Loading...
HomeMy WebLinkAbout81-00428 ,L:'~~ ~k~:;:" ;I~!!:~~t:" .!"<''l''':~ ,;,,~,i:~~'1i ~. ,,' r 1.1.t1{': llfltP'}' I ~iJlf"ei" ' ,~\'~1 ,.-- " i. \\,.-j --" .-"." ".1 :1,- -"; , ;, ,I I, ,I' I .. /, ,. 'I, " " Je .-'. ,.I! '" " ) ,II " I, 'i · I I . a Iii , I, " I, " I, " II H' " " ., "!r 'i /, ~ " J I',; I', j/. " ,1' " 'I" If ..:, I, /;< ,I, ;i,' NO. 21 ~81 PETITION FOR UTTERS OF ADMINISTRATION IN 'I'III~ Jol81'A'm oj,. ..,...J~lmh\lm"~..,,,,\Jl.I)},I,,~""",,.....,,,..,..,,'"'' I>JolCIMArell, ".- fro l' II ,t1R,~X" ,R;I, , ')~I~'~ t~" H"I;",,,,""""'''' ~";;",.",.,,,,,..,,, ,t."",.,.,....";..".t,.",,,, '" "" ,... HOll'lKtOl' uf WIIIK fut. thu CUllllt.l' III' ('IIIl1IJlII'llIlId, III t.Iw ('(jl1l1l111l1l1'l!ldth III' I'UIIIIK,I'II'III1II1. 1'ho' llotltloll of "0" ,,~'^lW.Ol\l&, .14"" $J,U.l\Uh.,."..,,,,,,,,,,,,,,,,,,, j'"..".."""".",,,,.,,.,," """"",.1.,;", ,'''','' 'i' I "". ,t! 11"\' l'uKpul'l fllll.l' Hhul\'lll h t hilt ....,...~~I.\\IHl,WJ...ft..".c.\\r.hll,,,,,,,,,,",,..,,"""""'"'' WIIK II reHldol\t of ..".~IIH::))A\\j,~Il>>,\\r,Il''''''''''''''''''''''':I~~~~~~~) ,('lIll1lllll'h\nd CUUllt~'i Stilton" )lol\lIKyl, Vlllltll, 11n\1l\ OIUl,oll IIf Ullltod 8tlltOK, 1111(,1 dopnl'lod tlllH 111'1' 1III0Htllto III tho (~ollllt.~' of "~m~,lI.\\r.,l;!1!1,~",, lIi1"<ljll""..Iil<Hh,.""""",,, nutl St.ut.u of -.,,,,,,,,\J,"nn,~,y,~N/nJ.l,E;\,,,,..,, ,......, d ,,,,,,,,, ",,,,.,,,,,,,,,,.,,.. "..",,,,,.!!.,,,,,,,,:,, "",,,,,.. on .~'R~M,t.9.n>.'"."",,,,,,,,,,,',. tho "";",,,,,Htl~,,~.,,,,..,,,,,,,,,, dn,\' of' """,,,,,,,,,~~.9'<;"!I""'"'''''''''''''''' A, 1);\ ln~JIl",t1 lit the' IIgo of ""..,~ll"... ,I'OIlI'H. Thill tho Hllld ,:;"....,,,..,\\j,~I)II.r.II..Il,t..Slll,r.1I.\t..,",..,....,....:....,,,. dOllOUHOlI, 101'( HUI'1'11'11111 the followll1l1' nllmed widow 01' hUHhl\lld, hoh'H IIlId lIo~t tn kill, tn Will .,..";,..,.,..,..",."""...""...".",.,.,.,,,,;,." NIIIl10 HollltlllllHhlp ROKhlollco 605 Alison Avenuo .. HochanicsllUi'l!.' I'onnsylvania "".. '~tl~" 'xr 'iao't'{ 'Xve'i\ua' ",,,.,,,, iit!"'" .."., ,Mil r.hu\\ ,l r....,1.\\1);8,., ;,v.\1ll>>,~,y,~lllm,j,a ,,,I, iI~A,'i".1.9;r.^RH.l1,,,, ~1MJ.l~ft., """"",,,.... ",.."Il~llh\\l;I!,,1:\ul;k, ,I),\lf,hn.." '.", """,., Wifo ,,,.,,,,,,,,,,,..,,..,,,,,,,,,.....,,,,,,,,, ,..,..,.,,,,,s,U\\.........,,,,,,.,,,,,..., .-.,;,.,.,..""""""",111""""""";""""""""",. "",,,,,,,,,,',,,,,,,,,,,,,,,,,,,,,,,,,,,'" """""""'''''''''''''''''''''''''''''';'''''''''''1111'''' ".'III"I""""""'I"'!t,,,,,.;;.,,,,,,,,,,,,,,,,,,jj,,,,,,, ,. ., """""",;",""""""""""""\" "",....,,,,.,,,,,,,,,,,,..,,,,,.,,,,,,...';;111111,,,1"'''''' II'I','.II""I""""!.!"""""""""""""""."",..,. ,,,,,,,,,,,,,,,,.,,,,,,,,.,,,,,..,..,,,,,,,, ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,"U,,"""..I,,.II,,,,,.,,,,,,,, """,.,",...,',..".,'.,.".,',.~~....,"~".,""~f'I "",,... mQ I \' ---"';:0 ;"".." ,,,., ~ ',"'"'' ,.".., "';g.~yyl".."=..!,,,..b1t;'j r- ~ii " ,j'1r1'\ "'iI' - "." ..""i..'..''''",....,j",...,;'','/"i ''''''''''looIl'HIIHii''',,' ',-" -~-,,; .',' , . :~.::f~ . ~ ,,'...! IO"""'"''''lI;,.,.,...,..""..,..lfHIII,u,"\7'I''''''!''' ., .-' 1'1 ",,,,,,,;,,....,,,,,,,;,,,,.,..;,.,,,.,,,,...',,,,,,...,,,,,,,, ,!'"""""",...,..',.",,,;,,,,,,,,,..., ",,,,,,,,,,11',;''''11'''''''''....,,,,..,,..,.,,.,,,,,,,.;;,,,. """",,,,,..,,.",,....,,,,,'..",,,,,,,, """,,,....,,,,,,,....,,,,,,..,,..""""11.""'.',,,,,,,,,..., ''''''''''''''''''''1I'''''''''''''''''''''' ,,,,,,,,,,,,,,,.,..,,,..,,,.,,,j.,,,,,,,,,,,,,,,,,,,,,,,,,,"".! """'.'"'.."'.""......,..""""."" Thllt thoso "bol'o 1I111l1od Inllludu nil of tho no~t of l<1n, HO fill' "" l{I)own. (il ,..t. 