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HomeMy WebLinkAbout81-00158 I' " " , . , , \ , 11k~t~t~mltll ~tub Wegt~uttnt Ii I<IDNNIl1'l'1I ID. 13InR1rRTlM, qf t.he 13orough of New Cumberland, CumbGlt'lanCl County, Pennsylvania, make, publish an,' 'declare t.his t.o be my wast will and 'l'estament, revoking and ,making void any ant'l' all wills by me at anytime heretofore made. 1. I direct my mxecutrix to pay my just debts and fUl1eral expenses as soon after my decease as may be con- venientr ant'l that she pay all taxes that may beoome due by reason of my death from the residue of my ,estate without oontribution 01-" apportionment from any beneficiary or the ,owner of any property with respeot to whioh 'any tax is due, whether or not forming a part of my estate passing under this will. 2. I give alid bequeatl'\ my tangible personal proPerty with'the exoeption of that oomprising a part of mY offioe for the'practioeof dentistry, unto my wife, STIDLLTlMARY B. BIl1RTRAM, if she sh,all survive me. Should my wife fail to suX'viv.e me, I giVe and bequeath the ,same unto' my qhildren equally, to be divided among them on the basis of the ) ... ,. ' ap'praised value of the various items as they shall agree. Any suoh article alloted to my son Robert durin9. his minority may, as my Exeoutor e;!eems ae;!visable, either pe e;!el:b/erec!\ to, the m~nor or to any person to hold for him without seourity, or be sold and the prooeeds adt'llfld to. 'my residuary estate. 3. 1-\11 the re~t, residue ane;! remainder of my estate, :f ' , give, e;!evbe' ane;! bequeath unto CCNB Bank, t>l.TI., Tru~tee under Agreement of Trust e;!ated Maroh 25, l!l7G, in which I am the Settlor, to be held and disposed of in acoordanoe with "laid 't\qreement as the same may ,be amended from time to time hereAfter. , , '-j, ,I If, 'H . " ., 4; I 'flame, OOnRt.i tute anCl appoint 8TIllLLI\MflRY D. nIllR'l.'IU\M " to ,be ,t.he l1ll(scut.rix of, this, my wii!, Should Stellamary 13. Bertram fail to survive me or for any teMOn fail to oomplete the al1minist~aHon of my efiltEd:e, I nominatq 001-113 BI\NK" N. A;, to b$ the, Exeoutor il'l her stead, 5. I appoint CCNB Dank, N. A. to be guardian of the estate of 'any minor benefioiary or of any ptopetty passing to the minor othl'lrwiae than unCler t.his wil'l with rCllspeot to whidh I am author.izeCl to appoint a 9uardian and have not otherwise speoifiqally done SOl and provided fur.ther that th~s appointment of anY fiduoiary of a gUardian shall no.t: supersede the right , ill .its disoretion to distribute a shllre where possible to the minor or to IInotherfor the minot's benefit. Suoh gUII~dian shall have the power to use prinoipal 'as well as ino~me from time to'time for the ~inorls support " , and eCluoation, inoluding oollege ed\.\oation(both graduate and undergr~u;1uate) without regard, to hiEl or her surviv,ing parent 's' ab~lity to provicle suoh, support. and eduoation, anCl to, make 'paymentEl for these purpos~!l without f\,Irt~er responsibility, to the minor or any person taking oare of, the minor. ~. 'In the event my wife" STl1lLLI\MARY' D. I3ERTR1\M, shall not survive me, I appoint my daug\1ter, SUS1\\'l I3ER'l'RAM, to be the guarqian of the person of my son, Robert, Cluring his , minori ty . IN WITNESS WIHllREOFi I have hereunto set ,my hand and seal 'this~r I~ day of J,~~)r"'1 /11-,\ , 1980., i; /',_'." " _"-;-7 .1/ ~;4--;'//j', l: :.~ ~;;;~;~~g/E,l;;f}i;'( tn:'Nt' ., / j, <..(SEAL) " .Signed, sealed, publiElhed arid decl_red by the above- named Te~tator as and ,for his Last-Hill and Testament in the . Ptesenceof us, who; at his 17equest., in his presence and in the presence of each other, have hereuntosubsoribed our names as witnesses. . .. ''') (",/~j) ,l ,-;- O~~A." VT.. ~~ d' I Ii - I" .' " " " '-1' ~: ,t 1f~"~ -,~ - 1 , '., ii' ;, 'I " , ',I " I . 1'4 " "~' I " , " IL ,. " " " " 'j " , , . " r '~ i ~ ' PH ! II i:' , i'l .' , . . '- jc ',," t ."