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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 2001 ? ~
Date Fran eropoli, ' ectd'l~
Division of Vital Records
P.O. Box 1528
New Castle, PA 16103
COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS C 14 4 b C
CERTIFICATE OF DEATH
(Coroner) _ __ .
NAME OF DECEOENTIFrC Mieda,LYQ SEX 30CIAL SECURITY NUMBER DRE OFOF.R/1Ik,•na:, Oey.WM)
+. CALVIN P DUTTON :Male a ..Feb. 21, 1995
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NAME ANO ADDRESS OF PFyRSON WHOCOMPLETED CAUSE OF DEQH
•akEDIDALEXAMBIERrconoNER I"B1n27)T~'P°~~'^'Michael L. Norris, Coroner
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REGISTRAR'S SIGNRUfE MID NU DRE FlLED,MaMA. Day, Year)
REV-1547 EX AFP (12-95)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX
BUREAU OF INDIVIDUAL TAXES APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
DEPT. 280601 OF DEDUCTIONS AND ASSESSMENT OF TAX
HARRISBURG, PA 17128-0601
ACN 101
DATE 06-24-96
ESTATE OF DUTTON CALVIN P FILE N0. 21 -0 6
DATE OF DEATH 02-21-95 COUNTY CUMBERLAND
NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS FORM WITH YOUR TAX
PAYMENT TO THE REGISTER OF WILLS. MAKE CHECK PAYABLE TO "REGISTER OF WILLS, AGENT''
REMIT PAYMENT T0:
FRANCIS A ZULU ESQ REGISTER OF WILLS
109 LOCUST ST CUMBERLAND CO COURT HOUSE
HBG PA 17101 CARLISLE, PA 17013
Amount Remitted
CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS 1
----------------------------------------------------------------------------------------------------------------
REV-1547 EX AFP (12-95) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF DUTTON CALVIN P FILE N0. 21 95-0176 ACN 101 DATE 06-24-96
TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule El
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governmental Bequests (Schedule J)
14. Net Value of Estate Subject to Tax
(1) 121.500.00
(2) .00
(3) .00
(4) .00
(5) 44.152.36
(6) .00
(7) .00
(B) 165,652.36
(9) 21,630.80
(lo) 72.198.33
(111 93.8 9.13
(12) 71,823.23
(13) . 00
(14) 71,823.23
NOTE: if an assessment was issued previously, lines 14, 15 andior 16, 17 and 18 will
reflect figures that include the total of ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Amount of Lina 14 at Spousal rate (15) . 00 X . 00_ . 00
16. Amount of Line 14 taxable at Lineal/Class A rate (16) 71,823.23 X .06. 4,309.39
17. Amount of Line 14 taxable at Collateral/Class B rate (17) •00 X .1 5. .00
18. Principal Tax Due (lg) 4,309.39
TAX CREDITS:
PAYMENT
DATE RECEIPT
NUMBER DISCOUNT (+)
INTEREST (-) AMOUNT PAID
12-01-95 AA082369 10.64- 6,600.00
TOTAL TAX CREDIT 6,589.36
BALANCE OF TAX DUE 2,279.97CR
INTEREST AND PEN. .00
TOTAL DUE 2,279.97CR
* IF PAID AFTER DATE INDICATED, SEE REVERSE ( IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED.
FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE
REV.1500 EXt p.vaj t ~
~~~ ~ v -• v ~ - r V
INHERITANCE TAX RETURN FbA POU ALDEATHAFTER 14131!91 CHECKHERF
pOVERT7 CREDIT IS CLAIMED O
RESIDENT DECEDENT
FILE NUMBER
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE (TO BE FILED IN DUPLICATE ~ ~ 95 ~ f7~
PA°ii
UE
G WITH REGISTER OF WILLS)
HARRISH
za-oaol
R
; COUNTY CODE YEAR NUMBER
DECEDENT'S NAME (UST, fIRST, AND MIDDLE INITIAL) DECEDENT'S COMPLETE ADDRESS
DUTTON CALVIN P. 612 Hilltop Drive
c SOCIAL SECURITY NUMBER DATE Of DEATH DATE Of BIRTH N e W Cumberland
P A 17 0 7 0
"' 207-16-2533 2 21 95 10 5 26 ,
col,° C m n
p Ilf AIKIGEIE) SURVIVING 5-OUSE•s NAME LUST, fIRST ANO MIDDLE INItUy SOCIAL SECURITY NUMBER AMOUNT RECEIVED (SEE INSTRUCTIONS(
~ ®1. Original Return ^ 2. Supplemental Return ^ 3. Remainder Return
ac c x
,' ; i v
°
^ d. Limited Estate (for dates of death prior to 12-13-82)
^ da. Future Interest Compromise ^ 5. Federal Estate Tax Return Required
c°
~ (for dates of death oher 12-12-82)
c m n
4~ 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)
ALL:CORRESPONDENCE AND CONFtDENT1AL.7AX INFORMATION SHOULD BE DIRECTED,.:TO:_~ -~'.~-• "`_`
y = N'U•tE
~ COMPLETE MAILING ADDRESS
Francis A.
