HomeMy WebLinkAbout80-00201
NO. 21-80 201
PETITION FOR LETTERS OF ADMINISTRATION
IN THE ESTATE OF .....GJ::MMO...W.A...MXERS........................... DECEAS~,D.
To ................J1R,f.9.~.g...~.......r:\C;;Mi!Xl~.,....!:I.c;;.Ung...R~g.~R.j;.Iil.+......................
Register of Wills for the County of Cumberland, in the Commonwealth of Pennsylvania.
The Peti tion 0 f .... .iI.fl.:\.. 1').0... i:. ,... .M.Y.~. f.$.............. ......,.....................................................................................
............. ............................................. respect fu Ill' showe th lh at.. .Ger.a l.d.. .W.... .My. er s..................................
was a resident of ......G!l.);.dn.Iilx:R................................'RowIR H;Hhil'x, Cumberland County, Slale of Pennsyl.
oroug
vania, and a Citizen of United States, and departed this life inteslate in the County of ............................
!;:.!J.ml?~ .+J.i!f.l.~..... ......... and S tate of ... ..~~.n.1;1 ~.Y. .1.Y.i!!'). t i'!.....................................................................................
on ....Manday................... the .........l.O.th................... day of .......Sep.teJDb.e.!:................... A. D., 19.7.9.....,
at the age of .....1~....... ~'ellrs.
That the said ...g~.+:i'!J9....W.,...k!y.!).r.!?.................................... deceased, left surviving the following
named widow or husband, heirs and next to kin, to wit:
Name
.J:lI')J.l<!.o...l/....M.Y.l;!.n>........................ ..
.. g,1-!XI!i!... .Ri'!.\!Si'!.8.i! 1-!.9f.\......................
..J.ohn...T.....My.ex:s............................
. J1i!y.D.i!.+:g..J:1Y.~f. R............................
.. y'~,l;g~1:\ ~.i!...M.Y.!i!.);.!?'..... ............... .....
. .B.e.tJ;.y,.. .Shiad..f f.. ................. .........
..f.gXm~.~...\1.t:\Jg);'............................
................................................................
................................................................
Relationship
...I'i:~.:f.I')...............................
...f!J.~.:t::.~.:r..........................
...13.);Q:I;.\1.>;:;1;'.......................
...i?J;'9.!::.h.C?);'.......................
... ~?J.$. t~.+:.........................
...S.~.!?,j;.~.+:.........................
...f!J.~!::~.:r..........................
............................................
............................................
Residence
.n.;;....~!:II').S.t.f).\1:t...!?!;:..,.,..J1.t......J:\R.11y
g .'..J?. ,. # .1...( ...)?g.t:\.. ~ XIS,.. fi.P.9.$. .,./....!? P.
1.3...NA...lJ.ig\1...S.t.~.,....Ne.w;v.ille., PA
.(!,!')~r.gl:i:r...............................................
R., .P..,. #1... .l\R.t:t.. ~.\1Sl.. .!;l.p' 9.$..,.1.... 'f..A
R,,I;1.,.#.4.....i;;p..+.U.!?,:\..~.,....p.P,,,...........
98 Fairview st. Lot #11,
........................................1.......................
Carlisle, PA
................................................................
................................................................
That those above named include all of the next of kin, so far as known.
The said decedent was possessed of personal property to the estimated value of $..1.2.,.O.U'O...UQ.........
and of Real Estate. less incumbrance, to the estimated value of $......None.................. as near as can be
ascertained.
That the said Real Estate in so far as is known is located in ...N/.lI.....................................................
........................................................................................................................................................................................
Therefore, your petitioner(~ respectfully apply(ies) for Letters of Administration in the above
named estate.
Dated .........~.~!:.~~...~:?:..................... A. D., 19.~.~....
Signature and Address
of Petitioner(s)
';...?~...:.~:......,(.'1~......................
..ll,~len..,;I;..,...My,!i!.););l..................................................
..~ l,~... i;;o.\'ls :t.m,\!;:... S. :t.!;l;!. e.t.......... ......... ...... ...........
. .\19. Y.n.t....!!9.U Y....$. P.Et!:l9.~.f... .J?~... ...:!-.]'9. .9.~.......
COMMONWEALTH OF PENNSYLVANIA 1 ss:
COUNTY OF CUMBERLAND
..J:! e.l.en.. .1.....1:lY,~ ;1;'.s............................................................................................... ..................................... named
in the above application being dull' ....sl'/.ox:n.............................. lIcconling to law, say that the facts set
forth in the above application are true to the best of ...l:\",.l:..... knowledge lInd belief.
b...e5flo'lrOe.!:mll.e...tO..... ......,....... ................. and subscribed I .................................................................... ....................
:. ;,'?JiL". -r; / ,/}.-/",.->.<: .-f..', . '
I.... "..........F..~.......r;................ ...l;.4'...v...:...,;.........I...........
t L1..'1~~..~J::~~~~~::;;,..J.....:1 A. D., ::.~~ y .......................,................................................................
~'1a . .., . ,.u.tk... . .......\.I..t...:1/(,V~" ""~:..................... .............................,..........................................................
, Register
Filed:
March 26. 1980
A HOl'lley:
(over)
.EdW,a);d..w.....Ha'rke.r'......i~
Estate No. .~.~.~~~...........~.~1.
BOND
KNOW ALL MEN BY THESE PRESENTS, That we, .....H1:;,LEN.,I.~...I"XE:~"...............................
.........., principaL......\
...3.1.5...Qb~&,tn\lt"Sj;r~ej;.,...Ht..JJ.OL~"Sp.rings"",Penn5Ylvania, ,.", ' "
and .......,.. ,LNSURANCE...CO~:PANY. ..OF., ,NORT H, ,AliliRICA...
.....................................
......".p..@a.g~::!.p.pj,a,..,P.~):\l'!5y;Ly.a.nia......,......"....,.., ...,,,
......................, sureL.y........,
;Ice held and fiemly bound unto lhe COl11l11onwealth of Pen"'y\l';Ini;l. in lhe slim of 'rWEWl'X~~)i'QV)1;:c..:r.l:l.O'\i~.!\N.P..
...a.Il:~...~~!;L9.Q."."",.."..............""",,...,,......,.. Dollars (s.-ltZ4,QOO.Q~:,,), to be paid to lhe said Coml11onwealth,
her certain attorne)' or assigns, to which paYllu:nt, well and truly to be m;tdc, we do bind ourscl\'(,~s, jointly and
severally, and our and each of our heirs, executors, .Hlmini strators, successors and assigns. firmly, by these presents,
for and in the whole of the said sum.
SEALED and dated lhe ""...Z5th..".".....,............."""....d;ll' of ..........JtJ.rch""."......."............, 19...".$0.
WHEREAS, the above' nal11ed ....."..liE.g;Il".I..,.}~,......."....."......"....................""''''''..."......"..".....".......
......................................................................................................................................-.......-......................-.............................
has or have made, or is or arc about to make, application to the Register of \X'ills of Cumberland County,
Pennsylvania, foe the gcant of IeUers ".o.~."~~?~r.<l:t~~Il.....".""........,..,,,....,,,,........,,",,...,,,,....,,.....,,"....".."
on Ihe estale of ..""...QF;MW..'iI...}lYERS""""".........
"..",,,,,.., laic of Gardners....."..."....."".......".....",
Cumberland County, Pennsylvania, deceased;
THE CONDITION or THIS OBLlGATION is, Ihat if the ,aid peesonal eel"esentati\'e ."..""... oe any of
them shall well and trul}' administer the said estate accord ing to la\\\ this obligation shall be \'oid as to the personal
representative or representatives who shall so administer th e said estate; but otherwise, it shall remain in force.
SEfAL~D and ddiveeed in lhe peesmee of
I ' . // ,<
_ (mmLjlsJ!!.t_LL~.--------..-
--------.--------------------..--------
x.JL.c(,_':._'__!lmJ~J:xJ1-L,4------- (SEAL)
HELEN I. HYERS
_________________--------__-____-n--- _ (SEAL)
_ _ _ __ u-'c- ___ _ ___ _ _ __ ,__. _, _ __ _ - -- - --'.-- - - (SEAL)
Insu n e Compar,y O~.~th /un"lic~
~;;-~~-- -qt:;i:;;'Il~8itfv' \~EAL)
_____n _______n____}________________ (SEAL)
Atto y-in-Fact '
-------------------------------------------
-------,.-----------------------------------
----------------------------------------.-.
COMMON\'lEAJ.TH OF PENNSYLVANIA
COUNTY OF CUMBERLAND ss:
P,'rsollaJly ;lprear<:d b<:fore me, ;1._....
...........................,
..........--.-.............................
in and for the count}' and
,slate', aforesaid ...
.....................................................................................................................................
of.."
.........................
..."... "... ."... "00'..'..., ..."".."."... and
.....................................................................................
..... '" ,,,,,...' "".. "'...'.." ...m.. "... ". ....,.... ......,....,.. .........,.... .of,. '."00'... ,.. "."......"..... ........".......... ..."".." ........... ..".. ...................
surities on the above bOlld who being duly sworn (affirmed) according to law, depose and say that they each own RC31
Estate worlh thc whole of the pc:nal sum named in lhe above bond, ovcr and abovc their debts and the debtor's exemption.
