HomeMy WebLinkAbout01-03-08 (2)
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15056041125
REV-1500 EX (06-05)
PA Department of Revenue *
Bureau of Individual Taxes . INHERITANCE TAX RETURN
PO BOX 280601
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
OFFICIAL USE ONLY
County Code Year
2 1 0 7
File Number
o 1 077
Date of Birth
125075561
1 012 2 007
03231916
WILLIAMS
HAROLD
MI
K
Decedent's Last Name
Suffix
Decedent's First Name
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix
WILLIAMS
FLORANCE
MI
K
Spouse's First Name
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
[gJ 1 . Original Return
o 4. Limited Estate
[gJ
o
2. Supplemental Return
o
o
o
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
4a. Future Interest Compromise (date of
death after 12-12-82)
7. Decedent Maintained a Living Trust
(Attach Copy of Trust)
10. Spousal Poverty Credit (date of death 0 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 Telephone Number
6. Decedent Died Testate
(Attach Copy of Will)
9. Litigation Proceeds Received
o
o
o
o
8. Total Number of Safe Deposit Boxes
(--j
3~~~ 4 1
,:.~
c.,:)
I V 0
V
o T T 0
I I I
E S Q
717
243
MARTSON
LAW
OFFICES
~
REGISTER OF WILLS USE~L Y r
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Firm Name (If Applicable)
First line of address
I
C)
1 0
E A S T
H I G H
STREET
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Second line of address
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x:-
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1"1
City or Post Office
State
ZIP Code
DATE FILED
CARLISLE
P A
17013
Correspondent's e-mail address:
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and t 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.
SIGNAT F PERSON RESPONSIBLE ORFI I G RETURN DAi
~ /
Drive
R OTHER THAN REPRESENTATIVE
Carlisle
PA 17015
DA E
/ < tJ1
HIGH STREET
CARLISLE
PLEASE USE ORIGINAL FORM ONLY
PA 17013
Side 1
L
15056041125
15056041125
-.J
..-J
15056042126
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: HAROLD K. WILLIAMS
RECAPITULATION
12507 556 1
1. Real estate (Schedule A)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1.
2. Stocks and Bonds (Schedule B)
.................................. 2.
132903.23
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) 0 Separate Billing Requested . . . . . .. 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) 0 Separate Billing Requested. . . . . .. 7.
722.55
8. Total Gross Assets (total Lines 1-7) 8. 1 3 3 6 2 5 . 7 8
.......................... .
9. Funeral Expenses & Administrative Costs (Schedule H) 9. 1 9 1 3 7 . 1 5
............... .
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) . . . . . . . . . . . . 10. 1 5 7 6 . 6 8
11. Total Deductions (total Lines 9 & 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 2 0 7 1 3 . 8 3
12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . 12. 1 1 2 9 1 1 . 9 5
13. Charitable and Governmental Bequests/Sec 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. 1 1 2 9 1 1 . 9 5
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 _ o . 0 0 15. O. 0 0
16. Amount of Line 14 taxable 1 1 2 9 1 1 . 9 5 0
at lineal rate X .012.- 16. 5 8 1 . 0 4
17. Amount of Line 14 taxable o . 0 0 o . 0 0
at sibling rate X .12 17.
18. Amount of Line 14 taxable o . 0 0 o . 0 0
at collateral rate X .15 18.
19. Tax Due . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 5 0 8 1 . 0 4
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
o
Side 2
L
15056042126
15056042126
-I
. REV-1500 EX Page 3
Decedent's Complete Address:
File Number
21 07 01077
DECEDENT'S NAME
HAROLD K. WILLIAMS
STREET ADDRESS
26 Cardinal Drive
CITY \ STATE I ZIP
Carlisle PA 17015
Tax Payments and Credits:
1. Tax Due (Page 2 Une 19)
2. Credits/Payments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
(1)
5,081.04
254.05
Total Credits ( A + 8 + C ) (2)
254.05
3. InteresVPenally if applicable
D. Interest
E. Penalty
TotallnteresVPenalty ( D + E ) (3)
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. (4)
0.00
0.00
4,826.99
5. If Une 1 + Une 3 is greater than Une 2, enter the difference. This is the TAX DUE. (5)
8. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(5A)
(58)
