HomeMy WebLinkAbout80-00210
..
Form RCC-a:!
,;{/- g'O-d2.JO
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF COUNTY COLLECTIONS
COUNTY OF
'*
..:>'.. .21'-10
RESIDENT DECEDENT
CUMBERLAND
IMPOHTAN'r: This return must he cOlllpleted in c1c1.1111 nnd (,I.lclt In clllpllcnlfJ, with will Ilttllchccl, with the
Ilcglstcr of Wills of' t1m County wlwrf! decnrlent resltlud; IlCt.III'1l is clue wlt.hln OliO year lifter
<Iut.e 0(' dent.h, unless 111I extension Is grnnt.fHt IlY the Sncrctnry of Ilcvenlll!. (Section 70:1 of
the Inheritance and gatute Tnx Act of' tOOl.)
IN TilE MATTER OF TilE ESTATE OF
_...,.,.,.,.......R,~.~~..~.:"..gJ::~y,.........,.,...
(S1at~ full n1m" of droerdrnt)
..,....,.....,....'..~=:::R
Coonly f:
tale olMechanicsburg,.Cumberland
Stale 01 .."... ........Pennsylvania...
County or
Cumb erland.........,..
..'...........}
55:
,\dmla-.o
.. .AnnabelLL..Elder.,..surviving. j oint tenant with ..,.right
or the estate or the above-named decedent being duly l'iworn, depose and say
vivorship,
.....",............,January.9,
(Munlhl
ofsur-., --
(lllly)
,., 19 .BO...J t~c::~~s:t.::wttt:.=c::oPFUt:at;t:ch=R~::a:t::aRJbfd. }
(\'l1lr) ld~!:!!:
Decedent died
Name and addr!.. or attorney or}
other authorized repr!.entative to
whom 811 correlpondence Ihould be
moUnd.
William L. Sunday
39 Hest Main St., Mechanicsburg, Pa. 17055
That as such ,...~,)Jl;".y.,j"y.QX,....."",,....... deponent is familiar with the affairs of said estate and the property con-
(Cx:a1zi~=hti:!li~1:::
stituting the assets thereof and their fair market value.
That at the time of death there was no safe deposit box registered in decedent's individual name, or jointly
with, Or as agent or deputy of another, or in decedent's individual name, with right of access by another as agent
or deputy, with the exception of the following:-
NAME AND ADDRESS OF BANK OR OTHER INSTITUTION
IN WHICH DECEDENT RENTED A SAFE DEPOSIT BOX
THIS SAFE DEPOSIT BOX RENTED
IN NAME OR NAMES OF
RELATIONSHIP OF JOINT
HOLDERS TO DECEDENT
None
That the cont.ents of sElid safe 'deposit box or boxes are it.emized under Schedules
return, with thp. exception of the follOWing, for the reasons hereinafter set forth:
or this
That Schedule A attached ,hereto nnd mnde part hereof sets forth fully and in detail all the
real property in the Commonwealth of Pennsylvania of which decedent died having an interest th~rein. It
also sets f~rth the mortgage enclDnbrnnces upon each parcel of real property at the date of death, giving
the amount still due at death, name of mortgagee) date, rate of interest, and book and page of ~ecord
thereor. It also sets forth in the columns provided therefore the assessed valuation of each of said
parcels, the estimated market value thereof as of dllte of death of decedent.