Sworn .1nd subscribed before me ,this
,;,;mmm ,,' "mm 1
uu..uu.......... I
...U u..... ..... uu.u........ ...:...... uU" ...u.".., .....u..,............. u. , (Seal)
,",.....,. ,.........' u ,...u ".... ..".., u.......u...... .,..........u.u....... (Seal)
'u..,.. ,. U' u" ....... ........... u..... ...... ....u....uu..u.................. (Seal)
.,........, ........u......."...............u. ......u.............. .............. (Seal)
................................................................
COMMONWEALTH 01' PENNSYLVANIA
COUNTY 01' CUMBERLAND
55:
Helen I. Myers
-- ,.-- ----- .---. .~.._.__.. ..-.. ._~--_.. _...--.._---
being duly .' _:,~()E!l. ". according to law, deposes and says that he _i~..th~..__ ...----
administratrix.. . of the Estate of ..Gerald_l'l...Myers._._____.____
-. .'--Dickinson Township
late of .. '--' Cumberland County, Pa., deceased and that tho
within is an inventory made by , Helen I. MY.':.J:!;;.._.. __, tho saidAdl11inis.tr~!J:'il{.
of tho entire est.te of s.id decedenf, consisting of ,,11 the person.1 property and re.1 estate, except real est.te ou!sido
tho Commonwealth of Pennsylv"n;,', and that the figures opposito each item of the Inventory represent it's fair value
as of the date of decedent's death.
)(..v-I:>-I,n /0
(~"'J_"--;"_( ,.-;,J 19 \/ ()
~~71'.~' ~&/!~"d. --
and subscribed before me,
X_.L%~1----~~
Exocutor . Administrator
315 Chestnut Street
N0,.!,.r:'( pURI!C
M C(\In~liuion [XI\:;C~ 1:.J1\' 1-1. 1931
Cllrlide. PA (umbcl1Jnd County
Mount Holly Springs, PA 17065
Addrou
Date of Death ._m _.. .._.1.0..._ ,_...m._.._._.__..sep.t.emQ_e:r_____..l~L7.3__m_______.
Do!IY Month Year
INSTRUCTIONS
I. An inventory must be filed within three months alter appointment of personal representative.
2. A supplement inventory must be filed within thirty days of discovery of additional assets.
3. Additional sheels may bo alt.ched as to personalty or re"lty
4. See Article IV, Fiduciaries Act of 1949.
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REV"'9 (8.78)
COMMONWEALTH OF PENNSYLV ANIA
DEPARTMENT OF REVENUE
BUREAU OF FIELD OPERATIONS
,;; /_ () /; ",h'/
RESIDENT OECEOENT
COUNTY OF ~u~e~!..an_~_
~=
IMPORTANT,
...._ ,_ .___.__._ '_ _ _.__.._. . u
';-rhl" ~ct;;rn lIIust hI.' cf)fnplel~d in dctllil IIml t'ilt'd in dllplic.lte, wilh ;1\1 ,,,wehcd, Wilh lht~ R('gislt~r uf Wills of the
COUllt)' when' decedent rcsided; Rclurrl hi due wilhilll1irH' month., ;Iller tlaw of death, 11111t:~S 1111 eXlension is Itranlcd
b~' the SccreIM)' of RC'ltCllUC,(Sl'l'ltUI1 70J of the InhclilllflCll Illlll i':stntc Tux AL:1 of tIJClt.1
IN TilE MATTEIl OF TilE ESTA rE OF } AFFIDAVIT or
Gerald We_sley ,Myers _____. r.:t1:t'to'rmt'
(STATe ~'ULL. t.AME Of [),"_C[~llf+HT) ,
A'J~IINISTIlATIllU.X
Lo'.ol Cumberland Coun'y
Pennsylvania
},,,
State of
Cumberland
Helen I. Myers
Adlllinistnll{r'x .--
.L. of fho ostole of the above-named dllcedl'ltll ~";n9 duly SWOlll, <l"poso,,.
County of
~Jtt....-lttf+f
-----_._._---~_.._.._-------_.__._._._._._--_.._._---_.--
and sou'
(MONTHl
Nome and oddroJl of attorney or }
other outhor!ud ,.pruenttltlvo 10 whom
all correlrondence Ihould bel moll"d,
That as such.AdIfl:inistratrix deponcnt is familiar wilh the affairs of said e.state and lhe propcrty constituting
t ~~':~t:l"~.ADM1NI 5T R A f<J1>iX
the assels thereof and th~ir fair market valt1l~.
That atthc time of death there was no safe deposil bo.\ rcgislcrcJ ill tlcccdcnl' s indi'iidual name, ur jointly with, or
as agcllt or deputy of another, or in deccJcnt's illdividual name, with right of access by another as agent or deputy, with the
exception of thc following: -
(DAYl
19.~ I. . t~ I- ..In:" 1,~trpy""'Uhh+o:-h-i..-ht"'et_UodUld.}
~.Inlo'toto
Decedent died
September 10
Room 203,
Harker ,___!>squiE~.. One ..Wes t, H~9h
Carlisle, PA 17013
Street
Ed\~ard \'1.
NA~E AND ADD~';5S OF BANK O~ OTHER IN5TIT~i~=n-T~1l5-~~F~ OEPDSI~ ;OX-R~-NTED RELATIONSHIP OF JOINT
IN WHICH DEceDENT RENTED ^ SAFE DCPD5I====t= IN NAME OR ''''''-5 OF "OLDER5 TO DECEDENT
-- ---- ~--l
-
That the contents of suid safe deposit box or boxes are itemized under Schetlulcs)lLLof this return,
with the eX~cption of the following, for the reasons hereinafter set forth:
...
That Schedule A attached hereto and mndcpart hereof sets forth rully and in detai 1 all the real prop,;rty
in the Commonwealth of Pennsylvania of which decedent died having an interest tlu:rcin. It also. sets forth the
mortgage encumbrances upon each parcel of real property ill the date of death, giving, the amount still due at
death, name or mOrlgagt:c, date, rate of interest, and !Jook anJ page of record thereof. It also sets forth in the
columns provided thl~rdorc the assessed valuation of each of said pl:llcels I the estimated market value thereof
us of date of death of decedent,
That Sd,eal.lfc B attached hereto and made part hereof sc.ls forth fully and in detail all personal property
whcrcsover situated o\'.:ned by thl~ decedent at the time of death; all money::; left by the decedent at the time of
death. whether in decedent's immediate possession, sla.nJing to dec~d.~nt's (;rcdit in bunks of deposit, savings.
hanks, trust compalties, or other institutions, whether individually, or ir.trust f(~r any other pcr:wn or persons
giving also separately {he accrued interest lhcrcon, if any, UOWl. 10 Ihe last intcrl'sr day prior to decedent's
death in the case of savings banks, and to the l!ate of dr:ccdellt':, death ill all otIH~" c:ascs; <Ill bonds, postal
savings, treasury certificates or notes ,and other e\'idcnt"(: 0r ir1d,~b:cdn:.:s~ of the lJnilcd Slates to the de-
cedent; all obligatiuns, whelher by statute or Jgfl.'Cllh.'1l1 thq/ Me lh:s-ignated as tax free. of the llnitcd Slatcs,
or any state, or political subdivision thereof, or of any foreign country, which arc owned al the lime of death;
all wcaring apparel, jewelry. silverware, pictures, books, works of <Ht, household furniture, horses, carriages,
aUlomobiles. boats, and allY and all uther personal challeJs of whitlsO(~Ver kind 01 nature, \efl by decedent,
loget!l'.:r with the fairly estimated market value thereof; all honJs ;!nd mortgages helJ by Jl~cedent and of\\1I
claims title and uwing dcccJcnt al lhe lime of death. and all promissory notes ur olher instruments in writing
for the payment of money of ,vhkh oecedetlt died Jlossessed, of whatsoever nalure, with interest thereon, if
any, giving Ihe face value ;lOd estimated fair nmrkct value thereof. and if such l~stimated_ fair market value be
less than the face vulue, it sels forth brierly the reasons for such depr;,:ciation as tn f-,.ach item; all moneys
J1::1)'able It) the l:state from life insurance policies carried by decedent; all annuity and endowment contracts
the proceeds of which were payable upon the Jealh of the decedent; all :Il1d the corporate stocks and dividends
due thereon and unpuid liS of the dute of de:llh, honds lInJ accrued inlcresl thereon 10 the dolt\: of dece'dent's
dealh Rnd other invcstment securities owned by the den'dent at the lime of death, with the murkct value iherc~
of at such time.
Tn Ow ClLfiC' of' sccurjUes of' c1fJs\' 01' j'ilmll\' 1''''Tr!''tt1(1n~i, U;(~ v'~I\ln~: \'f'pnrt,'c1llr~ us far as
pOfi!:ithlo HubstHntllltefl lJr f'ln/lIIctlll ~tllt\'rlnmU, (If' It,,' '"":":'1l1'1~!,11l:'<', SlllIW!II/!. Ow Il"l~et.<; (1Ilc1\JIL1111it!f!s
t.hl.'rl'ol' ns 01' t.ho clnLH of',tlen!.!\. The schf!r11l1e HlslI ~II~I.", ("i!'l.h Lh~~ l11I.l','pst (,r decl!clC'nL (tL till:! lime of
dellt.h 111 {mr cn-I'ltl'tnnrshlp (lr bllslnnsfi, /tncl In SllJlfHll'f ()(' ~ll" \,1l1\l'~ of' sueh InLt'l'llsL lhf!re Is llnnexl~d to
said sthodnll!, f'tllullcJl1.1 sLntnml.'lIts ~;h()wlfl~ Ulf! n<;:o;pt.s ,',,,1 111'1I! lll.l('s 01' 'l1l1r1 CO-'i1f,J'!rwrshlp or 1111s1ness.
