Loading...
HomeMy WebLinkAbout95-0072~~- ~~-C~~~°~ 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. Aug ~ s 2001 Date H705.TA3 Rev. ?/87 rrnE;PRB.r EY PERMANENT NAME euac ,~` . \J a z ~ pI . Fran eropoli, ' ect Division of Vital Records P.O. Box 1528 New Castle, PA 16103 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS Iw ~ >° CERTIFICATE OF DEATH _. "` N ..~..._..~. I w... ~1 , / '• OHN S• ~~/ELL.IN6Ton/ SE% SOCIAL SECURfTV NUMBER _. __ DATE OF DEATH (Noah. De%Yeer) M~~F 189 AGEIL~Birolmy, IINDER,vEAR UNDER,DM DATE OF BIRTH BIRTHPLACE(CYyantl ,. ,. -/d - 70/9 ..J,gN„H~Y /3 /99s PLADEDFDEATH(Dh.~a,lrana-,ae;,,Y„~nar„~na.,a,;,,, ~~ MwAM DeY+ Han = MMAaa (MOrIm, D•%Year) Stereo FOrepn Carlnvy) NOSPfPL: OTHER p ; nse:e~N Y~ I S- ao- /G , PA• .. i r : ~ ,„«. ^ ERK7apMyd ^ DDA ^ H~ ®' ^ ~ ^ a T Raalaarlca Y„ fbIMTTY'OF DEARI CITY. BORD, DERH FACILTIV NAME(Y nat'raliluEOn. Aire slreat arltl raariber) MMS DECEOEM aF HI3PANIC ORNiIN7 RACE- Arrrxbn Yrtlian. Bock. V/Ilna, ate. CUM13CRLANO `J PPEIZ ALIEN RENO VA ~EIJTi I~ N^I~ YM^Mys,yMdIyCILm, (SPeaIY) - .e . k. ,~ DECEDENT M.~. Puwro Rlprr. Ne. WN ! TE' ' S USUAL DCCUPARDN KIND OF BUSINESLINWSTRY (Giw kvNdwork tlorra aM WAS DECEDEMEVER NY ~urxw U.S. ARMED FORCES? 1 STA t e ~, o r' T. dworMrp YM; tlo not uee re6r~ ~ ,e. DECEDEM'S EDl1CATKNJ MARRAL STRUS•Maaatl SLMVNe1G SPOUSE am New Mr.gq Wlauw.q n m . n:. A7TO;ZNEY nb. PKTV TT' /NM. 12 v ~ No^ "°iA w a, ~meieanrrarn.> iM~,'~'~ooitliy + ) °~r°°(SV•ah) MA MARIC7E ~G o T ' N cecEDENrsMAILU+DADDRess+so-.al.cnrrw.m.slaoa,z~pcm.) DECEDEM•s ACTUAL PA• 8a7 MA ,.. , , ,y ,s. 4E i . vssE ,T..sMn NDY LAJVr atl na.®YlatlacatlwaWatl H/-IPDETV MP Yva In a ~ ~ ~) Ts. ,Ty, CU N 6 r'K to Jv ~ tawwNpT No, ascee.rA YvW - na ^ i M TiVHER'S NAME (F Mid1M, Last) . w 1 n edrMl YmW d ~~,~. ' u. GN/J CG / FFosCD WELL NG ~ JV MOTHER S NAME(Frg Mitlde. Maitlen Slrneme) M ./ o INFORMANTS NAME (TYPa•Pria) ,,, A><Y ~cYCJP 20a. M/~1RGAk ET WELL/NGTO /~J 11JFOp~YATp~~SlMAE.WG ADDRESS(Streel. Ciy/bwn, Stet. Z'~~~~dae) C~A I-lO N//-L V a7 /V/ANOY LANG Pfl ~ /70// METHOOOFwsPOSrrIIDIyyN~r DATE O1=asPOSrtKNI Burieli'J Cremalbn^ RsmovelhanSWe^ PA°^m. DaY. Veer) / , mq PLACE OF OLSPOSRION-NartKaCSmetary,c aplwPlaa remNOry LOCATION-CJIylTbwn, Sbro, Zlp CoM DaWUn^ OtM (^upecityl ^ pj] p . 2Ta. 2Tb. /- /U - 1 5 • 2/e-Z/~0/AN TD w~/V G~iPNgT CC/"L /~/tiNV/LCi=~ ~~ SKYNARIRE OF FUNERAI. SE ICE LICENSEE D,I PE AS SUCH ~ ~ LICENSE NUMBElR r 2Ttl. NAME AND ADDRESS OF FADETTV ~• - L ??e /~/E ILL ~/T/~ 3YO! MAreiC~T si ~ G'A/Hv ConlpMalleme 23aco 22b. ©/OT 7.5 J I//Ll PA./7o;/ PIIYaicLrrbaA eveiMON tlrnea EgthM b(Sigrulura anO Tpe~~~•~~~•tl atlM tlnie. AeN aM plac~. aMHG. LICENSE NUMBER DATE SIGNED , urley cMlw d naM. ~~ pAOrah, DaY.1ffir) r,b. zx. IMnr ze-2e mw a avnpned M nME of DEraH DATE PRONOUNCED orw,. a Year parmn who prorrwresatlWh. Y• ) WASCASE REFERREDro MEDICAL EXAMINER/CORONER? / / Wa^ ,b 27. -ART 1: E~MSrtM Oieaaaea, ir~winammpFCanoM whfM ceusadlM netlr. DO nalsasrlM ~~otledtlykg,s caraaear «,• N way ono eauee on NCh lrle. as aepkatory art sboM ahaert lAYura. rAp~ynma PART II: Otlrar alpnlflCaM ealBtian naribrAMprotlselh bul IMMEDIATE CAUSE (Final n , j Ild RalNnq in the unMrlylrlgnuw 9fwn in PART 1. orrsaleM tlgU ~ aaam)---. C'R//,0 C ~.