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HomeMy WebLinkAbout95-0250This 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. AUG 1 d 200r p . Date Fran eropoli, ' ect Division of Vital Records P.O. Box 1528 New Castle, PA 16103 ~~ N1os.luRr.?/Q TYrE/-plNt w PENMAIq/ NAME suck C uW~ O r 2 COMMONWEALTH OF PENNSVLIMINIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH u25?34 sc ~% SOCIAI SECURRY NUNBFA ONE OF DER111Napn.OaY.'AVl +. Reba E. Crowley aFemale x.202 - 42 - 7295 ~ Q,L fZ. 1 AOE QapISNga„ uweI1 TEAK uNDOI+ur DIEEOFaIrtrn EIRI}iIACEply,ro vucsasDCaNlpnaaa+,.o•.-w:rm,~ran.~,.an.,,n.~ Moen. Dry. Naas ~ Mnw I~paln.oa~.N1.) sil.arva.prcany, ~~ 91 Y~ 12-20-1903 Carlisle PA "O""^ ER10i"p""^'^ ~^ IIAgMp~ Raaiews^ ,O°"~,,,p collnTrasDE~aN DRxsaNanwDFDERN FADElTYNAMEnnanNNron.prrrlane,p.aearl NMEDECEDEMfOFNEEN/NCORgER RACE.ATaIbanApn.EYCk,NMIa.Mc al Cumberland Carlisle r Thornwald Nursing Home ~~~^EN~ww~. White M..w..l.-n.I• wrn, aIG DccEDe r • + 14 s+rol+A< IDIOasM18NE8811NpUSTpy NNSDECEOENfEyENE, UECEDENT'BEDIICRION NAIE$ILBTATUB-ManMO rna aarRaarAammo; u.s.AwIEDRDNCES~r „a,•„w,,,K~4 s a.srgw.; anw...raiea . m „ Teacher „Public School ,i ""^ "°~ EF1a 1 o+'~s=l 4 Wide , ,~ oECrnENra~r+rrNO~DDRessl~l.r.uwb.n.9r mcoe.l DeceDe+rs 'a PA ~ ,,,~^,,,~,~+~~ +T..$iI. , 442 Walnut Bottom Rd ~$~„~ . Carlisle, PA 17013 ~ ~` ~ ~~ Cumberland ~ ~~p1 '*'"~•~ +m 1Tp4191 wlYilawalAnrol Carlisle NO+EIYS NAME -~as.. i.w worNEn's N~-~sl~.l. wauw ~~.a.nsl.nrlly John I~hler ,~ ,NIda Flickinger wFOaMAMra+wlE~rNN~wlen swawD ADDRE$Sgaeal p>IW~ee+l. spry. mceapl JoAnne C Potter . 1848 Sterrets Ga Rd. Carlisle Pa 17013 PERIOD as DUrDerrlDN GFDIepDeDIDN PIACEDF D18-OEIIfON•Nama arCwnalrylCnalab„ LOCIEION-GIW1••R Siewmeoa .D.n ».~ al Dlnppwaaa CwerM^ Rallwelnaasw.^ ^ DarYOn^ o: ra3-18-1995 „a Resurrection Cemetery ?4W. Hanover Twp, Pa NAMEAND ApORE$E OFwICE/fY o man ~~~ O1m2748-L 19 N. Hanover St. Carlisle Pa u17013 e Inrew'I.ep•. e.aln aavner tlrtlma, mIa ane r aal w~iM~atrnrW ~~ T/a) Pler raNa ~~~~ DRESEiNEO aallMelplara MaR Dry. Nvl ~4v-58 cz rqq ~ ° ' ,1 „a~~r~ I ap DruERRDnoIllNCtDDEADIMw1.DryN•r) NNSCASEaESERREDroWED1cALOUwNERICaRDNEm 6.25 ,~ P•gQ.x March 12, 1995 ~•^ rA,~ a. wort r. Eaarerarrr, ~ nfw.>oolliao+IkrTlidlanraelMOaalll.DanpultrYrlrMalgirN.rdlrorrrswapiraloryrrl.anaotalpwn/Nae. ~ wayorulrraaalir. Mnollnr. wWfE: Oer alOpNprlealt•IaroreWYybrME4 bt ; rlap I.wilEnrr aWrliyaaraynnn wr7T I- E~ECAUEEIFirrl ~ ,arlp anrliaN . ~ //~ 4rra daltlion (.