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Home My WebLink About03-05-07 -.J 15056051047 REV-1500 EX (06-05) PA Department of Revenue '*' Bureau of Individual Taxes . PO BOX 280601 Harrisbur ,PA 17128-0601 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death INHERITANCE TAX RETURN RESIDENT DECEDENT Date of Birth ~ Suffix MI ~ (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI o THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW _ 1. Original Return c:::::) 2. Supplemental Return c:::::) 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required c:::::) 4. Limited Estate c:::::) - c:::::) 4a. Future Interest Compromise (date of death after 12-12-82) c:::::) 7. Decedent Maintained a Living Trust (Attach Copy of Trust) c:::::) 10. Spousal Poverty Credit (date of death c:::::) 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. 0) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Da ime Tele hone Number 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received () 8. Total Number of Safe Deposit Boxes c:::::) -_1 ( o Correspondent's e-mail address: bea mereS@ e..piX. V\e.t AD ESS 1>'"'TI1 UtE I<'EL ~ ~De~LEl).E' "'::D~. friEC.UAJJICSBUJeG-. p~ 170S~ S~NA~E~~~IVE ADDRESS CHA-ilLES E. ~H I E7.../::J(;; ""III:: '=> C1.t.>uSElf! RfJAJ>. hlG"CHA-h Je$t3UR4. fA 17 () s S- . PLEASE USE ORIGINAL FORM ONLY DAT~ :h ~. I; 'tfl- Side 1 L 15056051047 15056051047 ....J --.J REV-1500 EX 15056052048 Decedent's Name: t(AY/fIo/JJ) IF. W!Il.f,.. RECAPITULATION. Decedent's Social Security Number 1. Real estate (Schedule A). ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1. 2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . : . . . . . . . . . . .. 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . . . .. 3. 4. Mortgages & 'Notes Receivable (Schedule D). . . . . . . . . . . . . . . . . . . . . . . . . . . .. 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . . . . . . .. 5. 6. Jointly Owned Property (Schedule F) c::::> Separate Billing Requested . . . . . .. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) c::::> Separate Billing Requested.. . . . . .. 7. 8. Total Gross Assets (total Lines 1-7). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 8. 9. Funeral Expenses & Administrative Costs (Schedule H). . . . . . . . . . . . . . . . . . . .. 9. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I). . . . . . . . . . . . . . . . 10. 11. Total Deductions (total Lines 9 & 10).. '" ... .. .. ..... .. .. .. .. .... .. .. .. 11. 12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) .. . . . . . . . . . . . . . . . . . '. . . . . 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) ... . . . . . . . . . . . . . . . . . . . . . 14. TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .O~ 16. Amount of Line 14 taxable at lineal rate X .O'/S, 17. Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X. 15 19. TAX DUE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . 19. 15. 16. 17. 18. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT L 15056052048 Side 2 c:::> 15056052048 --.J REV-15~O EX I>age 3 Decedent's Complete Address: DECEDENT'S NAME File Number ;J,/ - ~,,- S5~ CITY ~AY/J!