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HomeMy WebLinkAbout81-00442 No, 21-81 PETITION FOR PROBATI! OF WILL AND LETTERS TESTAMENTARV 'J 'j ~ , !, "',,' In the Eet\lte of ~ Pauline G, Elsea , dlloeased, To Reglllter of, Willa for the Oounty of Oumberland, In the Oommonwealthof Penneylvanla, Petllloner(s) Is (are) the exeout _Q!JL__, nemed In the Leet Will and Teetament of pa.!-!].irie G, Eleea __ dated .. November B, 1977 Deoed,ent wae a oltlzen of the United States and a resident of ---Can1P pi 1 1 TOWAMlIll!Sor9ugh), Oumberland County, Oommonwealth of Pennsylvania, Deoedent died on Wednesday the -..J..~th. day of Jl,ll:t A.D, 19-!U..., In the County of Cumberland ,state of , PA at the age of..1J_ years. Deoedo.nt he,e (hae not) been married and has (hae not) had ohlldren born to him (her) elnoe the fiX' eoutlon of the above deeorlbed Will. Dsoedent wee poseessed of por$onal property to the value of ___ $ B 0 , 000 ando! real eetate to\tle value of $40,000__ ae near ae oan be aeoertalned: said real estate situated as follows_ 103 April' Drive, Campliill, r'A Therefore, your petltloner(s) reepeolfully apply(lea) for the pro~ate of ,the said loast Will and Teeta. ment end for loellers Testamentary theron. , " . , Dated July 17, 1991 /-;J/..,.fY';" ().:-2:17tL.-o-< .,f;;,' - h) .",-ph01i:7: MangleV' . r:+~ ..., , ~i2.e.,ttt- 117 Glenn Drive '7;ic.o, t_..-,L~ 9.a..fd9,19'1Y N~mfepeetnltdlonededr(ere)ss D~Y~J.Bt~n~ ~l\ };B901 ( ~~'b~rt-t !lE11se~(I>---- 30 Whisper Wood circle GreenfIeld, Indiana 46140 .' OOMMONWEAL TH OF PEN, NSYLVANIA }. OOUNTY OFOUMBERLAND es Phyllis J. Mangle and Robert R. Elsea \ named In above application, being duly _.__.Ilworn aooordlng" to law eay(s) that the et,ateh1~!1ts set forth In this petition ere true to the beet of thei r --.".. knowledge and belief, ,!'!WQ.m.,...., and subsOrlbed before u.................___..__,,_._.. m?~n-, ,"~11,~7L,.,Jl, -. 1~.B ..l.,.,.._......u._--,~"'-J-~"'"l' ut.l(f,~m~..q;=-- .. _jS;.... -<:::""/,Ji~__~;,(/."ef'o Flied: July 17, 1981 Attorney James R. Arnold, Esq. ,::;>/ -F) Jj'l~ cl\ ;;';1 -:-7 'J'-d', N q (;:, III Q.. y.:". t,,' :,'" ..-~, t.:1 " .1~:,n " r- '1'_~ .t.: t'_, ... ~....I ~:~[:I ""ff ;W ~ '?~ .. m' - d fQ OATH m' r.:RSON,o\(. R.:PRI~S.:NTATIVI<: COMMONWUALTH OF PENNSYLVANIA SSI COUNTY OF CUMUa~LAND Defore mo, ihe Reslslor for Ihu ProbRlo of Wills Rnd srunth1S of Lellors ofAdmlnlslrfttlonlnllncl for Ihe Counly of Phyllis J~ M~ng1e and Robert R. Elsea Cumberland, personnlly clime who, beln8 duly' s.....orl1 _, do__doposo and say that AS Pauline G. Elsea Coexeoutors of the IASIWIII end Testamonl of doeellsed they will wellllnd Iruly admlnlsler (he Boods and ohallels. rlshls and credlls Of sat~ deoeased accordlnlllo law, And alsp will dlllsently oonlply with tho \)rovlslolu of Ihe IIIIY relatln810 Transfer Inheritances. and subscribed before me, ) 0 /-,,}(J} ('It >; '}),' ~"!J ,~~ ",~, f,. I," .."~ ~ ,'".' \"'~-I(':" ~_.Lr A, C__.~"'.<.CJ-e~ July 17, . " ",D,. 19..E:.... 11;r<1 a. ~l;A~ I\~.~ ,--",-, ~ ~, ] (', , ,- Q. !~~ I;': 11 1.1 .:::!-l~_. (..~, \ f' '(;\\1.1 .... l;:~ ;;i; h"" , tl",.J ;:1,1- - r:.)ll..: ~ e(/J -;, IIJ,J UJh3 ''''l! U. ,I..' III '" fO ~~ti 0 III Q:; ~ u ~ N ! ..J . . l' "7't ..J t!> ~ I"'l .._ ,~l III ~ - ~ OJ 3: .~ ~ ,a . tl I"'l ,.... 1 0 ~ ~ I"'l d "" ..... ~ ~ i 1 l ~ DECREE Bo II remembered Ihat on Ih~ 17th-day of. July recorded the IRSI Will and Testament of PaUline G. _.A,D,,191l......, there WM probated and Elt3ea lale of Camp Ui11 Borough , Cumberland County, ~clhnsylvanta. Phoy Hie! J,' Mangle and I~obert R. mlaoa Doceased, Letters Tet3tamentary _were sranled 10 Witness my hand 'Illld pf(lelftl seal the day Rnd year aforesaid, -, 105 . Z7J1t~t/ e,(~~iJ I . , Reslsler j' ^""ot,ll, Mi.lfeft.fllI1Avl,tlY Artn~NlYl A'f 1.It" ..., IU"U 11'111 "' t,'Ii'fiild;.vtil'~'4'.i ll....