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Home My WebLink About04-0942STATE OF PENNSYLVANIA COUNTY OF CLEARFIELD ESTATE OF Lewis J. Opalisky LATE OF Smoke Run, Clearfield County Deceased, who died Testate on 12-19-03 To the Register of Wills, Cumberland, County, Pennsylvania To Whom It May Concern: O- ~ ' ~'~- {31 t.~ ~ I hereby certify that the Transfer Inheritance Tax on the Estate of the above named decedent was paid to me on 3-19-04, $6,500.00, and that the property of the estate on which said tax was paid included, among other items, Real Estate located in your County, described in the appraisement as follows: Vacant Lot Located on S. 17th Street, Camp Hill 11,890 (assessed value) x 1.05 (common level ratio factor=12,484.50 Value and appraised at $12,484.50 This certificate is made to you in accordance with the provisions of an Act. No. 418, approved July 11, 1923. In witness whereof I have hereunto set my hand and seal of Office this 8th day of October, 2004. Reager & Adler, PC, Attorneys Executor, Administrator, or Attorney for above Estate Karen L. Starck Register of Wills and Agent for the Commonwealth of Pennsylvania · REV-1502 EX + (6-98) i.i OOM.O.WSALT. OF A [ REAL ESTATE RESiDeNT DECEDENT ~ FILE Al( mai P~ °~ sole~ °r ms a tenam in common must be repo~eU at fair manet eeiue, Fa)r manet value ~ defin~ as ~ ex~anged ~n a wiJU~ burr end a ~E~ sel)e~ nei~er bein~ ~ wh~is oi~tl ~ ri ht ~su~Jvomh~ must be dlsclosed on Schedule F. ITE~ NUMBER KRR£N L. REGISTER CLEARFiEd iNSTR~ENi 200~1 RECOR[ FILE ¥ot~i TOTAL CU REAGER & A01 ~ DESCRIPTION VACANT LOT LOCATED ON S. 17TH STREET, CAMP HILL 11,890 (assessed value) x. 1.05 (common level ratio factor) = 12,484.50 VALUEATDATE OFDEATH 12,484.50 5TARCK RECORDER , CDUI, I'Ff 0 ~N OI21 $0.00 DMER PC TOTAL (Also enter on line 1, Recapilulalior more space is needed, insed additional sheets oIthe same sizej 12 484.50 PENN,~YLVANIA DEPARTMENT OF REVENUE o DEPT· 280001 HARR ~OURG, PA 17128 0601J REV-1500 IN, . RITANCE TAX RETURN RESIDENT DECEDENT DECEUEN ['S NAME {LAS'f, FIRST, AND MIDDLE IMllA[} OPAL SKY, LEWIS J. 12/19/2003 07/31/1921 [~ 1. Original Return ~]4 LimSed Eslale ] 6. Decedent Died Testate (^m~h copy E~9 Litigation Proceeds Received E~2. Supplemee~al Relum THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND NAME 0 9 1-6 4-6 5 4 THIS RETURN MUST DE FILED IN DUPLICATE WITH )'HE REGISTER OF WILLS SOCIAL SECURITY NUMDER r~5. Federal Eetate Tax Re/urn Reoulred 0 8. Teal Number of Safe Deeosit Boxes [] 11. Eleclion lo tax Jnder Sec. 9113(A) (x~ach s~r, o~ CONFIDENTIAL TAX INFORMATION SHOULD GE DIRECTED TO;,;; LINUS E. FENICLE REAGER& ADLER, P.C. 717-793-1383 COMPLETE MAILING ADDRESS REAGER& ADLER, P,C. 2331 MARKET STREET CAMP HILL 1 Real Es!ate (Schedule A) (1) 2 Stocks and Bonds (Schedule B) (2) . 3 CIose¥ I.teld Corporation, Padner'sddp or Sofe-Propdeloasbip (3) 4 Mortgaoos g No[es Rece[w]ble (Schedule D) (4) 5. Cash, Ba k Deposds & M,sce aneous Personal Properly (5) (Schedule E) G Jointly Owned Properly (Schedule F) (6) ] Separate Bil~ing Requested ? hlte¢-VJvos Translers & Miscellaneous Non-Probate Property ' (7) (Schedule G or L) 8 Total Gross Assets (lotal I_inos 1 7) 9 Funeral Expenses & Adminislra~ivo Cosls (Schedule H) (9) 10 Debts of Decedenl, Modgage Liabililies, & Liens [Schedule l) (10) 11. Total Beductions (total Lines g & 10) 12~484.50 31,701.9C t3 Cbar[lableandCoven en[alBecmsslSecq 3Tru*[slorw cha elec'onlotaxhesnolbeen made (Schedtde J) (13) . 