- ,., OATil 0.' "It.RHONAI!RIWRI(H1W1'Al'ln: COMMONWUALTH OF I'IlNNflYI.vANIA !HI COUNTY 01' CUMlll3RLANlj, ;" I' , , Ucforc IllQ, 'thr I~CBlsl~r for Iho I'rol1l1lc 'af Willa IInd BIllllllnB of Lcllurs of Adlllfnlslrnl/o!lln nnd for lho co'u'lty of S'i'l!lLLTlMAlW 13. IlJnH'l'Rl\M ClIlllborla",', pOIHonully CllnlU who, bolnB dllly_ SWorn ,dll_lil s depose nnd say lhnl ns_11l1s.9.Ql1trix of the Inst WlII and TOSII\ll\ont of Kl!lNNmTH ill. l3illR'l'HJ\M dooonsod she will wollllndtrllly admlnlslor IhoBOods and ohnttels, rlBhts and credits of8111d dooollsod 1I000rdlnalo IIIW, And ,,' , ,Sworn IIlsowlll dlllaelllly cOlllJ1ly with IIlc provisions or Iho law relallnslo Trllnsfor 'nhorltnnoos, to an~ subsQrlbod bofore, mfl, Mllt'C1h4 A,Oll 19.!tL... .,(t$~ik~r~1: ~n;~" , '9l~1 (Ii!~tj~~ Roalater q, " < ..,. ;, I 0" "1 ::~ ~ , r,;\ 0 ((;';t: i'~ ' :,~, ~~! (~I- ..,. r' I if: 1[', il "..."1 ~'Dn:. :~ lid '41 " [,:::\ li5 j'') '-' ff5 ~ Ql :!l ~ Ql ~ N I' ~ "J ] u.. 0 '~ ...J ...J ~ - , ~ M t:l ~ tril Ol l/1 Ql =II: J .~ ~ ,a I ~ ,... ~ =II: 1 l \0 ~ 111 'N d ~ ~ Bo II romcmberod lhlll' on Iho 6th dllY oL Kenneth E. Bertram' DECR.:E March 81 ' ,A.D,,19_, thorewRS probAted nnd III to of Ii reeordodthe last WlII and Testament or ' . . , ~el1\oyne Doocasod, Lettors 'l'e.tM\entary werc sranted 10~ 'WIII\ess my 11llhd nnd offlelal seal tho day IInd yellr aforesaid, I Cumborland County, Pennsylvllnla, Stel1aniary B, Bert.tam ~,91,.~.." (! ~,' ! " ~eslstor "GF.N~RAI.I~HaRITANCE TAX INFORMATION ..... " Unsatllfladllahllltlo& Incuffodhy tho ducod~n' (lflo! 10 his/her douth UfO doductlhlo agalnlt hla/her taxablo 0I1ule. In addition 10 dohlS, Iqcurfllll hy Iho docodonl 01 OLll1lo, otho! 1I0ma (110 clolmohlo Including the colt 'o,f odlllluletratlon, altu'nay loea, flducllllY foos, fuuoful,and buflul okponao~ Including the cost 01 a burial lot, tomb,tono Of YIUVO marker und othor rolutoubllrlol oxpeUbes, All dobts bolnu claimed aualnsluu ost(ltO aro IlIbloct to tho approval of the Roglster of Willi with whom tho Inhorllunco Tux Roturn II filed, Eviuonco ta SUllport tho docodont's of.tho OItate'lllahlllty for the debt. being clalmod should be attached to this 5chedulo, , A lomlly exemption may be clalmou by a spouse of 0 Jeaedont who dlod domiciled In Pennsylvania. If there I. nOlpouse, or II tho 'POUSfl ha.,lorfeltod hls/h'or rlghta, thon any child of tho decedent who I. a mOfl)~er of the same household can clalrn the oxernptlon. In the ovont thoro Is no such SPOUIO or,chlld, the OI('l11ptlon aanbe claimed by a parent or paronts who oro membors of the some houhhold os the decedent, The lamlly exemption II allowable only against allets which pass by a will or by the Pennsylvania Intoatate Laws, ., . NOTEI Compensation paid to an oltato represontutlve; namely, an executor or ad",lnl~trator, far sorvloes . performod In administering an os'tate Is foportable for Ponnsylvanla Income Tax purposes, Thll taxuble Incomo !tom should be reported on form PA.40.lrldlvlduallncumo Tax Roturn. ~ tI1 8 8 g ~ ~ ~ ~ ~' ~ ~ I ~ z rn ;l . p ~ . Z ~ 0 P 'Tl "l1 0 I z trJ . I ~ ~ INSTRUCTIONS FOR COMPLETING SC~EDVLE "fo" 1. If tho' lomlly exomptlon Is,belngclalmod, Indicate tho clalmont'anamo, addre.. and hla/her rolatlonlhlp ta the decedent, Entor"lamlly exemplton" In the r,emarks column and the amount clalmod In the amount column, 2. ASSign consecutive numbers to,ooch Item listed, ' 3, Enter th,\ldato on which oach dobt was Incurrod ond/orpald. ~ r, I d' , f . ' GENERAL INHERITANCF. TAX INFORMATION . . - Unsallsflad Ilubllltlas InCl/nut! hy Iho lioc"li""1 plilll 10 his/hot donth UtO dOlluctlhla uuulnlt hls/hor laxablo ,,51010,' III addition to dohl. IIICI/Hod by 1110 docodollt III "lIlulo, (ltllot lIolIIs uro clallllablo Including tho COlt of olilllllllsirutlon, uttornoy fooa, filiI/citifY 1005, lunotul ulld hUllul O~POIl$O' Including the caat of a burlallot,'tombltolle or grave mark or uud othor telllted hurlal OXpOIlSOS, All dabll'bolllu cll1lmod auallut l1n oa'tuto 010 luhlocllo tho UI1IHoval of Ihe Reul.tor of Willi wl'th who,n tho Inhorltanco Tax Return Is Wad. Evldenao to II/pporllho dacodonl" or tho e.fala'slldblllty forth, debtl belllg clalmod should he ottached to Ihll achedula, A family oxon\pllon may be clalmod by a 1110U$O of a docodont who 'died domiciled In Pennlylvanla. II there la no spouso, 01 If tho spouliD hal forfeited hla/her tlghta, Ihen any child of the decedent who II a member 01 tho lamo household can cilliln tho oxemptlon.ln f~e event there la no auch spouse or child, the O,ull1lptloncan bit clalmod by a paront or parent. who arO memburs of Ihe aamo household uS the docodent, Tho family 'xomptlon I. allawablo anly against a..ell which 1111a1by a will ar by the Pennsylvania Intestato l.ows. '.. NOTEI Campenlallo" paid 10 an estate roproaenlallvol namely, an executor ar lidmlnlltrat,or, far IOrvlcn porlormed In administering an estalo I. reportable lor Ponnsylvanla Incomo Tax pUlpasoi, This taxable Incomo lIel11 should bo reported on form PA.40.lndlvlduallncaI110 Tax Rotulfl. ' ~ ~ ~ 8 t; '~ Z ~ ~ ~, ,~ 0 ~ p ~ ~ , Z P 0 z 0 'Tl I-.l P .,., I-' , ~ co 'i co' I 1-', n 0 I, ~ Ul I-' ~- V1 r:-i ,,0; , l ~. co ,C<., , , l'fJ ~ ; n ri" . .