HomeMy WebLinkAbout95-0103~i __
21 I~rOID~
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.
5~
Auc i s toot
Date
•
Fran eropoli, ' ect
Division of Vital Records
P.O. Box 1528
New Castle, PA 16103
H105.,A3 Rev. 2137
N
PEMIAlIEIff NAME OF DECEDENT(Fra. Midde, La•q
~~ T. Evelyn H. Bloser
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COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS _ - - ~ -
CERTIFICATE OF DEATH ~~ 1 O 2' ~ 9
SE% 90CIAL SECURITY NUMBER DREOF OERHILbnlh, Dax Neer) _
xFemale a.179 - 12 - 3197 ,. Jan. 29, 1995
R1 DAY DRE OFSDTTN &RTT1Pl.ACE(Cily and PIACEOFOERN(CMdraay ans-eeserbuc2«rmc2araiey
I My,,,~ (Hawn. Dex yaerl Srbaf«aTCwmtrY) NDSpy1L
May 15,1914 Cummingstown,P ~k~ Eearoaro.awe0 ~+^ N~0^ Resioerae^ ,^
COUNTYaFceRN CITY, eorlO,TwP OF DERV R~CSJTY NAME(Ilnd saeewm,ow rnettea nunoar) NwsoECEDENTOR NISPA/aC DwDINt RACE•Atrwkett ltWen, Erdt, Wlels, etc.
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''Ci0e1• ~°°'"~ White
Cumberland Carlisle Carlisle Hospital ,
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DECEDENrSMAnxTU ADDRESS CSr.s. ciry/TOwn 9iW.Ip cods) DECEDENTS
ACTUAL 17e. stM. PA DM ,TO.^Nee, d.o.e«s a..er hp.
409 Arch Street RESIDENCE e.c.d.M
PA 17013
Carlisle (See eabuctlorr M r
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,.. Geor e M ers , Emma Reddig
2eFORMANf'8 NAME (ryPwr:y MAIUINi ADdE83ISlraet C2,yban, SIMe, &PCadN
Mar E. Bo er 50 East Pomfret St., Carlisle, Pa 17013
METHOD OF gSPOSTTION
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2BMC, 850 Walnut Bottom Rd. ,Carlisle, PA 1701
2,
REGISTRAR'S SN3 RE R ~
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~ ORE BLED (Moran, my,Nwr)
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77. ~~~~. _ a--84~-~ 7a.
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REV-t soo Ex+ (7.94) :~ ~, FOR DATES OF DEATH AFTER 14131191 CHECK
INHERITANCE TAX RETURN IF A SPOUSAL
POVERTY CREDIT IS CLAIMED ^ ~
.. RESIDENT DECEDENT FILE NUMBER
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE (TO BE FILED IN DUPLICATE Z ~ 9 S Ot 03
UERG
PA 671 WITH REGISTER OF WILLS
~
HARRISB
,
28.0601 COUNTY CODE YEAR NUMBER
DECEDENT'S NAME (LAST, FIRST, AND MIDD E INITIAL) DECEDENT'S COMPLETE ADDRESS
8 Los c-'t2 E~ c ~~ r...) f-l 409 (~.R..c.t-~ ~2 e>: z'
LZU SOCIAL SECURITY NUMBER DATE OF DEATH DATE OF BIRTH P~ r l~l~ L
~ Q C..(SC.G
~-tq -1L-341 '~z9/95 S~is~(4 ~
coD~t Gur-tgC~2~raa.,J
p (IF APPLICABLE( SURVIVING SPOUSE'S NAME (LAST, FIRST AN D MIDDLE INITIAL( SOCIAL SECURITY NUMBER AMOUNT RECEIVED (SEE INSTRUCTIONS)
~ Q 1. Original Return ^ 2. Supplemental Return ^ 3. Remainder Return
Yarn
Y
°G (for dates of death prior to 12-13-62)
,c'.,,o
.s
.c ^ 4. Limited Estate ^ 4a. Future Interest Compromise ^ 5. Federal Estate Tax Return Re ulred
q
~ a°c ° (for dates of death after 12-12-82)
a m ®6. Decedent Died Testate ^ 7. Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes
(Attach copy of Will) (Attach copy of Trust)
- -
y = tdAn~E MPLETE MAILING ADDRESS
v ~ TELEPHONE NUMBER
I, Z4y -~~ 6 G/,.iZ ~~ ~ ~, ` PA L"'7 0 l
1. Real Estate (Schedule A) (1) ~~ I C'AO , Op
2. Stocks and Bonds (Schedule B) (2) 209 t32~ ,Op
3. Closely Held StocklPartnership Interest (Schedule C) (3 )
4. Mortgages and Notes Receivable (Schedule D) (4 )
