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Home My WebLink About95-0082~I -g5-ODB~ 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 16 20pT Date H108.1.3 Rev. 2/87 Tv.ErvRrrr N ~F.RIIAIR~IT R Ad(IMN L h ^n \' 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 1 I ~ ~ i 6 NAME DF OECEDEM IFea. Mid1e. Leal 9E% SOCIAL SECURT/NUMBER DRE OF DERM IMaen. DeY. ~) ,.CHARLES E. FLICKER 2. Ma,Le ,. 204 - 03 - 0225 .. /~-~~- y~ AOE(Laa B+a.deb UNDER,VEAR UlIOER1DM DRE OF BMITH BBRNPLACE {Ciy ene PLACE OF DERH(ClncM aty ar-see.r.uctia^a. am eeel Monte . Deye Noun M4wMe ~~M/~paq. ~) a efOn 80 ~ 04/ ~ / 7 14 7 0~ ~ ~ HER: _ ~ VR . , 7 giprMr ^ ERIppfMiwa ^ DU1 ^ Ibr ~ RWaare ^ F$e~XYI ^ e COUNTY OF DERV CRY, BOIIO,TWPOF OEQII ! NAME pl not' end never) ~ ~ ~~a (q 0 I~MM~. BbtM.WMle.re 8 ~ c . ega~C Ne 0ed 1 Y aCumben.Land Co. ppPlC A.LLen TWP. ~ ~ /9" ~dlai . Meelun.PwrbRkan,r. la. Caucws.~an DECEOENy'S UBWLOCCURVION alwoF BU&NESSANDUSTiiV DECEDENT EVERw DECEDENT'S EDUCRgN MARIDLL 64QU8•MrvrNa BURNVYIO SPOUSE 1A0' ~ `" l m ° u D ~ ~ ~ a.a.. deemr0en nerve) a el ar .. e.a - ,FQIt"1Fhaw~°M. f Agk4CU.P.tulce „ ra ^ N•® 14~~a ,~. DNOiw a ~• (,Ia1t) W.i.doW ,.. N/A , CEDENrS MAEINO ADdIESS(8tr•r. OIYROwn. smb. ZgCoep DECEDENTS 1ZJ ~}T~h Aft.~l Tipp ^"n. ~~~~"' PA ~° ~~ ~..a«:.asar~eti ~ o 100 Alt A.P,~en Dndve RE810ENCE a«.aw ~ ,~llechaniaabwcg, PA 17055 °^ ~+ ,,, Cumben.Land Co. '°r^""p' „a,p ~,,, RATHEa'S NAME(Fia. Muse. Lrp MDTiMiR'BNAMEIFea. Maas. Meiaen Srnrne) cwt E. E.P.Lcke~c Grace Danner wFORMAM'S NAMERrwPmB 8 MAB1N0 ADOt1ESS(Streel, C3y/Wan. Ssas,ZpCOaN e E. E.P.icken 8 bean C.cnc.fe Alechani c.abwc PA 1705 5 METIgO DFDIS-DBITIDN BPOSRION ~ g PLC 018PCBItIDN-NrneaCwnrrY.Cnmaay y y ~ LOCRiON-Clly/Mnl9Ub.17pColDtu/261 I~Cg PA ^ ~~ ^ ~~^ ^ ~~•• y~~. 12/16/1994 r~ant Ce Mt P Ce eteh . , 4 Fn k P ~ Ch h Rd 1701 °+°"°°" 1,.. c • . m y 27 an . . n wcc ., ACTYKi AS SUCH LICENSE NUMBER NAME ANOADDRESpoF RICEfTY ~~- FD 010331-L COCKLIN FUNERAL NOME DILLSBURG PA 17019-042 r~~ ~,~bw.Nap., a.rX000wnardruA.,a.a.rpbc.rr.e LcENBENUMBER plaESlo NEp rr raraa.a~m ~ ~ d 21- ewee141Brr eaooeepMbdey TIME aF DERV DRE raa+ouNCED DEAD pann, Dey.,sa0 gN8CASE REFERREDlO MEDICAL EIfAMM/ERACORONEM ~ parson wlloporowdsaMT. o D / ~ O M. ,M ^ Ne se. /~ ^/ ~ FY ~ n.yRRT r. Enwar alrr.e,:qu.iwammpperarwwr cr.eenraern. oo ar mm.aMbp•eucnucardbc orrwperryemr. elmalwan bee.. IA,pnnYnr MRT E: Dare egNBCaroraaarraa,rpaypbare.er Llr Wyone err onredirr. YaNVrpaween i nr M ae ln noI n•eMnpaar eeabAyeptnrfa~rR1RT 1. a r e _ /y !~ ~b~)-.IFinr t C.