Zulli Es uire 109 Locust Street
~ ~ TELEPHONE NUMBER Harrisburg
P A 17101
717 232-1488 ,
1. Real Estate (Schedule A) (1) $ 121 , 5 0 0 • 0 0 -
2. Stocks and Bonds (Schedule B) (2 )
3. Closely Heid Stock/Portnership Interest (Schedule C) (3 )
4. Mortgages and Notes Receivable (Schedule D) (d }
5. Cash, Bank Deposits 8 Miscellaneous Personal Property (5 ~ 4 4 , 15 2 . 3 6 _
2 (Schedule E}
6. Jointly Owned Property (Schedule F) (6 )
~ 7. Transfers (Schedule G} (Schedule L} (7 )
a 8. Total Gross Assets (total Lines 1-7) (8 }$ 1 6 5, 6 5 2. 3 6
9. Funeral Expenses, Administrative Costs, Miscellaneous (9 ~ 21.6 3 0.8 0
Expenses (Schedule H}
10. Debts, Mortgage Liabilities, Liens (Schedule I) (1 ~ 7 2 , 1 9 8 . ~ ~
1 1. Total Deductions (total lines 9 i;< 10) (1 1) $ 9 3 , 8 2 9.13
12. Net Value of Estate (Line 8 minus line 1 1) (12) ~ 7 1 , $ 2 3 , 2 3
13. Charitable and Governmental Bequests (Schedule J) (13) -0-
1 d. Nat Value Subject to Tax (Line 12 minus Line 13) (14} $ 71 , $ 2 3 . 2 3
15. Spousal Transfers (for dates of death after 6-30 94)
See Instructions for Applicable Percentage on Reverse (15) _ ~ 71 , 8 2 3 . 2 3 x, __ $ 4 , 3 0 9 . 3 9
Side. (Include values from Schedule K or Schedule M.j .
16. Amount of Lins 14 taxable at 6% rate (lb) x..06 -
(include values from Schedule K or Schedule M.)
17. Amount of Line 14 taxable at 15% rate (17) x .15 0
o`
a
0
x
a
r-
Under
it is tru
based
(Include values from Schedule K or Schedule M.)
18. Principal tax due (Add tax from Lines 15, 16 and 17.)
19. Credits Spouzol Poverty Credit Prior Payments Discount Interest
+ 6,600.00 +
20. If Lins 19 is greater than Lina 18, enter the difference on Line 20. This is the OVERPAYMENT.
21. If Line 18 is greater thou Line 19, enter the difference on Line 21. This is the TAX DUE.
A. Enter the interest on the balance due on Lino 21A.
B. Enter the total of Line 21 and 21A on Line 218. This is the BALANCE DUE.
Make Check Payable to: Register of Wills, Agent
._ > _y::
=~;'< =~=~~ *~~BE:SURE TO: ANSWER~%1LLCUESTiONS ON~REVERSE;SIDE'^AND~T,G#RECt
~s of peryury, I declare that 1 have exomtned this return, including accompanying schedules and statements, and to the best of my knowledge and belief,
ct and amp) I declare that all real estate has been reported at true market value. Declaration of preparer other than the personal representative is
I on w ' repave as any knowledge.