'rho ~lIld dooo<lont WIlH llOHHMHl1llll1' llOI'R0I11111Jl'Uplll',t,~' 111 tho oHllnmtOll \'111110 of $,.U""11t:j,1l111~II.Q..""", 1I11!1 of HOIIII'l~tllto, IlIHR Inon1l1bl'l\nllO, to tho oHt.l1l111ttltl VIIIIIU Ill' $".."N,Q.\\fl.""""""""" IIH nl1lll' ilK, 01111 bo IIsoortlllned. 'rhllt tho RIlItI HOIII 1':Htllto Inilll fill' IIH IH known IH IlIlIlItod In ,..,,,..lll.(),,,,,,,...,,,,,,,,,,,,,,,,,,,,,...,,,,,.,..,,,,... !"'''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''';''"""""""I."..""',.,;,jj""..",o'"""",,,,,,,,,,,,,,,..,;"."",."""."..,,,,,..,,,,,,,,',,',,,,,,...... 'Phorofol'o, YOlll' Ilot.ltlonol'(ft') l'oHllllotflllly 1I11111~'(IoH) 1'01' Lotlol'H nl" AdtnlnlKtI',IIUon In tho nhove Ilftmod'sKtotO. ()l\tol!.,,,,,,.J.UlY...,,.M,,....,....:.....,,,,.., A.ll.. 111..,61.. Signature Hnll Addl'IIHH III' !'uUth'lll'l'!H) 11\ \'~ ' . '/~. ",('" , I" ''''....,.'''.,.'''\.''..I.'~l~jl..,I.~!I.''.'''' ",I,,,, ..~..I..\.I\',I,m,,{,, ""..,." ,!1,~.r..;1,p.x;1 ,cr". Ji,t, ,,~~~, ~R.~",,, "j i.... ,,,,;, """..i." II' 1111" ,,:{I ~Pl ~'7,;(8" II..'." .'" ~ 9.~, ..^,l, J.f:J.9.11",~ y.~ n ~:~."..".."",,.,'",..,,''' I' H' II'"'' HIChoqicabufg, Penn~ylv~nio 17055 ",..,."..",....,.".",.,..!.",.;".";;,.;."",,",'j"',;.IIII"''''''''';';,II'' COMMONWI':AI:nIOI" l'I';NNHYI,Vi\NIA } .. KH: COUNTY Ol~ ClJMllJoml,ANIJ """"",'" ," ,,,..,,,,,,,,,,,,,,,,,,,..,,,,",..,',.,"" ,HMHO.1\MI" ,~\ I.., (/l).l\\I,c\"":",..""""."",."".".."".."..,.....,, .",'.'" ,..,,,,,,, I1l1mod In tho IIbnvo IIflllll 011 1111 11 buill!!' dilly ........,ijW\ll:I1.........,..........,,,..,.. 1lI'I'lIl'llIll!!' III IIII\', Mil)' Ihllt Ihu rllctll 1101 forth 111 Illll IIbovu IIJlllllellUlIll 111'11 1.1'1111 III till' IJI!Mt lit' ....h,~\r,...., klllll\'l\lll!!'o IIlId hull\.r., , ,,,,,,,,"Wll,f,\\,,,........................,..,....,...., IIlld MlihRCI'lhod '\ ......:1,..(".,.i'\..........,....:h....L..,....,.,..I.",..,'.... before mOl ", ",.."", "",:,...,'~ ",...."......',.."",..""" ".."..".."",.,..",,,,,,, ,,,,,,,,.. ,\1.\\;\.Y. " , ..~19:, '",,'' '" ,,,..,.,.,.,,,,,, A I I) 'I 1 U '" R,l." "",.,.",.",.",.,...""."", I"""" "" """,,,' ,., H" ",., ,,,,;,,.,,,.., "" I ":~ll~l1t.(j:,..,{fL".dftt{..~"',..,'''',..,,..., , f RUlllKlol' """""""""'1""""""""""""';"""'"""""""""""""""""11 FlIedl, '''''',....o,'{u~..,;J.iI..".ll1,al..",..,..,,,....,,,..,...., A I 11I1'IW)'1 "m~,mi~M9.l,1\.,..~I\\PM!~,~,..~..,~,\1~mS,~,~" OATH OF PERSONAL REPRESENTATIVE , COMMoNwtnALTH OI~ PII)NNSnN ANIA COUNTY OJ~ CUMBEHLAND } KR 1 "'''''' "" ",,,,,,,,,,,,,,,,,,,, to",.."". It,,,.. """" ,~Jh,~\.;r,Q'JX~ ..li ..." ~.v.l\nh,; t!"";"""''''''''''';'''''''''''''' ",,,,.,,, i,,,,,.. I pot 1 tloner (8) boing duty "..".,,~~.p.F.n'''''.''''''''''''IH'''''''''''''''''' I\ccordlng to Inw do 9.fl....,... depoNo and Rny thut 68 the ,.udntlnlat.rn ~.vJ.~..,,,,,, of thu oRtntc or ,,,,,~~~H.~~P',..~,~.,,9.V.fi>>h..,,,,,,,,,.,,,,,.,,.,,.,,,,..,..,,.,,;.,,.."",,,,,,,,,,,.,,,,,,..,,....... "".."........."."".........".."..".....,,,,........,,...,,,,,.,,.,,..,,..,,..,"."..."......",.,."",,,.,,,.........,,,...,,,...,,,..,,,,,.,.,,.,,,,..,,..."''''''''"1111 dece88ed """!lllfl..",,...... will well Ilnd truly udmlnlatol' the gooclK IInd chntttlla, rlghtR unci cr~dlta of lIald deceased, according 10 law, And iliaD will dlllg~ntly comply with tho provtalonK of tho law rolntlnlt to Tranafer InherltanceR, .",..t,..,..,." ,$~.9.hn" ,... ".., ." ...t, ".. ...". and Rubscrlho<1 before me, ....."tti..;xulV.,.~4.."".."""..,.,....:j" A, J}I' 1{}".~.