~N.I) Lf'. W'+'-I- 7o'f,3 (!"f.,( l/ S L-E ,0/ Kk ~ L /) T 3 Z"Z LIF/6YS IM/LQf. Pl91!k I STATE LJ .Ll e /l-It.t./S/..E; rrr ---- STREET ADDRESS -"-" "-- I ZIP /7ZJ/3 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 1 I, 7'8'.~ o o o Total Credits (A + B + C ) (2) o 3. Interest/Penalty if applicable D. Interest E. Penalty () o B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (3) 0 (4) () (5) 'IJ7"11',8S (5A) 0 (5B) , I; 7'f,r,S-S" ~--~~~-------~ Total Interest/Penalty ( 0 + E ) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred;.......................................................................................... D I}g b. retain the right to designate who shall use the property transferred or its income; ............................................ D ~ c. retain a reversionary interest; or.......................................................................................................................... D ~ d. receive the promise for life of either payments, benefits or care? ...................................................................... D ~ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. D ~ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. D ~ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ D ~ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [72 P.S. 99116 (a) (1.1) (i)). For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [72 P.S. 99116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. 99116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in 72 P.S. 99116(1.2) [72 P.S. 99116(a)(1)). The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. 99116(a)(1.3)). A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1508EX+(1-97) ~. ."~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF WALL, /<A-YMONJ:> E. FILE NUMBER "?/ ~ ~ ~ pt, - 55=:> Include the proceeds of litigation and the date the proceeds were received by the estate. All property Jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION (,WE-HALF- r",:z.) IAlra.ES7 ~ -re7VA#r IAI tk;ItAi~AI /N 19ft.J ~/I~ jJbJOK ~8/a: N~AlE.. /lIN #- 08'1.- $" 31' ~ 7 (,SEE ~!,y dF r/7'~€ ,fNtJ fJultf1l/kE ""-tPl!51U A7TAt:lYe) VA-L.UE j)E7b7lMIA/~ ,8y ~p,yJ6Z 41t/1J ~(!tlT,e/~ ~ ~ "~, Sf)();~/) JJ//&/!'d PIV au/fl 8AU1If-71M/ ~ ~",/I/f,t!/S'A'.r.. twlf-;.t JtF ((/z.) /Alr82E:5r wAS ~y ~.AI~ By .. . (;l1IiJ/I,fII'N/ /ll1I/) H~ $AI~ HtIf1() A!:adJt:7tJT~ //Y~ 77l,f-/YSFEMetJ 7P HBf.. " fi /)1= F S I ,5Z)O' t:>t:> .:::: I, 1 S7), 00 ~ 3. C',fsl/ ~O{)!; IIIltullu V/N! IG/~rS~8SS"F2.qq3f.1'l (sU ~NVeN7DR.Y LJS.7 If 7'7)IfCHlF.:b /AlfEIVTPIlY DF ~AfblE' flETl5IJ/l/ll-iTY (Jrt;iF IT A m-OHED 1IE7lE7P) . -:I./U I2eFJtl'/tJ PH I()lft) /'liitStM/A! UOSE -IJur VALUE AT DATE OF DEATH ; I, 7S-/). Dt) "3~.2() ~ I 3, fa'l:t. '11./ 1 oS '17. ()() ~ I, I"'. 6C; if, s: TOTAL (Also enter on line 5, Recapitulation) $ J 7, 137. fl4 (If more space is needed, insert additional sheets of the same size) ....~~~~~..~:~?;;Z;!V)'.~... '~~S~&;41:7t;t l".~ '1'Ol111~~~"1' ; .,' ..,..,.,;....:: . "'" 4, "'".. :. _...."'