HomeMy WebLinkAbout03-0955Estate of
also known as
Register of Wills of Dauphin County, Pennsylvania
PETITION FOR GRANT OF LETTERS
NO.
2. l 0 3-c/.5.5
, Deceased
Social Security No.
(COMPLETE "A" OR "B" BELOW:)
A. Probate ~q_d G_~n~rs
Decedent, dated I~.--t¢~ w V/~
and aver that Petitioner(s) is/are the execut
and codicil(s) dated
named in the Last Will of the
State relevant circumstances, ag. ~enuncia~ion. death of executor.
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the documents offered
for probate; was not the victim of a killing and was never adjudicated incompetent:
II
B. Grant of Letters of Administration
Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse
(if any) and heirs:
Name Relationship Residence J
(COMPLETE IN ALL CASES:) Attach additiona/~ heats if necessary.
ecedent wa~q~ a~ ~I~L,.,~,iD ~ta_ ~'~'~~~ CO nty Pen~ni, izh t~r last t '1 rincipat
Decedent, the,~ years of age, died /~ ~ , 20~at ~~ ~~
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) All personal property .............................. ~
(If not domiciled in PA) Personal property in Pennsylvania ...................... ~
(If not domiciled in PA) Personal property in County .......................... $
Value of real estate in Pennsylvania
Real Estate situated as follows: ~ ~
Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of letters in the
appropriate form to the undersigned:
Typed or printe~d na._._me and residence
Oath of Personal Representative
Commonwealth of Pennsylvania
County of ~ C0MB~.RLAND
The Petitioner(s) above-named swear(s) and affirm(s) that the statements in the foregoing Petition are true and
correct to the best of the knowledge and belief of Petiti~hat, as personae re~%-~)enta~e Decedent,
Petitioner(s) will well and truly administer the estat~__.~ordi~
Sworn to and affirmed and subscribed ~,,,';FF~I~,I ? ~ ~ \-'-"-
18th of /
before me this day
November 20 03
Donna M. Otto, 1st Deputy Register of Wills
DECREE OF REGISTER
Estate of E. Jane Myers
Deceased No.
21-2003-955
also known as
Social Security No: 195-16-6884
Date of Death: ~Avcmh~r 12: 20f)q
AND NOW, Novemhe. r 1R~-h , 2003 , in consideration of the Petition
on the reverse side hereon, satisfactory proof having been presented before me,
IT IS DECREED that Letters EkTestamentary [] of Administration
are hereby granted to Ja~es H. Fetzer ITT
in the above estate and that the instrument(s), if any, dated June 6th, 1999
described in the Petition be admitted to probate and filed of record as. t, be last Will of Decedent.
FEES
Letters ...........................
Short Certificate(s) ..... 6. ....
Renunciation ..................
Affidavit ( ) ................. $
Extra Pages ( 4 ) ............
Codicil ..........................
JCP Fee ........................
Inventory & Tax Forms...
Other ............................
$ 115.00
$ 18.00
Donna M. Otto, 1st Deputy
12.00
10.00
Attorney:
I.D. No:
Address:
Telephone:
DATE FILED: November 18th, 2003
TOTAL ................ $155.00
Mailed letters to Executor on 11/18/2003
~W-7a
his is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as
Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $2.00
P 9650499
No.
Local Registrar
[)ate
,Rev 2/87 COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS
. CERTIFICATE OF DEATH
NAME OF DECEDENT {F~rsl M~dd~e L~) STATE FILE NUMBER
~.,;,,,,,?,,~ Fe~,- ~_.y,,,,-~ ,.F~,,,,/,:J,.~,s--/~,
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~0 '~'. ' ~ P. IO'-le/2~ t/e-ndo~. ,.,.,-,~ ~.~o~,,..,~
~UN~ OF ~H [ Cl~. ~ORO. ~P OF DEATH[ FACIL~ NAME Ill nol ~U,mll~+ g,~ slr~ and numar,
~CEDE~'S USUAL ~CU~N [ KIND ~ flUSINES~INDUSTRY I [ ~S ~CE~NT E~R N ~ECEDENT'S EDUC~I~
~ . . J _ ~[(~ ~e~[~ [~ ~ a
INFORM~'SNAME~y~Pnn0 / ~ iiNFORM~T.SMAiLi~A~E~{~.C~.~ie./~C~
8~ ~ Crl~ ~ Re~v~ fr~Slell~ I{M~B.~y, ~r) ]P~CE
~ ~ pm~e. ~7 I · [DATE PRO~UNCE O DE~ (M~th. Day. Year )
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21-2003-955
LAST WILL AND TESTAMENT
(Pour-Over Will)
OF
E. JANE MYERS
IDENTITY
I, E. JANE MYERS, residing in the County of Dauphin, Commonwealth of Pennsylvania, being of
sound mind and memory, and not acting under duress or undue influence of any person whomsoever, hereby
declare this to be my Last Will and Testament, and I do hereby revoke all other former Wills and Codicils
to Wills heretofore made by me. My Social Security Number is 195-16-6884.
All reference made herein to "spouse or my spouse" refers to the person to whom I am currently
married, namely, WARREN S. MYERS. By the ensuing provisions of this Will, it is my intention to dispose
of my interest in our property; I do not intend to dispose of anything belonging to my husband or to put him
to any election.
