HomeMy WebLinkAbout03-0333 PETITION FOR PROBATE and GRANT OF LETTERS
Estate of ~ C. F~70~R No. ~t' ~-',~,.~
also known as To:
Register of Wills for the
, Deceased. County of O,~nx~,~ in the
Social Security No. 91M-'Cl3-Koa I Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older an the execut rig named
in the last will of the above decedent, dated ~ 2 ,19 85
and codicil(s) dated ~
(state relevant circumstances, e.g. renunciation, 'death of executor, etc.)
Decendent was domiciled at death in ~ County, Pennsylvania, with
h ~_~ last family or principal residence at !3!4 .cr~a, na~a-~ nr~ ~ ~rrT._ ~ 1-n311 ,
(list street, number and muncipality)
Decendent, then ~ years of age, died crq-c~ 12 , l~gPf~;~
at ~~ ~ '
Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted
after execution of the will offered for probate; was not the victim of a killing and was never adjudicated
incompetent:
Decendent at death owned property with estimated values as follows:
(If domiciled in Pa.) All personal property $
(If not domiciled in Pa.) Personal property in Pennsylvania $
(If not domiciled in Pa.) Personal property in County $
Value of real estate in Pennsylvania $.
situated as follows:
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters
theron. (testamentary; administration c.t.a.; administration d.b.n.c.t.a.)
!3!4 ~ ~
~ l-lTrlr,-, ~ 1"/flll
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA ~
COUNTY OF ~~_ f ss
The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are
true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen-
tative(s) of the above decedent petitioner(s) will well an/~t~ly/~/administer the es~ccording to law.
Sworn to or affirmed and subscribed r t~'~
be f~tgh~ ~O-~ day of ~ ~ x'~'J~'~"-~ c~~'
Estate of ~ ¢- F~V~R
, Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW (~ ~ [ ~ c-~(.X~ ~ ~ in consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that the instrument(s) dated ~ - ,~ - ! Q <~_~
described therein be admitted to probate and filed of record as the last will of
and Letters
~e hereby granted to . ~ .
FEES Regist~ ~~
Probate, Letters, Etc .......... $ I~ ~ ~ ~. ~e ~ ~7
Short Certificates( ) .......... $~O. ~ A~O~NEY (Sup. Ct. ED. No.)
~~~. $/&.o~ ~~~, ~~, ~ 1~11
$ /0 - oO ADDRESS
TOTAL
Filed
~-1~- o3
This is to certit5' that the information here given is correctly copied from an original certificate
Local Registrar. The original certificate will be fbrwarded to the State Vital Records Office for perman~';~:
WAFININ~: It is illegal to flupHcate lhi$ ¢op¥ by photostat or photogr~pN.
P 8 g 2 9 7 5 4 ~~~ OOT 1
No. ~ Date
~3 Rev ~a7 COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS
CERTIFICATE OF DEATH
_,o,,_,,,,,. .... 1,. 72o, - o
.... ~ , 0'2 ¢3 ~ echan~csburg,P~~,,o~,,~ ~
Harri g .
m Dauphin ~. sbur ~. Harrisburg Hospital ~ .... ~o~.~ ,0 white
... Truck Driver [.~. Transportation ,= '-~ 11~ 10r°'m ~'~=*+' . Married 1~ Anna Marie Lupey
I ~C~OEm'S Pennsylvania ,,,.~ ~.~,, Lower Allen
1314 Stratford Road n~s,~
,,. Camp Hill, PA 17011 ~om.~ ,m.c~ Cumberland '~"~'v~ ~.~
l.~nn Fa rve r uom~.'s ~,~.,~, ~.om ~.m.
~,. Adeline He~inger
~. ~n ~. Farver ~. 131~ Stratford Road~ Camp H~ll~ Ph 17011
~ ~ ~a~October 16~ 2002 Rolling Green ~emor~al Park Lower Allen ~p PA 17011
J L~ENSENUMBER ~AMEANOA~RE~FmO~ Parthemore FH & CS, Inc.
~.FD 013 340 L
-
,, ..............
,i "" ................ ~ ~n~-~-' .... ' ~; .... /
,~1- 03-3,.3,B
I, EDWIN C. FARVBR, of Lower Allen Township, Cumberland County,
Pennsylvania, being of sound and disposing mind, memory and
understanding, do hereby make, publish and declare this as and for
my Last Will and Testament, hereby revoking all other Wills and
Codicils heretofore made by me.
ARTICLE I.
I direct the payment of all my just debts and the expenses of
my last illness and funeral from my Estate as soon after my death
as conveniently may be done.
ARTICLE II.
I give and bequeath to my son, EDWIN C. FARVER, II:
(a) My gun collection and gun cabinet; and
(b) My diamond ring.
ARTICLE III.
I devise and bequeath all the rest, residue and remainder of my
estate, of whatever nature and wherever situate, unto my wife, ANNA
M. FARVER, provided she survives me by thirty (30) days.
ARTICLE IV.
Should my wife, ANNA M. FARVER, predecease me or die on or
before the thirtieth (30th) day following my death, I devise and
bequeath all the rest, residue and remainder of my Estate, of
whatever nature and wherever situate, unto my children, KIMBERLY
ANN FARVER and EDWIN C. FARVER, II, share and share alike,
provided, however, that if either of my said children shall have
predeceased me, then such child's share shall pass to such child's
issue, per stirpes, and provided further;
If any beneficiary hereunder has not reached the age of 21
years at the time for distribution of his or her share, I devise
and bequeath such shares to Dauphin Deposit Bank & Trust Company,
of Lemoyne, Cumberland County, Pennsylvania, in SEPAI~ATE TRUST, to
hold, manage, and invest the share or shares as received, and the
accumulation of interest thereon, and to use and apply the income
and principal, or so much thereof as, in Trustee's discretion, may
be necessary or appropriate for the beneficiary's support and
education (including college education, both undergraduate and
graduate) without regard to his ability to provide for such support
or education, or to make payment for these purposes, without
further responsibility, to such beneficiary or to any person taking
care of such beneficiary. When such beneficiary shall reach the
age of 21 years, Trustee shall distribute to such beneficiary the
entire balance of principal and income accumulated thereon so held
in SEPARATE TRUST by Trustee and this Trust shall terminate. If
any beneficiary hereunder dies before receiving final distribution,
then his separate trust shall terminate and the balance of
principal income of such trust shall be paid over to by then-living
issue, per stirpes.
ARTICLE ¥.
During the time any portion of my Estate remains in trust, the
same shall not be subject to anticipation, pledge or alienation,
voluntary or involuntary, by or against the beneficiary.
ARTICLE ¥I.
My Executrix and Trustee shall have the power in addition to
those vested in them by law or other provisions of this Will,
applicable to all property, exercisable without Court approval, and
-2-
effective with respect to each item of said property until actual
distribution thereof, to sell at public or private sale, to
exchange or lease for any period of time any real or personal
property, and to give options for sales, exchanges or leases for
such price and upon such terms or conditions as they deem proper.
ARTICLE VII.
I nominate and appoint my wife, ANNA M. FARVER, Executrix of
this my Last Will. Should my wife, ANNA M. FARVER, fail to qualify
or cease to act as Executrix, I appoint DAUPHIN DEPOSIT BANK AND
TRUST COMPANY, Executor of this my Last Will.
ARTICLE VIII.
I direct that my Executrix or successors shall not be required
to give bond for the faithful performance of their duties in any
jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal, this
?~' day of //~ , 1985.
Edwin~-~Farver
Signed, sealed, published and declared by the above-named
Testator, as and for his Last Will and Testament, in the presence
of us, who at his request, in his presence and in the presence of
each other, have hereunto subscribed our names as witnesses~
-3-
CO1V~IONWEALTH OF PENNSYLVAN I A :
: SS:
COUNTY OF CUMBERLAND :
I, Edwin C. Farver, 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 and Testament; 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 before me, by EDWIN C.
FARVER, this ~. day of 'v~xe~ , 1985.
Notary PuI~I ic '~
~;,~TARY
CO~SSION ~PIRES ~C. ~.
I. EMOYN~ PA ~ER~ND CO,
-4-
AFFIDAVIT
CO~VIONWEALTH OF PENNSYLVANIA :
· *SS:
COUNTY OF CUMBERLAND :
We, (~.~_~_~_.~ ~.~ and ~ ~.
