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Home My WebLink About80-00137 ~ . OATH OF SUBSCRIBING WITNESS COMMONWEAlJl'H 01" PENNSYLVANIA! ss: COUNTY OF CUMBERLAND \ This..... ....,............... ....... .~~~.~...... ........................ day of....... .~~.~ ~~.~!):'... ......,. .......... ..,.............. A.D., 19 .~.~..., Harold B. McLane, Deputy before me n:el....1I E. AMlh'[]"", Register for t.he Probate of Wills and granting letters of Administration in and for said County of' Cumberland, in the Commonwealth of Pennsylvania, personally came .....,..,..... ..,.....,. ...~.9.~!:.. .~.~...~H~~...~!:.c;'\..~.~,~...~ ..... .~~.~.~y.. .... ..,.... .,.,... .",.......,..,......,.", ..,......... .............,.. .....,.......... .." the subscribing witnesses to the foregoing instrument of writing ]JUI'lxlrting to be the Jast Will and Testament of .. .Y.i!!:l.~..,~......I:I.?:!:".J;,y'................................................................... Dated ..?o.P.J::.U.. .+.~.,... JU7...,... ~(f;' ,;1(' ,.tJ /1.',1./ late of ......~~t...V.~l:'Q..T.QWIJ.s.h.i..I?................................................ Cumberland County Pa" deceased who being duly ...,.........?w,Q1:'T.I................... according to law, depose and say, that ..th~y...w.~.J;~.............,.... present, and saw and heard the testa.l;;t;.:ix....................., ......-!.?\D.<i!...f:1.,...!:I.i\J::...Y.,................,......,.............,.. sign, seal, publish, pronounce and declare the said instrument of writing as and for h..~X.......... Testament and Last Will, and at the time of' so doing ..........~)),<;\......,...............,.........was of sound and disposing mind memory and understanding, t.o the best of ........tne.i.,c..........,..............knowledge, observation and belief. ............Sw.arn..to........,..,..... and subscribed before ........~. .(/.'-:w..,........f......~..~k..............,.......... 1'1. ,.J i/ /.' .' , ./' ~-".' ,OJ 1 J)( ;, ' 'J,,: / 1/.1 ......r?.......:...'... ........'..............,._..~....iJ'...........,...... ~Y.Y1J.tX~,~h.~..~~~?>..~....,.~~.~~y . d E. ...l~ud.:.. ,-,ilL, Register - .................................................................................. AFFIDAVIT OF DEATH COMMONWEALTH OF PENNSYLVANIA I ss: COUNTY OF CUMBERLAND \ ,........ ...............!!'.~~,:t;'.7.~.c;:.7.. .~:.. .,9.~~,~,~~.:t;'.,...,..... .................. .,................ ....,. ..,. .............,.,.. ...., .,.. .."...being duly .............~:?'?~!,l........................ says that as nearly as can be ascertained the said decedent .......................... ....!.~!,l,7...~:....~.~~.;:y..... ...." ......,..... ............ ...........,.....,.......!. .".. ..",... ......,.....,......".... ..... ....,.., ...,.......,., ..., .died on ..........9.?:!;.~r.R.~.Y..................... the .~.!;h.....,...................day of ......~~!?~~,~.~y...,.......................... A.D., 19.~.~.., 1''';3 'I k M at or about ..........,..11.,:......................... 0 C oc ,.... . ,........................9.W!?m................and subscribed this ..;..................~~.~!!....,............. day of' ..P.'.7.~.:t;'.~!!.;-.Y.... 19, !l.Q...., before <.~J01,J.tf.S;..JYJ~.;;;l(\,;i,,,}.~....~.~~.~~x R.id.....l d E. /~II~t... ",...1, Register '" J /. . ,:f/, . ') " i/ ,. " ,_7, ..{. ,... .....{,.{.( il""I,,/f~.~Cl,"(.~-' . .. . . . . . . . . .. . . . . . . .. . . .. . . . . .. . . . . . . . . .. .. . . .. ... . . . . . . . ~ . . ... .. .. .. . . . . .. . . . . .. OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA} COUNTY OF CUMBERLAND SS: Before me, the Register for the Probate of Wills Ilnd grantillj.