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""" "..' i" ..~",\) .~-'f :~~..~. !~~"irj);''- ,. ,Y:',1}~',~;~,~~Y.,.,: .j! """'" ,. , . ' 'j ~' ' (.' ; . .f'" " .,..< . ",') ~ ..,.. ,. "",>.11 "il,,~l,,',,^, I. /.I, .,' nl~~ ,.tI'"'''';''''''''''''''''''''''''''''''' ",l,j"""",....",.l."",;~.l'jjtf,~~ ' I~ro , . , . . . , . , , . , , , , . . , . , '. ~ ' , , , ! , , , , . , , , , , ' . . , , . " , , " , , , , , , , , , . . , . , , , I III , , 1 . ii' 'I , III i 'II , , . """""'!""""""""""!"""""""""'""""""""""""";~/' &,7f} f."d--- .' ..:'." j" r::~r~~~~AA"'A' . 1~~Jf.j~~L. INHERITANOE TAX RETURN RI!SIOeNT OEoePENT ' /1 . .:<G~ (...,' Pllu Numbor 21-81-0134 oocollollt'l Nomo (LOll, ~Irtt, ond Mlddlo Inllloll PucodAl11'1 Alhlroll Irl'Qdat'iok, RU th' DBO~A8ID, BUCI0IB8curltYN,,"mhor ~" ,OAtoolO,o,oth , (1r~oln N1Hdf/oj VU,ll\ge 208-:18"9285" .?jiB/ill' AWe! n llr.a, ~9 I orne -----,"'" ----'-~,-..-. .-- , -Nsw-y.;\.-J,,1,&-,-P, , 1 7 ~ 41 OHEOK 1. Orl~nol nOlUm 0 2, 8Ulllllomol1101 ROlUm 0 3. nomolndor R,olllrn 0 APPRO, PRIA Tfi OORRI, BPO~OINT Nomo Riohard II,. Nix, Tolophono No, .' . (717) 652-8455 " BLOOK8 RfiOAPIT. , ULATION AND TAX OALCU. LATION 4, Lifo Eototo I I ' 6, podulol BltAtu TolC 0 Rotllm Roqlllrod. O. Oooodonl dlod t01l1\O n 7, Oonodont molntolnod 0 living D' 8, Totol Numhor,ol 0010 0 (Attooh COllY of Willi bd. trulI (Attooh COllY U!J!Ultl clopollt bo~ea Invontorlod All corrolpondonQo alld oOllfldonllol tox IlIlormotloll IhOllld bo dlrootod till -- ...Adllroll '-']~'{) l'r.inoe Street EJs'luh-e Oil J:larr.isburr Btato P A Zlp171'l9 Rooapllulotlon 1, Ruol ~Itoto (sohodlllo A) 2, Stooklll\d BondI (Sche<lulo B) 3J OlolOly Hold Btook/Portl\orthlp Il1toroll (Sohodlllo 0) 4, MortgOgllll\dNotul (Sohodulo 01 6, OOlh ~ Mlloollonooul PO(lonol Prollorty (Boholl'ulo EI 0, Jointly Ownod Property (Bohodlllo pI 7. Tronlfon (SQhodulo 01 ' 0, Totot' DrOll AI"tl (total IInll 1.71 B, Funolol' axponlO. Adrillnlltrotlvo OOIlI/MI/polloIlOQIII BxponlOl(~chodull HI ' 10, Oobl,/Mortoooll/Llonl (Bohodulo II 11, Totll Ooduotlontltotulllnol 9 & 101. 12, NIt Voluo',)fEI\nta (linn 8 minUlllno 111 13. Oharltablo BoqUlltl (Oohodu!uJI 14, Not VIIIIO IlIbluot tulax (IInu 12 mlnulllna 131 (1) I 2) ( 31 ( 4) ..,....~.___.. (6) -'L"."..~~J f!~.7 G ( 01 ( 7) -- ,;.IJ ",Ll :')i[ap '"^If;TJ 'c.' , "'1 " ~. i~ ~~-~ - (0) .L 219 . 76 ( 01...tJ,,~.7 4 . 00 (10) , (1l1;S ).,674.00' (12) ,~. -(1\24.?'4)-:,'" (131 - 1\ -- (14) .~,_7J424. 2 1_____ Oomputallon'cifrox , 16, Amount of IInl14 taXlblo at ll% rolo (16) ----=-lA.~j~L?,!