A. Enter the interest on the tax due.
4,826.99
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; ...................................................................... 0 [XJ
b. retain the right to designate who shall use the property transferred or its income; ............................... 0 [XJ
c. retain a reversionary interest; or ................................................................................................ 0 [XJ
d. receive the promise for life of either payments, benefits or care? ....................................................... 0 [XJ
2. If death occurred alter December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? ....................................................................................... 0 [XJ
3. Did decedent own an 'in trust for' or payable upon death bank account or security at his or her death? ......... 0 [XJ
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? .................................................................................................. 0 [XJ
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 alter 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 alter 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 exemDt 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 alter 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-1503 EX + (6-98)
*'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
HAROLD K. WILLIAMS
FILE NUMBER
21 07 01077
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
Edward Jones Investment Account No. 377-10244-1-5 (see Estate Valuation statement attached)
VALUE AT DATE
OF DEATH
132,903.23
TOTAL (Also enter on line 2, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
132.903.23
, REV-1508 EX + (6-98)
'*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
HAROLD K. WILLIAMS
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
FILE NUMBER
21 07 01077
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.
VALUE AT DATE
OF DEATH
722.55
ITEM
NUMBER
1.
DESCRIPTION
Cash in Edward Jones Account No. 377-10244-1-5
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
722.55
REV-1511 EX + (12-99)
'*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
HAROLD K. WILLIAMS
FILE NUMBER
21 07 01077
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Ewing Brothers Funeral Home, Carlisle, P A 8,013.93
2. George A. Strish Funeral Home, newspaper obituary 60.00
3. Second Presbyterian Church, Memorial Service 100.00
4. Food for Memorial Service 338.72
5. Lodging for out-of-town children to attend services 128.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City State Zip
Year(s) Commission Paid:
2. Attorney Fees Martson Law Offices (estimated) 6,500.00
3. Family Exemption: (If decedenfs address is not the same as claimanfs, attach explanation) 3,500.00
Claimant Florance K. Williams
Street Address 26 Cardinal Drive
City Carlisle State P A Zip 17015
Relationship of Claimant to Decedent Spouse
4. Probate Fees Register of Wills of Cumberland County 294.00
5. Accountanfs Fees
6. Tax Return Prepare~s Fees
7. Stock valuation reports 37.50
8. Register of Wills, filing fee, Inheritance Tax Return 15.00
9. Reserved for investment fees and miscellaneous filing fees 150.00
TOTAL (Also enter on line 9, Recapitulation) $ 19137.15
Debts of decedent must be reported on Schedule I.
(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
HAROLD K. WILLIAMS
FILE NUMBER
21 07 01077
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
1. Cumberland County Office of Aging, account payable 160.65
2. Visa account, account payable 86.08
3. ElmCroft-Outlook Point, account payable 619.95
4. Church of God Home, account payable 10.00
5. Dover Area ALS Medic 98, uninsured transport 700.00
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
1 576.68
. O<EV."" """*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
HAROLD K WILLIAMS
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 [include outritt spousal distributions, and transfers under
