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PETITION FOR PROBATE and GRANT OF LETTERS
Estate of Pl/l/Jv ~ Mile! No. ~- QJ - 03g a
also known as I To:
Register of Wills for the
Deceased. County of in the
Social Security No. I '1) - 40 - '7 ~ '1/ Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older an the executC)1?
in the last will of the above decedent, dated 4C4:jL(tN/
and codicil(s) dated c5'-lp r-( /h./"'-n J 'i ,) <{ 7R
,)...
named
,19~
(state relevant circumstances, e.g. renunciation, death of execUtor, etc.)
Decendent was domiciled at death in
h elZ. last family or principal residence at
(' ~j::!::~,j' countYiennSYIVania. with
f y ;J /} ~ ~I"\ Re)/Q.(.
p // I '.J
1F~rJ- f'n.n.J.!>O~o JOt.vJV....fnvh
(list street, numbe~ and muncipality) ,.
4P1" j I
cr
, -t9, :J Oc ( ,
ears of a~e, died
at . -J'" I 1;; {
Except as folIo s, decedent did not marry, was 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:
Decendent at death owned property with estimated values as follows:
(If domiciled in Pa.) All personal property
(If not domiciled in Pa.) Personal property in Pennsylvania
(If not domiciled in Pa.) Personal property in County
Value of real estate in Pennsylvania
situated as follows: --
~7~ (; G v
$
$
$
$
. .....~
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codici1(s)
presented herewith and the grant of letters
(testamentary; administration c.La.; administration d.b.n.c.t.a.)
theron.
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OATH OF'PERSONAL REPRESENTATIVE
COMMONWEALT~ OF-,PE~NSY~VANIA } S8
COUNTY OF C.:).\Yh") l:1""LA/~ i,) .
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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 affirmed __and subscribed ~; ~ /2 2d/fA '"
bef~)fe me this l~" I H- day f ~ ~ ~ ~.
A +) R Il .' C--,'- 1).. -C I)' a
. - 1" I '-J ~, s::
y(,v'\ "1'" j( ". ~
"-- '. ; / '\ RegISter ~ ~
}U L2-4-2-
No. ~/-OJ-OJf{a
Estate of
lV\ j~ '1 (1 I~LL [:\.1
, Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW /1 M EZI L rl-DO, 'in consideration of the petitlDn on
the reverse side hereof, satisfactory proof having been presented before me, -;
IT IS DECREED that the instrument(s) dated L\ llLl U 0 T i ~. i q (7 4 t+.- S Lf r I ~ I I q /7 %'
described therein be admitted to probate and filed of record as the last will of
/')") A RY (.1 . KE-LLf-=~
and Letters T'E.,S T A Y\: \E- N r A R'-j
are hereby granted to \..Ie) H N (:1 K E: L_Lf::"-/
,....- ---", . {\ -\
-Yvlu/Uf ~ ~i~~V iY(I}UL~~f' I __~
Register of Wills '
FEES
Probate, Letters, Etc. ......... $ 1./70. (i ()
Short--Certificates( ).......... $ QI, LJCJ
~- .yu~.' (I.:' n {."
IhR1Hl\,'atlon ................ $ -J __ I )
C"c'j)l elL r, $ {C 5[;
TOTA~lY $ 6,0(--
Filed ~.I.lr...C.l................ ~(:.9C\
fV\A I LIj) 'To E^-[f Lm~; ~ .
A TIORNEY (Sup. Ct. 1.0. No.)
ADDRESS
PHONE
'Chi:; is to certify that the information here given is correctly copied from an original certificate of death duly tiled with me as
L~cal Repistrar.' The original certif1qte ,will be forwarded.w the State Vital. .Records Offlce for permanenr fwing.
~
WARNING: It is illegal to duplicate this copy by photostat or photograph.
No.
