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HomeMy WebLinkAbout80-00316 i:\ ~ ~ m . >< ~ ll< " H H :II 'H rJ1 H I ~ ~ , , , 8 0 '.~ 0 ~ gj' re :;e . . rJ1 ~ 0-1 ~ ;1 ,.~ ~ H rJ1 ~ - 0 ~ 1I!i .s M tit. UJ No, 21.80 :31(; PETITION FOR PROBATE OF WILL AND LETTERS TESTAMENTARY in the Estate of HELEN L. SHOEMAKER , deceased, To Mary C. Lewis of Cumberland, in the Commonwealth is Petitioner(ti cue the executoR , Register of Wills for the County of Pennsylvania. named in the Last Will and Testament of IIRT,"tJ T, ~lIn"Ml\K"R dated Alia",,!: ll, 1 q7q , Decedent was a citizen of the United States and a resident of SILVER SPRING Township ~~, Cumberland County, Commonwealth of Pennsylvania. Decedent died on Fridav the 25!:h day of 1\pTI 1 A. D, 19 Rn , in the County of cumberland State of Pennsylvania at the age of 87 years. illsD6 ,&1i!Z her Decedent has not been married and has not had children born to lIIJIiIH since the execution of the above described Will. Decedent was possessed of personal property to the value of '1'WP.tJ'I'Y_FTUP. 'l'1I0n~l\l.m rYlT,UR~ and of real estate to the value of -NONE- as near as can be ascertained; said real estate situated as follows -NOtJ"- ~ Therefore, your petitioner:ki* respectfully applies for the probate of the said Last Will and Testament and for Letters Testamentary thereon. Dated May 8, 1980 N~~;e~~~o~~~~:s . ~!:;tp(. F~:E::~;~-/ ~:ea?(/,j - 1122 West Trindle Road [!6...1.alkicaLu~'::i' FA 1705S COMMONWEALTH OF PENNSYLVANIA ~ ss COUNTY OF CUMBERLAND r.F.O'Rt':F. 'P 1i'F.ll~~a.nr.J.t named in above application, being duly IIWO~R according to law say(s) that the statements set forth in this petition are true to the best of his knowledge and belief. .swn"" and subscribed before ,.-'~' ('1 '/1.. 'J' ." /') ~". _/"~' I .. ~m-~.(L. -1.1' It".(;; (t~(.Jlf ./ ~1ay 8 1~0 '1<-<"<"-';/ -- v Register ):5O[U me, ~}J(rI-1 ~, Filed: ,00/-f,IJ -8/6 May 12, 1980 MURREL R. WALTERS III ~ Attorney:22 East Main Street J -- >'&' (,2/ Hl!lchanicsbur9. PA l7055~ .. . VI. I give and bequeath to Daniel Billman, my automobile. VII. I give and bequeath to Jean Billman Brenneman, my chest of drawers. VIII, I give and bequeath the sum of Two Thousand ($2,000.00) Dollars to Mrs. Treva Billman for the kind services she rendered to me during my lifetime. IX. I give and bequeath the sum of Five Hundred ($500.00) Dollars to Mr, and Mrs, Clarence Shearer, of R. D. #1, Boiling Springs, Pennsylvania, and in this respect also, I give all of my pictures to Mrs. Shearer. X, I give and bequeath the sum of Two Hundred Fifty ($250.00) Dollars to Mrs, Larry Vogelsong, of 179 Konhaus Road, Mechanicsburg, pennsylvania. XI. I give and bequeath the sum of Two Hundred Fifty ($250.00) Dollars to Mrs, Jack Finkey of Carlisle, Pennsylvania. XII. I give and bequeath the sum of Two Hundred Fifty ($250.00) Dollars to Mary Jane Brenizer Lowry, of Carlisle, Pennsylvania. XIII. I give and bequeath the sum of Two Hundred Fifty ($250.00) Dollars to Master William McGuire, son of William M. McGuire, of R. D. #1, Mechanicsburg, Pennsylvania. lXV. I give and bequeath the sum of Two Hundred Fifty ($250.00) Dollars to Pamela Shearer Sentz, ~ ~ ~ ~ =' !: III !: 'i'~ ~ ui ~ !I I 0: - III ~ ~ I- ~ :; .-t. ~.. 10 'M 1&.+ III 3: ~ ~ ~ g ~ . ~ ~ ii[~ H . z 0: 0: . ~ I o ~ ~ .J l: ~ III ~ .. ~ ~ 0: ~ 0: ~ ~ ~ :J >---. :t l':--' ~ U f,..- .. 2 '. . ',. '. ., n " ,,: ( !-; C t~ C' .' :.J ~; u; U '" ~" c: ", I.; .~ l!~ ~1 H C . C', , ..: " u: '< " C " r.. ~: t1 [.: cr' ,.. r, r ! S:: , t., e: E c r '" r:. (': ,.. c::.. ri: c \" I"' ') E U ,:: (" b ,.: I. r, ~ , , c , 0' r; .,:" f:. (') I) u " ., b ( u. ~.: 0 ~.~ [~i [: t. h .- t ~ .' ~-:: rl C' "- 0 L' I.' t. .' t:: l' ..', 0 r L, .< ,. U". ,. I, I, r.~ ~' " (' ~ E-. U - r.. t" f:: ~.: (:: I' e.: H .~ f ~:; I n i. {,,'; r .' C ..1........ C:, r, O. r L ,: r.~ ,::' tn C. , ~1 (1;' ~" C ~l I r'o '-' f:. r::; C . [. <' CL U. P , ~ c: u c" :,. ."\ ....j [ b f.; C I.: H l.: ~'1 ,.': ,. (- r, I.: , . ;;:J t' 0-, ,,, H U ", C. ", "" r:.~ !..:...' , . L~ ~i L:_' : 0" ~.r , - ,:~,~ ~ N -' hJ;J1 ~. .," ,~ 0>- .... ~~;;:~: O:::(l) c..-:' OC' c:--. , Ub; :'\'.'.:..! ~'" 0 (":' .' ~ ., '. , . . :~ ;: \ ~J = :~\i<: ~ ~ \''-.) 0: < ":3' ':,. ..'. W;:: ti z -;.: "'-",~'~ , ~ ~ ~ ; ,'.,,", '" <( ~ <Il ~ " . ~ >- ~ 2 '~ ~ ',;, . ~ ~ ~ . "-. "...... a:: a: ti ci <~"::\:~ \, >tl ~ : i '",,\ a:: N U . Z . "-' ':"7 ~~ ~ X ~ ~ o ~ " ;.1 ;~ ~. _~ ~ '...J r ~ ., RCC-J 14-131 APPLICATION FOR CHARITABLE EXEMPTION FROM PENNSYLVANIA TRANSFER INHERITANCE TAX (Act of May 28. 1956, P.L. 1757, and Act of June 15, 1961, P.L. 373, os omended) .'. '1;'._rl.. ' -,' . " COMMONWEAL TH OF PENNSYLVA"'A DEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS Application is hereby filed far the approval of on exemption from Pennsylvania Transfer Inheritance Tax on the transfer of the property described below: 1. Bureau File 11.___~(:.f'O:.3.16 2, Dote of Death ._ AP~H 25. ,.l980_H .--.-'" 3. Dote of Approvol _.~2!C;1{Jt...J.