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Home My WebLink About95-0085a ~ -~S~D085 M705.7~3 Rw. ?/87 rrrEnwNr w v~wAKe SLACK M r Y r z w O w U W YD O W Z This is to certify that the certificate hereunto attached is a true and accurate copy of the original death record on file with the Division of Vital Records, and that Frank Yeropoli, whose name is subscribed thereto, was at the time of subscribing the same and now is Director, Division of Vital Records of the Department of Health, for the Commonwealth of Pennsylvania, duly appointed and commissioned as directed by Act 66 of the General Assembly, approved 29 June 1953, P.L. 304. AUG ~ s_ 200]' Date f Franc ~eropoli, ///' ect Division of Vital Records P.O. Box 1528 New Castle, PA 16103 COMMONWEALTH OF PENNSYLYMNtA • DEPARTMENT OF HEALTH • VRAL RECORDS J (~ ~ ^~ CERTIFICATE OF DEATH L.~ 1~ PE~'I"~'I®N FGR PROBATE ar~d GRANT GF' ~.ETTERS DOROTHY GAFFNEY ~ f . y's..-- ~S ~stat« v1' - No. clsv nnown vc _ To: ___ F.egister of Wills for the _ Deceased. County of Cumberland in the Sociv! Security Nv, 17 2 - 01- 5 6 5 Commonwealth of Pennsylvania T 1!.e petition of the undersigned respectfully represents that: Your petitioner(s), who is/are l8 years of age ar older an the execuc ~r ate.. y~_ P9r>,~rted in the Last will of the above decedent, dated ~ 3 and codicil(s) dated ~~ (start relevant circumstances, e.g. renunciation, death aC executor, etc.) Decendent was domiciled at death in Cumberland County, Pennsylvania, with h er last family or principal residence X40 Walnut Bottom Road, South Middleton Township, Carlisle (list street, number and muncipahty) 82 January 20 19 95 Decen ent, then ears f a e, tgd ,PA , alz~ea~er Nursing anyd Reoha~i itatian enter, Carlis e, , Except as follows, decadent did not marry, was not divorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: Decendent at death owned property with estimated values as follows: 2 , 8 0 0 . 0 0 (If domiciled in Pa.) All personal property {If not domiciled in Pa.) Personal property ire Pennsylvania $ (If not domiciled in Pa.) Personal property in County $ Value of real estate in Pennsylvania $ situated as follows: ~!'kIEI2EF(;Rl;, petitioner(s) respectfully request(s) the probata of the last will and codicil(s) • presented herewith and the grant of letters testamentary (testamentazy; administration e.t.a.; administration d.b.n.c.t.a.) ther.or,. G _ ~~ ~. ~V Harry D. R el ~.~ '~1 tl7 uaryar~ Avenue Camp Hil ,~A 1?b7 1 _~ .a - r s GATE flF PIi~R~ONA~, REP~BESENTATIVE ~~~-'~~iat6~'~t3]L'I'I-I ®~' P~?~iPd5q'L~'AN)i~ 1 "~;,~~ i~i~-~ ®~ CUMBERLAND ~' s's The petitioner{s) above-named sweaz(s) or affirm(s) that the statements in the foregoing petition are true and correct to tk{e 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 according to law. 5~s~orn to 'or affirmed and subscribed before me this 27TH ~'• ~_' L„ ~~ ~ ~ day5of A h~?A'~ ° ~ C. L E l~ I S F.egist2r ,` ~ -~- s .'- I ~' :. ,... r ~Tr~, __ 21 - 95~ 85 --, :.,~ , DtJRn`1HX GAF F I~?E4'~~~~@~ ~_._..___~.