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PETITION FOR LETTERS OF ADMINISTRATION
IN TIIF. El'iTATE OF ....WU~.Hi:..,r,."..,g~J,I1)......,...........,................. D1ICEAl'iF.D,
To .........."", klll);)!".C.." L,\',w.~~"""""""""".".."""."""",..""".",."
Register of \Vilis fOl' the Coullty of Cumbedalld, ill 1111' ('ommollwealth of Pellns,l'll'ania,
The Petitioll of ....,~~~i!,~.~..~,~,}l?:~,~.~,... ...,.... ......,...., ...., '........... ...,.. ....'.., ,.., .......... ........,.. ........ ....,......,......,..,
',..,",....",.."",..,.".." ,'.", ""'"...."""", respect fully showe I h I ha t "',\ol~,+,~,~~,,!:,:.. ,g~,+,~"',..,""""" "",..",.."""""..
'I f TO\\'lll-ihip , '1'1' I (' t I Qt,t. f P J
was a reSI( ent 0 .SO,uthamp,tan..........,...................'''I'lIS~lHj,''/< ,( um lei .Ill( ~OUn ,\, ., ,I e 0 enn,~y_
vania, and a Citizen of United States, and depal'tedlhis life ill testate ill the Coullty of ....~,':',~p.~,~,'.l.........
'..,.., ,..",..",.." ....."....""", and Sta t e 0 f " ..r.,e,I,\I,\~)! l Y.1l n;LFI""",..""".,...",.."",..."""",...."""...""""""""....,....""...."
on ..........t;,..~~i!y................ the ..........?nL.................., <Ia)' of ..ji!,l).~i!!;'X....,................,........, A, f)" 19,~,L.."
at the age of ,..,ft,e........ years,
That the said ,.........WUb,\.I);,J"..,H,e.1,I)]...................................., deeeased, left sUI'vivill!( the following
named widow or husband, heirs and next to kin, to wit:
Name
Relationship
'.., !;,Q,I1I1;L,e..,~ ,..,1':ly.~ ,~"..,...,"",..,""" '..,
"""'~,i!!!g.lg,~!;""""""""",..
................................................................
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..".....................
Residence
R.D.I/6 Box 147
................1...............................................
.. ,~,~, ~ P. p..~,!1? ~ !!.':.g ,." ~!!:,' ..!:.?,?,~,?," '.. '....
................................................................
................................................................
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.................................:.;~Z:1........:;:,...........',~~i,
C) .....
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..................................._;-!,;:~:..,.....~...,.........::;
,
That those above named include all of the next of kin, so far as known,
The said deeedent was POssessed of' personal propel'ty to the estimated value of $,;?",Q.QR.:.9,Q...........,....
and of Real I~state, less incumbranee, to the estimated I'alue of' $....0"..,.........,............, as near as can be
ascertained,
That the said Real Estate in so far as is known is located in ....,....,nmw..................,.......................,..,
',....,..,......,...."..,.."......"""..........."..",..",.."",..""""',......,"",..",.,.".""",..,...",.""",....",.,",..,""',...,"""",....""..",..""
Therefore, your pelitioner(s) respectfully appl,\'(ies) for Letters of Administration in the above
named estate,
January 6 , 81
Dated ......,................................,........,.., A, [J" ],),....,...
Signature and Address
( O{ 0
.(
of Pelitiollel'!s)
'" '~g:;N.~l~1.tyei:{"',.1?1.~J,f,(!.,2..!..,..,.....,',.."..
,'. ,R, II. "(/6",, .a.QI,:,..L it 7.."""..""" '..,..", '..""..,...." ,..,..",..
Shippensburg, PA 17257
............................................................,....,......................