(/ r a I I ~'/'-~ li P ' DUE TO (IXi ASACONSEW ENCE OF7: Q No H/Lif S 1NO/~,D.s.. Q v,' SsplanliaYy lM earoilbns b. ~~~y0/1r[ 6 Y N ok ( ~ 6`~ am/, e proimmMiate DUE TO (pi ASACONSEOUENCE TJeaa. Eaar UNOBILYNIO ` 1 ~ c CAUSE (Oisea9e ainjury DUE TO (OR ASA CONSEQUENCE OF): (. ~!' I I earErpm LAST tl I . YaAS AN AUTOPSY WERE AUTOPSY flNDING3 MANNER OF DEATH DATE OF INJURY TIME OFINJURV INJURY AT WORK? DESCRIBE HOW INJURY OCCURRED. PERFORMED? AMVUBLE PRNM TO (MOnm 1bar) DeY COMP , . LETION OFCAUSE r~ ^ OF DEAM7 Natural LJ Momkroe Accitlea ^ PeMinY Imaengelion ^ Vac ^ No ^ Yee ^ No~ Yee ^ No ^ SaleWe ^ Couro rat W tlaerminatl ^ JOa 20b. M. 3U. 30a. PUCE OFINJURY -At home hrnr atreM l t dfl , , , ec ory, ee LOCATgN (Strew, CMRnwn, Slate) 2M. 29. bdldM. ate. (SPacYY) CERTNTEA (Check only or»J 2a. ,a. •CEIITIFYNO PNYSICIAN(Pnysti~an carWyirg caused Ceara Then erwlher phy,;aar, hew ponamcetl tlaam ono compleletl Item 23) To tlw heal of mY ke•I"+•tlP, MatlrOtturteC auarotlra t+wa(a)alM marwra alal•A ..................................... ' ................ ^ SIGNMURE CERTIFIER 31b. ~^ • T+RONOUNCnGAND DERTNYBYG PHYSICIAN Ph re tti bee a my ArrowMdB., tl..ln oa:urrea n ~ ~RinO11p1e r.snsa aeem aw ~ealyirq to cause a seem) w.~..,neeu.roB»aau.~.l.ram.nn.r.a.rn.a .......... ................ ~g, LICENSEN R - OAT SN3NED _ (MOmn. Der. Year) ,Te. !~'Dv 53-~ „a.. / /J-9S 'YEDN:AL E)ULYINER/CORONER al NAME AND ADDRESS OF PERSON WHO COMPLETED AUSE OF DEATH (Item 21) Type or Ptlr~,~-r-y ~~ L /`1 • ~ , ~~ b ~Naeavamhutbn and/w Inveatlyalion~ M my op{n1on. daaNr xgxred et tM tlms. aata, aM plan. arM Wa to tM causa(a) srq J~ ! o H %-~ "~l~ ,T.. ............................................. ..... ^ .............. REGI RM'SSIGNATUREANDNUMBER ~. ~~~ ~ /~~ / ~° 73 DATE FlLED (MOah, Day, Year) ,,. i ~ " ,a..l AN ~ a 2 y /~ , i 9 9,~ Es3rte oir`_'~:~.x:T~'~4~c~t~E( CU~~~ ~ ~ No. Ail-- `~...~- ~a~-~ also .'rnaw;r as . 'P'o: _`_______- Register of `Hills fqr they _ Deceased. County of ~ ~ v~ ")~'~rr ~ ~.~ in the Sccind Sec.^.•r:~r;' 1'?'c. _~/~l ! '-- Crs;nmonwealth of Pennsylvania ~1'he 3zcti'ic„ ,, r' floe tand~rsigned respectfully represents that: ot;r T::titio;%c;;s), who is/are 18 years of age or older an the executy ~ x named in itc i;,st eviii :?` t~3~ ubo~dec~dent, dated- n,'_~~~G -~~~`' , 19.E 7 anti codicil(s) dat°d {state rele~~ant circumstances, e.g. renunciation, depth of executor, etc.) „cc<a:-dent ti.•«~ clon;iciled at death in L~~ ~'~~ -~~ Y (~`~ N ~- r County, Pennsylvania, with ?, _;____ ` .:1 "t 1 '; Oj ~rJrint:ipa lrestd-~n-ce at ~ r~i>-7 +'t~4 Uc(___~-~iN ~, Crr~-~T ~ {lrst strc~c.:, ^umber and muncinaiity) L~ecendent, then ,~ X ears of age, died `J ~?