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INHERITANCE TAX RETURN
RESIDENT DECEDENT
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT 280601
HARRISBURG, PA 17128-0601
REV-1500
OFFICIAL USE ONLY
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FILE NUMBER
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COUNTY CODE YEAR
NUMBER
SOCIAL SECURITY NUMBER
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DATE OF BIRTH (MM-DD-YEAR)
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THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
g1. Original Return
D 4. Limited Estate
D 6. Decedent Died Testate (AttaG~ oopyofWill)
D 9. Litigation Proceeds Received
D 2. Supplemental Return
D 4a. Future Interest Compromise (date oldeat~ after 12-12-82)
D 7. Decedent Maintained a Living Trust (Attach copy of Trust)
D 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
D 3. Remainder Return (date 01 death prior to 1Z-13-82)
D 5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
D 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
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NAME
FIRM NAME (II Applicable)
COMPL5E;5NGA0r~Qsart Rd
c.o.r~\. <t,le.. PA-- \'""10 \ '3
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TELEPHONE NUMBER.,
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(8)
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1. Real Estate (Schedule A)
2 Stocks and Bonds (Schedule B)
(1)
(2)
(3)
(4)
(5) \ ~l (D(')
{11}
(12)
(13)
:lOt ~3 ,00
I 3, '1'71,00
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lSI III .00
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3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Noles Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
D Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
(7)
(14)
x .0 ..0. (15)
x.O_ (16)
x .12 (17)
x .15 {18}
(19)
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(6)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
(9) ':;l 'J" 'd.3. DO
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CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
11. Total Deductions (total Lines g & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
131111.()O
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
Decedent's Complete Address:
STREET ADDRESS
CITY
A
r'<.d
PA nOl3
611
l \.'2, le..
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19) (1)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
Total Credits (A + B + C ) (2)
3. InteresVPenalty if applicable
D. Interest
E. Penalty
TotallnteresVPenalty ( D + E I (31
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
(5)
(5A)
(5B)
ZIP nOl
4>
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A. Enter the interest on the tax due.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
Make Check Payable to: REGISTER OF WILLS, AGENT
<P
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" 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; Of...
d. receive the promise for life of either payments, benefits or care? ..
2. If death occurred affer December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .....
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? . .................
Yes
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.........0
.........0
o
No
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IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct
and complete.
Declaration of preparer other than the personal represenlalive is based on all information of which preparerhas any knowledge.
DATE
'1- 72 :-O'L
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN
'J)\ (\M.Q . '3 ~J'\.N\O-..
Qd5 0reGSD'\ R-d.. ChA\~ ~0
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
ADDRESS
110t3
DATE
ADDRESS
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For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
[72 P.S. ~9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. ~9116 (al (1.1) (i1)J.
The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if
the surviving spouse is the only beneficiary.
For dates of death on or affer July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent,
or a sfepparent of the chiid is 0% [72 P.S. ~9116(al(1.2)J.
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 99116(1.21 [72 P.S. ~9116(al(1)J.
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. ~9116(a)(1.3)J. A sibling is defined, under Section 9102, as an
individual who has at least one parent In common with the decedent, whether by blood or adoption.
REV-1508EX+(1-971
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ESTATE OF
,-\f0.ff\e~
~recKeJ <3
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
.J..l.. FILE NUMBER
I.\.n\\ ~ a\ -()2.. -( ri4Lf
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER DESCRIPTION
1.
VALUE AT DATE
OF DEATH
nrs\- VNloN rtar.K S<A.\Lli'\3S AccoUV\-+
\I.D)OOO .00
TOTAL (Also enter on line 5, Recapitulation)
(If more space IS needed, Insert additional sheets of the same size)
$ J (,..., . (fDO.ffi)
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
...\"a Mer;
~rff"' J.<e-\g
lVl\\ .M:
.
FILE NUMBER
a\__02~lDU~
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A FUNERAL EXPENSES:
1. crE~ ~x~s.e'3 \,Ut,OO
'2.. C-evY\0krj e.xpe-Yl<;eS \1000.00
8. ADMINISTRATIVE COSTS: 1>
1. Personal Representative's Commissions b\ Rn~ <2,. "BAelUtq
Name of Personal Representative (5)
Social Security Nurnber(s) I EIN Number of Personal Representative(s) L\.
Street Address <;=;as 0r't?11SD"J Ro
City eQr\\S\e.. State ~Fr Zip L"'lOI3
Yea~s) Commission Paid: ~e... re\.o.
2. Attorney Fees $
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship ot Claimant to Decedent
4. Probate Fees (Oes,.OO
5. Accountant's Fees 4J
6. Tax Return Preparer's Fees 4>
7.
