HomeMy WebLinkAbout79-00739
No,21M19 ?:l;1
PETITION FOR PROBATE OF WILL AND LETTERS TESTAMENTARY
"
In the 'Estate of
~_..,..J 1\HIW n d.!.n..Q~ftl t.!J 0.<.___....
___I deceased.
HatQld B. MaLane, Deputy' " ...'
Tq Hletlare ,Ii. .^.Ar.ler9~R, Roglster of Wills for the CO\Jnty of Cuml-lerland,
Ih the Commonwealth of Pennsylvania. '
" . ,
IS .
Petltloner(~>ullEl the execut.oJ:,~..,,_..,-. named in tho L.ast Will and
Testament of ---'::3am~e .lL..,Jlt'.Ql1.n.:lnu,__.~____."_,,..,:..;....__. doted .._.Q.Q.1:..~x:.~.u+-.l9'7!l.
, .',.' . , j
D~,~ederit was 0 clt,lzen of the United Stotosand a res'ldent of
1k$txtixtp(
Borol;lgh, Cumberland Co.unty, ,<f9mmonwealth
Me olHlni0 eb\lr!l.
ofPennsylvanlQ.
Decedent died on, _._"IGC\,n13srlElv .the. :!let , day Of Novomb~~,
A. D. 1979 ,Inthe County of __~~.DmhClr1llnc'\ .______.~_, Stote of
Ponneylvan!EI ~__ at the age ofl:i6 years,
h~ ~!l: ' hlt~
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
tlnknown and of real estate to the value .of
$ 20,000 ,.ao ' as near os can be ascertained; sold real
estate situated as follows __,101 North Tirah Street. Mt'lch.a.niosburc;,T.
Ponnev1 vania.'
, , , ," ,,' ~~'P.t9! '
Therefore, your petltlone,.(s) respectfully applies for the probate
of,the sold Lost Will, and,Testameflt ,onel for ~etter~.~estarnentP.~_ t~~~n, '. ,
Doted Deosmbor14, 1979. . . ,. . CO~,:IIO!~. '"~~(~~,~~:~:,~~" ..'
, Name and address . By I 1/.,:tI!):J:.. ,~.." ,
. of Petltloner(s) . t . Robert 1<. Re - 131, Trust Offi
, . ' ,," oar
1510Ceclar Cliff nr..tva .
Clll11p Hill/ Pll~ / ]70]1
--
COMMONWEALTH OF PENNSYLVAN IA ( .
COUNTY OF CUMBERl..AND . ~ ss
RonERT It. R~ITZET" Truat Of'f.toer I
nomed In above application, beln,g duly sworn
say(s) that the statements set forth In this
best of hill knowledge .and belief. ./
according to. lQ,w
ore true to :the
Sworn.
ond subscribed before
me, .... I1ocCtl\ber_J4,.. 19,79
.b't' '~';;,~&'I!Y~t.r
'._oj'
Decelllber 14. 1979
Attorney: rmORGl'l H. \lOUCK, rl;;;;J'
COMMONWEALTH OP PENNSYLVANIA t
COUNTY OP CUMBERLAND J
.~~1.LO.._C.qPllJ!lI1C(;Jr~s t. 9ff1Qllr (It, t.hll.. GOmnQnWa,AHh.NAt1Qnl\lPJln1L~.m..____.___ P' ..u.......~
boln9dVly .,_sWQ~n~'_..." '.., ~Joordlog 10 I~w, dOPOlO1 and laYI Ihal5.ho ,..E~ecu.tor...._...._,_..:.:.....,_..,_..__
-_._,._-,_...;.,.......,....'.~m",." ol.lho Ellalo 01 ,..Il.alnlllLB.t_B.r.owning....:......._._... ..........,
1.10 01,. Borougtu.ueqhl\n~C~bUr9 , .....,...,---,,;,_, Oumborland Oounty; Pa., doooand. ~nd that tho
wl.lllln It anfnmtory m~dn by .ThldQn.rnonwell1th~Na.t1o_nl\tJl.ank...:..~_"tko lald-Exe.OU,mL._......._
ol.tllo ollllro ..lhlo ol.lald doo.odohl, oonll.ltlng 01 alllko p.orlon.ol prop'~rlY'ftnd rul 0, Ilalo, oMilopt .reol olhlO, ouhldo
Iho Oomm~nwoalth 01. PonnlylYanla, and thallho Ilgurol oppollte oaok 110m 01 tko /nvontory r~prolGnt It'l lair yaluo
al ollhe dalool dooodonl'l .doalh , .
III
SWorn to
-- and lublorlbod bolora'mo,
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Add.... '
T~! H,' ~",!. ,'j !
, .,.;t." A. O'Q". NOlqryPubU.' :,
"t...., Allon Twp" Q.'n~.""qd COllnly,pllo
My l':1omlntl\t111U 'lfplra!f '"Iv 5,'1081 '
Dot..'ol Duth - ,_._,~-.""gL._._m_:.-~m__'__...__Noyemb..er.__....:.._____---'--l~!l.
OIY Month V,.r
..........---,
INSTRUCTIONS
I. An I~v,ntoty mUlt bo Illed wilkIn. tkreo 'mo~lh. aller appolnlmenl OlpotlOhal roplOlenhllyo.
2. A IIlpploment Invonlory mUlt be I"~d withIn thlrly daYI of dl.ooyory '01 addItional a..oh.
3, Add/tlona/lhuh may bo attaohod 01 to p8rlonalty or realty
4, SoeAr\lolo IV, Flduolarlu Aot 011949,
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cli:rde (\. tll'owning Nfltson, ~401 Virginia Ronoh Ilpuleva:r(1,
NOrfoll<, Vir9ill~a,' if living at: tt\oUme whondistribllt:ion
of the proQeodll of the S'Ale ,of add proper.ty is to be made,.
,
If anY one of them ifI deceased fit that: t:i ma , the prOCeeQl1
shall then be divided among the sur.vivol's.
4.
""
If my :real l}!:'operl:y at 101 North Aroh Street'i~te-
ohaniollburg, Penrlsylvania, is sold (ludng, my lifetime I tllen
,
I <:Jive and hec;J1,leath One-third (1/3) ,of the prooeeds thll1;ridf
, ,
to my wife, , An'nie M. aroW)'ling, and the other two-thirds (2/3)'
to my mother and sisters named above. Likewise, all the rest,
relidUIl and remainder ,of my l11state shall be ~istributed in
,," '
the same ma1'lner, ,Le. ,one-third (1/3) to my wife, Annie M.'
