HomeMy WebLinkAbout81-00158
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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
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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 '
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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.
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4; I 'flame, OOnRt.i tute anCl appoint 8TIllLLI\MflRY D. nIllR'l.'IU\M
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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
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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.,
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" .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. .
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OATil 0.' "It.RHONAI!RIWRI(H1W1'Al'ln:
COMMONWUALTH OF I'IlNNflYI.vANIA !HI
COUNTY 01' CUMlll3RLANlj,
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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...
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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
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reeordodthe last WlII and Testament or
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~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
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" ~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.
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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.
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GENERAL INHERITANCF. TAX INFORMATION . .
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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. '
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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,
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r~~NSYLVANlt\.llillliUI~NGETAX C1ENEIW.INI'UflMATION
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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" ' ' . "
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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 '
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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.
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~.'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
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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.
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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,
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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
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M,VUI'U, 1"luwol' & J.ohIlU"1l '
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'l'hil'd &. Mlu'kat St;l'tll.ltu
Lumoyna, ~ ].'(0113
N!'l'EN'UON I 'l'hollllla l, MY01'Il
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-
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,',
"
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, - 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)
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Inven\ory of tho realan'd pereonal estato 01
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K lilNNlilTH_,~_~m!:l!,!~'l' 1Y.'li.,__,_,~""""c"_'_ deooased
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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,
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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.
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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)'~
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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