( of Letters of Administration in and for the County of Cumberland. personally came ......f.~".+.\;m.c;;~..N......<iif\;r;.9.n!il.t..,................................................. who, being duly .....~.~~.J?~...,..,....., do ~.~...... depose and say that as.....,!;:~.~~~.~::,~.~........,........,............,...... of the last Will and Testament of ..,~.~!'!~...~.:..,~.'!-.':.::X....,.....................,.........................................,..,deceased .~h-.~..............,... will well and truly administer the goods and chattels. rights and credits of said deceased according to law, And also will diligently comply with the provisions of the law relating to Transfer Inheritances. ......,?~.9.!:!L....,... and subscribed before me. ~";'f"~.~~.~~:7.~r~}~..;.~....... A. D.. 19::...~~. .,~~Jt)>~....".....Q'.&5!.",-"".,.......l?,....y R~"luud E. .:", , Register ,./ ~) !t (,/' ~ 1.:" Y' " (/tL.(l--(.t.>nl'''<.. )1/ _ /,( -el~(.e.-I:"-rlj~ ..........................................!....................................... .................................................................................. :.,,; 0: :QJ CO, : ~ 0> ~ ~ ,-If :QJ :0 LL. N' 0 co: 00; ~~ , N, r- ..J ....: M 0 :><, 0 >< i'" c-I ..J ~ I ~; ~: C"':l 0 ~ "': ~ 00 - f'l:' ~ .: ::1: I ~ :1:; U, ~: c-I .S E-<: .a, N .: [ii, <lJ: -. "'j -"<: 'U 0 QJ 00: ~ [ii' 'U CO z: ... ",: , 0 0;1', - ~ f'l:, <J *: C"'(j IJ, '" .5 ... QJ 'U ~ 'U bll '" IJl ~ OJ ~ fil .~ "' Il< ~ DECREE Be it remembered that on the ........~.~,~~,...... day of .................:.~~.~~.~.~~.............. A. D" 19 .~~..., there was probated and recorded the last Will and Testament of ....y.f\p..'i!...!1,...~.\\gy...................,.......,..............., I te I' ,. Upper Allep Townshin C b I dC P .' ' a 0 ....;...'..........;.;.........,.... .................../;.............,....., urn er an ounty, ennsylvama, Deceased, Letters (> ...7.'~.~.!;!~.!!!!'!D,~~EY.........,............... were granted to ..~.~.~!:.7.~~.7.. .!:l.:...~.~.~~.~~~......,......................;,..,........;,.. Witness my hand a:ld official seal the day and year aforesaid. , " '-'<~:h:kC.M.:1~~.JJJ~o{~,~.~.~~.~y RI...L~ud E. .....~....~........, RegIster.. ,,'..- .."- RC:V-~17 \8-781 COMMONWEAL TH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OFFIELD OPERATIONS APPLICATION FOR AND CONSENT TO TRANSFER SECURITIES REGISTERED IN THE NAME OF A RESIDENT DECEDENT ~.~ .""~ "f.Jj;:.l\ ~ ..... APPLICATION (MUST BE FILED IN TRIPLICATE) TO THE PENNSYLVANIA DEPARTMENT OF REVENUE: Application is hereby made far cansent to the transfer of the following securities of a Pennsylvania Corporation or a Nationol Banking Associotion located in Pennsylvania: DATE___~n5/30 (0) 556 (b) Hanco Corporation ..____.__.__.(c)___.___...cO:i~~r:_____ (NOTE: In describing securities enter in (a), ab ",e, either the number of shares of stock or the face amount of registered bonds, in (b), the nome of the issuing company and in (c) the cluss of stock or the stated interest rate and maturity date of registered bonds.) ISSUED ON various , and having a TOTAL MARKET VALUE OF L..~9,lS2 .Jane J.l. Harry Feb. , an 9, 1980 (DolO) as of the date of death of the decedent, (Nome of Decodenl) (Date af death) who was late of 1240 E. Lisbum Road V~chanicDburg Cumberland PA (Street cnd Number) (Post Office) (County) (State) The securities are registered as follows: J ana 1-1. Harrv -...