A r.OllY of lh(-' co-pllrt.nt!I'shlp ngrlwm('nt., (If 01'01,. f\ _~;t;li,";\I"'nt !~PI_I,11l1'. fOl'th t.he nlittll'C of' the II~r~ement)
togetlwl' wiLh Ii Stlltf!lIJ(-'lIl. S(!tUII~ l'ortlJ t.Iw CI'!lt'llc!.~r 'I!' t~l" h'lsllll'SS, It~; JuellLJon, ond ~ilIch other t'lletS
pertlltn11l~ to till! huslnl'!ss IlS nl/lj' Ill! pl'rllll'>llt In It "ul:' Ilnrl .lWil. 'IPJlrlil'~'li Ill' LlIl' d,~cedf:'ntl!) tnt.erp.st..
therein I1II1St. he sullmltlfld. It shoul(1 nJso M't 1'01"11 iI, ltr!l1lltl~d 1'0 I'm" t.ogf~LIl'~r wi LIl th..~ fnlr mCl.rkl~t VllltH!
thor'~of, /lilY ot.hcl' Ilropn.rt.~' uwnnd or be'lIJl'It(h'd \I~' -1\,. tli'l:l'd':nl lit. t.lll' 1.11:11: 01' d'~lllli.
The Schedule C nt.t.llchecl Iltn'I~t.(J 1111>1 Htlul(~ pHI't, li"/"lol' S(~U; fnl'l.h II Lrlll! lU\s....er to ench tnflulry
contl\lned t.herl]ln nnd 1n t.he Cfi.";(l 01' trnllsj'e/'~ ol'p!'OIIf!rLY, rl'ld or p.!rsollfl.l, within t.wo )"ears 01' (h~cedent' s
death, ln contemplation of' c1ee(~(t(>nt' S ih'nth, 01' HILI'/1flpd tll t,'1kl~ l'l'fl'ct In posc;c!'lsloTl or enJoymellt. at. or
aft.er delLt.h, salfl schedule setH l'ort.1I the lllll.\ll'f! f'.nc1 \',l!\~." of' ~:;l1c~h {ll'ol'ert.v, to whom trIUlsf'erred, the
reln.t.ionshtp of the trt\nsferees to tile dt~{'I~(~r'llt, thf'! prcp:\!' 1.1011/.11'.' Slll\l"~ 1'('''~f!1\'ell !Jy cnch trrtnsferee and
till otht?r'" facts at' II pcrtlll('nt nlLture r('g-lll"J1llg Sldd trIIIJ~;J'{',.~;. In t1w CllSI~ of t.J'llllsf'ers lntended to
take et'('eet tn po~ses5ion or cnJo~1I\ent. It" (,I' at'u'r t!(".:i.I(l :!\~':'e I~ nl.,o 11t.tIlCb(!lt to l\!~ 5chcltulc n COllY
of t.he di'!ed, trust agreement or ot.her l.n!;trlllT\l~nt erl~(lti!l!r. rJl(' trllst. Th~r'~ t!;; nlslJ snt. forth In Raid
schedule n list of nIl property, retllllnd personal, wIth j1.~. \'Jl,l,I!I.', lvhl(~h I'll~.S(>:; nt (lI~ce(lent's c1'Jtl.th by
virLue of the exercIse by decedellt, clUwr InrllvJlilllJlly. 01' !,dntly wiLh IlnOUII~r. or IIn,y po\\"er of nppoint.-
ment vested in dc~c(lent, either indivldulllly or Jojlll.l:.., hy t.!1f: II'lIl, de...rl, or other Instrumcnt of nnothcr,
with n COllY of tlw ,!nstrllmcnt crcnting such power Ilttadll~d to Lhe schedule.
Thllt Scl>~dvle 0 nttnched heret.o nnct mude !',lrt hl'r'~ol' :":I~ts i'orth t.11~ nflrne!l F.!.nil Itddress(~s of Il11
persons henef'lcinll;y Interested in thls eSi/1V'" nt. Uti! ttlllC oj' d(~cedent,1 s tlCllth, tht~ 1l11tlll"~ of' their res-
pective interests, their relntlonship, if nllY, to th.: dec\~dclll., tog,ether wtth the liges nt the time of
decedent's death oI'Il11 minors, annuItants uncI hefll~rlcl(Lrlf!s l'oJ' life 1IIlflerdecp.dent's lUll. It also
contnins a statement showing which of the hClll1ficl11l'le~ Hilmer! in the rll!cellent,'s will, If any, died prior
to decedent, the nntes of their denth, their tsS\l'~, lUll! the r{~lflttollShlJl 01' sncll issue to the benenclnry.
'l'hu.t S~.hedvle E att.ached hereto Ilml mwle II IJllr!. IIOt'COI' sets forth fill property, rCILI and per-
sonal, owned by the decedent. jointly with Illl(lth~l' or others, inclu(llll.~ intan/;ible, stllllding in the name
of the decedent Mil others, plus the date Ilnn plllc~ of l'cCG!'d oj' In~tl'wllfmt~ eff'ectiTlt~ the vestiture of
r~nl est.ate unfl the dlJ.te of acquisition of IH-'rSOl":.[llty, plus the nflmp., I1ddress anfl J'ellltionship, if any,
or co-owners to the ~eccden t.
That Sc/ledule F Iltt8ched llereto tlrld nl/ule t1 iH1rt herctjf sets forth f'ullr and 1n detall ull debts
and deductions claimed for ann on behalf of' t.hls decedent.'s f-'stHte, inclucHng fttneral expenses paid;
family exemption, where aplll icnhle; costs of flllmlnlst.rll!:iO;! of tl11s esttlt.e; counsel fees' IlmI fudi<?iflry's
commissions pnit! or Lo be paid; cost expend~~rl for blll'11l1 trust.!), tombstones or grflvemarkers, and reli-
gious services, in consequence of the nP-l1th of' t.he th:t:erlent.; Ih~bts IUHt ellltmS owing nnrl lItlll/lIeI lit time of
death; taxes accrued chargcnole 1'01' period prior to ,iecPdeiltl:; (tentll (C::ccllt those allowed under Sect~ion
651 of the Inheritance IlTld Estute Tllx ,\ct); t.ogctlwr wit.h It stat\~tTu~nt ,)1' collntp-rlll plerlgerl for obliga-
tions, lf any. It Is tlgre(~(f thnt the f'tcluclnl....' will p,'psent proof ot' 511tt! claImed obligations upon re-
quest, thllt if the Ilmount actunl1y paid in set,tl~m(!l1t. of' Ilny f(H>, cornmiss!.on or dehtts less t.han the
estimated amount. cllllmlng and nllowed, thllt. th{~ Slime w.fll he r{lJlOI.teti to the Heglster of Wills, Ilnd that.
t.he runount 01' tax Ilssessc(1 Cllll Ut'l rclt5scssed jll IlccordUl.\cP therpwi t.h.
Tha.t ~hetotttls of the lti1proprlnt.c columns in Schedules ",\", "H", "en, "En, llnlt "Fn'IlS directed therein,
have been carried forwnrd Ilnd properly rl~~lst(~red in the Summary,
Subscribed and sworn to before me this ......'elt.
2~ /7
'..................j....t............;".. day of 19...L.' X ,,' "",....,..,..,"'""'...."..,o:.....:..,....!..~....__..
....:,:7dll,0l::,<I-~~{~)_/ , 31 ~E;~::~~~:i;~:~.,.,..."."..,.,......_...__._...
NI'iT~r.Y PUr,!iC PA 17065
My CommisIicn r~!)irc~ };;!y I,!. 1l?3: r1C).~.!l:.~..."Ii.2.!~.Y.....~.PEJ~..9.:?.L...
",",:., PA . C,",b":,,d Coo"" (City or Town and State)
SO'fl<;~ Before sJglllnp; nf'ftdll\'1t lUukl> SUI'" Itll hla:li..: Sp,Il~{>S 1u the lIffhili.vit unci selJ(!d\lles Ilnnexed ure
ftlled III with detll11s or till? ....'01'11 "N(lIn~", /LIllI In ells~' 1,111' IlSSI'I.S lllel\lllf> J'ure and unltstecl sccuritif~s,
secllrit.1es 1)1' close or 1'Hmtly cOI'porlltllJlIS 01" 1!1l Jllt..~f('st III /Luy cn-llllrtllershll' or husincss, that the
dlltn nwl 5tlltf'ments reclulrt-'c' uwle,. llll~ pd',I;~raJlil It!JI,\'P ,I'lntlll/-:' tll Sehl'dlllf,' nB" lire n.tt.llche(l. Also mtlke
cortllln thut column #1 In lhe "SUJ'!,T1I1I'Y" )\1;'-; IlI'flll '!,r'lllwrly I~CJ;nI'll~tr.ti (IS Ilho\'e-dtrect.cd.
