HomeMy WebLinkAbout06-15-15 � 1505611101
REV-1500 EX�°z_1', �
.iF FICIAL USE ONLY
PA Department of Revenue pennsylvania ""
Bureau of Individual Taxes � `� � County Code Year File Number
Po aoxzso6ol INHERITANCE TAX RETUF�N /�,/ � � / ,�y(�
Harrisburq,PA i'71z8-o6oi RESIDENT DECEDENT � _ �0pf
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birti� MMDDYYYY
� � � � 9' t -zozo rS � 3Z3 J' ? Z- 9
DecedenYs Last Name Suffix Decedent s First Name MI
Rj ( Q � �c J- r Ma � �` a �^ �
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First IVame MI
�j � 4 �, �G f�j dt.: �' 6 e�. Y Q (�
Spouse's Social Security Number
THIS RETURN MUST BE FILEi�IN [�UPLICATE WITH THE
REGISTER �F MVILLS
FILL IN APPROPRIATE OVALS BELOW
� 1. Original Return � 2.Supplemental Return tl;�;a 3. Remainder Retum(Date of Death
Prior to 12-13-82)
p 4. Limited Estate � 4a. Future Interest Compromise(date of il"�:'�� 5. Federal Estate Tax Return Required
death after 12-12-82)
q� 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 0_ 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust.)
6� 9. Litigation Proceeds Received C� 10.Spousal Poverty Credit(Date of Deatn �C„=:;: 11. Election to Tax under Sec.9113(A)
Between 12-31-91 and 1-1-95) (Attach Schedule O)
CORRESPONDENT— THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIA�. .�.m ��F - --�
����� � TAX iNFORMATION SHOULD BE DIRECTEQ T0:
Name Daytime Telephone Number
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First Line of Address �
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Second Line of Address � L' � -�
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it or Post Office State ZIP Code �=_4��7��.-�-� ' -�r �
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CorrespondenYs e-mail address: rjf� � �i �r ���"�-�� " G�'�ry��
Under penalties of perjury,I declare that I have examined this return,including accompanying schedules and staternents,and to the best of my knowledge and belief,
it is true,correct and complete.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATU E OF PERSON RESPONSIBLE FOR FILING RETURN �D TE
��JG�`�'�Y'^�"^ ^• fJll.O�F.iL ..............�. ....o..._�..�. ..�_
ADDRESS
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SIGNATUR F PREP R OTI-�Fj�T�IFyi�Ft�PRES�EN�E � � ��� ��������� �
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PLEASE USE ORIGINAL FOR�I(ONLY�
Side 1
� 150567,1101 1505611101 �
�
� 1505611201
REV-1500 EX
DecedenYs Social Security Number
Decedent's Name: � �
RECAPITULATION � ��� ��+���� ��i �
1. Real Estate(Schedufe A). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. � � p O O. 0 0
2. Stocks and Bonds(Schedule B) . . . .. . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . 2. .
3. Ciosely Heid Corporation, Partnership or Sole-Proprietorship(Schedule C) . . . . . 3. .
4. Mortgages and Notes Receivable(Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . . 4. .
5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E). . . . . . . 5. .
6. Jointly Owned Property(Schedule F) � Separate Billing Requested . . . . . . . 6. .
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) C'.�`� Separate Billing Requested.. . . . . . . 7. .
8. Total Gross Assets(total Lines 1 through 7). . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8. �
4 v v.0 O
9. Funeral Expenses and Administrative Costs(Schedule H). . . . . . . . . . . . . . . . . . . 9. ,
10. Debts of Decedent, Mortgage Liabilities and Liens(Schedule I). . . . . . . . . . . . . . . 10. .
11. Total Deductions(total Lines 9 and 10). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. �
12. Net Value of Estate(Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. �
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J) . . . . . . . . . . . . . . . . . . . . . . . . 13. .
14. Net Value Subject to Tax(Line 12 minus Line 13) . . . . . . . . . . . . . . . . . . . . . . . . 14. ��p p P . O �
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES �
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9116
(a)(1.2)X.0_ �s p O O .0 0 15. Q
16. Amount of Line 14 taxable •
at lineal rate X.0_ . 16. .