-._____1_-- (Nome or names In which certificates ore registered) Florence ~L Gilmer, 12/fO Eo Lishum Road, Hechanicsbur~, PA J (~dd,"",,) Sli' r.' NAME OF APPLICANT onn 1'. Ke, ."sq. COUNTY FILE NUMBER 21-80-137 ADDRESS OF APPLlCANT__ Box 737, Camp Hill, PA BUREAU FILE NUMBER SIGNATURE OF APPLlCANL_\Jttk.J._-i" .--/ /'dL NOTICE: IF YOU FAIL TO PROPERLY FILL IN ANY PORTION OF THIS APpuff.TIOi'l, IT WILL NOT BE CONSIDERED COMPLETE AND WILL BE RETURNED TO YOU FOR CqMPLETlOi'l, ADMINISTRA TOR) EXECUTOR ) (Nome) COMMONWEALTH OF PENNSYLVANIA - DEPARTMENT OF REVENUE CONSENT TO TRANSFER SECURITIES /\ f / 'Ci DO DATECc'W~_-~ I hereby consent to the transfer of the above securities now registered in the name of the afQresaid Decedent and waive the filing of a certificate certifying to the payment of the transfer inheritance tax to which the property of said Decedent i~ made subject pursuant to the provisions of the Act of June 20, 1919, P.L. 521, os amended and the Act of June 15, 1961, P.L. 373, os amended. This is 0150 in accardonce with the provisions of the Act of April 9, 1929, P.L. 343, This Consent to Transfer the herein described property operates only in reference to the estate of the above-named Decedent. f:h, ~li'!'~t r._.~ . t;,;r l,';:' , "~;i(.l,Jl\ ;lO,"'~"~r,",jl;; k]J~~Jt~Qttj\~~;l~:,: '. ;1A, ^ ,,,\L 'S;9n~r'C) A {' Ii Uc.u~A~\'R()lit.~J;\)d LV'W~.....Ak\...~d, oJ '\ (Tl Ie) iJ l (CountYl ~ ,... -\ COMMONWEALTH OF PENNSYLVANIA COUNTY, OF CUMBERLAND I J 5S: D.y February Month 1980. -.---,.. ----__Elorence..M.._Gardner_____ _______ being duly __SW.o,rn_.____ according 10 law, deposes and says Ihas he__________.___..__ --.--E;xecut.rix-.---.-..-.... ._m.' of the Eslale of Jane M. Harry lale of Upper Allen TOwnflhi p , Cumberland Counly, Pa" deceased and that tho wilhin is an inventory made by ..----------..-her-------- ___....__, tho said_eX8CUtriX-_ of Ihe en lire estale of said decedenl, consisling of all the personal prop.rly and roal estate, except real eslalo outside the Commonweallh of Pennsylvania, and Ihallhe figures opposito each ilem of Ihe Invontory represenl it's fair value as of Ihe dato of decedenl's dealh. Sworn to and subscribed be foro me, April 15. ~/ ) ,I: . 1'L<_;~l'U../ y: /); ~{(..{ ,. , 19 80 .c;.::c,t:L/--n.~-",-- )/I_t-~(.{:"'-t...L~~ Executor. Administrator ,1 .-LL......' j 1240 E. Lisburn Road Thelma S. McC'",lin. Nol,r, p",,~C" ;.\y C(;l11rni~ljol1 [xllirc\ J:.h 1, JliEr, C61t1p Hin. PA (U~llcl!~r:d (v,m'lY __l1echanic.sburg, PA 11.955___ Addrltu Oalo of Death 9th Yur INSTRUCTIONS J. An invenlory must be filed within throe monlhs after appoinlmenl of porsonal reprosentalive. 2, A supplomont invenlory must be filed wilhin Ihirly days of discovery of additional assets, 3, Addilional sheets may be attached as to personalty or really 4, See Article IV, Fiduciaries Acl of 1949. .~ "'0j t-.... "<::1 ~I 0" , ..,; CIl ~ >- ~ ~ ~ ....!... I- W i ~ >- '" I- .. ....... w <( ~ . Q!, l1. ~ i2 u OJ 0 Vl ~ ~ 0 w C '" ,!<: ,. '" w .. ~ l- I l1. Q. .,~ " Z ~ ..J u.. .. .--l w <( 0 ;:;::1 l1. CI:l 0 u.. ..J <ll' :I: W 0 <( w ~I ~I ,;:. > Z '" <( ~I - . Z 0 c " ~ I ~ II Vl z 2t 0 0 '" ,",' U ] Z w <( I ::>, ... l1. "0 I c 0 .. '"' I : ~ -.:: 0 ~ ..0 "0 .... ~ E 0 - ..!! I .. ~ 0 , ..J U u: '" > REV0449 (8.78) ,2/ - &'0.