II-I?{'_/
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. L5----
COMMONWI.;A !.TI I OF I'ENSSYLVANI,I
COU"lTY OF CU~lImH!.ANll
............, .........' ..... ...c,?,!!)!,i,(! ..1~.~.. ,~y'!".r,s.,.. ,.,....,. ..,....,... ....,. ." .....,.,..,.., ,......,.".,.,' ...................."....... .........,.. named
in the above applielltion beinl( tluly ..............,..,........,................,.., a('col,tlinl( to Ill\\', ~IlY that the facts set
forth in tbe above application al'e true to tbe Ill"t of ....,..,........ knowlctll(c and belief.
.......,....,swoJ:n..,to......,..., .....' ,..,......, and subscribed \ .' .g~m.t~'\fye,l.l).L,,;r;~'.'~"." .,.."""..", ""..
before me, ,..",,' '" ..'"" ,.,..',' ",..' .""""",," .,.. """""..""....",",....,..,'"
uanuary 6 ,81
,................................,......"..,..,..,.....,.., A, IJ" \,\..,....,.. ....,....,..,..."......"................,..,...........,.,...........,.........,......
....,~Mj..,e".., ~~~d..........:,........,
..r.,/"t fI j.(.' Register
, January 8. 1981
Flied:, ..,......,.......,........,..,.,.........,..............................,
,
\ S8:
,..........................."..........................................................
A Horney:
,. )).?,I,1lH.t.9,n.,;;"..,P'W,J,s ........, ........,......"
P.O. Box 375
Shippensburg, PA 17257
OATH OF PERSONAL REPRESENT A TIVE
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
l's:
,..'" ....,....".., ..I;,o,nn~/i,..L ^ ..l:1.y,e J:s"..",....,..,......."......,.."""..",",..,',..,',..,",....,""",..,"",.., ,..."""",..,'. petitioner (s)
being duly ......,..,Ii>>',9,);n........,.......................,.... according to law do \'\~..,...., depose and say that as the
administra ",........".., of the estate of ..,..~~~~,':\:.,h..H.,,,~~""',..,..,",..,"......"....""'.."'........,....,....,.."".."..,',..,"
..............................,....,....,.......,..,..............,........................,....,....,......,..,............,....,..,....,....,.....................,..,..,........,....
deceased .......9,\1~....,......, will well and truly administer the goods and chattels, rights and credits of said
deceased, according to law, And also will diligently comply with the provisions of the law relating
to Transfer Inheritances,
........,~~,'?,!':n,..~,'?....,....,....,.."'...."".." and subscribed
before me,
....,......,..q,~,~,~,..~........,..........,....,.. A, D" 19,~,~....
Rta~..d.;f~.....................
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..,..,........Q:!,~......!b..~....,........,....,......,....,
Connie L. Myers
............................................................................................
DECREE
8~ ~ma~ 81
Be it remembered that on the .....,............,............. day of ............................,................... A, D" 19..........
Letters of Administration in the estate of ,......lV.ilbUJ:..L....,!lalm..,.......,............,..............................,....,..,..,....
,..,....,....,..,,'" ........"..",...."..,....,..,',..,',..,',.. ,.." ,..' ...... late of .." ,~,?~ ~ !:,~~p. ~,,?,t;',,, ~~~,\';~,!:,~ Ii...... ,...... ........, ...."...... ,..'
Cumberland County, Pennsylvania, deceased, were granted to ....~g,l,\l,\~~...It,',..tly,~,r.~....,......................,....,
..........,....,..........,..,......,............................,..........,......,......................,......,............................,....................,..............,....,
Witness my hand and official seal the day and year aforesaid. ~
..,........,......q2/d,....,c;",..,o/1~..'
/3t::J..
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
ss:
being duly _~Jol9.rn, .._' __ according 10 law, do poses and says Ihal ~e ,..is__the,_J"-c1minLsJ:'.ta.t..ri,l\..