I have the following children: JAMES H. FETZER III born July 31, 1947 and currently residing in
Knoxville, TN and RICHARD M. FETZER born January 5, 1956 and currently residing in Woxalll, PA.
DEBTS, TAXES AND ADMINISTRATION EXPENSES
I have provided for the payment of all my debts, expenses of administration of property wherever
situated passing under this Will or otherwise, and estate, inheritance, transfer, and succession taxes, other
than any tax on a generation-skipping transfer that is not a liability of my Estate (including interest and
penalties, if any) that become due by reason of my death, under THE WARREN S. MYERS AND E. JANE
MYERS REVOCABLE LIVING TRUST executed on even date herewith (the "Revocable Trust"), or if my
spouse predeceases me, under the Survivor's Trust created by the said Revocable Trust. If the Revocable
Trust assets should be insufficient for these purposes, my Executor shall pay any unpaid items from the
residue of my Estate passing under this Will, without any apportionment or reimbursement. In the
alternative, my Executor may demand in a writing addressed to the Trustee of the Trust an amount necessary
to pay all or part of these items, plus claims, pecuniary legacies, and family allowances by court order.
PERSONAL AND HOUSEHOLD EFFECTS
It is my intent that all my personal and household effects were transferred to the Revocable Trust
as a result of the Declaration of Intent signed this date. If there are any questions regarding the ownership
or disposition of these assets, it is my desire that such assets pour into the Revocable Trust, signed by me this
date in accordance with the provisions of the section titled "Residue of Estate."
POUR-OVER WILLS
Page 1
(Testator/Testatrix)
Name of Decedent:
CERTIFICATION OF NOTICE UNDER RULE 5.6(a}
E. Jane Myers
Date of Death:
11-12-2003
Admin. No. 21-03-0955
Will No. 2003-00955
To the Register:
I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphans' Court Rules was
served on or mailed to the following beneficiaries of the above-captioned estate on ! 1-19-03 verbal :
Name Address
James H. Fetter, III 12521 Fort West Dr. Knoxville, TN 37922
Richard M. Fetzer 2200 Hendrix Station Rd P. O. Box 103
Woxall, PA 18979
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except N/^
Da~: 4-8-04
Name James H. Fetzer~ III
Address 12521 Fort West Drive
Telephone (865 675-7442
Capacity: X Personal Representative
Counsel for personal representative
r--I Postmark
r--i
i--i Here
Total Postage & Fees ~
r--lr--I lSent To
r,- '~ ............
[?.r..,,..o.~.~ .................................... .?..L~..C?:.5..-_~..->....~ ...1
Postage
Certified Fee
Return Reciept Fee
(Endorsement Required)
Restricted Delivery Fee
(Endorsement Required)
I!. ~,~.,~,,.-~~? nyes
1. /~k=ie ~ to: If YES, enter del~,~ below, I-INo
FETZER JAMES H III
12521 FORT WEST DRIVE
KNOWVILLE TN 37922
7003 1010
'i i ' ii '~[:~ Return Receipt
[] Registered [] Return Rees~ for Merchandbe
[] i~ Mall [] C.O.D.
4. Restflcted De#v~ ~ Fee) r'lyes
DDDt 12D4 D482
102~1540
This instrument consists of 5 typewritten pages, including the Attestation Clause, Self-Proving
Clause, signature of Witnesses, and acknowledgment of officer. I have signed my name at the bottom of each
of the ~.pages. This instrument is being signed by me on this ~P~ day of
ATTESTATION CLAUSE
The Testatrix whose name appears above declared to us, the undersigned, that the foregoing
instrument was her Last Will and Testament, and she requested us to act as witnesses to such instrument and
to her signature thereon. The Testatrix thereupon signed such instrument in our presence. At the Testatrix's
request, the undersigned then subscribed our names to the instrument in our own handwriting in the presence
of the Testatrix. The undersigned hereby declare, in the presence of each of us, that we believe the Testatrix
to be of sound and disposing mind and memory.
Signed by us on the same day and year as this Last Will and Testament was signed by the Testatrix.
WITNESSES:
(Printedl Nan~e bf Witnesd)
ADDRESSES:
iPrinted Name of Witness)
POUR-OVER WILLS
Page 4
(Testator/Testatrix)
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF DAUPHIN
SELF-PROVING CLAUSE
BEFORE ME, the undersigned authority, on this day personally appeared E. JANE MYERS,
and ., known to me to be the
Testatrix and the witnesses, respectively, whose names are subscribed to the foregoing instrument in their
respective capacities, and all of them being by me duly sworn, E. JANE MYERS, Testatrix, declared to me
and to the Witnesses, in my presence, that the instrument is her Will and that she had willingly made and
executed it as her free act and deed for the purposes therein expressed; and the Witnesses, each on his or her
oath, stated to me in the presence and hearing of the Testatrix, that the Testatrix had declared to them that
the instrument is her Will and that she executed the same as such and wanted each of them to sign it as a
witness; and upon their oaths, each witness stated further that he did the same as a witness in the presence
of the Testatrix, and at her request and that she was at that time eighteen (18) years of age or over and was
of sound mind, and that each of the witnesses was then at least fourteen (14) years of age.
