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HomeMy WebLinkAbout95-0063~1 ~~~ CC(~3 i H105.1 A3 ReN. 1187 TrPE,P,w,T m PERMANENT BLwac RdK w W w D 0 Z This is to certify that the certificate hereunto attached is a true and accurate copy of the original death record on file with the Division of Vital Records, and that Frank Yeropoli, whose name is subscribed thereto, was at the time of subscribing the same and now is Director, Division of Vital Records of the Department of Health, for the Commonwealth of Pennsylvania, duly appointed and commissioned as directed by Act 66 of the General Assembly, approved 29 June 1953, P.L. 304. Date AuG i 6 20QT ?~ • Fran eropoli, ' ect Division of Vital Records P.O. Box 1528 New Castle, PA 16103 COMMONWEALTH OF PENNSYLWINIA • DEPARTMENT OF HEALTH • VITAL RECORDS ~ ~ '~ CERTIFICATE OF DEATH '" ~~ `' ~ ~~ NAME DF DECEDENT (FaeL Muddle, Leq SE% SOGAL SECURfTY NUMBER DATE OF DEAN iM<M. Dey.'Awf ,. W. Theodore Dahistran s Male a 086 - 05 - 5990 ~ ~Cem c l qy ADE ham DYdbeR UNOBl1 YEAR UNDERt dY DATEOF DRTTH BIRTHPUtCF /(:ayaad PLACE OP DERNtfllerJl onN one-swiaeucmro an dnw adN MonMa. I D•N Nona = rraew IMppl,DM1 MMr1 $twaFdapnCwwy) ,pSpgL InpaA<a ^ laaoulPerira ^ oLw ^ No ~ aa.iaerrc. ^ ^ a 92 Yo. . Brookl NY Set 5 , 02 , . , COUNTY OF DEVH CITY, BORD.7WPOF DEAN FACILITY NAME PInd •bMelrpn.gw steel and numori Yn4 DECEOENTOF MISfM1111CORgIN7 RAGE-AmedoYl mdln, BlaCK, WIIRe. arc Mw ^ Mya. eP.<IM Galan. lsa.arl Ctmberland Carlisle K Church O~ GoL> .. """°'R°"'"` ,a ,~, DECEDEM'9 USUAL OCCUPATM7N g11D OF BUSINESSANDUSTRY MYIB OECEDENTEVERIN OECEDENT'$EdIGQ10N MARITAL SLQW•MaInW SPOUSE dwN Wenulon lunnl AIMEDFORCEST ~ New U S er . . (CiieeNMawae darn mor ~or5. a-orNlww:eonaw°u..'<'~r.e.i Thread Co ,M~ ~^ ~ l 1 / ,.. Sin le ,s. ,,: „rBarbour' Linen & ,z ,x l~ oECEDEYrt'S MARJND ADDRESS (SRat Cily/TOewr, sMrzacoe.l DECEDENTS Pa ,TC a.c.eea Rreem East Pennsboro p,p ~7 rw 52 Greermont Drive , . , SR,ERe ~ t7P'~"' a°"r<.a.a Enola, Pa 17025 u <na ~` Clmberland '°"""'°' ,T..O ~~a ,Ta dtNBaro. tAHER'S NAME S"ew Miode. Laeq MOTHER'S NAME IF+f4 wm.. Maiden swn.mN ,.. Carl J. Laahh].stran ,., Anna Johnson INFORMANT'S NAME (TypwRee( M,PORMANT'9 MARYK, ADORESS{SeeM. CH/T<a+r• SMm. Z9 Codq ,,,• Carl A. Dahlstrom 52 Gteenror-t Drive Enola, Pa 17025 MErlaooFDlBPOSITION DATE OF DISPOSRION PLACE OF DISPDarrloN•N.n.aG.mR«K Granomry LocaroN-CRdbrrr, StaN. ap code elaw~ cr«Iwmi^ R.In•.aNmmsrw~ .D.xw.l >os»rPMO. „°~'m"~ °'"`"SD'~"` ^ ,,. Janua 4, 1995 ,<. Kensico Cemete z,d. Valhalla New York RAL 9E ACTRKi ASSUCI, t1CENSE NUMBER NAME AND ADDRESSaF FACILRY r et ~ree~ uw 011654-L ers-Hamer Funeral Hone In Hilt Pa 17011 yy<pay w,wn - yn prramyyrowMOyi.yrl, o<avmoaryN yme. ei,<ano pyc<MaNO. LICENSE NUMBER r DATE SKaYED ~~ pywd.nrna,Ywela.ruR.aaarnm o.eryal..aairn. and rlel .\ ( L • ~ ~i~ly M1 J p - bw 2.e. lXX RenM3adB mlalrtN COrnPrilad A' OFD ~~,~~,,r~ ~, PRDNOUNCEDDEAD (MONn. Day. YBY) CASE REFERREDTOM Q E1IAMINEpICORONER7 ~. Pareirl wlaprdrl<uma datlr ApfX~'"11~r . 1-,, ,,. 30 ~-1~~ M VCI M Zr ZS . . . tD. PART I: ENertla 4easM. mjurlesa canplkatiwr arrch catMdtM deem. DO rot M<rlM ngoeagiq,wc.aufafeoa mpiralary anM.algck arMrl hilxR Ihppoaimale P11RT R: OlllwaipriROnl opdbr<plbiWlq bo<iN. oul W oay orr plrean aecA Wr. ~YMwvel <eaven nN rw<Mrlpw tla uadedyetR earwglanNPART I. orRRYaldeel0 , ! r ~ CfYr- a. ~ 7~ r~-~•~. : A OUE D Q~ YinYW Io YwIr6rM eauM. EnW IRIDEILYR/0 CMIRE(Dirsaar irpay DUEIO/OR ASA OIR:N~OF): I ~ < DUE LID (OR ASACDYLSEWENCE DF): I eNr ilYMtlaNrlb rwWbpNdaetrl LAST d BRS ANAUIOPSY VYERE AIlIOPSY FINOM<CS M1aM1ER OF OFAH DATE OF MUURY TRaE OF INJURY RUURYRYYDRKI DESCRIBE YIgY R1NR,Y OCCUW,ED. PEAFORa1EDY AWIABLE PRIOR W / M<nm, Dry, Marl ,.._, C~rMLETIDN aF CAUSE NwM 1S Nomiaa< ^ ~ Ka ^ N<^ ~/ At tiOia ^ PMQip lrlyKlpilfon ^ M. l0~ Ma ^ NO Yn No Summe ^ Wrad na lM dNarmirod ^ PLACE OFINJURY-N 1101r1e. hrm, RreM, Iaclgy alllce LOCAION($eeM, CAy/bun. Smtel ouilb4 em. f3pe ~Yl 1eD, h. ]Oe. >01. CERTWERICned orJY anal RE ANO TfiLE R:R •CFATIFYRID N,1'SIGAN IPnyiica^<endY~^9 caused aearn when arwoler MYSicianlw p<ruurlceE Seam ana comPleloo nvn 231 % / '. TOMOMamy mm'w1edW. MeM ooeurree a,ean.e<auee(el end mamas ae Natal ..................................................... ` 110. •vIaNDIINDINDANDGERTIFYK«rPNrsIC1AN(pnyeclaecanaroraa,rcalyde~mandceraw~smcausedaeaml TO dre aeN a mY knewMege, eeatA occurred M die Wrre, dwe, and Wece, end drN b tlw cWN/a) iM maMlar ae wiled .......................... ^ LICENSE N BER D SID (Mdlm. Day. Marl ~,<. ~~ UZ6G -L a,d. ~'-r-~ Z 199 NAME AND ADDRESS QF PERSON WHOC LF~TEO CAUSE OF DEATH (Item 27)Type or PfiM 7 _ L/ y / ~ 'MEDICAL fl(AMINERlCOROHER On Vte Eaa{a a taeminatlon and/oY Investigation. In my opinion, deaM o«urted al tM time, date, and plate, and due to the cwae(al and J Z/ a _ f (.