HomeMy WebLinkAbout95-009521-g5-0095
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 1 +6_ X001
Date
H7o5 1 M Rev. 1191
TYPE/PILWT ~ I N !q L
w
PERrANEwT
BLACKNB(
~~
2
? •
Fran eropoli, ' ect
Division of Vital Records
P.O. Box 1528
New Castle, PA 16103
COMMONWEALTH OF PENNSYLIMNIA • DEPARTMENT OF HEALTH • VITAL RECORDS
CERTIFICATE OF DEATH
(Coroner)
~.i14~1/~
NAME OR DECEDERT(F+. Ma,ae,lm) sEx sociusECUwTr ixlMBEq ~'••^•~^ DuvE OP DEATH (Mailb. Der. ltYr)
,. Leroy E Wittle ,• Male ,173 38 6395 ., Feb. 1, 1995
A~ILr B~•b•YI t1FIDEA,YEAR UypERl dlr DATE OF BIRTH BpLTIPLACE (CiYmC PIACEOF OF QHICMCkanN once-ses iiatructionmWr~
SYMaFOraipnCwrtY) IIOBPIOIL
MwaM Days Han MMAea
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M Cumberland Silver Spring µl20 Mountain Lane, Enola ~,w ~R~.~'"" White
• ,a
8 KIND OF YYLS OECEDE/IT EVERW DECEDENi'B EDUCIPK)N ~M/rIW NIMO•ee~ SURVNBKi SPOI13E
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DEDEDO,rs MAKiq ADORESSIS•eel CNy/town. srb.2ip Cea•1 DECEOEMrs ,7a ~, P a . ~ ,t
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e
°n°"""0i) 10. Cumberland * ,~.OwB~~+e~a
fN1ER'aNAME(Flr Mi0tlla, LaeD
,,, Eugene L. Wittle MOIIEA'SNAME(Fi,L MMAe, sarrnN)
~~ Mildred WMilson
BIOgaANT'S NAPE RrP•~1r0 BMrORMANr'SMAK110 ADDNF88(Star, C7y/f ,Sw.Zq Calk -
Pauline Wittle 33 Riverview Dr. Enola, Pa. 17025
METNmoPOisraertaN
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February 9,95 • Cremation Society Pa.
Harrisburg, Pa.
~
BIBNRtBLE OP FLINF~AL OR PErIBON ACIBKiAS BLICH LICEl19E NUMBER NAME AND ADDREBeaP RICILRY
012774-L $ichardson29S.EnolaDr.Enola,Pa.17025
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~" NAMEANO AW RE&4 of PERSON WIp COMPLPTEO CAUSE OF DEAiII
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................................................................................................
"` Michael L. Norris, Coroner
405 Fairway Drive
h
i
REGl4TRM'S SKiNATURE AND n. Mec
an
csbur Pa. 17055
~
/ ' DREFiIED(Magn, OaY.Mr)
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%.~''!%"' ?f .f_-_ ~_,_Y ~G.^i l 1 ! .~.G NL`. 6r'+~ P ~ ~b..~i° ' ~w~P _
____-_,___.~ - Register of Wilts for the Z
_ Jecc-.csed. County of CUhiQERLAND_ in the s
.~~cr;rl ~~<^c~~rst;~ ;'+%c. %_~-~~ ~' ~ ~~3 ~ 5 ~ Comratonweaith of i'ennsyivania j
Tl•:e ~~+vtiti;:,r. of the undersigned respectfully represents that:
v ~;, r- 1°S v ~
oa; p7+.ti ;.rtcrE~?, ,vho is/are 1& years o: age or older, appl nor letters of administration
-------------------_.-_-- _ - on t}te estate of
.i.h.r , .. .. ;tc; c:uramr ahscntia; dttrante rnir;oritate)
~~ ces;d : ~'orr;iciled at death in ~ .tir~'16~~--i2L. 9 _n.! /~ o:ounty, Penns}~Iv ~ with
)L! ~- r'_ t ti:trtiiy ar principal residence at /a0 /I')~Jnl i ,9 ft~_Ei/~a ,~il/(>1,~9,~ _..
