HomeMy WebLinkAbout07-18-07
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15056051047
REV-1500 EX (06-05)
PA Department of Revenue '*
Bureau of Individual Taxes .
PO BOX 280601
Harrisburg, PA 17128-0601
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
OFFICIAL USE ONLY
County Code Year
File Number
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Date of Birth
Suffix
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix
Spouse's Social Security Number
THIS RETURN MUST BE FI~I;D IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
_ 1. Original Return
c:::::>
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
c:::::>
2. Supplemental Return
c:::::>
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 Daytime Tele hone Number
4. Limited Estate
-
8. Total Number of Safe Deposit Boxes
c:::::>
6. Decedent Died Testate
(Attach Copy of Will)
9. Litigation Proceeds Received
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Correspondent's e-mail address:
Under penalties of perjury, I declare that I have examined this retum, including accompanying schedules and statements, and to the best of my knowledge and belief,
it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
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PLEASE USE ORIG'INAL FORM ONLY
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Side 1
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15056051047
15056051047
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REV-1500 EX
15056052048
Decedent's Name: SAm lA ~L W D D i) S ~ R..
RECAPITULATION
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) _ 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 .0_
16. Amount of Line 14 taxable
at lineal rate X.O ~
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.
Decedent's Social Security Number
15.
16.
17.
18.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
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15056052048
Side 2
c:>
15056052048
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REV-1500 EX Page 3
.
File Number
jA / - 0 ~ -- 09 s-r
Decedent's Complete Address:
DECEDENT'S NAME
SA M lA. €"L.
STREET ADDRESS
:L2~2A
wooDS ~IC_
WA.L,vI/<.~ STJeEEI
CITYC
A(Y\
LL
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
t!). Q 0
3. Interest/Penalty if applicable
D. Interest
E. Penalty
cD.oO
Total Credits ( A + B + C ) (2)
~--~ TotallnterestJPenalty ( D + 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.
(3) (9.D 0
(4) C!J.QO
(5) ~ eJO
(5A)
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.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. . (5B) t9 . 0 0
fScl..e..dv....{ e.. F A~S8T'5 --n> 6111 eJ. S Q.f.e r<A..+..c..l y ,
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 ~
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 181
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. D t29
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. D t8
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. ~9116 (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. ~9116 (a) (1.1) (ii)]. The statute does not exemot 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. ~9116(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. ~9116(1.2) [72 P.S. ~9116(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. ~9116(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.
LAST WILL AND TESTAMENT
OF
SAMUEL WOODS, JR~.
'i
I, SAMUEL WOODS, JR. of the Borough of Camp Hill, Cumberland County,
Pennsylvania, declare this to be my Last Will and Testament, hereby
revoking any will previously made by me.
I - I direct the payment of all my just debts and funeral
expenses out of my estate as soon as may be practical after my death.
II - I devise and bequeath all of my estate of whatever nature
and wherever situate unto my daughter, Kathleen C. Zimmerman, providing
she survives me by sixty (60) days.
III - Should my said daughter fail to be living on the sixty-
first (6Ist) day following my death, then I devise and bequeath all of
my estate of whatever nature and wherever situate unto her issue per
stirpes.
IV - I appoint my daughter, Kathleen C. Zimmerman, Executrix of
this, my Last Will and Testament. Should my said daughter fail to
qualify or cease to act as such, then I appoint my granddaughter,
Suzanne o. O'Donnell, to act in this capacity. Neither of my personal
representatives shall be required to post bond in this or any jurisdic-
tion.
I
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ARNOLD . S KE, ATTORNEYS-AT-LAW. 2109 MARKET STREET. CAMP HILL. PA 17011
Page 1
.. I.
IN WITNESS WHEREOF, I have hereunto set my hand and seal on this
the
day of
'.. 1989.
~eNo~'
(SEAL)
Signed, sealed, published and declared by SAMUEL WOODS, JR., Testator
therein named, on this and one (1) other sheet of paper as and for his
Last Will and Testament, in our presence, who, in his presence, at his
request, and in the presence of each other, have hereunto subscribed our
names as attesting witnesses.
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Address
ARNOLD & SLlKE. ATTORNEYS.AT.LAW, 2109 MARKET STREET. CAMP HILL. PA 1701l
. .
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COMMONWEALTH OF PENNSYLVANIA)
55.
COUNTY
OF
CUMBERLAND)
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WE, the undersigned, the testator and the witnesses, respectively,
whose names are signed to the foregoing instrument, being first duly
sworn, do hereby declare to the undersigned authority that the testator
signed and executed the instrument as his Last Will and Testament and
that he signed willingly (or willingly directed another to sign for
him), and that he executed it as his free will and voluntary act for
the purposes therein expressed, and that each of the witnesses, in the
presence and hearing of the testator signed the will as witnesses and
that to the best of their knowledge the testator was at that time
eighteen years of age or older, of sound mind, and under no constraint
or undue influence.