~ ~'fj,~ -y '"'"n«>,stated .................................................................................................. ^ ~j~y o ~ I/ s~ U ~ ]ti. i~•vLnf + /v/ 32. ~ REGISTMR'S SIGNRVRE AND NUMBER DATE FILED(Mmm. Day. Rarl ~. K. s ,, ~~ ~" ~ ~ I'~'I(I~I ~ ®~$ FI~.~b~~'~~: ~I~~ ~al~.~l~-~' ~F Ia~'I"~'E~,~ testate ; Theodore Dahlstrom No. ~~,~ ~~ crtso known asy •~~t ~ teo ore a str~g~ Register of Fills for the t^ececred. County of •11m~P_-rl~~fl3 in the ~ccial Sv'Cd:P'liy IVn. - .= 0 Commonwealth of Pennsylvania The petition pf the ~.zzdersigned rmspcetfuliy represents that: - Four petitioner(s), who is/arc 18 years of age. or olclcr an the a ecur,~r ~_ ~t~med in the last will of the above decedent, dated Noverlber ~,_ , l9yy_._ and codicil(s) dated i (state relevant circumstances, c.g. renunciation, death of executor, etc.) Decendent. vas domiciled at death in Cumber land County, Pennsylvania, with h y,_~~~asj,family rprinc~alresidenceat 52 f;rPPmm~nY Drive,_Fnnla~ pt[ -12025 ,. (list street, number and muncipali[y) l~eceucPent, then 92 years of age, died._D~Q1~,~r 30, , 19 44 , at Ghurch of God, Carlisle PA EKCept as {'ollows, decedent did not marry, was not divorced and did not have a child born or adapted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: Decendent at death owned properly with estimated values as follows: (tf domiciled in Pa.) A11 personal property $_3~~sL~? (If not domiciled in Pa.) Persona! property in Pennsylvania $ (If net domiciled in Pa.) Personal property in County $ Value of real estate in Pennsylvania $ G~• Z~y situated as follows: ~VHEP,EFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters Testamentary (testamentary; administration e.t.a.; administration d.b.n.c.t.aJ the; on. V C V b n x ~~ b c` L ~~ ~.~ ^. y V .«. ~ O C .~ i, /~U, ~~ ~~`yy'--- 5 2 (' r e.~m o n t n r i r a, R n o_,.,1 a. P A 17 0 2 5 flA'I'kI ~~ IH~ItS®I~1A1~, ~I;j~R~i~'~.A''I'IYE ~~~`-~~2'd~Y~I~I.,TH ®~ P}EIVNSYLVAI'gilA -, ~ ';~l:Ji~d~''~' ~~ CUMBERLAtVD } ss -,. i Pte r~etitioner(s) above-named sweaz(s) or affirm(s) that the statements in the foregoing petition aze trut~ anc correct to the best of the knowledge and belief of petitioner(s) and that as ptrsonAl represen- tative(s) of the above decedent petitioner(s) will we~Y,l,and~tru~ly a"dminister~the.e~st_ate accordinf; to law. Sworn to er affirmed and subscribed ~ C.`t~ ~:_~C,~u/h~ -t. c, before me this 23RQ day of ~ ~, i~1A(~ Y C. L W I S Register ~.r _ , a"" ~~•~ . ., ~ .,~"s,, a~ , ,±.;;~ ; Oc c 2, .. ... .r ... . n ~, _ ....~.-. ti.;,..~ y r7 . = n° it'Lr^n(5n~~ i ~ ~rf'i jl-j~i ~~r'~=._ ~ y~ +• y F 2 I~ (~ _ .'.~. ~ .d a.J ~f 1 ~t .~~'i a;4 ~.^v kt (.~~?E~~' tl 'V' ,f ~`Y., °s~A~i ~.~+ ..n eis~GFt :'U t.~.w/~ ~'.~.~'i.LY.•. :'~. ~ _, art . r•..i~?~.-ak^^,.~ d~~t~i: cze,.~?~r, r. _.. _,t~': .. ) _. _:..Sii'xr.`; i; ~}' T?i•vCf ~n.,, ~?`,9 3i ~~"3.'~ ` ~iwri CJCF dS'a 1'i ar i ~i~ ,. ~..~ _• ., '~.~_f ''3f. ie~r4Ci~.FZ?:l..tc3 ~~t~:•~„___._ i_°,~_t'C{,~°_r~~ ~"`:.~.~{ ~0~.~~_~.~___-------`----- .:.'~! ; ~; t,tt is , .~ . , ..i, :,Sl'.Lx".-~ Zd itfG~.:Cc ii7Sf1 , ~':.u C3i~ ~7~r'3?'S°i ~:i C.~~1G !..ut 4vY;f~ 4.Di _ _~__~ ~ -;-~~L,n~,~ oa;-ins; ~ ~;t~, ~f~:i<~,. tu,~.-~~~ ~~;~c~~o~,~ ~a~~s~ ta~~; <~;:' Q;,.,,, r::.:,____r.~L a. L'•a~dLST~~id ..._..__________._.. _ ._.._____.._.__,_ 7 'r ~ ~ t ~! .~_.,,~~ ~ ~ ~ ~ ~ . ~ _~_- Jy 4 / ~ ~jT ts~ ' tiC r ff, / CP d r, 9 ~„ ~ , ~, ~. ~ .r , L i ry L+ Q (S . Ci. 3.iJ', iVQ.? ~.^.li:'J l ,C ..yC .......... ~; 3~. V~ A.'~.''O.\S*'F~' =~ ` ~ - - - ` i ~ ~.~._._ _. X - ` ~ S ~. ~ 7 . ~ _ 4j,Jf' __. _._. 3_._ i'..