.. ',' . ",,"' F /m(lllll/&ll r~~. J.;':",,"sm.l t~~~1 E:~~~ 'I" ;:.: ~ t . ./ OHI.o. NolITH CAROLINA. PENNSYLVANIA J)I~..RN6A ~ '''84J ACCOUIIT,!I.'73317~8~ MANUFACTURED HOME PROMISSORY NOTE. SECURITY AGREEMENT AND DISCLOSURE STATEMENT (CONV. - FHA - VA) Date O('JobM 1 g , 19--2.L.. '," MAKER: WALL, RAYMOND E., 7073 CARLISLE PIKE LOT 11322, CARLISLE, FA 17013 (Print full name) (No. Street) (City _ State. Zip) MAKER: ESBELBY. DOROTBY M.. 7073 CARLISLE PIKE LOT 11322, CARLISLE, PA 17013 GJU!:EN TREE CREDITOR: CONSUMER DISCOllNT COMPANY. 300 WEYMAN PLAZA SUITE 480. PITTSBURGH, FA 15236 (Name of Financial Inetiwtirm) (City _ State _ Zip) 01.~t.Nl\I_"#;!:"}': -' PERCEN1'AGE' RATE (The cost of my credit as a vearly rate.) 12.50 % $ My Payment Schedule will be: Number of Payments 2734.00 060 (The amount after j have made all payments es scheduled.) $ $ 8000.00 18548.00 $ 7814.00 7794.00 2,<J.OD .00 .00 .00 .00 .00 ..00 .00 .00 .00 .00 .00 7814.00 $ 10548.00 Amount of Payments -W~~P8vments.,6.re Pue Monthly beginning Novembvr. 20, 1994 175.80 8RURITY: I am.. . S8ClIIitv ilIferest ill: --!-. The goedi Of pI1IJlerlV atiAtJ filluctd. _ R.., propertyloclltedtt PIla'AlDftUl6ffES: $ 20.00 . IWPAlDOOCUMEIITAJfOIfIE: $ .00 . APftWSAi FEE: $ LATE CIAIGE: jf . tI8YlMRt is IIlDr8 tban 15d1yJJete, ! will be chlfllSd $ 5.00 or 2..:2E.... % of the ~I, wlJidrewr is PlEPAYMBfT: If 1IIllY eft _, I may flg tIfItitled to I mUlld af part af the filtllll:8 dtll1Jt. ASstIMPTIOM: So_iii lHtyinJ my llGtllllIll8V, suIlject tll I:lIRditiGns, bB dllwlll Ie a111l11B tile remllilld.r of my oi!igatilil 811 the original 1_. See b8low far Dny additional inlonrnnion about lIO"'YfIlINIl. d.fHff, 8t\}' rOljutrtd rllpayll\tfll ill fllllltefllf8 IlHlsdtadulB4 hIe. _ lIIWilIymftll refllllds Itld JIlIllaltitts. .00 LESS Physical Damage Insurance is required but I may obtain it from anyone I want that it; acceptable to you. If I get the in-aurance checked below .00 from you or through you. I will pay Vo.u $ protection for a term of 00 years. tor insuf ancEI 1. Amount Paid On My Bllnalt ............................ $ Name of Previous Creditor 1. Amounts Paid To Others On My Behalf: a. Paid to Public Officials ............................... + $ b, Paid to Insurance Companies ...................... + $ c. Paid to Appraiser....................................... + $ d.Paidto +$ 1I,Pltidto +$ f. Paid to +$ g. Paid to +$ h.Peidto +$ i. Paid to + $ j. Paid to + $ k.Paidto +$ I. Paid to + $ Principal Balanoe (1 + 2a.-1.) .............,........... $ Prepaid FihanclICharges ............................... DISCOUNT POINTS .IlJ A COlTlprahensiVe{$ '.NJAFlood . ~Uability ~Other .. N/A Other ~'Other .00 d6riuctiblal .N1A Vandor's Single Interest ~ OPTIONAL CREDIT LIFE AND DISABILITY INSURANCE CreditUfe and Disability Insurance are not required to obtain credit and will not be provided unless I sign end agree to pav the additional oost. The term of this insuranoe is 00 yeers. - $ . 00 ~ Single Credit Life Insurance .. $ ----:.?~ . -.!!!!: Joint Credit lift' Insurance ..........m......n;~~ ....!;i:!~! L.