- Q/~.J I J I DUE TO (OR AS A CONSEQUENCE DFJ: ~ e Yrry W bYSmsre DUE TD(OR ASACONBEWENCE OFk I oarw. Err UIIDEIILYIIIE ~ GMRE(Olereea FjrY i e. M~ WT DUETO(OR ASACONSEOUENCE OF): i a YWBANAVIOPSV WEfE AUfOPSV FwDw08 MANNER OF DERH pRE OF wJURY TMM:OFINJURV wJl1RYRVADRKT DESCRIBE 110WINIURV OCCURRED. PERFORMEDt A1Rp.ABLE PHpRro IMenn.Osy. Yeael OF DFCOMPL~ N~~~ Nrar d Hemkae ^ A w ^ e ^ lIr ^ No ^ cc n Pandyp nrlpelae M ,-/ VN ^ NoG `M ^ No ^ SuicMe ^ CoW na GaMrmiMa ^ . PLACE OFIWtIRV-N Mme. Mrs. euM.lac[ory.aBk• LOCRION(Strael. CNyl6.vlSW) Le. ta. Galsip, rc. (SpecBy) 10a. 101. ~(pMte a•/a,q TRIE OF CERTIFIER 'CBITMYMDPIIYBIDIAN IPhYe~ e~Mgcauseaa•afl wlMn Yroer VhY» hee ponpnC•d asM~enam^V~e~•a lbm 23) TeaN Mrdary a••+•+p••aereaeaeaeea awblMUUee(e/ana armwrrrea ..................... ................................ 110. ~ ~~ 1KE118E NUMBER DQE 9KN1EDpAayh. DeY. Veal •PRONaINONw ANDeeTrryaa PmraeuAel IPnyaer~ Mrs na~aerinp Deem ana erlNVq n ~.. a earn) . ^ Tea»era.ra•YA•M•.arnoeewesrrrBm..ar..rrq...wawbw.ew.Nel••em.M«rwua ........................ lG ~X o/~T iF 1/a /L-~J•Tv . NAME aN0 ADDRESS of PERSON vyllo COMPLETED CAUSE of DERH ~~ ~~~ (Arn 27) Type a Prir A ,~/ ~ ~'~ ~ K C Mcu 4a ~' On tlea sera Olaeaenelagen and/or enaatlpetlon. M mY apeaon, seats ecuenad M tlNl qme, dra, and p4ce, arts dW tOdM eeur(e) ana neMrewaLaLaa ....................................................................... .......:.................... ^ Ld YO hd'~rt GISTRAR'S SIDNRURE AND NUMBER ~ ~ /O d DRE FILED (Maim, Day.Yw) ~- ~ ~ 12/14/1994 !/'~' ~~TI'TI®N ~®~ P~®~~~'~ $m~ ~PiAN"~[" Q~ I.,ETTERS ~sto-te. of G ~/Lt ;'c' ~ C= 5 ~ , l` L lCK~ ~ No. .~~ ~ ~,`- ~01'° rrlsa 'mown os ~O' Register of ~JVilts for the -~ Deceased. County of C- ~ "~ ~ • -- in the Sac!~l SecurityNa. ~-p `{ ' 4 ~ ` Q-.°Z'~S Comrnonwealeh of Pennsylvania The petition of the undersigned respectfully represents that: 9!{„t.r petitioner(s), who is/are 1E years of age or older an the e cur o!^ n ~ in tn.t '::s,t wvill cf the above decedent, dated _ ~_._°_~ , 19~ and ;:^dicil(s) dated (state rc!evant circa~mstancrs, e.g. renunciation, death of executor, etc.) ~eceztdent was domiciled at death in ~-~ ^'t ~ County, Pennsylvania, with n .last family or principal residence at V Py°ty iC A ~--`-L' ~ ~`'t ~=CK~G . (!ict street, number and muncipality) vecendent, then ~ Years of age, died ~ ~ ` ~ 3 , 19~-, at-_-- ~ f.3o- ~C ~ 17D~~ 5 s -- Exccnt as follows, decedent did not marry, was not divorced and did not have a child born or adapted after execution of the vvil offered for probate; was not the victim of a killing and was never adjudicated incompetent: Decendert a[ death owned property with estimated values as follows: $ 3 ~~ y Zp , tc 0 (If domiciled in Fa.) Ail personal property (lf net domiciled in Pa.) Personal property in Pennsylvania $ (lf not daomiciled in Pa.) Personal property in County $ `•%aiue of real estate in Pennsylvania $ situated. as follows: WHEREFORE, petitioner(s) respectfully rt~~~t~~EA~~pbate of the last will and codicil(s) presented herewith and the grant of letters (testamentary; administration e.t.a.; administration d.b.n.c.t.a.) thcron. ~.~ ~ ~° : = _ r y n (.r L 4. ~ ~ e l~~ £ ~.