~ LAST WILL AND ~mSTAMENT OF PAULINE G. ELsmA I, PAULINm G. ELSEA of the 130rough of camp HH1, Cumberland county, Pennsylvania, deolAre this to be my Lllst WUl and 'resta- mant, hereQY revoKing any will previously made by me. I " I direot the payment of all my just debts and funeral eKPenSeS out of my estate as soon as may be praol:ice\l after my de~th. II .. I devise and beque'!i.th all the residue of my estate of whatever nature and wheresoever situate unto my husband, Robert L'. Elsea. III - Should my said husband predeoease me, then I devise andpequeat,h said residue unto ll\~' 6hildren, phyllis J. Mangle, 117 Glerm Drive, DoyleatqWll, Pa., 18901, ,and Robe!:'t R. Elsea, 30.Whisper Wood Cirole, Greenfield, In,iiana 46140, shllrlll andPnare aliKe. Should either of my ohildren predeoeasa me, his or her enare'shal1 be distributed to his or her issue, IV - I appoint CCNB,Bank, N.A., camp Hill, Pennsylvania guardian of any property whioh passes either,under this will o~ otherwise to a minor and with respaot to whioh I am authorized to appoint a,guardianand have not otherwise speoiUoally done so.' Suohguardian shall have tha power to Usa prinoipal as well ali income from time t~ time for the minorIs support and eduoation (inoluding oollege eduoation, both graduate and undergraduate) , without rec;Jard to hie or her parent I s abUity, to provid~for suoh Bupport and eduoation, ,or to maka ,payment for thelie purposes with- out further responsibillty, to the minot or to the mine!:" s parent or to any pel;'son taking oare of the minor. -a'", ,,' ~ g 1eLi.~'JJJ-A.AiJ- ". -~L~?<L' hg,. 1 101 ,.1- " , I ~ " ,.~P ~ r...I'1 ~I 5li'" I~r.. Wd~ == ,,,,ill_' !!~l" 'i," :l~. :r ...... I;:J~: ..J : ...~ J '. " ~~d' "1:l " :, .'-,l "-r~ .' , /'1 ~..:. , \(1 , ... ~ J I j +.t:l 1 ~ 1 ~ ~ lid, ,. I .:l t/) ~ a Nit e 61 j ,~ ,', , \1. . '. ... .. ".' ' of t?~ ~ ('11 Rl~ r~;I~~ Or.' (,'If'') '.. {,-i:u 'I 15 ;lj'.' .;"1 1'-,_-.1 " 'I , r...: , " " .~),'> , ''I, 7f.::t :~o r INFORMATION Thll doo~m.nl II Ih. NOllo. r.qulred 10 b. giVen ,und.r Seollon 709 01 Ih. Inh.rlllno. 'rld SlIII. T.~ AOI of 19s1 (72 P,S,lIollon 2488), If Ihl IlK II plld wllhln Ihr.. (31 monlhl .H.r 'h. dIO.d'nl'l dlllh, . dl.oounl 01'5'1\ 0,1 Ih, Ilx p.ld II .1I0w,d, Inherlteno. T.x b.oomlld.llnqulnl nine (9) monlhl,IH.r Ih. d,o,d,n,'1 d'llh, Inter'" II ohlrg.~ II Ihe r,l, 'of II~ (81 p,ro'nl per InnUm on Ih' ,mounl of unplld IIX, (,See eXAMPLe 8aLOW) aXAMPLe, If. b.l.nol 'of llx dUI of $2,000,00 " In I d'"nq~.nl 1IIIuI from 3-,3-80. Indp!Vm,nt I. m,.d. on e~23~so, Ih, Inl,r,,1 II olloulll,d .. IndlOII,d b,loWI tTIP 1 tTIP 2 O",rmln, Ih, r.t, 01 Multlplv Ih, b,llno, 01 Inl,r,,1 Irom Ih' Ilbl. b,low, Ilx due bv Ih, r'I' 01 Inl"eal, , ' tTlP a' Add Ih. Inlerlll '0 Ih. b.l.noe of !Ix d~., Int,r," from 3-03-S0 10 e~23~BO Rllulle In: , ,2 Monlhl . ,0 10 , 20'0IV' . + ,%Om R.te of Inllrnl . -: ,I 8111no, 01 IIx due Alte of Int.r_at ' INTftRaST '2,000,00 x ,Ol33B , 2 e, 70 ~~lln~e of \Ix due UI nllr." 10 ' , ~t ~' P'Y~"\1 1+1 '1'0 IX In ' Int,rlll 1<1 Oil, of Plvm'nl ' $2\000,00 I 28; 70 12,028,70 -------------------------------------------------------"------------- , , I ll111nlh ,008 4 monlhl ,020 7 monlhl ,035 10 monlhl ,oeD 2 monlha ,010 5 tnonlha ,028 ' 8 monlhl ,040 II mOhlh. ,01111 3 monlha ,0lB 6 mohlhl ,030 9 mOhlhl ,045 I 2 monlhl ,060 I dlV ,00017 I I dlvl ,00 186 2 I dl", ,00382 2 deVI ,00034 I 2 dlYl ,00203 22 dlYI ,00389 3 dlv, ,000151 1 3 d'vI ,00220 23 dlYI ,003ge 4 dlV' ,OOOaa 1 4 d.v. ,00237 24 !jIYI ,00403 8 dlV' ,OOoss 1 B dlVI ,002S0 2s dlYI ,00420 8 d'VI .00101 I 6 dlVI ,00267 28 diY' ,00437 7 dlV' ,00118 I 7 dlV' ,002S4 2~ dlV' ,00484 II d'VI ,OO13S 18 d.V' .00301 2 diY' ,004" 9 d'VI ,08'152 I 9 d'yl .00318 29 d,y, ,00488 , 0 dlVI ,0 la9 20 dm ,00338 30 dlYI ,00aOO -~--------~~-~~---~---~._--------~------~----------------~---~-~------ Any PI~IV In Ihlerelll,lnol~dlh9lht Comtnon",.lllh and Ih. p.r,ohll repr...n'llIy" nOI UII'fled With Ih. 'llpr.l..mehl 'hd ......m.n' mtv obJe~1 Wllhln ,IXIV (110)dIVI".H.r r,o.lpI, oflh" NOIIOe .. provided by Seotlon 1001 of, the Inherll'hC' tnd &ltll. Tlx AOI 01\961172 P,S, ..C, 248B ~ 10011,' MAl<I CHICK Oil MONIV 0~011l ,PAVAI~' Tal "IIIQX'TlII 0' WX~U, AO,N'I''' " DeTACH THe TOP PO~TION OF THIS FORM AND SUBMIT WITH YOUR PAVMeNT TOTHI;ReolsnAqFWI~LSFO~ TH. COUNTY SHOWN ON THe REVERse, sn . THe INHeRITANce TAX INSTRUCTION SOOK POR AOORPSS, I1l!V-"O I ,.aOI COMMONWeAL TH OP p~N,mLvANIA O~PARTMeNT 01' RIVINUU TRANlPUR INHIRITANCB TAX RIlID.NT D~CeOBNT . .....