
4 Interest I Dauphin Deposit Bank and'[lruat Oompany, 5 1:/4% Mastllr
S!lvingll AccoHl\t
8
1
5
Intereetl U. 8. Treasury Daily Rllpurchaso Agrllemonc
Interest I U. S. Treasury Da:l.ly R~purchase Agreement
Dividendi W,est PertnPower 0ompany. 4.5% Pr,aferrad
6 Intereat I. U. S. Tresaury 12 J./ 8% ,Notea due "11/30/81
22 pividendl "Janey CentraJ...Power andl;ight Company, 8% Preferred,
. '
4'lnterElat I U'i S. Traasury Daity Hepurchllae Agreement,
11 Dividendi Ganera1'Motora Oorporstion
2
Intereatl
2 Interestl
'5 lid:ersst I
2 Int'ereatl
3. Intereatl
1 II)terestl
2 Intereat,l
2 In,tereat I
4 Intereatl
2 Intereatl
1 Interest I
2 Il\terelltl
,
Dauphin Depoait Dank and Truat
Savinga Account
Company,S 1/4% Master
,,'
U. S. Trellaury Dahy'RapUroh\\ae Agrellment
Ui S. Treaaury Pai1y Repurchase Agreement
u. S. Treaaury 12 1/8% Notes due 11/30/81
U. 8. Treasury Da:l.ly RepqrohassAgreement
Pauphin Depoait nknk and TrustOompany, 5 1/4% Master
Savinga Account. ,
$
.24
P' 126.75
5.85
136.50
309.97
225.00
2,25.27
200 '. 00
84.02
69Cl.OCl
97.09
82.51
484.46
'2,425.00
,
1408.77
, 63.87
llal'risburg' Area Industrial Development Corporation, 21/2%
Twenty-five Year Debenturoa due 1/1/92 3.:103
U. S. TreeaiJry Da:l.ly Repurchase Agreement 127.02
u. S. Treasury Daily Repurchaae Agreement
U. 8.. Treaaury Deily Repurchaso ,AgrellmO\lt
U. S, Tr'easury PaHy Rapurchaaa Agreement
I?auphin Depoait Bank and Tr~at Company,S 1/4% Master
Savinga Account
P,OOt: :UJ:i. rf,[:f'G';-i2
4
~65. 3.8
165.Z8
125,19
1.38
Ii
-
d
"
1980
Nov. 3 Intereat I lI, S. 'l'l'oaaury Dtl:lly Ropurohallo Agroemdnt $ 1.58.41
Deo. 1 Internst I u, S, 'I't'o.llllury 1.2 1/8% Notcll duo l.1/~0/81 2,425,00
1 IntOt'es t l U. S, 'l'~el\IlUry flaily Ropurohalll;1 Ag1'ooolol1t 170.01,
1.981
JAn. 2 Interest I Dauphil1 ,Ilapoeit Bank ntld 'I'rust Compuny, 5 1/4% Haeter
Savings Account 5,,51.
2 Il1terast I, U. S, 'l'reusury Daily Repurchaee Agreement 208.75,
5 Intorost,l !larrisburll Aroa Industrial Dovelapment (Jorporatibn, 2 1/2%
Tw~nty~fivo ,Year Dobantures due 1/~/92 3.~3
P'ob, 2 Interest,l U, S. :I'reasury Daily Repurchase AS Tefilmen t 251.22
Harch 1 Intore$t I' U. S, 1'reasury Daily REjpurchase Agreement ?45,20
Ap1,'il 1 In t,ares t I Dauphin Deposit Bank and Trust Company, 5 1/4% Haster
Savinss Account , 4.36
1 I,ntersst l lI. S, 1'reasury Daily Repurchas'a AS reemen t 246.18
Hay 1 Inter,est I ' V. S. Treasury Daily Repurl.l,hase Agreement 187.20
June 1 Int'erast l U. S. Treasury DuUy Repurchase Agreement 234.93
2 Intersst, U. S. Treasury 12.125% Notas ,due 11/30/81 2,,425.00
July 1 Interss t, Dauphin Deposit Bank and Trust Company, 5 1/4'% Haster
SaYings Adcount d, 2.86
" ,
1 Interest, U. S, Treusury ,fldlY:Repurcl)use Agreement 285,43
2 In~erellt I Harri,abutg Aroa Industrial Development COrpOr!\ tion, 2.50% ,
Twenty~five Ye!\1' Debentures due 1/1/92 3.13
9 Inter,est I U. S. Troasury 12.125% Notes due 11/30/81 490,30
I''"'
,A\lg" 3 Interest I U. S. Treasury Daily Repurchaee Agreemel1t 727,94
~ept, 2 Intereetl U. S. Tre!\sury Daily kepurchus<;l Agreement 874.93
Oct, 1 ' Interest I U. S. Tr<l!\Sllry D!\i1y Repurchase Allt'oemont 77 5 .94
Nov. 2 Interest" U. B. Treasury Dd1y Repurchase Agreement 757.65
'!Jec. 1 hterestl U. S. Tre!\Bury Deily Repurch!\se Agreement 641.18
BIU "11'1" PIM G;'~l
. ,U..
