HomeMy WebLinkAbout81-00774
. No21..81., .'\ . " " , " \ .1
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Pl!TITION FOR PROBATE OF WILL AND LETTERS~ 0., ;;~,
In the,S8lal. of ,.JY] ~ y 7 A , G fL./ e h II ~ , deoeaeed.
To Reglsler of Wills for Ihe Oounty of Oumberland, In the Oommonwealth of Fannsylvanla.
lJor' . ,'. M A
PetIIIOner(8) Is (tfe) the e~eolJt,,~ named In Ihe Lasl Will and Testamant ot;...\" "'11 '
. ~ID _ dated c.:to b.V) 1-/ I q
Deoedent wae a 01tl~8n oflhe Unlled states ahd a resident of '"
row~ (soroughl, Oumberland Oounty, oom, monweallh of Pennsy vania,
~'l /tlU.l ~'W. ,T'1../.<-llls MY ,
Decedent dledon ~, " Ine' /:1+J, daY?f h J~ d A.D. 19 ~ I ,In Ih!! .
Oounlyof c..\.\M ~ l"'i-\J ," .,Staleof1f-l-\~IlI,."" at Iheage of Q r yelilrs.
Deolldent hae (L~ 1\ been married ~cj _ (hJ~s 901) ~a~ }hlldrtn born t9 .. (her) sl,n08 the e~'
eOl.lll.on oflhe above deeorlbed Will. 1-'e.C.l'.o/A... r I /'10' J ....""'1 f~f ~....'" /1.." ,If "\
Deoedent was possessed of personal propsrty to the value of r"ve n, "~!p,...d Pc:lll!ltl ( r'vl"rJ, ~u I
and 01 real eetate to the value of f; r ~ 1h~MS~ J D"I~.~J
as near as oan be asoertalned: said real estate situated ae follows 300 1- M~yUf St144,. t^l4I(
\"\:\\ ,Q~Y\,^11\J,,\\1"'A>I~ 11:,63.6r (1fo.,'k7 Jft.e.f, J.("v..-ir&l-1v). Q7fl1;1~ "
Therefore,'your.petltloner~resPllc\lullyappIY(lllSl for the probata of the eald ~a&1 Will and Tlllilta.
ment and for Letters Testamentary theron.
Dated De. UA+\ /a.., { 6 q
~A"fllJ (.!,E/..€.~A$ fYf: k~
MM A Ilclt(..;..?;'" 1((71,. Name and addteas
7 '. , . . of Pelltloner(el
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COMMO.NWEA~TH OF PENNSYLVANIA }
c;:lOUNTY OF OUMaeRLANO 88
G. 6:Q rt;(.; i J.. .> /! M PE.u.s
named In"above applloatlon, being duly " S W()r!. /J
statements set f,orth Inthle petitiOn are true to the best of
SWa It Wand IlUbsorlbed belore
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aOdordlng to law say(s) tl1at the
J.J I .'i knOWledge and belief.
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Flied: Dooember 231 J.981
Attorney
S TEllt 'c.,MIr..HOl-hS .r.sq
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If,tt. /l./ r (J1Hi.6, P" /f,'f.'II171 Pf
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LAST\vILL AND TESTAMENT
Or
-
MAllY A. BELEHAS
-,
I, MAllY A. 13ELE.HAS, of tho Borough of Camp HilI, count,y of
Curnberlend, Commonwealth of pl'lnt1sylvanla, bl.'llng of sound mind,
memory and \-lnderstandlng, do make, publish and d(\c;lare this t9 be
my Last W111, and TI'll\ tament, hereby revok 1 n9 any and a llW111 sand
Codlc::l1sbY me atany,tlme heretofore made.
ITEM 11' ,I hereby direct that the expenses of my last
Hlness and the reasonable costs of my funeral shall fl,.rst be paid
out of my Estate.
,
ITEM III I heteby give, deVise and beqUeath .11 my Estate
real" personal and/or ml xed ,of Y/hats.oever natwre and wheresoever
sltwate, ,unto my beloved husband, Jam,es Belehas.
ITEM IlII In ,the event that my saldh\.lsbflnd.should prede-
cease me, die simultaneously wt.lh me or under cirCUmstances In
which .It cannot be determt.nl\ld which of us d,led :flrst, ot If he
,
should die wtthln e period of six (6) months af~er my death, then
the bequest made, l.n Item II hereinabove Shall lapsel and, In sUch
event, I then glvEI, devise and bequeath all my Estate, real,
personal and/or mlxed,6f whatsoever nature and wheresolWElr st.tuat"
untolliybeloved ~aughter,:Constanca ~~ SempelE18, of, the, Borough of
Camp HilI, county of Cum?erland, Commonweal th of PennsylvEinlal I
knoW that my said dayghter, in turn, shol \ provide for her
. ' ,
chl1drM'1 my grandchildren, with as full ,consideration for them as
I throl,lghi th I s I hS t rument do for my sa I d dau;Jhter.
uwor"cU
~ARltN H, LOC~
"AU,"UI'I "HunV"N"
.!1f!;l IV I I hereby author Ize and empower my Executor, and
ltc.a A
215
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substitut~d ~xequtrix, hCl'einaftM namEld, to sell ell the real
property and any or all of the personal property of which I ~hall
di,F,l seit,ed or possessed, ,or ,to which lain entitled at my death, in
the sole discretion of seid I:.xecutor or substituted Executrix, at
private or pUblic sale, without an urder of Court, at such time cir
times and upon such terms ~s said Executor or substitulled t::Mcutri ,
shall deem propM .for the best interests of my Estata, thereby
converting tha same into cashl to execute, acknowledge and deliver
all proper writings, deeds of conveyance and transfers thereOf, an
to do any and al I things which, in hjs or her dhcretion, shall be
dalmed necessary fot the proper administration of ~y Estat~.
. ITEM VI I hereby nominattl, constitute and appoint my
beloved husband, James Belehas, as Executor of ,this, my Las't Will'
Bnd Tes tament. In the event that 'my sa 1 d hus ba~d 5 ha II predeceese
"
me or die before the .settlement of my Estate, I then nominate,
, '
cons t itute Bnd appei nt my be loved daughter "Cons tance B ~ Sempe las,
Bsthe substituted EXe~utrix of this, my Last ,Will and Testament.
, ITEM VI I I direct, that my I:.xecutor or substituted Executr x
appointed herelnabove' shall not . be required to enter security in
any jurisdiction in which said Executor or subs,tituted Executrix
me y ac t . ,
ITEM VIllI hf.'\roby direct that George W. Gekes, my
attc;irney, shall be retained by my I::x~cutor or substitl.lted Executri ,
hereinaboVe named, to be theettorney for them i.h cEu'rying out the
provillion,~,of this, my La~t \~ill and TeStli1mont.