1.
2.
3.
4.
5.
,
,
, 6 .
I
i
,
I 7.
I 8.
I
I
j:.'
,
,
I
I
I
I
I
i
I
i
I
I
I
I
I
I
I
I
,
I
I
I
!
HF.V-4:11 (8-78)
COMMONWEAL TH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
RESIOENT OEC~DENT
SCHEDULE "B"
PERSONAL PROPERTY
INSTRUCTIONS: This Schcdulc must disclosl: nlltangihlc and ill(all~ihlc personal property owned illllividulllly by the
decedellt, at the lilll!.: Ill' his death. Property owned hy lhe decedent jointly with another 0(' others lIlust he listed
under Schedule liE". Intangihle persullul property, lilled ill lhe l1ame of the decedellt, hut payable at death tn another
or olhers, including hulllOI limited 10 P.O.D, U.S. Savings IIllnds and lell talive Hllst l!l.:counls, must he listed, despite
the fuet that they arc nol or the administered estate.
Tangible personal prlllwrty should he Iistcd first (c.g. jewelry, wl:aring apparel, household gUOl.lS, nml
furnishings, bouks, paintillgs, autol11obilc.:s, bOilts, ctc.)
Intangible personal property, sllch as bonds, treasury certificates, eash on hand and in bank, stocks,
mortgages, notes, together with accrued interest or divilknds, salaries or wages, insurance payahle to the.estate or
fiduciary ill said capucity, partnership interests, interest in :IlIY undistributed estatL: or Of incomc from allY property
held in trust under thc will or agrecment or another, e\'ell though located outside or the State, at the limt: of death,
should be listed ill this schedulc.
Item
No.
nUl
List and describc fully
UNIT
VALliE
ESTIMATED
MARKET
"ALliE
DEPARTMENT
"ALUATION
(Do not write in
this space)
.
Clothing, 2 watches, stereo
Refund or premium on cancelled truck
insurance from W.R. Stubbs Insurance Co.
(check # 6060, dated 10/11/79)
Shares and insurance proceeds with Kinney
Carlisle Federal Credit Union (check
# 13484, dated 11/30/79)
Insurance proceeds for 1978 Chevrolet
Truck from State Automobile Insurance
Association, File No. 30-B-3489
Refund on death claim from American Healt
and Life Insurance Company, Policy
# 7921-01765555 (check # 300538, dated
10/8/79
Item subsequently received from Carlisle
Hospital
Wage loss from State Automobile Insurance
Association (check # 270188, dated 4/23/8 )
Estimated 1979 Federal Income Tax refund
$ 300.00/
55.50/
1,101.33/
6,872.67/
41.15/
14,785.47/
541.62./
400.86/
.
.
Insertthis total opposite uPl!rsonal Property", Schedule un" ill
the "As Reported" column on the la!il page or lhis return,
$24,098.60 ,1.H- ~'1.1', to
, .
~lg11'
xx
;:1::1,';.". J (!./ \~',' J _.'Ifl )'(Jt (IL! ,_.:'_J(l:-f.-l~{I(!.J.,-,. (/....'~t.':n_~.)C!J.
I r~"':;;<;';~i;;i:~"~"""~~~~='=~c_-'" -'~6'~~-"'
,I 812 WJ;STlIICIl ST, ...-
" CAnusu;, l'A, ]7013 . '-"'~","..','-',':"" :'. . 60.472
, " Oct 11:' l!l 7.9 '. ' 313
'I' l~J'~('I"r",-',
I, 0IlJlJ:Il'1lI' Estate of Ger"l~~?':.~.:'_.._....______. S' 55.50',.',
, I
"I~ -'-
I ~ FM.~~~~.!~r.~~i /l ~ /J I
! F""______--:;;~; ;;:;;;:;;,: ".i%'~,~~-I
.L_,!,:'~':':.~~--=':j:;!':;~,~~.:.,~ -.~.:"",:::;,.~~:.~:-:...,:,: ".1::'=-';;"::--"::"':..-'~."'..~ - -~. -. ...... ~~.- _.......'.-*~:...=-.-:..-:::::-~=:;-..l--:-_..-,\=-;!'...::....._- -.::.-=;. -=-..,;:.:~=_":_~""; ~._-:\
-';'. 1, '.i..'.) ::' I:; .;,
..... ..: .I~' :~ to' ., ,t " ., ,~.
1.... I"', r~ 1'1
~:]~!~~~_,ua!~. S...'._.\J_C~ r~'
__DOLl,^HS
.....,
. :-'if;'~:;:~~::::;~;;,~:,;;:;:~;:~:;",,;~::~""-"-"--'-...----~;~'l
,u ':j,,- 6~j~2 ~::
~ 4:1J.v.. .2tl__._.w7~
1 Em:~i;\l\l1,-[5.t".i~(2,..~E Ge.c::>.L d. .1Yi ye.P- s,. . __._..... _.. ~.__.u__S(~/!! ._. __ I
'I ,({2AJe--n.C>J..!~i;!EJ 6t'fe..4~J..'<(e,cLo.t;J,e }!.__~____._ _.___ _____. m DOLLAHS
C-~~l"Lr llHDln o,,'c~ Ah
The Commonwealth ,
Na!1~~~~P~N~P,~V~N'^ ~~
II
i
i
-.- .
/~V~?-~~~-.-ii
~ g 2 5 I, 2 b ~ 2 211' ,i
. ~ ~~ ~ +.';':"';:'__":';" p _ :- ''-::'-=~1'.::..~. '::-ft.~=..::;::...::::.:..;- "-=:"'-:'::"-'':'' ~ ~"7""'-~"".::;'';:' -.J}
1
) ".................. 11'0131,81,11",1:0 3 ~ 3008 2 ~I:
.I...=-,....-;.",o::",'.:.........-'....".~~-::,.;__~..~ .'''=:~':.:',,:.':-_'''_\::':'''''~'.~_:-._.;"''';':C'''7~:'.'':;._~:'' ... ..._,.... .. .
, . '.' .' , III' I
...)"'1 ," . r Ii' ..' ; ,,(' ,1/,' I ~ .'
, . \ ,'. ..... ,. i J "; -.-...
'.. ",.....J../(dl/2i :.:,,:: ::1'1,,'.' ,)
. / '. i
. /, ( / //'! i.I:) 5-5 ;;,,:5 G
,,'';1 P. 77
.:.-.. ~.; , l "
d 0/...91 C_
O"'TIo I~!;II[[J
10/08/79
"0: ,e> c.:o
, 'H I( , t-,o ,-,'1, ^(',~ ".\ (..(l',/lf<l.,;l D"TI
OO~0792100
. I>C.lNT co{)r
-f),PU;;'A:;ION-
AH qEFUND ON DEATH CLAIM FOP GERI AD ". MYERS
pnL #7921-01765555
----------,--_.,-_.~-_..._---_. -,_.-
__!~~[I!~S cu..'?.r'':'''=-=-_,~_~_ ..-----.-:.- -. ~l-'
I
,
ACCOUNT
AMOUNT
F27000007
41.15
A85000004
41.15 CR
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r.rrr.CT1Vr. LATr
,,; ""'UND'''''F'fCD T--c~,' -1-::'-.[."JJ"'~-;-J.rtM""M '~]".:::-"f"~J' -;;:j--:;'- 11
I I~-_u-,-, ---.. - - .. q .-- ---
______._..J. __.. _ . n. _ _ _ . _
D[A TO
SYM
AGe
one
0>-
~"
:>Z
<0
l:Xr>lkA'rION DAT[
. "'L'"
10' "'~
".t!
-----.-.-.--
"""',>.J;"""''''',,,''''
,oc",,,"'o.",,.
~"'I C," 'II'"
._L-~r'
IND!CI,ll
Pd'tllll or Fr'),,1
11'1
" ....'."1."1
'0'" "'Il.~ 'u t.."
,,15 8-20-79 to 9-9-79 $541. 62
""[;E"H."'lf"1l
<~
0" 1,'- ,~ Ln(.,
C_-
$541. 62
t''''.1
. ~'J
'-'.lI'll
Col.
'''.' '~.
.,
I'" ,~
t'\[>1
C-;;.".Pjf,G[
P.LP. TYPE or lOSS
Drl\l('I'S
ngt'-~-r:~=J
.ff f? .!'.11'-_,- 541. 62 (1)
II
"
l_.'
11
[OJ
o
01 __...___..._____.______ ('4 ~_o__
541. 62
07._________ O!'
-------~---
._-_.__...__!_----~._-_._."'-
03_._
NR 270188
~ 1 040A
O.partmtnl or Ihe TUllury-lnluntl RnrnUt 5r,...ic.
u.s. Individual Income Tax Return
/'73 ') L/
Your occupation ...
Spouse's or.cupalion ...
Your social $Ccurity number
nC i;;l,t;. !alJ'/
Spouse's social security. no.
f '67 130 10'.>'>
il oRe!!.
Use Your filii rum. rnd 111li11 (it jo;nt "WIn, .ho [In llJJUU" n.ml"sn4 l"ili.l)
::~'I. 0e Rid I}J.