Browninq, and two-thirds (2/3) to my mother and sisters named
"
above, whoa:r:o living at" the time of my death. "
5.
'LAaTI,Y', :c nominate, ,constitute and appoint ,the Com-
, '
mOnwealth National Bank to he the becutor of this, my Last
, ,Will and Testament.
IN WI~NrnSB MIE~O~, I have hereunto set mY 'hand
and Ileal this 12th day of <;lctober, A. D. 1979.
~/,wv~"~e} .f!) 6 r~-, d~'~;:rt'j-~~AL,)
Signed, fjaa1ed, published lU\d deolared by the above- ,
named JAMES. A. BROWNING, as IInd f.or. his Last .Will and Tes~!me"t,
in the prf;lS$noe of U!l, who, at h~s request an\1in his presenoe,
and il'l thEl pr.esanoe of. eaoh other, have hereunto 'suba,oribedour
names as witnes!lGs thereto.
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OATH OF PERSONAL REPRESENTATIVI;
CPMMONWIMI:I'H OI~ H1DNNSVINANIA}' Sf!:
COUN'rVOFOl,1MBlCIU,AND
,- "
~llfor~ mil. UlO Rllglatlll' I'm' thtl Pt'clblltO Ill' Wills IInd f.{1'untlnH Ill' l,6ttors Ill' Admlnlstl'lIt1on In llnd,for
, ,
th C U. 'fOun I 'I'd . 11,'n nOl'l1!1RT l< . RJilI!t'lmr'l 'rl'llFlt of:UQQr,
e 0 nitY 0 1 lot nn 1 pOI HUlln Y Ollt 0 ""'11,"""''''''111'''1''1'''','''''''''''' .",,',..''''.'..1111'''''''......''''''''''''"'''.1
who, baihg duly ,',',FfI,':<ox:n,,,t'oi'"11lli do flRtH,.. dopmw Und HHt"thnL nH'''II".,I;::'~.Q,9t~'ltC?th''l..t''IlHII,,,".j'HIIIIIIH'"''
;' ..' .- , .
fth I tWill dT' t t, ..Tl\MlnA n. lInONNINrl ' I "d
o _ .0' .as . nn. os"nffion 0 1l"""I"q"""""''''\'''II'I""",''''';;'1111111.f"III,""'I";II"I'I'I"III"";'II"IIII,.,(000o.80
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'!.."",,,!;\!'l....:,.... wlll ,o,yell'tllld truly ndmlnlstol' tho <<(lOds nnd ohntt.oIH, rights nnd ol'odlts ofsnld dooon~oq
acoordlng to Inw. And nlso will dlllf.{ontly comply with tho provisionS of tho lilw rolntlng to!l't'unsfor
Inherltnnoes. """".JlW,Q.!:n....." find s\lhscrlbod,
before me.
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'"~'_U. illllH".t""~.~fiJl~#i'.t.".~~;""'HII A. Djt,1917,~.."._...
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, , . Registor !
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DECREI:
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Be it rememborod:that on tho ....ltl~,~'~"''''n: dny'()f ,..,,,,,f?9I~fHnt~~tr'''j:,,o,,,,..tlf'If;I- AI D., 19'_"?,~",, there
wall probated and reoorded tho Inol, Wlltnn<< 'I'ostumont of """",,,,,,,,il.ilf1J:1,Ii\,,.T,1.......l;l,nf?!I,'!N.t~m,,,,.,,..~,,..,,.,,.,
late of .....,..,....."....k'(lf,lIM\I),-i,l1m?,>>~,'it,"""""'''',.,...",..Oumborhmd County, Penney Ivanlu, J:)e~eascd. Lettera
, ' '
. "", ..'r.fl,$. tmoon,t,IlX'y'"",,,.. ."..,.." wore grunted to ., ,t.\1fl..,r.Ql:\MII~\'ffi,M-I?;'J.l... N",?:~,QNl,IM.. }},1,\N~"...., '........ "..
, ,
Witness my hnnd and ?ffi,olu!sonl the day nnd yonI' nfores,~~:_U' .' . '. .
'o' .,fIn J. )~. c. ,,/ . D.puty
.f. .~.l;/J'." . .itC.'T....' ....1'.. 'I~~-;'I'IIIHHI
, , I Relflster.
,
.
QgNEeALINHeR1TANOeTAX'NrQ~
Unsfitlsllll~llIubtiltlos Inourrtld by tho dlloodont prior to hls/hor depth ero deduollhlllullalnst hls/I\~r t~~uble astute.
111 addition toelabtslnoul'l'od hy tho docodent or'llslute, o.lhor Itoms uroollllmoblo Inoludll111 tho obst 01 administration,
attorneyfeos, f1duolury loos" lunol'ulancl hwlul OXP0l1S08 Inolucllnll thu oost 01 0 burlullot, tOlnbatollo or grave markoI',
All (tebU bell1g.olalrnod ll\llllnsl un OBtato uro subloot to tho [lpprovol of tho Relllstllr 01 WIIIB with whom 'the ,
Il1horltal1oa Tax Rotum Is 1II0d. \:vldonoo to 8UppOl't tho dooodolit's or tho 08tll\O'S lIublllW lor the doblB bolng,ololmod
sltouldbe attaohed to this uohodulo. '
, .'
A fumlly exumptlon 01 $2,000 may,bo olnlmadby uspouso of u dooadont wlto dlod domlolled In Penns.Yhlanlo.
If tltera Is no spouse, or If tho spousa hU8 forfeited hl8/hol' rights, then IlIlV ohllc:101 the dooodent who Is a mambor of
the 8Ilma hOllaehold oun olelln the ox emption. In the ovel1t tltoro Is no suolt spouse or ohlld, tho exemption Oan bo
olalmed bya paront or paronts,who aro mllmbor1l 01 tho sumo housohold os \ha dooodont.
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INS1'I-\UCTIONS FOR COMPLETING scHEDULE "F"
2.
3.
4.
6.
6.
7.
If tho fl1mlly exemption Is being olalm~d, Indloe\otho o.lol!\lant~s namo, address end his/her reletlohshlp to the
deoedant. Entor "famllyoxemptlon" .In tho rOlllorKs oolumn and tho amount olalmod In the amount oolU!\ln,
Assign oonseoutlve numbers to ~eolt Item Ilstod.
En~er the dato o~ Whlolt. eooh debt was Inourl'od anelloI' ,paid.
Enter the names 'of oooh payee. .