17. Amount of Line 14 taxable
at sibling rate X.12 . 17, �
18. Amount of Line 14 taxable
at collateral rate X .15 . �g. ,
19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. . 9'
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT p
Side 2
� 1505611201 1505611201 J
li II.III'll I111 1
REV-1500 EX Page 3 File Number
Decedent's Complete Address:
DECEDENT'S NAME
N`.4,�-cv�.. � � �-�(GaGI�- _ �f-�-
- --- -- _ ___ - _ _ -- —
STREETADDRESS
----
__---_t��__� ��. .�.fl.� � — —
CITY ��� /f �� � STATE^� ZIP
l�i A/`- ,�./ 1 7 A � �
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) �
2. Credits/Payments
A.Prior Payments
B.Discount
� Total Credits(A+B) (2)
3. Interest
(3)
4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2,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) Q
Make check payable to: REGISTER OF WILLS, AGENT.
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "K" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred .......................................................................................... ❑ �
b. retain the right to tlesignate who sha�l use the property transferred or its income ............................................ ❑ ❑X
c. retain a reversionary interest .............................................................................................................................. ❑ �
tl. receive the promise for life of either payments,benefits or care?...................................................................... ❑ 0
2. If death occurretl after Dec.12, 1982,did decedent transfer property within one year of death
without receiving adequate consideration?.............................................................................................................. ❑ �
3. Did decetlent own an"in trust for"or payable-upon-death bank account or security at his or�her death?.............. ❑ x❑
4. Ditl decedent own an individual retirement account,annuity or other non-probate property,which
contains a beneficiary designation? ........................................................................................................................ ❑ �
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FtLE IT AS PART OF THE RETURN,
For dates of death on or after July 1, 1994,and before Jan. 1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse
is 3 percent[72 P.S.§9116(a)(1.1)(i)].
For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers lo or for the use of the surviving spouse is 0 percent
[72 P.S.§9116(a)(1.1)(ii)].The statute does not exempt 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 after July 1,2000:
. The tax rate imposetl on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent, an
adoptive parent or a stepparent of the child is 0 percent[72 P.S.§9116(a)(1.2)].
. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent,except as noted in[72 P.S.§9116(a)(1)].
. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent[72 P.S. §9116(a)(1.3)].A sibling is tlefined,
under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption.
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REV-1502 EX+ (01-10)
��'��� � �� �� pennsylvania SCHEDULE A
. DEPARTMENT OFREVENUE
INHERITANCE TAX RETURN REAL ESTATE
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
11�.a.r-�. �. � - �j�a-G�-. , ��" 2( - I ,� - �6 7�7
All real property owned solely or as a tenant in common must be reported at fair market value, ��air ma��lcet value 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.
Real property that is jointly-owned with right of survivorship must be:discicrosed on Schedule F.
Attach a copy of the settlement sheet if the property has been sold.
ITEM Include a copy of the deed showing decedent's interest if owned as tenaot in cornmon. VALUE AT DATE
NUMBER OF DEATH
DESCRIPTION
1.
l o i F (� e�.�'�- �� s1r � ol� � O�
N�-✓ �a,�.��-�a.ti.r�, �� r ���v e�'o
�� ����� ��� ����
TOTAL(Also enter on Line 1, Recapitulation,) $ ,S OO�.. .��
If more space is needed,use additional sheets of paper of the same size.
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OMB NO.2502-0268
a e. rrP�oF�onri:
U.S.OEPARTMENT OF HOUSINfi&URBAN DEVELOPMENT �'OFHA 2.�FmHA 3.�CONV.UNINS. 4,QVA S.❑CONV.INS.
6. FILE NUMBER: 7. LOAN NUMBER:
SETTLEMENTSTATEMENT �A��T�'����
. 8. MORTGACaE INS CASE NUMHER:
C. NOTE: This Fam!s lumtshed to g!w you a sfatemenf o/eCtuel seftlemsn!cost+.Amounb peid to and 6y Nro sefNemsn!sganf are shown•
(tems martced'YPOC]'wero peld ouGslds fhe Closfng:They ara shown hero RxlnhrmaGonal pufposes and ars nd I�ludsd!n N�totaW.