(list street, number and municipa:ity)
Cr ~'`
~ecen.d~_n*, ti~cn ~~ years of age, died ____,~.~',r3/~;59~Y!, , 19 i~ ,
ern, _,.
v ..~,~~ ~~rt.. t~e~ ~'- .~~~,1cd pr~opr~rt}' with estimated values :~s t~c`ilcv,s: _
iii ~ozr,icile~ i:~; i'_:.} Ail personal p,opcrty $ ~, Oo0
'if not d~+~•:~ici?ed in Pa.} Personal property in .Pennsylvania $-
(l` not ~o-ni~itec! ir. Pa.} Persanai property in County $
~Ialuc a~ rca'. estate in Pennsylv.~a/n}"ia ~ ~ $
situ~CCd ;iS ~o~.l~ws: ~ G r [(~<./n.~T,4r.y' ,~ni y ~%t.'~/~, /.q /~ CiLy
t'~?i;i.~rer-__ ai.°ter a proper search htiS ascertained that decedent left nn will and was surva~~~d by
*. lie t,~lto'.•.n:_, - ruse (i~ any} and heirs:
i/ t`:arrre)
- 1 Kelattonshtp '
-~ AZesidence
---
---- -
• - -
z-±ri.cl~t~.=.~, pe•titioner(s} respectfully request(s) the grant of tettet~s of administration in the
a?~prol'~r.ate term to ire undersigned.
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~ t ..."t,^.I`. 12I t?+. ft`. d.'l!l~ ~m't:iPOS: ?sie $Zi'1P. adld COX?CCL Y~ $~?L" ''OL'52 p~p~.ync(~.r't~{.~, ,. ~ ,_,U~),~
rf tt':: ~;2'",.C`+'4'iC£7~:1: ~t124 it«l7Cf 4f xetitiOner~3~ an:.a $Y%~t a$ p~S'StDna'~.i 5a~4riL:vlii:il;J ~i6;1:~ ~mh\
re~resc:rst~fivetiz} ci' i2., alt'ive decedent petitioner{sj vriil ere11 and
drLlY ++^..LiTii22;',.L:" k?`I^. €st2te c'tCCO.id3ng td ia~i'. '
5~~crn t~~ cr ~:I`.fz~~n~d and subscri~d
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21 - 9 5 - 9
," ' .; ~" !~F?i`;Y E. WITTLE
_ .__- - x
p,,i~dI~ TdC~,'i __ FEBRUARY 5, 24 95 , in consideration of the
petition on
the reverse sic hrreof, s~.tisfactory proof having ban presented before me,
~T iS ~~L r::~~ t~a.t _ PAULINE M. WITTLE
s'. / r ,°^ ~t~~' ~. `) x.~'tt'P5 Cf r(3F]le2i.Strr3t7CtTi, and iri nCCrilrd'lklth StACh l".?~%k2jT„ ,`4.ettCrB of ~+~tlar'PJSti'~ti~Jn
.:rF ;~;r,~~~. .~F,'c1ta PAULINE M. L~IiTTLE
i;:2 :}r~ es° t^ rf _ 4~ROY F. WITTLE
- ~~
1 ~^,~~,~ ~,0
/ Register of WiSls
GARY C. LEWIS
PE~'.S
Let±er.; ~'f rs-?Xrirvstrz+,iez2 ..... ~ 50.00
SI~IO*t ~ertif?catQs;S) .......... 5 15.00_
i?Qrlurls;ia0o^ ................
JCP ~ 5_nn
. • .iC>TAL _ $ 70.00
Filed ..,Fc3RUARY.6v..... t`~.D. 19 95
A?TORNEY (Sup. Ct. LD. P7o.)
i
1~DDRESS
PHONE
;_'~+~",:fir,; ; ;, c' or~er picked up by Administratrix on 2-5-95.
