HomeMy WebLinkAbout95-0065This 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.
auc ~ s cool ? •
Date Fran eropoli, ' act
Division of Vital Records
P.O. Box 1528
New Castle, PA 16103
H705.1.3 Rev. 2lB7
nPEmRtYT
Bt
PBLYANENT
BLAac uac
~i
1nT2
I/
a
Z
COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS J ~1 ~ [~
CERTIFICATE OF DEATH
NAME OF DECEDENT (Frr, Mir1019.
~ SE% SOCIAL SECURT' NUMBER DATE DEATH (MOMb, DeY. 16ar)
l
s
3
-
l~
~
,. oN
-~vF7~ 52 • 9
- 07 -
r/~ .. >
~Lr- _.
AlvunP. / I5 ~S
_•
AGE(LnlBirMday) l1NDERiYEM UNDERI DAY DATE OF BYrRI BIRTHPLACE (City erid PLACE OF OEIS/L(Clank aNyor-ariMUdiwson abler side)
M
atlh. D
ey. Y§er) Slab or Forego Country)
MoMM I Dsy Ibura . Mlnuln ( HOSPfOLL: OTHER:
'~
rr
//
- S. ~~ VR S b(' ~O' ~/ T L C-.S.,AlOA/ l ~A •
• IrgMti•rK ^ ERAkeprWY ^ DG4 ^ f~!•IB ~~ RridNrp ^ (Spsciy) ^
COUNTY OF DFFH
CRY, BORO.TWP OF DEATH FACILITY NAME(Y rlatvMitnion, give Elr9etaM number) NNS DECEDENT OF HISPANIC ORIGINT RACE-Angdcarlbdr,Bbck, WAn, Ne.
(SN~aiM1 ~ '
» CUM$[f~-LAUq ~ L ~ Fr'A:NSb6iCU
CAt+P N~tL CAk.E C?~2. w:®. w~Ritu ~~alan,
E!/TE'
W
t
~
y
DECEDENTS USUAL OCCUPAigN KIND OF BUSINESS/INDUSTRV ViLS DECEDENT EVER IN DECEDEM'S EDUCATION MARTBV. STATUS-Mortise SURVMNO SPOUSE
(Cane kind rwork der ewino rrgb U.S.MMED FOi1CE57
Newr~~
WIE
W
(nwile. give meitlen name)
E~1~)ry C~~
~
~
)
otworkirlq Y•; wo t•x ur rd+ed.) + ~^ W~.
J7C US NG ~DiM PLE D121 (1J ar5~)
O L'`7N~
U
tte.
110.
/VOR-CFO ,y,
tz tS. C~ u,
DECEDENTS MAILING ADDRESS (Street. C'ry/favn.Sale, Zp Code)
/~/O FtARK E? ST'• DECEDENT'S /1
ITe. Sirs P~-'
tre.^ Ws. w•catl•n1YwdNs
°"
~
Ar'LP i~71L[..I PA . /76/l RESIDENCE
a
ra.m
(Bee kNbucrione on:l•
.
ter. onoM«aidel tTa CUriP~i=KLAMD "°w'WIaT na.~$w~al'a1n.carllmli:r Ci9r•LP NI~G
drymoro.
FATHER'S NAME (FV9. Middb, MOTHER'S NAME (Fvsl, Middle, Maiden Surname)
,.. Acc,l3 / Ew 2 ,.. S.9KAl~ ~2oLL.IN
YIFORMANT'S NAME (TypalPrka)
zo.. t boYQAN Lt.l~.rwe~- AH7oEt2Sor~1 INFORMANTS MAILING ADDRESS (Strar. Cay/fown, SWe. Lp Coda) -
,,,, SESs gerexv/tw /eD M~3(~ //~A- / 7oSs
METIgD OF dSPOSRNJN
Bt•W la Crsmetbn^ RemovY kom Slele^ DAfEOF p.4POSR10N
(~M•~•~) PLACE OF DISPtDSRgN-NYrdCamesary, Gemrory
aO1tw PLep LOCATKkI-CYyrtown, Sbb, 2lp CoM
Donef ^ OUw (Spetilyt ^ / -s - 9~ /1
uG 6/LCL-`A
) Hrr•t
L
PK 770/!
NIIL
/~/-I
~f17'l
.:t.. :tb. _
-u~
.
.
zte. e /
.
f
zta.
' S7GNATURE OF FUNERAL SER LKS:IISEE OFi LICENSE NUMBER NAME AHD ADDRESS Of FACILITY
m. ~W+t6E z,,. ~/~-755-~- ~. 7l)e/lL F/-I- 3yol /-+r~aKe7 sT c/f~~~/I<< .~ •/7oi/
Colnpr•ilem•Z!•-caNy esnByMp Toth Wrof my knowNdg•.r.M OCCUradrOr tlllis.drear pkn rM•d. LICENSE NUMBER DATE SKiNED
phyiuenbnol evYWIer rwwnto (siprnae and rme) (MOMS
Year)
Dar
orLYymreaawn. .
.
z=e. zx. =zc.
Y•rt1e2428 nltm Wmrrlpleted sY
Prawn woo prOnostrlcr deM. THE OF DERH DATE PRONOUNCEDDEAD(MpM, DaY•Ybar) Na1.S CASE REFERREDTO MEDICALE%AMINERrCORONERT
/ a
^
"
~
Noe
za ,~ rn
_.. ` -" ~ M. zs.`~ / - / .. SS
=T. PART L' EMr Ma tlssear, NjuMS Or eompkalior whknnw•wtr wrM. DO nr anw MS mod•of dying, suchrnr6r err reapiretory amr,arck orhrrt taWr•.
rApprovlmre PARE II: GMrsigrlksnteaMMbr eMIrlWYq todnM.but
Lir oryor wlrrMrellWr.
rp reeuMYp in M•urlwrryirp cereYk'rMPART I.
M
j
Onrle
dws
kY11EDIATE CAUSE 1Firrol
I
`~°~
», d
M,--• L~ ,L~ c.tr~c~,2 ~ ! z K ,I., ~z n s~.t•r~~ ArScxt~ ~ LIB PD
WE TO (IXi AS A CONSEQUENCE OF7:
O
Setlusraiaey l'Nt carldYbne b. ' ~ OC-G'~/ _..
Y erly,Wdng to knnrwira r
q1E TO (OR ASACONSEQUENCE OF/: I
rerun. Emer IINDEIILYING
I
a
CAUSE lDiseeee err injury
f
~
I
Mr isknle0 everW DUE TO (OR AS A CONSEQUENCE OF):
1
`
resulting n drMl LAST I
tl
.
VAS AN AUTOPSY WERE ALJIOPSY FlNDINOS MANNER OF DEATH DATE OFIWURV TIME OFIWURY IWURY AT WORKt DESCRIBE NON IWURV OCCURRED.
PERFORMEDT AVAN.ABIE PRN7q TO
/ (MOmh, OaY. Year)
COMPLERON aF CAUSE ~(
OF DEATN7 / Natural VJ Ndnicid• ^
•tion ^ Vr ^ No^
Acciwenl ^ Pargin
lnvri
'
g
g
/
/
,~
~-/
30s. M. See. 3gd.
Yea ^ NO LJ
Yn ^ NO I~ Suicide ^ Coultl not be tlel•rmird ^ PUCE OFIWURV-Atfgme
farm
rrW
httor
office LOCATION
SI
C
/T
,
,
,
y,
I
raeI,
Wn. Stab)
M
wowing. rc. (Spedly)
Serb. 29. 3M. 9M.
f~ILTiYHICMck ONY °ne) /
'CERTIFYYiD PHYSICIAN (PhYSiiar~ certiryvg wuae a1 drM v.T,en anowbr pnyskien nas pronounced deaM and camlweled Item 23) I
Toth b•rd
lu
kM
d
M
W d
tl SIGNATURE AND TRLE OF CERTIFIER
J r / •
^
my
tow
ge,
r
Oeeun
taero
w e•un(•)•nw menn•rr Wbd ..................................................... Sts. 4
•PRONOUNaNG AND CFJITIFYNID PNYSIeuN(Pnyelcian bola p,ona,r,nng eeaM and certuying to rauaaadeaM) LICENSE NUMBER DATE SIGNED(M Day, Year
~`}~4 L
~ D51~
/ -~~
To Utabrtof mY knowMdg•,d•eM OCeumdaLtM tlm•.wW.•nw plxs.ar ww WlM eau••(a)err mnnerr •IaEW .......................... .
Sta 1 Std.
NAME AND ADDRESS OF PERSON WHO COMPLETED CAUSE OF DEATH
- 'MEDICAL E%AYNER/CORONER (11em 21) Type Prinl
'~ ~ 4 ~'~-T'LTC-'/~
On tIN bob W axeminetbn and/or Imrorlgetbn, In my opinbn, deeM oeeurtW r tlu tkne, date, end place, eM tlue to the cw
sa(s) atM
m.nrl«aar.Led .......................................................................................... ...
^
~
uU t
'
...
me. =z. %
P
Lc, ~
/)e(
REGIST 'S SIGNATURE AND NUMBER
• ~ 1
~ DATE FlLEO IMonM. Day, Year)
;
~.