TOTAl (Also enter on line 9, Recapitulation) $ ~d ~3.00
(If more space is needed, insert additional sheets of the same size)
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
NUMBER
1.
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS (include outright spousai distributions)
t
Anne- c. ~reCKe.\<3,
Uo-S 6feQ<;LX\. (20
CClr\ls.le, ~A qO\~
I.vl~E
AMOUNT OR SHARE
OF ESTATE
L(X) 70
II.
ENTER DOLLAR AMOUNTS FOR DISTRIBUTiONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRiATE, ON REV 1500 COVER SHEET
NON-TAXABLE DISTRIBUTIONS:
A" SPOUSAL DiSTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
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1"
B" CHARITABLE AND GOVERNMENTAL DiSTRIBUTIONS
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TOTAL OF PART II. ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $
(If more space is needed, insert additionalshee!s of the same size)
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PETITION FOR PROBATE and GRANT OF LETTERS
Estate ofJa.m.~T- f.,\~6t;
also known as j 'IY'P S P, I g
No.
To:
Register of Wills for the .1
l4-..JV<or1llo"......> . Deceased. County of ('lJIIIIAro/!{).I\Q in the
Social Security No. 01(0 -r-{1 - ){Ll1 ~ Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
21-02-644
Your petitioner(s), who is/are 18 years of age or1ol1er an the execut
in the last will of the above decedent, dated 1/ 2.. .
and codicil(s) dated
R\X
named
, 19~
1/ (.4-
(state relevant circnmstances, e.g. renunciation, death of executor, etc.)
hI S
(list street, number and muncipality)
,}42.Doo,
Decend t then
at
Except as follows, deceden did not marry, s not divorced and did not have a child born or adopted
after execution of the will offered for probate; was not the victim of a killing and was never adjudicated
incompetent: Nil+--
Decendent at death owned property with estimated values as follows: t:.
(If domiciled in Pa.) All personal property f. I 1.0 } ('YY) .00
(If not domiciled in Pa.) Personal property in Pennsylvania $
(11 not domiciled in Pa.) Personal property in County $
Value of real estate in Pennsylvania $
situated as follows:
ulv~
WHEREFORE, petitioner(s) respectfully
presented herewith and the grant of letters
theron.
(testamentary; administration c.t.a.; administration d.b.n.c.t.a.)
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OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA I S8
COUNTY OF CUMBERLAND J
The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are
true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen-
tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law.
Sworn to or affi.nned and subs .cribed k
before me this 17th day of
~I/;~ Y;/LLn~/pp:~~ .
RegISter
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[{,:gislr:lI The C)!'Jgird cendlcHc will be forwarded t\)
copied from all original cenitlc;lte or Jeach duly filed
the SLlre Vit-al Records OHlct' tCH permanent filing.
with me as
WARNING: It is illegal to duplicate this copy by photostat or photograph.
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NOV 0 6 2000
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21-02-644
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COMMONWEALTH OF PENNSYlVANtA . DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
NAMEOf'O€CEOUiTl~,,;M'da"~~---
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UNDER I DAV DATE OF BIRTH 8IR1'HI'LACE(C"'l~ PLACE OF DEA1'HlCl><\t.kOOly"""-- .....'(>51''''''''''"oo<lll1el...,.,j
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CITY. 8OAO. fWp Of OEJ;l"H fACIlfT'r' NAME /1. <'IOI'''''''tu/l(l(\, G''''' 51tH! ,nd num\lolI" RACf -~ INQn. 8Iac~. WhQ, I/tC
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KINDOF euStNESSlINPl./S1RY _SDECEDENT EvER IN WlI'mAl STRUS.u.n.cl StJAVlVING SPOUSE
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MOTHER'S NAME iF... MddIe. M"'deI1 SulnamllJ
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21-02-644
LAST WILL AND TESTAMENT
OF
JAMES BRECKELS
I, JAMES BRECKELS, currently residing in the Village
of Dobbs Ferry, County of Westchester, State of New York, do
make,
publish and declare this to be my Last Will and
Testament, hereby revoking all wills and codicils at any time
heretofore made by me.
FIRST:
I direct that my funeral expenses and the
expenses of my last illness, if any, be paid out of my general
estate.
SECOND:
I give all my tangible personal property to
my wife, ANN BRECKELS, or if she does not survive me, to my
nieces, LYNNE G. HUNT, residing at 9629 Timberhawk Circle,
Highlands Ranch, Colorado 80126, DIANE BARNA, residing at 525
Greasom Road, Carlisle, Pennsylvania, and nephew, DR. JAMES
BARNA, residing at 2539 Gary Circle, Dunedin, Florida 34698 who
survive me, to be divided equally between them as they may
agree. All charges for storing and insuring any of this
property for a reasonable amount of time and for packing and
Shipping it to my legatees shall be paid out of my residuary
estate as expenses of administration.