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 the Testator sign and execute the foregoing
instrument as his Last Will and Testament; that he signed willingly
and that he executed it as his free and voluntary act for the
purposes therein expressed; that each of us in the hearing and
sight of the Testator signed the Will as witnesses; and that to the
best of our knowledge, the Testator was at that time eighteen (18)
or more years of age, of sound mind and under no constraint or
undue influence.
Sworn or affi ~med to and subset ibed to before me by
~~X'~' and '~~.~, witnesses, this ~ da7
of ~~ ~ ~ 1085.
ie
I;~IAR~ PbSLIC
I EMOYNE, PA CUM~R~N9
-5-
OF
EDWIN C. FARVER
MYERS. MYERS, FLOWER & JOHNSON
ATTORNEYS AT LAW
· - LEMOYNE. PENNSYLVANIA
'~ CARLISLE, PENNSYLVANIA
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent: EDWIN C. FARVER
Date of Death: OCTOBER 12, 2002
\Viii No. 2003-00333 Admin. No.
To the Register:
I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphans' Court Rules was
served on or mailed to the following beneficiaries of the above-captioned estate on June 3, 2003 ·
Name Address
EDWIN C. FARVER~ II~ 7 WILLIAM PENN DRIVE, CAMP HILL, PA 17011
KIMBERLY ANN FARVER, 889 SCHOOLHOUSE LANE, LEWISBERRY, PA 17339
ANNA MARIE FARVERt 1314 STRAFFORD ROADt CAMP HILL~ PA 17011
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Date: June 3, 2003 ~.~ ~i
Signature
Name PETER J,- RUSSO
Address 3800 MARKET STREET
CAMP HILL, PA 17011
Telephone( 71)7 §91-1755
Capacity: __ Personal Representative
XX Counsel for personal representative
JRD/June 30, 1992/17858
In Re: Estate o£Edwin C F~rver : OI~I-IAJ'~S' COI_SRT DI¥ISION
Late of Lower Allen Township : COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY
Estate No.: 21-03-0333 : PENNSYLVANIA
:
: NO. 21-03-0333
NOTICE OF FAILURE TO FILE STATUS REPORT AND REQUEST TO CONDUCT A
HEARING PURSUANT TO RULE 6.12, SUPREME COURT ORPHANS' COURT RULE
Personal Representative: Anna Farver
Counsel for Personal Representative: Peter Russo
Date of Decedent's Death: 10/12/2002
Date o£Delinquency Notice: 08/11/04
The undersigned, Glenda Farner-Strasbaugh, Clerk of Orphans' Court, in accordance
with Rule 6.12, Supreme Court Orphans' Court Rules, hereby notifies the Orphans' Court
Division, Court of Common Pleas of Cumberland County, that neither the above named personal
representative nor the above named counsel for the personal representative have filed with the
Register of Wills or Clerk of the Orphans' Court his, her or its Status Report required by Rule
6.12, Supreme Court Orphans' Court Rule and that the requisite notice, pursuant to Rule 6.12,
Supreme Court Orphans' Court Rules, was given by the Clerk of the Orphans' Court on April 30,
2004, and that the ten (10) day notice to file the Status Report has expired. Accordingly, in
accordance with Rule 6.12 the Court is hereby notified of such delinquency and the undersigned
requests that a Court conduct a hearing to determine whether sanctions should be imposed upon
the delinquent personal representative or counsel for the delinquent personal representative.
Date: 11/08/04
Glenda Famer Strasbaugh
Clerk of the Orphans' Court
Distribution: Personal Representative
Counsel for Personal Representative
Estate File
~~ I o~ .2o~- q:3a ih.lq.
A hearing is scheduled for at in Courtroom No. 3. If the Status Report is filed prior to
the hearing date, the hearing will automatically be cancelled.
STATUS REPORT UNDER RULE 6.12
Name of Decedent: EDWIN C. FARVER
Date of Death: OCTOBER 12, 2002
Will No. 2003-00333 Admin. No.
Pursuant to Rule 6.12 of the Supreme Court Orphans'
Court Rules, I report the following with respect to completion of
the administration of the above-captioned estate:
1. State whether administration of the estate is complete:
Yes %/~ No __
2. If the answer is No, state when the personal
representative reasonably believes that the administration will be
complete:
3. If the answer to No. 1 is Yes, state the following:
a. Did the personal repres~entative file a final
account with the Court? Yes__ No
b. The separate Orphans' Court No. (if any) for
the personal representative's account is:
c. Did the personal representative state an
account informally to the parties in interest? Yes ~-~o
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.
Signature ~
~: PETER J. RUSSO
~.~ Name (Please type or print)
3800 MARKET STREET, CAMP HILL, PA 17011
~ il Address
( 71 7) 591 -1 755
Tel. No.
Capacity: __Personal Representative
x _Counsel for personal
representative
(MAH: rmf/AM3 )
4
RE\L1500 EX (IoCIIl)
,
'* COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
1lARRISIllRG. PA 171......'
w
...,
~:s~
!dIg
%lli!...l
ulLlD
~
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
<)F:r:'jC~t\L
FILE NUMBER
~1~ ~ _ N~33:L _
SOCIAl SECURITY N MBER
204-30-5911 '
I
I-
Z
W
C
W
o
W
C
DECEDENT'S NAME (lAST, FIRST, AND MIDDLE INITIAL)
Farver, Edwin C.
DATE OF DEATH (MM-OO-YEAR) --rOATE OF BIRTH (MM"()O-YEAR)
10/12/2002 ~2/23/1943
(IF APPLICABLE) SURVMNG SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Farver, Anna M.
NAME
Peter J. Russo, Esquire
FIRM NAME,lIf /oilPbIlIt)
Law Offices of Peter Russo, P.C.
TELEPHONE NUMBER
(717) 591-1755
z
o
5
::)
I-
D:
<(
o
w
0::
16. Amount of Une 14 taxable at lineal rate
17. Amount of Une 14 taxable at sibUng rate
18. Amount of Une 14 taxable at collateral rate
19. Tu Due
THIS RETURN MUST E FILED IN DUPUCATE WITH THE
REGI TER OF WILLS
-.----..- ..,.-.----.--
SOCIAL SECURITY N~MBER
I
o 2. Supplemental Retum
o 4a. Futura Interest Compromise (dele 01 deaIh Iller 12-12-82)
o 7. Decedent Malntained a living Trust (AIIaal copy oITl\IIl)
o 10. Spousal Poverty Credit (dele oIdeelh belwMn 12.31-81 and 1.1-85)
o 3. Remaind~ Retum (dele 01 d88Ih prkr 10 12-13-82)
o 5. Federal E+te Tax Retum Required
_ 8. Total Num~r of Safe Deposit Boxes
o 11. Election tJ tax under Sec. 9113(A) (AIledl Sch 0)
~ 1. OrIginal Return
o 4. limited Estate
o 6. Decedent Died Testate (AIIaal copy of WI)
o 9. Ullgation Proceeds Received
z
o
~
~
::)
Q.
:!E
o
o
~
1. Real Estate (SchediHA) (1)
2. Stocks and Bonds (SchedlH B) (2)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule 0) (4)
5. Cash, Bank Deposits & Miscelaneous Personal Property (5)
(Schedule E)
6. JoinUy Owned Property (Schedule F) (6)
o SeparaIB SlUng Requested
7. InIer-Vivos Transfels & M1sceHaneous Non-ProbalB Property (7)
(Schedule G or L)
8. Total GrOll Assets (total Lines 1-7)
9. Funeral Expenses & Mniristrative Costs (Schedule H) (9)
10. Debts of Decedent, Mortgage Uabi6ties, & Liens (Schedule I) (10)
11. Total Deductions (total Liles 9 & 10)
12. Net Value of Estate (Line 8 mirws Une 11)
13. Charitable and Govemmenlal Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tu (Une 12 minus Una 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Une 14 taxable at the spousal tax
rate, or transfers under See. 9116 (a)(1.2)
COMPLETE MAILING ADDRESS
Law Offices of Peter J. Russo, P.CJ
3800 Market Street .
Camp Hill, PA 17011
132,158.80
I
0'
c;,;b
<-!:O
r:J 1-Q
rn Q:; 0
~o\:':;::"hi
l_,,~ ,:2; ::0
,,~:::I(f) :;:s:;:
!..JI()0
:-)0 -n
(=~~
!:.-j
::s
-0
3
~
N
<...>
::0
:::om
n.O
Ci)O
;;:n::D
~:~'-l 0
rrlr.'