~~~~')~. N~ Amount Financed (3 - 4) $ $ ~~-$'. '$ .00 . GO -':-~-'~~;oy'j, o; j~ o//;? / JtUU ulleu 9 A Rockledge Drive Mechanicsburg, Pa. 17050 71 7-790-1527 KIEL2581 @verizon.net 1984 Oakbrook mobile trailer $3500.00 Dottie's furniture Square Table and 4 chairs Lamps Single bed Dresser Glider & lawn chairs End Tables Small appliances and dishes 1Atfe /kms a/rurly be /DIIJi.J iD decedenfs {!/)Mpo.num a.uI ~lolf' woitJd naf ~ a$s~sS411, -f,Jr I f\ her; -huu:.~ . TkyatG (istrd ~r d;sc.1t>.Su.re o.JUl ;V1~"Mrib:orl plLt'PDseS. Dad's J,,'f2. h."frf PM,.d,.priu cu.xre.{It esHMJid Recliner 10.19.94 $170.00 (left in trailer) - we.\1 u.~ "~S',f)O Stove 2.10.97 $392.07 (left in trailer) - E1uh-ic. nut '15.00 TV (left in trailer) - rwf '," ,tJOd CllIlJ. .,.~O./)O VCR ] 1.]5.01 $137.80 (left in trailer) - \.I.ell Ilw./ 1- S,DD Computer 2002 (daughter Linda has) - ~Mt'(J~-si...."" "'11'- fo 90. D{) 2 portable radios (daughter Linda has) ,. S, D() Desk (nocIWr) (daughter Linda has) - t>Je1 ~ ,;JD.tJD Bookcase (left in trailer) hAllCl.1ltJl.d, IIV lI.ect.lc.wf-bi "'f ,,~,oo Washer & dryer 11.2.94 $536.36 ~ ",ell u51.1 · - lSt:> .P' Queen bed set 10.19.94 $549.97 - ~/ ~5.f)fJ Dresser 11.2.94 $320.00 - ~ I () D. DO . ,. 5'-17.00 Clothing (mise items to Salvation army) Navy Uniform (daughter Judi has) va.l~ .. 2005 Malibu $ 13,642.44 (plArc.k4~ ~ w~eJts ~)= '13, '42.'1if Vin no. 1 G 12T52855F299349 a .o.eI. R,EV-1509 EX . 11-9~ SCHEDULE F JOINTLY-OWNED PROPERTY COMMONWEALTH OF PENNS) LVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF W'/-L.L, /i' II-Y IJf~Nj) G'. FILE NUMBER 5 ;Z I-OlD - SS- If an asset was made joint within one year of the decedent's date of death, It must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. .j ll. '0 11H L..EE: I< IE L 9A hCK J..E:PGE' 'JJ1e. NEC-ItA-NICS t3u.teG~,:JA 17IJS"D l)1ftl t:# TB( B. c. JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE Include name of financial institution and bank account number or similar identifying number. Attach DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT deed for joinUy-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. '1/31'11- MEAt $E1IS Is7" Ps. (!/l8JJi tlIIIIAN REGUlAtIt Sll-J'lN 65 A-(!(t7: II :/3'-"0 PIUAJe./~'" ~4l.. "i'Z, Z~D. 52 l1f,z" ~1(,.9I ~ SZ'h, ':U, /32.27 "12/ Z61'1,srI ~~. IIIr; ~ APt> ~, ~z. ;. A. 1/ /3/f1- /HEIllIJe;t.r /dT F1eD. t!.f/!.l!t>11" /,(1U1/)A C-N EClUN(; A- (! e.:r: 112.311- II fJlUN(!.II'At /JIH.. , '7, 7'1{,,, J 1 ~ ~''f,ftI ~ .52:?~ , A/!.CJt,. INT. 1# J:Mt> . z.t 7/ 7'~ /fI 3, If 2. '/2 (SEE- Y'lh-uIl71,A' ~77'~ ,+r~MSJ) TOTAL (Also enter on line 6, Recapitulation) $ :/S; ~I'I. 'f .. (If more space IS needed, Insert additional sheets of the same size) REGULAR SAVINGS ACCOUNT: Account Number/ Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Date Joint Ownership Established CHECKING ACCOUNT: Account Number/Suffix Date Account Established rincipal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Date Joint Ownership Established VISA: Account Number/Suffix Date Account Established Balance at Date of Death Name of Joint Cardholder Estate of: RAYMOND E. WALL Date of Death: June 5, 2006 Social Security Number: 211-01-8868 fvlm MEMBERS 1st FEDERAL CREDIT UNION 11236-00 10/09/1969 $42,260.52 $4.02 $42,264.54 Judith Kiel 09/03/1997 11236-11 09/03/1997 $7,764.63 $.21 $7,764.84 Judith Kiel 09/03/1997 I~ ~ '*:- INSURANCE DEPARTMENT 5000 Louise Drive P. O. Box 40 Mechanicsburg, PA 17055 1-800-283-2328 or (717) 697-1161 4121449998112366 09/30/1991 $75.00 None ~BERS 1 ST FEDERAL CREDIT UNION . . -~ ~. \cCt "-L.