~. JHNU~~ Y /79.s
I"ETITIQN F®Id PRURATF and GRANT IyF LETTERS
Fstate of JOHN R. WEAVER No ~~-.g~-- 4~j ~Ql~ p ~~~
clsv known a.~ _ To:
Register of Wills for the
Deceased. County of Cumberland in the
Socia! Security No. 7 9 5 0 7 X 1 7 6 Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older an he executrix named
in the last wall of the above decedent, dated Fe~ruary ~ _, 19 91
and codicil(s) dated n/a
(state relevant circumstances, e.g. renunciation, death of executor, tte.)
Decedent was domiciled at death in CumhQrl anA County, Pennsylvania, with
h last family or principal residence at ~ ~ 0 Market StreetT r'.amPLI3~ i ~~ ua
(list strceddt, number, Twp. or Boro.l
at De~amP~ Hhi~ 8~are Clem rage'Camp January 1 , 19 95 ,
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 1: i?'ing and was never adjudicated
incompetent: _ n / a
Decedent at death owned property with estimated values as follows:
(lf domiciled in Pa.) All personal property $ 5 5 0 , 0 0 0. 0 0
(if not domiciled in Pa.) Personal property in Pennsylvania $
(If not domiciled in Pa.) Personal property in County $
value of real estate in Pennsylvania $
situzted as follows:
WHERE~flR?E, petitioner(s) respectfully request(s) the probate of the last w711 and codicil(s)
presented herewith and the grant of letters-. testamentary
(testamentary; administration e.t.a.; administration d.b.n.c.t.a.)
theron.
v ~ 1f
av /
~.o i ~,
,o
,i
of
in ,
®ATI-I ®F PERSONAL REPRESENTATIVE
C~3P,~P~~Pa1WLAL'I'ffI ®F PENNS~i'LVANIA ~ ss
C0.~€11\''~'Y ®~• CUMBERLAND
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 and truly administer the estate ac/cording to law.
Sworn to or affirmed and subscribed ~~~ ~ ~~r~~../
before me this 13th day of r _ o0
is
a
a
~..
-.~-
~-
'- ~ 7
~~?~.
'%.-,*~~ a,3~' ~iC?i-iN R. Pii~AVi;R also SEA # 537 _~ ~£'~.~.~~
.z.r.;s ~ xir -r9s::1e Zd'.,a :'~~=- ~' M~ il. ~a ~~ ~~dl(a ~:~A'vx ~ ~~ ~~ s^. ffiJ
r~11~L' F4`!~`~,~ v t.; 11'!1~e3~ a7 25-' ~ Q } ~ t'; p..
-- - ~.~ .~. J. , ir< sensicSec;rti®ra Qf' the pctr.a ~_4 on
tt:.c .Pv^rse sfsz~: hazenf, satisf~ct~ry r~roai 1.3x:++ing beers presez~te~1 before rrsc,
?~?' '.,^s ;~~%.F~E~cy tl<_ t the ir.~.~tt;jrraerat4:~) :~tc~;~.-__ `r'e;aruary 7 , 1491
t'~fy;4;r3~:",L~ f.J~CTY'.I31 u~; ~ ~:+.9Lizteta t!? Arz)~3fit~ ~,1~.T 4~i°+`~ N1~ fC~QrC~~S tile0« ?~:5t +A'li) of ~~.I~~._.1.~~~.,:~rF°..;r:
;P:S
'~, ~L~at^, ~.z~-r.~, ztc... , ...... ~ 375.00
S`~e:t ~er'a~ar:,try:~43 .......... $ 12,00
r ~~ ~-_~'
~ ,~t~ister of SVills
~ ~~~!RY C. L~~~iS
F~ZARiC R . PAR7'HEMER (4A I . i3 . 10 8 75 )
ATfQRMEY {Sup. Ct. 1.D. No.
315 Nosth Front Stree~
P.O. Bor. 741, Harrisburg, PA
ADDRESS
717 236 9377
i'~IG~NE
~$
? ~
.J E,_ ~ Cw
:~ ~r ~
C-3 G) _-.
T
~j ~.
;
:~li
Q .= C:
.'"'r ``
~.t Z
..... {~ ~
I'ii' ~~?`; l~~i;`r'_?"~ 3~1~~ Ot"~P,1" ~i3 3~1.1`Oi CI~r.-'+,f ~i•! ?-•C+J•"~~,
n
z
-,'•L '. ~"" n 'a...~ F'(~.~h f"' x;Ja 5r, V" a ~~ y,~~C ~.Y~+.M~~~„ {~.:r3'a"S'dr ^'~"''`..+
w . ;bv+ . s ~'"«"' ~ ..F~;' . ,'~. ~+i r rw'.n't° ~^ .-0~ .'~5~, yC3 :~aS~ -t'1~..d ~ rer:.Y +N~'~! ~1.
17108'
i ..
i
t'
I
~ '
~ -
i .'
<, ,
~~~
~.
~'x<
P` ;'
L~~i~~
: , ~~
._ .. '" i
~:'a"~ ~$YLL T1~:ST~P~T
~~
a~'D Re ~ie,F~~R
.°~, ti,i~3~~I ~l, t~E~VER, of Caanp Hill, Cumberland County,
Pe~snsz-lt~~:n~.~~, w~ei>~g of sound nix!d, r~iemary and understanding do
hc,reb~: •L..k:°W ,. su.~alis~'x and d~:clar~: this to be any Last P7i11 and
T~~~.~~ r~: , :°~~~»I,~_~aq h®r~bu ail ~~S.lls and codicils at any time
i? F.; v' ? L fl:F Q i' ~' ~ y,- ;Ti is L[13 was' .
T
~ direct -::~ at a.ll of my ;ust debts together with the
ex~ens~fi ~. m~. :funeral and the cost of a gxavemarker by paid as
soon as s r~~;ct.i~:able niter my death.
II.
I gA~n, ue•vise tend bequeath certain of my assets as
~o~.loY~~.: ~'~h.~e~v ^'housand x$3,000.00) Dollars to the FT.RST CHURCH
^i~ T~?~: ~~;.~`.t'}~;~4zd. ~iarrisburg, Pennsylvania; F.liTe Thousand
($J, flCfl . flfl ? ;=c> t;~e ~.URaRA CLUB, Harrisburg, Pennsylvania; T,~to
`~^hous~.nca ~ $i , flfl0.00) Dollars to CELESTE WILLIAAtSON; Ttao Thousand
L~++ ~1 Rs 6'S S.+,SS, Y'T.~CI
G 1'
. , `,.
~' F
.-,
q;
I.
~'
M~
-"
H .. ::
r. ~. ~_
Y' . .,
Z' .
-' ?,
. ~- -.. r r ,.r.-,.-.~
r
~..~.. .., b,~. _Y. i..T a ~'f _.`.!l ~~V....i;,_p~ !.'.Y .EarsJ'i~ .,. L.. ... ~ ..R%d: i..''...:~~t;F.,6
r... ,. ~ ~ _ ,..
~ ~ Y .~ ~. ~,y, wp..~ ~.?~T,ltiT t. ~.n ~..~ ..p-"~,.,:.£'tS ~'5 ... <... .,.: 9.ai 1.1 .:7 ~.i ~' ,.. u' ..Y1:
.., .~ i
. L,. - , _, .. .j it ~ ..r•I2 t. c:.t• \ ' " a iit.1`s.! a 1+t' p ?/. :.~..`s.. ~ .. r,. ,.,..r ,. :!Y'<'
;,'~f`....~.'' `f.,....:'r, _~?.6'3'+l~a ;~~.. ~ :i~~ ~,~,i~}' . fs~+ ^ d'%t::.1. G~~.':~ ~~ ~;~:5 ~'~~:c~:;~ a .L't:>.~;Y•
,.. .» ».:r r...,. .:~ ..a:'',.i~ti.~r,'? ~ :'~?~'s:C'u.'.„.3~~.1Y'ap ~`4:521'ir,'~r~~,r{""yl.;) ~a p :w~7x' ~Z~*~~, ~"3,' ~.'_::
.d__ .... ..... +.?...,... r +1~..Nr ~'<i r,` ~.~5~.^~1~s., t:i~~. ~,~ -•~~tf ~~.X ~i~ ~a~'7. .5 .~.... .. ..~i~'.i.
~., ... _. as rr ~~ ~ qz r'~ ,..~.(~o.iLwl i2.:af 3' ':..`~, ~':~?;~ ., ~'i~ ~~ ~. ~.. ~ ~.t:.`._ ,. .. ~.=f
s- .C ~ «
.... '~;.'.f_1~~; ~Y2.:~ iZ~tr,2~7.~i: £i~.3 .=fit: :Lf'4~'~:, :"_'~''~b~l'LI"' ~
f ~. .... .__.._ _ ... _ Ar r;'13{:.~d~~^, .?CS#:~7. '^~~~~ ~~.Z'af~ 3= ~''~'J:`;'~~1 '.a~ '': ~.~.~~.!;-'1J'C~T ~~5.12°5'
~ifap l.i?'." ;~=:,-~";;°.„`.
i
~~.~L13s`1LE'p (.~:~ '«'ri?Cil 1 £~:+.~i~.j C~1^ ~`C?Sc~':'f3~°G a'}'.T" CJ:s.;
~. , . to z:= y ! ;-..-,
~_ .. :._ ~.:
2', T1C.~~~.~v, '~C C~'J_$L'1~`~sG' c"1~ u~'2^: ':, A-y-,
a Si'~b~ ~:E IG?I' ~s~~'tc...
t'
I ,a,: '"~ .Y..•_`~~ ...._!. 1. .~. yy,, d 'y 'S,, ,y
~,t11~..p t. ~.~1F_'. ~li~ Zii~~i ~ti.'~' 7 siG'a~C': ~.T~ A~.~.~A~~.Li~
", ,Yi .- _ .. .... .A.I'~ ~'~3_,Lr'~ ~~Xiixl_ ~~ i ~ '~.~ :~-i C. .'. ]_ !.~I'^. ~!.~.?F?}~~'%~d.