.,
_. _T . ., _,~ -.-~. _ ...._.. _~.. _, _ ~~
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~- :.~~a~~~r.
i ce~~i~~y tiz~t r,c.~~ice of bene~ci..i interest required by Rule 5.6 (a) of the Orphans' Court
1'.x:1:==s za:~~..:s Fe:-rbc o~. fir r:aii~a to the fcllowin~ beneficiaries of the above-captioned estate on
~'"'f ~~,~ ,~,;, _ ~3 iy rview Drive,~nola. PA 17(175
Netice has nov~~ b~;,ra niven to all persons entitled thereto under Rule 5.6 except: No exception.
D~t~~: ?~tarclt ti, l ~?5 Signature __ ~~ ~ ~-_.
T ~4
Name y~j~wye C. 1\1iGi901~
Address ~?07 Iti'ort~h Front S reef
,1~..ur~. PA 1711 n
Telephone ~7).~,,3~~9~,
Capacity: -Personal Representative
~. Counsel far Personal
Representative
Narno (s), address (es), and telephone number (s) of all counsel
- ~ ,-,
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Steve C. Nicholas 3207 Nerth Front Street (717) 236-9391
I-larrisbur•~, PA 17110
AddltionaI information may be obtained 1?om the undersigned~~~ r ~ ,
Dated: March 2, 1.995 Signature ~~~~'~---! ~ "~ ~~'~~~-_.._--
---_.
Name eve C. Nicholas
Address 32071~TOrth Front S r~
~Iarrisbur~. PA 17110
Telephone (7171236-9391
Capacity: _ Personal Representative
Counsel for Personal
Representative
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REV-1500 EX + t7-94) ~
COMMONWEALTH OF PENT
HARRISBURG, PA 17128-0601
~WITIZLE, Lerov E.
c'+, r~ ~
6U:~~~~
INHERITAN AX RETURN
RESIDENT DECEDENT
PTO BE FILED IN DUPLICATE
WITH REGISTER OF WILLS)
FOR DATES OF DEATH AFTER 12131 /91 CHECK HER
IF A SPOUSAL
POVERTY-CREDIT IS CLAIMED ^
FILE NUMBER 21 AS_nn4~
COUNTY CODE •~ YEAR N~
• [rC AYUK[JJ
120 MOU11ta111 Lame
)ATE OF BIRTH Erlola, PA 17025
08-11-53 c°Dnt Cuifiber7.aTld CO
W SOCIAL SECURITY NUMBER DATE C
173-38-6385 02.
O ~ (IF APPLICABIEf SURVIVING SPOUSE'S NAME (LAST, FIRST AND MIDDLE
ru'- [~ 1. Original Return
neQy
=oo ~ 4. Limited Estate
J
U
a ~' ^ b. Decedent Died Testate
(Attach copy of Will)
btt ±C `~AN
- yZ NAME
~~ Steve C. Nicholas
~~ TELEPHONE NUMBER
z
0
f-
a
a
v
^ 3. Remainder Return
(for dates of death prior to 12-13-87
^ 5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
3207 North Front Street
i~arrisburg, Pennsylvania 171-t~
1. Real Estate (Schedule A) $ 45,000.00
2. Stocks and Bonds (Schedule B) (2 )
3. Closely Held StocklPartnership Interest (Schedule C) (3 )
4. Mortgages and Notes Receivable (Schedule D) (4
5. Cash, Bank Deposits & Miscellaneous Personal Property 12,200.44
-
(Schedule E)
b. Jointly Owned Property (Schedule F) (b )
7. Transfers (Schedule G) (Schedule L) (7 )
8. Total Gross Assets (total Lines 1-7) "
9. Funeral Expenses, Administrative Costs, Miscellaneous
Expenses (Schedule H) ) 2 .137.12
10. Debts, Mortgage Liabilities, Liens (Schedule I) (1 3],,835.44
11. Total Deductions (total Lines 9 $ 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests (Schedule J)
/~
14. Net Value Subject to Tax (Line 12 minus Line 13)
(s) 57,200.44
(11) _ 33 972 56
(12) - ~Z ~~~ o0
v7 as rTv
(13)
(tal 23, 227.88
~o. spousal Transfers (for dates of death after b-30-94)
See Instructions for Applicable Percentage on Reverse (15)
. Side. (Indude values from S
x
h
d
l
K
=
c
e
u
'-
e
or Schedule M.)
