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HomeMy WebLinkAbout81-00755 . , t". '''I; 01\'1'11 (It' HUIISUItIlIlNIl WITNli"S COMMoNwaAl:I'H OF PONNSYI~VANIAI sSi COl,lNTYOF CUMlm~LANI). \ Thls__~__1.5'L4 '. . \lilY oL__.__.-!!!!!'llllll>lJt' ~A,I),,19 In , before me. Re8Is\~1' fqr th~ Probiite of Wills IInd8I'1\ntlngl~1l~rN 01' Admllllslrntlon Inlllld for slIld counly of Cumberlllnd, hi Ihe commonwoll\lh of Pe1\1\sY.\Vllnlll, \lorsonlllly Cllme~_ ~tlll'1.:In H. ~ICJCn 11ll) und lIulluj: M '_I!:!Yl'Y .-- BUNt IL the IU,bBorllbl1\8 \Vlln,o~ses 10 tho rOI'~801n8 Inslnll1\~nl of wrltln8 pUl'portl1l6 10 be lh~ IlIst WlIIlIl1d Tostiullelll of l:ll1\J.\: 1. llJ.BD l<I'IOWI1 IIH ' " . ,8nl'lIh R, SII1Hh ' I)ntod_ RlJlitl!lI1l>t!1' I'~. Fl77 , llite (If the, 1l11l~Olll.l;h 01' Ml'I'hlln j l'shuI'p;. CUll1bel'hllld County PII" d~cellsodwho beln8 dilly 1I000rdl1\810 IIIW, !\cposo and SlIy,lhllt. thoy wlwupreseni, IIl1d SIIW I1l1d henrd tho testll tl':1 x 1301.0<\ R.Bn\1.tl\\ uU'lO lmown liB Su l'~h H. Sill I th slgl1, sOlll, publish, pronounco lI1\d \lcclllre tho slIld Instrumcnt of wrllh18liS 1I\ld for h ,81' . Tostllmel1t IIl1d 1~lIs1 Willi IIl1d III the limo of so doln8 a he awot'1l . AH'mA VIT OF llEA'rIl C;::,OMMONWBAL,",i'H 01' PENNSYLVANIA I SSi COUNTY OF CUMBERLAND \ beln8 duly , alVaI'll SIIYS lhllt liS nellrly liS Clln bellscertnl1\od the slIld dcccdcnl . . ' S'arl1h H, Snl:1th. oLao ~ knolm ."a Sf!.!lli,.:_ R. SmIth dlod on -^.O,,l9!l..L, jl'ue~dE1Y , Iho pHa t dllY of_lJeoembflr at or IIbo\i(~-~ Sworn to b'c\ock, ~M, ijnd subscribed this ~)~, q ih d->'t~~L ' I . , ' 15th day of Deccmbe l' ~ 19, ... B~~ (2, Rcglstcr 131 0.\1'11 Ot. Pt:KH()NAI~ Kt:PKt:!IICN1'A'I'Ivt: COMMONWIlAI~TII OF I'I!NNSYI,VANIA sa: COUNTY OF GUMlIllRLAND noforo moo th.e Ruslster for the Probrtteo( Wills and l!ral\l.<I'8 uf l..etlorsof Admlnl6trutlonln and for tho County of CUnlborlllnd, POI'6qI1UIlYCIl11Ie-4/~ If. /Cr.&'-1((.l /7;1"U<L4 .}'";~-<C,' ,'.;';V}3 who,bolnl!duly AWVI'II_!do.111> ,dep060Ilndsllythatasl:xuC,\ltllv ..". of tho hut Will and Testamont of- H1I1'lIh R, Hndtll. docollsed i-' aha will wollllnd truly administer the soodslInd chattols,rll!hls UlId credits of said doooaaudllocOrdlnl! to law. And 11160 will dlllSel1t1y comply with the provisions of the IIIW rollltlns to Transfer Inhorltanoo6. ~-) ,. paoell1!Jep 15" "':-A,P.. 19 81. ] &31 <II ,... 10 u.. QO l:l ~~ 0 l J ~ l.J ...J 0 ,.. In ...J ~~ OJ i' ~ ~ - .ffi ~ III ~~ ,S () ,.. (\J ~ ~ ffi,~ I ~ I ,.. ~o<ll C\I ! ' en ~ ~ ! d 1 1 ~ en DECREE Be Itrol11Ol11bered that on the l'jth' dllY of' Deoel1lbep ,A.D..19 81. ,thoro WftS ptoblltod IInd reoorded thelllst Will nlld Testament 01' 8111'11 R. Smith. n1.ao kllOIVl1l1lJ Rl1l'C1h'H. SI1lHh IlItoof the !lot-ough 01' MlilohuldoHbul'g Docoll6ed, Lotters tElstl11111ilntl11'Y were lltllnted to Wltneu my hund IInd offlcllll seal the dllY IInd yellr IIfoteSllld, , Cumberl~nd County. PennsylvlInla. Con\lnOI1\~l?11 I. th N,it1onl1J.Ba Ill( . , . A 132 ~a,~ ,r . " Resister 'ssa~oOv ldO{ ~ooa NOI.L::lnld.LSNI