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OATH Ot. ..t:RSONAJ,REPtu:SENTATlvt:
COMMONWEAl.. TI-I OF PI2NNSYI. V"NIA 85:
COUNTY OF CUMUI;RI..AND
Defore me, the Register fOr the Probate of Wills and granting of Lelters of Administration In and for the County of
Cumberland, personully Qmlle ,Ot..'. I [' ~ ,)1-. '",,, (, '
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who, belna duly ~,I",.I-\.,,~I , do.u/ depolOftnd suy that al_ ,,'- X",~c'" ,', '_
df the la.t Will and Teltament Of (b.-I. I,.e~\, ) (..'tUI-.l.
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decea.ed
will well and truly admlnlstor the goods and Qhallel., rights andcredlll Of laid decea.ed accordlna to law. And
allo will diligently comply with the provision. of Ihe law relating 10 Tran'fer Inherllance.. ."M1'" and lublcrlbod before me.
July 2, .0\.0" 19~ l'-.( -it.
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Be II remembered tbat on the
recorded Ihe lall Will and Teslament of
camp Iiill
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9th
DECREE
July
, Ihere WaI probaled and
_Iale of
, Cumberland Counly, Pennsylvania,
Doris E. Thomson
81
,A,D,,19
day Of
Carolina Cloud
Deceased, Lelters Testamentary were,aranled 10
, Wllne.. my hand and official seal the day and year aforesaid.
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OATH OF NON.SUBSCRIBING WITNESS'
OoMMONweALTH OF PENNSYLVANIA },
, . . 8S1
COUNTY OF OUMBERLAND
,
Thls, the~._.~~.-.w'~_' ___'~"_H_nd/u ,:-~,(r:::_L_'m'~_..__,____"__ day of
;rOb.,,--:~:t:I:~:~:;-~I-';-~~~;I~~:',;;:':~:' ::,::gl:~:rn::r ~.
Cumberland,ln the CO~l)10nWealthI10~?nn~s Iv__~j~; personally came__~..
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\__...4-._..__~_,-.. .>?:H-:t:lC..?o:::t....,__ ,:::::--~::_- -~t'!:.l:?:.':.f:~~~-_'t-.c-'-.__..__ who belr;1g duly
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A.4~'1i~m_- accor~tolaw,~,eposed an~ t:.~t they;~e wellaoqualhted wllh
the handwriting of _un_,..c:L2~a--td::.:{ta1c.'(:""" .-~id!p.L - .._-, .
, WhQse, name Is attached as _..,..<tf:~~c:'r4:t.I-C>~-- to an Instrument of wrltlhg
purported to be _______u~_..-,-'n-'-m-_--u---.--.--u~-----'---- the Last Will and Testament of
~p '/' ~" /' /" 'L? . !
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"I~ 01 _~ .:.d!~~ ':;:1_/(..c.L"__~' d'o'~"d
'~~,h, at&,.sald Slgnjt~,s t~~ and genuine, an,d that the said. '
,,/f:::.g ...: .:VtJ,,~-a.;,,_IS now dflceaa.ed ~l!tb8'em
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sworn
__,-~_____,_w__. and subscribed before me,
this ___~__,n__2n~~c___~_~m_______n___..__day of
M..~W~dc- ..R:gl':'~~~=
per _-------------"..-.-..----~n'.....-----,--m-------.--.