\... ""g ". r.d('t..:+..,(!.,\(,~.aa;,J""",.",,,...... Relllste (/7"'" ,1\' 'J' C' h ':'~-')i, ...'C'" 'R.l..II,...... - '\. ". _l...._..'(..(.' ,,,,,,,,,,,,,,,,,..)r...'(),,,..,,,,,,,,,,,,,, "'"'''' ,,,,l,,,,,,,,,,..,,,,\t.;-:,, """"""""""""""""""""""""""",..""."...,.,."...,.."",......" DECREE Bo it roml)mbered thAt on the .":,,,,,,~.~,\;l),,.,,,,,,,,, tiny of ."...."".w.\4~y".",j"...""."".".. A, D., 19,,".f~.* ,Letters- of AdminlRtrntlon in tho oRtnto of ....",,I.\lGUAHJ},,S..,,,QUlU\A..,,,,,,...,,..,,,,...,,...,,,,....,,,,j...,,..,,,,...,,....."", ...., ".."...""......... ...,,,,,.i..,,,,, ""....,,, ....." ,,,, ...." "" ,,,.,, Into of }~R.r.9.>>8'~. uP. ~"1:\~.f.hP',,.thfth.Y.r.8'''''''''''t1I''''''''''''''"'''' Cumberlartd Cclunty, l'ennKylvllnla, decollKed, woro grllnted to ",.IIlAl\JOJU.E:..I.....GllRllh.."".." "".."",,,,,.,,, ...".oj'...ll"'."",.....,."..,""',.....,."..,.,.......",.,..,...",.......".,."..,..""."",.,;.".".."..",.,.",.,'."'.,""",.It.,..".....".""llII...."..."..,. Wltneumy hartlland offici III ROllI the day and YOllr IIforeK~ld " ' ~ ,) , , ~/J'/ , ~. ~ ' "",..,,"""~: ,'!2.,2 .~:.l.'t""C""\,, ~ .~~'"".."'',,..,''' (''''' I Register I "...~.,'.r,U lK+ (1-IOJ COMMO~W!A~ T~ OP PB~~'''~VA~IA OePARTME~Y OP REVI'~UE TRA~IPBR INHERITA~CE TAX RElIOE~Y OECEDEHT INHERITANCE TAX RETURN FOR INSOL VENT EST A TES (I1111lUCll0111 011 RovorlO Slrlo) ~J-H.I-i1~H ~,I-HJ -i1~H COUNTY ~O. ST~re NO, &Itat. of IU ohu I'tI H, UUl'lJII LUI add,... lill'i Al.IHoll Htl'uul: (lIT IH'hT) ( ) hoc, c<) Adm, Oth.r Nom. ~llll',I(H' 11' I., 1IIII'hu Social Socullty No. lHlJ-'iil-.1 ,'J~ I ~llJolllill:lllHllllI'l!; -IYl (CITVI '5T"'"1 J 7l1'i!i (7.IPI 1,; 0( o :> ~ Addr...(ill'i ^ I I Hili' Ii 1"1,,,,,1' (UTlIEI,TI ~1(Jl!hlllll('HIl\II'!-\ I'A .I71l5'i IclTVI IBT'T~I 1~IPI LJndnr 11unaltluI alp,rlurv, I doclllra thlt I haw o,lC8mlnod thle roturn and 10 Iho ~"I olnw knowlodg. end ~ellolllll \rU" oorroo\ ,I\ll oomRI'I~, ,I , ,~, IHII11.1.IlIEl"t:l'flh" X 'f . If,, (.QIIHh1'i<. \~I'r'1-..k'.l.._ 61 r turD 0' flduclarv P.t. Dot. of Doath .JUIlO (i , ,l'JH,t SoclolStoullty No. ~lIfl.32-117HIl TVPE OP AUBT ~ OPPICIAL UI' ONLY OATe g 6 ~ 9 i OPPICIAL UI' ONLY OBlCRIPTIO~ ESTIMATED MARKET VALliE PEPA RTME~T VA~UA TIO~ (OPPICIA~ un O~~Y) 1'0!:'HOlluHy: 1, Unlvel'HU . SUUlII'lty IIlHtl'lllIlI!I1tH..I1l0,: f'j11111 WllgeH 2, Chel~ldl1g IH'ODunt No, JlI-211l13lih.li.fltIlIHII(1' Fotlul'u \. SuvlngH, Unlthlll'Hblll'!-\. ~ltll'yllllld; hn]lInOll !J11 duto of llllutl1: UOIH'\ll!d IntUl'llHt 3, ,Jellp C']-'l, Jf)7') lIllJ(lu). Uppl"lI tHud vnlllO II, 1<IIWIIHUld lI1otOI'I'YI'1.0, J')7'l 11101101, Il P [lI'U :1 BOel vu '/\11' 5, lIollll!lIllldl! tl'U Hl!l'. Il PPJ'11'l Holl VII I.Ull Ii, 1I0J'shey 1111111,: 1'0fU11d nn 1'1111111l':Ing f1!-\l'IWIIl '111' 7. YUlI1uhu 1Il0tol'I!Yl'I.U, J<]72 lI1odol., IIppJ'uJHOd VlI1.Ul! oll1t1.y-l101.IClwoldl1fJ; 1H'(!!J\ll1t No, .I,Hl-H21i-lJ, 1.H1: 111111\' '" 1'!:,uat (:0, 111 :lo'll1t 11l1ll1UH of IUl'hlll' fllUf:!Oelel1t lUJ'olll) (lu7d RI~,I1I1I'd ~I, 'h Glll'llj HOI1 0 JOn()lI c .1./A.!. )11 1.u 11 1'0 * do horoby oO/lIfy , at the .bov. 0..0" WOIO opprRlu 'on till to Ill' dt'uth: s " 'iOIl,OO " lH ,li{J':; ~,3"'" ' 't~, 3. Will, O{J~, " f1 '"ill j-q,., !"'I"I ~II .. , " , , C._ ". HS,OP, liO. OP" , r,72,75 .- .c, " , l~ 1I111l,llll 1I~7.0[) TOTAL s ow. APPllAIHn ~AME OP PAYU NATURE OP C~AIM , AMDU~T C~"IMID 2 . 7.lH ,II 0 ~2. Ill) lH,OO .llJ,HlJ 5,00 2,OllO,lllJ 251l,llO l'J, no 353,llJ lJ,23 .1.,0112,11.1. .1., Slil. 27 IY~J'H runel'u1. 