----........ AFFIDAVI1' OP FIDUCIARY (Inntructlon, on Rovot'o Sid.) '* ~.,c;t-u-mt==~--_. ~-"o..m.u.~m1::l'!tt2l- - --_......~- S.tato 01 l'a\llillill G'.-Elua~_-_.~ ,u.~U'_" I.o.t Add rm .lOL"'lt;,U_Pr~'l.IL_.n__ db'._ _.Q.a!ll1LJIUl..-1A...t..J.1_QU______ -- (CliVI (alAn:) (1.\1"'1 Doto 01 Dooth ,Jul)'__15_,_,li8~......._...:.~_"___ u." ..., So~1 01 Socutlty No, .___ull1..~4!t.-:.a1Ql.u.n__..:...."..____" 13u r30U F II 0 No, ,.._____.___..,._,.._.__...________.__'u.. County File No, _,___._21~U~44,t...__.._~__nm 1. OecQdont dlodl ,( )Intealate (without a will) ( x) TUlate (leaving 0 last wlll--copy IIttacho(l) 2. I. Ih" IllIng 0/ 0 Fodoral Eatolo Tux Return roqulrod lor this ostate? Yos__.. No x 3. ( x) Execu,lor/Exeeutrlx ( ) Admlnlstrotor/Admlnlslrottlx Name Phr11:1.!~L1t'!!}i!~__,~.__.....,.._..__,__ ,Ro1)ert a, El..., "Address 117 Glenn Drive 30 Whhper Wood Oircle ..----~..---------~._._--_......__.--.----- ~l..town, P_!~.89Q!,_~~__~.. Gre.nJ!ield, Indiana 46140 (CITYI (01'I\Tf'.:1 UlIl) 4. All correspondence ahould bo mallod to ( X) Attornoy 5. II an attorney I. roprosentlng the ostalD, Indicate: N~me Jam.. K. Ju:nold J...-,Ill~~b At'nold, ,sU'K-.& 5ayre>,--'-~ Ad,dross ~ ~ g~ ~~k~ g7 S.!=.~!~~L,.__..._m_'u__._,,_--~ ...camn ..H!u..-.PJ4...l7..0.lL~..-----,--~-- (CI~ (HATnI (ZIP) , ) Fiduciary. I.latallaale d, opaalt boxes reQlstore(l,I,n the ,dllcodettt'sllndlvlduol n0l\101 or 10lntly with, or oa ol\.ogel\t or deputy of another, or In decodent's IndlvldulI 001\10 with tlghl 0 oCeORS by o""lnllr os agont or doputy. Include Iho,.nonlf and addre.s 01 tHo boakor othor InstltuHon whoro tho sCllo deposit box Is locotod, tho nama (s) In which ,the box la registered and Ihe relationship 01 the lolnt holders to tho docodonl. HAMe AND ADDRUS OP bANK OR,o'THeR INmWTION IN WHICN DeceDeNT MAINTAINeD A SAFe DBI'om cOX -~.. - ~;...==.~~~~~~ N4ME 00 NAMES IN WUiCH SMU DUPOSIT BOX IS REOISTERED ~=,"'-on..._..tr' 4=--'-- ~.....~.' .. CCNBBank, N,A. Camp Hill Shopping C.rtt.r Camp HiU,Pa. 11011 Pauline U, Ell'. ~, j, U L .U ,'I C ::;.. ',.' --- -------~-_....-.-..................-'._.. 1"1 i. .J, , 4~ / ,00 1 ~_u___~_______~__.~.....,._~.~_._ _..._ -.--. --------_.....~~~._--_.__. , -- Under penol ties 01 porlury, I declaro that Ihllvo examlnod this return, Including accompanying schodulOsond ..otomenta, aad'lo the bost 01 my knowlodgo and bollol It Is ltuO, corrocl Gnd completo, , l" ~"/P n L:,' t;f"t.. ~-.-..c:._p L'/ ~ 'r J\LJ.~~~._,", P.LI,~t2Ut.,""..'jC.,h:l.~"'I~,' "_-_ --a;;;NATUK OF PIDuCIA6' If ... J, rf) -~ t{ 1~;,/,I.,;J.JfI _10 ~ ( r -1:'./_.__- DAlE , - -- A:u:r-OIPAR1MINl Of 11OV'iiNO AND VIIPAN OIVIIOPMINT b, IYI'1 Of lOAN 'PISCLOSURE/SEr.EMENT STATEMENT.~ . '" ;" -",-f ----- , " , ~'l~!l Ill.", 3" 0 CON V, ImlNS " ':,1, ,\ 1'11"'',1,\/11,1' ' ...,', .." ". ."- 1'-.- ,.." ,. .\,fJfI,A 2DrMtlA. 'GRANDON'REAL ESTATE,'INC. , , .1 ,-,-, 'd\.I1..i;,,'il"j,il", " ,-" . ~ , , I 3916 Mlrkot r"OOI, C~mp HIII,Pa, 41] VA &, 1!J CoNY, lIiS','" " jll' .' , ., , , 0 III I NlIMIIl'j 1. LOAN NUMPIII I , , , (, -I: I't)": , " . - , , ,,,.,. -" .. " TMh.ln.LondlnU ADI' 'Pllllo' - - It Iho 10 Ihll \lonohcllon, p Trulh ,In. Lpddlng Q, !vIO~I,q, INS CAb I NO [" ,: , "olomonllo olllChod II pogo 3 01 Ihla lorm. " '."' , "', , -'~',,, .- n '.'", , '. " C, NOH: Thlolorm la l\"nl&hodlO Vpq Prlol,IO 101Iio",onl I~ \IIVD'yo,j'lhlollnOllon ohoui i/6'iirfioii(D,;;q!i'\c:o"a"pn~pll"'lni\fte' '''lly(t1onl 10' ohow theocluol ClOIIl YOV hpvo rold,nw pr.oeni' copy ollho 10111111,: ." '-. ,:: '<F'i :r' "",: ,',: ,';" ,,';;<;,:,'j' i" rJ I\OVANC~ rlIOCLOSUREOF.COSTS, 8011,01\0mo oro 0811molod, nnd Ofn mn,kt'" "(0)", Somo nmoun,o moy chong'o II 11\0 10.lllomol\1,. la hold 01\ . dMO olho, Ihan \I\O'dOlo eallmnlld holo\\" Tho P'O"OIO' nl Ihll 101m II nOIIOO,iCll\llhlo.lor 011010 or chonoea In omounl, fUlnishud bV 01hOII." I' '~,,'! ' . j- :".' ,,' I ,." ..:.) ',:\: I ,"" I, " ~ ' [J STATEMENT OF ACTUAL COSTS, Amounlo pold 10 nnd by Iho oo"lnmolll ('lIunl ..0 8hown, Ilollls "mMkod "(P,~"9'l':"W"o pol~, OU\lldo Iho oloslng; Ihoy 810 ,hQwn hlllo\o,lnlo,molionol \llllpOIOo nnd 010 nOI~dod In 1010,1., ".'