Loading...
HomeMy WebLinkAbout11-03-101505610143 -' REV-1500 ~`(°'-'°' PA Department of Revenue Pennsylvania OFFICIAL USE ONLY Bureau of Individual Taxes oErun~eHroFrs~u¢ County Code Year File Number PO 80x.280601 INHERITANCE TAX RETURN Harrisburg, PA 17128-0601 RESIDENT DECEDENT 21 0 9 114 6 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 183 07 8396 12 05 2009 10 14 1919 Decedent's Last Name Suffix Decedent's First Name MELLOTT MI DOROTHY H (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW 1. Original Return ^ 2. Supplemental Return ^ 3. Remainder Return (date of death prior to 12-13-82) ^ 4. Limited Estate ^ qa Future Interest Compromise (date of death aver 12-12-132) ^ 5. Federal Estate Tax Return Required g Decedent Died Testate ~ Decede^t Maintained a Living Trust 2 (Attach Copy of will) ^ (Attach copy of Trust) 8. Total Number of Safe Deposit Boxes ^ 9. Litigation Proceeds Received ^ 1 p. Spousal Povert Credit (date of death between 12-31 ~J1 and -1-95) ^ 11. Election to tax under Sec. 9113(A) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: -Name Daytime Telephone Number JERRY A WEIGLE ESQUIRE 717 532 7388 REGISTE~ ILLS l~ ONLY First line of address > "' ~~77 ~ ~'t7~ © r ~ " , ~-~ 12 6 EAST KING STREET -~ '"~ ~i +~ w ~r > .. -r - ~~~ C.3 ra-~ Second line of address CJ`--~~ ~~ r ~ ©~ Z ; tv City or Post Office ~ ~ ~-TE FILED State ZIP Code `~, SHIPPENSBURG PA 17257 `"~ Correspondent's a-mail address: Under penalties of perjury, I deGare that I have examined this return including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative Is based on all information of which preparer has any knowledge. SIGN OF PERSON RESPONSIBLE FOR Fu wr RFn iwu Jane L. Carl Drive. Vienna, VA 21118 126 East King Street, Shippensburg, PA 1505610143 Weigle Esquire Side 1 DATE ^_ ~~ 1505610143 J REV-1500 EX Decedent's Name: A11eiiOtt, Dorothy H. 1505610243 RECAPITULATION 1. Real Estate (Schedule A) ....................................................................................... 1. 2. Stocks and Bonds (Schedule B) ............................................................................. 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C)......... 3. 4. Mortgages & Notes Receivable (Schedule D) ........................................................ 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ............... 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested............ 7. Inter-Vivos Transfers & Miscellaneous N,o~ Probate Property (Schedule G) u Separate Billing Requested............ 8. Total Gross Assets (total Lines 1-7) ..................................................................... Decedent's Social Security Number 183 07 8396 75,000.00 11,152.00 4. 5 531,023.29 6 36,750.00 7. 315,890.39 $. 969,815.68 9. Funeral Expenses ~ Administrative Costs (Schedule H) ....................................... 9. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............................. 10. 11. Total Deductions (total Lines 9 & 10) ................................................................... 11. 12. Net Value of Estate (Line 8 minus Line 11) .......................................................... 12. 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ............................................... 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) ... ........................................... . 14, TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .00 15. 16. Amount of Line 14 taxable $ 0 4 3 8 8 5 8 16 at lineal rate X .045 . ~ . 17. Amount of Line 14 taxable at sibling rate X .12 0 . 0 0 17. 18. Amount of Line 14 taxable at collateral rate X .15 0 . 0 0 18. 19. Tax Due .................................................................................................................. 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. 75,029.54 90,397.56 165,427.10 804,388.58 804,388.58 0.00 36,197.49 0.00 0.00 36,197.49 Side 2 L 1505610243 1505610243 REV-1500 EX Page 3 Decedent's Complete Address: File Number 21-09-1146 DECEDENT'S NAME Mellott, Dorothy H. STREET ADDRESS 206 Roxbury Road CITY Shippensburg STATE PA ZIP 17257 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 3. Interest 40,000.00 1,809.87 4, If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 2 Line 20 to request a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. Make Check Payable to: REGISTER OF WILLS, AGENT. (3) (4) (5) 36,197.49 41,809.87 5,612.38 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred :............................................................................... ^ b. retain the right to designate who shall use the property transferred or its income :.................................. ^ ^x c. retain a reversionary interest; or ............................................................................................................... ^ 0 d. receive the promise for life of either payments, benefits or care? ............................................................ ^ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .................................................................................................................... ^ ^x 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?....... ^x ^ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .................................................................................................................. ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994 and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: • The tax rate imposed on the net value of transfers from a deceased child 21 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 percent [72 P.S. §9116 (a) (1.2)]. . The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent, except as noted in 72 P.S. §9116 1.2) [72 P.S. §9116 (a) (1)]. . The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent [72 P.S. §9116 (a) (1.3)]. A sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. (1) Total Credits (A + B) (2) Rev-158Q EX+ (11-08) SCHEDULE A REAL ESTATE COMMON WEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Mellott, Dorothy H. FILE NUMBER 21-09-1146 All real property owned solely or as a tenant In common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which fs jointlyowned with right of survivorship must be disclosed on schedule F. Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule A (Rev. 11-08) (If more space is needed, additional pages of the same size) Rev-1503 EX+ (6-98) SCHEDULE B STOCKS 8~ BONDS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Mellott, Doroth H. 21-09-1146 All propeRy jofntlyowned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER CUSIP NUMBER DESCRIPTION UNIT VALUE VALUE AT DATE OF DEATH 1 U. S. Savings Bonds -Series E, EE, and HH as per attached 11,152.00 listing. Bonds in name of decedent only TOTAL (Also enter on Line 2, Recapitulation) 11,152.00 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule B (Rev. 6-98) Rev-15Q8 EX+ (6-98) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Mellott, Doroth H. 21-09-1146 Include the proceeds of litigation and the date the proceeds were received by the estate. All propeRy jointlyowned with the right of survivorship must be disclosed on schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Cash from M 8 T Bank Lock Box 1,505.86 2 Cash from Orrstown Bank Lock Box 964.50 3 Comcast Cable -refund 5.53 4 County Tax Proration at real estate settlement 118.13 5 Family Traditions -refund 7,20 6 Fogelsanger-Bricker Funeral Home -refund 100.00 7 School Tax Proration at real estate settlement 837.93 8 Commonwealth of Pennsylvania -state income tax refund 106.00 9 F 8r M Trust Certificate of Deposit 2990187 25,841.61 Accrued interest on Item 9 through date of death 45.13 10 F & M Trust Certificate of Deposit 2994889 33,300.03 Accrued interest on Item 10 through date of death 223.52 11 F 8r M Trust Checking Account 70780 2,258.59 Accrued interest on Item 11 through date of death 0.00 12 M & T Bank Certificate of Deposit 0318829 _ 2,290.93 Accrued interest on Item 12 through date of death 2.07 Total of Continuation Schedules See attached a es TOTAL (Also enter on Line 5, Recapitulation) 531,023.29 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) Rev-1518 EX+ (8-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY continued ESTATE OF (FILE NUMBER Mellott, Dorothy H. 21-09-1146 ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 13 M & T Bank Certificate of Deposit 0319158 2,000.00 Accrued interest on Item 13 through date of death 40.98 14 M 8~ T Bank Certificate of Deposit 3803770 6,000.00 Accrued interest on Item 14 through date of death 2.80 15 M 8~ T Bank Certificate of Deposit 4396469 15,000.00 Accrued interest on Item 15 through date of death 42.00 16 M & T Bank Certificate of Deposit 6719817 2,604.14 Accrued interest on Item 16 