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COMMONWUAI:J'H OflPENNSYLVANIA SSI
COUNTYOJ1 CUMUBRLAND
\Iefore mel tho ROlllslor for tho Probnte of Wills and IIrnntlng of Lullors of Admlnlmntlon In and for the COUIHy of
CUl1lberland,persnnnUy ~lIl1ie--. 1\OIII~R'I' ~I, 1'llHllll,l~
who, bel nil duly SWOl'n ,do-!!.!.._deposo IInd say thllt as Exocul:OI'
of the last Will and Testament of lIolon AUllhinbilUgh 0' 0111'01\
_deceased
110 will wellllnd truly administer the goods and chilttels,rlshts IIndoredUs of said decoQ8ed aecordlnll 10 laW, And
IIlso will dlllSehlly comply wUh the proYlslolls of the law relating to Transf9rJnherUances, swo~n, IIOd subscribed before me,
1', 84' //) -4 I , "/ '" /
August .. A,D" 19_ <~ II' (\ r1! (AI. l./...-u..\.I.. ~ ' ~
. 'ROllER'!' 1I'.J}t~IlLE /,J .~~ ,)
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(/ .' Register
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Be. It remombered that on the
,. - ,
14th
~ dRY of
DECREE - NEW r,ET'l'ERS
-~
AllgllAt-
,A,O"I!ll4
, there was, prObated and
IlIto of
, Cumberland County, PennsylYanla,
recorded the last Will and Testamont of
11Il1.I'.N, AIIOHT~lIAUOII O'aOREK
M8Qhl'n~ig8h'1rg. 1\",..n
Doceased, Letters '1'utaAlQIll:arl' were granted to
Witness my hand and offlolal selll the day and yoar aforesaid,
Rohart II. Tl'imh 10
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OA1'" m' I'~;RH()NAI, "1':PRRSI~NTA'fIV~j
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COMMONWI1Al.T1l OF I'IlNNSYLVANIA SSI
COUNTY 011 CUMnI1RI,AND
Cumberlftndiper80nlllly clime
Defore me, the Resistor for lho I'robnlo of' WlIlsllnd srnlllhl~ 01' Lel.lers of' Admlnlslrallollln nnd'for tho County of
CHI\I1LII;S P. 0' QOHILK
who, belns duly
"1WOI"!:L., do
08 , EXrucuToR
' depose and say that ftS
HruLruN A~qHINBAUaH O'QORILK
deceased
.
of the last Will Rnd Testllmenl of
he . will we.lI ftnd lruly ftdmlnlsler the goods and challels, rights alld credits of said deceasedftocordlnll 10 law, And
1IIso will dlllaenl/y comply with lho prOvisions of the law relating 10 Trnnsf ~nherilances:
Apr1] 2Sth .-\,0" 19---.Ql
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,~W~l"in~(~~orlbed before me,
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, Resister
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. I'ocordod tho IlIst Will and Teslamenl (If
---NmW_Lm~TERS TESTAMENTARY ISSUED AUGUST 14, 1984
--";'''OECREE --"~--'------,
De il,rememberod that on the 2.8th day of April ,A,O,,19 01 "there was probated and
Hb11..E:N AUaHIN13AU~lH 0 f aORE,K
,
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408 E.Kelle~Sb~1 MechaniasGU~g ~OI"O,
. ~
lale of
Decoased, Lelters 'I'esb/;\mentary were,sranled .to
Witness my hand and Official. seal (boday arid yoar aforesaid,
I Cumberland County, PennSYlvania,
CHAHJ,l1lS P. 0 I GORElK
f.-1L3
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.. '.. . '. Resister
elt-lttiu"Y.illill\ JNI.U;mJ]J{QgJM,~\lfJiW3~bWm nll\~TI () ~
1. ~llli-J fOR RETURM
. Secllon 701 af tho Inharltnnae ond EatlltoTlIx AGt ol1!)611Iinvldl!~ thul thll!olluwlng porsons slwlllHllpmo lIlld 1110
o roturn:
0, The porsonol roplCsontotlvlI 01 thu o~tlllo.ol thu dm:lldnlll us tll plIlpurly of tho ducud('111 mlmlnliilorod hy him
01)(1 such oddltlonn!' propnrty whlr;hls 01 ,nay ho !illblor:llu'lnhurllllllcu rllx al whichho/shn sholl hovo or
, ocqul ro l<nowlodgo,
b, Tho tronstoroo of 111ll/lorty upon thO tmnsla! 01 which InhorltillH:O Tux Is or muy h') Imposorl hy tho 1961 Statuto,
Inoludlng 0 trustoo 0 properly tronslorlOdln trust, provided thut no sopOIatu rolurn nood ho mMln. by tho tronsloroe
of property IncllHled in the rQturn of 0 parsonul ioprnsontutlvo, .,'
2, PLAOE FOR FILING
Tho return Is to bo filed In duplicate with tho !leglstel of Wills of the county whoralntho docedontlosldod,
3, TIME FOr! FILING
Tho roturn Is duo nino monlhs tlllor the decodont's tloolh, IInl(lSS on oxlllfH:lon for (jlln~ hos heon op'pllod for ond
granted by lho Soorotmy of Revonuo within tho nlno.month porlod,
4, EAlblLRE TO PILE RETUR]
$ootlon 791 of the 1961 Statu Ie IHQVldesll\ot "" ,any, person who willflllly falls to fllo 0 return or othor,(oport
rOQulred of him, , ,shol! he porsonally liable, , ,to 0 ponolly 0125% of Ihe lox ultimately found to he due O( $1,000
whichever Is the lessor to he rocoverod hy tho Deportmenl of Revonuo os dohts of IIko amount ore reQovorohlo by
law."
6, TAX RATES
Inher.l.lonoe Tox Is pOYL1bleol the rot.o of 6% on..lrOnSfers to IInoal desconclnnts, slIoh os folllOI, mothor, husb..and, wlfo,
soo,daunhtor, grondohlldren, Rrondplllont,' son~ln.low and c1oughtllr.ln.low nnd ollllO rilln of 15% os to 011 others, ..
6".,PAYMENTOF TAX .
The tax assossed on the,\rnnsfer ofiiraperty reperted In 1110 rolurn Is du09 nionlhs nfter the dooedonl's death, Intorost
at the rota of 6% per onl1l1l11 nooruoS tllOreofter IInlll payment Is Inade, All pHyments reoelvod are first Hpplled to onY
Interest whloh moy,he'duo with anyromolnde.r applied tolhe tax, IF TAX ISPAIDWITHIN 3 MONTHS AFT~R THE
DEOEOEN'f"S DEATH,)\ DISOOUNT OF 5%OF THE TAX P^YMIT.NTIS ALLOWED, .
,
All ohecks should ho modo pOYOble to lho RoglslOr 01 Wills of tho oOlmly whoreln Iho deoodentresltled ond me
reoelved suhleot to the flnol.dotormlnnllon 01 tho Departmonl of Rovenuo, '.
7. E8ILURE TO PAY
T..he tOXIlS Imfosed, tORethe.r W....lth ony Interuet Ihoroon, are 0 lien upon reol properly, whloh Ilonlomolns In.eHeotunt.1I
the taxes om Interest Ilove hoen paid In full: The toxus IlIny ho suod lor I1ROll1st any real property Inlhe decedent's.
estote or ogL1lnst any property bolonglng to 0 lronsferoo Ilohlo for tho lax,
8, FI~INGOF FALSI! RETURN
Any person who Willfully makos 0 falso return or wpert 101Iuirod of li!ln sholl, In oocordanco with Section 793 of the
1961 Statulo, bo gUllly of 0 mlsdomoonot ond,oll.cOI1\llctlon thorool, sholl bo nonlllllclldto poy oflllo not exooedlng
$1,000 or undergo ImprlsonlliOllt not excoodlng ono yam or hlllh.