Other. PUllnl hem. Idd.rS\ (Numbrr rnd Illttl, Intludln, Irl"lmrnl numLfr, or lUI.1,oul,)
wise, R, D, ~J.).
plene
~:Ir;pe. G'~Il;;j~I~;i~' Sill. .nd IIA',
Presidential b..
Election y
Campaign Fund
1
Filing Status 2
3
4
Ll'lst "amI.'
Exemptions
A1wllYs check the
b.x l.b.l.d V.ur.
self, Check .Iher
b.... If IhoYlpply.
5.
b
No Note: Checking "Yes" will
not itlcrease your tax 01
If joint return, docs your 5POUS(~ w~nt $1 to go to this fund? No reduce your tctund.
Sinc[c ~Iivacy Act Notice. see page 14 of lnslluclions
Married filing joint return (even if only one had income) 1 - 1
Married filing separc1te return. Enler spouse's social security number 8.bove and full name here .._H~_~'_~~\~t.ej I
HClld of household. (See paRe B or Instructions,) If qualifying person Is your unmarried chUd, enter
chUd's name ...__ __ ___
Yourself 65 or over Blind }
Spouse 65 or over Blind
c First names of your dependent children who lived with you ...____________ }
Do you want $1 to ~o to this fund? .
........... .
Check Only
One Box.
d Other dependenls:
OJ Hlmt
lZIRrlalion$hlp
(3) Numtlrr 01
month$ lived
in)'our home.
{410id dependent
hive income of
SI,OOO Dr more7
(5, Did you provldr mort
lhlnont.halloldrpend.
tnl'$$upport1
Enter number
of other
dependents
Add numbers
cntercd in
bOlCes above
Enter number of OJ
bOlles checked I
on Sa end b ~
Enter number ~
of children 0
listed ....
~[Q]
I
~
~
J:
~
on
E 8
~
'0 I (See paces 4 and I Subtrilct Ime
aJ 9a Dividends______J.___10 of Instructions) 9b Exclusion ___ _.1.___ 9b from 9.1
ii: lOa Unemployment compensation. Total amount reccived_ _ _ _ _1___
o
U b Taxable part, If any, from worksheet on page 1 I of Inslruclions , , . , , . . , . , . , , , ,
.c
u 11 Adjusted gross income (add lines 7, S, 9c, and lOb), " under $10,000. see pace 2 of Ln.
11
< sfructions on "Earned Income Credit" . . . . . . . , . , . . . . ,
~ 12. Credil for contributions to candidates for public office, I
~ (See pace 11 of Instructions) . . . . . . . . . . . . , . . . l.!3.a
E: IF YOU WANT IRS TO FIGURE YOUR TAX, PLEASE STOP HERE AND SIGN BELOW.
b Total Federal income tax withheld (1/ line 7 ;s more than
$22,900, see page 12 of Instructions) , , . , . . . . .
c Earned income credit (from page 2 of InstfIJctions) . . . .
13 Total (add lines 12a. b. and c) . . . , . . , . , . , . . , , .
]4a Trix on the amount on line 11. (See InstrucHon:; for line 14a tt=
on page 12; then find your tax ;n the Tax TalJles on paces
'/(.c'
c: J 5-26.) .... , . , . . . . , , , ' . , . . , , , , , 14.
E b Advance earned income credit payments received (from
~ Form W-2) ................,.,... 14b
c.. 15 Total (lldd lines 14a and 14b). . . . , . . . . . . . . . . . , . . . . . . . , . . . . . . . .
If line 13 is larger limn line 15, enler amounl to be REFUNDED TO YOU ., , . , , , 1-
If line) 5 is larger than line 13, enter BALANCE DUE. "\tachcheckOl mOllcYOldNforful1 Mllount
payable to "Inlernal Revenue Service:' Write your so:ial security number on check or money order. ~ 17
Under penalties 01 perjury. I declare that I have examint'd this return. includlllg accornp;inymc !iCht!Oulcs and stalcmcnts, and 10 the best 01 my
~ knowledge and belief it is true. correct. and complete. Declaration oJ p}cparcr (other than IDlCpayer) is baSt'd on all information 01 whith preparer
aJ has any knowledge. .y. t /) / ltJ
~ t,.?J,L :J'H':'~' f.i(L/liL4.J: ,1... JJ,. ...l'i"f, . h. " .' ..'
.bD V Your filgn"lure Date f,' SPOUH $ ~l(nllu'r (II him!; JOInUy. U01/1 mud Ilcn tvrn If ani)' ant had ineomr)
V) .... r: Pr<'l1arcr's ~,.-----~ . Check il Prcparcr'!; social st'curily no.
CJ . 0 ~lcn"lu,c ~,~ sell.em. I I
2 ~ ~~ :lOrJ,dOlte J' _____..____,____~_..__ ploycd It- 0 1-- I
_ Co.. ~o !"lIm's name (or ~.!J_I' _/~i_'.li,;O/,'..-i.-il.'.:.'----ff:-.-',!:/-/.'/ Er~;, --I
c.. o:.~ YOUlS, if self.employed) --.-- -- ---- -""--'-
..dadd,,,, 'I'.'. If,.'!",!. (.,1:1"", (:',,/'1/ I',
{
6 Total number of exemplions claimed . , . . , . , , , , . . , . , . . . , , , , .
7 Wages, snlaries, tips, etc. (Attach Forms W-2. It you do not have a W-2, see page 10 of
Instructions). . . . . . . . . . . . . . . . . . . . . . .
Interest income (See pages 4 and 10 of Instructions). . . . . . . . . . . . . . . . . . . .
7
8
7:J.:,!;
I?
12b
12c
If (0
1((['>
,'(,
"
~
"
:I:
16
7((
[ (.0
f'r
"5 16
III
~ 17
,":(:
ro,m 1040A "'7',
REV-4!:l3 (8-78)
COMMONWEALTH OF PENNSYLVANIA
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
BENEFICIARIES AND ,\DIJR"~SES
(Slllte full Illl00l'S lint! lllJdrcsscs of all who
hllvc un interest, vested, '~()l1til1genl or other-
wbe, -ill estate)
.--.------.
~~.2-.~ Myer.s
R.D. 2
Gardners, PA
----
Helen I. Myers
--:n::jT~neScnuc ::>creet
Mt. Holly Springs, PA
Jean Raudabaugh
R.D. 1
Boiling Springs, PA
John T. Myers
13 N. High Street
Newville, PA
.
Maynard Myers
Unknown
virginia Myers
R.D. 1
Boiling springs, PA
Betty Sheriff
R.D. 4
carlisle, PA
Connie Miller
98 Fairview Street, Lot 1
Carlisle, PA...
.''1'
:d\. ~~ :!t)
'!f~ifW~.
<r, . .~I~t~)\~
'Ji<. j ~i '::'~,j;1i't..,.
.(",:.j.0i ,_.,;.. ,
...'<......:,~'.>~...-..,..
SCIIEIJULE "Il"
lIENEFICIAI(II'S
I{EI.ATIONSIIIP
(If step-d,ildn'll or
ilkf.:\ilimllll' chilllH'1l
arc ill\'tll\'I~U. set
fllrth this fact,)
Mother
Wife
Sister
Brother
Brother
Sister
Sister
Sister
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SIJI{VIVI'1l II \1'1, l
IlECEIlENT Ill'
ST,vIEnS 1I'1l'11I
OR NO
--YO'~9~'4/20 1:-
2/5/39 -J-. -
I1\TEllI'ST Ill'
JlI':NEI':CIAIn'
IN I~ST ATE
yes
.
yes
8/28/33
.----
yes
3/22/36
----
yes 8L)1/41
. .
yes 10/10/39
-
-'
J
yes 112/5/44
.
. .
yes 8/14/47
.
.
-..._._----_.~- -----_.~-_...---- - ----
----------..---------.-----
Deponent further says that aU the above-nomed beneficiaries are living at this time except below:
NAME DATE OF-;~:'T;; ~--- RESIDENCE
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SUMMAR Y
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RSU632 (8,141 REV l:
COMMONWEALTH OF PENNSYLVANIA VEHICLE SALES AND USE
OEPARTMENT OF REVENUE
BUREAU OF SALES ANO USE TAX TAX RETURN
HARRISBURG, PA, 11128
~._------ -- -
THIS FORM MUST BE ATTACHED TO THE APPLICATION FOR TITLE
MAIL TO: BUREAU OF MOTOR VEHICLES, TRANSPORTATION ANO SAFETY BUILOING, HARRISBURG, PA, 17122
I\Jl,it !,,If'{i'I:1 ,: Tax due wilh this relurn unless:
11,,/0, L 1Iivl'l"S" .'ji ~ ~~/I?,;', .,~ (n) Sales lax was collecled by Pa, mobile
I -i-+"<-I- ,'. ,Ie home dealer - Attach copy of Denier's
"/' {II J .
. Certificale of Tax Collecled (Form RSU-538).
, I.. I ,1 ' (b) Use lax was paid by contractor installing
County (, LtPl Or{~/a )ltl.. mobile home or house trailer - Attach copy
17' i3 ~ '1~ of Conlractor's Certificate of Tax Payment
Zip Code _.' - (Form RSU-446).