lAWC>>'PICII
~^RTlH H,~OQK
"AUI.n~'1 ""N~YU""I~
IN WITNESS WHER.t::Of', hove hereunto set my. hl'lnd end ,~eElI
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QATH Q}' PItRSONAL REPRESItNTATIVE
COMMONWEAL. TH .OF PENNSYL. VANIA 551
COUNTY OF CUMBERL.AND
aefore me, the Regl!ter for tho Probat,e of WlIIsandgrantlng'of L.eUers of Administration In and 'tor the County of
C\lmberland, personally Qame C?,e.q,(8,~ J, .~. 01 F \0 S ,
who,belna duly bul"....'" ,do e ) depQscand say that as ,. Ad tAl" ~ /" l~ h V c, r,~ '
of the last Will and Testament of . (}1 /tf., 'I AI) It l..t (j .4 J deceased
1-1 e will well and truly administer the good8lind~hallels, rights and credits of said decea,od accordlns.\o law" And
also will dlllgontly Qomply with the prqvlslons of the law relating to Transfer Inheritance" SWI v.., and subsQrlbed beforome,
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BO It remombered that on the . 23rd
recordodthe last Will and Testament of
DECREE
day or' December ,A.P.,19 8~. ,thore wa. tlrobated and
fYlA~'1 1/ ~ELi tflJ S latoof
220
, Cumberland County, Pennsylvania,
G~ <;Iv~/J, . 5~Wlf~/e$'
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c.-f1~n H I[...t
Deceased. L.ollers o-f- A~Ill:IA'\-r~ ~b.., GTn-,,-worqrantod to
Witness n\y ha,llf.land offlclnl soul the day und year aforesaid,
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INVENTORY Of' REAL AND PERSON4LISTATE
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.lit .~, _.<<,fllr .~, Ji....f Ilr""",,,,,,....,,,,i1M~X,,l\I!,,~W;r,.)ll~I,M':\,,,,o,,,,",,....j"""j'
. ' CI\IW liILL' , ' ' .'
Jite of ttllltffllltlltltttll"""HqlltHllllltlIIII"""11llttll'" tho County of Dauphin, State 0,1 Penna.;'dec"Hd.
. ' Jnll.ntofll 01 tho ro.l and perallnal bala\. which wore III the.bove.n.med
MARY A RTnT.lllHAB " " ,",
, Ittll"....tIIHI.ttUt!IIlltfll,tltt'iii1fi'lllllllllllllttl.llti'."llIlfltI.'t1'.I,IllllIllIlIl,tlll ~ocea8ed, Taken- and appral..d'
the 'qttH,HIlU',lllll day ollllft,tlttl",tl,tlltlll,u,19. , <pate o( death "HI~~;tl~/I~lttl"lIl1)
Real Eatata
1. 1263 )lailey Street, Harr~spurg, 1'1\ ~, 000 00
Dauphin County Recorcl$ Deecl Bcok
Pl1ge
'Property No. 09013036
2. 1265 Bailey Etreet, Harrispurg, PA 1,000 00
Dauphj n County Recorcls ,Deecl Book
. Page
l'roperty Nq. 09013037
3. 3p02 ,Market street,Call1P Hill, 1'1\ 49,640 00
Cumper1!\l)d County Records' Deed Book
a~26,Page 29
owned as Joint T~nant with right of sur~
vivorship with constance a. Sempeles
(daughter). Deed dated Maya, 1975
Decedent's interest 50%
PersonalPro~erty
6,
Duquesne Light company~ 3~6 shares
common, stock at 12 3/4 per'
Fruhau:E corporation - 125 ,shares ,common
s.tock at 19 3/8 'per .
National Central Finance ~ 4 shares
common stock at 18 'per
Household good$ ~ Misce~laneous Items
1\r~ata ~ Preferred stock - 4 s!\ares at
30 1/2
4,462 50
2,421 B 7
72 01
100 00
122 00
4.
5',
7.
8.
RECAPITULATION
.7,17R,fl3
ApptBteod value of Porsoll"l ProporlY 'I' 11"I'I'! ..,. III'" II'" ,.11...11111 111"'111111;1,0'.'11111111111111' I1III11111I11111I11
Appraisod valuo qr roa1 6St&tU III1IIHIIIlIHlttl'"111''''lt,Ht''UlIllI",.''ttlflllHlI'U"",,;,"q'"ttt . ~J",~~~,;t9,?
To I I d I . 58 81 B , 33
loa appra suya llU lilt It 1lllltll'ltHltlllll 11'1 I 1111"'1' ",j it "'I.lo't'I'I'1 I'.t I"~ I"tllll IltllI I' 'III'~I, I1l1t"III..lllltll
AFFlDA VIT OF PERSONALREPRESENTIrTtVE
County olPauphln III
OEonOE J, SEMPJ~rIES
tlllllll,ii'"111IIIH'ftt'tll"IIIIIIIII,'.'UI'llllltl'",,,i'ttllllllttllllltllllll,IIII'i1tii'tlllllllt','I'<lflflIllfllllllllllll"llllttllll
RX~cllto r
Admlhl8trat or' "the r~Btnte O("ItIlI..,~'All'l;IIA'\li.~mMm"'MHlIIIl'Il""'III1IIUHlltllll/flll"'''ill i1lHil't1111
.dce~a8ad, belllR" 1I\lly,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,",,,,,, sccordln~ to laW, dappse and sa)' IhRt, *ho
Items appearing In tho Invcntory Inclllde 1I1l 01 tho Ilorsonlll n8&o\l wher,ever situate and al 01 the
r,O,SI 08"tale,In tho ComlllonlVell, 1\h 01. f'cl1,l1sylvnl1ll1 or Sllld docod~II,11 thM the valuation pI seed oppollte
endl Itm11 of 8nld Illvcnt\lry rCl'r08cl1h Its rlllr vslllO n8 ollhq ,dele, 01 the .decedent'a death I and thsl
decedont oll'l1cd 1,'0, rosl c8tslc nlusldo tho Coll1l1lonlVolllth,9I"l'0111l8ylvanla eX,cept, thBt whleh appoara
1I111111Cl110r81HIIII11 81 tho olH,1 qr Ihe Inl'ontor)'. ,/1 ' C'-.)..) .
.;;SW,q.ui;\":l:hI,,,,,,,,,,,..,, nnd 811h8erlhod ~ . ~~:"t.~~~ ~~ , :'" ('~"" , '/
1 I ' tll' nn.t Id I ,Jfl"ill,""I1''''"I'-:;-~'liIW'U'ill I. 1i1TIfj'ltf".f..Ivf'pt(~tf~H,r,i1t1r'"
Ie ore 1110 1 f",,,.,,,........ ',1".........., s)' II ( 300B M Ifltl~'l!"l ;'~~'l!llt...\lM" " .
1II1111~~~?;JI.*llil'.i1.lIl1ltHIII'III1I.t A. P. .t9~I~UI Camp n~ 11 ~.--; .ennsy_+vt\nia 17 O~,l'
Y,'~- F):-; ,i'I,', ,/1, --'/)/)/1,1)') fr .""I.....IIHII...ItI\IIIHI"I""llll.III..HI:~i...,I"III'"HlllHIl..11I1I'"''
UIII'~.'1I~~"y.j'ri",.,If(."" III I.imiftl1(I'tHi!)" IIH"'" ""', . AQat...
LINDA l), f1I.NlrZ, 1I00nr./.,,,,,1I1:
HlIlll'born, D"<lpilHl Co '" INSTRUCTIONS
, , My COlTlmlsulol1 Expl(UII Jlilll1 ~11 HH.Hi '
'~f;fl"nll1veotory. mll.lbe ftleu'wlthln Ihreo monlhl att.r sppolntlo~nl of porlonal repr.l.ntatl'!l:
8, A supplemenl.l lnvonlory mu.1 be ftlod wtlbln IblrlY lIlIy. of dl.Onvery of Iddlllou.l a...la. 1,lh,
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a. Addltlonll Iheola mlY bo .IIMbod S' 10 per.on.IIT or restly. .;(; ,;.