Provide 0 brlel.el\plonatlon In tho remarks oolumn for aaoh dabt olelmed.
Entflr the amount of. eooh debt ~olng olalmod.
Tho form must besloned by tho persol1 who has o~sllmed tho responsibility for paving tho debts..
.1,
,
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COMMQNWSA~TH OP f'SNNlnVAHIA AFF IDAVI' OF '
oerARi'MeNT Clr RuveNUB RIDUCIARY
'(RANIPHR INHBRI1A lOB TA~ '
RellOeNT oeceoeN~ (In.truQtlo/l' nil R.v.r.. 51,1.) , "
F.#,~,;.r,::,t::V"""'F_~~:.."'tt=-::::=#,..~b ~_" f"'i"". 1. ":tt~.-~,2h~~~.t!tt'! 1_;+'-:'=~~'_._''''-~ ~"~l.'1<'r1"il".~
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e,lote of y/lIUit~Jl._P.r~l'Jn.JltD_,_.m_.u_.... ~.:...
,
1.0. I Add rm _tQLt{"..l\rcJLS.t1:(l.QL_~"~"'''''-'-m
~hi\ni~lly.r..9.LJ~.!lnnlYJ.Y.\lJ\j!l....11 09.6
ICITY) IHAIr,1\I Illl'J
, '
Dalo o( Doath "..c,..,..t{O'v.lllllhllr....Zl....J,91jL,..._".<<....
Social SocurllY No. "rgll.D.t&~O.G...._,_,_..__.",~;L_"H"
Butoou File No, _,..~,_?l.:L~,~..~L_._.-'"_.m__..~..._......_
,
Cou'n'ty fOil 0 I~(). _"....,....."...~~~_~mu_._'-'~"...__.~'....,
, '
1. Docodanl dladl
( ) \lHe.tolo (wllhllut n will)
(XX) Tostolo,(loovlng a IrIRtwlll....--:copy attached)
. - .'
2. I. Iho' flllno of a Fodorol ES.tllto l'nx Relurn roqulrod lor this o~lolo? Yos ...'..._. No ~X._
3. (XX) EKocutor/eKocutrlx ( ) Admlnlslrolor/ Adl1111llstrolrlx
Nllmo ~lLQllIUIl19..nwgAJj:.bJi~,l:I.QOilLI!~L___
Addros. ~1Q._S.Qut.h...Mmat...S~ll&tll_~_.__--..:..
,-,lia.ctis.b.urg.._P,lInusyJ.v.!ln:lA.._l1lQll._~_
ICIlVI ' . (UT^T1-a !ZII'I
. 4. ~II correspondonoo should bo mallod 10 ( ) Altnrnoy (X') Fiduciary,
5. If an otto,rney la reprasonllllQ tho ostolo, 'Indlcotoi
Nam~ Ge~l"Q.e..J!\,...J:\O.uc.k~___Es.qu.fr~,_____.__
Address. _NllUo.naLB.ar\.k llund, inQ---,--_...._...______._
, ,..-Mecha.nics.butg.._P..anns'y_lvania_..110li5__
1,91TY) PUTUI! Ill"'
.. I.lstoll aofe deposit baKes roglslered Inlho decodopt's In<lIvld.uql nomo'hor jointly with, 'or os 01\ 0'1101\1 or'depuly
of ooolher, or'ln docodont's Individual nama with r1ghl of occoss by .anol or as ogopl or doputy.hio utle Iho.OOIlI"
and add rosa 0/ Iho ~onk or other IlIslllullon who.ro Iho safo doposlt bo.~ Is locatod, Iho nllmo (s) In which tho box
Is. roglslorod and the mlollonshlp ol.Iho lolntholdors to Ihqdocodont,
, ... .. ~~ . ~_.~::;..... =--=...===-fmt..~ .
HAMe AHO ADqRBSS oP sAHK OROTHPR IHSTITUTIO,", NAMe OR HAMSS IH WHi'CN
IN WHicH OECEDBHT MAIHTAINED ABAru oepOSIT BOK SAPe DEPOSIT BOK IS REOISTERED
_._~. . .~tt:;:':'.= ,,.,.. ~~ ---i;'.l.~.~"
Re~ATfoHSHIP OF JOII-ll
=...!:!~;.llensJQ n.B.\l.u,~;L"
None
;_...._..._.~ ~_4_~___'__._"'..,__.-'ri.w<-_..;..._
................. n--._......_~_.,O-._~_... ............
.__.....____._~. .~~~.""-~--~......_.....-_..._---~- .-.r-;+-......,
---:.
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Undor penollles O( perlury, I doc.lllre 1.ll0t I hovo o~onilllod this roturn, Including nccnmpanylng schodulo,. and
Sllllomonls, and to Iho ba.I of mY know1udgo and bollo( .11 Is 'truo/ corroct and complote. .
The COl11l1dnwell1th National Bank '
J~tYt~L(~dl6-~/,_,_~Estate. Tax.Mgr. &"'0(1, G't"_
SIONATlIRU Of rlqllt:IARV . DAn
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!21:NN~Y.bYJ\WAllil:U;lUJ ANO U..M.gh~ E I! AI:.JN. 1'0 IlMA]lON
1,f.~R~\Wl~ESPON~ill!); r.Q1Uilll~Jll!