~, u. ~t~'I`~I ®~ I'EItS®NAI. REI'~SEN'~A~IVE ~~l~~R~[~i~1~ViEAL'>c~ dF ieEI11NS9-'I.'i'ANIA ~ ~s ~~~1~l1'~'Y ~~ CUMHERLAND 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) wil! well an trul dn.inister the ate according to law. S•,vorn to or affirmed nd subscribed ~ ~ - ~? h^fcre me this 251~H ~ S~ 1 1 ~.. ., 1`n +.r, w.-.-_-~-.r..:. .~~ a '...ice,... 1 ~n .:i~ a M \y ~T~, _~ 21 - 35 - 82 -~ ~,,t,~ ;~~ CHARLES F. FLICKER , ~~~'~~~~~ ~~A+~^ i'-,L '~'' .-_.__...~.. - F€.~~IIgRY 1 1~~`a~, in c6nsid~ration of the peYit:on on t`,v r€:~'~r~ e s~.:';. z' .reef, satisfactory g~rcof having been pr°sentest before rne, 6~ ~'... ~ z?.^t the i.-.sirumen:~s~ e?~ta~-__-- ~T,Y ,29, 1952 - t'~::wf_! iI?+. ." ."' ~'. t1e ~:.ie^]~ttn~ X.CT 17rQ;~i?f,CC J,Yi,tl' 3S~C€~ of r-i:4.of~~ as tp-.C ~B~L Frri81 tlf ------_ __ _ _____ Ct~~r~R_.ES E. ECICK~R _._____ --; ~r~L~ E. ~L~ct<~R ~~ 1 ~~~ lb~:~yistor ol~'~`ills ~' NlAR'r C. LEpJIS DES =ac;ra~c, °_;::',..^,r s, Etc.......... ~ 74.00 f'hort. Cectifirai~s(1 j .......... ~ 3.00 r3~ ~u~P.;1'Il ~'- C o E~ Z ~• ~ '~EJTf~~ _~ ~ 1~5A-- AT'P'oRNEY (Sup. Ct. 1.D. No.) F:DDRFSS ~xorr~ _ ~ .~ -_- ~~ .._ i - c•:; f ~ _ ` _ •+4 l .4.~+ +^ ~ '1''Z''S'... 'E?a~i^Y'S ilG 0"~~4?i^ t0 EX~I~~Q!" Qf3 2-1-95. -,. s r ~ .~ .~ ~ r,,,rr~;_ r A ;~ Y(~ ~~ ~ F,~ ,n t ~" " ti~ a t ~~~ ,.._ ;~ r ...~ ~ 4,~ r X~ rw. ~..t,~,~~t~. fµ"7 ~.^Z s n+•'~'~- a~°" ~'~ row ~rF'^+q~f'F~ ?~ _ ~F _ g ECISTER I~~' ~gI,I.S OF c v r~{ !3 C®~JNTY OA.TI~ ®~ SIJLISCIIialG WITNESS ` codicil (each) a sLbscribing'4ri~ness to the will presented herewith, (each) being duly qualified according to law, dero;e(s) anti say(s) that.. -present and saw , _ the testa; _, sign the same and thin signed as a witness at the presence 3n21`-(in the prese f testat in 1L u t e nce of each other) (in the presence of fhe ,_ o es r q other subscribing witness(es)). re d b f ib "s b - e o scr e u 5~vorn to or affirmed acrd me this . day of (Nainb) -_._._ 19 (Address) ~. ~ Register ',~ , ~ ~ . ~~ _ - ''" (Name) +.- ° ~ _3 (Address) ~ - ~ _ _ ~~ ~, 1 l_if ~~ t7j~ ~ ~ ~ ryn "' 4.~ CUMBERLAND COUNTY ~'P.EGIt ®I+' WILLS OF O~,TH ®F N®N-SiJ~SCItIEING WITNESS , (each} a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that ~~ ~ F familiar with the signature of C ` ~ Q S f= ~" ~ ~c /~ ~ ~ codicil testat~_ of (one of the subscribing witnesses to) the will presented herewith and codicil that i ~~- believes the signature on the wiU is in the handvKriting of to the best of ,~ 2 ~ lcnowiedge and belief. }.~yy~, Sworn to or affirmed and subscribed before ~,~~~ /1/ ~-'~~t;'"emu (.gcrcrress/ ~~ ~.~ r ~F r '`~ ~~' ~ 1':~, u~rz ~„a r ~, ~ ~ ... ° -!'-,y,E~ L.Ci~~k', of a~naghan Tc~-~ns11iF, fork County, Penn- r~... ~r ;~,.,~, ,~ }: q ~. ;~ti~.:u.i and dis~sing a3.ndf mexaory snd un.darstandins~, do j ~ +.~ sr'.;.< r ~Ja~3. ~ vd d declaxe this as and for rn}* Z:~.nt; 5di? :? and Testa- m~.._.^~, ~;e,.ti.i~y -e~T«k~.xl}~ snd x.;aking ~~oid any and all 3e'ills by me at any tiALC. s,;t':'~i'`. ~. , .