.. see Arllelo IV, Flduol.rI8l'Aol of 1819. ',,:"')
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OOMMONWIAL TH OP PINNaVI.VANIA
INHIRITANOB TAX ,,'TURN
RIBIOINT OICIIOINT
SOHEDUl.e IIp''
JOINTLV OWNBD PROPBRTV
BaTATH OP , . PlLIi NUMIlIiR
.... .' 'RIl1T,1j1J.1)\RcMII.\lV 11.. .' , ' _ ,07li36C
(Thl. ..haclyl, mun~. ..mPlllacI,1I 'h' d..ed.n',',1 'h. tlml.l hll 0' h" d"lh, owned Inv proPIf\V'" loIOllln'n! wl'h','hl rl,hl.1 .u,vlvonhlp,\
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Joint ttntntlt)I
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AMB
. Conilltande II ,$enlpeleS
ADDRess
3008 l1arket Stree
camp lIill,. l?1\ l7'01l
B.
0,
Jolntlv owntdproptrtvl
DOI.I.An VALue OF .
DECEoaNT'S INTaREST .
$49,6
!TIiM
NUMBeR
aR
LaTTaR FOR
JOINTTIlNANT
TOTAl. VALue
OF ASSBT
$,99,280.00
DIlCBOIlNT'S
%.INTIlRBST
50%
DBSCRIPTIoN OP PROPERTY
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Real Estate ~
3002 Market Btreet
Camp Hill, P1\ 17011
Bee cumberland
CO\tnty ReQo.rl1s Deed
Book T:l,' Page 29
Deed'dated ~ 5/8/75
,
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TOTAL lAlla ontor on line 6, Rocopltulatlon)
$
49 640,00
~V.lfl1tl(+'t"'ll
ITP-M
NUMaeR
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'SCHEPULE 1/11/
DeBTS OF peceOENT,
MORTGAGES, AND LIENS
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FILE
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DESCRIPTION
......---_. -_.~------~...
1, Harrhburg School pistrict Real !DFlti:d:e Tax M 7/70
Property ~o. 0901303G~9 (1263 Bailey street)
2. Hardllburg Sohoo1 District Real !Dstate 'rax ~ 7/79
Property No 09013036-0 (,1263 Bailey Street)
3. city of llartisburg Real !Dstate Tax - l/BO
Property No. 09013036,-0 (1263 Bailey Street)
4. arrisburg Sohool Dietrict Real !Dstate Tax ~ 7/80
Property No, 09013036-0 (1263 Bailey Street)
5. auphin County Real !Ds~ate Tax -L2/Bl .
property No 09013036-0 (1263 13aile~{ street)
'6., ity of Harrisbur~ Federal Estate ~ax - l/Bl
prop'erty No. 09013036...0 (1263 Bailey,street)
7.
B.
9.
10.
11.
12.
arr:!.sburg School District Real !Dstate Tax - 7/7B
proPllrty Nc. 09013037-B
,
tarrisburg School Distriot Real !Ds ta te Tax - 7/79
Property No. 09013037M8
,
ity of Harrisburg Rf3al !De tate Tax -, 1/80
Property No. 051013637-8 '
HarriSburg Schooloistriot Real !Dstate TaX - 7/80
Property No. 09013037~B
Dauphin county Re,al !Detate Tax - 2/Bl
Property No. 09013037-8
city of Harrisburg Real ,Estate Tax - 1/B1
property No. 09013037MB .
,....--.-------~---.
TotAL (Allo onlor on linn 10, !'locopltu\ltlot\) ·
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'llf more '"'Cl8" n.edlu1lntart .rtdltlUnill 'hee" of ttlnie tlltl
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lli!:!?.!1_~ATION
Thll dooumenl I~ the Nolloe required to pe given under Seotlon 709 of the Inherllenoe .nd E"at, Te. Acl
,of 1961 1721',5, aeotlOn 24B5),' '
If the te. II paid within three (3) monthl Ifl,r Ihe deoedent'l death, e dlloounl of 5~. of Iheil' paid II ellowed, '
Inherl\lnoe Ta. beoom.. dellnquenl nine (9) monlhl alter Ihe deoodenl" dealh, Ihter'I,' II ohlrged ,Hhe
rile of II. (6) peroent p,r ennum on I~e Imount of unplid 'e., (BEe eXAMPLS BELO,W)
, '
eXAMPLE, If I bll,noe of II. due of $2,000,00 II In e delinquent Italul from 3-3"80, end peymenl I' m,de
on ~:!.3-80, th, Inlereat la oelouleted .. Indlolted below! "
llTlp I
Determlno'the rile 'of
Inteleat from the teble below,
~T8p 2
Multiply the bll,noe of
Ie., due by the relo at
Inlet..l,
Inp II
Add Ihe, Inter'lt
10 Ihe bilenoe of
Ii' due,
$2,000,00
$ 26,70
Interu' tram 3"03-80 10 6-23~80
R'lulta In!
2 Monthl. ,010
20 Dave ~+ ,00~35'
RAte of Inter..1 . ' ,01 35
Belanoe 01 II' due
Bat. of Inloret.t
INTEREST
, $2,000,00
. ,0133Ji.-
$ 26,70
B,llnoe of Ie. due
PIUI Intern, to '
rMt ~f, pav~!nt 1+)
, ex 'n '
Inlerear 10 Olle'
of PAym.hl
$2,026.70
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" I month ,OQ6 4 monthl ,020 7, month' ,0311 10' month I ,060
2 monlh. ,010 5 monthl ,025 8 monlha ,040 ", month I ,06lS
3 monthl ,016 6 monlhl ,030 9 monlhl ,0413 ,12 month I ,05D,
1 d,y ,00017 1',dIYI :OD1B6 ~ 1 daYI ,00362
2 daYI ' ,00034' 1 2 daYI ,00203 22; day. ,00369
3 dlYI :000111 1 3 d.YI ,00220 ',23 daYI ,003!l13
4 deYI ,000eCl 1 4 daYI ,00237 24 daYI ,00403
11 d.yl ' ,00085 1 6 dlYI ,00250 '211daYI '80'420
e dey. ,00101 16 day I ,00207 26 d,YI " 0437
7 dey. ,00 I 1l~ 17 dlya ,00~84 27 d.y. ,004a4
8 d'YI ,00135 lB \l'y, ,00301 28 dave ,00471
9 dlv' ,001112 19' dlYI ,00318 29 dlYI ,004B8
10 dlYI ,00169 20 diY' ,003311 30 dlYI ,OOSOO'
" .. ,....." ..'... '
--------~~---~._--------_._-----------------~---~--~--~--~---------~---
Anyp,rlY Ihlnternl, Including th, Commonwealth end (he peraohll ,rept8len\etlve, not, ..till led with Ihe
apprill.menl ,hd ......m.nt may Obleol wllhln 11.1\' 160) d'YI Ilttr receipt of Ihll Nolloa 'I ,provided by
Seotlon 1001 01 Ihe Inherlt.not end Elllte n. Aot of 1961 (721"9,180,2486 - 1001),
MAI\I,OHICK 011, MONIV OROIII ,PAYA8LI TDI "1I101STIII OP WI~~S, AQINT"
DeTAcH THE Tal> PO~TION OF THIS FORM AND SUBMIT WITH VOllR PAYMENT TO TI:i~ ReGIST~~ OP WI..S POR
THe COUNTY SHOWN ON THE ReVERSE, . see THe INHERIT ANce TAX INIlTRUCTION BOOK paR AODRess,
ncr..u \l,1.UI
APPLICA TION FOR AND CONSENT
TO TRANSFER SECURITIES
REGISTERED IN THE NAME
OF ^ RESIDENT DECEDENT
.