A. TRANSFER INFORMATION: Give all details indicnted below.
MAK~ lOODY STYLE 'i=j-;;-EW -"-CONDITIO~
n j hr't.- .. 0 poon 0 FAIR
({I , ) I /11 Jj I;{ US EO Y'J GOOD
YEAIl MAKE Bo6VSTYLE -0 NE\;; CONOITION
VEHICLE 0 POOR 0 FAIR
TRADED 0 USED 0 GOOD
1.
YEAn
VEHICLE
PURCHASED '7 3
2.
PRINCIPALS:
!)- 3 0 "El~'J
3. Purchaser Purchase Dale
(,I.J-' J Ii ('. n
Name iT I(,V~v~ll L. .':;0{ 'It 1 (''J(:,,'u'lo-c.::<.r<-- 011, )1)1 w1)(.tv1 _
",~
I (,/. ~.' ,r( .,J, ;,-.;1.- ,
Address _~_' -11",/_1
/' ;" '1
_ County / (,' di.~/~"'S..{:'/\,,-l_
Z' C d i 7 (; 0 /
________ Ip 0 e __-.!...-..:.._______
Cily
n "
".'~~) 'I:' ..1~,..1'._.,__,.;~'
..... ---"l'-'---j
,
l.i I
Slate
4. Seller
Name .Iie/r'll .f-Ili/'(/.\
Address ~' () ).' '~
Cily G/,./;b1eu
,~ 1lct
State
p.;
TAX VALlOATION
(For Dcprtrlmonl U.e Only)
VEHICLL 10. NUI~BEH
TITLE NUMBER
pvJ '310 1,).,<>" F I tf 7 'I J...
VEHICLe 10. NUMBEr<
TITLE NUMBEn
TAX COMPUTATION
~purchase Price (1)
6, Less Trade-In
",Gce>
o
7. Taxable Amounl 3 c)((. ,"0
8, x 6% 15(:>
9. Less Tax Credit (2) ,)
10. Tax Due (3) i!?'o
(1) Purchase price includes any encumbrance or other obligation assumed by the purchaser. Enter total
purchase price, including instnllation charges, or c nlracl snles of mobila homes. If purchase price
less than prevailing market value, explain: . -;J! r"
.'
(2) Tax Credit... If you pnid tax upon the purchase price of the vehicle or mobile home to another state
which hns sales Inx reciprocity on vehicles with Pennsylvania, you may clsim credit for the amount of
tax paid. DO NOT COMPLETE item 9 unless: (a) You attach Evidence of Payment such as a receipt,
settlement stntemol1t, elc., or (b) YOUI' !ille shows amount of tax paid.
(3) Make check pnynble to "Pn. Deportmenl of Revenue". Purchnser is responsible for payment of tax.
Separate checl,s are required lor snles tnx and molor vehicle fees. If exemption is claimed, complete
applicable block under Pnrt B on reverse side. When a remittance is made by other than the purchaser
or registered dealer, the check or money order must be made payable to the purchaser who must en-
dorse it pnyable 10 the Pennsylvania Department of Revenue.
CERTIFICATION: MUST BE SIGNED IN INK BY BOTH PURCHASER AND SELLER
We certify thaI we have exnmined nnd signed !llis form after its completion and that the information given is
true and correct to the best of our bclief. If an exemption is claimed, the purchaser further certifies that he is
authOrIZed to claim thiS exemption, We undcrstnnd that misuse of this certificate or the making of a false Dr
fraudulent stnlcOlent helein is " crime punishable by 52,000.00 fine 01' three YO31'S imprisonment or both. .
11. ~UR~!\SER i'. 12. SELLER
--,-J~ ~~>':I~~~.:_--~~J.L:.:..:..:J__________ '=--~i//"t:..':L"l.-_~ 1")~)~:!..::---:~.--1----i_
!-; . (SIGN(<ruR~I, I . ':r (D"T~I --.. . (SIGNATURE)
..........~-, I .:.LJ=..~~~~~t:.~i/:_L~,j_~___._.__
.__ (SIGN/, TURE~_l._..~_..._.._~[J.," TE)
ti!;'w.'~ ""{II.D
(DATE)
--------.-...-.--....1.-......
APPROVED .
. ---.-. -----1-
i
FDA DEPARTMENT USE ONLY
---------iSIGNA TUnE)-'
(DATE)
REJECTED
1--------
COOE REJECTED
Fi I e Number
INHERITANCE TAX SUMMARY SHEET
(BUREAU USE ONLY)
21-80-0201
REV.484 EX+ (3.aO)
Estate Name __~ERS, Ger-,!ld -"-'---- -
Date of Death
09/10/79
Social Security Number
REPORT OF INHERITANCE TAX APPRAISER
I, the undersigned duly appointed Inheritance rax Appraiser in and far the County of Cumberland
Pennsylvania, do respectfully report that I have appraised the real and personal property as reported in the foregoing
return at the values set forth opposite each item in the last column to the right in Schedules "A", HBlt, lie", and IIE"
Dated:
November 6, 1980
A~h'(" , / '-/f)r~/?J"j )
INHERITANCE TAX APPRAISER
INVENTORY
VALUE AS APPRAISED
CODE
ADJUSTMENTS
(HARRISBURG USE ONLY)
REMAINDER APPRAISEMENT CODE
TOT AL GROSS ASSETS
s None 00+
24,098 60 10+
None 20+
None 30+
24,098 60 ----
40-
9Z+
Real Property (Schedule A)
Persono! Property (Schedule 8)
Jolnt.Held Property (Schedule E)
Transfers (Schedule C)
93-
Leu D.bts and Deductions
(SCHEDULE F)
CLEAR VALUE OF ESTATE
Valuation of life ostatos or
annuities. . . . . . . I . I . . . I
RATE
FACTOR
PRINCIPLE
VALUE
CODE
FOR USE OF REGISTER ONLY
Tax on $
~
COMPUTATION OF TAX
S
$
$
$
6%
Tax on $
15%
Tax on $
Tax on $
$
Tax on $
Exemptions
Total Estato
TOT AL TAX
INTEREST FROM
BALANCE
TO
$
$
$
Less Credits
OATE OF PAYMENT
AMOUNT PAlO
TAX CREOIT
$
$
iNTEREST FROM
BALANCE DUE
~ ~ Pi
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REY-4" (8-781
OFF ICE OF THE
REGISTER OF WILLS
,,';.! I,' (\'i' " ,;If.: 1
STATEMENT OF' DEBTS
AND DEDUCTIONS
OF Cumberland COUNTY
AND AGENT OF THE COMMONWEALTH
-:;1., /. I
'/." ( /~/>'
//
ESTA TE OF
Gerald W.
Myers
I
~/6/~0
LATE OF
DiCkinson Township
DATE OF FILING APPRAISEMENT
OATE OF OEATH Q/l0/79
-
DATE NO. OF NAME OF PA YEE REMARKS AMOUNT
VOUCHER
Letters of Adm., Short
3/26/80 3733 Register of Wills-Cumbo Co. certificate1l & Bonds c' 27 00
3/26/80 1 Fickel Insurancp nfTpn,,\1 Adm. R,..,nn 1nd nn
5/22/80 2 ('"rl i"l,., . inn ~"'nH~p1 :";~(T ?1 ~n
"
Commercial Credit Final Acct. # 2077106 5,679 94
N, .i"l ('roni I- "'; ~=ll ",..,,1- H 17k~~~~ 1 kk? OQ
American Finance Consumer Final Acct. # 25501374 302 10
~.
Co.
Amer. Finance Cons. Disc. Final Acct. # 14898888 2 177 00
5/30/80 Tax
4 Tax Claim Bureau-Cumb. Co. 1978,10700plin, Re"ll-u ~~n ~~
C"r1i"lp" ;1-,,1 T." "I- ...I.l1 no"" 1A O'~ A.,
Harris, Rotz and Associate to Last ,Illness 350 00
Neurolocrical Surcrerv LTD Last, Illness 75 00
Citizen's Ambulance Last Illness 27 50
Allan J, Mira, M.D. Last Illness 205 00
Webb S, I1ersperaer M D Last Illnes" 6H .nn
Thomas J. Green, M.D. Last Illness 1 950 00
Masland Associates Inc, La"t T11 n,.,,,,, ?,r nn
Belvedere Medical Corp, Last Illness 515 00
Carl~sle Radiology
Associates P.C. " Last Illn,.,,,,, ,4F QlL
, .n.na~ payment on purcnase
~I??/Qn , D~~ ",., of camper top 235 00
" ~. .1 "fTmo FlI ..1 Bi 11 2,060 65
" 16. 2
no fT" ~, 11" 1070 T "'"V -' IlSQ, 171... , .,~ Ido
T1 ~ Dent of Revenue 1979 Income Tax 760 00
Income Tax Officer -
('"r1 i ,,1,., Area Tax Bureau 1979 Earned Income Tax 72 35
COMMONWEAl? OP f7NNS?VANLo\ I SSI
COUNTY OF / ,.. .u. I> ,. j
I ''/:lc ".' S '/,:', , '("y' HEREBY CERTIFY, THAT TO THE BEST OF
MY K'NOWLEDGE AND BELIEF, THE FOREGOING IS A JUST ANO TRUE STATEMENT OF DEBTS, FUNERAL EXPENSES ANO
EXPENSES OF AOMINISTRATlON SUBMITTED TO THE ESTATE OF ,', ../ ' ///. .,', ",.'