~ t~'~"'dfr and direct Tiy r~;L'CUtOr, °C?,l'X'eina.~iter named, t'O C,;,; . ~ .l ~ _'',~ {1~',.+~ ~= i'c+.~?.~ral P_%,4^.i?TicCL,' and ~.r:.herir_a*Ce ta.Xes upf9n TLFt' „i ;~. r r ~~~ .. ... ..._., °-S YZi~!1'4 C{iT_'.L~'v L'.L2::2i2t:t~' i?t' ~G:AL' E':tt^r 1?ly dCC9Fl8 k'. '. ` 2 . S ;~Lve, devit~e 8.xi{i iJequeaL•h a3.1. 'the xast, resi3ue an.a? ca V• c ~' ~t~:, r~.sl, p°rsc~nal and mixed, of xia.atsoever kind 8nd ~hF,x~r,- v<,r "~.: ~t~ to my z,~ife, Edna M. E2icker, in `e~ 3ii-ag1e, absolutely. ~~.~;~:( ~ .if. my .wife, Edna M. Flicker, should predecease me or i';~ ~x~~sb4 ~Ee~.~F.Iy with me, i then give, devise ~.nd bequeath all the rest, :r ~ ~r..~ r ~~~nt?e- of :r.}- estate, of whs.tsoevor mind and ~caizeresoever ,~..~..... _ .,~._~J ..~~~.. Eala_ a',. 5,1CiLf'.r, h]_S hniY~ 2.~;xd ~36s.i~tt~ ~`OT:eJer. ~' !:,~:. `: l~~~rrby ~z~:r.~.nat~~, co.l~s':~±.tutc sand ~pnrairat ~a~_e T. Eli.cke:. tc7 i; ~~l°= i ~€~...~~.cc^r oy this my Last toil' and Testam4nt . ,t` ~, ~ i.;~irSS in?iETt:.(?F, I have hereunto set rny'nand and seal thi:~ s ~ ~'"'r<a= ti 2e'?tr, i~ <D , 9 1462 . a z-.r.3, :~°aul~_d, publisilec? and ~;~4.C.~.f.,,.4:. 'aJ .i7u ii~)t"1~iC"71.2i~?i?~ T4 .Y. X .~. :i'~ ~t E. ~ t ~zS'.ta?'f2d: , ':.Ei t~:{l p~-„t3a n^~ off' c::~ . *;aho at his re- r;,~,ie~t Foal ~n h~.^ prea~cnce an+i '_a3 ti2v p~z3?Ci"@C? of each Miler, ^c^.~~~ ilnrn~.iP.~~3 St_'.~JSCI"~.~?2d C3llr :za~?~fis r~d ~ai.j_nr.~~:7es thereto, the .i~v ,~~.~t ;ear ~_`{Jr~said. / ~~ // .' /1 / ,,; ~f ,i~ ~Y ~ ~.~~v~.w.. / ice: /r~L-'~`„,hs~~..~''"^~°'`{//i~. ~ ,~ ~,~ i / ~' n -# . ~ ~ ~? . ~ if ~~ ~ (sue) z j -~ w ' ;~ 5 t, t ~': ..~ `,~'~ I ~'; ~ ' ~~. '~" c~ Y_ ~ -' ir- g •. r,. 'r, ~~ ys~=e <' .; R `. i : ` ~:~k i ~ ,, J ~C >t r W 0 W D W YCfA ~~~ W V oa c=adm 4 W W 6 Z ~~ z 0 r a m s z 0 a v. 0 X FOR DATES OF DEATH AFTER tZISI M1 CHECK H[R[ ~ IF A SPOUSAL ' INHERITANCE TAX RETURN POVERTf CREDIT IS CjtA1FRED ^ r FILE NUM'14ER, ~ G" c~'~ RESIDENT DECEDENT ~ d NUMBER (T® ~E FiLED IN DUPLICATE YEAR PARTMENT OFFP0.EVENUEANIA ~j{TI'S REB;ISTER OF WILLS cou~TY CODE Nrr f 5 / N~ ho ~~ , CEPT. 280601 DECEDENT TES CO+dPIETE ADv s~ ~ ~ RRISBURG, PA 17128-0601 1`{ (_ $ S (~ ~ L L L~ hl ~ J+ EDENT'S NAME (LAST, FIRST, AND MIDDLE 1NITIAIi M y A GS ~ ! n~ ~ '~~j G~/ALL' S ~. I "~ 7' E ~ I G ~ ~ ~ DATF Of DEATH DAZE OF BIRTH ~~ ~ C ~.~ A /~/ J , V K :IAL SECURITY NUMBER ` J ~ ~[ ~! , Z 3 "~ ~ Coun ^ t' ~ ~ J / ( T AMOUNT RECEIVED (SEE INSTRUCTIONS) t/ FIRST AND MIOOLE INITIAL) SOCIAL SECURITY NUMBER gpp~l~AEIEI SURVIYING srousr's 4~~ME LUST, ^ 3 Remainder Return rlor t0 12-13-82) lementol Return (for dates of death P aired 2. Sapp ~ 5. Federal Estate Tax Return Rsq 1. Original Return 4a, future Interest Compromise [] 4. limited Estate (for datea of death after 12-12-82) _g• Total Number of Safe Deposit 3oxes 7, Decedent Ma of Trust)a Llving Trust Decedent Died Testate (Attach copy (Attach copy of Will) p~IET~A I~ ~ ~~D~ 2 Y C r, , tEIEPHONE NUMBER ~- ~~ > , ~ ~ Q 1 . Real Estate (Schedule A) (2 } ~ '_ ~ --~~ ~.. Schedule B) ~. i 1~1 C1 2. Stocks and Bonds (• 1 ~ _,, 3. Closely Ne{d StocklPartnership Interest (Schedule C} t ~ j ~ I _ ~ (, es and Notes Receivable (Schedule D) 3 Jr ~~-D , Q C _~ --D Gm 4. Mortgag - CT ~ cJ> p 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) D ~ O .