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Lou] RegIstrar
Fee for rhis certiflcare, $2.00
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COMMONWEALTH OF PENNSYlVANIA. DEPARTMENT OF HEALTH · VITAL RECORDS
CERTIFICATE OF DEATH
TYPEiPRINT
IN
PER.....NENT
BLACK INK
~
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sex
a. f&:mAL-E
DATE OF DEATH ,Mcnlll. Da,. "'1/
4. n to r ,I S- J..~' () I
BIflTHPu.ct; (Cory aAd
Stale or FOIe.gtl COlJrll.y)
~=,tyl D
17b. COun
Old
-".-111
IMI in.
IOw"s!\ip 1
MAAITAl SWUS . Uorr...!
~_ UO"Oocl. Widow-.l.
OI_,*, ($P8Clly)
!/V1'Dow
EAS.
RACE . Arnttncatl Indoan, ilIadl, WhIle. Me
(Specotyl
10. t1J1f I , E
SURVIVING SPOUSE
!II WIfe. g..... m.a.den name.
IWp
CIIy""""
7D70
DATE OF DISPOSITION
(MOllln. Day. _I
o 21b ,q l~iL Ll JODI
RVlfE ~~~ OR PERSON ACTING AS SUCH LICENSE NUMBER
W~...L 22b. DI?.1 '2 -;;L L
Com~l. II 23a-c only certlfymg 10 "'" _ 01 my knowledge, aeatll occurred alln. 11m., elate al\<l ptace ..ated
pn~)an IS not availabkf at lima of death 10 (Signalllfe and Tille)
. cenlfy causa of dealn
1"11
/701
a~,
TIME OF DEATH _ DATE PRONOUNCED DEAD (Monln. Day, Year)
24,' '6~ ... as, ;l-jJnl Fj.2 001
27. PilAT I: Ent... the 6iseases. W\)uries or cofflpHcahons whtch ~uHd the dealh. Do nol enter the mOde 01 dying, such as cardiac Of respiratory arrest. shock or htlact tallur.
LiSt onty one cause on each line
~~
, ~SCQUENCEQf):
No@
21.
I Approximate
: interval betwHn
I onset and death
I
l
PART II:
OSher stgnitlcanl COI"ldAiona (;OO(r1buting 10 dUm, buI
no".auIliniinlM ~_gN~in PART \
I :
DUE 10 (OR 1\5 1\ CONSEQUENCE OF)
WERE AUlOPSY FINDINGS
A"'ILABlE PRlOA 10
COMPLETION OF CAUSE
OF DEATH1
MANNER OF DEATH
DATE OF INJURY
{Moom. Day. 'tear)
TIME OF INJURY
INJURY I'J WORK1 DESCRIBE HOW INJURY OCCURRED,
Natural
~
o
Homicide
PendIng In~esl19alion
o
[]
o ;~CE OF INJURY. 1\. horn.. la'm~=;.." factory, ollie.
b\.li\di~. ,"c_ \SpocI1y}
30..
v.. 0 NoD
l:2il~
3Ge,
Ye. D
NoD
SuICide
Could nol be detennlOOO
a... 28b.
CUlTIfIER IC~ack ani. onel
.CER1IFYI~ PHYSICIAN Whys.c~n cerlltYlng cause of doaOllh wner .another ptl""~lan has plOOOUOCed .Jt:!dlh dnu COl'llph:leu ITem 2Jl
To Ihtl bt-ato' my knowledoe. .Ith occurred due.., rhe cauae(s) and mannAr.. alaled. .
2i.
.PRONOUNClNG AND CERTifYING PHYSICIAN tPhySIClan bolh ~OOOtJnclng tJealh alld CeftttylClg to ~.1I..I'.ie of dedtt,\
To the twet 0' my knowledi', death occ::urred It the lime. date, ,and pfac..,and due 10 the c::ause(.) and menner... .I..ted..
"MEDICAL EXAMINER/CORONER
<;'~~~:~:~:t::::.~~~~auon and/or Investlgation. In my opinion, death ~~~~~~~ ~~ ~~~ ~'m., date. and place, .nd dl.lelo Ihe c.~se(.) and 0
31..
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LAST WILL AND TESTAMENT OF
MARY G. KELLEY
I, MARY G. KELLEY, residing at 803 Conodoquinet Drive, Camp
Hill, Cumberland County, Pennsylvania, hereby make and publish my
Last Will and Testament:
FIRST: I give my entire estate, real, personal and mixed, to
my issue, per stirpes.