through date of death 3.57 17 M 8~ T Bank Certificate of Deposit 7876723 29,084.46 Accrued interest on Item 17 through date of death 150.18 18 M & T Bank Certificate of Deposit 7876898 7,054.86 Accrued interest on Item 18 through date of death 23.23 19 M 8 T Bank Certificate of Deposit 7876905 71,402.56 Accrued interest on Item 19 through date of death 235.13 20 M 8~ T Bank Certificate of Deposit 7878050 2,172.83 Accrued interest on Item 20 through date of death 34.46 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) Rev-1569 EX+16-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, ~ MISC. PERSONAL PROPERTY continued ESTATE OF (FILE NUMBER Mellott, Dorothy H. 21-09-1146 ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 21 M & T Bank Checking Account 97388130 13,799.47 Accrued interest on Item 21 through date of death 3.38 22 M 8< T Bank Checking Account 98189352 11,067.04 Accrued interest on Item 22 through date of death 2,74 23 Orrstown Bank Certificate of Deposit 27544 5,850.14 Accrued interest on Item 23 through date of death 14.28 24 Orrstown Bank Certificate of Deposit 28327 83,550.67 Accrued interest on Item 24 through date of death 9.27 25 Onstown Bank Certificate of Deposit 28328 84,119.72 Accrued interest on Item 25 through date of death 2.52 26 Orrstown Bank Certificate of Deposit 28329 24,971.49 Accrued interest on Item 26 through date of death 0.75 27 Orrstown Bank Checking Account 102002012 7,478.62 Accrued interest on Item 27 through date of death 0.03 28 Patriot Federal Credit Union 13-month Certificate of Deposit 57,035.17 Accrued interest on Item 28 through date of death 0.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) Rev-15Y6 EX+(6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, ~ MISC. PERSONAL PROPERTY continued ESTATE OF (FILE NUMBER Mellott, Dorothy H. 21-09-1146 ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 29 Patriot Federal Credit Union 15-month Certificate of Deposit 24,166.78 Accrued interest on Item 29 through date of death 137.68 30 Patriot Federal Credit Union Prime Share Account 2,203.82 Accrued interest on Item 30 through date of death 0.99 31 Gross Proceeds of Public Sale of Personal Property - 6-11-10 11,925.50 32 Personal Property - at appraised values 1,225.00 TOTAL (Also enter on Line 5, Recapitulation) 531,023.29 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) Rev-1568 FJ(+ (8-98) SCHEDULE F COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Mellott, Dorothy H. 21-09-1146 Han asset was made joint wlthln one year of the decedent's date of death, it must be reported on schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Jane L. Carl 2227 Abbotsford Drive Daughter Vienna, VA 22181 B. C. JOINTLY OWNED PROPERTY: ITEM NUMBER FOR JOINT TENANT MADE JOINT DESCRIPTION OF PROPERTY (NUMBER OR EMILARNDENTIFY NG (NUMBER. ATTACH DEEDOFOR JOINTLY-HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSE % OF DECD~S INTEREST DATE OF DEATH DECEDENT'S NTEREST 1 A 08/01/2004 U. S. Savings Bonds -Series E, EE, and HH 73,500.00 50.000°/a 36,750.00 as per attached listing. Bonds jointly owned with Jane L. Carl, daughter TOTAL (Also enter on Line 6, Recapitulation) 36,750.00 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule F (Rev. 6-98) Rev-1510 EX+ (6-98) SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMON WEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF (FILE NUMBER Mellott, Dorothy H. 21-09-1146 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-151X1 COVER SHEET is yes. ITEM NUMBER DESCRIPTION OF PROPERTY THE DATE OF ROANSFERSATTACFI ACOPY OF THE DEED FOOREREAEESTATE. DATE OF DEATH VALUE OF ASSET %OF DECD'S INTEREST EXCLUSION (IF APPLICABLE) TAXABLE VALUE 1 U. S. Savings Bonds -Series E, EE, and HH as per 315,890.39 100.000% 0.00 315,890.39 attached listing. Bonds Payable on Death to Jane L. Carl, daughter TOTAL (Also enter on Line 7, Recapitulation) 315,890.39 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule G (Rev. 6-98) REV-1131 EX+(10-06) COMMNHERITANCEDT~EDENTRN ANIA RESSIDENTT DEECC SCHEDULE H FUNERAL EXPENSES 8~ ADMINISTRATIVE COSTS ESTATE OF I FILE NUMBER Mellott, Dorothy H. 21-09-1146 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT N M A. FUNERAL EXPENSES: See continuation schedule(s) attached B. 1 ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) 12,215.16 Street Address City State Zip Yearlsl Commission paid 2. Attorney's Fees Weigle ~ Associates, P.C. 30,000.00 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 Register of Wills, Cumberland County 743.50 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 32,070.88 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 75,029.54 Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 10-06) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Mellott, Dorothy H. 21-09-1146 ITEM NUMBER DESCRIPTION AMOUNT Funeral Expenses 1 Family Traditions -reception 2 Fogelsanger-Bricker Funeral Home 3 Lollipop Shop -reception items 4 Spring Hill Cemetery 5 Tim Wyrick -grave opening Other Administrative Gosts 6 Borough of Shippensburg 7 Borough of Shippensburg 8 Borough of Shippensburg 9 Borough of Shippensburg -dumpster fees 10 Borough of Shippensburg -dumpster fees 11 Borough of Shippensburg 12 Carl E. Ocker -appraisal fee 13 Cody Lehman -snow removal 14 Cody Lehman -snow removal 446.66 10,843.50 75.00 750.00 100.00 H-A 12,215.16 175.66 141.00 120.00 136.60 62.20 220.50 75.00 50.00 25.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) SCHEDULE N FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF Mellott, Dorothy H. FILE NUMBER 21-09-1146 ITEM NUMBER DESCRIPTION AMOUNT 15 Cody Lehman -snow removal 85.00 16 Cody Lehman -clean up 125.00 17 Cody Lehman -clean up 70.00 18 Cumberland Law Journal -advertising Letters Testamentary 75.00 19 Everett Cash Mutual Insurance Company - 3 months fire policy 187.00 20 Everett Cash Mutual Insurance Company - 3 months fire policy 192.67 21 Expenses of public sale held 6-11-10 4,273.93 22 Grace Keiter, Tax Collector - 3-1-10 county real estate taxes 532.32 23 Grace Keiter, Tax Collector - 7-1-10 county real estate taxes 1,167.36 24 Jane Carl -executrix postage expenses 23.80 25 Jane L. Carl -executrix expenses including mileage, tolls, lodging, keys, and miscellaneous 4,528.04 expenses 26 Kendall's Tree Service -removal of tree causing sewer problems 1,800.00 27 Kough's Oil Service 453.08 28 Kough's Oil Service 212.16 29 Kough's Oil Service 266.48 30 Kough's Oil Service 398.96 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Mellott, Dorothy H. 21-09-1146 ITEM NUMBER DESCRIPTION AMOUNT 31 Kough's Oil Service 341.38 32 Kough's Oil Service 108.63 33 Lake Oil Burner Service 145.00 34 Larry Weaver -lawn maintenance 90.00 35 Larry Weaver -mowing 60.00 36 Larry Weaver -mowing 60.00 37 Larry Weaver -mowing 90.00 38 Larry Weaver -mowing 60.00 39 Larry Weaver -mowing 120.00 40 Larry Weaver -mowing 90.00 41 Lester W. Carl -ink printer cartridge 46.90 42 Linda K. Klein -notary fee 20.00 43 News Chronicle -advertising Letters Testamentary 113.00 44 Penelec 23.94 45 Penelec 77.39 46 Penelec 14.13 47 Penelec 16.81 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Mellott, Dorothy H. 21-09-1146 ITEM NUMBER DESCRIPTION AMOUNT 48 Penelec 17.61 49 Penelec 16.61 50 Penelec 19.42 51 Penelec 11.03 52 Real Estate Settlement costs -including Realtor Commission - $4,500.00; Deed Preparation - 7,169.22 $125.00; Realty Transfer Tax - $750.00; Borough of Shippensburg final water/sewer billing - $250.62; Home Warranty of America - $420.00; KirchofPs Termite & Pest Control - $1,123.60 53 Real Estate Settlement Expense -Seller Paid Closing Costs 3,000.00 54 Real Estate Settlement Expense -Rent Proration October, 2010 516.00 55 Real Estate Settlement Expense -Last month of lease rent 800.00 56 Rebecca Lehman -care of house 280.00 57 Rebecca Lehman -care of house 280.00 58 Rebecca Lehman -care of house 280.00 59 Rebecca Lehman -care of house 280.00 60 Rebecca Lehman -care of house 350.00 61 Rebecca Lehman -care of house 300.00 62 Rebecca Lehman -care of house 300.00 63 Rebecca Lehman -care of house 300.