Deputy Register
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Q!i~eRAt. Uili.ERITANCE TAX INFORMATION
Unsatlsflod IlabllitloBlncurrod by tho docodont prior to hls/lw doath arododl/ctlblo against hls/hor taKablo
nUllo, In addition to dobtslncurrod by tho docodont or oBtato, othor Itollllllro clllll1lablo Including tho Co.I 01
administration, attornoy foOl, Ilduclary fOOl, lunorol and butlol OKponSOB Including tho cost of a burial lot, tombstone
or gravo markor 'nnd othar rolatod burial uponBOB,
All do~t. baing clalmod against an o.late aro subloct to tho approval 01 tho Register 01 WIIIB with whom the
Inherllance TaK Retunll.flled, Evldonco 10 Bupport tho docedent's or tho PBtale'sliabllity for the debts being
claimed should be attached to this aahedule,
, A family uemptlan may be claimed bya spouao of 0 decedent who died domiciled In Penn.ylvanla, If Ihere Is
no 'POUaO, or If the spouae hasfotlolted hll/hor rights, then any child 01 the decedont who Is a menlber of the lame
hous,hold aan claim Ihe eKemptlon; In the evenl there IB no luch spouso or child, the OKlI11ptlon can bo claimed by
a pllrent or parents who lire metnbuts,ol tho Bame household aI, the docedont, The lamlly OKOmptlOn Is allowllble only
IIgoJnlt a8letswhlch pass by a will or by the Pennsylvania IntaBtate Lawl,
NOTE,I Compenaallon paid to an oslote representatlvel namely, an eKecutor or administrator, for IOrvlclIQ
. performed In admlnllterlng an eBtale Is reportable for PonnBy.lvonlo In como TaK p\lrpa.es. Thll taKable Income
IIem Bhould bo reported on form PA.40.lndlvldulillncome TaK Return,
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INSTRUCTIONS FOR COMPLETIl'!9 SCH]DUt.E "E"
1. Ifthe,familyeKemptlon Is being claimed, Indicate the c,lalmant's nome, addro81 and hl./her relatlonlhlp to
the ~ecedi'"t. enler "family eKemptlon" ,In the remarkB column and Iho amounl claimed In Ihe amount column,
2. AUlgn consoc~tlve numbers to each Itemllaled, '
3, Enter ,tho date on which each debt wOalncurrod and/or paid,
4, Ent.rlho names of oaoh payee,
5. Provldo abrle{ e~planatlon In IhoremarkB column for each debl claimed,
6, Enler tho amount of each debl being claimed, '
7. Tho form mUBI be signed by the person who has auumed tho responsibility for paying the debts,
IF ADDITIONAL SPAc:E IS NECESSARY USE BW' K 11" SHEETS,
11llV.UIII <<'.'111
COMMONWlA~ Tli OP peNNSY~VANIA
DIPAATMINTOFAeVeHUI
TRAHIFeR IHHlRlTANCe TAX
AlIlDeHT DeceDeHT
_. ._~~;t."~-:~~__.
AP,JjIPu~)lt$F
(In,truetlon' Oil Rovo... Sid.)
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Eltote 01 ll...", ~ 1l'..alcU4n.____._ m_..__._____..,._.__
L.asl Addrm .J.U..'.,.2_4'1~ 1~.u-AP1,._A.__n_____
Oamp lJilll...._.i.tnDL_---17.0ll.._
jCllYI (&1^ln (1.11')
Dllto 01 Doaril____J1.llt, ;',,--l~---------_._. .
Soclol Socurlty No. .___.2~!'!S!lJJ...___-.__.n..._-__ .....
Buroau File No, _.____.~_.______.___._....__._._..._,..-.
Coullty Fila No. __.__Q1/-=__rf.L::.d.l..3._...__._.....
1. Decadent died:
( ) Inteatate (without 0 will)
( .) Tutate (loavllI~ II lost wlll--copy attochod)
2, II the /llIng 01 a Fodorol Estote Tax Return requlrod lor this ostnlo? Yos. ___m No .-L..
3, (X) Executor/Executrix ( ) Admlnlstrator/Admlnistrotrlx
Nome
DorilLL--fbomRon .____.,_
"
Addrols __17_J._.a7..th.it1'AI.L______.__,
?(~~ IIHl ~'ffl'tt,~,---'-'----i,'?,?:U
4, AI\ correlpOndence should bo moil ad to (X ) Attornoy ) . Flduclnry.
5, II an attorney II ropreaontlng the 'ostoto, Indlcato:
Nome
Address
Robert J. !raoe _....,.__._.___._
111 Luoullt.4trte1;_____.___,________.._._.1
H~rUbul'r ' Panna____-_1'7.;1.Ol.-.._
ICITY) . t~,TATL:I j/iPY , .