SECOND: I name The Commonwealth National Bank, 16 South Market
Square, Harrisburg, Dauphin County, Pennsylvania, as my Executor, and
direct that it serve without bond in any jurisdiction in which called
upon to act.
THIRD: Any share of my estate, income or principal, which becomes
distributable to a minor shall be held in trust by The Commonwealth
National Bank, hereinafter referred to as Trustee, during minority.
My Trustee shall apply such amounts of income and principal as it, in
its sole discretion, deems proper for the support, education and welfare
of such minor, and shall accumulate any unexpended balance of income.
Such amounts may be applied directly or may be paid to the person with
whom such minor resides or who has the care and control of such minor,
without the intervention of a guardian. My Trustee shall not be
obliged to supervise or inquire into the application of such amounts
by such person, and the receipt of such person shall be a complete
release of my Trustee. Should the share of a minor, in the sole opinion
of my Trustee, be or become too small to warrant continuing such fund
in trust, or should its administration be or become impractical for
any other reason, my Trustee, in its sole discretion, may pay such
share, absolutely, to the parent or other person maintaining said minor,
Ih/frj
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or may deposit such share in the minor's name in a savings account in a
savings institution of its choosing, payable to the minor at majority.
FOURTH: If any beneficiary shall, in the sole opinion of my
Trustee, become mentally or physically incapacitated, my Trustee shall
apply such beneficiary.s share, either principal or income, for the
support and welfare of such beneficiary directly, without the inter-
vention of any guardian.
FIFTH: I give to any Executor, Executrix or Executors and to
any Trustee or Trustees, named in this Will, or any Codicil hereto,
hereinafter referred to in the singular neuter gender, the following
powers during the administration and until the completion of the dis-
tribution of my estate, and until the termination of all trusts created
hereunder and until the completion of the distribution of the assets of
such trusts, in addition to, and not in limitation of, any authority
given it by law or by other provisions hereof:
(a) To retain any property of any kind of which I may
die possessed, and to invest and reinvest any such property;
(b) To invest and reinvest in such stocks, bonds or other
property, either real or personal, including any common or diversified
trust funds maintained by corporate fiduciaries, as it, in its sole
discretion may deem wise, without being limited to what are known as
"legal investments" and without responsibility for diversification;
and to deposit and maintain, in its sole discretion, funds in such
amounts as it deems proper in banks of its choice, including the keeping
of reasonable amounts of cash in banks uninvested;
(c) To exercise any options to subscribe for stocks, bonds
or other investments; to vote, in person or by proxy, securities
held by it and in such connection to delegate its discretionary powers;
to join in any plan of lease, mortgage, merger, consolidation, exchange,
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reorganization, foreclosure or voting trust and deposit securities
thereunder of any corporation in which my estate and trusts may hold
stocks, bonds or other securities; and generally to exercise all the
rights of security holders of any corporation;
(d) To sell, transfer, convey, mortgage, pledge, grant
options for sales or exchanges, lease for any period of time or ex-
change any property, real or personal, which at any time may form part
of my estate, for the payment of debts or taxes, or for any purpose of
administration or distribution, at either public or private sale, for
such prices, either in cash or for credit, and upon such terms as it,
in its sole discretion, may deem wise, and to execute and deliver
deeds of conveyance or transfer thereof, without any liability on the
part of the purchaser or purchasers, or anyone else dealing with it
with respect to my said property, to see to the proper application of
the purchase money or proceeds;
(e) To renew notes or debts of mine, and to borrow sums
of money from any person, including any fiduciary, giving such security
therefor, including a pledge or mortgage, as it, in its sole discretion,
may deem to be for the best interests of my said estate and trusts;
(f) To make settlements and to compromise claims, by or
against my estate or trusts, including without limitation, any questions
relating to taxes or to any policy of life insurance, on such terms
as it, in its sole discretion, may deem wise without the necessity
of obtaining any court approval thereof;
(g) To make distribution hereunder either in cash or in kind,
or partly in each, as it, in its sole discretion, deems wise;
(h) In its discretion, to amortize from income premiums paid
for investments which are call~ble, or have a fixed maturity;
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funeral.