~1/til/ ^~9n WNI-- 1 DUE ropR ASACON$EauENCE Dck SaPralMy YOanfYwla i ( DUEroroR A$ACON$EauENCEDR ~ l GnM. UMONILIIEW I CA11M (Olprrorp~la, ~ ~ i Nai elYYiO •perb DUE ro(ORAS ACONSEOUENCE OFx ".~li~noaail off Q j NNE ANAUroPSY YA9EAUIOPEY R/EIi!(iS AIAIINER aF DEATH ONE OFrUURY TIME OF SUURT R4NMTRWORIfi DE$CREfE HOa INAlf1Y OCCU!>~D. pE1VORMEOT AINLAElE wN011W Main. Oaµ Nrq N1MlFIlONOFCAU$E ~ ^ OFFMi Naaaal 11p.n'rlea AoCiera ^ p~yN y.~yw,~, ^ - Nr ^ No^ NM ^ No~ Nr ^ No ^ 9licira ^ CouM nolMOSlamrNp ^ M• PLACE NUURV -Al lp)me, lane, abets, 1•clortt a1Rp LOCRIpN ISa•pp C'IWTOVw1 Sbr) . . 2rR r. Mralld ale. fSDadYI ~. Mf. CERTE7Ew lGnack ora,orl sIGNRURE rrt • wrtsrnorNm~a~N vn ~ ~ LEDP CERi1FIER »a.•~.rr+~o~•araa.~n..lw..+awnnv~a~nraa ..aa.un,~aro.•pn.an.mzn .vwnsw•ea•. eawnreurre elw a el. aarMNa,d mrww•• wr.e• ................. ................................... s1s. •PNONOIINeIIw N,D aATIFYr+O w+'rIICUN Iw.rsc+n oa9, aa+ounc+nD o.aN ana ~ /NY D oRE $KiNEDMain.O•yny, lbr, Tor.b..aNwry llneweo.,erN, aaaea.e MlM rlr.aw,.w Plr•. anaar4Naewgp al raaa•aNplrwlw .......................... ^ 70. 'NY 14 T 9J/- MEDICAL E%AMINENICONONEp PNA-aE ANDADDRESS OF PERSON N'IIO Cd1PLETEDCAUSE OF VENN ypaa Plinl I i ~~/~S. ON Nw Erala b eaalNnalNM anaVar InvasOyalbn, in my opMbn, Death oecumd M Nla tone. Aa1e, am place. am rw to Me eausapl and /`1. R GISTRRI'$SIONRURE ANp NUMBER M' T LtY .~ ORE FlLED Morph. Dry. Nrrl E 3t. ~. ~0~-. 1~- 194 kE`J''~13b0~~`X*r(7.94j ., ~ 417H OF PENNSYLVANIA ~1ENT OF REVENUE EP7. 280601 1RG, PA 17l28.rk5[11 ~o~~~~ -off INHERITANCE TAX RETI~RN RESIDENT DECEDENT (T4 ~E FILED IN DUPLICATE WITH REGISTER O~ WItLS~ FOR DATlS Of OlATN AIYER 121,1 /91 CHECK NlRE IF A SPOUSAL POVERTl! CREOIT iS CLAIMlD ^ fIL! NUMBER ~~ ~~~ ~~~ COUNTY CODE YEAR__ NUMBER . ~ f~~~ ~•-, ~~..zvc~.~a ~_vmr~rlC AUaRESS SOCIAL SECURITY NUMBER ~~- DATE Of DEATH DATE OF 91RTH ~' • Q'"Y ~,~~ f~L~~~~~~ ~~~E `" vld~- ~a- ~oZ. `%~ j 1 f ~5' ~ l !.~_3 C'/~rkLl51.E} f~4: 17L~13 O (Vi APPl1UBlE) SUR\9YIpK SPOUSE'S NAME ilA3T. FIRST AND M!UDLE Ih~T1A:) ~ SOCIAL SECURITY ~ UMBER Count AMOl1N7 REC-~. INgipUCT~ " -__._. ~ 1. Original Return ^ 2. Supplemental Return -"-"' Yoh ^ 3. Remainde- Return _~~ ~ ^ 4. Limited Estate (for dotes of death prior to 12-13.82} ^ 4a. Future Interest Compromise [ 5. Federal Estate Tax Return Required ~~m I {for dates of death after 12-12-82j ~fl. Decedent Died Testots ,~ 7. Decedent Maintained a livin Trust (AMach copy of Willj (Attach cagy of Trestj g ~ 8. Total Number of Sofe Deposit Boxes ~. .., +- ~~ y NAM ~ ~ ~ ~ ~` ,_ ('. ,~ ~^ C l E M I IN o ~ `sS~ J ~`3 J~' ! 