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Mellott, Dorothy H. 21-09-1146 ITEM NUMBER DESCRIPTION AMOUNT 64 Register of Wills, Cumberland County -filing PA Inheritance Tax Return 15.00 65 Register of Wills, Cumberland County -filing Family Settlement Agreement 100.00 66 Register of Wills, Cumberland County -four Short Certificates 16.00 67 S 8~ S Tax Service - 2009 income tax preparation 150.00 68 T. C. Hauling -clean out of house and garage 480.00 69 Tim Gruver Plumbing 196.00 70 Tim Gruver Plumbing 196.00 71 Tim Gruver Plumbing 99.05 72 Weigle 8~ Associates, P.C. -reimbursement for postage, xerox copies, and long distance 25.00 telephone calls H-B7 32,070.88 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev-1962 EX+ (12-08) SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, 8~ LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Mellott, Dorothy H. 21-09-1146 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Century Link 20.62 2 Department of the Treasury - 2009 federal income tax 89,192.00 3 Guideposts 23.95 4 Meals on Wheels -November final billing 54.00 5 PA Department of Revenue - 4th quarter 2009 estimated income tax 160.00 6 U. S. Treasury - 4th quarter 2009 estimated income tax 930.00 7 Walter Drake -balance due on order at date of death 16.99 TOTAL (Also enter on Line 10, Recapitulation) I 90,397.56 (If more space is needed, additional pages of the same size) Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 12-08) LAST WILL AND TESTAMENT I, DOROTHY H. MELLOTT, of 206 Roxbury Road, Shippensburg, Cumberland County, Pennsylvania, being of sound mind, memory and disposition, do hereby make, publish and declare this my Last Will and Testament, hereby revoking and making void all wills by me at any time heretofore made. FIRST. I order and direct the payment of all my dust debts and funeral expenses as soon as maybe convenient after my decease. SECOND. I give and bequeath the full sum of TEN THOUSAND ($10,000.00) DOLLARS to my grandson, DENNIS W. CARL, on a per stirpes distribution basis. THIRD. I give and bequeath the full sum of TEN THOUSAND ($10,000.00) DOLLARS to my grandson, KEVIN L. CARL, on a per stirpes distribution basis. FOURTH. I give, devise and bequeath all the rest, residue and remainder of my estate, real, personal and mixed, whatsoever and wheresoever situate, to my daughter, JANE L. CARL. FIFTH. In the event my said daughter, JANE L. CARL, should predecease me or is not living on the thirtieth (30th) day following my death, I then give, devise and bequeath the rest and residue of my said estate, in equal shares, to my grandsons, DENNIS W. CARL and KEVIN L. CARL, on a per stirpes distribution basis. (SIXTH. I nominate, constitute and appoint my daughter, JANE L. CARL, to be the iExecutrix of this my Last Will and Testament; if she be unable to fulfill the duties ~~ ~` a.~..-re., ,~; #, :1-~• ~"1')~-~~-%~ (SEAL ) MARK, WEIGLE AND PERKINS - ATTORNEYS AT LAW - t 26 EAST KING STREET - SHIPPEN36URG, PA. 17237 of Executrix, I then nominate, constitute and appoint LESTER W. CARL to be the Executor of this my Last Will and Testament. In the further event that neither the said Jane L. Carl nor the said Lester W. Carl be able to fulfill the duties of Executor, I then nominate, constitute and appoint my grandsons, DENNIS W. CARL and KEVIN L. CARL, to be the Co-Executors of this my Last Will and Testament. SEVENTH. I direct that my personal representatives shall not be required to give bond for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I, DOROTHY H. MELLOTT, have hereunto set my hand and seal to this my Last Will and Testament, written on/J two pages, the first page signed for identification only, this ..day of ~~f-~/L- , 1991. ~~~t~~'' ~• ~r (SEAL) This instrument was by the Testatrix, DOROTHY H. MELLOTT, on the date hereof, signed, published and declared by her to be her Last Will and Testament, in our presence, who at her request and in her presence and in the presence of each other, we believing her to be of sound and disposing mind and memory, have hereunto subscribed our names as witnesses. r /, -2- MARK, WEIGLE AND PERKINS - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG, PA. 17257 COMMONWEALTH OF PENNSYLVANIA SS. COUNTY OF CUMBERLAND . I, DOROTHY H. MELLOTT, the Testatrix whose name is signed to the foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. Sworn or affirmed to and acknowledged Ibefore me by DOROTHY H. MELLOTT, the Testatrix, this ~'~ day of /?i;~. , 1991. ~~~ ~.~~. NOTARIAL SEAL Jerry A. Wei~ie, Notary Public Shippensburg, PA Cumberland County My Commission Expires ,luly 31,1994 MARK, WEIGLE AND PERKINS - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG, PA. 17257 COMMONWEALTH OF PENNSYLVANIA SS. COUNTY OF CUMBERLAND , We , (7~~CL,~P.C1~ y'7, C~'(~t.~ and Q-tt+~t ,~ '~ the witnesses whose names are signed to the foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw DOROTHY H. MELLOTT, Testatrix, sign and execute the instrument as her Last Will; that she signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the will as witnesses; and that to the best of our knowledge the Testatrix was at the time eighteen (18) or more years of age and of sound mind and under no constraint or undue influence. `'and ~'i y6~r/ Sworn or affi}~ before me by ~) and witnesses, this to ,Y~ day of ~~ 1991. ~ ~ r NOTARIAL SEAL Jerry A. Weigle, Notary Public Shippensbury, PA Cumberland Gaunty My Canmission Expires July 31, 1994 MARK, WEIGLE AND PERKINS - ATTORNEYS AT LAW - 7 26 EAST KING STREET - SHIPPENSBURG, PA. 7 7257 REV-dR7 EX + IS-85) Date of Entry Month ~ Day Year ENTRY INTO SAFE DEPOSIT BOX ~ COMMONWEALTH OF PENNSYLVANIA TO REMOVE A WILL OR DEPARTMENT OF REVENUE CEMETERY DEED POST OFFICE BOX 8327 HARRISBURG, PA 17105.8327 Please Print or Type MUST BE COMPLETED BY REPRESENTATIVE OF FINANCIAL INSTITUTION WHERE SAFE DEPOSIT BOX t5 LOCATED AND RETURNED TO ABOVE ADDRESS DECEDENT'S NAME (Last, First, Middle) SOCIAL SECURITY NUMBER DATE OF DEATH ADDRESS OF DECEDENT Street Address City State Zip Code ~~ h~n~s ~ r U ~P~1_nQ U~ ~a i~'I NAME AND ADDRESS Of PERSON REQUESTING THE OPENING OF THE SAFE DEPOSIT BOX Nome. ~ ,. ~a~r~ ~~ NAME AND ADDRESS OF FINANCIAL N me of Financial Institut n ~ ~ ~ ~~~ Street Address ~~ E ~` ~~- NUMBER OF SAFE DEPQS BOX ,~ 1,t ,~ '~ na` ~ WHERE THE SAFE DEPOSIT BOX IS LOCATED q< ~~'t ~ City t~~ TITLE OR NAME(S) UNDER WHICH 8 IS REGISTERED a ~ n ., ~ e n I WAS THERE A WILL IN THE BOX? f YES ^NO If yas a. Date of will: ~ ~, ~ ~~ 1~~ I ''' MoMA Day Ywr b. Name and address of personal representative(s), if nomad in the will: Na e a n r.~ ~.. ~(~ State Zip Code 0 Street Address ~ City State Zip Code ~~~~ ~ (~~-5 ~~I ~, ~I ~~.,~..~ _ vim- ~ ~ ~1 Nome Street Address City State Zip Code c. Name and address of attorney, if any: Name Street Address City State Zip Code Name Street Address City State Zip Code 1 certify under penalty of perjury that the above record is correct and complete to the best of my knowledge and belief. ~ n Sign fur t : j ~. ~ Date 1 1 (/-/J/y11/ 1 Print Name Title f T :~L" Page ~~_~~of ., ..SAFE ®EPOSIT BOX INVENTORY `-~"~~:~~-==~:~~- ~T~+ ND. iiF3N OES~.+tfFi10N .. ~ I i lio~.~ ~ ~f ale... E; e:-tific ~ ~~~t erne ( e csL, - -Fv - us I ~ y'1 i T Y'- ~ r .~ _ I Y e ~ 1-i~fi c. Y. rv~~ 110 -I~I- .... o 15 O C` 1 SCP v r~ C a~'cl f D,~ r(~ , {~'t e I~ O~``~" r ~ I ~ r+~ C~'y'~i~i c ~ r an ~~ I ..r. ~~'X.~. r ,rzn~ HiC:.1'. ~1'1~l }'}' C~.r ~ -.._ ~ - ~.~~- :~s r~ me ~ ~ 1 ,. _ I err-; ': ~,- . ~"c ~" . r . ti i - C (c~~e ~1 rA.. 1'~e.i I ~ ro~1 Naze i~ ~av I d c~i`.~-j S~ ~'. ~' U ~ iC:_o~-'t, ~ {' ~O+` a ~ met ~ ~"~ -. I ~~~ ~ i ~' ~~' J~`~'~ ,~rr~SS~ ~ ~~r I e~s~ - ~ {~~~ ~~ (`~ I ~ ~ ., . vc r 11 11~ S I - - ' I I miry under penal of perjury that the a ve re<ard is cnrr ar:d complete to the bet of my knowledge ~.n ~ P~ ~ ~ 1~ : ~,~c,~-t~~ ~-e.~~i .o (Z }-Cash: Report total only. - -_ (2) Stoclts~list in detail every common or preferred certinccte, werrent or other rights found in box. Stocks are to be ~bsigneted by name of campcny, certincafe number, dcte of cartincete, name is which stock is «gistered, cnd number of shams and.dass of:stoclc. (3} Obligatiorrs,of U. S. Gover:sman!: Number of items, dare of issue, fete value; names in which registered cnd type of ownership, i. e., jointly held, pcycble on deQtfi, etc. - (4} Bonds-_ .Designate byname, amount, saricl number, or other designation. (Bearer Bonds) (5) Bank and Savings arsd Loan Passbooks: State name of depositor, number of book, last dcte appearing in . book, ncme of bank and branch; and balances. (6} .Jewelry, Cairss, Staeaps, Manusozpts, etc: list and describe as fully cs possible. (7) Duds,, Mortgage3, -Current lnsvraace Policies or otfser evidences of iadebtedaass:.. List and describe as '. ~ ~ ' _ fully cs possible. - .. (8) Atl otfter carrtents. - ... .._ NOTE: Attach additioriai SYz 1 l" sheet(s) if necessary or use dupiicates of this page of torm_ v, i l ~; ti ~`, 0 0 0 N N N . r N (II C a 1 L Q. 0 ~AW`W`` ~+ / d U a iri .O C O m °~.' - - -- --- 0 Z ~ ~., 'i lll ~ W cp t0 f~ c0 c0 cD Cfl CO CO C0 CO C4 t0 CO CO CO C~ O tO (D CO CO Cfl ~0 00 CO t0 CO CO I~ I~ I~ t~ I~ t` I~ I~ I~ ~ ~a:' r o r o r o r o r o r 0 r 0 r 0 r 0 r 0 r 0 r 0 r 0 r 0 r 0 r 0 r 0 r 0 r 0 r 0 r 0 r 0 r 0 r 0 r 0 r 0 r 0 r 0 r 0 r 0 r" 0 r 0 r 0 r 0 r 0 !