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Home My WebLink About95-0090~,~-~~S-CX~io H,DS.tAa Rev. ?/a7 TriE/PMR a~ PERM~Ne,r x~ac aMc 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 16 200 ? ( • Date Fran eropoli, ' ect Division of Vital Records P.O. Box 1528 New Castle, PA 16103 COMMONW EALTH OF PENNSYLIMHIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH ~` ~:0~3 71 NAME as oECEOOrt lF•a. Meas. Len socwu sECURrrr nuws~n OF DERV ~,. Elwell L ~ El u E~ ~~~• ~~' ,, . : male , 164 ~2 - 1741 , G ,r- AOEILe,laNee„ unPn,rEM IaIDlII,D/Y OREDPawm aaRliIACEI'faA.aAO PIAOEOPOERNICrceaayone-,w~« ,armaw.w Man/Ie. = Der• Ilwee ~ M4re (Main.D•F'~•fI ssravo.gnOe°eerYl oT1ER p 4 8]. vta , Philadelphia. PA n..wl. ~ ENQIpIWe G DDA ^ ~ ^ ~. ^iso•arl ^ 1913 , eourrtrarDE,oH CRI:aDRO.TN-OFDERN fACElfYNAMEnm:++w°.~.r.rwn.on.n DecEOENroFNMPANICanGan RACE•A•rleallbaeRelMee,glele ae . Cumberland E. Pennsboro w® ,e.^Ilre..•warae.+. ~~ ~P ~ i G McMCaI.I+wblaeel~ao. wh • te ,a DEC~wra occw~Rlw,wwD IaNDOF au6EEaSmIOU.4IRV Ee s ~ ~4 armmwosrauc a rea.aemr aoe u.8 D PI •ee PrnlrOr+nemel ••a+•E.umea °+.."~.u.i °Nar°"+o.a" re. €;J w^ e ` ° `° s .I , lIl'a t, ~ a Retail ,: ,., widaaed /{ . DECmer.ra.w,w~DDnEae~...ec„+~.,.sr..mcmx a Pennsylvania bower Allen """` 01 "`® "' OioiO""M 0` 1936 Chatham Drive , K.r,,, ~ i +•~ MCamp Hill, PA 17011 a ~" ~~ Cumberland ,,,,,,,a,(P, ,~,Q.~~~a /1ENEA'S NAME FAL Mean Lrq NAMEIF.,I. M~ea.. Mreln SvAema William Burton Leinber V' inia Mae Care nPD,r-AMtsMAME(rrP•~AA9 urine J• ~~~' METNOO Dw~onlD•, uPDawrra MAEa+DADOREaaRra. (%eM~er°. srr. LpDOOn 27 Chestnut St., t. 2, Mt. Holly Springs, PA 17065 DREDPOMPOa,gN PIADEOPOMPOMroN•Nrra anrnr. °inM""Oni"1Y°'~ •~M~•waw.avcaa -; , eaw^ •D•AMaI arl.I® cnol.eo•^ R.eb.ar ~ A ~^~••~ ~++•°~+«~ ^ ~-~(!i-9~ Rolling Green Memorial Park Lower Allen 7tap., PA Y7U11 a,w L~ENSEE•D"PENSONACraK+Aasuw NLMaEA ""'EA"D"DORESSOfApL1^'Parthemore FlIIleral Hcme Inc. FD 012 849 L rl~Ia aYl~iraa~inr ene.ra.~r~•°.~°~•.o•.e.a.oaa.wrn•a°+.ae.rwPM.•ar.a. tNtwe~n D~s(aNEo `iOT~ rer aa.w - Derr 1aer1 w~i+oa~wlwa..aal.M or DDUOa+a+°.Dweh.n wASCASEREFERREDroMEOICAIExAMINERICORONER, G ~- rr. ^ Iro fe. M. 70. lI.PM~k Earew aewKYyaNeaorprrarwtlell tlrOeell+. DO arr er Wrgw ulwan eeN M. Weq. surwrearara°•~Pf°•I•+-+•rl abcearal Whin. IApyleeYeey MRi M: OYrr•4°~.mlatfa~mr~i°OrAa4 Eu ~ ~~~ aeleWla `+~.wOwyYpriwy.w ie L ~ LL I {~ d~11~011 ~~ I,~,,~~ToR,y ~I ~~ ` ~ 1 Irl~gn ~~~~ L A ate 6gS1At-tCTIVE ~cl~t6. ~t74~£ ~ __ MI. ~ DUEroI(Xi A$A CDNSEOUENCE DFk ~ fJNNEpirreaeMle,. G n,l eiil,MC enae ° OUE roroR ASACOILSEOtJENCE OFj rwi14i+u•,IIN LAST ~ H11aAN AUR7PSV AIROP$Y f11Aa1fi3 MANNER DF OERN ORE OFMNJM TIME of IltR111Y W.AlRYRWORIf7 DESCAME /IOW eIRIRY OCCUtMNiD. PE/1PotilED, AMMLAREPRgR W luonn Deft wal OFCAtISE .-./ a DE/a117 PI,II•a Ld NombMe ^ Apgeea ^ Peltarp lm•d{Ya{p° ^ Iee ^ No ^ ... ^ Nod w ^ ND ^ sl+ae. ^ M. cawoaaal+«me~sa ^ PucearlN.lunv.klbm. Wm ,vr l.aa ale. wc~ . . . x noNtsrea.c,+wro.°°.srw aa,. zs ~ q. as (k+rNl ~ aa CMRIFIFII ~cA• a oM' o°°N . 'C6RVYMa-NYiIC1u/ IPnyenencemy.g w.ar.m •nen aranr a°ra~em Iw aawarwa arm arq canaaen can 23) Te M Oeel a •II Mtnwl..ye. beMl eeeu+rea e°n r a°•e•••NNre ea+•nr w ars ......................................... ............ ^ SKIILVU ° a+w '-IIONOINMpIp AND CFMIFYEq PHYSICIAN (PI°Y,A~aa Dom aaW°Ituq Oeeel etecelelyaq b Cauee a Deem( .~.e.aan„M,.~.a..ar°.~°.n.an.n....a...e.Plr...,°.a,.r.n«,n«•~.~.m.a,..ra.M. .......................... d C,~ ~ ~ ~ wvE SEMYE ~yI a, I t, NAME ANDADDIIESS OFPERSON WHO COMPLETED CAUSE DERH 'MaWCAL EkAYMEWCggNER Item 271 T ~ -i:., ~fr\ fT•a PfeN W- ` On aIe brM a eeemrrrn arelar IIIVMia•+r°°, r mY oW+°e°+. Aean oecurreO a Un Unle Are, an0 pree, aMdw to U+e eeur(•) arM mnrrrasaaw ............................................................ ................................... ^ re_ ' 1~1C~~yy.~1p lci~ ~~~ ' REGISTRAR'S SIGNATURE AND ~ 701~ aa. 2.1 QS `Sh _ CGt1 b. ~l ~ t DATE FlIFD(Mann. Day. Mebl C Z~J a.. / ~1.. 9 f r' v :.4":' d' ._ ,.. E'; ~?.i .. .i~ , la I'i~~-' ~ `~ c'n..:t e~T(J. .~l~G`1~ _.__ ____.._-______.- _ Register of `.Vials for the _--_---.-_-- .~, 1~e.~•ea~ed. County of Cutnuerland in the :'s~ •v ~ Se°ca;r=ty -'do. _'L.~~l- ~ ? - ~ 7 ~1 Ccmnlontivealth of Pennsylvania "~l~:e ,-~.:ri,<,~ i ahc n};derstgned respectfully represents that: 'c: ~, ~ ~~ t « (s), who i,/are l~ years of ale or older an the execu rlX ~ Weaned . ti;~~ 1.x t ~;+~ _: r;r:~ a;,ovr: decedent, slated -~e~tetrb~r ~~, 1 , l°-- --~, , ~ a di14 ~~. !state retcvant circumstances, ash. reruncistion, death of esccutor, etc.) z r^~ ~ r, ~ , C1.4tnb~rland ~ecc^.Ic. wa. ,-ton~.ciled .~~ c?eath in County, Pennsylvania, ti~zth ?~~ ` _._-_ i~:;t fL<.r,:iiy cr principal residence at ~ q~,~,_r,~a,~,.a,~~~yr~.~~.~ -~ - n~ z ~ w e,G ~c ~,sf 'lie w~Vat'tflP (lst street, ±~u:nbe;- and muncipality) r.'€~a`:'.1C~2ii? the:'t T ~"~ ~'CaaS Ot ar,.°., dlet'i ~c~,T'ii1~<.i~ ~ 2 ~ ~ 14 9~> '.:~:~~r. , ~.s Ftn.r~~ . dectrdent aid not marry, cues not divo~ ced and did not have a child born or ariopted :,firer r;te~~~uio:-, cS~ the wiPl offered for probate; was not t1~2e victim of a killing and was never adjudicated "'ta e°~~ t ,' ~: ~.ti 01•:_^.cd property with estimated valzles as follows: '' :';.nr_.--t, ..~' }.~ ~°u.) ill personal property ~ 30, 000.00 ;._ ,r~' ;~o:ri,:i.~~d ist F'a.~ 1?ersenal prop.,ry in Pennsylvania ~, _ -,. r_: ~.ir; tx, ;n °a.1 Pgrsonal property in County $ <1~~.. ,~: rR<:` r;~ta.2.. ir. 1'cnrtsylvania $ -~ ..'~±:=.te~ ..., ^13ot;: '? ra'~~ +^it.c^~,fih,~m ilri v_n~_Cr,.~Tl~r?1 ~.F_r a~ 't ~0_~ ~ "."~''-?==;'I::~:;I<~, petitoner(s) respectft!Ily request(s) the probate of the last will and cosiicl(s) -.-...-. - ..-.s~~it;~. __nt~ the ,rant of letters~l'£'st~m~t?t~•~v -_-- (testamctuary; ~dminist*ation e.t.a.; 4~tninistratSon d.b.n.c.t.a.? ~' i 4 J 7 d ;q~'- - '; ~ ;` ~' ~~ t Vi+~ERLAi~dt~ :; lip s~°:t:i~;:n~r!s) ~bo~vc-named swear(s) or affirrxl(s} than: tine statements in the foregoing petition arc t, } ~rc cv rYct co tlic l~.st. cf the knowledge grid bwF of petitioner(s) and that 2s personal represen- .,.. ~~ 4 _!s, e r_ aboti'e decedent Petitioner(s) will eve a d truly ad.tu~nister the estate accordiry~ to~ law. ~~ '"~?t ;:, .C~iZT~, c.P.,`I S1aJSCrlbed ~~ t - t /~~Fl^ da ti of ;, r f ~, i1 ~r I - ' ,, ~ __ _ ~ _,~~5,,-,~~~,t _ ~:~_~ .. I psi T C ~,.,....~,,.. ry ~' R_ ~~ I f y~. ,- _ ... ..... _ Y ." a,~~RY >' - ~5 - r ~%+~"J .ate.'. L.r ~s S.r+:~a~Y`~..~~~a ~'~`.~ .,,>..;~ I•,,~''.;`;~ ___. ~EiInUARY 6, _~~_ i9~~ , it conss~'~ratiorz of the getixi~~n ~a: ±i.., ,~ti~rr;~w °%c'~ ',.r~r°^F, .-€asf~ctcry ;~rnc~~ ~avi~~ is~n pr~s~r~2ec? be±'are ~,ze, . 's:y .,. - _~~.i~ tilt.t f~?^, i~~~"r~cr.~te-;~~~~ .r<at:~c~_.. ~e~t:.~~n~Fr $, 1 99~ .-~.. _;[ } ° ;:~:_ s ~z ?c~~iRt^'.:~ 2C9 ~}rC~',!~i.