COMMOHWBAl. Tit OF PBHHSYl.V,6.tIlA
OBP"RTMBHT OF RBveHUI
nURe"u OF COUHTV COl.l.eCTIONS
- ----._-_..,-_._-----,.~-.-_.....---_._---_..- --- ..------...,
DATe__~ 1, 1982
--.--
~ (MUST B~ FII..ED IN TRIPI..ICATE)
TO THE PENNSYI..VANIA DePARTMENT OF REVENUEI
, Appllcallon \a hereby made lor CQ1aont to !he t,ranaler 01 the lollowlng lQcurlll" of 0 Pennaylvanla
Corporation o,r a Notional Banking Anoclatlan located In Pennaylvonlol
(0) ,4 ,L (b) A.ro~tIl. Series A .'., (0) "PX'e:r.e~X'~d
(HOTEl In dncrlblnp '9curlll.. enlar In (a), ah(lle, ellhertl1e number a,f ,haru 01 stock or the lace amount 01
reglalerJd bonds, In (bl, the name of lhe I$&ulng company and In (c) the cla$& 01 slack or the ,stated Internt rate
and maturlly date of ngllterod bond..) .",
ISSUED ON ' ond hovlng a TOTAL MARK ET V A'~UE OF $ ~2. 00
(DOl')
0101 the do!. 01 death 01 the decedent, ...-.Me;,,}' A. nAl Ahnl;1
, (Home 01 D...d.nll
I on...-.AlIllu~t 13, leal
(Do'. 01 d..'h) ,
who wallate 01 ~D09.' ~In "kAt f3tt'ee1; I C1nmp Hi 1], C\lmbat~aJld Coun,ty; Pennsyl.van:l n.
(Str..' and Humb,,) (p..t 01(1.') (County) (5'0")
The ..curIlIOl arJ reglslerJd as lollowsl
-
(Mom. or Mm...ln whl.h ..,1111."" .rt "VI.,,,.d)
~~m.~ Gent'8" .T Jampfl1 """ , 3.0.D.B-1J, fU'.k, aj~:..s.t.r.\lfl-t.f.....Qnmp Hj 11,1 PA 17011
E")(EtO'l'OTC ..) (Mom') (Add..,.)
NAME! OF. i\PPLICANr __.GGOJ.'.g.a....J_Sampe1 eo.
(:OUNTY FILE! NUMBER d(/~j?/~ ?-1tADORESS OF APPLICANT 3.008 ,W~rket Stt~e,t/ cl\m~ H~l1
BUREAU FIL.I! NUMBER, ' SIGNATURE OF AP~LICANT /, i .. 'le' .<' '.F ,; !"'
. .'. ,
NOTICE, IF YOU .FAI\. TO PROPE,R\.Y FI\.\.IH ANY PORTIOH OF THIS APPLICATION, ITW.ll.l. NOT BE
CONSIDERED COMP\.IIU AHD WIl.L BE RE'J1URHED TO you FOR COMPl.ETIONf
- ......................--------_.
, '. C;OMMONWEALTH OF PENNSYLVANIA - OI!PARTMeNT 01= REVENUE~ ' . ,
, CONSENT TO TRANSFER SECURITIEl DATE tk~ )1//2-
I hereby \lonsent to tho transfer of lho obovo'eocurltlos nowreglstorod In lhe name of. ofotfald, '
Decedent and wq've the filing 01 acortllloato certilylng 10 the poymenl ~l the. ir~nslerJnherllanco taK to which
.
the proporlyol sald,Oocodo,nt Is madosubloct putsuant 10 the prOVisions of tho A,ctof Juno 20,1919, P.L. 521/
a$ amended Qnd the Act 01 J\.Ino 15,1961, P.L, 373, as amendod, This I, also In acoordan\le with Iheprovlslons
01, the Act of April 9, 1929, P.L. 343,
This Conullt to Translor thohoroln dOAcrlbed propMty operato~ only In roloronce ,to the ostato 01 the
obnvo.ntllned Oecodont,.
,\
,-j
,
,I
~' ,.~~\"'~'
J~'tfl.t.~
~..~%}}N ,
. {~,;,l.'(ijj}~~.
COMMONWSAI. TH OP PENNSVI-VANIA
O~PARTMI!NT Of R~veNUB
BUReAU DP COUIlTV COLI-BCTIONS
APPLICATION FOR AND CONSENT
TO TRANSFER SECURITIES
REGISTERED IN THE NAME
OF A RESIDEN'r DECEDENT
'*
~_____~~_~.,..'n.._._'.~'_._~'~~_'U n'__'__'~'_~"U""'~'_"_ .-_*.~___---.~~______
~ (MUST Be PILED IN TRIPLdCATE)
TO THE PENNSYLVANIA OEPARTMENT 0/= REVENUE,
Appllcallan I.. hlloby mode for cQ1sonl 10 tho Irons for of the following nturltlu of a Pennsylvania
Corporation or 0 National Bonking AUllclat/on locotod In Pqnh.ylvanla,1
(0) .125 ,(b) Fruhl~4t Cq"poroJJ..ap , . ,',. _(c)_COmlCOl'!
(NOTEl Indeocrlbln~ naurllln enler In (0), ab 010, elthor the number of shorn of stock or th, face amounl of
reglslered bond., In (\I), the name of the laau,lng company ond In (c) tho cia.. of .tockor th, .tated IntfrOlt rolo
and maturlly dolq of reglstere9 bond.,) , ,
DATE-J,'lllQ 1,..J..9aIL
ISSUED ON ,.and having 0 TOTAL MARKBrVA'LUE OF $..L 421 , 87' -----
(D.'')
080f tho dolo of dooth .of Iho docodonl, Mllrr A. J3e1ehas ~___~~_, on_ Auguat 13. 198L
(Nom. .f O...d.n,) (Do" of .d..th) ,
who was 1010 of 3002 Market at reat. Camp HJ,ll..t....9..umherhnct Count~, Pennsy1vl\nil\.
(S""I.nd Numb..) (Po.,Offl..) (C.unty) (St~t.)
Th, ucurItIOl,or,o reglslorod os followlt
~ ----....-.
(N.m. 0' n.m.. In which ...'111..'" or. "ol..t."d)
~ OeOl;ge J. sempelos, 300~)larltetStreet, Camp lUll, PA17011
EXeCUTOR) (Nom.) (Add,...)
NAME OF APPLICANT Qeorg!') J. SemneleEl..
COUNTY FII.E NUMBaR$f/~ 11.1 ADDRES.S OF APPL.ICANT...n.Q.Qft,.M1\r_ke~; str~et, Camp Hill
BUREAU FII.I:Nl.JMBER '" _,SIGNATURE OF APFI.ICANT _-(~!'<'>"-11<< 9!:..~?"'1'''':'1;'t:..~
HOTICS, IP YOU PAI,L TO PROPSRLY FILL IH A,NY PORTIONOP THIS APPLICATION?ITVfI~l;'NOT PIl (-
CONSIPIlRl!P COMPLETE AI'!D WILl. BIl RIlTURNSD TO YOU FOR COMPLIlTIOH. v
---
COMMONWEAL. THOF PENNSYLVANIA..; DEPARTMENT OF REVENUE
CONSENT TO TRANSFER SECURITIES
--- DATE
I 'h,llroby Clonunt to thelranefor of tho above ..curltllls now roglslered,ln tho nome of t
Ollced,nt and walvq the filing of 0 ClorllllcaillClertlfylng to tho payment of the trllnsferlnh,r1tMco lax 10 which
ih, property of s(lld' Oecedent Is mode sublo~I pursuant to tho ptovlslonsof the Act of June 20, 1919, P,L. 521,
ci. amondlld and the AC,t of June 15, 1961, P.L..373, os amondod, Thlale olao In accordc:oco with Iho provl.lons
~
of tho A~I of April 9, 1929, P,io. 343.