:::u c::J
c.:) 0
'Tl-n
~,,::;: ::n
"=-0
'=rn
l-
ena
-n
CX>
67,151.07
0.00
..... .1...
(8)
7,455.00
0.00
199,309.87
(11)
(12)
(13)
7,455.00
191,854.87
0.00
(14)
191,854.87
0.00 x.o Qu__ (15)
0.00
0.00
0.00
0.00
.._._,_.._--,Q~.Q.Q, x .0 .9___ (16)
0.00 x .12 (17)
m__.~.Qg x .15
(18)
(19)
pt.
Decedent's Complete Address:
STREET ADDRESS
1314 Strafford Road
CITY Camp Hill
I STATEpA
I ZIP 17011
--
Tax Payments and Credits:
1. Tax Due (Page 1 Une 19) (1)
2. CreditslPayments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
0.00
Total Credits (A + B + C ) (2)
0.00
3. InterestlPenalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty ( 0 + E ) (3)
4. If Une 2 is greater than Une 1 + Une 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Une 20 to request a refund (4)
5. If Une 1 + Une 3 is greater than Une 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (SA)
0.00
0.00
0.00
0.00
B. Enter the total of Une 5 + SA. This is the BALANCE DUE.
(5B)
I
Make Check Payable to: REGISTER OF WILLS, AGENT ;
l~i~I.1I Tr~.rRn~_~;&.tJ!lh+if&~'\':; ';~fli'/"
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRI~TE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred;.......................................................................................... 0 [iJ
b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 [iJ
c. retain a reversionary interest; or.......................................................................................................................... 0 [i]
d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 [i]
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. 0
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ 0 [iJ
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT A PART OF THE RETURN.
Under penaIIIes II pIIjlIy, I declII1IllIIll hive -**llhls IlItum, including accompanylng schedules and stal8menll, and 10 the best II my knowledge and belief, R Is true,
DedIndIon II pIIpIIW oller than the paanaI ~18IIYe Is based on all inIonnallon of which preparer has IIIlY knowledge.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN
[iJ
[iJ
0.00
,
{'I- 7- os-
ATE
"'.1'" /74
1..~ ,;~.., ,mr~_~M
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the urviving spouse is 3%
[72 P.S. ~9116 (a) (1.1) (i)). :
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 islO% [72 P.S. ~9116 (a) (1.1) (ii)).
The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a taXi retum are still applicable even if
the surviving spouse is the only beneficiary. ;
I
For dates of death on or after July 1, 2000: I
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a !tural parent, an adoptive parent,
or a stepparent of the child is 0% [72 P.S. ~9116(a)(1.2)).
The tax rate imposed on the net value of transfers to or for the use of the decedenfs lineal benefICiaries is 4.5%, except as noted in 72 P.S. ~911 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 decedenfs siblings is 12% [72 P.S. S9116(a)(1.3)). A sibling is de~ned, under Section 9102, as an
individual who has at least one parent in common with the decedent, whether by blood or adoption. :
I
I
............J.......
I
I
I
I
REV-1508 EX+ (8-98) '*'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
Edwin C. Farver
FILE NUMBER
21-03-0033
Include the proceeds of litlgatIon and the dale the proceeds were received by the estate.
All property jolntly-owned with right of lurvlvol'lhlp mUlt be disclosed on Schedule F.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
1. M&T Bank IRA Account No. 035004201767554
2. M&T Bank IRA Account No. 035004201914220
3. Personal Property at 1314 Strafford Road, Camp Hill, PA 17011
109,078.22
22,080.58
1,000.00
.
TOTAL (Also enter on line 5, Recapitulation) $
(If more space Is needed, Insert eddlllonal sheets of the same size)
132,158.80
REV-1509 EX+ (6-98*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIOENT DeCEDENT
SCHEDULE F
JOINTly-oWNED PROPERTY
ESTATE OF
Edwin C Farver
FILE N MBER
21-o3k>033
If an allt WlI mad. Joint within one year of the decedent'l date of death, It mUlt be reported on Schedule ~.
SURVIVING JOINT TENANT(S) NAME ADDRESS RELA 10NSHIP TO DECEDENT
A. Anna M. Farver 1314 Strafford Road, Camp Hill, PA 17011 wife
B.
C.
JOINTLY-owNED PROPERTY:
I.E11Bl DAlE DESCRIPTION OF PROPERTY % ~- DAlE OF OEAlH
I1EM I'M JOINT MACE 1Na.l.ClE NAME OF FINANClAl.INSTIl\ITIOHANHIAN(ACCOUNT NLfoIBER OR SIMIlAR DAlE OF OEAlH DE ~ VALUE OF
/IlMIER TENANT JOINT IDENTlFYING NlMlER. ATTACH DEED FOR JOINllY-IEUl REAL ESTAlE. VAUJE OF ASSET INTE DECEOEHT'S INTEREST
1. A. 1314 Strafford Road, Camp Hill, PA 17011 129,000.00 50 64,500.00
2. M&T Bank Checking Account No. 32334230 2,397.04 50 1,198.52
3. M&T Bank Mony Fund Altemative Account No. 98127403 2,905.11 50 1,452.55
TOTAL (Also enter on line 6, Recapitulation) $ I 67,151.07
Ifmores Is d I I
pace neede, Insert addlllona sheels of the same size)
REV-1510EX... (6-98*
COMM~TH OF PENNSYl.VANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
ESTATE OF FILE NUMBER
Edwin C. Farver 21-03-0033
ThIs schedule must be completed and filed If the answer to any of questions llhrough 4 on the reverse side of the REV-1500 COVE~ SHEET is yes.
DESCRIPTION OF PROPERTY I
ITEM INClUDE THE NAME OF THE TRANSFEREE. l1Bl RElATlONSIIPTO DECalEIIT ANa DATE OF DEATH % OF DECO'S E>!CLUSION TAXABLE
NUMBEF THE Ilf\TE OF 1lWlSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST VALUE
1. Diamond Ring to son, Edwin C. Farver, Jr. on May 1997 500.00 100 500.00 0.00
2. Guns to son, Edwin C. Farver, Jr. on May 1999 1,000.00 100 1,000.00 0.00
...
..
I
TOTAL (Also enter on line 7 Recapitulation) $ 0.00
(If more space IS needed, Insert additlonal sheels of the seme size)
REV-1511 EX+ (12-99.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Edwin C. Farver
FILE NUMBER
21-03-0033
Debtl of decedent mUlt be reported on Schedule L
ITEM
NUMBER
A.
DESCRIPTION
AMOUNT
1.
FUNERAL EXPENSES:
Burial and Expenses
7,015.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s) Anna M. Farver
SocIal Security Number(s)/EIN Number of Personal Representative(s)
Street Address 190 Meadowview Drive
City Harrisburg
Year(s) Commission Paid: 0
Slate PA Zip 17111
2.
AIIomey Fees
425.00
3. Family Exemption: (If decedent's address is notlhe same as c1almanfs, attach explanation)
Claimant
Street Address
City
State
. Zip
Relationship of Claimant to Decedent
4.
Probate Fees
15.00
5.
Accountant's Fees
0.00
6.
Tax Retum Preparer's Fees
0.00
7.
TOTAL (Also enter on line 9, Recapitulation)
(If more space is needed, Insert additional sheets of the same size)
7,455.00
REV-1513 EX+ (9-00)
*'
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
NlERITANCE TAX RETURN
RESIlENT DECEDENT
ESTATE OF
Edwin C. Farver
FIII.E NUMBER
211-03-0033
RELATIONSHIP TO DECEDENT i AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not lilt Tl'\I$tee(l) 1 OF ESTATE
I TAXABLE DISTRIBUTIONS pnclude outright spousal distributions, and transfers under !
Sec. 9116 (a) (1.2))
Anna M. Farver, 190 Meadowview Drive, Harrisburg, PA 17111 spouse 267,960.95
I
I
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-l ~ COVER SHEET
D NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN aECTION TO TAX IS NOT BEING MADE
.....
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 0.00
(If more space Is needed, insert additional sheets oflhe serne size)
!~{D~{~gDw ~~i~Q
.';U.J~ JoJ..,. "......,...,
~
PI Mla'Bank
499 MllchaIl bad, M1111boro. D5 IM6 Mail Code DE-M&-12
Pbane (III) ~9
FIIlIl (XU) ~9!'
