HomeMy WebLinkAbout96-00242
Estalo of
Register of Wills of ,... ,,, County, Pennsylvania
PETITION FOR GRANT OF LETTERS
..,:L....::. 110. dJ-Q&,-d4d-.
nlsa known as
I, _ ;I..-(j1
Social Socurlly No.
---' Doconsad
J," :. i'.h';' i~ . ,-; ~ t. 't: j: .. . ., ;<:\ t': I 'j': .-..
t'Ul\Onltlll. whO ~ yu" olng. Of oldOf, Ilppty(lfl'J tot:
(COMPLETE 'A' OR '0' BELOW)
o A. Probata and Granl of lollors Toslnmonlary ond n><lr dUlt polldonor(t) \<Inro d,o olocul-,-",,-nnmod In d,elatl waf 01
1110 Docodon~ dalod
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And codiell(l) dalod
'ffiiii ,..1.....11'1 DmJn.'atlC.... -i: IInuM\a1\ofl, dim" of IIKlJ'IOl'.ItlC.
EJlcnpl u fonows, DQC{Idont did nol mAIIY. wns not dlvorcnd. nnd dld not how B child born or odoploo nllor ")locution 01 tho dacuml'llls
ollorod for probata; WRS nol tho vlctirn 01 n killIng nnd WRS novor odjudlc:ntod Incompolnn!:
o B. Granl 0' lollors 0' Admlnlslratlon
~6tU:.I. :1*'6-"" ~.; dUlamlllbtlf1ll:du'll/'lr, "IMr'III
Politloner(!l) lIf10r 0 propor sORrch hn,"lnvo Rscmtninod Ihnt OOClldontloh no Will Md wos IUrvlvod by lho lollowing spouso Iii nny) nnd
hohl:
NIvoo
nolnlionship
no,idonco
(COMPlEtE IN "lLC^S~SjA~i';1Rj;r,.Ot;iif1ftQl!\'vr,
Decoden! was dornleilod 111 doad1!" .,:1'", 1; ~j !;;: ii. ,:..1'.. ::., 1':'1;. ';:.. : ':' II ': j i 1 ,County, Ponnsylvnnlll. with:hlllhor last fllnlily
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or princlpol roaldoneo nl_
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Docooenl al donth ownnd proporty with ostlrnnlod vnJuos nl follows:
(If domlcilod In P^) An pn..on", propnrly
(II nol domleilnd In M) Pn..onnl prop'"ly In PnnnsylvMlo
(If nor domlcilod In PM POIlonnl propnrly In Counrv
Value of mnl ostnlo In F'ol1nsyl~nnl"
6O'U
$
$
$
$ .:;23 ,~
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Whnroloro. Pnlltlonor(.)rn'pnellullr r.qlln,I!') tl,. prohnlO ollho loal Will and Codicil!,) pro'nnlrd with d,l, Polillnn ond tl,o grnnl 01
Inlto.. In !ho opproprinlo lonn 10 dlo undo..lgnnd:
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f'1I"f':tled by 1118 rfln""vl".""hl "tit "~\.OriDtlQn lenl
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Oalh of Personal Representative
Commonweollh 01 Pennsylvania
CDunly DI ('I::,:',unJ':;!J
The Pellllonor(s) obove.namod swoar(s) or olOrrn(9) that Ihe slalomonl5 In tho loregolng I'ollllon oro lruo
and correct 10 the bost 01 tho knowlodgo and bollol orpoUllonor(s) and Ihal, 09 personal represenlollve(s) of
tho Dacodent, Pellllonor(s) will well end IfIlly odmnl9lor Iho estalo according 10 law.
Sworn 10 or afflnned and subscribed . I..:'-::fr~-;,---' \) '-~
boforemelhls~.!~_dayol !,:."i':", :,:',! H
MARCH 19 96
~,1" 'f . " (~
/h1'I/)i j ,/1',' ,/',1' :;)'
": For 1110 neglslor-
MARY C. LEWIS
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No.
~ 1 - 96 - ~4~
Eslalo 01 :'::. iii,:, ,. ',","',' Deceased
:'(1, '_' (._\j; :'.; . / 1 ! Illi
Social Securily No: " ' Dolo of Dealh:
AND NOW, I~ARCH ~ 1 , , 19 96 . In conslderallon
ollhe Pellllon on tho reverse side horeon, sallslaclory prool having been presenled belore me,
IT IS DECREED Ihallelters 0 Teslamenlary 0 01 Admlnlslrallon
.. db n c ta.:Jl'IOdentt iii;aiiii"It .hI."I_; dl.lafllt rrincwtlas.
are hereby granled 10
" t'"."-",,, K ""1"\'" I ,',-,.".,., L..'....,..,.... I
. \ ' -,1',:\. . ,',!'" 'ill' . ~..., .: 1.;\ ;-, J :. l'. :~" ('(,- :;-:1:, '1] t ( ) l'~; ,
In Ihe above estale and thallhe Inslrumenl(sf daled A:,:,," i (j' .')
described In Ihe I'ellllon be admllled 10 probale and filed of record as Ihe last Will 01 Decedent
FEES
Lelters ..................... $
Short CertlOcale(s) ~.. $
nenunclallon ............ $
Alndavlls ( )............. $
Exlra Pagos (Z ) ......... $
CDdicll ...................... $
JCP Fee ................... $
Invenlory .................. $
OIher ......~.9.11.!.~.L... $
TOTAL ............. $
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60.00
18.00
6.00
Address:
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Mailed letters and order to Executrix on 3-71-96.
rCMm .nw.\ rial 2 01'
r"pNtd by 11'1 retln',NMIl, On' ^nodl'lMn 109t
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COUNS[LOR.AT.LAW
1021 NT. VllW Die,
ENOLA, P.. 170211
PHONIt ('7171 7:U.381S1
CER'rIFICATlUlI Of 1I0TICE ulIum HULE 5. 6 L~l
:~J\HLL I:. '.~ ',' ;,' I.' '.
lIame of Decedontl
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of Deathl _.J: .
Date
WLll ~.~ 1-\)0 Admin. o :-~)j :~
110. tlo.
To the ReqLslert
1 certlti thllt notice at beneficLal Lntere!!t r"'l'llt"'t I.
RuLe 5.6(1\) of thA Orphan!!' Court Rule!! WlI!! !!Arved on or mllll"'1 ,,,
the'J'?b ~g~ing bene fic Lariell u f the above-captioned ell tlltA on
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INHERITANCE TAX RETURN
RESIDENT DECEDENT
(TO BE FILED IN DUPLICATE
WITH REGISTER OF WILLS)
FOR DATES OF DlATH A"IR 12/31191 CHICK HIR!
IF A SPOUSAL
POVIRTY CRIDIT IS CLAIMID 0
Fill NUMBIR
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COMMONWEAltH 0' PENNSYlVANIA
DEPARtMENT Of R(VlNU(
OEPT ,eoool
HAUISBURG, PA 17128.0601
O(C(O(Nf'~ NAM( Il...~l. flR~I. AND MIOOII INlllAlJ
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~OCIAI SICUIUt, NUMIU
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OAT( 0' O(Alt1
'~)/, ,11'.
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ii, <}-I
1'" ""11(""11 SUhl_''''G "ovn'~"'il":P III~' ...t> ":POIl ,..'hAl,
rp:1.
04.
Original Relur"
6J.,1L-
COUNTY CODE
YEAR
NUMBER
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I!lCCIAt !ofCUIllh tlUMlfll
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03
05.
(l-i'i9
'- 2 Supplemental Return
[j.40 future InJere,' Compromi,e
Ilor dole~ of deoth alter 12.12.821
'b?1 6. Decedent Died Teslale CJ 7. Decedenl Mainlained a li\ling TrUll
r (Alloch copy of Will) (Attach copy of Trusl)
'ALL' CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
S)ur-' ~ \), 0. Gl'-E~
1Y2-- Ie "1c
limited Estale
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1. R.ol ElIalt ISch.dul. A)
2. Slacks and Bonds (Schedule BJ
3. Closely Held Slock/Parlnership Interest (Schedule q
d. Mortgages and Notes Receivable (Schedule DJ
5, Cash, Bank Deposits & Miscellaneous Penonal Property
ISch.dul. EI
6. Jointly Owned Property (Schedule FI
7. Tronsl." ISch.dul. G}{5ch.dul. LI
B. Tolal Gran Anet' (tolallines 1.71
9. Funeral Expenses, Adminillrative COSh, Miscellaneous
Expensel (Schedule HI
10. Oebh, Mortgage liabililies, liens ISchedule I)
11. Total Deductions (10101 lines 9 & 10)
12. Nel Value of Eltote (line 8 minu, line 11)
13, Charitable and Gavernmental Bequesh ISchedule Jl
141. Net Value Subject to Tax (line 12 minus line 131
15. Spousal Transfers (for dales of death aher 6.30.9d)
See Inslruction, for Ar,plicable Percentage on Reverse
Side. (Include voluel rom Schedule K or Schedule M.J
16, Amounl of line 14 taxable at 6% rate
(Include values from Schedule K or Schedule M.l
17. Amounl of line U taKable at 15% rate
Ilnclude \laluel from Schedule K or Schedule M,)
lB. Principal lOx due (Add tax from lines IS, 16 and 17.)
19. Credits Spousal Poverfy Credil Prior Paymenh
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T 0/01 Number of Safe Deposil Boxes
COMP1(tl MAlLIN':' "OO~U~
\J, o. 6,Y;<. 13
CN"-''-'' ()n. 176~
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12 ) --
13} ---
14 I --
15 I 11 -37 "1. 18
16} ju, C<)<:J ~u
17}
(9 I /G 36'~ ,71-
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110) >)-(, 02-8 ,<14-
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1151
1161
117)
Discount Inttrell
+
37.
3 77. :;8
I S I
1111 43, 333.18
112t<'--....:..-S-:Y Y3 . 4c 7
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{13}
1141 5" tf:r s
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x .06 =
x .15 =
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119}
(20)
20.
If Une 19 h greater Ihon line 18, enler the difference on line 20.
aD
This I, ,h. OVERPAYMENT.
1211
121AI
121BI
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21. If line 18 is greater than line 19, enter the difference on line 21. Thil ilt
A. Enter the interest on the balance due on line 21 A.
8. Enter the 10101 of line 21 ond 21A on line 218. Thi, is ,he BALANCE DUE.
Malee Checle Pavabll to: Rlglltlt of Will" Agent
k ~ ~ BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND TO RECHECK MATH -0( -0( ',_ .',.::'y:'
~':lder penohie, of perjury, I declore that I hove examined this return, including occompanying schedules and statements, and 10 the best of my knowledge ond b.elie!.
II correct and complele. I declare thaI 011 teal eSlate has been reported 01 true market value. Declaration of preporer other than the perlonal representahve II
base on infarmation of which pre parer has any knowledge.
IGNAIURf , fRSON. 'ONSlm fOR filiNG RfTURN AOO~U~ OAt(
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STATE OF CALIFORNIA
COUNTY OF CUMBERLAND
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WE, D-.l. I', G..IJrlu~ ,1""j<0/ r' r,~' , AND
", '" IE' (J,f'''' ' ,he T ".."" , and ,he wit""'''' ,e,peol""'Y,
whose n""" a,e ,igned to the alta- and ,,,,,,,,,,ng in,,,"menl. b"ng ""I d"'Y
,WOIn, do h"eby d"l"e to the "",,,,,~ned aut""'ity 'h'" lhe T"'''''x, MABEL E
MYERS, ,~ned and exe",,,d I", I",,,m,nt ,,",' La" Will. and th" ,he,;gnad
and exeouted it willingly, and thai "" """,,d it" he' ,,,e and "","n"", aol lor lhe
pu,pas'" th".in exp",,,d, 'hat ..,h olth' witn""" '" the pn"'''''' and "",ing
01 the T."a"'x, MABEL E MYERS, 'igned I", W111 "' """"",, and tha' to the "'"
01 our ,noW'edge and "ghl. w"' allhe lim..~h"en {I B) "mo" I"a" 01 age, 01
sound and disposing mind, memory and under no constraint or undue influence,
~L ~ ~".a/
MABEL E. MYERS (Testatr~)
e!.1/ Afd~
211 tf:.'ff/AfI ~ . /r ~./.7 P/
WITNESW tl ~'-
Subscribed, sworn to and acknowledged belore me by MABEL E. MYERS, the
Testatrix, who personally appeared belore me, the undersigned officer, and
subscribed totnd sworn to by the WITNESS1;S. .