- /.3 7 COMMONWEALTH OF PENNSYLV ANI A DEPARTMENT OF REVENUE BUREAU OF FlELD OPERATlONS ~* RESIDENT DECEDENT COUNTY or __~UMBERLAND __ IMPORT ANT, This return llluSl he completed in detail "1ll1 filed in tluplicafl', with all altadll~d. wilh the Register of Wills of the Cuunty where decedent rl~sidcd; Return is dlHl within lIU1e lIlollths after dale of dl:alll. unless UII extension is grlllltcll by the Secretary flf Ih~'lCllUC. (Se~'lion 70.1 Ilr lhe IlIhcril,IIIl"l~ ilnd Estate Tux Act <l( 1%1.) County of Cumberland Pennsylvania Cumberland } AFFIllAVIT OF --.. :~~K County IN TilE MATTER OF TilE ESTATE OF JANE M.. HARRY {STATE FULL NAME OF' DECEOENTI Lcto of Stato of } '" EXCCUlOr Decedent died of tho eslate of tho oboveonumod decedent bllinq duly ,"worn, dopou S and soy S February 9 ~O } . 19 loslate leaving 0 lost will, copy of which Is herl3lo attachod. IMONTHI IDAyl (YEARl ~~ } John E. Slike, Esq., Arnold, Slike Nama and address of attorne)' or :~~ecro;~t~:;~~:~;:p:~::~~o~~v:;~l:d~om 2109 Marke t Street, Camp Hill, FA Executrix That as slIch deponenl is familiar with the affairs of said estate and the property constituting I EX~ CU fO R- ADMINISTr~A TO RI the as sets thereof and their fuir market. va lue. That at the time of death there was no safe deposit box registered in decedent's inJividualnume, or jointly with, or as agent or deputy of another, or in decedent's individualllame~ with right of access by another as agcntor deputy,. with the exception of the following: - Florence M.. Gardner, A\J1!j1hl\.l'iO'ilPt & Bayley 17011 NAME AND ADDRESS OF BANK OR OTHER INSTITUTION IN WHICH DECEDENT REN1"f!O A SAFE DEPOSIT BOX THIS SAFE DEPOSIT BOX RENTED '!i-NAME: OR NAMES OF RELATIONSHIP or: JOINT' HOLiJERS TO ul::;:';''EUE1~T ' Thllt the contents of said safe deposit box or boxes arc itemized under Schedules wi tit the exception of the following, for the rC3.sons hereinafter set forth: of this return, That Schodulo A auached here\(, and made pari hereof sels forth fnlly and in detail alllhe real properly in the Commonwealth of Pennsylvania of which decedent died having an interest thcrein. It also sets forth the mortgage encumbrances upon each parcel of r~al propcrty at the date of death, giving the amount still due at death, nal1i,lc of mortgagec, datc, rate of interest, and book and page of record thcrcor. It also sets forth in the columns provided therefore the assessed valuation of each of said parcels, the estimated market value thereof as of datc of death of decedent. That Schec/ule B attached heretf) and mlldc part hereof sets forlh fully and in detail all personal property whcresover situated owned by the decedellt at the time of death; all moneys left by the decedent at the time of death, whether in decedent's immediate Ilossession. slanding to decedent's credit in banks of deposit, savings banks, trust companies, or other institutions, whelher individually, or in trust for any other person or persons giving also separately thc accrueJ interest thereon, if al1Y~ down to the lasl interest day prior to decedent's death in the case of savings banks, >lnd to tlu; datc of dccedent's deuth in all other cases; all bonds, postal savings, treasury certificates or not~s and other evidcnce of indebtedness of the United States to the de- cedent; all obligations, whether by statute or agrcemcnt they arc designated as t:D~ free, of the United States~ or any state, 01' political subdivision therenf, ~lr of any foreign counlry, which an; owned at the time of death; all wearing apparel, jewclry, silverware, piclures, books, works of art, houscho!J'"furniture, horses'. carriages. automobiles, boalS, and :IIlY and all olher personal chattels of whatsoever kind or m.ture, left by decedent, together with the fairly estimnted market value thereof; all bonds anJ mortgages held by decedent and of nil claims do.e-anJ owing decedent at the time of death, and all promissory notes or other instru:nents in