~~ir C.~1 ~~ ~ n.TC. .c. ~,, a _, w ~,. >`.. ±~ C;,.. 07 .. Cu ;~ r .., 4., 9 ` , - ~; _ r' ~° ,.. f u 1 %.i -~.. r 'i `J & ~ Y:L 71^3.. •~ ~ ~ ~ * ° h R Y,~ tl ~ ~,. n 0.r ~k:. .~ J - 7 ,y ~ ~., .T. r.-... ~ &~1~~ ~~:~~ D ~~~~Aw~ D~ ~~~DDCR~w S}3~$L~T13o?I' a/;cJa '~'~iL~'R~I7 ~R$oDDR~3 D1~~Gi~°$tlpI 1, a,'~s>~73~1k.~ DF~S~oM, of 52 creenmont Drive, polo, Cumberland County, PA 17025, declare this to be my least gill and testament, he.~:eaby revoking all prior Wills and codicils. dix.ect that the expenses of my last illzzess and 3 ~a 3 :t~.~ . . . ~ ft?ncra?_ <;~.al~. ~~e Faid from the funds of my estate. ~~ as . . "T~'~ lI. 1 give, devise and bequeath all of my property, both ,7 real ant personal, of every nature and wherever situate to z~y i brother, earl A. Dahlstrom, pxovided that he, is living on the ~~ thirtieth. (30tH) day following my death. 1'n the e~,ent that my brother, earl A. Dahlstrom, fails to i survive r„e by thirty (30j days, I give, devise and bequeath all the rest, res:.due and remainder of my property both real and personal, $, as fQ11oT~rs: ;m ~~~ ~?rst, ?give, devise and bequeath my coin collection ec~uall.y y ~ to Richard ,Tarn Mooney, Robert Edward Mooney, James Carl Mooney and , ~``° Aatricia Carol Dicke, now or formerly of the addresses listed ~ be1o~~. If the parties cannot agree on distribution, then 1 direct ?ny executcz to set value of the collection or parts thereof, or ,.~i make distr_ib~ation in whole ar in part, including making ~ ~ ~ . . }' distri?~~.tion of the entire collection to one or more of the above . and adjus~c accordingly those persons ° shares of the residuary of my ~ est~tc. ~ .~ e i '. i 4 i ~'ci r s"~{ ~. 1 n 4,; ~~ :~ ,i 4. t v~cc+;ad, 1 grive the rest, residue, and resiciua:~y of my estate as fo3.:~os°?~ s n. T~~aenty-five percent (25$) to my sister, slice D. i4ooney, '~56 Arlington Road, Camp Mill, Pa .3, Sig; percea~t (s$) to ~?iahard John Mooney, 2552 Naff Lane, Stilt Lake City, Utah 84109; C . 5 ~.~. ~eercent (~6$) to Robert Edward Mooney, 3 9 Connemara i?~c.ad, P,os'+sae~.l, GR 30075; ~:. ~~ix ~aercent (6$} to James Carl ~?ooney, 718 Westfield Court, Mechanics~surg, Pennsylvania 17055; ~.., :Fifteen percent (15$) to Patricia Carol Dicke, Z5 %°a.ackl~erry Lane, I~untincrton, New York 11743; _ . ~"o~~ar percent (4~s) to Carolyn Oale, 23 Oal Terrace, iiittery, Maine 039~Jg ? ~~. Si:r~ percent (6$) to Dorothy Jane Wurman, 606 West Wayne ~,,5'1?yZidP_, Wayne, Pennsylvania 19087; ?~ . r orxr percent (4 $) to Sandra LPOnard, Old Kents ~i?1 Road, Readfield, i~aine 04355; T_. ~otar percent (4$} to Calvir, Horsrnan, 149 Birch Street, Dozrer, New Jersey 07801; J. tour percent (4$) to Susan Allmendinger, 100 Radcliffe Dr~.ve, Newark, Delaware 19711; ~:, Six percent (6$) to Lois Rigoulot, Maple Av~:nue, Millbroo~:, New York 12545; L. Oa'e~. percent (1$) to Robert Rigoulot, cJo Lois ~ °:'!~'OT.llOt, ~Iax~I~: Avenue, l~ill.brook, New Xork !:;?545; M. t~~?e ,percent (1$) to Peter Dahlstrom, Little Rock, ~?rkansas 7220€; i ?`d. One percent (1$) to Mark Dahlstrom, 1320 rnttPrdam avenue, Colorado Springs, Colorado i~0907; i O. Cz^,e percent (1$) to Beverly Dahlstro~a, 3.320 Rotterdam Avenue, Colcrado Springs, Colorado 80gin'7 e ~ .. ~r, ]~~ I r ,. x ~~ ~' =. -= ; ,; f w. f' -. ~'::. };JJY ' d `~ y i' ,.~~ ~~ ~ '~, C P, 1 .' ,~ J' P. One percent (1~j to Karen Schattock, 2414 W. Rza~aa., Colorado Springs, Colorado 50304; ~. Three percent (3$j to the Haptist Home of Hrookiyn in Rhinebeck, New York= R. Three percent (3$f to the First Haptist Church, 260 2~fi11 Street, Poughkeepsie, New York 12601; and S . '.~'hree percent ( 3 ~ ) to the 51est Shore Haptist Church, 2025 F~Iarket Street, Camp Hill, ,~eatnsylvania 17011. IT~fS 1A2. Na interest of any beneficiary under this :ill or any rocziail hereto shall be subject to anticipation or voluntary alienation. ITS. a s:tl. ido provision in this *.