THIRD:
I give all real property which I own or
have a partial and shared interest in at the time of my death
to my wife, ANN BRECKELS. If she does not survive me, I direct
my executors to sell such property and to add the proceeds to
my residuary estate.
j7~.
FOURTH:
I give my residuary estate, both real and
personal, to my wife, ANN BRECKELS, or if she does not survive
me, to my nieces, LYNNE G. HUNT and DIANE BARNA, and nephew,
DR. JAMES BARNA in equal shares, per stirpes.
FIFTH:
I appoint my wife, ANN BRECKELS, currently
residing at 29 Livingston Avenue, Dobbs Ferry, New York, to be
the executor of this Will. If she does not serve or complete
administration of her duties, I appoint my niece, DIANE BARNA,
currently residing at 525 Greasom Road, Carlisle, Pennsylvania
17013, and nephew, DR. JAMES BARNA, currently residing at 2539
Gary Circle, Dunedin, Florida 34698, to be co-executors in his
place.
Any individual executor acting hereunder may resign as
such at any time without the permission of any court or person.
I direct that no bond or other security be
required of any fiduciary acting hereunder for the faithful
performance of duties in any jurisdiction. The term "executor"
as used herein shall include the executor or executors acting
hereunder from time to time.
SIXTH:
In
addition
to,
and
not by way of
limitation of, the powers vested by law in fiduciaries, I
hereby expressly grant to my Executor with respect to my estate
the powers hereinafter enumerated, all of such powers so
conferred or granted to be exercised by him/her as may deem
advisable, in his/her sole and absolute discretion:
(1) To retain, purchase or otherwise acquire, whether
originally a part of my estate or subsequently acquired, any
variety of real or personal property, any and all stocks,
bonds, notes or other securities, including securities of any
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corporate fiduciary, or any successor or affiliated
corporation, interests in common trust funds and securities of
or other interests in investment companies and investment
trusts, and partnerships (participating therein as a general or
limited partner), whether or not such investments be of the
character permissible for investments by fiduciaries and
without regard to degree of diversification;
(2) To sell, lease, pledge, mortgage, transfer, lend,
exchange, convert or otherwise dispose of, or grant options
with respect to, any and all property at any time forming a
part of my estate, in any manner, at any time or times, for any
purpose, for any price and upon any terms, credits and
conditions; and to enter into leases which extend beyond the
period fixed by statute for leases made by fiduciaries;
(3) To borrow money from any lender, including any
corporate fiduciary acting hereunder, for any purpose deemed
appropriate, including the exercise of stock options, and as
security to mortgage or pledge upon any terms and conditions
any real or personal property of which I may die seized or
possessed; and
(4) To exercise any stock options which I may own at
the time of my death and to retain the underlying stock
purchased on the exercise of such options; and to exercise all
other powers with respect to such stock as though such stock
had formed a part of my estate at the time of my death
SEVENTH:
All
estate,
inheritance,
legacy,
succession,
transfer or other death taxes (including any
interest or penalties thereon) imposed by any domestic or
foreign tax authority with respect to any property owned by me
at the time of my death and passing under this will (other than
any tax imposed by reason of Chapter 13 of the Internal Revenue
Code of 1986, as amended, or any successor thereto, and any
comparable tax imposed by any other taxing authority), shall be
paid out of my residuary estate with no right of reimbursement
from any recipient of any such property.
-3-
110
IN WITNESS WHEREOF, I, JAMES BRECKELS, have to this my
Last Will and Testament subscribed my name and set my seal
this~day o~~~in the year One Thousand Nine Hundred
and Ninety-six.
~1d.. 'If ~ 4P--tL ~
(/
WITNESSES:
--:r..e~ \II.~
~p~
-4-
SIGNED, SEALED, PUBLISHED AND DECLARED by the
above-named Testator as and for his Last Will and
Testament, before us, who at his request, in his
presence, and in the presence of each other, have
hereunto set our hands as witnesses this)~' day
of ~b.-('", 1996.
-:)€'l "ne '" (\\, \Le h 0 (\
res iding at 'dq L, \J '~ s.-t on C{ \J€..
Oobb.s f€u' '( I N .'1. l D l; n
~"""Ehc.<:" f:) bc.,-..Ic-<) residing at 1'--1 /1Itc..,:.... 5+v-~+
J.::)wU,J FUvJ/ ,..L/~. losJ.')..
-5-
, .