XV.L 3::lNV!lHSHNI .H.L SSS 'aSldSAaM aH.L NO NMOHS A.LNnO::l !lH! MOd S"IM dO Ma.LSIOSM SH.LO.L .LN3~^Vd'MnOAH.LIM !I~anS ONV ~MOd SIH.L dO NOI.L~Od dOl, iH.L H::lV.LSO u!N,IlV '1"11'1 dO IIIJ.IllllllutO.L 1,livAvd 1110110 A8NOl'l 110 ~alHa 1>iVl'l, '(100 I _ sa~t 'Qa' 'S'd t tl 1961 10 IQV xf,L altlla pua ,QUI\I'auUI a41 10 1001 uOllo'S Aq paplAo,d ., 101l0N"lul IIl,tO"PI' "II' 'A'p (091 AtX" UluIIMlo"qo A'W tU'\lJ'''''' pUI' lu,wnltJdd' 'ul ullM P'U,"n IOU "^lltIUP,.,d" l'Ull,,,(I 8\11 pll' 4\1t8MUOWWOQ oln DUlpn:oU! '\08''1UI 41 Ap,d AuV . - ~ - ~ ~ - ~ ~ OOROO' S8VOO' l~vOO' 1',111'00' ('EvOO' oavoo' EOvOO' 98tOO' 69COO' taEOO' 090' eso' OSO' .~ .. - . . ... - - - ... .. .. ~' - . .. ~ - - - ~ - ' ~ .- - - - - .. _, ~" ri .. _ '" _ _ .. OA'p at 69100' ,I,p 01 "'p ,61 t9100' ,I,p 6 ,A'PSI 9t100' ,I,p ,8 'A'P 1I 81100' ,I,p (. 'A'p 91 10100' 'I'p 9 'A'p 9 I a9000' ,I,p 9 .A,~ V I 99000' II'P V 'A'p E I 19000' 'A'p t ,I,p t I vCOOO' mp t 'A'p II, L I 000' A'p I " otO' OU:uow 9 910' 'IIIIUOW t SZO' '41\lOW 9 010' IIl1uow Z OW 041\lOW V 900' ,41uOW I " ~. - - -,',. - "' 'A'p ot 'A'p at 'I'P az 'Aop I. t 'I,p 9Z , 'A'p SZ ,A'p ~z ,I,p ta 'A'p zz 'A'p It sctOO' alCOa' 10&00' vazoo' L9Z00: 09Z00' Lcaoo' OZZOO' tOZOO' 98100' 'uIUOW Z I 141UOW I I 'uIUOW 0 l' g~O' 0\10' 9tO' lut\lOW l;i 'uIUOW 8 'UI\lOlll L _." ~ _ _ r. ~ .. - ~ ... ~ - - .. .. . ;.. h ~ ~ - - .., .. ., _...--.-....--~..---~--~. OL'atO't. 140wA'd 10 '''0 01 II0J8\1I1 pilI XII ]It.LQ! 'O'L '9 t . T.,:ncrow!l"djO' 'litO ,_.__,_. 'OU"juI~L!nld OO'OOO'Z' ,onp XII 10 801l'I'a '8nP XII 10 'OUlllq '41 01 ""8\4, '4IPPV II dUS nL'n $ .LoaM3.LNI ~-"'g'C'tTl)''''---~< -'"n8jar'TO"llIS OO'OOO'~$ onp xII 10aQ""'S gtt 10' . IlIl8lU! 10 81'1l lft'CoO' ~+" . ,110 0 ~ 010' ." '4tUO~ ,Z ,~__,_~,____._ :Ull1ln88M 'ba-t~-g 01 oa.&O~t WO'I t88,GIIII '\\I8JG\UI 10 Oil' 041 .\q anp :<'1 10 OOIl'llq 141 ^ld,lln~ ~ ~US 'MOl80 Ilql\ e41 WOJl"lIi8J8I1I1 10 alll lul a1l1UU8\80 IdUS :MOI8Q PO\lQIPU, n pOI'lnollO I! 10"8\UI '41 'Oa~E~.g uo ilplw II \IIeUJ.\od PUI 'O(l=.C-E WOJI on\110 luon~u'lop I uI II 00'000'Z9 10 onp XII 10 8Qu'"Q ',II :a'd~'lfXa , IM01aO '31d~'If"3a3S) 'x~1 p,oduh /0 lunowI G41 uO wnuu, "d IUIQ"d 191 XII 10 "" 8u'l' tl pIDJI4Q $I \O""UI '41UP .,Iuopooep 041 '$I II 041uOW (f;il' .,,!U IU8nbullop IOwooGq ~I! .0Illl"'4UI 'P.MOII" " Plad xII aul 10 "g 10 luMoo,P I "HOIo ;,IU'P8QOpIIlH J811" 841UOllI 1&) oG'41Ulu\IM .p,'O," XII ..n II il '198~~ UOil'I' 'S'd ~L) 196 I 10 lOV x'l 818'93 pUI! eouI1l4811UI aql '10 60l UQtpOS Japun uaMl oq 01 pSJlncQJ 9onON 94\ $1 \WUJJ"OOP \114.1., " NOI.Lvi;iii.iOdNI ;\ , .\' '14! I l!) "I ];111 1.B. ..';~ i L':W " , ,ld',l~Jij II.. ,;; ,,)(,J.. // I~,' '''- I ;' III V,luon rx' IIl'IIII nUIWAU or UXAMINA1'ION "UNN8YLVANIA IIBPAIITMWr M IIUVENUE P.O, nox 032" IlAnnlBnuno, M ""Oll ~t. ~ ......u~lff"'~""'~~ 1I0oodont'l Nomo II.UII',Flllt, oml Mlthllnlllllloll Uoootlonl'l Arlllrnn smith. S~rahR." ' ,,' 324 East Main Street DECEAun TnQi'iii8oollr,I1V NiimiiOi.