�0 7A! ie rFtle4N nn 11
O. NAMEAND ADORESS 6F BORROWER: E.NAMEAND ADORESS OF SELLER: f. NAMEANO ADORESS OF LENDER:
Jeryye Cepital,LLC Barbara R.Bleck
8 Cedat CIiN Dtive 101 17th Stteei
Camy Hill.Pannaylvanla 17071 Naw Cumberland.R4 17070
G. PROPERTY LOCATION: H. SETTLEMENT AGENT: I. 3ETTLEMENT DATE:
101 11th Streat ChaAer SeplemaM Company
New Cumberland,A417070 Jurre 4,2075
Cumberland County,Panmylvanfa PIACE OF SErTIEMENT
7200 Camp Hfll�ypass,Suile 205
Camp HIII,PA 17011
J.SUMMARY O S RANSACTION SUM Y QF SELLER' TRAN
100.GROSS AAAOUNT OUE FROM BORROVYER: 400.GROSS AMOUNT DUE TO$d.LER
701. CoMraet Seles Prics 55 000.00 407.CoMrect Sales Priee 55.000.00
102. Personel Pr 402. Penonal
703. Settlemens Cha to Batower Una 1400 1 307•00 A03.
t04. '�.
105. '�.
ustrnents Forltenu Aa1d SNlerin edvanee ustrnerNs For ttems Paid Seller(n advarice
106.Sehool Taxea 08I05H5 to 07N1115 �WB.Sehoot Tau�sa 08I05/15 to 07N1HS 77.
107.C Taxes 06/05115 M 01101/18 405.82 407.Coun Texes 06J03H5 !0 01lO7l16 405•92
108.C' Taxea to 408.CI Tazes to
109. 2nd wrler Trash 08IOSI15lo 07107/15 11.71 409.2nd uar�x Trash 08105/1510 07/01115 71.71
110. 41 .
111. 411.
112. 412.
t20. GROSSAMOUNTDUEFROM80RROWER 58,802.82 <20. GROSSAMOUNTDUBTOSELLER 55,495.82
200.AMOUNTS PAIO BY OR IN BENALF OF BORROWEfi: 600.REDUCTIONS IN AMOUNT DUE TO SELLER:
201. H or eamest mo 501.6xoss il See Inttrucliom
202. Fhinei alNnount ot New Lwn s 502.Sottlement Char ea lo Saller Une 1 3 860•00
203. Exisd loen s Iaken a eet l0 503. F�datin loen s laken sub ect to
ypq, b04. H Flrst e
�, 5. ond OR e
208. `�.
207. `��.
208. `�.
209. �.
ustrneMs For lfsms U d Seller usfmoMa Fa Ilems U d H Soder
210.School Taxes to 510.School Tazas to
211. Ta�ces l0 511.Coun Tazas to
212. Cf Taxes to 512 Ci Tawes to
213. 2nd uarter cewer bill 04N1l15 to 08105H5 66.43 573.Znd uaAx aewer A blll 04/Otf15 to 08l05113 66.43
Z�,, 514.
275. 515.
218. 516.
277. 517.
218. 518.
219. 519.
22Q TOTAL AND BY/FOR 80RROWER 68•43 520. TOTAI R6DUCTlON AMOUNT DUESg.LER 3,726.43
�00.CASH AT SETTLBAENT FROM/TO BORROWER: 600.CASN AT SETTIEMENT TOIFROM 9E1LER:
301.Gtoea AmouM Ous From 8orrower Una 120 56 802.82 801.Gross AmouM Dua To Saller lJne 420 55�95.62
302. Less Amount Pafd lFor Bmawx Uoe 220 ( 68.43) 602. Lesa Reduetions Oue Seller Uae 5Z0 3.728.43
3Q1 CASH(X FROM J( 70)80RROWER 56,738.19 601 CASH(X TO){ FROM)S�LER 81,789.19
The widenigned hereby acknowledgs recalpt ot a eomplatad eopy ot papes 132 of lhis atatemenl 8 eny adachmeMs reterred lo hmein.