AFFIDAVIT
STATE OF NEW YORK)
'ss.,
COUNTY OF WESTCHESTER)
Each of the undersigned, individually and severally,
being duly sworn, deposes and says,
The within will was subscribed in our presence and
sight at the end thereof by JAMES BRECKLES, the within named
Testator on the .J."" day of .No""""b~ ,1996. Said Testator
at the time of making such subscription declared the instrument
so described to be his sUbscription declared the instrument so
subscribed to be his Last will and Testament. Each of the
undersigned thereupon signed his or her name as a witness at
the end of said Will, at the request of said Testator and in
his presence and sight of each other.
Said Testator was, at the time of so executing said
Will, over the age of eighteen years and, in the respective
opinions of the undersigned, of sound mind, memory and
understanding and not under any restraint or in any respect in
competent to make a will. The will was executed as a single,
original instrument and was not executed in counterparts.
Each of the undersigned was acquainted with said
Testator at such time, and makes this affidavit at his request.
The within Will was shown to the undersigned at the time this
affidavit was made, and was examined by each of them as to the
signatures of the Testator and of the undersigned.
::Je~ '{\\. ~~
~~// ;;L,q
Severally sworn to before me
this~~d day of /Uo~~ , 1996.
~
Notary Public
KENNETH THOMAS
Notary Pljt.;"~ ::-~tfll,'" Of New York
N~ F.t,26338
Qual"; :;-""'. V'0~k County
COmmIS$~On EXf:I\\ es Apn118, 19%
^
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Date of Death:
~~Mes \SfeCKe\<;
\\\2-\WOO
Name of Decedent:
Will No. a\ -02-~L\.L\
Admin. No.
To the Register:
I certify that notice of (beneficial interest) estate admirtistration required by Rule 5.6(a) of thy Orpl'ans' Court Rules was
served on or mailed to the following beneficiaries of the above-captioned estate on ,., ~ II !?J:X) 7 :
~
Address
J~I'\V\e.. c, g('f('l(Q \c,
~2c; Grea'b"J Qd) ('(1 r\\.slD- PI+
nVl3
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Date:
') h~02-
~l'> \~ S grlJ\JV'O.-.
Signature
Name bl~V'\t:.. <; 6f\lCN A-
Address 5(1.5 0cflJSf?V\ R G
C'1l..l\\.SlL PA no \ 3
Telephone <1 \ 1) ~a - 4.( 50
Capacity: -0ersonal Representative
_Counsel for personal representative
)O,/'
I nventory of the real and personal estate of
j~s. ~\ecie-\<;
deceased
n 05t VN\(j\J R:m\K ~~lV\flS fk..ox.n t
IbIOW. oc>
':j
'-----
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
I.
i
55:
j)tAfV~ u?~_~NA
being duly ";wORN_ according to law, deposes and says that She \. <; ~ exec.u:!ii",
___ ___________ of the Estate of TAiY\&-S 'R1E'cKel '3
late of ~TJ)e(\n~1bw{\Sh_\R------ -__, Cumberland County, Pa., deceased and that the
within is an inventory made by ___b\&ne.-5. ~AeI\Jg_ ___ _ _____, the said e)(e(,\J~
of the entire estate of said decedent, consisting of all the personal prop~rty and real estate, except real estate outside
the Commonwealth of Pennsylvania, and that the figures opposite each item of the Inventory represent it's fair value
as of the date of decedent's death.
"SUXDeN
and subscribed before me,
,
~\~S ~ClhMO----
;;.;;md b~ i ~l ~
lo!' 'Lelfl-
E)(eeu~or - Administrafor
j
____fi2.5 {Qrea.<;av Rd
__ CQ...('ll~\e.. \=>A nOI "3
Address
Date of Death _~\d_____ _ rv(')\lem~____
QJ)CO
O'Y
Month
Year
INSTRUCTIONS
,. An inventory must be filed within three months after appointment of personal representative.