14h'~~.' L..,ti/ V ~ TE1EPhONE NUM9ER --• _____ ~ _ 1. Real Estate {Schedule Aj (1 j ~__ -- -~" ' 2. Stocks and Bonds {Schedule B) (2 } ___._~___ _ ~ __ 3. Closely Hsld Stock/Partnership Interest (Schedule C} (3 } ___ ___ __ d, Mortgages and Notes Receivable (schedule Dj (4 j ~ _ __ 5. Cash, Bunk Deposits & Miscellaneous Personal Property (5 j __ ~h ~Jat.~ , ~f Li z (Schedule Ej - b. Jointly Owned Property (Schedule F __ _ ~ 7. Transfers (Schedule Gj (Schedule L } (6 j V ii 8. Total Gross Assets (total Lines 1-7j (8 j f ~~ !J~ t y~~ c ~"++ 9. Funeral Expenses, Administrative Costs Miscellaneous { 9) ... p ~ 7 ~ 7 ~ / ~~ -----'--`- °C Expenses (schedule lij ~ -~"------' i 10. Debts, Mortgage Liabilities, Liens {Schedule I) (lpj ~ 7 ~ J'r, ~t 11. Total DeduNions {total Lines 9 & l Oj (i i j - / c3' Cr '~ ~ , ,+ / i2. Net Vo(ue of Estate (Line 8 minus Line l Ij (i 2j _~! ~~ f7~ -7 ~-- 13. Charitable and Governmental Bequests (schedule Jj --~j-`~~-- (( (13j __ 14. Net Value Subject to Tax (line 12 minus Gne iJj _.___ `__ _ (~ 4j - _1 / q v c f c7r 7c~ i5. Spausol Transfers (for dates of death offer b•30.44j ~~ ' -~- Ses instructions for Applicable Percentage on Reverse (i5 _ ___ Side, {include values from. Schedule K or Schedule M.j j )~ ~-- -"~~-x'--' ~ / - 16. Amount of line ld taxable of 6% rate (16j L~ ~ ~ L_L._~~~__`x .Ob a ~ cA c~-~1 ~~ (Inducts values from Schedule K or Schedule M.) s`/J t~~" "-' ~ --- -7 p~ _ 17. Amount of Line 14 taxable at 15% rate (17} ..__._/ l _~_~_~ Z{. ~ _x .13 c t/ J O ,~ c (Include values from Schedule K or Schedule M.} ~ - ~ .---_ 18. Principal tax due (Add tax from Lines 15, 16 and 17.j ~ 19. Credits Spousal Poverty Credit Prior Payments Qiscount interest ~ + ~ + ------ {19j i "~ 20. If Line 19 is greater than line 18, enter the difference on line 20. This is the OVERPAYMENT. _ (20j ''' ~ ® ^ -- I'21. If line 18 is greater than Line 19, enter the dlffsrena on Line 21. This is the TAX OUE. (? 1 j ` a v` t ~j~ ~. ( A. Enter the interest on the balance due on lino 2iA. (21Aj - __ B. Enter the total of Lins 21 and 2lA on Line 21 B, This is the BALANCE 013E. Mnke C6sek Payobb tv: ReBislor of Wills, Apent (21 Bj -.`~~,,~,1 , 5" .s3 Under penalties of psrjury,ht odors t at I eve examined this return, including aecompanxtng schedules and statements, and to the est of my knowledge and belief it is true, correct and complete. I declare that all real estate has been raporte~3 at true market valve. Declaration of prsparer other than the personal representative is based on all information of which prsparer has any knowledge. St AT OF PERSON RESPONSIeIE R IIING RETURN ADDRESS --'- , DATE la. ~J/(]~~~ SIGNAT E Of PREPARER OTHER AN REPRESENTATtvE ADDRESS ---- -~~'.