-----~'0iii.iirQ'iiqllt ~'Ilchanicsburg I Pflnnsy1van1a 187.16-6874 '12-1-81 ' -..... ,-~~"'-'-~"'~--"''''-'--'-''-''----~--~'-~ CHECK 1.01lglnol ROli'III W 2, 811pplomonlolllelllrll 0 INliEl1lTANOIl TAX RIlTURN RE81DllNT OF.CHI)IlNT Fllo Nllmher 21-01-765 17066 , 3, Remainder Relllrn 0 A~rno. PAlATE 4. Lllo gllQto 0 6, Foderal ~lIoto Tu 0 Retlllll Reqlllred, BLOCK8 S. 1I0eotlont tiled 1,"1010 t":'.l . 7, Ooootlenllllolntolnetl ellVl,ng 0 8. Nllmher 01 lelo dopollt r:I (Attach oopv of ~~~ lrlll\ (Auoch COPV 01 \111111 ,ho~OIlnvell\orlod Ll..J OIlRRE. ,All corrolpolldonoo and cotilldcllllol lo~ Inlormollon shoold he dlroclod tOt 8PON08NT Nome'. Addrell 10 South Mar~et Squarll Commonwoa1 th_ National Bank Telophollo No, (717) 780.3141 CALOU, LATiON ROOOlllIulollolI 1, Rool UIIQle (Sohodolo A) 2, Slockl and Sandi (Sohedulo 6) 3, Olololy Held Slook/Portnonhlp Interoll (Schodlllo 0) 4. MONOoOOl ond Notol (Schedolo DI 6. COlh & Mlsoollon,"I!1 ~orloOft: Proporty (Sohodolo EI 0, Jolnllv Owncd Propcrty(SohOdolo FI 7. Tronlfon (Sohedulo at 8. Tot~1 Oroll Assell (lo\OllInol i'71 0, Fllliaral E~punlQl Admlnlltrollvo Cous/Mllclllonaoul E~pOIl'OI (Sohodolo HI 10, Dohls/MorlOQoesnllns (Schotlulo II If, Totol Doduc.lonl ((01011lno19 p, 10) 12, Not Vol 110 01 Estelo (l\no 8 mlnulllno 11) 13, Chorlloll{o Ooqoelll (Schodoio JI 14, ' Not Voluo IlIhloo' 10 tON (II no 12 mllloo IIno ,131 ComRotallon of Ya~ Harri sburg .. CII 1''1(') .',e (') ( 1) ;i:1 '-.- t'.'I ." ( 2) '" " ( 3) -' ( 4) 36.304 di8 ~.' ( 6) ( SI_ 25.534,79 --~ ( 71 " ( 8) 61.~39. 37 I\ECAPIY; ULATION , AND ( 81 (101 7,419.66 0,459.90 (11) --!t~7~.~ (12) _ 0, 6 . (13) (14) -Afu959.91 TAX 16, Amount Of 11M 14 teNohlo ot 0% rlto !lnolodo VOIlIOI horn Schotloll KI 16, Amou~1 of IInl 1410~s1l1Qlt 16% rllo , !lnclllde Voluellrom Schodolo KI 17. ,Prlnclpolte~ doo (addtlK Iromllno 1 B plol to~ hom IIno IS). 10. Totll Prior poymontl! (el Amoont Peld (hI PIIII DI.cnullt (el Mlnllllnlo!oll 10, Uolonoo 000 (11110 17 IIIllIulllne 10) Mako Chock Pavoble tOI Roolster 01 Willi, Mont' * * * PLEASE RECHECK MATH * * * . (161 K,OS- (101 48.969.91 ~.16- 7.34~.99 (17) 7.343,99 6.700.00 ' 300,00 (18) 6.000.00 (19) 1. ~4~ 99 Undor PlnoltlOl of porjorv, I doclerl that I havo uxomlllod Ihls rotllrn, Includlno ooCOIIIPonv1ng SChldolol ond Itotomonll, ondto tho hOlt of my knowlodoo and bollof, II Illroo, ourrool, Ind oomplote, Doclorollon of Itrlporor othor II\on thO p8110nol represontetlvo II beud on elllnlormollon 01 which properor hOI any knowledoo. ' ' The Commonwealth National Bank, Executor 8IGNi\TUF\S op'I'eASON L I;PRESENTATIVEIS) AODREBS B I (f 'I'" ' ~ '0 Vice Presidllnt and Tax 1a I?ATE C / <,' ,J" / '1)-1 SIGNATURE or I'I'lr-PAllEn OTfIFR Tli:\'NT1i"i'nESi:NTATlVI! MbI1tSS OATE COMMONWEAI.Tli or paNN8VLVANIA INltllRITANca TAX RETUllN Rl!SIDaNT DllcaDl!NT ESTATE OF Sarah R. Smith tAlIllfOlltlHV JQlnU~w""d wllh thtt nldll1'ufBllfVI\lonhlUll'UII\ ~,jjlaloucll1l1 9r,h''''UIQ'fltflll ITEM ' '~P.SCRIPTION NUMBER "\I. I t6t l~. ,'#,'11 f. 2, , 3. 4. 6, 6. .- 7. 8, ?,' 10. 1L 12, SOHEDULE "E" CASH AND MISOEI.LANEOUS PERSONAL PROPERTY .