Thnt Schedule B nttnched hereto and mnlie pnrt hereof sets forth f\llly and in detail all personal
property,wheresover 5i tunted owned by the decedent at. t.he time of death; all moneys left by the decedent
at the time or death, whether In decedent's inunerllate possession, standing to decedent's credit in banks
of deposit, savings banks) trust cOlllpanies) or other lnst! tut.1ons, whether individually, or in trust for
any otheI' person or persons giving also separFttely the accrued interest thereon, if any, doWn to the last
interest day prior to decedent's death in the cuse of savings banks, and to the date of decedent's death
in all other cases; all bonds, postal savings, treasury certificates or notes' and other evidence of in-
debtedness of the United States to the decedent; all obligations) whether by statute or agreement they
are designated as tax free, of the Uniter!. States, or any state, or political subdivision thereof, or of
any foreign country) which are owned ILt the time of death; nIl wearing apparel, jewelry, silverware, pic-
tures, books, works of art, household furniture, horses, cllrrillges, automobiles) boats, Rnd any and all
other personnl chattels of whlltsoever kind or nntllre, left by decedent, together with the rairly estimated
market value thereof; nIl honds and mortgoltcs held by decedent tlull of 1111 claims due and owing decedent
at the time of deatht and 1111 promissor,y notes or other instrlUnents in w,rit1ng for the payment of money
of which ctecedent died possessed, of whatsoever nature) wi th int.erest thereon, if any, giving the face
vnlue nnri estlmllt.eri fllt r mllrkpt vnlup thprpof, nnrl t f ,slIch est.1mllted fair market vlllue be less than tho
face value) it sets forth briefly. the rensons for such depreciation as to each item; all moneys payable
to, the estate from life insu,rllllce poiici'es cnrried by decedent; all annu~t.y anrl endowment contracts the
proceeds of which 'lmre IH1~'lIhle upon the death of the decedentj and all the corporate stocks and dividends
due thereon Rnd untlaill' IlS of the flnte' of (h!Rth, honds and nccrned tnterest thereon to the date of dece-
dent's denth anfl other J.nvestment set:uri ties oWIlPl1 hy the decedent at the time of death," with the market
value thereof' at such t1me.
if
i.
..-; . ')
.-s-q;jJ
~.
..
In the CHsn 01' s(!cllrlttes of' clns(! or fU1l111y l:ol'porntlollH, lhe VIllllf1S r(~J1(lrled nfl.' liS f',ir liS
possible sullstlLnttnlcfl hy 1'llll111clnl st.lll,enwnls 01' t.hH (HII'porlltloIlS, sllnwlll~ the HSSf~t.S unci Illlhl] lUes
t.h~rcol' liS 01' thl~ Illlt.e 01' dent.h. Tile schedule nlsn snts !'ur\.h t.1\4~ lllt.nt'l'st. 01' (\(~c(HIl.'IlI. Ill. the t1f1If! of'
<lentil In !my co-pnrt.nershlp or hushwss, unci In support. of' t111~ \,11]11(> of' s\l~h IlItl!rl~st. there Is 1I1l1lf!x l!Il to
said schedule, 1'InllllcIllI stnt.nnllHlts show.lnp;t.hcllssnl.s Ilndllllilllll.II!s 01' snld cO"IIIlI'l.ncrlilllp ur hllslnoss.
^ cOl'Y 01' the co_portnershlp o~reeme1lt, (If ornl, 0 st.ot."",e1lt. S"t.t111~ I'ol't.h !.II" ool,1I1'e 01' the o~re"'"e1lt.)
together with II sll1temcnt. setting; Corl,h the cllllructer 01' 1.111) bllSlllPSS, Its IOCIlt.toll, IUlIl such other "uets
11ertntntnJ; to the huslllcss II:; 11l1l~' he pertill!!1l1. t.o II f'1I1r Hllll just npprutsnl 01' the df!(~!!dnnLl s Intr!rmit,
therein must 1m suilmit.tl'fl. It shrllllll nlsn set l'orth tll Iteml?!!ll forlll, I.nw!l.l1f'r wlth 1,111_' 1'1111' llIurkn\, \'UlllH
thereof, /lilY other IJrol'ert)' OWI\(!/l or IJU'IlInnl.hml hy the dl!celll:'lIl Ill, till' tlmn of' dl!lil.lt.
