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Home My WebLink About95-0211~z~-~5- o~~~ 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, ' ect Division of Vital Records P.O. Box 1528 New Castle, PA 16103 nPE~,ENT M PEKNANENT NAME !LACK 2 0 O COMMONWEALTH OF PENNSYLIMNIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH X14482 "` 9El( SOCIAL SECURITY NUNEER DATE OF DERNUAanln.OaN'Arq ~ _ +• Marion H. Gottshall Female s.159 - 40 - 1018 Feb 14,1995 ~~~•~ ~01~1 D~•M N'~• 1~ ~wITN ~NRII/FlILE1CMw0 PIAC[ oEATNYCS•1rnM'an•-Yw.atrue4arancllr. ypq ( °~~4 a«vlcala.w Nt)BRDIL: 80YR Apr i 1 2 3 Mo+1w• ^ 17YQ11paliala ^ ooa ^ IINan~r ® R..d.ll,. ^ ^ • COlR1iYOFDERN an,EDRp, TN-OR DEATH NAaIE na:•NUlpl, ta"•,awand nmiearj w+sDECEDENracNlerrtNlcoRK{wr RACE-Amwtana1er11.el.alcv,ratw.te ® ~~ w^E,...,o.w,aea,,, (EPacaq Cumberland N. C .. am Hill r Leader Nursin Hine West ''`"O"°11oW14"•"~ DECEDENT•a oeuw~ElaN ' ItwoorxlswESywp,slRY wwoEDEDENrtevENw ,a lOir•Iigal+vMaorbqq~arrpIamor O'EEDtIC1Y10N Naw~YrrYaRllb•~i4 a,a•aYYlyttb; dsnollrrain,d.1 P1rA1 ta"+maldrllrrly • D . School teache rin field Sch l ~ "•~ ,i "''~' 4 ('~+1 ~~" DtecEDtorrs LtAKSIO ADDRESS 13a•aLCM,/61rn, Sub.2bCaeN +~• , 216 Allendale Way n.str._pa ;'~ 'Ta'~w.^w«w+~.ab r^".,pr i ~Pn ,,,,• Cartg Hi11, Pa 17011 ~" "~~• " __ I•a•NItP7 +~ ^ 7H ' '•MYIn•rlilYhd -oNER'9NAME tFaaL Lllder Lsy YOTNEME NAME ~ ,L L•de•. wen sulalry D' ,a ICa Ste=rner wFORIL~W i'9 NA4E RR'+rRilq John M Gottshall sluKwADaKESSISrw.D•r+w•nsl.b.noc•dq 216 Allendale W NE*nDDOCDIesowr,oN H , Pa 17011 ice y, ~~~ ~~ •Daxwr+ ~~'Nraaol cayrt ••~strw aPtaaa t1•dY^ G•1•,do11 [J Ranlaoi Mola3bla^ Dw1 a ^ ^ n . aMrtsa.wL ~ »w DF oR AcrnDASSUCN +a' +~. ' NIArER ~~ r~,rY 190 M arket Street ,, m. 011654-L ers- ' .~ era! In ll Pa 17011 1onRl•ep•,O~WloaunM•flMlinr.er•aMM•naNNA. LK'ENB rrlwataarea M~~ r ENUMBER dOESgI1ED ,alwaa.~ (wN. Datt wrl 1L1E aa1N troolrlpl,hdp, d1•p1or1.1a1caa4.111. ~~~ DRE PRONOUIICEp DEAD PIOr~a1, Dolt wh NRa CASE REFERREDW MEdCAL OGNYIERppgpNER, O. /AKT l: coabal'aIb1N •11141 oa11aMM e Y ~ ~ aa 1. D• 11q •N•r M nloda al eyMq, aucar •nlacor 1•paalory amtL antra arMrl tair•. allaaanwtll M I+M raMarbe 1 PAI,T F. Otlrr•171Kt•I•o•1d11e'IaaollaLulYgbdaa/1 a1R , laaryala•IYr•an ~1••1•Dgi••I.1•d1aMlgaMwywnYlRVR1. E/II[p11TE CAUSE (F•1al jaelwt•nedw11 1 oarldYCr1 ropRASACaNSE aFl ° ~ EE ~ _ D11EWpRA3ACONSEOUENCE OFk 1 ~ a 1 a1ENtd •qrY •1MaY I WETD(ORASACONSEOUENCE OFk 1••a•rq+ldbY1) WT I d M1~4 ANAl17OP$Y WE/1E AtJ10PSY F111DEq$ NAI11/E1I OF OERN 1 R CO1RM10NOECAUSE (,~,o,n,~,w) TINE OFINJURY wJtIRYR MORKT OESCRIEE NDRr wA111Y000URRED. OFDE/OM7 Naaaal ~ /Ialnidtla ^ A•Cieala ^ Par1d•p Ylvraptlb.l ^ w ^ No^ w ^ Nn~ w ^ N• ^ 31Ydd• ^ Caad m W eatarminae •t' ^ RACE OF wJURY-At nom.. !arm mw facbry olac• , , , LOCA7K711 (Slnal. CiylTwrl, SNb) b0. 2y W1N10.•b.ISP•ryY) C~fIREN IprCk n-/o1W e••' ]01. • ~~noYler onY+~cam naf POrqurlcaeewnard compgtae llem 231 a T•Mn•N OI m, b1••+•dM MaN SIDNATUfIE OF (ERTIF , OOeomd AbbM aarra•(a)a11a m•ImnNN•t•C ............................... ...................... 'PRDN 1,0. OUNLryND AND CERTIEYwD PNYSICIMI(Pnyaun pqn wanour¢rp Oaari ardc TeMlNrt of an+ymo b~ala.debml •1rlm•wbdpa,daatN«ewrwNMama aw LICENSE VEER DaE Q,oran. , ,a•dP4ca,andawbMeaaaapl..ldm+rm.ra•Na1K ........................ ^ ,e. MA b yS 'L- »a. 1- 16 'MEDICAL E7fAL1111ERR:ORONER NAPE AND ADDRESS Of PERSON W/IOOONPLE'IED CAUSE OE.QN (Item 27) Typa a Print On U1• hwla a/ aaam4btlon andlar Invesllyatlon, In my •plnlon, death •ccurr•d at M Uma, da,a 111ar1Mf b atnad . and pbeq ant Aua b,M n ~ 1 ~'~ ~-~ , . .......................... a•(a) and uu .......... REGISTRAR'S SIGNATURE ANp NUNSER "~/ / / / DATE FlLEDI wYn. Day. Rarl " REV - 1500 EX + (7-94) D E C E D E N T HARRISBURG, PA 17128-0801 DECEDENTS NAME (LAST, FIRST, AND Gottshall Marion H.d CAB u 1. Original Return H P L u 4. Limited Estate ~ R C K P S ^X 6. Decedent Died Testate C p ALL( R N NAME E E La S (~ TELEF - T / R E C A P I T U L A T I O N T A X C O M P U T A T I O N AND SOCIAL SECURITY NUMBER DATE OF DEATH DATE OF BIRTH OF DEATH AFTER 12/~[gt CHECK HERE ,~ FILE NUMBER 21 X895 0211 DECEDENT'S COMPLETE ADDRESS 216 Allendale Way Camp Hill, PA 17011 159-40-101 ~2 14 95 04 23 14 count Cumberland APPLICABLE) SURVIVING SPOUSE'S NAME (LAST,FIRSTAND MIDDLE INITIAL) SOCIAL SECURITY NUMBER r1~Y~~~ti INHERITANCE T ETURN RESIDENT DECEDENT (TO BE FILED IN DUPLICATE INITIAL) 2. Supplemental Return 4a. Future Interest Compromise (for dates of death after 12-12-82) 7. Decedent Maintained a Living Trust (Attach a copy of Trust) AMOUNT RECEIVED (SEE INSTRUCTIONS) LJ 3. Remainder Return (for dates of death prior to 12-13-82) 5. Federal Estate Tax Return Required 1 8. Total Number of Safe Deposit Boxes COMP E MAILINGAODRESS once B. Abrams s ire oads & Sinon LLP E NUMBER P . O. BOX 1146 "'` " "' "J1 1. Real Estate (Schedule A) Harrisbur PA 17108- (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held StocWPartnership Interest (Schedule C) (3) 4. Mortgages and Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Sch. E) 8 780.98 6. Jointly Owned Property (Schedule F) _ (6) 7. Transfers (Schedule G) (Schedule L) 43 366 92 8. Total Gross Assets (fatal Unes 1-7) . - 9. Funeral Expenses, Administrative Costs, Miscellaneous 7, 686 00 Expenses (Schedule H) . ~"- 10. Debts, Mortgage Liabilities, Liens (Schedule I) (,10)/ 36 00 11. Total Deductions (total Lines 9 & 10) . 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests (Schedule J) 15. Spousal Transfers (for dates of death after 6-30-94) See Instructions fo A I' (8) 52, 147.90 (11) 7, 722 00 (12) 44 425 90 (13) 0.00 (14) 44 , 425.90 r pp (cable Percentage on page 2. (15) 0.0 0 X 0 0 = 0. 0 0 (Include values from Schedule K or Schedule M.) 16. Amount of Line 14 taxable at 6% rate (16) 44 , 425.90 (Include values from Schedule K or Schedule M.) 2.665 .55 ~,~f: 17. Amount Of Line 14 taxable at 15% rate (17) 0 . 00 X .15 = (Include values from Schedule K or Schedule M.) 0.00 18. Principal tax due (Add tax from Line 15, 16 and 17.) 19. Credits Spousal Poverty Credit Prior Payments Discount Interest 0.00 + 0.00 + 0.00 - 0.00 20. If Line 19 is eater than Line 18 enter the difference on Line 20. This is the OVERPAYMENT. :. .. ! . 1 . ... ,:: i:: ~. ..:. .,~:: ~.. ..: ~ .... 