NCM:IlIIler 1, ~
L81f 0IIlcct of
Pe_r J RUllO, PC
3100 MIIrkat Street
Camp BiD, PA 17011
R.: &1- of: Edwin C FD1'WI'
SodcJ SM:urttv: 204-30-591 J
I}gtE ofD<<zth: October 12. 2002
. I
Dear Sir or Madam: i
Per )'UlD' iDqGiIy dIde4 Ottobar 'IT. 2OOS, pleue be advised 1bat at tbl:I time of death, 1bD ~ ~ b-.d Oft
dr:poaI wid11b1J ..... fb1lowiDI:
1.
7jpf ~ At::txMrl
CMddnt: At:cDllPlt
32334230
~NfIIII_
~(NamtBqO
A,1'I1IItI M FtII'Wr ·
EdwIn C Ff/IMfT ·
~/:)rM
Baklnt:tI ClIf lJIlle cfDatlh
.4s:t:nMdlrtWd
TCltal
08128/64
$2.396.96
$ f). 08
--$2,397.04 ~--
I
----_...........---------~--_.
2.
7.\p ti' At:cowtt
At:cauN Nvmbftr
~p (NtI11ID tIJ
MDI'I81 Fvnd~A/:tJorlnt
98121403
EriwI1r C Ft.rVfU' ,.
A1I1IQMFtI1WI' ·
~DaJe
lJtJI1D1tIc8 em Dote t6Dah
Acc1wtIbaIwt
Tf'JId
4121/97 ClD.rfd JOIZ31NJ2
U9()4.45
$ 0.66
$2,905.11
I
--_..~-_._-----.,.-
I
I
-----..------.---------~---i-...
11/B1/2BB5 14:26
3B2-934-2136
M AN!) I ~ ~l..:l..JIoa.ki
~Abt:. tJ.# tJ~
3.
1}p tf .tfa:atInl
~N""""
IRA
035004201767554-
~Al/jJrst* 870tJ010398300J
0t-6I'J. (NflIIfIJS cf)
cpmbIg D-.
1k1liIIIts ClII /)f.de ofDtttllh
A.a:rrMtd~
total
F4win C Fr.tIW1" ·
04102182 Closad 07102/03
$101,8J3.92
$ 1.254.jO
----_..._----_.._--_..._--------------------~--
$109,078.22 !
!
----t-
.---------
4..
1)ptf~
Atx:tIfIIfI MmIIJv
IRA.
~ (Nome8qf)
ap.mgDrJt8
lJt1/lft:e on Dt:1It8 qfDeaJh
ADt:1wd hrIe1ut
ToItIl
1JJItrnI8/ PaidY/'D
03500420J914220
fi:1nnerly A1ljlnt f 87/0020398300}
Edwin C ForYtIff
]]101/00 ClOJ.a f17/01/03
$21,!JOO.$3
$ 180.05
- w.08O.T---d-
-so.oo ~~1IDI~ J..--
. Fa.- fIII1Mr MlllUt .........tioII, nprdIIlg oncnbiltt cIanrcI 81ldlor rcbD.......t of ~ ctc., ,.. call
6eHIP..... Pu1l~# 717-137-33'.11 . !
!
Skarely,
~
Jteoora. ~
=- =:-=-. -'~-::i~~.' . .. ;;;"{; .t.;"~:; .:; .;~:~;;."~':::.~':';- ."" ; .:. "~;~. :S;" '/:: .~. .. ~ :~';'~;' :~:.7-~:~ ". --'
.' ""l;"l'~\/ ~'!r1'~~~::-;~'!I..~I", .' ""',: .,,; ...... }..... >,.' .,M:)....u~.>..: ';, ..,....:.; ;. . .
'~~': . '> ~~ :.~,~;,.;:;:~;~~:t~;~~~~~.tt.{~l~~~~.~:i.~~';,,~',;~~,:,:;~;',..;. ~;~'. 'S;-::,. \.'. .::' 7...;.," ;":... .:;......~ "" F'.. '. .:' _ .. ,
. "
.. ',~"~ i :'4... ~~~~ !~;~ '~.~i) '-\'~~:~~~:~i';:~:F~;4~~.~~~tl:~~ ; '.~' ~ ~.~ -. .~~.: 't
. '";
....: : .,,~,::~, .~.:t..."
.. .' ..
.
'(
.. -- ;;.,. .....: '," '.
"'", -~""! ~".-,.. ::" :. "w" '!,.II,'L
'. y . . .~., li~'t.l. ,IS..
, JJIIIHJ"."If:~:' ;-...... ;.... .
.'~'; I" ", ..... ......." .
'. . . lite_DElI or.H~ ....~ :.....
. -- U .. ~)." ....
. S'IO n in ... ..... ;:, .'
. ",. .'. iii . ~ . , .
:!'. .,'..:....~.;,. ...~..~.-....::~'.;:,:,. ,,' c'
.... '. i;lt.;..,\\~!=n;lI.LIIl& ., .." .
, '~'..i.' ..", . ..:~.. .
.,....
~.
'. . "
,'l:t~.
"
,ft:.
....'
. ','
CCAC'# .;:Jy, 7.
,
.,' i
.; !.
.1
I
,
f'EE..SDiIPl~ ouo-rr.--ri..
i
" .
'I"
", i
,
i
'.:.,.1'
,.
. i
~ ," ~ ~I ~ '-I "7.:~,' i
:- ~~~.;:~~,"':"ijj4i5 '3J*tlt1tr? .fIubt libt
. :';<':';":" ::'1d:L~9-J".:..~
.... . T~~' ~~ lI;rJ.d -_Silny~.UI ~66)" ..~ '. .
",~o:::.~~~~~~.;: ~~n~:;'~: "","FR""; ....u...f ,~l'"
, ',' , ' ':~ _:~; ';.,.:; t: :,,:: :~D < , , ", i: :,';:' '>'~~~.;.-.r:;: ,': .
"'; . ':.. '.., - '.. ". ." '.~ . .-.:.
- . .... . ..... ........... ..........1,.
....... .,.. . ! .~. .~:...:~~. ;',.L 'i.": . 4..
':. . EJ)"'~ C. .FA~YEIl.~ ANHA M. FARYE;R. ~~ y,'lf~. 01 W.o&'~~y.~~~r .'
, ~..IIcr1&Dd COWl'~.:' .r.IUaII)'1v.nli~. Gl'anle~., ..."u.. .' ".: ..... ". ....
. " :';:"1 . . .;'
." ...:.......
i
t..". -.. ;'..
'......:...
....
';~.">)'
'':-;'/+.<.'.
1 ~.'
. .
. .
,,' t
.:....:
. -'.'~' .,
: ,..........::.... .: :
......: '':'': ;~. .
.....
.'
I
,
,
I'
'.
~
~
~
,
..'
~
t
f
l'
!."
.t
"
f"
r
f
....
.0;....
.......
.,.' [
f<l,
~:"f,
U
.,
!
.1
'1
,
. i
I
I
,
A
.i
'I,
.j
I
I
,
I
!
:
i
I
,
I
.;::;=
." :.~
(;., .
n"1
"
:i
.
: 'J
.'
.
.j
I
,
I
L
-..... ---....;---.-.-.-
:-
,./
~,J
'c.:
'1..'\
. ',;
.
. ;
;.1
8~INC \he ..UIIO prcini..c. whic~ N.. P. Ni"ne~Q, Incorporated ('a Penn_tavanJe" :',
Corporatloa)IrAntecl ane eonv~yecll,lnto Kenneth F. Canny and Franc~. .... caa..e,..' hi.
wUe. by Deed Dated October ZS. 1952. and recorded h. Deed Book D. V.ollHDe IS,
'P&'e~" .G.um~W:la~.~ounty ,record., '. .
J.. ..... If _lid p - ( . ~,,~\.~ 1 "\"f"\ D 9 ~ Jl\.~
t_ . c.. 'I. . _ _ J:I...J __
I... .111 <<"'"'," -,.. hi ., ~..I Dbl: C...... Clr; P.I.
II( . ~. /t'!..' . . .... .thl.l. It...., , T..
'1 ,."
.: r
.1
1
I.
.1
I
. .1
~ I
'11,':'
. ,.
...
~'i .
)i..")
. ,
!
Of.'" '..
. ~.: J.