~_ _ 14 , in consideration of the petition on ;r:; iw''.':;r~° ";:I+_ ~"is~'r~'41f, =~.tiS~?.atUi~~ cSC"Of 'ilaVlnF CFf:en pt'CSenird 1)Z~'OIe :?1C, i'I' 1S ?a:;CRF':c~TJ ?'zat t2rta?siruartent(s) datc~__ MaY 11, 19 9 3 c?escrih~c4 t,~c~•cin he ~t;~rc;~tt~d to p~robatc and filed of res:ord 3s *.he Iasi will of _ Dorothy Gaffney a,d Let°es•s ~____y.F testamentary ; ace here'~~; ;.ranted tc__ Haxr_y D. Reel FB,ES ?~rr~l~aie, Lit°rs, Bic. ......... ~ 2~0~0.~0~0 JC? _ ~ 5.O~t ~~TAL ~ ~ 217.00 Filefl .... F E.8 F~ i3.A~r2'~:. 3 ,.. ~ g 9 5........... . ~.` + ~ <'7 ~ r~ -_ y is "- - rte.. _ _ ;.,,~4 ~7 t _r:; U ? ,- ~~ ry rY- '~ ." ~::'~ ~L~ ' . 'i ~~~ ~-,~-- Register of Wills MARY C. LEWIS John E. Slike, Esq. 06262 ATTORNEY (Sup. Ct. I.D. No.) Bos 737, Camp Hill, PA 17001-0737 ADBRESS 73?-3405 FI~oxE 2 i z ~._ r .- t - ,~ / .. F r,. g t i L~ - ~5 - uJ Pi~~~'~t'~..Rd~g+~ 7I@',A~.~.rg~T ~F g~i IIAT p 7~y~+c C®~11~~'~' r~S~~ ~~' ~~~~~~~~~~ ~1~1~Yi~7~ ~\, ' s codicil (caclz) a subscri}".rl~; w1tnCSS t0 ille will presented herewith, (each) being duly Q fled according to law, depose(s) and say(s) that ~~ present and saw '~~ - - ~ - - . the tesiat_.____.______, sign the same and that _ `'~~ signed as a witness at the request of testat_.._.___ in h presence and (in the preseZreee of%each other) (in the presence of the ot'?.cr subscribs.;Tg ~:~itness(es)). '~~ ~~~ Sworn t o or a1'fi:~ed zrrd subscribed before me this _ ~ day of ~ (Name) 19 ,. ~ ~ (Address) ~;~ ~ =% ~~= Register's _ - «: = ~ c - , (Name) _ .~ i.: ,~ _ r- ~ ; ' ~ (Address) n: . ~ -- ~ ; .,s , , , ~ i .v ,~ «~~ ~~ ~ ~~ ;.'°~ ~~ ~,~~ ®I' ~dY~I.S ®F CUMBERLAND ~~UNTS' >'Fs i ~~' Pd~Iei-~TJ~S~~Pd~ ~1VI'TNESS RTJ~H L. REEL and HARRY D. REEL (each}. a s~.:bscriber hereto, (each) being duly aualifieJ according to law, depose(s) and say(s) that the ~_r_ e familiar with the signature of Dorothy S . Gaf fne;;- , :adieil trstat ri%_ cf !one of the subscribing witnesses to} the will p*esented herewith and they ~d that believed the signature on the will is in the handwriting of testa.t rim believes the signature of the will presented herewith and that they cal Dorothy S. Gaffney ~eli.eves the signature on the will is in the handwriting of _ to the best of ~ne'iti _ kncwledge and belief. S~-~orn to nr affirmed and subscribed before ~ d~ me this ~ 7TF1 day of N me) ~' ~~,~~'~h~~~ ,Y ~ ..~! D ~ ~ao y-yav-pl fVY-~., y~-~vw,P G~'t ~~, , ~~~ ~, ~' c~`,7~~ r ..~7 (Address),-, ~~ 1` C. L ~ ~! I S Register7~ ~~___~ ~`',y'~~_~~. (Name) ~ ~ ~~ %,~" ~4;, ~,t: (Address) ~{,~ -FKN ^?'~ j qs J e _, ~} ~ ~ ~ ~;~~ ~ ~~. _ ,», ,„*' Crs:?„~'*~' i, t.~o~A~ztl=,.da Gs. ~ney, of ~8~0 Lancaster Avenue, Harrisburg, Fenrsylvania, being csf s~r,un~ ~r~ira.d, me=_r~ory and understanding, dv hereby make, publisl: and ~e~:l~.re tips ±o he my last uaill and testament, hereby revoking and making null z~.~.~:i =~ ~_~'. ~r.- ans~ ail wills azsd codicils heretofore made by me. m xrs+.: 1 r~r~.er and direct nay ecutQr, hereinafter named, tv pay all ~?.r debts ar~cl costs of adrninistrativn as soon as conveniently possible. ~e~~orde 1 devise and bequeath the residue of my estate of every ~catgare and wherever situate, in equal shares, per capita to x.~ay sister, ~gatilda Finn, and my sister-in-law, Ruth L. Reel end my brother-in-law, Harry D. Reel wha shall be living at 0.he tune of my death. 