Soc\lon101 of tho Inhorltlll\W 011<1 r:$lnto Tnx Act of ,190\ pruvidou Ihnt tho folloWIIlI('pOf!lOn~i shalllHOjlOIO nnd 1110
'I !olllrn: ' ' '
Il. Tho pOlsonnl roprosontntlVO of tho oslnlo of tho doCodont as 1(\ piOpoltV 01 IIwdocodllnlllllmlnlstlli(l(l hy him :
nud sllch oddlllonol proporlV which Is or moy ho slll)lOCllolnhprll!lnCO To'x olwl\lql1.ho/sl1!l shnll havo or '
, neqlll ro knowl odno;
" b.', Tho Unnsforooofprorl1lty lI\)on Iho Irnnsfor 01 which IlIhOlllnllOIl Tax ISOIUlOy ho Imposod hy Iho 1961 Slatlllo,
IncludlnRa lrustoo 0 IHO!lnllY IrnllsforrlHlln UIIsl,!lrovldodlhal no sopnrnlo 10111111 nooc) 1)0 lIIodo hy Iho llllllsforoo
oL!Hoporty Il1cllldod III tholohrrn 01 llpormlllllIIllPlOsnntntlvll" "
"
2, PLACE FOil FILlNCl
"
Tho mhllnls 10 ho flltJd In .(llIpll(;o\o wllh tho Hr.f(lslm of Wills ollho cOllllly wl\orolntho \iocodollt rosldod,
, '
3, '[IME FOB FILING
l'he.roturnls duonlno mOfllhs ollor Iho dooollonl's (100111, lInloGs!1II oxllll\sionlor lillnP. hllshoonnpplloll for ond
graijtoll bV Ihe Sor.ralnry of Rovonllo wilhllllllo nino-month porlO(I., '
4, E.Al.bU RE TO ,FILE RE'Dill~
Soollon191 of tho 1961 Sloltltoprovldos lhol " , , ,nflY !lOrUOn who willfflltyfnils 101110 1110111111 or olhnr roporl
reQulled of hirn,. ,sholl ho porsollally Ilablo, , ,10 n pOlll1lty of 25% of lho tox ul1l1111110lyfollnd to hodllo or $\,000
whichever Is tho lesslll to ho locovored hy lho Doporllllonl 01 RovoollU as dohls of Ilkomnouot me locovorohlo by
law,"
6. TAX RATES
Inherl(onoo Tax Is pflyahlo allho wlo of G% onlrllllslols 10 Ilnoal dasculIlIonls, .SIIOh os lolhor, lIIolhol, hushooll, wlfo,
son, daughter, Rran(\chll(!luu, p,rnrHlpmenl, sOIHu.low ar,ld dmIRhlnr-ln.low o;j(1 ollho rolo of 15% as to 011 olhers,
6. e.A~
The tc'x ossossod oli'tho trnllsfor of proporlv roporto(lln.lho ralurn Is (lu09 montlls ollor tho docodent's doalh, Inlerosl
0.1 the roto of 6%por nnl1lllll acorllOS Iholooflor ulltll poynlOnt Is lIIado, All povlllonls locclvO(!am f1rstappllod lOallY
Intorest which OlaV hoduo with ahy 10nlOlndor oppllod to lho lux, IF TAX IS rAID WITHIN :~ MONTHS AFTER THE
DECEDENT'SDEATH,ADISCOUNTOF5%OFTHETAXPAYMENTISALLOWED,. ,.
" 1\1.1 checks should ho nw(lo 110ynbld 10 tho RORlalor of Wills ot tho counly whorolnlho dooodontro.$ldod and me'
,recolvad slIblocllo lIlP final dlllQrmlnotlon 0.1 tho DopOllll1ont of Rovonllo,' ,
7. fAILURL::(O PAY
the laxos Impos~d,. top,otllo; wllh nnylntoroSlIhorcon, oroo lion upon ron.1 proporty, Whlellllo.n rOll1nlns In ofloet lint.1I
the toxosand lolerest hflvo lJoonpold In lull. Tho tnxos muy, bo sllud for ~Rolosl anv ronl proporty In the decodont's
estate 01 ap,ol~sl~ny proporty,holonp.lnR to 0 trnnsforoo Ilahla for lholax,
8. FILING OF FAL.SE RETU~N
:-. .....---.'--:- '
Anyporson who wllllullV h\fll<ds 0 lolso r~turn or roporl'roqulrod of hili! sholl, In occordollco wllhSoctlpn 793 of lho
1961 Slalule"bo Rulllyof a lI1is(loll1ounor und, on conviction thoroof, shall ho sOI\loncod to pay 0 1100 oot excoodlnR
$1,QOO Of urdOfp,o IllllHisonlllonlnol oxcoodinp,ono yom 01 holh,
, ,
, IMPROVEMENTS
Typo! 2~1/2 Story nriok,DWQ11in9
5~,1 x 117.2' ,
Lot al&o, "'t",,,,~,,,,,,,,,5J"!''''tt_.,,X.......l.l'''~~!_'_'it,,,,C:l'nltructlon, Exl'tlng ".."..;"",,,):(,,,,,,,,,,,,,,,,.....,,,,,,,,,;.....,... Propo'od,,,,,,,,,,...._.....,...,..,.......,.I,~
Living ,lInll. ""Q.nI;l""...",Cunltructllltl ,.._"Q.I;',~.QlI...,,,..l!:J.:l'lIllQ.,,,":,,l\l,\lIl\~nUm,,,,Iil~,aJn.'iI,..,,..,...,...".... Sturle...,...2.lt;......;.,...,Age..:z,5i,.."
Pu"inent..".."~M,J.l..".Q,tIl.lUlmt.Oj;..i,.."g,h.r;l,~l.O.a..,,l:,J.p,\il,r,.,....9,\,\,~,I\I.i.,a,\I..,,,l1.Iil,l,l,~.l:....,~I:l.f;,l:,li\n!;l,~,.....:..,...........""""'''''.'''''''''''''''''''''''''.''''''''.'''''.
.."".,.,',."."......_""""",...._;.,..."""""...,,,.,....."......,"'''"..,..,',.......,',......H..'''''"",,,,,,,,,,'."""''''''.'''''''''''''~'''',.....,.,''''''''...''..,,'''~,,.."'''..".,.,.,'',.,''''',.."..~.,.,'''''''''"...._.......,'"!"....."..,"",.."..~",..
"If" floOirl.LR"",....~.,",."'. DR...."..1.."...... t(...."'"l"..... OR,;";"""",,,...,, 'Clo.ot"",'1.."....",\."" 8ath""""....,..".""" Othor ..."..F.Q~,ti',A::,'l..",.,.,""~".........NN"'''".....
;, 2nd floor, ,LIt,,,t,,,,,,",,,,,,,, OR"....,..""""",I K"",..._..I....... BR,..",..,,'~..I",,'. Clo'(Jt..",~"""",..""" 8ath,,,,,,,,,,,,,,11,,,,,. Olhor .~''''''''''.'''oI...;''......;.."....,''w,''''"j".."".,,''_
3nd fluu/l.LR..,,,.........,....., DR"......,,'..,....... 1(....."....,.,...... BR.."..,.."l"..".. 0101011"......"......"..".. Bath..,...."..,..,.....,.., 'Other ,..,.........."..;''''''..........,........,....."..:.............
· T't'PQ OP ,PLUMBING, (al .Bbthruum. ....,I:lR~,U:,M..,~,IlJn/il!;l9,Ung...ll.~ll\l.ng....9.9./.l1i;?~.n1.\.M,9.I:l....,t.\l,!?,,,,iln~..../iI.h!?.w.~.h..''''''..''.