<cJ;f.L 4, Nome of Decedent 1I1llen L. Sh~er S. The Commonwealth's appraised value of the property for which on exemption is claimed is $ Is: of residult (Note: Where the property is other than 0 specified amount of cash, the exemption cannot be approvod until the value of the property has been estoblished by appraisal by the Commonwealth, except in those cases where the amount of the gift or bequest represents a stated fractional or percentage portion of the entire estate or the entire residue. In those cases enter such fractional or percentage amount above). 6. Checkthe manner in which the transfer was effected and submit a copy of the document authorizing the transfer, unless such material has been previously Filed. WILL t!c DEED 0; TRUST IHDENTURE 0; SURVIVORSHIP 0; OTHER 0; (If other, explain) 7. Correct Business Nome and Address of Charitable Organization receiving property: NAME ChriA~iAn HArAld r.hildrAn's Home ADDRESS__40 O~rloq~ Qrive, ChaEPaqqa, NY 10S14 o See listing on reverse side for additional charitable organizations covered, 8. I certify that the information contained herein jJi; to th"e best of my kn~~ and belief, true and correct. h(~ ~-;~ Signature of Applicant ~/..'i A ... -- Murre R. Walters III, Esquire Address 01 Applicant 22 East Main Street. Mechllnicsburg. PA 17055 Attorney for the Estate of Official Title Helen L. Shoemaker Dote (i) ~Q 3 I 'i rf-O I This form must be completed in triplicate ond all three copies delivered ro the Register of Wills for the County In which tho decedent resided, or In which letters were Issued for (I non_resldont decedent's estato. If tho decodent was a non_resident of Pennsylvania and letters were not Issued by 0 Pennsylvania Roglster of Wills, deliver all three copies to the Director, Bureau of County Collections, Penna. Deportment of Revenue, 26 S. 4th Street, Harrisburg, Po. 00 not write below this line. For Official Use Onl REFERRED to Bureau Headquarters Approved 0 For Secretory of Revenue ~ Denied" 0 a (Sig ture of Regis r of Wills) 4' 4?1 / rt1 L"/JVZ':- ~ (County) /W,mIUA/ cJ ~ /1 f1 (Date of Approval) , , (Initials ef Register of Wills) (Authorized Signature) (County) (Title) (Date 01 Referral) (Dote of Action) * See reverse side for roasons MUST BE FILED IN TRIPLIC~,T~ ~CC.3 (4.131 APPLICATION FOR CHARITABLE EXEMPTION FROM PENNSYLVANIA TRANSFER INHERITANCE TAX (Act of May 28,1956, P.L, 1757, and Act of June 15, 1961, P,L, 373, as amendtld) i+- ~ COMMONWEALTH OF PENNSYLVAtllA OEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS Application i, haraby filed lor the approval of an exemption from Pennsylvania Transfer Inharltanca To. an the tran,fer of the praparty da..rlbed below: 1. Bureau File 1/~~r:_S).~_:_~_L".__ __w__ 2. Date of Dealh. APr;~ 25, 19BO __.. u" ,..,.----- 3, Date 01 Approval J:;I;!J."::t~k.h-~,;2~f',tJ 4, Name of Daceden t Helen L. Shoemaker 5. The Commonwealth'. appral.ed value of tho praparty for which an a.emptian I. c1almad isJS ... of residue (Note: Where tho proporty /s other than a spocified amount of cosh, the exemption cannot be approved until tho value of the property ltas boen established by appraisal by thO' Commonwealth, except in those cases where the amount of the gift or bequest represents a statod fractional or percentage portion of the entire estate or the entire residue. In those cases enter such fractional or percentage amount above). 6. Check the mannor in which tho transfer was effected and submit a copy of the document authorizing the transfer, unless such motorial ha, bean praviausly Hlad, WILLXX; DEED 0; TRUST INDENTURE 0; SURVIVORSHIP 0; OTHER 0; (If ather, a.plaln) 7. Correct Business Nome and Address of Charitable Organization receiving property: NAME ~fVen of "."t ADDRESS ~410 Hyperion _Av~tle, Los Angeles, CA 900U o See listing on reverse side for additional charitable organizations covered, 8. I certify that the information contained herein i.....,.yo tho bes~o~m.Y. kn wlad 1> and balief, true and corract, 4~Y~..~:'; Signature 01 Applicant //..1?"~/ /~ - Murrol R. Walters III, Esquire 1 1 i I I I I 1 I i Addre.. of Applicant 22 EllA!:. Mllin Suset:. MechlU\icAbura. PA 17055 (f) vV- Q. 3 (YJ-il At:l:orney for the Estate of Helen L. Sh~er Date I Olliclal Title This form must be completed In triplicate and all three caples delivered to the Register of Wills for the County In which the decedent resided, or In which letters wore Issued for \,1 non_residant decedent's estate. If the decedent was a no~resldont of Pennsylvanl(l and letters were not Issued by a Pennsylvania Register of Wills, deliver all three copies to the Director, Bureau of County Collections, Penna. Deportment of Revenue, 26 S. 4th Street, Harrisburg, Po. Do not write balaw this Ilna, For Olllclol Use Onl APPROVED: For tho Sacretary of Ravenua REFERRED to Bureou Haadquartars Approved 0 For Secretary of Revenue Denied' 0 ~J (Authorized Signature) !! (Slg ure 01 Regl er of Wills) ~(41:1 k(!:r4~.k- -$.' // (CaJnty) ~ , ~fl1.ff.eJ ~ ~ If yZ) (Date of Approval) (Initial. 