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 balance due on Line 21A. B. Enter the total of Line 21 and 21A on Line 21B. This is the BALANCE DUE. ~ - BE SURE TO ANSWER ALL OUE Under penalties of perjury, I declare that I have ezamined this return, Ineluding aea correct and complete. I declare that all real estate has been reported at true market which preparsr hoe any know'-'-- SIGNATURE OF PERSON RE SIGNAT R J~O~F'~PC~~EP.ARE I ~....J.;..ti ~.., ,noe t..,.~ ~., ,., FOR FILING R f~/R THAN REPRES~ I V1-f ~~~ ....i., roc.,..,...., i.... (18) 2 665.55 (19) 0.00 0.00 (21) 2 665 55 (21A) 4T8 84 (218) 3,084,28 JS ON PAGE 2 AND TO RECHECK MATH Q Q fine schedules and statements, and to the best of my knowledge and belief, It is true, Dxlaration of prsparer other than the personal rsprssentatlva Is based on all information of ETURN ADDRE3S -'------- DATE 216 _Allendale_ Way _ ------------------------ Cam Hill PA 17011 ~,.y,~9~ ATIVE ADDRESS DATE P_O__Box_1146 __ Harrisburg PA 17108-1146 ~ I ~~1~ 7 cam.,., ~rJtn ram., ~_aei Act #48 of 1994 provides for the reduction of the tax rates imposed on the net value of transfers to or for the use of the spouse. The rates as prescribed by the statute will be: •3% (.03) will be applicable for estates of decedents dying on or after 7/1/94 and before 1/1/96 •2% (.02) will be applicable for estates of decedents dying on or after 1/1/96 and before 1/1/97 • 1% (.01) will be applicable for estates of decedents dying on or after 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 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 properly 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? H 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 COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. f:mm~in V.~ln\ 1COe s..,... .,.l~.....e ,...~.. no~.._._~. ~__ REV - 1508 EX + (2-87) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT tSrATE OF Marion H. Gottshall Please Print or T e FILE NUMBER 21- 9 5 - 0211 SCHEDULE E CASH, BANK DEPOSITS AND MISCELLANEOUS roe ointl -owned with RI ht of Survivorshi must be disclosed on ITEM JMBER DESCRIPTION 1 PNC Bank, N.A., Certificate of Deposit No. 20-01012437 Interest accrued to 02/14/95 2 B1ueCross/B1ueShield, refund 3 Country Meadows, refund (Attach additional 8 1/2" x 11" sheets ff more space is needed.) r.......~..ti• i..~ ~oow s...... ....~~... ~... ..-~.. r.eo..-.-_- . VALUE AT DATE OF DEATH 5,000.00 2.78 93.20 3,685.00 8 780 REV - 1510 EX + (2-87) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Marion H. Gottshall SCHEDULE G FILE NUMBER - - ~~ ~~~+~ ~ oc wtvtra_t f ED AND FILED IF THE ANS ITEM DESCRIPTION OF PROPERTY NUMBER Include name of the transferee, their r 1 Alliance Bond Fund - Corporate Bond Portfolio Class B, 563 shares Q $11.58/sh., Transferee: John M. Gottshall, III, son. Date of transfer: 09/02/94 CUSIP NO. 018528885 2 Alliance Mortgage Securities Income Class B, 1094 shares cta $8.27/sh., Transferee: John M. Gottshall, III, son. Date of transfer: 09/02/94 CUSIP NO. 018639203 3 Fortress Utility Fund SBI, 615.9963 shares ~ $12.12/sh. Transferee: John M. Gotshall, III, son. Date of transfer: 09/02/94 CUSIP N0. 