-. ,.. . i3: ':'-1'_ l'fJ &' F- O'I_'~_~; ~ ~ . "l" 8t.','., ;";- J:~ I:ll LiJi~ ~ I~~t:; I-' l'fJ ~ ~ 0:: ~ ...l ;:l ~ I r.) ~ m c: ,en INSTRUCTIONS FOR COMPLETING SCHEDULe "~" 1. II Ihe latnlly oxemptlon ,. being claimed, Indlcato tho clalmant'aname, addross and his/her, rolatlonshlpto Ihe docedent, Enter "family oxomptlon" In the remar~a column and tho altiount clalmod In the amount column. 2. Assign consecutlvonutnbers to oach Ilem llst,d. 3. 'En lei the date on' which each debt woa.lncurred and/or paid. 4, Ent"r tho nomoI of oach payee, 5, Provldo a brlof oxplanatlon In tho ,romarks column for oach dobt. claimed, 6, Enlor tho OInaunt ,of oach dabt bolng clalmod, , 7, Tho 10 till must bo slgnod by the porsol\ who has ussul110d the rOlpollllblllty lor paying tho dobts. IF ADDITIONAL SPACE IS NECESSARY USE 8~1" x 11" SHEETS, , ' r~~NSYLVANlt\.llillliUI~NGETAX C1ENEIW.INI'UflMATION " . . __.' .. .. ~..__~_'''_'m'~'_''_rl~_____~'_~'.'''_.'''' l.URSON..S.R~SPONSI [jL E FOJLllETu'B!! ' Sooll01\70101 tho hlhoritonco nud Ealoto Tnx ~cl 011961 plllvl<lo$ IlIallho Irlllowlol'. pO(:illlW sholl prilpi1l11 ill 1(1 1110 a return: ' " "I Tho porsonol ropresontatlvo 01 Iho ostnto 011110 <loco<lonl as II) PlopOlly of 1110 110(;(1(10111 allmllll:-;Iorml hy hllll and such nddlllounl proporly which is or IIIOY ho suhjo(;llo InlllHililll(;O 'f ,IX 01 which hU/:ihu sholl havu qr ucqul ro knowlodgo: b. Tho tronoloroo of PID/lerlY upon tho tronslor 01 which IlIholilOlICll Tax Is or lIJay lie inlpo!loll hylho 19~1 Slntlllo, Including 0 trustoe 0 proporty Ironslorro<lln trusl, III0VII!tld lhalllo sopmaln rOlll[lIl1l1o<l bo 1II1IIlo,hy lho Iransleroo' of property Includod In Iho roturn of 0 porsollal roprosllIltnllvo. ' 2, e1,ACE FOR FILING The teturn Is to Iio f1lod In dUpllCOle with 1110 Roglstor 01 Wli!!, nl ,tho collllly whololll Iho docodonl rusld()(l. 3. liME FOR FILING " Tho rotutnls duo nino monlhs ollor tho docodonl'~dbolh, unl~s~ illl OXIOlI~ioll for filing hilS Iiooll appllod for ond grontod by tho Socrotory of Rovolllio wlthlnlho nlno-molllh porloll. ' 4,EAILURE TO FilE RETURN Secllon791 of tho 1901 Statuto provides Ihol " , . ,ony person 1'1110 wlllluily Inils 10 fllo a rolur,lI or olhor roporl requlrod of hllll, . ,sholl bo porsonally Iloblo, . ,100 ponollY 01211% 01 lho lox ullllllnloly loulld to ho duo or $1,000 WhiChever Is the lossor 19 bo rocovorod by Iho Doportmollt oLRovollUo as dohls olllko olllounl fife rocllvoroblo hy low" ' ' . " . ' 5. TAX RATES Inh,erltance Tax Is payable ottharato 016% onlrnnslors,to IInool doscendanls, such as lather, lIIother, hushond, wlfo, son, doughtor, grandchildren, grandpnronl, sou-In-low and daughlor-In-Iow ond 01 1I1O rnto 01 15% os to nil othors, 6, f.8YMENTOFrAX The tax assossedon tho transfor ofproporly reportod Inlho rolUrIl Is duo 9 lIIonlhs afto[ Iho decodonl's death. Intorost at the rato of 6% per ,1nnUIII accrues thoroaftor ulltll poymonlls mflllo. All pOYlllonls rocolvorlnro flral oppllod to any Interest which IIIny bo (Iuo with any rOll1olndor appllod 10 lho tax, IF TAX IS PAID WITHIN 3 MONTHS AFTER THE DECEDENT'S DEATH, A DISCOUNT OF 5% OF THE TAX PAYMENT IS ALLOWED. All chocks, should bo lIIudo payablo \0 \,hO R(JgI sial 0 r Will ~ ollila cOlmly whoroln Iho dOI;Q\IOn, \ rosldod and oro rocelvod subject lo tho final dotormlnollon o.f tho Doparhnonl 01 Hovolluo. ' 7, FAILURE to PAY " " THo tax,os IlIIro.sod, tORolhor with any lalorost, thereon, ara a linn \IPOII, rO,al" IlroporlY, whleh II en rOlllolns In Off,oct.unlll tho taxos on( Intorostlwvo boou paid, In lull. Tho toxos may ho, SUf)(I [or agolllst any roal proporty In tho doc,odont's ostote or !lAolnst any proporly hOlonR'np, to a transf%l1llahlll IlIr Iholnx. . , a, EILINGOFFALSERETU~N ' " Any