~-y_._. DATE ., ~;. ~ `~ 1 -Inventory of the real and persona! estate of CC// ~~~ ~ ~~~~~'~ j~-- deceased ~~~/lf~~ ~ I rdllSF~Y~j~ rC~ `V , ll~v~,~ ~s S~--~,N~~s ~,~Z~~y~rv ,0~~~.r C'~ ~ ~ - ~o ~~33-~ ~ J'~l~O ~V~I,~Q )~,, l a~Cl ST C... ~~7=', ._. /~I~E~.'4 / /,~ ~J /~'/./6' 11 ~ C-t' ^.. ~ + C~~ ~r`~_ G~~~J~ ~~b67~ dD ~a~/3 3v ~aa~ ~~/ /~ ~ ~.~ ~~~3 a-~ ~~q ~ ~07~.IC19 ~~ ,, • REV 1308 EX+ (2~H7) SCHEDULE E CASH, BANK DEPOSITS AND COMMONWEALTH Of PENNSYLVANIA MISCELLANEOUS IN kES10ENTEDE~lDiNTRN PERSONAL PROPERTY ESTATE OF ,/} Plaase Prinr or type /~~r~~ ~, ~'~~~~~, FILE NUMBER {All property (eintly-owned wNla the Right of Survtvorshlp must Fie disclosed on SaMdub ~ ~ /~~~ 1~~~'~ ITEM NUMBER ~~ 3; ~.J~ 1~,, DESCRIPTION i 't !/C~~~ ~ ~}•U~7 ANC .~ INCz:.1.~k~~/VC, ~Gt~'iV i T4'~, <G.r1'Il~fs~ ,Gjr~~P,gf15rDe /.: iT~~~ ~ ~ ~D ,vex ~ 7l/ „ 7~~~ f~.~~~lsa~~C ~, i IlC~~ ~fl~G~i~vG ?~lccr ~1~ ~~~/-.3 C~1 ~ ~ - ~~ ~/y3~ ~~~ n ~E~ul~7 ~~ C U ~O~E~; U~~~/ ~~~; ~~~~/ VALUE AT DATE OF DEATH %ll~~' ~ ~D ?~ ~ 9 ld~~i3, 3~ ~~~. ~~ %~ ~ t 3.5'"c'3 ~: ~ Y3, a7 ~~~~I a~ ~G4, /0.3, ~.~ ~~, ~, 3.~ TOTAL Also enter on line 5, (Attach odditionat B'fr" x li" sheets if more spo<e is needed.) $ .5~ ln~~~ ~~ I I ~ SCHEDULE G ~GMMOtJWEAITH OP PENNSYLVANIA ~ tNNERITANCE TAX REtURN i TRANSFERS RESIDENT DECEDENT t'IPASP PRINT OR TYRE ESTATE Of ~-- 1, _:_-- .. _: .- _.- FILE NUMBER ` "- THIS SCHEDULE MUST BE COMPLETED AND FILED IF THE AN5WER TO AMY OF THE ©UESTiONS ON THE REilERSE SIDE OF THE COVER SHEET IS YES. i---____ _ --.- ----~.. ----.- _-_ ..-_-- r---- _.._ -- ITEM DESCRIPTION Of PROPERTY T- ----~--- '"----- -"'---- NUMBER Include name o1tAe transferee, their raloi;anship to a"acedent, date of transt®r. I EXCLUSION ~OTAI VALUE I p gip' ', p01lAR v,gi.UE Oi ASSET ~ Ur p£CF.pENT'S ---~---~~~.- -._____---____---...------------------~--------- iNT. I _INTEREST---- f~vr~isb~~~rC? Ia~e, l ~ 1 r l ' ' i 1 . ~Es ~ r~'~l~Ti DJ~ iG` %77~?t~ NE~~ y~~ ~ i -rte ,~~- ~~s r~'/~~r'~Ci.