. "'" " ' bonllQW~A ~, BEHEII F, IINDEII , p, NAM~ UF --,j" . .,'1 , , , , ". , ~, wrLLIllM L. and: PS'l'1\TEl OF P1\ULINE G. EtSl!11\ Pennsylvania \'l4,tional" ." JUDITH'a. Bank I'! , " , I ,,' .. p" , , " 0, PAOPERTY lOQATION , , H, SnTLEMENT AOENT , " I, PATOS , i'" DlsClOSUR~ . " I Marvin aashl:)re, Esquire lOAN COMMITMENT ADVANce 103 lIpril Or! va ,', '\. .,,,1',.,' (',",' .,1 ,',.1 '".' ; ,,'. .., Camp Hill, Penna. I PlACE OF St11lEMINT &t11lEMtNT O"tE Of PIIORATlON6 IF " I" DIFFlRENT FROM ' Penna. National Bank 10~8..81 .. .. d" SET11EMENT " ,. , J. SUMMA'RV OF llORROWER'S TRANSAOTION , K. SUMMARV OF BELLER'S TRANSAOTION FnoM 400, OROSS AMOUNT OU~ TO S Elun I ',' 100, o nosa AMOUNT OUE BORRowsn I 401, Conllocl 10108 \lrlcl :l,l., uuu . UU 101, ConlllcI 60101 DIleo ti.L,OOO.DO ""402, POIsonol plODO'Iv " 102, POIson.1 orooOllv 403, 103, 80\\lomonl ohMgol 10 bOil ow., 1,574,18 404. ' ' (from IIno 1400, 80ellO,n L) Adlullmonl& 10' lIoms puld bV 0011,01 In odvonco; i -- 104, . ' , , 106, I 406, Clly/lown 10~QB 10~8 10 l-...-u; :1, - --- 10-b 1-1-B: Adjullmonll for 110m' paid bv lollor In advonco: 406, Counly 10~0' \0 :1," 39,97 407, A&&o&8manll , , 10 ,., .' 106, Cllv/lown I',x.a 10-1;1 ; to 1....1~ 4Qii:liChool Tom 10MB 10 7-.L-1I; , . ;O:lIb.IIJ 107, Counlv I'ooS lO~8 10 1-1-82 ' '\9.Q'7 409, , t6.' , , 108. AolDumonll ; to ::m:;]l 410. , , . .10 . " , 109, Soh 001 T..8I 10.:sTiO 7-1-11;0: 411, .", 10 110. 10 , ., 11 1. 10 420, Clnoss AMOUNT oliE TO' 'SElIER 51,325.80 1 I 2, 10 , " NOTE: Tho fallowlno BOO ond 600 lorloa 'oOllon. bro nol " 'oquilod 10 bo com\llolod whon Ihls 101m Is Ulod lor odvonc.' 120, GROSS AMOUNT PUE fRPM BOHROWER, 52.899.98 dl.ol08UIO 01 10ltiomon,I CO&lS \1,10110 101I10monl. 200, AMOUNTS IN bSHALf Of ,sonROWER, 000, RE!.lUCTIONS IN AMOUNT PUE TO 8Ell~R I PAID bY OR 50', Pnyoll of liiiii'molloeoo loon , 20', DOPollI or oMOO" monov ., ",," "" 502, Pnyoff ollocon~ mOllaoao108n ............- 202, Pllncloal amount 01 now 100n(l) Ali" nnn nn 503, 501l10monl che'Ons 10 sollor ' 203, Eolsllno lonn(a) IOkonsubjOOI 10 (ltom 1100 1400,,800110n L),. . " .. .,4,157.00 - 204, , , 206, . , , 604, Eolslino 100n(l) )okOn .ubloel to . 606, ' C,odil. to bOllo,wor fOl llama unpol~ bV aollo" , , 606, " , 206, C,lvltown la~o. 10 607, " 2D7, c~v ,taxo. '10 , 608, . - - 208 Auaumon" 10 609, , -208. - 10 C,odll. 10 horrowo, 101 1I0ml unpnld by BOllor: 210, -J 10 , 211. 10 61D, Cilv/lown 10'OS ": \0 212, 10 611. Co~nlV 10..1 10 220, TOT At AMOUNl9 PAIP SY Oil IN USHALf 42,500,OO( 61 2.A8&0~.monls 10 Of bOnnOWEn " 6'3, 10 300 CASH Al 8nTlEMENT REOVIAEO FIIOM OR PAYADlE 6\,\: 10 TO QoRROWtR: , 6'16 10 301 (110&1 onibunl dOl hom hOllowo, 620 10TAL IIEOUC1'ON' IN AMOUNT out to 4,157.00 SEHER: " (hom 111\0 120) 52,899.98 600 CASH TO SHlER FADM ett'tLEMENt: 1----- ~ .. 302. Lou omo~nl& pn,d hy 0'10 hohnll 01 (42,500.00) 601 ClIOU nmount duo 10 &oller 51,325.80 bOllowor (ltom lino 2201 (hom \lno 420) , " Lo.. IOlnllndutl!ono In OhiOUnl duo 10 ,~-- ----- , 602 ,OMoUtntb 001101 (hom \lno 620) ( 4 ,157 :..O?~ cAUl fROMl OR , 10,399.98 ,[J'o,YAAIEtol bt>RAOWEh 603 CASH 10 annn rAOM SETTlEMEN1" 47,168.80 -- ." t , . <--- '-- I j ,I , , 0) 9;. v t> 1ft "" ~ A~ tUU, . ,::. mmMlNT CtlAROU :O~~~~~S p:~e(~~8M 700, 8ALEB/UROK8R'S COMMlsulON b.r.td!'" ~~!-.....!.._?~OO :~.~_!__"~.~,,.____._~-- ....:.... fIlNO~~,,-- ._..:_ FUN~_.___ ,~~O~'-:)rJ~iI6~~r~.~~~lrl~~~~~ 1;11)~l'!!~...,,_...._ ~..__.-n_~..._-_..-------_..,~",,""=,=",m, ,.,,},~,,~~?,,':,~~~~, 3570 00 G d "~l E' t t'. _ ... - :::;:;:;J::::::::1;:l;:;:::::::::::;:~:::::;:::::;*]*:lit::!:::::::;:::;:;:!:;:::::!:::;:;:::: 102, S . _ to rro1 on ~"\Io,;}n a a ~o, ..,00 I _ ...____ ;';'l'l';';':';':'l':':':':':':':':':':':':';':';';':';':'l':'l':';::':';';';':':"':"';:::;';"; _7~3~-$" "_~~,._~_ - _____.- , ' =---===,,~.._..~~.~=~--~:_~=~~-l!lllil~~:l!jl\l~~~i:i~:i!\i~!j~\:i!ijii\~!@llill 704, ' ' ". . . , 600. ,'iTEMS PAVAa~8. IN CONr,9.!~ON WITH L~~N, 1k----.-..-...----.~_n._' "'8gi:==-I,!>.!!,LQl!u1n.quon 100__'1t1.