314286402 4 Merrill Lynch Corporate Bond Fund Investment Grade Portfolio Class B, 446 shares ~ $10.76/sh. Transferee: John M. Gotshall, III, son. Date of transfer: 09/02/94 CUSIP NO. 590907507 5 Merrill Lynch Global Allocation Fund, Class B, 787.0610 shares ® $12.31/sh. Transferee: John M. Gotshall, - III, son. Date of transfer: 09/02/94 CUSIP~NO. 589939206 6 Merrill Lynch Global Bond Fund for Investment and Retirement Class B, 536 shares $9.04/sh. Transferee: John M. Gotshall, III, son. Date of transfer: 09/02/94. CUSIP NO. 589921105 21-95-0211 EXCLUSION I TOTAL VALUE I DECD. DOLLAR VALUE OF 3,000.00 6,519.54 ~ 100 3,519.54 0.00 0.00 0.00 0.00 0.00 9,047.38 ~ 100 7,465.88 ~ 100 4,798.96 ~ 100 9,688.72 ~ 100 4,845.44 ~ 100 9,047.38 7,465.88 4,798.96 9,688.72 4,845.44 - - 4 001. TOTAL Iso enter on line 7 Reca itulation (If more space is needed, insert additional sheets of 4 3 3 6 6 . r.......b.Ld ~.1 +oae r...... ....~~,..e... ....i.. noe.._._-' '-- Same slZe.~ SCHEDULE G TRANSFERS (continued) Yn Money Fund, Account No. 872-45454, Transferee: John M. Gottshall, III, son. Date of transfer: 09/02/94 0.00 329.75 100 329.75 8 PNC Bank, Checking Account No. 51-4022-2126. Transferee: John M. Gotshall, III, son. Date of transfer: 09/94 Date of death balance, $3,669.40; accrued interest, $1.85 0.00 3,671.25 100 3,671.25 ESTATE OF: Marion H. Gottshall FILE NUMBER: 21-95-0211 ITEM NO DESCRIPTION OF PROPERTY EXCLUSION TOOF ASSETE INTERESTT g DECEDENT SUINTOERES 7 Merrill L ch CMA Total. (Carry forward to main schedule) • $ 4,001.00 REV - 1511 EX + (7-88) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES, ADMINISTRATIVE COSTS AND ~~- .w v v~f G19~7GJ Please ESTATE OF Marion H. Gottshall FILE NUMBER ITEM NUMBER DESCRIPTION A• Funeral Expenses: 1 East Harrisburg Cemetery gravemarker grave opening fee 2 Myers-Harner Funeral Homes, Inc. B• Administrative Costs: 1• Personal Representative Commissions Social Security Number of Personal Representative: - Year Commissions paid 2. Attorney Fees _ Rhoads & Sinon LLP 3. ~ Family Exemption Claimant John M. Gottshall, III Relationship Son Address of Claimant at decedents death ~ L/ Street Address 216 Allendale Way I`~- City Camp Hill State PA Zip Code 17011 4. Probate Fees 950.00 3,500. 0 45.00 C• Miscellaneous Expenses: 1 Cumberland County Register of Wills short certificate Filing fee, PA Inheritance Tax Return and Inventory 2 Reserve for final costs and expenses 3.00 28.00 25.00 21-95-0211 AMOUNT 585.00 470.00 2,080.00 0.00 ter more space is needed, Insert additional sheets of same size.) 686 REV - 1512 EX+ (1-83) SCHEDULEI COMMONWEA~THOFPENNSYLVANIA DEBTS OF DECEDENT, INHERITANCE TAX RETURN RESIDENT DECEDENT MORTGAGE LIABILITIES AND LIEN ESTATE OF Marion H . Gottshall Please Print of T FILE NUMBER 21- 9 5 - 0 211 ITEM NUMBER DESCRIPTION AMOUNT 1 Tamdot Homecare of Harrisburg balance due at death 36.00 TOTAL Iso enter on line 10 Rec itulation (If more space is needed, insert additional sheets of same size.) 3 6.00 REV - 7513 EX + (2-87) COMMONWEALTH OFPENN3vLVANIA SCHEDULE J INHERITANCFbTAXBETURN RESIDENT ECEDENT BENEFICteaIF esTATE OF Marion H. Gottshall ITEM NUMBER NAME AND ADDRESS OF BENEFICIARY A. Taxable Bequests: 1 John M. Gottshall, III 216 Allendale Way Camp Hill, PA 17011 FILE NUMBER 21- 95 - 0211 RELATIONSHIP AMOUNT OR SHARE OF ESTATE Entire estate .