This Consent to Tronsfor tho horoln doscrlbed property operates only 111 roferenco to tho oatalo of tho
..
abovo-nomod Docodont,
d'
COMMONWEAL TH OP PENNSYL VANIA
OBPARTMINT OP REVBNue
BURlIAU OF COUNTV COLLBCTIONS
APPLICA TlON FOR AND CONSENT
TO TRANSFER SECURITIES
REGISTERED IN THE NAME
OF ^ RESIDENT DECEDENT
'*
_o_________. __~__.__~ m'_______...._._.._..~~._.~__.__~__,.., _.____...
~ (MUST BE FIl..ED IN TRIPLICATE)
TO THe PENNSYLVANIA DEPARTMENT OF REVeNUEI
Application 'a her.by made for conaentto the tronafer of lhe following 10curltl,olOf oPenn.ylvanlo
Corporation \lr a National Banking Annc,latlcm located In Pennaylvanlal .
(0) ,SO, ,(b) 'Pu~uesne Light Company, , _(c)-.Qommon
'(NOTE, Indeacrlblnp securhles enter In (o)/ab O/e, either the nU"1ber of. ahurea uf atock or the face amount of
rOlllll'r.d bo,1dl/ In (b), the name of th~ IlIulng company ond In (c) the clall of alack or thnlaled Intereal rate
-and maturity do!o of reglat.r.d bondl,)' " . "
DATE
ISSUED ON
, and having a TOTAL MARKET VAtUE OF $ , , Ii ,-469 ~O
" (O~IQ)
aa of the dot. of d.olh of the deoedent, Ma~y ~. a,s lehue
(H~m. of P...d.~I),
"
,0n--A1I1l'1IRt. '~, '(:lRl
(Pal. .f d.ath)
who Waa lot. of
3002 "'arl(~t Stree~, Camp Hn~, Cumi:le~'l1,pcL.Oollnt.YI p",nn"Y'''Rnifl
(S"..t Q~d Numb.,) (Po., Offl..) (Counly) (SI.'I)
The aeeurltl.. pre registered a. follows,
(Ham. or nom.. In which ..,lIfl..,H .t. togl"."d)
~~~ml~B~X'~l'll OSP"iA :~NQm~~mpal as; 3008MRrkat....Bi;r.aal:.(Adf;~I.Wl_ J.li11, PA 17Cl.ll.._
. "NAME OF APPLICANT OeoJ:.S~~.S$lllP911l~
GOUNTY FI!..!! NUMBER ~ 1-i'l.41i ADDRESS OF APPLICANT 3008 Marltet Stl'Elet' Oarn Hill
/
BUREAU FILE NUMBER SIGNA TUR E OF APPL.ICANT,.2.....-.<J...->.. ~/ ...c;'-,z,'/
NOTICB, IP YOU PAIl. TO PROPBRI.Y PII.I. If.! ANY PORTION OP ,THI~,A~jiLICATION, 1fT wi' NOT If
C(jN$IPBR~DCOMPI.BTB AND WI 1.1. IlB RBTURNBD TO YOU POll COMPLBTldNv
'"""'"-- .
COMMONWEALTHOF PENNSYLVANIA... DEPARTMENT OF REVENUE
CONSENT TO TRANSFER SECURITIES ,
, DATe
I ,hereby con18nlto the Iransfer of Ihe above securities now reol"hned In the name of t
Decedent ond wolve the filing ora cerllflcule certifying to'the paymenl of'thelransfer Inheritance lax to which
the property ,of said Dece~enlls modesublecI pvrsuantlo the provisions' of the Act of Jvne 20, 1,919, P,L.,521,
~s arnend.\fond the Act 01 Juno 15, 1961, P,L, 373, as amended, This I" a!ao In accardal),cewlth the provlalons
of the Mt of April 9, 1929, P,L.~ 343,
This Consont to Trana/er Ihe floroln doserlbed property operoles only In roforonee lo,the estate of the
abovo'"ome~ Docedont.
-....-.--
!"-~,,,
,~
RCC''II19'6I1
APPLICATION FOR AND CONSENT
TO TRANSFER SECURITIES
REGISTERED IN THE NAME
OF A RESIDENT DECEDENT
*'
COMMOHWE"~ TH OP PENtUYLVAHIA
OEP"RTMEHT OP IIEVEHUe
BUREAU Of COUNTY CO~LECTIONS
..___..._.._____..______.~_____~ ~~..........,...._.__wr __~..._....._.._...
~ (MUST BE PILED IN TRIPLICATE)
TO THE PENNSYl.VANIA DEPARTMENT OF REVENUEI
Appllcutlan Is ~.r.by ,mad. for aonnnl to lh. tronsl.r of tho followlngsoaurltles o,f II P.nnsylvanla
Corporation Ilr 0 National 'Banking Auaallltlon loallt.d In Ponnsylvonllll
(0) (\ (b) NRtiolH~l CentrRl FinRnce c~rporRtion_(c)' ,Common'
(NOTE I In d..crlblng ncurltl.. ont.r In, (a), ab 010, ellhor tho numb or of shares of stock or tho 100. Ilmountof
r.glst.r.d bonds, In (b), the "limo o/lh. lsaulng compuny and In (a) tho cllllS 01 stock or tho stotod Int'''s,I rllt.
Ilnd mllturlly dllt. of r.glltored bonds,) ,
DATE
Juno 1. ,1982
ISSUED ON
, and having a TOTAL MARKET VA'LUe OF $---12..00
(P.to) ,
as of Ih. dot. of d',ath of lhe decedont,Mary_^, )301.ftlUHL_
(Homo of O..od.nl)
_, on~^UO:UF.lt 13. J,981
(Pat. .f d..th)
who was lat. 01 3002 Marltet ,m;,roet .-9...MIJL IIi 11 . Culllbel'lnnd Count:i, PennBy1 vlI.nh
(Stroat and Hum~..) (Pa.t 0111..) (Caunly) (Stato)
The &taurlli'.. Ilr. reglstor.d as followsl
(Ham. a' nama' Inwhl~h ...,111..,,, are ,ogl.,...d)
A~1i.Q.ffl flAl"l1'i{1;! .J. .a~~a",_.:i.QQ.a,_Mru~llilU:t.,r.e.~t I CRmn lIi11.PA 17011
~,*~ClJTOR .....") , (Nom.) (Add,...)
NAME OF APPLICANr __.....nao~e-J. !::1emp.e;J.AB
COUNTY FILE NUMBeR (,;(/-fl".~ ADDRess OF APPLICANT .:,\OOR Me r1,<<lt 1'l1', 1'~Af; I Co,mp Hi 11
, ' , , . ( ,"
BUREAU FILE NUMBER , _SIGNATURE OF APPLICANT'::~ .-> i ),. " Joe ' :;(', ( .r,
i'lOTICI!I IF YOU FAI\. TO PROPI!R\'Y PI\.\. li'l AI'IY PORTIOi'l OP THIS APPLICATlOi'l"IT w'IL\. i'l,OT BI!'