!j
R~V'_14 11.001
COMMONWUA~ TH Q~ PQNNUV~VANIA
lIuPAATMaNl' OP "UVUNUU
TRAN8PIR INHeRITANCe TAX
RlllclNT oucePINT
""'I,IIOlIIJ", rm RovofRO 8/(10)
.~~~,
~f)
BOHEOUI.E "E"
JOINn Y OWNED PROpaf\TY
Estatll.of
HELEN AUGHINDAUOH o'qOREK
- ~-
'filM TOTAL '\ VALUE OP DP.IWlTMENT
NO, DESORIPTION MARK!!T OnCEO!!NT'S ' ' VAWA'T10N
VAI-U!! INTIlREST (Off/t,M (An OllIV)
rt'-1_.;ttl.:;-
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TOTAL. THIS PAGE
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WHEN CLAIMING THE ~AMILV EXEMPTION, COMPLETE THE !'ou.OWINGI
Olalmant Rolotlonshlp to Dllcndttnt .----.-.--.--'.~.-.-.-
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4L!1 '" ,101 No" ---'___ ,..eM ,,-,\1,," ",",-IL~--:"'''--- --1D,05 :
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5/81 ..J:1~.(lra~nerlll..J:!.~.me~___-...-..... .._...I~,t!](l.raD!lL---......,,_.-..-'--"~-'- _.1Ql0, 45 --
6/~1 Wm. Cl'" _--- ^"p"I"l__--~ 7;,00
6 81 ....../J.!J.. lHtzman' 11lat I11neaa --....- 60,00
/81 Rice Mt;'.!ll?l'lal .._--- ~I'Il\le ~..-'-,-~._---~-.. _LM.Q..,Oo
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1281 J.Q.&later of Wl11a .~.__- ......1il.1Mdebta .&.deduct19.n.t\ 12.00'
12 81 'Rell.latel' of WllliL-..~------'" fl1111g_1n.Y~n1QJ:Y.._~_..
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I horebycor!1fY l\1ot 10 1110 bost 01 nW knowlodgo alld bollof Iho forogolng.ls 0 1~lsI and IfllO s\alOl11onl o{'dobts. funeral
oKponses and OKponsOS tlf ndl11lnlslratlonsubmlllod 10 l~~a:~}s ~i'~C}~~fS J tH 111110rl\oncO TaK Pllr;~ot:~:, I A I
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=' = OFFIOIAL USE.oNLV-~"-~ , n
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DEBTa AND DEDUOTIONS ARE !>,t.I.OWED IN THE sUM OF $
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Q.!1JJU1ALlliWmllllN QJ1..U,Xl.Nl:9Jl MA T I O~
U,islIllsflbd II1Iblllllnu Inounud by IhoduCllllunt prior tu hls/lllIr dllllthlHU dllc/uctlblo 1I01llnsI hln/hor tllxnblo oulolo,
In lIddlllonlo dobl8ll1ollrrqd by Iho doourlunt or ostllto, othur It0ll1811ru olnllllnblo Inuludlnu tlw oosl.of IIdmlnlslrallon,
nltornoy foos, flduolllry .fOilS, fllllorollil1d Illltlol OXP(1I18114 IIIOIII[lIl1u Ilia (losl of 0 bll rill I 101, lombr..lono or ornvo markor,
All dobts bol110ollihped lIU1lll1st ol1'ustulo liro 8ulll(lo\ 10lhn upprovlIl of IhoRoolslor of Wills with whom.lho
'Inhorltonoo TllX Roturn 18 fliod, Evldolloo 10 suppor\ tho douudunl's or thu 'oslute's IllIblllty for tho dubls bolng ololmod
should.bo altaohod 10 Ihls sohlldllle,
A family oxomptlcin'of $2,000 IllIlY Illl ollllll1od by II SpOllSO of II dooodol1l who dlod domlolllld In'PlIl1nsylvimla,
If thllra Is 110 spouse, or If Iho 8p01l80 hilS forfoll/ld hls/hor rlohls, thol1 oily ohlld of Ihe deoodo.111 wh9 Is a mornber of
thu seme housohold oan olalm fI)o oxompllon, In Iho.ovent thore 18 no sunh SpOil so 'or ohlld,lho oXOI11Pllon oon be
claimed by a poront or porol1ls WIIO aro rnombors of 1110 slImo housohold liB Iho deoodonl. Tho family oxemptlon Is
allowllblo only 1I0ull1slllS90lS.whlch pIIssby II will or by Iho POI1l18ylvllnlo II11n8tlll1l LIIWS, '
~
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INSTRUCTIONS FOR COMPLETING SCHEDULE "F",
I "
1. If the famllyoxempllon 18 being olalmlld, IncHoale Iho olslmanl'a nalnO, acjdross nnd his/her relationship to Ihe
daoedent, Entllr"foll1l1Y exemption" In the romarksoolUmn and Ihe arnount olalmlld In the amount oolumn,
2, Assign oonseoullve numbers to eaoh'llem IIsled.
3, Enter thl! date on Whloh eaoh debt wa91nourrod ond/or paid,
4, Eo.ter Ihe names of eaoh payee,
'b, Provide a brief explanation In th~ remarks oolumn. for oaoh debl ololmed,
6, Enter theamouf1t of eaohdabt being olalmed, . .
7. The form mllst be slunod by tho. porson who has P99umed the re9ponslblllty for Paying tho debts,
-, -". .~ ",.n",," .~......_~
COMMONWIALTH Oil PINNSYLYAN1A
COUNTY OF CUMBIRLAND
III
~~.IJ~llId~S P. O'OOIIIo:.\<.. .....____ '_._....... .. _...
b.fnl/ duly ._ .IlI'lQrn. _ aocordlnll 10 law, d.polol and laYI Ihal h. . jll_JIll! KKQ~\.ltQX.._ "..".__,
.... H........ 01 Iho Ellalo 01 .lJlIL.lm-AUl.1IILNUAUc.;U_.Q~GOlll\K-___o_._
1010 of 0..406. Ii. Kellol' <il. I McchllnlcHllllrg, ., Cumborland Counly, P."d.o....d .nd Ih.t the
within I. .n Inyon/ory modo by. . IIIM$I~I,I". .. ........ . o___' Iho .ald__IiXQ,S:.\!l2L_,___
of Iho onllro Olt~to of .old dooodonl, oonllltlnll of all Iho potlonal prop'~rty and rn.1 ..Iato, oKo,pl rotl utal. ouhlde
Ihe Commonwo,/Ih of Ponnlylvanla, and thai Iho IIl/uro. oppollto .aoh 110m of Iho Invontory reprolOnl It'. fair valuo
at of Iho dolo of dooodont'l doalh, .
Sworn _ and lublcrlb.d bufor. mo,
L~),-\ '4 ~<.LJ ,_ ,p ~__.__19.-,JI_
(I l.. )} /} / ~' . L, j'
:L'/.(e" (1.(/,. 7/1.0fJ.i (/(10'" tli1:,-
'-././ (HI tW,\ M ','/lllllf1t,ltl', 'I,ll 'Y P!lhllp 7
IHlI',IIII,( Iii).' ,', F\ I 1,I.'jlY.
L..
,
?:.~ (' .)/1(. 0'~)/ !
I . '-"' /.,~ ""
,.- 1(''', I" - .' -, ',' (. I'. .- I
"i~~';;;t.;' :-Ad~~mX ''''''_,__.mo_
CI1AllLllS 1',O'OOIHIK
........._~~. .".~~------~-'......