~ill is intended to exercise any p©eaeA csf appointment. TTY ~J. In addition to powers vested in them by law, my ?executor and his successors shall have the following powers, applicable to all property held by them, including all property held ~'or :r~tnars, effective without the order of any Court and ~yn~i: actual distribution of all such property: ~. To retain any property received by them including the stccx: of any corporate fiduciary acting hereunder. B. To sell real estate for any purpose, publicly or y~riva'~ely, for such prices and on such terms as they deem proper, ;~fi.t.Y~ev.t liability on the purchasers to see to application of the nurc~:a:~sea an+~nies. C~ To compromise controversies. ~, To distribute in cash or kind or partly in each at valuations nixed by them. .E. To hold investments in the name o~ nominee. ~ ~ "w .tea ~ ~.ta~ ti'.K~~ ~5.,. . ~.~. _> «~3'sj3 '~?:~ ,t s $z~`~. ~ f .~.: ~ ~'~ ~?°: £ ~ ~ "~ .... v.. ~"1:;~. ~ ::~~:t~~i -s 'w.$ ~:;: +~ ~z ., ¢¢ t , , ? . .5. 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TY r~ _ y, 7".,r7 _,, r 1 ~~ r .r^'" '~f"n ~ Aa^ . : .. . `` _ k CQ;~iMOP4t~lEA.GTE~ aM" PEPINSYLVANIA ) SS: CaUAdTY OP Ct~BEFtb~A.D1D We Theodore Dahlstrom, Testator, .!~~~T~1' `~~~~ _ , ~~~Ll~~~~fi~ and _~~~ f~1l,~d~~i~~ the Testator and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testator signed and executed tkse inu::rument as his Last Will and Testament and that he had signed willingly, and that he executed it as his free voluntary act for the purposes therein expressed, and that each of the witnesses, in the presyr_ce and hearing of the Testator signed the Last Will and Testament as witness and that to the best of their knowledge the Testator was at that time eighteen (18) years of age ar older, of sound mind and under no constraint or undue influence. Testator, ^`'~'~`"'~~`~ ~ of 52 Greenmont Drive, Enola, Cumberlana Co=.anty, PA 17025 Witness !~ i'/ residing at ~ZG ~1~~/ ~ /~~ ~ ~' S~ ~,~ Witness f~~ ~ `~~ residing at ~ 'u~ T^Iitnes /,~'~ ~/ ~ca-y residing at /7~z.(~ ~,c,~.,~ ,~t,~ o~ ~cl ~~..~-~.c.~, r4 Subscribed, sworn to, and acknowledged before me by Theodore Dahlstrom, Testator and sub cribed and sworn t before mew-rby }~o~ n ~ f~ u~ i .fez., ~'~ee. vn ,and -arct.L~D-l4~~/ the witnesses, this day of .¢~, 1994 / Atotary P lic A4j Ccrm+is~on f-~.I~n 2ff.1Q~7 ""'"' r ~- .~ G. w, ;: .~ . }:. ,__ . As~ id~~,y ~;+ ~,.i~~~g.S ~`.'.~~' ~-''t,i~E°..'~`w~~'u'in .~~'d.s~'..rx~c..~j ~..'v~'+'L_"";.~3~.x.ndn.~x~} `:~~it~i 'ti F ;~:7a'~LStrf Y°Rsi'~r'1at.i~~ -.yr :7'N, fem. ~.,;. ,<y e„ I • ~ ~_ ~~C ~(^a ~..5" yc'...)R~.. l..~A a ~+\;s~,3iyA. ~73 P---`i_._..~Y`'Q. ..~.~~_.~_ a -. ~~ ,M, ^,;..~:.:.~~_ ~12~~. 1lt7ai~t"'. ~f tx3I3e:Eici~l L?t'~G'~'~S~ reauirec~ ~~;~ Rule ~~~, :~ <~ ; t.~. ~.~~~ tr.~~~,~,:.ras d ~ou~~ RuIE~ s~*~~ ~er~resl can ~~ ~~~i~.e~ ~© ~~e ~c1~~~:;~:-i_~= ,3o~iciarie~ o~ the move--o~.~a~ionec~ ~~ta~:e ora .. _,... _ ,..._ .~. f. ~. ~ ~ 4~• ~e~±tt.`L^2.~.9rj_r.~a~.~-S ~~-'..@~.~.-~^_..r~~"._•b~..L_'i" ~ts~... 'f~.c:ti{::~ .i:.~:.w~ 9-~~.~ba ~~:~rt c~ivexa 'zo all p~~sr~zx:~ Qx~'~~.t:~.eca ~:h~,~e..~:~a une8ex t ~enne?~.~. ~o L.~i~e, ~~c~ui:~U 126 ~ou~~ ^s'~~Exc~~ ~. ,,,~ ~ i ~~ ,.. ~ . ~. -..~, 1Ye" ;,,y MK'~`..~y~~~~",`.:T~~o~ K1 ~T' ~~•~s~,(ts`r~~~ ~a ~~* ~ ~..~'~"'~, ;d- ~'t' ~ .ham •T"+a'`Sr~ ~4:<' ~,~, - .~. , - . ,. ~< ~- ;n r~..~~ .__ - ~ 50110511~~ ~i- i/ REV-1500 EX+ (T=94) ~, ~'~ ~~ INHERITANCE TAX RETURN FOR DATES OF DEATH AFTER 14131191 CHECK HERE POVERTY CREDIT IS CLAIMED ^ ~ RESIDENT DECEDENT FILE NUMBER / COMMONWEALTW OF PENNSYLVANIA / DEPARTMENT Of REVENUE (TO BE FILED IN DUPLICATE QD~ DEPT. 280601 WITH REGISTER OF WILLS). ~~ff ~''` o / HARRISBURG, PA 17128-0601 COUNTY CODE ( YEAR L1 NUMBER DECEDENT'S NAME (LAST, FIRST, ANO MIDDLE INITIAL) ' DECEDENT'S COMPLETE ADDRESS ~ ' D/~'J GrJ, ,CJ'Tk 7"/~C'd L o/e ~ ~` oc' • Q~~'~J/Yio~1T v W SOCIAL SECURITY NUMBER DATE OF DEATH DATE OF BIRTH ~g • ~ 70~~- a ~ y~ .3 ~ /~ d ~- A ©~'6-os-5994 /a-3o-/99~ °9'OS'd°~ ~ ~ co~n p QF APPLICA6lE) SURVIVING SPOUSE'S NAME (LAST, FlRSt ENO MIDDLE INrtIAq SOCIAL SECURITY NUMBER ' AMOUNT RECEIVED (SEE INSTRUCTIONS) (±+ 1. Original Return ^ 2. Supplemental Return ^ 3. Remainder Return Yarn (for dates of death prior to 12-13-82) W d~ ^ 4. Limited Estate ^ 4a. Future Interest Compromise ^ 5. Federal Estate .Tax Return Required _ ° ~ m ° (for dates of death after 12-12-82) ~ m a ^ b. Decedent Died Testate ^ 7. Decedent Maintained a Living Trust 8. Total Nu ber of SaFe Deposit Boxes (Attach copy of Will) (Attach copy of Trust) F•• ~~ ~- ,_s ~L ~AF1L~S'T~OA'1 .COMPLETE MAILING ADD E55 .