5. Cash, Bank Deposits 8, Miscellaneous Personal Property (5) 3Q . L 39 ~~° )
Z (Schedule E)
6. Jointly Owned Property (Schedule F) (6 )
~ 7. Transfers (Schedule G) (Schedule L) (7) S ~Q 4.9 l
a
8. Total Gross Assets (total Lines 1-7)
(g) _
~ o ~3
~~ 3t3 304 52
, ~
9. Funeral Expenses, Administrative Costs, Miscellaneous
E
h (9) '
xpenses (Sc
edule H)
10. Debts, Mortgage Liabilities, Liens (Schedule I) (10) ( `',' $cJ
11. Total Deductions (total Lines 9 & 10) (11) _ ~S~OO t
12. Net Value of Estate (Line 8 minus Line 11) (12) _ ~ ~~J ~C) 3 , t 1}.
13. Charitable and Governmental Bequests (Schedule J) (13) _
14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 3~5 303. t~{-
15. Spousal Transfers (for dates of death after 6-30-94)
See Instructions for Applicable Percentage on Reverse (15) x,_= _
Slde. (Include values rom Schedule K or Schedule M.) ~y Q+ C~
16. Amount of Line 14 taxable at 6°k rate (16) ~ p rJ 3O3 ~ ~ ~ x .06 = ~ a , 3 t v ' ( /
(Include val f S h d l K S h d l M
z
0
a
r
a
0
x
-a-
ues rom ceue or ceue .)
17. Amount of Line 14 taxable at 15% rate (17)
(Include values from Schedule K or Schedule M.)
18. Principal tax due (Add tax from Lines 15, 16 and 17.)
19. Credits Spousal Poverty Credit Prior Payments Discount Interest
20. If Line 19 is greater than Line 18, enter the difference on Line 20. This is the OVERPAYMENT.
~^
21. If Line 18 is greater than Line 19, enter the difference on Line 21. This is the TAX DUE.
A. Enter the interest on the bolance due on Line 21A.
B. Enter the total of Line 21 and 21 A on Line 21 B. This is the BALANCE DUE.
Make Check Payable to: Register of Wills, Agent
15 =
(20)
t21) _ ~~ X402 ~2~5
(21 A) _
Under penalties of perjury, I declare that 1 have examined this return, including accompanying schedules and statements, and- to the best of my
it is true, correct and complete. I declare that all real estate has been reported at true market value. Declaration of preparer other than the pe
based on all information of which preparer has anv knowledge.
SIGNATURE OF PRE ARER OTHER THAN REPRESENTA VE ADDRESS
representative
DATE
DATE
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°Xo (.03) will be applicable for estates of decedents dying on or after 7/1 /94 and before 1 /1 /96
• 2°yb (.02) will be applicable for estates of decedents dying on or after 1/1/96 and before 1/1/97
• 1 °~o (.O1) will be applicable for estates of decedents dying on or after 1 /1 /97 and before 1 /1 /98
• 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.
YES NO
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 ~}n an~n~rust for'. bank account at his or her death$ ...................................... ~
-F , ~~F THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,
YOU-NI~JST ~OMPL~TE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
__ ~ _
~ `~` ~' ~ ~
C? CJ
c:anW'N:~t::MGPi;: +1.. ~+~L~S~:.,Mw=~~ t i. x; ~:.: }:X....~.-..~+.: ~.._.. _........
LAST WILL AND TESTAMENT
OF
EVELYN BLOSER
I, EVELYN BLOSER, widow, of 409 Arch Street, Carlisle, Cumberland County,
Pennsylvania, being of sound and disposing mind, memory, and understanding, do hereby make,
publish, and declare this as and for my Last Will and Testament, hereby revoking and making void
any and all Wills by me at any time heretofore made.
