HomeMy WebLinkAbout95-0244a-i -q5-oa~~
N705.,13Rw. 7A7
TY-E?pWT
w
PERBUUIDiT
BLApI YIK
~'
3
z
W
O
O
t3
Z
This is to certify that the certificate hereunto attached is a tine 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.
Auc i s-2oo7 ?
Date Fran eropoli, ' ect
Division of Vital Records
P.O. Box 1528
New Castle, PA 16103
COMYONWEALTN OF PENNSYLIMNIA • DEPARTMENT OF HEALTH • VITAL RECORDS
CERTIFICATE OF DEATH ^ 7 ~ S? r '~
NMIE OF OECEO®iT(F..L -YGd.. Lrq SFX SOCIAL SECWI/IY NUMBER ORE OF OE/7M irn~. O.icYw,
,. a =FeT11i31e ~ 1 - - 3 a
AOEil..r pyB.d.,) ,rEU, t>lcet, wr DReaswrtt e+m.tACSial~.w .uc.as DE~aNCa,ea«+ra»-,».rln,cea.man..aq
tApr1. = Dx• Npw 11r..r Iw,n. D.~rw, str.osa.q,c.urq HOSADIL
oTrlEtc
79 YR y 15,1915 ~Iarrisburg, PA `9r'r" ^ E"'a'°'""" ^ 0°A ^ Ha.:"a,~, R..iOr.. ^ ^
couNrvasDERH cm;BDra.,vwasDERN wtrEp^r:a..w..o»r.r.,e~.,ron, ostwAt«eonatNT RACE-Anl.taRt.aw,err~wNr,rc
N. w ^ s v.s tv.wroe... la~c.vl
Dauphin Co. isburg Susquehanna Center ~ ^'"°"'°~~ ,a White
usuALacctrr+vaN IBNOastxuxlESSnNOUSTRr WASxcEDENrtvER« oECEDExrsEDUCatar, tArrruLStRUS•etr,Ne swrnwostroua
~r U.S. Ai1MED FORCEl7
N•
M
~
~
N
rtNC.WW.•.q 111wr.gMmrd.n MPN,
r•a.M~.
•• r.F•a
'• d^a1
~
~0
•
`••^ N0~
n+
«s
Clerk ,Mate Government ,
, 2
*r Married
,a
DECmENr'B tAARyJfi AOOREBB IS...L CiIY/brl,SYw 21PCoeN a ,Ta SUr Pennsylvania
7
^
..
qe ,
h..auaw..r.sl•
1831 Elm Street RESIDENOE e.ceRV ^ a
,~ New Cumberland, PA 17070 •^ ~~ ,~ Dauphin County rM..rNIaPt ~."~ r Harrisburg
wettExa NAMEIFir, rips., taNi u'Y~.,a
uIDTtlErcs NAME Ii..t I.xaw. r.en&rP.Rw
Huhn F. AdaltLS Whi
tNNORIAIWI'S NArERiow.:q S tAARD10 AODNESB WiNL Ciykr..9u+A zbCaly
~~ 960 Clearfield St., Harrisburgl, PA 17111
DREOFasroa,rlDN tucEaFDlsPasrttort•w.,.ao.nsx~l.•+o~r LocRaR•C.,+ro...slrwnncoa.
•D•x Mrl ~ aOtMrPtr.
G•nrtloR^ R.,..gItN.1BW.^
^
Orrlon^ ottrr
=„March 24,1995 a Harris Cemet ,a Harrisburg, PA 17103
tilllFlYIL UCEHBEEOR ACTWB A6~ NtMNER N111AEANDAOOIESSOfiAOLITY
FI>-013163-L ~usselman Funeral Home, Inc.
Lemoyne
PA 17043
,
,
M..I.O.•••Mw1rRa.WW7 wlwerr., oonnMrprtb, ..p p.orr.a
rlr.Yrrr•rtl.raarNr fsaY+.•.~pTrr LICENBENUreER D,vE9117NED
ew.aara ~ ~ or`i Er134 L i"°'+n.D.Y.,wn
a zt i9ts.