~ : t1G ~~ii~`l~ Ca :'~CC:~x'Ci ?5 :)4& ~S£'~Sk 'rV)(j C)Y _ ~..~~ ;~"3~~~; '''Ili::1C'~';P.ci'i ............ .... :.i _.,. ... ... ... F ... .. ...... .r~ `"~ - ' ~ ~N . _._ ~`ry f tt: . ~ ~ r , ' f .~ x: r ~'ro ° ~..a /~ h '~~~ ~~ - cat,~t~ f 4x~~Zi~ ,, o tr I~l~~i t~ . ~ ~ t~ ~ J AT'1'ORAFrY (Sup. Ct. d.D. 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Y,.f' ~T~u"~'k°'3.Y~T~`',x~»..~ t k'~:~:lt:rY. ~ka''3~vy Fl%~?'.d iS 3~'s~sT~.t+l~t S4D 4.~G' ~i~~,C~iflc'.'i~~'JS ._ ,, x + ~. ~.Y";~i~ ,,t,,.:iA w1',a .w:~ ~?:.s.~ v. 1. "." t'•ASt,'~'9 ~"~rY~ fi~S ~'~'~~7~7 SG~if)w.iai ~ $1!S~i~s ,. - ,.,. r r ~.-. .. ., ... ~. 1. ~.~~. P l"'i~C ~:. ..:• .s. -:: t. ~1..y <...~ ~"^.~ wV ~: Al ~~'.~~y.A,v9 .I..i.3~~: „ ._ _. 1:~, ;,,.~ .. ~ - .y. .. i n~ ~hf3" A~ ~ a~v~}~ F ~r ~1.~ ,. J- JP/ .f , sworn or affirmed to and acknowledged before me, by EL"e~VELL L. '.F..a;~~Ln.~~Li?, tine Testator, this $ day of_ S~~ ~~ , 1994. '~.ed,, s`aled and publis'~ed and declared by the above-Warned Testator as and for <aA:~:.~<: 'i;s%i .s:~~' ~'est~rn:~t, in t~;e sight and presence, who at his request, in his sight and rP•~•~~~:;c, ;:n~:° 3=; tiac sight and presence of each other, have hereunto subscribed our names as ~~11~71v~fiC~. ,n'' ~"iTIQESS ~avrT~ss ~®~rii~Ia€~;~~ ~ n..~'S.L, ~l~ P~2~P3sYLVt~.~ ~c~r ~~ x~~.~ ss. 3TJe, tine undersigned, being the witnesses whose names are signed to the attached „~13°cre~;eir.L z'~•.str!?rr2ent, being duly qualified according to law, do depose and say that we ~E~ere prese~?t aFZd ~^.qr~ tl~e ~'estator sign and execute the instrument as his Last Will and Testament, that h.e si~-n r~3 it ~~,,f~ia~gl~r and that he executed it as his free and voluntary act for the purposes tJaerein 5 \ >~. ~' a: ;>~ vj~; `C: ~P ~''Ya ~_ y: t' . \'~ ~~. . ~ r F-.. ~.,: s, ,. 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Z'QC~Ul~'P.Ci ~J~ _ C-,. ::,"' ^.t::% :it:.?.~S ` :: `Jl}L$: '?iZZ 25 H7c?.S S'~'!'472rt OIZ Or mai.iecl t0 . ~ 1 f , . .' ._. ':~-'~.,_~' t ~.?" 1_k?:^a Cf G~P e?.~O'TQ-0~~~ ? O714?~ 2S'tc3t@ OF1 -- .. <, -~, ~ r' ~ `- <..... ._., .._.r ., ~ ,~:_ ?3v ~~~~_:r>an ~r~.v~:r ~ux:~p SST iir z~~~ 1x011 ~` ;~: i i ~ .:<;; z., ?~; -~.~ :•.,-~~,~~° CT;.ai?~.i ~ , X27 ~a~t ,a rind ± ~c~; ~s~c~aana.caburg Pk '! 7'055 c. ". ~. f. ~ ...:?'?.11'~O~ _r'lI'>? :.`QIi~L~` 5~ E''•c:S~' ,.`'.Cc ~,.i. .~~ I ~'~~CI?.e?,.I13.C$bl.d.~"C~ P['~ _. __._._._ M._._.__--~__. .__..___. -_.____.~._ - _ 1 7055 _L.''., t1 .. , .. - ...ia aJ. ~'~Sa. ~::~=%.a~JS?S E'P~ii.14-'r: .. L .L-~%O l):'3`..'Ei t'_.... j t / ~.. __..,__.~._._ ~~ ~. ~ e3CU_O ~f/ •" 3 '~ J1~ ° ~ r , f /, ~ r r ~ ~,~ ~ ~ ,/ ~ss Suites 3, 2'~2?1 Gett,tsburg ROad .°" aecir 3 ~,, . ,s a;,. ' Ca;c;~ Hi1'., P~nn~ylv~n.l.a 1 7~-1 S V r ' ~ _ ~ ~ r.1~.~° ~~t~ ~ ~~ t ~r e ... , '~f? ~. Q p^. Yl O I3° s~ s ~~ ~s ~ ~ -° ~ ~ ~ ~ ---- ~" ~~ r . ' _. ._ .~ Pnc~'^.~.O~1~~ T'~:'~1iC'~'S~'31`LEtt.'`'^? ~~:~S~:iC~~,~'~'• ~~fi -- .. ... , _ ,:~c1 ~. - ~ ~ f _ ~ ~~ ^ca~:zr~~:1 f ~:~ ~~~r a.re~.i ~ . ~~ ;. "~: 'r ~~ ~:~~ ..l . a Y m~ ._ ~ r - ,,. ~ ~ :`a' ~ ~ t :?."~"I~7~? C~' I~C'!'IC~ L~Tv~ER RULE 5 . 6 (a ,~, ` . ~ : r : -:~: . ~t .~ ~ I i ~! _ ~. c ,,gigg ` a uirad ~ t rec t l i i ` r j .Y `~ y ~ eres n a ~y ~k-±~:~~. ~~o `rce o~ ~ene~ j_c ~~ c ry_ a _ L "-;~'~ ~~' t;o~~r~. °~u~.es was sex'vea oz or mailed to . . .~. ~- ~. e ~~bcv~ ca.~tione~ estate on ` p r ~- e~. ii.~, F:.. AaCd~~PC3 S+~7 ^~ ~ ~_ ~ ~ :; e.~_ i 33~i Ck~atham Drive ~ Ca.mS~ Ri? 1 PA 1701 1 A-~~ ;~ ~~: _ .~ _ ...~ 4.: L.ni ::_';~~:a ~~' r ? 335 Ch~.t~axn ??river C~Tr~n Hill, P~'~ 1 701 1 ~~,:: j;~"' ty ,327 Last Brindle Ralf Alechanicsbuzg Ph 17055 ~ .~~~_.qer lir~•in:i ?: . ... _.._ _.. .~ .._ . .,, -•~,; t- ~- ~ ~ 5 ~-~` T<:.as.n St. t~ecnanicsba~~: PA ,.. _ ...... _ iI'_~3,s lr!3 ..,rJ?Ti~ r 3Fsc'l.a w i ~ ~ "'' ._.-_ -_--._ ___._._ _.___._ ---- 17055 ~~C`'= A.t_ >= ii~.x~ i~ °':;?r.:'"z ~i~TT~?Xl to ali persons entztled thez'et0 under ~„N r~°. _. ,, ` ; ; j _ ~ c ,:w, _. T 1 l..:_ r C~5 C/ .s _ de:, "'S .~.~ i e Stever 3~owell, Esquire .Address Suite 3, 2929 Gettysburg .Road Camp ~iiil, Pennsylvania i?011 ~ele~s%?onea';~~ 737-890 Cao~-~cityz ~e~sonal Re~xesentative X Cc~un:~el for personal represents~tive ;,;.', -` ~,. ~ . .~~' w~ "'"-= '"' ~ ,, h ~;t ,: f.. ,,....,,:; '.ii. y~ _ i3. '~Yk ,~~k7j. •K '~^ '<fr '~^T~~+lf ~c _ _ _~ _- ~~ ,,.:.. , ~~ r ' 7,°~~j aCE C3N ?EI~~F ICZF~L FI~TEktE57.' TN F,ST,~TE 3•rO~'L '1'z~~ R.a'JrS"e.`~~R OF k+3i.LL5, COUNTY OF CU13F3ERLAND PENNSYLVANIii T 5~. YE Este:.'. ~~ ELr~°;ELL ~,. LEINk3ERGER , deceased, -'~, -_~',~ „t?~P~ - __v=~T'~'-~~Gisit ---- (benefi.ciar'Y) rr,-~- ~ r, ' <<. - (address ) --r 5,27 vast a'rindle Roan, Mechanicsburg, PA 17055 ;?lease take notice of the death of decedent and the grant of _L.=~tf~~=:~s to t'r~e }.~nr_s•onal representatives} named below. You may ha~re ;~,~,;~=~:tic.~;~' i,T,~veyest in th4 estate as fellows: .e :' `j ?. i'µ 'i ~, t:t~ ?I?closea Last x'11.11 and TL-?.~ita.ll~eni:. ~ ~4 ^ahare -- C~.-~11 ':?zd~-~:'">'C:~°_ ~.ri persona proper y eXCept antiques) . ('_x addijwion.~~ space is needed, use back of page) t~<azr~ of decedea~t_Elwell L. Leinberger - - :~~~~t. r-now•~ ~c.',ciYe,s. 1Q35 Chatham ?rive, Camp Hill, PA 17011 -______ .""-date Of d2at;1 ,i~,Ti~ ~ - dace of c~c:=Ftt~ ?poly St~irit Hospital 21 st Street, Camp Hill, PA 1'7011 Cou;:tV of crr!rn of original letters Cumberland County __ D^,c-:e d.-gin;-. c ea ~ tostatP intestate. ccnZr of- the ryi i ~ is is not attached. name (s } , address (es } and telephone number (s) of all personal Yspresentative appointed ~..tt„e Address Telephone L«~aYtr~~v ,,; r,~~~--z:berc~er, 1335 Chatham Brive, Camp Hill PA 17011 ,_- ~-~"'~ (71 7 } 975-2320 --- „~: -- ra - !~ _v U ~J C7 _ i.~.l ?t.^_ 'fi't ..r,. - I ~ s: r t"', -x <. Y ^_ l i L, ~, U,~ ~ ' ~ ~ "v -_ ~~ -~, ~,~. { ..r . #- a W tMr, y1. r .. -. ,.... .. .. ~'4?~. iii: r~%3 ~, t'~ 'I .. .. ~ .. ~ +~f~lh` ,. /-~?i;1~', d + i r,~ .Y~~ riti~,"~~ .:+1~-a~i ... ..' r........ ... J' ...e.rjb'~.L ........ '....... .',.... _... __ . .............i..,..,,.~. ..~...~ ...~.~~~.ai. ~ ..~.~~ ~• ai.??^tiab:? L j ,`~r .'. C3 2`~!~~'.Y51 ~. a t"„~~Sill?:'K1 _ a Ct ~4 a!~x~ ~. ~i.T ? __.r..._.. _ _.~ ~7 (7 .ll. 7 ~ f~ ~:, ~~+i dt ~"t 1.+_.~..~~r.._ ~:'~ ~.1.:. r~.. 1r, Y. .Z ; ~ ~'~ J' '1 ~. 7i ~"` ~'i-~63^ .