I~ P. Go. Jrh,"1 and h~~) ,..~ T~~' on thIS,
the _ 1. '-I'lL day 01 ....1 ,19.9.L-. f-
' 17 Ii (j)Jl
~UBLlC
My commission Expires: ,fci". ~~ 11 Y 5
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, Please Prinl or T e
FILE NUMBER
:/{ -1~.- ()2</.1-
~:~.9_
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COMMONWEALTH O. ,fNNSYlVANIA
fNHlIlIANCI TAX InUIN
IISIDINT DICIDINT
SCHEDULE E
CASH, BANK DEPOSITS AND
MISCELLANEOUS
PERSONAL PROPERTY
ESTATE OF
\'" 'h::OLS I
(hO~
.-
-=-
(All property lolntly..owned with ,h. Right of Survivorship mutt be dl,do..d on Schedule FI
ITEM
NUMBER DESCRIPTION
I
I
, ,
i
I
I
I
I
I
0)
(2)
CD
(1)
o
C0
5-........~ eIL(;-!).... u"',,,.)
ll\Bt ~~ M'(ljL"'...t:~ Il"l~ 1,1,,1) f 5~1> k>"- ~" In"\)
\1wuL.Q$ Ht-.,........ (.)V o:::n..,,) c:( I-\""W ~.:::. II c1U;:l
<:\'-'c:.P~ 1~\.-9 cO> PIL\...1v\1 ~C5
\JC""'- 6',~l.C"::'~..> f;~ sn~L c..F (.(EM""\~~
cf- \.\'W...:;u-.LQ 6;,..r"C) ~'1 (Wc...,'\l"",J~
OJ. cc~ LeilS
9~'-n..l Oc::6'ct>,.-.- CI\-<'':''\::...I~(~ ~c~
TOTAL (Also enler on line S, Reca itulationl 5
(Anach additional 8\'2" x 11" .h.,,, if mOrt space II n.eded,)
VALUE AT
DATE OF DEATH
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'):.(, 01.l
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ouREAU tJ"nOOF Of N.
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.'EUANI~ lNCOf,AI.'ON'
A. 0 JOINT TENANTS \'11111 R1G1IT OF SURVIVORSHIP - ON DEAnt OF ONE OWNER. TITLE GOES TO SURVIVING OWNER
e, 0 TENANTS IN COMMON _ ON DEATlI OF ONE QWlIER.INTEREST OF DECEASED OWNER GOES 10 HIS OR HER HEI11S OR ESTATE.
NOTE: IF TilE vEHICLE IS BEING lEASED, CIIECK TIjlS BLOCK D.IF BLOCK IS CHECKED. COMPlETE AND ATTACH FORM MV.1l.
MESSENGER NUMBER:
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HABEL E HYERS
1100 BOYER Sf
$UHHERDALE PA'110Q3
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Dauphin Deposit Bank
and Trust Company
MAIN OHICE: 213 MAntC!T STnEET. UAnAUIDuno. rENNSVlYANlA 17101
"'2Ss..2I'1
Docedent Confirmation
Name: Mabel E. Myers
Social Security No.: 202-16-9141
Date of Death (000): 03/11/96
I ....
ACCO\A1t No. 4301720730153690 0017315506
---- --_.-
Type Charge card Checking
Date Opened .- .
or Issued 05/03/84 01/04/95
Dnte Closed
or Hatured 03/20/96 (Closed)
Dnte of Death
Do 1lll1Ce $46.30
PlUS
Onte of Death
Accrued Int. $12.69
Joint owners
(It lII1Y) None
---
Date of Joint
Oowlership
( $5,114.07 )
~
Non-Interest Bearing
None
Special n........l\ts: N/A
AddItIonal tnfonoatton avallabla at 120.00 por hour. One hour .Inl....
Onte Prepared: March 28, 1996 Prepared by: carolyn A. Berkebile
CUstomer Management Information Dept. (OII)
Telephone No. (717) 255-2054
Page 1 of 1
For. 00-020-2IB (R!V 7/13)
UV.1SOt I" 1""'1
'*'
SCHEDULE F
JOINTLY.OWNED PROPERTY
COMMONWEALTH Of PENNSYLVANIA
INHUnANC[ TAX RETURN
RESIDENT DECEDENT
ESTATE OF
"'" ~ C ..6~..5 I
I
\'rI1"\~ L
~
=-
rLE NUMBER J
~_ f~ .- 6".) '1-1-
Joint tonantl.)'
RELATIONSHIP TO DECEDENT
NAME
A. ~~ K ""'jelLS .5-
B. RoC>(~ UV\'fd\.'5
ADDRESS . . Q
2:;)- 3 o"J c...~/o. 'Uct...Jc-
') ..--
C1-'<-/O (-/} ,-1uL-S
400 (b",-/J'l 'SrI
~,,^W1...,{td..Ld.L. 41'l-
"u~3
Su~
..:sv~
C.
Jolntly-ownod proporty: M~))t:: (\\--<>lVt~:) 4-~u e.,Y0(t 'Tr S ,-OM h-\;;;0l'V ALe::: I a:1=r-
ITEM LmER DATE
NUMBER FOR MADE DESCRIPTION OF PROPERTY TOTAL VALUE DECD'S DOLLAR VALUE OF
JOINT OF ASSET % INT. DECEDENT'S INTEREST
TENANT JOINT
1. A -I;) 5(/1,{tll.-- f.)::i::~ '[~ ?-s.,,.., ) ~ q 0, o'tU fs '#
(h.:. ~ t..sTl'lE: 3/J} u1JU
G Y7 C\)...t-C~
IJ t:-,\-v\?<... Ys ,~~j
OS :.3:.' I ..J. '-rc.~oIS
l"..J ,--I">< -'"IlK: -- .
~CJ\i" ~ <:iJOl,'\iIVc('.3lnY
{J'3 (Jc.~ Oc......'-i:).. c(-
s/It..{12--- l,.,i1'hC{-
I} () "TPO~~ I-!-6't:c"lV
TOTAL (Also entor on line 6. Recopitulation) S 50. caD
(If morl' spac. is needed insert additional sheets of some size'
~ARRANTY 1)[[0 - 1"0
P\.AHlI,lNHOflH CO. WllLlA"'SPOAf. PA
, '''''"R~....
Counly P,1rcel Nu,
Wqis ;!Eledr,
MADE the
)(~~
,
day of
NINETY-TWO (1992)
MAY
in the year nineteen hundred and
BETWEEN HABEL E. MYERS, IHdow Woma.n, of Summerdale, East Pennsboro
Township, Cumberland County, Pennsylvania, hereinafter referred
to as "GRANTOR"
-AND-
MABEL E. MYERS. ROBERT I. MYERS. III. and ROBIN MYERS,
as "Joint Tenants with the Right of Survivorship, and NOT As
Tenants in Common", hereinafter referred to as "GRAN'fEES"
WITNESSETH, That in eonsideration of ONE ($1.00) DOLLAR a.nd NATURAL LOVE
AND AFFECTION -------------------------------------
Dollars,
hereby grant
in hand paid, the receipt whereof is hereby acknowledged, the said grantor
and convey to the said grantee ,
do es
ALL THAT CERTAIN tract or parcel of land with the buildings and
improvements thereon erected, situate in East Pennsboro Township,
Cumberland County, Pennsylvania, more particularly bounded and
described as follows, to wit:
BEGINNING at a point at the Northwesterly corner of
Fourth and Boyer Streets; THENCE along the Northerly line of
Boyer Street, North 61 degrees, 30 minutes West, 100 feet to
a point; THENCE North 28 degrees 30 minutes East, 150 feet to ~
point on the Southerly line of the 12 feet wide public alley;
THENCE along same, South 61 degrees, 30 minutes East, 100 feet
to a point on the Westerly line of Fourth Street aforesaiu;
THENCE along same South 28 degrees, 30 minutes West, 150 faet
to a point; the PLACE OF BEGINNING.
Having thereon erected a dwelling house known and numb"r."l
previously as 410 Boyer Street and now known as 400 BOYER 9TnEE~,
Summerdale, Pennsylvania 17093.
60& R 35
410
... ~..
~~... ''';'
AND the said grantor will
hereby conveyed.
specinlly
WARRANT AND FOREVER DEFEND the property
i:
'I
,
"
"
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II
II
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IN WITNESS WHEREOF. said grantor
day and year first above-written.
ha s hereunto set her
hand and seal , the
Suled and delivered in lhe presence or
.....~...............()G2'............
c:='U4!\~MP.t.t.~ .................
.....o!J~l~..l2:k~......I~rnl]
1.IABEL E. j.IYERS 0
............................................................l~rnlj
............................................................1Srnlj
............................................................I.Srnl]
............................................................I~rnl]
............................................................I~rnlj
"
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I .......................................................
CERTIFICATE OF RESIDENCE
I
il
I hereby certify, that the precise residence of the~rant herein is as follows:
. ~~:i~T E ~~ M~~;~S, III and .. ............... .G{.cY.J!..B..().............<
ROBIN HYERS Allorn,y or Ag,nl ror Grante'
400 Boyer St.
Summerda1e, PA 17093
Q!ammanlDenlllt of l!IrnnBulunnin
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Q!ann1n of .....~.~!:l.~.~.~.~~~~?....................... f
ii On this. the 1~~aYOf fJ1~ 199~eme
!,' I,
the undersigned officer. personally appeared ~IABEL E. MYERS
, a notary public,
whose name is subscribed to the:within.
'~I \' .";. -'.
executed the same for the purp~s~\llb~rr,i.j1., ':',. .
.: .;" ~ ',\ "~~": ....'J:. t~.:. .
4."'. .." ... "'[.
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IN WITNESS WHEREOF. I have hereunto set my hand an~d 0 ffi ci a1"n~'~:':;~ :s~::'.::'li/
C!/- . , h' c.. .'
M, Comm;,"" UP;"' .......!.!P..f q2w~ ""... ~ . . .... ...'fl......... .......:.:.....1
.... r~.:,;;,::sw! 'I
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E~~. ~~;,~~~~,'i;~ \~--.i.~:..~.~: ~:;-~;.:, II
"
"
.'
known to me (or satisfactorily proven) to be the person
instrument. and acknowledged that
she
"
,.
! I contained.
'I
BOOr. K 35 pm 412
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UNIFURM RESIDENTIAL APPRAISAL REPORT
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o oIlbltwxdJlll.... II.. to the ....,Ird the ~~-1.Ill~2Jh. .....LgL!I!L""'LoLU_'._!!bJoc.l!!>JIIP:r..ImJ~___
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h' VIr",t !rnf to
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FtfIOl' lhlt ,Il.et .hI "'''....,tblPly " 1N ",ope,t'" In th. "'Iot-hethood !pIorlmll, 10 ~plo,rNnt Ind tm.,-,l,l... ....pl"ment ..tbtNty. 'rru"lll m.....t, ,'t I~
...J!lIPltet II lcarted In 8 ","1~L!!:!llJ!!mlJrnl"tlJ~Lof.J.ImlJ~~_I~.Jn.the.teJllt;r;t_~__..!Q_b!-"'\L""lrtllral.rnL
~"xl. slturted In the amnnl~J!'''~\!Jn.fm~ lcsnhID~~_Q;rJ.ELI!""e-'llL~Lu_u,,-"" "",JJY_u:cm'l!bI,-,o_tho "bl""_
~. 11>'''' hldwM ouI1 .. Intontet.. 81 & 81 .... In c100e lJ~~~ .-. ,'!.JtgrlI'llIrd_Il1pI.J!l'!I!!LImIl'f'S ~ tho rrm._Jl:oe_
stet. <mltel 01 H<rThhtll I' IUlt "'""" the rl.....1!...-. d." < .... 8 .....Ietv 01 stl!LI!!l~.1 Icb_,...._ly1ill.._lMllLrtl..!.-~""""t1IJ!l.u)l;I.1 !!JJl!!~_
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""....1 condlll_ In,'" l\iII.ct ""'OtilOfhood f1nm-t1roo '~pOlIIDf 1....110_' CGof'u.l_,t1Il'"'I !.....,.nd "",&plll, ..'1..... tf.m.....'.."'r>l,..not "'....I!''G 11m..,. ,ut'h.. If"t M
C6l?lptlIU,. "operIS.. ter ....lntM ne'o~OIhood. d"Cllllllert 0' '''',",,''.ne. o'ul., rod nn~rc1 eonUtllone, IIc_l: p,~'!Jy_wh.~.J!'L~.!'Lf;l)>Ja;;t.J.!'Jdj;aho:xlJlp1T~9_~_
In:nmlm. DrmrdI"tl!lY..!u.ln_l:ell!'Dl In," IlCtI'U:l!llLes12lU!!loet. The~. I. ,,_.........!Uy .~.&Ih_d"'-""'-..,,_""'mLI]I.!!""_"'t1!'llI..L!o_
..I'" 3-6ll'CT<hs '-l m Inlonmtlm ,"'" !t>L..lTlJ\1I.:ll1L1m1.~I.. of II1ls sMe !!P IY'I'!J!l!ILlr~l\j!iClllliJr.l.axl ~\I$ll--1!!!!!!"lt
I1J,dw-e .... rot tn'otll..... It 11111 t11l'1! wllI1 an.<nt1....ll'llt..lfdor 9X. _ fa- IlrdlrnJ1~J!!!!!'-J!-'!!ll.Lld:>!.J!:!!<!.!..'!!W'..!~ty 01 oa.rceI.