~~ G'~Pr~,Ain-'.~..,/~ ~~E', ' v~ TELEPHONE NUMBER ~~~~ :v ~ ~ ~~ / 70 ~~ --, ~~ t/ ` 1. Real Estate (Schedule A) (1) C Cn ~ -~ ~ 2. Stocks and Bonds (Schedule B) ~7+ (2) a °`~ °Z ~ ~ ~ ~~ ~'t 3. Closely Held StocklPartnership Interest (Schedule C) (3) ' 4. Mortgages and Notes Receivable (Schedule D) (4) ~ 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) ~ 0 ~ ~~ • ~~ ;.Fl - z (Schedule E) b. Jointly Owned Property (Schedule F) (b) / 9 ~SD ' d L> ~ -- S 7. Transfers (Schedule G) (Schedule L) (7) ~ ~~. ~' • • ~~ ~~ F 8 Total Gross Assets (total Li 1 7) ~ (8 '~~ `~ J~/~• ~"~ a . nes - ~"? • ~ D ~ ) 9. Funeral Expenses, Administrative Costs, Miscellaneous (9) / Expenses (Schedule H) ,~, 10. Debts, Mortgage Liabilities, Liens (Schedule I) (10) ~~`~' ~~ 11. Total Deductions (total Lines 9 8~ 10) (11) r ASS. O ~ 12. Net Value of Estate (Line B minus Line 11) (12) ~S'J ~G'3 • ~O2 13. Charitable and Governmental Bequests (Schedule J) (13) V $O 14. Nef Value Subject to Tax (Line 12 minus line 13) (14) -~-- ~ 3 • /02 15. Spousal Transfers (for dates of death after b-30-94) See Instructions for Applicable Percentage on Reverse (15) x._= Side. (Include values from Schedule K or Schedule M ) . 16. Amount of Line 14 taxable at b% rate (16) x .Ob = (Include values from Schedule K or Schedule M.) ,_,~._.. Q z / 9 7 17. Amount of line 14 taxable at 15% rate (17) ~<3• /~ x .15 = n ~ z° (Include values from Schedule K or Schedule M.) ~~ j/ ~ ~ a 18. Principal tax due (Add tax from Lines 15, 16 and 17.) ~ / . t0 (lg) as 93~. ~ ~ ~ 19. Credits Spousal Poverty Credit Prior Payments Discount Interest a 20. If Line 19 is greater than Line 18, enter the difference on Line 20. This is the OVERPAYMENT. (20) ~ ~^ 21. If Line 18 is greater than Line 19, enter the difference on Line 21. This is the TAX DUE. (21) n oz o2 7 ~ ~ - ~' A. Enter the interest on the balance due on Line 21A. (21q) B. Enter the total of Lins 21 and 21 A on Line 21 B. This is the BALANCE DUE. (218) ~ a- ~ .3 ~ - g 7 Make Check Payable }o: Register of Wills. Age nt on dare that I have examined this return, including accompanying schedules and statements, and to thi I declare that all real estate has been reported at true market value. Declaration of preparer other ch preparer has any knowledge. ~~ - --.._..__.. .._.~... ..,,~~.~R,. AVURCJi 50~ ~. ~£E~tJ µ,~+•~.~~ .~r2 IGNATU OF PR ARE OTH THAN REPRESENTATIVE ADDRESS (o ~l,t ~ L L ht~~ L ~`~ ~ ~••,gt%// ~.,E~ G~~iy~ CtJ D o D.s Ta C .~ ~v ' `> , ~ a ~9r? of my knowledge and belief, the personal representative is DATE ; ~ A~~ ~ ~ i /~~o .r~~ ~. ~ ~ ~ ~,~~ s :.Qo ~ Act #48 of 1994 provides for the reduction of the tax rates. imposed on the net value of transfers to or for the use. of the spouse. The rates as prescribed by the statute will be: • 3% (.03) will be applicable for estates of decedents dying on or after 7/1/94 and before 1/1/96 • 2% (.02) will be applicable for estates of decedents dying on or after 1/1/96 and before 1/1/97 • 1% (.01) will be applicable for estates of decedents .dying on or after 1/1/97 and before 1/1/98. • Spousal transfers occurring on or after 1/1/98 will be exempt from inheritance tax. PLEASE ANSWER. THE FOLLOWING QUESTIONS BY PLACING A CHECK MARK ~,~) IN THE-APPROPRIATE BLOCKS. YES NO 1. Did decedent make a transfer and: 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, ............... '~ c. retain a reversionary interest; or ................................................................................... d. receive the promise for life of either payments, benefits or care? ....................................... 2. If death occurred on or before December 12, 1982, did decedent within two years preceding +-, death transfer property without receiving adequate consideration? If death occurred .after December 12, 1982, did decedent transfer property within one year of death without receiving ,~ adequate consideration? ...........................................................:...................:....:..........:... ./ 3. Did decedent own an 'in trust for'. bank account at his or her death? ...................................... IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE .SCHEDULE G AND FILE IT AS PART OF THE RETURN. REV•150+3 EX+ (4.8/~l. . SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS AND BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER (All property jointly-owned with Right of Survivorship must be disclosed on Schedule F.j ITEM NUMBER ~~ ~ ~ DESCRIPTION vAOFEDEAT~H TE a, A ~w~y f Fo. ,.sc,~ ~. 