1. I direct my hereinafter named Executor to pay all of my debts to which I am bound and
the expenses of my funeral, last illness, and of the administration of my estate as soon after my
death as may be found convenient to do so.
2. I declare that I am a widow, and that I have three children who are Mary E. Boyer,
Robert J. Bloser, and Edward L. Bloser. I further declare that I have no other children.
3. All the rest, residue, and remainder of my estate, real, personal, or mixed, and
wheresoever the same may be situate, I give, devise, and bequeath in equal shares to such of my
children as shall survive me by a period of ninety (90) days. The share any deceased child would
have received shall not pass to his or her issue but, instead, such share shall lapse and be added to
the remaining share or shares. At the present time I have three (3) children as aforementioned.
4. I hereby nominate, constitute, and appoint my son, Edward L. Bloser and my daughter,
Mary E. Boyer, or either of them as Executors, and I further direct that neither of them shall be
required to post any bond to secure the faithful performance of his or her duties in the
Commonwealth of Pennsylvania or in any other jurisdiction.
5. In addition to the powers conferred by law, my herein named Executors and Trustees are
empowered:
a. To invest any part of the trust corpus in such securities, investments, or other
property as may be deemed advisable and proper, irrespective of whether the same are
authorized for the investment of trust funds under the laws of any governing jurisdiction.
b. With respect to any corporation, the stocks, bonds, or other securities of which
may be held, to vote in person or by proxy on any shares of stock; to consent to the merger,
consolidation or reorganization of such corporations; to consent to the leasing, mortgaging,
or sale of the property of any such corporations; to make any surrender, exchange or
substitution of such stocks, bonds, or other securities as an incident to the merger,
consolidation or reorganization of such corporations; to pay all assessments, subscriptions
and other sums of money which may be deemed wise and expedient for the protection and
maintenance of the proportionate interest of the investment in such corporations; to exercise
any option or privilege which may be conferred upon the holders of such stocks, bonds, or
-~ other securities of such corporations either for the conversion of the same into other
securities or for the purchase of additional securities, and to make any and all necessary
payments which may be required in connection therewith; and generally to have and
"~ exercise as to all such stocks, bonds, and other securities, the powers of an individual owner
who is under trust obligation.
.., c. To hold the trust corpus in one or more consolidated funds in which separate
shares shall have undivided interests.
d. To sell at public or private sale for cash or upon credit, or partly for cash and
partly on credit, and upon such terms and conditions as shall be deemed proper, any part or
~ parts of the trust estate, and no purchaser at any such sale shall be bound to inquire into the
expediency or propriety of any such sale or to see to the application of the purchase money
arising therefrom.
e. To keep on hand and uninvested such moneys as may be deemed proper and for
such period as may be found expedient.
f. To compromise, settle, or arbitrate any claim or demand in favor of or against the
trust estate.
g. And authorized in the discharge of fiduciary duties, to employ counsel and to
determine and to pay such counsel reasonable compensation which shall be charged against
the principal or income of the trust fund, and shall further be entitled to charge against the
principal or income such other reasonable expenses and charges as may be necessary and
proper to incur for the proper discharge of fiduciary duties and for the proper management
and administration of the trust estate.
Page 1 of 2 pages
~,
ir+.....~.r....W.rr.r....w..........
h. In making any division of property into shazes for the purpose of any distribution
thereof directed by the provisions of the trust, to make such division or distribution, either in
cash or in kind, or partly in cash and partly in kind, as shall be deemed most expedient, and
in making any division or distribution in land may allot any specific security or property or
any undivided interest therein to any one or more of such shares, and to that end may
appraise any or all of the property so to be allotted and the judgment as to the propriety of
such allotment and as to the relative value for purposes of distribution of the securities or
property so allotted shall be final and conclusive upon all persons interested in the trust or
in the division or distribution thereof.
i. Authorized to register any shares of stock or other assets of any trust in their own
names or in the name of a nominee.
IN WITNESS WHEREOF, on this page 2 of 2 pages, I have hereunto set my hand and
seal to this my Last Will and Testament written this 2nd day of June, 1993.
..w ~ ~ `~+-~-a'-~Pir/ (SEAL)
EVELY BLOSER
Signed, sealed, published and declared, by EVELYN BLOSER, the Testatrix above named,
as and for her Last Will and Testament, in our presence, who, in her presence, at her request, and in
the presence of each other, have hereunto subscribed our names as attesting witnesses.