rtlljlld ....onn.IIdon r. PU(:)e ar .p'"'lc.bl.H.,.... d.,.lo~In,....'dtlln conllol ol.....llom. 0",,.,,' ""Utl.tlon 1l10An Plo
",ppt,IIm.I,'el" runb.t 01 ""I, In 'N Itlbj'C1 pl~'Cl !v.A ApJ"ulm'''lottl numb" fll lJ'"tl1l 'Of u"ln lhe 'l!tile! ".tIj.et W^
On<<ibe CDmmon Iltm.nll and I.Cfullonll lulllll..: A
01m....10I. 100' 00' 1 '
Sil, All' 1S.toJ Sf'! .34 kres Com., Lot
Spedfle .orlno el...me"r.... trd d"el'Cllt~ Resld:ntlal
lorolno n",p'ltne. [i] holf 0 half noneo..;OfmlI"lCllI01vdr......,td "..I 0 In~1f
HIo.....' . bflt lA, ..I",,,o.,.d lil PItt'", ,., 0 01....' ..,'.."'-'nl WA
N.
Topogrnphy
Sin
Shnpft
O,n'""o"
View
lnndflcnplng
!!:'!"l
.!lI>lcel 01 ""'"
R~...
~Jt:i'!lJ!I.
~~
!._ 01 ""'"
o No.onIno
I
I
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a:
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(3
Q
Off-elte Type Publlo Private
10000rovement. Dllv'"., SUlf,c, Stq:e
Eloctrlclly liJ 00 Service Strnt A1f~lt 0 ""ptl.nl hum,nl. Stmbrd Utility ~~:lt.9
G., @ Curb/Gutler Cacrete 0
W.,., Sld.w.lk tm:retl FEMA Sp.cl.1 Flood U.,.rd A,.. 0 Vo. !Xl No
Senllery Sewer Street 1I0ht! ttre FEMA Zone C Mnp DRIft !1J5~
SID' SewI AliI Itre F A OQ No. 4<lIl5\1J 1m!
Commlnt'!'rPlront let.".. .".,.,...t.. tnCIOICtwn,nt.. IPler.. ...,"m'nt.. ,ud. "....lIItO" Of ItO" nonconfllmltlQ lO....na.Ut.. 'te.h ~ ere ro ~ (It 1IM!rse_~~_a'_
uu...d..ult5. The Ilhltet cbes rot!m!!!' '0 II. In e f9l\ ""'''nrtm flood !I:r1!. The so.hl<r:t ",htlxslu:d will ,..." D,bIlc IIlter IMlltrtle 'f'!lY ~._1l!e_
..In IIller II..... In the AI"""A .... In 1lCl!.
GENERAL DESCRIPTION EXTERIOR DESCRIPTION FOUNDATION
No. of Unh. Foundation ex: at Shlb
No. of Storln 5 ExtllrlDr Well. Allin & fnmL e'l' wi Splice ..,
TW.IO.t.'Atl.l ncIxxl Roof Surtec. .Qlm. 9l11'll1. el,'.m.nt III
Oulon IStvfe) .S St Ou"'" .. O........pl. e!I Sump rump Jb
hltlirQlf'loPOHd Exlsttrn Window Type Da..ble ~ Oerrlpn...
Age lYre,} StDrm/Screene Y e!J Selllement tb-ce
(II.cll." . II, 10-3) M."uflclI...d If0u6Ub In rest III Ion cb-ce
00 .-l.lYin 1...Kl Flmilv Rm. R.o, Rm, ll91f=' ..!JlJl.1h!_ _LM!!l!llY_
Buement 1
~~1 1
~~2 Z
Ulffilhtl
Public
Other
BASEMENT
Auu!I Sq. Ft.
% Flnl.hed
Ceiling
Well.
Floor
Outsldo Entry
INSULATION
nonf
Cf'llIIng
Wnlls
FIDor
None
Unlno......
o
A""!)UO__ liJ
~""'-""'-- [!]
&!1 0
o
o
ImJlBtrd UIrtb8
Olho, )\1!!n.J;q,E!.
1!'4.
--.-&'~
.--.2ill_
8\4
m
JoI"
~...D'
C<rcret.
Y..
Finished 8,e8 Bbove rede conteln.: 7 Room,' 3 Bedroom,' 2 Beth,' 1 J7Z S UOIO Foot 01 Gran lIvin ^'M
INTERIOR .."..I.I.It....'''.. HEATING KITCHEN EOUIP. AlllC AMENITIES CAR STORAGE
Floo,s J!Ml1! & VIMfA'<I TWI lJL.."J.Jro!! R.frlg.rltor ~ None FII.pl.c.I., , ~o- 0 Non. rJ
W"Us~" FuM.91l nenOft/Oven ~ Slrd" Patio .~~'t~t~J:I!t~_lXJ Gnlnu" , 01 c.'.
Trlrn/Flnl!lh \bxf Pelnt~ ondlllOl'l ~ 01'110,,11 O,op Slelr DIck '!1J.A 0 AI......." !V~_
eeth Floor ~,& VIMf.l'oq COOLING DI.hwI.hlr ScuW. Po,ch .?~~ rrtJ.!1'_ [!J 0...,... Ll:lr_
!lllhW.lnleOI Il~tmsl~ Central .tp FenlHood Floor Fftncft tv" __+_ __ _ ._ _ 0 "..', I" -'V"__
000111 ~ Polnt~ Olher ~ Microwl!lve Hul"d Pool.!VA 0 empofl WA_
COndltlOfl A We. he, r e' Flnl.hed Otlvown 2.4
,Adlill[OfIt1I..hn.l.pecltl INIO' ,lnel,ntI1''''I. 'le.l:!effnt~....Mtd.9l ~frrts...l-~~..J'!W-LrwJ~ta:t~t~._1UdJrn gl.rrn_~_~qm_t_o_~ cd p1t!!J,_
Ill. IIllk-ln clooets m ~ IIcxr. t1J1IIdlller en~. eltetrlc \!IN hrsID'!'dP!1.LI'IIl'1.JI'!'Cl:c;.IJ.-dJl''''m:>tJBrdy ",(11,_
C"'dlll.... ,I ,htIrnpt..."'.nt'. dlOf.tl.llOl1lphy.rc", '1Nlton", Ilf'd "ltI...". "p"" nMd~, 4utlllYlf fO,"I'UC:llo". ,.",Ofl.r'"ll'tdtllllorw, ,Ic: ~~RiJJt;CJJU!L~ mtJLtllJl_
I... so.h 0 cxr It'd ... 0101111... Il:l eovIcl;tp! 01 fln:1I1J!l~_"""'"l!L~ll!'<tJ~_Wl'I_
did rot cr",l<p' Inlonmtlm tml IrdlroJ.rd 1Jx...l''-U~ '!!J'lli<>:rL-
121"...."13
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UNIFORM RESIDENTIAL APPRAISAL REPORT
rn. 110. WJ1l17'J
, .~;j
. '-<'/1
,~~;l;
;,\
'~N fA liMA TED BITE VALUE. . . , . . . . . . . . . . . . . . , , . . .. . . "'.WJ CUIHI1I1""_ nn COlt Al'fllnnr.h 'tueh ftt Intlle" of cn.'
~'i ESTIMATED nErnOOUCTlON emU.NEW OF IMrnOVEMEN15: ...lhuIlIJl. ..II. "..111ft, l'1un1ft 'nnt r.nklltnllnll "Hd III' HlJO.
.~. OWfllllng tJ1Z. Sq. n. (D . 49.00. - . ___t8.'->>. VA. "lid rlllll^. "u, nlllllll'flll,nlllnlllll1U flCOIlO!tllr.lll.. of
JHJn..DiI1t- ~. Sq. Fl. O. 9.U. - 7.7'JIJ I". !'.nl...lv" _... .. _. m...."'" .....
"PlI""',JWJlI.l~ - ~ll. .11" "',I~\I.& ~If. Iknlo..,.... ,rm,." ftl.ld In... _._
O.'.OolCo'po,1 ~. Sq. Fl. 0 . l6.zt - IO.m "",'~IIII U"I'~II\II",h U\Hhlrll 'A""'Vl''<I~lIly. "1'1_..
Tnl.1 Eollm","d COI' N.w ................. - . 9MIl ..11..1,,1.1" \0\1..""," I",J JI""...hl.<lJIRIllO....lfIU1I_
~ D.procl.lIon Zl,~ In 0 . . Zl.y,z .__.t>1!ml\1Il R...lnlrU [rollmc llf..I.)5I....,._
D.p,.cl.l.d V.lu. 01 Improvom.n.. . . . . . . . . . . . . . . . ... . 7IJ,Ufl ____ [.'1 Irm.lIl RamlnllU "1)'Ilcnlll r. ,. /IJ 1"...._
"A,-I," Villus of SUelmprovenuU111 ...........,...... t ______~~ ..___ .,___ __ ___._ .__ _ ______
INDICA lED VALU< OY COST APpnOACII . . . . . . . .. . t 95 'HI s..., 0.. .1I"tnt .~.lrh fa CIA 'nl"~..I,,..
ITEM I SUOJECT COMPARABLE NO I COMPAnABlE NO.2 COMPAnABlE flO. 3
.... IIJJ Il<>,<r Slroet 113l1.llJllDl Rml IJl D.nlnlml Rml 31S I,. Slim
" ....,_9.lnnnl1'. I!Plt &1>1. !lJnltofml.
:.' P,..,:,,~.. ..~.~ .",,",\>", ,_.' ,;;, M'" I , 1'''''1.. 2 Blocl:o
Ii ff4=~ ~,~.. "~;,"::~f:"''''''''':~;;.~. .i:,~~~. .,
t? v..... -- '''UMtlJn . hr.Cl\!prlON hU.r"AlprlnN .'.11 AdMtmtnt I'\rSCRIPtlON !.ut.M1~~t -p!SC",""0..!!.-. ..!...1Jtffll~
.> '. r..r..., rlrl-'nl ~;.Qi<':i~~A{;:\).: OrMntlctnl O::rMrItlcml nlo\
Fr.. Conu"I_Jm't].,.:t};1~;~,P::\;:'_..; Prlwtf SlIte I ,., h 0 lot f:6 D.O.P-!.
\; I "IttoIS.r.fTlmt t~:;'.~:-j:',:;':?;-.:,':;' ,.~ ..... ~ ~
:/ .ill!"-:;:;::' !Uubn "":"!Uubn 9#J.lm
i: .ill""''''''' Slm~ -;::;'!!PI. 1!!l!..ilI1J1!. ~np!. roo SI!lP!.
S". .34 kros .00 kros -am Jl"ros .30 t,c...
" VIo~ A~ It_ A~
L. ~~. ' . 1.5 $1",,1_ I , · ..~I!ftmm 2 SI!'Y/!\~
.' 0""0.1 c-,,'_' 0.:::0 r AlunI!Y!l'A-.""Il'L.- I ...... & AI""'A~ .~ M"",!Y'l'.~""!:!rn
A,. .. 15 -15(1) 56 n
c.nd,"," A~i A'f!!OOIJ T ^"-"tUO
1Il ::::.::: .~"~ It'.m'T :".. ;"~ 1:"m'T:"" "IXn~tm!.I~'~"- f'!''-Ij-;':''''I~''~'~ ---. .,1Xn
~ 0...."., Iv" · Tn .. r. 1 312 ... It. 1.9<l\ ... It. .5500 J.~ !>Lll
Z .",m.... ,,"'''''' FlAl bmmmt FlAI B.T.01tJ1t rullilmoTmt rull R.'Y>1m1\
cl; Room. ..,... 0.", 'hllnl""" I '1I111lv Ram '15O! Urllnl!l"!'l
Z . .
o r~llon.ruml- A~ I .a,_ _A~
lQ HuU-/Co-"-" II'I'Ul.Ala-e ~
; ,.." 'm"-II"". '...'81odul......... Slmll... ' Slmll... Slmllor
~ .l!.!<....-. .. ,...... """1m · .....llPt.mxl .,,,,,11mo +ZiaJ .1!Tr
8 P~'h.'."..O".. rxNl'ollo&lJI'<:n!1oo qmrnrrol'<nh +am qmFnmrJ'mhcs .11Xn qxJ,r"""J'mhcs
. ..-~.-.............. ~ I u.... tm!