1 n~.ne ~Zar~~v J. keel, l;xecutor of my will. i+.r1~ ~-~if].r~ess ~uhereaf, i?have hereunto set my hand and affixed my seal, this I f ~'~Gay ~f ~6Li~y i~~J. ,; ~~T 5i~ne~d, seale~-1, published and declared by the said Dorothy Gaffney as her last ~~~a? ~ i.n €1^ne _reseoce of us, wha, at her request, in her presence, and in the i~reser~.ce ;~. owe s.nather, have hereunto subscribed our names as witnesses. ,, F ~,r ~.~ s r ''~ 03 .Sc /Ye ~ ~a1C ~our7~" e~ ~~-'. tX .,~,~ }, `3~. i ElEi- r~, , I " .:,.. r` ~• , 1,~ A i ,., __ ~~ '~;E'1"1~J 11'::.1 ~. ~..."J.~ ~f ..,~:~~.r: L^ ' 3`.~e~:;:~L'~'a: ~~~ z?u~r~p °?G P 195 i T. r ,~~~,;, novice c~ ~e~z~~:..ciG.~ i~atnrest requi.~:E:d ~~ 1. ; , r. thc:~ t~rpi~~~.n~' t.t~tif. V Ru~cr ~•~.~ serv~:d ors ur m~i].~d ~ y= ~.::r~ ~riiµ~~~°i.:~q en«~ficiaries or wee above-cap~ioned e~~~te on 't l ri.~,~ 1~.. .i~. L ~u t.li iJ. ~~. tea` t SA~rr~ l..Y • 11.~.'P.~ ~? .~.:~ ,.~' ±:~~ S'"~.. 31~'~ ~ar~strzrd7lAve. ^107 FtL?~.rv~r~dlr~v~=. ,1 .~_('. ._ r '.a a~,.~~~ 21 ~_? .S p L~Fi ~~i1t~ d:. 1.1~ r .G'"R1 s'~'.'? .... "~_ :"'L~'' .:;~`iET?. riven ~4 :^.i~.~ ].'3G'rSOnv E'3.3~:1~~.E:d 1~1~Q.rl~.k.~ l1I'id~r ~i~~~.J:~xt .~.. ,Yn~ :y.o.: r. .7o n~~S? i~C~ b~~ir~ ..-..___. s 'i 7 .~ 7 i,:QUYI~it'~ 1:'C+.T_" ~r-.^r,'30Y1E3.1. ~s.t'~i'f3'~E:i~'i:~z.'i...~r~? Y ~ ' q' ~~ p'. ~Y ~~ ~s,. SJa} " . ~~ r.;, {~~~ . ~: ?s ., i4+,. ~Y ~` ~. e f~ fi iq ~' .!} ..,. r Y. 1'- i xc"t~ wi te, ~ , - ' w".::=:,y<n~:K~gr,~r ,~!r+fa..: ~~T+¢~gn~;tie"1s:P?'+'..~a1 r .ry of ~..Y~; ai"'a: ~„ ~ ~~.,I -7 .~ _ ~ ~~ I. -``` ..gin ... i i" ', .- ACN ASSESSMENT AMOUNT ?ECEfVEa fRQM: CONTROL NUMBER •\ ,, _~ __ • ,, ~.. •_ ~~ ~ ~ `. ~ \, ` .; _ y rY }.t l: .".FWt102 Ekl-1•x,11 - '~e r"fw~F~]. isYNr~Y'! ~$ S`T~T4Ai;#. tT .•ty :1• ~i,~70~t~ - FClD HERE ~ _ qp~ ~ i ~~ ~ ~~ a ~ r~~ +^K~ dm:.. S q _ c ~ ~ ~ .9~~g4dy~Eey,~~rL~IIryC~ ~~Q A.7 7WQ J1 / ~ 9 ~"~~ ~; Y L!. PA 17C?O i FOLD HE ~+''~_~~x~Qx~ ~ • TOTAL AMOUNT PAID ~I1 ~~~•~ a SEA: ~ 0~•~1t~". 17 ~~ fr' ., .~' . 1 RECEIVED BY: /1~i ,%/-Y •! ~ URE /' REQISTER OF W!l.LS MARY ~.. NI~'~~ :~ -~- r ~'~ {;~ /~' R~4iY1~~~R ~ ~IILL~ ;~ (; -- . _ c•,, , ~-, -: -~ ,~ ~ ,.u y i ~1~, _~ , `s, ~ ~+ . i., r#t' ~.) .. '4.53 .'1','q!'~,'t f~~~:'.. • r ~(1ii4312 ` ~ FOR DATES OF DEATH AFTER 12!31/91 CHECK HERE ~ REV-11s00EX (7-94) INHERITANCE TAX RETURN IFASPOUSAL TYC ITI CLAIMED 1Y(/ , pp RESIDENT DECEDENT FILE NUMBER 1 l „ do ~I~~IAV~E[ ~O FP,Jj~(~$xl~~(ANIA ~v tt NNUU tt ~ ~tt ~ (TO BE FILED IN DUPLICATE 2195 - 0085 I ~ 12 8 - 1 , H RISE j WITH REGISTER OF WILLS COUNTY CODE YEAR NUMBER DEC ENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) DECEDENT'S COMPLETE ADDRESS ~.~ ~' D F Y, DOROTHY A. 940 Walnut Bottom Road `''q ~ C OCIA ECURITYNUMBER DATE DEATH DATE OF BIRTH Carlisle, PA 17013 ~ •' '~~ p 17 -O1-5695 0 /20/95 11/29/12 N county Cumberland T (IF APPLICABLE) SURVIVING SP SE'S NAME (LAST,FIRST AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER AMOUNT RECEIVED (SEE INSTRUCTIONS) A B 1. Original Return 2. Supplemental Return 3. Remainder Return ~ P L 4. Limited Estate 4a. Future Interest Compromise (for dates of death prior to 12-13-82 (for dates of death after 12-12-82) ^ 5. Federal Estate Tax Retum Required CPS 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes (Attach copy of Will) (Attach a copy of Trust) ~ p ALL RRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: R N NA COMPLETE MAILING ADDRESS R D hn E. Slike, Es wire Saidis, Guido, ~}1~f &Masland S N ELEPHONE NUMBER 2109 Market Str~i' ~ ~ ~~ - T 717 737-3405 .