E. JANE~ MYERS
Testatrix
Witnes~ / '
(Printe~t Nan(e of Witness)
Witness
(Printed Name of Witness)
SUBSCRIBED AND ACKNOWLEDGED before me by E. JANE MYERS, Testatrix, and
subscribed and sworn to before me by and
19 t~. , witnesses, this the ~ ~ day of~z~e-7'~- ,
JEFFREY D. JONES
Commissioner of Deeds
Commonwealth of Pennsylvama
My Commission Expires Nov 17 2003
Notary l~ub~c,, ~wealth of Pennsylvania
POUR-OVER WILLS
Page 5
(Testator/Testatrix)
JRD/June 30, 1992/17858
APR 1 6 2004
In Re: Estate orE. JANE MYERS
Late of LOWER ALLEN TOWNSHIP
Estate No.' 21~03-955
ORPHANS' COURT DIVISION
COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY
PENNSYLVANIA
NO. 21-03-955
NOTICE OF FAILURE TO FILE CERTIFICATION AND REQUEST TO CONDUCT A
HEARING PURSUANT TO RULE 5.6(e), SUPREME COURT
ORPHANS' COURT RULE
Personal Representative: JAMES H FETZER, III
Counsel for Personal Representative:
Date of Grant of Original Letters: 11-18-2003
Date of Delinquency Notice: 02-28-2004
The undersigned, Glenda Farner-Strasbaugh, Clerk of the Orphans' Court, in accordance
with Rule 5.6, Supreme Court Orphans' Court Rules, hereby notifies the Orphans' Court
Division, Court of Common Pleas of Cumberland County, that neither the above named personal
representative nor the above named counsel for the personal representative have filed with the
Register of Wills or Clerk of the Orphans' Court his, her or its certification required by Rule
5.6(e), Supreme Court Orphans' Court Rule and that the requisite notice, pursuant to Rule 5.6(e),
Supreme Court Orphans' Court Rules, was given by the Clerk of the Orphans' Court on
FEBRUARY 28, 2004, and that the ten (10) day notice to file the certification has expired.
Accordingly, in accordance with Rule 5.6(e) the Court is hereby notified of such delinquency
and the undersigned requests that a Court conduct a hearing to determine whether sanctions
should be imposed upon the delinquent personal representative or counsel for the delinquent
personal representative.
Date: 04-14-2004
Distribution:
Glenda Famer Strasbaughr ~
Clerk of the Orphans' Court
Personal Representative
Counsel for Personal Representative
Estate File
A hearing is scheduled for ~at 0ff~ ~in Courtroom No. 3. If the Certification of Notice is
filed prior to the hearing date, the hearing will automatically~~q~ ~ ~,.,~
Geora~ E~jl~ff~, 1~. J." ~
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU Of INDIV10UAL TAXES
DEPT. 280601
HARRISBURG. PA 17128-0601
REV-1162 EX(1 1-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
FETZER JAMES H III
12521 FORT WEST DRIVE
KNOWVILLE, TN 37922
_____'n fold
ESTATE INFORMATION: SSN: 195-16-6884
FILE NUMBER: 2103-0955
DECEDENT NAME: MYERS E JANE
DATE OF PAYMENT: 06/20/2005
POSTMARK DATE: 06/20/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 11/12/2003
NO. CD 005458
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $35,116.00
I
I
I
1
I
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TOTAL AMOUNT PAID:
$35,116.00
REMARKS: LEGG MASON
CHECK# 71330805
SEAL
INITIALS: VZ
RECEIVED BY:
REGISTER OF WILLS
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REV.1500H(6-00)
'* COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG. PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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DECEDENTS NAME (LAST. FIRST, AND MIDDlE INITIAL)
f1 'fEltS tM nil J.
DATE OF DEATH (MM-O[!'YEAR) n.... n lDATE OF BIRTH (MM-DD-YEAR)
1/- S - 2003
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST. FIRST. AND MIDDLE INITIAL)
~ 1. Original Return
o 4. limited Estate
D 6. Decedent Died Testate (AIIact1copydWiH)
D 9. litigation Proceeds Received
D 2. Supplemental Return
D 4a. Future Interest Compromise (daleofdealhafler12-12-82)
~ 7. Decedent Maintained a Living Trust (A\lac:hoopyofTrusl)
D 10. Spousal Poverty Credit (date 01 death between 12-31-91 and 1-1-95)
FILE NUMBERO 3
1-1 -
OOCf5.5
~~---
COUNTY CODE YEAR
NUMBER
707.2.90
.
SOCIAL SECURITY NUMBER
ItJ5-/?