TIIO Schedule C nUllched hel'eto HUfl mnde Jllll't, Iwreol' set.s f'ortll H I,run 11I\5WI!r t.o c/lch iUfllltry
contntncd tlmrcln nllcl 1n t.he cnse n1' t1'nnsf'ers (JI'propel'I,~', I'f!ul 01' IH!I'sonul, wi tllln two )'OI\I'S of' decedentls
denth) In cOIlt.emplnt.lon of decedent.' 5 (Ienth, or lutclIClell t.o t.fJ.kc I!ff'f~et. In possession or cn,1oynmnt. Ilt or
after <tent.h, sulci schedule set.s fort.h t.he I\lIlur(! 1I11e! V/lltH! of' such pl'fJpert.~', t.o whom t.rnnsf'f!rrf!d, t.he
relntionsh1p of the lrmlsf'(!rees to the ftececlent, the prnpnrt.lollllte sllllre rel:f'lved 1J~' ench l.ransferee nnll
all other fllet.s of' Il pertinent. nuturc reWlrrtlng; sHld trllllsl'crs. In t.he ellSI! nf' tl'lll1sf'(~rs intenrled t.o
take effect. 1n possession or enJoyment. Ilt. or l~ftcr dCllth, t.here Is nlsa llt.tadllHI to t.he schedule Ii cony
of the deed, trust agreement or ot.h(!r ins t.rumen t, crentlng t.he trust.. Thf'rl~ Is Ill.so set. fort.h 1n sulci
schedule /l list. of nIl propert.y, ,'col und llersonn1, wlt.h it.s Vldlle, wht.ch pl~~'5ns Ill, decedent.'s (Ient.h by
virtue of the exercise by decedent, either Iwl.1vidulllly, or .Jointly WlUl Imother, nr /lll~' power of' llJlJloint.-
ment vested indeeedenl, either indlvtduully or Jointly, h~' the will, fleed, or ot.her Instrument of' Illlother,
with u copy of the instrument crelll.lng such power at.tuched to the schedule.
That Schedule 0 attached hereto /lod Inlute purl. hereof set.s f'orth the ullmes nnll ndflresses of nIl
persons beneficially interested in this estnt.e Ilt the time, of' decedent.' S flent.h, t.he nuture of t.heir res-
pective interests, their relotionship, il' nny, to the decedent, to~ether wllh the ages nt the time of
decedent's denth of al) minors, l1nnuitnnts Hnfl henef'lclllrl,CS I'or life under rleccdent's \\'111. It nlso
contains a statement showing which of the lJeneficlllries named In Ull~ fleeellent.' s w1l1, if nny, died prior
to decedent, the dntes of their dellth, t.heir issue, lUlll t.he relationship of sHch issue to the beneficiary.
Thnt Sc/tedule E nttached hereto nnll mUfle a pllrt IlOreof sets f'ort.h u11 property, ronl nnli per-
sonal, owned by the decedent .Jointly with nnother or others, including int.anglhle, stllndillg 1n the nllme
of, the decedent ond others, plns the dote nnd ploce 01' record of instrument.s el'l'ecting the vestitnre of
real estate nnd the date of acquisition of persol\lllt.y, plus the nllme, address and relationship, if any,
of co-owners to the decedent.
That Sc/tedule F attnched hereto !lnd mmt'e Ii purt hereof sets forth full~' nn'd in detllll all r1ebts
and deductions claimed for ond on behall' 01' this deeedent's ost.nte, lnclndlng fnneral expense. paid;
family exemption, where 01'1'] lcoble; costs 01' odmlnistrnt.lon 01' this est.nt,,; connscl I'ees ond I',diciary's
commissions paid or t.o l,c pnid; cost expended I'or tlllriol trnsts, tomhston'" or gravemorkers, and reli-
gious services, In conseqneoce 01' the denth 01' the dece,lent; del,ts o!HI clolms owing nool nnpnlll 01. time of
death; taxes nccrned chargenble I'or period prior t.o dec",lent.'. ,Iellth (exc"p!, those IIllowed nnder Seetion
65101' the lnheritanee and Estnte Tnx Act); toget.her with 0 sllll,elllent 01' collnt"rnl pledged I'or obllgn-
tions, if any. It is agreed t.hllt. the ftduc1llr~' wHl' 1lrcsent proof of' said clnlmelt ohl1glltions upon re-
quest, thnt If the amonnt nct.unlly pntd In setll"ment. of nny r"e, commission or debt Is less than the
estimated amount clnim1ng nnd nllowed, thnt the sump. will he reported t.o the Ileglstor of Wills, llnd thut
the amount of tux nssesserl clln he rellssess(!ll hi llccordunce t.herewl t.h.
That the totnls of th" opprol"lnte columns In Sche,lulcs ',\', 'Il', 'C', 'E', lITllI 'F' ns dtr"cted therein,
have been curried f'orwnrfl find Jlroperl~' reglst.ered ill t.he Sllnutlury.