-.. -..,...- llit..ll NUMlIER' 21~B1~ 766 HousehQld 90odSl,appra1sal attached HoUsehold goodsl sold at JewelrYI' appra1sal attached Coinsl sold at Statemeht Savings Account No. 14-004011~~Jw1th The Commonwoalth Nat10nal Bank Christmas Club Account No. 14-3000257-4 w1th The COll111onwealth ,National Bank Checking Account No.142~a4222~-2 w1th, The Commonwealth National Bank ' Uncashed Chr1$tmas Club check dated 11~6-B1 Premium refund from Lykens Valley .Mutual Insurance Co. Accrued income and income balance from A.Wayne Smith 'Trust under Will No. 13639~00-0 with The Commonwealth Nat10nal Bank Cash on hand , Claim payments from Pa. Blue Shield' ~ Medicare TOTAL (AIIO ontoI' on IIno 8, Rooopltulotlonl Of mUt..P.o. It h..dld In"" IIddltlon., 'h..,', of Mm. till) VALue AT DATE OP DeATH 2,170,00 1,636.60 250.00 468.60 17,641. 3B , 20.00 11,608.30 246.26 33.00 1,995.50 103.06 132.00 $ 36,304.68 A[F'[]&'Ll~S~ll I er~,~na I property;,,., "':': ""/4-~~.:::..:.-" " I I' () ..../,1' ':' " / I~pral&ed by :'_ ';/(,,,</,;; t. I;) ,.,~~.:,,(,,;/,:..::,/ ITEM VALUe --,-' ~ '/-h,'::----. ,) ;?,C:vvd cX;J.."-o -..-. -_..~..,. :.~" .., //,. ,.7~ .4!.-:...-c i::;?_t.A _ ':~~'l;..t~Vf--!2l.?-(!I{1;f' ~~'2-ll;6,~~~ 1~Wh-.J?1' ;i..i,,,:,,,,,~" 77.4.(1.. :h"t,-p . "~ I( 1 'L ", ' ()./- (J ':::"'./~/f~-' ../:/",-'[;-'-1 ~~" l{,~~J Tj~~-- 'I..}..,<:~~,~. "1'--:'\" I,;r-:I D/'.....:..."7":.a..., 7 L..(...J~ J .SI l' /', " j1 /F..; , 'h-rl!..~A.Y..,i"'l }:;. ,,''-:'"'':''' L~--c...-"\ ~ n' , /,v/~'';/l'' ~L<-:f", ~ ..;It- ,,~-, If--<~, )2,;> wA (y~ i,~.<>u ~>S.---... :D,~..-I't. .- -....,;,;.".. ... -- , L~~ );';~1 J~j' "..., ''ji Ii)) ...Ii I"~~.....k~,c-...... \..,.r"'"""/: , I' I '/1, ";7'-- II i )... ,/.,.tj...-1-v.,....-r "..,,'/ n '.., " I {;'" , L~{'::e~'I...1'!- t;l.~__. .~ "'''//' ,,' J /" (;1.' : L.t~oI../ ,F t'1::f7 A (":..-.e.. t.:. C. ~;/~\---~1 C,<"-'i:'"l--I:... ' V..<-',..,t-i.,.L.,- ~,~ 'l '\'*- I) '''-1."..., l ,,,/Y<-.'....~ '(i\-'i.-~' A.-t-"""tf/ , ))~ ..., '-- ' .- ._'''\..~..;,I.. /1.-:.<....,.1"....(...1/' -' ' 7.i:,. (~" :;::;:::. 21,IJ, "'0 ; I ..- '" ,(.! /t' ,':'oc / l/;,oo It), 0 lJ )7'., t,() 30, QI.; I~\, (", , ') , ';.. Ii ,. I , -,...., .., _1';)-' l, t: . $, e'( ~-iU , 1(.' , {)() t7o,ou t::,..-= s1' , (10 f,,(.. ,c..;, _ $' ((,) !i/,C'i' ..UI },\ 7....j\.; L. ::;7 . () t ,35', Ow 3'd,c,u Se!, to ~._,- ... ...~.. ." ..;, /.', " ',' <"'I ( po'. "", ..~ ..,~; ~.~ ,.' ,i t'; ~'. /. .......__T_ "b"f:'" ,-.:'.' < . ~ . ..'\-", ,.'.' " )'1 t'/' ,,2 ():2 ,(tre'W&l,12 'I) ......... .) / Ii .. , ~ 'fI ,v.,. .: . 0 r, .tJ )11' 20 , f~--- "0 ,-' , " .--:.:::..(t~. ~'>C' i:;Z~ ;".,,: r'" . ITEM , ,2 r {' C\n/'"",', C~..{n,,,,~f ,v. (" , /:'}.I f C~V.l--'\" '..[)'-<"""!V'i ~IJ.-t" l..<"'{"V'1"v..-1 , , , I ~ ' .. _.. I . "71 4.. -'- ,r." ' J " ,'..... /7- ~0,~/t ,V) ,'771../.1- I , \,'" , ./1 ;", ,....J I .>l , Ilv.., D/\'I,.lu.. C... ,/,.-:..,. ,-- "i' '"", ;;;.:> I '/' , ,.' /"'<::.1' ...... /. .._,--..... r'" - ,/.J " -'r:T/I~ .' .' 1""":";" ,'~ ,.",:,1 ,. ~_/,' _' I ... " ! ,.'_ ~_. L-. ':.. _ t:+: ,.