- 1 b. Amount of Line 14 taxable at b% rate
(Include values from Schedule K or Schedule M.) -
17. Amount of Line 14 taxable at 15°h rate (17) _ 23.227. $8 ~
z
(Include values from Schedule K or Sched
l
M
%'r 3, 484.18
c
u
e
.) f,,
18. Principal tax due (Add tax from Lines 15, 16 and 17.)
a 19! Credits Spousal Poverty Credit Prior Payments Discount Interest (18)
~ + +
20. If Line 19 is greater than Line 18, enter the difference on Line 20. This is the OVERPAYMENT
(20
.
^
)
21. If Line 18 is greater than line 19, enter the difference online 21. This is the TAX DUE. (21)
A
E 3, 484.1$
.
nter the interest on the balance due on Line 21 A.
(21A) _
B. Enter the total of Line 21 and 21A on Line 21B. This is the BALANCE DUE 7Q 1
.
Make Check Payable to: Register of Wills, Agent (21 B) -.- ~ P tiC)'~ 3n
~ ~ -BE SURE TO ANSWER ALL QUESTIONS ON REVS SE SIDE AND TO
Under penalties of perjury, I dedare that I hav
i
d
h
S
MA
e exam
ne
t
is return, including accomPanymB schedules and statemeMs{
it is true, correct and complete. I declare that all real estate has been reported at true market value
and
e best<m<nowledge and beli
b o all information of whi
D
f
l
h
.
ec
c
aration of preparer other tha
preparer has any knowledge.
IGNATUR Of PERSON RESPONSIBLE fOR FILIN RETURN e
,
n the personal representative is
ADDRESS
33 Riverside Drive, Enola
PA 17025
SIGNA
URE
DATE --
,
T
Of PREPARER THER THAN REPRESENTATIVE ADDRESS
~
~ 77 p.
(,'j 'ot ~+ /
~'°'°""'~
'
°'""~ `'~'"'~ 3207 N. Front Street, Harrls}»
g, PA 17110 DATE
'~ - ;I - `~ l~
^ 2. Supplemental Return
^ 4a, future Interest Compromise .
(for dates of death after 12-T2-82)
^ 7. Decedent Maintained a Living Trust
(Attach copy of Trust)
NA
Act X48 of 1994 provides-for the reduction of the tax rates imposed.on the net value of transfers to or for
the ursa of the spouse. The rates as prescribed by the statute will be:
•' 3%(.03~ will bs applicable for estates of decedents dying on or after 7/1/94 and before 1/1/96
• 2% (.02) will be cpplicable for estates of decedents dying on or after 1 /1 /96 and before 1 /1 /97
~~ • 1%(.O1) will be applicable for estates of decedents dying on or after l/1/97-and before 1/1/98
a Spousal transfers occurring on or after 1/1/98 will be exempt from inheritance tax.
PLEASE ANSWER THE FOLLOWING QUESTIONS .
BY PLACING A CHECK MARK ~ ~) 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? ...................:..............:.:.
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,
YOU MUST COM~~ET~S~F~E,~, G AND FILE IT AS PART OF THE RETURN.
1.~;' ~ . ;. :>l.~~l~
~~: ~ ~ £-. ~nr s~.