-.. (Schedule E} (b ) 6. Jointly Owned Property (Schedule F) (7) 2 J ~ ~ , y ~ 7. Transfers (Schedule G) (Schedule L) (g ) g, Total Gross Assets (total Lines 1-7) (9) ~' ~ a o1 ~'~ - 9. Funeral Expenses, Administrative Costs, Miscellaneous ~ rd Expenses (Schedule ff) ( ) (11) -_ S ~d. - 10. Debts, Mortgage Liabilities, Liens (Schedule !) 10 ' ~ ~ G ~ a ~ (12) 7 11. Tote( Deductions (total Lines 9 & 10) 12. Net Value of Estate (line 8 minus Line 11) oT / `fG Gt 1131 G L ~_ (14} I 13. Charitable and Governmental Bequests (Schedule Ji ~~ ? 4. Net Value Subject to Tax (Line 12 minus Line 13) x -- 15. Spousal Transfers (for d~ICable Percentage on3Reverse (15) ~ C'" ~ ~ 0 O See Instructions for App ~ ~ ~ ~ ~ ~ ~ _x .06 = J Side. (Include values from Schedule K or Schedule M.) (16) _ 16. Amount of Line 14 taxable at b% rate x .15 = (Include values from Schedule K or Schedule M.) (ln J ~ ~~ 17. Amount of Line 14 taxable at 15% rote (18) / 0 D - ~ -~; (Include values from Schedule K or Schedule M.) S 7 ?g. Principal tax due (Add tax from Lines 15, 16 and 17.) DISC6 ~t Interest 7C~, ,S p __ ousel Poverty Credit Prior Payments yq ~lq) 19. Credits SP + _~-_ } 7 /f- _---- __----- 'ne 19 is greater than Line 18, enter the d'dference on Lins 20. This is the OVERPAYMENT. (20) S • C ' . • 2C. If LI ~ ~ (21) ~ ~ (21 A) ~ r r n . t"D I21. 1f line 18 is greater than Line~olan a due onlline 21A.n Line 21. This is the TAX DUE' (21B) ~~ A. Enter the interest on the - ;, ` B. Enter the total of Line 21 and 21A on Line 218. This is the BALANCE DUE. ,, Make Chock Payable to: Reyldor of tlYills, Ajiio^t best of m knowledgo and belief, r' Under penalties of perjury, I declc it is true, correct and complete. 1 < based on all information of whi ch L-~~~ ACS.-_~ 1 SIGNATURE OF PREPARE i P rer other than the psnonal ropresontative Is ova examined this return, indodin9 accomponyin9 schedules and statemoMs, and to the d rk ___-----~-------- it all roal estate has been reports of true ma st value. Dedoration of reP° DATE has any knowledge. ~ TURN ADDRESS --~"-'~- (_ DATE TIVE ADDRESS - .... ,....n .. ~~~;..4r - .. r~ f ~ 494 ro~ider~ for the roduction of the tax antes imposed an the net valor of transfers to or for A,ct ~~€3 ® p the statute will be: thc, ~;,,~ of tS~e spa+s+s~r. 'fha~ rates as prescriiae~d by in on or after 7/1/94 and before 1/1/96 w 3~s ~.~3~ wi-i be ~app9'scab8e for estates of decedents dy fi ~ ,~'~ f .~2) ,~iit ow ~aiicabie for estates ~+$ decedents dying ~+ or after 1!1 /96 and before 1 /1147 ~. . .