~ y 1>'1
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
D 3. Remainder Retum (dale of dealh prior to 12-13-B2)
o 5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
D 11. Election to tax under Sec. 9113(A) (AItach Sch 0)
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THIS SECTION MUST BE C~LETEll.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
NA!IEo 4 i/ ,"i) I-fA I.- L l- f? g S COMPLETE MAILING ADDRESS
FiRMNiliiE(Il......;O;;-- __--I---=- 'L---- 19 f"O en!: iJ,'?,COI<; Z v
---- c!t.. CO.vA ?A
" 170'12-
TELEPHONE NUMBER
7/7
7- '/ J. - '152P-
[/'~
.33. 7":;"""
(8)
L/. 9 'lS
-.:>-
, .0 (15)
x .0 tiS" (16)
X.12 (17)
x .15 (18)
(19)
19. Tax Due
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
(1)
(2)
(3)
(4)
(5)
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1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation. Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointiy Owned Property (Schedule F)
D Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage liabilities. & Liens (Schedule 1)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate tUne 8 minus Une 11)
13. Charitable and Governmental BequestsfSec 9113 Trusts for which an election to tax has not been
made (Schedule J)
-)
c:;
c..)
-.;
74/, /'1S
,
(11)
(12)
(13)
4/ If 7.5'"
73? . /?D
/
73~, 17D
(6)
(7)
(9)
(10)
14. Net Value Subject to Tax (Une 12 minus Une 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
16. Amount of line 14 taxable at lineal rate
2.:3~ /J 0
(14)
.33 12 Y
.3,3 12;-
,
20.0
.. Be lIURETDANSWER ALL QUESTIONS ON REVERSE SlOE AND RECHECK MATH < <
17. Amount of line 14 taxable at sibling rate
18. Amount of Line 14 taxable at co6ateral rate
Decedent's Complete Address:
STREET ADDRESS 1..5;:L.. b.Jo",:~ R.. 1~~l:I)~__
CITY
STATE
?A
M Ii} L
I
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Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. CreditslPayments
A. Spousal Poverty Credn
e. Prior Payments
C. Discounl
(1)
Total Credits ( A + B + C )
(2)
-,;)-
3.
InteresUPenalty if applicable
D.lnterest
E. Penalty
(3)
(4)
(5)
(SA)
~'f
99'(
4.
TotallnteresUPenalty ( 0 + E )
If Line 2 is greater than Line 1 + Line 3, enter the difference. Th~ is Ihe OVERPAYMENT.
Check box on Page 1 line 20 to request a refund
ZIP I '7 0 S-7
~3, 12.f>
/,9ff
5.
If Line 1 + Line 3 ~ grealerthan Line 2, enter Ihe difference. This is the TAX DUE.
.35' II?
"
A. Enter the interest on the tax due.
.$.5', II?
o
B. Enter Ihe total of Line 5 + SA. This is the BALANCE DUE. (5B)
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
a. retain the use or income of the property transfenred;................ .............................. .......................................... D
b. retain the right to designate who shall use the property transferred or its income; ....................... ................... D
c. retain a reversionary interest; or. .................................................... ................................ ................................. 0
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 wnhin one year of dealh
without receiving adequate consideration? .............. .................... .......................................................................... 0
3. Did decedenl 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? ........................................................................................................................ IX1
No
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IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN,
Under penalties of perjury, I declare that I have examined this retum, including aa:ompanying schedules and slalernents, and to !he best of my knowledge and belief, it is true, correct
and complete.
Declaration of preparer other than Ihe personal representlltive is based on aM infunnation of which preparer has any knowledge.
SIGNATURE OF PERSON RESPONSIBLE FOR FiLING RETURN DATE
ADDRESS
SIGNATU~~OT~ESENTATIVE
ADDRESS
/9ff; (!..OLi-31LOO?/( ~'i)
?A
LJ".3A.J..,.I
/7o't'Z-
DATE
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the nel value of transfelS to or for the use of the surviving spouse is 3%
[72 P.S. ~9116 (a) (1.1) (i)].
For dates of death on or after January 1,1995, the tax rate imposed on the nel value of transfelS to or for the use of Ihe surviving spouse is 0% [72 P.S. ~9116 (a) (1.1) (ii)].
The slaMe doAs not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets anq filing a tax return are still applicable even if
the surviving spouse is the only benefidary.
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 0% [72 P.S. ~9116(a)(1.2)].
The tax rate imposed on the net value of transfelS to or for the use of the desedenfs lineal beneficiaries is 4.5%, excepl as noted in 72 P.S. ~9118(1.2) [72 P.S. ~9116(a)(1)].
The tax rate imposed on the net value of translels to or for the use of Ihe decedenl's siblings is 12% [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 1he decedent, whe1her by blood or adoption.
REV-1503 EX+ (6-98)
..
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
Z'M 1111 .J f1 '/EJl.$
FILE NUMBER
All property jolntly-owned wilh right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
{{)f>tuU:,.} ;) ,g E.. JAAJE J1YEtZS A/VINl, Jau:;r
/'f111/../,AL SUAfU:
VALUE AT DATE
OF DEATH
L/.31, .,j~27
i..L."", HAS<-u IItA c:t1 $04- 7IS?;)
2
3
L(
.5'
Lgc,G. I'1t11.HN
:d- 30<1- 6>IP.:>(.,
7; (,. <,10
/I rl ~I'-I
23/ 1f'3
1/ Y/ L/S-9
j-1(rrVAL,pF OMAIIA _j),J,'h'iT'/ -dc,f"VI917?
~'fl.s-r-1I<u:;r. - SuICv.v.o,{ filA - ::tJ-~/03YOl.2.j-()?