~ cc G^ ~ S , 19~~_, l::xrept as fellows, decedent did not marry, waS not divorced and did not have a child born or adopted after cxecutiotr of the will o fered for probat ;was not the victim of a killing and was never adjudicated it:contpeient: '~~L~r~•,~b )'1~4_L~d'e~` ~~'~~ T~-,l - I?ecendent a: • cash a~~ned property with estimated values as follows: } (If c<orliciler. inr'a.) All personal property $ I ~'~;~~~ (If a~ot der~icilec? in ra.) Personal property in Pennsylvania $_ {lf 7,r~r „o~niciie,:i in Pu.) Personal property in County $ '/aiuF of rea? cs?at~ in P~nn~ylvania $ situat^d ~ follo;vs: C~~ ~t'1-IEP~FOi3~, petitioner(s) respectfully req st(s) ~~1,``robate of the last will and codicil(s) presented hc~y.=~it`t ar_d the grant of letters ~te~~~wiP I {testamentary; ad rnistration e.t.a.; administration d.b.n.c.t.a.) t~he~-cn. -~~~ ~:~ ~~ C ~~ - L' G7 n g~; ~ ~ ~ ~~ 4~ ~~:~e~ 'lJ"~ Y~ V"8 ~Y.I~~®~T~BJ YWL~~YJI.~'Ll~ Y l H 1~ C III ~~;~1'9'd' ~~ _ CUMBERLAND I ss ";"r.e petitic;,~er(s) above-named swear(s) or affirm(s;+ that the statements in the foregoing petition are true an~+ ccr-rc to the bast of Lhe knowledge and belief of petitioner(s) and thetas personal represer.- tati~~e~s! ,~f the :!hove decedent petitione.r(s) will well and truly administer the estate according to law. S1~Jnrn tc. or ~.ffirmcd and subscribed ~7~~ti~~ % / ,~„~~~ :n i~efcre :~, this .,~ ~ h'~`-' da r of -_~-____ ~ 11~ ~, ~ / r - r ~ ~. ~; ~'~~s 21-~9'5-72 ' ~, ~':y ~3~? JC?I-lir'__STANLEY WELLaNGTGi`i -_, ~~~.~,~~ ,,;1:~ ~:,~~-,.~ _-- JA~~UAP,Y 2 % ~ .9 95 , in cotxsi~tration of the ~e±ition on t ,c!~° . ...:C'. t,, :~C", o~t.af3at0~'~' '~rUpF ;'iF16'i'Vg J^~ D~''".SC;It+°tl hCf4ie nlfw, ~'~" I5 5~~:~; ~.'~~:.'.> rtl~t tr>c instrurnent(s? ~ated~ i~Ar?Cki 1'! , 1 ~7% _! °sc-;bed ~ 7~s:•.ir~ :~~: <.~niittcci to probste and ~ilvd o>F record as the iZSt'~;ill of _~ JONi`~ S:Ai~LEY ~lELLIN(~TON _ _ t _; ?:'': ;~-:r:v-. ~-;~.Y'.'e~ t,s p."ARG~~P.t! T. ~~ELLIiiG l t~h ~~.S ~~'~n'~^.r,~. L~:~ters, etc.......... $ 235.00 ~,~„r, r~art~~ < <<<•:! "i r.......... ~ 45.00, -~'a~,~ 3.00 L ~) 1 !~L ~-~vr1: av .:.-~ci ....''!"~~~li/yR"..27, 1.55............ :~ . ` ., ~,. `,~ . . S=~ i ~ .. CJ r- ~ _ ; '^.;f - " _ - ~.J r-i , ~ - _.. ._._ > `~ _ .~= ~ ~ ~~~ ~~~~~ 'I R 'ster of Wills F~1ARY C. EEWIS '+ f+.:TOI~NNEY (Sap. Ct. LD. No.) ~n~I~ss ~ ~~~/ ~~~- ~ ~= o ~%~ PHQNB ~,_ , . ~'.'. ~ =~~::t'.;`7'~ d~J G'i"d~Y' i0 dt~err.~~ Ui'1 i-C7^4J~ :~~ a=~ . 4' ~,., .., . -.. ; . . ?~""`~"'ir~"w2S~~ti ~'wp" Yvztr ... ;"" ka°. ~:-` ~ ~ ~. F.~°~.~ ~t'r.f ~~; _- ., .. ,v .., ,. - ~" . ~. , ~ .S` ~~ _ ~la~..A°~~" .- _ ___ ,\ 2~ -95-7i 6J!~.'~'~ ~~' SUI~SC1R~Ii~1~ ~'~~'I'~~S ~ ~-. _~_- Y COdlcil /~ • {each) a s~.~bscribiri~ witness to ti-iE~..,will presented herewitDz (each) being duly qualified accordsng to law, deposers) znd s<,y(s) fl:.ct present and saw il•e testat_ ~ rE tl:e slme and that signed as a witness at the re~gtlvst o_`~ t•~~t:tt_~~ ~?~ li_ presence and (in tia~ presence of each other) (in the presence of the ;~;-orra tc~ ~l- .r_'ir1*~e~i .z~.,~ ;u~scr;bed before me ?e.._ _-- ---- day of ,, (Name) ~~~ -------- l ___ (Addc~s) .