~._s~-~..~ n
l
Page 2 of 2 pages
REV-1502 EX+ (12.851
SCHEDULE A
COMMONWEALTH OF PENNSYLVANIA REAL ESTATE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
~ lro5 e>z, ~'v Ei..`-~ ~ t-} 2 t `j5 O l 03
(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
~ P c~2-i-~? r~-~ Q c~j ,oer., u S ~ ~ c.~a. t_~s ~ ~ ~ ~+a 64 ~ oca . °-°
TOTAL (Also enter on line 1, Recapitulation) $ ~jd. ` ~1QQ,
`~
.... rvv ~ r~
GEN6RAl I •r T /{c ~.. ~/ N' ~
NFORMATION ON PROPERTY /~ C_/fYL/d 1"1VV
GENERAL INFORMATION ABOUT BUILDING
STREET IMPROVEMENT YES NO CONVENIENCES BLK MILE FUTURE ECONOMIC LIFE OF BUILDINGIS}
WALKS GRAMMAR SCHOOL MAIN BIOG. YEARS OTHER SLOGS. O YEARS
tunes ___ ~~' HIGH SCHOOL ! ASSESSED VALUATION
PAVING (. STORES LANG S.~J ~` _ y ^~ ~,7
ALLE VS
STREET LIGHTS / ~~~ CHURCH
TRANSPORTATION __ MAIN BU_ILDING_E_~_ _
OTHER BUILDING ~ ' O '~(
~V' v~--
S
FIRE PROTECTION (~ ~ r~ ~f // TOTAL E ~~( (~
_____~..1 .~,. _4_______._.__._.._~
________.-._..___ __ _ __ COMMENT ON ANY SPECIAL ASSESSMENTS
- --__ ANNUAL TAXES
_.____.___.._._________. __ _ A. GENERAL $
SIZE OF LOt
I(~
/
~/'
1 ZONE (J _/
4
I CORNER
~
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KE
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______ __ r~ SlOP1
N
G ~_I /IILLSIOE I~
I
AT GRADE RI ABOVE GRADE
Y`~ I ~I RE LOW GRADE
DRAINAGE _ _-_ _ ___
__.______ ___---_____
RETAINING WALLS
L_I POOR ~,pD EOVATE I~~ FAULTY I _~ AOEOVATE I I NEEDED
ANY EVIDENCE Of FILLED GROUNDf ANY UNFAVORABLE FEATURES
rrEUreFa. r oEra.l c _ etr ~rre.ne
-_WAl_l_$
__ _ ROOF ROOF TYPE FOUNDATION _ ARCH. __ _ QUA L.CONSL __ SEWAGE FENCE
_
ST UCCO_
-_
W000 SHINGLS.
HIP
-
CONCRETE
CONVENTIONAL
-
MINIMUM _
SEWER CONN'D
/ __
__
W000 _
WOOD SIDING_ -
- ___ _ COMPO.SHING
__ - GABLE _
-- - 7~
Y CONC. BLOCK
-- MOOERN_ _
_
AVERAGE _ SEWER IN S7. _ CINDER BLK.
WOOD SHINGLES
ROLLED COMPO
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BRICK _
RUSTIC -- --
GOOD - aat:-- - - -- -
BRICKS
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WOOD SNAKE
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SPANISH __ ___
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_---------
-- P[1~TK_
SEPTIC 7K.
--------- CHAIN LINK
STONE
----
CONCRETE BLOCK TILE WINDOWS ELEVATION __ cess Pool OUTSIDE IMP.