_.., a ... .:.1:.. _,_ .., J" k":~~J~'.!,'a.; ~'t: p O?_" ~~ ~;:$2~ £x"0.2~~7:6Tr~~3." L"1~ '~Y~~TRfi
~
;
`
t ~. ,
:~ ~3
r
,. - . _
M
' ; ,
,. ,
' „
,.,.,. ~ . __~._. , ~~. ,~ .. , m . ,
,n:..,~. _, ., _~
,~.. a
.. 1. ~._I~.~~i'~ L3A.'~`.i.ld4Sq: L. ~Jy d°r `.~'~ue...t 6.S~~.r.~ ~L 1:~6 i".~~..Y~~~~.X84 li.'.~.1 ~~.`'~~~Ita"~>1~. l.ti, k~e. `1'..~.,''. !~.X~.'+
Z ~ _ t' T .r fx r.;.~ ~" w ~ ~ ~ f .~ 'd~ "1 °'^5 ^4 a ~n~ r ~., ,~a
.,.. ...,... „., ,.i.'. .':~' d.~'.a• L b'4 a. .. S. ~~;:"lfm e"`'. a ~ {.a n , ~ ..r Y;.A~~:.. ~ ~... ... L'?
.; n. ..... .... '~ ~ -.. ..~.."`'.r. .~i`?.:3..~. °:G i"~..iii..i.~.'~+` C>:~' .>~~.`S'~`1~,' 'n',1..~.T~:'wi:F. ~.A:;•.a..
e... ~.._ ,.ti°.'~w .S3_a m re~ a~k^~.~a~p ~.i.. .~',l. k~ i) L.. ~L~a~~:.'~11~n.~ +'..i'~ ~:~.~.T> ll1Sf°
,tr4, . .. , ~,. E _. .,_:'. ':°r!is~C'+W?.11ti::i'it'". J PA ±:?4'~'t; ~~~.~E?Cfd :~::~t~~. ::1~?.',.'t4~. iK.1is A'~11;°`04 :"~;'`,
fe
~: ~.5..'.'=i3~'~. `~}1?1~ rie ~3~'ZSf~^ £~'.°i7'.3.Y"..C `~.£r °t'~'~':~cS~~.A].X. i7X'..'".«L"F'.C11~+,?Y' of
'i:.~y~s ~~'_ ~ "! ... ~. d°c=~~u~,red ~o en~ex- ~?ecu~ ity mn ~~~ j u~:a.s~3y<w~icn i.r
i:'Lt:».1=1'?. '.: a3~3",' '!it~"`?~ U.C.
~~ ~
d.. ''+L..j`o :"a~~~~.~~i!~e T S:1°wSTe i:il~.3 %`3~' ~r:'~~7 C1t ~j~~~a"Li1
r i
~ ~~~~ ~
~,
~..
•, ~,~:.
~,..,
k;
Y .
{
{
~~
µµ.
C,
fY
'i
S~'
~ ~ _ ~ ~ R { V
^~,! ~
. _ ._ ~. ~, .~'. '. a y,,, - tr it ~ ~ b *. n~o fy .`' ~ ~ ~ Vr.? h, -~ ,y ~f.• ~ "~ r
` ... ~... AX ~'" "~"~-" r »;, Y.~ , . w t f ti~,sa~ ~, wt ,t K~v r ,rr~ „~,.., '"z- ~r -} „a ~e
~. .. ._ ._
~.., ~c w.r-, ~'.~y,.. n.r~`!54'"3.r'^'-"71F~1~~ ~°`.,..r" f.~' +~~Y '!~ ~'r~7x
~.~ .~
7vsa ~%^~+; ~ ,";`rt~~r r~ .. s~t~.i?~Ji.:~~ :.E s1.J7~ ~:
.._;t :;".ti °:,'suE"Il(:^ G~ ti£! ?ti~h.G, ~~:, tl~u
::y_Y7?.:. ~`,-`.", .. "ta!:i aCi' ~.`~E"C~ ~~1~ I?e"ild1f24a5 ~S
.r.~~~.~~y~~; .~ i1:..£ pa°E~cw~rc:~. s~.aacl
l3F~'...i]G;' ~r't~~i~':1% sf.i. ~s11:.`'. wF:"~71't~
a_'.'1'ti:~''C~
r~ t) / ~
~;~ ~r._~' ~ A
r f
~~.~,~, ~,~,.;~. ~~ ~ouR na~~s
- vn_...~~ .~~
~N R. ~A~~
1
{
.a
µ,,.~ ,., ..~ ,
p ~ ~ ,~ ~ ,.~'/ ,ti ..`F,. w. a+'~ rN it „~a~ 'Y 4x h~M~'ti~~~~~ ~'J^~ ~'~..."'~~'q ,~ ;.. .~A -rP ~ z,~,.it'+iy ~ ~. .
!~r1 i
~.TC ~i ~~~ +k; 7Frt ! ypxJ~~..~++ ~t.~'. o_tI ~.. rs / M:
__
_ .
_.
ra ,
CC~A~MONWFAI~'TH OF PENNSYLVANIA
SS
COUNTY OF CUMBERLAND
~~
We, JOHN R. WEAVER, ~~k~'JU~"-~ ~"~ , and
~a'h'2. ~' ~2 ~rU~` , 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 that he had signed
willingly, and that he executed it as his free and voluntary act
for the purposes therein expressed, and that each of the
•r~itnesses, in the presence and hearing of the Testator signed
the Fdiil as witnesses and that to the best of their knowledge
the Testator was at the time Eighteen (18) years old or older,
of sound mind and under no constraint or undue influence.
~~Z
J N WEAVER
~•
~~
W TNESS
Subscribed, sworn to and W~, ESS
acknowledged before me by
JOHN R. WEAVER, the
Testator, and subscribed
and s rn ~e~o;e ~e by
ce1 ~ e r!
t~ritness~ this /} day of,
-f~~~v~e~~ , 1991.
Notary u is
NOTARIAL SEAL
CYNTHIA LOU MYERS, Notary Public
Harrisburg, Dauphin County, Pa.
My Commission Expires Sept. 7, 1992 ~~
-
~~ -
-, - _
,. .
.~ ~-
\ ~ \ `.
-
~ ~ ..
\ ~
i ~ ,.
y~ ~t41~Qr6'1~1 ~ . ~
t ~
~~~~
`' t
ti ~r
J p h ~
1~®~ ,
k - 1
}
- y, °
REV-1162 EX (f.Dfl' ~ . ~ ~ ~
et
.+o .. ar. qc ~c.'~ ~°^-~e ,
1 ,~.
'^.. s. al v•Y~ •i.
ACN
RECEIVED FROM: ® ASSESSMENT ; AMOU
CONTROL NT
NUMBER
t)EF~QRA6.1 WEAVER 1 -- ~'33~tf0
°5b8'S CREEKV I EW RD
C
PIECHAAi 3 C$HLlRO PA 17035
- Fplu HERE
ESTATE INFORMATION:
FILE NUMBER
~i-1995-OOb3 F&N i~5-0~-~11b
NAME OF DECEDENT (LAST) (FIRST) (MIS
WEAVER J03-IIN R
~ DATE OF PAYMENT
POSTMARK D E
I COUNTY
Cl1MI~Gl~I.
DATE OF DEATH
REMARKS WEAVER DEIDORAN
SEAL CHECKS 1 1 ~
~....~,
REGISTER OF WILLS
.`O(D HERE-
TOTAL AMOUNT PAID .~OOR.00
P11 I
RECEIVED B1f'y',-, ~~ ,~1 ('. . f a _ i
~ ~ ~Z~'F ~
MARY c. ~ wits ~'-~~'b~~~~.~~::
ReoxeT~R ~ W~ ~ ~
e
~... , . , :..3 3, ._,~ ~ ._ : -
-. ~. ~ _ ,
.,,
_ _
_ _
_
_
--
._.
,.
,
,. ,,.~ ;,
'~, _ '`
~~ ~ ~
/,.j3~ e
/// ~ .. ~L/ ~ /C,D-~-C1
~ ,~
• J Deborah .A. Weaver ~~
5655 Creek.view Road ~°
FRechanicsburg, Pe'A 17055 `;~;
(717) 731-8826
larch 7, 1995 ~ ''
John R. Weaver Jr.