~~ ~~M aRDE,aN vRDNOUMCED DEADwmn.Dgt Nr) w+s cA9E REt~RRED7D MEacx ExAwNEwcotaNFM
Iq
~ Zi'$3 P,,.~ r. x MAaCi1 ZU ,qqr ~•^ N61+.
O. wlRft
~
Q~ ~
•.•iP~pro rtiNaRr.pi^.a.rtl.D. notrar n..oe.aq,.,p, ail.cre.e>
.IVkatwnltlu,.
A
irP+•dTrrr
w
r.
~
.
~
ppq.
lr. P/Uff t^ Our.iv~tanalt.Ia
Lw
. mnYWIFgrU../40r
MMMYw.n nrrwr.
i
l
I
q
lt
w u.plA,^IOtrM¢~vnin PMNii.
~DtA[CMIN ~ifW tOfIr1.110 p..ltl
str.aaxgilm /J.~~J U~rK NA I .
nwi44 n 0nN1^~ a O a r t ~
ID~ORASA OUENCE Ot•L
0.4Mr1Y,'Y ansYwr b <~ ra.L ,'p.J
~.. E~pUIOiRY1110 OUE TOICRASA CONSEIXIENCE OF} 1
QMIB[104rraryvy ~ ~
~~~•~~
OUE,O(OR ASACONSEOUENCE OFk
n ~) WT I
1
1M'ANAUIORSY Blf./E AUIO/SY Ft101NO3 NANNEAOF DEAN DRE OFitNU11Y TRAE aFINJURY INJURYRWORKt DESCRIBE HOW BiR1RYOGaMpEQ
'7 MRII.AREP1110111D (~+M.Oy,Mr)
Of CAUBE
OERM NY..1 H.miap. ^
AospM P•nWgYn.W9rb^ ^ 1M ^ N. ^
M. ^ N.1~ N. ^ N. ^ 3uklp. ^ CgM..I W dN.m.irp ^ r.
PLACE Of INJURY-N 0.•w
1u.n
lrM
dliw LOCR
I•«
,
,
,
%
gN fSU•r. Cily/kn, Smy -
7M ~, MYIlr4.le (SPid1Y)
50.. ]
f
~BITIFlH11GNrJ<n+Y art .
•ct~TrvwonnslaAN
v /
.
osc
l
rw+o.^o.,+r•sow.aaw,~,.an.o^w~~nnw~rcwo..u,.ro~omwlwmm2s, ~
- mw. swta.vr~.wrrw.~.In.oeun~awr+we•.Wprr m.w.rwra .................................... ^
•rROnouNDBgANDDemPrINBMnSICIAN(PAyaiconpa^parpund.pwap,.rawniMrgnuurao.anl
Ta prwwaww•.r.s•.a..axe.,wrm.w^..er....ew.c...^aa»+,u».n.q.,,.sm..,.,..rmre .......................... DATE pAa+n.D.A1Y.rI
,. ObOU IS'134L
~, mac 21 144s~
NAME AND AOORESSOF PERSON WHO COADM.ETEDCAUSEOF OFAN
•11EOICAL OIAIWIFA/CflAONEp
OR UI.O.•i.d•arMtitbn.rlp/OI Itw.•IIE•tion,M•,y•prloR,p.rh oeeumprtlr tNn.,dr.,.M pl.u,.np OUt totM au .rW
^rnnNgraMA 2T, T,q. a V,wlt
LO 2Nt A•Q~l' C. ~~l
22.
a
~
~
...................................................... ...... ^
ila i
k
~i 300 lGw~bOU
'
REGISTRAR'SSIGNRUIIE ANO NUMBE
q ~'~n~n ,'~6~r P4 X7110
i
~
~_ l /
y
~ ORE MED (Map.. 0.Y Meu1
. >~ ~ S
r
.,
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
/°;~ -' HARRISBURG, PA 17128-0601
,5~a~s.