01 Registor of Wills) (County) (Title) (Date of Referral) (Date 01 Action) '" See reverse side for reasons MUST BE FILED IN TRIPLlr.~T~ RCC.J (4_131 APPLICATION FOR CHARITABLE EXEMPTION FROM PENNSYLVANIA TRANSFER INHERITANCE TAX (Ac:t of Moy 28,1956, P.L. 1757, and Ac:1 of June 15,1961, P.L. 373, as amended) COMMONWEALTH OF PENNSYLVAtI\A DEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS Application is hereby filed for the opprovol of an oxemption from Pcnn1ylvania Transfer Inheritance Tax on the transfer of the property described below: 1, Bureau Fi Ie "__;\ /-,g!l~ :SJ~:_____._ 2, Date of Deoth . _ Apri~ 25, 19BO .." .., ,..-.------ 3. Dote 01 Approvol _&Id".dt~..b.jeS!~-.L;!,ft7 4, Nome of Oeceden t /I..1..n L. S!Io.IIIlak..r 5. The Commonweahh's appraised value of the property for which an exemption is claimed is" ,. oft r..irht. (No to: Where the property ;5 other than D spocifjed amount of cash, the exemption cannot be approved until the value of the property has been established by appraisal by the Commonwealth, except in those cases where the amount of the gift or bequest represents a stated fractional or percentage portion of the entire estate or the entire residue. In those cases enter such fractional or percentage amount above). 6. Check the manner in which the transfer was effected and submit a copy of the document authorizing the transfer, unless such moterial has been previously filed, WILL &; DEED 0; TRUST INDENTURE 0; SURVIVORSHIP 0; OTHER 0; (II other, explain) 7. Correct Business Name and Address of Charitable Organization receiving property: NAME Wn.,.lrl: T.ot ....,....,ft"'. (',..,'a,~. ADDRESS 20232 Sunburst Street, Chatsworth, CA 91311 - - -- ,--- - - .' o See listing on reverse side for odditionol charitable organizations covered, 8. I certify that the information contained herein is,....to the best of my kl!owle~ge and belief, true and correct. ~~~~~- Signature of Applicant /~_ ~ ~M<Y <-' .> Murrel R. Walters III, Esquir.. Address 01 Applicont 22 East Main StrHt',"Mechanicsburc:r, PA 17055 Attorney for the Estate of Official Title "9'.n T ~l1~"''''.r Date (!) c3{';Z. J 19H I This form must be c:omploted In trlpllc:ate and all throe c:oples delivered to the Register of Wills for the County in whlc:h the dec:edent resided, or in whlc:h lettors were issued for 0 non.rosident decedont's estato. If the dec:edent was 0 non.resldent of Pennsylvania and lotters were not Issued by 0 Pennsylvania Register of Wills, deliver all three c:opies to the Direc:tor, Bureou of County Collec:tions, Penna. Deportment of Revenue, 26 S. 4th Street, Harrisburg, Po. Do not write below this line. For Official Use Only For the Secretary 01 Revenue REFERREDta Bureau Heodquarters Approved 0 For Secretary of Revenue xd Denied' 0 a;;;ig ture 01 Re. 'ster 01 Wills) Y/)K4.-!Mt--d - ~ (Counly) ~V&JJ~J~~ ,FJf21 (Oat. of Approval) (Initials 01 Register of Wills) (Authorized Signature) (County) (Title) (Date 01 Relerral) (Date 01 Action) .. See reverse side for reasons MUST BE FILED IN TRIPLICHF RCC.3 \4.131 APPLICATION FOR CHARITABLE EXEMPTION FROM PENNSYLVANIA TRANSFER INHERITANCE TAX (Act of May 28, 1956. P.L. 1757, and Acl of June 15,1961. P.L. 373, as emended) ".,"" ;J. ). ~.' ' ') COMMONWEALTH OF PENNSYLVAtIlA DEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS Application is horoby filed far the approval of an exemption from Pennsylvania Transfer Inhoritanco Tax on tho transfer of the property described below: 1. Bureau File :: ,. ,'3./:., SL:,3LL______________ 2, Dote of Deoth April 25. 1980.....,..____. ----..-..-....'-_ 3, Dote of Approvol 3ltfJ@1J!,<LJ ..R ~_lilcJ 4, Nome of Decedent ~Jl!!!l\kl.L.- 5. The Commonwealth's appraised value of the property for which an exemption is claimed is S 'r of residUA (Note: Where the property is other than a specified amount of cash, the exemption cannot be approved until the valuo of the property has been established by appraisal by the Commonwealth, exct'pt in those cases where the amount of the gift or bequest represents a stated fractional or percentage portion of the entire estate or the entire residue. In those cases enter such fractional or percentage amount above). 6. Check the manner in which the transfer was effected and submit a copy of the document authorizing the transfer, unless such material has been previously filed. WILL !I; DEED 0; TRUST INDENTURE 0; SURVIVORSHIP 0; OTHER 0; (If other, exploin) 7. Correct Business Name and Address of Charitable Organization receiving property: NAME Holy rand ChriR~ian Mission ADDRESS~UUO East R~ct Brid~Roact,__Kansas Ci~V, MO 64131 o See listing on reverse side for odditionol choritoble organizotions covered, 8. I certify that the information contained herei " o~e ~- wle ~ and belief, true and correct. ~~"',-',- ..~ Signature 01 Applicant Walters III. Esquire Addre.. 