TOTAL (Also enter on line 2, Recapitulation) $ ? () 7 2 q 0
(If more space is needed, Insert additional sheets of the same size)
REV-1508 EX+ (6-98)
'*'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
?M-'1" .j
FILE NUMBER
Hyt<l5
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jolntly-owned with right of survivorship must be disclosed on Schedule F.
( .
/'1-1 I
B~.h<'
DESCRIPTION
e.t...A.S$;~ C.;-f~~I<UV~ e:r
971JIZ ~b~1
VALUE AT DATE
OF DEATH
J 9. 0 '7'1
/
/9 yoif'
I
ITEM
NUMBER
;:..
t,rIZE,.JS 6AAJ'< - C,-fE{"'<'''v(c ~
tJ ()()(" ~ -if 2(, --?
TOTAL (Also enler on line 5, Recapitulation) $
(If more space IS needed. insert additional sheets of the same size)
.3 3 S'sS-
REV-1511 EX+ (12-99)
..
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
?-rlMA .J
FILE NUMBER
11 Yfa. $
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES: Pl/.fi~'i:>
1.
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) Corrvnission Paid:
2. Attorney Fees -i.JVD
3. Family Exemption: (If decedent's address is not the same as claimant's. attach explanation)
Claimant
Street Address
City State _Zip
Relationship of Claimant to Decedent
4. Probate Fees // 0 I) 0
5. Accountant's Fees
6. Tax Return Preparer's Fees </7.7
7.
TOTAL (Also enter on line 9, Recapitulation) $ L/ 97,j
Debts of decedent must be reported on Schedule I.
(If more space is needed. insert addilional sheets of the same size)
REV-1513 EX+ (9-00)
'*'
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
HVUl5
["1 H A -J
FILE NUMBER
NUMBER
[
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS ~nclude outright spousal distributions, and transfers under
Sec. 9116 (al (1.2)J
1-
liMO ,-iY /1.i [rt$
'1013"". 3fL,')4U;>'+'''' ?" i70,j--
DAR.i3'!lA ,J"..JE 111.-4C-V
7-&17 t1DU"'~'<V .<Iv 1 ,1AvH""Krr; 1/A 22D(.,f
tl)M/.d..$."; I(AR:L. /1VUS
104'</5- 5A",Jv)ltY /lVi, -f"'v~S"1 0,< 711;.37
SeD rT S t1vU$
ft,J-i7 ?oTDJ"'fA~ j). vi, DIlAf)/)uGI( /+c;-rs, rei) z/7/Lj
f?o;Sl-d..' I t1ifUl>
10S(. S )Jv-rl1t~ 5'1, ihDY Dr< 'IS'373
.J~,-ilS H- ri,za, II!
/: ---r'A1 J}iH_
11..)'-' 1"0,<.T WE$'--- j)rt i !UJo,^"'.cl, I
2_
3
<-/
.c
{.,
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s}
.s"N - STL?
74vt:1j.-rC.t- Sr.c?
s"'.v
S",J
.5~Al
50.......l
AMDUNT OR SHARE
OF ESTATE
.4 /010& 0
/0" 00 D
Is OiC 5cMl
II~ ",~ 8 ,-II-.J(
J,,-- 01" 5vML
'/3 or () iH-clL
'/~- t>'::: ScHE.
y, v.;- ortl-{:.iL
1/__" --
/:J ",,-
!/z p.<"
5~,'-((
D,-'.{-E.'t
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 16, 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
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-I500 COVER SHEET $
(If more space is needed, insert additional sheets of tl1e same size)
09-05-2005
HYERS
11-12-2003
21 03-0955
CUMBERLAND
101
APPEAL DATE: 11-04-2005
(See reverse side under Objections)
A.oun1: Relli1:1:edl I
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE _ RETAIN LOWER PORTION FOR YOUR RECORDS -
iEv:is4;-Ex-AFP-io3:osi-NOTICE-OF-INHEiITANCE-TAX-APPRAISEMENT:-ALLOWANCE-oi---------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
EMMA J FILE NO. 21 03-0955 ACN 101
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
BUREAU OF INDIVIDUALQ~m~nrr" (In:I'''::: "'APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
INHERITANCE TAX DIVISION'. -',,"--' -~ '"l.) I"'.: I I./L_ '-j' OF DEDUCTIONS AND ASSESSMENT OF TAX
PO BOX 280601 . - F "
HARRISBURG PA 17128-0601 I - I
ZOOS ~::-p -2 PH \2: ! 0
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
CLE~li< OF
Q,"""""""
DAVID HAL,J.,~E'SQ - ,
1980 COLE'8koOK RD
CLEONA PA 17042
ESTATE OF
HYERS
*'
REV-1547 EX AFP (06-05)
EMMA
J
TAX RETURN WAS: (X) ACCEPTED AS FILED
) CHANGED
DATE 09-05-2005
If an ass.s~en1: was issued previDusly, lines 14, 15 and/Dr 16, 17, 18 and 19 will
reflec1: figures 1:ha1: include 1:he 1:D1:al Df ALL re1:urns assessed 1:D da1:e.