5
" ,.
.....
1982
,Jun. 5 InteraRtl U. V. 'l'roI,lRlll'y fliH1y l\epul'ohllRU Agreemont
5 Interest I IlllrrlnhurB' Arqll tndllH trilll Duve1opmont oorporatlon,
duo 1/1/92 '
I'eb.. '
M/.\t'llh
1\1'1"1.1
1980
Aug.
1981
. April
Aug.
POll.
2 InturQn,t I' U. '8. 'l'rnllllut'y D~Hy I\onuyohllso A8rQOmon't
2 Intoron t 1 U. 8. 'l'rollnury Daily I\apurt\hane Ag ruemen t
5 Ihter.ent 1 U. S. 'l'rQanury flaily l\llpUrohllse Agreement
'I'OTAL INCOMIt RIWllII''I'S
INCOMlt DISBURS EMEN'l'S
,
29 Dauphin Deposit Bank and 'I'runt Company, M SllI'vica ohargo for prepara";
tion of 1979 }Iiduaiary Income T/.\x Rot\lrns $ 20.00
7 lnterna1RevQnue Servioe M 1980 U, S,! I'iduaiary Inoome 'I'IlX ,. 1,478.00
7 Pennny1vania Depllrtm~nt of Revenue M 1980 Pennny1vania IOooma Tax
25 ,Fee, for Tax Return prep/.\ration for 1980
1 Banjamin Burna M Pintribution
.1 SamUel Burns', It M Distribution
Dlluphin Deposit Bank and Trunt Company - Comm:\,saion on Inoome
TOTAL INCOMIt DISBURSEMENTS
SUHMARY
PRINCIPAL REOEIPTS
PRINCIPAL D1SBURSEMIlNTS
INCOMIl RECEIPTS
INCOME, DISBURSEMIlNTS
$1~3,()29.31
96.940.53
$ 18,317. 56
14,526.SS
" J
BALANCE
RBCONCILIA1'ION ACOQUNT
Balance as per First and F,tna1 Ao~oUnt
eoor. :1.0:1. P/,(;f m't!
6
87.00
,26.00
6,000.00
6,000.00
915.88
$ 14.526.88
-
$ ,36,088.78
, 3,.790.68
$39" 879.46
J 39.879.46
I
Ii
I..
, ,',
: IH1lmnt1Y bOllof'J(lJm'1ou 011' {\(Jt~tl\ln .11IllUNltIUn Ilpliolon on my lU'o, '
rrtw 'l't'UlltOOfl. .In tholl' 11(1.1(1 dltH1llotton fr11i,y HUll un,y plwt of' lit'ouo
,11I'oooodo in bho !'(Iymonlo or dellth 1,lIKon aI' ""ntn aI' (fdminint~ntion
aOn<\el'n.[ne; my !,.'ohllte IIol,llloo whidh 1lI'.[O(lO by vil'tuo or my donth,
1'1'1"101 ~lIl II' InY wlro Ilnd I Ilhl(11 d~o untWr
tUOll oJ.J1(lUrmtnnQon tihnl; tho CiJ1Ucn1 or our' dfJtlthu pE\nnot bo aatub-
Hnhed, 'it nhall hooonolllnivoly prll6umod t'Ol' nJ.l purpones Of th1.a
will thnt my wHo eu"VIvod mo,
'XTEI4 XIV I
I dli'o6t thtlt all taKen thet,may \le
aeooollad in aonoequapoo or my danth, or whataver natUra'lnd by
whatllvor Juripdlotion impoeod, whothvr'upon my probata eatate or
otharwise, ehnll bo paid r"om my ranldu8"' aabebe an pn~t or the
aKpanpou of adminietrntiDn ,thoreof, aubJaat'to tho dinaretion whiah
I havo L ,atod in tho 'r'i'uetoao purnunnt to l'PEM Xl hereoP"
IN WITNg~S WHgR~~(W, I havo herounto .et my hand thia -1.!I..th
rln. 0 P __May
, 197'1,
/0/ John p, BurnB
Tho prooeding inatrqment, ooneiating or thia and Pive other t.P.~
written pag.e, ,eaoh idontifiod by the Billnatqre of the taetator, '
" wl\e, on tl,e date thereof e;1gned, pqbliahed and deolared by JUliN p,
'BURNS, "he tee tutor, therein namad, as Bnd for hiB Last, Will, in
the preBenee' of ' us, who, at,his ~oquest, in hiB preeenae and in tha
preaen,.e of eeoh other, havo Bubaaribed our nameB eo witneeess
hereto, '
IBI ruul IL CIOllsar" Esq,
" 112-11'\ Nor'th 2nd St \ I Hat'piabtu'g t P(l,
/a/ ~lo1Ue J. Ilar10y
1055 Plane ,St. , 14iddletown, ,Pa,
Reeiding at
ReBidlng at
"