01 Applicant 22 East Main Street. Mechanicsburg, PA 17055 Official Title Mal_", T. ~hlVtm.1r.,.. Dote () C./f :23 / 19'.0 Attomey for the Estate of This form must be completed I,.., triplicate and all three copies delivered to tho Register of Wills for the County In which the decedent re51ded, or In which letters were Issued for 0 non_resldenl decedent's cstate. If tho decedent was 0 non.resident of Pennsylvania and letten were not Issued by 0 Pennsylvania Register of Wills, deliver all three caples 10 the Director, Bureau of County Collections, Penna. Department of Revenue, 26 S. 4th Streel, Harrlsburg, Po. 00 not write below this line, Far Official Use Onl Far the Secretory 01 Revenue REFERRED to Bureau Headquurters Approved 0 For Secretary of Revenue ) ~(..'<.'.P' Denied' 0 (Initials 01 Register 01 Wills) (Authari zed Si gnature) (County) (Title) (Dote of Raferroll (Date 01 Action) .. See reverse side far reasons MUST BE FILED IN TRIPLIr.HF RCC-J \4-7Jl APPLICATION FOR CHARITABLE EXEMPTION FROM PENNSYLVANIA TRANSFER INHERITANCE TAX (Act 01 Moy 28, 19S6, P,L, 1157, and Aa' 01 June 15, 1961, p, L. 373, as amended) r.~- ~ COMMONWEAL Tfl OF PENNSYLVMlIA DEPARTMENT OF REVENUE BUREAU OF COUNTY COLLECTIONS Application is horoby filod for tho approval of an oKomptlon from Pennsylvania Transfer Inhorltonco Tax on tho tronsfor of tho proporty doscribod bolow: 1. Buroou Fila ff :j,)-J>o - 31 t. 2, Data of Dooth APri~~,.19BQ j'._________... 3. Doto of Approval _1!!d2~-?nj::...~.-J d? /" /.p' 5cj 4. Name of Decedent 'U_'an To. ~h,wn"''It...,.. 5. The Commonwealth's appraised value of the property for which an exemption is claimed is $ 2,nnn nn (Note: Where the property is oiher than a specified amount of cash, the exemption cannot be approved until the value of tho proporty has boon ostablishod by nppraisol by tho Commonwoalth, oxcopt in thoso casos whoro tho amount of tho gilt or bequest represents a stated fractional or percentage portion of the entire estate or the entire residue. In thoso casus enter such fractional or percentage amount above). 6. Check the manner in which the transfer was effected and submit a copy of the document authorizing the transfer, unless such motorial has boon proviously filod, WILL XX; DEED 0; TRUST INDENTURE 0; SURVIVORSHIP 0; OTHER 0; (If othor, oxploin) 7. Correct Business Name and Address of Charitable Organization receiving property: NAME ~t ~tllpb.II' Ll~.h..."n l'1mr..h ADDRESS >>~~fngston, pa 1101' o See listing on reverse side for additional charitable organizations covered, 8. I certify that the information containe~her~i 5 t. e)~~~:n_af k -ledge and belief, true and correct. " ~/~~ / ~ ~~ Signature of Applicont-/?:' ,.J ;- Murrel R:-'Walters, III, Esquire Address of Applicant 22 FASt:. MAin Stt_f:, ~.."hllni"sburq. PA 17055 Official Titlo Attornev for the Estate of Helen L. Shoemaker Thla farm must be completed In triplicate and all three copies delivered to the Register of Wills for the County In which the decedent rellded, or In which letters wore luued for a non_resident decodent's ostate. If the decodent was a non~resldent of Pennsylvania and letter. were not luuEld by a Pennsylvania Register of Wills, deliver all three caples to tho Director, Bureau of County Collections, Penna. Department of Revenue, 26 S. 4th Street, Harrisburg, Po. Dote (!!) c'/.f- :;Z.. J I /rtF-v Do not writo below this line. For Official Usa Onl APPROVED: For the Secrotary of Rovonue REFERRED to Bureau Headquarters Approvod 0 For Secretary of Revenue .) Doniod' 0 i) (Si ature of Ro istor of Wills) t.ll-1?1/W ._d~./J c..-,( --- .M1 , _ (County) ~<{:-'ml!<-e-J,;( ~ )~11/ (Dato of Approval) (Initials of Rogistor of Wills) (Authorlzod Signoturo) (County) (Title) (Doto of Reforrol) (Doto of Action) ll; See reverse side for reasons MUST BE FILED IN TRIPI,Ir.AT\" ...:' INFORMATION To insure proper credit to your account, tho nnme of the oststo and file number should be clemly print- ed on the check or money order. This assessment is made in accordance with Section 708 of the Inheritance and Estate Tax Act of 1961 (72 P.S, 9 24B5.708), To the extent that Inheritonce tax is paid within three (3) months after the death of the decedent, a discount of five (5) percent is ellowed (72 P,S, I 2485.715), Inheritance Tax, other than t8x on a future interest, is due at the dato of tho decedent's death and becomes delinquent at the expiration of nine (9) months after the docedent's death (72 P.S. '3 2485.711). Inheritance T8x on a future interest Is payable within three (31 months after the transfer takes effect in possession and enjoyment and is delinquent thereafter (72 P,S. 9 2485.712), Calculate interest from the delinquent date shown on the face of this form to tho date of actual payment using tho following interest table: --------------------- ------ ---- --- ---- --------- - - - -- - --- -------- -- -- -- - -- -- 1 month .005 4 months ,020 7 months ,035 '0 months .050 2 months .010 5 months ,025 8 months .040 " months .055 3 months .015 6 months .030 9 months .045 '2 months .060 1 days .00017 I I days .00186 21 deys ,00352 2 deys ,00034 12 days ,00203 22 days .00369 3 deys .00051 '3 days ,00220 23 days ,00386 4 deys ,0006B 14 days ,00237 24 days ,00403 5 days .00085 15 deys ,00250 25 days .00420 6 days ,00101 16 days ,00267 26 days ,00437 7 deys .0011B 17 days ,002B4 27 days .00454 8 deys .00135 18 days .00301 28 days .00471 9 deys .00152 19 deys ,00318 29 days .00488 10 days .00169 20 days ,00335 30 days ,00500 -- --------- ---------- ------- ----- -- - - ---- -- - ---.