!II r.n<' ..~ ... ~.. SI....l... -:, r..:il.r Slmtlor
.~ 1"'1" ......... ,.'o.lvo. . . ..,. _~..Kf1mm
~ I ....\0iili!C~/;J.'/,,\*', 'r.! + -IT- " U'M n. J.I_ .< 500 '-f;j' . n_ . 4,5!JL
t' ..."",.. S"" ..,.. +'li~,\ljt~1')!i'i'~Wf!'~' illrujii'1)hF;' ".:.....".;. I:' 1m" ~.~~.~RM'.,L~;'...~."';f.i;;A,...i!i!";?..~...... /IT cm nUtJ,~~i"~.L.Z," 5..2~' I 91.500
.1 c-,..... .~*~,,9~~'}j.i/:r:"'(:1.:.rrt>:'~,~:r,,7~:~m}'~,..I:~~ . . ,- . . .
..... \:"'~':"';:>'v. ~~;>2 :-;~,;::'-;..;::';]: : ~ n;:A'l:. ,-{i 6-ft ~..
. <-,. el"""".ntl "" h'e. Com,...IIM llndurtlng tht .ubjut proptth', c_p.llblfl"t"ht ".lo""hd14, "..Ito!. The c:hcrIDtlm IrdubJ I cPltlr ~M!r!mt ~-1(Cts_~_
"> mrlet l'Olrtlm to tf-oob It... 01 .,..>llIcmt _1.llm I:etIlm \he ablect .rd cain!i-rIoIe ttUlertl... All ..I.. .... C.\mL!.l'!!:r"!'!Ll!:!'~!LtglJT<.Ibl~_
'i .... arslclrnllr/i!rm! IrdlCBtcnl 01 wlu. mlln ..,ItI1tul o:JJlllv In Ihe ffml'hiatr:lll.tlm. D..e to \he lImltul r\!l!J>r of ncn! tumt mj~hml~
,. ___rble t,,",Ion In Ihe ""'JllCt reliLQ;"'m:l~.. ~cl:t..tIDlo_I!:!I.JJ"!Lf[!J"Uj)IJ1!II1fJJ!JtbJl._I~._Ih<LlXllJ1YrI~.._
, _l.I1!!l.'" I:rll.....ullo ~tho 1:rs.l.[r,!l!!r;t>l..Jr<m.ll _ IrclLdJmJ!!o mAtHl,t lll'IVl",. STEIl..!=.ts 1!:!I_~_th:1r,p_~.
. /..1
"1
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OUOJ<CT
110 Pritt'
Sol.. lIoIul
..... "'" Rcard;
COMP'n'n....O ,
110 Pritt'
SlII.. lIoIul
~
COMPARABLE NO.2
110 Pritt'
Soho 1IoI1Il
1.....""'RlXUd;
l;.()MPAnA!!I.E NQ~3_
110 Pritt'
SlII.. 1Io.1Il
~ Rcard;
01", r.lct end 011'
SO"'UIOfplIOfUIH
Wlthlf'l\<lIf o'IJIPu,..r
<,
.-."".,11, 01 tn., CUllnt lO"tmtnt or ..r.. opllon, or ""Ino 01 1M '\lbflcl PHIl"'" t'" tnll.,.I. 01 tn, pllllf ..... of .ubl.ct Ind temp".bl.. wllNn OM yu' 01 !hoe dllt 0' 'PIl'liU"
Tho ablo::t I. mllUTlJ1tlv um- cmtrnol Itt' "'.L-tho [.,tal. 01 flhl ""'"' I. """'1m tho nrrmt ....~et Wll>!.
.
.'
INDICATED VALUE OY SALES COMPARISON APpnOACl1. . . . . .. I . .. , . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . .. 9 ncm
INDICATED vALUE OVINCOME ArpnDACIl -I '..""...' ''''m..........'.... . Ull ~... 0.... R..."'"" Ii.. N/A = 9 N/A
...~ ,... I"","..l" mid. -m....I... Ultll.ct t,lt. flpalll, tlllI.II_, nf)f:tloot ~ e~lI~ Il,ttd blre.. U 'lkI.ello (&",,,I_lIon ll.' p.... lOll Iflle"'ttl'IlI".
C....'''_.I ..".." . The ahlllCt I, m:relso:lln II'. oreomt cxnlltl!!J, ~ tho etlocho:l Stot01tf1t oIllmltlm Caditllm ..dtt.JltH'I~=tn!!!."L-.
'." ~rl.Jnltt'alJlt"J1l1 txnnmll. : ..... (
.;. '~"n,,~,m..,""Thetmri<l!t """""" t. \he ~~ mltho CJ!!...llr 1Il!!h tho_nn;!~UdJ!lLd1t.J'__
:I! OMII'..... .... ~~.i:'.-h.l! Irdlcotodl1i tho ntn:et 1<D'OlIC!1. tho Ircme rumrlt I. rot !W.llcffi!.L~.JL'Ll)piCO.lPIJ!'T~-1?_
~ "'" Int....todln t!lIIlII'fr1ltt.. \he ~.'re tIm ~ II """ nM .....! ..
. 1N ""ft, tf t.... tppu1ul\t tlt.lImlt.,.,. m"ht ..,.... .1 thl ,ut pl'llplftr thtt It.... t....tlltd.f tH, hllOlt, ",..d on ,,,- .bo.. Comillone tnlt It. CIII"llintlon. CD"11"O.", ..od ~m'I!"
'''''1I''''. "mil"" .,.h,1I dtllrillon thlt III Ihttel In I'" ,".cked r,tddlt Mle rOl," "'l/ft,."lt M.. h,," 100n Inhllld m 1!2!- I
..- . \
'~~b~ie THE MAnKET VALUE. AS DErlNED. OF TIlE ~E^L pnOPEnTY TlIAT IS TltE SUI1JECT OF TIllS nEPOnr. M OF
~ · c ":"' "'. .lWHICltlS T DATE OF INsrecT1DN AND THE ~FFECTlVE DATE OF TIllS nEPOnn TO BE . ,\9,cm
.- .,' ,', . ~'o' ~.o.ttArMNsmloNLYlrA(aUlnrDI
.... . .......Ii"iIoNtJ4r.Ji~ .
I:.'.t).~ ~ I. "t,f:~t...4J~k~klA ut..r...
.. '.:D,"~~ NlA
........ /"'f';''''~iMfA
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OOld DOIdHel
tnlp.ClrUj)tlly
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Slltt N/A
_II'. "'/A
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~Ir....'" J " ,............ hlll'l'I 1004 . U
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'1V.1~1111. 11"1
ESTATE OF
ITEM
NUMBER
A.
1.
a.
B.
A.
C.
1.
2.
3.
A.
S.
6.
7.
8.
Please Print or T~pe
FILE NUMBER
;)1-1(, -6-"c.lL-
~.'~}(\
-w...
COMMONWEAltH 0' PENNsnVANIA
tNHERITANC[ tA" R[TURN
RESIDENT D[C(D(Nt
SCHEDULE H
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES
~'\~S I (V\O-f>6-
-
c.
DESCRIPTION
-
,3.
Fun.ral Exp.nses:
(<\<..\\...~.~.,;<.) \ ~ h....C~()'- ,.....,,"'-c
(,,('~I>,J)J.c.~ ~""&.tll'- r.~
- ~- "
Qt!.~"-') 0<VLLrr
1.
n .-
1"-: f"'::'::{l .-\ V \\" '4\...t\- ...)
1"i1- 4(,- 7 17L'
Personal Representative Commissions (J.(.. "y l-< ,{ ( ,-, -Lc.::.,oL
Social Security Number of Personol Reprosentative: IJ-{ - .)i/ - ,) <Iv",!
~ CG Cot J r
Year Commissians~aid 1" , t- (,.I\~,~ \j ITV(\~Wu?"
2.
3.
Family Exemption f
Claimant ~,_ M'jc it )
Relationship
~J~
Addrell of Cloimant at decedent', death
Street Addrell ~, e..."f-il '1~
City :S_,^,-lM'C..{L{) ~ State (),\. Zip Code 11 ~ B
Probate Fees
Miscellaneous Expenses:
001ltl\rr NC-...J,)
~ -;:j'<.>...rt.t.lilL-
- L (.(l\II':"
",",';':iv.
" LCC'jO-L
n<uJ
''Mo.. c.!.il
V, .
R::~1..""-"'~L\:.
n
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Gn..)~
j.ll(C'(U) I ~Ol..
G.KXu..~ (h.:s\1>ClS Pr6"r,t"1>IlL' 7, 0'11 - "f/",.,R.l" ,~ i!u
u-;n'i~ CV'-'1C'-1tS (,\~",,-;>uJ ~O> / c..,.,',,(,oJ\Yli:: M Ijl~L\"ll &
(l.z,~ ~L ..h.. ~\ H''>..'L G-J (~.f\<-.. 'i<1; /".,Jx.."d
\L.I"-l\::\ lL- 'D. 5~ CS) /\- 0't),,'<t<'. -tNC5
f'()~\'> &-fL."':":> J u -c-,((;.. c.o;?('" -61.A__C ill.-f.
TOTAL (Also enter on line 9, Recapitulation)
III mar. space Is needed, Insert additional sheets 01 same slz..)
AMOUNT
~(, 71..(., , 66
I 335': O\J
~, n~_
42.. ~7
((3+ ,4q
4'$4 . "1
{o"" P,ol..
I
8(.8 /l e, \'VJ""L
3 S6Z> ' ~'O
.
1", cJtJ
(.,3,. ~u
{,o. OZl
.;)0". 60
5fJ . 071
"3 5: <m
.;1,::;'-
_~,-a t'b
.)/11 ;~ 41
5 I~ .
.1+
d/t6o. 711akL11(~
WORKSHEET
(THIS IS NOT A CONTRACT)
./J. SERVICEfa~t;:?/};~~~o 7-.9~/~"',:,.
r;<'~4ASKET /3p.:Ji{;i;~~;,rk.,r~~o .1~I~C::;:Z
t;,recTtllc..VAUL T Cb~fe.o ~ P. ~P.f,IQ~o .t.We~. 0 ~r oJe.d... 0.0..00000
FLOWERS 0.0 0 . . 0 0 000 000 .. 0 . 0 0 0 0 0 000 0 . 0 000 0 . 0 0 0 0 0 0 0 0 . 0 0 0 0 0 . 0 0 0 0 0 . 0 0 0 0 . . 0 0 . 0 0
OTHER MERCHANDISE 0 0 000 0 0 0 0 0 0 . 0 . 0 0 ..0.0 0 0 0 . 0 0 0 0 0 . 0 0 0 0 0 0 . 0 . 0 0 0 . 0 . 0 0 . 0 0 . 0
CASH ADVANCES .00.000000000.0...00.. 0 0 0 0.0.0000..0.000. 0 0 0 0 000.00.000000 .f.
f>1f~; ~
b"{,(J. qg
TOT AL
'tOO I. ~
~eathC~~I~IC~~~ ~~~iJ.~o~~( -1.J.~~).~~~olo~o~o~~~: ~~~ o~~ST F~':lJ.Noo
Obituary Nolices ($5010 $200 per day) ... 0 ..0. . 0 . .. .. .. 0 ... . 0 . 0 ..0... 0 . . 0 ... . 0
(./ Clergy Honorarium ($SO to $500) .J<Jm-drtfM(e.. ,(1~r.@ . o&~~r.: .,. StJ. ~
Organlsl ($50 10 $150. taped music no charge) .@./!.f?'!!!'.1.:'!: .'<!:"!.1.~).
Soloist ($50 10 $150, taped music no charge) ..................................
Church Custodian ($25 10 $100) .........00.0.0.0.................. 0..........
Airline Frelghl Charges on Ship Oul
Easl Coast ($300 to $500) 0.0..0....0.... 0........ 0... 0.0. 0..... 0.........