~~ ~ ' i~ fi i ; r:1 '~ S rJ 11 4 . f 'i v Z' ~ C-° G ~ ~~ _~ ~~ , . . . . .. ' w ~ ai ~~` ~? ~ ~ (7 ~: y sf I i ;', F i r;~. ,w; ,. ;. F ~ { ~ J , ~ * f r1'' %o °~ . ~~~~`~ REV-tsoo Ex+ ;,~•ytl n/ "~ ~ t ~ ' ~q[4gTHAFfiR 1S/31I91 CHEEK HERE ` ` INHERITANCE TAX RETURN ~ :~ ~ ^ `~~ s~~~Ep RESIDENT DECEDENT iiLE NuMSER COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE PTO BE FILED IN DUPLICATE 21 9 5 0 0 9 0 DEPT. xeosot H R .WITH REGISTER OF WILLS A RISBURG, PA t7lze-oboe COUNTY CODE YEAR NUMBER AN MI 1 I W Leinberger, Elwell L. 1936 Chatham Drive o s u SOCIA SECURITY MBER DAT OF DEATH DAT OF BIR H Camp H 111, PA 1 7 01 1 W 164-12-7741 1/12/95 9/24/13 ° Cumberland co~~ ~ ~ ~ 1. Original Return ^ 2. Supplemental Return ^ 3. Remainder Return f d f 5C Y ,vo.u ^ 4. Limited Estate ^ 4a. Future Interest Compromise ( or ates o death prior to 12-13-82) ^ 5. Federal Estate Tax u ~ m (For dates of death after 12-12-82) Return Required o. ®6. Decedent Died Testate ^ 7. Decedent Maintained a Living Trust Q 8. Total Number of Safe Deposit Boxes Q (Attach copy of Will) (Attach co of Trust I W z Steven Howell, ?:sguire Suite 3 ~ ~ O Z 2929 Gettysburg Road TELEPHONE NUMBER O Camp Hill, PA 17011 ~ 717 737-8690(voice)/8695 (FAX) 1. Real Estate (Schedule A) (1) $ 6 6 , 0 0 0.0 0 ,~ ~ ~ ~ ~ 2. Stocks and Bonds (Schedule B) (2) $ 0 • 0 0 ~~... - ~ ~ tD 3. Closely Held StocklPartnership Interest (Schedule C) (3) $ 0 • 0 0 ~?~' ''+~ ~ ~. 4. Mortgages and Notes Receivable (Schedule D) (4) $ 0 • 0 0 ~ ~= ~ ~ `~ ~ ' 5. Cash, Bank Deposits & Miscellaneous Personal Property( 5) $ 2 , 6 71 .0 $ ;_ ~., , , , ~. t\t "?, ; Z (Schedule E) ,~~ ~„;~ 6. Jointly Owned Property (Schedule F) (6) $ 4 , 0 6 5.0 2 ~ ~ ~, g ~ 7. Transfers (Schedule G) (Schedule L) (7) $ 0 . 0 0 ~ ~ ~ - ~' o F- 8. Total Gross Assets (total lines 1-7) (8) $ 7 2 , 7 3 6 .1 0 W 9. Funeral Expenses, Administrative Costs, Miscellaneous (9) $ 2 0 , 7 2 6.9 2 ~ Expenses (Schedule H) 10. Debts, Mortgage Liabilities, Liens (Schedule I) (10) $ 3 , 71 5.4 0 11. Total Deductions (total lines 9 & 10) (1 t) $ 2 4 , 4 4 2 . 3 2 12. Net Value of Estate (line 8 minus line 11) (12) $ 4 8 , 2 9 3.7 8 13. Charitable and Governmental Bequests (Schedule J) (13) $ 0.00 14. Net Value Subject to Tax (line 12 minus line 13) (14) $ 4 8 , 2 9 3.7 $ 15. Amount of line 14 taxable at 6% rate (15) $ 4 8 , 2 9 3.7 8 x oe . $ 2 , 8 9 7.6 3 (Include values from Schedule K or Schedule M.) . 16. Amount of line 14 taxable at 15% rate (16) 15 = $ X 0.00 O (Include values from Schedule K or Schedule M ) . a . 17. Principal tax due (Add tax from line 15 and from line 16.) (17) $ 2 , $ 9 7 ' 6 3 ~ 18. Credits Spousal Poverty Credit Prior Payments Discount Interest a ~ + + - (18) $ 0.00 ~ 19. If line 18 is greater than line 17, enter the difference on line 19. This is the OVERPAYMENT. (19) $ 0 . 0 0 ~^ ~- 20. If line 17 is greater than line 18, enter the difference on line 20. This is the TAX DUE. (Y0) $ 2 r 8 9 7 . 6 3 A. Enter the interest on the balance due on line 20A. (20A) _~ 0 . 0 0 B. Enter the total of line 20 and 20A on line 20B. This is the BALANCE DUE. (20B) $ 2 ~ 8 9 7 . 6 3 Make Check Payable to: Register of Wills, Agent ~~~tellll _._. nder penalties of perjury, I declare that I have examined this return, inducting accompanying scheduler and statements, and to the beat of my knowledge and belief, is true, correct and complote. I declare that all real estate has been reported at true market value. Declaration of proparer other than the personal representative is ~ don all information of which pr arsr has any knowledge. ATURE O PERSON RESPO BLE F F14NG R URN ADOR SS BOX Al O , FOX HO OW Oa DAT Shermans Dale, PA 17090 _lD ~ ATURE OFP RE OT IV DORESS DATE 2929 Gettysburg Rd Camp Hill, PA 1 701 1 „/„ ~~~ ~~ PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING A CHECK MARK (,~) 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, ~ x ~I c. retain a reversionary interest or .................................................................... I X -- ~ - -1 d. receive the promise for life of either payments, benefits or care? ....................... ~ ' x 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? ................................................. ~ X 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. REV•1502 EX + (12.85) P ~' SCHEDULE A ~ COMMONWEALTH OP PENNSYLVANIA REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT . ESTATE OF FILE NUMBER Elwell L. Leinberger 21-95-0090 (Property (ointly-owned with Right of Survivorship must be disclosed on Schedule F) All real estate should be reported at fair market value which is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Real Estate known as 1936 Chatham Drive, Camp Hill ,/ Cumberland County, Pennsylvania 17011 $ 66,000.00 See attached Real Estate Appraisal See attached sales contract and Settlement sheet. TOTAL (Also enter on line 1, Recapitulation) I $ _ 6 6 , 0 0 0 . 0 0 REV•1507 EX+ 14.86 t. SCHEDULE B COMMONWEALTH Of PENNSYLVANIA STOCKS AND BONDS INHFQITANfF TdY oCTllowl FILE NUMBER Elwell L. Leinberger 21-95-0090 (All property jointly-owned with Right of Survivorship must be disclosed on Schedule F.) REV~t50a E%+ ~3.94~ • ~ SCHEDULE C ~'' "~ CLOSELY HELD STOCK, COMMNHERITANCETAXeRETURNANIA PARTNERSHIP AND PROPRIETORSHIP RESIDENT DECEDENT Pieas@ Print or Type ESTATE OF FILE NUMBER Elwell L. Leinberger • ~ 21-95-0090 ITEM NUMBER .- DESCRIPTION VALUE AT DATE OF DEATH 1. N/A TOTAL (Also enter on line 3, Recapitulation) $ 0.00 (!f more space is needed, insert additional sheets of some size.) REV~15Q5 ER+~ (JA4) ' - r SCHEDULE C-1 '~ CLOSELY HELD CORPORATE STOCK C~~INHERTANCE~TAXRETURNANIA INFORMATION REPORT RESIDENT DECEDENT ESTATE OF Please or Print Elwell L. Leinberger FILE NUMBER 21-95-0090 A. Detailed description showing the method of computation utilized in the valuation of the decedent's stock. B. Complete copies of financial statements or complete copies of the Federal Tax Returns (Federal Form 1 120) for the year of death and 4 preceding years. C. Statement of dividends paid each year. List those declared and unpaid. D. List names of officers, salaries, bonuses and any other benefits received from Corporation. E. If the Company owned real estate, submit a list showing the complete address/es and estimated Fair Market Valuels. If Reol Estate Appraisals have been secured, please attoch copies. F. List principal stockholders at date of death, number of shares held, and relationship to decedent. G. Any other information relative to the valuation of the decedent's interest. 1. Name of Corporation N~A State of Inc. Street Address 2. 3. 4. 5. 6. 7. 8. Date of Inc. City ~ State Zip Code Total Number of Shareholders Federal 1. D. Number Business Reporting Year to_ (Same As Federal Form 1120} Type of Business Product STOCK TYPE TOTAL # SHARES OUTSTANDING pAR VALUE # SHARES OWNED BY DECEDENT Common Preferred Provide all rights and restrictions pertaining to each class of stock. Was decedent employed by the Corporation;: ^Yes ^ No If yes, Position Annual Salary $ Time Devoted to business Was the Corporation indebted to the decedentie ^Yes ^ No If yes, provide amount of indebtedness $ Was there life insurance payable to the corporation upon death of decedent$ ^Yes ^ No If yes, Cash Surrender Value: $ Net Proceeds Payable: $ Owner of Policy Did the decedent sell or transfer stock of this company within one year prior to death if the date of death was on or after 12/13/82 or within two years if the date of death was prior to 12113/82$ ^Yes ^ No If yes: ^ Transfer ^Sale N of Shares Transferee or Purchaser Consideration $ Date Attach a separate sheet for additional transfers and/or sales. 