- aniell~ne Insurance Services Specialist July 28, 2006 5000 Louise Drive. P.o. Box 40 · Mechanicsburg, Pennsylvania 17055 · (717) 697-1161 · www.members1st.org REV-1511 EX+ (12-99) . . .~j.l~)~ " ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF tv A-lt. I ;e,4Y /111 /Vj) E: FILE NUMBER 01. /- ~~ - ssS" ITEM NUMBER A. B. 1. 2. Debts of decedent must be reported on Schedule I. DESCRIPTION 1. FUNERAL EXPENSES: C It. EIHII-TIIJV IJ)If5 I' If!EPIf-I D . 1>ell-iH aell.:1"IF=/C'+ Te-'"S Ft.-fl/() I!'1ItS PA r~//) r-IVIFNS tlI!J/12I Ate Y A/tiTl ~ Hf)AI()L~/l/U/l1 n /II/N/srt!9(, Fool> jdJ( rUN5X!At 11LQL. FifAMIN6 0&=- /l/eTa!tR, eoaA6G./ fllllA)""N' I/II)TtCJFS. ~. 3. 'I. s: ,- 1. ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) .J"t(!>I--rH L.E'€ KIE"L Social Security Number(s)/EIN Number of Personal Representative(s) .: Street Address 9 A !a(!./cL.E"D61? :/JIf.IVe City l11e CHIf/llIC $ 4J/,/J((;. State..etC. Zip I 70SV Year(s) Commission Paid: AttorneyFees CHA-te~g E'. SIIIELi>S m::- 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) 4. 5. 6. 7. 8. ,. /P. /1, Claimant JlIAI~ Street Address City State _ Zip Relationship of Claimant to Decedent _ -' ., J........ ....f short e" ......L,. f.,.,. .j..,es Probate Fees PMlil Dr'J,n4A i ......we. v ~rl n....-I~ Accountant's Fees '1. . ~ l-4+1l /!It.-De/(. of M~eHlfA/Ie.s8ul2.6~ ~.4km.s Tax Return Preparer's Fees I P'II, IIIf I/o i //)'11" FfIIIfI ,4tA lIetti $; ng " h +Ra. C u."", \Je.r\D.N1 d LfUV rD ""r"t') 0-1 A-e!ve.rtisin .. n +ae.. Ca..t"\is\~ ~t.'YleJ A-,1,jI'hdn~1 .s/lIJrf (Jerf;h'cQ,!;~ ,.f- ",// hi; 114 / /I/'YJ ba 7e .fe.e. /f,ltJl','h'l,,41 ShlN.f- C1erf"h'ca Ie~ ( ~I/ !t'" (,f td) AMOUNT " 5'], /){) -, 0 tf. 33 l' ~;.:t. 6() -/ ~S-.OO , ~OI,D3 '.s-o#~7 " I, 7 32. 3'1 f ~ 1015", It./- AlIJAlE ".. " . 00 , ~7S: ~f) .,. 75,00 .,. 101. q, ~ ~ /)f) ~ q.() , ()() r 8'. OD TOTAL (Also enter on line 9, Recapitulation) $ s: 8'3".. 38 (If more space is needed, insert additional sheets of the same size) 5 e fleD. 1-1. I 16n;/;J ...._______________..___ E5 1:__ PF__.&;f4J_&!YIH~A/ ~_K___________________.I='_t..~~___2/- t!_~ - ~S? _____ 1~.__EiIil1?fil--~-!'rt..~fh~-_---~--~------ ~S:~_ __ ._ 13.A/Alb/(ISaI~L~{!mrk~ E. S4/dd's tlL ~r_I!-<:,_/.lI~~~~.1D,iO-_- _________d ____ fJ~a!~ /'4" .ef_ t:l$?DrftY(~I!i~~1-~' hies J_,tDsmp,- e/;: /l-.J.,~.i?J_--- _____________ as~[~J!..rse~__t._~d; _K,''',{, ~x ______________~9?tl.L IS: _ ;(lIfnb"r~ 1i .:krl,' /(/e/, PxeeJ.Jrix ~~__ fru,/~~ -/l;r ~ ";",/1> ----- _.____________t ~r~._..ht4_~Uh1___~-~r ~P-lefJ-.-,,-JXl4!t'.tr rY!P-~F_~"___J~~--------- _ CblU'thoU$L,_~____ '+1'1__ rn ;J~.s. ________________________~1~6__ ._________________l6. ____fi>L.ba {!)vt:d!:.t__L.r~se4 r.dJ_,__i1Js~-~-'-lln;~ ~_JJ:{!j4l:-~____________ _________________ _f!!ts--t.