-onvnonr ~o~ iee4 roan software only CPSvatema. Ine_ ~ '~-"" ""°`~ `~~ siurle SIZG) Form 1~M Schedule .1 fgav. 2_871 Register of Wills of CUMBERLAND County, Pennsylvania Certificate of Grant of Letters Testamentary No. 1995-00211 PA No. 2195-0211 ESTATE OF GOTTSHALL MARION H Late of LOWER ALLEN TOWNSHIP Deceased Social Security No. 159-40-1018 WHEREAS, on the 16th day of March dated Februar 1st 1977 1995 an instrument was admitted to probate as the last will of GOTTSHALL MARION H ~ , late of LOWER ALLEN TOWNSHIP CUMBERLAND County, who died on the 14th day of February 1995 and, WHEREAS, a true copy of the will as probated is annexed hereto. THEREFORE, I, MARY C. LEWIS Register of Wills in and for the County of CUMBERLAND in the Commonwealth of Pennsylvania, hereby certify that I have this day granted Letters TESTAMENTARY to JOHN MERVIN GOTTSHALL III who has duly qualified as Executor(rix) and has agreed to administer the estate according to law, all of which full appears of record in my Office at CUMBERLAND COUNTY COURT HOUSE, y CARLISLE, PENNSYLVANIA. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of my Office the 16th day of March 1995. G eggs er o i' s **NOTE** ALL NAMES ABOVE APPEAR (LAST, FIRST. MIDDLEI _ LAST WILL AND TESTAi~1ENT (Executed in duplicate) KNOW ALL N~EN BY THESE PRESENTS, that I, MARION H. COTTS~iA . of the Township of Muncy Creek, County of Lycoming and Common_ ~~-~,~>~;~ . _ :wealth: of Penns ~- ^'" ~ ~uo_ * ~.. ylvania being~f~so'tc~~~~dspost,~'rig~~d~y'~d memory, do make and publish this to be my last will and testament hereby revoking all wills and testaments or writings in the nature thereof made by me at any time heretofore. FIRST: I direct that all my just debts and funeral ex- penses be paid and discharged by my Executor, hereinafter named, as soon as may conveniently be done after my decease. SECOND: A.11 of my estate, real, personal and mixed, of whatsoever kind and character and wheresoever situate, I give, devise and bequeath unto my husband, J. Mervin Gottshall :::, ~~< . absolutel , ~ ~ i_..: ~ "~~;~~,.~~.,~ ,~_~4, .rr ~: µ ' , . y, provided he"~ be -Tivirig ~'at `the expiration' of a` ~pe~ od , ~,..., of sixty days after my death. THIRD: In the event my husband, J. Mervin Gottshall is not living at the time of my death, or dies within sixty days thereafter, then I give, devise and bequeath all the rest, residue and remainder of my property;. real and- ersonal tom son John Mervin Gottshall III. ; ' 4 '` " °` ~ I the; vent that; my-son;~should predecease me then the share yirhi h he~ woul°d, ha e~ been 'enti ~~>,~,. -~ ~ tied to :receive shall ..;- ~ ' ~~ ~~, , ~, ;>~ ~ .. pass to my daughter-in--law ;. Nancy,, Gottshall, and my grand- . children in equal shares. It is my intention that my daughter-in- law receive the same share as each of my grandchildren. ;; ,~~<.: . , - FOUR ~, ~:''~ ~,.::..K w ._ ~ -,. _ . ,, :: ~, .. under the age of twenty-one, I give, devise and bequeath all of his or her share of my estate to Nancy Gottshall, IN TRUST, how- ever, for purposes as follows: (1) To hold, manage, invest and reinvest the trust prop- erty, collect the income therefrom and pay over the income there- from at such time or times as my Trustee in her sole