9. Did the corporation have an interest in other corporations or partnerships$ ^Yes ^ No If yes, report the necessary information on a separote sheet, including Schedule "C-1" or "C-2" for each interest. 10. Was there a written shareholder's agreement in effect at the time of the decedent's death$ ^Yes ^ No IF yes, provide a copy of the agreement. 1 1. Was the decedent's stock soldZ ^Yes ^ No If yes, provide a copy of the agreement of sale, etc. 12. Was the corporation dissolved or liquidated after the decedent's death$ ^Yes ^ No If yes, provide a breakdown of liquidation distributions, etc. Attach a separate sheet. REV~ISU6 E%+ 1592) ,~;>e~' SCHEDULE C-2 COMMONWEALTH OF PENNSYLVANIA PARTNERSHIP INHERITANCE TAX RETURN INTEREST REPORT RESIDENT DECEDENT ESTATE Of Elwell L. Leinberger Please Type or Print FILE NUMBER 21-95-0090 A. Detailed description showing the method of computation utilized in the valuation of the decedent's interest. B . Complete copies of finoncia) statements or templets copies of the Federal Tax Returns (Form 1065) for the year of death and 4 preceding years, including a balance sheet for the year of death. C. If the Company owned Real Estate, furnish a list showing the complete address/es and estimated Fair Market Value/s. If Real Estate Appraisals have been secured, please attach copies. D. Any other information relative to the valuation of the decedent's interest. 1. Name of Partnership N/A Federal I. D. Number (As per Form 1065) Address Date Business Commenced Business Activity 2. Decedent was~a ^General Ulimited partner. If decedent was a limited partner, provide initial investment $ 3 PARTNER'S NAMES % OF INCOME % OF OWNERSHIP SALARY BALANCE OF CAPITAL ACCOUNT A. B. C. D. 4. Estimated Value of decedent's interest: $ 5. Was the partnership indebted to the decedent? ^Yes ^No If yes, provide amount of indebtedness $ 6. Was there life insurance payable to the partnership upon the death of the decedent? ^Yes ^No If yes, Cash Surrender Value: $ Net proceeds payable: $ Owner of Policy: 7. Was there a written partnership agreement in effect at the time of the decedent's death? ^Yes ^No If yes, attach copy of agreement. 8. Did the partnership have an interest in any other partnerships or corporations? ^Yes ^No If yes, report the necessary information on a separate sheet, including Schedule "C-1" or "C-2" for each interest. 9. Did the decedent's interest in the partnership change in the year before death if the date of death was on or after 12/13/82 or if death occurred prior to 12/13!82 in the last two years? ^Yes ^No If yes, explain: IU. Was the decedent related to any of the other partners? ^Yes ^No If yes, explain: 1 1. Was the partnership dissolved or liquidated after decedent's death? ^Yes ^No If yes, report all the related information, including copies of the Sales Agreement and/or Settlement Sheet 12. Was the decedent's partnership interest solder ^Yes ^No If yes, provide a copy of the agreemnt of sale, etc. REV ISU7 EX+ (7881 ~~~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE D MORTGAGE5 AND NOTES RECEIVABLE Please Print or Elwell L. Leinberger FILE NUMBER 21-95-0090 (All property jointly-owned with the Right of Survivorship must bo diselos~d on Sc6~dula F.) (ff more space is needed, insert oddifiona! sheets of same size.) RE~.tsoaEX+I~.e'' SCHEDULE E ' CASH, BANK DEP051TS AND COMMONWEALTH OF PENMSYIVANIA MISCELLANEOUS INNERITANCETAXRETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF Elwell L. Leinberger (All property jointly-owned with the Right of Survivorship must be disclosed on Schedule f) ITEM DESCRIPTION NUMBER 1 1986 Chevrolet Celebrity Sedan (VIN # 2G1AW19R8G1294586) (see Attached Appraisal from QCS) 2 Fishing Club of America Membership Refund Please Print or TY~e BER 21-95-0090 VALUE AT DATE OF DEATH $ 2,031.75 $ 6.33 3 Internal Revenue Service Refund 1994 $ 133.00 4 Internal Revenue Service refund 1995 $ 100.00 5. Personal Property $ 400.00 (see Attached Property Appraisal) __ _!__ TOTAL (Also enter on line S, Recapitulation) $ 2 671 (/wach additional 8y~" x 11" sheets if mole space is needed.) RE V•i30V E%~ 117•dd) J~ ', ~yjV~ j1 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TA% RETURN SCH~DtJI.~ ~ JOINTLY-OWN~U P'ROP~RICY ' RESIDENT DECEDENT ESTATE OF Elwell L. Leinberger Joint tonant(s): NAME ADDRESS-__ _ _ _- A• Courtney J. Leinberger Box A10 B. ' William L. Leinberger C. Fox Hollow Road Shermans Dale, PA 17090 c/o Ursini's Bakery 5327 East Trindle Road Mechanicsburg, PA 17055 NUMEtiER 21-95-0090 RELATIONSHIP TO DECEDENT Grand-daughter Son Jointly-owned prop erty: ITEM NUMBE LETTER FOR JOINT DATE OA 1 TOTAL VALUE DESCRIPTION OF PROPERTY i OF ASSET ~ DECD'S Wo INT. DOLLAR VALUE OF DECEDENT'S INTEREST TENANT J INT ~ i ~ ~' A ~- 1992 _----_.----------------------_._..-._....__...-....._.__..__.- Farmer's Trust Bank _ r ' Account I 433 South 18th Street Camp Hi11, PA 17011 ;$ 6,335.79 50~ $ 3,167.90 Account #013-302310 I 2 B ~ 1992 I PNC Bank ! PO Box 8874 - Camp Hill, PA 17001-8874 I$ 1,794.23 50~ $ 897.12 Account #51-4003-7406 i _---_`~_^- TOTAL (Also outer on lino 6, Recapitulation) ~ S 4, 065.02 (Il more spoce is needed insert additional sheets of same size) REV~ISIOEX+ 1287) i. ~~ SCHEDULE G j COMMONWEALTH OF PENNSYLVANIA TRANSFERS INHERITANCE TAX RETURN RESIDENT DECEDENT 1 _ __ ~ PiEASE PR1NT OR TYPE ESTATE OF ~ FILE NUMBER Elwell L. Leinberger 21-95-0090 THIS SCHEDULE MUST BE COMPLETED AND FILED IF THE ANSWER TO ANY OF 7HE QUESTIONS ON THE REVERSE SIDE OF THE COVER SHEET IS YES. ITEM NUMBER ~ DESCRIPTION OF PROPERTY Include name of the transferee, their relationship to decedent, dufe of transfer. i ~ EXCLUSION TOTAL VALUE _ OF ASSET OECD. DOLLAR VALUE % OF DECEDENT'S _ INT. _ ___ INTEREST _ ~ i I NONE i I ~ I I i i ~ I I I I I ~ i ~ 1 I I ~ ~, I 1 I 1 I I i I ~~ j ~ i _ TOTAL (Also enter on line 7, Recapitulation) $ 0 ~ ~ ~ ~- --- (If more space is needed, insert additional sheets of some size.) RFV-1511 EX+ )7•BB) SCHEDULE H ~~~ FUNERAL EXPENSES, • COMMONWEALTH OF PENNSYLVANIA ADMINISTRATIVE COSTS AND IN RESIDENTEDC DENTRN MISCELLANEOUS EXPENSES Please Print or Type ESTATE OF FILE NUMBER Elwell L. Leinberger 21-95-0090 ITEM NUMBER DESCRIPTION AMOUNT A. Funeral Expenses: ~~ Parthemore Funeral Home $ 161.51 2. Pealer's Flowers _ $ 90.04 3. Rolling Green Cemetary/Memorial $ 762.00 4. Parthemore Funeral Home (Death Certificates) $ 14.00 B. Administrative Costs: payable to Courtney J . Leinberger 1. Personal Representative Commissions 1 6 0 - 6 6 -4 8 9 2 -$ 2, 9 0 9. 