~., ,.. Cam Hill PA l~:bll '~" ~~' 7. Heal tstate t,5chetlule A) (7) 2. Stocks and Bonds (Schedule B) (2) "~ <. 3. Closely Held Stock/Partnership Interest (Schedule C) (3) =; 4. Mortgages and Notes Receivable (Schedule D) (4) E 5. Cash, Bank Deposits & Miscellaneous Personal Property (Sch. E) ( 92 , 014.16 ,; - C 6. Jointly Owned Property (Schedule F) (6) ~ ~:.: ~ ~'ry A p ~-~, 7. Transfers (Schedule G) (Schedule L) (7) _ tv , T 8. Total Gross Assets (total Lines 1-7) (8) 92 , 014.16 ~ 9. Funeral Expenses, Administrative Costs, Miscellaneous (~J 3 ,157.08 A Expenses (Schedule H) / T I 10. Debts, Mortgage Liabilities, Liens (Schedule I) 784.41 O 11. Total Deductions (total Lines 9 A 10) (11) 3 , 941.49 N 12. Net Value of Estate (Line 8 minus Line 11) (12) 88, 072.67 13. Charitable and Governmental Bequests (Schedule J) (13) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 88 , 072 .67 15. Spousal Transfers (for dates of death after 6-30-94) See Instructions for Applicable Percentage on page 2. (15) 0.00 X = 0.00 (Include values from Schedule K or Schedule M.) _ 16. Amount of Line 14 taxable at 6% rate (16) 0.00 X .06 = 0 .00 (Include values from Schedule K or Schedule M.) A 17. Amount of Line 14 taxable at 15% rate (17) 88 , 072.67 .15 - 13 , 210.90 X (Include values from Schedule K or Schedule M.) O 18. Principal tax due (Add tax from Line 15, 16 and 17.) (18) 13 , 210.90 M 19. Credits/Sp Poverty Prior Payments Discount Interest ~ + 11,500.00 + 660.55 - (19) 12,160.55 A 20. If Line 19 is greater than Line 18, enter the difference on Line 20. This is the OVERPAYMENT. (20) 0.00 T Q ^ Cheek Erere if, you ars rsqu~tin aeNundatyour ovle~ sent: 0.00 t) 21. If Line 18 is greater than Line 19, enter the difference on Line 21. This is the TAX DUE. (21) 1, 050.36 N A. Enter the interest on the balance due on Line 21 A. (21A) 0.00 B. Enter the total of Line 21 and 21A on Line 21 B. This is the BALANCE DUE. (21B) 1 , 050.3b Make Check Pa able to: R istsr of ~Ils, A nt - - BE SURE TO ANSMIER ALL QUESTIONS ON PAGE 2 AND TO RECHECK MATH ~ ~ Under penalties of perJury, I dec are that 1 have examine this return, nc u Ing accompartying sc u es a statements, and tot a best o my know ge a be lef, It s true, correct and complete. I declare that all real estate has been reported at true market value. Deelaratlon 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 Harry D . Reel ...,~ ~ ~ ~ 3107 Harvard Avenue - ----------------------------------- >~&t--t.~~~,r~'4t'~ Camp Hill, PA 17011 SIGNATURE OF PREP ER OTHER THAN REPRESENTATIVE Saidis, Guido, Shuff &Masland n 2109_ _ Market_ St_r_eet l' / Cam Hill, PA 17011---------------------------- r...,.,.