~:D!l!l~ N.ationl!Ll~ .__________.n_. ___.1QQ.QQ..- .-,,~----- _!!02,_.1\1on PllemJl1I_~---'ffiitr~' __.._n._____--'- --r----- _,...-c-.._ ..IDil"__~i'J1lli!I!Jlll!J',J!!.-"'1lianna ~~ on\--nanT' ' _....~--....-- -- J~<'L_...__ ____30 ),,9.91.._ .- OOLJilll.!!!l..B!VJli.Uo a1!l~~__~~_--__..___,,~_..-...-._.m,,-__..1'2<L_..- _..J90, 02L _.:.""::'--- 806, L~ndur'Urllill!\illon f~, ,,--~--------------_...,_..-----._"'"_."-- -".----' ''':'':- O'Q..6, M;lIJJI!!ll~_~\HH~nIlO ,ppllcltlon luo.1\L,...______- _...__~_~nu...-~---- --- . .JNL...-b.l!umpllol'/lo'lnon.9.!nilJu...-__--~.'" ,.....-----.... --- ..JN8, ._800.- ' _J!lL._ ' all, - 000, IHMS REtlUIREll BV LENDER TO BE MilliN ADVANCE, '-:-O()J'-~_Jntololl~~ 10-=-_-=~.1.._ 1s!!Y,,"-- _J!Q2._MpJ.\U!!llu Inluranco premlum!P.L__.'l1o. 10 .J!Q3J...Jl~'-!l!~ lI1Iuraneo momlum for -1'" 10 ...~_Q4.'__h..n__--~--- ' yrl, 10._ 00&, 1000, RES~RVV8 DepoBITED Willi LuNDIlR FOR, --,--------_.-.-~- .1()()_k..Ji~,!'llUm.!illnoo mOJ.~j Imo, ,',' .JQQ2"-__Ml)~.Il!Ul!.lnlu'oneo mo,@$._,__/mo, --------- . ..!.QQ~,c......9.!lY...I2ll'llorlV IO~OI 10mo, @ $ _ Imo, _ _ _ .. , 1 .l!lQ~'u9ou~lU..!.9'p-orlV 10~0I mo. @ $ ___..__/mo'-___. ----.--.--.-) 100&, AnnUli ol\ol\mon\l~. @ $.__........J~_._----,-~--.._--~ ' 100~Jl9.hoql Tax 31110, @ $ , Imqc...~______"'__________ _~lldL... 1007. mo.@$ Imo, ]'OOU,----' 'mo, ii$"""T---7mo'.--.----'--..-u-'---..--- .llQ()J-... TinE CHARon, ~"---- ----.... 1 101, G~lIlon~l1 01, olollno foo I~ ---.---- I I 02, f,hlllool 0' Iltlo looloh 10 ~llgl,::'." Tillo 9~!m~niO ,1104, Till. hlllllol1eO blndot 10 l1Q~~.:::J)'ocumonl PtoP~loll~-' ___ .lJQ9.c..:J~.oIOlV 1m 10 .. caalL J.1Q!,-_-"~.1.C!!.Il~Y" FOOl to Marv.it'Laashoi:a,__~CL.--__---.,..--- ~_~._.._ (Jt2Elodos aIJove Itoms No,,', ...J -- 110B, Tltlo Inlur4nco to ' I .. I I d h' I N --) -~- ..,."",.""",.""""~"""""""",."""",,.""""';'~~ _____ inc ',J . et a OVD tom. 0..' : - -- :'::;:::::,::::;:::::':::::;:::::1:1:1:;:1:1:1:;::::;:::::::::.:::i:i:i:!:;,l:i:i:i:::.:::'::,.,: _ ..............._ ---,:,:,:,:,:,::::::::~:':':':':':':""':':"'l':":l:'i':::"':':':';':';';':"';"'::"':';':': 1100, Lunder', CloyoraQo $ :::'::::::::::::::::.i:;;':;:;:;:;1::;;.:::::.::::::::::::i:;:i:i:l:::;::::::::::;:,:;.i:!:::,"; . ~ ...,.-,.:.:.;.:.;.:.:...:.;.:..,.,1,1.':"':':"';'"':,:,;,:,:,:,;,,:,..,.:.:.:.:.;.:.:.: :.l" , I 110,Ownu,'1 covorogo $ ",' ::"':::::::::::'::::':::':0:::'::,:::::,:,:,:,:::,:::,":':"'::::'::'::::,:,:,:::::::,:'::' I IF:=-'-Pr.!'porlllon of Dood 10 ..JanUILArnOid,_nE8Q11i ,.13-=.-=--==---:=---- - -~ -'i1WlO- 1112. \;'3-:-- .--- 1?OO, OOVERNMENTf\EOORDINO AND TIIANSFER CHARGES :J_2"oT,-'~.t~o~Oi7iii;g-loOI: Oood S '.a...o.Q i M.2r.tnogO $ 9.00 "010011" $ I~02. Cilv/cou.!l!Y..!!~llllmPII Dood fBlO.UO ; Mortoogo,$ , )?i)3~.--'i;IIII.~,.IJI~/ltom.l!!L..Q.!lnd $ SID. 00 : MOr\llgOS 1~04, ., :lOn, ,AIlOITIONAL bEttLEMENT CHAAQES ' :,:i_oC._s;'!iciC.'\2. - _.:=:..:.--..==----. ...@oL..Pu,I\!!'.!l!!l.<;.H2!lli.------.--- 13n3, J)04",=~:'----.-.---...----~~==--..=-~--.. 130&, 1400, ..- ." ..... _ .--.-.----, Jj ,_, , " ,- \ ' . ----:_:==-~~-===~-=-=~.:~~=-==-..=-= =--::=:= - " , ...---t-- .. . -~ ,"" ':.. ---.--------- ---~.. . ,~,-"- .-.--- ,\ ,~ , I.i ._n__'___ -" , ,-. ., 14d,7" --,.------- , - " ..;;...--..--- 1 I ' - , ,. -An~ M }.OlL.._ '::::::::i::::::l:;:::::!:;:::lf&:!:~!n:::::;:::;l:::t1:::!:1:1;::;:::;!;:;i*::::::!::~: , , - 18,00 , l)J.U.UU , " 510.00 , , -.---.- TotALUtTLEMENT CllAROES I~n",.d"" Iin~1 103 ."d 603 S.cllnn. J .nd /(1 1. 574. 18 4., '.00 NOtf; Thu Ulld~:llg,n>>~~CknoWlod~O~IPt of ihll DlltlolUlo 501\IomOnl 5tlllomo,,\ o"d Ag,oollo Iho CorroelnOIl Thereof. ... Iv ,l,(:A(~J,I,f./ k, A.) t' f..( Ii tt ' ' , ~ IJ~ .I .