person who willfully lI1!lkos a Inlso)otllll1or report roqulw(i of hllll shall, III occordmll:o wilh ~e6lion 793 of tho 1961. Statuto, bo p,ullly 01 (\lIIls\loll1ol1nor nlld, on eonvicllonlho[tlof, shall bll slIqlonclIdlo I1ny 11 llrio nol oxcoodlnp, $1,OOO,or undorgo IlIIprlsonmont'not oxcoodlnR ono yom or holh. I ....' . " " . . ~.'IH\IIIIO, l,lolll:ltlj:\ILw IIIHI <lppblnl.: ~lfJ'~ll,l'/\MJ\HY IL UlllH'l'RlItl 4, Lo ba the mxoouudx nf Lldl-l, 111'1 IVI 11" Uhou1d SLollAlnt\l:'Y 13, IJIH.t:t:tlmCiIU \;0 /lUl1vlvu nl\) or hili <lny I:umjon' euil \:.0 oomplel:u I.:ho tH:tmlnJu\;I',,\:JOI\ of ,IllY uutntu, I I\OIll.ll\ilLo UCNU UANK, N. ^" \:.0 bw Lho 1':XuO\l \.'u r J n hll r II Loiltl. 5, 1 IIppoin t; uc.~NU U,\llk, N, ^, \.'0 \JU gLIIH'ditl1\ ot the , ' l:lutat:e of tiny minol1 bllnul:l(,1.111L'Y or, of tiny propurty ptlllSing to the minor othorwll3u' Lhun undur LhJa will with reapeot: to , I , whioh I am authot'.LIlod t;oappo.l.nl: II lj\lanl:lun and have not: othE\rwiae spooifioallY do no 130, Ilnd provi.ded further that thi,s appointl1lenl: of A ljum:dilln LIIHlll not; auperaeda the right ot any fiduoiary in na diaoruUon 1;0 dial.:r~buto a share where poaaib1e 1;0 tho IIdnor 0).' \:0 unothur for the mino!:' Ii benefit, Suoh guard1tln shaH ,hi;\vU the poworto UIHI pHlloipal ~s wall as 1noome l!rom Hme to (;i,I\tO for. tho mino!: 's support anct eCluoat1\Jn, inoludillg ool.1ocJouCluou\:;,ioll (both gradueLt~ ~nd undergraduate) without r00a1'd to bis or hor surviving parent' s a~~ili.l;y to providu uuah j,luppol'l; and eduoation, and to lIIa~e paYlllont;s eOl' thello pUl'poaell wi thoul: further !:esponaibility tio thu minor or any pot'son taking 0111'0 of the minor, 6, III the evellt lilY wif.e, 13'J'I):!.,r,fllotAHi' 13, 13mH'l'l~M, shall not survive me, I appoint:. my dauijhtt.ir, SUSAN UlilH'l'RAM,' to be the guard1an of the pet'son' of lilY aon, Robart" "uring his lIIil10ri tY' , IN Wj1;'!'NIlJ13S WlIlJl!{JllQP ,I hava horounto llet my hancl and 'aea1 this ~ ~'; duy of. ji'p)("l'l~J\ , 1900. ." ", .' ,; , "!{ ~" "',l'.> '...1,', -. --::-:- Konneth'g; Dert.rain '-('77;" f I '1~ ,~Sm1\L) Signod, aen1ed, pub] ishod and doolal:l:Id l)y I;he abOVe" IHlma,l 'l'estal;or all and for. hls l.a8\;\'I111 and 'I'estalllent in'the prellenoe 'of Ull, who, a I; his requos I:; ,in his presonoo and in \;he prosenoo of oaoh o thO!: , hnVlil ho1'ounl:;o llublloribeCl our namos nil witnOI3I!1Ull, , ') , I, \ '~"___,' ',_..."~L.'1-' _,'2":_~:::::L ,..1, ' ( \ .' \ " ;, 'n..~ ..u.;j~_...o=;'.:_~~i.;...~.w.'~""-'" .....~--'~_._~S:J...i,'-~ ... ~! ,lj'Y'.I:d I Ai \t'iI'"\1 C:OMMONWEAL TlI OF f'aNNSYL VANIA DePARTMENT Dr REVBNUE, TRAN$rER INHERITANCE TAX RESIDeNT DEceDeNT SCHEDU~E "a" I'ERQONAL I'RopaRTV t:stnto of ITEM 'NO, 5. 6, 7. 8 . UNIJ ESll~T&D DEPARTMENT VAL & M R &T VALUATION VALUE IOfI'IOIAI. USE ONL yl 77. 8750 152,635,00 86,4375 4,840,50 30,3750 2,430.00 18,5625 1,856.25 41.6250 4,578.75 49,50 14 10625 9,843.75 20,3125 4,773,44 200,00 1,548.65 279.93 131. 64 1. 07 6.94 ~ 01. 89 97,50 12.00 <140,00 1,609,35 154.77 1. 22 (Im/wa/(rJ/ls UI/ flllVllrslI ~'lrI"l PTlC11l1 1 KE1NNElTII l!l, 13ElRTRTlM DESCRIP'l'IOH 1. Stock I ffi"[-l3harss "" Elal3t:man KOQak 56 sha~es Hewlett Paokard 80 shares Vale~o Enerqy Corp, 100 shares Storage Teohno10gy Corp. 110 shares Sun Co, sun dividend ~aid 2/1U/81 700 shares Husky Oil ,Ltd. 235 shares Granger Assooiates 1973 Cadillao Automobile (po<?r oorilition) Tlooounts ~eoeivab1e from former clentll,l 'patients Provident Mutual Life - disability payment 2/8 - 2/26/01 West Shore Tax Bureau - refund Mutual li'eneHt Life - Clividend R, 13. Landauerr Jr. & Co, -refund provident Life - refund of premium P01iqy No. ~PC-162288 ' commonwealth ofPennsYl vanip Unemployment oompensa't!'on aooount . ad j ust",ent - Amerioan Exp~ess Company - refund Citioo~p TraVele~scheoks ,7 - $20.00 eaoh CCNB 13ank, N .A. Cheokin~ Aooount No, 060-616-6 !3avingsAooount No. 003-10221.\i-3 ., Aoorued interest Notel Martih J. Pastuoka and Ladora M. pastuoka, his wife - dated Peoember 24, 19BO - Amount - $47,000.00 Intere.st - 10% per ,annum ' Payable. - 60 ,instailments of $998.62 eao Disoounted by reason oJ; inte'rest rate -' 87.5% 'Aoorued interest 12/24 - 2/26/81 2. 3. 4. 9 , J.D. 11. 12.' 