14 Net Value Subjoct lo Ta× (Line12 minus Line13 rate Britons[ers [rider Sec 9110 { ' ' lO Amounl ol Line 14 taxable al linea~ ra~e ¢9 Tax Due (19) I20 ~ b, ~ ~ .... , c , ' , . , . .., PA 1701' 9,511.82 2,430.65 (11) ,. 11,942.47 (12) ' % 12-'5, '~-¢).zI O.ON 0.00 0.00 0.00 >> 8E SURE TO ANSWER ALL QUESTIONS ON REVERSE SiDE AND RECHECK MATH, <<~ , ', P.'O. BOX 34 ( Payments and Credits: Tax Due(Page I Line 19) Credits/Payments A. Spousal Pover[y Credil 13 Prier Payments L," '~' O C) O o C Discount /,2 -7 i.~'' Total Credits (A + B +C) (2) fnlerest/Penalty il apphcnble D. Interest E Penalty Total interest/Penalty ( D + E ) (3) I Line 2 is groalor lhan Line 1 + Line 3, enlor tho difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) Jl I.~ee 1 + Line 3 is greater than Line 2, enter tbe difference. This is file TAX DUE, A Enler ll~e inlorost On lbo tax due. (SA) B Lnlor the [oral of Line 5 + SA. Thru is Ihe BALANCE DUE. (SB) Make Check Payable to; REGISTER OF WILLS, AGENT , ::z. OS. ~o PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain lbo use or income et lbe propedy transferred ........................................................................ [] [] b relain fhe right to designate who shall use lhe property lransferred or ils income; ........................................ J~ [] c. retain a reversionary inlerest; or .................................................................................................. [] [] d. rece've the promise for life of e~ther payments, benefils or care'~ ............................................................ [] [] 2 g deatb occurred after December 12, 1982, d'd decedent transfer property wiihin one year of dealh wilbout receiving adequale considorali0n? ......................................................................................... [] ~ 3. Did decedent own an "in trust for" or payable upon dealh bank accounl or security al his or her death? ............... []. [] 4. Did deceden[ own an Individual Relkement Account, annuity, or otl~or non-probate property which conjoins a tloneficiary desigeation'~ ............ .' ................................................................................... [] [] 4E ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEBULE G AND FILE IT AS PART OF THE RETURN. lal,,s of dealb on or after July 1, ' , ', ; ' ' '.S ~. 116 (a) (1.1) 0)1.~ ' ' 1994 and before Janunry 1, 1995, the lax role imposed on lhe net value of transfers Io or for the use of Ihe sunavmg spouse Is 3% h!l{~s of dealh on or after January 1, 1995, tile lax role [reposed oe tile not value of transrers to or for tile use of the surviving spouse is 0% [72 P.S, §9116 (a) (I,1} (ii)]. ~tnln!n dgos_not~ezemp, a ensfo lo a s ~rv v g ~pouse from ax, and tile s a u ory requiremenls for disclosure of assets and filing a lax return are sfill applicable even if urvw~ng spouse is Ihe only beneficiary 131os of cloath on or after July 1, 2000: ~n,: rate imposed on the nel value of transfers