-' ...' ~ ... ,a.. ...'. .... , .<,,' t/ 1-.' If.. , , },' ~ _"I i r! .- ..._ 1."'( ...'....} / / /."..J I .../ I" , '''' ( ,~-, (.', r"'.., ~-~.;. ",. ' I ~ " . ,'... 11 .~. 'J '/ I ~...,. ......'... .... -, ,'/ -: I i"r'~""~~_"'''''L.... ..' r... ~. I' ~ .1 '/. ~:;,i' ,/",~. . .. I~.J_.,.~..~./-..t r'. ..'., , t'(."""'<"~i~""-.' i"itlCS: : Jio.Lllitj:loLll (, ()C bs -:retv'Il"L'I? 'i ~ , t: d ,110, ClCl , leu"o , " ............... 'VALUE .....""t'....._-~- ~'f.!f. \:II, .. ._l.-L'\~-.!-. ,::::::;: .L(; . 0 .:P"" .j","oo ~.. y lIS '.~ ';'~. ~ >, .. -- .-. .. IIY,1I0.... I...tl COMMONWIIAl.TH Of! peNNSVl.VANIA INHIIRITANoe TAX RETURN RB81DIINT Dl!Ol!DeNT SOHEDULE "P" JOINTLY OWNED PROpeRTY IThl. '.h"'ulo m,Utl b. .omplotod If Ihodo..d.n\, Of In. 11m. of ht. 0' htr d"lh, own.d .hY proptrlV II .Iolnt tln,nt with tho ,Ivnt of .~,YIYOllhlp,1 l!STATe OP Sarah R. Sm1 th PILE NUMBER 21~81~766 , Joint ton.nl(l) I 0, Jack E. S,m1 th ADDRESS o e gowoo ace orth H1lls ' /lrkersbyrg. WostV1rg1n1a 26101 02 East Marple Street eChan1csburg. Pennsylvan1a 1706 01 Wedgewo,od ,Place orth H111 s arkersburg. West V1rg1n1a 26101 RELATIO SHIP TO DEOeD NT ece NAME A, Margaret H. Sm t B. Lou 1 se Burtner Brown N1ece N1ece I s husband . Jointly owned property I ITIIM LIITTIIRPOR DESORIPTION Oil PROPERTY TOTAL VALUE DECSDENT'S DOLl.An VALUS OF NUMBllR JOINTTENANT OF ASSBT % INTEREST 'DECEDBNT'S INTEREST 1, A. Statement Sav1ngs Account No,14~0016B04~2 w1thThe ,Commonwealth National Bank. dated 1~21"77 19,604.91 60% 9,B02,46 2, A Certi fi cate of Depos i t No. 141~000699..6 w1th Th Commonwealth Nat10nal Bank. dated 9~~"B1 '12.066.37 100% 12.066.37 3. A Interest accrued .to date of death on Item No. 2 446,36 100% 446.36 4. A $600. U. S, TreasurySer1 E Bond. Qated JanUary 19 526.60 60% .263.30 6. A $600. U.S, Treasury Sori H Bond. dated ,June 1966 600.00 60% 260.00 6.. ,B $600. U.S. Treasury Seri s E 'aond. dated August 197 461. 60 60% 230.80 7. C $600. U.S. TreasurY Sari s E Bond. da ted Janua ry 263.30 1976 ,..- 626,60 60% 8. 0 $60, U.S. ,rrallsury Serie E Bond. dated January 139.90 60% 69.96 1961 ' 9. 0 $60. U.S. Treasury Serie E Bond. dated March 1977 47.66 60% 23.78 10. 0 $60. U.S. Treasury Serie E )lond. dated ~'arch 1978 44.84 50% 22.42 TOTAL (Allo enler on line 6; Reo.pllulallon) $ CONTI NUED UI mor..p...I. n.Id'" In..t' .~dlllon.I'h..t.of 'om. 'till I'Y.ltot'U IHII COMMONWllAL TH OP PIINNSYLVANIA INHIIRITANOIl TAX RIITURN Rll8lDl1NT DaCllPIINT SOHI!OULE "P" JOINTl.V OWNED PROPERTY BSTATH OP FILa UMBER SmhR, Smith 21-a1.766 "" . , ' -~ (Thtll.hld~t' mUI'~' .'mpl",~ If ,h, d"od,o"" Ih,Um," hll', hI' ~..\h, owo.