RE N E f0 flll RETURN ADDRESS DATE
tEP RER OTHER THAN / RESENTATIV ADDRESS DA~ ~ '
(18} $ 4 , 309.39
(19) $ 6 , 600 .00
(20) $ 2 , 290.61 -
(21 }
(21 A)
(21 B}
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 wit) be:
• 3% (.03) wii! b• applicable for estates of decedents dying on or after 7/1 /94 and before 1 /1 /96
• 2% (.02) will be applicable for estates of decedents dying on or after 1 /1 /96 and before 1 /1 /97
• 1 % (.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 Qt1ESTICrNS
BY PLACING A CHECK MARK (r) 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? ......................................
Ff THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,
YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
~~c~t ~iII ttn~ C7~ P~trzmettt
OF
CALVIN P. DUTTON
I, CALVIN P. DUTTON, of New Cumberland, Cumberland
County, Pennsylvania, declare the following to be my Will,
hereby revoking all Wills heretofore made by me.
1. I direct that my debts, the expenses of my illness
and my funeral expenses be paid out of my estate.
2. I give, devise, and bequeath all the rest,
residue and remainder of my estate to my wife, HELEN A. DUTTON,
provided she survives me by Thirty (30) days. If my wife fails
to survive me by Thirty (30) days, I give, devise and bequeath
my residuary estate in four (4) equal shares to my children,
CALVIN P. DUTTON, JR., LAURIE R. SPIDLE, MARSHA B. McMANUS
and THOMArS I. DUTTON. If one or more of said children shall
not be living at the death of the survivor of my wife and
myself, I give and bequeath his or her share to any issue said
4aeease~.~ child raaY ha;,e, Nho are then 'giving, per stirpes.
3. Until actual distribution, no part of the income
or principal shall be subject to anticipation or alienation
by any beneficiary, and the same shall be free of the
obligations of any beneficiary and may not be attached or
taken because of any such obligations.
4. I direct that all inheritance, estate, transfer
and succession taxes, federal, state and foreign, of any kind
whatsoever, which may be due and payable as a result of my
death, together with all interest and penalties thereon, with
respect to all property includable for such tax purposes, shall
be paid out of the principal of my residuary estate. I authorize
my Executrix to pay such taxes at such time or times as she, in
her absolute discretion, may deem advisable.
5. In addition to the powers vested by law and
those granted elsewhere hereunder, I authorize my Executrix to
retain any or all real or personal assets of my estate; to sell
or to exchange any or all of such assets on such terms as she
may decide; to invest any assets of my estate without being
confined to "legal investments" under the law of aciy juris-
diction; to make distributior~sin kind; and to compromise any
claims by or against my estate. The foregoing powers shall
continue after the termination of my estate until actual
distribution of the assets.
6. I nominate, constitute and appoint my wife,
HELEN A. DUTTON, as Executrix hereunder. Upon the death,
resignation or inability of my wife to serve as Executrix, she
shall be succeeded by my son, CALVIN P. DUTTON, JR., who shall
have the`same powers, rights, duties, discretions and
immunities as I have conferred upon the original Executrix named
by me.
7. I appoint as Guardian of any property passing from
me to a minor grandchild of mine, whether under or outside of
this, Will, the respective surviving spouse, as the case may be,
-2-
who is the surviving parent of such grandchild. The said
Guardian shall have the power, in his absolute discretion, to
expend or distribute principal as well as income for the
maintenance, support, education and general welfare of each such
minor. In addition, the said Guardian shall have the power to
retain any investments in the form received by tier, but she shall
be restricted in making new investments to savings accounts
guaranteed by the Federal Deposit Insurance Corporation and to
obligations of the United States Government.
8. I direct that no fiduciary serving under the
provisions hereof shall be required to give bond or enter
security in order to qualify or to continue as such, any rule
or law to the contrary notwithstanding.
9. I relieve my fiduciaries from any and all liability
for loss or for any other cause which results from their deci-
sions, acts or failures to act, arrived at in good faith; and
they shall be absolved of any liability whatsoever if they shall
obtain the approval for any past or future action from a majority
of the beneficiaries affected thereby who are then sui juris.
IN WITNESS WHEREOF, I have hereunto set my hand and
seal this ~~ day of mG~~~- 1979.
~~. ,~~~~EAL)
SIGNED, SEALED, PUBLISHED and DECLARED by the within named
Testator as and for his Last Will and Testament in the
presence of us, who, at his request, in his presence and in
the presence of each other, have subscribed our names as
witnesses.