~egester ('Name) (Address) ~~~~Sr~L~ ~~` ~~LLS ~~ CUMBERLAND C~;UN~ `~'° ", '~~-~ ~+~ NON-S~U~~C~IPoi~ ~I'TI~'~S~ E~ 1'>"a .~a r C'nn C.~~~ }~Y~~ ~;GLL. 1 9JC~ TC~1~ _ I~ s~~ I ~~~~ {each.) a subscriber 'aercto, (each) being duly qualified ac~o`fding to law, depose(s) and ay(s) t at }'~ r ' ~ familiar with the signature of --.{e!s~l /~ S ' codicil testat__ o (ore: of the sutsscribing evitnesses to) the will presented here th and codicil ~,. r_h.~ t . ~ ' ~" believes the signature on. the v~rill is in the handewiting of _~ /-~i1 '/mil ~ _- _ ~ ~ ` / ~~ _~ to tt;e Z?esi of ~~,1. ,._.~ :cno~viedge and Sworn to er affirmed az:ci subscribed before m? this ~- 3 ~-' P day of J tr,~~; ~~~~~ , ~ . `~Rils' ~ C , ' E14 i S ~ ~~fsner ~" ~`S ,~,~~ ~~ (~~i~J~) zl~q ~, s"uti~~Nia~E #~9 Z2"3. ~f~~f~G~'/~c.D Mo 6~'a9 i. ~_ r u_ },-~_ ~. ~ {`. „~, { ,~~ +~ . :z~ ~, _,. k w~.. ~~ L. k ~ .~ .,..,... a ~ ~ `~itt .,.. _ , ~,~, t'- .,. . „- »r.. ~' LAST WILL AND TESTAMENT ?", John S. Wellington, of R. D. ~kl, Springs Road, Meadville, Crawford ~I' County, :pennsylvania, do hereby make, publish and declare this my Last Will and ', k '; Testament, hereby revoking any and all wills by me at any time heretofore made. xIRST: I direct that all of my just debts and funeral expenses shall be paid a:~d fully satisfied as sooa.as may be convenient after my decease. ;~:~CC.2': I give, devise and. bequeath to my wife, Margaret T. Welling 'i sIl of the rest, residue and remainder of my estate, real, personal and mixed, of wha`ever kind and wheresoever situate, of which I may die seized or possess it or to ~rt~,ich I may be entitled at the time of my death, including any propexty e~r:r ;ai.ic`: ~ :,=~~y noca have or hereafter acquire any power cf appointment, and _~ :~y :aiu.-ai~e has predeceased me, or if we both die simultaneously or she dies t0ithi.n a period of thirty (3~J) days after me, in or as the result of a ;; cou4uon disaster or otherwise, I give, devise and bequeath said estate to my j !' children .tsha S. Wellington, Jr., Mary Gay Wellington, and Charles Howard ~ i' i~?~_llinr;fcn, or the survi•~ors of them, in equal shares; provided, however, that ~'• !~ in the event that any of said children should predecease me leaving issue me I i surviving, such issue shall take in equal parts per stirpes the share which 'i such child who predeceased me would have taken if such child had survived me. J 'AiiIRD: I hereby appoint my said wife, Margaret T. Wellington, ~~ e~ecutri~ of this my Last Will and Testament, and as substitute executors, I apYOi,at my said children, John S. Wellington, Jr., Mary Gay Wellington, and 'i `' Cha.rJ_es ~?oc,:a~^d Wellington, or the survivors of them, and I hereby direct that said e~~cui-rix, and substitute executors, shall serve without bond or surety cr other st~curity. FCITRTH: I give said executrix and substitute executors, respective- i', ly, the fullest power and authority in all matters and questions and to do ~( ~i all. acts Which I might or could