13. (See page 20f Schedule B for a&:I1. Personal Prop3rty & TOtal) TOT Al If addltlonalspnco Is nocolSory, Jso BW' x 11" shoeta, 41,:)125.00 'B 4 3 . 82 .....-..._.0....-- CCI'-IEI CQNtt HANK, N" MAIN OFFICE 331 BRIDGE STREET NEW CUMBERlAND, PENNSYLVANIA 1 7070 BA~K (7171774.7000 DIRECT DILtu IllHlUlllhul' 3, 19tH 'l'O, .MyOIIU t M,VUI'U, 1"luwol' & J.ohIlU"1l ' . 'l'hil'd &. Mlu'kat St;l'tll.ltu Lumoyna, ~ ].'(0113 N!'l'EN'UON I 'l'hollllla l, MY01'Il liE I - Eutntu or l(ulllluth M, BUI'tl'WII -'"NWno at' lluoadont liB ot' Tho t'oll.owing io 11 complete reoord at' .tha abova duoadont' B !lOOOUlltu l~ehruary r26, 19131 . Date at' !leath -' loount 110, Type at' Aooount Bal.anoe on Pllte or Death Prinoipal A'"iiDrUed lnt, ---- -.- , " ')371022).6-3 Savingll * 1511,7:( ~nt22 \'()~ 6.l6~ 0 Cheoking 111.1..609.35 ,None NameD on Aooount (All Ownol'8) DILt., or Cr"nt k: oj' J(\int Q)!J.l~rJl~.l~.i::c:' K, EJ, Bert I' alii , D,ll, , K, EJ, Bertram, lJ,P,', " y7f~~' '''~'l.d''~H'''" ___.." , - Auldlat'ly.lId BII',II11t'UI'C' , .- lll1.ESTIONSOONCERNING PROPERTY TRANSFERS I, Old decodent, within two yeMe of doath, mako ony lronsfor of ony m~o~nl pnrt 01 his ostoto without recolvlng valuabla nnd odeQuota conalderatlon? (Answor I'VOS" or "No" ,) t:'''''_ 2. Old decedent, within two years of death, ,transfor proRorty Irom hlmsolll hersolf to )}Imsoll/horsolf and anotllor party or parties (Including a spouse) in lolnl ownership? ('Answer "Yos" or "No",) ~., 3, If the answer to one or two apove Is "Yes" and thetranslors oro clalmod,to be nontaxablo, prOVide the following Information: -Sc t' r <" V e .. ~.. " a, Age of decedent at lime of trensfor, b, Copy of deeth. certl II cate, ' c' Aflldevlt by 1110, ellendlng physician Illdlcatlng the stato ofdecedont's health at time of transfor, d, All othor Informallon supporllng nontaxablllty of transfer, 4. Old docedent, In hls/her,llfqtlmo,makb any transfer of proporty without receiving a valuable or adequate conslderetloQ. therofor which was to ,take eflectin possession or enjoymont at or after hls/hor doath? (Answer IIYes" or 'INo" ,) ~ a, Was thore any possibility that tho property transferred might return to transferor or hls/hor estate or, be subJoct to his/her powet ofdlsposlllon? (AnsWer "Vos" or II~O" ,) . b, What was th,o trans(oree'a aRe at lime of decedent's death? 5, Old decedent In his/her IIfellmo make any transfer without reoalvlng a valuable and adequateoonslderallon therefor, under which transferor expressly or Impliedly reservoa for hla/her life or ony period which does In fact end before hi a/her ~a~: ' a, Tha posseselon or enjoyment of or the right 10 income frol\1the property transferred? (Answer lIyes"or "No",) .ALJ:J. b. The right to desll!llale the persons who shall possess or onJoy the property transferred or .Income therefrom? (Answer "Yes" or '.'No" I): 6, If the answer to five b,alxlvels IIYes,1I state whether the right was reserved In decedent olone or others, 7, Old decedent In his/her 1,IIelll11o m,ake 0 transfer, the consideration for,w'V,.was transferee's promise to pay Income to or for the benefit or care of transferor? (Answer IIYes" or "No",), 0 " , a, Old decedent, ill any ,tlme,lransfer properly, the brJ1efl clal enJoyn\ent of which wassubj ect 'to change, because of a reserved power to,alter" amend, ~mOke, ,or which could revert to decedent under torms 01 tran~fer or by operat,lon,',ol law? (Answor "Yes" or,IINo",). ')", , , 9, If the answ~r toolght above Is "Yes\" was Ihe power to alter, amend or revoke the Intorost o,f Ihe beneficiary reserved In the decedent alone or tho deceden and others? (Answer IIYes" or "No",) i Q) ~ ~ ~ m M @ "l' 0, ~ ~,: ~ till I' ,-, .-I, ,-,[:: cd A~~ ~. ~ .~ f':":_ ~- ~ J~ "t':.: 0 Hi-';- 'ng ~ CO . :E llle, 8 i/dtJ lOr<< , U '.1"1 C') it"-'I .-I U Q) 1;':;1, ,...., !d ~ ~I 'd ~ , i :&; ': ... 0 (0, ~ ., Z a. '. tJ 0 0 -~ i co ;4 . '-" ~ ~ 0 Z 0 ~ ; d ~ ~ ~ d gj z z ::.i d d 'I": ~ ~ Z ~ Z ~ t:I ;;J " Ii! ~ ~ 8 po; :l " 'ISOJOllI16,llIOpOOOp 041 jO onlo^ 10>1JOUl 041 oloOlpul 'v 'ISOJOIlll RAlIOpOOOp 041 jO 060lUOOJod 04l oloolpu I 'E '^IJodo,ld pOllMO ^lllIlol aliI 10 01110^,I0>1JlllU 101010410100lPUI 'z; 'POllsIIQUISO 80M dl4SJOUMO lUlol aliI ojop041 puo (s) JOUMO,OO aliI jO lUOPOOOP Olll 01 c1ll1SlIOIIQIOJ puo 680JppU 'OUlOU aql OPl110UI '"e"alnpOlloll J016110110nJ18UI a41 UI POIOOlpUI80 ^IJOcjOJd IOU~8Jod 118 8QlJORoq ',,'rI1I olnpOllos JOI 8UOll0l1Jj8UI 0\11 UI Po\OolPUI 80 ^IJocjOJ~I'IOOJ 110 oQpo80Cl .