OECEASED, AS DEDUCTIONS FOR INHERITANCE TAX PURPOSES.
>{ ?J... IL
~
.~~ A - (L.S.)
. =-
,"/
SWO N AND\~UBSCRIBEO BEF,ORE ME THIS' /Ii
;.' ":;'~~-'(""'''-I i' ,/' 19 J (.':
:.!.~I~',{:r. //., ,A ~J../'" (. .- Cl ..II.Y~
" NO~1R,( pur,,;
N: '(omr:1~jcn bpirr: ::J!'j~", \q91
,Y, A Cumbcrl.llld County
CulI,le, P
DAY OF
B~'I.II':'~ I,C(O,:'~l 1'~Uil--1 pP:rVlou~
ltlll,jO'~[ I.dl...tt~' I rt~ClNU,Gl Ull 5IAt[MENl DATt
717-243-,,%6 1765555 20.78 06/15/79
~r. ;!.\;J'''''''r'''-~Io\.":';ii~ ."f~~dFB;~dh,,~:n~'"-1
I' I I .
I I .
UOI' OGO. \ I
I ~OANS Up TO 'lC,OD~ NO~ AV ILABLE. IF YOU ARE BUYING
lHO(~~I~:TUl~~_~PPLl~1ES _~~_ A~_HAJO PURCHAS ...GIVE US
RfTURN ADOIH55
PO [lOX b18
CARLISL~ PA 17013
H
~'AllMWl
OAT!
09/20/79
ACCOUNT STATEMENT
k.,,,,.(I;
rWMp.{R
792
III.'At-l(H OfflC[ AUDRES5
COMMERCIAL CREDIl
p~ BOX 618
CA~LISLE PA 17013
08D&B
I\MOUNT
ENCLOSED _ $
A((OUN1
IJUMll!1i
207710&
CUSTOMtR t-lM>U AND ADDRI55
~H, GEf-.ALD MYER.S
1{.).2
GA~D~ERS,PA 17324
CU~'P{Nl
PAYM!N!
115.67
AMOUl4!
IN fJffAU\1
133.59
DlfEIIM[tJI
(HAIIGl
o .00
UNPAID
IAU CHARGES
-I 2.31
-{
-I
PUA$E DElAeli ANO 1I[1UII~.lHI~ PO~IION WIIH YOU~'l<!MllIANC[
COMMERCIAL CREDIT
I.CCO'JNI
ANNUAL
PREVIOU~
p.i!,l].
1/,e/7'1
S.>OJL IS P:..~.. . PLEA EJ.JR.IVE kAREFULLY
.--~_._.__._._'_., ,._--_.._-_..._--_._~- ---..- --- - - .~--
--.-...------.-.---.--.-.--------.-. .... .....--..---.--. .--'- ...---.. -----.------ --. iJ-"--'
t r,~rn l'AlI,'H.1 I)',ll 1./....,QUN1 lllHI'M(N10IARGl tAT(
. ;:0:~~~~7 91_~E:--67-' l'r3':'S'g 0';'JJ'6 ] o:ci 0 C2',''3'1""'
RETURN ADDR[55
P~ i:;OX (,10
CARL JSL~ pg 17,,13
H
~".Jlf,\ENl
OAT!
09/1,+179
t\CCOUhlT STATEMENT
l.;../-,,'I'
i. ! ',' : ~ 1
r,~:f,fKH Offl(! f,DDR(S~,
792
COMt.\[RCIM CREDIl
PO BOX blb
CARLI~LE PA 1701J
AMOUNT
ENCIOS[D _ $
02551<
A((Oll'~'
~~UI.',f,! ~
1765:;55
(U5TOM(R NAME '.NO ADDRfSS
Mk GE~ALD ~ HYERS
RD2
GPF;OdkRS,PA, 17234
.",,' :.','.0:1',1 :jffn'N.tl~1 UI,:rAI!.i
, .. "'!!ll;.')11 ( ,.:.~(;[ I.. If. (t1:'I!GfS
71;; :; ~ 7" ,- :l O. Q 0 1. 12
. ~. , ,.
;'111 '.( t:, . /. '"- ,. "r I.,',.~
,!!tl',r'( :(;..,', ,c,".t'.'.171;.',Cf
~ . ! .-. . I '.'!!.;
COlv'Hv\ERCIAl CREDIT
J9/14179
\='---------- _._--~-------_.-..._--
11o;lf;ffi"irf~1'--~-;:-~9-1
'''--'A~--l-'---'''-O-i''IIMINl (HARCor J tATE
17~~A~f9 -~Ol;"tfb -rO~1101 CiA.1I1f2DUf
NEXT PAYMENT
DUE DATE
10/0817iJ
CONTACT us IF
YOUR PAYMENT
WILL BE LATE
251.77
TOTAL
AMOUNT DUE
TOTAL
AMOUNT DUE
251.77
NEXT PAYMErH---'1
CUE CATE .
10/02/79
CaNT ACT us If
YOUR PAYMENT
WILL BE LATE
r------,
I 152.30J
TOTAL .
Ll'MOUN..!..Q!!!.
ACC UNT-RECEIPT
-.
PREVIOUS
STAHMWl BA.IANCE
1&&2.90
$10,000.
A CAR,
A CALL.
t 10, 00 O.
lOTAl
1~~~'3'll'E
NYl~J'S, (;l'l'rdd 1\',
I'llru 1.:,'il{)rMl S[ I,Vler- r:01l1:,
1 C""',U1I.II",".I"'lOlf:d
i r;""'.ldl.l"CH'!. r.tl'''''~l!
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r. Pi"'Urn""",..;,II,l"'7"'P'ly
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6 FU!h,I',"V't', l..ml1cn
9 '.'CI111l':ulo7Ia:'hy
:0 rn,t":jh'C\'
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:~ rOlj(),,'U:l [':(':l'.,\p
N[UIlOI Orilr.rll. !illl1ril:lW, I. TD
~~"l I lillml r nCMn
C".'/.P Hill, PA 17/111
1l11:1"lnt:[ if,"}":'
)6( )1/'1:)
J\lr. Cera} J 1\'. MyC'rs
H. U. 2
(;;Jrc!llc:rs, PA 17.~:?4
~
IllS #23--1g.1~:'H(j6
I.AIIlyn '-'COJlI. ~o
GHJfir,( n lOTI', .111 lAD
/,C..:i[n t1 Crj1r;AJit.IAD
.
DATE
THIS 15 AN 11[1.~I::r:D STAiEI.'.EtH O~ YO~A I,CCOWJT
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FORM #6
CARLISLE AREA TAX BUREAU
16 WEST POMFR~T STREET CARLISLE, PENNA, 17013
PHONE 243.3725
ANNUAL EARNED INCOME TAX RETURN
l' 9 7 (j'
'1"
DIST. NO,
SOCIAL SECUI1ITY NO.
14
1.(6 26 0181
I
MYERS,GERALD W
I'~ D 2, BOX 120-8
GnRDNERS, PA 17324
Fill in lines 1 lhrough 7 below and
sign form. To avoid needless col.
Ivclion procedure, return this form
even though no tax is due.
" .--. ... - .....
PLEASE PRINT OR TYPE
fiRST NAME ^ INITIAL LAST NAMe
SOC'''' L SCCURtTY NUMBeR
Ge Ra.ld:
I.
z.
17b- ;)t,-olf!
/'l1
w.
eKS
ADDRESS (NUMBER a STREeTl
,.
R, D. d.
\)c-;( \~- G'
POST OFFlcr, STATE AND ZIP coot:
Cl'rY, DOROUGH OR TOWNSHIP
D;c.b'~i.5D)\ TUJp
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PLEASE INDICATE CITY, DOROUGH OR TOWNSHIP WHERE YOU LIVED DURING THE: YEAR. IF YOU
LIVED IN MORE THAN ONE, LIST IN ORDER WITH MOST RECENT LAST.
DURE:AU USE ONl.Y
f>E:HIOD OF TIME:
nUHING VI:AR
f'HINT NAMe OF CITY
BOROUGH OR TOWNSHrr
%
SHARI:
MaS,
CODE
ble klhl>""
1'(,1'
JAN,
TO
TO
TO
TO
1, COMI'UTATION 0'" t:AF~NE:O INCOM!: TAX rOIl V':An,
A, TOTAL OF CROSS CAnNING!> H!:rORTJ:C ON ATTA,CHCO '"- OrHJl5ls1 w.: IWI1CT~H:R
011 NOT CAHNEO WAGe TAX HA,S 11I:EN WI"HtH:L.O '''UOM SUCH I:A~ININr.!..
U, 5EL.f'.EMI'LOYMt:NT NeT l'IIOFIT!> FOU YCA,U AS IIJ:POUTi:lJ ON u.~,. '-HCA5UIlY "CUM
1040, SCIH:OUU: C l"r~onT f"UOM lIUSINt:$S 011 f'1I0H:S~;iON). "TTACH SC~lr:CULC COPY. I S
1040, SCHJ:DUL.F. F ISCIH:PUL.I: or "AR.....'NCOMt: ^ J:)U'I:NSq, AT'-AC~l !,Ctit:OUI..C COI'Y.