4 4 Social Security Number of Personal Representative: dear Commissions paid 1 996 2. Attorney Fees Steven Howell, Esquire 2929 Gettysburg Road, Camp Hill PA 17011 $ 6,524.04 3. Family Exemption Claimant Relationship Address of Claimant at decedent's death Street Address City State Zip Code 4. Probate Fees (See Attached Sheet under B-4) C. Miscellaneous Expenses: ~• The Patriot News $ 141 .16 2• Cumberland Law Journal $ 40.00 3• The Mail Room (Notary Fees) $ 2.00 4. Farmer's Trust Bank Research Fee $ 15.00 5• Mark Hilbert Appraisal Associates $ 250.00 6. Richard Cassel (Trash Removal) $ 855.00 7. Ensminger Appraisers $ 90.00 8• Steven Howell, Esquire (Deed Preparation) $ 125.00 TOTAL (Also enter on line 9, Recapitulation) $ 2 0 , 7 2 6.92 (If more space is needed, insert additional sheets of same size.) SCHEDULE H ADMINISTRATIVE COSTS B-4 Probate Fees Registrar of Wills 1. Filing Fee $ 250.00 2. Petition to Buy House $ 30.00 3. Filing Fee - Return $ 15.00 4. Filing Fee - Settlement Agreement $ 17.00 5. Filing Fee - Rule Absolute $ 15.00 SCHEDULE H C - MISCELLANEOUS EXPENSES 9. Realty Transfer Tax (See HUD-1) 10. Buyer's Closing Costs (See HUD-1) 11. Real Estate Commission (See HUD-1) 12. Notary Fees (See HUD-1) 13. Jack Gaughen Realtor (See HUD-1) 14. Disbursing Fee (See HUD-1) 15. Lower Allen Township Taxes 16. Lower Allen Township Sewer/Trash $ 660.00 $ 1,800.00 $ 4,620.00 $ 6.00 $ 250.00 $ 35.00 $ 682.03 $ 367.70 ' I- REV,151"/ EX ~ (1.97 ~ ~ • r` ~ .~, , , SCHEDULE i COMMONWEAUI/af PE Nfi SYIYANIA DEBTS OF DECEDENT! INNERIfANCE TAX RETURN MORTGAGE LIABILITIES AND LIENS Rf SIDENf DFCEDfNI ATE OF ------------- Elwell L. Leinberger ITEM NUMBER 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11 . 12. 13. 14. 15. 16. 17. Please Print or T LE NUMBER 21-95-0090 DESCRIPTION AMOUNT ALLSTATE Auto Insurance (1986 Celebrity) $ 234.20 Commonwealth of PA (Car Registration) $ 24.00 Ken's Service Center (Car Inspection) $ 37.10 CIGNA Insurance (Homeowner's Policy) $ 185.40 PENN DOT (Title Transfer) $ 15.00 Home Paramount (Termite Abatement on Estate Real Property- See HUD-1) $ 524.70 Susquehanna Surgeons (Medical Bill) $ 4.84 PP&L (Electricity To Estate Property) $ 238.41 Inners-Davis Associates (Medical Bills) $ 100.00 Capital Health Products (Medical Bills) $ 69.71 West'Shore Pathology (Medical Bills) $ 120.00 Bell Atlantic (Phone Service to Estate Property) $ 946.70 Pennsylvania American Water Company $ 148.09 Reader's Digest $ 145.09 Mellon Bank VISA Gold $ 316.08 UGI (Utility-Gas Service to Estate Property) $ 427.98 Ken's Service Center (Car repairs to Estate Automobil )$ 178.10 TOTAL (Also elder on line 10, Rocapilulation) I $ 3 , 71 5 . 4 0 (If more space is heeded, insert addifionol sheets of same size.) 0.E K'~s 17 Ex, 12-1371 /!wi~ER1~ COAV.~ONWEAITN OF PENNSYLVANIA INHERITANCE iAX RETURN READENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER Elwell L. Leinberger 21-95-0090 ITEM NUMBER NAME AND ADDRESS OF BENEFICIARY RELATIONSHIP AMOUNT OR SHARE OF ESTATE A. Taxable Bequests: ~~ Courtney Leinberger Grand-daught r See Q2of Wi Box A10 Fox Hollow Road Schedule E #5 Shermansdale, PA 17090 See ~[3 of Wil 2 Lane Leinberger Grand-son ' See ~j3 of Wil Apartment 308 1/4 2311 North Front Street Harrisburg, PA 17110 3 Casey Leinberger c/ W hi Grand-son See Q3 of Wil o as ngton Fire Company 1/4 53 East Main Street Mechanicsburg, PA 17055 4 William L. Leinberger c/o U i i' Son See ~j3 of Wil rs n s Bakery 1/4 5327 East trindle Road Mechanicsburg, PA 17055 ITEM AMOUNT OR NUMBER NAME AND ADDRESS OF BENEFICIARY SHARE OF ESTATE B. Charitable and Governmental Bequests: 1. ,NONE TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Also enter on line 13, Recapitulation) $ (If more space is needed, insert additional sheets of same size) L 1 an< L 1 /4 L L L REV~ISia E5. (3~9i ,. ..::,,, '~; COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT~DECEDENT SCHEDULE K LIFE ESTATEIANNUITYI TERM CERTAIN ESTATE OF FILE NUMBER Elwell L. Leinberger 21-95-0090 This schedule is to be used for all single life, joint or successive life estates and term certain calculations. For dates of death after 12-31-61 and before 5-1-89, actuarial factors for single life calculations can be found in Revenue Booklet (REV-15016). For dates of death on or after 5-1-89 actuarial factors can be found in IRS Publication # 1457 Actuarial Volues, Alpha Volume. The instrument creating the life interest is a: (Please attach a copy of instrument) (~ Will n Interviv~s Dwwrf of Trust n C7ttier Name(s) of Life Tenant(s) ~ ~ a Date of Birth Pressnt Age (Nearest Birthday) ~ Term of Years Life Estate is Payable NONE ^ Life or ^ Term of Years ^ Life or ^ Term of Years ^ Life or ^ Term of Years _ ^ Life or ^ Term of Years _ ___ 1. Value of Fund from which Life Estate(s) is payable :......................................................... $ 2. Actuarial Factor per appropriate Table ......................................................................... . Interest Table rate - ^ 3'/z% ^ 6% ^ 10% ^ Variable Rate 3. Value of Life Estate (tine 1 x Line 2) .......................................................................... $ Name(s) of Annuitant(s) • ~ ~ Date of Birth Present Age Term of Years Annuity is Payable (Nearest Birthday) NONE ^ Life or ^ Term of Years __ _ ^ life or ^ Term of Years _ ^ Life or ^ Term of Years _ _ ^ Life or ^ Term of Years _ 1. Value of Fund from which annuity is payable ................................................................. $ 2. Frequency of payout - ^ Weekly ^ Bi-weekly ^ Monthly ^ Quarterly ^Serni-Annually ^ Annually ^ Other 3. Amount of payout per period ....................................................................................... 4. Annual payment' ......................................................................................................... 5. Annuity Factor (see instructions) Interest Table rate - ^ 3'/z% ^ 6% ^ 10% ^ Variable Rate % __ __._ b. Adjustment Factor (see instructions) ............................................................................... ----- 7. Value of Annuity - If using 3'/z%, 6%, 10% or if variable rate and period payout is at end of period, calculation is: Line 4 x Line 5 x Line 6 ........................................................ If using variable rate and period payout is at beginning of period, calculation is: (Line 4 x Line 5 x Line 6) + Line 3. NOTE: The values of the funds which create the above future interests must be reported as part of the Estate Assets, Line 1 through Line 7. The Resulting LifelAnnuity Interest(s) should be reported at the appropriate tax rate on Lines 13, 15 and 16 as required. 