'MY i;OMI,II':':lIilll!.I'IIII:!i (lIC 11. Hill?
i M~lllhnr, fJfll1mylv,1ill,\ 1\~,~,nClnliMl 01 UfllilfW$
406 II. Kol'lor St.. Mochnhlcabu'rg, I'A
. .- un' -.-.-. -'-^dd;;;;---~--+--f7055'-'-'--'-
Delo 0/ Doath '__"
.2L
O'Y
". .AprHnu_,. _._______L9.81______-'-_~__._._
Month V..,
. (,
I~STRUCTIONS p:;,
I', An Inventory mUlt bo. flied within Ihro. monlh. aftor appolntm.nl of potlonel reprOlentallv'o;:;:~!
'''/''
. 2. '" .upplomont Invonlory mUll bo fII.d within Ihlrty daYI.f dlloovory of eddltlonal am", i"::'
. 3. Addlllonellh.." may bo allach.d al to potlonalty or roally .,..
4.' SOl Arllolo IV, Flduolarl.1 AoI of 1949,
~
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or ffi ~ I 5
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COMMOt4WEA~ nt op pat4t4$Y~YAt4IA
DEPARTMEt4T OP REYEt4UE
BUREAU OP COUHTY CO~~ECTIOHS
APPLICATION FOR AND CONSENT
TO TRANSFER SECURITIES
REGISTERED IN TH!: NAME
OF A RESIDENT DECEDENT
*'
~ (MUST BE FI~.ED IN TRIPLICATE)
TO THE PENNSYLVANIA DEPARTMENT OF REVENUE,
Appllgatlon Ishoroby modo lor gOOlont to tho tranllor 01 the fallowing 10ourltl0l 01 a PonnlylYanlu
Corparotlon or a Notional BanKing Anooloilon logatod In Ponnsylyanlal .
(a)~~_.(b)~Q,~~w...u.~:tL't\ai.)'o~_B~_~__s_W(c) , Q.d """~JL'!L~~_,_,
(NOTEI In describing IOCUrltlU onter In (a), ab 0/0, olthor Iho numbor 01 .hares 01 Itock or tho.laco amount 01
roglstorod bOn!!a, I.n (b), tho namo 01 tho Iss~lng company and In (g) tho clol8 01 Ilogk or tho Itatod Intorolt (ote
and maturity dato 01 roglstorQd bonds,)
. /1~.''1(j. J/a.,.,,, , , "0
ISSUED ON 3/~' 113 ~ ~LlilL, and. having a TOTAL MARKET VAWE OF $. 3~1 .31 ~_ -
(Poto).. .11..1 A, l.~,
as 01 tho dato 01 doath 01 tho docodont, J;:U;J.cxWiLLJ\hUw,lC&. U1.J1Qu_L, on If / ~/ / 81
. .. I (H~7j D..o~ ) (Poto of~ool~?
who wa.lato 01 ,J/O(P l.---':/du 61.-,iH~~4Jjflf-l_fljJf~il'ka' ~-
(5t...1 ond Humb.,) (Po.IOffloo)' (I' (Counly) (51010)
TholOcurltles aro rog.lstO. red as 10110W.SI\~ e.\<':.",. . b~!u-1:L- b. ,_~I CD./~. .u........"..~.
. .' . . . (Homo or nom""~ which c.ttlfl~.. cr. ,cpl.I".d) ,
AIJ.\1l1l0ll\;%IJlURl f!A iJllj~_J1.J::lJ:ln~ei. _!Jp_LC~i?k'" /I~MM ka. ~
EXECUTOR... I " (HOmO). -:J---. (A~d, ..) '. ...,..,c.:.::. cO .V,
, NAME OF APPLICANr.-=~. I LtJ;lot.
COUNTY FIL.e NUMBER':':/- Y.'I'""' ADDRESS 0' "'LICANT~~'~ ;. '.
BUREAU PILE NUMBER . SIGNATURE OF APPLICAN+"':':-~ ~. -n-. Lv....:-a......
NOTICE I IP YOU PAIL TO PRQPERL Y PILL IN' ANY PORTION OP THIS APPLICATION! IT WILL NOT BE J
COMSIOEREP COMPLETE.ANDWILL BERETURMEO ~?U PtOR C,gMPLETION.
COMMONWEALTH OF PENNSYL VANIA... DEPARTMENT OF REVENUE
.. CONSENT TO TRANSFER SECURITIES
DATE
I horoby consont to thotransler 01 tho abovo socurltles now roglstorod In tho namool t
. OAT ~ _~l-/..I'" LI_'O"L.____
Docedent and walvo tho 1IIIng 01 a certl/loato cortlfylng to tho payment 01 the tranefor Inhorltanc,laK 10 which
. . . .
the properly 01 s.ald Docedont Is modo subloct pursuont to tho proYlalon's 01 the Act.ol June 20,1919, P.L, 521,
a. amonded 'and the Act of.June 15/1961/ P.L.373, as amondod. Thl'. Is,also In accordanc,o,wlth Ih, proYlslons
of tho Actof April 9,1929, P.I.., 343.
Thl. Cons.nt to Transler the heroin doscrlbed proporty operatesqnly In rololonco to tho ostato oltho
I
.above.named Decedent.
.
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d
Ii
COMMONWEA~ Tft OF rEHHSYI.YANIA
OErARTMEN f OF REYENUE
OUllEAU OF COUtlTV CO~~ECTIOHS
APPLICATION FOR AND CONSENT
TO TRANSFER SECURITIES
REGISTERED IN THE NAME
OF A RESIDENT DECEDENT
'*
__.__~..,",__n~_.u.____L..__~. .-_.~---. ~--_.
DA TE_J.~I),'LfL~--~.-
~ (MUST ~E FIl.ED IN TRIPl.ICATE)
TO THE PEl'lNSYLVANIA DEPARTMENT OF REVENUE,
Appllootlon II horoby modo far oOnlOnt to tho Ironsfer of tho followlno loourltlol of.o Ponnlylvonlo
Corporation or 0 Notional llanklno Auoclatlon locatod In PonnsylvanlcUk?
I~OTEf-f, ~::,(~~~~~~=:~~{;~~:';~bf.:1~;.I';, ;!1':;f.,~;~;;;~,"",..T
reglatored bonda, In (b), Iho namo of tho luulng company \lnd In (c) tho'cI081 of atock or tho .tatod Intorolt roto
and maturity do to of reglllored bandl,)
ISSUED ON "","II /n.,_~, and haying 0 TOTAL. MARKE'T VAWE OF $.~,~.fI:1.~o~____.____
01 of Ihe dote of d(r::h1of Ihe docedent, . \~t\c.~ . Il.i\W~ (,!JI~ ~<<-k.._, a,,-Jj~d.lt._~--,-
(Ha.Jwl.1 ou~donlU (001001 doni")
who wal late Of.~*,,-~_iJ:Jk_ft_~!tdd(/d'..1__tl~f.t.~i..A..n_-_n_'_.- .
(St...t and Humbo,) . (Po.t Offl.o) V (CounIY) (S,.to)
The IOcurlll.. are regl.leredal followlI \4~ \~ '" _,~,_O_~.a. oJ':~~-----_._-----,--_'
"1..111 . ,n 1J1f4A~(}:J.. .r~zm;~n:mO;.~.:'~"{&'.mO"~...:~:A. 6~ ,d2~
EXECUTO.R .) (Nomo) . ' . . .(Ad<llO."l \ I'. F'.~ I:.J~
. . NAME OF APPl.ICANT -. ..hLJXl.l.--.1.U ~,..,- /J
COUNTY PiCE NUMBER. "l,. !' I "P'.DDRE" O~ APPCIC^NT JS3~_ - --.f!, ~
BUREAU FILE l'lUMBER. . SIGNATURE OF APPLICANT ~ ~ ~ \..V--" (h . .
NOTICEI IP Y.OU PAIL TO.PROPE.RLVP. .ILL 1M AHY P O.RTIOH OP T H. ~S PLIC..A Tlo, I.T. WIl.L HOT a.E :.)