~~~ r ~ : _ ~~3a
}~ ~ ~3~:a~~d
s T
1
REV-150r 2 EX i~ 12-BS)
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COg10NWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
FILE N
WITTLE, Leroy E. 2195-0095
(Props ny j«ntly-owned with Right of Survivorship must be disclosed on Schedule F) All real estate should be reported at fair market value
which is delnod as the price at which proaerty would b..Y~6ane.d b.+..,.e., ....,:u:.... ~....,__ __~ _ ___:ue_ _ _ _.. ..r __
r- ----- -r-^ •- ^~~~~w nraerr w~rnvnoi sneers or same sfze.J
REV•7508 EXi(t-87)
SCHEDULE E
CASH, BANK DEPOSITS AND
MISCELLANEOUS
PERSONAL PROPERTY
Please Print or
ESTAT'EOF FILE NUMBER
WITIZ,E, LEROY E . „ a ~_,,,,~~
COMMONWEALTH Of PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
(Attach additional 8'/z" x 11" sheets if more space is needed.)
Dauphin Deposit Bank
and Trust Company
MAIN OFFICE: 213 MARKET STREET, HARRISBURG, PENNSYLVANIA 17101
717 255-2121
Decedent Confirmation
Name: Leroy E. Wittle
Social Security No.: 173-38-6395
Date of Death (DOD}: 02/01/95
Account No. 5700367238
TYPe ----------- ------------------------
------------------------
Statement Savings
Date Opened ----------
------------------------
--------------------
or Issued 10/18/93
Date Closed ----------- ------------------------
------------------------
or Matured
Date of Death ------------ ------------------------
------------------------
Balance $0.44
PLUS -------------------------
------------------
Date of Death
Accrued Int. -0-
Joint Owners ------------ ------------------------
------------------------
(if any) None
Date of Joint ------------ ------------------------
------------------------
Ownership
Special Cortments: N/A
Additional informatiah available at $20.00 per hour. One hour minimum.
Date Prepared: February 16, 1995 Prepared by: Cheryl A. Bowers
Customer Management Information Dept. (CMI) Telephone No. (717) 255-2054
Page 1 of 1
Form 00-020-216 (REU 7/93)
d REV-1511 E~ +~ (7~)
CONgONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
C.
f
SCHEDULE H
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES
wur~c yr
WITTLE, Lero E.
ITE M
NUM BEI DESCRIPTION
A. Funeral Expenses:
i - Richarson Fts~eral Home
Clty State Zip Code
4. Probate Fees Register of Wills::
B. Administrative Costs:
1 _ Personal Representative Commissions
Social Security Number of Personal Representative:
Year Commissions paid
2. Attorney Fees NIchOlaS & Foreman
3. Family Exemption
Claimant Relationship
Address of Claimant at decedent's death
Street Address
Miscellaneous Expenses:
~• The Sentinel -Legal Advertising
2• Cumberland Law Journal -Legal Advertising
3. Nicholas & Foreman, copies, postage and notary fees
$1;200.00
$100.00
62.12
i+0.00
35.00
TOTAL (Also enter on line 9, Recapitulation) I S 2;137 _ 12
Please Print or Type
3ER
219 -00
AMOUNT
$700.00
(If more apace is needed, insert additional sheets of same size.)
r
REV-1512 EX-t (1-9(
COMMNWEALTH OF PENNSYLVANIA
IMIERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES AND LIENS
., r
~fl'LE, Leroy E.
ITEM
NUMB ER I DESCRIPTION,
1 • I SEE ATTAQ3ID SCHEbi7LE
Please Print or
NUMBER
2195-0095
AMOUNT
$31, 538 44
TOTAL (Also enter on line 10, Recapitulation) $
31,835.44
(If more space is needed, insert additional sheets of same size.)