2EV~16d4 E>;+ (3.84) INHERITANCE TAX SCHEDULE "L" COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN REMAINDER PREPAYMENT OR INVASION 21 -95-0090 RESIDENT DECEDENT OF TRUST PRINCIPAL FILE NUMBER I. Estate of Leinberger Elwell L (Lost Nama) (First Nama) (Middle Initial) This sthedule is appropriate only for estotes of decedents dying on or before December 12, 1982. This schedule is to be used for all remainder returns when an election to prepay has been filed under the provisions of Section 714 of the Inheritance and Estate Tax Act of 1961 or to report the invasion of trust principal. II. Remainder Prepayment: N /A A. Election to prepay filed with the Register of Wills on . (attach copy of election) (Date B. Name(s) of Life Tenant(s) Date of Birth Age on date Term of years income or Annuitant(s) of election or annuity is payable C. Assets: Complete Schedule L-1 1. Real Estate $ 2. Stocks and Bonds $ ____ 3. Closely Held StocklPartnership $ 4. Mortgages and Notes $ 5. Cash/Misc. Personal Property $ _ 6.' Total from Schedule l-1 $ D. Credits: Complete Schedule L-2 1. Unpaid liabilities $ 2. Unpaid Bequests $ 3. Value of Unincludable Assets $ 4. Total from Schedule L-2 $ E. Total value of trust assets (Line C-b minus line D-4) $ F. Remainder Factor (see Table I or Table II in Instruction Booklet) G. Taxable Remainder value (Line E x Line F) $ (Also enter on Line 7, Recapitulation) III. Invasion of Corpus: A. Invasion of corpus _ (Month, Day, Year) B. Name(s) of Life Tenant(s) Date of Birth Age on date Term of years income or Annuitant(s) corpus consumed or annuity is payable C. Corpus consumed $ D. Remainder Factor (see Table (or Table II in Instruction Booklet) E. Taxable value of corpus consumed (Line C x Line D) $ (Also enter on Line 7, Recapitulation) REV•1645 EX+ h.asl INHERITANCE TAX SCHEDULE L-1 COMMONWEALTH OF PENNSYLVANIA REMAINDER PREPAYMENT ELECTION INHERITANCE TAX RETURN RESIDENT DECEDENT -ASSETS- FILE NUMBER 21-95-0090 I. Estate of Leinberger Elwell L (Last Name) (First Name) (Middle Initial) II. Item No. Description Value A. Real Estate (please describe) N/A Total value of real estate (include on Section II, Line C-1 on Schedule L) $ B. Stocks and Bonds (please list) Total value of stocks and bonds (include on Section II, Line C-2 on Schedule L) $ C. Closely Held StocklPartnership (attach Schedule C-1 and/or C-2) (please list) Total value of Closely Held/Partnership (include on Section II, Line C-3 on Schedule L) $ D. Mortgages and Notes (please list) Total value of Mortgages and Notes (include on Section II, line C-4 on Schedule L) $ E. Cash and Miscellaneous Personal Property (please list) Total value of Cash/Misc. Pers. Property (include on Section II, Line C-5 on Schedule L) $ III. TOTAL (Also enter on Section II, Line C-6 on Schedule L) $ (If more space is needed, attach additional 8'/s x 1 1 sheets.) :Ev.i647 EX+ IIl.aal INHERITANCE TAX ~.•'~r",>'~. SCHEDULE M .C'.: COr~nMONwEAITH OF PENNSYLVANIA i INHERITANCE TAX RETURN FUTURE INTEREST COMPROMISE ~ FILE NUMBER .2.1=g~-.~_Q90 RESIDENT DECEDENT I. Estate of Leinberger Elwell L (Lose Nome} (First Nomej (Middle Inuiai} This schedule is appropriate only for Estates of decedents dying after December 12, 1982. This schedule is to be used for all future interests where the rate of tax which will be applicable when the future interest vests in possession and enjoyment cannot be established with certainty. n a---t~-~--~-- NAME OF BENEFICIARY RELATIONSHIP SEX (M~ Maie (F~ Female DATE OF BIRTH AGE ON DATE OF DECEDENT'S DEATH 1. 2. 3. 4. 5. III. Explanation of Compromise Offer: I V . Summary of Compromise Offer: 1. Value of Future Interest :............................................ $ 2. Amount of Line 1 Exempt From Tax ................................... S Inlen anfar nn I ina 1 3 RPmnitulatinnl 3. Amount of Line 1 Taxable at b% Rate .................................5 (also enter on Line 15, Tax Computation) 4. Amount of Line 1 Taxable at 15% Rate ................................ S (also enter on Line 16, Tax Computation) (If more space is needed, attach additional 8%z x 11" sheets) ~E~:.;o.r9 ~ ~ rr.o21 - ~~ • ~~ SCHEDULE N .~- ~~,,. ~'~~` ~~~ SPOUSAL POVERTY CREDiT COMMONWEALTH OF PENIJSYLAt•ttA INHERITANCE TAX DIVISION (AVAILABLE FOR DECEDENTS DYING AFTER 12/31/91) __ ESTATE OF FILE tlUM6ER Elwell L. Leinberger_ _ ______ ____ _ 21-95-0_090 This schedule must be cornpletod and filed if you checked the spousal poverty credit box on the cover sheer. .. , 1 . Taxable Assets Total from line 8 (cover sheen ..............j~.~.A............................................... 1 . 2. Insurance Proceeds on Life of Decedent .......................... ................................................ 2. 3. Retirement Benefits .............................. .... .. ....... ..........................._.. ........ .. ,3. r ._.._...----- __ ----. d. Jornt Assets wish S ouse ..............................._ _.................................. p j d. 5. PA Lottery Winnings ........... .............. _.... ...................._................ ~5 60. Other Nontaxable Assets: List (Attach schedule if ner:assary).. 6a.1 bb. t r ~ 65._i..._.__._...._ ..._..-~-------------- ~ bd. b. SUBTOTAL (Lines ba, b, c, d) .............................. 7. Total Gross Assets (Add lines 1 thru b) .................... B. Total Actual Liabilities ........................................... 9. Nei Value of Estate (Subtract line 8 from line 7),...... I! fine 9 is greofer Ikon 5200,000 • STOP. The eslole is not elig Income: a. Spouse ...................... b. Decedent ................... c. Joint .......................... d. Tax Exempt Income..... e. Other Income not , listed above ........... TAX YEAR: 19 6. 7. 8. .................................................... 9. to claim fire credit. If not, continua to Port II. TAX YEAR: 19 f. Tolah._~ ................. I tf.l ------ -... ~2f. ~ .. 4. Average Joint Exemption Income Calculotiorr 40. Add Joint Exemption Income From above: • ., TAX YEAR: 19 3f, -------- 4b. Average Joint Exemption Income ..................................................................................... _ ------- If line 4(b) is greofer than $40,000 • STOP. The estate is not eligible to claim fire credit. If not, continue to Part III. I. Insert amount of taxable transfers to spouse or $100,000, whichever is less .......................... 11. c. Multiply by credit percentage (see instructions) .................................................................. f 2. _ ___ ___ _ _ _ _ 3. This is the amount of the Resident Spousal Poverty Credit. Include this figure ~ in the calculation of total credits on line 18 of the cover slieel ................... ~ 3.i _ _ .................. a. For Nonresidents, enter the ratio of the decedent's yross eslole in PA to the vahre of the ' decedent's gross estate .................................. .. .. .. ..................... ,1.