from a deceased child Iwonb,-one years of age or younger at doalh to or for lbo uso of a natural parent, an adoptive parent, olepparenl of the child is 0% [72 P,S. §9116(n)(1 2)]. m× role imposed on lbo nel value of lransbrs to or !or Ihe use o[ tile decedent's lineal beneficiaries is 4,5%, except as noted in 72 P S §9116(1 2) F2 P.S. §9116(a)(1)]. lax rote imposed on the not value of transfers to or for Ihe uso of lbo decedenl's siblings is 12% [72 P,S. §9116(a)(1.3)]. A sibling Is defined, under Section 9102, as an iduol wbo bas at least one parent in common with the deceden[, whether by blood or adoption. COMMONWEALTH OF PENNSYLVANIA INaERITANCE TAX RETURN RESIDENT DECEDENT )SCHEDULE A REAL ESTATE ATE OF FILE NUMBER ALIS. KY, LEWIS J. 17 04 0121 il real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the pdce at which pmoeny would be exchanged be~/een a wilting buyer and a wilrng seller, nedher being compelled ID buy or sell, both having reasonable know~edge or [he relevant [a~, TEM /MSER KAREH L. ISTER ANC :LEARFIEL£ INSTRUMENT 20L-t41' xECOROE FILE J ;~'0~-0 G[R A ADLER Real property which is jointly-owned with d,olrt of surv VD ship must be disclosed on Schedule F. DESCRIPTION VACANT LO]- LOCATED ON S. 17TH STREET, CAMP HILL 11,890 (assessed value) x. 1.05 (common level ratio factor) = 12,484.50 l ARCF, RECORDER (:OUN fY NUrlBER Ol.i 5 F'~ 21 s: i3 ~0,00 P(: VALUE AT DATE OF DEATH 12,484.50 TOTAL (Also enler on line 1, Recapitulation $ 12.,484.50 (if more space is needed, insert addi[ionaf sheets of Ihe same size) COMMONWE-ALTI i OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ) SCHEDULE IF JOINTLY-OWNED PROPERTY \TE OF FILE NUMBER ALISKY, LEWIS J, 17 ~)4 ff an asset was made joint within one year of tile decedenrs date of death, it must be reported on Schedule 0. DORVIVING JOINT TFNANT(S) NAME ADDRESS ,IICHAEL OPALISKY 4 Truffle Glen Road Mechanicsburg, PA 17050 0121 YNNE BARB :ATHRYN CARUSO 23 Prenfiss Way Exeter, NH 03833 29 Devonshire Square Mechanicsburg, PA 17050 :~ELATIONSHIP TO DECEDENT Son Daughter Daughter JTLY-OWNED PROPERTY: LE11LR gA IL DESCRIPIION 01' PI?O/~E H1 y % OF DATE OF DEATH A 1988 COUNTY NATIONAl_ BANK 8,397.65 50. 4,198.8: Acct fl 2055242 A,B C 1984 NEW CUMBERLAND FEDERAL CREDIT UNION I0,480.99 25. 2,099.41 Acct # 1167 (MONEY MARKET) A B C 1984 NEW CUMBERLAND FEDERAL CREDIT UNION 319.41 25. 79.85 Acct# 1167 B 1959 PNC BANI< 50,647.61 50. 25,323.81 Acct fl 5'1-40047778 - checkin9 TOTAL (Also enter on I'ne 8, Recapitulation) / ¢ ,,,,,~¢, ..... ~ ,,,,~,~,,, ~ ............................ 31,70I. ieets or tho s~me size) COIvIMONWEALTH OF PENNSYLVANIA INI IL=RITANCE TAX RETURN RESIDENT DECEDENT SCHr=DUL. E G ,.., ER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ~,TE OF FILE NUMBER \L[SKY, LEWIS J. 17 04 0121 This schedule must be comploled and liled if the answer to any of questions 1 Ihrough 4 on the reverse side of Ihe REV-1500 COVER SHEET Is yes. DESCRIPTION OF PROPERTY r.c~uu~ ~r~ ~.uE or m~ ~r~srEr~Er, r,,~,~ ~ru, r,o.s.~. To orcrDrm ^.o DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE VALUE OF ASSET INTEREST (~r .~-~¢--'~e VALUE BALTIMORE LIFE ANNUITY 5,494.57 100, 5,494.5' 1tl 92740619 BALTIMORE LIFE ANNUITY 5,494.57 100. 