INHERITANCE TAX RETURN
RESIDENT DECEDENT
(TO BE FILED IN DUPLICATE
WITH REGISTER OF WILLS)
ADAMS, SARA M.
W SOCIAL SECURITY NUMBER DATE OF DEATH
188-32-3910 3-20-95
D (IF APPLICABLE) SURVIVING SPOUSE'S NAME MAST, FIRST AND MIDDLE INITIAL)
:~.
FOR DATES OF DEATH AFTER 14131191 CHECK HERE
IF A SPOUSAL
POVERTY CREDIT IS CLAIMED ^
~""9'P~ n ~ . •
fir' ~~ ~~ C~~'i' ~>~
NTY CODE YEAR NUMBER
vca.cucrvl'~ C.VMPIETE ADDRESS
1831 ELM STREET
DATE OF BIRTH NEW COMBFRT.A1~Tn r PA 17070
5-15-15 c°unt„ CUMBERLAND
N/A N/A
L+' ~] 1. Original Return ^ 2. Supplemental Return
Y C N
Liu d ~ ^ 4. Limited Estate ^ 4a. Future Interest Compromise
~ ~ ~ (for dates of death after 12-12-82)
a m ~] b. Decedent Died Testate ^ 7. Decedent Maintained a living Trust
(Attach copy of Will) (Attach copy of Trust)
~~
H =
W Ly
~ O
oz
v o°-
z
0
f=
J
o.
a
v
z
0
o_
0
U
X
^ 3. Remainder Return
(for dates of death prior to 12-13-82)
^ 5. Federal Estate Tax Return Required
0 B. Total Number of Safe Deposit Boxes
,.:~~~, $s a ,
TELEPHONE NUMBER 101 PINE STREET
P.O. BOX 932
1. Real Estate (Schedule A) (1) 5,~, U00 _ 00 ~~~ ~1,
2. Stocks and Bonds (Schedule 6) (2) - Q -
3. Closely Held Stock/Partnership Interest (Schedule C) (3) - 0 -
4. Mortgages and Notes Receivable (Schedule D) (4 } - Q -
5. Cash, Bank Deposits & Miscellaneous Personal Property ($) 5 8 , 414.7 3
(Schedule E)
b. Jointly Owned Pro ert (S h d I F - Q
P Y c e ue )
7. Transfers (Schedule G) (Schedule L) (b) - 0 -
(7 } ~ ~ ~~t~` ~ T
8. Total Gross Assets (total Lines 1-7) (g) 121, 414 .73
9. Funeral Expenses, Administrative Costs, Miscellaneous (q) 22, 216 • 71
Expenses (Schedule H)
10. Debts, Mortgage Liabilities, Liens (Schedule I} (10) - -
-
11. Total Deductions (total Lines 9 8 10) ~/~ ~ ~ ~~
(11) 22, 216 • 71
12. Net Value of Estate (Line 8 minus Line 11) ~/~[f;j~~Al,
T
+
~
`J 99,198.02
13. Charitable and Governmental Bequests (Schedule 1) 3)
(
1
/ _ _
14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 4 9 f 1 9 f3 Q 7
15. Spousal Transfers (for dates of death after b-30-94)
See Instructions for Applicable Percentage on Reverse (15) - 0 -
Side. (Include values from Schedule K or Schedule M
) x._=
.
16. Amount of Line 14 taxable at b% rate
(Include values from Schedule K or Schedule M
)
(16) - 0 - x .Ob = C G
~' ~~~ J r Z
.
17. Amount of Line 14 taxable at 15% rate
(Include values from Sched
l
K
S
h
d (17) 9 9 ,19 8.0 2 x l s _ 14 , 8 7 9.7 0
u
e
or
c
e
ule M.)
18. Principal tax due (Add tax from Lines 15, 16 and 17.) (18) 14, 879.70
19. Credits Spousal Poverty Credit Prior Payments Discount Interest
+ + 743.98 _
t0. If Line 19 is greater than Line 18, enter the difference on Line 20. This is the OVERPAYMENT.