CONCRETE GRAVEL WOOD N ONE STORY INSULATION DRIVEWAY O PAT 10
TILT-UP LG. ROCK STEEL TWO STORY CEILING JL /
• SPNAIT POOL BPO
`a~Rr6 ALUMINUM SPLIT LEVEL WALLS CONCRETE HEATED SPRINKLERS
UNPAVED FILI EREO Gl11t ERG
_ ____ __ WEATNERSTRP slzE--_-~- -- -~- BiiT'ooon -
LIGrI i1NG
PROPERTY D _ _
_ _ _
ETAILS - INTE _
RIO ~
R ~ -- ------~--_-! -~----~ - - ~ ~-"--"---~-~-
ROOMS KITCHEN BATNRMS. )_y __HEATING__ CARPET FIREPLACE GARAGE WALLS-CLING
LIVING ROOM~
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LINO. FLOOR
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BEDROOM _ _ TILE D.B.&S. SHR,LAV,TLT. WALL FURN. ONE BEDROOM DOUBLE ___ DBL, CAR PORT _ _
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DRY WALL _
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FAMILY ROOM _ FORMICA 0.8.&S ~/ TUB,LAV,TLT. N FLOOR FURN. TWO BEDROOMS B.B.Q. SGL.ATTAC FLED ACOUSTICAL
DEN - _. B.I,RANGE $OV. LAY, TLT. RADIANT THREE BEDRMS BRICK DBL.ATTACHED
DINING ROOIA J B.I.DISHWASH• SPACE THRUOU7 NOME STONE SGI.DETACH~ FEATURES
DINETTE ___ GARBAGE OISP. FLOORS PERIMETER __ _ G000 COND. L~ _ DBL. DETACH SERVICE PORCH
RECREATION _ FANH000 __ HARDWOOD AIR COND. AVERAGE COND. __ _
FLOOR PLA N _ _ BASEMENT C
_____ __ 8.1.REFRIG. CONCRETE _ _
GAS___ _ POOR COND. _
POOR __ _ _
PANELING _ _
INTER-co
M
B.I.WSH&ORY
PINE /
ELECTRI _ _
__ _
/ C _ AVERAGE KNOTTY PINE FIRE ALARM
a.ace roe urn B.I.FREEZER
f-I nevi w
..,~ PLYW000 OIL
---
- GOOD
- OPEN BEAM
-------
- WATER SOFT NR
-----
---- -- - U.,~n~... ~vnvni I 9VILT UP /w~
SETTING ~ UNDER - IMPROVED ITS DISTRICT ~ OVER _ IMPROVED `S.•
CONDR710N O POOR '~ SATIS. ^ EXC. EX E IOR LJ POOR SATIS. Q E%C.
_ CONDITION x LANDSCAPING O POOR ~ SATIS, fl EXC.
PLOT P AN ---
---_ _ - - - ERs ,S~ ~_
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CE~h L,
~ i_L_r_I_ i l I I r l i f L I ~_ t.f_.r t 1 1 -._I_f"_~._~"1__H-~-l~~f~T~
oo-loel IREV. 3•TOI 1~~~
1 ~f^ rJ l ~
REAL ESTATE APPRAISAL ~ U~~
MARKET pATA APPROACH TO• VALUE (COMPARABLE SALES)
r
ADDRESS ~ SALE
PRIG! .SOURCE OF,
INFORMATION DOWN
PAYMENT TYPE ~,.
LOAN
DATE BUIl01N6.
312E LOT
312E
BDRMS.
BAT NS TOTAL
ROOMS
AGE AOJUBTED
PRICE
.!} ~R~.N~ s595 CP~fi, ; - o= !a0 2.¢X~o 2, 1 .r QS ~
C~ ~5°~E° s CP~~A ~S"~ ~f~ ~92 / 6 ~
. s
v
3 ~~~~~.~ :63c~0 -~~~;v. i - - 30 9 /ado 3 }~8 3 / ~ 7,f s ~~ ~D
G
INDICATED VALUE BY MARKET APPROACH E G40w
INCOME APPROACH ,TO VALUE ! ~
SALE NO. ACTUAL RENT
.. FAIR RENT VALUE GROSS RENT MULTIPLIER
I
S
y
S s S
l
s•
s -
s
BIND
INCbME CAT D ti
AP~OACH
(GRM) X (FAIR RENTI E S
COM AY'9~1.G ~,1 /S T ~ .be ?0~~ Coy~,gr~-b/~ A~ s i T is ,¢~L •r3 r" ~ ,~- qNo
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b ~`~ ~~ d e p -~ ~ ~ s No ~ c~le~~o ~s `~~.~ s~ ~J.~c 7~n~~r ~~ s~
t n ~- ~~ ~: 9 ~~~~ ~ e U er C D rlq~ ~~. ~vb voT //
~ ~ 9 ~hcA ~r Nt~J9~ ~ h
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~'! ~i ~ ~- V e(~y~o o rN s .. - - ~ ~ ~ 7~" Gi -e h o o ~S /} re NY1 ~1C7'J ~ ~
TAI ~ ~ ~k~ su 6~ e~7~p~~r~;
CvM Rr~l ~7//~Pa. #?-J,1 fi./IIeV~ S~.ttti~gr /ivG ~t~G ANP CO"!/d`7`~vrACitr~~i~bC
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,, /'9 ,~
g ~u ~ ~~7~--~~ AN~~ No ~ Npgr/y ~ s a~r° s~rr~->~ ~~,~ s ,~hc~, ~~7~
~c7 cN A/'9' l'~ -~,,3 No `F" FI- G v o off" ~' 0~~9~1'Y#SE ~ /~ s ~~e tio~ ~ is .1*~v~~i
1-,+s1~j~ r ~1- ~ b¢'3 f c c.e A-5 (1'1 u c (1. q Nouac~A•~b. t~ NOT" p-'~y7~-cl~.P~-~~f4/~__.__--.._..__.