ASSESSMENT OF TAX:
15. ~ount of Line 14 .t Spousal rat. (IS)
16. ~ount of Line 14 taxable at Lineal/Class A rat. (16)
17, _t of Line 1<0 .t Sibling rat. (17)
18. A.aunt of Line 14 taxable at Coll.teral/Class Brat. (18)
19. Principal Tax Du.
XC:
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. R..l Est.t. (Schodule A)
2. Stocks end Bonds ISchedule B)
3. Closely Held stock/PBrtnership Interest (Schedule C)
'i. Mortgages/Notes Receivable (Schedule D)
S. Cash/Bank Deposits/Hisc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
11)
12)
(3)
1<0)
IS)
(6)
171
.00
707.290.00
.00
.00
33.955.00
.00
.00
(B)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitabl./Governaental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subiect to Tax
(9)
110)
4,975.00
.00
Ill)
112)
113)
11<0)
NOTE:
.00 X
736,270.00 X
.00 X
.00 X
DATE
06-20-2005
NUMBER
CD0054 8
INTEREST/PEN PAID (-)
1,290.07-
AMOUNT PAID
35,116.00
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
00 =
045 =
12 =
15 =
119)=
NOTE: To insure proper
credit to your account,
sub_i t the upper portion
of this for. Mith your
tax pa~nt.
741,245.00
4.970; 00
736,270.00
.00
736,270.00
.00
33,132.15
.00
.00
33,132.15
Cumberland County - Register Ot Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 10/11/2005
FETZER JAMES HIlI
12521 FORT WEST DRIVE
KNOWVILLE, TN 37922
RE: Estate of MYERS E JANE
File Number: 2003-00955
Dear Sir/Madam:
It has come to my attention that you have not filed the Status
Report by Personal Representative (Rule 6.12) in the above captioned
estate.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO.
103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after
July I, 1992, the personal representative or his counsel, within two
(2) years of the decedent's death, shall file with the Register of
Wills a Status Report of completed or uncompleted administration.
This filing is due by: 11/12/2005
Your prompt attention to this matter will be appreciated.
Thank You.
Sincerely,
Ah.~~
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
cc: File
Counsel
Judge
\..-CY
Register of Wills of Cumberland County
STATUS REPORT UNDER RULE 6.12
Name of Decedent:
Emma Jane Myers
Date of Death:
11-12-03
Estate No.:
2003-00955
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following
with respect to completion of the administration of the above-captioned estate:
1. State whether administration of the estate is complete:
Yes 0 No Ji]
2. lfthe answer is No, state when the personal representative reasonably believes that
the administration will be complete: 12-31 -05 Trust resolution
outside my control
3. lfthe answer to No.1 is Yes, state the following:
a. Did the personal representative file a final account with the Court?
Yes 0 No 0
b. The separate Orphans' Court No. (if any) for the personal representative's
account is:
c. Did the personal representative state an account informally to the parties in
interest? Yes 0 No 0
c. Copies of receipts, releases, joinders and approval of formal or informal
accounts may be filed with the Clerk of the Orphans' C rt and may be
attached to this report.
Date: 11-7-05
......
C...J
James H. Fetzer, III
Name
12521 Fort West Drive
Knoxville, TN 37934
Address
865-675-7442
Telephone No.
Capacity: kJ Personal Representative
o Counsel for personal representative
V.t
Cumberland County - Register Of Wills
One Courthouse Square
Carlisler PA 17013
Phone: (717) 240-6345
Date: 10/30/2006
FETZER JAMES HIlI
12521 FORT WEST DRIVE
KNOWVILLEr TN 37922
RE: Estate of MYERS E JANE
File Number: 2003-00955
Dear Sir/Madam:
This notice is to serve as a reminder that the Status Report by
Personal Representative under Rule 6.12 is due on the below listed
date.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103
SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after
July 1, 1992, the personal representative or his counselr within two
(2) years of the decedent's deathr shall file with the Register of
Wills a Status Report of completed or uncompleted administration.
This filing lS due by: 11/12/2006
Please feel free to contact this office with any questions you may
have. If you have already filed your Status Reportr please disregard
this notice.
Sincerely,
,bi / (7'~ 4-' (J
~---u~xJh~~ru
Glenda Farner Strasbaugh
Clerk of the Orphans' Court
cc: File
Counsel
()
Register of Wills of Cumberland County
STATUS REPORT UNDER RULE 6.12
Name of Decedent:
Emma Jane Myers
Date of Death:
11-12-03
Estate No.:
2003-00955
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, 1 report the following
with respect to completion of the administration of the above-captioned estate:
1. State whether administration of the estate is complete:
Yes 0 No [l
2. If the answer is No, state when the personal representative reasonably believes that
the administration will be comp1ete:rrrm::t- resolution outsido my
control, see letter 11-7-05.
3. If the answer to No.1 is Yes, state t~~~t1~~ new short certs for
bank and sent them. Expecting
a. Did the personal representative fia arfmsbJl:;WJlnti..'6$luths Cswum, 1 2 - 06
Yes 0 No 0
b. The separate Orphans' Court No. (if any) for the personal representative's
account is:
c. Did the personal representative state an account informally to the parties in
interest? Yes 0 No 0
c.
Date: 11 -11 - 0 6
V'd 't." ."