do if living, including, without limitation, }'i comp lets po-~ler and authority to make distribution in kind, to sell, mortgage, ,, is '~ } r b a a '_'~ P N ,~ ; `, . r~ i -mac-=4 =^~-'_i~•:or,e a.f_ all property, real and personal, at such times and upon =u..h t:ers+t~ r?a::~a conditions as they may determine, all without court order. ":r~ Witnres Whereof, Z have hereunto set my han3 and seal this ~~= f ~~ ~~~ SEAL - John S. ington i ~=_z~a~:~d, sealed, publ-?shed and declared vy Doren S. Wellington, the ~-==s ~ ~~c _~ gib: ~ ~- ,za:~l, ~.s and. for his Iasi 5Ji11 sand Te.~ Lament in the pres~.nce ti._ .-s„ ~.F~c;, <;._~ hire request, in his presence rand in the presence of each atZer 1~ `rR' i~~`SF*_',:T14:C+ stzbSCribed Out' naIrie3 AS witnes&eu reereta. i I i v ~.v / f I .. ~ i i '' i '' ~ i ~' , i~ i ;.'~` ,. . - , __ ~'.` 4 s ~:; _ ~- ~ `\ ~~. . ... are ~~::.ava.-::sc~ es =+:: rc•::~azu:" a t ~ :Y:. s ... ::r.,r:...~.r_...`._ _ :...c..~~~. :W...~ , _~ ... . . . . ..:.a.~ ..:_ ~u.eara .r . ~.. ~r...:.~~ ~ ~ ~.. ...~.. ......:~ ~ ~:,,,;_...ba:.s:.....~~:. .... .~ . ..~ .I..... . ...,r;; . r ~ `y.~(, ~`~\ @y}~ M Q L~{V/~ .. T Yi ` ~ t E'~ ~ s C r p+~~ ~~~Ai p~~~ •[Si.ii~,. ~p~ ~'~\.R MRlla '~~ ~ "t .11!Itb7 E%Id.G1) >`: ~, . ACN VEG F h5 ASSESSMENT ; AMOUNT : REC~S 4 CONTROL NUMBER ~~^~ PYA~~° E3'T6t'~~7 4~~:~~"~''~;?a~~'~~M ~~ 1?102 - ~J:b HEFE ESTATE INFORMATION: j FILE NUIvIBER NAME OF DECEDENT (LAST) {FIRST) (MI) ~~ @~'El..~_ ~ f+3G{~'+i~~`a .TC3l~!~ saTF~f~~Y _ i D.4T OF FAYME^:T ti da ,~..~ to a_n2-_- ~& FOSTMA^nK DATE COUNT\'-~~~~~~~ IOATE OF DEATH t~~ a'~ 3L~~'nr REMARKS er`3fI~~T ~~' 4~E~LLINii~'CDN Qd f ~ R~~~~ 3C E ~L ~ ®N SEA,- ~Nrr'~.3~;~ ~ REGIS'PER O~ 1Qe'lLLS ., --- ...~,.,..r ,.. t ., -. rr ,:.... ., ~- ~ ~ )~ ) ~ '4 „ Ffxt) NERE z e TOTAL AMOUNT PAID 1/6~7AS~~00 /' ~K RECEIVED BY ~' ///!;'~./~J~C1. ;-~~ r~r;.:1/ ~f / ' .. Sff7GltA URE~7 1 - ~- .. r, . ~i E ~.1 son ex. p.a~j POR oJ-ns or OEATM A/TtR I aai MI tMtCK IIt- 4 INHERITANCE TAX RETUt3N Pa A srousAL ~O"'I""' `"tD1T13 cLA,Mto ^ RESIDENT DECEDENT COa1MOPo1Y(ALYN O- -ENNSYLVAwil- T rPLS WYMitR PTO BE FILED IN DUPLICATE Df-ARTMa NT Of REYENU: D[-T. ?e0cat MA R 21 1995 ~ 00012 N-ITH REGISTER OF VUILLSj R ISBUR6, -q 1719l-01i01 COUNTY CODE HEAR NUMts N 'S NAM I I 827 Maud Lane w SACIAI SECUEI NOME R DA o- oEA oA E a uRTrt Ca~r1 H~ ~ ~, PA 17011 v W 184-12-7014 1-13-95 -16 Cum'berl ahd . ~ ' o M A-nKwettl a,wwq rrovat7 NAME }A,s, rl,lli AIW wOttt INlivy iOC1Al SECURITY NUMEER AMOUNT RECEIVED (SEE IN7 » ~ ®1. Oripinat Relvrn ^ r. SupplealeMal Return ^ 3. Ranok-der Return # h Li ~`'c = n `~ ^ d. Umlted E d•. future InlereM C ~ doles oP death Pry b 12.13•E ^ M ^ S. federal E»oh, Tox Rehtrn Required ~, ~ ~ 6. DeoadfiM Dk-d Tentole (Pot dote, of death oher 1.19-iT) ^ 7. Deaedont Mdnbined a Uvinp Trv,l ~,.1, Teo~f NvRaber of Safe boar ~h AN ( copy of Witij (ANOCh copy of Trv,t) ALL CORRBSPONDE D CCiNfiDENTLAL TAX INFORMATION SHOULD BE DI _ • . N MAtu e Paut J. Killion 214 Pine Street - 4 ~ v12 r aNONe Nina a Harrisburg, PA 1tI01 v ~~ " _ -- _ O ~_ .