Borrower Jeyye Capitel,LLC,a Penmylvanla Umlted Uabtdry Se��er
���y Berbare R.Bledc
BY:
iii un � i
wo.:
L.SETTLEMENT CHARGES
700.TOTAL COMMISSION Bseed on FMa S 7b ""D�0" R4DFNO�"
v o on ,a on(rrne 70o e: arrnns: eonrtowers ea�ors
FUNOSAT FUNOSAT
7 2. 6ETTLEYENT SET7l61BR
703. ml Id at
704. 10
800.ITEMS PAYABLE IN CONNECTION VYITN LOAN
801.Loan Ori Inallon Fse % to
802.Loan Discounl '% to
803. aa Fee to
804.Credit R to
805.Landar�ins Non Fee to
8d8.AAoA e Ina. . se to
7.Aasum on ee lo
808.
810.
871.
800.ITEM9 RE�UIRED BY LENDER TO BE PAID IN ADVANCE
901.Intere�t From W S Id ( d %)
902.M P Tot m. w U n a months ro
803.Hwrd Inauranes Premium tor 1.0 ra lo
904.
905.
1000.RESERVES OEPOSITED YVRH LENDER
1007 t months r month
7002.Mort e lereuranca moMha S r month
1003.School Taxei moMhs S r month
1004.C Taxea moMhs r moMh
1005.Ci Taiaea momhs E r mamh
1008. monqis S r moMh
7007, months S r month
7008, montln E r mornh
1100.TITLE CMAROES
1101.SotqemeM or Cloei Fee to
1102. Inheriance Tax Escraw to CAaAet SetUemoN Com 2 500•00
7103. lo Chartet SetUemenl Com 10.00
1104./Utom Fee to WIIIIamLl4dler Es Wre �•�
1105. Desd rallon lo Charter SeltlemeM Com 100•00
1108. Note Feee M Ca Adlar P.C. �.�
1107.Al1 Feas lo
udes eDove fQm numDsra:
11 I I Ir Ameri n Ti I r 85
lncludes above ltem nwnbero:
17 . � over
1110. B er e S 55,000.00 5 .
1111.
111 . lob oke on er herter Omenl pa
1 3. al resa a es aAer Setl emenl parnr
t�ta. nanx ement m
11t .
1116.
111 . DlfDunament a ea
1118. ChaAer 3etllemBnl COmpany
1200.60VERNMENT RECOROIN(i AND TRANSFER CHAROES
/201.Racw� Fees: Deed i Bd.50:Mon e 3 Releases E 84•SO
1202.CI Cw� �
1203.State TaxlStam : 550.00:M a 550.00
1204.
12pS.
1500.AOOITIONAL EETTLEMENT CHARf1ES
7301.Surv W
1302.Peat Im Oon to
1303.
1304.
13p5.
7100.TOTAL SEITLEMENi CHAROES Entar on Una 1 W 8eetlon J and 50 Seetlon K 1,307.00 3,660.00
Br tlynlnp Oay�1 W ei4 Nob�mM a�qpnabM�atlmowMOpe rsatlp�ets mmyNleO mOf N W C��oln��Mp Dap�qMmenl
Mid-Penn Abslract Comparry.Settlemant Apsnt
Certifled lo be a We eopy.
(,IAwEGJ+ITAL-tot�,NrreGwta-lot�1
il IIIIIIII I111 I
REGISTER UF WILLS CERTIFICATE OF
CUMBERLAND Gt}UNTY GRANT O� LETTERS
PENNSYLVANIA
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�� �, ,�. , �.�`° '�•� �s ta��e O�: MARION R BLACK JR
� t�. .�, � +� IFir81.M�AJI€,Last! --.��
� � �C� �
� � ;� , ti� �
.�• L,.�te �f: NEW CUMBEf�LANL7 &C?ROUGH
� �� " ''� � CUMBERLAN� Ct?UNTY
,���,�. � �
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'==i"_ ��f3C4c�5G'C�
��_; Sacia.� Securi ty No: 174-2C��-D909
'�75fl __...
WHEREAS, c�n the ��h day of June 2�15 an znstrument dated
December 35th z995 was adr►tit�t�d �a prob�te as the ,Zast will af
MARION R BLACK JR
/F;rsr.hti�lrna.cnsu
late of NEW CUMBERLAND BdRDUGH, CUMBERCAN� County,
who died an the 2�th day of January 20Z5 and,
WHER�AS, a true copy of the cvz11 as p�nbated is ann�xed hereto.