2. A supplement inventory must be filed within thirty days of discovery of additional assets.
3. Additional sheels may be attached as to personalty or realty
4. See Article IV, Fiduciaries Act of 1949.
CL
, ~
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--.---
/'/"", /"t <-~-- _ '~,
/- ,/ v' - /~,
\, BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT, 280601
HARRISBURG~ PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
DIANE S BARNA
525 GREASON RD
CARLISLE
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
09-02-2002
BRECKELS
11-07-2000
21 02-0644
CUMBERLAND
101
-
nV-1S47EXAFP[Ol-02l
JAMES
T
PA 17013
Allount Rellitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
ilif,,=giri-Eif-AFP--foFo2Y-NOT"icE--OF-YNHEifii'AiicE-T"AX-APPRAysEME"NT-,--AL:rOWAit'crOR-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF BRECKELS JAMES T FILE NO. 21 02-0644 ACN 101 DATE 09-02-2002
TAX RETURN WAS: I X) ACCEPTED AS FILED
) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule AJ
2. Stocks and Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule CJ
4. Mortgages/Notes Receivable (Schedule DJ
5. Cash/Bank Deposits/Misc. Personal Property (Schedule El
6. Jointly Owned Property (Schedule FJ
7. Transfers (Schedule Gl
8. Total Assets
(1)
(2)
(3)
(4)
151
(6)
(7)
.00
.00
.00
.00
16,000.00
.00
.00
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adll. Costs/Misc. Expenses (Schedule Hl
10. Debts/Mortgage Liabilities/Liens (Schedule Il
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governaental Bequests; Non-elected 9113 Trusts (Schedule JJ
14. Net Value of Estate Subject to Tax
(9)
(10)
2,223.00
.00
Ill)
(12)
(13)
(14)
NOTE: If an assessment was issued previously, lines
reflect figures that include the total of ~
ASSESSMENT OF TAX:
15. Allount of Line 14 at Spousal rate (15)
16. Allount of Line 14 taxable at Lineal/Class A rate (16)
17. Allount of Line 14 at Sibling rate t17)
18. Allount of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
NOTE: To insure proper
credit to your account~
subllit the upper portion
of this forll with your
tax paYllent.
16,000.00
???3 no
13,777.00
.00
13,777.00
14, 15 and/or 16, 11, 18 and 19 will
returns assessed to date.
13,777.00 X 00 =
.00 X 045=
.00 X 12 =
.00x15=
(19)=
.00
.00
.00
.00
.00
TAX CREDITS:
"J AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID 1-)
TOTAL TAX CREDIT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00 I
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
I IF TOTAL DUE IS LESS THAN $1, 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.)
RESERYATION: Estates of decedents dying on or before Dece.ber 12, 1982 -- if any future interest in the estate is transferred
in possession or enjoy.ent to Class 8 (collateral) beneficiaries of the decedent after the expiration of any estate for
life or for years, the Co.monwealth ~ereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
at the lawful Class B (collateral) rate on any such future interest.
PURPOSE OF
NOTICE:
To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. (72 P.S.
Section 9140).
PAVMENT:
Detach the top portion of this Notice and submit with your payment to the Register of wills printed on the reverse side.
--Make check or 1I0ney order payable to: REGISTER OF HILLS.. AGENT
REFUND l CR);
A refund of a tax credit, which was not requested on the Tax Return, lIay be requ'ested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Taxn (REV-1313). Applications are available at the Office
of the Register of WillS, any of the 23 Revenue District Offices, or by calling the special 24-hour
answering service fer forms ordering: 1-800-362-2050; services for taxpayers with special hearing end I or
speaking needs: 1-800-447-3020 (TT only).
OBJECTIONS: Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment
of tax (inclUding discount or interest) as shown on this Notice must object within sixty (60) days of receipt of
this Notice by:
--written protest to the PA Departllent of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 11128-1021, OR
--election to have the .atter determined at audit of the account of the personal representative~ OR
--appeal to the Orphans' Court.
ADMIN-
ISTRATIYE
CORRECTIONS:
Factual errors discovered on this assess.ent should be addressed in writing to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg~ PA 17128-0601
Phone (717) 787-6505. See page 5 of the booklet Plnstructians for Inheritance Tax Return for a Resident
Decedent" (REY-1501) for an explanation of administratively correctable errors.
DISCOUNT:
If any tax due is paid within three (3) calendar 1I0nths after the decedent"s ~eath, a five parcant (SZ) discount of
the tax paid is allowed.
PENAL TV:
The 15Z tax amnesty non-participation penalty is co.puted on the total of the tax and interest assessed, and not
paid befora January 18~ 1996, the first day after the end of the tax amnesty period. This non-participation
penalty is appealable in the same .anner and in the the same time paried as YOU would appeal the tax and interest
that has been assessed as indicated on this notice.
INTEREST:
Interest is charged beginning with first day of delinquencY~ or nine (9) months and one (1) day fro. the date of
death, to the date of payment. Taxes which beca.e delinquent before January I, 1982 bear interest at the rate of
six (67.) percent per anou. calculated at a daily rate of .000164. All taxes which became delinquent on and after
January l~ 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate
announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2002 are:
Vear Interest Rate Daily Interest Factor Vear Interest Rate Daily Interest Fa(:tor
1982 2:0X .000548 1992 9% .00024.7
1983 167- .000438 1993-1994 7% .000192
1984 Hi:' .000301 1995-1998 9% .000247
1985 137. .000356 1999 7% .OO0l9Z
1986 107. .000Z74 2000 8% .000219
1987 9% .000247 2001 97. .000247
1988-1991 117. .000301 2002 6% .000l64
--Interest is calculated .s follows:
INTEREST = BALANCE OF TAX ONPAID X NONBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
-~Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifte&n (IS) days
beyond the date of the assessment. If pay~ent is .ada after the interest cOIIPutation date shown on the
Notice~ additional interest must be calculated.
f .