I;!M,U,$,~~.l~.."1(.,Il.f.l,~.!1y',/.",J.'f.~.~.~..",t.g....l:i,1.\~l..,,Q~,~I?!i!,U,1l9..,........",....,..,....,......,....,....................."..",-...!.....:,.......""""''''''''''''''.........,.."......,,,,..!....,;,,..,..,,..,,,:.....
(b) Kltehon ,..~~g,~''',\I.~.QJf.l.I'!,t,/iI,I"..l1!i1.1i,!1.I'!~,/iI.~.n....dl.l.K,,,...C.~.~!i!..../iI.!1.",Il~Mg.",g./iI./iI,...I.:.Il.f.l.g!i!l.....!l.l~:::"
b~.~,',~~""Q.,f;\1J"'"~.n~"",n9,9.!ti.,,"'''~.~~,~'',,S,'i?,..,W.~,!,*..",9..~,1i1?9.'.~~,ng~,.;'.I."''''''..''',.:,''''''''""''''''"....,''''''''.'....N...''''',.,'~''',."....,''''''"",.,",....."..u,""'''',.".,.,'".,''~....,..
INTfiRIOR\ 'Woll. - Plaltor .......,.....I.{,....""....;..".......Dry :....,....,1.1...............",,,,,.......,,.. .Other ''''''''''''''''''''''''''''.'''-,''''''''''''.....................,..".,........,,'.;"'''''''''''T''''''''
Ploor.1 ,....~.tn~!.,..'!.ILQl1\,~.p.I'!,~..~.\1"...l",Y.!!:lY.~..:....",.. Wuudwork ...",....,:..".r.,~.I1\!....................,.. Natural Plreplace,~,Ii..!.!?,k:::'J,!t,.~9.~en
BASEMENT, Poundatlon ",~,~,g,n!""""""'''''''''''',,,,,,,,,,,,,,u'''h,floor,..,,,,,.,,.,,,,,""",gP"9.M,tl9..."".""""",,,,,.,,,..,,,,.,,,,,,,BxcDvatod ...,,,"',,..,,..,.,,,*,9,,,,,:....;,... %
Heatlngl typo ...""'g2.~""~,~;~,~"~",',j"..""..",..,i..."..,."""'Puol,,,,,,,,":i"w..,.."'''''''',Q,~,~""...".."''''".""'',,'',,.i,,,,,,.Alr Condltlonlng........"...~..!:tg,n,~...._._,
. Wuler heater .,'..,9..~..~",..~,!;\.f..n,!!,!?,lI............,.."",........,......Ij""...'aWulor ,0(lono, ,...."..ti~,f.l.~........i:"...,Laundry tray.,..~....!"..!i!'1!,n,9,Cl".....
ROORI Type ;"'~.~,;,~l~,,~..l~~lP.b,~,~,t, Condltlon""".""e,~"'''".;'''''t''''''''''''''''"."''',."...,,Outtorl and down.PQut....,....,,"'~...,,~....n...,~,~""""''''.
. ,,".ng.&.e. , ,
MISCBLLANao US, I nlula tlon ..",,,,,~9,tl,~,,,"",""'''''''''''''''''''',,:,,,:,,''''';'''''',.,,'''."""",,,..,,.,,,,,,,.........,,,,,,,,,,,,,Slorm' ..""..~.~""'".; % S~roa n.",,,,,....e.Q.,,,,,, % '
CONDITIONI (a) e~ferlor." ;...Bt.i,Qk.,....AlLlll1i,n~m..S,i(UI\IJ..,,,&....lr,amQ...,I:1..,,A!l.arA\l,1l...Remalnlnll ule(ul IlIe af building,
. (b) Inlerlor, ,,,,P.+AIlI,tQX,Q,cl,,,,tU1Q.,,,dJ:,Y,W,All,..,:":',,..AM',eJ:',~,9"it;....",..:"..,,,,,,,.""......1.""'..'..,,.,,,,.,,,;,,,,,,..........,,,,,,,,,,,...,,,.,a,~,.",..:,;.."._.
GARAOel Con.'tructlon .,"",,,.N.Qn,~,..,,.,,",,.,,"""""'j'"'''''',,..~,,.,''''''',,.....,,'''''''""...".,.....RQof' ..."..""".."'~.r.l".""'".......",,.,.,.,,.,,"'....."NC)i ,of car........,~,~."..........
j 5,lzo "",,,,,.,,.,,,,,,,,,I,,"',,:::'.::.......,,',,,,,,....Typ.' 'of door. """i":""~,~"'".,"'.."...,.""";"!.,,'...,,i.,,,,,, DrtvoWQY ."".."NQn~".".."'".,..,...;".".."..,,,......,',......,..............,,_
6THeil BUILDINGSI ....A,t,tA\ilh!l,\:1,...IiI.t;,R~."9,\t..,llhllg"..,a,\;,..,Ul1.r,....\il.l:..,..\;\W.li1J.;I..i,T,l9"..:,l,~..!....~..";H,!..,......,...:........,....,,....................,.....~
UTILITIBS, Sewer ..,....,:~I.l.\;!.l.,Ll1,.......;..,',......, Water .......I?\l.b..l.,Ll1,.............",..........Gal ......,P"\,\,P.lJl1......"...,,......,Eloclrlo l?M,Ql.~g,....,..,''''.............".,
,; Woll "1H",,,....,,.,,,,,..,N,gne,,'.l',":..",,,,,...,,,,,,,,,,,,,,,...,,"',....\.""""""."'''m.....''''.\;'''"..."."'"."''''~..",,,,,,,58ptlc; t~nk,,,,.N,Qn~,,,,,,,.,,,51Ie' .'""".::.:."".,..:"."........,',;.,....
STR~eTIMPRoveMBNTSI Walk' .qg,ql1.U.t.fil.......",......PaYlngM.ll.!;I,~i;l,l\Il\,C, ~ndGuller ..c.P.o!;l,j;.lt.~:I'l....."Alley ..,.....MMMl\/.l1.,,"....~ T AXBSI Cv.rrent g~nera I ......"..l~.~,J..t.e.~,..,..,......,.............;....,......:...Speclal Clu'"ment. ,-,Q\l,ill:.~,\I,II..~....fil.filW.p.r....,l!~,I.:,\l.lgll....g,h.l!.~,Il.IL'
COMMeNT, No,ghbo~h:~~ ,'bllJ'~m.e.~~r.~~.trS!'f~,~,u;.€wr,:,f~,~.~.~"..!....,~.~~,~,~,~'~'i~irai'i'e""''''''''':.'''''.''''''''''''.''~ll''''::::'''Ill'O'-
Type structuro. ....".""."..,,,..,,'''''''''''''''',,.....,,,,'':....,,,,.,,,,,,,,,,,,,,......''',,..,,..,,.....,,,,,,,,,,,,,.,,,Cotld,ltlon ,,,,,..,...,,,,,..,,..,,.,,.,...,...,,,...,,......,,.........Ag. '...._........"............._
Any area deterlmon,tallnfluencell Mixed resiClenthl, commercial & industrial.