-Jlk.4-~Jf _~l!-~h ___I!!..~ .hJt fv!!!.Je iL~e~ eJPt_ p~?g;,,--------------------- ~ . .._.. ________.._______.___ 111211."'1----------------------------- ---- ------------ .--~Z,t:.eji~--------------.--.----f}$= ~f.____ ______________ /7. ___~f_!!{.__7i~lll~!:r~1--{~lA--~---/~~~- ~~j-1_1~~__ _~~'-'-S!!----- i------/i: __f!!&_l_L. ... ..._ _7i'IU/.Jk!j11f-7Z~m~-7bUlll1-.....-------..---....------- -. -- _.____..______.___~E~~ I I "- ~.....__.._~"..-,.~-~_.-...-_...~._~"_..._"._.._-_._~--_.._-------_._--_._.~---_.,._~.,._._--_..._-".--'--- REV-15.12 EX+ (12-03) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER ~ 1-~'-SS.5 ESTATE OF WA-LL, ,l1J-'y/l!~Alj) .E. Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH ~. 3. i. s: 1. IJIflANC!E' Du E" 9311 ~3'4 ({)EE Lt;77~ C e-/~ API( "IV RlI&=h16gS 1ST Jl'IS,If ehe.J:J IF .LJ/ZI <JY9Q ~ 7S.ID ;;e, sellE"D. r:) R> It. Cfite I AI S u.Je. A 77";1-(J 1-If?1) ra I U- 7;) u..€ ~ ILJ3.JZ ~ 9,,4 .97 " "8.8"S 'ifS. Of) ,tJ /tP/l/Fiery 7./1- X GS ~AI T,t!.~1 L. c"'e FiN At./.3/tL 7D /J I'll. lUll TtllH.. ~r o/JI1Hl4 - LJFG" /AJ,JUe /l~m/u.A1 ;))1.lI!!= TOTAL (Also enter on line 10, Recapitulation) $ Lf:i'l." 'I (If more space is needed, insert additional sheets of the same size) REV-1513 EX+ (9-00) . SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF fA) All I ~ lJ.y /I( I)A).!) Eo NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. POf<.o7HY wooDY €SIfEl8Y 71#13 , Cl/-ltJ.rstE PIKE' LbT 322 LGI/JYS 7/(A-It.EIe, PH!Jl. C!I/.IUJSLE; /JA /74/3 :/. ..JL\D'TH tEE Kia 'fA ~t.G/)G~ ])~. A/Ec.HA-Al/(!,S/Jt(/t.6>, /JA 17/)5'0 3. t./A//J~~. KAllFPAtAN 7/:2: ONGE Elf/I) mAl) 7)It.lS6u/fG-, ;0,4 /7/)19 'I. f/1f(;tAl/A A-. wit-a. r-R ~~,c 9/)f ,d~NIVY 41#&' JJ!EcHA-Nles8ttll6,,(JA /7oS"S FILE NUMBER RELATIONSHIP TO DECEDENT Do Not List Trustee(s) CoJU,(J/rNIDAJ/ ~ Ie-N/) 'DA- u ~Nr61t. iJ A-a ~ II,S!. /)II-UGH,a. ,1,1- tlt, - SS'$" AMOUNT OR SHARE OF ESTATE y~ INTZrI2.EST /AI /Ju8llG HeN/ii Y3 0':: ~€S//)"~ fa 0': i!liSIDuE' '/.3 ot: ~/DlLt;" ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) Jot; --------- ------------- - ----------------- -- 'R * Last Will and Testament ~ .e: * ~ * t I, R 11'1 f(t'JJb E. IV,4L L- of the City of C /Iii L ! S L 1: : ~ * ~ County of C V H ~ c tZ L JT-Jlj f> , State of P l! /11 AI1/-- * ~ being of sound mind, and not acting under duress, menace, fraud, or undue influence of * ~ any person do hereby make, publish and declare this instrument my last Will and * .e: Testament and do hereby revoke any and all other Wills and Codicils heretofore made *' .e: by me. * ~ * ~ FIRST: I order and direct that my just debts and funeral expenses, expenses for * ~ administration of my estate and any inheritance, State or Federal taxes ~pon said estate, * ~ except those, if any, which are secured by mortgage or deed of trust, shall be paid as *' : soon after my death as may be practical. : : SECOND: I am a Wi htl \IV JE; /2.. person. My spouse is and : : ~)() b J'1/.1-1v e- E,k!! L) L / IV 1>/4 If Ill: /(tf f) J::'t:N/f/l; f/f?OI,vIJ. I).;v IV 1i-r-rtiIl1c.1/. 