5,494.5~ #207747993 BALTIMORE LIFE ANNUITY 5,494.57 100, 5,494.5; fl09710454C1 BALTIMORE LIFE ANNUITY 5,494.57 100. 5,494.5'; #175787745 BALTIMORE LIFE ANNUITY 25,199.50 100. ¢119449710AA BALTIMORE LIFE ANNUITY 6,380.50 100. (~, "~"O. #19444971O BALTIMORE LIFE ANNUITY 25,199.50: 100. ¢~,, iD/L! f,h 75405334 BALTIMORE LIFE ANNUITY 6,389.27 100. 11175405334 BALTIMORE LIFE ANNUITY 6,368.23 100. fl 165541 O40 TOTAL (Also enter on line 7 Recapitulation) (It more space is needed, insod additJonat sheets of the same size) COMMONWEALTH OF PENNSYLVANIA INHERITANCF_- TAX RETURN RESIDEN r DECEOEN'r 1 SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ATE OF ALISKY, LEWIS J. Debts of decedent must be repodod on Schednle I, FiLE NUMBER 17 04 0121 TEM JMr~ER ,L 10. 1 1 DESCRIPTION FUNERAL EXPENSES: KRUISE FUNERAl_ HOMES, INC. ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative (s) Social Security Number(s}/EgN Number of Personar Representative(s) Street Address City State Year(s) Commission Paid: Attorney Fees REAGER & ADLER, P.C. Family Exemption: (fl decedent's address is not the same as claimant's, at{ech explanation) Claimant Zip Street Address City State Relationship of Claimant to Decedent ProbateFees CLEARFILED COUNTY REGISTER OF WILLS Zip Accountant's Fees PREPARATION OF 2003 RETURN CLEARFIELD COUNTY LEGAL JOURNAL THE PROGRESS - LEGAL ADVERTISING FINAL HOUSE CLEANING MAILING EXPENSES OF EXECUTOR ADDITIONAL DEATH CERTIFICATES 'k AMOUNT 7.765.00 1,200.00 73.00 110.00 32.00 47.20 175.00 25.00 84~62 TOTAL (Also enter on line 9, Recapitulation) $ 9, 511.82 (il more space is needed, inset1 additional sheels of the same size) ) $CI~EDULE ! DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ATE OF FILE NUMBER ._ALrst__<Y~ LEWIS J. 17 04 0121 Include unreimbursed medical expenses. ITE~,4 VALUE AT DATE ~!UMBER DESCRIPTION OF DEATH MEALS ON WHEELS - FINAL BILL VISA - PAYOFF CREDIT CARD ALTOONA HOSPITAL - FINAL BALANCE PldlLIPSBURG HOSPITAL LIFE LINE- FINAL BILL FINAL UTILITIES - ELECTRIC, WATER, PHONE 2003 INCOME TAX RETURN DUE 13.75 708.53 34.58 437.17 22.00 308.62 906.00 TOTAL (Also enter on line 10, Recapitulation) more space ~s needed, insert additional sheets of the same size) 2,430.6h .'OMMONWEALTH OF PENNSYLVANIA INHERITANCE '[AX RETURN r{ESIDEN r DECEDENT SCHEDULE J BENEFICIARIES ~,TE OF \hlSK¥ 1 LEWIS J. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY 'T'AXABLE DISTRIBUTIONS [include outrighl spousal distdbu[bns, and frans[ors under Sec 91 ~6, (a) (12)] MICHAEL OPALISKY 4 Trufl'le Glen Mechanicsburg, PA 17050 LYNNE BARB 23 Prent[ss Way Exeter, NH 03833 KATHRYN CARUSO 29 Devonshire Square Mechanicsburg, PA 170,50 FILE NUMBER '17 04 0191 RELA'RONSHIP TO DECEDENT AMOUNT OR SHARE Do Not List Trustee(s) OF ESTATE Lineal Lineal Lineal ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET NON-1 AXABLE DISTRIBUTIONS: A SPOUSAL DISTRIBUTIONS UNDER SECTION 911~ FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART I! - ENTER TOTAL NON*TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (11 more space is needed, insert addi[ional sheets of the same size) 2oo3-04 REAL ESTATE TAX NO?iCE CAMP HILL SCHOOL DISTRICT MICHAEL !4 HARLING 206 S !TTH ST CAMP HILL PA !70!1 SCHOOL ** AUGUST O1 2003 12 ll,S90-' '~ WEDNESDAY 9:00AH TO 2:00PM n:OOP~ TO 6:00PM _. PHONE 7!7-~30-0230 _~!.73 155.90 DISCOUNT AUG-SEP !3S.90 ! ]FACE OCT-NOV !