Midwest ($500 to $650) .... 0 . . . . . . .. ...0. .. . 0 . . . . .. .. 0 .. .. . . . . .. 0 . 0 . . .. . .
Western Area ($600 to $eOO) .0.. . 0 . 0 . ...0. . 0 . 0 . .. 0 .. . .. . . . . . . . . 0 .. . 0 . . .. ..
Cost 01 Grave ($600 to $1.200) .00..... 0 .~... ......... ..~....... ..I........ .
(...00""( ..,g / /7/1. o.tJ
Opening and Closing a Grave ($350 to $80 0 . . . . . . . 0 o. 0 . Z' . 0 . '/1 I- (JlV!L.
Mausoleum Openings and Closings ($250 to $500) .....00.... 0 00 0 ./4
Memorial Marker ($400 to $800) 0...00... 0.0.0. ..0. . 0 ... .. . . . . 0 . 0 0 ..0. . . 0 0 . . . .
Double Memorial Marker - add dale ($50 10 $150) ....................... 0 .. 0 .. .
Memorial Marker Selling Fee (foundalion $150 to $300) 0.. o. 0... 0..00.00000..0.
~::~:~~YE~~:~~ee~; ~o;~~;"~;c'o o(~.~~ ;~.~~~~; 0:::;:::::: :: ;;;: :;~~: :: d ~
(,.../"tasket Flower Spray ($150 to $500) ...... ~/f. oW. 0 o..~ r...~. me~
c.c.11,,;::l~, 1 V8tJIt Ilolldl;Il\:l Glldlyes \~~U to ~~UVI ........ Se~~........... 'In
Oul of Town Funeral Director Charges --- 'flt.S ...
(Depending on desired services ($50010 $3.000) ..0.. 0 0 0..0..0.0.00..0.0...
TOTAL '174(;,. '?E
fJ2d~ filUrf~ //1(,'{, oJ 1. 199.2
~ . fJ r::yt' 0".
.
( ; R !\ 'N D V II'~ \V
III IX."I" ~'lll1'" \IT III II '.11" I I
,\"''''\'1111".1' \ I ..,,:
r\lFtlIORI^L
1':\ltK
"hl1ll'- 11111 'Of. ~ I.. I I
........
March 20, 1996
i
\
\
'.
Current velue af 2 plots in the Garden of Devotion......Lot 119-8 - Spaces 1 & 2.
$1,ODO
~
---~-"'.
. -,---
Single b~onze installed on granite - with a vase..................
2 matching single bronze markers installed an granite - with 1 vase..$1,715.00
-+._----
// 'J~ )
/'Jt/./'.~{,..~>?o l'J~e1"'A./
'l-1~r"""'.,,,.r",,~,(J (~((..,,~(A1/
. .
Proof of Publication of Notite in The Po 0
and The Sunday Patriot-News" ",
UDder .-\ct No. U,", I\rprouod ~I.)' 1ft. 1D'20.
Commonwealth of penns/llvania,} .
COlmtl1 of Dal/phin .....
............................!1~.c;,b.!!."':l...!:!~.r..J;.~.\;o:...........................bein~ duly sworn according to law, deposes and says:
Asst. Controller
That he is the ............................of THE PATRIOT - KEWS CO., a corporation organized and existing
under the laws of the Commonwealth of Penns)'lvania, with its principal office and place of business at
812 to 818 Market Street, in the City of Harri.burg, Count). of Dauphin. State of Pennsylvania, owner
and publisher of THE PATRIOT and THE EVENING NEWS and the SUNDAY PATRIOT-NEWS
newspapers of general circulation. printed and published at 812 to 818 Market Street, in the City,
County and State aforesaid; that THE PATRIOT and THE EVENING NEWS and the SUNDAY
PATRIOT - NEWS were established March 4th, 1854, and February 15th, 1917 and September 18th,
1949, respectively, and all have been continuously published ever since;
That the printed notice or publication which is securely attached hereto is exactly as printed and
Hetro \'1est
bl' h d' th' I Id't' d' h' h d th 9th, 16th, and 23rd
pu IS e III elr regu ar I!, I Ions an Issues w IC appeare on e..........................................................
days of April 1996.
........................................................................................................................................................................................
That neither he nor said Compan)' is interested in the subject matter of said printed notice or adver-
tising, and that aU of the allegations of this statement as to the time, place and character of publication
are true: and
That he has personal knowledge of the facts aforesaid n is duly authorized and empowered to
verify this statement on behalf of The Patriot-News Co. a 0 sai by virtue and pursuant to a resolu-
tion unanimously passed and adopted severally by the st k 01 rs an . board of directors of the said
Company and subsequently duly re.:orded in the office for th ing D in and for said County
of Dauphin in Mi..,ell.neous Book "M". Volume 14. Po~e 317. ~
Copy of Notice or Publication I
........... ...... .... ...............
fo 9'~-2.4.l:.h....day of
...~P.1:il Nal;~~ ..~.. ..........,:.-.~
Tony L. Aul<Sell, N6ia,y Public Notnry Public
Harrisbu'jl. OoUP"," Counly
~lC&mnilll!lloli~d08e.~...\~J:a.. ..............................
~iatementc;r4avertising Costs
_..
LEnERS OF TESTAMENTARY on the e..
tll't.ofMobttE.M.,.rs.lcmofSurnrntrdCl~. East
P~nsboro TOWNhID. CUmberland County,~"..
.YIYOr'IIa. hove bttn luutd. All Dff'IOn knowing
thtmselV't'S to be Indebted to sold .stem ore r..
QUe"1d to maltllmmedlaft PClYmtnl, and ttIOM
hewing ckllrns will PfeMnI them wtrtJovt dlkrt for
.."letnItItto: .
RobertM""C1nd Ittty Krllfl....COO...arton
P,O. 10. 11
Summwda!e, PA t70fJ
<<to:
Donald .. ow.n. 1M.
Counstlor AI Low
1115 MI. View Dr.
Enokl. PA 17t1J.1SU
DQna~d..B_...Ow.en....Co.ur.s.e.l.o.t:::At::.La"'......
Eno 1.<I........J?1I.........l.7.Q.25.............................................
To THE PATRIOT-NEWS CO., Dr.
For publishing the notice or publication attached hereto on the
above stated dates - $.......Ji.6.d.9........
P b t. $ 1. 00
ro a Illg same ............................
63.40
Total $............................
Publisher's Receipt for Advertising Costs
THE PATRIOT-NEWS CO., lJub1isher of THE PATRIOT and THE EVENING NEWS and the
SUNDAY PATRIOT-NEWS, newspapers of general circulation, hereby ackno\\'led~e receipt of the
aforesaid notice and publication costs and certifies that the same have been dul)' paid.
THE PATRIOT-NEWS CO.
a" '.
'il .
By.....................................................................................
ClIMBERLAND LA\\' .JOlIRNAL
2 LIBElrry A VENlIE
CARLISLE, PA 17013
APRil. 11) 11)l)6
Cumberland La\\' Journal is published every Friday by the Cumberland County Bar
Associalion and is designated by the Coun of Common Pleas as Ihe omt'iallegal publication for
Cumberland County and the legal newspaper for puhlication of legal notices.
TO: Donald B. Owen. ESQUIRE
RE: Mabel E. Myers. ESTATE
Legal advertisements must be received by Monday Noon. All legal advertising must be
paid in advance. Make all checks payable to: Cumberland Law Journal.
Advertisement inserted on following dates:
APRIL 5.12,19,1996
Second Proof Requesl
$ 60.00
$ 0.00
$ 0.00
$ 0.00
..--........----....
$ 60.00
Advertising Cost
Proof of Publication
Payment received
Total Amount Due
Payment received
by
fr-'l:
Performance Appraisal
BOB Division Street, P.O. Box 284 FILE NUMBER
Grantham, PA 17027
6C092270
I
To: N
Attention: Ellen Owen V
Donald B. Owen, Esq. 0
105 Mt. View Drive I
Enola, PA 17025 C
E
1mioIc. Approise! Apptoloor ClIent ca. Nu...... Approi.oI Olflce roll 10 Numb.. Apptol.oI Office
Del. Date Phone Numb.r .
03/29/96 03/25/96 LRB Myers 25.1707421 (717)691.5549
1<
1 Purchaser/Borrower Estate of Mabel E. MYers
.Z Property Address 4DO Bover street Unil
~2 -
o:~ City Summerdale Subdivision N/A
ll!~ Counly Cumberland Stole PA Zip l7D93
00: legal Descriplion Deed Boak 35 Volume R & paae 0410
0:0
.....
>3:
.,
Man Reference
...
,.. Appraisal Fee Amount . . . . . . . . . . . . . .. . . . . . . . .. . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 20D.DO
~z Meil or Hendling Fee. . . . . . . $
.0 AddiliDnal Charges 1 . .. $
w!= . ..
';1!C Addilional Charges 2 .. . . . . $
02
;:00: Additional Charges 3 .. . . . . $
ZO
-... Sales Tu . . . . . . . . . . . . . . . . .., . . . . . . .. . . .. . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . $
;!;
.
..'...' Thanl< you for your business I Total Amount of Invoice S 200.0D
.<
INVOICE
Please detach and include the bottom ponion with your payment. . . Thank you I
~
SEPJ>>ml'1l 18,1996
DEAR DON,
&JB.JH:T: REF. ESTATE AIHINIsmATOR <XlST JUNE 16, 1996
LIS'IED l\EWJ ADDFD ESTATE OO-EXEI:U'l'OR I AOONISIRAIOR <XlST (ORG. I'IE!I~)
4.) rm<<ZATICIi OF ESTATE 'IELEPIIlNE CAILS (P~ 1 OF 12) WAS $662.96
SEE ADDFD PAGES 13 OF 15 * ADDFD <XlST IS $442.71
5.) POSTAL SFBVIGES, alPIES,FAX SFBVIGES AND lI>TARY FEE
(PAGES 1 OF 14) WAS $172.30
SEE ADDID PAGES 15 OF 20 * ADDFD <XlST IS $56;62
7.) MEAIS AND TIPS
PAGES 1 OF 4 WAS $193.46
SEE ADDrn PAGES 5 OF 6 * ADDFD <XlST IS $18.76
ro.rAL EXPmSES ADDFD IS $518.09
___'__~------------.;o.
ORG. ro.rAL BAL. OF.mnNIS'IRATOR EXPmSES IlJE WAS $1,597~
AS OF SEP'II'MIlm 18, 1996 ro.rAL BAL OF AI:HINIS'l1lA1U EXPmSI'S IlJE
$1,105.67
228.92
212.22
C0;~~~;~)
\. \qk \'iu\-e:. -~- ~/\ 5 ::'1 s.\~l't-
\~ ~~. -m -nd \,) -t"L~. (0-1.-1 U\.Jd'r- I (Lo-k.eL
'C\ cw\.. ~'- 0"':> ~p c....J\u~ - '5~ ,J
~ -\-' S, hUJ~ \M-o.'J~.l,- c.l +k..- AI..( ~ .
---rk ~~. -n \::x... vd 'v..l t-- <G.l~~~
w--- S" '-"-'. Iv \ o<.5.,YL fL-~ SIJO]lELY
~~
W\...L VeN /"
OX~ -.., --~~ ~J BElTl. KRtau.rK
~ ~ ~ cl.\ff.~d-r ~.k -\1:> -QM We-
-- d ~_.. ~--rLL
\)e. <=.. ., >'2. J o.-le:! L\ -ht...!>6 ~...5).JS -
O\...>e. ~ o"\"" l-J ~ es c() - -O{..e c..ul--wL. (~v~, ~
ele ROBFBT K. ~ "M..d~ \. WII"> h-J ,oJ /\ ...~ v..w';f .
@ ~ '^'-'L ~ ~ t;r>-r~ fl; I}- .3
C () _ ouA-C-l(. ~ .J \"H. ~~ l+-- -N> . d.I-r-:- ~
\~> ~ Rv'tw;t- e../~ ~ cd- v..a ~~ \;;Sl
. I
JUNE 16, 1996
PAGE 1 OF 2
DFAR DON,
5llBJEX;r: ESTATE OO-EXm11'OR I AIENIsmATOR COST
1.) HE1ITZ RFNI-A-cAR $1,147.00
ORG. COST WAS FROM 3/13 'DIRU 4/"!AJ/96 $2,122.00, I 1URNED
IHE CAR IN EARLY & WAI..KED AND oor A RIDE. SAVED $975.00
2.) UNI'lE> .AIRLINES FARE $ 777 .00
ORG. COST WAS $1,600.00, I TOOK THE RED EYE FLIGHT AND THE
DR. AND HOSPITAL TO VNUFY IHE DEADI OF MY SIS'lE{ SAVED A
TOTAL OF $823.00.