Jmh rf p 16'
0./
1
STATUS REPORT UNDER RULE 6.12
Name of Decedent:
, T
-,CU'V\fS
W- tr"'J(Q.l s
Date of Death:_[l~l-l.OOO
Will No. ::;>.\ -02-lou'Ll
Admin. No.
Pursuant to Rule 6.12 of the Supreme Court Orphans'
Court Rules, I report the following with respect to completion of
the administration of the above-captioned estate:
1. State whether administration of the estate is complete:
Yes V No
2. If the answer is No, state when the personal
representative reasonably believes that the administration will be
complete:
3. If the answer to No.1 is Yes, state the following:
a. Did the personal representative file a final
account with the Court? Yes /' No
b. The separate Orphans' Court No. (if any) for
the personal representative's account is:
c. Did the personal representative sta~e an
account informally to the parties in interest? Yes v' No
d. Copies of receipts, releases, joinders and
approvals of formal or informal accounts may be filed with the
Cerk of the Orphans' Court and may be attached to this report.
~.~~.
see Ct-Mm:'j;ta d
Q~~
SignaLure
'b\l:lnt S.. ?-/'reN 14-
Name (Please type or print)
~O-S 0remYl KC C{l/) \lSLD- PH-1013
Address l
(1lL) jJ-lC1- 4LSD
Te 1. No.
Capacity: ~personal Representative
Counsel for personal
representative
Date:--.3- 5-2002
(MAH: rmf/ AM3)
r
-~-
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
r'
BUREAU OF INDIVIDUAL TAXES
INHERITaNCE TAX DIYISION
'"be:PT. ZlD6Gl
HARRISIURS, PA 11121-0601
*'
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE DR DISALLOWANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
RU-U" U ~ lGl-Nl
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
09-02-2002
BRECKELS
11-07-2000
21 02-0644
CUMBERLAND
101
AIIOunt R..itted
T
DIANE S BARNA
525 GREASON RD
CARLISLE
PA 17013
JAMES
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ...
R"iv:ii4,-iin;:p-fiI::oiY-NOViii--6F-YHHiiiii'AN"Ci-VAX-APjin-iiiiiiNT~--ALUiWAiiCi.iiii---------_._-----
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF BRECKELS JAMES T FILE NO. 21 02-0644 ACN 101 DATE 09-02-2002
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Fun.~l Expens../Ad.. Co.t.I"Ssc. Expens.. (Schedul. H) (9)
1.. Dobts/Hortgago Liabiliti../Lion. (Schedul. I) lID) .00
11. Tot.l Deductions (11) , ."1\ nn
12. Net V.lus of Tex R.turn (12) 13,777.00
13. Ch.rltabl./Ooverneont.l B.que.t.; Non-.l..ted 9113 Tru.t. ISchedul. J) (13) .00
14. Net V.lu. of Est.t. Subj.ct to Tex 114 J 13, 77 7 . 00
- .JIO'I'~- Iof 11I'I ..,,..--'It---w.. - i..' ,odlll'eviouSll/. linn 14#15 .mt.I-CI1'_-16. 17 r 1& a.... 10 ..ill
r.,lect figure. that includ. the tet.l of ~ return. .......d to dat..
ASSESSMENT OF TAX:
15. A.ount of Line l~ .t Spou..l ret. (15J
16. Aeount of Line 14 texabl. .t Lineel/Cl... A r.t. (16)
17. Aeount of Line 14 .t Sibling r.t. (17)
18. AMount of Lin. 14 texabl. .t Coll.t.r.l/Cl... B r.t. (lB)
19. Prlncl~l Tex Du.
TAX RETURN WAS: I X) ACCEPTED AS FILED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASID ON: ORIGINAL RETURN
1. R..l E.t.t. (Schedul. A)
2. Stock. end Bond. I_dul. BJ
5. Clo..ly Held Stock/Partnership Inter..t (Schedule C)
4. Mortg..../Not.. R...ivsbl. ISchedul. DJ
5. C.sh/Bonk Dspo.itsIHisc. P.r.onel Property (Sch.dul. E)
6. Jointly OWn.d Prop.rty ISchedul. F)
7. Transfers (Schedule G)
8. Total A...t.
DATE
_ER
INTEREST/PEN PAID (-J
. IF PAID AFTER DATE INDICATED, SEE REVERSE
,--- -.. -... .---.. ..... ...........-r...l'Vof&1 T"T~D~~T_
J CHAHlilED
(1)
(2)
(5)
(q)
IS)
(6)
(7)
.00
.00
.00
.00
16.000.00
.00
.00
(8J
NOTE: To insure proper
cracl! t to )four account)
_it the upp.r portion
of this for. with your
t.x p.~nt.