-•= 1. Reol Esteh {Shceduie A) (1) -_ =~ a. soma and bonds (Sdoaduls q ~ { ~ )• - 309.859, 00 ;u _,, r-. 3. Ck~ely Hoed SbekiPaAnr>~p lnwtnx (Sefieclt,b Cl (3) -- _ d. IkanQaQeE and Nola Rowivoble (Sehe~ p) { d) -- .-.. S. Co,h, took oalsoeieo 6 Mleallaneous P.rwtwi -roperfy (S) _ 11.200.00 -- _ - '' ~. " (5chadvla E) ' 4 6. Joirsly Chrned Y (ScAedv{o F) (e) -- 7. TronEFarE {ScMdute G) {Scl+edule t) (7) -- , t. Tobl Oreee AENOE (lobl UneE 1.7) _ (S) . 321,059.00 s 9: fw+eral E Admkll~treNw Cee1b AAhaRaneow (9) 31, 634.00 ~ Exponees ule H) , i o. o.bt~, MnrtQage uabpP,le,, I,LnE (schedule q { 1 oy _ 5 3.119.00 _ • ' 1 t. Tavel oedvcti~s (tolwl ones o a 10) {11) 84.753.00 12. Nel Volue d Eafo4e (line 0 minus one ] ij (12) __ 236.306.00 13. r'1~ar1tablo and Ga+nern+rleeMof tequoESs (Schedule J) (1 S) ~- t d. Net Valve Sub b To'c (Una 12 Rtirew Une 13) (14) 236 , 306, 00 1 S. Spouwi Tronehr, 'fs. dote, of death oher 6.30-94) See Inttrvcfions ioi Applicoble Percenlaye on Revere (1S) - -7~~_ ~Ofi_:lil Side. (Ilxlude rolup Front Schedule K or ScPredvle M.) z,Q,,~~ ] .089. ~0 Ib. Amount of Une 14 bxoble or e11k rote (161 (Indudo rolves from Sdtedule K a Schedule M.) z .06 ~ 17. Ansovnt oP Una 19 bxoble of 15% roN (17) z .1S v - ~z (Induda calves from ;xhedule K or Schedule M.) h 16. Prindpai tax daa {Add lax from ones iS, lA and 17.) (1e) 7,089.00 a 19. Credits Spoveol Poverty Credit Prior Poyments Discoltttt Iolersa - ~ - , 354.00 _ (191 354.00 '.~ 20. ff Uno 19 h granter thou lil» lt, enter lho dlHarance en line Z0. TMs H the OVEkM1iMENT, - {20j 21. If Un. 1 t is greotw thou one 19, .nNr th. dilfetena on Une 21. ThiE s. tk. TAX DUE. (~ i) b , 7 3 5.00 A. En-er Tlw bltereq on the balance dw en Una 21A. (21N b. E nler tht total of Una Z 1 and 21 A on Una 21 t. ThIE b tM BALANCE DUl. (Z 1 t) f+, l ~ 5 _ OQ Mlske Chock Peyeble tes RealeNr of WIMe, AoeM ~ ~ . B!x SURE TO ANSWER ALL CUESTIONS ON REVERSE SID! AND TO REgitCK MATH ~ ~- - under panalhos or perjury, 1 declare rhor i haw axomined this rewrn, Including occompanYlnp sclndvle, and slolemenh, and ro the beat oP Rry knowledge and b•6 .t is true, corroct and compkste. I clatters shot ali coal estate ha, bean raporfad of frus mocker wive padprol{an of ra onr orltar th fM l bo+ed on o , il information of which areoarar has env keawl.,ln._ p p sn parw~w raprpanroHdr N R~ ADORIts 7/ !/ ~~ AODRE ~--vR/T ~~~+.; :gin ~, ,,~.._ . .. _.w ~^~ `•; -°~ ; ~w ~ _., - ~. . 3 g ~~ ~~ ~3199~ ~ce~+ridos ~ Vhs redustloc9 ~ tho 4®x eoeerai irre~os.d aw fla yet vaatuo sf 9n>twfor~ 4® or fog s~ Rx ~~ ~ ~;~~~~a~. T~~ na~® ~~ ~+a~scsfil~asl Ivry 4haa a~lut® vsvil! bsa r~~4~ §.~~~~ ~~~~~< ~~s ~16c~a1 ~r e~ ~ e dY~ oEe or oStaer T/1l94 ta9s6ore 9/1/9 ': } ~ ~rxa ~.~~~ 'cl` ~E ~' ~ dY~ ~ os ohar 101/96 ®rtd beioro 111/97 ~ 1' ~.~1? ~' ~a+ ~~Il~a~ ~a orit~s~oss of d®c~ad~nte d7~ oee or eaftor 1/1/!7 ~ m 1!1/98 '~~:a~.