Lilt al\lale dep~llt boxOl reglsterod In the docodept's Indlvlduql name or lolntly with, or as a" (Igo"t or dopuly
01 another, or In decedent'llndlvldualnamo wllh right 01 access by anothor as agent or deputy, Includo tho IHln,"
bnd nddresa,al tho bank or ather Institution whoro tho solo doposlt box Is located, the nOl11o (s) In which tho hox
II registered and the relationship of the lolnt holdors to the docodont,
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=...,.;:~;:.-..u..~~ .~__
NAME OR NAME,\ IN WHiCH
SAPE DEPOSIT DOX IS REOISTERED
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NAMB AND ADDRUS,OF DANK OR OTHER INSTITUTION
IN WHICH DBChOBNT MAIHTAIHBD A SAPB OEPOSIT Dax
rul ton lank
Third and Oalde~' Streetll
HarriliJblU", Penna. 17102
Olll'oline Cloud
John H. HoulIer
RELATIOHStll!' OP JOINT
TO-'~~~EDe'11.a' ...
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____.___~H_... .__._..__--'-_.._..__..____
Under penalties 01 perjury, I duclaro that I havo examlnod this return, Including accompanying schedules and
Itatements, and to the hest 01 my knawludge and hollol It Is truo, correct and COII'llleto.
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SICNATURE or- PIDUCIARY
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I'''Tn
'lIIV'4~4 11,'0)
gOMMONW_AL TH \IF ,'eNNeVLVANIA
OePARTMeNT Of lIeveNue
tRANepelllNHeRITANQe TAl(
IIUloBNT DeCeDeNT .
8CHI!DULIlIIl"
JOINHV OWNfiO PROPfiRTV
(lIIIt'IIO"OIll on Bovorlo Sldo)
OyoUn' 01QUll
a.tBto of
-
ITEM
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OfiSORIP1:ION
1.
kYiPCI AaaQu.n~ 110..01'7:51..0
OaroUn. 0101111 and DOrill I. Tb0lll8Il11
2.
0I1.ak1111 Aooo\ll'lt 11Q6..8,1..440-2
JOM .. BOUI.&' IIIlIl Oarll1:ll,. O1oud
'"villl.Aaaou.n~ ,. lo..~1l.\7"'; .
JobD B. Rolmr and 0a1l'01:l11, ONoW!
Qo1d '.vinp ,. 10.100'1"'1
JobD I. Bou..r and Oarol:Ln. 010ud
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4.
TOTAl.
MARKeT
VALue
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10/2/'6 . 6,19'.1 ~
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7/1/,s ~
,1/29/70 lXlf'
VMua Of
0I10e0I1NT'S
INTI1RaST .
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10%.96
8260.6'
4098.02
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DEPARTMeNT
VAl;UATION
(Offlc)ol U" Only)
TOTAL THIS PAGE Sl6,513.20 1(." P;: ~&
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IN.STRUCTIONS FO~ COMPLETING SCHI:PUt..E "E"
Sohedule "E" must Inolude 011 property, ronl and perspnal, owned by IIw deoodent jointly wllh 1I11.otlw
party or pertles es joint tenants with rlghl of survivorship, Both tangible und Imanglble rropody 01'0 ,to bo
Inoludad.Llstroal estato first.
1. Delorlbe all reel proporly as Indloated In IIw InslruotlqllR for Schedulo "A",Pescrlbo oll,parsonol proparlY
as Indlcoted In the Instructions for Schedule "B", Inolude the namo, uddress und ralutlollshlplo the
decedent of the co-oWner (s) und Iho duto the )olnl qwnershlp was establlslwd,
2, Indicate tho total markot vlllua of 11111 Jointly oWnud propurty,
3, Indicate tho I>oroentugo of Iho tlooedont's Intorest,
,
4, Indicate tho merket value 01 tho deoedonl's Inlorosl,
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i';' < ,.. ',,', ,',.. ,.QOMNlONWI;ALTHOF PUNNS,YI.:.VANIA
1 "1010SA1 , OUPI\IITMUNT 9P RMNIJU
NO,' .. i,""'t)'I'PIQIAl;. ReQEIPT I PENNSYLVANIA INHeRITANCE AND ESTATBTAX
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AaBuaon1onl conlrol No,
m AMOUNT
P~ob.\.