. .
,
,
. !
.. ~.'" . ...'
\:':,',', '.
" f
.~: .;
"'1
:~i'
. .,
. I
o"i
.~ , . ...
, .l
,~
.,:.
~". 't. :_:" ,~.
" :~':,~ i~:~{,;;~~::,:;;:~;' .
. .....
. ....10 .........
"".~~.,~ .~..::;j= :~';'t.:~.;' ',:,;;
". ....... ...; :.....~. ......
.. ., .....
....
..... . ..
:..
. )..
.:' .
-......
. '. >':':f~:~>(~;~:::":" ",;
'. . ~i:i~::. :~r . ."
....
. .'';'': .".
..' .' ;'.'; .....,.::..... ':.'.
::: ~:~\':?i'~ii,,~iW:';;,:':,; · . , "
.. . :. .:. ~..' ;.... -:::X ~~;U ~;f !i~:': \: ::"'/: ~. :', i {:.L~.i~/.. !.
..
"~ .
. . ,
. ~ ;. . '.. ::.
. '.' \,
. ;. '. ~ \. . ...., ~i
.. '..,
. ~ ..L..:....~~....~~~~
.,
!:~.~: ::'
'. .
.....
,.:'.:
........;. '
I'. ';':' .
. ,
" .",,' :..i...~.:,:~~y~:=:~;.r(.. .~: .....
.., ' ....~,. ' ....' . :'i~' ... ,t . ' ~ . , , '.
, : \-.J i!;.!1..~n:1.'i.:.)l ..' ,."
. ,:.. "~:;, ~:;~l): ~~: '. :'. '
. ;.,1.::'.' .
'. . .:.: ~'l ..... :::, ~"" ~..I
. ,.':
"0' .
..'
"'"
'cr~.~~..
..i' ......
"~~PAG[ 497.
.,
\
\.
'-.
. ,
-..-..... .....__._-~~..~-_....-..-.......__._...__._-....
...---.-.-.-
. .
..... .. r',
"',
",;
,.f
'I:~
..:~'
::..
~;~
":
".J'
I.
I.
I,
t:
.i
".
r..
:"~
,.
I
i
k
".
r
i
f
,.
~
;
:....
r
"
~'.
!~.,
j'.
i'
~:
I
!
,
,.
.
.
,.! :
.'~)..l': 'J:t~~
, ; '.1. "
\Il:F'U':
" i . ," ",
::1' ,
. .'.f
.,\ ..
~U.l"!!-.:.:;
~ ..:
.." .1. .:",:" ',' I'
i I
. . ~
l!'~'!''-~ .~\,.. ,I\. " J .'
~ " ,',.' I ,'. . .
.. I
"
"
. f ,";\I'U ,oo rt.~": ~:~., r.:~" ":,' '. '.
iBlIgetJrl'f ,..;,. .. -.I _,~r. ,.. "_-". ~,rJ"__,." ... -,t-"*-- ,. ,., -- "'..".,
., I. ~.. "11n--'. .." II. ,.wr,;.., __ "",,,i..., ".."".., ..J "...1".. ".'1, ;,.,,;.. ..J In""
'__I, Ana .IIWI ., 1M "".. tI,,,. 11I1,. I."'..... ".""7. ".,. ..., ",__w "'-1_'.". "-III ill 1__
~ ""'7. ./,'" uU "." ie. ., ,_ i," "". ./. ;". ,. or ..., ./,M"" ",..ion. ..J '''''1 .,.."
..J t-rM ,,,,,,./ "
I
I
. ~
liD lillOI' lIlIb to t;alb ,. "N ",..,i",. ~!t" .u '''' oj.,.. 'III -,,.,,,..,,.. ..,. ,.
..." ""i". . ."M....J 1<<'. their w".,_ooJ ""S." '0 _J ,., '" .., ".", ... _""
. ",,,-/., III, """"" i.. ., ,., ""-",, "". thdr '-i" .... ""'" /.,.-,
Anl.
TH! SAID Gzanlore, panic. 01 Ihe hral pari, Iheir
"1 ,Irr" ;"".'1. ro.'"....,. ,ro'" '_.. ",,,, ,. ,Ill IIIlI' 'III
theb _i" ."J "';,.,. 'M'
pi ihe Hral pari, their
Idn. ,.nII..- __ _I4irtidNJor" .
. """ ""1". ./ '" __ 1<<1.
II. ~ Oranlor., parti..
".' .f'
-- "" ..I ...,. 'M k,JiItr_.,. .. It";". Iwr,i,,-'I., "~I __ 1'..',1 ",' ...,iII"d. ..J
~ .. I. Jot. ..uJ. -,~-.. ..,. 'M .-.I ,." ie. ./ 1M '<1M IN'. th.h' Mit.
..J -.Ipt. .,.,." ,,,, Mil ,..., I... of 1M f"" ,..".. the. r ",;" _oJ .'NeII JI ... "'",81M'
, ;m. lit ""., ....,_. '...1""7 "..,." or I. dOl. (I. I."" ", -"1 "'" IM_/.
." ",. rrNIJ. ~ U1r" ",,,.,'. .AJUlANT AND lOIlEVEl DETF.ND
",
lit .itnlss -4triof..
"""..,,, ", the i.. lHotJa:.
~J.. J., :..... l(."' .~.'..',. "rt """1,,,.
~~.. ~ ,................ (SI;...LI
~~~...1.?1.,......~.~. ....... ........._ (StrAL)
t~ oMJ ",/ i..
-- ",j .
./ ,I. ,..., ,."
.. . .,.
SiSnco.l, Scaled and DcJivcrlrd
in rll., PrftCn<< Qf '
....'............. ...... ..................... .... ........ ....... ......... ........ (Sf"".)
:.'..................."..................................... ......... ......... (SI;AL)
I
--_...-;..__....._._-._........-..._.-:....~....
...................'............'........._.................. ................ (U"'I,)
:.................-........._........................ ...... ........... ($I;;"'L)
....." ........-.........,-......._.......................... ............ (S';"'L)
.....-......................................-.....-.........-.......... (SE"'L)
-.-....._--....__..-...__...-._....._~................-
, ,
--.------..........--..--.........
---.--.-.-:---i-..-.....-.......
-.....-....-.........................._........._...................... (SltltL)
................. ..-.............-............_..._......_........ (UltL)
....... :,..................... ..........................'..... ............._.. (S~"r.)
....-.....---..-.--........-.....-............................... (SE"L)
--oo--...----.--.-.-
~ 22rAri 49B
I j
- ...-:- .,....... .
...
J..ae
I
I
I
I
I
I
I
i
I.
!'
I
!
!
I
I
I.
I
I
J
t
l
I
I
i
I
I
,
I
J
I
I
I
I
.1
!
I
!
I
I
i
I
I
I
i
I,
I
I
.
I
I
i
I
t
I
I
I
I
i
i
I
I
j
i
I
I
I
[
I
I
'.' I
,j I
I
I
I
1
".
"
j'
I"
~
t
I
~'!~ i,
1
l
,0,..
::A-
. ,
I ;.~
. .
. " ..
.. I.
('I. ",
)i:: j.
. J'.'
. ~ I
~ r
;;'0/"
.;:j
..,
I
:t-.!
"1
: !
I
;.,
. ,0. ~
. i
....1
.- j ".
.: I"...-,rf
':1.
..\.oi.l
~7.' '
."j
. ":
)
!
T
..
I
p
I. ;
", .'~~~:~ .
',. 'tt;
~
".: ':'1
. .
......;.....h........_....__
...~:~:~,. 'j,~...
"'....
..'\'.;.
. " ~'
---
.'"
'{
':.i;~'~"';'~J'i
J'
.f..
...
.~.l ..
. ~NTY ~F .,~:"'~L'~,_:":':~~. 1 ~ss: I.
. 0.. ,~.. ,~:.:2ifil..-;.-;:, ._.~._... . . .. .._.................___....._. ,,~.ft_. Iwf- _I .
---.--:--.---.-........----.... ........... ...----.-...............-........._.__. IW ....IrnJ"..d
. ..#tvr, ,,"--'IT .#/NmI.;.~......Kc;IIQ~.tII...F.;..!i.iI",.qx..ll.Q!1o..F.nD.Ii~."..M'-.k!JI[!tr~.!..l!'!..1!~
,., I
~---- ...--...-..---.-.-.....-.....-.-------.--
.::.o~:::;i::;..~:.~;.....::.;..,:~.:~~..:,-...---...".-----.~....-....,':".~-----.~ . .'. "
~'''o' .t........-.~..(ar ";'IJ/UI-'T "..'ftIJ ,. ~ ,ht In'.. a..___ ...... _.., ...__ ."f"n;W ,.,_ . .'