Thl. prupoily could renl lur$,.....6.9.Q............,....,.....,..per munlh.
The. marketobllUy of thl. property' I. ,..""""~~,~.h.""......."""""......,..,",..""';..,,,..;,,.,,"""~,,....".._-,-..,..............,t
I',;
,
Recommendod neceua~ repCllr. und puulblo cOlli
.Dw~lling is in ~ver~ge oondition ~~d no repairs ~ro needed.
P!UI Pla~ .k.,ch ,and/or porlmeter drawing 01 building.
~'t0tl.lc>.! >~ltl f
IJ'
b' t
@ 1"1'
2,"a.. S"1"Il~ .t
J)..."l.L..IM(.., 3/'
1
.
I"'--,1V --II
. ,
CALOOLATIONS
"
DWOll1ng Ana
24' ll' 31', X
14' II 16' x
2.5 ..
2 ..
1,660
446'
2,306
Ilq.ft.
II If
:~ephcoment COllt- New
Dwelling
2,300 IIq.ft. @ ~22.00
.. . $SO,77~
,
IIq.ft.
Potches
224 sq. ft. 0 ~8.00
StoP\go Shed
, 312 sq.ft. 0 .~6,.00
.. 1,792
Porohes ,
8' ~ 14' x 2.. 224 sq.ft.
Storage Shed
.u' ,I< 24'.. 312 sq.ft.
.. 1,072
$54,~40
l.us Depreciation
Physio~l 35\
(Age & deferred m~intenanoe)
Functional 5\
(b'loor plan)
Economio
(Industrial
10\
Zoned ~Ull\.)
-
. 50\
.. -27,220
Deprecillte~ V~lueof Improvements
$27,220'
X.~lldsc~ping,fenoing, Ilnd p~tio
.. 1,OqO
.. 7 ,500
$35,720
l.And
Comparable Propertles
Add,," Dale Sale PrI~e Sq, Pt, Lot Slz8
No,. 1 .,l~,..,1P.I111t"~~!1\l?l!.9.n..,~h,,,...,!1~,!?t1~,n.;,!?l!.~,I:1.~,9.1,~,~..L:,:,..~(1.~..............l~.~../"~g~..""..,.......",~d,~,~,,:......,?,~~..",~..;.;,~,~,~,
"".J..~""~'?~!1'~,I."..,3.,,,..~~,~,~,?,c?'!)),~,t,,,,,;.....~,~,~.h}........~,,,9.,~.~..,,,~,~,:,~:~,~d....,,,,,,..,,..,,,,:,..,,,,,,..........,..,,,,,,,,,"""""""''''''''''''''''''''''''''''''''''''';'''''''''",
No, 2 ,';'~3""~,~..,~~.~.~,t,!:!,~~."~.,~,,~,,f.,..,t1~,~~.~,,,~P~,~~,~~.L~~,~,..""~!2,;,...."",,,,~,,~,~,!:~.~ ,~,....".,;,..",,,,,~,r..~,~,~....,,,,....~.? ..,"'~""~,~~":,,
(6 Roome, 3 bedr90ms, l~ bethe. 1 C~r Garage,) ,
~"..:"'. ...". .,.." "'" >'''''." ..."'''.'',. ..",,,,,,,,,,,,,,,,, /'!"""" ""..".., "'''' '0'. ,., ''''',,'' ''', '''''''''',,'' ,,,.,..,,,,,, "";"'.'''''' I.t., "l..1 i..;"" "'h .", "..,.. ",,'.., I'"~ ."""".. ,,,,,,,..,,,.,,, "",..i"".,.", "'."""" ";'.;' ".i. ,i,; .i...
. No, .3 J,Q9..",~9.~.~.h.. .X,9.~K"~.~,l"I":.t:!,!!9.,h~,r.~,~.~,b.,I:1,~:9."I.?.~.,~,,,..,,.""~<.,?,~,,,,,:,..,,,..!.~.~,!.,9..99....,,..,,,,,,,..,,,~,!.~.~.~....,,,,,,,~,9.:.~,.."~"..?:.~.~..~,,
(7 Rooms, ~ bedr()oms, llf bAths,)
;......"....."""",,,,,.,,"',,....,,,, "..............,," "".,,,,,,, ':" ''''''''''''~''m..' ,"'.. '" ""'" ..'tt'""..",,, ",,,,,.,,,.......,,,,,,, 'm "...,..""'",,,,,,"'...,., ,,, ,,,,"',,,,.... "."..",,, ."".....",,:,~'" ..h.......'" j, 'hi.",,,. "..i....",,,
VALU.~ BY MARKeT APPR(:lACH ,,,..,..,..,,,:,,,,,,,,"'..,..,,,..,.......,,,,,,,"'$ 3$ ,000
II'l
19
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COMMONWIlALTH OF PENNSYLVANIA "
O~PARTMENT OF RIlVf,NUE
BURIlAU OF EXAMINATION
OFrlolAL NOTIOE OF
INHURITANOE TAX
AflSEllllMENT
*'
---
.COUNTY FILE NO:
; ". j. J
f --" I {~_.."........--"_~_
DATU
~<.o i,; ,j :\ (
;/~
BaTATE
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, OOUNTY
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DA TE OF PEA TH
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Apprallod Voluq of EOloln:
Rool Emlo
por,onal Proporly
Jointly Hold proporlV/Tronsfor'
.
+
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/
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TOISI Gross ESlota
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Total. Approvad Deduotlon,
"il /-'1
, .
Olear Value of eelste
,
"
/ '.
,
Less: ApptOyod Oharlleblo Exomptlon,
Olear Value of Eslale Subjeotto Tox
. /, ," t,
I
.11_
Amount Ta~eble @ 6% RelO
. ~'i't{'
(.-'
,/ -,
.
lex duo
.