1. 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 21 A.
B. Enter the total of Line 21 and 21A on Line 21B. This is the BALANCE DUE.
Make Check Payable to: Register of Wills, Agent
(19) 743.98
(20)
(2t) 14,135.72
(21 A) - -
(2tB) 14,135.72
BE
Under penalties of perjury, I declare tl
it is true, correct and complete. I decla
based on all information of which Orel
I have examined this return, including accompanying
that all real estate has been reported at true market
er has env knowledgw
y/~ C-~~~~i~ lC~ l ~~
OF PREPARER OTHER THA REPRESENTATIVE ADD
IE.AND TO RECHECK MATH
`;'~
ales and statements, and to the best of my knowledge and belief,
Declaration of preparer other than the personal representative is
DATE
DATE
N/A
Act 348 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:
e 3% (.03) will be applicable for estates of decedents dying on or after 7/1/94 anti before 1/1/96
• 2°y6 (.02) will be applicable for estates of decedents dying on or after 1 /1 /96 ~ =yd before 1 /1 /97
e 1 °y6 (.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 (r) IN THE APPROPRIATE BLOCKS.
YES NO
1. Did decedent make a transfer and:
X
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
X
c. retain a reversionary interest; or ...................................................................................
X
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 X
death transfer property without receiving adequate consideration3 If death occurred after
December 12, 1982, did decedent transfer property within one year of death without receiving g
adequate consideration$ ...................................................................................................
X
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.
FEV-1502 EXe+ (12-85)
SCHEDULE A
COMMONWEALTH Of PENNSYLVANIA I REAL ESTATE
INHERITANCE 7AX RETURN
RESIDENT DECEDENT
FILE NUMBER
SAEA MARY ADAMS, DECEASED -- PA #2195-0244/
(Property iointly-owned with Right of Survivorship must be disclosed on Schedule F) All real estate should be sported 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
NUMBER DESCRIPTION VALUE AT DATE
OF DEATH
~• Property situate at 1831 Elm Street, New Cumberland,
Cumberland County, Pennsylvania, improved with the
northern half of a double frame house, conveyed to
Decedent by Deed dated November 27, 1970, recorded
in Cumberland County Deed Book X, page 427.......... 63,000.00
TOTAL (Also enter on line 1, Recapitulation) $ 63 000. ~
(If more space is needed, insert odditionol sheets of same size.)
~ t
REV-1508 EX+ (2-8~
SCHEQULE E
CASH, BANK DEPOSITS AND
COMMONWEALTH OF PENNSYLVANIA MISCELLANEOUS
IN RESIDENT DEACEDENTRN PERSONAL PROPERTY
Please Print or
ESTATE OF FILE NUMBER
SARA MARY ADAMS, DECEASED -- PA ;2195-0244/1995-00244
(All property leintly-owned with tM Rig6t of Survivorship must M dlselesed on Sclsedub FI
ITEM
NUMBER DESCRIPTION VALUE AT
DATE OF DEATH
1. PNC Bank -- Personal Checking Acct. 51-4000-0304.. 17,027.33
2. Harris Savings -- Certificate of Deposit No.
04-56-195285 .....................................
3. 1979 Ford Fairmont automobile, Title No. A3208583 .
4. Personal effects (See attached appraisal)......,,,
5. Travelers Insuarnce -- Proceeds of life insurance
policy No. 2276004 (named beneficiaries
predeceased Decedent) .............................
35,417.40
500.00
4,470.00
1,000.00
TOTAL (Also enter on line 5, Recapitulation) $ 5 , 414.73
(Attach additional 8'/z" x 11" sheets if more space is needed.) j `
REV-1511 E%+ (7-88)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES
SARA MARY ADAMS, DECEASED
ITEM DESCRIPTION
NUMBER
A. Funeral Expenses
B. Administrative Costs:
1. Personal Representative Commissions
Social Security Number of Personal Representative:
Year Commissions paid 1995
2
3.