1101110, Ino. I'llIlll!'1I \. I'XIH1nHeA {oglHtot' uf W n I.H 1.0ttrJ1'H 01' utlll1lnl Htl'U t I Oil 'urnbo!'1.lIntl I..IW ,]01 11'11 U1 Illlvl!J'UHlnfJ; udlldnlHl:l'ntl',lx eat Shol'o 'l',:lrnOH II11Vtll't1AJI1fJ; udll1ln:lHtl'lItt'.Ix l!fJ;:lAtl!C' of WillA 1':1 UI1fJ; ful' 'li1t' ;jod e I." GU1'hn I'l1l1d Iy llxl'lIlptl nn nalh111<oI', ~luCn loll ,-. 1:1.Ioko' Ul:tOI'I1l'YH ft,o ,-.p 1'e 1.0phol10 Go, of ~lIl, 11l!('Dllllt aUI'H, Rooblll!k '" Cornpllny nl)(~IlUlIt IIl1ltlll1ot'l! GUH '" J:ltll!, Cn, lll)(!nitnt : :11' ,:I.IJlI Il 1, VI Hl1 111"'IlUl1t luRtu!' CItI.lJ'go l1nllnUl1t '" 'i' l1ot11:' ' I1nt:ln TOTAL '" 'i' H ,OJ'!, j:!l1 I . () . UEOUC. TIONS A~l.OW"n REOIUUM 0'" WILLI IHSTRUCTIOHS " ASSETSI UP E OF AS$IIl -Indlcalo wh.th.rtho o"ot I. roo,l ..tato, panonallHopotty, trol1.lo, or lolnlly.ownod. ESCRIP IOH _ I.I.t all o..oh ownod .ololy ~y tho docodant or ownod lolntly with al1othor potty or ,\1111110& o' lohonh In oommon or o.olnt tonanh with 'Ighl ol,ulvlvalBhlp ot tho timo 01 dooth, Inclodo tho dacadont'. poic.ntoyo of ownor.hlp, Ih. nom. (.) arid r.latlon.hlp to th.,docadont of tho ,olvlvlnglolnt own.,. ond Ih. ..tlmot.d merkot volo. of tho d.codont'. Inl.,..t a' of tho d,oto 01 doath, Inclodo Intonglbl. pOI.onol prap.,ly tltlod 111 Iho namo 01 tho docodol1' ~ot poYahlo at dooth to al1othor porty ol/ortlOllncludlng but not Ilmltod to p,O,C, U.S. Saving. Bond. ond lonlotlvo,tru.l accounh. I.llt ony plop oIly tronlfom by tho docodont within two yaall of d.alh,fol which hO/lha did not I.c.lv. valunbl. pnd odaquala canlldorallon, ' DOIcrlb. 0111.01 ".tato locatod In POl1nlylvanla by 101 and block I1Umb." .ir..l oddlo'" number of aC,,1 and Il1cludo 0 gonolol d..cllptlon 01 tho lond and bulldlngl, Allo, Includo thobook,und pog" nUlllb.r 111 which thu dood I,' rocold.d and tho exoct tltlo 01 Indlcat.d on tho do.d, ' I2E~TS & DEpUCTI9i'1S _ Unlalllflod Iloblllllol Il1cul"d hy tho d.codont prior 10 hll1hol dootll oro d.ductlblo agoln.t hl./hol lo,o,blo OItato, In oddltlon to dobh Incullod by tho docodont, olhollloml 0'0 clolmoblo Including tho COlt 01 a,d,mlnlltrotion, ottoln.y fOOl, fiduciary, fOOl, ,funeral and burlol uponlal Including tho COlt of,a burlollot, tombltona 0,' g,rovo malkot. I.llt tho dolO on which oach doht wal Incul/od and/or pold al1dlho nomoI of ooch payoo, Plovldo 0 ~,lol "plonatlon 0,1 tho nature 01 ooch dobt .Ialmod and Ih.am.unl holng clolm,od, ' ' IIvldonc. to ,uPPoll the d.codonl'. Ollha OltOto'. liability for tho dobll boll1g clolmod .hould b. attached to Ihl. returl1 , A family ex.mptlon moy bo clalmod by 0 .pou.o 01 a dooodont who dlod domlcllod In Ponnlylval1la, If,thara II 110 IpOun, 0111 tho IpaulO hal forfoltqd hll/her right., th.n any child 01 lho docodant .who II a IIIombo, of tho 1011I0 hoolohald con .\olm tho "ampllal1, In tho ovent thoro II no luch 'pUUIO or child, tho aKomptlon con bo clalmod by 0 palOnl 01 pur.nll who 010 momb.,. 01 tho lomo huulOhold 01 tho d.codont, ' . " > " '9 8 ::r. ~ - ... I'Q m 0 m . ~ a ,~ ~ ~ a . g ., it. >> .g C m if ~ j ., 3. i c '" 8 8 ~ m i ! z ,. en ~ i m 1= m m ~ ~ ! z ~ !!l ~ !i P I , ::r. ~ 0 p '" -t p.l ; z m z p o " ,j --< ~ --< E " ] IHFORMATIO~ pl.ACE FOR FILIi'lG _ Tho roturn I.to bo fll.d Iii dupllcal" with th. Rogl.t.r of Willi of thu county wh.,oln th. d.cadent ,rolld~d. . , ' TIME FOR~U..I.l@. _ Th."turn II doo nino monthl altol tho doc.donl'l dooth, unlo.. on ,,'onllol1 fOI filing hal boon oppllod ~y tho Secretory al,Rovonuo wltl'!n tho nlno'mol1th porlod. ' FAI~URETO PII.ERBTURl'l _ Sootion 791 .f tho 1961 Slntule provldo' thot" , . ,ony p.rlon who willfully 10111 10 fllo a 10tU/ll,01 other report roquhod 01 him ah.11 