THEREFtJRE, I, LISA M. �RAYSON, ESQ. , ���g.isCer of Wi11s in and
for CUt�BERLAND County, in the Commoncveal �h crf� Fennsy.�vania, hereby
certi fy Cha t I have th.i s ci�y gran ted I�et ters TESTAMENTARY to:
BARBARA R BLACK
who has du.Zy qualified as EXECUTOR(R/X)
and has �gr�ed �o adminis��r the esta�e �ccordsn_q to 1aw, a1.3 of cyhich
fu.�.�y app�ars r�� rect�rd in my a�fi ce a� CUMBERLAND COUNTY COURT HCIUSE,
CARC lSL E, PENNS YL VANIA.
TN 7'E�7'IMONY WHEREOF, 1' have hereun�o set my hancl and affixed the seal
of my o��'ice on the 4th d�y of June 2075.
,
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**NOTE** ALL NAME,� ABOVE APPEAR (FIRST, MIDDLE, L�ISTJ
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WILL OF MARION R. BLACR S
I, Marion R. Blaok, of the borough of New Cumberland, Cumberland County,
Pennsylvania, declare this to be my last will and revoke any will previously
made by me.
=TSD� I. I direct that all my just debts and funeral expensea, including
my gravemarker and all expenses of my last illness, and any and all taxes and
� assessmenta imposed by any governmental body as a result of my death, whether
on property passing under this will or otherwise, shall be paid from my
� residuary estate as soon as practicable after my death as a part of the
�� expense of the adminiatration of my estate.
�
N� ITSM II. I give and bequeath all of my household goods, automobiles,
\ jewelry, and all other articles of household and personal use, equipment and
ornam�nt, together with all insurance thereon and relating thereto, to my
wife, Barbara R. Black, provided ahe survives my death by thirty (30) days.
Should my wife fail to survive my death by thirty {30) days, i give and
bequeath all auch items and insurance thereon to those of my following
children who survive my death by thirty (30) days, per capfta and not per
stirpes: my daughter, Terri L. Black, of Lemoyne, Pennsylvania; my daughter,
Carol L. Wagner, of Pembroke Pines, Florida; and my son, Kevin Black, of
Lemoyne, Pennsylvania, to be divided among them with due regard for their
� personal preferences in as nearly equal shares as practical. The decision of
my executrix with regard thereto shall be final, binding, and conclusive on
all parties.
=TSM ZII. I give, devise, and bequeath all the rest, residue, and
remainder of my possessions and estate of every nature and wherever aituate to
my wife, Barbara R. Black, provided she survives my death by thirty (30)
days. Should my wife fail to aurvive my death by thirty (30} daya, I give,
devise, and bequeath all the reat, residue, and remainder of my posaessions
and estate of every nature and wherever situate in equal sharea to thoae of my
following children who survive my death by thirty (30) days, per capita and
not per st.irpes: my daughter, Terri L. Black, of Lemoyne, Pennaylvania; my
daughter, Carol L. Wagner, of Pembroke Pinea, Florida; and my son, Kevin
Black, of Lemoyne, Pennaylvania.
ITSM IV. I appoint my wife, Barbara R. Black, executrix of this my
last will. Should my wife predecease me or otherwise fafl to qualify or cease
- 1 -
I ll iu 111 1
to serve as executrix of this my last will, I appoint my daughter, Terri L.
Black, executrix of this my last will. Should my daughter, Terri L. Black,
predecease me or otherwise fail to qualify or cease to s�rve as executrix of
this my last will, I appoint my daughter, Carol L. Wagner, executrix of this
my last will.
IT�t V. In additfon to the other powera and authorities granted to my
personal representatives by Pennsylva�nia law and by the other terms and
provisfons of this will, I hereby give to my personal representatives the
following powers and authorities effective without court approval and until
actual diatribution of all properry: to campromise any claim or controversy;
to make distribution in cash or in kind, or partly in cash and partly in kind,
and in such manner as my personal representatives may determine and at
valuations finally to be fixed by them; to invest in all forms of property,
without restriction to investments authorized for Pennsylvania fiduciaries, as
my personal representatives deem proper, without regard to any principle of
risk or diversification; to retain any or all assets of my estate, real or
personal, without regard to any principle of risk or diversification; to sell
at public or private sale, to exchange, or to lease for any period of time,
any real or personal property and to give options for sales, exchanges, or
leases, for such prices and upon such terms or conditians as my personal
representatives deem proper; and to allocate receipts and expenses to
principal or income or partly to each as my personal represeneatives deem
proper in their aole discretion.