_. 1813 Rudy Road ~-
Harriaburg, PA 1710
a ~- ~s ~s
RE: °I'he Estate of Jahn R. Weaver, Sr. ~ O ~~
O V
Dear Jci?o,
ian behalf of the Estate of ,Tohn R. Weaver, Sr., his will was probated
at the Cumberland County Register of Wills Off ice and letters of
testamentary were granted to me on January 26, 8995.
r
~
all the rest,
5'our. father cared for you deeply, and bequeathed you
residue and remainder of my estate, both real and personal, of
*ahatevNr t~cin:~ and ~r4~cresoever situate, of which I shall die possessed
or of ~rhich i shall be entitled to dispose at the time of my death,
including ail. ~-.~ght, title and interest I have in Hillside d~part-
m~nt~, Tnc., to my children Deborah Weaver, and John R. Weaver, Jr,
or to the survivor of them:'
` John, this is after payment of debts, and other bequeaths to friends,
two churches, and the Aurora Club. While I know this may seem
formal, I want you to be fully aware of whats going on.
I'm in the process of collecting the values of all the assets and
finding a~zt what needs to be classified "in the estate" for tax
purposes. If I pay the Commonwealth of Pa money by March 31, I can
get the benefit of a 5$ discount an the amount we awe and ultimately
save at least $1,800. I also want to find aut how much tax can be
paid on as~:ets we will inherit "on our behalf" so that we do not have -
to pay inheritance tax.
Cnce c~*e ha~.~e tree valuation of the apartment build3.ng and its aFprais-
al, we ~.*z1~. be able to figure out how much money we can invest and ~
still get the return that we want--and figure what the rents should
be. .~11 tha_s, however, has nothing to do with settling the estate
which I am endeavoring to complete in as timely manner ag possible.
I would send you photocopies of the will and certificates of deposit, _
! but do not have a copier here--so I drill show you them and copy
whatever rou want copied at a future date. P.S.-- There are a few
hie3~n interest bearing ad's at Hamilton Bank you may want to buy snee
they *.aiil not :nature for a while.
~
~
brery trul~~ ~'OL?r:as C
~ ~71
D "+ ,
3 ~ l) --` . ~-~. ~ - ~ C7i Cr7
~ ~
~ -.:-,_
~Je3~orah cleaver
Executrix - your sis '- ~ ,-, r' ~
_i ~ _ ~,
~ ~ G~ ~
~ ~
i. ,
.~~
~2reUr~~-~~a ~. ta?~~~p~s-
Q f1.?) 7~~-aF~e?6
i~.S.i L`~ /:d kJf.i '. 'G°a g ..'.ra n.:. ..s. f .ad.°.i S
bE#',., ",yzi:.^•. W~,,1:~ :f?' ~~ ~O~'R?}. ~. F9~3liF~Y'g ~~',
~~
i
f~
~~
~~a ~+~~~~.~~ ~~a~: ~:~-~~ ~sc~t~ ~rf J~~~ &~. nd~~~+~~, ~~., ts~.;~ ~~~~. ts~:~ gTr~~~t~;d ,..*.
~? ~ ~c:~ ~~~~~:~ :: ~~~:. ~~su~•a}gp ~es~$ ~~:~~: ~i: ~d~.~~~ L3~£~.c~ a~sad lett~~~ og '~r
AI, i~ ->!^`~ fr~ w' x~ t". „.~' ~.~~.~.'~'~ l_C^l~ y C~S,Y14d T~'C~14,A~Q ~ ~. ~.tl~ A.i ~.EIS~1:3Z3` A. T'"CA'l3g c.d`"i~. Q~~ -.
";_ •yn~} ~,Y, w gar: '~:'.~as':'E a~`R"~s'~"~ ~T&8~.1~'t"cT~.tA~Y ~L1LIa~":.g 3lH3t~ a~T,~'+~`il~~e~~'i~sb '~.~;.
c?,~:,,w~3a.~'~° ~. ~ ~,. T~ ~ ~~~ ga~sa~y~~al s~~~. ~y ~~.~.~ `~~~ ~~~i 2~L$V~;&m"t3 .~,a~d7,, '
'}: :.t_2.3a~.~.f.~.;_}~ x! :: ^4~ 1'~GI'1 ~.{.>~.-iZL~'a.F'S:~.C,s~'A 'Z2:~C P_~:4.-' 'mS='~:.i2~~'. '!'.ST ~~E~Ss92."~Vf"+si~ tSl~.' '
~~ ~~CI
b~~.?Or,Elh ~. 67f~aSd'er
~~JS ~r~~D~zFl~'bF RC3~2d
Mechanicsburg, P14. .',.~ w ~5
~9arc~i 'D, ~.J~S
Jeans~:i~ use? 1, ~,~.ecut~.ve I9irentor
q
Rte: the ~s~~a~e bf John R. cleaver, Sr.
i"1.~~r ~~'ai'2.l13~.',
u~ b~:~:~.3.s cap' •~he ,state of Sohn R. tweaver, Sr., hip, will was probated
~~t t~~c C~e1-~i~~r~and Countg~ ~?egigter of dills Office and letters of
4eE~::a~~n~~~~r.;~ 4.~~re e~ran•~ed to rrre on Januar~a 2~, i39~.
i 3cnoxa ~' fat~i~r cared for the mission of the aurora Gluib, a:~d
hec~~.aeathed ; ~~ $5, ~t3U. t30 in his will . I will ~eeg~ you aa~v =aed anal
~n3~~_r.~~te~.~~ a~•r~3.nae upon distribution of the estate to forward you the
z3et3i1e i .
~., 9
)~ ~~
h~
......._.. _ _ _ _ _
.- ~
~.
~~ Deborah A. ~1eac~er
~ ° 5655 Creekvied Road
A~echanicsburs~, FR 3755
f7i7) 732-8826
!~«rch ?, .L99S
~~
i
r^
i
i
I
~., i
~~v_ 1r~+.a ~^ g~~~ ~s~~an
F?_a st CP~.a~~'~°?~ caf the Brethren
2:~~ Htz„~v~~ ~. ~; ~:reet
Harri~~buxq~ x~~, 37~.~~#
~?~: 'l'he E3t~:te of John R. 6a'edS7ei', Sr.
on behalf Qf the Estate of John R. BnTea~er, Sr., his will was probated
a.t the Cza~rl~and County Register of Frills Office and letters of
testar~aen~.aagr wire nranted to nae on January 26, 3995.
I ;ts~ow ~~ fae:,her cared for the miRsion of the First Church of the
~ret?a~~n.. :~r~d ~aequ~at~aed i.t ~3,Od~G`.Qa in his will. z will keep you
w.r~~~ise~ .v~z~d. ;~~.tis~ate~.y arrange upon d~.stribut~.on of the estate to
.~.0~:'~f3~c'Pi 41 °gr^.'~'t '7;iii~ ~K"t~33.G.°:3L .
~'z^'~P 'c_:~ L1 .z ~' 'SFiJ1L'.~'S ,
?~~c~JC?Y'?xfl ~'Y~ sa r ~^
~SO[~ti%
' .~
...
_, ,<
~; ~<
A
~E"t?C~g'ffi?3 d~. ~Q~'~'~S'
~c~r~rti~~k~a~~€~, ~~ .~'i~55
//~''~' ~//~~,~} ~\'\~`'//~J~'
`"I 6ie727 ~ 732-q~€4~$y2~,,
~+~2
i~ :SRi
$~`:iL7 a: '!.5 ~y5 b.~d~
~_
n
1
{y.~1 ~i ~.?
t ..r .y .... 4~~L ;~.{,~F<J' i ~r~f~'. ~..~. N. ~
~
Y
tl'V f.[4.!
gq
~
7
~~~ :~~t ~%a~ cap'. ~f9~n ~ , weaver, ~r .
~~~r fir:. ~2eN
,
Vn ~%"('°r .'a'.L A~~- 4.s 't :r.: :~~L~3.~ Q.~L Ua~lG~s tel. ~7i~~.~Q:'~
<.°{. t
_RaF.. ,~'~iz...?^~ ds~ada~ ~,'~i91,1I1a~"
~~~{ ,}' y yy 1
~
~
~
~
~ fir.' 77
~1.~.43 Ta$'.~.1d i~T~3 FAy"c'al~a~e~
.
.
te
7
r ~
~L
~~dd-~
~"-~'~~l. r..~.~ f.~~~y ~~ 5,:~~?y fa ~~3" ,~
-
.~--~~~-c~~ t0 ~E
a
n
~~
~
n~ar
y r.J~1 ~s°'~ t'~~~ 1~~,~~~'r~ +~i
~G, 13
95.
,L~:y,
p
~- 3~~~.FJti° ~4~_ i¢): LS&Y~.~ ~.la~'~~ ~L~r ~DU 'UQr'E"L3 9 ~~4X
p
q~
~
}
~
r
1C'a ~1i.£; Pa:~::.'~ . ~. ~'A~I 3{EaL
A
' A
~p.~,~.~4~~d ~Q~ ~3, WA7®.ll S:
~
}ALE ~t~?
3f3~'.+{~ ~~53 R~A'~~I:.'CELi'~.~.''~~' a$rra~~ge €.I~$rl
,~ ~r:~:aa:t ? 4~fi?: ~,'r_ ~.,u?~ F~w'~u'~~fr ~t2 '~'Jr6
i
°Y~~
'
o
s
4,~ ~ ~
nf: ~b~r,~l.1;£~'~' .
~~~~
K
`.
N
pp~3(~/.,
S.
F
,.
~~
~.:
~sr
~;:r.
yk51~.
W ~A .