VV 'j:V: /,:
D::JnO'j'- ;., ' 'G:..ldYVno
dO JiiJi78'dliO
I S :2 J.1d
. Oc ADN 900l
James H. Fetzer
Name
12521 Fort West Drive
Knoxville, TN 37922
Address
865-675-XXXX 7442
Telephone No.
Capacity: Q Personal Representative
o Counsel for personal representative
,'> !
....,""', .-.;.\...-i
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Page 1 of2
James Fetzer & Associates, LLC
From:
To:
Sent:
Subject:
"Atkins, Danielle S [PVTC]" <danielle.s.atkins@smithbarney.com>
"James Fetzer & Associates, LLC" <jfa@tds.net>
Wednesday, November 15,200610:32 AM
RE: Estate of E. Jane Myers
.Jim,
We have set up the account and I am mailing you the forms you need to sign. There \\ill also
be a Letter of Authorization included \\ith the new account forms, sign this as well. Please
return the signed documents to me as soon as possible. We have all the other information
neccessary to journal the account. I \\ill mail these papers to you by the end of the day. If you
have any other questions let me know.
Danielle Atkins
Client Service Associate
'-;l1lith Heln1e\'
3lJ \\ f'atri,'k St., Sk 20('
F I" c'c1<'I 1I:k, \1l) 2] i()]
Di lee I ( Jill) hL}h-,'.c;3
Offin' I ) h()J-S0~' j
Toll F rt'e (-i()()) 63-l--()(li2
F,l \ ( J() I ) I'h j--l-icq:-;
,b ill "I 1",-",,) t k i IlS(1i -.. III i tll ba rIle\' .l'OIll
'Sill i III BcHIW\' is ,1 d 1\'1',1011 of Ci tiglOLlp C lubd I \Llrkds, IlK,
-----Original Message-----
From: James Fetzer & Associates, LLC [mailto:jfa@tds.net]
Sent: Monday, November 13, 2006 10:06 AM
To: Atkins, Danielle 5 [PYre]
Subject: Fw: Estate of E. Jane Myers
Danielle:
The attorney used the Myers Trust number for all transactions.
I have made application to the IRS and have received the following tax number, 20-7147267, for the E.
Jane Myers Estate.
Please confirm receipt of this information and as a result of this information an explaination of the process
that will be happening in your office to complete the estate business.
Regards,
Jim Fetzer
James H. Fetzer, III Executor
E. Jane Myers Estate
12521 Fort West Drive
Knoxville, TN 37922
865-675-7442
Ifd ''O'J G. .;;n,(r;~-j!/\ln"
~ "'-'-.J-...U i v
18008 SJNH&10
:10 >18318
IS :2 Wd 02 ADN 90UZ
11/17/2006
Page 2 of2
----- Original Message -----
From: James Fetzer & Associates, LLC
To: Atkins, Danielle S [PVTC]
Sent: Monday, November 06,20064:47 PM
Subject: Re: Estate of E. Jane Myers
Danielle:
I have searched all the files I have and have not found another number.
I am waiting for the attorney who handled the estate to respond to me after he has researched his files.
He had hoped to call me today. It doesn't look like that will happen before the COB.
I will continue to persue the info needed.
Jim Fetzer
-- Original Message ----
From: Atkins, Danielle S [PVTC]
To: jfa@tds.net
Sent: Monday, October 30,20064:39 PM
Subject: Estate of E. Jane Myers
I received the letter that you sent to Kris Wilson in regards to setting up the Estate. I
am Jean Joyce's new assistant and if you have any questions please call and ask for
myself. The tax ID number you provided for the estate is the same tax ID number we
were given for the Myers Trust accounts. These two numbers should not be the same.
The Estate should have a unique tax ID number, you may need to apply for one if you
have not done so already. Please let me know when you have the Estate Tax ill
number and we will gladly open up the account for you. Please let me know if you
have any questions. Thank you!
Danielle Atkins
Client Service Associate
'-,mith [j,lrIH:'\'
31l \\ f\ltnd; '-,t. '-,k 2Ut'
Frl'derilK. t\.lD 217111
Dirl',t i int' (3m) 6CJ(,-R2:=,-:.
Clttic\' Line (3ill ) (1(,3-003",
],,11 Fr"l' (00UI 63-l--()()72
rel'- (3Ul) 1163-1790
lLmiellt'...,.eltkin'-!r! '-111 i thb,lrl1l'\ .(orn
'~mith Ijdrlw\' is cl di\isiul1 ut Citigroll~' C!.,bc11 \lc1r'v~t..",lp.Y/;i""f "'"
ltJ~O~:rs.,,/~if/~bnJ
:10 )jcEJ1~)
15 :2 Wd 02 AON 90az
11/17/2006
Cumberland County - Register Of
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Wills
Date: 10/16/2007
~ ,
,
FETZER JAMES HIlI
12521 FORT WEST DRIVE
KNOWVILLE, TN 37922
~-.J
RE: Estate of MYERS E JANE
File Number: 2003-00955
Dear Sir/Madam:
This notice is to serve as a reminder that the Status Report by
Personal Representative under Rule 6.12 is due on the below listed
date.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103
SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after
July 1, 1992, the personal representative or his counsel, within two
(2) years of the decedent's death, shall file with the Register of
Wills a Status Report of completed or uncompleted administration.