~t!J~ ....... aU~.1 01 Avonl , B,lIe, Of AQ*nt ~ ' :'(, U"dor ~t'rrul" ~/"uml""COI Iho Iwnowor alld sol/or m~y /10 pormit/ / to w~lve tho f2.tleyperlorhwllch /Ilus' 1I0rlll~lIv o~~ltr IwlWCPII ,rA'Mce disclO$ltre ,lid sottl0/l10llr, III "'0 flVOllt sltcll 4 walvo' is mMlo, cop/olaf the S,IoIOmMtf of w,lvor, .KOCl, !otl .1 provldod In rhe rogol4l1011S 01 r/lo /)ol,orrll1ollr of HOl/slllg .lId UrIJ,111 /)"'010/)//10111, Sh,1/ /10 ,tr,~/Iodro and Ih,do. pnn 0/ 10rll1 wllOll/he form IS Itwd,s alolflomon, s/,/omeIlL ' ' IIl'O' IIlv ~,n A$ , AS 1\3111 I" ' '. ~, , , , , LASW WILL ANP TESTAMENT OF l?1\UI,INlD O. ELSEA I, l?1\ULINI!l G. ELSEA of the Borough of Camp lUll, Cumberland County, l?ennllylvania, deolare this to be my Last'\'/ill anCl Testa... mant; he~eby revo~inq any will previously maCle py me. 1: ... t direotthe p,ayment of all my juat debts and funeralexpensea out of my estate as soon as may be praotical afte'r my death. II- I devbe and bequeath all the residue of my estate of what.ever nature and wheresoever situate unto my husband, Robal:'t L.' IUllea. III ... ShoulCl mysaiCl husband predeoease me, then I devise :and bequeath. said residue unto my. ohildl:'en,l?hyllis J. Ml'I!lgle, ,117 Glenn Prive, Ooylestown, ,Pat 18901, ,and RobertR. Elsea, 30 Whisper Wood Cirole, Greenf1eld,Indiana 46140, .share and share alike. S!\ciuld either of my ohildren' predeoeli\se~~ Fhis or har share shall 'be ~istributed to his or her issue. IV - I appoint CONB' Bank,lof .A., Camp Hill ,Pennsylvania 'iJuardian of any property whioh passeseith'er under this will or othetwi/ileto a minor and with. respeot to whioh I am authorh'$d. to appoints, gUardian and have not otherwise specifioally done so. Suohgual:'dian shall have the power tQ use prin,oipal as, wsll as inoome from ,til1le to time for the minorl ssupport and ~t1uoation (inoluding oolle';Jeec1uoat:ion, both gl:'aduate and Undergraduate) without reqard to his or l)er parent I sability, to provide for such S,Uppol:'t and education, ,or to make payment for these pux'poses with..., out further rasponsibility to the minor or to the minor I II parent or to any person taki~g dare of the minor. ..0, " "(). 'C' ~ ItlA..~..v:.." ..;(T, (:::-, .f..,a..c page 1 , ' , t'" t ., QUESTIONS CONCERNING PROPERTY TRANSFERS . " ' , ' '" , 1. Did docadont, within two yoars of death, l1\akeany transfar of any n\llterlnlpntlof his estll\O without receiVing valU,able and adequate conslderatlcn? (Answer HVeS" or "No" ,) tlO '" 2,' Old decedent, within two yeMs of dnath, transfer proportyfrol1\ hll1\Se,1fI herself to himself/herself and another party or parties (Including a spouse) In lolnt ownership? (Answor IIVOS" or "No",) ~ 3, lf the answer to OUe or twoaoove Is "VOS'I and the transfers aro claimed to bo nontaxable, provide lhelollowlng Information: " a., Ago of docodent at time of transfor, b, copy of doath cortlflcate. .' c, Affldavl\by the a\lendlng physician Indicating the state 01 decedent's health at time of hansfer, d, All ,other Information supporting nontaxablll\y of transfer, , 4, Old docedent, In his/her Ilfetlmsjmuke any transfer of property without l,or.olVlng ~ valuable or adequaleconsldoratlon therefor which was to takea(fectln possosslonor enloyment a\ or nfler his/hot death? (Answer "Ves" or "No" ,) --- a, Was there any 'possibility thai the propelly transferrod 11\1 ght roturn to transferor or his/her oslo to or be subject to his/her poworof dlsposltlon'/ (Answer "Ves" or "No" ,). No b, Whal was.,lhe transferee'S age at lime of decedent's death? 5, Old decedenl In hls/herllfetlmo make any transfer wllhoul receiving ri vnlunble and adequate consideration therefor under which transferor oxpresslY or Impliedly reserve,s for hls/hor life or any period which does In facl.!lI1d before his/her death: a,The possession or enloymenlof or the rlRhtto Income flam the prcperty hansferred? (Answer "Ves" or "No" ,) 'blQ b, The right \0 deslR11ate the persons who shall possess or onloy the properlY transferred orlncomo therefrom? (Answer "Ves" or "Nq" ,) No . ij, I f the answer to' II ve b, above Is "Yes," w'os Ihe r! ghl reservod in deco(\en ( 010110 ( ) or docodont and olhers ( ), 7, Old decedent In 11ls!hOr IIfetlrno make a transfer, the cOl\slderallon for which Was transforee's promise to pay Incoll1e ,toor for the benefit or care of transferor? (Answer "Yes" or "No",) No ' a, Old decedent, at any lline, transfer property, the bll1eflclal enjoyment of which was sublect to chango, because of a reserved power 10 aller, amend, or revoke, or which could revert 10 decedent under tetms of transfer Of by operation of law? (Answer 'iVes" or "No".) No' . 