CQi'lSIDBRI!DCOMP\.I!TE Ai'lD WILL B~ RIlTURi'lI!D TO YOUPOR COMPLI!T10i'l;
"
COMMONWEAL. THOF PENNSYLVANIA -'::-OEPARTMeNT OF REVENUE
" CONSeNT TO TRANSFER SECURITIES
. ~, ~n
I hGreby Cansonl to th.tronsler of t~e abovo securltlos now' roglst.rodln tho nom. of th
I
D',codont an~ walvo tho fl,llngol 0 corllflcpto corllfylng 10 the poymont of thetrensftr,lnherllana~ taKlo wh,lch
thepraptrty 01 sold patodenlls l11ado sublect pursuant to the piovlslons ol.tho Ael of June 20, 1919, P.L. 521,
.. ' .,
as amended and Ihe'Act of Juno 15, 1961, P.L, 373, as amendod. Thls,ls 'ol,ao In accordance with the provisions
of tho Act of April 9, 1929, P.L. 343,
This Cansont.to Transfor tho horoln doscrlbed property oporotoB only In rel,lIronco, to tho estate of lhe
,above-named Docedenl,
, ."
/1 .)/./ "
/- .:){f"1./ ~ ..:.')
."~.,,~~~:,.
1~,,"~l~~~t'M
,
" Docodunt'l NIIIIO (~all, Flrll, and Mlddlo Inltlall
l3ID!JlmAs, MI1~.
OEOEAseD 8otlulSebu'iiiVNumhur
201-18;..20:313
-- -.--.----'.-.---....-...........
CHECK 1. Orlglnll Rotum 0
, "-1111')/),
"">r,. rL.'
INHERITANCII TAX RETU~N
RESIDENT DEOEDENT
'~nu Numbor . '
--:< /-,f/-77'f
, .
~ 1.1..,1(,":.....
0010 of OOllh"---
'A\lf,(\IHI. 1:3, I DH 1
------....-.-- ----
2, ,8uPl110montll Rowrn [}D
Olcodont'l Addroll
:!'002 Mlll'lwt Sl;l'()ol;
CU,IIIP 11111. PA 17011
a, Rlmllndur Rulurn Cl
APPRO.
PRIATE
, 6: fldurl1811atoTlxD
ROlum Rluulrad.. '
SLOCKS 8. Oucadont dlod 101lUlO D ~, Doaodonlmllnlalnud u IIYlng 0 a, Totul Numbu' O(IOf,O 0 '
(Altloh copy 01 Willi ' _ __ . IrulIlAttlch copy of IrulII _ c1onollt boxollnvuntorlocl
An aorrolpondonca Ind aonflduntlll tuxlnlormltlnn Ihould hu dlrualod 10'
CORRE,
8PON08NT Nlmu~AlldrtuJJjJ07 NDrth liJ!ml t Street
St0VD C, Nj.oh21~m8 \llro Post Offle)o 3D 902
TalonhollU Nn, ' '
(717) 23C:l-93m '011 tInl'l'jflhul'g 81110PA
-.-'
'4: ~lto 811I100
~
-
Zip 1.7108
,
"
Ri'
" ~fJ,ffl
!.',J<">
o'hJ
"'.1
"1
I
,1"
A80APIT,
ULATION
AND
RtOlpllUllllon
, 1, ROil EIIIIO (8chldulo Al
2. 8100kllnd Bondi (Sahadnlo 0)
3" Olololy Hald Sloa~/Portnorthlp ,lnlorolllSahodulo CI
4, MortgOghlOnd NOlO! (Schodulo 01 '
6, O..h & MIIClnunoou' PUrloool Propurty (Sohocfulu EI
S, Jointly Ownod Property (Schudulo FI
7. Tronsfoll (8chOdulo 01 ,
S. Totll DrOll AlIon hotll 11001 1.11
9, Funml Expunl" AdlJllnlltratlvl OOltl/Mllcullonloul
.' Ex~unlGl (Sohedulo I,ll
10" Oobtl/Mortglgul/~lunl (Schodulo II
11, Totll DoducllonlItallrllnGl9 Bil01
12, Nit Voluo of BIIIIO 1II00 S mlnulllne 111
13. Ohor1\llIlo OOUUOIl! (Schodulo JI
14, N~tVlluo lubluct ta tl~ lIIno 12 mlnullino 131
( II
(21 ill 114, 00
( ,3)
(41
( 01__
(8) "_
(71___
I
,
>J
'd,
,-,.,
.
( 81 'ill l'14, 00
( 9) , (;.00
(101_
(111_ 5.00
1121
(13)
(14) 13A,00
TAX
PALCU.
lATION
__ I
Under llllnal\lll 01 Ilorllli ,I t1eolare lliltllllVO mmlood Ihll return, Includlna accomplnylog Ichedulu,llOd IIltlmonll; Ind to thu bOil of my knowlldgl
:ri~ bO~~J~~:.lruo, co~:r6i;0 d o~mPloto, ooolorIU,o~ 01 pr~parur olliur th~n :110 r~on~IrIPrel~~"11VO II h~lld on :~~ Inlorm~\Ioo o:~lilchPreP::ur Ii..
._ "'r}.:..... \ ",/ .h.k <' CC " ~i(,bf &f"/ ) ,I ' "Mil It l ~f Ji,." ' 'i!r~ Ii \...
ION TURH PHRBQ A RBPReiBNi'ATlvsIBI ' ADDRBSS if , . ----2f...D !lATH
",.t-L-- '
oomp~\atlon ol,TIX
16. Amount of line 14 tlxlblo 01 8% ratu
Unciudo vlluol from 8che~ulo KI
, 8, Amonnt of line 14 tmhloet16%rolo
(lnoludo vulu"Irom Schudulo K)
17, PrlnclPllllX duu (Idd lax from 1100 16 plul \Dx from IInolSI
lS, Totll Prior poymilltll
(II Amount Plld
(hI Plul Ollcounl
(al Mlnullntotull _
19, 9allnco Ouolllno 11 mlnulllno 181
Moke Chouk PlY ohio Iq! Roglllor of WillI, Agont
. . · PLEAS8 RECHECK MATH' · ·
1161'
13FJ,OO
)(,08._~
,
8.34
(191
x.l0"_
(171
(IS)
---
" (19)
SIGNATURB OF PAEMAEA OTHBR TftAN RBPftBBBNTA'TIVB
lIY'1l" 1X+ 11-111
pClMM9NWIIAL TH OP ~IlNN8YLVANIA
INHIlRITANOB TAX RBTURN
R1l8lPBNT DSOllPBNT
~lIlLEUAB j MAltY .,A 0
SCHEDULE uH"
FUNERAL eXPENSES,
ADMINISTRATIVI! OOSTS AND
MISCEL~ANEOUS EXPENSES'
PlLS NUM SR
071a3GC
" '
ITlM
DeSCRIPTION
AMOUNT
Ao Puner,1 eMpftnlell
,
1.
.. 1.
,
i' 2.
,
,
,
p, Admlnletratlve COltll
Persona' Representative Commlnlon'
AttorneY FIB'
10
Co MI,loellaneDU' Sxpanee, I
CUmb~.rland. County Register of Wills - filing
supplemental return
$ 6,00
1.,_,
, "
'I
TOYAl. (AIIgJ.'l\llr on linea, nllo'1pl~JI~(1011)
$
5.00
---
(If mo,. 'P~., I. n~.d.d Inl~rl 'dctlllooll,hOlU .f ..ma ,1,,1
IU:CAPITULA'rlON
^Jlpr"lHod v"l\lu 01' runl, uHtat(l Ii i 11,'il' ,,_1" "i',;""'" ,.,.,. t II'" ..1 ,. II "11 11..I'I...IIIIIIIIlllllltlll
. ,,,j~.,(\111I,'1OII'
'...0.. '
. tltt'llilllll!-!!!"
Ap,_ralsud vahio or l'JurttnnnlPru})otty "'" ;,',,0\1,"1.'''''' it... ;,;1"" "i,;II...II'OII"'; ...illll'IHlH
,- . " '
'rotal apptalHoll ynlllu "It.. I'" llilll".i'I j i, '1111" 'I"'" j;t.... "" ,'.,.... ',""" 111.11 111""tHI "'~III."