3 moo. -- 3. ~A-nJ~~ a¢ /s'J.LG ~~eoo.~C N, y. ~°Z /o a-a..~. --- ..~ ~ ~• J7e~r-korT ~.a/soil % Sa .3Ia~• /3 D ~f/ o ,~,a r J'o ,~ 3 v o ~S8 7. So ~©o a~Ga... ~a ~~..o V l 0 c.J y`~ ~i ,~' c ,c /~cc ~ v P.rJT b o a d~~~~~ oVc~ s~s~. ~T~~-c. c~. Kc.n,~~~2 u. ,r. ~'Io ~er~,~~c Tv,~~ ~'C~ ~ L /. 3~ ~! yt o ~. 7L v~/bs n ~ ©~ /a. ~rrr,~,P2 /~ic~l ~icL~ ~~,~~ t «s G yG. ~'3 ~~ o ~/• I~emPc~ ~ //c~s~t'i:±.p l~vc. ~.i.vl~ CL,B L~~~. ~~ 9 7D 0. ~ ~'~' owDS /a /Saoo ~!~' n'7 ~'aRP. 1~arc. J.d~ f'a /~l odd •-- .3 ~G b d ~ C" ~ ~/ C-`!'PwJ' ~'~r SL./ C L L T~ L t:~~ ~`~ ~ /`000 ~".~-~.~„~ ~~~ ~~ Auk. i'awe~ ~,D. ~3 ~G~'. ~/~ TOTAL (Also enter on line 2 Recapitulation) I $ 8~ ~ ~^, ~ / ~ (If more space ~s needed, insert additional sheets of same size.) REV-1508Exr 12.871 ~ - SCHEDULE E - CASH, BANK DEPOSITS AND COMMONWEALTH OF PENNSYLVANIA MISCELLANEOUS ' INHRESIDENTED CEDENTRN PERSONAL PROPERTY Please Print or (All property jointly-owned with the Right of Survivorship must be disclosed on Schedule F) (Attach additional 8'h" x li" sheets if more space is needed.) REV•1509 EX+ 112.88) . SCHEDULE F COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE 7AX RETURN RESIDENT DECEDENT ESTATE OF , / ,•~ ~rT E'O.G/ 4 r~'~ Cn ~A, f~l ~ ~.4'.T ~ rJ FILE NUMBENR ~ `L/~ NAME ADDRESS RELATIONSHIP 7v vectutrvi A.~~~L ~s~~L..f'T~~M B. C. ,x'02 G~~erf /rae,tt;r- ~k,'. ~~2a~N~=~° Jointly-owned property: LETTER DATE ITEM FOR MADE DESCRIPTION OF PROPERTY NUMBE ,JOINT JO{NT TENANT a ~~. TOTAL VALUE DECD'S DOLLAR VALUE OF OF ASSET °k INT. DECEDENT'S INTEREST r TOTAL (Also enter on line b, Recapitulation) $ ~ 50 .- (If more space is needed insert additional sheets of same size) , REV•1511 EX+ (7-88) - SCHEDULE H FUNERAL EXPENSES, _COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN ADMINISTRATIVE COSTS AND MISCELLANEOUS EXPENSES Please print or T YP _ RESIDENT DECEDENT ESTATE OF FILE NUMBER ' / ITEM NUMBER DESCRlPT10N AMOUNT A. Funeral Expenses: ,. ~ y ~~s _,~A 2,~~ ~ ~~~~,~~ L /-~~, ~ may'' ~~` ~- ~,c~ , CA-m r° ,~,~/L L / ~C n/ S ~ c o C' c.r~ c T~2 j/ - G iP~ vc di°c.v rx/ G - 1~~6 h~~ tL ~a ,J . ' / ~' ~ ~ . f iP eS,~ Y- .C e Len/ L3 - ~j1 c,~1 fl SS To n! c - V R G~ h~ R ~ L ~ nl . ~/. L ©©, J'^o N al ~o ~ !' e N A L - C c c ie ~/y /yl r¢,A/ p ,- B v ,e / xp L / / ~ a . - B. Administrative Costs: 1. Personal Representative Commissions _ _ Social Security Number of Personal Representative: Year Commissions paid 2. Attorney Fees ~a ~ ~ • ~ 3. Family Exemption Claimant Relationship Address of Claimant at decedent's death Street Address City State Zip Code 4. Probate Fees C. Miscellaneous Expenses: T ~ r c~00 1. .q:X nc?u~-~{ /yJic%/,qE,C ~./ , ~ACCtoa/c -J.//•/e~E'./ %~1/.~Ce , 2. 3. 4. 5. 6. 7. 8. TOTAL (Also enter on line 9, Recapitulation) $ $ ~ ~'a, ~'' (If more apace is needed, insert additional sheets of same size.) REY--1512 EX• ~1.43~ SCHEDULE COMMONWEALTH OF PENNSYlVAN1A DEBTS OF DECEDENT • INHERITANCE TAX RETURN MORTGAGE LIABILITIES AND LIENS RESIDENT DECEDENT Please Print or Type ESTATE OF / , `~ FILE NUMBER ,/ (If more space is needed, insert additional sheets of same size.) REV-1513 EX+ Nt-87) ~ ~ ~, SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN ESTATE OF FILE NUMBER ITEM NUMBER NAME AND ADDRESS OF BENEFICIARY RELATIONSHIP AMOUNT OR SHARE OF ESTATE A. Taxable Bequests: ,. c,~~~ ,~,~~Ls~~a~, ;~~~~~~ goo f ~~5~: ~o,~T,, ~,>,~~ ~~ ITEM I NAME AND ADDRESS OF BENEFICIARY NUMBER B. Charitable and Governmental Bequests: AMOUNT OR SHARE OF ESTATE ~So. -` TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Also enter on line 13, Recapitulation) I $ a 5~ , (If more space is needed, insert additional sheets of some size) ,,~.