~ 'OV P"P"IV " "'0101 ,,0'0' wilh 'h' ,I,hl 01 ,u,vlv,nhlp,1 JClln,ttenentll)1 , NA E 0, Pamela Sml'th Ross E, Ch~1stophe~ E. smith F, D()~glas W. smith JClI~tlv ClwnedprClpe(w I ITEM II TaR I.IlTtllR FOR NUMBIIR JolNTTENANT 11 0 12 0 13 E 14 Ii 15 E 16 E 17 E 1B F 19 F 20 F 21 G 22 G AODRliSS RllLATIO SHIP TO DECEP'&NT 4253 Boono Street Grand-Nieoe Ph11adelphia, Pennsylvania 1921 ' 1438 NewCastle Road G~and-NephllW Apartlnent B-1 " . DurMm, North Carol1na 27704 2066 McLendon Avonue, G~and-Nephew Atlanta. Georg1a 30307 TOTAL VAI.Ull OllOEOENT'8 DOI.I.An VALUE OF OF ASSET % INTEREST DECEDeNT'S INTBREST DESORIPTION of PROPERTY $26" U.S. Treasury Seri e E Bond, dated January 1966 $26, U.S. Trel\sury Serie E Bond, dated April 1976 ' $200. U,S. Trol\sul"Y Seri s E Bondi dated Ma,rch 1977 $26, u,s.T~easurySerie E Bond, datll,d August 196 $26, U.S. Treasury Ser1e E,Bond1 dated JU1y'1966 $26'. U.S. Treasury Se~ill E ,Bond, dated February 1 69 $26.U.5. T~easury Serie E Bond, dated February 1 66 $26. U,S. Treasury Serie E Bond, dated March, 1977 $76, U.S, Treuul"Y Sorio E 80~d, datedSoptombor 1943 $200. U.S, Treasury Ser1 s E Bond. datedMa~ch1968 $25, U,S. Treasury Serio E Bond, datod Deoember 1944 . $100..U.S. Treasury Sori s EABond, dated April 1916 46.02 60% 22.42 50% 190.24 60% 38.86 50% . 44.06 60% 38.01 60% 43,02 SO% 23.78 60% 260.31 50% 463.36 60% 86.04 50% 89.68 60% , , TOTAL IAI\o enter Cln lint 0, Reo. Ituletlon) IIf m.,. ,....11 oHdlld 10,""~~IlI'oll'h"\l.f 10,,\0 ",.1 22.61 .11. 21 ,95.12 19.43 . 22.03 ,. 19.04 21.61 11,89 130.16 231.68 43.02 44.84 CONTINUED !IV,'''' U+ ",lit COMMONWIlAI.TH Of' P8NNSVLVANIA INH8RITANCII TAX R8TURN RBSIP8NT PIlQ8P8NT SOHEDULE "F" JOINTLV OWNI!D PROPERTY ESTATe OP PII.S NUMBIi S a 21-81- 6 IThl, t.h~ulomu'l bo .omplmd" Iho d...dont, ,t tho tlmo'", hi' or hll duth, .Wh,d tny .ro..rly.. 0 ,.tnl "n.nt with tho rleht oj ,u.YIYOrthlp,1 . Joint ten.nt(l)l " NAME G. Margaret SnavelySml th H. Frances 1. Tll te 1. Clifford R. BroWn .' Jolntlv owned propartYI ITeM Tll J;ETTIiR FOR NUMBBR OINT TBNANT 23 G 24 G 25 " G 26 G 27 H " 28 I 29 J 30 J 31 J 32 J 33 J FlElLATION HI O,PeceD~~'f Grand-Niece ADDReSS 2684 BriarcliffRoad, N,E. ExecutiVe PuksApt. #4 Atlanta, Goo~gia 30329 603 Whitefield Drive' None Mechanicsburg, Pennsylvania 17 55 302 East Marple Street Niece's Mechanicsburg, Pennsylvania 17 56 i;, DeSORIPTION OP PROPERTY $20,0., ,U.,S. Treasury Seri s, E Band; datlld.March 1958 ' $10,0. U,'S', Trea, sur,Y, Seri S E BOnd, dated ,March 1977 $25. U. S. TreasurY Seri e E Bond, dllted March 1943 $25. V ~S. Trliasury Seri Il E Bond, dated January 1944 $500. U.S. Trllasury ser,i s E Bond, rlatedJanuary 1976 " ' $500. U.S. Treasury Seri s E Bond, doted Juno 1978 $25. U.S. TreMury SEirie EBond I dated Fabrua ry 1968 $25. u. S. Treasury se,ri e E Bond" dated' October 1967 $26. ,U.S. Treasury Serie E Bond, dated, March.1967 $50. U.S. TreaSUry,Sorie E Bond I dated ~'arch 1977,' $25. U.S.,TreasUl'Y Soria E Bond, dated February 1~70 husband "I' TOTAl. VAI.UE peoeDI\NT'll POLI.An VAI.UE OP O,P ASSIlT % INTEReST' PIIOEPSNT'S INTERIIST 463.36 60% 231.68 96.12 60% 47.66 88.22 60% 44.11 86.34 60% 42.67 626.60 60% 263,30 ,462.80 50% ' ,226.40 39.6t 60% 19.79 '4036 60% 20.18 . 41. 