~ rr
'~.
r
~€~borah ~. ~3etlv~r
555 eree~.~riew toad
'~schaa~ice,B~~a:rg, gl?, ~..7fl55
a ; 3?) 73.1-8~~~s
~.~ ~ 2 °~a,. ~s~ ~. ,Y.a e°:~~~
~~?
~';. ~'?~e ~~:~tat~ of ~Tohn ~ . Weaver, ~r
Si~L4A 1.~.~.~A.~~~~ e
t?n belza3f o:E the estate of John ~2. Weaves fir., his vPti11 was grob~;:ed
at tie G~~~~aerl~~nd ~ounfy Register of Wills Office and letters of
ta~i~as~r~var~,~ 4~wy re granted to nme on January ~6, 1995.
~: z~nc~• i:3lT ~:~.t~;s.r cared for you deeply, and be~aeatPaed you $2,fl®0.flfl
:~_~ ~.i~ ~a :~l , ~. .__ ll Vie.-fi you ad°Jiss~c~ anti ult.irratel;r arrange tsgr~n
<?a.~. ~: f;s °~_~at~ ~::x.~~;?. ~.~ € ~.~~ cs~.ate to for~rardyou thy: 3a~:~eae3t .
' f ~F
r I~
_,~~
sa
:~X
;,
:~~
>~
.r
` ' `k; -,•
I7ebora~h A. ~+leaver
565 Creeka~ieca Fload
~fecfi~a~aicsburg, Pd0. ~.705a
t7.~~a ~~~.~-~€~~s
far. ~~;~a 'A, i~39~
~i0~ 5~ggo~.,,r~ Swr~:«:•?~ ~i,~0lf
LZLa ; f. 6A~ .Laa `tu Y. C~ w~G" ~~ V L7Lin da . 9V~.a~~r y Sr m
On behalf of the estate of John R. weaver, Sr., his will was probated
at the Cumberland County Register of [dills Office and letters of
testazmentsry u+ere granted to rye on January 26, 1995.
1 ~ne~~ ~~,° father cared for you deeply, and bequeathed you $2,000.00
in ~ai:~ ~'~.1a.. ;~ a,~~.~.~. beep you ad~ri~sed and ultimately arrange upon
d~.s•~.xi~~.R•~~.io~. c{ .a,h~W ~sta~i:.e to forward you the bequest
=rely •~rv.3}• 1°n~;.r~ ,
c,~f_~M
~ 4.
~ _
- _ ~ - >.
,. •~
~f'~L'a.s°.'s3F~ cx~.. ""s2~~r~~1'v'X.'
.h, °'' ~~ '2. C' .,. SAY JL C,:.;: ?i''_'
M1 ~ f• .:.
~'.xe~a o ~.~. ~' :e i7 01 ~,4.~ °.1 ,~. d.~ry1Rn Si • '97 ~C°. h~Z%~.~ p ~7~ o
±.`o `L.sa;°w- a,'; z~'. F,~^y'`'.f'.$~ fli e~G3~tY3 '.^-s'. '~7~'c'2V~°~A SZ'., I'P1I1^.a 53..~I ~a'~.F.~ ~iR'As3~FT£~
~: ,_.~~~ ~ ~~:~~ ~- fi~:t%~'~ v"ou.~a~:~r ~~ty~3.'3'~.`C3~' o~ Ld~.llr c~~`;Cao~ And ~~t•~~?` ~ ~~
v ~ ?~?° ~ y ~~~ ~ r:~ ~°~-?,~ ~~~ fo?~ Yost ~aat~ de~~pZY, ~nc~ ~e~~tts~.~.~acd ;~~ou ~
•~ ~;s ,~? cs ova , '~~` '~ ;~~ iaZ ~i~.5 zaY3t . I ~Ja~.3 ~t~~ga You ~dtt~.~~d anc~ ul~~.-
z^ro ~~~~ ~• .=?r~-~~.,~; a.~~~za =~:~~tr3.b;.t~.~.on c~' trams ~a~~~g ~o ~o~~a~.rd Y~~u ~.~~
', ` 9
;;r
;.
d
t$
~-_ ~~ t
,,
;~
~,.
9~r
F;.
:~..
~~4t>~ =-
yA t~~-
e~~~
~ ~` ;
:~q:;»
.`
ti
';4
5`{t
'~
~o~~
De:~orah .~. w~eauer
5~a5 ~ree~view RaEtd
~pchanioskrurg, F~~ 5`'~~s55
E 7,Z? ~ 73i~-S~326
~aarch 7, 1995
~a7r's. JoFgn K. R~;riisili
Rio Tea ~~,twue of Jahn R. Weaver. 5r,
'a~8c"ar t~.'"'$. Rut?iSiS.l,
~.~ i~~~:~3f e~ v.~~~* 3~state of Sohn R. Weaver, Sr., his wi3.1 was gradated
a~ ~.~s.e ~~r~~~a~:~.t,,sd Caunty Register of t~il~.s (Office and letters of
'west~~ncnt~ry 3.r~~-e g: anted to sae, Deborah ~-eaver, an January 26, 5..995.
~i~ scattier bec~ucat3~c~d xenelope Zuilo the earn of $2,000.QQ in his wTill.
Since y~u.r_ l~at~a haasb~ind was listed as the "responsible relative" on
s~~~r .~ecawds, 1 ~7r~s hoping that you could mcivise me as to how to get
~:t~e ee,:~.;er~t vra hex. I e~ill keeg you advised and ~zlti~ately arrange
ug~~ dst~;'a~t€_c1a~, of the estate to forward the Eaegtrest to g;aat+. or and
r3?`.'.ph t ~' ~-.. ~ i]"!^s'c: "~ ~a'1' ?:~rC+'Gylc~~'_ to ?1l~" .
~:~ca.~,~ "^,^~,~~: :'~~:~' sarcagat~ay an the loss of your hcasbar_ci~
fiery ~~s^ uley ~,c~,.~ti ~ ._ . _ U
~abrrai~ ~-aa~;,a~.
,t
REV-150/; EX+ (7-941 ~
fs.
s •wt, ;
COMMONNIEALT t' r PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT: 2804111
HARRISBURG, PA 17128-0601
DECEDENT'S NAh1E (LAST, FIRST, AN[
z
W
D
W
W
D
L-7CIAl SECURITY NUMBER
195-07-3116
APPLICABLEI SURVIVING SPOUSE'S NAME
N/A
W
Yay
]C
d m
o_
a
W Z
~ W
a: ~
O Z
~d
z
0
J
a
a
v
z
z
0
H
a
a
0
U
x
[~ 1. Original Return
^ 4. l,j~ited Estate
INHERITANCE TAX RETURN
RESIDENT DECEDENT
(TO BE FILED IN DUPLICATE
WITH REGISTER OF WILLS
V - _
FIRST AND MIDDLE INITIA SOCIAL SE[IIRITV NI
^ 2. Supplemental Return
^ 4a. Future Interest Compromise
(for dates of death after 12-12-82)
FOR DATES OF DEATH AFTER 12/31191 CHECK HERE
IF A SPOUSAL
POVERTY CREDIT IS CLAIMED ^
FILE NUMBER
21
95
COUNTY CODE
0065
YEAR NUMBER
1710 MARKET STREET, P.O. BOX 503
CAMP HILL, PA 17011
Decedent Died Testate 7. Decedent Maintained a Living Trust
(Attach copy of Will) ^ (Attach copy of Trust)
IRRESPONDENCE-AND CONFIDENTIAL.TAXYNFORMATION SHOULD BE
^ 3. Remainder Return
(for dates of death prior to 12-13-82)
® 5. Federal Estate Tax Return Required
L- 8. Total Number of Safe Deposit Bozes
TO:
5655 CR VIEW ROAD
MECH SBURG, PA 1~y705
f'~ ( `L .~
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. Mortgages and Notes Receivable (Schedule D)
5. Cash, Bank Deposits 8 Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G) (Schedule L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses, Administrative Costs, Miscellaneous
Expenses (Schedule H)
10. Debts, Mortgage Liabilities, Liens (Schedule I)
11. Total Deductions (total Lines 9 ~ 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
(21 << -
C=,
(4) ~ ~j
• '>
(7) 28, 000.00 ~ -
i
(10) 0 ~C
(~ (11)
r?`' ~^) (12) .~.t error-- . e .
15. Spousal Transfers (for dates of death after t5-30-94)
See Instructions for Applicable Percentage on Reverse (15
Side. (Include values from Schedule K or Schedule M.) ) x'-- p.
16. Amount of Line 14 taxable of 6°k rate ~~ ~ ~~ '"~'
(Include values from Schedule K or Schedule M.) (16) 1 131 ~ ~ A ~~ x .06 = y ~ ~~~ ~t. 4
17. Amount of Line 14 taxable of 15°h rate (17) _ 1(1 ~~ n _ nO x~ ___~ 5.0o cG 7
(Include values from Schedule K or Schedule M.) .~.,~~~'!/
18. Principal tax due (Add tax from Lines 15, 16 and 17.) ~ °'r^ - •~
19. Credits Spousal Poverty Credit Prior Payments Discount Interest ~/ `~i ~ ~3 '~ ~ 9 M_.
Z0. 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) 7 s 377.26
A. Enter the interest on the balance due on Line 21A. T
(21 A) _
B. Enter the total of Line 21 and 21A on Line 21B. This is the BALANCE DUE. (218) 7~3.ZZ_26
Make Cheek Payable to: Register of Wills, Agent
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND TO RECHECK MATH ~ ~
Under penalties of perjury, I declare 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. I declare that all real estate has been reported at true market value. Declaration of preparer other than the personal representative is
based on all information of which preparer has any knowledge.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN AODRE55
DATE
DATE
~~
d ~t
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 % (.O1) will be applicable for estates of decedents dying on or after 1 /1 /97 and before 1 /1198
• 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 (r) 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 ................................................................................... ,X
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 .................... X
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,
YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Ktv-~OU3 tX+ 14-86)
O ~ F
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OF
SCHEDULE B
STOCKS AND BONDS
JOHN R WEAVER
21-1995-0065
(All property jointly-owned with Right of Survivorship must bs disclostd on Sch~dub F.)