COHSID.BRED COMPLETE AND WILL aE RBTURHBD TO YOU' OR COMPL TlOH. '
.... ...- - ......---.,
J. ...... -' -..... -
COMMONWEALTH OF PENNSYLVANIA - DEP AREN:r;O' REVENUE
CONSENT TO TRANSFER SEC.URITIES
. DATE
I herelly conlOnt 10 ihe Ironlfer of the above IOcurltl~1 now reglltered In the name of
D~cedenl and walv.e the flll,ng of a certificate cerllfylng to the payment of the tranlfer Inheritance taX to wlllah
Ihe property of laid Decedent II madelublect purluanl 10 the pravlll.onl of the Act of June 20, 1919, P.L. 521,
al amended and ihe AcI af Juno 1.5, 1961, P.,L, 373, a. amended, Thll II 0110 In aocorda~ce with Ihe pravIslonl
of Ihe Act, of Aptll 9, 1929, P,L. 343.
Thla, Conaonl 10 Tronlfer Ihe herel.n doaorlbed property operaiel only In reference to tho oatClte of the
above.nomed Docedent;
'*
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"
\.. C::;, F_r
t, i" "'f
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li:V' !!!it Ilff":!
(:}; ~ \:\~I
rutij m~!~
8<'; ..-"
Iflr.i ~ dW
c.:'~
.,
IH'-V..1(1O (0,"/6)
UJMMI.lNWE/\I:rlj cW P'~NN~\YLVJ\NI/\
IIFI'/\f\1 Mf~NT (W IWVl:!>IIJr
IIlJl~EJ\U or Irua,D ol'lm^Tltlt~~
APPl.lqTION POR CHAllITAB~E EXeMPTION
PROM peNNsYl,VAN'A TRMlsPElllNueRITANce TAX
(^r;1 flI M11V 2f1. 1966, p.L. I'lS111H1I1 Act or Junft 151.11)611
P.L. 373, 01 cunelldftH)
l~~
..........
I
..
'j
- !~w"~~"I...'I:-'-"-'-T~ - _n"_____-:~ ---"'i~'~-~
_..~
,
,
,l.,
Ai'I'II"oll"n I" hOloby 1I,Iod fOl th,; oprrovol
ilf (Ill (J);UIlIPtlnll frut1l PiUlIlsY!Vrllllu T'(Inlfot
Inhotl'ollo" Tox UII th" "oll"ft'r ollh~ ptopo,ty
"olo"ho<l bulow,
1. lIo,ono Fllo II. ./~JC(t'/"_q,;;J_6"(._ n__.._
2. I)uto of OQuth. Apr.il 21 t 1981 h . h,
, ~ i Pi'['.
3, '00'0 of App,ovol .. .. )y'(vv'l\f'1'1---~->..I.--'-(_H:~:!:-"----.
;~~..!!/ ().co".I~L:.==._.E11ULAUGlllN13AUGlL9).GOHEK .
0, Th. Com'nollwo"'!th',, orp'"I,,,d vllloo.1 tho p,opo"y 10, whl.h 011 oxomrlloll ,. clu"n.~ 1.$ ...._ 40,042,,50. __......
(Nolol' Wh.,o iho p,upolty 10 .tho, Ihon . op.ClfI.d o,'\.unl of cooh, tho nx.mpllon connolb. opp,ovnd "nIlI' tho v.loi) of
Iho P'9p~rty hOG hooll' u.I"IoIl"ho<l by ullprul.1I1 'by Iho Cummollwoullh, o"c,oPtllllhuoo coou wh"o Iho'ol1l.onl.1 tho Rift
., boquo.t 'O,,'.OOllt; " ,t.lod 1'0011011010' ".,QOlllooo ".rll," of tho .nll,o 0.101. ., tho Ulltl,o I.olduo, In Ihou caoo.
OIl;V' .oj.h f,ucllolltJl 0' "o<<unlooo 0010011' obov.),
6. Chock Iho mOlloO, In which ,11,0 frall,fo, wn. .floct.d "nd ,olomlt 0 copy of tho ,I~com.ot .utho".lng Iho 110001.1, ulIl...
.ou"h ,"oto,lnl. 10,,, buolI p'."lnu.ly fllud. d . I '
II I' 11 L! Ii" 1'<'Ii~.1 '.(,"/"1""
WILL IXI)( .t 0 -b'l!lill~;1 TRUST IHllENTlJllE 0; SURVIVOIlSHIP!}; OTHER 0,
. (If olh." oxploln)'H~____h__m'_._h_~:-'.~...,.n___.__._~.._.__'__
7'. C.,raal B"oln... t4um.' on,l Add,... 01 Cho,ltobl. O,go,d,'o'tloll ,ociolvlno p,opo,ty,
N AM E ----;.-----.'-n--WESLELUNl.'LllD.Jv1lU'lIOIllS't-CHU.RCH__
.-....-~_._---------------.-
ADD R e SS _____n:.:..F-llbnr.L_._&.c. Simps 0l1mStr.e.eis..,_Me.c.h<l.fl1cs.\m1:.g-.-14\-.-1+055
o 500 IlstlllO on ,Oyu,sosldo for uddltloriol charltablo orgolllzollonscovo,ocl,
8, I cOltlly.thol tho IlIfo'mnllon conlnl~d 100'011110,. t Ih" bo.t of nlY knowlodo. ond,boliof, Iruo ond,co"..t.
"'-. '-~(>L-,-. <\/1 . J ( .SL~
~lgnollJr. .f Appllc.nl 7r-------- _~'n---'-. _+_~~-~--~-. .. j ~__
Add,ou.I'Ap~llconl ( )',S~~~_~.ox_ 288.!._J~llsl~.':l.Eg.L.fL' 17019 .. ___.
O/flclol 1'1/10 ____~J~':t:'~:Y_J~~.__Esta te __~_~___._Dot.'
. 1982
~~"""-o.
Thl./arln mUll booomlllol.d lu 1,Ipllonln 1I1111"lIlhIO. n'lllos dollvolnd 10 Iho (1oglotol 0/ Will. 10/ Iho County In whloh Iho
doCQd,,"t l'o.ldod, Olin wlllnl) Inllo" WOIll IUlII<<1 fOI'" nou.,o.Id"nl dooodollt'. .ltnlo. 1/ tho dooodolll woo 0 nOI1<ro,'donl of
P.nlllylYOhlo nnd 10\/011 wo,n not III1Iml by n P,,nllGY'vunlol10011t01 of Will., clollvol "lIlh,ooOnl)lo. 10 tho DllOolor, BUlollU
of FI"ld 0110mllon8, Ponno, D"'lOlllllollt of. l1ovonllo, P,O. \lo" ~o~o, Hnrrllblllll, I'll, 11100,
D. not w"to h.low thlo linn ; Por _Off.!E~J. tho Onl'
118FERIl8D 10 Bur.ou.Hoodqo"I."
Applov.d 0
PUI Soer,'oIY of R.v.non
D.ol.d' 0'
--,-<--._---~".-. ....---- .
(llIltlol. .f Rugl,'o,.f Wills) (AUlh"I~od Slgnotur.)
,
~--~.........-~.......,.........~---.-.. -"-----------.-...---...-.-"~-_.
(C.unty) (Titlo)
---.---"", ..L______~*+~--...~__-----'..~_____.......~ _______...--<-.............