\L_". x,OO- lInollldo voluol trom 90hodllle'k) 10, Amotil\t 01 IInl 14 toxoblo a116% roto (16) _ x',16- lInollldo vIllIOI fro", Suhldolo KI 17, Prlnolpll to~ dUo (odd tox from 1111016111111 tax Irom IIno 10) (17)'" ( 0) 19, Total Prlorneymontll (0) Amollnt Paid (bl 1'1111 Olloouol (01 Mlnlilln18rOI\ (19) _ 19, 9010ncoOuo U1no 17 mlnulllno 19) (191 " Moko Ohlok Poyoblu tOI Roolltor of Willi, Agont · · · PLEASe REOHEO'K MATH · · · UndOt pOllolllolOI por/ury, I dooloro thet lliovo,mmlnod thll ;otum, Inclt;dlno occolllndnylno lohodulll ond Ilatlmontl, and, to thl, but 0,' mY,~nOWl8dgo ond bollol,lt II truo, oorroct, and oomnloto, Ooola[ollon olnroperor olhor than tho potlonAI roproluntotlvo II bOlld on IlIlnformfttlon ol.wlilch prlporlr lill ,lnYknowlodgii, '), J, (,) '711 -,'.P I A /'1,. III C '0'" , ',121~ ' I tctuv II s" I ~";!..~."f\L..Vj "", N~''tJ "'. .::/- ,;J ,1 .8.;} SIONATURa OP paRSON L RePRBSS ATlve S ADPRMS' 7, OATS' j I I I I I i , I , i 1 I' <., SIGNATURB OP PRBPAl1BR OTHER THAN l10Pl1BSENTAT!Vi COMMONWIALTH OP PINNSYLYANIA \, COUNTY OP CUMIIRLAND J '" ,,,"..,.~W^NRI\.MtJ,r,JQR "". __,,___ '_'_'H" -..''.'-----___',,._'__.~..'Hm' bolng duly ,....PJ'LQ);IL,,,,,.. _'''" oooordlng to low, do pOI"' oild IDYl thot Sho ':,ls,'.ths.J\dmlnlstrat:.,dx"n __u_._.__,,~_, ,.u" '''.__H "... ,..+ ...._ 01 tho Etlolo 01 __.JJ.\l.l<L1r.Q~lIDi.J.&lL_,___,__.__ loto 01 "on ' , '";;''' ..""_, Cumborlond County, Po" docuud and that tho wlt~ln lion Invo'';tory modo by , __, _hpt'...."'._.on_.,,. ...._ _no; U" .~_, tho loldAdnL1..nlliJ;A\;w 01 tho onllro OltOto oluld dooodont, 00",IIIIn9 01 011 tho portonol prop'~rty ond rool OltOto, OMoOpt rool Dlt.to ouhldo Iho Commonweolth 01 Ponnlylyanlo, ond thot tho 119uros oppOllto ODoh Itom 01 tho Invontory roprolont It's lair voluo os 01 tho dato of dooodont's doath, ' .' , ' ,~\~">,~ _ ond lublorlbod bolore me, OJ H.__D)~~_.~t-~eJ.w ....a....'..... Admlnhll.t., ~),,('~ 52'3. 19 7$" -..dn,1./1 T'd.ArtLUo.. nl.J l,i,I'I, T, 1'lIll1AM9, NOllfy Publlo '/ Ill.lIh~Ulal D:wphln CoulIly. I'A . My COtllmllllon Expl,ol Oo~ ii. 1~B4 ...._..~.'L1LILg.!)~()nt.\mr.r.y Ro..lliL" Har.rlsbur.11 Pennsylvania 17109 OT_......_..._._,_.~. __._--+_. Add,.1l 18 Februar.y Date 01 Death ____,.~_.__.___,____..,,~______.._, O.Y Month 1981 v.., INSTRUCTIONS I, . An Inventory mUlt be flied wlthln'three monthl olter appointment 01 pellonol repreunlotlvo, 2" A supplement Invontory mUlt be !lied within thirty ,dOVIOI discovery 01 additional Dlull, 3. Addlllonal shooll may be attaohed at to pOllonalty or roalty 4. Soo Arllole IV, Flduolarles Aot of 1949, I, , " "'. r',_ to', , l- e, (" '.1--:.; " (iii., " "'\111 li!l' 1"'\ fC' I'r) t;' ~ ~ 1 j \ I o ~ f I ~ ~ 8: '~ l5 i ~ o ~ j ~ ~ - Z "" J , ~ ~ J