16,000.00
2,223.00
13,777.00 X
.00 X
.00 X
.00 X
00 .
045 =
12 =
15 .
11')=
.00
.00
.00
.00
.00
AMOUNT PAID
TOTAL TAX CRIDIT
BALANCE OF TAX DUI
INTEREST AND PEN.
TOTAL DUE
.00
.00
.00
.00
IF TOTAL DUE IS LESS THAN .1, NO PAYNENT IS REeuIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRJ, YDU HAY BE DUE
-~.. --- -..---.--..-..- ..
STATUS REPORT UNDER RULE 6.12
Name of Decedent: ZELONA F. MCBETH
l
Date of Death: JULY 26, 2003
Will No.
Admin. No. 2003-00644
Pursuant to Rule 6.12 of the Supreme Court Orphans'
Court Rules, I report the following with respect to completion of
tl~e administration of the above-captioned estate:
1. State whether administration of t}ie estate is complete:
Yes~_ No
2. If the answer is No, state when the personal
representative reasonably believes that the administration will be
complete:
3. If the answer to No. 1 is Yes, state the following:
a. Did the personal representative file a final
account with the Court? Yes No~_.
b. The separate Orphans' Court No. (if any) for
the personal representative's account is:
c. Did t:he personal representative state an
account informally to ttie parties in interest? Yes g No
d. Copies of receipts, releases, joinders and
approvals of formal or informal accounts may be filed with the
Cerk of the Orphans' Court and may b~ttached to this report.
Date: ~O'~~O~l
gnature
ANTHONY CBETH
Name (Ple s type or print)
'- 1~~; 407 NORTH FRONT STREET
"~ HARRT BITR ,, PA 1 71 01
Address
r~:-.. -
V ~'.
1717) 238-3686
Tel. No.
Capacity: Personal Representative
(MAH:rmt!AM3)
_~ .Counsel for personal
representative
RW-27
RECEIPT AND RELEASE
KNOW ALL MEN BY THESE PRESENTS that I, Dolores D. Cohick, heir of the Estate of
Zelona F. McBeth, Deceased, do hereby acknowledge that I have this day had and received from
Anthony T. McBeth, Counsel for the Estate of Zelona F. McBeth, Deceased, the sum of $40,390.92,
in full and complete satisfaction and payment due me as said heir.
And therefore I, the said Dolores D. Cohick, do by these presents remise, release, quit-claim
and forever discharge the said Anthony T. McBeth, Counsel for the Estate of Zelona F. McBeth,
Deceased, his successors and assigns, of and from his actions as Counsel for the Estate of Zelona F.
McBeth, Deceased, of and from all actions, suits, payments, accounts, reckonings, claims and
demands whatsoever, for or by reason thereof, or of any other act, matter, cause or thing whatever.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~ day of
Ju n ~ 2004.
~~ ,~
Dolores D. Cohick
~iD -- ~o - .~ 3 3 1
Social Security Number
}
_,
-,
t~ ~m~
~ ` ,~ , i._, ~ ~ ~ ; ~,~;
yi ,_7
RECEIPT AND RELEASE
KNOW ALL MEN BY THESE PRESENTS that I, Mark N. McBeth, heir of the Estate of
Zelona F. McBeth, Deceased, do hereby acknowledge that I have this day had and received from
Anthony T. McBeth, Counsel for the Estate ofZelona F. McBeth, Deceased, the sum of $40,390.92,
in full and complete satisfaction and payment due me as said heir.
And therefore I, the said Mark N. McBeth, do by these presents remise, release, quit-claim
and forever discharge the said Anthony T. McBeth, Counsel for the Estate ofZelona F. McBeth,
Deceased, his successors and assigns, of and from his actions as Counsel for the Estate ofZelona F.
McBeth, Deceased, of and from all actions, suits, payments, accounts, reckonings, claims and
demands whatsoever, for or by reason thereof, or of any other act, matter, cause or thing whatever.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this day of
2004.
Mark N. McBeth
Social Security Number
. ~ ,~ ,
~.~
-,
RECEIPT AND RELEASE
KNOW ALL MEN BY THESE PRESENTS that I, Richard M. McBeth, Jr., heir of the
Estate of Zelona F. McBeth, Deceased, do hereby acknowledge that I have this day had and received
from Anthony T. McBeth, Counsel for the Estate of Zelona F. McBeth, Deceased, the sum of
$40,390.92, in full and complete satisfaction and payment due me as said heir.