Sec. 9116 (a (1.2)]
1. Craig L. Williams Lineal 37,637.32
4302 Park Street
Camp Hill, P A 17011
2. Susan M. Rudolph Lineal 37,637.32
1100 West Chester Pike, L2
West Chester, PA 19382
3. Cynthia L. Williams Lineal 37,637.31
Cambridge Hall Apartments, C2
500 W. Rosedale Ave., West Chester, PA 19382
(Note: Spouse filed Disclaimer, copy attached] Spousal
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 TAXIS 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 07 01077
(If more space is needed, insert additional sheets of the same size)
Estate Valuation
Date of Death: 10/12/2007
Valuation Date: 10/12/2007
Processing Date: 12/13/2007
Shares
or Par
Security
Description
High/Ask
1)
55.4403 US BANCORP DEL (902973304; USB)
COM NEW
NYSE
10/12/2007
33.22000
2)
Div: 0.4 Ex: 09/26/2007 Rec: 09/28/2007 Pay: 10/15/2007
252.231 AMERICAN BALANCED FD INC (024071300; BALCX)
CL C
NASDAQ
10/12/2007
3)
116.967 CAPITAL INCOME BLDR FD (140193103; CAIBX)
SH BEN INT
NASDAQ
10/12/2007
4)
519.555 CAPITAL WORLD GROWTH & INCOME (140543307; CWGCX)
CL C
NASDAQ
10/12/2007
5)
469.224 JENNISON VALUE FD (743916108; PBQIX)
CL B
NASDAQ
10/12/2007
6)
714.019 JENNISON 20/20 FOCUS FD (743979106; PTWAX)
CL A
NASDAQ
10/12/2007
7)
339.49 LORD ABBETT AFFILIATED FD INC (544001308; LAFCX)
CL C
NASDAQ
10/12/2007
8)
1445.24 LORD ABBETT SECS TR (543915607; GlLAX)
ALL VALUE CL C
NASDAQ
10/12/2007
9)
1644.115 LORD ABBET INVT TR (543916506; LAUSX)
US GOV&GOVSPRC
NASDAQ
10/12/2007
10)
787.263 VAN KAMPEN REAL ESTATE SECS FD (92113P303; ACRCX)
CL C
NASDAQ
10/12/2007
11)
5000 FIRST HORIZON MTG TR 2003-7 (32051DZW5)
OTC
Mat: 09/25/2033 5.000% Fact: 0.98496885
10/12/2007
CMO Accrual
Page 1
Low/Bid
32.67000 H/L
20.41000 Bid
67.92000 Bid
49.12000 Bid
23.01000 Bid
17.38000 Bid
16.72000 Bid
13.26000 Bid
2.55000 Bid
30.78000 Bid
86.31509 Bid
Estate of: Harold K. Williams
Account: 5314.2
Report Type: Date of Death
Number of Securities: 13
File ID: 5314.2
Mean and/or Div and Int Security
Adjustments Accruals Value
32.945000
1.826.48
22.18
20.410000
5,148.03
67.920000
7,944.40
49.120000
25,520.54
23.010000
10,796.84
17.380000
12,409.65
16.720000
5,676.27
13.260000
19,163.88
2.550000
4,192.49
30.780000
24,231.96
86.315090
4,250.88
7.52
This report was produced with EstateVal, a product of Estate Valuations & pricing Systems, Inc. If you have questions,
please contact EVP Systems at (818) 313-6300. (Revision 6.4.1)
seH.
13 ::r~ I
,
Date of Death: 10/12/2007
Valuation Date: 10/12/2007
Processing Date: 12/13/2007
Estate of: Harold K. Williams
Account: 5314.2
Report Type: Date of Death
Number of securities: 13
File !D: 5314.2
Shares
or Par
Security
Description
High/Ask
Low/Bid
Mean and/or Div and Int Security
Adjustments Accruals Value
12)
7000 FIRST HORIZON MTG TR 2004-4 (32051D3WO)
OTC
Mat: 09/25/2034 5.650% Fact: 0.995
10/12/2007
89.93998 Bid
89.939980
6,264.32
CMO Accrual
12.02
13)
6000 RESIDENTIAL FDG MTG 2004-SR1 (76111XKZ5)
OTC
Mat: 09/25/2033 5.600% Fact: 0.99597403
10/12/2007
91.66045 Bid
91.660450
5,477.49
CMO Accrual
10.23
Total Value:
Total Accrual:
Total: $132,955.18
$132,903.23
$51. 95
Page 2
This report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, Inc. If you have questions,
please contact EVP Systems at (818) 313-6300. (Revision 6.4.1)
F: \FILESIClients\5314 WilliamsI5314.2.disclaimer
EST ATE OF HAROLD K. WILLIAMS, DECEASED
NO. 21-07-1077
DISCLAIMER AND RENUNCIATION
I, Florance K. Williams, hereby exercise the rights granted to me in Chapter 62 of the Probate,
Estates and Fiduciaries Code (the "PEF Code"), and I hereby disclaim and renounce any interest to
which I may be entitled under Item 2 of the Last Will and Testament of Harold K. Williams dated
March 21, 1988, and under applicable law, to the following assets:
Any and all remaining assets, after payment of estate expenses, inheritance taxes and
other legitimate deductions of the estate, in Edward Jones Investment Account No.