~• Musselman Funeral Home.. _
Funeral Luncheon... ••••••••••••••• •••••'••'•'• 7.113.00
R. J. Romberger & Sons•(Monument•Letterin•). 159.27
g -••••-•• 98.00
Attorney Fees
Family Exemption
Claimant
Address of Claimant at decedent's death
Street Address
Relationship
6,713.18
- 0 -
City
4. ~ Probate Fees
C
1.
2.
3.
4.
5.
6.
7.
8.
(If more space is needed, insert additional sheets of same size.)
Miscellaneous Expenses:
397_27
Legal Publication of Grant of Letters ................ 112.20
UGI (Gas service to 1831 Elm Street) ................ 105.56
Be11 Atlantic (Telephone service to 1831 Elm)........ 40.50
PNC Bank -Estate checking acct. service charge....... 5.00
Susquehanna Rehabilitation Center (Final bill)....... 11.40
Internal Revenue Service (1994 Income Tax Payment)... 156.00
Comm. of PA/Dept, of Rev. (1994 State Inc. Tax Pay.), 46.33
Pa. American Water Company (Water Service/1831 Elm).. 25_14 f"~
(See attached sheet for Conti uation)_
TOTAL (Also enter on line 9, Recapitulation) $ 22 ~ 2 • 71
Zip Code
206 - 32 - 1932
6,713.18
Please Print or
A 2195-0244 1995-0024
AMOUNT
e
SCHEDULE H (CONTINUATION)
ESTATE OF SARA MARY ADAMS, DECEASED
PA #2195-0244/1995-00244
C. Miscellaneous Expenses (Cont.):
9. PP&L (Electric Service to 1831 Elm) ..............
10. Sammons Communication (Cable Final Bill).........
11. State Employes' Retirement System -- Reimbursement
of excess benefits paid ..........................
12. Musselman Funeral Home - Fee for obtaining death
certificate of Dorothy Taylor (predeceased
insurance policy beneficiary) ....................
13. Borough of New Cumberland -- Sewer/Trash.........
14. Ross' Lawn Service -- Lawn Maintenance 1831 Elm..
15. Chuck Bricker Auctioneer -- Fee for personalty
appraisal ........................................
16. A.Z. Rittman -- Medical expense unpaid by
insurance .........................................
33.55
4.65
151.00
8.00
49.40
197.16
75.00
1.92
RE ~~1513 EX+ (2-87)
COMMONWEALTH OF PENNSYLVANIA
INNERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SARA MARY ADAMS, DECEASED
ITEM
FILE NUMBER
PA 2195-0244/1995-00244
NUMBER NAME AND ADDRESS OF BENEFICIARY RELATIONSH AMOUNT OR
~.
2.
3.
4.
5.
6.
IP SHARE OF ESTATE
A. Taxable Bequests:
Jeremy Taylor, 4477 Taylor Ave.,
Ogden, Utah 84403-3140 ................. Nephew One-Sixth Sh
ari
Jonathan A. Taylor, 9927 Rand Drive,
Burke, VA 22015 ........................ Newphew One-Sixth Sharf
John F. Adams, III, 275 Spring Hill Rd.
Roselle, IL ............................ Great Nephew One-Sixth Sharl
Charlotte Valentine, 4956-3 Columbia
Road, Columbia, MD 21044 ............... Niece One-Sixth Sham
David G. Adams, 6960 Clearfield St.,
Harrisburg, PA 17111 ................... Nephew - One-Sixth Sharl
Susan Taylor, 43 Ski Run Trail, Carroll
Valley, Fairfield, PA 17420............ Niece by One-Sixth Sham
Marriage
ITEM
NUMBER NAME AND ADDRESS OF BENEFICIARY AMOUNT OR
SHARE OF ESTATE
B. Charitable and Governmental Bequests:
Not Applicable.
TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Also enter on line 13, Recapitulation)
(If more spoce is needed, insert oddifional sheets of same size)
SCHEDULE J
BENEFICIARIES
S
APPRAISAL
.Personal Property of S q, ~,g-,~ y ,~d/~-M S / 83) ~~j 5 j, ~,,~w cv~9,Q ,~;~
Appraised by Chuck E. Bricker AU094-L
Date ,
/~ ~ ~ c
-
-
~- c~S
ITEM VALUE ITEM VALUE
~i25 L~,L.~ /c ~v7ir(/.9 oZ D D,~D ylL KJ~ ys/a E 4~0 d
[.E TU ~ .2St1, e~ Ll0 ~ut~r T B cf e ,
~ N ~~ ~5 w -c FT, a o,o d SE , s 3a
Q
~ D FScI Env ~/' SES /4 a.~ d .L ~ c ,
/S a
~2 o B~,e fr ~N ~~y v a o .2 ~ro.9 ,vEy ~ /~ s 3a
~
GU ~ E o~ ~ 00 /~'I/ DiQ ,
U~/' L / e,e
lad,QD
OU L 0 ~ CE ,o:
S7J
a~
,
o, o ~ Gve v c /~ s ja , a ,
ui ~~vu ~ ~E o,' ~ T ,Bc~ ao, ou U ~~~ itiE ~, o
G SE H U Nd G~li~v 5U d e M/c' o w vE ~o
v
' ,
/Q,O
1
~S c sT G G s
o
/~ TEd' G~CEs~ ~
w
o
.
,
R LSE E .yEL~Duc~ G<liN ~6,dv /U/ S' ~ ~~
SET S/~ v~,~ // ~
7S, a o
Gc/t'!// ~ // F (~ .
C/
.2.5, D
~~
~ c~E /,2a e~ ,~ ,~j«T c~Es
7v, o
2v
I~ic i S ~dE ~
~~ V
S T ° o
, a
~4
, U
~~/z ' ~v v T ~ e o 1~ES ~ ~
' -
, a
C
o ~ a po i/, "v, o a ,~2 a c ~ ~ ,
L
~. RAE ~L L
~v D o
/ ~ lea. .9ti~`/ /G S/~i~ I,3Fd ,
, G
l'
~ U
e
~ 5 KCTT4~ ~ ~~,d d 6fo~ NEX i>2ESSE/L .
~'~
~
~ ~; ,, ,
G~i
~' ,~ .3a, e a ~ ~ G~ c` L ~ ~
-2S
e
Sow ,
.
Co E~ T ~ d2 Q o~ c-"E ~ cif~s ~~
~ ,
!J R c P LF ~ M P T ~ `~6, d a G~iN d 5 ~ ~C o <.~Fit ,
,
,vrLE GL~ c
~G,ao
/.3657vN ~ o c F , ~
~
S 4, Gc
~/Ec.f C ~o c,C ,.SZ, E;ts C6L ~,e Poor TU;.s 3?~, a
b Cd ~ /~lJ i .5
~7'~S 6 d
.2 8 6 D K ~CkS ;
~G
G
~ G ~ ~ ~ f~I Es ~0 , 0 v 5 ~'/NAT /J~SK ,
$ D
a
S/Lo u ETT~S
20 o a
3/c . F~ .e/`'% S~ /~ ,
.
S~
S; ~ ~ C ~
D, ~
5 5 i , ,/~i~ES - GT.S ' .vim- o
%SZ ~
/~'~55 Gg-rI 20 d o ~ /lrti - =-
~1 /.!/fin ci t1 I /F~/ /~f2F,4 ,~ .~~ A i /T / .5-71 ~i~ ~. ,. _ ~ ;~ e L /~i/il c <L _~
LAST WILL AND TESTAMENT
SARA MARY ADAMS
I, SARA MARY ADAMS, of New Cumberland, Cumberland
County, Pennsylvania, a single person, without issue, being of
sound and dispo:~ing mind, do hereby make this as and for my last
Will and Testament, revoking all other Wills and Codicils
heretofore made by me.