~ LAST WILL AND 'I'ES7'AMENT aF .. ELWELL L. I~EINT3ERGER I, ELWELL L. L.ETNBERGER, of Camp hill, Cumberland County, Pennsylvania, being of sound and disposing mind, memory, vid understandnig, do hereby revoke all other wills and codicils heretofore made by me. FI.IiST I direct the payment of u~y debts not barred by a statue of limitation and expenses of my last illness and funeral from my estate as soon after my death as conveniently maybe done. 1 direct my Executrix to utilize the cemetery lot owmed by me at the Rolling Green Cemetery in Camp Hill, Pennsylvania. I authorize my personal representative to purchase a contract for perpetual care, using funds fi•om my estate, in such amount as she shall consider necessary and desirable. Further, in tlus connection, I authorize my personal representative to expend funds from my estate, ui such amount as my personal representative shall consider necessary and desirable for the purchase, erection and inscription of a suitable marker for my grave. ~~ ~~~~~ sECOlvn I give and bequeath the following items of personal property: All antiques once owned by my wife, Evelyn Leinberger, unto COURTNEY LEINBERGER, my grand-daughter. TIIiRI? I give and bequeath all retraining real estate and personal property owned by me at the time of my death, together with all insurance policies naming any Estate as beneficiary, unto my son, WII,LIAM L. LEINBERGER, and my three grand-children, CASEY LEINBERGER, COURTNEY LEINBERGER and LANE LEINBERGER, to be divided in as nearly equal shares of one-fourth (1/4) each as is practicable, if they suwive me by thirty (30) days. In the event my son or one of my three grand-children should predecease nee, his or her share shall go to the surviving beneficiaries and shall not pass to a deceased beneficiary's children or spouse. r0 UR'TI I give, devise and bequeath all the rest, residue and remainder of my Estate unto my son, WILLIAM L. LEINBERGER, and my three grand-children, CASEY LEINBERGER, COURTNEY LEINBERGER and LANE LEINBERGER, divided in as nearly equal shares as is practicable, one-fourth (I/4) to each, if they sui•~~ive use by thirty (30) days. In the event my son or one of my three grand-children should predecease me, his or her share shall go to the surviving beneficiaries and shall not pass to a deceased beneficiary's children or spouse. i'TFTTI I direct that auy and all Inheritance, Estate acid Transfer Taxes imposed upon my estate passing under my Will or otherwise, shall be paid out of the principal of my residuary Estate. SIXTIi In addition to the powers conferred by law, I authorize my Executrix, in her absolute discretion: (a) To retain in the form received, or to sell either at public or private sale any real or personal property. (b) To manage real estate. (c) To invest and reinvest in all foi-~ns of property without being confined to legal investments, and without regard to the principle of diversification. (d) To exercise any option or rights arising from ownership of investments. (e) To compromise clai~i~s without coiu-t approval, and without the consent of any beneficiary. SEVENTH Any and all pay~neut or payments of any Burn or sums, whether in cash or in kind and whether from principal or income, shall be made upon the sole receipt of the respective individual to whom the payment is made, and free from anticipation, alienation, assignment, attachment, and pledge, and free from control by the creditors of any such beneficiary. All shares of principal and income herein given shall be free 6-om anticipation, assignment, pledge, or obligation of any beneficiary, and shall not be subject to any execution or attachment. 3 CPU-~~o~'- ~ 1 EIGI:LTki. I nominate, constitute and appoint any grand-daughter, COURTNEY LEINBERGER, Executrix of this my Last Will anal Testament. I Hereby relieve my Executrix from the necessity of posting any security or bond in connection with her duties as such in any jurisdiction in which she maybe called upon to act insofar as I am able by law to do so. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and Testament, consisting of six (6) typewritten pages, the first three (3) of which bear my signature in the margin for the purpose of identification, tli.is $_day of S~~„,~~~.~ , 1994. ~~E~,~~(SEAL) ELWELL L. LhINBER R. COMMONWEALTH OF PENNSYLVANIA COUNTY OF YORK Ss. I, ELWELL L. LEINBERGER, Testator, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will, that I signed it willingly, and that I signed it as my free and voluntary act for the put7~ose therein expressed. ELWELL L. LEINBERGER ~ 4 i SS WITNESS Sworn or affirmed to and acknowledged before me, by ELWELL L. LEINBERGER, the Testator, this g day of S~~~~,,,~, ~ , ].994. ~~~o w ~ Notary Public N~arfal seal 8erit T. Nowep, Ptt~pc FaiMew ,York My Commisslon~E~tres May 1 ,1997 mbar, Signed, sealed and published and declared by the above-named Testator as and for lus Last Will and Testament, iu the sight and presence, who at his request, in his sight and presence, and in the sight and presence of each other, have hereunto subsc •bed our names as witnesses. ~ , .~ ~ COMMONWEALTH OF PENNSYLVANIA COUNTY OF YORK SS. We, the iuidersigYied, being the witnesses whose names are signed to the attached and foregoing instrument, being duly qualified according to ]aw, do depose and say that we were present and saw the Testator sign and execute the insti•~m~ent as lus Last Will and Testament, that he signed it willingly and that he executed it as his free and voluntary act for the purposes therein 5 expressed; that each of us in the heaiy~ig and sight of the Testator siguecl the Last Will and Testament as a witness; and that to the best of our knowledge the Testator was at that time eighteen (18) or more years of age, of sound mind and iuuler no constraint or undue influence. Address: 2929 Gettysburg Road Camp Hill, PA 17011 Address: 2929 Gettysburg Road Camp Hill, PA 17011 ~. Swoni or affu~med to aiul subscribed before nle by the above named witnesses, this ~ day of ~{/ , 1994. Notary Public ~dotarial Seal Be1KT. HoweN, FCC ~ Car~irn~t , lrorft May 1 .,1997 6 WITNESS if PNCI~~N][~ PNC Bank N.A. No. ~- ~• Southcentral PA 040 '- . 1 , 60-12731 16 l.Jl.x~nwA. a 19~~ 313 PAY (~ ~ -Q- ~ ~ . ` . 4 0 ,, TO THE ~~-Q.b.A.JV~xn. ~ `~v ~J~.7''.t ~ ~ ~1~ 4~ \ ; .1 • ~3 ORDER OF ~ loo DOLLARS FoR PPc j-n.~nel t_~-x-~CQ It--,~ E TE OF ~ \,.]