(i) To pay from my estate the expenses of my last illness and
WHEREOF, I have set my hand and seal on this my
/:'. /I.. day of !2{Lt fUr , 1974.
It /c~{~'7
IN WITNESS
Last Will and Testament this
SIGNED, SEALED, PUBLISHED and)
DECLARED by Mary G. Kelley, )
as and for her Last Will and )
Testament, on the day and year)
last above written, in the )
presence of us, who, at her )
request, in her presence, and)
in the presence of each other,)
all being present at the same )
time, have hereunto subscribed)
our names as witnesses: )
)
)
)
)
)
)
Ll~ L.~
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(~~ /)}c;At-)
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In
/ L-.t'fL/
MARY G. KELLEJ
-4-
(SEAL)
~ _It
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..
CODICIL
I, MARY G. KELLEY, residing at 209 Hallmark North, Briarcrest,
Village of Hershey, Dauphin County, Pennsylvania, declare this to be
the sole Codicil to my Last will and Testament dated August 12, 1974.
1. I revoke Item SECOND of my Last Will and Testament in its
entirety, and substitute in its place the following:
SECOND: I name my son, John G. Kelley, of Harrisburg,
Dauphin County, Pennsylvania, as my Executor, and direct that
he shall serve without bond in any jurisdiction in which
called upon to act.
2. In all other respects, I hereby ratify, confirm and republish
my Last Will and Testament dated August 12, 1974, together with this
sole Codicil, as and for my Last Will and Testament.
IN WITNESS WHEREOF, I have set my hand and seal hereto this
I"~ day of ~. , 1978.
~Eyl; ~I
( SEAL)
MARY
SIGNED, SEALED, PUBLISHED, and)
DECLARED by Mary G. Kelley, as)
and for the sole Codicil to )
her Last Will and Testament )
dated August 12, 1974, in the)
presence of us, who, at her )
request, in her presence, and )
in the presence of each other,)
all being present at the same )
time, have hereunto subscribed)
our names as witnesses: )
)
J.4 L...~ i
, // )
(MtJ(~l
)
)
)
)
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ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF oIl~ (/'~. '. )
SS.
I, Mary G. Kelley, the Testatrix, whose name is signed to
the foregoing instrument, having been duly qualified according to
law, do hereby acknowledge that I signed and executed the instrument
as my Last Will and Testament; that I signed it willingly; and
that I signed it as my free and voluntary act for the purposes
therein expressed.
~b&4,
Mary G. K ley
Sworn or affirmed to and
acknowledged before me by
Mary G. Kelley,
the
/il~
7' day
of
, 1978.
~~. t2-~~~
Nota Public
My Commission Expires:
h/~,11~LJ
... ~
.,.
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF :J:> rI c...) P /-1;, /V
SS.
WE,
, e"..eL.E<. ~6EP/111L1 ;r:
and
~~A/Y'';L~
, 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 Testatrix
sign and execute the instrument as her Last Will and Testament; that
she signed willingly and that she executed it as her free and voluntary
act for the purposes therein expressed; that each of us in the hearing
and sight of the Testatrix signed the Will as witnesses; and that to
the best of our knowledge the Testatrix was at that time eighteen (18)
or more years of age, of sound mind, and under no constraint or undue
influence.
)tlt~ L,. ~
C~uk~~
INLt-~ qY ~/LnZ1~
Sworn or affirmed to and
subscribed to before me by
,~~fd~ ,
Ok~. ~\
and ( ~c-=' :;u / -----J,
this /~ !?" day of
~ '_ 1978.
-~ aa... ~,{ -I
NOtar~ublic -
My Commission Expires:
97/CJ)/9Po
G
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent:
l}1naj
AtR/1
(;. )(dkv
. I
S' I :2 00 I
Date of Death:
Will No. ~OOI - oo?J8:L
Admin. No.