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Witness
and
day
ibed, sworn to and acknowledged before me by the testat~,
'bed and sworn to before me by both witnesses, this ~I
, 1981..-.
>f~ :d~
~tary Public
NOTARIAL SEAL
THELMA .~. McC..~,USL!l'~, 1-:~IC!ry Public
Camp Hill: PA Cumb'3iland Ccunty
My CommIssion Expires July 3, 1992
ARNOLD & SLlKE, ATTORNEYS-AT-LAW. 2109 MARKET STI\EET. CAMP HILL. PA 11011
REV-1508 EX + (6-98)
*'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SAMUEL WOODS, JR.
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
FILE NUMBER
21 06 0954
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
Checking Account #032009680 with date of death balance of 8796.20 plus accrued
interest of .22. See attached letter from Commerce Bank dated December 15, 2006.
VALUE AT DATE
OF DEATH
8,796.42
2.
U.S. Treasury refund for 2006 Federal Income Taxes
1,030.00
3.
Furniture, personal effects.
300.00
4.
Cash in home
200.00
5.
Poarch Creek Indians death benefit 5000.00 (non taxable)
0.00
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
10326.42
.t3a5 04: 57
COMMERCE WIRE-ACH
7177956128
P.02
Commerce
_Bank
Decemb~r 15, 2006
Allen E Hench, E~quir~
220 Milrket St
Newport PA 11074
RE: Estate of: SaIQl.lEil Trioods
Social Security *: 211-22-6547
Date of D~ath: October 21, 2006
l'
Dear Sirs:
In ref.cr~nce to the letter regarding the above mentioned E~tate, we
would like to inform you of tne informatlon that w~ have researched end
found.
Type: Checking
Acco~nt #: 0320096RO
Dat~ opened; 10/23/1989
~rimary Owner: Samuel woods
Date of Death Balance: $8,796.42
Accrued Interest: $0.22
Principal Balance: $8,796.20
If there GIro any qUlOlstions or additional in!o:.mation that i:o n&eded,
ple~5e feel tree to contact me at (717) 412p6134.
Commerce Bank I Harrisburg. N.A.
PO 8cx 4999
3$01 pax\on Stre.t
H.uri.burg. F'A 171" -ovgg
oommer_pc.com
TOTAL P.02
REV-1509 EX + (6-98)
*'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF
SAMUEL WOODS, JR.
FILE NUMBER
21 06 0954
If an asset was made joint within one year of the decedenfs date of death, It must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME
ADDRESS
RELATIONSHIP TO DECEDENT
A. Julie M. Schweitzer
8 Mary Avenue
friend
Mechanicsburg, PA 17055
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 DATE OF DEATH DECO'S VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A. Privileged Savings Account #0401003989 with date of 17,454.37 50. 8,727.19
death value of 17429.68 plus accrued interest of 24.69.
see attached letter from Integrity Bank dated December
21,2006.
2. A. Privileged Checking Account #201004676 with date of 1,128.17 50. 564.09
death value of 1128.11 plus accrued interest of .06. See
attached letter from Integrity Bank dated December 21,
2006.
TO BE BILLED DIRECTLY.
TOTAL (Also enter on line 6, Recapitulation) $ 9 291.28
(If more space is needed, insert additional sheets of the same size)
SAMua WOODS
JULIE M SOIWEITZER
2707-A WALNUT ST
CAMP Hal PA 17011
Savings
PRIVILEGED SA VIA'GS
ACCOUNT NUMBER 0401003989
~ous ~ ~:a AS or oe/30/06 ........................
PLUS 1 I:lEPOSITU MD O1'HIlR CRBDI'rS ...................
LESS 1 WITHDRAUALS AND O'1'HlR DEBITS . . . . ... . . . . .. . ..
CURRENT STATIMBNT BALANC]~ AS OF 10/24/05 .........................
NUJolBlIlR OF DAYS IN THIS S~~A'l'EM!N'J.' PBRIOD 24
Beginning Rate
. Account Transactiol'1!1
DATI I)I!:QUPTION
10/23 IN'rERBST PAYlolENT
10/23 CLOSING WI'!'HJ)RAWAL
DOJTS
1" 454 . 31
. Balance Bv Date
09/30 11,429.68 10/23
.00
PAYER FEDERAL ID NUMBER................. 52-2389022
INTBRBS~ PAXD ~~ TO DATE.............. 327.49
"'u IN'rEREST EARNED THIS STA'l'EMBNT PERIOD ...
DAYS IN !?ERIOD .........................
INTEREST EARNED ........................
MNUAL PSRCEN'rAG3 YIELD EARNED (A1'~)....
22
24.69
2.3/%
~/v
v06vOZ6LTL
3fuog ^~T..tOa~uI
P8ge: 1
EnclcmlNI: 0
StaWnent Date: 10/24/2006
Account Number: 401003989
CLOSED
2.35000
17,429.68
24.69
11,454.37
.00
CRlDm
24.69
WV 9C:ZO Tz-~aa-900Z
~/~
SAMUEL WOODS
JUUE M SCHWEl1ZER
2107.A WALNUT ST
CAMP HILL PA 17011
Checking
PR.lVILEGED CHECA7NG
BeginnIng Rata
ACCOUN'l NlJMBZR 0201004.;7 6
PRBVXOUS S~"BMIN! BlLlHC~ IS OJ 10/20/06 ........................