Name A dres~sj
N e Addre s
REV-1502 EX + (72-85)
r
SCHEDULE A
COMMONWEALTH OF PENNSYLVANIA REAL ESTATE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
CALVIN P. DUTTON
(Property jointly-owned with Right of Survivorship must be disclosed on Schedule F) All real estate should be reported of fair market value
which is defined as the price at which property would be exchanged between o willing buyer and a willing seller, neither being compelled
to buy or sell, both having reasonable knowledge of the relevant facts.
ITEM
NUMBER DESCRIPTION VALUE AT DATE
OF DEATH
~• 612 Hilltop Drive, Borough of New Cumberland,
$ 121,500.00
Cumberland County, PA (see attached appraisal report)
• - - -~--- •_ ••---~ • •••~~•• a~uv~nawa~ sneers or same srze.J
REV-1308 fX+ (2.8~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS AND
MISCELLANEOUS
PERSONAL PROPERTY
N
Please Print or
Calvin P. Dutton
(All property jointly-owned with the Right of Survivorship must ba disclosed on Sch~dula Fj
1TEM
NUMBER DESCRIPTION
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.',
23.
24.
VAtU E A7
DATE OF DEATH
PSECU - Checking account no. 0207162533
Interest to DOD
PSECU - Share 1 acct. no. 0207162533
Members 1st Federal Credit Union -
Savings acct. no. 6167-00
Interest to DOD
Members 1st Federal Credit Ur.ion -
Checking acct. no. 6167-11
Members 1st Federal Credit Union -
'IRA acct. no. 6167-10
Interest to DOD
Nations Bank of Texas -
Checking acct. ro. 216-808-6
AARP Investment Program from Scudder -
Acct. No. 0405-304-865-9 - 32.180 shares @$34.31
UGI Refund
AARP - Refund check
Haband of Prospect Park - refund
TV Host - Refund
Time, Inc. - Refund
RD Publications - Refund
Amos Press - Refund
Hearst Corp. - Refund
Amos Press - Refund
Patriot News Co. - Refund
AARP - Refund (Membership fund)
Nutrition. Action. Health Letter - Refund
Kirke-Var. Orsdel, Ir_c. - Refund
1994 Pontiac Bonneville - Appraised value (attache
Stamp Collection. (appraised value) (attached)
Household goods - Yard sale proceeds
Zeigler Auction. Co. - sale of persor_al property
_ TOTAL (Also enter on line 5. RR~nr,i+.~l,
(Attach additional 855" x 11' shs~ts ii mans spots is nMd~d.)
1,729.47
1.99
5.37
4,253.06
9.03
214 .76
16,974.67
33.21
~, 1,357.64
1,104.10
50.07
76.75
28.50
2.39
115.83
2.59
32.56
33.30
59.25
7.20
35.00
8.50
200.86
~) 11,000.00
5,240.00
1,425.33
150.93
REK ISII EX +11891
.~: ~~~.
CCl~ONWEALTH Of PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES
Please Print or
ITE~1A
NUM ;BIR DESCRfPT10N
A. I Fvnernl Expenses:
1• I Parthemore Funeral Home - burial
B.
C.
2
3
4
1
3.
4.
5.
6.
7.
8.
(If more spaca is needed, Insert additional sheets of same size.)
AMOUNT
6,911.89
Administrative Costs: CalviP. P. Dutton, Jr.
Personal Representative Commissions
Social Security Number of Personal Representative: 175 40 9794
Year Commissions paid 1996
Attorney Fees Wion, Zulli & Seibert
Family Exemption
Claimant Relationship
Address or Claimant at decedent's death
Street Address
City State Zip Cod
Probate Fees - Cumb. Co. Register of Wills
'Miscellaneous Expenses:
Cumberland Law Journal - Advertising
Diller Trash Removal - Clear_ up house
The Ser.tir_el - Advertising
Wior., Zulli & Seibert - copies, postage, rotary fees
'Register of Wills - Short Certificates
Roger Gratz - Stamp collection evaluation
Theodore Stefan, Jr. - Appraisal
Calvin Dutton, J. - cleaning supplies for sale
The Sentined reAdvSefor
yard sale
The Patriot - Adv. Yard Sale
Engle Publication - Adv. house for sale
Mellon Bank - Estate checks
The patriot News - Adv. house for sale
Barry Limppo - Removal of trash and junk
Winn Iii 1 1 i ~, Sei 1'1PYt _ Ao~~r..., C,.... r_ ~ _ _ _
8,000.00
5,000.00
258.00
40.00
107.54
68.84
25.00
12.00
25.00
250.00
300.p00
25.24
10.40
42.00
39.60
155.29
140.00
TOTAL (Also enter on line 9, Recapitulation) I S 21 , 6 3 0 . 8 0
REK1312 EX -+ (1-R .'