3.) HOTEL, ~ INN $ 119.88
IXJE TO FllEDS VIST, BFX:AUSE OF MY REAL'IlI AND ON GOING HEATED
ARGUMml'S AT 400 00Ym smEE:I, CAlJSING MY BlOOD PRFSSURE TO
GO UP TO 220/100. SPFm 1W NIGIII'S AT THE HOTEL. AND mm I
HAD TO GO STAY wr.m MY 0'IlIm !@! NEl'IIDl IN l'IDLA. (ROBEIIT)
4.) J'IEMIZATION OF ESTATE TELEPHONE CALLS $ 662.96 +
SEE PAGE 11 OF FOR TELEPHONE CALLS ORG. COST WAS $762.96
CHEX:K ro. 125 FOR $100.00 P"RTIAL PAYHEm PAID BY THE ESTATE.
5.) POSTAL SERVICES, COPIES AND FAX SERVICES $ 172.30 +
ORG. COST WAS $223.21 A TOTAL OF $20.54 C/N 0008, C/Nl30 $13.93
AND C/N 131 $16.41 A TOTAL OF $50.91 PARTIAL PAYHEm WAS PAID BY
IHE ESTATE SEE PAGE 14
6.) MISC. STATIONERY, OOOKS, PLANNER, lOCK, POR:IFOLIO, 1W l'llONFS $ 373.17
(REF. 2 l'HONFS ROBIN AND DEBORAH wmr BALLISIIC OVER THE ORG.
l'WNE,:nUd.fAID IHE PHONE BILL, I HAD ~ FROM nIaI 3 X
A COPY OF IHE BILL. I NEVER SAID I \lJUIl) IDT PAID FOR MY-PHONE
CALLS. I AJ.S:) PAID FOR CALLS HADE BEFOR I oor TO 400 00Ym STREIIT
IHE CALLS WHrnE HADE ON MARCH 10 & 11 MY FLIGHT oor IN ON MARCH 13th)
PADS, PENS, TAPE AND ENEVELDPES.
7.) MEAlS AND TIPS
8.) MISC. GR<:x:mIES (FOOD) AND WATF1l. FROM MARCil 31 'IlIRU APR.ll. 24th
9.) BILL') PAID IN FULL FOR MABEL E. MYrnS
PP & L CHEX:K ro. 2956 $61.47 6/7/1995
ALISrATE. ~ INS. CHEX:K ro. 2955 6/7/1995
MEDICAL SUPPLIES CHEX:K ro. 5371 $43.11 3/29/1995
MEDICAL SUPPLY CHEX:K ro. 5400 $22.00 4/17/1995
HFC (FINAL PAYHEm) CHEX:K ro. 3085 $20.00 (SEE ATIACHED CONIRACT)
IDTE'lHIS DOESN'T m::L 3 KlN'DJS OF 24 HR. CARE AND DOUBLE EXPmsES
roR WHAT ROBERT HAS PAID. WE AJ.S:) HELPED TO PAY FOR HER AIR FARE
TO RElURN IDlE.
10.) SEE PAGE 2 OF 2 FOR TOTAL AND ADDITIONAL EX:PrnSE.
$ 193.46 +
$ 342.03
$ 309.58 +
PAGE 2 OF 2
REF. PAGE 1 'lUIAL ElCPmSES FOR AlENIS'lRATOR rosT
u:ss PARnAL PAYKmI FOR REINIlORSKfNI OF rosT FOR
EKEX:Ul'OR AOONISTRA1'OR ElCPmSES, cmx:K Kl. 0007,
PAID BY THE ES'IATE OF HABEL E. HYERS.
'lUIAL BAL. OF AOONISTRA1'OR ~ OOE
$4 .097.40 +
-$2,500.00
TOTAL
$1,597.40 +
PAID DEOORAH KEIsm AND (ROBIN D. MYERS)
'IRAVELERS ~ES Kl. HB390-922-041 $50.00 (TO PAY FOR A BILL)
-045 $50.00 (FOR sroRAGE RmIAL)
-046 $50.00 (FOR STORAGE RmIAL)
$ 150.00
MEDICAL OOST FOR DR. OFFICE VISI, VALIUM AND vmAPAKIL OOE TO
ALL THE smESS 'Dm 001lI PUT HE mRU FROM MARCH 13, 1996 mRU
HARCH 30. 1996 AND STILL ON GOIN;I
FOSTAL ElCPmSES PAID BY ROBFlIT K. MYERS IS UNKKlW KI mE TIME.
$ 195.40 +
KlTE: REF. rI:aI Kl. 1.) AND Kl. 2.) ON PAGE 1 OF 1 TOTAL OF
SAvm;5 WAS $1,798.00
SINCERELY,
~~D
ele ROBERT K. MYERS CO-EXEX:l11'OR
">111"""", '*'
COMMONWIAlIH O' 'IN,..,,,""NIA
INHIIITANCI 104. IIIUIN
IUlDIN,DICIDIN'
ESTATE OF
ITEM
NUMBER
1.
J..
.3.
f.
~
~,
(p.
1.
8.
ll,
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES AND LIENS
~~C:::~ I \V\1'rOC.-"-. E-.
Plea.e Print ar Type
FILE NUMB~R
;), -(/~ - ()V./-L
DESCRIPTION
AMOUNT
ll'.
II.
IJ...
I?~
'+.
'S:
It...
11.
IY
SJ..~ 0,\ Co
(30 ')<.CJ '.s
~.~.?J.;.\I"":-- Ih~6'.hL
l\-q,\ < i\' ru.:t 1~(j'.kL
-\(u..!. 'ro'~ t\--s :.uc.... . l)"'I1: S
H ~c... f' I ,.,(.I..:>,~ u..,
O<l~cJl~L- "",.~,l.-.-..L_ .
0>-;.- Q.."~02..~"-"'6" ~k ~
l\ \, \1 .-p"",>
" .1'tf6
~~,'" ~~
c~ (k~. ~r..fta ...-we S'C--..Jd\/ ('{~2
\~.JC-{L\ > :.:rt'5 / f'l\..L:;~
D~(l.'rI,J OC-(b:" r- 8p~ O-K"(U\~ c~
flo"" ,) lC,.ku-,'."J~
CJH'l ':>\ '-'....,s Ct.... ,.J \ co-<-. L~
(\'\~\q-.J ~(lP~)
~. Qc.~,)s a..~ ~~L~ ~\Jl('-:-
::r: ~s ck \'C-{l...'S'<te{ e.. lo.>u<-I) l.J-....m
" f? -d. L- - eu,,--C;:;--It.<..-
42~ ,38
q';)... 110
I~;l... . aU
I, 06(" , 81
45,Jf
.90. ro
108,06
;);J. 3, ;wJ
4 fl.';7
~o ,Ie
..J.""3. u~
05(1, q1
4, , w. c)1J
Il.~'()
I '1, ~G,8, 37
3).5"0
4". l1U
'.;:5~L~
TOTAL (Also o.'or on line 10, Ro(opitulo'ion)
(If mo,. space is nudecl, insert additional sheets of some size.'
., -.... ,. .
(
I OAIE ::r- NUMBER =l
"rnIL 10 10bs )
SADLER
FUEL OIL.HEATlNG & COOLING
328. S. MAIN ST. P.O. 80X 116
Marysvllle, PA 17053.0116
PHONE 717.957.2127
L_____ -~
(
HABEL HYERS ESTATE
P.O.BOX 11
SUHHEROALE PA 17093
Oal.e Jrn1 U Tl'x Dty Hem Amount Tax -;';;;8a1 'I
03120/96 309202 S SAL 1.0 LABOR 42.50 0.00 42.50 I
02l2B/96 309067 5 REI1 Remark 0.00 0.00 I-
02120/96 309067 5 REM Remark 0.00 0.00
j':02i2-1/96 .. - - .-'- I
5356 0 ~AL 205.3 FO 198.94 0.00 198.94
__0. .
I _. I
01113/96 527B 0 SAL 204.6 FO 1B3.94 0.00 1R3 94
_0.___.__. _ .
BALANCF
.125~3B
.
STATEMENT DATE I 03
ACCDUNT NUMBER
PAYMENT DUE DATE
NEW BALANCE
MINIMUM DUE
AMOUNT ENCLOSED 0
q
IUQSUU934
U(,127/'16
'12.IU
25.UU
ll~!J-
OCtI(CX IIUlE If ADD6fl5S IS IHCWlNlC1. "....r C'IAHCU OH NlYLNS( SIOL
DAlE STORE
01/11"/96 CREDIT
DAlE SIO"E
OZlZD/'J6 ,.
DZlZD/96 CllEJlIT
TD VOLR lAST
tIOHTtltS UUHCE
PUH 01 91.97
TOTAL 91.97
A~ DAlLY PfRIDDIC
BAUHCE RATE
...
1."11I...111".1.1.".11,11,,,11...1,,1,.11,,1,,1,,11.,,,1.11
ESTATE OF MABEL E MYERS
400 BOYER ST
SUMMERDALE PA 17093-0066
10'1508'1340
000'1210
0002500
DETACU AHD RE1URN mE AlOV[ PORno" "1m YOUR REMITTANCE
PLAN II N[CUUR (RElUl PLAN
REfERENCE .
DESCRIPTION
INtEREST DEBIT ADJUSTHEHT
PAYKEH1S
AItO...r
.U
REFEREHCE .
II .,llUI
QS05001'l
DESCRIPT ION
PAy~r - TlWIK YOU
HSf PAYHEH'T REVERSAL
AItOUHr
-Z5.OD
B.DO
WE ADD WE SUlTRACT' TO ARRIVE AT YDlII
PIJl(IIASES FlttAHtE CHARGE CREDITSlRE1HS . PAYIEHTS NEIl BAUHCE
B.IS .00 ZS.DD .00 9Z.10
15.13 .00 Z5.0a ... 92.10
FlIWtCE .. ......L . AIlOt.ICr "1"1- PAV"ENT.
CIWl<t: PfRCEHIAo;t; "AlE PAST oue. . AIIOUHT QUE DUE DAlE
lOX 15.00 zs.oa 04/27/96
FOR ACCOUHJ JHfOAKATIOH PLEASE CALL 1-100-755-7812.
STATENENT DATE: 03/31/96 PAGE 1 FOR ACCOUNT NUNDER 109508934
NOTltE: SEE REVERSE SIDE FOR UtPORTAHT IHfORKAJ10H, P.t.V UUHCE IV' DUE DAlE ru AVOID ADDITlDHAL flHAHCE owu:ES.
"'\'il"',
.L
~
POBOX 8633
ElHHURST IL 60126
HDme Equity Credit Line
Peyment
Caupon
Account Number
New a,l.nee
Billing Oat.
Due Dile
MinImum Payment OUI
713304-10.281518-4
20.00
03/10/96
04/04/96
20.00
D31004!i697
HABEL E HYERS
400 BOYER STREET
SUHHERDAlE PA 17093
Mail Payment Ta:
D
iiJ
New address Dr phone numbor') Ploase
Cfleck Do_ ilnd ccmplcle revPrse Side
HFC & SUBSIDIARIES
POBOX 1878
CAROL STREAM IL60128.Q00l
1,11"11"""11"1,11"1,11,,,11,,.11,,,,,,11.,1,11
3000020007133041028151840000020000
Reh,Jm thiS portIon Dl you' stalemenl WIth yout payment
; Mall Payment Ta
POBOX 1878
CAROL STREAM IL60128
Your Credit Line Has Been Cancelled
Your Available Credit is $ 0.00
Ta Discuss Yaur Accaunt
Please Call:
800.365.9699
Account Summary
Aceounl Number
Blllmg Dal.
Out 0..,.
Amount Put Due
Minimum Payment OUt
713304-10-281518-4
03/10/96
04/04/96
.00
Previous Balanet
(-) Payments
(oJ Credits &
AdJu,lmenls
(+) AdvanceJ & 1+) FINANCE
Other Chargn CHARGE
{+>> InsuranCl! "New Balance
Ch.rgu
.00
.00 .00 20.00 .00
Account Detail Since Last Statement
.00
Tranuctlon 0,1, Posting D'l'
Tra"Jacllon Oes.c:r1ption
Trl"Jactlon Amount
02/10/96 02/11/96
BAD CHECK CHARGE
YEAR TO DATE FINANCE CHARGES COLLECTED DURING 1995 -
$1271.36.