__,__________,..__'__'_ __,_" 01 Iho Eslale 01 _Wilbu1" To, Helm
lale 01 R. D. 6 Shippensburp; , Cumberland Counly, Pa.. deceased and that the
within is an invenlory made by, " ,Collnis L._MJ_s..J:'.s____ ----, Ihe said Administratrix
01 Ihe enlire eslale 01 said decedenl, consisting of all the personal properly and real estate, except real eslale oulside
the Commonweallh 01 Pennsylvania, and Ihal Ihe figures opposite each item of Ihe Invenlory represenl it's fair value
es of Ihe da 0 01 decedenl's dealh,
.._..COJ1n;i.<;j L. \1y,<;j1::8
._-- - ...----.---- .--. ----- -.- ._,-~._._.-.---- -- ---
..d ..b ",,..d ",I." m., \
19 9/
_,_c.o-~ :to J7l~tfA.I
XM9'!lieKX Administrator
ELlZMETII n. fEIZER ,olory Public
r'Jc'Nvillo, (um!;,:: :J:1d Co, ;dy, Pi!.
V,y Commis~ion Expires Sepl. 12, 1983
_,__..--R._12...-6'J--Box 147
Shippenshli.rg, FA 17257
Addrou
Dale 01 Dealh _--..-2--..,-
Day
Januarv
Month
1981
Year
INSTRUCTIONS
I. An invenlory must be filed wilhin three monlhs alter appointmenl of personal representative.
2, A supplement invenlory musl be Iiled wilhin Ihirly days 01 discovery 01 additionalassels.
3. Additional ,heets may b. a"ached as to personalty or realty
4. See Article IV, Fiduciaries Acl 011949,
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Inventory of the real and personal estote of
Wilbur L. Helm
--.--.----
-,
I
Cnecking Account #28760-1 Peoples National
Bank, Shippensburg
Conrail wages earned and vacation pay
1977 Ford Sdn. sale price
Refund on 1980 Federal Income Tax
deceosed,
,} /1')
..
$ 2,95 .01
3,46 .10
2,60 .00
1,73 .00
II
I
f~E""Ull (,~ao)
COMMONWEAl. TH OF PENHSY I.VANIA
OEPARTMENT OF REYENUE
TRANSFER IHHERITANCE TAX
RESI~ENT DECEDENT
AFFIDAVIT OF
FIDUCIARY
(Instructions on Reveno Side)
r~
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Estote of W ilbu~r" L~.__!1e 1m
Lost Address R. D. 6!.,_~ox _147
Dote of Deoi\, _~__.!!,n\llwy 2, 1981
Social Security No. _?1 0-26-6219
Shippens~urg, PA 17257
Bureau File No. -'-~'-'
lei TV)
(SlA TEl
( ZIP)
County File l~o.
21-81-12
1. Decedent died:
( X) Intestate (without 0 will)
( Testate (leaYing 0 lost will--copy attached)
2. Is the filing of 0 Federal Estate Tax Return required for this estate? Yes,_ No X
3.
Executor/Executrix
(X ) Administrator! Administratrix
Name Connie L. Myers
Address
R. D. 6. Box 147
4. All correspondence should be mailed to ( X) Attorney
) Fiduci ary.
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~l1ippFmAhllT'g, t'A 17?S7
(CITY) (STA.TE) (ZIPl
5. If on atlorney is representing the estate, indicate:
Nome
Hamilton C. Davis, Esq.
Address
P. O. Box 375
Shippensburg, PA l72~7
(CI""') (!:oTATE) IZIP)
List all safe deposit boxes registered in the decedent's individuol nome, or jointly with, or os on agent or deputy
of another, or in decedent's individual nome with right of access by anotner os agent or deputy. Include the nome
and address of the bonk or other institution where the safe deposit box is 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 DECEDENT MAINTAINED A SAFE DEPOSIT BOX
NAME OR NAMES IN WHICH
SAFE DEPOSIT BOX IS REGISTERED
REI.ATIONSHIP OF JOINT
liOI.DERS TO DECED~NT
NONE
-_._-_.._--~--
-'-r
..--.-., .- ._--..... ...-...-".-.-.-
Under penalties of perjury, I declare that I hove examined this return, including occompanying schedules and
statements, and to the best of my knowledge ond belief it is true, correct and complete.