COMONWEAUM OF PENNSYLVANIA
IMERITANCE TAX RETURN
RESIDENT DECEDENT
aF
Ca
SCHEDULE 1
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES AND DENS
ITEM
NUMB ER DESCRIPTION
t.
2
3_
4_
5_
6.
7.
8.
9.
10 .
11 .
12 .
13 .
14 .
15 .
16 .
17 .
18 .
19 .
20.
21.
22.
23.
24.
25.
26.
27.
PSECU - Equity Loan No. 207-16-2533-L10-1297
Original amount $18,414.28, dated
12/5/94 - DOD balance
Members 1st Federal Credit Union - Key Loan
Line of Credit (1st mortgage) No. 6167-00,
~' dated 3/20/92, original amount $5,000.00,
recorded in Mortgage Book 1057, Page 217
DOD Balance
Members 1st Federal Credit Union - Personal
Members 1stnFederallCredit UnionB(2ndcMor
dated 3/20/92, original amount $66,850.OOtgage),
recorded in Mortgage Book 1057, Page 219 -
DOD balance
Brenner Cadillac - Body repairs to car
UGI Corp. - gas bills 3/95 to 10/95
Bell Telephone Co. - phone bills 3/95 to 10/95
PA American Water Co. - Water bills 3/95-10/95
Sammons Communication - cable bills 3/95-10/95
,USAA - Homeowners Insurance & Umbrella Policy
PP&L Co. - Electric bills 3/95-10/95
Betty Seidel & Assocs. - 1994 Income Tax Prep,
Borough of New Cumb. Sewer/trash bills 3/95-10/95
Exxon Co. - Gas credit card
Stephensons Flowers -
MBNA - Payoff on VISA and MC
Sears - Payoff credit card
PSECU - Car loan - March payment
Assoc. Cardiologist P.C. - Medical bill
PSECU - Car loan - April payment
PSECU - Car loan - May payment
PSECU - Car loan. - Jur_e payment
PSECU - Car loan - July payment
PSECU - Car loar. - August payment
Robin Gasperetti, Tax Collector - 1995 county & twp.
real estate taxes
Robin Gasperetti, Tax Collector - 1995 school real
estate taxes
Borough of New Cumberland - final trash bill
TOTAL (Also enter on line 10, Rscapituiation~
Please Print or Type
IMBER
AMOUNT
17,497.74
1,597.31
2 291.61
43
X698.19
559.71
398.31
286.63
119.18
126.91
318.93
377.46
90.00
L10.20
14.00
42.35
23.98
10.45
03.17
46.29
03.17
03.17
03.17
03.17
~4 : Ol~
.,524.13
51.87
~~ ,„~
(If more space is needed, insert additional sheep of same size.)
r 1
REV-1513 EX+ (2-8~
r
SC
HEDULE J
COMMONWEAITM Of PENNSYLVANIA
INHERITANCE TA% RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF
Calvin P. Dutton
ITEM
NUMBER NAME AND ADDRESS OF BENEFICIARY
A. Taxable Bequests:
~• Calvin P. Dutton, Jr.
51 Longview Drive
Mechanicsburg, PA 17055
2. Thomas I. Dutton
612 Hilltop Drive
New Cumberland, PA 17070
3• Laurie R. Spidle
305 Lafayette Drive
New Cumberland, PA 17070
4• Marsha B. McManus •-
52 Scarsdale Drive
Camp Hill, PA 17011
ITEM
NUMBER NAME AND ADDRESS OF BENEFICIARY
B. Charitable and Governmental Bequests:
TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Also enter on line 13 Recapitulation) I $
(If more space ~s needed, Insert add~tionol sheets of same size)
FILE NUMBER
RELATIONSHIP AMOUNT OR
SHARE OF ESTATE
son 1/4th of residu
son 1/4th of residu
daughter 1/4th of residu
daughter 1/4th of residu
AMOUNT OR
SHARE OF ESTATE