discretion shall determine, to or for the benefit of my grandchild or grand- children. ,ill111~1i1 ~ . , l2) To pay over to or for the ~b~enefit~ of ~m grandchildren such sum or sum ,Y grandchild o trust, as she may determine frometimedtortimehinpthecexercisetof. her sole discretion. (3) To retain and set aside, at the outset or as she may determine, such property or sum of money as she may consider appropriate to be used for the purpose of providing a college education-for my grandchild or grandchildren. Such property or sum of money as may be so set aside should not be regarded as having been set aside irrevocably;,the Trustee is authorized to use the same for maintenance, care and su or grandchildren it bein m PPort of my grandchild suitable maintenance, cage andrsuclpal purpose to first provide of life, so far as practicable. pport compatible with my station (4) To terminate the trust and to make distribution of the principal and accumulated income therefrom when my youngest grandchild attains the age of twenty-one, or shall have died with- out attaining the age of twenty-one. Distribution, if there be more than one grandchild, shall be in equal shares. FIFTH: I nominate, constitute and appoint as executor of this my last will and testament my husband, J. Mervin Gottshall. Should my said husband predecease me, or for any reason fail to serve as executor, then I nominate, constitute and appoint my son, John Mervin Gottshall, III, as executor of this my last will n testament. In the further event that my son should rede a d P cease me, or for any reason fail to serve as executor, then I nominate, constitute and appoint my daughter-in-law, Nancy Gottshall, as executrix of this my last will and testament. I direct that none >f the above shall be required to post bond for the performance of .heir duties. `~° x ti~ ,~.=,: . ,:> set my hand and seal this ~_ day of ~~3'~v , 1977 I .-' ~,.~ ~ ~~ '~1 ii .~--~.-r s-L:.:~/ : C.~>,_ C~/~. r ~_ ~ SEAL ) Signed, sealed, published and declared by the above named testa- trix 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 set our hands as attesting witnesses. G~c,~ .// j pennsylvania DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES _ INHERITANCE TAX INHERITANCE TAX p�V-UURt- �s1 P1CFi�` O� STATEMENT OF ACCOUNT REV-1607 EX AFP (12-14) PO BOX 280601 SE C 1 U J O C HARRISBURG PA 1712,4¢0 1 t .1 l� J is DATE 02-09-2015 FEB 17 FM 1 19 ESTATE OF GOTTSHALL MARION H DATE OF DEATH 02-14-1995 FILE NUMBER 21 95-0211 NAN> CP",;;T COUNTY CUMBERLAND ABRAMS S �'"LAWRENCE� A ACN 101 RHOAD§,LVASIWidW, ' �. PO BOX 1146 Amount Remitted HBG PA 17108 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 _ _�_ _ RE_TAIN LOWER PORTION FOR YOUR RECORDS _-- - - - - - - _ _ _ __ _ _ _ _ _ REV-1607 EX AFP C12-14) *** INHERITANCE TAX UN STATEMENT OF ACCOT **; ESTATE OF:GOTTSHALL MARION H FILE NO. : 21 95-0211 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: 11-10-1997 PRINCIPAL TAX DUE: 2,665.55 PAYMENTS (TAX CREDITS) : PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID C-) 08-11-1997 AA211625 418.73- 3,084.28 02-06-2015 SBADJUST .00 .01 TOTAL TAX PAYMENT 2,665.55 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. (� V�\