This filing is due by: 11/12/2007
Please feel free to contact this office with any questions you may
have. If you have already filed your Status Report, please disregard
this notice.
Sincerely,
Glenda Farner Strasbaugh
Clerk of the Orphans' Court
cc: File
Counsel
In Re: Estate of
MYERS E JANE
ORPHANS' COURT DIVISION
COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY
PENNSYLVANIA
NO. 2003-00955
NOTICE OF FAILURE TO FILE STATUS REPORT
(~
- ~
.0
>~
Personal Representative: FETZER JAMES HIlI
Counsel for Personal Representative:
Date of Decedent's Death: 11/12/2003
The Orphans' Court record indicates that neither the above named personal representative
nor the above named counsel for the personal representative have filed with the Register of Wills
or Clerk of the Orphans' Court his, her or its Status Report required by Rule 6.12, Supreme
Court Orphans' Court Rule and that the requisite notice, pursuant to Rule 6.12, Supreme Court
Orphans' Court Rules, is hereby given by that the you have ten (10) day to file the Status Report.
Ifthe required 6.12 form is not filed in accordance with Rule 6.12 the Court will be notified of
such delinquency and the undersigned will requests that a Court conduct a hearing to determine
whether sanctions should be imposed upon the delinquent personal representative or counsel for
the delinquent personal representative.
Date:
11/28/2007
..;1
$'_1 it'
.;t~Md:ff~~f:/
,'W ~
Glenda Farner Strasbaugh
Clerk of the Orphans' Court
Distribution:
Personal Representative
Counsel for Personal Representative
Estate File
t-~
=
C~J
--..J
z
o
-:::
N
\D
-0
::J!:
N
..
-.J
cJ
DEe 182007
IN RE: ESTATE OF
MYERS E JANE
ORPHANS' COURT DIVISION
COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY
PENNSYLVANIA
NO. 2003-00955
NOTICE OF FAILURE TO FILE STATUS REPORT AND REQUEST TO CONDUCT A
HEARING PURSUANT TO RULE 6.12, SUPREME COURT ORPHANS' COURT RUL~
o 25
c; 0 -.J
Personal Representative: FETZER JAMES H III ~:::g ~~
,)
Counsel for Personal Representative:
Date of Decedent's Death: 11/12/2003
Date of Delinquency Notice:
The undersigned, Glenda Farner-Strasbaugh, Clerk of Orphans' Court, in accordance
with Rule 6.12, Supreme Court Orphans' Court Rules, hereby notifies the Orphans' Court
Division, Court of Common Pleas of Cumberland County, that neither the above named personal
representative nor the above named counsel for the personal representative have filed with the
Register of Wills or Clerk of the Orphans' Court his, her or its Status Report required by Rule
6.12, Supreme Court Orphans' Court Rule and that the requisite notice, pursuant to Rule 6.12,
Supreme Court Orphans' Court Rules was given on the above date and that the ten (10) day
notice to file the Status Report has expired. Accordingly, in accordance with Rule 6.12 the Court
is hereby notified of such delinquency and the undersigned requests that a Court conduct a
hearing to determine whether sanctions should be imposed upon the delinquent personal
representative or counsel for the delinquent personal representative.
Date:
12/12/2007
.. I'/J~ . I '~fj' I idf:;1:d-~.(4a..~f
,tt/t;f!d'tP., 4]1lltnw-....j .' ..- .' . /
Glenda Farner Strasbaugh
Clerk of the Orphans' Court
Distribution:
Personal Representative
Counsel for Personal Representative
Estate File
A hearing is scheduled Aoril28. 2008 at l1AM
in Courtroom No.2. If the Status Report is filed prior to the hea .
automatically be cancelled.
....
-u
~
N
U1
Pa. O.C. Rule 6.12 STATUS REPORT
REGISTER OF WILLS OF Cumberland
COUNTY, PENNSYLVANIA
Name of Decedent: E. Jane Myers
Date of Death:
11-12-2003
File Number: 2003-00955
Pursuant to Pa. O.c. Rule 6.12, I report the following with respect to completion of the administration of
the above-captioned estate:
1. State whether administration of the estate is complete: . . . . . . . . . . . . . . . . . . .. ~ Yes D No
2. If the answer is No, state when the personal representative
reasonably believes that the administration will be complete:
3. If the answer to No.1 is YES, state the following:
a. Did the personal representative file a final account with the Court? . . . . . .. t;!Yes DNo
b. The separate Orphans' Court No. (if any) for the personal
representative's account is:
c. Did the personal representative state an account
informally to the parties in interest? ............................... ~Yes DNo
d. Copies of receipts, releases, joinders and approvals of formal or i
filed with the Clerk of the Orphans' Court a be art to
,/'"
Date January 15, 2008
D Counsel
James H. Fetzer, III
Name of Person Filing this Form
12521 ForT WP~T nr,
Address
Knoyvillp, TN 17q11
22 : II hit L I
T:/ hOG5-675 7442
e ep one
I -,
Form RW-IO rev. lO.13:"06'~- ~
y