bo pO/lonullylloblo, , .to 0 ponolty of ~5% of tho to~ ultllllo,tely found 10 bo duo 01 $1,000 whlchovOll1 the 10.. to bo locovorod by tho Dupallmontol Rovonull.s dobts of Ilko omO,~nt ore looovoloblo by low." tiQlli Fee& paid \0 an 'eltole replelel11atlve; nomolYi an eMeculor or odmll1111rotor, 101 lervlces p..rlormed In od- mlnlltellng an eltalol& reportable for Pennlylval1lo Income TaK purpo&e&. Thl& taMable Incomo Itom Ihoud bo roportod .Il 101m PA.40-lndlvlduallneomo TOM Retuln. .. ,WV,lOOO ~~, (0.81) , 'IlURllAU OF 8XAMINATION r8NN&YLVANIA DHPARTMeNT OF ReveNue p,o, ROX 8311 tlARRlIIlURO, FA 11108 Oecedenl' NI I (Leu, ~I'. ,,:IM~~~"It1:}.1 ' Oecldlllt'l Add'.8I' DEceASED. t. ',_~_ "~,,r /f/t.J'~"" ~~~-ft!t- Snclll, uCllrllv mher ,Olio of 008lh / /'J .,._.J~' ,. .,l.,(" ?I,.,,'" ~,_~ ~(/ '1'/ on. ,A~"Ir~,t$AI~lCil) rf"(, tUrr " Orlginll Retuto ~ ,2. IUlllllemonll1 Return D 3. Remllnder R'llurn 0 ' 11..(Q~:(~y Plio Number ."z/~ ,1/-(1'1,.1' INHeRITANoE TAX ReTURN RESIDeNT DEOEDeNT -~, cHeCK APPRO. PRIA TB 4, lIfo Eltotel ] 6, Flderll EItIIO Tox 0 Return Required. SLOCKI I, Oeced, enl died Ill, tltl n, " Decedent mllnlell1ed ellvlng D 0, Nllmher of IIfl depollt D (Attlch copy of WIIIl,.bd lrUIl (Alllch copy ullrulll boxe,lnVlnlorlld All oorrllpondenee Ind confldentlll tOK Inform,t1cn Ihould bl dhocted 101 CORRE, 8PONOENT Nlmo',...t~-<b1OA"le ~, J?!f.vulJ)If' ~ rb'4" ~dIM/ .6~ ,,,.,,,"' N, - ~!-~1:~"..'~~ OompUtetlon 01 T'K la, Al110unt olllnl 14tmblo It ll% rite IIel IIl1Qludl vlluo' from Ichodul, KI 10, At!1ount of line 14 IIKlblllt 16% rIte (10) (Inolude vllu" from. Ichldlllo KI 17. Prlnolpll IIX dUI (Idd tlKlrom IIno 16 plul tlK 'rom IInl181 10, Tot,I.Prlor pIvmel11l1 '(II Amount Plld (b) PIUIOlloount ,(c) MlnuI Intmll 1181 _ 19, BellMe OUI (IInll1 mlhullIl1el0) Mlk. Chick PIv,blelOI Regllter of Willi, Agent · · · PLEASE RECHeCK MATH · · · RIClplt~l.t1on; RECAPIT. ULATION AND 1, ROIl euale (lchldull AI 2, Stooklend BondI (Schlllull P) 3, Clololv HlldStocklPerlnltlhlp Inlllllt (Schedull cl 4, Mortglglllnd Notel (Ichldull 01 6. Oil!! & Mlmlllnlolll FIllon.1 Property (Iehedule E) 8, JolntlV Ownod Proplrtv (Ichedule PI 1. Tlel111811 (Sohedule 0) 8, TOIII Droll Allotlltotll IInol 1.11 O. Fune,/ll Uxpen18' ,Admlnllltltlve COltl/Mll8ll1lneOuI EXlllnl" (Sohedule HI 10, OebtllMortglgellLlenl (8chedule n 11. Totll Oeduo\lonl ltotellll1el9 & '01 12, Not Velul o. 8111le U1ne 8 mlnulllnl 111 13, Chltltable Paquoltl (lohedulo,JI 14, Net Veluo lubleol to ilK (lll1e '2 mlnlllllnp 131 TAX CALCU, LATION (11 ( 21 ( 3) I 4) : ::- #;.;.~,.:;:~ ( 1) ( 81--'..-: ('+II; 11 . 10) s: N 1, ~r:> 1101_ . m:. ~~J:f!;t:' 1131 114I'_~LAf("/V~A.I+- x,os" K,10' 1111 (19) .., Underpenllllel afperlury, I doollr,. that I bovo UKlmlned thll retutn,lncludlng oooompenvlng lohodulellnd ItltemOntl, ond to the bIll of mv knowledgo Ind bello', It II truo, 00111l0t, Ind complole. Oeclerltlon o. preperer bthor thin the pOtlonl1 tepr8lOntl\lvo II bmd on IlIlnformlllonol wbloh prlp.rer hel anv knowledgo. SIONATU!lE O~ P~ABtiNAL Rep!l88eNTATIVsI81 SloNATURS OF PREPARSR OTHEFl THAN FlOPFl8S8NTATIVS AOORUS , OATS A00f1E88 O;! K,l ~,1:! '-','1k' .,J....... c''j:.t, ";1 d!l " !H, !II : ;;i ~.' ~ ~~ 'if i'J INPORMATION This dooumonl IS Ih. Nolloo ,OQullod '10 bo glvonundO/ 'S.elIOn 709 01 Ih. Inh"II.noo .nd 0.1111 TI~ Aol of 196 I (72 P,S~ 1001l0n 2~e6), If ,lhO 10' Is p,'d vvllhln Ihroo (31 monlh. .fto/ Iho dooldonl'. dOllh, . ;;I1,oounl 01 5'1i of Ih. \OK p.l;;I II IIIOwod, 'Inho'ilOn08 T.. b.oo",OI ;;I,"nquonl nln. (9Imonlh. '110' Iho dlo,dlnl's dOllh.ln\l'''1 Is Ohl190d '1 Ihl rllo 01 .'