/V~'G.. l.2 1J /~ nor C-~s-~ ---- ----------- "" ~:0 3 L 3 L 2 7 38~: 5080 5 7 LO 9 Lii' r' ~ RE~~i500 EX+ (11.91) r r Z W W V W W a W d U ve.m a. Q I W z c°Ce o O z U O d J r `a d V W ae z O h F a O U x COMMC DI HAS <I 1~J~'~1~®~R~ ~'~ INHERITANCE TAX RETURN ~'~~ RESIDENT DECEDENT ALTH OF PENNSYLVANIA (TO BE FILED IN DUPLICATE MENT OF REVENUE WITH REGISTER OF >EPT. 260601 ~ ~c ~~~ WILLS IcouNnr coDl: 21 LEINBERGER, ELWELL L. OCTAL SECURITY UM6ER DATE ~ YI 1936 Chatham Drive Camp Hill, PA 17011 95 ~qG 1 64-1 2-7741 11 /12/95 19/24/1 3 COYOty ^ 1. Original Return X~{ 2. Supplemental Return ^ 3. Remainder Return (for data: of death prior to 12-13-82) ^ 4. Limited Estate ^ 4c. Future Interest Compromise ^ 5. Federal Estate Tax (for dares of death after 12-12-82) Return Required ^ b. Decedent Died Testate ^ 7. Decedent Maintained a Living Trust _ 8. Total Number of-Safe Deposit Boxes (Attach copy of Will) (Attach coat/ of Trustl Steven Howell, Esquire :. Suite 3 TEIEPHONENUMB R 2929 Gettysburg Road 717 737-8690 Voice Camp Hill, P~~1011 ~ ~ ~~ 1. Real Estate (Schedule A) { 1) - ~ ~', 2. Stocks and Bonds (Schedule B) (2) Z+ ,= 3. Closely Held Stock/Partnership Interest (Schedule C) (3)- - ^~% - _ 4. Aortgages and Notes Receivable (Schedule D) (4) _ ~I .. _ . -` ' t :ash, Bank Deposits & Miscellaneous Personal Property( 5) $1 5O . 45 (Schedule E) ~ "~~ .. ' fo ,- ~y I c. ~inlly Owned Property (Schedule F) (b) s,.tl ~ ~ Cxr = ransfers (Schedule G) (Schedule L) (7) 8. folal Gross Assets (total lines 1-7) (8) / S yf~s 9. Funeral Expenses, Administrative Costs, Miscellaneous (9) Expenses (Schedule•H) lU. ()obis, Mortgoge Liabilities, Liens (Schedule I) ()p) 11. Total Deductions (total lines 9 & 10) (11) 12. Net Value of Estate (line 8 minus line 11) (12) _ ~~ ,~ ~ ~~' 13. Charitable and Governmental Bequests (Schedule J) 14. Net Value Subject to Tax (line 12 minus line 13) (13) (14) 15. Amount of hne 14 taxable of 695 rats (Include values from Schedule K or Schedule M.) (15) _ ~ 1 5 0 4~ x .Ob = $ 9 . O 3 16. Amount of line 14 taxable at 1595 rats "' (include values from Schedule K or Schedule M.) (16) x .15 = 17. Principal tax due (Add tax from line 15 and from line 16.) (17) ~~ ~~ 18. Credits Spousal Poverty Credit Prior Payments Discount Interest 13 + .13 ~ + _ (18) . 19. line 18 is greater than line 17, enter the difference on lips 19. This is the OVERPAYMENT. (19) ~^ . 20. line 17 is greater than lino 18, enter the difference on line 20. This is the TAX DUE. (20) 8.90 A. Enter the interest on the balance due on line 20A . B. Enter the total of line 20 and 20A on lino 20B. Thi s is the BALANCE DUE. (20A) (206) _ S 9 0 Make Check Payable to: Register of Wills. Aa.nf ...,aor penairies or psrlury, I declare that I hove examined this return, induding oceomponying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. 1 declare that all real a:fate 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. SIG TURF OF PERS N RE fl N RE R DDRE 5 1910 Spring Road - Rear, Carli~l~ DATE / P R E AD SS ` 2929 Gettysburg Road, Camp Hill, PA 17011oaT 2 'LEASE AN5WER THE FOLLOWING QUESTIONS BY PLACING A CHECK MARK (~) IN THE APPROPRIATE BLOCK5. Did decadent make a transfer and: a. rei~_~i~i the use or income of the property transferred, .................................. b. retain the right to designate who shalh use the property transferred or its income, c. reluin -~ reversionary interest or ......... ........................................................... d.. receive the promise for life of either payments, benefits or care? ....................... '. 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? .......... ....................................... ~. Did d~~:~dent own an 'in trust for' bank account at his or her death ...................... !t~ THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, fOU Nt ST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. .. r~ t ' s Estate of Elwell L. Leinberger PA Number 2195 - 0090 Cumberland County Number 1995 - 00090 Social Security Number of Decedent 164-12-7741 Supplemental Information Pennsylvania Inheritance Tax Return Amendment of Schedule E (Personal Property) 3. Internal Revenue Service Refund for 1994 $283.45 **** PLEASE NOTE THAT THE VALUE OF THE 1994 INTERNAL REVENUE SERVICE REFUND FOR 1994 WAS ESTIMATED TO BE ONLY $133.00 ON THE ORIGINAL INHERITANCE TAX RETURN FILED APRIL 12, 1996. THE ACTUAL REFUND WAS $283.45 FOR AN INCREASE OF $150.45 TAXABLE AT 6%. THE AMENDMENT HAS BEEN REPORTED TO THE POST ASSESSMENT REVIEW UNIT OF THE PENNSYLVANIA DEPARTMENT OF REVENUE. **** • /- COMMONWEALTH OF PENNSYLVAN7' ' DEPARTMENT OF REVENUE 'BUREAU OF INDIVIDUAL TAXES `~ INHERITANCE TAX DIVISION INHERITANCE TAX DEPT. zaoeoi STATEMENT OF ACCOUNT HARRISBURG, PA 17128-0601 REY-107 Ex ,F- (OS-7i) DATE 09-03-96 ' ESTATE OF LEINBERGER ELWELL L DATE OF DEATH 01-12-95 FILE NUMBER 21 95-0090 ' COUNTY CUMBERLAND STEVEN HOWELL ESQ ACN 101 STE 3 Amount Rseiittsd 2929 GETTYSBURG RD CAMP HILL PA 17011 MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, subeit the upper portion of this form with your tax payment. CUT ALONG_ THIS LINE __-__ RE_TAIN LOWER P_ORTI_ON FOR YOUR RECORDS __~ ______ REV=1607 EX AFP (03-96) ~~t3~ INHERITANCE TAX STATEMENT OF ACCOUNT ~t~tx -"-------"-'--- ESTATE OF LEINBERGER ELWELL L FILE N0. 21 95-0090 ACN 101 DATE 09-03-96 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPIICAHLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 07-29-96 PRINCIPAL TAY DUE :....:........................._............_......_._.................._......................._........._.._.._._...___.......__....__......._.....__._._._._......_..._..__.. 2 , 8 9 7.6 3 PAYMENTS CTAX CREDITS): PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST C-) AMOUNT PAID 04=12-96 AA112730 ~ 13Q.98- 2,897.63 08-09-96 AA146612 3.85- 134.96 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. * IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS .LESS THAN O1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A ''CREDIT" (CR), YOU MAY HE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) 2,897.76 .13CR .00 .13CR ` d ~^ /~ ~^v 4 , pennsyLvania j 1, j DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX REV-1607 EX AFP (12-14) INHERITANCE TAX DIVISION PO BOX 280601 STATEMENT OF ACCOUNT HARRISBURG PA 1712s-o6RECORDED Ci FILE OF REGISTE". CF WILLS DATE 02-09-2015 BE HIS FEB 17 Feil1 14 DATEESTATE OFOF DEATH 01LEIN-12-1995RGER ELWELL L FILE NUMBER 21 95-0090 C LL F,', C F COUNTY CUMBERLAND HOWELL ESQ0RpH!�-,TFVEN ACN 101 STE 3 & A R E P Amount Remitted 2929 GET URG 'RD ''-' - - ' ' I CAMP HILL PA 17011 1 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 4- - ---- ---- ----- - STATEMENT I TAX Ti O� ACCOUNT k ii--1 i i f l3k-AFP (12-1k)-----*;;-INHERITANCE: ESTATE OF:LEINBERGER ELWELL L FILE NO. : 21 95-0090 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: 04-21-1997 PRINCIPAL TAX DUE: 2,906.66_ PAYMENTS (TAX CREDITS) : PAYMENT RECEIPT DISCOUNT AMOUNT PAID DATE NUMBER INTEREST/PEN PAID 04-12-1996 AA112730 131.38- 2,897.63 08-09-1996 AA146612 4.13- 134.96 03-20-1997 AA185286 .00 8.90 05-07-1997 AA211272 .54- 1 .22 TOTAL TAX PAYMENT 2,906.66 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.