%1.73 i ?ENAL~Y AFT NOV !55.90 j 01-22-0535-342 C,_~L!~-, : ~"~S J 4 ~RUu~'~ E GLE~; -~" ~ vECHANiCSBURG P7.. 1'7050 THiS SiLL TO yo"~,=_, Y. ORTG~.GE '~' .... '" S !7TH STEEE'T -- ,'~';r, i,/i2/203TM 7AXE£ .... ' -,:, TAX CL.-'.iH S:JE:ELU- WILL Register of Wills Certificate of Grant of Letters No. 1704-0121 ESTATE OF Lewis J. Opalisky Late of Smoke Run Clear'field County, PA DECEASED Social Security No. 097-16-4654 WHEREAS, on tho 25th day or February, 2004, instrument(s) dated January 17, 995 admitted to probate as ll~e last will of Lewis J. Opalisky late of Snloko REin, Cleadield CouI~ty, PA who died on the 19[h aay of December. 2003, and WHEREAS, a true copy of the will as probated is annexed hereto THEREFORE, I, I(aren L Starck, Register of Wills in and for the County of Clearriold, in the Commonwealth or Pennsylvania, hereby certify that I have this clay granted Leiters Testamentary to Michael J. Opatisky who has duly qua?fled as IExecu[or and has agreed Io administer the estate according to law, all ofwhlch fully npl)enrs of ~ecord in my office at C]earfield, Pennsylvania. IN TESTIMONY VVHEREOF, I have hereunto set my hand and affixed the se;-,! of my orfice the 25[h (lay of Februaq/, 2004. Register of Wills MY COMMISSION EXPIRES FIRST lvlONDAY IN JANUARY 2008 .! 1,A.q'l[' WILL AND THES£ P~ESENTS, that LEWIS J. OPALISKY, of 93 Cumbcrland County, Pennsylvania, 17011, mcmcry and understanding, do hereby make, for my Last Will and Testament, hereby t'evokin% ~ u nl.~hLni~, nul.], and void any and all fenner Wills and/or Codicils 1 do dit',ct my Executor hereina£rer named to pay all my jusc debts inheritance and estate taxes on property passing by this, ~y-'Past Will and; Federal transfer I r. lo 41[.ve, duvise, and bequeath my rea]. esEa~e si~uage in the Vil].aqa of !~Jltl.)lce .~t~t/, ]~ttCC;ll-:[:l Tovzn~Jtip, Clearfieid County, Pennsylvania, my childr~,l~ kt.~.l. ~.~., of _._) Prentis~ Way Exeter, New Hampshire, 03833, ;,IiCIIAEL OHAI.1SKY, of 844 Meadow Lane, Camp llii1, Pennsylvania, 17011, and I'.AJlH, .~, CAllUf't), ,~t [o:.7 Do.,wocd Dri. v~, Jamison, Pennsylvania, 18929, in cqu:~l .:hays,.:, .l~ar(, and ~:haru' alike. If any child named herein shall pr,'dec.a::,, m,, ;ii]ti ],~' ':ur'.,iv.,~ by chiJdreu, their share shall be divided equ.'~]ly amou?, tlu, ir c-h~]dr,~u, then ].ivinF, at my death. If any child named r:h;R!J, be dJv[dt, d ,?l.q]]y ;m~on~ my children named herein then living at my and bequeath unto my children, LYNNE BARB, HIC]b\EL OPAL1SKY, etd K,'V['IHIYN CARUSO, ~ eqtml shares, share and share alike. If any chiJd n:m~t'd herein :;hail. prcdecea:;e me and be su~ived by Children, t:ht*ir~'..h.t_'--' >flm]l bo ali. vialed ~..qually a,nOlq~ their children, then living at my death. '.f any ch.i!d earned here~e shall predecease me and non be survived by ('1~{ Ld~'~, . th,.i ,' ?h;,:-~, -:hn I.] ho divided e~uail, y among my children named hcrui~ ght,~l ]i,:iml :~t my death. T ~,.Lvc, ct.mfe~ and grant unte my Executor the authority ut sell property of which !. re:ny die :;eized or possessed or which may at any time form part of my esta[e, at public or private sale, for such purposes and I eom[nato, censt[tu~e and appoinn my son, MICI~EL OP~ISKY, as L:l~:t Will and Tr, stament Should my son, MICIhiEL b,TM- o~herwise unable to serve in this capacity, I appoint my daughter, LYNNE BARB, as Alternate .l ','! i .,. 