,;,'; ,./i ,/
;'/'
Amount TeKeble @ 10% Rolo
t~x due
TOTAL PENNSYLVANIA INHERITANOE TAX DUB W ," /1 'I IN
(
,will be
Leh Orodlls:
DATB OF PAYMENT
,.-
. . . . . . A five peioenl dlsoount totaling
grsn\od If lhe Inl1orllonoo TaK Is paid by
.
AMOUNT PAID
DISOOUNT
J!iTBRe~
.
TAX OREDIT
.
+
$
a
$
+
a
+'
a
!nlareet 'aoorues al the rale of Ilx (61 peroenl per annum
,on the unpaid balanqo of .Inharllonoo Tax from
10 dale of paymont, Inlor~81 duo ,If pold by ~ II
BALANCe or PENNSYLVANIA INHERITANOe TAX Due
,- .(-,-/
, ~:/ I ;r(I 'l
v' (.'
/'1", I',' fl.'}" "
- - ,- I ~'-.,
I
"'.....d by: "/! (' 1.1 r, ,)
800 Info,m.tlon on RoYOr" ~Id. Ag.~,~ fgi ~~. '1II;7.,~ih /
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114101 dlqsuoll01llJ J1I4/s14 PUIlSSOJppll'OI!IOl./ s,luowlolo Olll 0100lPuI'PPWl0lo OUloq 81 UOlldwo)(o AIIWllj oql II '~
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'lUOpOOOp Olll so PI040SI1049UIOS041 10 SJoqwow OJ004M 81UOJod JO,lUOJod 0 Aq pOWIOIO
oquoo UOI~dwoxo 041'PllliO JO,osl1oda 40ns Oll SI OJ0411UOl\O 041 ul 'uOlldwoKooql wlolD UOO PI04081104 ou/os 041
~oJoqwow IlSI 04M Iuopaoop 041 10 PII40 Auo lloql'sI461J J04/s14 pollOI,IOI 804 o8nods 94111 .10 '081l0ds ou 8i OJoql II
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paWllllo 6uloq 81qop 041 .101 Allllqoll 8,Ol01So 041..10 S,luopooop 9411JodtJn8 01 OOliOPI^:1 'POIlI 81 UJI110~ xOJ. aOUOIIJ04UI
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'UOll0JISIUIWPIl 10 1800 oqj,llUlplllOUI olqOU'I,OIO 0.10 SWOI,I JOlll0 '010lS0 .10 lUOpooop 041 Aq pOJJI10U Slqopol UOI1lPPO ul
'0101S!! 91q9KOl J04/S141SUlollo 9lqllon(1011 0.10 4100P J04/s14 OlJOIJd HIOpooopoql Aq pOJ,lI1OUI s0111l qOIl POllsllll8un
,
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NOll 'VWl:lOiJ N I XV! aot\l'Vl.IlHIHt.J1 1vl:lSI'I:ro
"
.
:J!!uu'.lalllolltnL
Ifh V""~I\ 11'101
~OMMONWUA~TH Of p~NNSYLVANIA
OePARTMUNT Of RBVeNUS
TRANlfUR fNtfSHfTANCS TAX
RBJfPXNT DSCHPSNT
---~-,",-~,...-
.::.u.~.~~~r=~~~~~~~'tl~:==r:~tr...:J,tl~lltlt.-.r--o;...-:rt-.~
AFFIDAVIT OF
FIPUCIARY
(In'trugtlon, on Rovo,., Sid.)
tit
I
"
Estato 0/ .lnmu,t;l.Jl.!."IIF_o..l"}.!.:!!l,~_",__,,___,,_j,,_,_;__,"
!.a'I,Address 1,0'\ !i.~,i\rc()h'~,c.ro!l..t.___,__._._._...u""
..ltf;lchn!l!2_,,!.II!1!'13L..:..r..6 JI05,L
(CI'rvl (I-iT^lm (lIp)
-~
Dolo 0/ Doalh ,",tiHYQl11lw.r:...aL 1979 __.....~__.
Social Socurlly .No. _..z1~.o.7-89(J6'_~_____._.
13 FII I,' ' 21"79"739 ' ,,' ,
urocw - (J ,0, .....___......__~____...._-----...........~__,
,
1. 00codol11 d/"d:
( )lnlol&lolo (without a will)
(XX) T,stato(loMll1g a lust wlll-.:..copy altnchod)
2. I_ th, /llIng 0/ a Fodatol Eslulo Tax Rotull1 roqulrocl ,for this 0510/0? Yos...__ No X
3. '( ~) ,Executot/ExoCUlrlx () Admlnlstrnlor/Aclminlatrotrlx
Nom, 1'he Comi1\onwolllth Nntionnl !lnnk
.....-.-................-.........,...-. I...~-~-
Caunty Fila No. ._____
I"
4. 'Allcortospondonce should be moiled to ( ) AItMnoy
5. If an attornoy Is roprospntlng lho osloto, Indlcatol
Nom' ~Orll(l~.!!oUQk,E.squi.!~_~_____,--
Addrllas ._..l!L.S.5'~~) Ma!..k,otSclunr..!!_..~,
HIIt'risburll. __-"R~__," 17108
ICITY) (STATUI Illf11
~
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t",1~1 .~ 'I~
"I ~{l :1"
rj! N ;,'tL
'>Ii~: .... ':....
'.:.Ii,' qj
"'!ij .". ."l
, , \0 N,
l.:, ,
'1'
'f>
ex ) Flduclllry.
Addresa ,NnUolllll n..~~nkj!.uH5,!in&.n__h_'_'_"_'___
MgaMniQSbllU~....l.z.05..L__~
IOITY) ('TAH) (W')
I;.lst '~II safe ,d,eposl! boxn roglslerod I.n thlldecedent's IndlvldUol nomehor lolntly with, or ~&al\. a gel'll ar d.e puty
of another, Ot In decedenl's Individual name with rlohla/ access by llnol.oros agenl or deputy. Include Ihe namo
and addros. 0/ thobank or,ather Instltullon whore Iho sllfo c1oposlt baK Is 10COlod,'Ihe nome (s) In which Ihe box
,. tolllstored andlherelatlanshlp 0/ Iho lolnl holdors to Iha docodonl. .,
~~ "j~
NAMS AHP APP~BS$ ap BANK a~ OTltUR INSTITUTION
IN WHICH psceoBNT MAINTAINsa A SAFS PPP051T OOX
.
..... - --~-.-.
NAMP OR NAMBS IN l'IHIC,H
SApa, PSPOSITOOX IS REOfSTURUo
RELATIONSHIP Of JOINT
HOLPBRS TO pecelle
Nons
---------.-..