22 50% 20.61 47,66 60% 23.78 37,.91 50% 18.96 TOTAl. (Allo anter 9n line II, RlIOepltUlatlon) $ (11m... tP..olt nttdtd Inlln tddltlontl thMt. 01 ..m,.I..) UV,IIOlIHI"'lI COMMONWBAL TH OP PBNN8VLVANIA INHBRITANCB TAX RIlTl,JRN RB81DaNT DSCSDBNT SCHEDU\.E "P" JOINT\. V OWNED PROPERTY EBTATE OF SarahR. Smith 21-al-755 (Thl. .ohoduto mU'1 ". .omplOlOd If Iho d.."'onl, .1 Ihollm. of hi. o. hor ""lh, ownod .nv prop.rtv .. '.Iolnl IIn.nl willi Ill. .llhl of IUJYIVO"hlp,1 , " JoIP\.ton.nth) I , NAME ,1.StephenR .'-sm1th ADDRESS 301Swi ft #5 Durhllln. North Carolina 27705 I'IEI.ATINBHIT D OE08 T Grand.Nephew JolnllVownod proportyl ITEM TER I.IlTTIlR POR DESORIPTION OP PROPIlRTY TOTAl. VAI.UIl DEOIlOIlNT'S OOl.l.AnVAI.UIl OP NUMBBR JOINT'fENANT OF AsseT % INTERl!S'1' OIlOEDENt.S INTEReST 34 J $25'. U,S. Treasury Series E Bond, dated September 1968 38.78 50% 19.39 35 J $25. U.S. Treasu ry Seri es E Dond. dated April 1978 22.42 50% 11.21 36 J $100.,u.s.Trellsur~ Serie " E Bond. dated Marc 1978 89,68 50% 44.84 37 J $100. U.S. Treasur~ Serie E Bond, dated Marc 1977 95.12 60% 47.66 38 J $25. U,S. Treasury Series . E Bond, dated August 1966 42.09 60% 21. 06 39 0 $50. U.S . Treasury Series E Bond, dated December 1944 172.08 60% 86.04 40 0 $25. U.S. Treasury Series E Bond. datud Septol11bllr 44,,84 1942 89.67 60% 41 D $26. u.s.i'reesury Series E Bond I. da tad Oc tabor 1942 89,67 ,50% 44.B4 42 0 125. U.S. Treasury Series E Bond. dated March 1968 ' 289.60 60% 144.BO J TQTAL (Allo enlor on line 6, Rooeplluletlon) $ 26,634.79 (If mot. 'PIOII. "ttdld lntttt addltlDna' ,hi'" of ume II.., "IY,IUlIKi ('.11) SOHl!OULE "H" FUNI1~AL EXPl!NSEEI, ADMINISTRATIVE OOSTS AND MlsoeLLANEOUS EXPENEle8 OOMMONWIlA\. TH OF PIlNNSY\.VANIA INHIlRITANOII TAX RIlTURN RBIlIPIlNT PBOIlPBNT EBTAT' 0 Sarah R. Sm1 th _, ' l ,"ITEM 1, 2. , 1., 2, 1. 2. " 3. 4. 6. 6. 7. B. 9. Pllll N Mil " 21.~1.166 DESCRIPTION, A. punerer Il"penlell Myers Funeral l10mel tne, . Funeral , , Ropel't Wolf ,. Re1mbursemll~t fO,r cost ,of gravllstone So Admlnll\ratlve COlli: , Peraonel Reprasentatlve Commlaalona Commonwea' th Natl ona' Bank Attornov feos R1chard C. srio'bakor.Esq. c. MlsoellanDouI EXPOIIIOII Regis tel" of W111 s, Cumberl and County . Cost of probate Register ,of W111 s, Cumber'llnd County. Sho'rt certiflcates , Cumber,a,nd Law Journal . E~tate Notice Mechanlcsburg tnsurance servlce - L labil1tY insurance ThePatrlot News,. Estate Notice --'- TOTA (Alia onter on line Q ROoe Itulft\lon) Ilf morl .p,OI' l'h..d,d In..t. IIddltlon.1 th..tl of II"" .!ttl AMOUNT 2.640.66 , 1~6. 00 '1.816.00 hB16.00 46.ob . 10.00 lB.OO,. 41.00 66;49 50,00 26.00 66.00 7,92 OONTtNUEO IIV.III1 UC-t- tUlI SCHEDUI.E"!" DEara OF OECEPENT, MORrQAQI!S,!:\ND l.IENS COMMQNWIlALTH OP PIlNN8VWANIA INHIl,I1ITANCIl TAX I1I1TURN I1B81DBNT O&CBDIlN.T ESTATE OF Sarah R. Smith' - ITIlM NUMBER 1. 2. 3; 4. 6. 6. r 7. 8. 9. , 10. 11. IL' -"'UMaeR 21-UH2.G DESCRiPTION A. Z. R1tz,man Asso01ates, Ino. - Profess1onal serv10es, John' I. G1.l son '-December rent ~ell of pennsylvan1a - Statement' UGl Gor~. .. Statement Pennsylvan1a Power & I.ight - Statement The Commonwealth Nat10nal Bank - Trustee's fee ,- . -.. - ., su1l1van.