~ 0 r 0 r 0 ~~ N O N (D N (O N t0 N CO N tO N CO N CO N CO N t0 N C0 N (fl N Cfl N CO N CO N CO N C4 N CO N CO N CO N Cfl N tO N CO N aD N 00 N 0O N O~ N CO N aO N tt N ct N ~ N d' N ~ N 'V' N ' N ' N ' la C C 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 ~ 0 ~ 0 ~7 0 V W L ~- ~ o 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 0 0 Q~ ~ ~r ~M _~ r O N r O N r O N r O N r O N r O N r O N r O N r O N r O N r O N r O N r O N r O N r O N r O N r O N r O N r O N r O N r O N r O N T O N P O N P O N r O N r O N r O N r O N r O N P O N r O N r O N r O N r O N r O N T O N r O a+ tfl (p C0 C0 t0 (O CO CO 1 CO \ CO \ Cfl \ tO \ CO \ CO \ tO \ tO \ (O \ (O \ (O \ CO \ CO \ Cfl \ CO \ N \ N \ N \ N \ N \ N \ '~t \ '7 \ ~ \ tt ' ' N ~ 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 ~t 0 ~ 0 ~ 0 ~f 0 ~ 0 Z ~ 0 O 0 O 0 r' 0 c O 0 \ O 0 \ O 0 \ O 0 \ p 0 \ ~ 0 \ O 0 \ O 0 \ O 0 \ O 0 \ O 0 \ O 0 \ O 0 \ O 0 \ O 0 \ O 0 \ O 0 \ O 0 \ 40 0 \ dO 0 \ N 0 \ N 0 \ N 0 \ N 0 c N 0 \ N 0 c f~ 0 \ l~ 0 \ l~ 0 \ ~ 0 \ ~ 0 \ 0 \ 0 0 0 0 07 ~ ~1; O 'd; ~t ~ d; ~ ~ '~' ~ ~ ~t ~7 ~ ~ ~ ~f' V '~ d' ~ ~ tp tA tA ~ tn ~ O O O l O l O l~ O (~ O 1` O I~ O } to Ln In l1) In tp In It7 LA lp 1.f) L(~ lL~ l[~ Ln l(') t1') L(7 Lf) to In LA Lf~ In l(7 In tQ lf~ In lf~ i.n l[') to tf') In If') I.(') lA 0 0 0 0 0 0 0 0 0 c 0 \ 0 \ 0 \ 0 \ 0 \ o \ a \ o \ 0 \ 0 \ 0 \ 0 \ 0 \ 0 \ 0 \ 0 \ 0 \ 0 \ 0 \ 0 \ 0 \ 0 c 0 \ 0 \ 0 \ 0 \ 0 \ 0 o 0 mod,, 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 0 0 0 R 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 0 0 0 ~ ~Y' ~ ~t ~ V' ~1' ~t "d "~ d' ~ ~i' ~ ~ ~ ~t ~t d' ~ ~Y' ~' d' d' ~t ~ ~7 V' ~ "d' ~' ~P ~t ~t ~ rt V V r!' 0 00 0 oD 0 00 0 O 0 O 0 O 0 O 0 GO 0 00 0 00 0 00 0 a0 0 00 0 CO 0 GO 0 oD 0 00 0 Op 0 OD 0 c0 0 OD 0 aD 0 OD 0 O 0 O 0 O 0 O 0 O 0 O 0 00 0 OD 0 CO 0 d0 0 00 0 OD 0 QO 0 0p 0 a0 d N N O N N N N N N N N N N N N N N N N N N N N O D 0 0 0 0 0 0 ~t ~ F 0 0 0 0 0 0 0 0 0 3 ~ CD h CO 1~ ~ ~ OO f~ O~ I~ OO ~ OD ~ OD ti a0 ti 00 ti 00 ~ a0 ~ a0 ti dO ti 0D ~ OD ti CO ti DO ~ 00 ~ 0D ~ aD ti OD ~ OD ~ ~ ~ ~ ti ~t ~ ~1' ~ f~ O l~ O ~ tt7 `~t ~!')_ ~i O "~ ~ c!' tf) ~ t1~ ~f tn ~Y ~ tt ~[3 r yg r r r r r r r r r r r r r r T r r r r r r r r r r r r r r T r r r r r 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 0 0 0 .r+ ~ 00 d0 O O O O O O O O oD O O O O d0 00 OD 00 CO OD d0 00 O O O O O O OD 00 a0 00 OD 00 OD 0p 00 tl! d N N O N N N N N N N N N N N N N N (V N N N N N O D C O O ~ O D ~ ~ 0 0 0 0 0 0 0 0 0 i i d O N aO N ~i' O_ aD N 00 N 0~D N_ aO N CD N aO N_ aD N aO N aD N aO N OD N OD N a0 N 00 N oD N OD N OD N 00 N o~ N op N V' N ~ N <7 N ~ N N CO N c0 ~!' 0 ~ 0 ~t 0 ~ 0 'd' 0 d' 0 ~ 0 ~f 0 V 0 ~ r r r r r r r P r r P r r r r T r r P r r' r r r r r r T r r r r r r r r ~ Q u 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O y 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 0 0 0 V •L 0 ~ 0 IA 0 to 0 lq 0 t!7 0 tf~ 0 to 0 tp 0 In 0 Ln 0 i.[) 0 In 0 i,() 0 Ln 0 l1~ 0 lL') 0 In 0 LL7 0 In 0 In 0 Lt7 0 LA 0 In 0 Ln 0 t.[) 0 t[') 0 i.(7 to N X N 0 lC') 0 ISM 0 lf) 0 Ln 0 In 0 Ln 0 In 0 to 0 6C) a d m cfl O co O ti CO m vD co o0 co a0 co d0 co CO co CO m DO co a0 cfl oD co CO m Op co d0 co Op co 00 cfl CO co d0 m OD c~ 00 co 00 c~ d0 c~ 00 co 00 c~ 00 m CO m OD co 00 ~ CD ~ OD ~ 00 ti Op ti 00 ~ 00 ~ a0 ti 00 ~ 0p 7 ~+ N ~ 0 r 0 r 0 r 0 r 0 r 0 r 0 r 0 r 0 r 0 r 0 r 0 r 0 r 0 r 0 r 0 r 0 r 0 r 0 r 0 r 0 r 0 r 0 r 0 r 0 r 0 r 0 r 0 r CA r 0 r 0 r 0 r 0 r 0 r 0 r 0 r 0 r 0 r N~ C~O C~O f~D Cfl C~O (~O C~O ~ C~D (~O C~O Cfl (~D C~O C~O Cfl <fl (~O C~O C~O C~O C~O (~D © ~ G~O O~D O~O O~D t ~V ~ d~' ~ d~' ~ ~ ~ 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 0 0 0 d .~ W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W ~ W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W ~ Z N tp M ~ ~I' to CO t0 (+ u7 00 ~ O ~ O cfl r c0 N t0 Ch c0 ~ c0 lA cfl C0 t0 1~ c0 0~ c0 O c0 O I~ r I~ N ~ M ti ch ti in ti M O Ci' O tA GO G~ ao (p N 1~, N M ~ ~' ~ U~ ~ Cp ~ l~ t(') d0 O O ~ O O r O r ~ r '~ r ~ P ~ r ~ r ~ r ~ T ~ r ~ . ra. V r 'a' r V T ~ r ~ . ra. V r ~t ~- ~F r ~C . r+ V r ~ r ~ r ~ r ~C 00 ~ OO ~Cl Op ~ ~ ln (fl r ~ r r CO r CO r .V r CD r (fl r CO r CO r CO r (O ~ CO ~ (O ~n C0 ~n (O ~n CO ~n CO ~n CO -n CO u~ CO ~n CO ~n <O ~n Cfl ~ (fl in CD ~n CO ~n CO in tO ~n Cfl ~n Cfl ~ CO ~ tO u~ CO u~ tO u~ N ~ N r~ N ~ N r p ~, O ~, O ao O ao O co O ao O ao O co O 0o O m O ao d v v v v v v ~r v ~ v ~ v ~r v v v v ~r ~t v ~t v v ~n ~n ~ ~n r r o o o o o 0 0 0 0 (n r r r r r r r r r r r r r r r r r r r r r r r r r r r r ~- N N N N N N N N N ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ D ~ ~ ~ ~ ~ ~ ~ ~ ~ O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O I O 0 0 0 0 0 0 0 0 0 O O O O O O O O O O O O O O 0 O 0 O 0 O 0_ O 0 O 0_ O 0_ O 0_ O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O O O tf') O tt~ O O O O O O O O O O O O O O O O O O I 0 r r r r r I r r r r r r r r r r r r r r r r r r r r _ r r r _ r i _ r i _ r T r r _ r _ r N • ~ W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W ~ W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W Z r N M 'd' ~ CO I~ o0 O O r N M ~ tc> CO I~ a~ O O r N M ~ In (p I~ o0 O O r N M ~ tn (O I~ O r r r r r r r r r r N N N N N N N N N N M M M M M M M M 0 o 0 N N r en ~ ~ a ~ I~ 1i M m 0 N rn cts a m M Z N C MO W n ~' v (n J ~ o ~ ~J 1~ rpm i y c a~ E U O O (0 .c .~ Q a~ 2 N 0 rrN^ V! C c m U O O U O /~ OL i^,i +, ~AA`` }~ W \~ rn~ oa oa N ~ ~ N N r- N . T TTN aV N (II a ~ C ~L as m iri C O m .. 0 Z A w ~ L 3 1` f~ I~ I~ t~ I~ I~ f~ 1~ 1~ f~ 1~ I~ 1~ 1~ l~ 1~ 1~ 1~ 1~ l` O M O O O M O O M M O O O O M O O i+ ~ (Q w T 0 T 0 T 0 T 0 T 0 t~ 0 T 0 T 0 T 0 T 0 r" 0 T 0 T 0 T 0 T 0 T 0 r 0 !~ 0 T 0 T 0 \"~ 0 t~ 0 T 0 T 0 T 0 T 0 T 0 T 0 r 0 T 0 T 0 [~ 0 T 0 T 0 T 0 T 0 T 0 T 0 ~ N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N ~t '~7 ~ '~ ~i' V V ~ ~' ~ ~ ~7' ~t ~Y' d' ~f ~1' ~ V V ~ N N N N N N N N N N N N N N N N N lC O O O O O O O O O O O O O O O O O O O O O r r r ~-- ~- T T Y-- e- r r ~- T T T T r G o o o o o a o o o o o 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 +~' i+ C~ 0 T 0 r' 0 T 0 T 0 l~ 0 !~ 0 T 0 T 0 T 0 T 0 T 0 T 0 T 0 T 0 T 0 T 0 T 0 T 0 l~ 0 T 0 T 0 T 0 T 0 T 0 T 0 T 0 T 0 \"~ 0 [~ 0 T 0 r, 0 T 0 T 0 r 0 r 0 T 0 T 0 = R N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N dd ~ V V ~ ~ V ~ V V ~ ~ V V ~ V V ~ V V ~ V ~ W W W VJ W W VJ W YJ W W V./ ~1! t1! W W W ~ 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 0 0 0 Z O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O O d O O O O O O O O O O O O O O O O O O O O O r s- ~- ~- e- r r T e- r r T e- r- e- s- t- ~. tL) tL~ t17 l(~ to l(~ In In Ln In l!) lS') to lA lf') In (!~ In to l17 tf~ to LLB l(7 Ln Ifs lI~ l!7 to lL') In t(') ~ L17 Ln lf) In tl~ 0 0 0 0 0 0 0 c 0 \ 0 \ 0 \ 0 c 0 \ 0 \ 0 \ 0 \ 0 \ 0 \ 0 0 0 0 0 0 0 0 0 \ 0 \ 0 \ 0 c 0 \ 0 \ 0 o 0 o 0 0 0 0 0 0 0 0 0 ,M 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 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 0 0 0 0 0 0 ~ ii' ~f ~ ~i' tt a d' ~ ~1' ~t ~f' ~1' ~i' ~T ~ ~ ~ d' d' ~t d' ~t d" ~7 ~f V' d' ~' d' ~t ~t et ~t ~t ~t ~t V et' 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 0 0 0 O O M O M O O O O M M M O 0 0 0 0 O M O M 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 d 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 N N N ' N N N N N N ' N N N N N N N N ~ d' ti' ~ sl' ~ ~' ~t ~t `ct ~ ~ d' d' d' C ~t ~t d' ' d' ' d' ' ~Y ' M tn u ~ tn tn O O tn tc ) 0 0 -n tn tn O M tn to Ln L[) lI~ lp lA L!') Ln Ln L() lfy t.p lA tp ltd l1~ In l( ) l[ ) ~.! ) l1 ) ~J' ~1' ~f V' ~' '~Y' t1' ~' '~ ~ ~' ~' ~' ~ ~' ~ ~ T r' r r' T T T T !~ r T t"' T T T T T r T r T T T T T T T T T r r T r' T t"' T _ r _ T (~ 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 0 0 0 w+ ~ M M M M M M M M M M M M M M M M M M M M M 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 f/1 d O O O O O O O O O O O O O O O O O O O O O N N N N N N N N N N N N N N N N N i L ~ t}' ~ ~' ~ ~ ~' ~ ~ ~ d' ~' ~ ~ d' ~ d' ~ ~ ~' ~ ~ In lf~ L(~ t(') to to In L() (17 ll') In to In L(') l(~ L(~ ~ y 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 0 0 0 w~ Q r r T {~ T T T T T T \"' T r' T T T r !~ T T T ~~ 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 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 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 0 0 0 0 0 0 0 0 0 V 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 0 0 0 a ~ r~ ~ ~ ti r•. ti ti r~ ti ti ~ ~ r~ ~ ti ti r~ r. ~ r~ ti M OO M M M M M M M M M M ao oo M OO M N d O O M O M O 0 0 M O 0 0 0 0 0 0 M O 0 0 0 0 0 0 0 0 0 0 M O O M 0 0 0 0 0 0 7 ++ 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 0 0 0 qJ lQ NO e- ~ [~ ~ T ~ T Q~' T ~ T V T dam' [~ V T ~ T ~ r d~ T ~ r V~' r Q~' l~ Q1' T ~ T ~ r ~ r ~ r d~' !~ ~ r" N r N T N r N T N T N T N r N T N \"' N r N T N e- N T N T N T N r N O O O O O O O O O O O O O O O O O O O O O T r r r r ~- r T T T ~- r r r ~- ~- ~- V ~ w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w ~ w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w ' w w w w w w W w ~ N c0 M c0 V CO O (O CO CO f~ CO M UJ 0 CD 0 I~ ~- I~ N 1~ M 1~ ~d' t~ O 1~ Cp 1~ 1~ I~ M l~ 0 t~- 0 M r OO N M O N M 'a' 0 ~ 0 tn e- ~n N ~n M ~n ~ ~n t[ ) t~ tO ~n f~ tn 0 ~c') 0 tn 0 tp ~- Cp N 00 M 00 Z T r r r T T r !