.f.to~;~~-":'~~:'... ~l&IJtd," '''''':':_~br .][....... ,,,",,,,I,IN .."'.. '.r,"''''''/'tm ,IIn,;,. ft..~..;..,J, ,.' . . .
.. 'c.a' . ...~ ,..;. ,"
i~'~~~ ..0. ~..;. 'n" :;'ITNE&S "'''EIlEOf, , 11r,.;,,1o ,.., "'1 ,....1 ~"'''''''~"J ~~~. .. :'
:~"..... ....~... - ..-:-:(,' ...... . ~gp .
'l~:o ....:..:...\:I;.i..~. '. . . - '''--7'--' '--' .....N. i'
. ....~2iiy~..v"~... , . ..' . . . . 10'7 RI",..illllO" ,~,.,'" "-'. . .~Z. 'L,2(;;"f.:........ I"
....~...~.....( """'T _'1/, '#I..y,.;, ~. &,;.I""<<d~.JIJJ ~~ i. ~,~ JJ7. ;, _____ .
.---LV~~o/p..-:!.~~_S".~t':(yR~~!...(__.-~~.~.."'"_.. J...
'--:---~--"'. ---:._._-_..__.-~~~Yr-#7.T--- I'
.' .. _..~. .;f'fi:..~.:r.:$t<-__I.
. ". r.G........ .,!'
. 'I' ..J.!
"
'.
...
. ,',
:. ....
" ,fit",",
'. .,.~.;':"..,.,;....:r.('( "" ...,;"...;. ,"/-" :. "",.
,.~:~..~.. >
., :.' I .' ":~
,:'" .j
I '-".
01~
~.,;
,~
-=. :i
i
'V.~ ~
=..c; 2:
.>o'~ :'. -<
Ww ,. 1
A: IIIl ..
.r...t.,. '. .... .:bl
/&oto. . .w.....
.;j~, ....~ ~'i..
~ '.' -< -<.-
. Ji :..r ...to.:2
X ... .
...l3 .' '. "0. at
~.~..' .,":. a; ~
Ei -< . . ..It'r:!ll
....1IIl.. ~-<
.~. ~ " <..!"l r..
.0
..ot.' .
....
....
. I
f
,
,
. !
j
....
!. '0 ",". :,.;.:.. . ::' " 10 .
.'. .
, '.
,
..;..--...--......-.,....
.1
'. ~ ..
.. .'
..
.~
, ! ! I !
I I
I. i .
! i 1 i
j i
f oj
! i ! j
j' ! o!
.r o! i ,
r !
j f ~~ i i
i j . . I i
... . .j
":; r ..... I
j i .,.i r
! I
, .~ ! I. I
! 1 ~ I
I ! .! I
r
r f ~. 11
i
j t. ...
J c ~ j'
! ~ or: i
i,,"','
i .
I
I"
J .'J :.
J ._
~ l !
~ ..
fl" ~ J I ..~ !
L j 'Iff' r.'
J ";. ~ . ~.
.:~l.' ~
I' :
'.
t' " .
I.
-_-v
.' I,.',
" '.
'.
, ~:
'.
:
f
;.
:
.
I'
..
T- ',',
.
,~ .
.'
,
.
!
'. ;.
,
!"
I i.
1< .
I
'. .,
..
. :1 I.
,.
... ..
. . I~ '.
J,'(J{ 4" 4UU,",
.........u~
r ... . .... ......--,--
.,
.. . ... "'-..--..,..-.--..-
','
, . '0' . . i' . I' . "
. I,.'
. ~,:\.L / ~ ' '. .' '.:~L~:'::...:, :.
"---~ ,'..-.::..--- ~ ~ ..I.. '7Z...-.-ZI '. . Of '...
-~.. :. - - ,'a.ram..,}' .z.r~~tio" " ng
. .
PARTHEl\Ul!J&mFUnei-a1 ~e. ~o ..Services;:t~ic. ..
w...AaM..~ :" . . , ,','
U148L 1(..1.... .' .
euapSDJ,.'A l'7Dll-
'"
. ......-. ~ :~ ,'.' .-:~ :\' ''':-''''-.'','. , ".
. ," 'It 1
, , ,
'-""-'-"1""
-
. . .'
'. .
.:-. .
. ~ ... ,"
'~ ,'.: " .
I3Q1 BricIP 8tJwc n. P'aIlcnl Sarvb fix Mr, EdtrJD Cad Fcwr '. :',.
P.o. BcIlL'431 ' . w... ""~~dJe_fi~~""'p1iIadia'~IIII!1..ip
H..~ PA l?070 _ _ 'IN CID., Ploue fed fEw to OOIdIctlBif,..haft..-y
(11""774-7921 ---~ --." , ' ,... ,
,.,. -, .~
. (Fa) 174-5541, 11IEJIOU.OW1NG g AN I'nIMIZID ITADatDr OP11IB "'YICiIi~
~ ~. ANDl\CEIt:IIA:NDlIB'DIAT'YOU!DUC'UID WBIN,JlCMDIG
.....~ .
, .
tD"'~~ "
iIIr,..ntotIWI
~
llUNDAI.
.....".......... ........,
~s.wt. . . .. . . . . . .'. . .
JVN-..r.... Sla9ICS CIL\aGa .
DU.C:1'BD~
. .
"
..- .
. I.
. -I- ",
14M CII
f45fUI
. . .
Gilbert w. I'8t1f .1Ii 1"
'4lWMI6Irr
......C2ItJc~~ . . . . " . . . .. . _ .. ; . . . . . ,_ _
. 1'III:CXIft-0IDI~~.MIIt.......
'lBAT'rUUMV&SII.IC'J'BD . . . . . .. . " _ . . . ':". .
CMII......... 1
~~IIf'D.eIa~. . . '. '. . . . . . . ~
a..;,w.... ..l1l- . ; . . '" ... ',. 1 .
s..... K.~""""" PJo---. CIIIr:III: oIfn!Y . . . . . . . . . . . . . ; .' . .' .'.j .
CJI'lJp . ~.Iq- .u" . . . . . .' . . . . . .. ..'. . .1
'. D...-Nadaaw~., .... - . . . . . . . . . .j .,
BIUIlaLI"......."".... . a..c..................--... . . . ... . . . . . . . . . . .
~Nfmc:o(ln.. ll''''J c::rr TOr'.u:CAlBA>>VAJIIr::aAJ4DInCW:.<=II~. . . * . .
T... ..
., .. I .
01.. J.~
~.IJ'l'"
......
.tz4SD.aD
a78U.IIO
1kL00:
'UlQ,,,,
II,.,.. ' '"
SJI.~
SlIs4D :.
al.19 '
1lGT.G .:
T~c.. . . . . . . . . . . . . .. .
..., .
lG/14t.lDOa..-. a...iJ.m _,......,.... . "
'fOTAL~DIlI: .' . . . . ,:' ~
. . ...
. .
S745Z.S2
........ ~ .... . ~
NPDA. PPDA
DCPDA. COl'DA
~..
, ~...... a.-.
.,.... IN >>-
.'. . . '0 ,,". . .
. *,
$4G7"sz
'atIUJII
n.l~ 1 v..................._........Na~ <-'143;:110:I. "
Tbca,..w .....___0 __ if ~.. .1.25 ".............~..II~ ,..-..
....
"
"
. 'I'
" ,
, .
.' i
I
I,
WI'. B4wiD c.t l'InW
... 1
WHEREAS, on the 15th
dated Ma 3rd 1985
was admitted to probate as the last will
"..-,.-,
Register of Wills of CUMBERLAND Cqunty, Pennsylvania
Certificate of Grant of Letters
No. 2003-00333 PA No. 21-03-0333
ESTATE OF FARVER EDWIN C
(LA::n:, l"l.t<.::>'l", MllJlJL.l:!i)
Late of
LOWER ALLEN TOWNSHIP
CUM~.l:!i.t<.~lJ CUUN~Y,
Deceased
Social Security No. 204-30-5911
day of April
2003 an instrument
C
late of LOWER ALLEN TOWNSHIP CUMBERLAND County, w 0 died on the
12th day of October 2002 and,
WHEREAS, a true copy of the will as probated is annexed hJreto.