~ ., F' ., ,'lUll 010180100J 1811 'popnloul oq 01 eJO ^lJodoJd 0lQl6uoluI pliO 0lQl6uoIlllOe '~llqIJ0^I^Jn8Io 1461J 41lM 81UOU01Jul0189 8al1JU~.J,O MJud JG4101l0 411M ^IIUIOIIIJopaoap 041 ^q pOllMO '18l108Jod puO 109J,!AlJodOJd liB opnIOUI18f)Ul"3,, olnpaqos "3,, 31naaHolil DNI.LS1dWOO 1:l0::l:sNOIJ.OnI:lISNl " '. '1 ' ; .11;'-"" '>;,.', 'I, , ' .. , ~ ,~ ~ ' J J i 0 . ". ~ I I II I ~. :" ad I I I I' ~ .' N ~ . " ~ ~ ~ 0 0 ~ ~ ~ 0 0 ~ Z Z 0 , lj. ~ 9. ~ z ~ z ~ Sl ~ 1', Inven\ory of tho realan'd pereonal estato 01 ... K lilNNlilTH_,~_~m!:l!,!~'l' 1Y.'li.,__,_,~""""c"_'_ deooased -....- - - -------- ,--"'--~ _....-_.'--_._-~.. ..-~_. ,~-.,,'-_. . -_.~__.~,,_.._..___..._.., _~. '_--'0---" 1 . Stock I ,1960 sharee - lilastman ((odak @ 77,0'750 p/ah. 56 shares Hewlett Packllrd@ 06.4375 p/ah. 80 shares Valero lilnergy Corp, @ 30,3750 p/ah 100 shares' storage Technology Corp. @ 10.5625 p/sh 110 shares Sun Co. @ 41.6250 p/sh, SUn dividend paid '2/10/01 700 shares Husky Oil Ltd. @ 14.0625 p/ah 235 shares Granger Associates @ 2~.3125 p/sh 2. 1973, Cadillac Automobile (poor oondition) 3. Accounts receivable from former dental paUenbs 4. . Provident Mutual Ufe - disability payment 2/5 - 2/26/01 5.' West Shore Tax Bureau - reeund 6. Mutual Benefib Life - dividend 7. R. S. Landauer, Jr. & Co. - refund 8. Provident Life - refund of premium Polioy No. 6PO-162288 9. commonwealth of pennsylvania - unemployment adjustment 10. American Iilxpress Company - refund 11. Citiccrp Travelers Cheoks - 7 @ $20,00 eaoh 12. CCNB Bank, N.A. Checking Aooount No. 060-616-0 Savings Acoount No. 003-102216-3 13. Notel Mattin J. Pastuoka and Ladora M. paatuoka, hia wife Dated. Deoerriber24, 1980 , Amount - $47,000,00 - Interest 10% per annum' Payable - 60 installments of $998.62 eaoh, Disoounted by reason of interesb rate - 87,5% " Accrued interest 12/24 - 2/26/81 14. .2222% interest in professional ~ffioe Building partnership (ll~5 EaBt Chocolate St., HerShey, PAl , Assets - Real lilstate (Appraised value - 000) Book value of other AsaetE! - $950,000.00 20,809.00 970,809.00 793,802.00 177,007.00 @ 2222% Ii Liabilities - Mortgage Net Asset Value (1\Bcertaired in accordance with partnership Agreement) TOTAL *Interest on, savin~s noct. No. 003-102216-3 TOTAL 152,635 00 4,040 50 2,430 00 1,'856 25 4,578 75 49 50 9,843 75 4,773 44 200 00 1,548 65 279 93 131 64 1 07 " 6 94 101 89 97 50 12 00 140 00 1,609 35 154 77* 41,125 00 843 82 39, 330 95 2G6,590 70 1 22 266,591 92 COMMONWIALTH Oil PlN~SYLVANIA \ COUN1Y Oil CUMBIRLAND J "' stallen\ary B. Bertram ._._T_______..."...__._~_ _-,-',_....u__.~~.'"_,,_~__, __ _:"_,.' ~__~ _,,_ 'Ij-~.- - ............ .-..~~-.-.,'.. ~-,.-.'--n.-__.."'---..""'"'T_--~~.~.c.-r '''T_O'" u._______+ boing duly ."..___-B.~~r.~.. .'_ aooordlng to law, d~pololalld lay I thet'Shil ...18.. m~Q!:!ll.1;..!.CJ_lt.,._ .-.....-- _.lc_~__....,.._..H......m.h. ,,_'"' .. ... 01 tho eltato of_....KIilNNIU.'l!lLJ!l.._Wllntt'.RAM..___..:.__ la" ol,-!3.ot'q.~.\lh o,f.Ltll.l11oyne, ., ., ..".---..--'-' Cumborland County, Pe" dooOOled and that the within II en,Invontory m~do by ......he..r...,_,+_._~..._........,,____...._._, tho IOld__!!l_li~c\.!W.~ of theontlro eltatGol uld, deoodont, con lilting 01 011 tho potlOnol prop.~rty and rul oltato, except roal OItate ouhlde the, Commonw'oolth 01 Pennlylvon1o, and thet tho flgurol,oppollle oooh Itom 01 tho Inventory ropruent It'I fair value 01 01 tho dato 01 decodont'I doath. ," . Sworn to ; ~J~"" , id.({cu.'l{C'fJL~f./ili' ,', ' : <,~ftt:'#::..,"..:_ STI!1l'UMl\RY ~ , urRIX' 80~ Michigan, Avenue _ end,'Iublcrlbod boloro mO, ~ /k~V.::,m4~,G 2"" (.~ ' I' -." \;~. , CL.....'L-: ..1.....-.. -~~\-~...-,.,-- ! '. - . _ _ _ t ~ . NOTARY PuoI.lO,.) .J 'IIv 00lllIlI1...0Il Kaplm Peel, :11/ _I ;"IllCIJ1If' 1'0" a~loocl (loIps\f ?/ _19._.._ 'f _ _~______'______.-1____' Lemoyne, Pennsylvania 17043 .-.-- -_..._._,",_..._~-------...~-~_...."'""--------......;,..--_.-.. Addrlll Date of ,Death _.____~6t~"__.....:.__.