Subscribed Bnd sworn to before me this
......."..,....,,,......,,,,'...
r ^. ,('J -,..... 0:-:' (' \\
\_:...._.........r.~..I..-:..---- _,--, C-,.t.::I0.c.l,--
"""".''''''~''.T""""""Z.lst, day of
'\' / .' ." /~}
",,,,,\'.,/:';;,;-::,,/-i.,{/' .. ,/~I..;
-:r'
::;~J::.y':i.,y.:i:,T:l,g"::T.QJ,1.1..1,:"",::r..~f.l:!l:!,l,!:.",,,,,,,,,,,,,,,..,,,,,._,,
~cut~;'''*'';
1Ql,...,Qr<;]:g~,.F..9:..,,,:?,t.r,~,~,1;:,,.,""""',.,.,,....,,,,,,,,,_...,,,-'.
(Street Number)
..Mechani.csburg,."Pa.."..,lIO.5.5."."""",,,.,,,,.,
(City or Town and State)
SOTE: np.f'nrc sll?;nln~ nff'idlwil make Sllrl~ lill hll\lIk slwees 111 U,e fl.f'1'Iduvit lIIllI schedules nnnexed ure
f.tlled In with detnlls or the worrl "NOlie", /lllll 1n Cllse the assel.s Inellltle rllrl! nncl unltsted securilies,
securities of' clo!'ie or I'nmtly cr.)rporntlnns or nll illll~rl~st ill /lilY C:O-tllll'tncrshtp or husJness, thllt the
datfl nni! stllU'tlJPJlt.s required Willer l.ht! J1 II I'lll-!;rllJ11 I llhove rl~lllt.in!!. to SClll'lllll1~ "B" IIrH nllllcholt. Also mllke
cert.ldn lImt column #1 in the "Sllnunnr~'" Iills llcen properly {~nml'lct,.!tl /IS nho\,e-11Irccl,!rl.
March..
" 19,8Q...
(:1'1(,/ ~n d ....
".
.
, Ree -35
RESIDENT DECEDENT
SCIIEJlULE "B"
I'EIISONAL 1'1I0I'EI\'J'Y
~~
'1-;4 t\
,'I . "
,
COMMONWEALTII OF PENNSYLVANIA
TRANSFER INIIEI\I'l'ANCE TAX
ISSTRl!CTIOSS: Th1.s S~hedlllc must dlslo}OSfJ Illt t.lInglhlf! fIIlfllntlillglhln persollul IJI'oJlort.y ownnrl incllvtdufllly
by tho rlcccdent., III tile tiTne or Ills dl!IlLII. 11"OI)l!I'tr owned hj' the decedent .lolnt,ly with Ilnothcr or others
must be 11bted uneler SdlOdllle "E". Int.nll}.!;llJle Jlor-solllll prOpl!rty, titled 111 l.l1O nnma of' the dcccclflnt, hut
pa~'1l1l1e III dO{lth to nnutilel' 01' others, Jllcludlllg hill not. limited t.o P.O.D. U. S. Suvlngs llonds nnd trmtu-
tive tl'ust llCC01Ulls, mllst. h(.: Ilst,I!II, dl'slllte Ule filet. thu!. tlLey IIrll not (If tile lulmlnlst.ol'crl oslllte.
'rllllgLb"lc persollll] Ilr()!ll!rt.~. should he IlsLfJrI nrs!. (c.g. .IewfJII'j', wCI1r1ng IlJlPllrel, household
goods, and f'tll'nlshlngs, hooks, tJl111lt.lngs, hlll.Ol1loblles, haHLs, ute.)
Int.llnglhlt~ lwrsonnl proJler'l.y, slIch liS bonds, t.rcltsl1r~' cel't.lflclttes, cllsh on hund unet in bank,
Ht.ocks, mOI't.gugcs, not.es, I,ognt.her .....lth Heel'lled IIIt.crl!st. 01' rl1\'Iilemls, slllltrles or WllgCS, Jnsurance Jlay-
ullle to t.he Ilst.Ht.e or' flclllC1HI'Y III SHill CIlIl/leI ty, purLnel'sltIp Interests, Int.erest in un:yundistributcd
astute of' or income ('I'om UTI)' PI'OIIl!rt~. ll(!ld In Lru:'it tUldt~r the .....111 or ngrccm1mt. of another, even though
located outsllle of tile St.HLe, I\l. tile Ume 01' deat.h, shoulll bn listed JIl t.hts schodllle.