& C1ncotta. M. 0, - Professional services PA Department of Re.ve~ue - 1901 State Indiv1dual Income Tax Internal Revenuo S(lrv10e - 1981 Fedoral Individual Income Tax FHN Associates. Inc. - Profess1onal services Holy Spirit, Hospital - Pa,id by 1nsurance .l TOTAL. (Allo onlor On IIno 10,Reoapltulallonl ftf more,plc..I'- nHd.~.ln..i"t 'd~I~lon.1 'h".l ot.'iml Iii,'.' :1 AMOUNT 47:00 160,00 22.00 12,68 278.33 3.33 60,.00 34,14 662.00 ,211.70 4.018.82 . 6.469.90 Inv.ntory of the rtolan~ p'r~onlll ..till. of Sm. RoJilllld Smith ,_~._d.c'o..d, ,~ ..........---.- Relll Es tlI te None JlIn9i bh Personlll Property 1. Household goods, IIpprasied at 2. HOUSllhold ,goodsl sold at 3, vElwelrYl apprasied at 4, Ooinsl sold at Inhngible Personal Pr.QQP.rtv, ,;:^','::i/ ", ,,"': , ' ;~ \1 i) i';. 6. Statement Savil1gs Account No. 14-0040112-9 With The COl1111onwea:11lh' National Bank 6, Automati cChrhtmas Cl ub No .14-3000267~4 wi th The ,Cotl11lonweal th NatiOn/ll Bank ' 7. Checking Account No. 142-842222-2 with The OOl1111onwealth National Bank 8, Uncashed Ohri~,tmas OlubCheck. da,ted'11/6/81 9, 'Refund frornLykens Valley Mutual Insurance Co" Policy No. H000016960 10. Accrued 1.ncome and income palance from A, Wayne,SmithTrust un'der Will No. 13639-00"0 with The Commonwealth National Bank 11. 66 SPecial Claim payment fromPenl1sylvania Blue Shield 12. Med1car,e Claim payment from Pal1nsylvania Blue Shield 13. Cash Tota 1 Persqna lty ,; 2.r70 00 1.636 60 260 00 46,a 60 17,641 ,38 20 00 11.608 30 246 26 33 00 1.996 60 23 20 to 80 _-1.0 36 30 COMMONWaAI.TH 01' PINNSYWA~IA l., "I . CQUNT'(OPCUM,aaRV~ND J Lol s Jb..c,qpJ!l.qnsLJQ11.l or TrusUtlli.llt...Q.t.IJuL,C.Q.nJ.ntl~a.1.thjlo tl Qn6 1 Dllnk beln~ dyly ClWOnll_ ' ~ ~ocordln9 I. liW, d.pol.' ~nd I~YI th~ls he . El/9cutql" . . _.__ .1 tho Ullole 01 Sara Ro~1and Smith " , I.'. .1. l\orQllg~ ,nf.ll\aCJ1~1l1lZsllur9 ,., ' -, Oumborl~hd Oounty, P~., d.ooue4 .ndthol.th. within II on Invontory m..do by .__s:ommon~~,~.1~.b NationaL ~,~Js, Ih. uldExecutor olth. onllro 8Ilole 01 laid d.,oodonl,00nll,lln9 01 ~lIlho porlonal prop'~rty end rul OIlole, neep,l ,..1 ell,al. oY\lld. tho Oommonweellh. 01 Ponnlylvonle,.nd Ihot the f19uro, opPollte oeoh llem 0' Iho Inventory ,.prOllmllt;I hlr valu. .. 01. the d.l. of deoodont', Cloolh , '. . '". , , ' ' .' \..015 n. Cope1an~1 Senlor Trust Offlcer of sWorn to ,~nd"Iublcrlbod bofo,. mOl The Co nwea h ~lona1 ank~, J~lY ..,'],J...' 8a ~ .. -- . " -( . L1~~.~,,~~r~'~ . tlAftftISlUAll, nAUPHIH COUNTV MV COMMISSION UPlftU rES. \I, ,'.5 iolsmbl', Pennl,lvlnll AII~I,tl'" of NoIII'" Oalll qfD..lh _ L P'v ",oc"r CUff Pl'tVI ~ C_Iit11, pennlt. 11011 IIddr.iI D.w;ember Month 19S1 Vur , INSTRUCTIONS I. An InV~nl"'Y ",ull be fIIedwllhln Ih,ee monlh.alt.r oppalntment o'p8ll0n~1 ,.pr.,.nhllv.. 2. A ,upplem.nt Inventory ",ult' b. filed within thirty deyl 01 dhcovery 01 eddltlonol OII.h. . S. Addlllon~.1 ,hee". miy b,o eltoch,d ,as 10 p8ll0nelly. or rulty 4. ,lee Arllele IV,PI.duolarle' Aot of 1949. \ \ ,- t~ ,-, ~-... (,-\ . I_I' hJi &:l/~, ~,w 10.1'" '.'" tit':'_: ~ ~~ :f;i ~ ~ ~t:m I '0 fa ~Ir 'i 0::, \ ~ \ , 'ij 1 i ~ '\) i. ! ;1 ~ ! Ir ,"" 1 ICl ~ 1