~~ vane ~ ®pgaiicabie for estates of decedents dying on or after 1/1197 and before 111148 m i c!e ~ ) Q ~~$ai trans$e~ oc€dp~ing on or after 1/1/98 will be exempt from Bnhoritance tax. R~~ASS ABdS~~ K r® ~N H pFpRQPRIAT~ ~~.4CK5. ~~ ~~,~~~~ A GHE~K ~ 1. D'ed d4seedent make a transfer and: arty transferred, .......................................... ............. c:. re4oiae the ~s~a ar ir+come of the prop , b, r~stain the right to designate who shall use the property transferred or its income, ..••••••••••••• c. reta'sn a reversionary interest; or ................................................................... d. r®ceive the promise for life of either payments, benefits or care ...•••••••>•• 2. if deem occurred on or before December 1 ado98atedd onsid ation@~tifndeathyeoccurpred aft°1 death transfer proP~rty without receiving q '~rc~mber 12, 9462, dad dated®nt transfer property vnthin one year of death without rsca , ......................... .................................. ad~q~oate cansida:'alien! ......................... 3• did dgc®d~nt ov+n cn 'in trust for'. bank account at his or her eat ~F TAE ANS~~R T® ANY t?F TIE ~-B®\/ s ASE~AR of Ta'IE RETURN. YOU BUST ~+~~~ETE S~FlEDULE G AND Ftt.@ i= ...: L_ r~ ; ~: F ~. w{ ~: ~:~~,; i y. ~{ ar.''~'4~`.,.;. a .... -~s. ,. ~. .°' :. - •.: ,.. ~-' '4~n~Ft7'S 1'tt°°q~'~y'v_T'?TRC+'.!eF~3iF`"~±.YK"C'fLM'^~a~°.°.+n... '~. ,. ..- ,... ... _:- ~~ , it a ... ~ .. .4. - ~, .ply... ,) iii t'..~lja ~} ~~' ~ ~. 7 ~~fSuF2uM~~:J ~ z w._ ~ - - _._. _.._._~___ ____..__..__. ~--._..-_~..___.__._,___M-- , . 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I iir •..+P.l !Y'i xp-'SF¢ ~:'Sr~~"'4'3:5+°$Y+: i ,~ j _. ~. Kj„ ~} ~. ` ---- SCn;~.E. ZA9sa cnt~ar on lines 4, ~.7,HCCF:iituooti0i7; I j ~, _ ~• ------- ---- ---_--- :`~ ~-r;?c ~p-~ss»~ ^~ :s~s,arsd, in?~trr2 a~s~i4ru.'~1~7 «ln.^>errt~ t3tr ~a~a aex„~., { ,.,y ~ ~. F., 1 x ° ,„ `y~bH ~• ~ ~~'~t~ 1 ~~.1an~~~k~e~kL_L~'~. ~ lK'~ ~~.j~]r ~ ~ J W• ,~ O ,~ O O ~. ~ -, ~, ~ 7 ~~~x~ ~a e5i fir, x ~ °,~~" 1 h,C~ { 'F ,ip°, i ~ .. `.~j `~. f ,~ : ' 6 :-. /y(~Li/~~7CNi ~M"~R --- ;~_ . ..:. .~ , ~, .... , ~ .' ~~~:r~/~t i~P,"i•~,~;l:t,t. 3E ~'~'f,~.Tz ~~~v e-~^vs ~ r: £%re i3, rte. , r3;uitaYirn~ - --- ----._._._...-_ '*. ~::.,. s W, ,,.^re« ~t C7~^B.~&ii, dw33ra."1 C4'~t~%'F~°SaC:ii $f:Sra"'~: 6'+Z k^.r:ccit rr+°,w ~.yry 1 J ~ , "C 'l ~'{ ~.~. ~ r ~~, M. ~ ~' tl. >~~~; fit' ;.Y.J T . ~~ ~~1. :.~KL _, ~ - ~ ,:~ _ `~~ ~~IY~ ~ ~ '~ +T y . ~~ REKI}bt EX~.4Vaj ~,,;y... RECEiVEp FROM: Do~L~ E ~L.I~KER ~ ~l~Y~i'~tY ~T '~~-lt~~"~I~;S~ IAA A?O~°~ ESTATE INFORMATION: FILE NUh".EER ~ ~ "` ~ ~~-aa~~ a ~"Q~-'sue. NAME Of DECEDENT (1A57) (FIRST) IMII ~_1.~~~~'FS ~~_ A ~i~~ DATE O` PAYMENT ~++ `?~' .. /~' F ms ~'~ ~; : "~~ ~ ^~ ' ~ h 1 .-. s, 9 : POSTMARS~ ~ra., ~ (COUNTY r ~s 1,~.~,~~tT7 ~1-,~1~ DATE OF DEATH ~~ } 1 .ts. ~.y. .~~ 'p S ACN ASSESSMENT ~ AMOUNT CONTROL NUMBER i I FClO HERE -i t' • TOTAL AMOUNT PAIQ ~~.