111"'1, '711
RECUIVBD FROMI
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e~TATB INFORMATION:
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FI~E NUMSER
NAMU OF DECEDENT
DATE OF PAYMENT
POSTMARK OATE
COUNTY
DATE OF oEATH
REMARKS
21..81.413
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Qumb.r.'1a1\4
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157'7.18
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GTOTAL AMOUNT [>AID
SEA~
RECEIVED BY
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PA YMENTi "D'I.~h the lOP portion 01 thla NOlie. a,d aubmll With ydur paym.nt mad. payabl. 10 the name and ,dd.... prihled on
Iha reverae -,d,.
All, Paym.nla rec.lved ahall llral b. appll.d,to anv Inler.1t whioh may b. du. wllh ,ny r'malnder applI.d to the tax,
ReFUNP (CRI:.
Rep~y
TOL
'PISCDUNT:
INTERESTI
A ".fund ofa tax oredll. whloh W.. nol requ..l.d on Ih. Tax Relurn, may be "qu..l.d by nompl.tlng an "Applloatle>n
fe>r Rafund" elf P.nnaYlvanla Inh,rltano. and eatat. Tt~" (REV- 1313), ApPllcallona ar, avallabl. al Ih. OHI~.
elf Ih. Re9laler of Willa. any Qf the 24 Rev.nu. 'Olalrlol OHio... or from the O.parlm.nl'~ 24-hour
For,m. Ordering I.I.phon. linea In Harrlaburg - (7171 787~8094. In Phllad.lphla - (2161 36 1 ~20116,
Onn PIII.burgh - (4121 686-380 I.
qU..liona regarding err ora conlalned on Ihll nollO. .hould b. addreaa.d 10: PA Deparlm,nl of Rev,nua, aur,au
of Individual TaX'I, ATTIIJ: POal A.....m.nl Review Unll, p.oaOx 8327, Harrl.burg. PA 17106-8327.
17171 787-8606,
If any lax du. la paid Wllhln 'Ihr" 13) oalandar monlhl after Iha dec.d.nl'a dealh. a flV. percanl 16%1 dllOoUnl of
Ih' lax Paid la allow.d. "
Inl,r.11 II 6harglid b.glnnlng With flral day of d.llnqu.noy, or nih. IS" mOhtha and On. (\) day from Iha dalf of
death',lo th. dal' of paymenl. Taxea whl,oh b.oam. dellnqu.nl b.fore J.nuary 1. le82 "ear ,Inlereal at Ih. rale of Ilx
(11%) p.re.nl per annum Calculal'd at a"dally ,at. Qf ,,000 I 84. All Ilxea whiCh "acam. d.llnqu.nt Qn 'nd aller
J'nuary 1. IS82 will b"rlnte'U' a' a rlla WhiCh will Vary from callnd., y.,r 10 ,~alendlrvear with Ihll rll.
'""Qung.d by ,th' PA Peparlm'nl of R.v.nue, Th. aPpplloabl. Inlf,eal ,"ea for I e82 through IS8e ar"
.\'.!!t. Interelt Rat. DallY Inter'll F.olor rur. Inlereat R". S!!!!' Inltrea' Faclor
IS112 20% .000648 le85 13% .0003136
ISB3 IS% :000438 ISBa 10% .000274
19B4 11% .000301 le87 9% .000247
le8B . I "1 .000301
--Inle..8I il calculaled al 101l0wII
tNTlRlST ~ .ALANO. OF TAX UNPAtD X NUM81R OF ~AV8 DILtNQUUNT X DAtLY tNTUReST FACTCR
-~Any NOllo. luu.d all."he lax b.oomea d.llnQu.hl will refleol .n Inllireal calc'ulallQn 10 flll"n (181' day I
beYOnd Ih. d.1t Qf Ihe .....Im.hl. If paym.nl la med' aft.t ,h. Inter,,' cOmPut.llon d.1e .hown Qn Ihl,Netlol.
addlllOnal Inlete.' mUll b. calcul'led. '