~ittle.sci/estates/scn
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES AND LIENS
~fem Deccrintinn
Amn mt
L Farmers Trust Company -Loan Balance as of 2/17/95 $8632.13
2. 1994-95 Cumberland Valley School Personal Tax
Account # 250-0406659 202.40
3. 1994-95 Cumberland Valley School Real Estate Tax
Parcel # 38-04-0365-008 381.16
4• 1994 County/ Local Real Estate Tax
Parcel # 38-04-0365-008 106.72
5. 1995 County/ Local Real Estate Tax
Parcel # 38-04-0365-008 106.72
6• Associated Products Services, Inc.
Account # 12406 82 68
7• PP&L
Account # 5246700751 334.97
8. York Waste Disposal
Account # 03008 70.08
9. Bell Atlantic
Account # 717697-2621-66834 189.51
10. Paramount Exterminating Co.
Invoice # 36517 58.30
11. West Shore Oil Co., Inc.
Account # 024171 275.35
12. West Shore Oil Co., Inc.
Judgment 300.85
13. Gary Radebaugh Heating & Air Conditioning
Invoice # 5444 57.50
1
i
vrittle.sci/estates/scn
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES AND LIENS
Item Descrintinn
Amennt
14. Motor Vation 5437.76
15. Cumberland Family Practice -Medical
354.15
16. A. Z. Ritzman Associates -Medical
43.00
17. Bankers -Shippers -Open Account 50.00
18. Harrisburg Hospital
Account # 162679731 99.51
19. Daniel T. McGuire and Donna A. McGuire
- ---
Civil Action 592 Civil 1994, Cumberland County, PA ~
-
records (Disputed Claim
' `14599
65
`~ .
20. Acordia of Central PA
Insurance - 120 Mt. lane 253.00
28• Orthopedic Surgeons -Open Account 200.00
$31,835.44
2
REV-1513 EMr (2-d7)
Y 1
COMMONWEALTH OF PENNSYLVANIA
INNERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE DF
WITTLE, Leroy E. 4-~
FILE NUMBER
TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Also enter on line 13 Recapitulation) $
(If more space is needed, insert additional sheets of same size)
SCHEDULE J
BENEFICIAIt1ES
ITEM
NUMBER NAME AND ADDRESS OF BENEFICIARY AMOUNT OR
SHARE OF ESTATE
B. Charitable and Governmental Bequests:
~~ ~t~L try . P~ ~ 4~:.
pennsyLvania
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX REV-1607 EX AFP (12-14)
INHERITANCE TAX DIVISION
PO BOX 290601 ffATEMENT OF ACCOUNT
HARRISBURG PA 17128-OUCot�0'7n C F F I C E
REGISTE'� OF �VILLS DATE 02-09-2015
?01S FEB 17 12M 1 14 ESTATE OF WITTLE LEROY E
DATE OF DEATH 02-01-1995
C L LE F',, GF FILE NUMBER 21 95-0095
COUNTY CUMBERLAND
WITTLE OP.x P Ej/f�0
,,t INE;, ht ACN 101
33 RIVERI�blfy2PRj tq'- — "A
Amount R-emitted
ENOLA PA'17025'
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— - ----------- - -
ACCOUNT
;i4f b� C70Nf
STATEMENT-W�' cli:1747)----I*;; -i7kiNiiffA7NH-
iii--l;if 6X TAX
ESTATE OF:WITTLE LEROY E FILE NO. : 21 95-0095 ACN: 101 DATE: 02-09-2015
THIS STATEMENT PROVIDES CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. BELOW IS A SUMMARY OF THE PRINCIPAL
TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 02-24-1997
PRINCIPAL TAX DUE: 3,484. 18
PAYMENTS (TAX CREDITS) :
PAYMENT RECEIPT DISCOUNT AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID
07-03-1996 AA146504 210.85- 3,693.30
02-06-2015 SBADJUST .00 3.63
TOTAL TAX PAYMENT 3,484.18
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.