To the Register:
I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphans' Court Rules was
served on or mailed to the following beneficiaries of the above-captioned estate on ~ I II, ;) i) " , :
Name
f 19"" l.{/J
J" 1, V) ~,
/J?/C},AQ,(
F/Jtt~Jq'j d
k <--'Ie.;
)( Yelle;
Address
~ B(;~ 6'10 Si.t~ Vt?//ey ) U4~i) 133fS3
.2.. III /9bt kl1~ tktlle. CIt.evy (/'/lS'-e PI/) ;2o'?/fJ
,:).~~ ItA4 //(fI1 rLAce &TJ,~~ I II; 1 tfb) 7
J ~ .J- 'f HAJR cI w~tI &11~ /l7 c/ fW,-V __ V)9 ::2;til>(
J:L{ CA/JI? (J77z~t JVew cJur,~~1fI J~7l)
';;0 3 ~)Q J~~ $ 1t).2- .IJ'kd/P11aJ'J~y I'~ / )o6'r'"
/7JM.'1 IlJM/htte-T Ti C(~-ey
P~Y?elCJ/I} /Y/JJ1e f C",J"J d."C1'"
PAIA~f/,). I'JJMu:! J(L..u"tt ~
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Date:
CT~L1 .2.2~ ~~O,
~4.~
~
Signature
Name
(fohN t. _kelf~
J ~i CArl/) ( J' rrR~1-
New Cvh1~blJJf~I, 1'/1 ) 7f)7P
Address
Telephone ()I'1) 7 "7 If .... t t 1)1'
Capacity: ~ Personal Representative
_Counsel for personal representative
- _._~--"
~ ....;..;;;.~...~..~ ==--=~:=:.:;...:::.:.:-=:;-.:.::::~=-.::.~=.~~-~--=::-:=.:.::.:...:.:::.:.::: -..: =::-:=~-=--=-:=-..:= =--~--:
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT.280601
HARRISBURG. PA 17128-0601
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
No.AA 496694 REV-1162 EX (11-96)
RECEIVED FROM:
I
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
.:;- (J~. ~ :'"J lJ ~~ [:., ~. L.~ E~ "y'
1 i",~
:~l 1. (.'~ 1 ,,:~ :~~ r::~ . (~(,f
i C='.~ C~ t-.;:{ [1 ~.,_ ~. -r t~ f~, : "f
f ~J ~.~ l.~~ C~ !'.J f~; Ef f:~ F~ L~ C'. h~ [). Fl ~-:\ 1 ~:_l () -7 t)
FOLD HERE
FOLD HERE -
ESTATE INFORMATION:
FILE NUMBER
::.: '1 ~._,==1()(} 1 "".()382
:;:.' ';::. "J 1 C' 1. .. 4 (.- "7 8 L~ 1
NAME OF DECEDENT (LAST)
(FIRST)
(MI)
t/'Lt._LE:\{ J'~~{~f~\( C.-
DATE OF PAYMENT
...:." <~t ~j/ c:,' I.} '...' 1
. '
"
i; /
POSTMARK DATE
REMARKS .fC;Hi"! G !>j~LLCV
RECEIVED BY
f'
..
":.
,l-
i>
, -r? 1 2', b~:..~~ . ("I)
. -
"".