___~__._..E'e~ruaEr_.._._,--- ' " ' o.y , Month, 19B1 V..r ':-'j (hlr:;"\ INSTRUCTIONS ':~;,j ~'t1'~-: I. An Inventcry mUlt be lIIed within threo month, alter appolntmontol pDllonel reprllontatlveiH: 2. A lup~lomont Invontory mUlt bo IIlod within thlrt daYI 01 dllcovery 01 additional ulOh, ;. ,.i: ,- 'I' 3, ~ddltlonallhoeh may be eHachod al to porion a ty or roalty , , '<I!' 4, See Article IV, Flduolerlll Aot 011949. ,I" ~ ~ ~ ~ t1l ~ ,~ ~ ~ ~' ~ co In ' 7 .-I co I .-I N i - ", z " " S!:! ;>;R1 "'~ ~ me. <(')T .tt? ,;;1'11 -~ ';:' :':.';l .;, , ., .'" .. ,.< I~-" ill j "0'1 "I' o I"- .-I ~ i ~ 111 ~, 1 ~ j i e f ~ d, 1 ; 1 . Il< , <lI ill ~ ~ .1 ~l~ ~. U'l Ul N ~ .-I , ~ ~ ~ ~ ~ I:Q , o ... J ~ Ili'v,-.lIllhl.q COMMOHWaA~ TIt OF IIaHH\Y~VANIA oel'ARTMENT OF HavENue PUHeA~' or l'la~o OllCHA liONS APPLICA TION I'OI~ MID CmlSE:NT TO TRANSI"EH SECURITIES REGISTERI::D IN litE NAME OF A RI::SIDENT DECEDENT * AfP1ICA'illlli(MlJST BE FILED IN, TRIPLICA TI:) TO THE PENNSYLVANIA DEPARTMENT OF ReVENUE, Appllcat,lon I. horeby modo for ca15onlto Iho trllnslol 0/ tho lollowln~ sotllrlllo~,of II Penns,ylvonla Corporation or a National Bonking Association 10clItod In PonnhylvlInllll DA,.E l/ll/aa ,..., (a)HUQ....~_jbL" .S1!!'lQQ. d.' . . . ,..uP'(C)' QJlllllnC;ll:l . ....-.. (NOTEI In dOBcrlblngsocurltloa ontor In (n), nb 0/0, oltlibr tho nUlnbo,r of shutos of stOl;k or tho faco alllount 0/ reglsterod bonds, In (b), tho nomo'of tho lUlling COlnplIny "nd In (c) tho dun of stock or tho stated Intorost toto and moturlty date '01 regl.torod banda,) .. ISSUED ON vari9~~~~.t:':!!~....., and havlnQ o TOT ilL MARK ET V AL\JE OF $ ~ m.1.LH!1!.7.L.....---......-,... (001.) , ' as 01 the dato 0/ doatlfof tho decodont, _..3~~.l!'E~!.I..fl1'_.~P.J~.,!,I~.M...~~_._., oL2/~~ft~_.__..._--. , IHIIIII. a' O.c.dulIl) (Dol. uf d.o'hl' , who 1\101 loto' oL.._,BO.9..Mi.ohigan ,Ave.I1Ut;l..,..Le.mo.ynq (Slt.'., nlld Humb.,) (PI"I Dillen) .cumberJ.and. ,.~.....l'A_.__...__ (Cuunly) (51010) Tho locurltlos are reglsterod os followsl....,.lillNNlD'l'H m .UmR'l'MM .... ,.. ..,.__.._..__.HH____.~....- (Nal1\4t af f\QnlU III which c:uttlflcntat afO ,pvlttur"d) ARl6lffiliK6\URiK)_~_.__S:J.'.lil.tJlilllMARX-lt!. ,aIilB'l')!lI.M ..e.Q.2. ,t!U,Qh!g{;\n"..MjL, .,__X.~M,...u..:.m EXECUTlai RIX (Homo) , (Add,,,,,)., 17043 NAME OF APPLICAN:r.M'illlRS,..MYmRal...F.LO.WER-.&._.J~. COUNTY FILE NUMBS,R-'.J...::.e.l::-.ll.6-...,- ADDRESS OF APPLICANT,_I?..Q..BOKH-1:lJi:,...J#lmQ1/.na"cJ?~~,l'104 3 ~~~~~~ F 1~;~uU ~~II RTO'p'RopeR'LY'FI'LCII~~:N~U~;R~io~~ppL~~I~N~1'~\{iiir~TTE-c,"~,,-,-, CONSIDERED COMPLETE Al'lDWII.L. BE RETURNED TO YOU POR COMPL.ETION. ",_<__~~,___'_~__'m."""""~ ._._~____.~_,~___.,__~."_ ..,_.o._._~~._-,_ L'_ ._, _,__.___ ... ..,,__ H'_'._. ., _ ,. ,-, -.<_",_...". ;..,-.- .._-~."',,.... -;. ",-. .".....,'--~.., ."__',__H_ -.. _ ... _._,___, _~_.u.-:.....__". n'.'.~'_""" _~_..~.._.__n_ _-:-:____._ . _..____", ... .. __' -- --.. _ "."' - "w' ~."- r .--......, ,n.,_ --~~"'-":"': ,.".._..,!-~",:]!--- ...,,-.-..... . COMMONWEALTH OF PENNSYLVANIA.. DEPARTMENT OF RI;VENUE " . ' ' " . CQ.t!l~~]_19J:.RANJf.~B.SEgl!8..LT.J~J OA T'/.JA,~/1tlf/Jl. I horeby consent to Il)e trans/er of Iho ~bovo socurltlos now, roglstored In the nome of. ~f;~-;'ii<<'" , Decpdont and walve"tho IllIngof a cortl/lcato corllfylng 10 the paY1nonl 01 the trai\ftfor Inheritance .tax to which , ' the property of sold Deoodent la nldde si.ibloct putauant to the provisions 0/ tho Att of Juno 20, 1919"P,L. 521, , j '/ oS amondod and tho Aot of June 15, 1961, P.L.373, aS t1l11enyQd, This I. ol~o In acotlrdanc~'Wltht~1I provisions 01 Iho Act of April 9, 1929, P,L, 343, T';ls Consont to TfllI1sfor tho horoln dO$ctlbod I',oporty OpolotO& only In reloron!;eto theeatatooU!le abovo.named Docodent, !C.u"ly)'~ " . , .' ,1-, , .' , , , .. ft.; I,' tR 'e 1;., f,'! LL' "'I ,~-, i .... " ("II Ill.' ''"''!l! 'W' a~ '-'I,I/ '-". I .,'~ ,~~-: ';" ~I~ BW tl~ !:; l!!!lii jXj ~1('1 '-' "'j " " " ;'\ .It/E.QllM.l\Il{lli. To Inlura propRr orodli 10 yow noo('W'I. II'" IIIUllo IIf 1110 tlolnl" /lnd filII r,umhor sllllul<l 'hn nlonrly p,lnl. 0<1011 1I1Q ol,ook or monoV,ordor. This ...nlUmonl Is msdo In o(onrtlnllno will,' fonollllll 7(>0 nf Itlll IlIhurlionnn nlld Oslnlo To. AOI of 1961 (12 P,S, D 2~S6.7Qa), Yo Iho clXlont Ihnl ,Inhorlinnon In. II pnltl wlihlll 111'00 131 1110nlll. nltor IlIn dn/llll of Iho dooOtlOIlI, s dlsoounl of flyo 1611l0roonlll nlloWod {72 p,a, y ~466.'ll0I, Inllorllnnoo Yo" olhor Ihsn lOX 011 0 fUluro Inlorosl, IS duo /111110 d,u/l 011110 'Iooodolll'1 donlh nnd booomol dollnquont .1 Iho oxplrollon 01 nino {Ol months .ltor Iho doo"dolll'l doolh (72 P.O, b 2400.711!. Inhorllnlloo TIK onn fulur. Inloroll Is pnynblo wllhln Ihroo (3) monll18,ollor 1110 trollof"r \(,ko. offool In ponoBBlon ond enloymnnl ond la dOllnquonlll,or.sltor (72 P.8, D 2466.712), Caloul"ln Inlorusl from Iho dollllqunnl dalo .hown 'on Iho fooo of Ihll form 10 Iho ,Inlo of oOluolp"ymonl uslnU Iho folloWing Inlornllllllhlo: ---........