I tern ITE.\I UNlT ESTBlo\Trm DEI'A1ITME~'T VAJ,UATION
No, List UIIIl descl'lbe fl,ll)' VALUE lIAIlKEI' VAt.lm (Do no t wrl to 1n
this space)
NONE NONE
I
I
I
I
I
I
!
I
I
1
I
I
1
I
I
, ,
I
I I
Insert tllis tolul uppo~i to "Personnl Proper t.y", Se!\("!llule "U" :i.n X X NONE -{1'
the "As IlcpoI'ted" enllillul 011 Llll~ lltst. JlI1;,;e of t,hl s rt't.ul'n. .J?JfI.'
. ' .
REV.453 (8.761
Il-
~~i~' oil.
'~~u?iJ \: . "~:: ~~
.~C~~,...
COMMONWEALTII OF PENNSYLVANIA
TRANSFER INIIEIUTANCE TAX
RESIDENT DECEllENT
SCIIr,IlULI: uD"
llFNI'r'IClAHIl'S
._- -. r--
IlENEFICIAllIES AND AllDllI<SSES IIEI.ATIONSIIII'
(Stnlc full names nnd nddresses of 1\11 .....ho (If slep..cllildron ur SURVIVED DATE INTEREST OF
huve un interest, vested, contingent or other- illegitimale childu:n DECEDENT OF IIENEFICIARY
\\:isc, ill estate) IIfC ill\'ol\'l'd, set STATE YE."i Il!llTlI IN EST ATE
futlh this fIlCl,) OR NO
^~~"h~11 T 1<'1,1",. Nie..c." y~ Mav 10 Entire
1930
~azd-s.t.l;eet--
Mechanics burg:, Pa.
" 17055
,
,
,
, ,
-
, ,
,
.'
,
-
,
-
Deponent further says thot all the above-nomed beneficiaries orc living at this time except below:
NAME
DATE OF DEATH
RESIDENCE
I\j
"'" ~ ~ ~
~
~ rl
;z: ~ ~
0 :>< 1
I ~
~ '" rl
::> ,..
'"
...l ~
, 0( rl
~
........ u ;z: :>: r.>
~ 0
ll< ~
ll< ~ 0
0 ll<
~ ll< 0 Z
!-< 0 t/l >- !-< 0 0
'" ~ Vl Z
~ f.>.l !-< "1 Z
0 Z 0 8 ~ z ::.: ~ ~
...l - 0 ::> u c::
;:;; Z
...l Z ~ Z Vl ~ 0 0 ;;: -
~ ~ u 0 '...l
';'I'!'/
J . I'
---------r----------'
, .., h" j .,.,:~.~~~31' i.
, "F' ~).rh t'
, '," :'f ,~"'..~:I I
',' ":1"';;:'V;'
i <1'1'1" i~..Ii I
_,. ",."j,,,IJ':I\
( \" 'F)' .:;"
",,:, \'\!'fl,~
",,', ""J.., IJ"
, , .", ' "., ',' ,a ~ r~(:
, : "'("
-.J _\1
J"'" I
OFFICIAL NOTICE OF
INHERITANCE TAX
ASSESSMENT
,,"';
( h ... ",,0'i::: ,
::::TE OF ). ;~; "13~ \\j7:(,d;it~~; J
. . \:I \ ,. , v,-_ , . _Jt:!',\~~/,t~);~,
FILE NO. . ,~)) )>1'\ ex I ().... (I'"~
^ .11./ f" J 'J I I "~" ". 0 '.', '~' : '.:"i]:\J,,\:,
'II~ '.": \,.-\ ,I ,'. ,'. ;. , , " ,'" ' .