~_i..m&JM/
SIGN~E- gF Flt\UCIARY
l/ / ./~/ R(
DATE
REV-4!lf) 1'-aOl
COMMONWEAL TH OF PENNSYLVANIA
OEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT OECEDENT
SCHEDULE "A"
REAL PROPERTY
:~~~1.-
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1,.,1,. .',.
'.'v'~fi/i:j
(Instructions on Reverse Side)
ESTATE OF --.Wilbur_L.Helm__
ITEM ESTIMA lED DEPARTMENT
DESCRIPTION MARKEl VALUATION
NO. (OFFICIA~~ USE
V ALU E
ONLY
NONE
TOTAL THIS PAGE - {J- - . cJ -
-
./J~
REV.451 (1.80)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "B"
PERSONAL PROPERTY
'*
(Instmci'ions on Raversa Sic/a)
Estate of Wilbur L. Helm
ESTIMATED DEPARTMENT
ITEM DESCRIPTION UNIT MARKET VALUATION
NO, VALUE VALUE (OFFICIAL USE ONL Yi
Checking Account,Peoples Nationai Bank $
No. 28760-1, Balance January 2, 1981 2,953.01
Conrail - Wages earned and vacation 3,463.1 (
wages owing as of January 2, 1981
1977 Ford Sdn. Sale price 2,600.0
Refund of 1980 Income Tax 1,737.0
TOTAL THIS PAGE ........ I,~ 7:13./1,
$10,753.11
;#
;1
QUESTIONS CONCERNING PROPERTY TRANSFERS
1. Did decedent, within two years of death, make any hansfel of anI' material part of his estate without receiving
valuable and adequate consideration? (Answer "Yes" or "No" ,)--..NiL.
2. Did decedent, withinlwo years of death, transfer property from himsel f! hersel f to himsel f/hersel f and another party
or parties (including a spouse) in joint ownership? (Answer "Yes" or "No",) --1I!L-
3. If the answer to one or two above is "Yes" and the transfers are claimed 10 be nontaxable, provide the following
information: not applicable
a, Age of decedent at time of transfer,
b, Copy of death certificate,
I c. Affidavit by the attending physician indicating the state of decedent's health allime of transfer,
i d, All other information supporting nontaxability of transfer,
I 4. Did decedent, in his/her lifetime, make any transfer of property without receiving a valuable or adequate consideration
! ' therefor which was to lake effect in possession or enjoyment at or after hislher death? (Answer "Yes" or "No",) Nn
a: Was there any possibility that the property transferred might return to transferor or hislher estate or be subject
to hislher power of disposition? (Answer "Yes" or "No".) N/ A
b. What was the transferee's age at lime of decedent's death? N/ A
5, Did decedent in hislher lifetime make any transfer without receiving a valuable and adequate consideration therefor
under which transferor expressly or impliedly reserves for hislher life or any period which does in fact end before hislher
death:
a, The possession or enjoyment of or lhe right to income from the property transferred? (Answer "Yes" or "No".) -lliL
b, The right to designate the persons who shall possess or enjoy the property transferred or income therefrom?