I U('~" "A UTN rcU51ilP nCTUH I~ 0 r I NCOM I;' A TT ACH SCHl:OULI': COI'Y.
C. OT Il C 11 I oa:sc I~ I n C I .. '.n......... ....._ .......... ..... ......_ .... ...... ....................... --......... .-. ..-.....'.
0, 101AL.I:ARNE:O INCOMe SUlln:CT TO TAX IAOO 1.'NC~i 10", 711 AND 1Cl
t, I:AHNCD INCOMe T ~X FOH ,yeAR' 1... OF I..INI: 10
.... CRl:OITS;
T"'X WlTI011:LO flY I:MI'L.OYCRS ITOTAL "1:1/ ...Tl ACI1Cl)I O'IMI~.l W ~)
s
s
s
s
. ~....... ,
.. :--.'.
-/p ;'? I:'
7 ,.I. ':1
(r.' , "1
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OU^flTCIIl..V Off LSTlMA1'CO TAX ,.... YMCNT5 M...ne l,llJlllf~.. yr All
T...x CUCDIT FIlOM OVr:HPAYMI:NTor "IH:VtOU~; ytArll~,lll.Xr:~,
s
G, II YOUn T...X 11.IfH: 1r:1 I~ LAUGI:fI "H...N YOlll! I'" YMI'fl'rl'q ll.lfH. /1'1 !:II n:11
UfU'A1D I1AI.ANCr: Ht:ln: "'NO "...... THIS AMOUNT
n, IF- .,OUIt PAVMI:UT(~J ILINI: 1F'1 AUI: L...nr.l:n TliAN '1'001, 1 (,~: (I tfll, 'I~I U~l!;ll
OVI:Hf'A...MI:NT HeRe
s
..
,..
s
I, l'IOICA1E AMOUNT 0,- L.IN[ 1H YOU WISH
CIIE:DITL:D TO NI:)(l
vr:,,,,'!. 1 '.X
F-:' .:=J
HC'-UNOr.O
J. WI: DO NOT REFUND OR COLLr:CT ANY AMOUNT UND':U 'LaO,
I dr.cl,II" unciel pl:n;llll!~~ prOVIded hI' I.Wi Ih.l1lht~ tr.lufn ha~ hr.r.n rxnmincd by me and TO the be~1 of,my
~l1fl\...ICd9" is;l \lur, ,(Jrl!'(t ;lI1n (OlllPlclf rrlUIO,
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0,111'
(Sl.t It/STUlJCl lor~5 {ltIll[ VI, Ilf,t: or SI.COt<D 511rl, 11
+,:,- (
TAXPAYER'S COPY
. .
~1040A
Of~rtmrnl or lh. T"nul)'-lnlUul R,YfnU, SrrriCt
U.S. Indivldu~llncome Tax Return
G'JD;Jnl~,~fi~. 51.,. .nd llp~l,
173)L/
Your occupation ...
Spouse's. occupation ....
Your soci.lll security number
nC Id.-C-IO R
Spouse's social ~ecu,jty no.
t 07 130 I 0-:>" ~ .
<1 o~el!.
U..
IRS
Ilb.I,
Olh<f'
wilt,
please
pilnt
" typ..
YClUC;;'~;' .nd dIU" (if IW"rllJm. .110 lin I~UU'I n.m.".n4Inili.l)
l'rr1lnl hom, addrtU (Numh,f ud 1\l.II, lntludln, Iperlmrnl numbu, Dr lur.' louhl
R,D,~j.l
Lllsl ""mc
Presidential
Eleclion
Campaign Fund
1
Filing Status 2
3
4
Check Only
One Box.
..... Do you want $1 to go to this fund? . . . . . . . . . . . . No Note: Checking "Yes" will
,. not increase your tax or
If joint return, docs your snouse wi1nt $1 to no to this luncH No reduce your refund.
SinClc rOf PIiVilCY Act Notice, see page l~ ollnslruclions
Married filing joint return (even it only one hild mcome) 1 11'
Married filing separate return. [nler spouse's social s~culily number "bove and full name here ..._H~_t2'_~~\_j.~.
Head of household. (See page 8 01 Instructions,) II Qualifying person Is your unmarried child, enler .
thUd's name ~_
58 ~urself 65 or over Blind }
b Spouse 65 or over Blind
c first names of your dependent children who lived with you ....____________ }
d Olher dependents:
Ul Nlmt
(21 Rtl.ticnship
(llIlurnbcror
month,livrd
InfoulhClme,
141 Did dep~ndcnt
hlVt incnmt of
SI,OOOol mOl/l7
(~) Did fall provide mort
lhlnont.hl!foldtptnd.
fnl'illlpport7
Enter number of [0
boxes checked
on 5a end b ...
Enter number .@]
01 chlldr.n 0
listed ...
~[Q]
I
Exemptions
AlwlYs .h"k the
bot l,b.l.d Your.
self. Check olh<f
bomU Ih.y Ipply,
~
~
~
:r
'l'
3::
~
E B
~
'0 ' I (See pages" and I Subtract Ime
rD 9i1 Dividends ,_ ___ __.1__ _10 of Instruclions) 9b Exclusion _ _ _ _ 1. _ _._ 9b from 9il
i;: lOa Unemployment compensation. Total amount received. _ __ _1___
o
<J b Taxable part, if any, from worksheet on page 11 of Instructions. , . . . . . . . . . . . . .
'5 11 Adjusted gross income (add lines ], S, ge, and 1 Db). If under $J 0,000, see p.1l~C 2 of tn,
Jl
c::: structlons on "Earned Income Credit" . . . , . , , , . . . .
~ 12a Credit for cOlltributions to candidates for public office.
:l (See page 11 of Instructions) . . . . . . , . . , . , , , .. 12a
0: IF YOU WANT IRS TO FIGURE YOUR TAX, PLEASE STOP HERE AND SIGN BELOW.
b Total Federal income tax withheld (tf line 7 is marc than
$22,900. see page 12 at Instructions). , . . . . . . . 12b
c Earned income credit (from p.lgC 2 of Instructions) . . .. 12c
13 Total (add lines 12a, b, and c) . . , , . , . , . . . . . . . . , , , . , . . . . . . ,
~ ]4a Tax on the amount on line 11. (See InstructIOns lor line 14a tt
J: on page 12; then fl/Jd your tax In the Tax T.11J/CS on lJileCS . .
c: 15-26.) .. . . . . . . . . . . . , . . . . . . . , . . . ., 14a __...!..!:.'C.
E b Advance earned income credit payments received (from
~ Form W-2) ..........,............,. ] 4b
a.. 15 Total (add lines 14a nod 14b). . . . . . . . . , , . . . . , , . . . . . . . . . . . . . . ., 15
'5 16 If line 13 is larger than line 15, enter amount to be REFUNDED TO YOU .. . . . . . I-
'"
- 17 If line 15 is larger than line 13, enter BALANCE DUE. Atlachcheclo.orrnoncyordcr for full illTwunt
::;:
_ payable to "lnlern;)1 Revenue Service." Write your !.oci~1 !.ccurily number on cheel-. or lrIoney onler, p.. 17
Under penalties 01 perjury. J declare that I have examined thi!. return, jnCluc1inr. aecompanyHl[; ~ctle(.lull':;' ana statements, and 10 the best 01 my
GJ knowledge and belief it is true, correct. and complete. Dr.clar.ltion oJ ptep3rer (olher ttwn tilxpaycr) ;r, hilsed on all information of which Drcparer
~ h.1S any knowledSC,_ ..y. i/3/J'/J
c: f,1J.':A. :J,,.,,,:~, arLlm. '1- -}c.,;<,z... Jt'_ ...C),'t,.. f..,
,blI Y YOllr siGnature Dale J; Spolllt'J 5itnl!'Jlt (if fillnt join Ill', !Jom mU51 lil:n t~rn if only onr hd intomrl
rJ) .., c Prcpilrer'S ~ Ctlf:ck if Prcparcr's social ~(',:urity no
flJ ._,2 :,ICn.1lu1<, . sC'II'l'fTl' I I "
~ ~ ~ ~ and dilb: . played l'. 0 I
-1., c..:to. rlr01'lo n,lme (01 ... elfl r'--I(,;{~tli r/.' Ii '."'(,. F)/; 1[1 f'") ~ I
~ iO ~ ;'~d';d~I,;:;'''n~'OY''d) "/-'/I:-'-t~Z::~~-;~~-);\~r~"'"~I'; :7i"tt'" ---l7IP ~~~:~~=~::=-~:==---=.=
~c form lOtlDA CJ~19)
6 Total number of exemptions claimed . . . , . . , . . . . , . . . . . . . , . . .
Enter number
of other
d('pendenls
Add numbers
entered in
boxes above
7 Wages, salaries, tips, etc. (Attach Forms W-2, If you do not have a W-2, see rage 10 01
Insfructions), , . , , . , . . , . . . . . , . . , . . . ,
Interest income (See pages 4 and 10 of Instructions). , , , , , , , . , . . . . , . , . , .
7
B
7;>.:'5
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II (0
I {1 0,
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