°I 9e<,'<;,^~'~ ~~~esriea~ ~~ ®r saf:~r 1/1/9i vori9) Iz~ e~~pf f$ows bie6~eoQt~eco tea. PLI~~E ~NSWE6t THfa POLE®9NING QUESTIONS ' ~~' PL~B~ING A ~HE~CiC lI~RiC (r) IN THE APPROPRIATE RLOCICS. t . ia~i~ r~e~y ~atx~ a traa>r~r aid: ~ X ~.a. 6'.3f~3:,~. S'~ ?s~ ~u4Csl~81eA ~ 1hA ~ropr6+r4Y traRS~reod, ...................................................... '~. restain ~ r€g4at to d~signrst~ wha shall aess the property tra~na~rrod or its irecaaa~a, . .............: ~ . c. rat®in a r~r~rsiotsasy inBOr~t; ®r ................................................................................... x r,~. r~~i~~ ~¢~~ ~;ar~rri~ far li$~ cif aith®r paym~nta, k~ne~its ®r carob ....................................... X ~, EG -~~~.,~~~ ~cn~ur,.~~ cs~ cr ~r~$~s~ r~ber i~. 19~T, did dmcodant wit}-in tar® years pcAC~ding ~,=,~:h ~r~Mrs~v,. :r~~,~rs~ wive roeaiving ad®gaato caaesideraticsn0 I~ d®ath ~rr®d after x ~~:,: 3r-r ' ~, s ~~;?, did si,~ant tran~r pro~tty within ocao year of d~rh without r~aieeg ;~. :°-i~? ~~+.^.~r~;sEt2 ~_~:~ ara r~ true? d~or'. banbc auount at Geis or her doatht .............................. X ~~" ~~'~ ~ ~~~S~~~R T~ ~~~° ®~ THE ~~®!/E Q~JESTI®NS IS 1f ES, . '~`'~' ~~~~° ~~®PL~'E SChIE~~LE O ~N~ PILE IT AS 6~~1RT ~P THE ItETtJRN. .. ~ ., N.. ~; w = `? ;,. t i ~- qq~w3~~ e~ ~, • :"vra ~sl ,iv waf atr ~a ~~ .... ..... ~ Cq ~ ~.'~5l*,'+,° { its m~ s ipgP": n°' .~.__..-. ?~--c._.~...._.~...~......:.~.~-=---.a:c:,.r~r.._..__,....~:'.:.w.,^.cc:'~c:ry,^r.-~_------~ ~-=__-.rm..~^:rar_':-.•:rua~ _-- p.;..~.~ ~ ~1 4J-~~ru ~e~...~..,„ ~ _.:_j? L+l~'2 bin +i" *~ :tClFl. ff3oi"a~if~ '.'EL- GC&i X82 ~~$t;~sn L~ iOAfi ~4'~44CC.~55.~ ?~,1 ..~......~.,~.~.. -~~ ..,,.e..~w...~......_...`.. ~ ~ , _ : r ~~,z~~.FYP~~s ~ 6'1f: fd~~ATtf v. 2 ?!" _p 7f r,. .. lY~-~„.'~"~ IPC~4~ { ~~... ~~' ~ ~~ ~S,SA7:7. i1a if sz,z~a.oo W. !•;; ;~~~N :~;f+~r~c.:ar i~~~~tip i~'r~~~f~.~~s O~v°~. ~~~,%~~ ~ ~~ ~82,a0 a ~`.. &2 '` .:,'f ,. ~a~.~~~<<~1~: r~~~s~tsf^ces, Tf~c. t~7.s~+~ ~ 10,9~2,Oa :~, °'^" ~~a:.a~"2~.~ ~~~,~ ~.~+~~. {2.x.07, =~~,2aa.a0 f ~ ~aU~,$59.aQ ___..._ _._.---._-- .__._______._ K~:i~4 f,AEtA eat*.~- c+n ts.% ;, ~,-,~f ,~,~cnnj _____ ~ ~ ___.._.__. ~~ ~s~.va __..,.~___.e______..._,. .~ ~ rr,:ga3 4r.~r.~anrd aerart ~f >.:w+a aix~e,~'typ _ ~+,~' ~~ {.rS ,r a vµ'aS ,~~ is ~ ~~~ ~, ,~t~'„p~•~~ ~{" ir.+~ ~ ~ ~t~f F. . k , .y.• ~ ~"isy`x~ :' S.A. 4r,'x.~'' M ~ ~ ¢~"' ~4s'Yt'~°" ~t ~' ~"~.~~~~~~ ~ ~ ~~ E: -. ~. y' , is'-° f ~ :: i ~:, ,~,r - r~ i ~ " ~.t:. x . . . -" >-, r, ~ , ~ ~r~t N k ~ • .. ., _~. ... ... ._ .. _.... ..T,_._. .... _..., __... .. _....~_.-.....~.e._~~_...._.,_.,_......_..s...~..........~..,~_.._..__.~~ _..~._~...._....~~._.... ~ ,•er .. .. r ~' _.._._._...._....~.._.. ........ ........._.~,... ..__._.._~.__._.._,._~._.......„.,_.........._.,..........,..._......__.,..:..._.._:.~_._..._.,_._......_,,.,._..._.~.......,,._._.S_,.._........_,_....,__,.. __._._.,.....__..__....._. 'i,~..~ pR~.k~~~.~r~ f r r I ~: .. ,. i 1 d 1 1 I ~ i n~ . 7 . fi /S '!~ ' ,- ,... `^ "~ ,.,'i 7 ~`'~nr u, ~.~ ,•x t ~ ~ `'r ri. ,,,F~,~,.rf'hm~„- ~' ,~7~ , T - .tee ~•~- ~~7 ~:.... ir- ~ ~.. ..