(Dote .f R.f.".I) (bot. of AolI.n)
, Soo rovdfoiuld. f.r '.0000'
. ,
MUST OS PI~SO IN TRIPLICATE
UH"tf..\tINW!: AI.Tli,OI' P1:'NNSYl.Vf\NIA
II/':PI\f1TMUi.I'f OF tltVr,NUP'
\'UHU-\~HW f1ltil.lJ OflHR^TIO"'~
APPI.ICATION /io~ CHAfllT AtlLE EXEI,\PTION"
r-nOMI'F.IINSYLyAtHA TnANSPCR INHERITANCE TAX
, (1\(;1 IIf MIIY 711. 1?b6, !"t.. 1157.111111 ^cl of jUfHI JUI 19/dl
f1,I.. 3731 (Ill nmfllldbd)
rT" ~"u_,,,...,,, _._--.'.
~",___n~,~.....n_
~,..- f~'~~"" .-"",11-''''--- --74 -T1~-'~-~~'X
-R." .':'.4":':"__..........~. __""40__ -41~R
Appliccltlon I. hereby 111..1' fo, Ihn .pp'ovol
011111 oxomptlop fron' P.III1,ylvenIU T!Oll.rer
'I\horltllll.. T~~ 01\ Iho Irllll"lt'r 01 Ih" properly
d..crlb.d bolo>w,
1. Ilu,,"u I'll. 1/..-..., ,:U.J I.. . ,:{ /, :;
2.0.I.ofOolllh ^Pd[,21,1981, __ "'u,
l3' Oule 0' Approv.1 '-. - ,)!\~~ld .~3J..._ !-2J.'-'?~_,,_u___~,um____
I,
-I. Nomo 01 D...d.II1 - -_..---..---.JillJ.J.\N_.A.UGIJ1NJ3AUGlI (}'OOIIEK
-.......---.. ....--------- ... --.
S, Th. Con,m,"w.ohh', CplHol,ed vuloe 01 tho IHoporly f.r which 011 e~.elllpllon I. c10lmed 1.'$ "...lo.,1l0Q..O(L__--.:~,., .
" , 'j
(Holol Wh.,..,h. prop.rty .1' olhol thon 0 .p..III.d omounl 01 cn.h, tho oxoillptlo" ..""01 be opp,ove<l untll.lho v.luoo'
tho proporty h., b.." .,Iclbll,hod hy oppr.l.al by tho Commoliw~ullh_ .r...pt In tho.. ..,'.' wh.r. tho .mounl.f the Alft
or baou.uI (opr"'oitl, 0 .tlltod IrO.lloitlll or p.r.nntou. portio" .f Ih. ontlr. ..101. 0' th. onll,. rOlldun, In Iha.. 00...
."tor .or.h f,octl.nol or p"""nf.u" omounl .b.v.),
~,.ChUck tho mnn"nr In whlah tho Irarl.l.r was .ff..t.d .nd .vhmlt nc.py.f Ih. docum.nt .vlharl~lnA Ih. Iranolor, unlo..
lu.h n"'t.ilol hn, b,\on p,.vlou,ly III or!,
. WILLXZ';
Dl!6.D LI;
TRUST IN06HTlJRE 0;
SURVIVORSHip 0;
OHtER 0;
(f' alhor, .xpl.'n) ----.___..~__.'--_._~~_"'n u _.u___,______nn,.___n_'.--.-_~_________
7, Carr..t l?ouoIM'" Nom. and Addre.. 01 Ch.rltllhl. Organl~atlon r.c.'vlnD proporly'
N AM E~________..!!I.~L E Y..l!.!'!2!ll J) _~,lrl~!.9D ~!_~~I~~~~_II f
ADDR BSS J1i 1 be.::..!_~~~:.r~tln~8:~_~echll n lc~bu)~~!.^-] 7055
o 500 I'lstlng On revorso sldo lor oddltionril charltoblo. orgonl~atlan5 caYMad,
8, I ..rllfy fhil' th.'.nf.rmal'on .0ntolnqlJ hor.I'l' I., t. Ih. hool of my knowl.dg. .nd b.lI.f, frv. ci"<l .orr..t,
, ,
i ) e
SI t fA II t ','~ \",_ (, __/'1__
gn. IIr. 0 1'1' .on -lu-7~--------'--'~--'=---"---=r:--- , _
Addr....f Appll.anLm---,__2.~O~_._.!l_~~2~~__QUJ_!l..~~!.!:g, I'A }]019 .____________.
Olllclal Tltl. ...:..__~!.t~~:L!:~!:_HI!,8~1iJ:.~__~._', ____Dato_.. 1
1982
Tlil. form multbo uamlllotnd "Hrlpllonto nndlllllltroo oalllo. dollvorotl to th. Roul.t..r of Will. for tho County In wltlol, tho
do.odont ro.ldod,.r In Wlllnh lettnr.. wnrn 1..lIorl for ["lon.rn.ldont tloootlnnt'. ootalo, 1f,Iho donedonl wos 0 nan.rn.ldonl of
Ponn.ylv.nlil nntl lotlun wnr/) not IMu"r1lly 0 Pnnl1lylVllnlo Reolstor of Will., dnlluor 011 ,throo 001110. to Iho Dlrool"r, Blllonu
of Plold Ororollon., Ponno, DOllor!mont of Rovonuo, 11,0, Bl1~2n70, Hortl.blllO, Po, 1710(;, ..
_,_~_ O~ not writ. b.lol'!..lhl. Ilno. ~.r OJ!!.~.LoIU,. 0111
'Par lil. S..rot.ry'., Rev."u. RBPBRRBl!to B\lr..u,H.ad~uarl.r'
__.o.-..._---.______._--.__~
;..J
AppraYod 0
Par Socroto,ry 01 RoYonuo
D.nl.d*O
t.r 01 Will.)
~ ._~-
9ut. (County)
-~-". '. l,"~. -o1-4-l1L~.
. (Data l'^ppiov.1)
(Il1ltinl~ of RUIII,'.r 01 Will.)
(AUlltorlzodSlgl1oturo) .
----.----------,---~-------------..__....
._._-~.....-
(CoUI11y)
(T1'tlo)
---"__.._._____..4__,..,..~____...._________
__..__.__........___..._H..______~.._,__"__" _~.....".
(Oat. 01 R.,.,tal)
(bato of Acll.,,)
· So. rovor.~ sld%r reo.on.
, MUST De PILeD IN TRIPLICATe
, ,
" ,\"
.
i '1
" 'j
~ubJl)ut I"'" to C\\ill'\\" 1I\Il'h tuXI'1I ,If\,ilIlHt ",'Y r,'III,llIilry "lIt,ltII', It b,nn",
my IlItl'lItlulltllllt I\\IIHI ill' till! ,.11'111""101"1 tilXI',I, ,tlt'",r [,,,1111'011 Dr '~t,HU,
or 'uny prnpl'rty ru,lllIlrc'll tll lw IlIdl,"I,,1 III I1lY ~r."11I ,UHtiltu" 4nJur thu
pru~l/llulIlI,of UllY ~t,ltu nr .1'1'1111\',1\ 111101 1\1'101 In fur"" or IWrI'lIft'r 'Md"
ad, /lIMn bu prqr,ltud .1I1111nlol thu pur,1l1l\l1 II1tl'rllllt",1 In my ~~lItiltu to 1oI1",m
,
lluuh propurty 1IIIIr IMy bl! t 1'1111'1 1'('1'1'11,1 or t" IIh.\m ,Iny bllllllflt IlcuruII~"
JJ'J:1\ 81 if ilt thu tlm,. 1)( my,dl'"llllll, tll."'Uh,IIIII't bu"n II \\r,IVII'ltrlllll
plUI1UII 011 th,' lot uf my pllf\'lIt II , Jllhn IV .In.II.1 11\ l\u\\hlnbiIU~h, Cholltnut
I\lll Cllmutury, HllclI,llll,ltlhlHI\' ,II1'lIlIlIylv.lIllll, I th,'ll dlrllct my huruLlIlIftuf
11 II IIIIHI I(xllullt"r tll UI'I'u,t II f\I"I~I' IitUIII' 111111 pilY rill' 1I111111! Ollt u[ my'ollt,itu,
1l1&.~1 91, t. IIPl'ulllt my hllllhllllll, ChlldulI 1', 111(1oruk, 1111 !\xuuutor
of thLII lilY 1.lIlIt \Htt 1111<1 'l'ulltlllll"l1t, ~1\l\IIIII"IY. lnllChllll.l (1I'U.lIIOIIIIIIUl1ll', full
tu qUll! tfy, CUIIIIU tll n~t o't' rUII""11,,,l Pl'lI""t,!, 1 thuII Llp\loll1t guhu!'t 11"
:):rl.lllb1u of 214 IlLlllt Nl1in Strullt, fluchLllllclIburtl, PUlll1uylvII111ll, all 1I1turl111ta
Ilxouutat' of thill Illy LIIHt WIt \ IInd 1'ulltllmunt, If I\olll'rt II, 1'rilllhll1
ill ul1L1ble to perful'ln 111 thlllclIlH\(llty, I I1ppalllt Judith 1'dmI>1.€1 fll\uVO
liS sauollu nlturllutu of thlll my LI\1l1: 'Inl \ nod 1'clltuml1l1t.,
Yl'I':H 101 1 \\ll'l'd thllt IllY I(XI!Cutlll' or hlH 111Il\I)UlIlIllrll "hnll not.