-ugi~'~ REMARi<S ~~~~ ~. ~LI(CIC~~ 5"c,al. ~^~.¢,~;g„N ~~7 RECEIVED 8Y RIA U / P3E~IST~R OF WyLLS ~~FQt ~Z:..L.~„ .. _ _._. _ _ .__ . ..~,~~~ .e.~~ { rr!-K<; .or~ ,ezz-g ~ r+c+'.'-~a^'+~"ts*,^'T'.~- g`~E'!~ s°. ~ { _ ~.f- ~4,, w 7~~ » ~ '~ ..~ .. .. .... ~ ~.: .rte... . ~, ~ ,r . ~:. ~ .. ~~ ,~,.. ^. i ?~.°.:^ L`14~;",~.P.TTCi~ ~~' T~1Q'1 ~Cr~ +~~3~t~r"~. Fi.€.i~,~ ~ . G f a 1 r _~.--------- - ~i " . i i~ c :~ ,. _ .. ~ ~~ a~~~:=_.~fy that no~~.:ic~e og bone~iGia~. ~.n~~ere~t rec~ua.red ley ~;~, ~,-~ ~~, .. ~ ~ s~~ tl-re ~r_a?aans ` Couxt `~u.les w~.s serveca. on or rctarlecl eo . ~~_ __ .. ~ ~. .r; ~e~e~zr.i~Y~.ev caf the above-capt~.oned estate on a -..,, ~, .~ddxe s s ~~,,°.~~-::~ ~.~~:- ~~a=.4° :oc-~~.~{;. ~ ~-;en ~o al? ~e~~ons entitled thereto ~r~der f'~A~aC ?c ((ti~~~ a~ }* ~y _ , ` ~> 2t'~~r~~~+._.-T'"~!?'r'SG~Tlrg.l .~G~~ "E'~~*Sit?~,l`JE' ~ ~.»6~: i-r; ;~_~. i..; <~ _~ ..: ~,~ -x"hty v,.r ~~.., _._. ~~~\ ~.~--~~ ~ %r /'~~~ ~- trN `~ ''~""a'"t'"`t~a?r ~' l10TxCE OF YPlkERITAMCE TAX AB%N 101 ~,~ ~.o „= Ar7 *.tH.?i Ta;?L~ ~'~~~+..~ APPRAYSEPlFliT, ALLOkAPdCE ©R SIISALL049ANCE DATE 04-10-95 czar. zeaaai OF D'EDt(Z:TEOMS ASiU ASSESSMEPtT OF TAX hrtaaxsa.~v. a~ a~.zs-ae,ax j =-~-___~.-~ FILE KO. - 2 E~3TA"!"E a~F ~-~-L~~>-~~,~~ ~' CUMBERLAND ' DATE t3~' DEedTF! 12-13-94 OOUA9TY ,r,~N,. C{~YE; Ttd IMSt&t?~C PRt4PE4? L~ES97LT 70 YO(7R ACCOtA6T, 51lDM1T THE t)PPER PDRTItXi DF TkIS FORM MITk YOl)R TAX t'AYPB%^S~' TD TFtE :EEto':S7'~i~ gF 6!ILLS. kA9CE CHECK PAYABLE T© ^REt)15TER OFR~~gSr, pA SENT' TO: n,5l.c E E~.ICKE~ REGIa7ER Oar 4EILLS RAY~EF~?,;, C. i CU~ISERLAND CO COURT HOUSE i~lECl1A9~TC:,~lfiZra PA 2T055 CARLISLE, FA 1013 Aowo-xtit Roaittod ~~~ :°!.!'f ArOF~4G TE~Yw LIi~E ~^- R'~TAIt~ LO~lER- PORTION FOit-YOUR RE~CORnR ----01-----------„---°------ t~EV..1~4 `~ B»X :~E~ ~ 12-~~ ~ ~I~ALLO~tAEICENOFRDEDiN9CTZOtdB AMDRASSESSMEPITAOFOTAXCE OR . ~~~ATY,. r)E' ~'LICkER CHARLES E FILE PBO. 21 95-0082 ACPI 101 DATE 04-10-95 ---------- TAX RZ:Tt1FEtd kAS: (k) ACCEPTED AS FILED ( ) CP)AM6iED E{E3ERVATIC~! teOPbCE~tA1IP~5~ FUTUF?E YN7EREST -SEE REVERSE A~+PRAISEYb VALUE OF RETURPI ~SASED Otd: ORIGINAL s ~ ~~ 0 el) 3-: ;~- ~ ~ ~ ~ `~ A) 1. aa~l Est®ta (Scteodule ._ , cr .00 t2) ~^ ~ '- ' 2. stos~cs ans9 Sedsrls (SaNo~+la B) - ~. ' ~~ 3. Clua~,lb 4f®ld Suck/Partnsrs4~iP Intorost tSchsduls C) t3) 0 ~ ,= k.. riar$mr ~^a~:s/tvot~x &ZaeenSveSalrse :Scsels ,) EI d l . 0 (4) ~~ _. 0.40 O t5) J1 , -., u • .~. Gas2~/Bar~k CJe~ositcl~7Ssc. P®rsanml Propmrty (Scho ` " ," 6. .fointly G'~mard ?rs~tr$~I (Sr.Pv~adul® F) . 00 (il. (- D~ c~)f ; ~Q920.40 S. To#n). dAsaots .. + W A~~ROVED BE:4'UCTItO~lS ANA) EXEi~PTIONSs 5,422.12 4. F~ewral Ex,raaoses/A+dra. Coata/Mitc. Exponsma t3eP+sdulo k) t97 1C. q±tah#sa/:'Snrtgma,,~ li~sil.ltioa/Lions t5chw~ul• I) tlOD .00 4 5 li.. 7atrr3. Eterssc:tias~s (11) .42 _ 26,498.28 _ ~.~. ,:;*~ 'rr2aar~ fl:' Tc*r. Pstu.