~ (61 p.'OO"1 P.' .nnum on I~o .mounl 01 unp.ld "~, (SSE eXAMPLE aeLOW) , . EXAMPLe: If., bllOnQI of II~ ;;IuO 01 ,2,000.00 II In . dollnqUlnl ".Ius l,om 3~3~BO, 1,,;;1 p.ymlnl I' m.dll on 5-23~!l0, ,Ihl InlO'''' I. o,'ou'llld .. Indlollld bolow:' , .TlP 1 OotormlhO Ih. rll. 01 In\o'"1 I'om Iho IIblo bOlow, STEP a Mulllply Iho blt.nOI of II' duo bv Iho "11 of InlOrOll. STlP (I A;;I;;I Ih, Inllro*, 10 IhO blllnoo of ilK dUI, ItllOroll from 3~03~80 10 6~23"eO R"ulls In: ...,. 2 Monlh.. ;010 20 D'YI . ~ ~II. of ,In","" '. ~ B.lsnol of tl~ dUI Rltl of Int~t TREST 12.000,00 x ,O~335' . 6,70 B,llne, 01 '"~ ;;Iu. PIUI 'InlOrOlI 10 ~t of PIVflnl (+) , IIX In Inlo/'It ,10 O.to of P,vmonl '2,000,00 . 28.70 '2,026,70 -----~--------~-----------------------------~------~------~---------- I monlh ,005 4 mOlllhs ,020 7 monlh. ,0315 1 0 monlh. ,060 2 monlhs .010 5 monlhs ,025 B monlhs ,040 I I' mOnlh. ,0156 3 monthl .016 6 monlhs ,030 9 monlhs ,,0415 12 monlhs , ,060 I d.{' ,0001' 11 dlVI ,00106 2 1 dlVl ,00382 '2 dlvi ,00034 I 2 dlVI ,00203 22 dm ,00369 3 dOv. ,00061 13 dlVI ,00220 23 dm ,00386 4 dlVI ,00068 I 4 dlVI ,00237 24 liOn ,O04(l3 6 d'vI ,00086 1 5 dlYI ,00260 26 dOVI ,0(l42(l 6 d.v. ,00101 Ie dm ,00267 26 dlVI ,00437 7 dlVI ,00118 17 ;;I'VI ,00284 2? d'VI .Og464 8 dO\'1 .00136 18 d.vI ,00301 28 d'VI ,0 47 I 9 dOVI ,00152 19 d.vI ,00318 29 dlVl .00486 10 dlYI ,00169 20 dlVI ;00336 30 dlvl ,00600 ----------------------------------------_.~--------------------------- Anv Pltlv in Inlo'"I, Inoludlng Ihl CommonWOlllh Indlho p.tlonll IOP,"..nlll'VO, nOI OIlIlfild w,lh Iho 'opllll.m,nl Itla "UUmonl ml" oblocl Wlltllh IIKIV 1601 d'vI ,"0' toollo\ 01 Ihll NOI'OI II provldoa bv 80clloh 1001 of Ih. Inhorlllnoo Ind EIllIO Tax ACt 01 196 I 172 P,S, 100, 24S6 - 1001). MAKe CHICK OR MONIY OIlOIR PAVA.~e TOI"fleOISTlII OP \!IILLS, AOINT" bETACH THE TOP pORtiON O~ THill PO~M AND SU~MIT WITH YOUR i'A'fMeNT TO THE ~SQt!lTeR OP WILLS POll THE COUNT v SHOWN ON THE REVeRSS, SEE TH~ INHeAIT ANCS TAX 'INSTALlCTION BOOK POR ADORSSS, l-t'f ,... ~ /Ho: ;.I'J ;(~ ---,~ 1";'11"" '~ f""" ~ '-- } [-':;,'.1 -. \'-_,;Ii: :J"'\ ~l:f ".m <;~';;:b it!1 it', ita ::1 " ., INFO~MA nON Thla doO~monl lathoNot'oanqUlrOd to be glvOn undor S.otlon 7011 6f Iho InherltahOe OIld eatato Tax Aol 01 1961 (72 P,S, nOllon ~4S5), If tho 10>< la Paid within Ihroe (3) monlha altar the dacadent'a death, a dlaoount of 511 of tho tax paid la allOWOd, , Inn.rltanoo Tax bocom.a dOllnquanl, nln. ,I9l m,onlha' altar IhO dootd,nt', dOOI,h. Il1t"OIt la Ohltg'd al Iho ral8 of alx (6)pO/cont por .nn~m On Ihe amounl of unpaid ta~, (!lEE EXAMPLE' eELOW) EXAMPLE: If .balahOe of I.x dua Of $2,000,00 II Ih a dOllnquanl alalua flOm 3-3-eo, .nd paymenl II madO on 5-23-eO, Iho Inlerool la clloul'led aa Indlealad' b.low: , -- -- l! STeP 1 DOlormlne tha rlID of InlOreal ftom Ih. labia bolow. STlP a Mulllplv Ih. bOllnoe of IlK dU.bV Ihe rala of Inlarflt, 11I1.nco 01 10>< dua $2.000,00 Bolt...IlilaJI.tlllt 'x ,0,1335 INTE~EST $" ~6,70 sTlP ~ Add Iho Inloreal 10 Ihobal.hce' of tax due, ' InlOroat from 3~03-eOlo 11-23~1l0 ~..ulta In: , 2 Monlha. ,010 i " ,. ' 200m '. .:L...&ll.3.311 i=laID of Inlateal '. ,01113'6 ,,- - . , .. ';" '",;"":.. ........ _" Or.. _;__.......... ",._ _.... _.................. ~ _......... ">- _.. ,.__..................;........................... _........ elllnco of 10>< duo P:ua InlO/oat to .