9. If Iheanswer 10,elght above Is lIvas," was the power to altor, amend or revoke the interest of the beneficiary reserved In the decedent alone ( ) or decedent and others ( ), " , ~UCTION8 FOR COMP\.ETINCU9tlEPULE "E" BQhedule "E" must Include all property, real ond personal, owned by the deoedent lolntly wltl, another psrW or pertles as Joint tenants wltl1 rlyht 01 survivorship, 80tl1tonglbla and Intangiblo property ora to be InQludsd, List resl estate first, . " Ossorlbe ell real property M Indicated In tho Instructions for SQlladule "A", Dflsorlba 011 porsonal pruporly eslndloated In the,lnstruotlons for Sohedule "B", IllOllldo tho nomo, addross ond rolutlonshlp to tho deoedent of tile co.owner (s) and tho dstatl1e Joint ownorshlp was establlshod, 2.lndloate the total market valua of the Jointly uwned properly, (3, Indloete ,the percentage of the decedent's Interest. '4. Indloate the market value of tile docadent's Intorost, ........~_._......--._~.._....__________-n....,.._ l: ::'" ~ r, 6 tT1 6 :;! z ~ 0 ~ Z /'; ~ M Q ~ ~ p ~ p '.;7. z ~ ;j \ p p o-l ~ ~ I Z 0 0 P 'T1 'T1 I ,~ ~ o ~ ~ Cl " " , I' l", t', ...\1 t;n 'N \011 ' t-... ~; ti' C11 e L'\l': (I'll cl.f'l ~~ ~j;":r ;;l ;;l H,'-~ F hlf..) .~.l ~ ~ l..' !::: I(l ~ ~ RrV'414 HXt ..,." INHERITANCE TAX SUMMAIW SHEET (BUREAU USE ONLY) PII. Numb.r Ellal. Nom. Pal. of D.alh Saalal Seourlty Number 21~01-01j1j2 Pauline~. Elsea Gl Orl glnal C:J Syppl.~.nlal o Rtmalnder July 16 , 1981 10'7~IjIj~a201 ....----, .---- REPORT OF INHERITANCE TAX APPRAISER .. . . - -- I, Ih. und.nltn,dduly apptlnt.d In~.,ltano' Tax Appral.., In and for th. Caunty af ' ~9r,ap(l P.n",ylvanla, cia ,..p.otfully ftpart that I "av. appfal"d th' ftal and p.nanal prop., at r~art. nl,. a,.tah'~ ftlum at th, valutl "tlorth'appult. taah Item In th.I,,1 oalumn III . rl h I,n Soh I.. "A", "B", t C", and t I" Dat.d, ~ovember 23. 1901 - INVBNTORY VA~UI AI AppRAISID COOl ADiue~~INTI RIMAIHDIR AppRA'UMIHT COOl (HARRI S Ull OH~V) R..I P'op.ny (Soh.dul. A) 00+ . P,nonal Prop",y (Sohadul. I) 10+ Joln,.H.ld p'Op.Hy (Ioh.dul. I) 1Il+ T..nl'''' (Sohadul. C) 10+ TOT "L. oROn "SlITI -.-. ~... Dab,. and D.du.lIonl 40. u. (ICH IPUI,.I 1') CLIAR V "L.U . OP BST A TB o LIf. IlIlat. W.I p"CTOR pRIHC'pL.B VA~UB COPI - o Annuity ... paR USE OP AIGISTIlR ONL V T.. on I T.. On I Tn. On I To. on I T.. on I hlmpll,n, T...I e"',la Qg,Ja \, COMPUTATION OP TAX I I I I ..,.-- 1- 691 1511 TOT A1. TAX INTeRUT PROM BAI.ANCe TO I I I L.... C"dllt DATI ,01' PAYMeNT AMOUNT PAID DISCOUNT $ + I INTeReST + - I " . a INTUIST pROM BALANCe Due BA~ANce TO d a m r- !ll rl ~ ~ ,~ ~ ~ ~ , ~ 0 ..! . ] m :;:l ~ J ~ w , ~, ('l l ~, 0 ~ rl S ~ , l:s ~ i g ~ ! ~ i , i g' i ! ~ ~ Iii ~ ~ COMMONWIALTH OIlPINNSYLVANIA l COUNTY 011 CUM,IRLAND j Oil ...~, ,... ..... .~h~:lU.ILJl.J1tmilJLanr;LRob~J:'t.R.:. n:lsU...'~m.~'_~.__~___'''''_''_n_ .....~'..uu.. boln9duly .swcu:n~~u...._~ ,__ aoaordlnglo "w, dapolPl alld "YI Ihalt hoY~__n.._:'-_"~n__....' ~~.._.. -_C_Q.~}lli.llill.lt:.Qt'ILm_"u. '.~_m___n_.._Cu of Iho Ella Ie of _.-F.auline.-O~ Ell A AR Ie Ie of ...",..,Bot'ougl) ofCam~ li:LH...n--...__...., Cun,borla,nd OounlV, Po" dooUlod and that th. within I. an Invanlory mado by _l'hY_L~.!!.ol..J1~p.aleh9<~ ~R~et'.L~.n!tlse,!\he IOld.---20~Eiliecut9t's /;If tho ontlr. 011.10 of lAid dooodenl, oon,I,lIn9 of all tho perlon.1 prop'~rly .nd ro.1 III.h, OKoopt ro.lo.t.to ouhlde Ihe OommonwOllth 01 Ponn,ylvanla, and th.llha IIgura. oppollte eaoh Ilem ollho Invanlory roprolOnt It'. fair v.lue .. Qf tho dolo 01 deoadonl'l dealh, ::;" ' ,- ) l\},~-e.,( :t~-.k". i:C1,'"aAJn.--. _ ...~~~_., ~~. - and 'UblOrlbod balore ma, ,of~&~-i~.~11fQ;~ ~@.. eC...?~ ' ,,' 19-"'/ }i/ '-hia / j 'J C~_<--e......!" t' 117 Glenn Dr:Lve Thflllll 5, Mc(.ullln, Nat.ry Public Mv Co"'mllll~". bpi'" /ulv I, 1984 ~ HiU, P4 Cumbtrl"d COU"IV . . Delo Qf Duth '-__h~.E.~__..m___'___h'_'__ Ju~_~___. DIV Month ' _ _pgy_le~~.9Jm.I_J:a. 18901 ^ddr." , 1981 Vur INSTRUCTIONS I. An Inventol'ymult be lIIe9 wIthin Ihree monlh, allor app/;llnlmont 01 pmonal reprOlOnlatlv., 2. A.upplemo~t Invonlory mu.t bo II10d within ,Ihlrly doy' of dhoovory 01 addltlon.1 ....II. 3, f\ddltlonal .hoo.. may be atlaohod II to pertonalty or really . 