~' ~s Fi~o Y~'t~~.c;, ~'r~'~,'V ,0~~~; , ~ ; ~1~~-~~F,ry C \/ DfI>JNf C. r (n ~-E~L~~~ ,~ ~ ~IGHTf~. ~',~o ~~E~-~ s~,~ I''~~~i~, ,C,~C~i {C~ ~1~~{, ,~IIJ(~E `~' .vE Dre~~C. SILL. ~it?,~';^ Sl»V ~ I I I J __ __ _ _, _ __ TC)TAl (Also enter on hne 7 Recap ~ulot;onl ~ $ ~ _ _. _ (if more space a needed, insert addrhona! s6eefs of same size.J 9C8EDULE aAp 8C88DULE REFERRED TO IN THE ANNEXED TRUE AGREEMENT DATED , iSi91 FROM REB 8. CROALEY, SETTLOR TO J08EPH d. CROi1L8Y, JR., MAUREEN C, 1CREIDER, AND JOANNE C. POTTER, CO-TRUBTEEB PROPERTY DEBCRIPTION: ALL TEAT CERTAIN lot of ground situate in the Borough of Paxtang, County of Dauphin, State of Pennsylvania, forming the eastern portion of Lots #1 and 2, Sectfon A, part of East Harrisburg Addition, which Plan is recorded in the Recorders office of Dauphin County, aforesaid in Plan Book "'K"', Page 102, succeeding plans in Plan Book "K"', Page 86, and Plan Book "Kp, Page 50, which said lot of ground is more particularly bounded and described as follows, to wit: BEGINNING at a point on the southern side of Brookwood Street of said Plan, at the western line of Lot #3 of said Plana thence Westwardly along southern aide of said Brookwood Street a distance of sixty-four (64) feat to a point, or iron pin, thence southwardly, of an even width of sixty-four (64j feet, and parallel with the western line of said Lot #3 one hundred thirteen (113) feet to an unnamed twenty (20) feet wide allay; thence eestwardly along the northern line of said twenty (20) feet wide alley sixty-four (64) feet to a point in said western line of Lot #3 of said Plana then northwardly, along said last mentioned line me hundred twenty-seven (12?) Peet to a point in the southern line of Brookwood Street, the place of BEGINNING. HAVZNG thereon erected a one and one-half (1-1/2) story brick dwelling known as #2903 Brookwood Street. -14- RFY 1511 ez. p.epl i SCHEDULE HI FUNERAL EXPENSES, COM,MOtvWEAITM OF PENNSYLVANIA ADMlNlSTRATIVE COSTS AND - tNHER!TANCE TAX RETURN MISCELLANEOUS EXPEN5E5 EtES1DENT DECEDENT ITEM NUMBER A. ----- I. 3: ~r B. ~ 1. 2. 3. Q C. 2. 3. a. 3. 6. 7. 8. _ _~_ Please Print or Type FlJ'~ '+ FfIE MU BER ` DESCRIPTION I AMOUNT - _ f7~'1 i~~'9,w'.N /C D'7~ ~ /~lrk'~'~., ~7~/~r'~ ~t~ N ~it'N~'yc=~ u-t, ~/ClJ~t.t 5 ~. Y/.~0/'? /~/~~F¢~Gf/.i :~3~~c%~'.~- ~4' C C7" t~~1V~9i~/-9.~, I Cor.F ~~OCESE~ /~EC~~; ,~;Z't,1rI~.~I~'<.. tiCi"Ef~S 4~~~. ~CC:~. yod IQ,.o< ~ ,~;',~ Kf~2) ~ C'.lc. r f~Ml.i,T C ~F~ - C~~O~tL~S~F ~,~:: "(~c~~ ~L',{~ y'~tJ~ !VQ~S E~Lu~!/C~ - C f11~~(.5<E /~',,(' m rnstrotive Gosts: Personal Representative Commissions _ Social Security Number of Personal Representative; ~~ _~ ~~ ~~ Year Commissions pain ` ~~ ~__ ~'~'~~(r~-~E"~'L! ~K12~~~ ~~~ ~I.4~~ ~ ~J t Attorney Fees ~~ ~ ~ 1 ~' / 7Ll ~°NT~Io.~>~~ ~o:s cF{ 1 ~- ~HU,a~.~ KEi~,`d~ ~1~c.