bo ruqull'lld tu (lIVll I>tllld l'ul' till' I'lIlthl'lll pu,'rurnll,lwI' 01' thlll1~,dlltluR
'111 IIdy .lllt'ltidlotlul1,
IN Wl'l'NI':HH WIII'~I(I.;oI",
.:::ri . '
t.\IIY of _,.__.._.f\N,\,l.,ct,.V. .~
). IHt~u hUI'lIl1l1l:lI lIut ,my hllllll,'IIIHI lIl,!,1 ,thin
joM
.._n' '......,~.~
198~, . d
'Ii /l I , j,. /010 'dJ
...: Ir I~ 1I.',(;d.~JI r!'("'" (,t ,L!( ..t:; '~tM. (-..,'
\II':I,I.;\,j AunllINII;l\lJOI O/OOln:K' '"
... t.'
1'111' pl'I"~l\,III1l\ 11\>111'11111<'1\1., eOI'" I >It 11\1\ or (:h I II 111\.1 tWII othur
,. . /I
typl'\~I'II:tl'll p,1I Ill' 'I Willi UI\ thl! .IllY 011.\11 dlllu thl!I'I'''1' fl I 1',1\0.1 , IH.'1110d,
pIIl>llnhl'" 11111' ,I<>cll1\'o" by 111,11'11 AOI',hllll>;lollll olnOI'l1\\, thllTI1HI:lltl'lX
hot'ulll IIlIlnl"', 1111 111111 for \",i' LlIHI: \~III 1111" II'UIIl/II\\lllll, [n'thu prl"lunou
:1).( UIl, who, Ill: hur rUI\lluuL, In hill' PI'UllUllI'l' ',llId [" tho pl'uHI!I1Un Ilf ',,",
\~\h Ot.hlll', huvo HlIhHcrlhu.l IlIl\' 1111\\\1'11 II~Jl\\l'fIIHHI hUl'utll. ! . /
~~:,;.,....LJ~,',,: .." __\:tg,~:" (':,~y-:h.,.,'
( .. . .. d.o.. 'fiJ .,;/1 f,...0l' ..jJJ.,.d...'. ~~~
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PRESEJNTI;:ri' LW Diane G. Radoliff:, Flaquir,9
Wij.ey & l3enn, aox 2~rj, nillsburg, J?1I 17019
(717)432..9666
, "
~~ BBHALF 0J1'.1 Robert. H. Trimble, alternate
eXbcut.or of: the estate of Helen lIughinl;laugh
o'C',orek "
-:;"'t.J M "'1I1.,~'lj ~<41
f '~ ,t-
. I
. .'
,
"
Re~, 11l47BK (10.88)
J aUREAU OF eXAMINATION I NOTICe OP INHeRITANCe TAX
PENNSYLVANI~.c?a~~~T~:~J OF ~pVENUE APPRAXlaMeNT, ALLOWANce eR DISALLOWANce ACN
HARR~~URO. PA 171~~ . . 1_ CF DeD~CTlONS: AND ~ess\tleNT DP TAX OAT~ 11~24~P?
!STATI OP OaOREK IlIllLEN 11 FILe NO, . 21 e1~0268
gAIL.M-!lJAT.I:L...Q.4:"~.l... . ._"_~__~_'__~_'nn_._.-',~_ ,u__.umQllYl'!tI'_CWIEIlllll"TlllIL
NOTS, TO INsURe PRopeR CReOIT TO YOUR ACOOUNT SUBMIT THS UPPSR PORTIoN OF THIS NOTICe wnH YOUR TAX
PAYMeNT TC THe RSOISTSR OP WILLS OF THe ABove COUNTY, MAKe CHSCKS PAYABLe TC "RSOISTSR OF WILLS,
AOSNT" ,
101
CH1IRLES P oaOREK
. 405 E f{IllLLER ST
MEOll1lNIOS8URO P1I 1?055
PLEASE RETURN THIS
PORTION TO REGISTER OF
WILLS IF PAYMENT DUE
I
OUT ALONG THIS LINB
.. '.. .. .. .. .. .. .. .. ... + .. ... ,.. ~ - .. .. ~ - - "" - - - .. . - , .. ;. ... - .. .. 0- .. - .. _ , _ .. .. h .. R . _ .. .. _ ,.. _ .. .. ~ h "' . .. .. <- ;. .. _ _ .. .
NOnCS OP INHSRITANce TAX APPRAIUMeNT, ALLCWANCS OR OISALLOWANCS OP OSOUQTlONS ANO ASsesBMsNTCPTAX
RSV, 11l47SK (10.88)
'UTATS OP OOOREK llELEN 11 FILS NO,21 81-0258 AON 101 OATS 1l~24-82
...............-
"-~""'-"""'--'---"oo_._~_..._~___.__._-----+-o___~,_._._,.._.__~__..~_..~~.,....,..__..
T,AXRETlJRrt WAS: ( ~.A9CEPTE~6.\!.llilL_.L.L c~I.eN.Q~P----=-?.!;)JLfiTT1IqtllPQ._NOT IQEl. '
APPRAISSO VALUS OF RSTURN IlASSO ON11 SUPPLEMENT1IL
1. Re.l EII,'e (Sohedule AI
,2, Slooke .nd Bondi (Sohedule B)
3, Clo..ly Held Sloo,JPlrlnerlhlp ,'nlereal (Sohedule CI
.4, . Morlg.gea .nd Nolea (Sohedule pi
I, C,sh 8<MllnellAneoul Peraonal, Properly (SohedUle Pol
B. Jointly Owned Properly ISohedule FI
7, Tranafera (Sohed4le QI
,8, T Olel Auals
RETURN
( 11 5?,000.00
I 21______.00_
\ 3) ~~__~....:.
141 .00
I 6) __. 1 n i 569.84
( G) _. __J..Q.\L...
I 71_ .00
(81 _. 22h569.84
APPR~V~~ O~OUCTIONS ANp SXSMPTIONSI
9, Fun,rel, Expenses/Admlnl8\r.IlY, ,Coal.!Mlsoell.".ou~
Expensel ISohedule HI
10, Deb\s/MorlOlgea/Llena (Sohedule II
11. Tot.1 Deduot,ons
12, Net' V.lue of T.x ROlu'n
13, Ch.rllable/(lovernmenl.1 Be~ue.tl (Sohedule,J)
,14, NOl Value 01 Elt." S.ubjeot io TlX
AsseSIM'NT OF TAXI
1 I, AmoU'l1 01 line 14 lex.ble II 6% "Ie
16, Amount.ol'lIn. 14 i_xeble .1 15% rile
11, Prl~olpel Hx DUe
1AX CRSDITS I
1151 158 ,1;;83. 84 X,06~
I 161_.......!J 420 . 00 X. 1 e~
(111
9,521.03
363.00"
9,884.03
PAVMENT R~CEIPT
DATE #
",- .............