- ~- r r r r r r r r [- r r r r ti ti ti ti ~ I` ti ti ti ti ti ti ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~o ~o ~ ~o ~ ~ ~ ~ ~ ~ ~o ~o ~o ~o ~o M M M M M M M M M M M M M M M M i C p a 0 o 0 0 0 0 0 0 0 0 M O 0 0 M M O 0 0 M O 0 0 0 N 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 m o 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 o o o oo ti ti r~ ti r~ r~ ti ti r~ r- r~ r. r~ ~ ~ ti fn N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 2 ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ r2 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O I 0 O 0 O 0 O 0 O 0 O ~ O O T O T O_ T O_ T O_ l~ O T O_ T O_ T O T O T O_ T O_ T O_ T~ O_ T O_ T O_ T O_ T O T O_ \"~ O_ T O_ {"~ O_ T O_ S~ O T O f O_ r' O {~ O_ \"' O_ T O_ T O T O_ T O T O_ T O_ T O Z' O_ T O_I [~ d w w w w w w w w w w w w w w w w w w w w w w cu w w w w w .w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w w C 0 M 0 ~ T c1' N V M V' V' V' 0 ~' C0 ~2' 1~ ~Y 0 ~I' 0 V' 0 tn r tn N tC) M t[) ~ tn tf) t(7 Cp O f~ tl~ oD tp 0 tn 0 tO T Cfl N CO M (D ~i' CD t1~ CO fD CD I~ (O M t0 0 c0 0 l~ T ti N ti M ti ~ ~ ~ ~ CD ~ Z cp 0 N N rn d rmr^ VJ M Z C 0 m t~ VJ O V ~ LT' '~ c a~ U O 0 L _0 L _~ .C .a a~ a S 0 C r~ VJ c a~ U O U O O ~^' W O ~„+ ~ d U ~a ~~ a~' ~,+ y '~ W ~ y ~ ~~ ~ ~ v~~ ,~ .~ , O O N N N •-- ~ O ~. - - - - - ~ _ _ ___ -- - _ _ .._. _ _ l v I .~ I~ N Z -x ~ ~ « ~ ~ a N ~ r +r 'i ~ ~ ~ ++ R +~+ CO r O O O r O O O r O O D r O C O r O O D r O O D r O O O r O O D r O CO r O GO r O t O r O a D r O d7 r O 0 r O 0 r O 0 r O 0 r O 0 r O 0 N 0 N 0 N 0 N 0 N 0 N d' N 0 r 0 r 0 r 0 r 0 r 0 r 0 r 0 r 0 r 0 r 0 r 0 r D ~ R N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N N O N O N O N O N O N O N O N O N O N O N O N O N O N O N O N O N O N O N O N C !0 = r r r r r r r r r r r r N r ~ O ~ O ~ O ~ O ~ O ~ O ~p O ~p O ~p O Cfl O (O O CO O N r r O M O M O M 0 M O M O M O M M ~ ~ ~ U ~L LL O O O O O a ~ ~ ~ d ~ '" ++ o r O 0 r O 0 r O 0 r O 0 r O 0 r O 0 r O 0 r O 0 r 0 r 0 r 0 r 0 r 0 r 0 r 0 r 0 r 0 r 0 r 0 r 0 r 0 r 0 r 0 r 0 r 0 r 0 r 0 r 0 r 0 r 0 r 0 0 0 0 0 0 0 _~ N N N N N N N N O N O N O N O N O N O N O N O N O N O N O N O N O N O N O N O N O N O N O N O N O N O N O N r O N r O N r O N r O N r O r O r O ++ ~ CO 0 CO 0 CO 0 (9 0 CO 0 CO 0 C4 0 CO 0 Cfl 0 CO 0 CO 0 CO 0 CO 0 d" 0 ~t' 0 V 0 '~ 0 d" 0 V 0 (D 0 (O 0 (O 0 CO 0 CO 0 CO Cfl e- CO C7 M C'') M ('7 M C7 N ~ N ~ N ~' Z 0 0 0 0 0 0 0 0 0 0 0 0 0 0 .a \ 0 '~T \ 0 ~ \ 0 'V' \ 0 ~ \ 0 Q' \ 0 d" \ 0 ct \ 0 ~t \ 0 ~T' \ 0 ~ \ 0 V \ 0 ~ \ 0 \ 0 ~ \ 0 ~ \ 0 \ 0 \ 0 \ 0 \ 0 \ 0 \ 0 \ 0 \ 0 \ 0 \ 0 \ 0 \ 0 \ 0 \ 0 \ 0 \ 0 ~ ~ ~ ~ \° \° d } r ~ r ~ r ~ r ~ r tn r ~fA r ln r tC) r Ln r t1~ r t1') r u7 V r tcn f r ~ l - r tn I~ r tn (~ r ~ f~ r tt~ I~ r tA M N ~Cj M N LCj M N tn M N t!') ('r1 N ~ M N A 1~ O ~i' O tl~ ~ tt~ ~ tt) ~ tA ~ ~ ~ ln ~ tn ~ 4~ ~ ln .a. tn ~ tt~ ~ t ~t (0 C4 00 00 C0 (O CO CO CO (O CO (D 0 0 0 o 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 .4+ 0 0 0 \ 0 \ 0 \ 0 \ 0 c 0 \ 0 \ 0 \ 0 \ 0 c 0 \ 0 \ 0 \ \ c \ \ 0 \ 0 \ 0 \ 0 \ 0 \ 0 \ 0 \ 0 \ 0 \ 0 c 0 \ 0 o 0 \ 0 \ 0 c 0 0 0 ~p 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 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 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 0 0 0 0 0 0 0 t(~ 0 0 0 0 0 0 0 0 0 0 0 m N ~ ~ N ~ NN ~~ N ~ N ~ N ~ N O N ~ N ~ N I.C) N ln N ln a0 r 00 r C~D r Op r Op `"" Op 'r O ~ O ~ O ''~t O ~Y O ! O ' 0 N 1 aD to N 0 ~ 0 tL) 0 ~ 0 u'j 0 iCj 0 ttj 0 tCj 0 ~'j 0 t~j 0 ~j ~ ' ~ ~ ' ~ ~ ~ d ' ~ ' ~ ~ ~ V r r r r r r Cp_ ap pp pp ~ pp ~ pp ~ r O r (p r N M N M N M N M N t'7 N M N M N M N M N M > r r r r r r r r r r r r r ti ti ti ~ h , ~ ~ ~ ~ ~ ~ _ ~ _ ~ w .^a 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 0 0 0 0 0 0 0 0 0 0 0 0 0 N d d Y L N ~ N ~ N ~ N ~ N ~ N ~ N ~ N ~ N ~ N In N to N l(~ N I(') OD r OO Op Op Op ap O O O ' O O O O O N ti O ~ I~ 0 If') 0 tCj 0 tfj 0 ~(j 0 t~j 0 i,~j 0 ~j 0 ~j 0 ~j 0 ~j L d d O O W O W O O O p O O O O O r (O r <O r CO r (O r CO ~ M ~h M tY M ~ M '~7 M V M ~ r tO M I~ f` I~ I~ I~ I~ 1~. 1` I~ I~ ~ 0 ~ ~ ~!' d' 7 ~ ~' ~t ~t rt t1' ~ '[t 'd' r N N N N N N N N N N 0 0 a 0 0 o 0 0 o 0 0 o 0 0 o 0 0 o 0 0 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O o O o O o O o O ~n r~ o o o o o o o o o o 0 0 0 0 0 0 0 0 0 0 0 0 V O O O O O O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O ~ ~ 0 0 0 0 0 0 0 0 0 0~ •L n ~ i.f) to t[) ~ tt~ L[~ t() ~ O to to ~ tf) 1.() ~ tp tt~ ~ ~ t() 1.[) In In l() O r (y to ~ ~ ~ ~ ~ ~ ~ ~ ~ - N N N N N N N N N N N N ~ ~ G1 y O ao O ao O ao O ao O 07 M co M 0o O ao O ao O 0o M ap O co 0 a~ 0 ao 0 00 0 ao 0 ao 0 ao 0 ao 0 p 0 O 0 O 0 0 0 ~ 0 0 0 0 0 0 0 0 0 0 0 0 ~ ..r N ~ O r O r O r O r O r O r p r O r O r p r 0 r 0 r O r O r O r p r O O p p O 0 O 0 O p O 0 O 0 OD 0 ao 0 O 0 ap p ao O ao p ao 67 op O oo O ao O co p oD 0 N Q \ N r \ N r \ N r \ N r \ N ~' \ N - \ N \ N \ N \ N \ N \ N \ N \ cr \ ~' \ ~ r \ ~ r \ ~' r \ ~ r \ O r \ O r \ Cfl r \ Cfl T \ CO r \ CO r \ N r \ r r \ (h r \ M r \ M r \ M r \ M r \ M r \ M r \ M r \ r \ r \ ~ r r r r ~--~ r r 0 0 0 0 0 0 0 0 0 0 0 0 r 0 0 0 0 0 0 0 0 0 cr 0 ~ 0 ~ 0 L ~ W W W W Lt1 W W W W W W W W W ~ W ' W W W W W W W W W W W W W W W W W W W W W W W W W ' O Z ~7 CO ~ CO CO f0 t~ CO 00 (O p CO O I~ r I~ N I~ M ti ~}' ti tn ti (p ti W (O W I~- W W W O W O W W W W W W ' W W d ~ ~ j j W W W W W W W W W W W ti OO ti OO ti OD t~ aD ~ O~ r~ 00 ' ^ CO ~ 0D ~ d0 ti 00 ~ C0 ~ 40 ~ 00 rn ~ rn lf) rn lnt rn C) o CO r o tO O v r v N v M v ~i ~t Lp v Cfl o N o O ~ W ~t W M W N W r t W (~ W ti W (p W ~ W ~p W ~ ~ y, tl~ p~ tn 0 ~ 0 tA p tt) O tf ) O tn p tn O ln 0 tn 0 ~ 0 tn 0 tn 0 M O M O M C O 7 M Ch N N N N N N N N N N N N O f~ CO M N pp p 0 O 0 O 0 O) 0 O 0 p 0 O 0 O r O r O r 41 (n f~ N l~ N f~ N i~ N l~ N f~ N (~ N f~. N 1~. N t~ N 1~ N (~ N ti N ~ ~ ~ O ~ O ~ O ~ O ~ O ~ O ~ O ~ tO ~ C4 ~ 0) ~ O ~ ~ N ~ N ~ N N N N N N N N ~ ~ ~ ~ ~ ~ ~ ~ ~ 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O ~ N 0 t1) 0 0 0 0 0 0 0 0 0 0 O O O O O O O O O 0 O~ O O O O OI O O 0 O O 0 O O O O O 0 r 0 r 0 0 l 0 0 0 0 0 0 ~ Q r ~ r r r r r r r r r _ r r r Lf') lf') I t(y L n I!) lf) l7 ~, {) lf) to In ~J O r r r r r r r r r N ~ ~~ W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W W O f Z i ~ ~l C0 ` I 0> ~ O CO r aD NI OOC "7 O ~1'l CO (~C O0 OI 0pC ~ O OJ O~ O Cp O O r p) NM pp ~ ~I p~ nt p OI pO ~ 00 p O p O O r O N O M O ~1'I O f~ O COI 0O ~ 00O OO 0 r r r N r M r ~ r r r ~ r r r r r r r r r r r r [B .~ a t!i C MO W .~ L ` O ^ A is iA,i O W/~/ C LL ~ ~ ~ N v •,,/ . y H~ ~'~ ~~ ~~ ~ ti ~ T, ,-,- ~' ~~ v _ 0 0 N O N N ~-- o ~ ~ . - - -- - -- N . Z N A r w, 'i ~ ~ ~ ~ ~ +~+ O T O O r O O r O O `_ O O r O O r O O `- O O r O O r O O~ r' O (4 r O CD r O (O r O CO "r O O r O O r O O r O O r O O r O r N O r N O r N O r N ~- N ~- N r N r N r N r N r N r N r. N r N r N N N N N N N N N ~ ~ ~ N '7 N t7' N V N ~' N tA N tc~ N ~ N ti~ N u~ N tl7 N N ' ' N N N N N N N N N N O N O N O N O N O N O N O N O N O N O N O N O N O N O N O N O N ~ O O O O O O O O O O t0 O ~Y O ~t O ~ O T r T r T r e- T e- T I~ O I~ O GO O O0 0 0 0 p O~ T r T r r- r- V ~ V '~7 C ~ O O O O O O r T r ~-- r- x- 0 0 0 0 U L tL W N ~ 1 i m d 0 r 0 r 0 r 0 r 0 0 \"' r 0 r 0 r 0 r 0 r 0 r 0 r 0 !~ 0 r 0 r 0 r 0 r 0 r 0 r 0 0 0 0 0 0 O O O O O O O O O O O O O "'' ++ _~ 0 N 0 N 0 N 0 N 0 0 N N 0 N 0 N 0 N 0 N 0 N 0 N 0 N 0 0 0 0 0 0 r 0 r 0 r 0 r 0 r 0 \"' 0 ~' 0 r 0 r 0 r 0 ~"' 0 f 0 r 0 T 0 t~ 0 r 0 T 0 r 0 T 0 w~ '~7' ~ d' rt tD~ u~ tfJ ~ t1~ (O V ~ N ~i' N tA N l(~ N ln N l N N N N N N M N N N N N N N N N N N N N N ~ 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 n 0 Ln 0 r 0 T 0 N 0 N 0 0 M 0 M 0 M 0 M 0 In 0 lf~ 0 tn 0 ~ 0 ~ 0 tn 0 d" 0 ct 0 tt 0 ~t 0 Z „a 0 \ 0 0 0 0 0 0 0 0 0 0 Gi l[7 ~ ~ '~ to '~ t(~ ~ 00 '~f QO ~ dD V 00 st 00 V O ~ Op ~t } CO CO CO (O (D CO CO (fl t0 C~ In 0 o 0 o o 0 \ o 0 \ o 0 \ o 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 \ o 0 \ 0 \ 0 \ 0 \ 0 \ 0 \ 0 \ 0 \ 0 \ 0 \ 0 \ 0 \ 0 \ 0 \ 0 \ 0 c 0 0 0 R o o o o o 0 o o o o o u~ ~ ~ ~ u~ ~ ~n ~n o o o o o o o o a o o 0 o 0 o 0 o 0 o 0 0 0 0 0 0 0 0 0 / y ii ~ ~ a. V ~ . a V . a. V a ~. V ~ y V . rt V ~ . a. V a rt V T r ~"" r T r T r ~' ~ ~ . a. V ~ ~ ~ + V Q~ ~C .0+ V .0rt V .0a. V .0a. V .0i. V ,0y V a0.