~..ti i~~.nmes.,......s•..._... ....,,, oc....a__... ,.._ DATE i ~ !o y 5 DATE _~ Jc~,_~S_., .. ~• Act #48 of 1994 provides for the reduction of the tax rates imposed on the net value of transfers to or for the use of the spouse. The rates as prescribed by the statute will be: •3% (.03) will be applicable for estates of decedents dying on or after 7/1/94 and before 1/1/96 •2% (.02) will be applicable for estates of decedents dying on or after 1/1/96 and before 1!1/97 •1% (.01) will be applicable for estates of decedents dying on or after 111/97 and before 1/1/98 •Spousal transfers occurring on or after 111/98 will be exempt from inheritance tax. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING A MARK (X) IN THE APPROPRIATE BLOCKS. 1. Did decedent make a transfer and: a. retain the use or income of the property transferred, . . b. retain the right to designate who shall use the property transferred or its income, . c. retain a reversionary interest; or . . d. receive the promise for life of either payments, benefits or care?. . 2. If death occurred on or before December 12, 1982, did decedent within two years preceding death transfer property without receiving adequate consideration? If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? 3. Did decedent own an 'in trust for' bank account at his or her death? . YES NO X X X X X X IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COIN~LETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. !`nnvnnMlrl t°°A i........s~ ........ ....... roc....~.._... ,~~ I, Dorothy Gaffney, of 4800 Lancaster Avenue, Harrisburg, Pennsylvania, being of sound mind, memory and understanding, do hereby make, publish and declare this to be my last will and testament, hereby revoking and making null and void any and all wills and codicils heretofore made by me. First: I order acid direct my Executor, hereinafter named, to pay all my debts and costs of administration as soon as conveniently possible. Second: I devise and bequeath the residue of my estate of every nature and wherever situate, in equal shares, per capita to my .sister, Matilda Finn, and my sister-in-law, Ruth L. Reel and my brother-in-law, Harry D. Reel who shall be living at the time of my death. I name Harry D. Reel, Executor of my will. In witness whereof, I have hereunto set my hand and affixed my seal, this i l th day of May, 1993. d ~.~ ~~~ y , -Signed, sealed, published and declared by the said Dorothy Gaffney as her last will in the presence of us, who, at her request, in her presence, and in the presence of one another, have hereunto subscribed our names as witnesses. .~/ r~ '7i o~ _S', /rcr r o ~ L~c~~ ~~ ~~ rY, m ~Is~4 W?,, ~~, i 7 0~ 6 •REV - 1508 EX + (2-87) COM ~N~F~LTxOF~Fy~,~R~yANIA DOROTHY A. C,AFFNEY SS~k 172-01-5695 01/20/95 Please Print or Type FILE NUMf3EF 2195-0085 (All property jointly-owned with R ht of Survivorship must be disclosed on Schedule F) ITEM DESCRIPTION VALUE AT DATE NUMBER OF DEATH Harris Savings Bank savings account 06-00074389 6,825.80 Harris Savings Bank C.D. ~p06-63-223235 6,020.15 3 Forethought Life Insurance Co. - rebate on prepaid funeral 170.40 4 Leader Nursing Home - refund due 203.72 Dauphin Deposit Bank and Trust Company C.D. ~~8100393664 15,019.73 C.D. ~~8100393672 15,021.70 C.D. ~~8100393699~ Checking Account ~~0036038105 20,030.58 9,905.39 Passbook Savings ~~4919106161 18,816.69 SCHEDULE E CASH, BANK DEPOSITS AND MISCELLANEOUS TOTAL (Also enter on line 5, Recapitulation) S 92 , 0 .16 (Attach additional 8 1/2" x 11" sheets if more space is needed.) Coovrightfc) 1994 form softwareonlvCPSvstemc.lrr ~_.