~ t12) .00 13. ~~r''tsSaJ~~(~oa~srn=~an'i®1 B~~luasts tSc'atlo .!) (13) 26,498.28 Z~. ~?e+± ?.'a:3~!,~ a, Es'~a~ts 5s~vmot to Tmx tl~) ptOTE: I~ era ~~~~~:`:~.;~~~ ~a~ i~~u~d pr®~-ioual>o, tin ~T ad~ ~~ $a~ n r~ 18 Pahl ~® x~e~1~~ ~~,~(~^~s~ ~Hta-~ ia:ol~d® tte~ toga o4 . d t s ~ ~ Cur e~~ sESS~?MP~:' OC' I'.~X; .00 X .03, .OD 15. r,~n,an~4 a~ Lines lc at S~sussl ra#o t15) 26,498.28 X .0~ 1,590.00 1~,, ~x~rsa~nS o$ Li~s:2 :~.!+ ;ax~ls at Linaml/Clsas A rato t16D . 00 X .15. _ .00 1, . fs~~ua3 cf Li:~s A4 #t~xabls ai t:®llatorallClass B [`ati! 217) 590.00 1 ti5) , T.~X t~iy: .V'A~i'Wn. P~i~;~'C I Ftr%wY"7 DISCDIJPXT (+) AA4DtRPP PAID j :J 1TF ~ "'? ~'c~r? IP9TEr"FEST t -) _- 'zF P)aI'0 AF7F4~ taAaTE If~'aCt)TED, SEa'c RE16E FClP, CdLCE1a..:TaQyS '°F e~SaL'iTZ(S:y.Ai i?~TEREST. __ ~ r r• r ~.~ TOTAL TA!( CRED3T 1e590.00 1QALAt~E 6P~ TAM DUE .00 IDITEilEST . 00 TOTAL DUE .00 ( IF TDTAL DtDS IS LESS TkAk A1, MD PAYME)ff Ix IRgt1UIRED. ZF TATAF. !'l6FE IS REFLECTED AS A "CREDIT' tCR), YtMI MAY tE ~S)E A REFW9D. SEE REMERSE SIDE OF TPlIS ltR1M F4R IDiS.TRUCTIDMS. ) ~,~.e;.ety,a;,;,,+t,.~ kc, 6 ; ~ ~._ - ;_ ~.~ ~ =~ ,'~' t'~~- .,,~ ~~;. 4 -. ;' r~' t ~;~' ~~ ~-= .,~... s~",. {!A ~w L~C.~l%~s~. ~atr~....__.. '*-.r r~~p~,~y p4..f~ ,/ ~. C...... "'._-~-rG" ~ C.. Y'~`".~,,,.,~-.. ~.% s... ~`'; % .v,~C :._ dP ~.~..~ ~~ ~i.J ~ ~ ~ !~,,.f -_.f~~Tdn ~.n . t,3C~ . ~ - __ _ ___-_,___.__ t~rstz~~;.,~r, to ''male 6 . i2 0 the ~up~reane Coax,rt brph~~a~s' F-<.'>>•.iy ~:5"'air-.:; I rt~~ort r.yho following ~ri~.h r•espoot *o oo,.~p~.etion of ~~;.., ;,+r+x"'.a'i,.;~i.it3~1!QA~ '~¢ tli~' r~AJo~.Te°~t'"i~~7t1.~S'.n~''d ~Fr'~d~R~B ,~, Sta~.e ~:~hether adtninistratio~: of the estate is complete: ~rei~_ ~~ ~?o .~,~ Afi:e an4~,3=er .is k~o; sty tQ ~,.*h£"n the personal _ -~r_,.:. _ _ ~,p~ ~.,:. ~sw r,~aas:~nabl..~r bed. ieve^ .hat tra.e ae,~r+is~istratior. will be is ~); i' ,}""i ~' t.:s i:.':=1 :?. :f the answer to Fro. I is Yes, state the fo3:~owing: f~. did the personal representative file a final :~.ccc~~.~:i. '<T ~.~~:h i~h.o Court? Yes Y 2do~. ~,, ~. 7°l~e separate t7.rp::ans ` Cojlz.'t tea. { i7` any) for ~q: y'}~ ~t~l_rl~t~Gl r'Qpresentc3t~.'Se's aCC~~r:t ~.~''.: c . Dirt the persona? represe.atative rotate an ~,...,.. Win."`~ .._:~%~~ELti12a31I3f L'O t;2~ parta.F:s in 7.?1i.~'rE?s;:' i~£~a__ /~ ~'~fJ cR. Genies of r_ccea.pts, releases, joinders and d~p-~c:s-G :;.'= of foal o:r ia~for:sia:[ accounts max be filed with the C~~r'.c ^ ~ ~~ ~~ C~-phan,' Couz•t and ~«aalr 1ue attached to this report. ;~ ~ ~~~ ~ - '.~ ~~.; _~ -~ `:., .y, .. ti-~ ,~`n~ r~ataa:.re P~u!~:e ~ rle~se type ox_ Yg'int j ,~ ,r "` t i a' ~ ~ ry t ~ ~pa .Ll.' ~ ~ f ~ ~ L. _ _ `x'~^3 . ~~o . Capacitu: __"~,_~rereonal ~epr~:sentative ~o^~;res:~l ::or p~~aanrdl re~xe~se~att~tiY~o ;' ~;. ~; r~ _ ,: ..., i. r ' ~~r ""1 1 "Y. ~~ rte'" C., ril,.~`A""',~-.R•t[~tr`, .~ k .. ~' S, r `Y l~ti tk _4 'Y'~. TA+. '~ ~. 2 ~`~~ Yfs ~4r°.r'; g _r - ~ r ~,1 ~ 3y ,. t. .. .. ., , .- ,~ .