~. V ~0y. V 0 ~ a0t. V ~ O O O O O O O O V N ~ N ~}' N ~ N ~' N ~' N 0 QO 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 0 0 0 0 0 0 0 0 0 0i G1 ~ ~ N ~ N ~ N ~ N M N O N p N O N O N QO N N O 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ~ M M M M M M th M M l~ ~ tn lp 0_ O_ 0 0_ L~ 0 0 0 0_ 0 0 0 O ~ O 0 0 0 0 0 O 0 tp 0 0 0 0 0 0 0 O - r r r r r r r r r r r _ r _ r _ r r r _ r _ r r r _ r _ ~"' ~r 'a O O O O O O O O ~i' N ~t N ~ N rt' N d N "~t N O aO M ~ M ~ M Cp Cp (p Q p pp pp pp p ~ N N N N CO ~t d' V t{ op 0 0 0 0' N d d L t(7 ti ~ ~ tt~ ti to ti 00 ~ 00 ti oD ti 00 ~ OD ti 00 ~ N O O O ~ O r O r Oi r O r O tO O CO '7' (O ~ O M O M Cfl ~ (O er (fl '~t (O d' M I~ tn ~!' t1') V tn ~' In c1' ll~ r1' N N CO M t0 M 00 M C0 h ~~ ~+ N ~ N N N N N N N N N N _ ~` M ^' M ~ M ~ o0 ti 0p ti aO ti C0 ~"~ ~1' ~ 1` t !) I~ M CO <'' ~ OO ti OD ti OD I~ CO 1~ OO M ~ 0 O 0 O 0 O O O O O u ~ M CO M M t . M - ~ = r ~ OO OO OO ~ Q _ V O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 p 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O O O O O O O O O d V 0 ~ 0 ~ 0 ~ 0 ~ 0 l [~ 0 l f ~ 0 ~ 0 l n 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ~wL. 6F? O ~ O ~ O O O O t1) 0 0 0 0 0 0 0 0 ~ O 0 O 0 O 0 O 0 O 0 tf~ 0 0 0 0 0 0 0 0 5 ii \"' r T r r r r r r r r r r r r r T r r r r S ~ d 0 p 0 p 0 p 0 O 0 O 0 p 0 p 0 O 0 O 0 p CO p (Q 0 t0 0 (O 0 Op 0 00 0 00 0 CO 0 Op 0 ~- 0 ~--. 0 r 0 ~- 0 r 0 r 0 T 0 r T T r T T T T N N N N ~ °'' qJ !a 0 r \ 0 r 0 r 0 r 0 r 0 r 0 r 0 ~--' 0 r 0 r 0 r-- O) r O e- O r O1 r 0 r 0 r 0 r 0 r 0 N 0 N 0 N 0 N 0 N 0 N 0 N 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 N 0 O \ O \ O \ O \ O t O \ \ \ \ \ \ \ \ \_ \ \ 1 \_ \ \ \ \ \ \ \ N \ N \ N \ N \ N \_ N \ N \ N \ N \ N \ N \ N O O O O O O O O ~-- r ~- r ~-- O O O O O O O O O r r r r ~- ~- O O O O L .a ~ W W W W W W W W W W W 2 2 = _ 2 2 = = 2 2 2 2 2 2 2 2 2 2 = 2 2 2 2 2 = 2 2 ~ Z W 00 W W W W W W W W W r 0 O 2 O = O 2 .- 2 Q' 2 lA = t0 _ I~ = Cp 2 N 2 e- 2 Cfl = tn 2 M 2 ~t' = ~ _ CO 2 (p 2 OD 2 O 2 O 2 r 2 N 2 ~+ry 2 f~ 2 (pt 2 n 2 ~1' ~ O - O O O r N r (fl r I~ r O r 07 r O N N N r ~' 'ct N Ln N ~ N N M N M N M N M (V ~ t0 O (fl O O ll7 O t[') ~ 00 ~ 0D ~ Cp ~ ap ~. ~p ~ pp ~ pp O pp (fl dp t~ pp ~ 0 N 0 N 0 N 0 N 0 ~L as ~ N ~ r N tf) r N -n r N ~ r N p r N ~ r N ~ r N i!") ~- N ~ r N ~A (4 ~ d' 0~ 0 O 00 0 O 0p 0 O N `7 rn N d' O N ~i' 0 N ~ 0 (V ~ ap M M O M M O 'cp r r- ~I' r T ~- 0 ~- ~-- 0 r r 0 T r- 0 0 ~ ~ N ~ N ~' N ~I' N V' N (p ~ r M r ~i r O r O W c0 c0 C0 CO Cfl tO CO Cfl Cfl CO T '~' ct rl' (O tO C4 tO ~ o0 a0 a0 o0 a0 o0 00 T G0 ~ a~ a0 C0 o0 GD c ~c ~ U U U U U U C~ U U U ~ o O O ~ ~ ~ ~ o g ~ ~ ~ g g ~ g p g g g g ~ p p 00 ~ oD ~ O0G ~ 0 ~ ~ 0 o 0 o 0 o 0 o 0 o 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ~ ~ r r r e- r e- r r r O_ l[ ~ U 3 ~ O_ O_ O O_ t L ~ O_ O O_ O_ O_ O_ O O t n O_ O_ I O 0 O 0 O 0 ~ 0 O 0 O 0 O 0 O I 0 r r r ~ r r r r r r r r r r T T r r _ r r _ r _ r _ r N W W W W W W W W W W W 2 2 2 2 2 2 2 2 = 2 2 2 2 = 2 2 2 2 % 2 2 2 = 2 2 2 2 ~ LL! W W W W W W W W W W 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 0 Z ~t r O r ~ r CO r ~ T O N r r N r N N r M N r ~i' N r ~t N r D1 N r ~O N r { D N "' O N r O M r r M r N M r M M r c1't M r t~C M OI M ~ M 00 M 0 M 0 ~t r ~f' N V' M ct' ~t ~ [>C tt Ot ~ ~ ~ OD ~ O ~. O ~ r ~ N ~ T r r r r r r r r r r r r r r r r r ~i (Q C ~L a iri C m 0 ~' N O f0 a O~ ~ ~~ \ m ``~^ VJ n ti ~ ~ ~ C c~ C U O a O ++ L .C .~ ^Q I..L' rn c '~ VJ N c a~ U O p U ! ~ ~? ~r~~~ L O ~~ W O N 0 ~ i+ N d U rn 0 0 N N N r rn o y -- - -- - 0 N . Z . 0 r `+ i ,~ ~ ~ +~ ~ ~+. N N •o N N o N N o N N o N N o N N 0 N N 0 N N 0 N N 0 N N 0 M N 0 M N 0 M N 0 M N 0 M N 0 M N 0 M N M N M N M N M N M N M N M N M N M N M N M N ~' N ~ N ~ N ~ N ~ N ~ N ~ N ~. N ~. N ~ ~ '~ ~ N ~ N 1' 1~ N 1~ N i~ N t0 N a0 N 0 N N N N N N N N N 0 N 0 N 0 N 0 N 0 N 0 N 0 N 0 N 0 N 0 N 0 N 0 N 0 N 0 N 0 N 0 N 0 N 0 N 0 N 0 N 0 N N 0 N C ~ C O O O O O O 0 O a0 O r r r r N O N 0 N 0 N 0 N 0 ~ 0 ~ 0 CO 0 (O 0 (O 0 C~ 0 (p 0 O 0 O 0 O 0 N r N r N r ~ 0 tr 0 ~ 0 ~ 0 'cr 0 CO 0 f~ 0 f~ 0 I~ 0 f~ 0 U ~L LL a y ~ ~ "'' ++ o r 0 0 r 0 0 r 0 0 r 0 0 r 0 0 r 0 0 r 0 0 r 0 r 0 r 0 r 0 r 0 r 0 r 0 r 0 r 0 r 0 r 0 r 0 r 0 r 0 r 0 r 0 r 0 r 0 r 0 r 0 r 0 r 0 r 0 0 0 0 0 0 0 0 = Q N N N N N N N 0 N 0 N 0 N 0 N 0 N 0 N 0 N 0 N 0 N 0 N 0 N 0 N 0 N 0 N 0 N 0 N 0 N 0 N 0 N 0 N 0 N 0 0 r 0 r 0 r 0 r 0 r 0 r 0 r 0 r 0 ~ 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 O O O O O O O O O O O O N p N 0 N 0 N 0 N 0 N 0 N 0 N 0 N 0 N 0 Z 'a d } ad+ 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 \ 0 \ 0 \ 0 \ 0 \ 0 \ 0 \ 0 \ 0 \ 0 \ 0 \ 0 \ 0 \ 0 \ 0 \ 0 \ 0 \ 0 \ 0 \ lQ O ~ O ~ O ~ O d' O ~ O ~ O ~ O ' V O ~ O ~ ~ r O r tn r tn r tl~ r 0 ll~ 0 t(y 0 t~ 0 ~ 0 ~ 0 ~ 0 i,{ 0 ~O 0 ~ 0 ~ 0 ~ 0 ~ 0 ~ 0 ~ 0 ~ 0 ~ 0 ~ 0 ~ 0 ~ 0 ~ 0 ~ 0 ~ 0 ~ r r r r r r r r r r r r r r r r r r r r r r r 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 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 0 0 0 0 0 0 0 m ~ ~ 0 O 0 0 t1) 0 0 O 0 0 _O_ 0 0 O 0 0 O 0 0 O 0 0 t[ 0 0 >O 0 0 O 0 0 O 0 0 O 0 0 O 0 0 O 0 0 t[ 0 0 >tf~ 0 0 O 0 0 tl7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 O 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 > ~ l~7 In tL7 _ r r r r _ r r r ((~ ~ _ r r r r r _ r O l[7 O l(7 O r _O r _O r _O ((~ _O ~ _O (~ O ~('~ _O ~ _O r O r _O r _O r _ r' ~--~ ++'O N i O O OO r M CD O r M O r r ~ O r O r ~ 0 O 0 O O OO V Cp ~ (fl ~ O M ~ N tp N p ~t N f~ ~ ~ ~ ~ N d: N '~t ~fi V `ct V. O N r O O N O N s~ O N (O O CO O CO O Cfl O ~ (fl r (p r ~p r p r r i L ~~ CO ~- N d' CO N C7 (O N O M r (O N OD Cfl N 00 M r ~ O In 00 O ln 00 CO 0 0~ Cfl O C0 Cfl 0 40 N M O C7 O V ~f r ~h N ~ r ~ p M r p 1~ r p~ f~ e- p I~ r p 1~ ln M OD lA M OD l` i~ r O N r ~t N 00 ~}' N 0D V Cp 00 ~ N M C N M V' N M d' N I~ 1~ (O Cp (D Cp CO (p (D (p ~ h' V M 00 00 00 QO OD r 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 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 0 0 0 0 0 0 d V •L 0 O 0 0 ~7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ~7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 to 0 0 O 0 0 O 0 0 l17 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 0 0 0 0 0 0 0 0 0 0 0 0 0 ~y ~ t~7 l!7 In r r r r r r r ~,(~ ~ r r r r r r lf7 0 l(7 0 r 0 r 0 r 0 t17 0 to 0 In 0 ~('~ 0 ~('~ 0 r 0 r 0 r 0 r r a d d N 0 N 0 N 0 N 0 N 0 N 0 N 0 N 0 N 0 N 0 M 0 M 0 M 0 M 0 M 0 M 0 M 0 M 0 M 0 M 0 M 0 M 0 M 0 M M M M M ~-' ~ ~ ~ ~ ~ ~ ~ ~. ~ ~ ++ tl! R 0 N ` 0 N 0 N 0 N 0 N 0 N 0 N 0 N 0 N 0 N 0 N 0 N 0 N 0 N 0 N 0 N 0 N 0 N 0 N 0 N 0 N 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 N~ V O ti O ti O ti O ~ O ~ O ~ O ~ O ~ r ~ r N 0 N 0 N 0 N 0 N 0 ~ 0 '~V 0 C~D 0 ~ 0 t~O 0 ~ O N C~O O N ~ O N ~ O N ~ O N N N N N N N ~ N ~ N ~ N ~ N `~ N ~ N h N ~ N ~ N ~ r r r 0 0 0 0 0 0 0 0 0 0 L d _ _ _ _ 2 2 2 2 2 2 2 2 2 = = = 2 2 = Z I ~ ~ o M tC) GO ~t ODI M ~ tn O ~ M pp CO rn r o N ~ N d' N M N ~D O C0 O 2 (O N f~ OD ~ C0 CO 1~ (U 00 Cfl 0) t~ N I~ T I~ N M OD O I~ O Cp CO = p 2 O ' 2 r 2 N 2 N = r = N 2 M 2 'Ch ~L ~ O M ~ O O 07 O O ti O ' O V' M O O O O O ~p ~ N O O ~ O O ~ ~i' CO p c1' Cp O ~ (p O M O r O M N (p O OD N M N M N M N M N M O M O M O ~ O r O p I~ (p 1~ O O ~' M l~ tL ) M f~ ~ M ~ ~ M O II~ M ~ V' M ~ ~f M ~ ~Y C'7 ~ d C ~ ~d r l ~ r N ~ r N M r N ~ O u7 O r p tD l~ O t~ O ao O a0 O~ ao oO r ~ V' N O N M ~ tp M V' O ~t O ~ O ~ O O N O N 1~ ti 0o ti ln N ~ N r et r ap r ap l r ap t~. r ~ op ~ p O ~p ~l p ln p ~t lf7 ~p O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O O O O O O O O O O O O O O O O O O O_ ti7 O O_ O O O_ O_ lf7 t[7 O_ ~ O O O_ O_ O O_ O O O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O 0 O Q ~ ~ ~ 1. n r r r r r r r L(7 1.(7 r r r r r r l{7 1.() _ r r _ r _ ~.(~ ((~ ~(") ~ ~ (('~ _ r _ r _ r _ r N •L = 2 2 2 2 = 2 2 2 2 2 5 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 = 2 2 2 = _ _ = ~ 2 2 2 ~ 2 2 = _ _ = 2 2 2 2 = 2 2 2 2 2 2 2 = 2 2 2 2 2 2 2 2 = 2 2 2 2 2 2 2 2 2 M O O Z r ~ ~ r ' L { L7 ~~ ~ CO 1 n~ r r ~ nt M c~ T O ~C r O O T r COC r N Ot r M OC r ~ I flC r ,n ( DC r p I OC r ~ OC r O OC r O O1 O ~i r ~f N ~1 M ~t ~ t ~F t) t `~1 p i ~t ~ -~I 00 ~I 01 ~c O o r 00 N 0CiC M d `~' 4 oD 1) ( aD p f a0 ~ m OO a0a O o O rn r r r r r r r r r r r r r r r T r r r r r r ai f~ 0 C ~L a C ~~ W m O to N fa a rWr^ V`J Z N C O m ,~ VJ C I U O 0 a O N .~ Q a~ 2 O ._ l~ VJ C t0 N ~C C 7 U O O U O O .~ : M G G O G~ t0 N N Z ~ ~ ~ M O O N NT ~ ~ ~ o ~ co r. N ' ' ' , . . ~ ~ O ~ ~ N1 ~ ~ ~ 0 V r,` ~ ~ .. ~ d ~ V N ~ N } ~ N d N d N .~ N M N t r 0 - lC d. H} ~ ~ ~ ' c d I Qj ~ ~ + ~ Q ' 0 N 0 C V 0 N 0 N 0 C V 0 C V 0 C V 0 N ~ \ `~ ~ 1 o \ o o o \ o ` o ` ~ o M a 0= = ~ ~o ~-' U ~ ' - LL. y cn ~ • ` i a w ~ ~ N ~ ~ p ~ ~ 1 ~ i Q~ ~ 0 [~ 0 T 0 r 0 ' r 0 T 0 T 0 r 0 \" ' 0~ ~ / ~ ~ Y .atq V'Q LL = ~ 0 0 0 0 0 0 0 0 ~ y ~i' ~ i7' ~ ,~ ~.~ 0 ~ ~ d r ~ u ` C C ~ ++ X N N N N N N C O C O i C0 G ~ ~ O z 0 0 0 0 0 0 0 0 .di ~ r ~ 3 s Z~~ X v~ c _~ ~ p 0 L "' U . ~ O ~w "O ~ a d o O ~ ~ W N _ ~ O ~' 7 ~' ~ O ~ n _ ~ ~ O ~-~~0~ fl ®` C , U (Q ~ d o o o h o o o o o h 0 o 0 ~ o m o =za~~ . ~v ~? ~? ~ ~n u~ ~n u~ o ~ M a~0 = ~,~n... ~- r r r r r r ~' L ~ N CCN3` (O i~~ ~ O 0 0 0 0 0 0 0 0 0 0 o o o o o a~ ~~ C~ N ~a~m ~ o° o° OO O° o°° °o °o ~ pa, °~~~axi~ '~ ~ o O o O o O o O o t n ~n o r ~ r mM°-~x`~ ~ L N ~ w6 C m > T r r T U~ M O (n ~ 0 ~ ' ~0 z N 1 ~ I .