-- -- - - - - --------- ---_..~ Any party in interest, including the Commonwealth and the personal representative, not satisfied with the assessment may object thereto within sixty (60) days after receipt of this Notice as provided by Section 1001 of the Inheritence end Estate Tax Act of 1961(72 P,S, 9 2485.1001), Make check or money order payable to: "Register of Wills, Agent" Mail to the address listed below: GENERAL INHERITANCE TAX INFORMATION Unsatisfied liabilities incurred by the decedent prior to his/her death are deductible against his/her taxable estate, In addition to debts incurred by the decedent or estate, other items are claimable including the cost of administration, attorney fees, fiduciary fees, funeral and burial expenses including the cost of a buriallnt, tombstone or grave marker, Ail debts being claimed against an estate are subject to the approval of the Register of Wiils with whom the Inheritance Tax Return is filed, Evidence to SllPPOrt the decedent'S or the estate's liability for the debts being claimed should be attached to this schedlde, A family exemption of $2,000 may be claimed by a spouse of a decedent who died domiciled in Pennsylvania, If there is no spouse, or if the spollse has forfeited his/her rights, then any child of the decedent who is a member of the same household can claim the exemption, In the event there is no such spouse or child, the exemption can be claimed by a parent or parents who are members of the same household as tile decedent. The family exemption is ailowable only against assets which pass by a will or by the Pennsylvania intestate Laws, c '" 0 (') > 1"1 > :s > 0 0 0 (Jl 0 Z ~ (') c:: 0 -l Z :::: Z t'" '" t'1 ;>; Z ;<l > 9 - 0 t'" Z -l Z ~, t:: Z 1"1 -i r.1 1"1 ","" ;.:.;: .~. 9 9 -l -:: (Jl - ~:;J"-' (Jl ,: Z (Jl 0 -i co 'J 0 (; a: c.> 0 "1 "1 :;>:l ':!),:"":l ~ ", Zc ~ 0 "- 4-i. .." 0':" <;J' - .." C}L,;' N ~.:t 0 - rr..-l Z (') U,jul t; 00:: - 01" ,w > ",0" co ,:('51 OC:;; (~.t.. t'" Uw 0 II.JE c:: ::!'" co ...J (Jl . 'J t<l 0 Z -:: -:: ~ 1"1 1"1 ~ :>- > ;<l ;<l INSTRUCTIONS FOR COMPLETING SCHEDULE "F" 1, If the family exemption is being claimed, indicate the claimant's name, address and his/her relationship to the decedent, Enter "family exemption" in the remarks column and the amount claimed in the amount column, 2, Assign consecutive numbers to each item listed, 3, Enter the date on which each debt was incurred and/or paid, 4, Enter the names of each payee, 5, Provide a brief explanation in the remarks column for each debt claimed, 6, Enter the amount of each debt being claimed, 7, The form must be signed by the person who has assumed the responsibility for paying the debts, . Rel/.449 EXt (3.80) COMMONWEAL TH OF PENNIV L VANIA OEPARTMEIlT OF REVENUE TRANSFER INHERITANCE TAX RESIOENT OECEOENT AFFIDAVIT OF FIDUCIARY (Instructions on Reverse Side) -* -~ .- Estate of Ii:":, Lr::1 I,. r..:iOr;.~;\:'-::~: Date of Dea ih ;:"o:,x:il 2:;, l~l~~') _.______.___.___.__n___._____..___. Last Address__ 171 ;:~nh"us .'~"d _______.__ Social Security No. 1 ;..~:,-- .1/1. -. (;C :J/ i1f:Chanicsbur<j f rl~ 17'):JS Bureau File No. 11.:11"'0 (S1" A TV-I (ZIP) County File No. \, ~/'eI:" - ,9/t. 1. Decedent died: ( ) Intestate (without 0 will) ( :, ) Testate (leaving 0 last will--copy attached) 2, Is the filing of 0 Federal Estate Tax Return required for this estate? 3. (X) Executor/Executrix ) Administrator! Administratrix Yes_ No ,. ,r'- 'f', ex! ",'" 0 ,.,,~ :::> mo Li):;o :-:l "'10 --l ;-;1f'T1 ,',,) -:..,0 :~ -:0 "1""'11 .-q B ::.~c; _".".J .':'ir1 ,':) ., ~I Name GEORGE I? F2R'1'E;iBAUGH , ~.-:; , : ~:~ , :: ~ Address 1122 TrillGllL.!\o.-,,,j -WaG1-ta-l~~\U;.gr-~ J '/'"lS':: (CITY) (STATF.:I (ZIP) 4. All correspondence should be moiled to (:: ) Attorney ) Fiduciary. 5. If an a!!orney is representing the estate, indicate: Name r.mRr~EL R. 1SI.L'::~~R.3 III Address 22 Eci.si:. :.:ain SLr~,ei; ;.l(:',chdnicsburg I PI, 17 OJ 5 (CITY) (STATE) (ZIP) List 011 safe deposit boxes registered in the decedent's individual namel or jointly with, or as an agent or deputy of another, or in decedent's individual name with right of access by anotner as agent or deputy. Include the name and address of the bank or ather instituti~n where the safe deposit box i~ located, the nome (s) in which the box is registered and the relationship of the joint holders to the decedent. NAME AND ADDRESS OF BANK OR OTHER INSTITUTION IN WHICH OECEDENT MAINT^,NEO A SAFE OEPOIIT BOX NAME OR NAMES IN WHICH SAFE DEPOSIT BOX 15 REGISTERED RELATIONSHIP OF JOINT HOLOERS TO OECEOENT 7'C'~:-- Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the bost of my knowledge and belief it is true, correct and complete. 