FIRST: I direct the payment of my debts and the expenses
of my last illness and funeral from my estate as soon after my
death as conveniently may be.
SECOND: I give, devise and bequeath all property, tangible
and intangible, real or personal, owned by me at the time of
death, together with all insurance policies. thereon, unto my
niece and nephews, JEREMY D. TAYLOR, CHARLOTTE T. VALENTINE,
JONATHAN A. TAYLOR, JOHN F. ADAMS, II, DAVID G. ADAMS, and unto
SUSAN M. TAYLOR (widow of my nephew, Jeffrey Taylor) in equal
shares, if he or she survives me by thirty (30) days. In the
event any bEneficiary fails to survive me by thirty (3C) daY~;;,
such property shall pass to his or her issue, per stirpes.
I authorize my Executrix to deliver such articles
to which a minor may be entitled under this paragraph to the
guardian of the minor or to the person .having custody of the
minor, or to retain such property until an age at which my
Executrix considers it appropriate to deliver the property to him
or to her, provided in no event shall such property be retained
by my Executrix beyond the time the minor attains his or her
majority. The receipt of such of the above enumerated persons as
may be selected to receive delivery of such property shall be a
full and complete discharge to my Executrix. In the event my
Executrix at any time decides it is desirable to sell any
property hereunder for a minor, the proceeds of such sale or
sales shall be delivered to the guardian of the property of •~he
minor.
THIRD: I direct that any and all Inheritance, Estate and
Transfer Taxes imposed upon my estate, passing under my Will or
otherwise, shall be paid out of the principal of my residuary
estate.
FOIIRTH: In addition to the powers conferred by law, I
authorize my Executrix, in her discretion:
(a) to retain in the form received, and 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 forms 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;
- 2 -
(e) to compromise claims without court
approval, and without the consent of any beneficiary;
(f) to distribute in cash or in kind;
(g) to join with my niece and nephews,
JEREMY D. TAYLOR, CHARLOTTE T. VALENTINE, JONATHAN A.
TAYLOR, JOHN F. ADAMS, II, DAVID G. ADAMS and SUSAN M.
TAYLOR (widow of my nephew, Jeffrey Taylor), or their
personal representatives, in the filing of any federal
income tax return for any year for which I have not
filed such return prior to my death, and to consent to
the treatment of any gifts made by them as being made
one-half by me for gift tax purposes notwithstanding
the fact that such action may result in additional
liabilities for my estate. Any income or gift taxes
due on such returns and any deficiencies, interest,
penalties or refunds thereon, shall be allocated
between my estate and my said beneficiaries or their
estates, or all to any of them, in such manner as my
Executrix and my said beneficiaries or their personal
representatives may agree.
SIBTB: I nominate, constitute and appoint NANCY M. ADAMS
as Executrix of this my last Will and Testament. In the event of
the renunciation, death, resignation or inability to act for any
reason whatsoever of my said Executrix, I nominate, constitute
- 3 -
and appoint CHARLOTTE T. VALENTINE Executrix of this my last Will
and Testament. I hereby relieve my Executrix from the necessity
of posting security in connection with her duties as such in any
jurisdiction in which she may be 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
this /~i day of ~ , 1993.
(_'
~ ~..,/~
C~L(t ~~v `-{-~„~.!1 ( SEAL )
SARA MARY. AD S
SIGNED, SEALED, PUBLISHED and DECLARED by the above-named
SARA MARY ADAMS as and for her Last Will and Testament, in the
presence of us who, at her request, in her presence and in the
presence of each other, have hereunto subscribed our names as
witnesses:
~~~;v ~~~~.~~d~ZQ~Address C~'~~.~ ~{~; ;~~_ .
_~ ~ :~ ~ ~ Address .~Q~ ~ i~..~~' C l/1 , ~/+
i
~ Address ~,y,~.