WE HOPE THIS INFORMATION WILL PROVE HELPFUL TO YOU. IF WE
CAN BE OF SERVICE IN ANY OTHER WAY, PLEASE PHONE OR VISIT
OUR OFFICE AT ANY TIME,
20.00
20.00
20.00
. ' .
Pleas. .nl,r addllss Ollnlurane, etlang.s on back .and check lhis bo. 0 Plus, dellch along dolled line .1nd reru'" this polllon Ywllh your paymenl
PLEASE PAY nllS AMOUtH
OU~ OV
/ltfRRIS/lURG I'Ol.I'CUNIC Mlin em
2601 NCJRT/I TIIIIW STIli:''''''
/ltfRRIS/lUIIG /',1 17110.209,Y
II
108.00 04/26/96
AMOUNT PAID ~ $
SEND
PAYMENT
TO
HARRISBURG POLYCLINIC MED.CTR.
2601 NORTH THIRD STREET
HARRISBURG PA 17110-209B
ACCOUNT NUMDER AND NAM~
5273633
MYERS ,MABEL E
FOR INFORMA TlON ON ACCOUNT, PL~AS~ CALL
717-782-4354
COLLECTION DEPT
, ADM DT: 122795
0 DSH DT: 010996
.
" SB: S0699
~ 7I 7-732-0642 5273633
, MABEL E MYERS
~ HR: H10 400 BOYER ST
I SUMMERDALE,PA 17093
...................................................................................................................................................................................
POLYCLINIC MEDICAL CENTER
2601 N. THIRD STREET
HARRISBURG, PA. 17110
Accounl Numb,r:
PIII,nl Nam,:
ServicI Slarl:
Slalem'nt Olle:
5273633
MYERS ,MABEL E
12/27/95 SI~;"End:
04/12/96 l," S""m..1 DaI"
Pao. No 1
01109/96
03/22/96
QUESTIONS? pr.... Call:
717-782-4354 ~~"b COLLECTION DEPT
108.00
.00
ACCOUNT BALANCE
~STIMATED INSURANCE DUE TOTAL PATIENT CREDITS
TRANS DATE DESCRIPTION
AMOUNT
PREVIOUS BALANCE
03/11/96 MED IP-R BENEFITS T95 MEDICARE REHA
7,903.99
7,795.99-
HIP 2 H 0 10 ACCOUNT BALANCE 108 . 00
PMC WAS HAPPY TO BE OF SERVICE YOUR ACCT BAL IS SHOWN
IF YOU HAVE ANY QUESTIONS-PLEASE CALL IMMEDIATELY
T95 MEDICARE REHA .00 817 BLUE CROSS 36 .00
X V 02/20/96
I A~ nA"
1996 PERSONAL TAX NOTICE
EAST PENNSBORO TWP
1&0 ('t~ ,nallU roo
ALICIA 0 STINE, TREASURER
98 SOUTH ENOLA DRIVE RUUM
ENOL PA 17025-2796
PilON NO 732-0734
"" CO U N T Y "" DAI! ASSESSMENT BIll NO. l. 1
MARCH 1, 1996 73S4
I RETURN ORIGINAL COpy WITH PAYMENT
101 MONDAY THRU THURSDAY
8130 AM TO 4100 PM
CLOSED FRIDAYS AND HOLIDAYS
:RTrI'
10' ... --
M
"
"-1'7
11II 1 U ...~
M
"
M
..,
iii DUMfQ nn p!RK)O
"'l<.>"..II''''.I..IlI'....IPI'..tC'''"'''''OIO._t.oIIoou-lllftt
PAY nas ."OUNf
(, . 90
5.00
5.50
(, .90
5,00
5.50
DISCOUNT
FACE
PENALTY
MARCH-APRIl
MAY-JUNE
AFT JUNE 3
9.80
10.UIl
11. U U
MYERS, MABEL E.
(,00 BOYER ST.
SUMMERDALE, PA 17093
IF UNPAID BY 12/31/96 TAXES
WIll BE TURNED OVER TO
DELINQUENT COLLECTOR.
ACCT t 050-0543400
SS. 202-16-9141
JOB TITLE I RETIRED
B TITLE IS 90 DAYS FROM DATE OF THIS 8ILL
:--DEAULINE
240-6365 OR 697-0371 EXT 6365
TAX YEA"
1996 PERSONAL TAX NOTICE
EAST PENNSBORO TWP
&ucI C'lltal '''UlI roo:
ALICIA 0 STINE, TREASURER
98 SOUTH ENOLA DRIVE ROOM
ENOLA PA 17025-2796
PHONE NO 732-0734
1111 COUNTY 1111
OAT!
ASSESSMENT
BIll HO. C 2
101
MARCH 1, 1996 7354
I RETURN ORIGINAL COpy WITH PAYMENT
MONDAY THRU THURSDAY
8130 AM TO 4100 PM
CLOSED FRIDAYS AND HOLIDAYS
C~ /
lO-~ M .., II " M "
4.90 4.90
5.00 S.OO
5.50 5.50
II
"
It DUIINCI T1ttI PfRtOO
I~Ql..'I'''''II..I'I''..I..,I'tOO..,.1l101~~t'O'l11~
PAY nn AMaUN'
DISCOUNT
FACE
PENALTY
MARCH-APRI
MAY-JUNE
AFT JUNE 3
9.80
J O. OU
11. U U
MYERS, MABEL E.
400 BOYER ST.
SUMMERDALE, PA 17093
IF UNPAID BY 12/31/96 TAXES
WILL BE TURNED OVER TO
DELINQUENT COLLECTOR.
ACCT t 050-0543400
SSt 202-16-9141
JOB TITLE I RETIRED
M! AND ADDRESS 0' bENEFICIARY
----...-
AMoUIII O~
SHARE OF ESIAlE
,
"HYlICIANI CLlNtc.\L u.aOftA,TOfI,Y
DEN."T"ENT 448lI3
olAH ,M.HClaCD, CA ...,~
8U1IMBI OPftCI!
/oc!ol......,...
HOURI ~ AU. 4:00 PM
.',~-. ...h:-'.. .$",.it
.' 'I . ~;.' .~.,:~
0-.. .
PLEASE 8E ADVISED peL IS NOW REOUESTING PAYMENT DIRECllY FROM YOU.
.
..--
MABLE MYERS
--
151383113715-0
--
04/211/111
-
.-a #
-'"
I ........
05/18/15
C" _,
-.
IDa
..-
8ASIC CHEMISTRY PANEL
CHEM PANEL
GOT
IRON
SPECIMEN HANDLING FEE
GLUCOSE. FASTING
PMT/CREDITS
ES WERE RENDERED
22.411
14.10
12.211
13.110
22.00
-13.110
101
80018
82877
83540
81001
82847
101
101
, 05/18/85
05/18/85
04/10/811
MEDIC
ELIGIBILITY NOT IN EFFECT WHEN S RVI
ELIGIBLE AT TIME F S RVICE. PLEASE
-0-
,
I
,
SECOND NQrICE OF PAYMENT DUE. PLEASE REMIT ROM TLY BY CHECK.
MONEY DR R DR CREDIT CARD.
71.110
(I4LlHCE OUl
PlEASE PAY PRQI,IPTl'1
IRS 06&4280528 MABLE MYERS
51383B375-0
04/2B/8B
DIAGNOSIS CODEISI:
2500
THIS BILL IS FOR LABORATORY TESTS REOUESTED BV. J 0 H N 5 HIT H H D
THE SPECIMEN MAY HAVE BEEN COlLECTED AT THE PHVSICIAi'lS OFFICE OR AT PCL
OUR CREDIT POLICV
All ch.rg_ .r. dUI end payabl. upon ~lpL Ther. will ~ . $10.00 ..rvl~ chlrge on ,II returned check.. Phy.lcla~ Clinical Labor.tory caMot Iccept the
,"ponelblllty for eollKtlng your Ineur.nce claim or ".galllllng I .."Iemen' on I dl.puted clllm. 't'ou ar. r..ponelbl.'or payment of your Iccount.
, sao LATE PAYMENT FEE WILL BE ADDED ,0 YOUR INVOICE FOR PAYMEN, RECEIVED AFTER 30 DAVS FROM YOUR ORIGINAL INVOICE.
: _.eo;t.cns eool..~ :c oa', C~::uctloles ""ld E tOlar.a!'c" ~. 5e"le':,= ,....:s~ ~e Olre:teC to t..~ "'e'"'lN!' ServIces ':'!!::;a"":'""enl ol yO"'1 ~ealth Plan
.....\ :::~"e' Questlens Sr"O..I~ oe dlleCle::: ~o (BOO) 446-0330 Stlllng Ser-.',ce :''!oa~ent :....~c~ale:: Belan:e I"CUlf\ S\lsteM'l e'jl!l;llab1e 2.1 hOuIS cav
LocatkM'l cod. nOCed above ktenttfl_ one Of more of the PHYSICIANS CLINICAL LABORATORY locallo,. ""Mre teet. ..... pertonned,
NORTHERN CALIFORNIA REGION
(
101 3301 C Steet '100E
S.c~amenta. CA
;::ess€- tetiJ~n t--:!. ~:.t.=H" WI~~, )'O"~ :3.y....,e~~ ':" :::rIE:t oro:e5slng
o M/C 0 VISA
o DISCOVER
ri)
U ~tG
:ARO ..0
EXP DAtE
PHYSICIANS CLINICAL LA.BORATORY
P.O. BOX 160527
SACRAMENTO, CA 95816.0527
PAI~T NAUf
SIGNAT~E
PHYSICIANS CLINICAL LA.80RATORY
DEPARTMENT #44663
P.O. 80X 44DOO
SAN FRANCISCO. CA 94144-4663
513836375-0
HABLE HYERS
400 BOYER ST
SUHHERDAL, PA 17093
""'OUNT ENClOSED'
ACCouNT' 513836375-0
'.,:,.., '_~ :', : """:-.t .; ;:......:; :,A'IIS C..:'IIICA.. V.EC~.l~CCl\l:;" .p:~.
.:...:. ,~...: :4~" :.."....;:,. 'l.Ave~ ...A:.e W,." :/OE'-;- :.:.10:
MABLEMVERS51383b3750042b9b
71. 50
1
miD
"J .........-, '..,...--;;;-.-".....~.. '-.
:.~. .. _ .' ,- .' -'. ..\' ...
.t . , ~ .'"
PcnnsYlVJ\nia .Ppwcr & Light ~~~~l1.ny _'(OIII..I{IT']!Ollil~.\3Tr:mma
521 4H4:\ IlKI
~il~lGULW~ ~~IJI,[IJI
Electric
Service
1'lUOIt IIIJ.I.IN(;
'1'0\:11 rll,,"I.II~llIill
Rellllned Check A,"onlll
I.lIle I'lIymenl Chlllge
Amuullt YUII SIIII Owe IL~ ur Mill' 25, 1996
ClJlmENT CHARGI~S. Feh 211 -1\1111' 21
Residenlilll Rille ItS
IIl1sic Scrvie,'
lJ~e: :!llll KWIIIII !I.IX)e per KWII
(~Kl KWIIIII /I.IX!" per K\VII
/lllG KWIIIII 7.411" per KWII
Sr.ecilllltllle Adjuslmenl
I'A TIIX Adjllsl,ilelll
Ellergy Owge
Chmges rur Eleclric Service
$'11.00
55.1Il1
1.11:\
Fur:
EsrATEor MAllEI, c MI'ElIS
'"'1l0YER sr
SIIMMF.RDAI.B rA I7111J
$ 147.11:1
l'in.1 Dill
(,.411
1/1.(10
4/1.00
5'1.64
-1.60
,ll.76
,11.04
ell,tulllrr Srrvler
P.O. Box 35()0
Allentown PA
1/11(1(,.050(1
1.800.342.5775
$ l:!lJ.7:!
\
OTHER CllARGES
Ilndgel 5elllelllenl
Iludgel 5elllel1lenl AlIIolIlIl
Tolnlof Olher Chllrges
$ 8U.4S
.7.'1/1
/1/1.4:1
l' '-'A"" ^ ." ~'.,." ... ., ~. ... '
Ouu uc;;r:: ...~v....!.._.~..~ ).:..::,.......'.:. ..':.' '.' .. ".' .,;
....'..'"....."<,..,.. Du 15 6 '.,
Due D8te,':~' t-;{:,,\<,;:r.',:nlllount cAp" ,199 . ,;:.,' :
ot'''61'~5(i'L..:\,..,.'t;:t''';'$~.}<''~''''':''~:.'''';'''''''' ," .... ....,....'.'..,
'r~.. ~ ~.~~:-. '....:~.~:-;.:;...<.:"~.~',~.~.~.:.::~" >....: "~~.-:: .'. . ~-,' -- ,.:-
$ 358.00
For Your
Information
19% Lllle I'lIymenl c.1ll1rgcs S I.II~
We "l,predllc Ihe opportunily to hnve served you. l\celluse YOII haw paid
your 11115 wilhin 30 dllYs over Ihe JI"sl yem, you haye eSlllhlished IIn
cxcellenl pllymenl record wilh I'ellnsylvllllilll'ower (.< Lighl Company.