377-10244-1-5
IN WITNESS WHEREOF, intending to be legally bound hereby and intending that this
Disclaimer and Renunciation shall be filed of record in the Office of the Clerk of the Orphans' Court
Division of the Court of Common Pleas of Cumberland County, Pennsylvania, as provided in Section
6204 of the PEF Code, I have hereunto set my hand and seal this :5 f d.- dayof::r tMt-a. (t' ;( 0' 8.
\- /~ )(. zJL//~
Florance K. Williams
COMMONWEALTH OF PENNSYLVANIA )
ss.
COUNTY OF CUMBERLAND )
~
On this, the ,3 rot day of ;j ~E' ,:)J;(J K, hefore me, a notmy puhlic,
personally appeared Florance K. Williams, known t me to be the person whose name is subscribed
to the within instrument, and acknowledged that s e executed the same for the purposes therein
contained.
~~--X)~~~Y.l
Not Public
COMMONWEALTH OF PENNSYLVANIA
NOTARIAL SEAL
Conine L. Myers. Notary Public
Carlisie Borough, Cumberland County
My commission expires May 27, 2011
LAST WILL AND TESTAMENT
OF
HAROLD K. WILLIAMS
I, HAROLD K. WILLIAMS, of South Middleton Township (mailing
address: 26 Cardinal Drive, Carlisle, Pennsylvania 17013), Cumber-
land County, Pennsylvania, being of sound and disposing mind, memory
and understanding, do hereby make, publish and declare this as and for
my Last will and Testament hereby revoking and making void any and all
Wills by me at any time heretofore made.
1. I direct my hereinafter named Executrix or Executors to pay
all of my just debts and funeral expenses as soon after my death as
may be found convenient to do so. I direct that my body be interred
on my burial lot located in St. John's Cemetery, also known as Peace
Church, along Trindle Road near the Borough of Mechanicsburg, Pennsyl-
vania.
2. All of the rest, residue and remainder of my estate, real,
personal and mixed, and wheresoever the same may be situate, I give,
devise and bequeath to my wife, Florance K. Williams, her heirs and
assigns, to the exclusion of my children, born and unborn, provided my
said wife, Florance K. Williams, shall survive me by a period of
ninety (90) days, but should she pre-decease me or fail to so survive
me then the same shall lapse.
3. Should my said wife, Florance K. Williams, pre-decease me or
fail to survive me by the aforesaid period of ninety (90) days, then
in such event all of the rest, residue and remainder of my estate,
real, personal and mixed, and wheresoever the same may be situate, I
give, devise and bequeath in equal shares to such of my three (3)
children, their heirs and assigns, as shall survive me by a period of
ninety (90) days, they being Susan M. Rudolph, Cynthia L. DeCicci, and
Craig L. Williams, but should any of them fail to so survive me then
the share such deceased child of mine would have received shall pass
to such of his or her issue as shall survive me by a period of ninety
(90) days, per stirpes, and if there be no such issue the same shall
lapse and be added to the shares of my other children, per stirpes.
4. I hereby nominate, constitute and appoint my said wife,
Florance K. Williams, as Executrix of this my Last Will and Testament,
but should she pre-decease me or fail to qualify or cease serving as
such, then in such event I nominate, constitute and appoint my three
(3) children, Susan M. Rudolph, Cynthia L. DeCicci, and Craig L.
Williams, or any of them, as alternate or successor Executors, and I
further direct that none of them shall be required to post any bond to
secure the faithful performance of his or her duties in the Common-
wealth of Pennsylvania or in any other jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to this
my Last Will and Testament written on one (1) page, this 21st day of
March , 1988.
Ok f\/ I,,~,C '
'AI i ~li~
Harold K. Williams
(SEAL)
Signed, sealed, published and declared by HAROLD K. WILLIAMS, the
Testator above-named, 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.
/k'h:-h- r. (
1/ I.
If-oi~ li:,
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
OTTO IVO VICTOR III
10 E HIGH STREET
CARLISLE, PA 17013
_____n_ fold
ESTATE INFORMATION: SSN: 125-07-5561
FILE NUMBER: 2107-1077
DECEDENT NAME: WILLIAMS HAROLD K
DATE OF PAYMENT: 01/03/2008
POSTMARK DATE: 01/03/2008
COUNTY: CUMBERLAND
DATE OF DEATH: 10/12/2007
NO. CD 009136
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $4,826.99
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$4,826.99
REMARKS:
CHECK# 12350
SEAL
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
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