~t of Pav~.nl (+) TO . IIX an ' Inloreat to 0110 Of, Pavmenl $2.000,00 $ ,..ll.ZQ $2.026,70 1 mOnlh ,001l 4monlha ,020 7 ",onlh, ,036 10 monlha ,060 2 montha ,010 6' monlhs m5 S ",onth, ,040 II monlha .0Qll "3 mOntha .015 G month. ,030 9 ",Ol1lha .046 1~ ",onlh, ,060 I dlY ,00017 11 dll" .001ee :n daYS ,Og382 2 diya ,00034 12 d.va ,,00203 22 dava ,0 3611 3 day. ,00051 13 dIva ,OOll20 23 dIva ,003B6 4 \iOva ,000ell 14"davI .00237 114 diva ;00403 e ,daya .00085 15 dava .00260 25 davI ,.Og42O 6 dava ,00101 16 dlya ',00267 28 dlVI '8m 7 dav. :00118 "dm ,00284 27 davI , 041$4 8 day. ,00136 18 dava ,00301 28 dava ,00471 9 dav. ,00162 19 dlvI ,00318 29 dm ,00488 10 dOv' ,00169 110 dm ,00335 30 dm ,00800 ........... ...,........... ....~...... -,............... -~.............. -...... -..... ~...... ....... - -....... - ...... _.0..... _._....... ~....... "~"'''''' _._ AnY~attv In Inw"t, InoludlnQ IhO CommonwOallh _nd Ih.~_rlonll"PIO"nl_lIv" nOI flllafled with Iho 'Pptilnmonl and .a....m.nl mav ObJO~1 Within IIxtV (60) dav' _flOr rocOIpl ~flhli Notlot .a Plovldtd bV $oollon 100 I 01 tho InhO/ltanco.nd E8Iale Tex ACI of 196 I 172 P,S, no, 248$ _ 1001). "'AkadHICk \lR MONIV DROaR PAYAILI TOI "RllaunR Q' WILla, AllINT''' DQTAc;H 1HE 10P POi=lTIDN OF 1HIS FORM AND SUBMIT WITH YOUR PAvMeN1 10 THE i=leQISTei=l OFWILLIl,POR THE COUNTV SHOWN ON THE REVERSE. SEe THE INHE~ITANCe TAX INSTRUCTION 800K POR ADDRESS, COMMONWIALTH 01' PINNIYLVANIA l COUNTY OF CUMIIRLAND J ... ..~_+~..~._._n'. lIUJ'Jll1:Jt' h.. ,ll!u'IH! ....._,~ '''_''L'' ""_~._'n"'._ ....~_._~_,._....._., being duly _n tlW01'lL...... ._. ucordlng 10 lew, dOpolO1 eild leY I thai Hho __. J.tLllllL._~'nn..'_,_" ...__ ,.n.., _..__.._....J.ld1nJ.uiBtl'.u.1;J.!.lX...-----..,nT ~. 01 tho Ellele of ...._---,.J1J..ulllU.'.lL,li._UuJ.'IJlL_._.._._,~ leI. of_~ll\L llQl'l.l,\,llo.\h,ui'NuuhUlllutlIJlIl'l!. .,--.......----.,' Cumborl,nd Counly, Pe., d.o....d end thet the within II en Inv.nlory medo by -'''C ,,~JlJ!'j!)l'J,\LL.~.J.JudJ.IL .n____.____~_, tho IIld..,.J!l.!!ldn:l.f.l tC,gJdx IIf Ih. .nllro "t,lo al uld deo.denl, conlhl",g al olllhe pmanol prop'~rly end rul "hh, .xo.pt rul .,hl. ouhld. Ih.. Commonwulth III Ponnsylvonlo, end Ihallhe !Ilium Ilppll'''' uoh Itom of the Inv.nlllry repr...nt It', felr v.lu. e' al tho delool. d.oedont', dealh, and ,ublcrlbod boloro me, ~ .~ .~(.1 (? 4~ .~ . ~J!Vl..L';d (,~. A1~.,it#';dJ.J.'J..J , OAIIIMIIIE r. OOU$UM, NOTARY PUBLIC MECIl/lllIC~~')RC ao~o, \lUM8ER\IlNO COUNIV !I\' COMMllSIOl1 EXPiRes fEll. II, 198' , ,,' ~'Mlylv.nll AIloellnon Of NoWIll SWOlll1 19 !l~ .--!'YYi~~~~);<<:~~;I"lfi~ 1 k I ~'LU..~_ , ____..Jili.'LJ\l:l.Bon Htl.'lmt .__ ~leohII1110IlbllJ.'g. 1'1n1I1Bylvlll1l.U 1711!J!) .~._~--_.-.--~~- Add,," Dele of Duth ____"_.....JlllL___________._~._J.uIlt! Diy Month lDHl V.., INSTRUCTIONS " , ,. I, An Inventllry mUlt be flied within IhrIG monlhl ollor applllnlmenl Ilf perIanal reprllenhllv.;i" 2.' A .Iupplement Inv.ntllry mUlt ~o fllod within thlrly days Ilf dlloovery 01 addlllonal elleh. i':; ,:, 3. Addlllllnol Iheeh may be aHaoh.d 81 ,to. perlonally III rully .. 'I. 5" Arllole IV, Flduolorlll Aot Ilf 1949. ~ ~~m , r,;,rn ';'~(1) '-,.;41 _,I:'J ,:;111 1':1 N -. ".., ., In C- r...." ::l .0 ~ III () '..-i 1 ~H i:l ::3 <0 B t<l:' '€i I-'-l ~ fi! ~ j I '" ::r :::> ~I ..!l t.:l I ~ 4-< ri- co ~ I ~ , 0 ..!l Ul j N ~ () r ::l ;!:: tll e u 0 "" p:: H, "" J ~ p; 'ii ~ ~ .w H J ~ Ul Inventory of the roaland personal estate 01 ..,...___Bl t: 11^i11)..~,--,5JI J Il Jl/L~_...~~____. deceased l.......~ , ---, "'-"'0 -+,--",;';...,';':'.. .-;~;:~r:-=-.'":1C!:"'i'-t"':~:Un.t.;';'~'..,-..--:..:r";'-:,";_'_L .,-~ ............"" 'IlEAl, I:: a 'I'A'I'I: Nono 'I'(l'l'^,-, 'llI:AJ., I:H'I'A'1'1:: pflIlSOIMf/l'Y. . , . . ... . 