TOTAL INDICATED VALUE BY MARKET APPROACH ...................................... /r~ S ~
~~ ~~v~-
TOTAL INDICATED VALUE BV INCOME APPROACH ~~~' ^^""'~~~~
................................... ..~ _..._ ~ S ~.,.
TOTAL INDICATED VALUE BY COST APPROACH ................................................................. S "/ ~~y"~
CJO~~ FINAL ESTIMATE OF FAIR MARKET VA~UE S `~~
COMMENTSI- ~ < - 1
~ ~ ~ su 6/,r~ p~~°a,~~.~ ~~ ~~ ~o~ co~r~l ~o~. d~~~s ~.~~~
Fv R sv,~a ~ ~dsM~e ~ ~ lr~.//~~'rvaPl ~-~. /~ `>~~l/ y,~P "~~~~~,~
t $ ~ A! ~ S 1~ ~ U ~ r s 9 C',4 6i,~..~ ~a , //~l ~ rXlo.,~~~7`~~C?'7`ir ~~ ~N /s'
t f'~ ~~ FF ~~ a7--F ~Poo~' ~No cTs1~ `t'!, A f r ~ v~~ rtii/~ t~q ~.r~ / ~- ~ 7~ . .
/4^-(1(t~ ~S __V!~~Pi^ ~PyG .P/r~f/YY~ 7p it`e~~CE. / rl~ 4.F~e/}-~rp~r •t91/l~~~PN/~~o
1 HAVE PE~O~~L LT~ INSP C^E~TH~INTERIOR ~ND EXTERIOR OF THE PROPERTY DESCRIBED ABOVE FOR THE PUR-
POSE OF ESTIMATING THE MARKET VALUE. I WARRANT THAT THE STATEMENTS MADE BY ME ARE, TO THE BEST OF MY
KNOWLEDGE ANO BELIEF, TRUE AND CORRECT. I HAVE NO INTEREST IN THE PROPERTY, NOR IN THE LOAN APPLIi=~]
FOR, AT PRESENT OR CONTEMPLATED.
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REV-1573 E 7K + y_g7~
SCHEDULE J
iOMMONWEAITH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE Oi FILE NUMBER
ITEM
NUM BEI NAME AND ADDRESS OF BENEFICIARY RELATIONSHIP AMOUNT OR
SHARE OF ESTATE
A. Taxable Bequests:
~ _ Nt ~ dZ~! l3p`( ~_
SO C. ~aiM Fiz.r?~- ST 7P,~CI~-t~YL ONE-Tl~ 2~
C~-2(~~S(.tr L ~A, L~UI
2 . >/~ La ~z. ~ ~I.oS
~ ~s ti (, C`>'' -D~ L JF So r ~ o r•5 F - I ~ -2-~
3. ~o`~c~.'~ '3LoSeR
t ~ 2.2, tit, ~3ar.~ c~irr ~ ~,.~ Y S d ~ e rJ ~ - -[fit I ~-~
~.!-/ C L tM t tJ~TU yJ ~E' t ~ gC~ - ZC,, l I
ITEM
NUMBER NAME AND ADDRESS OF BENEFICIARY
B. Charitable and Governmental Bequests:
AMOUNT OR
SHARE OF ESTATE
TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Also enter on line 13, Recapitulation) $
(If more space is needed, insert additional sheets of same size)