~'t~} i°c~ ~ fit~i?of'. p °ga~9.y~,~: r , t: ~~P~S tii?ttf++`, "a, sw.fi2: ~Kii t: atA ~'~;~~~n~~~~~~ ~'ia~;d2'~ r~ igY? t3? .. .. "7 (JS; S; t:S'{:':.'!n°~'±;?),7 ti V,9 ~gri1.R143i©%5 . , ~ is *t,ra-°a,~r ~.~f r'~azrsa4ncaR Ft~~ar~rsrantastiva: _ !_ ____ ... j; ;~r~z~-;~,^~ "~,... s ... I7 r "t~"~. ~ r ~ ';,!.~;,-;,., _~a>;.,yc~r~'~ ~~e~lii~t~tOn Rolc¢istns4~p ~'ift~ ...`,.~. ' ~i;~41";::!i17 K9°, :e6°rC~C~~flP~E (9~s5SPh (~ ~ ~ 1 .. "~r..n-. ,. ~ ~~~~~ 2~0~0.lJA _. _ __ s, i A, W,.~Y~;,;a~~'~i .~'"ar"~d~'w`.R.. ~ ''" ` '1 ~ { ~S ~I ' s ~ y„d"~'„ T "1C '` y'" ~~ ,. ~ . ~ ~~~;,~ r ~,,t~~ u,}. . ~ ' r. . . .:. .. ° °~ ~, hex ~~~'','~ 'M 'Y'L~y~'[A~~~.'~~z~~~ ~ ~}~'~ ^' ~'~ ~~1 ~'h~f Y ~,. ...~ r. ... .., ~4 ... '- R ~~ ~~ ~~[+ $~ c..: {i A- /t .." M ' ~. a. ~~ ~. ` f ~' ~„-: 7~., ~~~~ 'r avw~,r-w7n +voaxsa ®s>fSN' gn isnp Y, ~+"~.'t'L,ptT~diQPPSJIF) I~ ..'"a ~'`°J~r. Q~/ C ... ar**~i e.:'~ 6~rt TR 45Y'='4~Q~~ ~fb,v~e: ~?P ~iR~R~t~'31"'S~~a ~3h;1fi B'd~3~ ,. ,v e;fi99 ~*h'e9' 9 ...~~.........._.....~,~+,,.....a.~,..~.. . ,~ ~, ~p!a ~~r n ~ ,y~~1u ~k+x! $a t. +a r ,n.. . '4:'„ .. ~dyu 4.~A6a gg 4Y~~~vv^ [ S'py4 4:. .' 4F ~ } ,.. au. ~.z. .' ? .v ~1w ~ Y~ a a)'1 ,.EA ;~ .... r 5.rs ~'~,r) _ _ e... ..,. ,_..._......~...,..,.,...~..,..-._..a..._..._..__.~......_.._._._.M....w_-......w.,~..__...-..m.._. . '.' .'fi~C}t `a' ~.'1.Y'^~' ~~~OU~I%S ~!tep F'd9i.?1 ~71~5 i F~1!'wb~~#~~ .~"~, ~.~J,r3.~~ ~~7 . ~d~ ?,ri63.0~ 793. Q{2 4P~47.~0 _ ___ __ _..__._._~_._ _ .Y ~s , _.______.._.___'_-___a.. __..__._ - p_....____.__~....,-d~~~f. i."~.i+u:~t~~+R .'S:.". ;iC ~'~. :~',......~.~s?.9a ussras: T~~°" r`- .~is €~J.s.....~ rr f :.'+:7 ^+ cy^~'"^^3 _ '«iw;,!~n„°.~ ,:i s Fy 4^4~+7~!:!!.'7,a. a.'?l"«'~ C.Y ~ :.h! 1 :.r:.^..~ -~..~.....-....-.....,....., ~..,...~ 4 +..,,._.,a..~.e....,... ~.,, t ,, i ~ «d'" ~` x c4,~"~ y ~ a^ des' ".^~~ "~ ,l "~ W i ~ ~F } ~ 7 '" t .~ sti. r ~•oP n~`.w ° h< r:°oy' ~.~*.~n~r~~ ~W _ .. ~ .+._ 1. ~ ~x F +.~i 7'f:.t,.~M' t F ~ v'~ ~.~J}~ h;r~r a >.~ 3 +"~' P .f -i F '* ~'d'. ~ .:~5 l4' -Ard jl. ~a( Neff' Y'~ .1,~"~,~].+!4.ih . - , :~, zq `"' -v~~..""R *T ,~ ~t, ,r. 7 ,. a , 'YSa'"I,~,~r.,~wll,.~.. _ ;'t" r'3~~;s:n :?chat er y !c yr" e ._ _._.~,._ ..._. _r.______ ~.._..._... »_ ?~r.~ ~ ~'._' "'.`',i,~~:,~R~ c~i33?,~c~ 6~s~ i3~~E1~1C7b~R~ ~ ~.~ ~ a~ ;~~ i 3 ~ n~~;~n I 1 I i I i i '':~.~;"~.~~~ T , f~R,RP~ s'6~D A[3pRESS ®f ~Ei~B~PlCEdtR~ _-_j r. ~:~tr~+-~~~ c:rd ~dravnmonfdi g®quA.ta: 1. EtEI.e~T3f,~~i~ic~ ~ ~f4~OeiAIY p~ 5~,~~$.`E ®f ~~TdTE f~5~~ I i i ~ ' i i 'I _____ . _. _~~ _ ~~~''~ ~ "" ~;~"~ L~.JYEF~~~,'~9E;,1TsAL ~~Ga~7ESiS `~li~ a*;t~ ~;~ iir~~ 1;, ~d~rl~a;aa;~ F;:f ~s~^a :.~~*,p is ~r.4e±~, is~ c+~~rkia?~9 s,Eeae4A a~ ruaa~>f ai~m~ ".~0lM Pil1AUiJf~T O~ ~l~13E CTf ~!'iT/4TE ., r 4, -- - __. ~ ~ {'S}' "'i ~ ` ~ .v~. r%'.;Yt-v~ is "y~ ~ ~ 7,-s-t"+ ~t ~,,h~ r'tia 'F i~~'~~~~ra~3~ ieri~:ti ,« ' ,. .er+ `~~'v''4' •y` J `f~~-d t ~~~~ ~~!3'^ ~s''.~'a„~n~^~'+. ti 4 r~.'1' ~ ~y~ '`„;~'r`d~ p'eA~K~k„~i~"`C ~;F~f,~u ~ a,t .1+t~ r,?^,,?'s.~!._ ~d~t..,'~u~.,"G.._. *~^,^,r}x'r R