1 ....... ',.;Iii.i;{I.'.OF, I have hereunto set my hand and seal on this, [,,t,.m~nt the preceding page hereof bein~ identif'itu, l/ by mv Lnit£n],: conta:ined in the margin, thereof all done the x-,,', 7 / / d:q/ of , 1995. ~ 5ICNED, .UiALILD, PUBLIf',HED nnd DECLARED by the abov~ named Testator CO~:INONI,!IL,\LTiI OF PENNSYL\,'ANIA: COUN'I'¥ OF E'.].EARF[]{LI3 : I, L£W[S J. OPALISKY, Testator, whose name is signed [o the ~.tt:lched or fort~;o'in!.~ iuntrument, having been duly qualified according to law, cio hereby acknowledge that I signed it willingly, and that I signed it c<now/edl;ed beretta me by LIiWIS J.' OPALISKY. the this /'777[ta:., of January, 1995. Notary Public ,'.Iy commission expire's: ('I I'~AI',F ! (L]) : Ue, Pe~l!.',7 :]wrm.~on :md Deborah L. Tarbay, tile witnesses whose names .ir,, qi',u~ed ~n th,, attached or foregoing instrument, being ,' ~uly qualified a<cordln>,, t~ l. aw, do th,,pon~, and say that we were present an~ saw Testator, I,~%!~'.] J. OPAI.~;KY, ni. fU~ nnd execute the instrument as his Last Will; that i.I!L'I~] .Y. OP.!L[~UiY ,:iy, ned wi].].Jng].y and that LEWIS J. OPALISKY executed it as hi,' fr~oe and ye.fuhrer7 act for the purposes tberein expressed: that each of u,:, In tim hpa~iny, and .:/?,hr of the Testator, signed the Will as witnesses; and that t,> ~he be,:~- of our knowledge, the Tea:tater was at the time eighteen 5~T n.~:ur~ iC,Ir~E'i{ L. STAnCK {bqister Deborah L. '['arb:w witnesses, this/~ /' I day of January, i995. :NotarM Ptiblfc. ..-','-.., My eo,n~ii,:nion exPirk~:" INVENTORY Estate of OPALISKY, LEWIS J. 3lSD known as , Deceased No 17 04 0121 Date of Death 12/19/2003 Social Security No. 09164654 Personal Representative(s) of the above Estate, deceased, verify that the items appearing 'n the following Inventory Include ell of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuatioF placed opposite each item of said inventon/represents its fair value as of tile date of the Decedent's death, and that Decedent owned no real estate outside the Commonwealth of Pennsylvania except ~hat which appears in a memorandum at the end of this inventory. I/We verify that the statements made in this invenlory are true and correct. I/We understand that false statements herein made are sublect to the penagies of 18 Pa. C.S, Section 4904 relating to unsworn falsification to authorities. Adorney: ID. No.: LINUS E. FENICLE Address: REAGER & ADLER~ P.C. Dated CAMP HILL PA 17011 Personal Representative: Telephone: 717-763-1383 Description VACANT LOT LOCATED ON S. ]7TI'! STREET, CAMP ltlLL 11,890 (assessed value) x. ].05 ~common level ratio factor) = 12,484.50 (Attach Additional Sheets it necessary) Value 12,484.50 Total $I2,484.50 NOTE: The Memorandum of real estate outside the Commonwealth o¢ Pennsylvania may, at the election of the personal representative, include the value of each item, but such figures should not be extended into the total of the Inventory. NW-4