0?"20~81 029658
01-20~82 069954
........ ---.-.---.----------.....
DISCOUNT (+)
INTEREST .(-)
_----.-~-,......-,-_.,-_.........-~, ~~-----
390.00 "
.00
AMOUNT PAID
?,410.00
2,080.46
IN'l'IllRESTi 18 OHAR(lIllO AT 20 PERCENTF;; 322 -~ 1- TOTAL~TAX CREDIT., ,. =--i.JJ.iio...A(L~~
D1IYs Fa OM 01"22-82 '1'0 12-D9~82.. BALANce OF TAX oue' , 3.51
c~-'jNTSRBST -,~ .63 -
II IF PAID AFTER THIS PATE SEE REVERSE FOR CALCULATION -~-~ TofAC Due --- ---"-- 4.20
"""""" INT"''' · '. ___ _ . . .
RSTAIN THIS PORTION FOR .YOUR REOOROS (If Bal.noe Due II Ie.. Ih.n $1.00 no p.ymenl la reqUiredl
I'"
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UURftAU OP ftXAMlNATION
PIl"N8V~VANIA DIlPARTMON:f OP RSVIlNUS
1',0. UOX 0321
HAIlnI88UnO, PA 111011 '
.
OlCldlnfl Nlml (Lilt, flrll,ln MI dlllnltl,1I J, Omdenl'l MdrulI J ,/ ("
~ '" ".( ':4. I ,I , 1/&' I .&7 11't"lrrlf! ",?I',
OEOEAIEO SOg IIS,eurlly Numh, Olltof O..th r Ii J, hi
_. 1#''1- e'''i1'.:.!L't',jf c1l/- ~".rl A/f'f!;/~AI;'~.( ""11 I 'H, 11(.1:r~
1, OrlDlnl' Rllurn 'IKI' 2, 8uppl'm,nl,1 Rllurn 0 3, R,mllnder Rulurn 0
/I ,;.1,/11 'L? )
INHERITANOE TAX RETURN
RESIDENT DEOEDENT
"'-,
, !/';c' "'1/0.(1
Pile Numbor 0-:/- If/ - ,I twdr:. Ii
-
OHBOK
APPIlO,
PRIATe 4, LIf. EII'I' 0 6, fldlr,1 EII'I'T'K 0
R,turn Rlqulrld,
BLOOKI 8. OlOldlnt dlld '11111_ 7, Oleldlnt mllnllln,1I I living 0 8, Number ol..fe depolll 0
IAu,eh co V ul Willi trUlt IAUtOh co of trulII bom IlIvenlorled
All corrllpondlncl Ind aonUdlntll1 IlK Inlormatlon Ihould ba dlreetad 101
OORRE.
SPONOBNT Nlml Addr," ";jli/c,.if: /i-1/h-A! -l'-r:
011 ~
Rlftplt.ll1lon
" Rill EII'tl (8chldull A) (11
2, Stockland 80ndllSahtduII 81 I 21
3, OlolllV Itlld Stoak/P'l'1nlrlhlp Inllfllt (Sahldull 0) ( 3)
4, Mortu-glllnd NOlll18ahldull 01 ( 41'
6, Celh & Mlleell,neuul Parlnnll Prollartv (Dchadule BI ( 6)
IltiOAPIT, U, Jolntlv Owned Proportv (8chudulo P) ( 01
ULATlON 7, Tllnllera (8ehedule 01 ( 71
8, Tol,1 Groll AIIIII h01l1 IInll 1.71
ANO 0, punurel SKPlnll1 Admlnlltr.Uve COllI/MllCellonooul
EKp.nlll (8ahldull Itl ( 0)
TAX 10, Oebll/Mor1gl9ll/Llenl (Schldule II (101
11, Tol., O,duotlonl hotalllnll 0 & 101
12, Nil Value of Ellall IIIn, 8 mlnulllne 111
OALDU, 13, Charllobll 8.qulm (8chldull JI
LATION 14, Nit ValullubllCI to t'K Ulnl12 ,"Inullln. 13) ,
.1""~ ..",,~, (It'
/71; ,rt Yo .r~
.I?- "t.!..!, ;)'"~1
( 81 ~.:!I; ,1"0' S't/
(111 . ~-t;:tI
(121
(131 /'~ j~ .'
(141
K,08" ~ ,~"'.2.;l,';~
K,16' .1'4"'7, t/G.~
(171 ( fI :r F, ?'-~
Oomputltlen 01 Tu
16, Amount 01 IIni 14 IIKlb11 al6% lIte
lInaludl v.lulI Irom Schldull KI
16. Amountolllno14 tmbl..t 16% r.tl
(hlQlude vllulI from Schldule KI
17, Prlnalpll tlK dUllldd II" frem IInl 16 plul tlK Irom IInl 18)
IS, TOIII.Prlor Plvmlntll
II) .Amount Paid _~~\"':~_~
(b) Plul Dllaount __ .., .......
(al ' Mlnulln!"..1 .. Llld, ,11J
1ft, Ollaneu DUI ti1n117 mlnulllnllll
Mlkl Chick PIVtbl1 tOI Rl9ll1lr 01 Willi, Agent
· ., 'LEASE IlBCHICK MATH' · ·
(161-L.J"~ ;1'"li~' ill
(16) ~ i tc..~, -;4(J
1181
*7; 41'(), (t(l
(101
Under plnllllll of perlury, I dICI,,. thlt I hlVllKimln.d thll return, Including 1IC0mpinvlng !Chldul.. Ind Itltlmlntl, Ind to the bllt 01 mV knowledge
Ind blllll,ll II tru., aDrllat, Ind c.omPtltl, OlCllllllon 01 ptiptrer oth.r thin Ihl Plllon.1IIpr..'""tlvlII bllld on IlIlnlorm.lIon 01 which preporor hUI
unv kl1owlldgl,
SIGNATURe op peRsoNAl. RBPRSseNTATIVB!Sl
-
OATS
ADDRBSS
iiii.iNi\i;ijAiiOmEPARiiiioTHIl R THAN R BPRIlSSNT A T I VB
ADDRBS8
PATU
He C-li 19-G81
COMMONWEA~ TH OF FENN5Y~~ANIA
DEFARTMENT OF REVENUE
BUREAU OP COUNTY CO~~ECTION5
APPL.ICA TION FOR AND CONSENT
TO TRANSFER SECURITIES
REGISTERED IN THE NAME
OF A RESIDENT DECEDENT
.-. . ... . . --~.. --- ,~- - - .
w,
.. ".'oATe~iZ~.1~~;21~--f
~ (MUST BE FILED IN TRIPLICATE)
TO THE PENNSYLVANIA DEPARTMENT OF REVENUEI
Application II hereby mode for c CII1sent to tho transfer of tho following socurltlol of 0 Pennsylvania
Corporation or 0 Notional Bonking A..oclallon located In Ponnsylvanlol '
(0) !J38~. ,(b)-~l1:h-tla1:irmlll-'Dl!IIIIHItDck-"-----'---' (cL--~Qml:111-:---
(NOT n doscrlblng sec111lflor6nrllnil\0/, l1D OlD, oTllf6r"fllo numbor of sharos of stock Dr the faco amount of
registered bondi, In (b), the nomo of tho luulng company and In (c) tho cia.. of .tock or tho statodlntorosl rota
and maturity dato of reglltered bonds,) ,
1/2/70 .. 3/2/70
ISSUED ON 3 '26 ,%3 _ II '.u.u_, and having 0 TOTAL. MARK ET V AWE OF $ ~~l~O,.-
r r( .,.) rur u..
a. of the dato of death of t~e decel!ent, llo1en ~inb!lltl'rh-O'r.lOt'ttJt.--,-._, an--4ARf&l
, .m.-.-IPi.....d.ntl (D.t..f d..th)
who wal late of -461Hr,-I<81-l~ rt:reot, -Maclhenwe~r-eunt.l1~1-N'drPtlnrl8V1Vftn'!a------
(Itr..i .ncfflum " (P..t 0/11..) , (C.unly), (St.,.)