~ . II ~~-.., :::;. COUNTY. OF , ~',,~''''. ,f "':',: ~ J\ tl,;" '!.: :'; .:" ": ,.';;'~,:::-:I::::';;;!,+!,\
For.County',"h'lformsllon purpose only' - _" -r- "'~ I \ .. '-.)j, ~/ ...0.., \1,1 . '-"''', <.:"-,'t.-;(,l!"',
",,~~U,~TY,~ILENO:P),-,fO, ~/~', . DATEOFD'EA~'~:'"' .0 T!~;I\;ni;;;~;~~'
l'ITf:2:j~t~~7--~-'---~------------ -~------ ------~-----~-,---- -~~-~~~~'~'~~i:i:!:::!:;;!i~; ,
ppralsedNalue,of Estate: ' ..__ ");:;"J':r<;'~~:f~
2i,ii~~~i!~~~~~;~~~;~~orty>rranSfers $ . :.) r~ k r.) ;1, rJ I) :'I;~:')~(~i
;\id{~[,:~i~;~'E~ia;;':' $ -',..; ,""1; 1/ 17rl ., "
#f~\,1;:~D_;;~?;:::':';;'~~/>'::"::'~':'''':',;;\:~~,l':-:, ".'., ' I, ' ,.. '. I';' ;,','
~;Tol~i 'Ap';;ov~d Deductions, AI,\-, Li (, <;' r),;:(
~~:l~.rr:j!f:'~:i~:\X:':::~,:,;/\.~>.::~!;>:~:',~" ',::..' "1 ',", '", ' " I .
'~e.'~r~):C!~,8tYol~.e.of,Estate' '~'" '-\', $ ~) ::J, '~J I} /? C:>.O
;},;:"<~~.;'~.:~},:';:~~i'::~)\:~:,:" -.,>: ><__ '. -, ,-: " '; .
.;J!-':,.::.f.\'?\ less:",.\ppr,oved Charitable: Examptions "._'._'.'~_._-"
::R~';\.:%:;:.(;:'i:i~:,:':::';'\~'J_ -:-; :,:" :~,\!.,:,'.:. .::: i,-.':.'~;:":',',:, .'.',-', :,:< -" " .'
(:{.81:: Value 'or Estaie SUbJ.~ to Tox $ ;) ,o?, I, (1' V d 0
:)!jf~)~!;tf~~;\2?(::~., . : . ' ",;\ ," "'I'
",,'i'.;;I~;:'::::,::~:~:::::o $ ~.J~ G, ~. V ;; II ::::::$'~~u,!iq.;!-/~/::~i:ti~~,:1
...~,"',..,'''''' ' . ., .' "" " ..." ' , . ,;,-. ., t ., t -_~'r .,":'" '. - . ,\,-,.,..,"'t~~'"..\;J. ,
, . ~ "~I 'Je' \:" : ' :':::': ::,\::':,",: ""',",".:' "':~',:~~~!:'>'~;~!}~!; ,r
",,',:':"""~""i{:'~';:: 'C, . . ,;,' TOTAL PENNSYLVANIA INHERITANCE TAX DUE" $'~~' ,) 1/9 q 5''''';, .
-,' .,... I .t, "":.,""-:~ "/.';,,:._{),;,f;'..t\~,~.:':;
~iil~};!:~',~s~.'.~i~~'!~'~i:"i):,,;:.::,.":,,:, " 1. -; '.,'~.t" "",,"'''~~f''
,;;,('.' 'DATE OF PAYMENT . AMOUNT PAlO . DISCOUNT . 'INTEREST TAX CREDIT '; <\.'.,.i:":/';;:j'
"',':'....-1"7';/ '... '
,~~'/~;iJ "j-,;" $~::J'717 ~'V+ $/f7;J,1..1. [I - G = $~=<;/LI/-9, tIc) J,"~~l
c"L",}",::," " '. + __ =':; :/;~~..
" ." "~''''r
+ = ':~''':;;':'::{~:'k~:l
. $ (::;J c-I' !'~1 ,,)~:,: '" /~'l'.-
,.:J4.~ ,,1 ,f"v,#,' c'.
- _ <':':","'..,/
, :,,"
,:.,.
';',
,
'-',
. "
'.,'..
. , '" ,
BALANCE Of PENNSYLVANIA INHERITANCE TAX DUE
,j,;
,.'.
at the . rete of six (6) percont
'from
,
'.
per annum on the unpaid
,to' the dof
. ' /'
of
','/,i:,,-".
" .