-........... ...-.. ................. ..............----- ......... - ........~. - - ...--- ......-...... ......-.... ......... --.... --.............. --..""" -........- lmonlh .006 4 monlh. ,020 7 'l1ontlll1 ,036 10 monlha ,060 2 monlhl .010 6 monlhs ' .025 6 monlhs ,040 11 monlha ,056 3 montha .Ot6 '6 monlho " ,030 a ,,\Onlhs ,046 12 monlhs ,060 1 (jova ,00<>17 , 11 doyn , ,ootoo 21 doys ,00352 2 dSys .00034 12 doys .002(J3 22 doyo .00369 3 daVI ,00061 13 dnyn , :00220 ~3 dnvs ,00386 4 deya ,00068 14 dnyn ,00237 24 doys .00403 6 daya ,00005 16'doy. 00260 26 doVa ,00420 6 dOYI .00101 10 <IllY' ,00207 26 dSys .00437 7 day. ,00118 17 doy. ,Om04 27 daya .00464 8 days, ,00136 18 <loys ,00301 20 daya ,00471 9 dava .00162 10 dsys ,00310 29 daya .0048fl 10 daVI ,00169 20 linys .003,~6 30 dava ,00500 ..- - ---....---- ---...-.--........ ---- -..... ,- -..... -...... ..-.... - - -........... -.......--.-....- - - - -- .;.;......~....~-- -..-..... Any porly III Inlorosl, InollJdlno Iho Commonwoolth 011<1 Iho p""onol roplosonlollvo, 1101 aallbflodwlth the o..oasmont mav Ilblool Ihorolo, wllhln sl.ly {OOI dllYs ollur rooolpl 01 Ihls NOlloo ftR IlroYldocl hy,Soolloll 1001 011110 Inhorllllnoo nnd aslolo To~Aol of 190~ en P,S, fi 24116.100 II ' MakG Ollooklor monay ordor pnynulo to:, "RnuI9\Or of Willa. Auont'! Mall 10 tho odelress IIsleel bl,low: lNEQIlMI\UQN. To In8\1,0 prop"' crocUt 1C' vour Ollluutf1l, thu IlIHIll! (Jf Illu 1l11llllU llnci !illl Illlmhor nlllHlld hlJ olollrlv print- od on Iho ohook 0' monoy o,do, , Thin n"DlSmont 19 mudo in ncourclnrum \;VIII" UU(:1I01I 'lOll of IlIu IfllHlfllnnuo' oml riutfl1U ,TII,I( Aot of 1961 (72 P,S, fi 2496:7061, To Iho OKlonl Ihol Inherllonoo 1/1. 10 p..ld wllhl" Ih,,,. 131 Ill(l,,'h. nli", \1.0 "..,,\I. IIf Iho doo"donl, 0 dlloounl of IIV~ (61 po,oonll. ollowod,l'l2 II,S,!I Z406.7101 Inhorllflnoo Tal(, 0lho( thnn 10)( UI1 0 hUUfO lntorosl. 10 dllo nllho dnto 111 tlHI clooodunt's clotHh nnd hooomo8 dollnquont 01 Iho explrollo" 01 ,,1"0 101 mo"lhe olior \lHI (f"cudu,,!'. (l"Ulh 172 p,s, !I 2406.7111. l"ho,IIOooO Tax on 0 IUluro Inloroel 10 i'nyohlo wi\l,I" \1""0 1311ll0,,,ho ..flo, Iho 111,,,.10' Inkon offoCI I" pOOBonlon ond enJoymonl ond 18 dollJ1<IUOnllhoroollo, (72 P,S, P 2406.7121, ColulllolO 1111""'.1 from Ih" d"lInq(lonl dolO ohown on Iho fooo of 1111. lo,m 10 Iho "Oil' 01 ooluol i'"ymonlllelnll \lHI followlllg 1"I",oOllohlo: ___.....__"_.__ _........__... _..... _.......... _"'4 _ _...... _ __.......... _.___ _.. OH _ ~ ., -.... - ........ --.-. -.--. -.. --... -...... - --....- I monlh .006 4 monlho ,020 'Itll(lrulm ,036 10 monlhe ,000 2monlhe .010 6 ",unlhe ,026 0010"111' ,040 11 mon\l18 ,056 3 monlhe .015 o monlhe ,030 o mo"lI,o ,046 12 mOlllhe, ,060 .----- 1 dove ,00017 11 dl'ye .001[10 21 doye ,00362 2 deye ,00034 12 doy. ,0020:1 22 dllY. .00300 3 deye .00061 13 dOv. ,00220 23 doye ,00380 4 deye ,00068 14 doy. ,OO2~17 24 dove .00403 6 deye .00086 15 dllYII 00260 2,6 dllye ,00420 6 doye ,00101 10 dllY. 00207 20 doya .00437 7 days .00118 ,., dllYII ,00204 27 dove ,00464 a deye ,00136 1 B "oye ,00301 20 dovo .00471 8,daye .00162 19 doys ,00:110 20 doys ,00466 10 daye ,00160 20 doy. ,00336 30 doye ,00600 ..- ---- -------...--.---...- - --~. -.. -..... .., -......... ~..., -.......... ....,.... --.. ......-.-......... -...... -... -....--.......-- _...~ ..... Any porly In lotoroel, illollllllng 1110 Cornrnoowollllh IIrllt III0p",.,,,,nl rop,oe"ntollvo, nol 811llellod wllh Iho OBBe.emOIlI moy ohlool tho,nl" wilhlr' .i'ly 1001 dnyn nllnr 100011'1 of 1111. NOllo" 00 p,ovldod by Soollon 100101 "'0 InhorlloJloo "n" E.lolU To. Act ot 1001172 r,Q, 'i 240f,.\001l Muko ell oak or I1lUlJuy ur<lor pnyniJlo to: , "Floglsll1f of Willa, Agont" Moll to tho od<lloos 1I11tod IHllow: L