The securltlos are, roglltored as followll-He1lil'l-A\WIUnbaUlJh--01Gol'ek------....---..----------
(Nim. .r n.m.. In whl.h ..11111..,.. .r. r.ol.t...d)
ADMINISTRATOR)~tH1 P 'G~~-4()6-1~KQl,18t'-8tll:4lQlor#\QI.:II\IW,gIlW~V;h-iIoMay.J.van~n
EXECUTOR) (~.m.) '" ,(AM/i..) ,-
NAME OF APPLICANT ---.iJatHI.-WUe'frP;tJ~d;lltt~--'---
, ,
CqUNTY FILE NUMBER. 21 Bl-a68-- ADDRESS OF APPLICANT ,.P..o..-~ll.,...DUJ.IIl1utq, ~.sni4
BUREAU FILE .NUMa~R __SIGNATURE OF APPLICANT_~
NOTlcel IP YOU FAIL TO PROpeRLY PILL IN ANY PORTION OP THIS APPLICATION, IT WILL NOT BB
CONSIDeReo COMPLeTe AND WILL Be ReTURNeD TO YOU POR COMPLeTION.
COMMONWEALTH OF PENHSvCVA~i:DEFi~T 6F. ",;.NU;;~. . . ~
CONSENT TO, TRANSFER SECURITIES . DAT ""--~/.'(1./.I::2f./flg
I, hereby conunt to the transfer of the above aocurltlos now roglsterel! In the nome of the a .oruold . ,
Decedent and walv~the filing of a,oertlflcatecertlfylng to the ppyment of the tra~sfer Inhorltanco tax to which
,
the property of laid Docedent Is modo sublect pl)rsuo~t to tho provisions of tho Act of June 20, 1919, P.L. 521,
as amondod and the Aot of June 1.~, 1961, P.L: 373, 01 amondod, This I. 01.0 Inaccord\lnce with the provlllons
of the Ac't afAprll 9, .1929, Pi!.. 34~.
This ConlOnt to franlfer the horoln described property operatos.only In roference to the ostote of the
obovo-named Decedent.
'*
. 51 gno~}.o. ";~~':"I'" of R.....~ . I
. BY~ - ,A (I, ~/A: d'./..
4' ) 51 on. ') (i / '
~.., .--ifl- 'e'~, j,~,.)_.;ad/le'U&1!t,,(--
) 1(14 ( .vnly)
, ;; .
L '
COMMOHweA~ TH OF PENN$HVANIA ' APPLICATION FOR AND CONSENT
oePARTMENT OF ReVENue I TO TRANSFER SECURITIES
BURAAll OF COUNTY co~~eCTIOHS i REOISTER!:!D IN THE NAME
1 OF A RESIDENT DECEDENT
,,>- ,.-~~-_..;.~_.--.._-,-....,-<-...-..-~"._--_. ._----.....~~-~~-"' ..,. ... ----.. --
APPI~ICATIQtj (MUST BE FILED IN TRIPLICATE)
TO THE PENNSYLVANIA DEPARTMENT OF REVENUE:
APlllicotlon I' hereby rJ1Qdo lor CCAuo"llo Iho Ironsfor 1\1 tho following 5ocurl!109 010 F'onnoylvanlq
COlpolullon or a National Bonking Auoclatlon,locatod In POf\n~ylvOiliCl:
(0 Ll3-<t1..'S h jb)_e.!.l_~~',:lL~;.....~~ 'Ja"" ~, . (c 1 .~ t:-.~'r.'f,\.f_ ~...._m_~
(NOTE, In doscrlblng soculltles ontor In (a), ab 010, ollhor Iho numbor 01 Ghoro~ 'If stock Dr tho loco Uf1\ount of
, rogistorod boods, In (b), Ihe nomo ,~f,lho Issuing compony and In (0.) tho ~I'll' ')1 slock or tho Slolod Inlorost roto
and maturlly dato 01 roglsl.rod bonds,) "
J
'*
D A T E..]J.i!Lf~._:=_=~_.mm
ISSUED ON~~t.\I_&~-.'''' and having a TOTAL MARK ET V ^ LU.~ OF SJ_..3_((L.~51.g_.~~,u_n.n..-
.. (1l.1~) .1 '0.' I b I , 'I I
as ollho dOlO of deoth ollhe docodont, J~dtY\- 1.lJo.\\;Y\QI.I,,~k" Ijlrd:, , "n ,.<(..l.t.l.oI,"
nlfllll'bJ", ,D')cl,"jul~ CO.1Ift)1 ;J(tJII,\
'who 'NOS Inlo ol"__!l~_~~..tf,.j~/hr.".~rL. j(/(dA~ H I::"~. JII ~J.~t(I1!;' "~,..~ R.o.
(5"",' tJnd N~mb,n (1"'('\"Offir.nl I elllfl",) $1-J1t,,)
Th~.socurltln QrO rOglllorodol fol.lows:_J~.c,J "~,,,G IM't\~,~", ~k.Qi C(fYl!J~d' ............
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EX l:CUTOR (Nom. I . ,lid'." I .
NAME OF^PPLlCMlT u "'i..,.' , "'.~:: '~. ,~'.u""_''''_
COUNTY \II.E ~luMBeR;J-U::._(l~~,r^DDRESS OF APPL'ICANT.:.r, """~_:_'''~'';''>''''~rL.'-~~-!I,/ I
~~~~~~ Fi~;~Y'~~.I~R.TO PROPllRL.Y mCII~N:NTVU~;R~io~~~L~~I~NATp -~\I-~~~~~t~I'L(~6;~~---
CONSIOllRSD.COMPL.llTllAND Wll.l. all RETURNED TOVOU FOR C MPL.llTION,
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_.......*.._.___.____,....______._____.___....._...........___~._+_~..,~~..... ..____+____.,_ ,__ .'.__'__ '.____<"__.. ;,.-"'''' ,_ ,___.., ___ '_"',_ .._.__..~_,,~__.-....n-~.-.
....n--_.C:OMMONweACTHO-F'pe~iN'S.YCVANI.A+:::'i:)e.p ARTMeNT' O'FR'riV'ENU E! .... ,"u.__
CONSENT TO TRANSFER SECURITIES ~'
I hereby conlO~t to Iho trolll:-of th~ ab:~..::~~;~:I~:-;:w--r:I~I~';:d In the nom~~,r~;(/fo;os91d'~..l-f-.f:g
Docedont Qn~ wolve tho :fIling of ocortl/lcato corllfylng to thopnYlnonl of Iho transfo,r ,!nherltance lax 10 y.'hlch
Ihe,proporty of sold Decodontls '\1O?0 subloct pursuQ~t to tho provlslQr1s ollho Act of June 20, 1919, P,L, 521,
os Qm,endod drld tho,Act of June 1S, 1961, P,L, 373, os amendod, This Is nllo In accordance with Iho provisions
of tho Aql of April 9, 1929, P.L, 343,
This ,Conl~nt 10 Tro~slorthe horoln doscrlbod proporty OnorolO! only In roforonce to th.o Oltate of tho
obove'Mm~d' Decodont.
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Slgnod for Ino Secrotory 01 Revonuo
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