1.. lll1J.venBol seolwl.ty InHtl'llInuntR. l'no, I rJllU). WllgUA 2; OhoClldng.Moount No, 1)1-21J1J:illli-II, StllndUl~d rudul.'ul HllVln!!iA, GlIithol'sbUI'!!i. ~llll'yIHlicl: llnlIH1UlJ 011 c1l1tu Df denth 3" lIol'llhey BunK: llo['ul1d 011 1'l.1I1111ol.I1g ll!!il'OUI\1Unt l/, ,JUl,'!P OJ_5, 1979 model, l1ppt'C1l.l'll'd Vl1J.uo s. ~lIwuBuld l\1otoroyo1o, 1971l11odul, UPIH'lIis('d VlIlll€' 6., YllInal1l1.l\1otordyull'!, 1972 modol, UPP1'1I1.1lod vullle 7,' lIol\1ul11ado t!:>pJ.10l" nppt'ul.aetl volul'! 'rO'l'^,-. PER80NM,TY RECAPITUI.tI'I'IDN l'Ol'^", VAt,UJ:: IlEAl., l~S 'rA'rB TOTAl,. VAI:.UJ:: I'E RSONAJ.1'Y 'tol'AL AI'PRMSIm VAWE NONE $1I.61G.3'i $'I.616.3S \. Nom NJ $ SOli llO , 18 (ill ~7 2 75 3,llOll DO as 00 '100 [)O 110 00 SI 6 II % " LAW o",ou eN.~lIAK.A, . .~'CK.A !' TlW 'I' ^NI! 1'1 N^I, ^CCOIIN'I' Of' ~1^H,IlIIlII: L. (JUHII^, ^1J~1JNIH'I'IWI'HIX 01' '1'111: I:H'I'I\'I'I: OF InCU^I{i) H, (,IIIW^, INI'!: 01' '1'1iI: IHIIWlllill 01' ~tI:t:II^NI CHilIIIHi, CIINIII:IlI,^NIJ COUNTY, l'I:NNHYI,v^N,I^, IJI:CI;MH;IJ ~l^H.lOlnl: I" OIII{1I^, ^lilldllll'I:I'lIt,I'lx Ill' lI!'ol'uHldll IlIld ^<'Ulll,lIll' rill I' 11l'I't>:l1l IlVUI'H IlH 1'0110\vH: IlNl'I: 01' IJI:CI:IJL:N'I" S IJIWI'II IWI'I: 1,t:'I"I'i:HH OF ^1)~11NIH'I'IWI'ION IHHI.II:IJ dlll\l! 1>, l'Hn ,JlIly 111 \ ]\)81 ,lllly ;~ :1, "II, ^"gUlll: h, 1,\)81 ,111Iy ~", ii, ^"f!;IIHI: 7 , 1081 1,1~'I"I'i:HH \VI:IU: ^IJVI:WI'IRI:IJ ^H I'OI,I,OWH: WI'Il t Hltol'o '1'11111'1' CIIII1I)1,]'lll11(1 I ;lI\V .10111'11111 I'I:HSON^L'I'Y . I'I1INC II'^" ^CCOUN'I' 1l1:ill 'I'~ 'I'hl' IIc'uountllllt t-lHI1'gUH hlll'l-w II' \vl tll l'ut'l,lp!' of'i:ltu \I('I'I](lullt'8 glllldH IIIIlJl'hnttl1lf< Ilfl 111<I1'U 1\llly 'Hilt !'Ol'tlt In tilu IIIV('lItlll'Y uml ^flflI'IlIHI'1lI1illl 1Il!l'I'toflll'u fJ ll'd III tho OffJ,'u of till.' Hugl Htl!!' or II'IIIHIII IInll 1'01' CIIIlIIJI!I'lIlIHI C'"lllty, 1'lmIlHylvIl1I11I: 'I'O'I'^L, I'J:HHON^','I'Y, I'HINC1P^', ^CCIIIIN'I:, III:II/"I'H: ~ '1,(;10 .3~ I;, 'J.(j1{J.:,5 , I'J:HSON^I,'I'Y ,. I'll! NCIP,\I,^Cr:OIJN'I! 'ellIWl'I'S --- 'l'hE' ^qoqlllrtllllt 1'11111111' l'I'I'IL! I: 1'01' l"lH' l'ol,lowJl1g J[OIllIl to 1111 pill tI 111 tho (}1'llol' HOt- l'lll'th 'lwf\i1()[-lnn 'n')~ of thu 1'1'1.11)(lt('. 1;llboloH 1I1tLl I'JrhH'lul'JI'H (;ollo Ic'!'''"t pO!'Honlll t:y ppJIII!Jpol IIP"11 I'IIIII.'II'IIIU t'I 011 o I' tlil~ UOI'''"I1I:: CLASH 1, C08'1,'8 01' ^Il~ll N IS'I'R^'I'lON. 1. 1lI'>I;:lIlt:l'1' of WJ I'IH: 1,Ottl'I'H nl' ^LlIIIJIIJHtl'/Itlnlt ~. Cllll1bl'l'l/lntl I.i,\" \/0111'1101: ^ilvl'I'IIH.IIIg ndmll1JH b'o t I'JX" IHI tli'I' i, WIl81' Shll!'1' '1',11I108! 11llvI'1't1H:ln.\ 1Il1ndnIHtl'lll'I'Jx' nntJ(!p ". 81ll'lbnl<0I', ~lI'Cid,f!b 8, I:Unl,ol': i1t1'DI'liI'Yf.l 1'1'11 (,;, R(~gtH'l.Pr' of \~:fllH: "Jl:lJ1g I'p(,' ~i l ,',',F,", II" 0" ",':'>"J . ;'" ;,~, 'lid "'_J" ?,~,(JO lH.nll 1!l,81J ~'iO.()() r.>, Oil Hla:M'I'I'IIINI'lllN -.....----.... I" 1'1: HSllNM ,'I'Y ^, l'IUNC II'^I, M:COIJN'I' , lJuiJItH Cl'udHH 111111111111' (SliHlI, (JIJ) SIJ .lllh,~S '; .lll3, ~'J II, lNCOMI: M:CO\lN'j' DoIJ:1 tH Cl'odJ tH IlnlulIl!l! $ 0,1)(; NONI: 11,1)r, c. NI:'I' BM,^NC I: Ill' I'I~ HHONM.'I'Y ($1111'; ,'Il)) 11, ,HI:^,. I:S'I'^'I'I: ^. PIHNCll'^l, M:CllIIN'I' IlIJ\J:I tH NONl: CI'l!d:ltll NONI: IIrd,uIH"O N()NI: n. ] NCO~lI~ M: ~OIJN'I' ,,; Do J: tH NONE CJ"I~dl.l:1l NONE lIululIl!l' NllNI: (; ; NE'I' 1l^1,^NCI: OJ' HI:^I. 1:8'1'1\'1'1: NONE Ill. NE'I' IIA!,^NCI: 01' EH'I'^'11E FOR IlIS'I'HIlllJ'I'IIlNI NONE l-AW OI'I'IQII ~ 'N.~QAK.R, '. M.IlA~1Q II K~It;lK.A -IJ.. Li!,[R 11"-, l'i,CL ': ~,O