ITBM VI. I dizect that my personal representatives and fiduciaries
shall not be required to give bond for the faithful performance of their
dutiea in any jurisdiction.
iN 1�ZT/N833 �tSOF, I have hereunto set my hand this �✓rday of
��fC' /yl/j�' , 1995.
��i��'��.��-
.
Marion R. Black
- 2 -
II II.IIIIII I111 1
The preceding instrument, consisting of this and two other typewritten
pages, each identified by the signature of the testator was on the date
thereof signed, published, and declared by Marion R. Black, the testator
' therein named, as and for his last will, in the presence of us, who at hia
V� request, in hia presence, and in the presence of each other, have subscribed
� our names as witnesses hereto.
� , �
�
Veozge A. Vaughn, III
� . .
�
� Diane B. Je ins
�
- 3 -
ii� uu � �
cornKoxw�.Tx oF pExxsnv�xiA )
( ss. .
CO[JNTY OF CiTMBERLAND )
I, Marion R. Black, being the testator whose name is aigned to the
foregoing instrument, having been duly qualified according to law, do hereby
acknowledge that I signed and executed the foregoing instrument as my last
will; that I aigned it willingly; and that I signed it as my free and
voluntary act for the purposes therein expreased.
� .�'�•�_��/
Marion R. Black
Sworn or affirmed to and acknowledged
before m by the testator named above NOTARIAISEAI.
� iRANCES T.VAtJGNN,Nolary Public
this /� day of ,�.Ce.vst-bPit.. , 1995. �p��.�Ctnnbs�fatd Co.,PA
����� � ���� IY1y Conanlsslon Expins Au 9,1994
Notary Public
CONIIdONWEALTH OF PENNSYLVADIIA 1
( SS. .
COUNTY OF CUMBERLAND ?
WE, George A. Vaughn, III, and Diane B. Jenkina, the witnesses whose
names are signed to the foregoing instrument, being duly qualified according
to law, do depose and say that we were present and saw the testator sign and
execute the instrument as his last will; that he signed it willingly; that he
executed it as hia free and voluntary act for the puxpoees therein expressed;
that each of us ia the hearing and sight of the testator aigned the will as
witnesses; aad that to the best of our knowledge, the testator was at the time
eighteen or more years or age, of sound mind, and under no conatraint or undue
influence.
�� �
eorge A. Vaughn, Iii
�
Diane B. Je ns
Sworn or af f irmed to and �f,�
ackno edged b�fore me this /�,'�_ day
of �C.��� , 1995.
� ���
� � -
Notary Public
N4IARIAL SEAL
fRANGES T.VAUGHN.Noiary Pub11c
HotnpcNn Twp..Cwnbsfta�d Co.,PA
My Commhsion Expi��s Au 9,1994
II IIIIIIII I�II 1
WILLIAM L. ADLER
ATTORNEY AT LAW
4949 Devonshire Road
HARRISBURG, PENNSYLVANIA 17109
PHONE: (717) 652-8989
FAX: (717) 307-3343
EMAIL: BAL�Bi11Ad1erLaw.coin
WEBSITE: Bi11Ad1erLaw.com
LEWIS F.ADLER KOHN AND ADLER
(1934_1984) (1934=1960)
DAVID S.KOHN KOHN, ADLER&ADLER
�i9sa_i9as) (i96a-�9si�
LOUIS J.ADLER ADLER&ADLER
(1959=1999) (1999=2010)
CRAIG LADLER
June 11, 2015
Cumberland County Courthouse
Register of Wills
One Courthouse Square
Carlisle, PA 17013-3387 , ,_,
c7 :,,a �
�
C � '=�
Re: Estate of Marion R. Black, Jr. -�'� `; c_ '';' 'c�
��,`7 _;,,t �- ..._.. <�...:1
�"r'� Y u�
7 �- �� i"�
Dear Register: � � cr� �'
_ �
: . -.� ..
Enclosed please find an inheritance tax return for filing. Please return a clockec��dpy to me th�le�i�elope
f`Y"3
provided. Thank you. � , �-� J� �,� �
co -_,
Very truly yours,
�Vl�
William L. Adler
WLA
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