4. S.oArtlole IV, Flduolarlll Aot 011949. I. l".J .:, \, _. , - '. Q. u;;:;.' " h q;~,; ,to; (;I, i:j!, N c...., Ii. ' llip-I 0': .~J ~ {-;::OIL' a:': v;, ,\11 BU' ~.!,rn ~llt '-I.:L Sii tile .0 N ~ ~ ~ m ] i ~ ~. ~ 1 ~ I ~ I ~I~ ~ , i ~ tJl j .~ .~ - E lit J '1l :8 ~ J , Inventory of ths realllnd personal elltate of Pauline G. IUsea deoeaeed . ~ .~ __ -- -~ ........;:~-:;r.,c=---..:.=;:::~~_ _ ~AL ,PR:OVERTY House and lot being T..ot No. 13, Bl,ool~ 0 on Plan of Lots of T"ri, n, d,le,VHla, ge", Seotion 3,W:Lt, h a dwelling house oroote,d, there"on known, and n,umpered ,as 103 Apr:l.1Drive,' Camp .lUll, pennsylvania, aoquired bydeoodent andh,erprsdeoeaa:Lng husband" Robert L. , Jl:ls(la, ,on December 27, 1960 by deedreoorded in Dalid BC)ol~ 0, Vol. 20", Page 92, .Oumberland County t'eQords valued :l.1'I"aooordano& with aotual sah price on October 8, 1981 l,OOQ 00 f!RSONAL PROPJl:RTY CONB Banl~, N,A, _ Cheoking Acoount No. 006-002668-9 OONBBank, N.A. _ Sav:l.ngs AC,count No.006Nl07189-0 CONn Banki, N.A. .Oertificateof Deposit No. 34312 issued June 18, 981 _ interest at 13,606% 5,0 un:l.ts of The' Corporate InoomeFund 86t11 month:!.>, paymsnt series _ Cert:l.fiqate No, 8GMP02244 Cusip 219896 31 3 'at 661.68 per unit .. ~Urn:Lture, household goods and personal effeots 1969 Chrysler TOTAL REAL ANDPJl:RSONAL PROPJl:RTY ~t:';1L_ 2,5.18 40 5.366. 42 1,,219 19 3,048 00 1,000 00 100 00 14,252 01 IIE'H600~)(' (o,en IlUREAU OP EXAMINATION PENNBVLVANIA PEPARTMUNT or RuveNUU p,O, IlOll 83a7 HARRleIlURO, PA 171Q8 oeedl!9~t'l Neme (Lell IIlI,lnd ~lddl8lnltlll ~\.~ ' DBOBA8BD 8ncll18eQlulIV Nulnber . Olle of Oulh , _ m-:.~.i.L_ OHBCK ~~lgllIll R~~Uti1-tJ ., ~, 8uppllmentll Relurn 0 ! J .- ,9rf:;J.4 J INHBRITANOII TAX RBTURN RSSIDeNT DBOBD8NT File Numbet .raJ ~ ~ /- OL.f4:~ Decedenl'l Addrell -~ 3, Remllnder Return r' I APPRO. PRIATE 6, hdmll!lIB1B Tex 0 RBlurn Rlqulred, SLOCKS O. Oecedcnt (lied telllte D' 7, DeDident mllnlelned IlIvlnu 0 8. Numb, er of 18le depollt 0 (AlleDh ccpv ~ Willi, ' Irun (Attech copy qf trultl ' box8llnventorled All correlpcndenoe end cnnfldentlel tex InlormBtlolll!lculd be dlrQoted tOI ODRRB. - --- 8PONOBNT Ne , . ' ,_~ III TClep~ ~ ,y 4, l.lle Bltlle 0 AddrelL- CII 8tlte ZII TAX RQctpltulltlOIl 1. RIBI BlIete (8ehedule Al 2, Otockl and Bondi (8chBdule al 3, Clclelv Held $tock/Pertnellhlp Intcr8lt (Sehedule Cl 4. MbrtueUII end Not8l (8qhedulo 01 "6, Calh & Mllcellenooul Pmonal Property (Schedule EI 0, Jolntlv Owned Property (8chOdule FI 7, Trlniferl (Schedule 01 8. Totll Oroll Alletll1clel IInel HI 9, Funml Bxpenl8l Mmlnlltrotlve cOIII/MllCBlloneoul Bxpenlev (Schedule HI 10. 'OebtlIMortgeg8l/Llonl (Schednle II 11, Total Oeductlonl (tctolllll819& 10) 12, Nel Volue of BBtete (line 0 mlnulllne 111 13, Chltltlble Be~ueltl (ScheduleJl 14, Net Volue lublect to lex (line 12 mlnulllne 131 (1) ( 21 ( 3)_ ( 41 ( 61 ( S) (71_ RBOAPIT. ULAtlON AND ( 9) (101 ( 81 - \'iI"8~!S,~ 0 (11) , (121 {131 (14) x,QOa K,10a (171 QALCU- LATION Comnlltellon 01 Tlx 16, Amount of illIG 14 Imble Bl6% rete (161 !Include voluel from 8chedule Kl 18, Amount of line 1411xoblo ot 16% rote (181 !Include voluol from Schedull K) 17, Frlncl~al teK dlle (odd tIX from line 16 plUI tex from line 18) 10. Total Frlor PIVmentll ' (I) Amount Plld (bl FlulOllcount (cl Mlnullntofell ,(18) 18, Blllnce Due (line 17mlnulllne 18) Mike Check Plveble tbl Ae~llter 01 WillI, Auent . .. PLeA8E ReOHECK MAtH .. · Under ~ellftltlel 01 perluiy,l decllre thot I hive mmlned thll return,lI;clUdlng Iccomponvlng Ichedul81 end lIetementl, Indto Ihe bell of mv knowledge Ind belief, 1111 trllO, corr. ind complete, OeclerBtlon of preparer other thIn the pertonll fepr8lBntltlve Ilbmd on alllnlofm.,lon of whleh prepafer hll Inv knowledge,. ~ J / ~.a / t ~ AOOREBB I' OAT a (19) BIONATURf.O~ PIlEMAnR OTHF.R THAN AEPREBnNTATIVE ,r ,. t..., " Co I ;~'j ,',,' \'", ()..' ~.: :";t: ., .'.,<\ .... ~ ~.~ .:. I ~i~; L:L ;1";' ~ "jl .~ . ' '~ ,FJ \,6 ... rJ I I