, ]114,00
'!tIIl"Olllftl!!11
I.'
AFf'1DA VIT 01" Pt:RSONAL REPRESENT-MWE
County 01 DftupJlln 881
,QEOROI\ J ,SmMPEJ"Efl
Illlltl II II ""'" I /11111'"0 Ill., "lillI''' 11111 j I" I! II;' '"'"."....., I" !I'" II'" Iii' ...11" '"' It t11tH1111I iltllll" U'" 1I11111111illll
l\xecut or '
~llftlH\'lil<")i II I thll FKtu tll "[,,, ,,,~l.li~~"'t.,..A., ......I,\fil.~i.Y,))Jh\'l",,,,,,,,,j ,...."...." ~.,'"..,"j,."'.."'''''...''''''''
d~~,e"8ed" \ICln!l"h,II,y""...".",,,,,,,,,,,,..F.lW,\I,r,J}.,..,,,,,,,,,...,,..,,,,..,, nccordlnR to Iftw, depose and, 8ft, ,Y lha, the
Items ftPpearlng In Ih" Invenlol'Y Indndll nil 01 thep""KOlUI! RSKcla wherever 8ltUfttO ,and ftl 0 tlte
renl catatc In the Conllnunwllahh uf Pcnnlylvalllu of aald dcecdellll that t\1enluatI9" placed o,Ppo,.lte
OM,h It"l11 of aal<l Invontory I'I'p,'e.,,"tK ItB lull' vallie UB of the dato of lho docedent 8 deAth I ftnd that
(Icoodelll owno(' 1\0 real eHtat" nlll.lde 11\ll COl11l11nllW(ltllth of 1'0llnBYlvall&2;oept thftt wltloh appeara
In u n;;~~~I\l~~l al tho end of the Inl'cnt\ClI'Y' ,,,/ . ._ ,) ,
1I11f'''IlH''"'llIIlIlUlllllIlIOll'' Rnd 8ubRcrlbcd ,~-'1 \._ I "'" /' ,/, ~' L)
I r 11 I f..~h I r ft ~fi1\'I,":fII""""j~m'"~1 " "tllt'i'.~n(IfJ t11,if;I1rM'r"'--
JC ore tlll! t 1 P;.... Ml'''lllItI+lllllll'''''1I11 C uy 0' rlOl8out I Adll~hd.t"'to
, .::-. J ,,(, ,"'" 300B MlU'I~Gt~ root '
HlIIWr'ft~'/~tt\wR: '","1"111111'''" AI D. 19,fOillo C "1" 11 (,--" _ ^ _'llr11'1
~, '.-?'<., il -A,;P(l1)1~" ,(\mp".~ ,hi~d,,'"'' ..\l,."" 1. .;(,~d""..""."..",,,,,i,,,,,,j,,,,"
lI"i..rl1f~1'll,(tl~t"Ilfr(.''''H(;rr;,t'''''1 I "''''''1';'''' Aa r...
LINIJA,f), I'LAIHl., NolMV )1\0
Iiurrlllburu. ()Clupllil1 Cu, '
My Colllml,~lon Explro~ Junu a. 19111I INSTRUCTIONS
,tl An \IlvenlUry mU81. bll ftlo" wllhtn throo nllllllb.arl.r nlll101I\111101l1 01 porBona1 roprtlent.II,.,
I, A 8upnlemonlallllVOlltnry lIIu.lhu ftIOlI,\'Ilthl" thlrlY 411Y. or dl..ovory 01 addlllonal.uela,
:i AddUIII"al .huol8 II1KY ho attlohud hi tu pounUftlly or roaltY,
't BeoArllolDIV, Vlduotnrl.. ^"I or 1941, '
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COMMONweAL TH or PENNSYLVANIA
OEI'ARTMeNT or REVENue
BUReAU or COUNTV COLLEC,T10NS
APPLICATION FOR AND CONSENT
TO TRANSFER SECURITIES
REGISTERED IN THE NAME
OF A RESIDENT DeCEDENT
*'
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r- "-- ,~,~~ ~ .~..~"._n+~ ~~"nnH'"''
I ~ (MUST BE filLED IN TRIPLICATe)
I TO THE PENNSYLVANIA OEPA,RTMENT OF REVeNUEI
i Appll~11110n II hOl'oby mlldo lor Olll1lont to tho trl1nllor 01 tho lallowing locuri'tlo. of aPonnlylvllnia
I Carporotlon or a National Banking Auocll1l1on lacl1tod In Ponnlylvanlal ,
i (a )___~_jb) Nfl. :2:~~~~~~!-~~~~..~I~L.11:!."ll.I\_II,cl[II_.~<!~p[~.!~\.~;..J~-,!.. (c) .._~.,.. m. _<:)~:~I),!,!,P_,-....~-,,_
(NOTE I In dOlcrlblng IOcurlllOl lIntor In (11), ob 010, olthor tho numbor 01 ahorol 01 Itock or tho laco amount 01
tegllloredbonda, In (b), Iho name 01 tho I.-ylng company and In (~) tho cll181 of slack or tho Itotod Inlorust ,role'
and maturity dolo '01 r.gl'Iered,bonda,)
DATE .-,..~~17{'4..~'l,~~ ~
ISSUED ON_
....__, and having a TOTAL MARKET VAWE OF $.,2.1JL.Q.9______m..~.----
(Po,.)
aa 01 the dale 01 doalh 01 tho docodont, -..!larJ......A~ BolohnF.!_..,....__,___":"'_, on__AllJU!l:It 1 S , 19fU,--
, (N"mool Do..do"t) (DlI" .1 doo,h)
who waa'lalo 01 3002 Marl\Ot...~~; 1'00 t ,_.9~t.11]p._.I!.~.11 ,..Ct!m\}!)1:l!,tl1~l_ Cll!!nJ:Y_,..J.:ol1nsy 1 V\l'}l~lL-,
(5',.., ond 1010mb.,) (PDi,OIlI..) (Coun'Y) (5'0'.)"
, JarnOB al1t MlH'Y :3010111\1'l, h:18 wHo, oJltmos ne1ehll.s
Th. ..curl ties 0;0 ronllterod 01 10110wsI cUod 011 Apl,'i 1 12, If)77,. lUlU tho stocl( pecu.me Pl'O-
, · "fIU1"t'Y..rr1'...~~ltl'\r.-ti '"'"11n:1n\TI1J'I'C'"'1lV'-rifIT'''1T"':TBn-m-~~
, < ' (Namu or nctf~o, In whiCh co ,H~a'tu, "fo rcr",.qll'a~1 o. nw I
=~m~lttlRl Oel'~2 J(No~f~l)"~.1 ~E!.L..aOl)~_.MI\:1'15gj;-~..t.t(J'~~"('A-d;'~~\) II i Ll.l..E.!L.J,1 0 11
"..-{II ~i'I-7/~ NAME OF APPLICANT .._GeorK(Ll:".mSenlil~J,Rl~L_.,_____-
COUNTY FILE NUMB~R~_IC.~_ ADOReSS o,F APPLIG:ANT.._l~Q.9}..JdlU'l(ett:~:l'~_eJ;....-<::illT\g/i ~6j 1
BUREAU FILE NUMBER 21-81..,774__,SIGNATURE OF APPLICANT~~i ~-~~ "\;,.~, ,t:'r..,:-.-_
HOTICEI,IF yoll pAIL TO PROPERt. Y FILLIH AHY PORTIOH OF, THWAPPLICATI' ,IT J LL HO E
~OHSID_E~~M::::~ATLET;J;';~N:ES~ :;~~~-;~~'~~E:~~~re~~:~~~F~~tUE~-==;'~.:::_.': '
. " " CONSENTTO TRANSFER SEC!,!RITIES OAT " ?~df /ff.:z.