1= : .e: *' .e: are all my children either natural or adopted. *' .e: *' .e: THIRD: I nominate my spouse as Guardian of my minor children. In the event that my *' .e: spouse shall predecease me or fails to serve as such Guardian, then I nominate * ~ Ar ~\ * .e: and appoint I!..YJ rr- Guardian of the person and property *' .e: of my minor children. I further direct that no bond shall be required. *' ~ *' .e: FOURTH: I hereby make the following specific bequests: , 1 Q (2?-/ *" j." V Jl U ~ ~ 0 CJ K fd;Cl ( *' , :; f1 y Y2-- ~ tv AI ~IX.,S!-II jJ Sl/f 191< E 8 1= / /f i 7 C (),,- r, lv, ~ ~c' ~:; ,~-~i'" I;' .e: h Ci l~ I ~ 5- /-J 0 He -,.., -r J,.. IF #-"3 k J 19 -W f'. -1P H Y J.- J vI! / ~ '.-: [;r l.cc /J' ,,t /.,...... 0 ,.,/)_I/-LI W()(J)/) ~I /~sflet-.16Y ~,,),'; t-- .e: coJl-fPI7N!t}/IV J '''-''' If ! - 1}- .e: ~--~ j." ~~ ~ ~.-.<, '"' j.",r , *' -..... 0 f; ~ ~ *' .e: FIFTH: I hereby give, devise and bequeath all of the rest and residue of my estate, all *' t property over which I have power to dispose to fly J'fll?l3lE (/I/l. ARelf/ I3fAvltl-/.. .l( :: :: SIXTH: I nominate and appoint J t)' b J -r +I L e c: k / 1= l- :: -tx as Executor of this will. In the event that the Executor named above shall predecease me * -tx or fails to serve as such Executor of this will, I nominate and appoint * :: L (A/l>iR.4E W/Wrpl1,q,lv as Executor. I further direct that no appointee hereunder : If- shall be required to give any bond for the faithful performance of their duties. ~ ~ ~ 1~1~~~~~~~~~~~~-~~~~~~~~~~4~~~4444444..t~ 1* * ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ,~ ~ .J.:I ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ tf tf . - I subscribe my name to this Will this * * *' *' *' *' *' *' *' *' *' *' *' *' *' *' *' *' *' *' *' *' *' *' *' *' *' *' *' *' *' *' *' *' *' * *' *' *' *' *' *' *' *' *' *' *' ;::1~), / I?.-, / 7CJ2~- 2. '10"3 *' , *' /CJ(JO SOI,(ltk/'vlO ,1-f (~~, ~lLJrv~ i3- ~. *' Address I 7070 ~ ~ SEVENTH: I hereby authorize my Executor to exercise all power, rights, discretion and duties deemed necessary for the proper administration and disposition of my estate. tl1 E{ ffdNI CS JOt//? G City /O'itrDaYOf HlffZC II ,19 97 at , P e /vMS Y A- Vlf-IU I /J- State -dB ~Jg Wr / ! . .7.1, I , . ~lL> . <_' Jl.u0/ -~ Signature On the day written below, R It Y"1 0 v.~ fr W"'/~L declared to us, the undersigned that this instrument, consisting of 2 pages, was 11/$ Will and If E requested us to act as witness to it. thereupon sigr:t.ed this Will in our presence, all of us being present at the same time. We now in If! g presence and in the presence of each other subscribe our names as witnesses. It is our belief tha t R Ii Y H tJ J) 6 IE, w /It 1- '- is of sound mind and under no constraint or undue influence whatsoever. We declare under penalty of perjury that the foregoing is true and correct and that HIfR ctJ /0 97 this declaration was executed on , 19 Fc If) ;1).( Y ).... t/ IT II) I /l-- at H ec I-fll-IV' e.. S J8 U Ie c;, f?JJ UA4</1;vw~ Witness .tj& (Br'u9/t"~ )( ech I r~ CL Address ?~t(~.?/~~ Witness /p~ aj;/1A I/o /!?;4 d Address c;,;~f"~/#fL Witness ~I~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~I~