ITEM
NUMBER ~ DESCRIPTION
~• WEST CORNWALL TWP PA MUN AUTH REV BONDS REFUNDING FIRST MORT(
FIRST MORTGAGE CORNWALL MANOR PROJECT @3.85%, Fixed income
security, Tax Free $50,000, maturity 06/1/95
2• LEBANON CNTY PA HEALTH FACS AUTH HEALTH CTR REV BONDS UTD
CHURCH OF CHRIST HOMES PROJECT @6.25%.,Fixed income security,
Tax Free, $ 10,000, maturity 10/1/97
3• LEBANON CNTY PA HEALTH FACS AUTH HEALTH CTR REV BONDS UTS
CHURCH OF CHRIST HOMES PROJECT @6.5%, Fixed income security,
Tax free, $90,000, maturity 10/1/2006
TOTAL (Also enter on line 2, Recapitulation
(!f more spoce is needed, insert odditiona! sheets of same size.)
VALUE AT DATE
OF DEATH
$ 49,718.00
9,824.00
85,603.00
REV-1$04 EX+ 13-921
`' SCHEDULE C
;=3 '~ CLOSELY HELD STOCK,
COMMN ERITANCETAXeRETURNANIA pARTNERSHiP AND PROPRIETORSHIP
RESIDENT DECEDENT Please Print or Type
ESTATE OF FILE NUMBER
JOHN R. WEAVER 21-1995-0065
'~ ..
ITEM
NUMBER DESCRIPTION VALUE AT
DATE OF DEATH
~• HILLSIDE APARTMENTS, INC.
26 Unit apartment building located at 1710 Market Street
Camp Hill, PA. $362,048.66
_ TOTAL (Also enter on line 3 Recapitulation) $
(If more space is needed, insert additional sheep of same size.)
1
1
2.
3.
4.
S.
6.
7.
8.
9.
10.
ll.
12.
101-49
~fV-rSpy Er. p.o11 ~j],~
~,~ ~~
COraMONWEAITM Of++-ENNSYIVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
JDHN R WEAVER
§ 101.12[1]
PI•os• Typ• or Print
FILE NUMBER
21-1995-0065
A. Dratoil~d description showing the method of computation utilized in the valuation of the decedent's stock.
B. Complete copies of finanao) statements or Complete copies of the Federal Tox Returns (Federal Form 1120) for the year df death and d
preceding years.
C. Statement of dividends paid each year. li:t those declared and unpaid.
D. list names of officers, salaries, bonuses and any other benefits received from Corporation.
E. If the Company owned real .state, submit o list showing the complete address/es and satimated Fair Market Value/s. If Rsoi Estate Appraisals
hove been secured, please attach copies.
F, list principal stockholders or date of death, number of shares held, and relorionship to decedent.
G. Any other information relative to the valuation of the decedent's interest.
Noma of Corporation HILLSIDE APARTMENTS INC. Penns lvania
Stare oFlnc. Y
Stress Address 171() Market Street s P 0 Box 153 Dore of Inc. August 10, 1949
City ('amn Hi 1 1 Store PA Zi Code ~ ~n i i
P ~,.~,_,._ To1al Number of Shoreholdsrs 1
Federal I. D. Number _ ~'T_ 1~2Rn3,Fj5 Business Reporting Yaor_ AugttGt 1 to Ttil "~ 1
(Same As Federal Form 1120) ~
Type of Businea ~i den i ^ 1 AD^ Yma~cLL Product T.i yi n 4
g1n ^ r• a
STOCK TYPE TOTAL aY SHARES aY SHARES OWNED
OUTSTANDING PAR VALUE
BY DECEDENT
Common
Preferred
inn
Provide all rights and restrictions pertaining to each close of stock.
Wos decedent employed by the Corporations (~ Yn ^ No
If yes, Position Manage_r____ Annual Salary $ Y~1<1=ed
Time Dwoted tc business vats Pd
Wos the Corporation indebted to the decedents [~ Yes ^ No
If yes, provide amount of indebtedness $ ~~ ~ ~~~ 89
Was there life insurance payable to the corporation upon deorh of decedsntl ^ Yes
If yes, Cosh Surrender Value: $ ®NO
Nst Proceeds Poyoble: $
Owner of Policy
Did the decedent sell or transfer stock of this company within one year prior to death if the dote of death was on or aher 12! 13/82 or within
two years if the date of death was prior to 12/13/821 ^Yss
^ No
If yes: ^ Transfer ^$ol~ / of Shores Transferee or Purchaser
Consideration $ Date __
Attach a seporote sheet for additional transfers and/or sales.
Did the corporation have an interest in other corporations or portnershipsl ^ Yes
If yes, report the necessary information on a seporote sheer, including Schedule "C•1" or~"C•2" for each interest.
Was there a written shareholder's agreement in effect at the time of the decedent's deaths ^Yss
If yes, provide o copy of the agreement. ^ No
Was the decedent's stock soldl ^Yss ~ No
If yes, provide a copy of the agreement of :ale, etc.
Wos rhs corporation dissolved or liquidated aher the decsdem's deorh? `n Yes '~ No
IF yes, provide a breakdown of liquidation distributions, etc. Attach o seporote sheet.
PAYMENT AND COLLECTION
SCHEDULE C-1
CLOSELY HELD CORPORATE STOCK
INFORMATION REPORT
ESTATE OF JOHN R. WEAVER
INFORMATION FOR SCHEDULE C-1
FILE NUMBER 21-1995-0065
A• HILLSIDE APARTMENTS, INC.
Valuation of Stock At January 1, 1995 (DOD)
Assets:
Cash balance (bank stmt) $ 89,454.96
Amount due from Deceased 45,120.00
Accrued Rents for Jan 1, '95 8,034.00
Automobile-'88 Tempo 750.00
Appraised value of
Building and Land 235 000.00
TOTAL ASSETS 378,358.96
Liabilities:
Payables 9,508.30
Security Deposits 6 802.00
Stockholder Equity 362,048.66
TOTAL LIAB & STOCKHOLDER E 378,358.96
B. Copies of Federal Returns enclosed
C. Dividends paid 1994 - $50 000.00
Dividends paid 1993 - ~ 0.00
Dividends paid 1992 - 9,000.00
Dividends paid 1991 - 12,000.00
Dividends paid 1990 - 14,000.00
D. John R. Weaver, President
Management fee paid 1994- 8,000.00
Management fee paid 1993-15,000.00
Management fee paid 1992-18,000.00
Management fee paid 1991-18,000.00
Management fee paid 1990-14,000.00
There are no other Officers, no bonuses, however
deceased Manager maintained residence in an apartment
without paying rent.
E. Corporation owned the apartment building at 1710 Market Street,
Camp Hill, Pa, and no other real estate. See enclosed appraisal.
F. Deceased was sole stockholder
G. No other relative information
REK1508 EX+ 12-8~
J _.
COMMONWEALTH OF VENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS AND
MISCELLANEOUS
PERSONAL PROPERTY
Please Print or
JOHN R WEAVER
(All property jointly-owned w1fFt fh~ Rigl+t of Survivorship must be disclosed on Sc6~dul~ FJ 2 1
ITEM
NUMBER DESCRIPTION VALUE AT
DATE OF DEATH
1 Checking account-Account No. 0033381380
Dauphin Deposit Bank
Balance at Date of Death $ 32807.63
Plus: Accrued Int 40.41 32,848.04
2 Checking account-Account No. 0064538799
CoreStates
Balance at Date of Death 18581.02
P1us:Accrued Int 5.19 18,586.21
3 Amount receivable from Hillside Apartments I~~
, ,
1,302.00
4 Tax Free Money Market Fund-Part of Personal
includ
d B Portfolio which
e
onds listed on Schedule B- Acc t ~~4350795004
Dauphin Deposit Bank, Harrisburg, PA
Adj Bal at Date of Death 86043.00
Plus: Accrued Int 1236.76 87,279.76
5 Certificate of Deposit #8000138891
Dauphin Deposit Bank, Harrisburg, PA
Balance at Date of Death 40,000.00
Plus: Accrued Int 180.82 40,180.82
6 Certificate of Deposit ~~8000138999
Dauphin Deposit Bank, Harrisburg, PA
Balance..at Date of Death 10000.00
Plus: Accrued Int 0.00 10,000.00
7 Certificate of Deposit #020104121-0650870
CoreStates Bank, Lancaster, PA
Balance at Date of Death 20,000.00
Plus: Accrued Int 10.69 20,010.69
8 Certificate of Deposit 4020104121-3618757
CoreStates Bank, Lancaster, PA
Balance at Date of Death 20,000.00
Plus: Accrued Int 143.97 20,143.97
9 Certificate of Deposit 4020104121-4970128
CoreStates Bank, Lancaster, PA
Balance at Date of Death 25,000.00
Plus: Accrued Int 145.97 25,145.97
TOTAL (Also enter ~n lino 5
ation) $
----L--~ ~ .~ 6
(Attach additional 8Yz" x 11" sheets if more space is needed.)
i t
1 ~ 1-S 3 PAYMENT AND COLLECTION § 101.12[1]
.nr.~w. ~. p,.aq
h~
COMMpf1WEA1JN Of -ENNSYlVAN1A
INNERITANCE TAX RETURN
RESIDENT DECEDENT
JOINTLY OWNED PROPERTY
JOHN R WEAVER
lotnf fenanf(s)t
NAME
A• JOHN R WEAVER, JR
g' DEBORAH A WEAVER
C.