I horoby conson! to Iho translor QI tho abovo, socurltlos nOW roglstorod in lht! nama 01 tho orosald
O.cedenl nndwalve Ihe filing 01 a cortlllcalo c~rllfylng to tho'poymenl 0/ Ih. Itonllor Inhorlloncota~ to which
Iho properlY 01 saldD'c,edont Is mad8'Suble~Ipursuol\t 10 tho provisions 01 Ih. Act 01 Juno 20','1919, P.L. 521,
asam.nd.d an~ the Act 01 Jun1l15, 1961,'P,L. 313, as amondod. This Is also In occo~danco with the provisions
01 tho A~I 01 April 91 19291 P.L. 343.
Thl~ Consont to Ttonslor the heroin dOlcr,lbod proporty opoto'tos only In rl!lororico In the t!slale 01 tho
abov"nomod Decedont,
'*
SI(Jn,ed lorr,i h .,.so,c,~ reta,ry 01 R,e~,enuoFl ~,')
L:-t?Jl t1.1 Y
By '/) ~ ""'.. " ,q.s;;L
4~/(Slg~o,ur '~;) " "i ~
.... .. 1/;;1~ _~1-'J..Lj(1:1fci-C:1.t,ct.'::"'~
( If' ( Ullly)
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IIEV, 1147BX (Io-sa)
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AUREAU OF EXAMINATION :b' NDTIOB OF INIiIIlITANOB TAX I
PENNOVLVANIA DE,PAATMEN! OF REVENUE APPIlAIUMBNT, ALLOWANCE 011 DIIA~LDWANO~ IACN
HARHis~'u~~\.~32: 71 05 . ,DF OEDUCTlON', AND AISIIIlMBNT D~ TAX .
_---'-' ..' I _ _ _ _ _..____~-----.:,J-.-I..-;~....-J.QW lQ:.a~...B2 -
IITATI OF, S\1lL!tIlAa HARY A FILl Ntl, 21 al~0774
9A'U...QttjWl!.I:l,.Jle!'.l.~!:eJ.." u.. ~__'" ,.,.,., ,'..,., ."...,...."u...._..d..--, .".~...QOUlilr "e'.,QUMlltml.<lIWIL__.!~_-_..P".
NOTlI TO INIUIII P~OPIIICIIIDIT TO YOUR AOCouNT IUIIMIT THI UPPIII POliTI ON OF THI8 NDT10i WITH vaUIITAX
PAYMENT Ttl THe IIEDlltaR OF WILLI OF THG AIIDVB CDUNTY, MI\KI CHIOKlPAYA8~1 TO "IIIQIITlfI OF WII.LI,
ADINT" ,
1,01 '
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8TI'JVE 0 11101l0LAR l!:SQ
3207 N FRONT f.\T
PO SOX 902
HSG PT; 17108
PL~ASE ReTlJRN THIS
PORT ION TO REGISTeR OF
WI:LLS IF PAYMfZNTDUS
CUT ALONG THIS L1NB
w ., .. ,,,.. " _ "',._,~ _ ... .. ... ..- _ ". _ ._ ~ _ .. T_ ~.' u .., .., ,. ... _ _,.. .. . - - - - u .. "" a - -- . - .. ~ - - .. ~ .., - . .. " ..
NDTIOI OF tN'~IIUfANCE TAX APPRAISftMENT, A~LDWANCE DR DISAL~OWANO! OF OIDUCTlDNI ANIl AIIBlIMQNT OF TAX
!I.V, 11I471X (IO-sa) ,
ISTATE OF BEL!!:HIIS HlIHY 1\ FILl NO,21 Sl-0774 ACN 101 DATE 10~2~"S2
._.---....-------..~.........-- ....~'>"_t...-.. ........--_~_____.__......._...,~,..u_.,~.........--.....-_____r:-.-.----............--.,-----r"'~--.-.--...~._..._...,__~ff__...,...........__".......--.--........,
TAX RBTURN WAS, I X I ACCEPTED AS FI.Er- ( ) CHANClEt) ,
,_ __._..___............----.---...."--'.-+---.......-.--:..... .,_.----"._._~_____.t_____._..___f"... __.......~_,...'-!_.~...-..--<<-,.....--- ._..r~~~.____._--r-----a_-....
APPI\AIUO VA~Ue O~ nnURN IASID ON' 1 8UPl'LlllMlllNT1\L RETURN
1. "ital Eslllle ISon~dul. AI ( Ii ____.J2.Q"....
2, $looka and Bo~da (SOhAdul. a) ( 21 _. X.44. O.Q.._,
J, Cloul\, Held SIOOklParlnlltahlP Inlo,..1 (Solwdule C) 'I 31' .00
A, Motlgages a"~No\~a (Soh.dul. DI ( 4). '''=.. ..29_:
b. Caah & MlloallaneouQ Peraonal P,operlyISohadul. EI ( 81 _, .00
a, Joinlly Qwnad ~rop'rlY ISoh.dYlit FI I 6) _._~__,,-----.1.9.Q..-
,7, T,.nal'ra (Son.~yl~ GI I 7) __.~____J1Q...._
D.', 10lar As.." ' (81 ______-144. 00
APPADVIP OIOUOTIONI ANO IXEMPTIONSI
9, Fun.'" ExPon...IAdmll1lalta\'v, Cos\aIMlac.llan.oua
Exp.n..a ISoh.dule H)
10, D.blaIMot\gageaILI.na ISohedul. II
, 1 Tal" f,'laduollona
'2, N.t''Vlluo of Tex Relurn
'3. Chati\aUltIClov.tnnianIQI B.qu.als ISoh.dul.J)
14, Nel Va'uo 01 ealalo SuUI'ol!o Ta.
( 91 ._.._...J.....P.Q.-
(, Q) ---_--!.-QQ.-
(11l
. (12)
(13)
(14)
6.00
. ' 1.3Sl..l.QQ...
_......_~_.OO
.--.:.'.,,].~t..!?1I~ . 6~
AIS.IIM_NT OF fAX'
Ill, Amouni.of line 14' laxabl. a' all ral.
16, Amoun\ 01 IIn. "4 la.abl. !il 18% tale
1", Pl'lnclpal "t. Due,
f,AX .!l~IOJTII
I 18) __5l..t.E.~~..L.~.c.:)"oe. __~_112~1.56_
1'6)~.___t9LX,II1. .00.
(nl _.~.:-:.ltJ.?J._. 56 _
~
PAVMENT
DATB
--.--........
04~2.1"e2
0\1.,;1.7,..82
RECEIPT -'--"-:T~DiS'COLjNT 1+)"--
# INTEREST H
~.---._--
AMOUNT PAID
..----,-___._.1'____
--._.~....-...-----'--.....~-- -...---------..--....-
010675
0,49805
.00
.17-
3,213.:;12
12.96
~ -"'" '" """ ....'..L~
-.------.---- -_~~L~Ce _~~_~~X PUE ~":50R
INTlRU" . 00
II IF PAID AFTER THIS DATE SEE REVERSE FOR OALCULATION ---TOTALOui 4.45CR
OF AOplTIONAL INTEREST' " III B"al;-;'Oue II I.;; than $1.00 no paym.nl!;'7;Q'Ci;.dl
RITAIN THIS POIITION POll YOUII RECORPS
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