THEREFORE, I, DONNA M. OTTO Register of IWillS in and for
the County of CUMBERLAND in the Commonwealth of Pennsylvania, hereby certify
that I have this day granted Letters TESTAMENTARY
to FARVER ANNA M
who has duly qualified as Executor (rix)
and has agreed to administer the estate according to law, al of which fully
appears of record in my Office at CUMBERLAND COUNTY COURT HOU E,
I
CARLISLE, PENNSYLVANIA. I
IN TESTIMONY WHEREOF, I have hereunto set my hand and aff~xed the seal
of my Office the 15th day of April 2003.
MIJLBJ
I
I
I
I
",'." '. -1,""'<>', '::,>;',,, ,'",.;c'<,).,., ,',";"""."" """
I
I
I
I
**NOTB** ALL NAMES ABOVE APPEAR (LAST, FIRST,
"',:~-,~~'-:",I':!'>.t~-"""-"';""''':':''~''''''~'::~)H;:,,,~,:A'~,,',~,,-:-''~C"':':":''':'_.: ':"C':;;':;':'/';-~.'P'i:~:.::1Y'~.'~';~7",,';:-'~:';""_3:"J";Jf':'":i"'g"'';;'''':;;?"';',':r'r'lo:~,;~'qw<n;':i?~~r.::.s;~~:'!i'i'''::C~:';;::;i
11Ict5t 3lIlIill attb Wtgt~~33
I, EDWIN C. FARVER, of Lower Allen Township, CUmberland County,
Pennsylvania, being of sound and disposing mind, memory and
understanding, do hereby make, publish and declare thi as and for
my Last Will and Testament, hereby revoking all oth r Wills and
Codicils heretofore made by me.
my
as
ARTICLE I.
I direct the payment of all my just debts
last illness and funeral from my Estate as
conveniently may be done.
and the expenses of
soon af er my death
I
I
ARTICLE II. I
I give and bequeath to my son, EDWIN C. FARVER, 11:1
(a) My gun collection and gun cabinet; and I
(b) My diamond ring.
I
ARTICLE I I I . I
I devise and bequeath all the rest, residue and retinder of my
estate, of whatever nature and wherever situate, unto y wife, ANNA
M. FARVER, provided she survives me by thirty (30) days.
I
I
ARTICLE IV.
Should my wife, ANNA M.FARVER, predecease die on or
before the thirtieth (30th) day following my death, devise and
bequeath all the rest, residue and remainder of my Estate, of
whatever nature and wherever situate, unto my childr n, KIMBERLY
ANN FARVER and EDWIN C. FARVER, II, share and s are alike,
provided, however, that if either of my said childre shall have
predeceased me, then such child's share shall pass to such child's
issue, per stirpes, and provided further;
If any beneficiary hereunder has not reached age of 21
years at the time for distribution of his or her sha e, I devise
and bequeath such shares to Dauphin Deposit Bank & Trust Company,
of Lemoyne, CUmberland County, Pennsylvania, in SEP E TRUST, to
hold, manage, and invest the share or shares as received, and the
accumulation of interest thereon, and to use and appl the income
and principal, or so much thereof a$, in Trustee's di cretion, may
be necessary or appropriate for the beneficiary's support and
I
education (including college education, both underfraduate and
graduate) without regard to his ability to provide for such support
or educat ion, or to make payment for these purpo es, wi thout
further responsibility, to such beneficiary or to any erson taking
care of such beneficiary. When such beneficiary shall reach the
age of 21 years, Trustee shall distribute to such be eficiary the
entire balance of principal and income accumulated th reon so held
in SEPARATE TRUST by Trustee and this Trust shall terminate. If
any beneficiary hereunder dies before receiving final istribution,
then his separate trust shall terminate and thel balance of
principal income of such trust shall be paid over to br. then-living
issue, per stirpes. I
I
ARTICLE V.
During the time any portion of my Estate remains
same shall not be subject to anticipation, pledge 0
voluntary or involuntary, by or against the beneficiar ·
n trust., the
alienation,
I
ARTICLE VI. I
I
My Executrix and Trustee shall have the power iq addition to
those vested in them by law or other provisions o~ this Will,
applicable to all property, exercisable without Court ~pproval, and
-2-
_.. ._-~--~,-_...,,~-=--.,,-,.,,;<n~~....t-t~._. ..~r~~mr~!~,~;t.r...~;;-~~~?];9i
I
I
I
I
effective with respect to each item of said property until actual
distribution thereof, to sell at public or priv te sale, to
exchange or lease for any per iod of time any real or personal
property, and to gi ve opt ions for sales, exchanges r leases for
such price and upon such terms or conditions as they proper.
ARTICLE VII.
I nominate and appoint my wife,' ANNA M. FARVER, Executrix of
this my Last Will. Should my wife, ANNA M. FARVER, fail to qualify
or cease to act as Executr ix, I appoint DAUPHIN DEP SIT BANK AND
TRUST COMPANY, Executor of this my Last Will.
I direct that
to gi ve bond for
jurisdiction.
ARTICLE VI I I .
~ Executrix or successors shall no
the faithful performance of their
be required
uties in any
IN WITNESS WHEREOF, I have hereunto set my hand
1rrJ- day of Jt1t~ ' 1985.
~~
Edwi n
a~d
i
seal, this
(SEAL)
Signed, sea 1 ed, pub 1 i shed and dec 1 ar ed by t he above-named
Testator, as and for his Last Wi 11 and Testament, in the presence
of us, who at his request, in his presence and in th presence of
each other, have hereunto subscribed our n~es a~ witnesSeSj
___~~~~=-i!L1)-' I ---------
~~----- -------------
-3-
ACmtOWLBIXIlIENT
c:nM)NWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
ss:
I, Edwin C. Farver, whose name is signed to t,e foregoing
instrument, having been duly qualified according to la , do hereby
acknowledge that I signed and executed the instrumen as my Last
Will and Testament; that I signed it willingly; and t at I signed
it as my free and voluntary act for the purposes there'n expressed.
Sworn or aff i rmed to and acknowledged before
FARVER, this 3.....cL day of 'vv'\ ~
~E~~ - ~
I
me, I by EDWIN C.
, '985.
I
I
I
I
I
~ .
~-----
Notary
i:"TARY PUBUC
MY ~ISSlON EXPlftES om.. 21. -
lEMOYHE. PA CUMBE1llAND CO
-4-
. '
~Illr.,",,"",~lr>-;.-~;".n'..',
"1.,,1...' ....,'~.r_,,~....~"'_~""<,I~~...e''''
APP lDAV IT
CCM<<>NWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
.
.
ss:
We,~~~.~ and ~C.
the witnesses whose n~es are signed to the foregoi g instrument,
being duly qualified according to law, do depose an say that we
were present and saw the Testator sign and execute Ithe foregoing
instrument as his Last Will and Testmnent; that he si ned willingly
and that he executed it as his free and voluntar act for the
purposes therein expressed I that each of us in th hear ing and
sight of the Testator signed the Will as witnesses; nd that to the
best of our knowledge, the Testator was at that time eighteen (18)
or more years of age, of sound mind and under no constraint or
undue influence.
-~.-
~l&=--
----------
Sworn or affirmed to and subscribed to before me by
~~,..".~' and .~<l.~ witnesses, this 3AL day
of 'Y-n~ ' 1985.
-~~~
-------
ie
-5-
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG. PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
FARVER ANNA M
1314 STRAFFORD ROAD
CAMP HILL, PA 17011
____nn fold
ESTATE INFORMATION: SSN: 204-30-5911
FILE NUMBER: 2103-0333
DECEDENT NAME: FARVER EDWIN C
DA TE OF PAYMENT: 11/29/2005
POSTMARK DATE: 11/28/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 10/12/2002
REMARKS:
CHECK# 2161
SEAL
ACN
ASSESSMENT
CONTROL
NUMBER
101
TOTAL AMOUNT PAID:
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
REV-1162 EX(11-96)
NO. CD 006037
AMOUNT
$ 21 7.00
$217.00
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
C"€:.. ),~'J'~-/. ~A.x:'<;
Law Offices of Peter J. Russo, p.t.5?~
The Chelsea Building
3800 Market Street
Camp Hili, PA 17011
(717) 591-1755
Please contact us if you have questions, comments or desire more information,
r-~~
Name .A-r\,14) .-:=-ftflVL.r!l
The Following Information is Enclosed:
Enclosed For Your Information
Date .' (/i: z.h ,~-
, ,
.A c) f'tffl 0; J..z. TeU::;>Ptk.!LN.~
CG.'L'v'(J7L3A:n(i1,/ ;DCL'tt'8'cr
)
/ ,'t) C L u ~ (::)
I. 1 ; \./ i~ I C' t.T
'-U,'T/-!