't---P I t. ,-, _ ,. ." , d.c.!'u "'1.6a~(.f0. IGNATURE OF FIOUCIARY "/ (K'f:; -< ~ /7lfCi OATE PENNSYLVANJA INHERITANCE TAX GENEHAL INI'OHMPTlON ------_._------~---- 1. PERSONS RESPONSIBLE FOR RETURN Section 701 of the Inheritance and Estate Tax Act 011961 provide:; th;illhe fnl:ow;rlf: p,:rsuns "hall prepare and file a return: a, The personal representative of lhe estate of the decedent ,15 \0 \Irop"lfy ul Ihe dt:cellcnt :Jrllllinisteled by him and such additional property which is or may be sobfeclfo Inhetit,lI1ce 'Iax 01 which he/she ~,hall have or acquire knowledge; b, The ttansferee of properly upon lhe lwnsfer of which Inheritance T;IX i'i orll1ay he imposed by the 1961 Statute, including a tfllstee of property ttanslerred in tfllst, provided ih<1lno :.I:p,\lale retnlil need be I1wde by tbe transferee of property included in tbe relurn of a personal representative. 2. PLACE FOR FILING The return is to be filed in duplicate witb lIle Register 01 Wills of the county whereiu the decedent resided, 3. TIME FOR FILING ~he return is due nine months aflerthe decedent's death, unless an extensioillol titing has been applied for and granted by the Secretary of Revenue within lI\e nine-month period. 4. FAILURE TO FILE RETURN Section 791 of the 1961 Statute provides that" , ' ,any person who willfully f<1ils to file a return or other report required of him, , ,sball be personally liable, . ,to a penalty of 25% of lI)e tax ultimately found to be due or $1,000 whichever is lhe lesser to be recovered by the Department of Revenue as debts of like amount are recoverable by law." 5, TAX RATES Inheritance Tax is payable atlbe rate of 6% on transfers to lineal descendants, such as father, mother, husband, wife, son, daughter, grandchildren, grandparent, son-in-law and daughter-in-law and at the rate of 15% as to all others, 6, PAYMENT OF TAX The tax assessed on the transfer of property reported in the return is due 9 months after the decedent's death. Interest at the rate of 6% per annum accrues thereafter until payment is made, All payments received are first applied to any interest which may be due with any remainder applied to the tax, IF TAX IS PAID WITHIN 3 MONTHS AFTER THE DECEDENT'S OEATH, A DISCOUNT OF 5% OF THE TAX PAYMENT IS ALLOWED, All checks should be made payable to the Register of Wills of the county wherein the decedent resided and are received subject to the final determination of the Department of Revenue. 7, FAILURE TO PAY The taxes imposed, together with any interest thereon, are a lien upon real property, which lien remains in effect until the taxes and interest have been paid in full. TI18 taxes may be sued for against any real property in the decedent's estate or against any property belonging to a transferee liable for the tax, 8, FILING OF FALSE RETURN Any person who willfully makes a false return or report required of hilll sh,ll1, in accoldance with Section 793 of the 1961 Statute, be guilty of a misdemeanor and, on conviction thereof, shall be sentenced to pay a fine not exceeding $1,000 or undergo imprisonmenl not exceeding one year or both, QUESTIONS CONCERNING PROPERTY TRMSFERS 1. Did decedent, within Iwo yeiHs 01 deilth, milv,e any trilllsfer Ilf ilny IlIilterial \lilrt of his esU,[L; without receiving valuable and adequate consideration? (Answer "Yes" or "No" ,) 410- 2, Did decedent, wilhin two years of death, trilnsfer properly from himself' helsell to hllllself!herself ilnd ilnotnor party or parties (including a spouse) in joint ownership? (Allswer "Yes" or "No",1 -WI:>- 3, If the answer 10 one or two :Ibove is "Yes" and the tri1nslers ,1re t:lillilWrlto be nontaxablo, provide the following information: a, Age of decedent al time of transler. "fftlt- b, Copy of death certificate, c, Affidavit by the attending physiCian indicating Ihe stale of decedent's Iwalth 'llliw: of lmnsfer, d, All other information supporting nontmbility 01 Irilnsler, 4, Did decedent, in hi s/her lifetime, Inilke ilny {r;,ns(er of property wi I/Ioul receiving a valllahle or adequate cOllsi deration therefor which was to take effect in possessionllr enjoyment at or ilflCll1is/her death? (Answer "Yes" or "No",) 110 a, Was there any pOSSibility t1li1t the property transfmred mig!!t relurn to Irilnsferor olhis/llCr estate or he subject to his/her power of disposition? (Answer "Yes" or "No",) Ill. b, What was the transferee's ilge ilt time of decedent's deilth? 110I ilIA 5, Did decedent in his/her lifetime make ilny transler without receiving iI valuable and ildeQllate consideration therefor under which transferor expressly or impliedly reserves for his/her life or any period which docs in fact end before his/her death: a, The possession or enjoyment of or the right to income from the property tmnsferred'! (Answer "Yes" or "No" ,) ~ b, The right to designate the persons who shall possess or enjoy Ihe property transferred or income therefrom? 