writing for thc puyment of money of which deccdent dkd possessed, \If whatsoever nature, with interest thereon, if any, 'giving tIll'. face value and estimated fair market ,value thereof, and if such estimated fair market value be less than the face vuluc, it sets Carlh bridly the n:asons for such depreciation as to each item; all moneys payable to the estate from life insurance polich:s carried by deccd~nt; all annuity and endowment contracts the proc.eeds of which were payable upon the death of the decedent; all and the corporate stocks and dividcnd~ due thereon and unpaid as of (he date of deOith, bonds nnd accrued interest thereon to the date of decedent's death and other in\'estment securities owned hy the decedent at the time of death, with the market value there~ of at such time. <, In the ens!) of seeltr1t.ltHi of clo:-\11 or I'llmlly corpcrllLjollS, the vldlWS rl~ported llre tlS far as p05!>thl/J ~llhstHnt.llltml by l'lnlllletnl ~l(ltem(!nt5 of' the corllofut.LoTi!i, showing the ass~ls Ilnd Ilnhilit1es tlll'rlH)f' liS of t.1l1~ dntc 01' tlent.lI. The sr~herlllle I\lsu !-tct.s forth t.he I.nterl~st or c1ncf~r1cnt. III the tLme of c11!lltll In llnr co-pnrllv'!fshlp or hU!'ilncss, nile' In support. 01' t.lLe VII'ltW 01' such lnl(!rcst.. there 1s Ilnncxcd to slllcl sclLt~(lllle, I'JIlllnclIII stlltemf!llls showing tltensscts Ilncl lllLhllLL1es 01' sulfl cO-lInrtllf"!fShLp or husiness. ,\ l:npy ot' lh(~ cO-plIl'tncrshlp ugl'I"I'ml'llt, (If orfil, 11 stntement sl~ttln~ "orth thn nflture of the dgreemcnt) tOJ;I'lIwr wIth n stntemnnt sctUn~ forth the chnrncter or t.he 11llslnl'ss, Its locution, and such other fncts }lprl,/ltnlng 1,0 till! hU!iilncss us 1lI1~~' he perl.1nent to Ll fnlr IIml .lust flf1prldsnl of the dcc/~dcnt.'s intcrest thort'llI must hp. sllhmlttf'd. It. shnllld /lIst) set f'urth In Itemlwd form, togclh~r with the flltr market value thcr(~of, nil)' otllcl' property oWllml or hef)ucnthed by tll(~ decedf~nt. at the lime nf (h~l~th. The 5chc-dul(> C Ilttnched hnrt~jo /lnll mntl~ 11Ilrt. h(!l'eof sets fort.h 11 true nnswer to each inquiry COlltnlncd thornln lH\tI in the r:nsc of' trlulsf'f~rs ufpl'npcl'!.j', relll 01' persollnl, within two yent"s or decedent's denth, in contempltttlon oj' decedent's (Ienth, or tlltl~n(lcd to to.ke ef'f(!ct in possession or enjoyment at or after dcath, saicI schedule sets forth the nature Ilnrl vlllue of such property, to whom trnnsferred, the relat.1onship of the transferees to the decedent, thfl proportJOTlllte slulre receivc(} by ench transferee and Ill1 other facts of a perUnent nat1lre regarrlinJ; Sll!<i tl'fmsfers. In the cnse of' tl'nnsfers intended to tltke ei'feet in possession or en,loj'1nent Ht or llfter (hHlth, therfl is /11so lIttnehHrl to .the schedule /J. COllY of the deed, trust agreement or otller instrument crrHlttng tile t.rust. 'l'herl~ 1.5 also set forth in sa.id schedule n list of all property, real und personal, with its vlllue, which pll~ses at decedent's nea.th by virtue of the exercise by decedent, either individually, or.lnintly with nnother, or llny power of appoint- ment ve5t..~d in decedent, either incUviduully or jointl~', hythe will, deed, or other instrument of another, with n copy of the instrmnent creating such power Ilttllched t.o the schedule. Thnt Schedule D flttnched hereto and mude part hert!