(Answer "Yes" or "No",) No
6, If the answer to five b, above is "Yes," state whether the right was reserved in decedent alone or others, N/ A
7, Did decedent in hiS/her lifetime make a transfer, the consideration for which was transferee's promise to pay income
to or for the benefit or careot transferor? (Answer "Yes" or "No",) No
8, Did decedent, at any time, transfer property, the blMficial enjoyment of which was subject to change, because of
a reserved power to alter, amend, or revoke, or which could revert to decedent under terms of transfer or by operation of
law? (Answer "Yes" or "No",) Nn
9. If the answer to eight above is "Yes," was the power to alter, amend or revoke the interest of the beneficiary reserved
in the decedent alone or the decedent and others? (Answer "Yes" or "No" ,) N / A
REV.453 (1.80)
COMMONWEALTH OF PENNSYLVANIA
OEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIOENT OECEDENT
SCHEDULE "0"
BENEFICIARIES
~. ~\
~
(Instructions on R(NerSe Side)
Estate of
Wilhur L. Helm
BENEFICIARIES AND ADDRESSES RELATIONSHIP SURVIVED DATE OF INTEREST OF BENEFICIARY
DECEDENT BIRTH
Connie L. Mvers
R n h Rnx 1),7 Dnwzhter Yes sui-iuris 100%
-,
Shiooensburg, PA
17257
*-*_._-_.. ----
- .
- --.-.--.--.- ---.----.- -,----- ---~-_._.
._------ -'---- ---~._._-- - ---. ..---.-.--.....-..*-------
-,
- ----- -- -...
-"---- 1--
;
; - ,---, ..-----t
,
-- --~ . ",. ", - .__n_ - -, ..,-
: The above beneficiaries are living at this time except for the following:
NAME
DATE OF DEATH
REV.454 (1.80)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
(Instructions on Rever.lie Sido)
~,
W.""
" f ,~.;}Il ,
" .t
SCHEDULE "E"
JOINTLY OWNED PROPERTY
Estate of Wilbur L. Helm
P
TOTAL E VALUE OF DEPARTMENT
ITEM R
DESCRIPTION MARKET C DECEDENT'S VALUATION
NO, VALUE E INTE REST (Official Use Dilly)
N
T
NONE NONE
-
TOTAL THIS PAGE -()- -O~
--
;j~
Fl,EV.455 \1.80)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIOENT DECEDENT
SCHEDULE "F"
STATEMENT OF DEBTS
AND DEDUCTIONS
*'
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-_.._---------_.~---
--~-_..- . , .--.~ .. --.. ---' ~~
.--.------------- .-. -,-~---------_.__._-
Estate of Wilbur L. Helm Date 01 De<lth January 2, 1981
WHEN CLAIMING THE FAMilY EXEMPTION, COMPLETE THE FOllOWING:
FilP. No, 21 -81-12
Claimant
Connie L. Myers
Relationship to Decedent
Daughter
Claimant's Address R. D. 6, Box 1~,7, Shippensburp;, PA 17257
ITEM ,
NO, DATE NAME OF PAYEE REMARKS AMOUNT
Register of Wills Letters of Ad:n in is trat ion 13.00
Re~ister of Wills Short Certificates h.OO
Cumberland Co. Law Journal Advertise Letters 18.00
. The News Chronicle Advertise Letters 15.00
Westminster Cemetary Funeral Account 115.00
Fo~elsanQ'er Funeral Home Funeral Account 1 Qnc' nn
Cnnnie L Mv"rs Familv Exemntion 2 000.00
Connie L. Mvers Administratrix Commission r:,'n . 66 'd
Hamil ton C. Davis Attornev Commission ~nn nn
Cosh Reserve for Filin" Account etc. sO.OO
Register of Wills FilinQ' Inventory 1.00
TOTAL THIS PAGE I $S.1S0.66/
I hereby certify that to the best ?f my knowledge <lnd belief the foregoing is a just <lnd true statement of debts, funeral 1/j
expenses and expenses of administration submitted to the estate as deductions for Inheritance Tax purposes,
() t'VJ1/r1 / ~ d' ,//..(.{.eA,.L:J,/ 1-:t3-R'1
SIGNATURE OF A'.TO~EY/FIDUCIARY DATE
OFFICIAL USE ONLY
A
DEBTS AND DEDUCTIONS ARE ALLOWED IN THE SUM OF $
AT
PERCENT,
nEGISTEI~ OF WILLS
DATE
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