Jointly-owned prep•rtys
1813 Rudy Road
Harrisburg, PA 17104
5655 Creekview Road
Mechanicsburg, PA 17055
21-1995-0065
Son
Daughter
DEC
ITEM ~~RR DATE
JM6E JOINT
TENANT ,RANT DESCRIPTION OF PROPERTY TOTAL VALUE
OF ASSET DECD'S DOLLAR VALUE OP
96 INT. DECEDENT'S INTEREST
~• A 021188 Certificate of Deposit $15 000.00
Dauphin Deposit Bank int 167.67
Harrisburg, PA~~ooo 13t~'~'
Z. A & B 010291 Certificate of De osit 15,167.67
P 60,000.00 50% $ 7,583.84
Bank of Pennsylvania int1,217.43
3. B
110387 Reading, PA-lE8000$i^b;:: 61,217.43
Certific
t
f D 33.3° 20,406.22
a
e o
eposit 10,000.00
Dauphin Deposit Bank int 137.40
4• B
051088 Harrisburg, PA~~•ov~~ ~~ ° ~- = 10, 137.40 50% 5,068.70
Certificate of Deposit i 21,219.15 I ''~
Dauphin Deposit Bank int 246.37
5. B
020687 Harrisburg, PAS %" ' ` ' ' "~~r'~` I 2 1 ,465.52 ~
Senior Note 50% 10, 732.76
; 50,000.00
Da hin Deposit Bank OTClprice405.00
rrisburg, PA ~' N - :>,~_~ --_-~ ~ 50,405.00 1 50% 25, 202.50
• (ff more spoil it needed insert oddiiional sb•d: of same ds•~
TOTAL. (Also •nlsr on line 6, R•copilulalionl $
68.S94,02
~ e
§ 101.12[1] PErnvsnv,~-x~ Tax SERVICE
AEv.tsio Ex• RJR
CO~oNWEAITII oP PENNSYLVANIA SCHEDULE G
R1iNERRANU TAX RETURN TRANSFERS
RESIDBii oEUOENr
En.n .,~
101-54
PLEASE PRINT OR TYPE
• •rr nvmDCR -''
JOHN R WEAVER
21-1995-0065
THlS SCH EDULE MUST BE COMPLETED ANO FILED IF THE ANSWER TO ANY Of TH
fTEM E QUESTIO NS ON T_HE REVERS E SIDE OF THE COVER SHEET IS YES
NUALiER
DESCRIPTION Of PROPERTY
Ineltrd. none. ollb~ Hont/,.,,N, ~~~~ ~ ~adMl~ dale of hotul~~
EXCLUSION
TOTAL VALUE
D % ~ .
DOLLAR VALUE
'
1
$10, 000 gift made b
h OF ASSET
- •
ill. _ OF DECEDENT
S
__ INTEREST
y c
eck to
$3
000
10
000
0 __
John R. Weaver, Jr., son on , , $ 7,000.00
December 30, 1994, and deposited
same day into son's savings.
2 $10,000 gift made by check to
S 3,000 10,000 0 7 000
00
arah Anderson, granddaughter .
'
,
on December 30, 1994, and
deposited same day into her saving
3 $10,000 gift made by check to 3,000 10,000 0 7 000
00
Deborah A. Weaver, daughter, on .
'
December 30, 1994, and deposited
same day into daughter's savings.
4 $10,000 gift made by check to 3.000 10,000 0 7 000
00
James Anderson, son-in-law, on .
'
December 30, 1994, and deposited
same day into. his savings.
TOTAL (Alto .N.r on ling 7
(u ntoe~ tpacti i nwd.drr.A oddi-iond th..h of tom. si:..J
S
' REKli11 EX+ (788)
' ~ ~;
COMMONWEALTH Of PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
B.
C.
SCHEDULE H
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES
JOHN R WEAVER
ITEM
NUMBER DESCRIPTION
~-• Funeral Expenses:
2.
2
3
4.
2.
~•
3.
4.
5.
6.
7.
8.
Gibraltar Mausoleum Corp, burial plot, memorial, opening of
grave.
Neill Funeral Home, traditional service, death certificates,
minister honorarium, organist, flowers casket, vault,
memorial register, folders, and acknowledgement cards
$ 1,833.36
Administrative Costs:
Personal Representative Commissions
Social Security Number of Personal Representative: _175 ~~ ~~~
Year Commissions paid l oo s
Deborah A. Weaver-preparation of all Letters, documents, re,t rns,
(Attorney Fzeesfers and payments on behalf of the estate and benefice rtes
Hershel Lock, Attorney- Review and consultation on estate
Fomily~zemp~ionhemer, Attorney- Initial settlement consultation
Claimant -nnna Relationship
Address of Claimant at decedent's death
Street Address
City State Zip Code
Probate Fees
Includes petition, copies, and fees for filing inventory,
Misc~o~~~pPen~~ return, and releases.
Cost of publication in Patriot News and Cumberland Law Jou
G. R. MacDonald, Appraisal, valuation of property in Sch C
Medical bills for final months, less medicare co-pay
include hospitals, labs, oncologist, ambulance, etc.
Taxes due on final 1994 tax return: IRS 14,060, Pa
Revenue 1,475, and West Shore local 60.
James K Roberts, CPA, consultant in preparation of returns.
Pennsylvania Tax paid on behalf of specific bequests by the
estate ($10,000 X 15%)
Reinbursement for clothes while hospitalized, care of pet,
copy of obituary of bequest, food after funeral,and postage
paid by the Personal Representative
Amount owed in loans from Hillside Apartments Inc.
1
6,554.00
35,000.00
7,544.00
1,143.19
441.00
216.20
3,500.00
2,491.48
15,595.00
3,000
347.47
45, 120.00~°~~
TOTAL (Also enter on line 9, Recapitulation) $ _~ ~ ~~
Please Print or
21-1995-0065
AMOUNT
(If more space is needed, insert additional sheets of same size.)
o ~EY~ 151 J EX+ ~2-87i
~ r ~, l
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
c~~hFC yr
JOHN R
ITEM
NUMBER
2.
3.
4.
5.
6.
7.
ITEM
NUMBER
1.
2.
3.
4.
NAME AND ADDRESS OF BENEFICIARY
A. Taxable Bequests:
CLASS A
JOHN R. WEAVER, JR
1813 RUDY ROAD, HARRISBURG, PA 17104
DEBORAH A. WEAVER
5655 CREEKVIEW ROAD, MECHANICSBURG, PA 17055
CLASS B
Margaret Miller
4108 York Street, Harrisburg, PA 17111
Celeste Williamson
1922 Market Street, Harrisburg, PA 17104
John & Martha Michaels
47 Ann Street, Highspire, PA 17034
Iona Anthony Nies
7371 Chambers Hill Road, Harrisburg, PA 17111
Penelope Zu11o,Deceased April 6, 1994.
FILE NUMBER
21-1995-
RELATIONSHIP
SON
DAUGHTER
Friend
Friend
Friends
Friend
Friend
NAME AND ADDRESS OF BENEFICIARY
B. Charitable and Governmental Bequests:
Pine Street Presbyterian Church
310 North Third Street, Harrisburg, PA 17101
Pine Street Presbyterian Hick-A-Thrift Class
310 North Third Street, Harrisburg, PA 17101
First Church of the Brethren
219 Hummel Street, Harrisburg, PA 17104
The Aurora Club
2114 North Third Street, Harrisburg, PA 17110-1897
TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Also enter on line 13, Recapitulation)
AMOUNT OR
SHARE OF ESTATE
50% Residual
50% Residual
$2,000.00
2,000.00
3,000.00
3,000.00
0
AMOUNT OR
SHARE OF ESTATE
$ ?00.00
r-
3,0 0
o',
3,000 0
f,,
5,000 00
S 13,000.00
(If more space is needed, insert additional sheets of same size)
Register of Wills of CUMBERLAND County, Pennsylvania
Certificate of Grant of Letters Testamentary
No. 1995-00065 PA No. 2195-0065
ESTATE OF WEAVER JOHN R
Late of CAMP HILL BOROUGH
Deceased
Social Security No. 195-07-3116
WHEREAS, on the 26th day of January 1995 an instrument
dated February 1st 1991
was admitted to probate as the last will of WEAVER JOHN R
~ ,
late of CAMP HILL BOROUGH CUMBERLAND County, who died on the
1st day of January 1995 and, '
WHEREAS, a true copy of the will as probated is annexed hereto.