()f' sets f'orth the nllmes anci addresses of all persons beneficially interested in this estate Ilt tile time of decedentt s denth, the lluture of their res- pective interests, their relationship, if any, to the decedent, together with the nges at the time of decedent.'s dcnth of nIl minors, I\nnuilllllts nnel heneft.cinr1es for life linneI' decedent's Will. It also contains nstntemcnt showing which of the benei'tc1nrles nUllIed in the rlccertent's will, 1f any, died prior to decedent, the dates of their death, their issue, lUul the relationship or such issue to the beneficiary. That. Si:/'1edu/e E attached hereto llod macl~ [l part hereof sets forth 1111 property, real and, per- sonul, owned by the decedent ,Jointly with anot.her, or othel's, including intangible, standing in the na.me of the decedent and others, plus the dat.e nnd- place of record of instrmnents effecUng the vestiture of renl estate und the date of acquisition of personlllty, plus the name, nddress finrt relationship, if any, of co-owners. to the decedent. That Schedule F attached hereto and made a pllrt hereof sets forth fully and in detail all debts ollcl dcduc tions clllimed for and on behal f 0 f this deceden t' s os tute, 1nc1 mUng funeral expenses paid; family exemption, where applicllhle; costs of administration of this estatej counsel fees nnd 1\ldiciary's conunissions puid or to IJe Jlllid; cost expended for burial trusts, tombstones or gravemarkers, and reli- giolls services, 1n consequence of tile de 11th of' t.he dece(ientj debts nnd clo.1ms owing anrl llnpairl at time of death; taxes accrued chargeahle for period pdor to decedent's death (except those allowed under Section 651 of the Inheritance Ilnd Estute Tax '\ct); together wit.h n statement of' collateral pledged for obliga- tions, if any. It is agreed that the fiduciary will present pt"oof of suid clnimHd obligations upon re- quest, that if the amount actually paid in settlement of,any'fee, commission or debt is less than the estimated n.mount claiming llntl nllowed, that the same will be reported to the Register of Wills, and that the amount of tax assessed cnn be rl!lIssesscd In uccordlUlce therewith. Thllt thl! t.otllls (If tht! npproprintc columns 1n Schenules "'\", "B", "e", "E", and "F" as d1rected therein, tlllve been curried forward and llroperl~' reg1slered in the SlImnlllry. Subscribed and sworn to before me this 16th April .. .....................7) "day of ," \..-/ I).. j' IL-'t" f I; I l..( I . ,'.. ,...../..: j'. '''<L;h~~' s:~;~;"'li~:. ~;\;~ ;.biic Mi' ((JI\lrni!li~n bl'ilCS Ju~\' 1. 1980 (amp Hill. Ph (urllbclland (oon\V 80 ..., 19......",.... .2f&~~T.::~::f.",.ItI,df~~.~::::::::...,.......,--,...,-" (Executor-Administrator) , ",~,?,4Q.."~.?.~"1;:"...1..t..(1.P,gX.n"".RQ.,ag",,,..,,-,,._,,-,-,. (St'reet Number) '" "M.,e.,C:~<:lrJ,~c:~.~~Eg.!.!:'A"J}Q~.2."..,."."..""". (City or Town and St<tte) sorE: Bpl'nrH st~ntTlJ; aff'lrlllvit. mllkH sure all hlunk splices In t.he Ilt'f'tdnvit lInrl sche-tlnles annexed nre fillf:>d tn with di!tnils or the word "None", nun ill CIISC tlH~ IlSS(.ts tncll1fle rlirc and unlistccl securities, securlUes of close or fllmil)' curporul1ul1s or fill 1ntl~r~~st in I\II~' co-pnrtnershlp or busIness, that the illltu and slllt,l'nltmts requtrcII tllllter the PIlI't~Al'llJlh IllltWI! rl~lnt1nA ,to SclH!IJule "Il" lire attached. 'Also make cf~rtldn that collUlUl #1 in the "Sunmllry" hilS l)(~en propl~rly completNt liS Illlove-tHrectcll. , . RE~V.4~3'18.781 C()MMONWEAL I'll OF PENNSYLVM'UA TRANSFElllNHElllTANCE TAX RESIDENT llECEDENT l' !1i\ t,,,,,,t!