If you nc!"llo eSlllhlish credil nlllnolher ulilily youmllY use this messllge
n.~ n credll reference.
Oenlllhe coils on Ihe bllck or hollom of your refrigernlor even' ~ mOlllhs.
I>usl covered coils wasle energy. .
Qllcslloas obOUI
Ihis hili?
Please conlacl
us by ApI' 15
IIIIJlllrhml illrorlllulioll 011 hllck ...
.---........-..--..............-.....--..............................-.-...-..-...-.......--.......................-
Relurn this pari 10 IIddress below wilh 0 check pOYllble 10 PP&L
'. . ',.,.'
.' .. '--.
. Your CUllom!!r Number
Pic... PlY BY .
~
. ...'" ~, .'
..,.....
521 4843.100
..'-.. '. -'
.... .
. .
:'" .,'
::. ..1
.' ";.'
Apr 15. 1996
$ ~SH.(K)
j ':~~'.' .'~,~i.i';i-.~;-:',
_II' ""7c;,1~j;,p,>.
, ':"".~~~~~:":.. .
. "~":::,::: ':
. .. :'....1.;.'{(\,.
~ ~.., .,.....
\ ,".
\.., ';;.~.,..
2500003580050000358002 5214843100
PP&L
lWO NORTII NINTII !i'lltEl:!'
ALLENTOWN I'A 18Jl11
IS -fn -.3
DUREAU OF INDIVIDUAL TAXES
IHtl[RITAHC[ lAX DIVlSION
DEPr. ZaDftDI
tlARRISBURC, PA lIlza-oliol
CDMMONWEALTH DF PENNSYLVANIA
DEPARTMENT DF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
DONALD
PO BOX
ENOLA
BOWEN ESQ
B
DATE
ESTATE DF
DATE DF DEATH
FILE NUMBER
CDUNTY
ACN
PA 17025
r-
03-10-97
MVERS
03-11-96
21 96-0242
CUMBERLAND
101
Ahount Relll tted
(:.
~*
11'.lh' III" 1l1.'U
MABEL
E
~
MAKE CHECK PAYABLE AND REMIT PAYMENT TD:
REGISTER OF WIllS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALDNG THIS LINE ~ RETAIN LOWER PORTIDN FDR YDUR RECDRDS ~
iiE"v:is47-EX-AFi>--nF9&-nioricEuoi'--fNHEifiTA'ifcE-rAX-iipiiRiiisEHEiir-;-Al.i."OWANCniR'-----------------
DISALLDWANCE DF DEDUCTIDNS AND ASSESSMENT OF TAX
ESTATE OF MYERS MABEL E FILE ND. 21 96-0242 ACN 101 DATE 03-10-97
If an assessment was issued previously, lines 14, 15 and/or 16, 17 and lB will
reflect figures that include the total of ~ returns assessed to date.
ASSESSMENT OF TAX:
15. Anount of Line 14 at Spousal
16. Anount of line 14 taxable at
17. Anount of line 14 taxable at
18. PrincIpal TaK Dua
TAX CREDITS:
PAYMENT
DATE
TAX RETURN WAS I I X) ACCEPTED AS FILED
RESERVATIDN CDNCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE DF RETURN BASED DN: ORIGINAL RETURN
1. ROIl Est.to CSchodule A) III
2. Stockl and Bondi (Schedule OJ (2)
3. Clos.l~ Held stock/Partnership Int.rest (Schedule C) (3)
4. Hortgagas/Notas Receivable (Schedule OJ (4)
S. Cash/Sank Oaposlts/Hlsc. Parsonal Property (Schedule E) IS)
6. Jointly Owned Property (Schedule F) (6)
7. Transfers (Schedule G) (7)
8. Tot.l Assets
APPRDVED DEDUCTIONS AND EXEMPTIDNS:
9. Funeral EKpenses/Adn. Costs/Hisc. Expenses (Schadule H) (9)
10. Dobts/Moctgogo Llobllltlos/Llens ISchodulo II (10)
11. Total Deductions
12. Net Value of TaK Raturn
13. Charitabla/Governnental Bequests ISchedule J)
14. Net Value of Estate Subject to Tax
NDTE:
rat.
lineal/Class A rate
Collataral/Class 8 rata
lIS)
1161
1171
RECEIPT
NUMDER
DISCDUNT C+l
INTEREST C-)
CHANGED
.00
.00
.00
.00
7,379.78
30,000.00
.00
ID)
16.304.74
27.028.44
1111
1121
113)
1141
.00 X .00=
.00 X .06=
.00 X .15=
I1DI
AMOUNT PAID
TDTAL TAX CREDIT
BALANCE DF TAX DUE
INTEREST AND PEN.
TDTAL DUE
NOTE: To insure proper
credit to your account,
subnit tha upper portion
of this forn with your
taK paYll8nt.
37,379.78
43.B3 18
5.953.40-
.00
5,953.40-
.00
.00
.00
.00
.00
.00
.00
.00
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATIDN OF ADDITIONAL INTEREST.
IF TOTAL DUE IS LESS TitAN U. NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCRI. YDU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF TNIS FORM FOR INSTRUCTIONS.)
If\
,-
o
'"
;;JL
C:.: -
r -
~) \
-~~ ::l
()(.)
RESERVATION: [,tat.. af dec.d.nt. dying on or b.for. D.c..b... 11, 1982 .. If any lutur. lnt.r..t In the .,tata 1. tran.f.rr.d
In pa.....lon or .nJoy..nt to Cl... B (collat.ral' b.n.flclar.a, of the d.cadant aft.r the .xplratlon of any a.tat. for
Ilf. or for y..rl, the Co..onw..lth h.r.~Y ..pr.ssly r...rv.. the right to apprals. and ...... tran,f.r Inherltanc. Ta...
.t the t.wful Cia.. B (co11_t.ra1) rat. on any such future lnt.r..t.
PURPOSE OF
NOTICE:
To fulfill the r.qulr...nt. of Sactlon 114Q of the Inh.rltanca and [.tat. Te. Ict, Act Zl of 1991. 72 P.S.
S.ctlon 21<<.0.
PAYHEHT:
Detach the top portion of thl. Hotle. and lubalt with your pay..nt to the Ragl.t.r 01 Will. prlntad an the rav.'.. ,Id..
"Mak. chack or .onay ord.r pelf.blD to: REGISTER OF MILLS, AGENT
All pay..nts r.c.I~.d Ihall flrlt b. appll.d to any Int.r.lt which ..y b. due with an~ r..alnd.r appll.d to the tax.
REFUND lCR): A r.fund of a tlx cr.dlt, which WII not rlqu.lt.d on the Tax Rlturn, .a~ b. r.qu.lt.d b~ coapl.tlng an "Application
for R.fund of P.nn.yl~anla Inh.rltanc. and Eltat. la." CREV-ll11). Application. are a~lllabl. at the Offlc.
of the R.gllt.r of Willi, .n~ of the Zl RI~.nu. Olltrlct Offlc'l, or b~ calling thl Iplclal Z~-hour
anlwarlng ..r~lc. ~ber. for for.. ord.rlngl In P.nn.~lvenla l-aDD-16Z-Z050, out.lda P.nn.~I~anla and
within local Harrllburg ar.a (717) 7a7-aD9~. TOOl (711) 11Z-ZZ52 (Hlarlng lapalr.d Dnl~).
OBJECTIONS: An~ part~ In Int.re.t not letl.fl.d with the .ppr.I....nt. allowanc. or dl.allowance of d.ductlon., or a.I.....nt
of tax (Including discount or Int.rl.t) a. ,hown on thl. Notle. .u.t obJlct within slxt~ 1601 da~. af r,cllpt of
thit Notlc. b~:
--wrltt.n prot..t to the PA Dopart..nt of R.v.nu., Board of App..ls. D.pt. Za1021, Harrl.burg, PA
--.I.ctlon to have the .att.r d.t.ralnld at audit of th. account of the plr.on.1 r.pr...ntatlv.,
--app.al to the Orphan." Court.
171za-1021.
OR
OR
AQKIN
ISTRATlVE
CORRECTIONS:
Factual .rrar. dlscov.r.d on thl. a.,~...ont .hould b. addr....d In writing tal PA D.part..nt of R.v.nu.,
Bur. au of Individual Tax.., AT1NI Po.t A.......nt Rovl.w Unit, O.pt. :10601. Harrl.burg, PA 111:1-0601
Phon. (717) 717-6505. S.. page 5 of the bookl.t "In.tructlons for Inn.rltanee Tax R.turn for a R..ld.nt
O.c.d.nt" CREV-ISOl) for an ..planatlon of ad.lnlstr.tlvely corr.ct.blo orrors.
DISCOUNT:
I' .ny tl. due I. paid within thr.. (1) callndar lonth. aft.r the d.c.d.nt". d..th, a 'Iv. p.rc.nt C5X) dl.count of
the ta. paid I. allow.d.
PENAl TV:
The 15% tax eana.ty nan-partlclp.tlon p.nalty I. co.put.d on the total 0' th. t.. and Int.r..t ....,..d, and not
paid b.for. January la, 1996, the 'Ir.t day a,tar th. .nd af tha ta. a.n.sty p.riod. Thl. non-p.rtlclp.tlon
p.n.lty I. appe.labl. In the .... .annlr and In the the .a.. tl.. p.rlod a. you would app.al the ta. and Int.r..t
that hat b.en a....'.d a. Indlcat.d on this notlc..
INTEREST:
Int.r..t I. charg.d b.glnnlng with flr.t day of d.llnqu.ncy, or nln. (9) .onth. and on. CI) day fro. tha date of
d.ath, to the date 0' pay..nt. T.... which b.ca.. d.llnquent b.fore January 1, 19aZ b..r Int.r..t at tha rat. a'
Ilx C6~1 parc.nl p.r annul calculat.d at a d.ll~ rata of .oaOI6~. All ta... which b.ea.. d.llnqu.nt on .nd a't.r
January 1, 198Z will b.ar Int.r..t .t a ratl which will vary fro. calandar y.ar to calendar y.ar with that rat.
announc.d by thl PA O.part..nt 0' Rlv.nu.. Th. appllcabll Int.r..t rat., for 198Z through 1991 ar.1
!!!! Int.r..t RAt. DAlly Inhra.t rlletor !!.!! Int.ra.t Rllta Olllly Intera.t rllctor
1911 ZO:c .ooos~a 1987 .. .0aOlU
19U 16:C .0DD/93a 1988-1991 ll~ .000l01
191/9 ll~ .000l01 1992 9% .000Z/91
1985 U~ .000lS6 1991-1994 1% .ODOI91
1986 10~ .0D021" 1995-1991 9% .00D1/97
--Int.r..t Is C8lculat.d .. followl!
INTEREST = BALANCE OF TAX UNPAIO X NUNBER OF OAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Notlc. I..u.d aft.r the tax b.co... dellnqu.nt w!11 refl'ct an Int.ra.t calculation to flft..n (IS) dAY'
b.yond the data of the AI......nt. If pay..nt I. .ad. Aft.r the Int.r..t coaputatlon date .hown on the
Notlc., additional Int.r..l .u.t be celculAted.
STATUS REPORT UNDER RULE 6.12
Name of Decedent:_M (.\ 6~ L- E, MlEr-S
Date of Death: fr\~.\ \\ 1%':'.
will No. Q),",' Admin. No. ..J IfG
1-
Pursuant to Rule 6.12 of the Supreme Court Orphans'
Court Rulesr 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~ No
2. If the answer is NOr 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 r;rresentative
account with the Court? Yes No .
b. The separate Orphans' Court No.
the personal representative's account is:
file a final
(if any) for
c. Did the personal representative state an
account informally to the parties in interest? Yes j< No
d. Copies of receipts, releases, joinders and
approvals of formal or informal accounts may be filed with the
Cerk of the Orphans' Court and may be attached to this report.
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'~i:'gnature'
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Name (Please type or print)
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Address
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Date:~
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Capacity:
Personal Representative
){__Counsel for,personal
;-representat1.ve
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