~ •r+ 'a 0 O 0 O 0 d) 0 OD 0 O 0 lf~ 0 N O ~ . ^ ~+' a . 3 T ~ ~ ~ . .. j ~ d i i O ~ O ~ O~ ~ O in ~A 00 N '~Y' N oN0 _ ^o /^~, p~ C C •- cOU~C '~ ~~ O d w t N ` d' a p N ~ 'i.l pZ~ ~ ~ o rn ~ . Q > o ° ° ° O ° ° ° c ~ ~ ~~1°~° ~ _ o o o O o o o h7 ~ ~, ~ _ ~ ~' ~ a o r o r o r o T ~n T ~' ~ _ N+ y ~~ C EF} .F+ ~ 1 f tll + f6 ,~, ~ ` f0 C Uv,oo~ ~ 0 ~ ~Y 0 ~ 0 V 0 'cl' 0 C 0 ~ 0 M 0 CO ~ i M a M ~ C Cv- Nom'-.--0 ~ ~ N O ~+ + ND ~ ~ ~ ~ C ' c'~j M ~ ~N ~ c~y~~ D w ao ao a 0 a 0 a O N C O a r O C t/1 . O O O O O O r 0 i L ~ (-~ ' y 'N V -O i X ~j w .~ m m ~p Uo33W o L ~ w °' ~ ~ ui ui `o ~ i ~w _ _ 1 i Z 2 = ~"~ (9 p Q Z N O) M O) V O) It~ O) N ~ N ~ O O ~ r' -~ ~v~tn y _ ~ oD ~ OD 00 dD O N Cfl ~ ~ CO NNNfQ ~ ._ •- _ L t N I~ N I~ N ~ N V O ~ i~ ~ ~ I O U O O l a y ~ !- r r r ~ (p O T ~ ~ ' O C G f0 (0 3 X X X X > Q ~ ~ v, u, v, N ~ 0 o 0 o 0 o 0 o 0 o 0 0 0 0 0 0 l ~ '~ 0 O O O O O ~n o o ooo -_ ~ o o o o ~ri r= r= j ~~~ m o T ~ T r t- .,! ~; -~i cn ate, -~ ° - ~ °' _ _ = = = = = w o ~ u d = = = = = = = w t- ~ ~ ~ ~ ~ ~ e- O) N O) M ~ ~1' t O) ,n C ~ p f O) ~ 0 0p 0) >` N ~ C M ~ U ~ Q Z r r ~ re -~ - r s - ~ m Q m ~ U RN.~RJ [I• (1.71 ~~ C(1MMONWEAETN Of PENNfI'IVANIA DE-AtTMEM 0[ R[vENUE 1[weertARla tAx olvwofl oEn. 7e0f01 NARRISRURG, PA 1717LOf01 SAFE DEPOSIT BOX INVENTORY Pbos~ Print or MUST BE COMPLETED BY REPRESENTATIVE OF fINANCIAI INSTITUTION WHERE SAFE DEPOSIT BOX IS LOCATED AND RETURNED TO ABOVE ADDRESS COUNTY CODE FILE NUMBER S ~ IAl SKUR~ OR DEATH CER'TIFI~TE NUMBER ~~3 ` 0(J '/7/I DECEDENT'S NAM (usT, FIRST, MIDDLE) LLT1 t~ ~. ~ ~. ~ 6AT !a N s ~ ~u ADDRESS OF DECEDENT (ST ET} ~ ~~ ~ S -~ ~- c~ KRYI i -ten rf ~ ~~- (STATE! RIP CODE) ~ I ~' NAME AND AD RESS Of PERSON REQUESTING THE OPENING Of THE SAFE DE-OSR BOX (NAME) ~ (STREET ADDRESS) i oZoA ~bC.y ~.S rs 1T1q V l e~'1 rj GL (STATE) ~/7T~ (ZIP CODE) ~;~-1 ~'/ NAME, ADDRESS AND RELATIONSNII (IF AHY) TO DECEDENT, OF PERSON(S) PRESENT AT THE BOX O-ENING e. (NAME _-~-( TIONSNIP} (STREET ADDRESS) ~~lt..n~1~ GZ. S Cc~-~ ~~ K17Y) (STATE) (ZIP CODE) b. (NAME) (RELATIONSHIP] (STREET ADDRESS) (CITY) (STATE) (ZIP CODE} E. (NAME) (RELATIONSHIP) (STREET ADDRESS( (CITY) (STATE) (ZIP CODE) ' NAME AND ADDRESS OF FINANCIAL INST RUTION WHERE THE SAFE DEPOSIT BOX IS LOCATED (NAME) r~~^I~°r~ LC-/~-- ~r Jc.~2.~~ ~ > (STREET ADDRESS) / /KIT`!) (ST~) (ZI>P CODE) E NAME OF RSON MAKI/N/,G U15T RY 0 NDT,/IME OF NTRY DATE OF CON ACTT RENT BOX NUMBER OF BOX o~~% ddb T NDER ,H~ H BOX IS REGISTERED - tta~~t l~cLLo .~ NAME AN ADDRE S OF PERSON(S) NAVING ACCESS TO BOX a. NAME) b. (NAME) (S EET ADDRESS) r~ s G~,.-l~~-~^~.- (STREET ADDRESS) ~-- Gl~'irL~- GL.~ !-_. Gt.~-ll„1' c.-- K (STATE} (ZIP CODE) (CITY) (STATE) (ZIP CODE} NAME AND TITLE OF EMPLO,,Y~~E]]TAKING THE INVENTORY WAS A WILL IN THE OXt OYES O IF yes, a. Dete will: b. Nanw and addnsf of perfonal npneentative, it named in fife will (NAME) (STREET ADDRESS) KITY) (STATE) (ZIP CODE) c. Nome and addnu of erierney, if eny {NAME) (STREET ADDRESS) (CITY) (STATE) (ZIP CODE) -55- Page ~ of ~~ SAFE DEPOSIT BOX INVENTORY INSTRUCTIONS '~;~ (1) Cash: Report total only. (2) Stocks: List in detail every common or preferred certificate, warrant or other rights found in box. Stocks ore to he desipnrrted by name nl rompony, certificate number, dote of certificate, name in which :cock is registered, and number of shares and doss of stock. (3) Obligations of U. S. Government: Number of items, dale of issue, lace value, Homes in which registered and type of ownership, i.e., jointly held, payable on death, etc. (4) Bonds: Designate by Home, amount, serial number, or other designation. (Bearer Bonds) (5) Bank and Sowings and Loon Passbooks: State Hams of depositor, number of book, last date appearing in book, Home of bank and branch, and balance. (6) Jewelry, Coins, Stamps, Manuscripts, etc: List and describe as Fully os possible. (7) Duds, Mortgages, Current Insurance Policies or other evidences of indebtedness:' List and describe os Fully os possible. (8) All other contents. ITEM DESCRI/TION ~ J L/ ~J .cJ CJ r rS ~ w r>. ~c3- L'_~ '~" ~ v^ ©O GJ -~ 7S ~! y S ~' S`c'~ • ~ i-SSC~~~.. ~~Y~o ~' C? ~ yo ~~e ~ ~.~ ~ '~ ~, d ~. - ~ ~# l 3 ~ ~ ~ ~ o ~ a ~-! H I CERTIFY VN6ER -ENAITY OF -ERJURY THAT THE ABOVE RECORD IS PERSON RECEIVING ~vrT yr CORRECT AND COM-IETE TO THE 6EST OF MY KNOWLEDGE AND BELIEF SAFE DEPOSIT dOX INVENTORY: ~ ~ i ` 1 AM A A IA %~ l t tt t Eseculor(Mstl ^Adminiuretor(trir<) ~~~ ^EstaU RepresenleKw ^ Joint owntr of safe deposM bo^ NOTES Attach t1t~It1onal i><i" x 11" shad ( I( necessary or use dupllcotes of thls page e1 iKSSS. - 57 - v J § ~ ~ ~ .J ~ v ~ u ~.1 `~ , ll ,~ ~ ~ ~ ~ ~ c ~! J ~ ~ \ ~ i1J ~ q ~ j\ - -~ U z ~ ~ •'q a~0 a ~ ~~ `'c~ ~~ ~ ~ a ~ ~o oQ { ~ ~~ ~~Q (~y ~~ ~fl ~`~ z z ~ A 4 .~ ~ ~~ . ~~1. .! ~' i c~ ~ ~ ~ w v H ~ ~ 9 `V. a ~ ~` ~` ~- ~' a-Wi C ~ h u. (~~~j a ~ ~ ~ '` O E9 ~ ,~jCI S J ~ ( ~ ~ Ll ® Q d ~ p '~ F- W 1L ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ \ •~ v J +~ V Q ~ i`,~ ( O ~ _ J 6 W m p ~ to u `~ ~ ~ ~ ~ ~ ` ~f a -1 v ? W ~ ~ ~ ~ ~ ~ ~ S r~, ~ ~ ~ ~ '~ ~ ~ ~ ~ ~ f ~ ~ ~ ~ ~~; ~ W Z , 2 Q ~ ~ ' O G1 ~ ; ~ ~ W ~ ` V '~ :. i \ _Q Z ~ W C ~ Z W ~ W r aLL O~ ~ _.. ... S~W? o a ~ ~ ~ ~ ~ ~ ~ ~ ~ \, j/ ~ I ~ ~ .1 ~ I G V \ 'iF. u ~ ~ _ ~ L i ~6 G ~ O U I! :l \ y C ~ ~ ~~ e°.v~nN9 PgItIPn~F ArR OIrJ9lato ' ' •^' "•~ j~ ~ ~ •~~~ ~J ~ ~ ~~r v,., " rorm HUO-1 (3195) rar Hangnao: .\ ~.~ ,;''~' `_- a. r Settlement Statement U.S. Department of Housin g and Urban Development ~"R,ANKI.lN REAI. EST/~Tt: StwgVtCES A~NU A,t35"ft1,ACTtNG CCiMPANY, INC. OMf3 No, 2502-0265 2T3 LINCOLN INAYEAST • CHAMBERBBURG. PA tT20t ~, TYPE OF LOAN r>wl.. 77~•~6~1-3290 1. ^FHA 2_ ^FmHA 3. ^C¢nv. Unins. FJUL• 717-26a-7 965 4. qVA 5. ^Conv.lns. " 6. FILE NUMBER 7, LOAN NUMBER CTA1244 _ 8, MORTGAGE INSURANCE CASE NUMBER e orm a urn e e e 9 ve you e e n men o ae ue se ems cos n. oun p^ a an y e ^e omen age era ^ own, C, NOtt?: Items marketl ^(p_e_e.r^ were peltl eateltle the eleeingg theyy are nhown hero for Mionnatlon - _ - YYAtINING: I! Is a crlmo to knowingly make Pelee atetemanis !o tha Unltnd titArq,~ on this or n y etherelmRer torrrlr PeneM ,otela. TttleEXpreSS Setil8m8nt Sys EanVlGtltln can Include a thlo end m d e upe e r abmt5^nl. Fbr dololl^ ^^a; Tltla t8 ~, a, Oade aeetlan 1007 enq aeetlPn t979. D. NAME OF 00RROWER: Sueann R. Johnson and Dirk C. Starliper Printed 10/11l2D10 at 10:45 ADDRESS; 8641 Path Yalle Road Fannettsbur PA 17221 E. NAME OF $ELLEFt; Jane L. Carl, Executrix of the Estate of Dorothy H. Mellott ADDRESS: 206,208 Roxbu Road 3hi ensbur PA 17257 F, NAME OF LENDER: CASI~I ADDRESS: G, PROPERTY AppRESS; 208208 Roxbury Road, Shippensburg Pq 17297 ---- , Shf pensbura Borough H. SETTLEMENT AGENT: Franklin RfE 5elViceS and Abstracting Co., Telephone: 717.264,3290 Fax: 717-264-1995 PLACE of SETTLEMENT: 2731,1ncoln VYa East Charnbersburg, PA 17201 I, SETTLEMENT DATE: 1Q/'12/2010 J. SUMMARY OF gORRQWER'S TRANS,q,t~T)p~; K. SUMMARY OF SELL~F~'S TRANSACTION 100 GRO --~^ . ; SS AMOUNT DUE FROM BORROWER d00, GROSS AMOUNT DUE TO SELLER 101 Contract sales ri . ce 75 00000 401. Contract sales rice 102, Personal Pro ert 75 OUO _. 103, 5etilemenl cha es to borrower line 1400 402, Personal Pro erl 1525.75 403 . 104, 404, 105. 405. Ad'ustments for items aid b sell®r 107, Count taxes 10/12110 to 12/31/10 In advance Ad'ustments for Items atd b seller In advance 109. School Taxes 10J12110 to 0613Q111 118.13 ~ 837.93 40~. Counl taxes 10112/10 to 12131/10 408, School Taxes 10112110 to 08/30(11 _ _ - - 11.8. 109, 409, 837. 1 0. ~ 410 111 . . 411 - 112. , 120. GROSS AMOUNT DUE FROM BORROWER 77 481,81. 412. d2p, GROSS AMOUNT DUE TO SELLER 200. AMOUNTS PAID BY OR ON BEHALF QF BOR 201 17e oaii or earnest no e ROWER 500, REDUCTIONS IN AMOUNT DUE TO SELLER 75 956. . n 202. Princi al amount of new loans 10 000.00 ,- ~D1. Excess De osit see instructions ona c,.:.,an,. I,...,,r^i Iwl.w.. w„17,...1 ~„ ~ 502. S9ttlement cha es to seller fine 1400 ens r..:_'°--'---._~ . .. .. _ 7169.: ~IUiflnrlw AYq nl~RnIMR ~'-'l~ ~`~ ~ r-~ t ~ ~ ~u~ ..i ~J-.ti'; DEPARTMENT OF HOUSING ANQ URBAN DEVELOPMENT form HUD-1 (9186) ref Flentlboak a~'ETTL~MENT STATEMENT File Number CTA7244 PAS= iOD. b9sed I Real n P. PAID FROM PAfD FROM BORRpWER'S SELLER'S FUNDS QT FUNC7S RT SETTLEMENT SETTLEmEr i_ ~i~u~, i~itie insurance tv Franklin RE Services & Abstraptinq Co lnc I linrh trice ohnvo I}oma Aln~ !itAndart~ Rate ~ ,rI December 23, 2009 Weigle & Associates, P.C. Attorney's-at-Law 126 East King St Shippensburg, PA 17257-1397 To Whom It May Concern: RE: Dorothy H Mellott In reference to the above customer, our records show the enclosed information to be accurate of today's date. If I may be of any further assistance, please contact me. Sincerely, Tricia Ganoe Deposit Operations Manager 717-261-3624 717-264-6116 888-264-6116. P.O. Box 6010 Chambersburg, PA 17201-6010 FINANCIAL SOLUTIONS... FRONT PEOPLE YOU KNOW w c 0 .