~ LAST WILL AND TESTAMENT OF. THEODORE DAHLSTROM, a/k/a WALFRED THEODORE DAHLSTROM I, THEODORE DAHLSTROM, of 52 Greenmont Drive, Enola, Cumberland County, PA 17025, declare this to be my Last Will and Testament, hereby revoking all prior Wills and Codicils. ITEM I. I direct that the expenses of my last illness and funeral shall be paid from the funds of my estate. ITEM II. I give, devise and bequeath all of my property, both real and personal, of every nature and wherever situate to my brother, Carl A. Dahlstrom, provided that he, is living on the thirtieth (30th) day ,following my death. In the event that my brother, Carl A. Dahlstrom, fails to ...survive me by thirty (30) days, I give, devise and bequeath all the rest, residue and remainder of my property both .real and personal,.. as `follows: - First, I give, devise and bequeath my .coin collection equally tq Richard John Mooney, Robert Edward Mooney, James Carl Mooney and Patricia Carol'Dicke, now or formerly of the addresses listed below. If the parties cannot agree on distribution, then I direct my executor to set value of the collection or parts thereof, or make distribution in whole or in part, including making distribution of the entire collection to one or more of the above and adjust accordingly those persons' shares of the residuary of my estate. Second, I give the rest, residue, and residuary of my estate as follows: A. Twenty-five percent (25~) to my sister, Alice D. Mooney, 756 Arlington Road, Camp Hill, PA B. Six percent (6~) to Richard John Mooney, 2552 Neff Lane, Salt Lake City, Utah 84109; C. Six percent (6~) to Robert Edward Mooney, 39 Connemara' Road, Roswell, GA 30075; D. Six percent (6~) to James Carl Mooney, 718 Westfield Court, Mechanicsburg, Pennsylvania 17055; E. Fifteen percent (15~) to Patricia Carol Dicke, 15 Blackberry Lane, Huntington, New Yark 11743; F. Four percent (4~) to Carolyn Gale, 23 Oak Terrace, Kittery, Maine 03904; G. Six 'percent (6~) to Dorothy Jane Wurman, 606 West Wayne Avenue, Wayne, Pennsylvania 190£i7; H. Four percent (4$) to Sandra Leonard, Old Kents Hill Road, Readfield, Maine 04355; _.. ,_ I. Four percent (4~) to Calvin Horsman, 149 Birch Street, Dover, New 'Jersey 07801; J. Four percent (4~) to Susan Allmendinger, 100 Radcliffe Drive, Newark, Delaware 19711; K. Six. percent (6~) to Lois Rigoulot, Maple Avenue, Millbrook, New York 12545; L. One percent (1$) to Robert Rigoulot, c/o Lois Rigoulot, Maple Avenue, Millbrook, New York 12545; M. One percent (1~) to Peter Dahlstrom, Little Rock, Arkansas 72208; N. One percent (1~) to Mark Dahlstrom, 1320 Rotterdam Avenue, Colorado Springs, Colorado 80907; O. One percent (1~) to Beverly Dahlstrom, 1320 Rotterdam Avenue, Colorado Springs, Colorado 80907; P. One percent (1%) to Karen Schmock, 2414 W. Kiawa, Colorado Springs, Colorado 80904; Q. Three percent (3%) to the Baptist Home of Brooklyn in Rhinebeck, New York; R. Three percent (3%) to the First Baptist Church, 260 Mill Street, Poughkeepsie, New York 12601; and S. Three percent (3%) to the West Shore Baptist Church, 2025 Market Street, Camp Hill, Pennsylvania 17011. ITEM III. No .interest of any beneficiary under this Will or any Codicil hereto shall be subject to anticipation or voluntary alienation. ITEM IV. No provision in this Will is intended to exercise any power of appointment. - - ITEM 'V. In addition~to powers-vested in them by law, my Executor and his successors shall have the '.following powers, applicable to all property held~by them, including all property held for minors, effective without the order of any Court and until actual distribution of all such property: A. To retain any property received by them including the stock of any. corporate fiduciary acting hereunder. B. To sell real estate for any purpose, publicly or privately, for such prices and on such terms as they deem proper, without liability on the purchasers to see to application of the purchased monies. C. To compromise controversies. D. To distribute in cash or king or partly in each at valuations fixed by them. E. To hold investments in the name of nominee. ITEM VI. All taxes and interest and any penalties thereon payable by reason of my death with respect to property comprising my gross taxable estate, whether or not passing under this Will, shall~be paid