0 (Answer "Yes" or "No",) llo 6, If the answer to live b. above is "Yes," stilte whether the right was reserved in decedent alone or others, 11/" 7, Did decedent in his/her liletilllC make a transfer, the consideration for which WilS transferee's promise to pay income to or for the benefit or care of transferol? (Answer "Yes" or "N8".) 4<10- 8, Did decedent, at any time, trilnsler property, the brneficial enjoyment of which WilS subject to change, because of a reserved power to alter, amend, or revollO, or which conld revert to decedenlunder terms of transfer or by opemtion of law? (Answer "Yes" or "No",) lIo 9, If the answer to eight above is "Yes," was the power to aller, amend or revoke the interest of the beneficiary reserved in the decedent alone or the decedent and others'! (Answer "Yes" or "No" ,) ~IA-- R~V.4~4 EX+ (3.801 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE TRANSFER INHERITANCE TAX RESIOENT DECEOENT SCHEDULE "E" JOIi'lTl.Y OWNED PROPERTY (Instructions on Reverse Side) '* Estate of Helen T../o Shoomak(jr ITEM NO. OEseR I PTION TOTAL MARKET VALUE PE \ N T VALUE OF DECEDENT'S INTEREST DEPARTMENT VALUATION (Offici.' Use Only) .._- -NONE- TOTAL THIS PAGE Nt"'LL INSTRUCTIONS FOR COMPLETING SCHEDULE "E" Schedule "E" must include all property, real and personal, owned by the decedent jointly with another party or parties as joint tenants with right of survivorship, Both tangible and inliln'iible property are to be included, List real estate first, 1. Describe all real property as indicated in the instructions for Schedule "A". Describe all personal property as indicated in the instructions for Schedule "B", Include the nal11e, address and relationship to the decedent of the co' owner (sl and the date the joint ownership was establisi1ed, 2. Indicate the total market value of the jointly owned property, 3, Indicate the percentage of the decedent's interest. 4, Indicate the market value of the decedent's interest. .. ." t:I n ;y - > ~ >- '" 7. 0 0 CJ ~ :I. " :I. - C'l n C t:I :.: i6 .. tT1 tT1 :r. 7. ;;:l 9 9 .. z Z tT1 -l tT1 -l ~ r:-i p p -l .... l/'l '" Z 0 l/'l 0 -l I 0 ." ." ~ ~ I I ~ 0 I ." - ." 0 i'i z - >- .. C Ul tT1 0 Z -< -< S; ~ tT1 tT1 >- > ;::l ;::l File Number INHERITANCE TAX SUMMARY SHEET (BUREAU USE ONLY) 21-80-0316 REV.484 EX" (3.801 Estate Name ____________..lI<1.1."ll.L.,--m}g-e.r."li"x Date of Death 4-25-80 Social Security Number 186-34-0654 REPORT OF INHERITANCE TAX APPRAISER I, the undersigned duly appointed Inheritance Tax Appraiser in and for the County of _ Cumberland Pennsylvania, do respectfully report that I have appraised the real and personal property as reported In the foregoing retum at the values set forth opposite eoch Item In the lost column to tho right in Schedules IlAlt, flB", ICC", and liE" Dated: November 20. 1980 ,~/",.,... ,'" ) '/fF, p_. .' } INHERITANCE TAX APPRAISER INVENTORY VALUE AS APPRAISED ADJUSTMENTS CODE (HARRISBURG USE ONLY) REMAINDER APPRAISEMENT CODE Real Property (Schedule A) Personal Proporty (Schedul. 8) Jolnt.Held ~roperty (Schedule E) Transf.rs (Schedule C) $ -0- 00+ 92+ TOTAL GROSS ASSETS 23.576 85 '0+ -0- 31+ -0- 30+ $2.3_.51.L _13_?_____ ________ Leu D.bts and Deduction. (SCHEOULE F) CLEAR VALUE OF ESTATE 40- 93. Valuation of life utot.s or annultl.s. . . . . . , . . . . . . . RATE FACTOR PRINCIPLE VALUE CODE FOR USE OF REGISTER ONLY Tax on $ CODE COM PUT A liON OF TAX $ $ $ $ 6" " Tax on $ \5% T ox on $ Tax on $ Tax on $ $ Exemptions Total Estate_ TOTAL TAX INTEREST FROM BALAN CE TO $- $ $ Lus Credits OATE OF PAYMENT AMOUNT PAlO OISCOUNT INTEREST S + S S = + = BALANCE $ INTEREST FROM TO __ S BALANCE OUE S TAX CREOIT $ III III 0 ..... ... '" . Jl " '0 Pl ~ ~ oj ~ r:<: ~ 0 . <: " ..: 0 '" ~ Z I<l ~ .c: <Il ::l III 0 >- '" en c .0 '0 ... .... r:I Ul r:: Itl '" . .c: u 'J '" 0 ...:l C ... .-< ;:l I ~ r:: '" 0 r:: 1l " ...l <Xl " .g <: I .-< .... u - .... " ..... ~ ::l ... ~ U Z '" I:: ... l.) .... III '" - 0 ~ ~ - 0 0 ~ 0 ~ <Xl ~ 0 I ~ ... 0 0 '" 0 Z 0 '" III '" >- ... 0 - Itl :::2 z z B ... Itl Z ...l 0 - 0 z ::.: Itl Itl ...l Z ;:;: Z 0 ;:l u " Z ~ ~ '" ~ 0 0 <: - [.>l u 0 "" ....l IN 'l'HE COURT OF CO~ON PLEAS OF CUMBERLAND COUNTY, PENNSYLVM1Il\ ORPHAN'S COURT DIVISION IN RE: ESTATE OF HELEN L. SHOE!'AY-ER, LATE OF SILVER SPPItIG ~'OI'lNSIlI", COUNTY OF CUMBERLAND, AND CC11l1OmlEALTIl OF PENNSYI,VI\NI7\ SCHB!ll1LE OF PROPOSED IlISTRI~!~~I~~,I. suggestion is mace, thdt tl)(~ baldncf:) in lHlwln o( i'\r.c:ouubm1" rot" Distribution, to ""it: t:-w. sum of $17,OlO.lB in f?~lrsollalt:y Hurl clHill pllrtHlltnt. to the provisions of t.he LZ\ST \Hi,L of Gl'.Ct'rJpnt, dS follo'I!~;: I I \ I I \ I 1 1 I I I I I i I I , \ , i \ TREVA C. BILI~All, (Paragraph III) Hiscbllamwus rurnitur~, per dpprdisul EILEEN BILLHi\)l ",OUDERS, (Paragrap:l IV) piano, per appraisal KAY BILLHAl1 RYDER, (Paragraph V) Furniture., per appraisal DAHIEL BILL',""", (Paragraph vI) Automobilb, 1948 Chevrolt':t'., per dPprctisul JEA'il BIT.lL:-il'''I'i BR::I:n'jfj'Iiu.1, (Paragraph VII) Furnitur~", per apprdisal '::'l\1NA C. ;;Uli1A;I, (paragrapL VIII) Cash MR. and lmS. CLARENCE Sl1EIU'<ER, (Paragr"p!l T:':) C"sh L,i\RF.Y VOGELSO~G, (Fc.traqrctph ::) Cash JilCK FI:;I:EY, (Paragrapn XI) Cash r.1}\RY Jl'..tlE PP.E:ilZ,1':P. LO,\'::1Y, (Pardgraph :.:IT.) Cdsh HILLINl c. I.!cGUIRr:, (Paragrdr-h :n.II) Cash PA!'