, SEE REVERSE SIDE FOR INSTRUcTIONS
.' REGISTER OF WILL'S COPY
REV-oI!!' (8"'8)
.. ()
/.. . I"
I Jl..
,/(
DEDUCTIDHS A~I.DWED IH
" 2 ' 5'0
THE SUM OF $ '" J' G -
~~Te APPROV~D,. }.J( ~t.L9..~.Jl
\'\\O'\)j.C ,;{UJJ.IJ.u. :'\?h-'l~~
\REI'5TEH OF WIL.L5, ~~}Et:T
------.-
OFF ICE OF THE
REGISTE R Of WII.I.S
STA TEMENT OF DEBTS
AND DEDUCTIONS
OF CUMBERLA~.!L____ COUIHY
AND AGENT OF Hit: COMMONWEAL Tti
/' .
ESTATE OF Rena B. Gr~ I.ATE Of Mechanicsburg,
DATE OF FI~NG A~I'R:~MEI~;>~-ilit_0..tl(1 ~'O DATE OF DEATl1 January
=J;; .
Pa.
9, 1980
--_._--------~--------- -_._.0-0--....
~~:. .'n.~~~~~j~R.[=:_-=._~,~~_OF.PA Y~E' 0__._-_----
REMARKS AMOUNT
- -
1980
--. ---..-. --
J an ..U. _.4 3_9__,___ _-'t<lJ[l,~s.L_'(~_qg.!'r . M. D MA.Q;L~1>.P..e.n.s..e--P..a y a b 1 e -5.5_ .0.0_
~E.e.b,..l.8_ _.43.1...._ f--James_P".....Yeagler, M .D. IMo.1~ ~aL.expAn.A p"y"h1p 50 00--
-Mar_,_5. -.438-- -Mye.r,.s-F-uner,a-l---Home -lLYn.e.r-al-*pe-ns e 2.ill~ lliL
--2.1- -4-39--'- f--Wa-l-te1:'-Monumen-t ~ ;~ . _3.0~ .Q.L
21 44.0__ _~icI.1e.J'Jemoria1 Hospital Hospital bill 96. 50
21 ..441___ ...B~gister of Wills Filing -~OO
~--- I
__2.L._4A2___ ..li?_1!,b_l; 11JL,R. Conboy Notary fees 3JOO
_._~-
21- -443-- _Willi"m T. _S,undav Attorney fees
- 100 00
.- --
f--
l_=~~ --
-- .
f----t -- f---- -
I .
----.- ---.- I ___0
.
_. - -- -
I.
--- -.--.--- --- . --- '--
- I ~_.___._._._______"__O__O_.
'--r--.---- -- -
,
~J==- -.-..--..--.-----. - ___0_- -
_..o_______~.. _ . o_._,,~__.. -
____o.~.._o__.______.. - ------ _____.0 -~
=~~.."Jc.c'," _.__ _...'.__0" ..m' 0 ______'___O'_M___' ,-.-. . - TOTAL .2896 50
_.O~.,,_ . "...._-_..-----. 'o.___...._____.______._~ -. - . .. nO -
CO,",. ~.OI{WEAL TH O. P PENNSYLVANIA (
CQIJt>TY of,_.f.~~_RLA~D I SS:
I, Annabell..,LE1der,s.ur:u:i.ving_Join.t.-t.e.nan.t , HEREBY CERTIFY, THAT. TO THE BEST OF
MY KrlO\/I.LDGE AfW BELIEF, THE FOREGOING IS A JUST AND TRUE STATeMENT OF DEBTS, FUNERAL EXPENSES AND
EXPErlSES OF ADMIIHlTRATION SUBMITTED TO THE ESTATE OF Rena-.B... Gr~y ___
DECEASEO. AS DEDUCTIONS FOR INHERITANCE TAX PURPOSES.
\. I "'\_ <:.. ( I
,,~-..,-,-,..\.( ~ \
. c..._-"":"":'-=..n__. (L.S.)
SWO~N AND SUBSCRIBeD BHORE ME THIS 21s~_ DAY OF
,-+Mar.c~___..,.=-,....' 198..(L .
'-/<7.. I:LL.( { _'-'-.I........ { . l . ( ", j
('-;.:,:,