>,X1/11,~ Po 4~x c ~, fabcl ~. Family Exemption Claimant ____-___ Relationship `._ Address of Claimant of decedent`s death Stree! Address - --- City __ _____ -----~_____State _ Zip Code___ __ Probate Fees Aiscellaneous Expeeses: fG~7S /955c~Cl~.fr~ c~J~SX)~ !>f' ~~~~'c~l~~ I~VTiE'UST Lts~~~ oN ScN~~1U~- C~ ._, ~.PSTE:C;; o~v RF~~~~ 1/SC. %~~~/N/S~r'C'~f/~11/ ,~'liR.. Q'l/.~~~~- ~'S:~nJ'i~ - L'45T.~~~ /yl~.9i ~ r /~G~ f~ES ~ !.~•-l7/VK, C;,`7r~(~r'~ 5 ~ ~A!n/Tf~U.n.yr_~ ~~ 7~u~"T ~KCjP~~7` _ us;rf~~ orr h'~vfresE ~2.57> if l ~'5~3, ~ ~~~~~~ // 7. ~ ~ l ~+ J~~,~ ~~ 3 Z~, I~ ,~~~/>~ /l% '~ ~' 1Y~j oC(~ ~'~~3, ~~ TOTAL (Also enter on Tine 9, Recapitulation) (IF mare space is needed, insert additional sheets of same size.j s ~~~7~717 C, ~ - Cu5T5 ~c~~z>c., zvf~~0~ ~r ~Cls ~ ,~? ~° ~_d ~~T~ C~C~~'I/'~ ! 5 S /INNS ~~O i ~ ~~CK, C~~91,(Gh~~ ~~'~>~ ~~ 7-~9 ~, C , 3 . ~%~c~~v,-f~~,~v~~ ~~ ~~P~s~- ~~~~ ~ "7.5, d~ 3.~! l~-O ~~ 9, ~ ~3, ~ .51~ i ~~ Sb ~-t T l z ~T/ ~ .5 G~r7T~~C; v /.tea u>~'V ~~~ ~- ~.S ~~ST ~v~~GL ~f~5, C~3 I.cJX'sT~ ~i5~~s.~,L ln~k c~ /~ ~ . L'V /~~C~P~ R r ~ J ~vs ~~~ NCF n /`i4 lNT S~~p~ lF~, ~F/u~r/t7 f FIE,E, ~~. L~ ,Cka ~E Fit ~ Tx ~ < ; ~~~.~'i~~ ~/3 3; ~ ~ l"1 ~ ~f,3 ~D%r~' ~, f `~~3. U~ RFY•I512 EX+ p~93) SCHEDULE i C7MMONWEAITH Of PENNSYLVANIA DEBTS OF DECEDENT, RESIDENT DECEDENT INHERITANCE TAx RETURN ~ MORTGAGE LIABILITIES AND LlEN5 ESTATE OF -`L--- -- rrEM NUMBER ~. v~:- .~, DE5CRIPTION '~ ~~~t?1~i0~:.. ~~C,~~Elds~.~ ~ ~~`« trar~~, -- Iti~GIC~• - f/t 5~(fi~+/'~ C~.~'~2~E J % S7~} (~~t~l~ISE~LiN~., ,C~'J y v~Rr~u~ ~'~~>/~ar~e5 ,/, ~ , - C~~u,~s~F ,~~G' I POease Print or Type IMBER ,~ 9`.5`- t~~:5~ AMOUNT ~3 ~~, ~~3 ~.:~ ~.5". y~ l3, ~l _, ..__.. ..,,..,, ,.,n..r anavrs a7 sO7iA SlZB.~ ESTATE t' ; COh1hSON WfAITM OF PENNSYWANIA INNERlTANC6 TAX RETURN RE310ENT OKEDENT i r~79 ~ ~ ~/C ~~'UL.~ ~~ ITEM ~---~-_-~ -~ NUMBER ~, 3. /` NAME AND ADDRESS OF BENEFICIARY a. Taxable Bequests: X35" ~~~~~.~~ ~,~, t",/Q1~Ji~' ~i,t~ ~,~', % IZ%~ ~ VI~~E~~ Cr`~ , C QDr'.l~~F- ~' ~ C©~~v~~ C ~ ~ ~ ~~: ~1G'.U4 i iN~~ '~.c • ~ ~~..7 ~lO:~~NE ~ ~'Urr~~ 185 ST~~r~s C~~~ ~Il~~ . ~~3 9 ~3~e~~~~ s-~. ~-i'~,,.~~~ a1~~t r~ao ~ 7 ~~ t FILE NUMBER ----' RELATION HS IP I ~ AMOUNT OR SHARE OF ESTATE ~4j-~af~'i E>~, f i Sn~v i ~'~L h'~"E~_ l I~~FC`~~ ITEM f __ ------ ---- NUMBER j NAME ANO ADDRESS OF BENEFICIARY 8. Charitable and Governmer-tol Bequests: - ~~ TOTAL CkARITABIE AND GOVERNMENTAL BEQUESTS (Also enter on line 13, Recapitulation} {If more space is needed, insert additional alraets of sums sFze) SCHED~UlE J BENEFICIARIES -- S ~~ ~'d `1~ i~~~ AMOUNT OR SHARE-OF ESTATE