Y(',..)/L P/lYVY,,<.,.,..N1 cr
<. 0t
Q ,;(/ =j- <70
a o'Z~/SiL.~ (0) r-- ~/u..';
.~
,~-
auvr1(}~C)
CRo......vT1
My File No,c1/-06 - ~333
This lnformatio~:
o ':.-' :T~
[ ] Pu~jmt to your requ~st'
-T- r
[ ] Pursuant to o~~ convei~~on
[ ] Just,!P keep yoo info~
the: ~gress ~Jhis ma~(.
File if desire<6. . "'
c..h62K <::21 ~ (
I~~ ~-
~ f c:J~,
d~~ cJ~~ ';
~ (J ----
~ (3J <<- /7d//
,-,j?V.-
'\ '70 i :';:/:';::;:'3 i
1 II ,iii 'Illll'll! ,1111111111 n 1lI111111m 11111,1"1.1,,,1 1111
,~,~,
.1
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
01-10-2006
FARVER
10-12-2002
21 03-0333
CUMBERLAND
101
APPEAL DATE: 03-11-2006
( See reverse side under Objections)
Amount Remitted I I
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
9Y!_~~9~9_!~~~_~~~g______~___~~!~!~_~Q~~~_~Q~!!Q~_~Q~_!Q~~_~~9Q~~~__~____________________
REV-1547 EX AFP (03-05) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
EDWIN C FILE NO. 21 03-0333 ACN 101
BUREAU OF INDIVIDUAt:fM(ES
INHERITANCE TAX DIVISION
PO BOX Z80601
HARRISBURG PA 171Z8-0601
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
"'-'1
PETER J RUSSO ESQ
P RUSSO LAW OFFICES
3800 MARKET ST
CAMP HILL
PA 17011
ESTATE OF
FARVER
TAX RETURN WAS: [X) ACCEPTED AS FILED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate [Schedule A)
2. Stocks and Bonds [Schedule B)
3. Closely Held Stock/Partnership Interest [Schedule C)
4. Mortgages/Notes Receivable [Schedule D)
5. Cash/Bank Deposits/Misc. Personal Property [Schedule E)
6. Jointly Owned Property [Schedule F)
7. Transfers [Schedule G)
8. Total Assets
) CHANGED
(1)
(2)
(3)
(4)
(5)
(6)
(7)
.00
.00
.00
.00
132,158.80
67,151.07
.00
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses [Schedule H)
10. Debts/Mortgage Liabilities/Liens [Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts [Schedule J)
14. Net Value of Estate Subject to Tax
NOTE: If an assessment was issued previously, lines
reflect figures that include the total of ALL
ASSESSMENT OF TAX:
15. Amount of Line 14 at Spousal rate (15)
16. Amount of Line 14 taxable at Lineal/Class A rate (16)
17. Amount of Line 14 at Sibling rate (17)
18. Amount of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
TAX CREDITS:
DATE
11-28-2005
+
INTEREST/PEN PAID [-)
.00
NUMBER
CD006037
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
(9)
(10)
7,455.00
REV-1547 EX AFP (06-05)
EDWIN
C
.00
(11)
(12)
(13)
(14)
DATE 01-10-2006
NOTE: To insure proper
credit to your account,
submit the upper portion
of this form with your
tax payment.
199,309.87
7.455 00
191,854.87
.00
191,854.87
14, 15 and/or 16, 17, 18 and 19 will
returns assessed to date.
191,854.87 X 00 =
.00 X 045=
.00 X 12 =
.00 X 15 =
(19)=
AMOUNT PAID
217.00
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
.00
.00
.00
.00
.00
217.00
217.00CR
.00
217 . OOCR
[ IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. ~
IF TOTAL DUE IS REFLECTED AS A "CREDIT" [CR), YOU MAY BE DUE V
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
Marjorie A. Wevodau
First Deputy
One Courthouse Square
Carlisle, PAl 7013
Glenda Farner Strasbaugh
Register of Wills &
Clerk of Orphans' Court
Kirk S. Sohonage, Esq.
Solicitor
Phone: (717) 240-6345
Fax: (717)240-7797
OFFICES OF
Register of Wills and Clerk of the Orphans' Court
County of Cumberland
FACSIMILE TRANSMITTAL SHEET
Janet Bush
FROM:
Margie Wevodau
TO:
COMP ANY:
Peter J. Russo, Esquire
PHONE:
717-240-7766
717-591-1756
DATE:
February 28, 2006
FAX NUMBER:
RE:
TOTAL NO. OF PAGES INCLUDING COVER:
o URGENT
o FOR REVIEW 0 PLEASE COMMENT 0 PLEASE REPLY
o PLEASE RECYCLE
THIS INVOICE IS PAST DUE. PLEASE ADVISE WHEN WE CAN EXPECT PAYMENT.
THANK YOU.
Glenda Farner Strasbaugh
Register of Wills
and
Clerk of Orphans' Court
Marjorie A. Wevodau
First Deputy
Kirk S. Sohonage, Esq
Solicitor
Register of Wills and Clerk of the Orphans' Court
County of Cumberland
One Courthouse Square
Carlisle, PA 17013
(717) 240-6345
FAX (717)240-7797
INVOICE
Bill To:
InvoiceN 0:
Invoice Date:
Estate of:
Estate No:
PETER]. RUSSO
THE CHELSEA BUILDING
3800 MARI<ET STREET
CAMP HILL, P A 17011
Qty
1
Fee Description
Additional Probate
Total
Fee
217.00
$217.00
Total:
$217.00
Checks should be made payable to the Register of Wills. Terms: Net 30.
Please return one copy of this invoice with your payment. Thank you.
640
11/18/2005
Edwin C. Farver
21-03-0333
R. Kelly
TRANSMISSION VERIFICATION REPORT
TIME 02/28/2006 09:00
NAME
FAX
TEL
DATE, TIME
FAX NO./NAME
DURATION
PAGE(S)
RESULT
MODE
02/28 09:00
95911756
00:00:26
02
OK
STANDARD
ECM
BUREAU OF INDIVIDUAL TAJCES
INHERITANCE TAX DIVISION '
PO BOX Z80601
HARRISBURG PA 171Z8-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
'*'
REV-1607 EX AFP (03-05)
9:52
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
02-27-2006
FARVER
10-12-2002
21 03-0333
CUMBERLAND
101
EDWIN
C
(',';
PETER J RUSS&\\t'sg.
P RUSSO LAW OFFIcES
3800 MARKET ST
CAMP HILL PA 17011
Allount Relli Hed
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLEI PA 17013
NOTE: To insure proper credit to your accountl submit the upper portion of this forll with your tax paYIIBnt.
CUT ALONG THIS LINE
--+ RETAIN LOWER PORTION FOR YOUR RECORDS
~
---------------------------------------------------------------------------
REV-1607 EX AFP (03-05)
~~~ INHERITANCE TAX STATEMENT OF ACCOUNT ...
ESTATE OF FARVER EDWIN C FILE NO.21 03-0333 ACN 101 DATE 02-27-2006
THIS STATE"ENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NA"ED ESTATE. SHOWN BELOW
IS A SUHKARY OF THE PRINCIPAL TAX DUEl APPLICATION OF ALL PAY"ENTSI THE CURRENT BALANCEI ANDI IF APPLICABLEI
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT DR RECORD ADJUSTMENT: 01-10-2006
PRINCIPAL TAX DUE: .00
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
11-28-2005 CD006037 .00 217 . 00
02-06-2006 REFUND .00 217.00-
TOTAL TAX CREDIT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
. IF PAID AFTER THIS DATEI SEE REVERSE TOTAL DUE .00
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
l IF TOTAL DUE IS LESS THAN $11
NO PAYHENT IS REClUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" lCR) I
YOU "AY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FOR" FOR INSTRUCTIONS. )
C;/