- 4 -
~ Y
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF 1-~`^'"`-P`te'
We , SARA MARY ADAMS , ~-~i~-~ l7 ' ~~~'`` `~'
~•F~Y~"ru-- ~-• ~-~to~.r'n'""~- and 1J~1roa-vL~. ~ ~- ~~~t,,,~;
the testator and witnesses, respectively, whose names are signed
to the attached or foregoing instrument, being first duly sworn,
do hereby declare to the undersigned authority that the testator
signed and executed the instrument as her Last Will and Testament
and she signed willingly, and that she executed it as her free
and voluntary act for the purposes therein expressed, and that
each of the witnesses, in the presence and hearing of the
testator, signed the Will as witness and that to the best of
their knowledge the testator was at that time. eighteen years of
age or older, of sound mind and under no constraint or undue
influence . ,, `~
TESTATOR:,~~ -~;Li,~ 1'~ ~{~2~ 1~~v residing at ~'~~,(,- JCS=~v~~~~~~,_, /~,
WITNESS : _ `~~~zt, ~~ ~ ~aJ residing at ~~~vta.~ Q>
WITNESS~~+~~.~~ ~,~--~ residing at~a~-t ~~~ ~lV~ , ~~
WITNESS: ~ ./residing at_~~l/I ~ T~
Subscribed,' sworn to and acknowledged before me by SARA MARY.
ADAMS, the t stator, and subscribed and savor to before me by
and
c~-c~-Lin. «~~~-~ , witnessesr\this ry _ day ofn
~--,,C~~~v~ , 1993 . ~1 I ~ ~ \~ ~I /
Nez~ry ruAlic_
Notarial Seal
Stacy L Barkanslo, ~~
- 5 - My Feb.1,1997
REV-1593 EX AFP (12-95)
COMMONNEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
INHERITANCE TAX
RECORD ADJUSTMENT
DATE~OFvDEATH~~J HRH ~ FILE N0. 2 - 44
03-20-95 COUNTY CUMBERLAND
NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS FORM WITH YOUR TAX
PAYMENT TO THE ADDRESS SHOWN. MAKE CHECK PAYABLE AND REMIT PAYMENT T0: ,
NANCY M ADAMS REGISTER OF WILLS
101 PINE ST CUMBERLAND CO COURT HOUSE
PO BOX 932 CARLISLE, PA 17013
HBG PA 17108
Amount Remitted
CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV-1593 EX AFP (12-95) ~* ---------------------------------------------------------
INHERITANCE TAX RECORD ADJUSTMENT ~~ -------
ESTATE OF ADAMS SARA M FILE N0. 21 95-0244 ACN 101 DATE 04-15-96
ADJUSTMENT BASED ON:
VALUE OF ESTATE:
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule Cl
4. Mortgages/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Administrative Costs/
Miscellaneous 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
TAX:
15. Amount of Line 14 at Spousal rats
16. Amount of Line 14 taxable at Lineal/Class A rate
17. Amount of Lins 14 taxable at Collateral/Class B rate
18. Principal Tax Due
TAX CREDITS:
PAYMENT I RECEIPT I DISCOUNT (+)
DATE NUMBER INTEREST (-l
06-12-95 ~ AA047867
* IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
708.30
14,135.72
OTAL TAX CREDIT
LANCE OF TAX DUE
INTEREST
TOTAL DUE
ASSESSMENT
CONTROL N0. 101
DATE 04-15-96
678.07CR
( IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A •'CREDIT•' (CR), YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
(1)
(2) .00
(3)_ .00
(4) .00
(5) 58.414.73
(6)_ .00
(7) nn
(8)
(9) 20.986 34
(l0) . 00
(11) 0.986. 4
(12) 94.4;9.6
(13) 00
(14) 94.439 6
(15) 00 X.00 = 00
(ib) . 00 x.06 = 00
(17) 94 .4~9 6 X.15 = 1 4 . 1 65 94
(187 14.165 95
AMOUNT PAID