THEREFORE, I, MARY C. LEWIS , Register of Wills in and for
the County of CUMBERLAND in the Commonwealth of Pennsylvania, hereby certify
that I have this day granted Letters TESTAMENTARY
to DEBORAH WEAVER
who has duly qualified as Executor(rix)
and has agreed to administer the estate according. to law, all of which fully
appears of record in my Office at CUMBERLAND COUNTY COURT HOUSE,
CARLISLE, PENNSYLVANIA
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal
of my Office the 26th day of January 1995.
egl er o i s
>~ : -
A _-
LAST WILL AND TESTAMENT
OF
JOHN R. WEAVER
I, JOHN R. WEAVER, of Camp Hill, Cumberland County,
Pennsylvania, being of sound mind, memory and understanding do
hereby make, publish and declare this to be my Last Will and
Testament, revoking hereby all wills and codicils at any time
heretofore by me made.
I.
I direct that all of my just debts together with the
expenses of my funeral and the cost of a gravemarker be paid as
soon as practicable after my death.
II.
I give, devise and bequeath certain of my ass s as
follows: Three Thousand ($3,000.00) Dollar the FIRST CHURCH
OF THE BRETHR Harrisburg, Pennsylvania; Five Thousand
($5,000.0 to the AURO LUB, Harrisburg, Pennsylvania; Two
Thousand ($2,000. Dollars to CELESTE WILLIAMSON; Two Thousand
N R. WEAVER
PAGE ONE OF FOUR PAGES
(,$3,OQ0.00) Dollars to JOHN and MARTHA MICHAELS or to the
survivor thereof; Two Thousand ($2,000.00) Dollars to PENELOPE
ZULLO; Three Thousand ($3,000.00) Dollars to the PINE STREET
PRESBYTERIAN CHURCH, Harrisbu , Pennsylvania, for use by its
"Hick-A-Thrift" Class and Two Thousand ($2,000.00) Dollars for
its general use; and Three Thousand ($3,000.00) Dollars to the
former IONA ANTHONY.
III.
I give, devise and bequeath all the nest., residue and
remainder of my estate, both real and personal, of whatever kind
and wheresoever situate, of which I shall die possessed or of
which I shall be entitled to dispose at the time of my death
including all right, title and interest I-have in Hillside
Apartments, Inc., in equal shares, to my children DEBORAH
WEAVER, and JOHN R. WEAVER, JR., or to the survivor of them.
PAGE TWO OF FOUR PAGES
HN R. WEAVER
_ 4__.'
-~•~ _
_. f'
IV.
I hereby nominate, constitute and appoint DEBORAH WEAVER as
Executrix of this my Last Will and Testament. In the event she
shall for any reason fail to qualify or having qualified shall
cease to act as Executrix hereof, then I nominate, constitute
and appoint JOHN R. WEAVER, JR. as Alternate Executor of this my
Last Will and Testament in her place. and stead and Trustee of
any trusts created hereunder.
V.
I direct that no person serving as Executrix or Executor of
this Will be required to enter security in any jurisdiction in
which they might act.
IN WITNESS WHEREOF, I have this ~~'" ~
day of (7iG"~- ,
1991 hereunto set my hand and seal.
PAGE THREE OF FOUR PAGES
.~
~ HN R. WEAVER
.4"N.
!_..y. Y .f..
,. `ai~x+cu, acalcu, ~JLLL11511CC1 dilCl C1CL1dLCC1 D~7 LL1C ctJ~UVC-lldi[ICCl
Testator, JOHN R. WEAVER, 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, all being present at the same
time, have subscribed our names as witnesses.
WITNESS:
~. ~~
of
`-~ ~Q
of
PAGE FOUR OF FOUR PAGES
;~
t (,1M~
Zrv
HN R. WEAVER
REV-1547 EX AFP (12-95)
COMMONNEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX ACN 101
BUREAU OF INDIVIDUAL TAxES APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
DEPT. 280601
HARRISBURG, PA 17128-0601 OF DEDUCTIONS AND ASSESSMENT OF TAX DATE 02-19-96
ESTATE OF A J FILE N0. 2 9 -0
DATE OF DEATH 01-01-95 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 T0:
DEBORAH A WEAVER REGISTER OF WILLS
5655 CREEKVIEW RD CUMBERLAND CO COURT HOUSE
MECHANICSBURG PA 17055 CARLISLE, PA 17013
Anount Raaitted
CUT ALONG THIS LINE - RETA_IN LOWER POR_TIO_N FOR YOUR RECORDS ~
-----------------------------------------
---------------------
REV-1547 EX AFP (12-95) NOTICE OF INHERITANCE TAX APPRAISEMEWT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF WEAVER JOHN R FILE N0. 21 95-0065 ACN 101 DATE 02-19-96
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 Estat• (Schadul• Al
2. Stocks and Bonds (Schadul• B)
3. Closely Held Stock/Partnership Interest (Sehedul• C)
4. Mortgages/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/Misc. Personal Property (Sehedul• E)
6. Jointly Owned Property (Schadul• F)
7. Transfers (Sehedul• Gl
8. Total Assets
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adn. Costs/Misc. Expenses (Schadul• Hl
10. Debts/Mortgage Liabilities/Liana (Schadul• I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governwental Bequests (Schadul• J)
14. Net Value of Estate Subject to Tax
(1) .00
(2) 145 .145.00
(3) 362 .048.66
c4) . 00
(5) 255 .497.46
(6) 68 ,994.02
(7) 28 .000.00
(8) 859,685.14
122, 785.70
(9)
(lo) .00
(11) 1 .785 7n
(12) 736,899.44
(13) 13,000.00
(14) 723,899.44
NOTE: i~f an assessment was issued previous)y,
refilect 'Figures that includ
th lines 14, 15 andior 16, 17 and 18 will
e
e total
ASSESSMENT OF TAX: of ALL returns assessed to date.
15. Anount of Line 14 at Spousal rat' (15) . 00 X .00= . 00
16. Anount of Line 14 taxable at Lineal/Class A rate (16) 713,899.44 X .06. 42,833
97
17. Anount of Line 14 taxsble at Collateral/Class 8 rat' (17) 10,.000.00 X .15. .
1,500
00
18. Principal Tax Due .
TAX CREDITS: (lg) 44, 333.97
PAYMENT
DATE
03-30-95
10-02-95
RECEIPT
NUMBER
AA082199
DISCOUNT (+)
INTEREST (-)
,..~~.~~
1.85-
AMOUNT PAID
5,000.00
7,377.26
INTEREST IS CHARGED FROM 10-03-95 TO 02-27-96 TOTAL TAX CREDIT
AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 44,217.52
REVERSE SIDE OF THIS FORM 116.45
INTEREST 4.26
TOTAL DUE 120.71
* IF PAID AFTER DATE INDICATED, SEE REVERSE ( IF TOTAL DUE IS LESS THAN 91, NO PAYMENT IS REQUIRED.
FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE
REV-1470 EX (6-88)
r,' ~ y
COMMONWEALTH OF PENNSYLVANIA
DEPARTMEN" OF REVENUE
BUREAU OF IN:)IVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 1 71 2 8-060 1
SCHEDULE ITEM
NO.
C-b
INHERITANCE TAX
EXPLANATION
OF CHANGES:
John Tr+~eaver
2195-0065
i01
EXPLANATION OF CHANGES
Payment__oP inheritance tax is not an allowable deduction.
TAX I::XAMINER: Llsa Garland-Funk
PAGE
—Y—A-L— Pennsylvania
-4
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TA XE OF INHERITANCE TAX REV-1607 EX AFP (12-14)
INHERITAN ff I*,j"
C zTyn 15 STATEMENT OF ACCOUNT
PO BOX 280 1 ,
HARRISBURG PAR J�:7�?Pe.0-9
DATE 02-09-2015
ESTATE OF WEAVER JOHN R
DATE OF DEATH 01-01-1995
C L E FILE NUMBER 21 95-0065
COUNTY CUMBERLAND
WEANk DEBORAH A
ACN 101
56 �Ri-E KV I E W RD
Amount Remitted
MECHANICSBURG PA 17055 _fmoun
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
NOTE: To ensure proper credit to your account, submit the upper portion of this form with your tax payment.
CUT ALONG THIS LINE RETAIN LOWER PORTION FOR YOUR RECORDS +—
jEV--jjjf *;;-i7WHiiffAH_fAYififEAilif bViffiObif- -*;i----- - ------ --
ESTATE OF:WEAVER JOHN R FILE NO. : 21 95-0065 ACN: 101 DATE: 02-09-2015
THIS STATEMENT PROVIDES CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. BELOW IS A SUMMARY OF THE PRINCIPAL
TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 02-12-1996
PRINCIPAL TAX DUE: 44,333.97
PAYMENTS (TAX CREDITS) :
PAYMENT RECEIPT DISCOUNT AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID
03-30-1995 AA022998 1,842.11 35,000.00
10-02-1995 AA082199 1 .85- 7,377.26
03-16-1996 AA112625 4.77- 120.71
02-06-2015 SBADJUST .00 1.08
TOTAL TAX PAYMENT 44,333.97
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
IF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM
FOR INSTRUCTIONS.