.lr..I.u~. SIn:i~.ER SE:~'l':';, (Pardgrdph :ZlV) Cash TAr.1J~Ri\ SHEAR::n. ST:..~mC:RG, (rdrdqrdj.)l~ :-:\,) Cash ST. STEPHEllS LUT;-:r,:1)\': CEUPCli, (Pdl~dlJr..\n:1 ~:vr) Cash DAVID ;], BO\''ERS, (Pardgraph :':\'II) Cash GEORGE D. rr:RTF;lj\Al.~r.H, (r'ciraqrctpl\ :-::::.:) Cash GEOJ.GI' P. FEHr:l'r:::'J'.t"GI', (Purr..1?f,\;lll >":.:) Cash CI!RIST!".~! 1:EY'AI}J C!'IV;~;~':' ~~ "r}:',., (hU-'lPli.l1,11 :,'\')), Ct1.:1h HOLY LT\~!D Ct:nISTIl','j !:If:-:IC':, (J"""t',j{;rll!111 :-::.:1) I CclH'l ,- (1'15.0{) (,0.00 115.00 lO.OO 70,:111 2,nOO.Oo !)On.00 ~jO.~O 250.ilO ~SO.OO ~50.0() 2)0.00 2)0.00 2,000.00 1,000.00 loOCO.OO 1,000.00 1,112.55 1,112,55 \ I 'lIilf'l \,,'j,'I 9/,' I J:n r:: r< H 1:: .:: 0 .' , H r: < ,", U :0- u: ,:; ,.1 .:: :> ~ o. ~" : ~. "- t..: >1 0 0 " E: H .' H ~~, ).. ~~ o. P< Ul OJ, C ':, H " ::s H ", !:\ ~ :0- G c., ~, 1-1 'J 0 ,,, ~ H U -' [, u, ~. Cl (", ~ ,-,: ,', r" t.,' ;:.., .'" r.! r. b ,.. 0 [-< U. ~ C C ~ : ',~ u r. cr: ~1 ~J (,; [- ". ~ ~ <' [, {;~ ;-5 ,,-, ~ c " [-~ f'.: I.:, [, }:: 0 u ,. ~i u <5 H 0, r..~ Q H [,< U r" ,~, Vi r: 8 rr. ~ 0- r,~ 0.. ~ ::0 co 0, C u; '" 0 ~..- r:: >1 ~, U ;:: ~: P: F-! '. i? p; r" , ." '-J f:l P' [-" " L ", (S ,~ t.'~ '" -, r: '" 0 '" 0 ,~ ....; rr '" ~ H ::.:.. ,. H '" U". U z :5 0_ ~ i H U -, ---= c -- " .. ~ ". ~j --. '" , : " ~, "'. c. r') c.:.- 1..;.1 ~ (.,; a j;' &.0....', "'" c.:..;.. 6e'. N Lt.JL._ >- 01,- r:..:> 0:::..... r.:= OCj U!.I.J 0 ~o; ~ '&.1 (l --',-.-;'PI7l'1rr.rP"7~r;)-::'y- .n"o~ (- 0/\1 . . IJ I. 041.;;8 '4~tMaJ8L1 U(")l1nq!ll<;:tP 10 ..lln .P~lfJS pGSr~'dOJd l.I~:M ,j')<.I(,[.:..:~,,,,{; 1I~ p<"JaJ~);::;p uopnq!Jls:p PlP! '~i;'l;.qc;':",;(! Po;WJ: :_0:) IlJno:J::J't;!~.\.~__~}:7:'~~f."" '~"].ll . ,..,..... -' ,..,' '-,-' .,,' ~ '.-' ~~~ S~! "''''li.l .~.... ~:~ Lj;~' C) " " " " .' -... '.~. " ,.~ .. . .. " ~ u - ~, .', " ." '":":j .. c' ~J '.' .:.' .' " " ~:~ ,.-~ ,,\ ~; .~.~. \\/ ::~ -; ~ .. ';,~',""i ,. :) ~" '-.;; ~ " "g "\ ," ~, :1 " .. ." "....... "':':i~ -.(~ ~,~~ , "." 9.<"""''''' .. :"\ "" .. .' ~ " " ~ r__ :: .; .~ .- .-,"C ~ S ~ .~' ~ ":ij .. - - iii ffi ~ ~ w ~ ~ ~ ~ : ~ z ;;: :< , z ~ It OC ~ .J ~ < w iii ~ N N It D: ::l ~ ~ ~ g !.') :"") :! ('''I z < > ~ > ~ z z r.. ~ S) .; ~ ~ "'- m ~, lJ) !,r:. !! -' z < x u w ~ -_.~_._-.---- :lIS~\lIP:1p'~Erlt!'S Accountant asl:s cr(:di t. for l:'l('~ following dmonnts prli.d out,: _ Register of Nills - filin" r....e" _ 14yers FUlwral Home - funeral cxponsr>s _ Cumberland publishers - Estate notice pUblication _ Chuck Bricker - ~ppraisa1 _ Howard Roy cohen - Medical _ Howard Zlotoff, D.P.M. - Medical _ John W. Snoke, D.D. - Medical _ Credit Bureau of York - Fire Insurance past due premium _ ~~.bOr1and Law Journal - Estate Notice publication _ Seidle Memorla1 Hospital - Medical _ Waltz and 81xler, P.~. - Medical _ Mrs. ~larence Shearer - !AIXlr, orgaJU.ze household goodS _ Mrs. Treva Billman - Labor. organize household goodS _ Cash _ Notary, postage. reproduction of documents _ George P. Fertenbaugh. Executor's commission _ Murrel R. Walters III. Esquire - Attorney's fees _ Register of Wills. Pennsylvania Inheritance Tax $ 74.00 2.094.70 21. 50 25.00 233.04 87.24 12,00 124.2'/ l8.UU 203.00 lU.UU JU.UO 30.00 37.00 1,175.00 1,175.00 1,224.00 $6,573.75 TOTAL D ISBURSE~Ifl'ITS REC1\PITUL~TI011 GROSS EST~TE ~SS~TS LESS: OISBURSF.:,IENTS $23,583.93 6,573.75 BALANCE ON HA'IDS OF ~CC0U11TN'lT FOR DISTRI!1UTIml $17,010.10 COt',!MON\'1r.AL'J:':~ Of? PEi'iNSYLVA:lIA S5. Personally appearc.d bR:ore mp., the. undf':rsiqnH1 office.r, a :'lotary Public, in and for said COPJ)";'lonwealth and county, GeorgI:' P. Fertenbaugh, Executor of the Estate of i.:elen T.... Shoe,T:1a]:er, late of Silver Spring 'l'owns'hip, cumberland County, l'ennsylvdnici., dt-:CedSH:, \.,hu being (July sworn a.ccording to la\o,', d~poseS ar:.d says t:r.at. he. is U....,e i~ccountdl1i.: in thH ann\~:.:p(1 l\ccount and t!1at th(~ said .,<....\1 """" ~ccoullt is true anc1 correct to t"" bf,St. of hiG l:no>llec1ge, information and heliof, ,.' ,..",:?i!.:,'Il,nd thdt there an. no unpaid credit:ors to b" notified of th,., filing of thi.s ~ccount .".,;;"" '.' ,I.r:: ;; "-'II,l that. ~Tittcn not.icn of the filino of this [,ccount dn,l thf'. day of p"oprosed ::,,:";;r-"'~': -::_, ~(j,r"e of confirmat,ion has hr!<'n 'liven to all person" ,,1'0 hav<'l any int.erest in the :....1 ".,:.;': ./,', ,', ......" b f" ' .'~"'. .~: ~....~'t.f? as ~ni.:"" '~Cl.arl.f-s. ,~, ";~; .:~.<~~ '.. :~.\,..n::.: " ,",,:q~~!:1' ct0.~q{U1;~~"uFscril:.ed bpfon:. rr'j ,\!~"..;~,:.<vJ..;::" day of ,fl,:?;,"../,u-L ,l~GQ. "" :',:./.I- :';"'':~',c, " -r~) - """ :.. uoc'''., Nol''''' P,bUo "'..orQI' '.:,;'!j0?:,~ U /"-. . T- \<\F~~'~"''''' 5~t'b"l..d Co',~ .~~. /.... A---:%. A.J~~__U,'-t.o'1nlrUtt6.\~f.f~29. \.>>M/;)J'I COUNTY OF CmlElmL1\;,:)