And therefore I, the said Richard M. McBeth, Jr., do by these presents remise, release, quit-
claim and forever discharge the said Anthony T. McBeth, Counsel far the Estate of Zelona F.
McBeth, Deceased, his successors and assigns, of and from his actions as Counsel for the Estate of
Zelona F. McBeth, Deceased, of and from all actions, suits, payments, accounts, reckonings, claims
and demands whatsoever, for or by reason thereof, or of any other act, matter, cause or thing
whatever.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~ ~~ day of
~~ ~ 2004.
. ~~
,;
-,
RECEIPT AND RELEASE
KNOW ALL MEN BY THESE PRESENTS that I, Mark N. McBeth, heir of the Estate of
Zelona F. McBeth, Deceased, do hereby acknowledge that I have this day had and received from
Dolores D. Cohick, in her capacity as Administratrix for the Estate of Zelona F. McBeth, Deceased,
the sum of $36,775.92, in partial satisfaction and payment due me as said heir.
And therefore I, the said Mark N. McBeth, do by these presents remise, release, quit-claim
and forever discharge the said Dolores D. Cohick, in her capacity as Administratrix for the Estate of
Zelona F. McBeth, Deceased, her successors and assigns, of and from her actions as Administratrix
for the Estate of Zelona F. McBeth, Deceased, of and from all actions, suits, payments, accounts,
,\
reckonings, claims and demands whatsoever, for or by reason thereof, or of any other act, matter,
cause or thing whatever, limited, however to the receipt of this partial payment, reserving
nevertheless my rights as an heir to the expectancy of complete payment that the amount of complete
payment remains undetermined, and that additional payment from the Estate's assets may be minimal
or that there may not be additional payment form the assets.
IN WITNES' S WHEREOF, I have hereunto set my hand and seal this ~~day of
~"M/~`~ 2003.
. .,
" Mark N. McBeth
Social Security Number
RECEIPT AND RELEASE
KNOW ALL MEN BY THESE PRESENTS that I, Richard M. McBeth, Jr., heir of the
Estate ofZelona F. McBeth, Deceased, do hereby acknowledge that I have this day had and received
from Dolores D. Cohick, in her capacity as Administratrix for the Estate of Zelona F. McBeth,
Deceased, the sum of $36,775.92, in partial satisfaction and payment due me as said heir.
And therefore I, the said Richazd M. McBeth, Jr., do by these presents remise, release, quit-
claim and forever discharge the said Dolores D. Cohick, in her capacity as Administratrix for the
Estate of Zelona F. McBeth, Deceased, her successors and assigns, of and from her actions as
Administratrix for the Estate ofZelona F. McBeth, Deceased, ofand from all actions, suits, payments,
accounts, reckonings, claims and demands whatsoever, for or by reason thereof, or of any other act,
matter, cause or thing whatever, limited, however to the receipt of this partial payment, reserving
nevertheless my rights as an heir to the expectancy ofcomplete payment that the amount of complete
payment remains undetermined, and that additional payment from the Estate's assets may be minimal
or that there may not be additional payment form the assets.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~ ~~ day of
~.':.' ~~loj?~„~~~ , 2003.
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Social Security Number
RECEIPT AND RELEASE
KNOW ALL MEN BY THESE PRESENTS that I, Dolores D. Cohick, heir ofthe Estate of
Zelona F. McBeth, Deceased, do hereby acknowledge that I have this day had and received from
Dolores D. Cohick, in her capacity as Administratrix for the Estate of Zelona F. McBeth, Deceased,
the sum of $36,775.92, in partial satisfaction and payment due me as said heir.
And therefore I, the said Dolores D. Cohick, do by these presents remise, release, quit-claim
and forever discharge the said Dolores D. Cohick, in her capacity as Administratrix for the Estate of
Zelona F. McBeth, Deceased, her successors and assigns, of and from her actions as Administratrix
for the Estate of Zelona F. McBeth, Deceased, of and from all actions, suits, payments, accounts,
reckonings, claims and demands whatsoever, for or by reason thereof, or of any other act, matter,
cause or thing whatever, limited, however to the receipt of this partial payment, reserving
nevertheless my rights as an heir to the expectancy of complete payment that the amount of complete
payment remains undetermined, and that additional payment from the Estate's assets maybe minimal
or that there may not be additional payment form the assets.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~ day of
/UO t'~ rn l~ ~ r` 2003.
,.
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1.
Dolores D. Cohick
,~? icy ~- ~G' ._ :333/
Social Security Number