~ Bann ~_~_~.., a ~„_.. ~ e.~ REV - 1511 EX + (7-88) COM MONW ETApL~TCHEOFp~P(E~NENTSUYpLVANIA INFIES~DENTDTECEDENT N SCHEDULE H FUNERAL EXPENSES, ADMINISTRATIVE COSTS AND ESTATE OF fILE NUMBER 2195-0085 DOROTHY A. GAFFNEY SS~~ 172-01-5695 O1 20 95 ITEM NUMBER DESCRIPTION AMOUNT A. Funeral Expenses: B. Administrative Costs: 1. Personal Representative Commissions Social Security Number of Personal Representative: Year Commissions paid 2. Attorney Fees Saidis, Guido, Shuff & Masland 3. Family Exemption Claimant Relationship Address of Claimant at decedent's death Street Address City State 4. Probate Fees Register of Wills Zip Code C. Miscellaneous Expenses: 1 Cumberland Law Journal - legal ads 2 Patriot-News Co. - legal ads 3 Register of Wills - filing fees 4 Register of Wills - reserved for account fees and unbilled medical expenses 5 Dauphin Deposit Bank - estate checks Waived 2,300.00 21.00 40.00 59.08 25.00 500..00 16.00 TOTAL (Also enter on line 9, Recapitulation) S 3 , l . 08 (If more space is needed, insert additional sheets of same size.) Copyright (c) 1994 form software only CPSystems, Inc. Form ~ $00 Srhs,riul NlRnv 7-AAl REV - 1512 EX + (1-93) SCHEDULEI COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT, INHERITANCE TAX RETURN RESIDENT DECEDENT MORTGAGE LIABILITIES AND LIENS Please Print of s ESTATE OF FILE NUMBER 2195-0085 DOROTHY A. GAFFNEY SS~p 172-01-5695 01/20/95 ITEM DESCRIPTION AMOUNT NUMBER 1 Carlisle Digestive Disease Asso. - balance due 30.51 2 Edward A. Rosboschil, DPM 40.00 3 Tri-County Ambulance Services, Inc. 37.88 4 Carlisle Imaging Associates Services 5.93 5 Pine Street Podiatry ~ 9.00 6 A. Z. Ritzman Assocs. 17.78 7 West Shore Medical Offices 12.74 8 PA Department of Revenue - 1994 individual tax due 47.84 9 West Shore ALS - ambulance services 61.95 10 Carlisle Pathology Assn., P.C. 24.66 11 Carlisle Community Ambulance 20.85 12 West Shore Medical Office 35.13 13 Carlisle Imaging Assn. 53.63 14 Carlisle Pathology Associates 24.44 15 Carlisle Hospital 139.57 16 ATS Medical Services, Inc. 222.50 TOTAL (Also enter on line 10, Recapitulation) S 784 1 (If more space is needed, insert additional sheets of same size.) Copyright (c 1994 form software only CPSystems, Inc. Form 15~ Schedule ((Rev. 1-93) REb' - 15"13 EX + (2-87) ~M No~N~s~A~~~OTF EEN~,~~~ANIA I SCHEDULE J ib ~'b BENEFICIARIE ESTATE OF 2195-0085 DOROTHY A. GAFFNEY SS# 172-O1-5695 01/20/95 ITEM NUMBER NAME AND ADDRESS OF BENEFICIARY RELATIONSHIP AMOUNT OR SHARE OF ESTATE A. Taxable Bequests: 1 Matilda Finn Sister 1/3 of residue 1242 Red Rambler Street Jenkintown, PA 19046 2 Ruth L. Reel None 1/3 of residue 3107 Harvard Avenue Camp Hill, PA 17011 ? ~ Harry D. Reel None 1/3 of residue 3107 Harvard Avenue Camp Hill, PA 17011 fir more space is neeaetl, insert atltldional sheets of same size.) Coovriaht fcl 1994 fnrm snftwarn nnhi RPC~.cf.me L.r - aenw _ . . ~ ,_ _ __,