~ m r m d 0 d m O 0 m °' ~°o - N 01 _ N to 2 a`> .a ~ E °~ a~ D hi .. E m m zo a~ w E ° o a~ N f0 U ~ p~~ 499 Mitchell Road, Millsboro, DE 19966 Mail Code DE-MB-12 Phone (888)502-4349 Fax (302)934-2955 December 21, 2009 Weigle & Associates, P.C. 126 East King Street Shippensburg, PA 17257-1397 Re: Estate of: Dorothy H Mellott, aka D Hazel Mellott aka Hazel K Mellott Social Security: 183-07-8396 Date of Death: December 5, 2009 Dear Sir or Madam: Per your inquiry, please be advised that at the time of death, the above-named decedent had on deposit with this bank the following: 1. Type of Account Certificate of Deposit Account Number 31003913803770 Ownership (Names o, fl D Hazel Mellott Opening Date 0420/00 Balance on Date of Death $ 6000.00 Accrued Interest $ 2.80 Total $ 6002.80 2. Type of Account Certificate of Deposit Account Number 31003914396469 Ownership (Names o, fl D Hazel Mellott Opening Date 07/01/83 Balance on Date of Death $ 15000.00 Accrued Interest $ 42.00 Total $ 15042.00 3. Type of Account Certificate of Deposit Account Number 31003916719817 Ownership (Names ofi D Hazel Mellott Opening Date 10/18/06 Balance on Date of Death $ 2604.14 Accrued Interest $ 3.57 Total $ 2607.71 4. Type of Account Certificate of Deposit Account Number 31003917876723 Ownership (Names o~ D Hazel Mellott Opening Date 06/02/08 Balance on Date of Death $ 29084.46 Accrued Interest $ 150.18 Total _..._._....____.._...._.._...__.....__......_...._......_. ................._.. _.___ $ 29234.64 5. Type of Account Certificate of Deposit Account Number 31003917876898 Ownership (Names o, fl D Hazel Mellott Opening Date 06/30/08 Balance on Date of Death $ 7054.86 Accrued Interest $ 23.23 Total $ 7078.09 6. Type of Account Certificate of Deposit Account Number 31003917876905 Ownership (Names o~ D Hazel Mellott Opening Date 06/30/08 Balance on Date of Death $ 71402.56 Accrued Interest $ 235.13 Total .. . . .. . . .. . . .. . . .. . . .. . . .. . . .. . . .. . . .. . . .. . . .. . . .. . . .. . . .. . . .. . . .. . . .. . . .. . . .. . . .. . . .. . . . .. . . .. . . .. . . .. . . .. . . .. . . . $ 71637.69 7. Type of Account Certificate of Deposit Account Number 31003917878050 Ownership (Names o, fi D Hazel Mellott Opening Date 01/09/07 Balance on Date of Death $ 2172.83 Accrued Interest $ 34.46 Total _. _ ........................._ _................................................... _. $ 2207.29 _............__.._......._...._......._..... _.... 8. Type of Account Certificate of Deposit Account Number 31003920318829 Ownership (Names o, fl D Hazel Mellott Opening Date ~ 04/08/09 Balance on Date of Death $ 2290.93 Accrued Interest $ 2.07 Toral $ 2293.00 9. Type of Account Certificate of Deposit Account Number 31003920319158 Ownership (Names ofl D Hazel Mellott Opening Date 01/09/09 Balance on Date of Death $ 2000.00 Accrued Interest $ 40.98 Total _...._.2040.98 .._........_...... _.._.. _..___.. __ ........._ _ .................................._.._......_.........._ _............. 10. Type of Account Checking Account Account Number 97388130 Ownership (Names o, fl D Hazel Mellott Opening Date 0128/08 Balance on Date of Death $ 13799.47 Accrued Interest $ 3.38 Total $ 13802.85 11. Type of Account Checking Account Account Number 98189352 Ownership (Names o~ D Hazel Mellott Opening Date 11/28/97 Balance on Date of Death $ 11067.04 Accrued Interest $ 2.74 Total _.........._ _... _. ................. _...._...................................... __ .._ _._............_. _.......... $ 11069.78 _. Please be advised, there was no safe deposit box found for the above decedent. * If upon reviewing the information above, you believe there are additional accounts not referenced, please provide us with an acrnunt number and/or Heine of any possible joint acrnunt holder. For any additional information on the above accounts, including ownership and any changes, closures and/or reimbursement of funds, etc., please contact our Kings Street branch, 35-39 East King Street, Shippensburg, PA 17257. Office # 717-532-4132. Sincerely, ~~ N issa Sears Adjustment Services ULL-IJ-LUU 711ULJ IU~UI Jerry A. Weigle, Esq. WEigle & Associates, FC I26 East King Street Shippensburg, PA 17257 Fax 532-5289 December 15, 2009 Re: Estate of Dorothy H. Mellott Social Security Number 183-07-8396 Date of death December 5, 2009 IT' IS HERERBY CERTIFIED THAT THE ABOVE NAMED DECEDENT, ON THE ABOVE DATE, HAD THE FOLLOWING ACCOUNT(S) WITH ORRSTOWN BANK• CHECKING ACCOUNT Account - Title of Account - Date opened - Joint Account (name /date) -- Balance -- Accrued Interest - CERTIFICATE OF DEPOSITS Account -- Title of Account - Date opened -- Joint Account (name/date) - $alance = Accrued Interest -~ 102002012 50+ Interest Check 11/28/06 No $7,478.62 $.03 4000027544 24 Gald Medal, W/Dep $/15/08 None $5,850.14 $14.28 Account - 4000028327 Tit1E of Account - 30 Gald Medal W/Dep Date opened - 9/4/08 Joint Account (name/date) - None Balance - $83,550.67 Accrued Interest - ~ $9.27 .: .. T~-. ...' .. .. .. .. ... .. .... .. F,~NANCIA~:VER, iVE.s~ L~ .. .. .::' °A:Tradition.ojFsccllcncc:: :• I V V I f V V L 77 l=ast King Street, Shippensbur~, Pennsylvania 17257 ~UU7~IULJ IU~UL ACCOLInt - Title of Account - TJate opened - Joint Account (name/date) - Balance - Accrued Interest - Account - Title of Account - Date opened - Joint Account (name/date) - Balance - Accrued Interest - 4000025328 6-11 Month Growth 9/4/08 None $84,119.72 $2.52 4000028329 6-11 Month Growth 9/4/08 None $24,971.49 $.75 Best Regards, ~ , Vicki L. Gullixon Customer Service Specialist ~. UULt UUL 7? Ease King Strtet, Shippcnshurg, Pennsylvania 17257 Weigle & Associates, P.C. Jerry A Weigle, Esquire 126 East King Street Shippensburg, PA 17257 k ~~ f ~_ '~ ~~ y a ~o ~~~ ! ~ r • RE: Estate of D. Hazel Mellott To Whom It May Concern: December 16, 2009 ~~ ~, I am writing in response to your request for date of death values on the above referenced member. This account was opened on 06/25/1965. Account Date of Death Accrued Joint Owners 108500 Princi al Interest Prime Share (00) $2,203.82 $0.99 Chick Mellott 15 Month CD (41 $24,166.78 $137.68 No Joint 13 Mth Choose a Term $57,035.17 $0.00 No Joint CD Paid on death $17.90 If you have any questions with regard to the above balances, or need additional information, please feel free to contact a Membership Officer at 717-263-4444. Sincerely, Patriot Federal Credit Union 800 Wayne Avenue, Chambersburg, PA * (717) 263-4444 * Mailing Address: P.O. Box 778, Chambersburg, PA 17201-0778 7=704.5+ 3=677•+ ~=97.5+ 12=839•x= 8 = 345. 35~= 0•~ 8=345.35+ ~-~ (~j,8=245.35 f ~~ ~~ ~(2~3.53 7 ~ .~ i~ s ~ ~ s~ 9ti~ ____---_ ~~~ 1. , '; 7~ s~ . ~ 7 N 0) (") O` ~ O ~ .~.. Ch ~ N ~ 00 tp # s ,~ f L~p~~ ~ , ~. : # _'~ iJ ~ f ~~ whaxs irnpo Vienna Office If You have any questions, please ~, call our Telephone Rankin at 1-800_ 9 Center '~ 24-2440 ~ $ Today's Date: 06/22/2010 Business Date: ~ ~ 06/23/2010 time: 04:46 Pht i Checking Deposit *~**5301 $8,245.35 Tota 1 Balance: ~ Avail bl ~1 ` J ~. 3 Q 1 f/1 W a e Balance; 5 264.83 X7,019.48 M a 3059 /02 ~, 6 iL w . a~ ~o ~ o u°Ci w ~ ~ ti Z z>r Thanks for visitin ~ ~Qa o f- o - -a 4~e are 9 us today , ° . _. happy to assist ~ ~ ~~~~ a~ ~ you . ~ W ~ ~ c0_ ~ _ '~ Q V~~~ _ ~ Z Wamn ~ ~ I z.,'A r ~ n >? C - -- W c,,°.si ~ - - ~ ~ -- '~G VvUa _-- o _ _ - - - _ - ~ w h- t=- O t o aC _~ do _W 0 N x ti tt1 ~« ~ ~ ~'' V ~ M _o atom X m W ~ CV ~ N O N Q ~~IQ C O ~ ~ c ~~c`V~t> m s .. s 0 of r. o' rL of M ,~ 7. ~SU 8~ ~. ~ a z.sv /,3~ .sa ~ y. ~1v l7 s~ /~ ~ ~~-~ / f `` y~~ ~6 ~ -~ 3~'" 8os /~ ~i ^~ S i'~ ~~ ~{ Z~ ~ , s ~/~ ~~~ a~ ~~" 8, ~~~ `~ pJ ,,../~ -~ -~ ~~~2.e 7 7= f~ Z-7, sa t v ~~ rA ~~ ~ ~~-. -~ ~,~~ f~D Gtr ; ,~... ,~ ~a ~~ ~~.~ Lam, i~.r-= ~~~;~; ~ CARL E. OCKER AUCTIONEER 4401 Philadelphia Avenue Chambersburg, PA 17201 (717) 264-6578 Personal Property Appraisal for Estate of D. Hazel Mellott 206 Roxbury Road Shippensburg, PA 17257 WALNUT GRANDFATHERS CLOCK .............................. MAHOGANY BREAKFRONT ~ ........................ 150.00 OAK RAISED P .......................................... 300.00 WF BEDROOM SET ..l?.~ ~~ #, S ~so~.~j:... ................................. 600.00 • ..... ..~.. WF CEDAR CHE .... .. ~ ~.~~.... 200.00 ST ................ BUTTE ........................................................ 50.00 RI'RINT PRESS BACK BED """"""" C 1900 .............................................. 125.00 TOTAL ..................................................................................................... $1,425.00 = /Z zS:dv I, DO HEREBY CERTIFY that I have examined the tangible personal property of Estate of D. Hazel Mellott, 206 Roxbury Road, Shippensburg, PA 17257 And do value and appraise the same at $1,425.00 as being fair market Value of said property on this date of May 24, 2010 ~ i Date •~ y p Carl E. Ocker Appraiser