from the principal of my residuary estate. ITEM VII. I hereby nominate, constitute and appoint Carl A. Dahlstrom, Executor, of this my Last Will and Testament. If my Executor predeceases me or if for any reason does not act or continue to act as such, I appoint James C. Mooney, Alternate Executor of 1720 Orrs Bridge Road, Mechanicsburg, PA as the Executor in his place. No fiduciary acting hereunder shall be required to post bond or enter security in any jurisdiction. IN WITNESS WHEREOF, I have set my hand and seal this ~-""r day of ~~---1994, to this my Last Will and Testament,. which consists of four (4) typewritten pages to each of whichI have affixed my signature along the left hand margin .for purposes of ensuring authentication. ~~.~~w ~'?,//~',~ /~ Theodore Dahlstrom r R COMMONWEALTH OF PENNSYLVANIA ) . SS: COUNTY OF CUMBERLAND ) We, Theodore Dahlstrom, Testator, I~~~/~~~/ ~ ~~~Sl' , p//~f(~lS %~"~G.~~I~L`~ and (/~~ ~/~-~~'~/L! the Testator and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testator signed and executed the instrument as his Last Will and Testament and that he had signed willingly, and that he executed it as his free voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testator signed the Last Will and Testament as witness and that t~ the best of their knowledge the Testator was at that time eighteen (18) years of age or older, of sound mind and under no constraint or•undue influence. Testator, ~~ of 52 ~reenmont Drive, Enola, Cumberland County, PA 17025. Witness v" "` residing at /1G~<~~ ~ /~~~/~/~/ S -L ~ ~~,~-~1 Witness residing at Witnes ~ / ~ residing at L7~0 (.,~~ /~-c.c C/~,.c? ~~ ~~~ , Subscribed, sworn to, and acknowledged before me by Theodore Da 1 rom, Testator, ,~ncl subs ibed and sworn to ~efore me by ,~yt~f?'l~ ,~~ l ~/~' , 1~/~i~/ C ~0/~~' , and [ the witnesses, this ~ day of ~? 1994. .rj ,~ 1 ~ ~~ Notary PLt~lic Ptotadaf Seat ~~Ng, Dauphl~Co x~ry~ NN Comml~ Expires Jan. 20,1997 ~. 4° .~ y~ f ,s `~s K/~ REV-1547 EX AFP (12-94) r~• COMNONMEALTH OF PENNSYLVANIA ~..p g€PARTNErYT OF REVENUE NOTICE OF INHERITANCE TAX ACN 101 ~ „"«--" $UREAU OF INDIVIDUAL TAxES. APPRAISEMENT, ALLOWANCE OR DISALLOWANCE DEpT. zaoeol OF DEDUCTIONS AND ASSESSMENT OF TAX tdR~ISBURG, Pa nlza-o6ol DATE 07-17-95 ESTA E OF A AL ED FILE N0. -00 DATE OF DEpTk' 12-30-94 COUNTY CUMBERLAND NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS FORM WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS. MAKE CHECK PAYABLE TO "REGISTER OF WILLS, AGENT" REMIT PAYMENT TO: CARL DAHLSTROM 52 GREENMONT DR ENOLA PA 17025 REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 Amount Remitted CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS t ---------------------------------------------------------------------------------------------------------------- .REV-1547 EX AFP (12-94) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF DAHLSTROM WALFRED T FILE N0. 21 95-0063 ACN 101 DATE 07-17-95 TAX RETURN WAS: ( ) ACCEPTED AS FILED ( X) CHANGED SEE ATTACHED NOTICE RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Sonds (Schedule B) 3. Closely Hold Stock/Partnership Interest (Schedule Cl 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 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 (Schedule J) 14. Net Value of Estate Subject to Tax (1) .00 (2) 82 , 289.16 (3) .00 (4) .00 (5) 10.278.96 (6) 69.750.00 (7) .00 (B) 162,318.12 (9) 8,982.00 (lo) 173.00 (11) 9 .155 _ 00 (12) 153,163.12 (13) . 00 (14) 153,163.12 NOTE: If an assessment was issued previously, lines 14, 15 andior 16, 17 and 18 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate (15) . 00 X .03_ .00 16. Amount of Line 14 taxable at Lineal/Class A rate (16) . 00 X .06. .00 -•..lT. Amount of Lins 14 taxable at Collateral/Class B rats E17) 153, 163.12 X . 15. 22, 974.46 ~ ~=~ .~D. Principal Tax Due (lg) ?2,974.46 " ~TA~; "'CREDITS: PAYMENT RECEIPT DISCOUNT (+l AMOUNT PAID DATE NUMBER INTEREST (-7 05-04-95 AA047721 .00 22,936.97 PAYMENT MUST BE MADE BY 10-01-95*. TOTAL TAX CREDIT 22,936.97 BALANCE OF TAX DUE 37.49 INTEREST .00 TOTAL DUE 37.49 * IF PAID AFTER DATE INDICATED, SEE REVERSE ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRI, YOU MAY BE DUE