-
Und'r Pflflollles 0/ perjury, Idoclaro,thal.1 havo oX(lml~odthls rolurn, Including accllmponylng schodulea ond
slotoI110",I'(,ond 10 tho bos,I o/my kl10wledlleand bollol It Is true, corrocI andco!11ploto.
~'ho Qdmmonwolllbh Nntionnl !lfll1k
Ily; i;";,,;) ~/;"', llsta,to Tax Mgr.
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SIOIIAl'URS"OP ffPUCIARV
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PRINCIPAL RECEIPTS
,-,
Par i nvantory attaoh.ad
,. j, " ,
,0.2114/80. AdVl\l1oa from Annie Brow/ling to coyer
(J~t.ate expenses ' ,
'0.5/27/80. -
12/24/80. Claim payments from Capital BHle Cross and
PennSYlVania BlUe Shield
, '!
0.3/21180. Pennsylvania Lottery Winnings
1979 Federal income tax refund
06/0.3)80.
99/23/80.
0.9/24/80.
10/24/80.
. "
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0.9/23/80.
Received from the sale of 10.1 North
Arch Street, Me6hl\l1fo~burg; Pa.'
1980. P.rc- rata city tax
Notary fees "
1980. Pro- rata county tax
pro-rata sewerb,11l '
Pro-rata. refuse bill
1980.Pro-'rata school tax
Pro"rata fuel .oi1 raimbursement
Refund from PennsY1 vani (1 Nat i ona I Insuranoe C9, .
t'eal estate, 'insuranoe premium payable to esta,te
but due to Mrs, Browning
$
11.33
1,50
7,21
3,63
,33
178,92
-
TOTAL PRINCIPAL RECEIPTS
CDNVERSIDNS WnH GAIN/LDSS ,
,
, Gain
10.1 North Arch Street; Mechani csb\lrg,
PennSYlvania '
Proceeds $38,90.0, DO
Account,Va I ue 35 , 0.00., DO.
TDTAL GAIN AS SHaWN DN SUMMARY SHEET
$351 D~a. 25
80.,0.0.
630.,0.2
,
fl,OO
32,0.0.
20.2,92
142,31 '
24.o.q
~ 36.20.4', 50.
1&ll
,$ 3.90.0.,0.0 $ ".....
"
.$ 3.90.0..0.0. ,$ ..-
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CONVERSIONS INTO CASH
-.
10107/80 510 units Oommonw.IHl1 th Nat i ona,l Bank
'Commel' FlInd A-2
$ '510,00
,
J.0/98/80 4 lInits Commonwe/\ 1 th Nat i on/\ 1 Bank
Common FlInd A-2
,
10109/80 1 unit Commonweal~h National Bank
Common FlInd A-2
10/24/80 80,units Oommonwea1th National Bank
Common Fund M2
01/15/81 30,405 lInitsCommonwea ltl, Nat. i ana 1 Bank
Common fllnd 'A-,2
'530 lInits commo'nwea1th National Bank
Common FlInd A-l
01/25/8p
02/~3/80
0~/06/80
04/25/80
06/17/80
07/18/8.0
08/26/80
09/23/80
09/23/80
ii'j
09/23/80
09/23/80
d
4'.00
1',00
80.00.
30,405.00
530~00
PRINCIPAL DISBURSEMENTS
GElorgeM. HOlick I Attorney. rejmbursement
for probate.andaqvance costs
Lester G,/Conner - real estll~e appraisll1
West Shore Times. legal IIdvertising
Regi ster of. Will s . cost of fil i ng inventory
GeorgeM, Houck, ,Attorney - reimbursement of
expense~
Regi ster of Will s . one' short cert Hi cllte
'Register 'of Wi 11 s '.cost f.or 'fil i ng 'statement
of debts and deductions
Chris DerricII . ,l1iwn cutting
1980 School tax and 1981 pro-rata
hrmi ni,x · 'pest inspection
Recorder of Deeds . 1% rell1 e~tate transfer
tllX
$ 46.00
100,00
16.75
3.0.0
10,00
1. 00
6.00
3.00
228.33
450.00
389.00
2,723.00
,
09/2,~/80 M. C, Walker Realty . 7% comm,ission on
sale of real estate
1.1;:..1'1
~i.All.
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4
c'OMMO.NWBA~TH Of PIlNNSYLV~NIA I.
CO\lNTY OfCUMBIlRLAND J
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..~JalL~,j, COR!lJ!mLLlru~l.9.tfLQ.qLoLJh~.. CQlmtQn\'lQl\ l,th_.Nl\,t.t.Q.[1l\lfJJ!nk____~.__.__",,_~"':"""~
b~ln9 d~ly .,_$Wo.rJL__...__,~Meerdln~ to low, dopalol and UYI thotS.he ,__execu.t'or':__~_"::"::"'.."""'..
, --"------...........;..-4..-~--~- 01 tho EIloto 01 -llllrne.s.Jl,._Ll.r..ownlng__ .
lalo of . Dorouah of l1echan1m4ra ___, Cumborland Oounty. Pa,j doa0410dand that tho
within I; ~n Inv,ontory ma.do by ....1re...QQIIDlQ.nw.e.l\Hb.J!Ilti.QMl...D.QnK_~~, tho uld-Ewutor
01 tho ontiro oltolo 01 laid doeodenl, conllltln~ .01 olllho pOrlonal prop,.rty ,cnd rool Oltato, oHcept r..I'OIt.tO'ouhlde
thc Commcnweolth 01 Ponnlylvanla, and that tho 11~~rol oppollle ooeh Item 01 thclnventcry rcprOlant It'l lair 'value
u cl tho. dotocf qocodont'l doath, . "i"'," ,
Sworn to ~--~ and lubl~~lbod bllloro 010, I _~
e"o.Io, . ^dmlnlll'.Ioi
__ 19-
J JJ~Q_Ceq!!.t Cliff prl'lB__
_9BJ1!R Hi 111...fh_170~1
Add'fll
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Oat. 01 Death _
2L
D.y
..-1:!Qymnb.e r
Monlh
197L
yw
INSTRUCTIONS
I, An ,Invontory muHb, IlIed wl/hln thru monthl aHor oppolntmont of perlon.1 repruentotlvQ,
2,' A. lupplomenllnventcry inul\bo IlIed wllhln thirty doylof dhcoyely of.addltlcnolollOh,
3. Adultlonol .hoe" moy be .ttached uto po;.onolly or tully ,
4,_ See Article IV, Plduclarlel Act 011949,
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