-~ ~"Y,~"" ' 1~';liJ',t\ j ~YI->.hJl'j\I", \'{(\ ,{"..,;!s;.;:,"tl!,~'j(bl, .i~I.'"':."J!.."P.:M/- SCIIEIJULE "Ii" BI'NFI'ICIAIUI'S BENEFICIARIES AND AllllR"~SES (Stule full names and uddresses of ull who have an inu'rest, vl'stcd, contingent or olher~ wise, in estate) RELATIONSIIIP (If slep-dlildrcn or illegitimate children nee involved, set forth this facl.) SURVIVED DECEDENT STATE YES OR NO DATE OF BIRTH INTEREST OF DENEFICIARY IN ESTATE Benjamin F. Harr Ne hew 100 Dawes Avenue Somers Point, N.J. 0824 Yes $.l...2.8 'i Fred B. Harry Nephew Yes $3 388 1062 Green1ea Road Hershey, P A 17033 Tina Harry Brown Niece Yes Cameo ri.ng 1702 Mill Road Boothwynn, PA 19061 Lisa Harry Niece Yes Onyx ring 4702 Wisconsin Ave. Washington, D.C. 20016 Florence M. Gardner None Yes House & residue 1240 E. Lisburn Rd. Mechanics burg, PA 17055 Deponent further soys that 01.1 the obove.named beneficiaries arc living at this time except below: NAME DATE OF DEATH RESIDENCE w BV'l"": ~< P"'l 1>- '" ",. " 'c ~ e ._ 0 ::l ,gc.o ...::: e CJ , o. l-oU:':' S... IU = '" ~ U = w o E g, '" u !:! Cl: . , SUMMARY I{Clll Propcrty Pcrsonal Propcrly Trl.1nsrcrs (Sch. HA") .1; (Seh, "II") .$ (Seh, HC") $ .$ $ .$ \JI'OSS Taxnblc Estatc E-- '" .... Z ~ " W '" " :;;; ~ >< u W u '" u ..I - Q < ..: on 0:: u.. .~ :;( Q., 0 " '" 0.. " Il- " ..: <>W ~ Il- ..c W ..cE-- >. < 0 E-- E--..: '" :c " Q Z " E-- ....E-- c :z 0", u u.. W a.. < Ie 0 ~ I- 0 '" .~ 0:: -5 0 ~ W Il- " -;; .... E-- w ~ ~ <II E-- ~ " '" 'M ..: ~ 0 c <: c " 0 - 'S ::;; ;; E ;':"0 e = E ~< " c 0 .J U U (I) (A s Reporte~) (2) (As lJelerlllille~) $ $ $ $ $ $ R(V.4114 EX-t (J.t\OI INHERITANCE TAX SUMMARY SHEET (BUREAU USE ONLY) File Number 21-80-01:57 --------------------------- Estate Name ._._~.a,!)~._~_'_.l!arry .....n_._.n...._.. n__'" _____________..__ Date of Death _F.ebf.Ue,rYn9.,.J.9.6Q.. Socinl Security Number ....n....... .------------- REPORT OF INHERITANCE TAX APPRAISER I, tho undorsignod duly appaintod Inheritance Tax Appraiser in and lor the County 01 Cumberland Ponnsylvania, do respectfully report that I have apprai sed tho real and personal property as repartad in tho laregaing rotum a' tho values set lorth oppasito each item in the last column te the right in Schedules "A", "8", "C", and "E" Datod: July 17 , 1980 j/IJMf,,) ~/I' '(H,t) INHERITANCE: TAX APPRAISER INVENTORY VALUE AS APPRAISED ADJUSTMENTS CODE (HARRISBURG USE ONLY) REMAIHDER APPRAISEMENT CODE Real Property (Schedule A) Personal Property (Schedule B) Joint_Held Property (Schedule E) TranRfers (Schedule C) $ 00+ tD+ TOT Al GROSS ASSETS II __._._--59.,.O.7.Q .33 20+ 30+ Leu O.bts and Deductions (SCHEDULE F) CLEAR VALUE OF ESTATE 40- PRINCIPLE Valuation of life estates or annulll.s. . . . . . . . . . . . . . !!ill FACTOR -- ~~ FOR USE OF REGISTER ONLY Tax on $ ~ 6'. " 15% Tax an'S , Tax on $ Tax on S T ax on S Exemptions Total Estate TOT At TAX INTEREST FROM BALANCE TO Less Credits DATE OF PAYMENT AMOUNT PAID DISCOUNT INTEREST S + 5 S = + ; BALANCE 5_ INTEREST FROM TO __ S BALANCE DUE S VALUE COMPUTATION OF TAX S S $ S I s s s TAX CREDIT $ --- 92+ 93- CODE I E R 'd M III ~ ~ ~ Jl ~ * :; Il M Z ~ ~ ~ 0 ~ ~ ;S ell ;:l U . j ..l ~ <( :J - u Z U M - 0 C\J ~ M r... - M r... !;: 0 0 .~ i:l:i r... ~ 1i; 0 ell 0 z d ~ ell >- f-o 0 - ~ z Z f-o f-o t>l Z ..l d - 0 ~ p:: S ~ ~ ~ :; Cl U ~ ..l Z ~ Z ~ 8 0 z ~ ell - ~ Cl ~ ..l COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION J _._.______._ _ __.mn OFFICIAL NOTICE OF INHEHlTANCE TAX ASSESSMENT ~. -~ TO:_1--:":.2.. . /1 ::.LJ._'-~.' DATE._ / ESTATE OF ./'..., J. ? ~.' "') 1,("'" (.;.1 ,1'1- 1" (I "-'<F(,~'L,I:" i.~.:~r /.,', 1'; -, " " '0:- Fr.::-~:".-'<J-- "-LL-'" ( ".' "" I - " .[., ' (. .--' -I-~-;..~~............--:-.-:-.- ---.---- FILE NO, ,'j. ./, . /// /:h.F",i,.I".....~- ., . /'/(? (i .-- ) / -.- I ' ;..///' / . ,'..."