PLUS 1 DEPOSIT~ AND OfHZR CREDI~S ...................
LiSS 1 CHECKS INn OTH!R DEBITS ......................
CURRENT STATBMEHT BALANC! As OF 10/24/06 .........................
HUMBZR OF DAYS IN' THIS stATBMBN'l' PBRIOD 4
. Accaunt Transactions
DATI DESCRJPnON
10/23 IH't'ER!lST PAYME,N'T
10/23 CLOSING WITHDFAWAL
DEaITS
1,128.17
. Balance BV Date
10/20 1,128.11 10/23
.00
PAYBR FEDERAL ID 1UMBER................. 52-2389022
INTEREST PAlD ~~ TO DATE.............. 9.41
**. INTEREST EARNED THIS STATI!:MEN'I' l'l!:RIOD ***
DAYS !N PERIoe .........................
INTEREST EARNED ........................
ANNUAL PERCENTAGE: YIELD EARNED (APYI....
2
.06
0.98\
v06v026L TL
l1uog k~ i ..tOa:i,UI
Page: 1
EnclosUl"U: 0
Statement DIlle: 10/2412006
Account Number: 20100lf676
CLOSED
1.00000
1,128.11
.06
1,128.17
.00
CRED:rTS
.06
WV 9~:20 t2-0aa-9002
REV-1511 EX + (12-99)
.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SAMUEL WOODS, JR.
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
Debts of decedent must be reported on Schedule I.
FILE NUMBER
21 06 0954
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Sullivan Funeral Home 7,109.00
2. Camp Hill Cemetery burial lot 650.00
3. Funeral Luncheon 300.00
4. James Gingrich Memorials Headstone Inscription 125.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s) 0.00
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City State Zip
Year(s) Commission Paid:
2. Attomey Fees Allen E. Hench, Esquire 2,000.00
3. Family Exemption: (If decedenfs address is not the same as claimanfs, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees 106.00
5. Accountanfs Fees
6. Tax Retum Prepare~s Fees
7. Estate Notice and Proof of Publication in Cumberland Law Journal 75.00
8. Estate Notice and Proof of Publication in Patriot News 124.17
9. 3 Short Certificates $4.00 each 12.00
10. Filing Fee for Inheritance Tax Return 15.00
11. Miscellaneous and final probate 500.00
TOTAL (Also enter on line 9, Recapitulation) $ 11.016.17
(If more space is needed, insert additional sheets of the same size)
REV-1512 EX + (12-03)
'*
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SAMUEL WOODS, JR.
FILE NUMBER
21 06 0954
Report debts Incurred by the decedent prior to death which remained unpaid as of the date of death, Including unrelmbursed medical expenses.
ITEM
NUMBER DESCRIPTION
1. PPL Electric 44.99 + 74.25
VALUE AT DATE
OF DEATH
119.24
2. Mel telephone 39.82 + 36.25
76.07
3. Miscellaneous
500.00
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
695.31
,,,,.,,,,,,, '.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SAMUEL WOODS JR
SCHEDULE J
BENEFICIARIES
"
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON{S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I. TAXABLE DISTRIBUTIONS ~nclude OU'ta\ht s~ousal distributions. and transfers under
Sec. 9116(a (1. )]
1. Kathleen C. Zimmerman n/b/m Kathleen C. Zogby Lineal
1227 North High Street 100% except joint accts.
Duncannon,PA 17020
2. Julie M. Schweitzer Collateral
8 Mary Avenue joint bank accts
Mechanicsburg, PA 17055
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 II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
FILE NUMBER
21 06 0954
(If more space is needed, insert additional sheets of the same size)
ALLEN E. HENCH
LAW OFFICES
220 MARKET STREET
(CORNER 01'" MARKET AND SECOND a ONE-HALF STREET)
NEWPORT, PENNSYLVANIA 17074
(717) 567-3139
FAX NUM.." (717) 1587-3130
Email: attomev@pa.net
July 17, 2007
Register of Wills
Cumberland County Courthouse
1 Courthouse Square
Carlisle, PA 17013
Re: Samuel Woods Jr. Estate
File No: 21-06-0954
Register:
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I enclose two (2) original Pennsylvania Inheritance Tax Returns to be filed for the
above referenced estate. I also enclose an additional copy ofthe return and ask that you
please time stamp it and return it to me in the enclosed self addressed stamped envelope.
I also enclose a check in the amount of$15.00 for the filing fee.
If you need anything further, or have any questions, please give me a call.
Thank you for your assistance.
Sincerely,
d!&n e ~
Allen E. Hench ~
AEH:wmc
Enclosures
7-17-07W
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CLERK OF
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CUM: ' , CO.. PA
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