/' ..1.... ... ,Ih .."l......- ,,'. ...<"', , j'() / / , COUNTY OF (' j ,',,'. j,J-( ,/ (/I )/.... \._ F<! County Information purposes only COUNTYfILE NO: >/... ,.!) . ;. .::) ? DATE OF DEATH.... >::j. ,ej /// () Appraised Value of ESlate: Real Estate Personal Property Jointly Held Property/Transfers $ , ,'/ , '-r' I) .(' ."1 . ,. -'~' ., II Total Gross Estate $ I '/,~ -- Total Approved Deductions (,.,.1 .-//) Less: Approved Charitable Exemptions , r " " /' $ , I '/ ....-.--..-- I . I~" l' $ .> , .J Clear Value of E'itale Clear Value of Estate Subject to TRx Amount Taxi3ble @ 6% Rate $- . tax due $ Amount Taxable @ 15% Rate /.' /~ II'; , / ()~) -2-L lax due -,..-/ -- ., /)(?tl./(/ TOTAL PENNSYLVANIA INHERITANCE TAX DUE S Less ,Credits: DATE OF PAYMENT AMOUNT PAID DISCOUNT --'-- INTEREST -- TAX CREDIT -! " t:',-:'..) ,I (.- _ / (, $ '.. 'j-). ,. . ./ f -"-' + $ .: .;, , .,j ~~/ L-_. = $ >~/ ,/{J, 17 + = + BAlANCE OF PENNSYLVANIA INHERITANCETAX DUE $ -~I ,. .....;.;,.;:.,> fnterest will accrue at the rate of six, (6) percent per Inheritance tax from annum on the unpaid balance of to the date of payment. Assessed by: /i ."' I- Allonl fot'the ,ilmmo0 '~Hlth-' >~,... ...c~ '.(II..{, . 'J SEE REVERSE SIDE FOR INSTRUCTIONS REGI.STER OF lJl,.'iLL'S COpy REV"4~' (6-7B) ""i -; " 7 .:-'0/ - S () .-)-3 STATEMENT OF DEBTS AND DEDUCTIONS OFFICE OF THE REGI~. TE R OF WILLS OF Cumber land CDU NTY AND AGENT OF THE COMMONWEAL TIt f ESTAHOF Jane N. Har'v I.ATE OF _1,!p~]:" Allen Township DATE OF FILING APFRAISEMENT C. 7./.;),., J? ;cJ,f/ DATE OF OEATH February 9, 1980 NO. OF Y_ V .l REMARKS AMOUNT DATE VOUCHER NAME OF PA YEE Myers -Hall Funeral Horne .I Funeral expenses 1,100 00 John M. Sullivan, N.D. Medical expense 70 00 Dauphin~osit B&T Co. . Service charge ?8 00 Arnold Slike & Ba~ Reimbursemen~r Letters and legal ads 53 00 Florence M. Gardner Reimb. for X-ray 18 00 - Robert N. Tecau, D.O. Medical expense . 60 00 Florence M. Gardner Reimbursement for funeral flowers & Jewelry appraisal 121 46 Arnold, Slike & Bay1~y Reimb. for legal ad 20 19 Dauphin D.!illosit B&T Co. Half of balance on mr" I? "F.? 17n " Florence M. Gardner Executrix's Commission 2,954 00 Arnold, Slike . & Bayley Attorneys' fees 2,954 00 R~ister of Wills Filin" fees Q nn PP&L Electric bill 114 nn TOTAL 20064 35 I . - , , --- ---- -. __.___h.._.. -- __0__.- _____"__._ u. ---- -.---."---'" '~'_O'____'___.___" ___n~_ _..___..._...__. -- -.,-_.-.__.--,........_--.--".~---- ..-- .. - ----_____.0____,-'-.--.--.------'-.- COMMONWEALTH OP PENNSYLVANIA l COUNTY OF_._.c..~~~R1AN~ I SS: I, _..___.._.....____n____.F1orence l:L Ga~~. HEREBY CER TIFY, THAT TO THE BEST OF MY KNOWLEDGE AND BE1.lfF, THE FOREGOING 1$ A JIJST AND TRUE STATEMENT OF DEBTS, FUNERAL EXPENSES AND EXPENSES OF ADMltmmATlON SUBMITTED TO THE ESTATE OF Jane N. Harry DECEASED, AS DEDUCTIONS FOR INHERITAN.<:E TAX PURPOSES. ./ ~..V/L d' ,/(/ .tht'-n..'-<. Ilt, /lJ-t"<.--<:A.u...... (L S ) .- - - - .. SWORtj.AND SUB5<:RI1I!',D BEFO. tlE ME THIS 16th_ DAY OF I ' Apri~' 80 Y .---.1.-,;-..,.... 19__ /({'{//I"t) '>?!~ /I} ~-/.tt(\..,j [l.". . -- -. T~(--. - - Thelma. S. McC.tidi.. l4ol.ry PuL~c Mv (l'lmmb:ioll h;:;Tl'l Jl,h L !~'~m . ((mp Hill, (1,\ (1I~,br,;'~I',! ; .," , 1'1) i' ~ I .......... ~ P, 'M .c ~ ~ "0 ~ 0 >-- ~ iiiH'-'<II j:1 QJ . j:1 ;:J U :O;QJOQJ .-lUO ~.-l z":"O .. ..: j:1<11 " H <II'M QJ.-l j:1 ~ p, H <II o P, QJ ~ ~.o ::-. w SUl H4--I;:J j:1 <: 0 U j:1 H QJ U) QJ Po< W'-' <II H :'\l ~l 'r ..,,>~8nlJ..)' 7:, P'(j J~T:> ""'J.(g .4~IM.JwLC UOUnqplS!" 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