. >: t' H . ~ ~~. 1t","J C~l !,_~'t
COUNTY
C. !J ~~ B t~ ~~: L. i-::$ hJ C~
TOTAL AMOUNT PAID
DATE OF DEATH
:.,. .:..)5 /2CJ(-1
~~ {"4 ;:~;' 'r'
PO ,I '~1"'.~ j
. . -.. :..;...," /" .--....,
~C. /.' i ,
..} .. / j / /
,... .., T. .. c- ,.} /6/..2.. ,jI"....~.'" PA. /
_.-' ~'J ALL,:.:, /~..,,-.r t/'frv"c/'-
. / ('
.'/' 'i .J... '. "'-
, , ~ -,.,../\; /./ -:::--
~/\.",/ tll "-, -. ," .~'>"
C t-~ L c: F # \ I j:.',
SEAL
REGISTER OF WILLS
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
JOHN G KELLEY
1 21 CAROL STREET
NEW CUMBERLAND, PA 17070
____un fold
ESTATE INFORMATION: SSN: 1 91-40- 7 841
FILE NUMBER: 21 - 2001 - 0382
DECEDENT NAME: KELLEY MARY G
DA TE OF PAYMENT: 1 2/ 1 8/2001
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 04/05/2001
NO. CD 000651
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $566.00
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$566.00
REMARKS: JOHN G KELLEY
CHECK#130
SEAL
INITIALS: DO
RECEIVED BY:
REGISTER OF WILLS
MARY C. LEWIS
REGISTER OF WILLS
)/~-,::;;~)y- ~
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG I PA 17128-0601
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
ReC'o'
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
02-11-2002
KELLEY
04-05-2001
21 01-0382
CUMBERLAND
101
.02 fEB 19
,.!', Q .,18
"u .~ }
JOHN G KELLEY
121 CAROL ST
NEW CUMBERLAND
*'
REV-1547 EX AFP (12-001
MARY
G
P A (l:7111 0
GUlntA
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 ~
REV :iS4-j-ix-iFP--fi'2:otjr-NC)fici--oF-"ftiliiifiTAifcE-YA)rAPPRA-isiifENT-,--iLL"owANcE-Cri----------- - -- - --
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF KELLEY MARY G FILE NO. 21 01-0382 ACN 101 DATE 02-11-2002
TAX RETURN WAS: (X) ACCEPTED AS FILED
CHANGED
If an assessment was issued previously, lines 14, IS and/or 16, 17, 18 and 19 will
reflect figures that include the total of ALL returns assessed to date.
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. Amount of Line 14 at Sibling rate (17)
18. Allount of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
TAX CREDITS:
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
(1)
(2)
(3)
(4)
(5)
(6)
(7)
120,140.00
1761764.00
.00
.00
23,140.00
.00
.00
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governllental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
(9)
(10)
7,463.00
.00
(11)
(12)
(13)
(14)
NOTE:
.00 X 00 =
312,581.00 X 045=
.00 X 12 =
.00 X 15 =
NOTE: To insure proper
credit to your account,
subllit the upper portion
of this forll with your
tax paYllent.
320,044.00
7.463 nn
312,581.00
.00
312,581.00
(19)=
.00
14,066.14
.00
.00
14,066.14
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
06-08-2001 AA496694 675.00 12,825.00
12-18-2001 CDOO0651 .00 566.00
TOTAL TAX CREDIT 14,066.00
BALANCE OF TAX DUE .14
INTEREST AND PEN. .00
TOTAL DUE .14
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
( 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.)
STATUS REPORT UNDER RULE 6.12
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Date of Death:
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r;: J( elle,!
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Name of Decedent:
Will No.: :J.ot?J" 00?J8 ^
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 0' No 0
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 0
b. The separate Orphans' Court No. (if any) for the personal representative's
account is:
c. Did the personal ~,resentative state an account informally to the parties
in interest? Yes ~ No 0
c. Copies of receipts, releases, joinders and approval of formal or
informal accounts may be filed with the Clerk of the Orphans' Court
and may be attached to this report.
Date: .a.L. /.2 7~
S~ture
'J0411 tP Klle-v
Name /
/~/ CA~(;/ J'7:rJ; Mew Cw"!eet,,,.;./7o 70
Address
"7/7- 77'f~tr;oK / wit "7rrPJ>.2()...
Telephone No. I
Capacity: 0' Personal Representative
o Counsel for personal representative
Cumberland County - Register Of Wills
Hanover and High Street
Carlisle, PA 17013
,. Phone: (717) 240-6345
Date: 3/10/2003
JOHN G KELLEY
121 CAROL STREET
NEW CUMBERLAND, PA 17070
RE: Estate of KELLEY MARY G
File Number: 2001-00382
Dear Sir/Madam:
It has come to my attention that you have not filed the Status
Report by Personal Representative (Rule 6.12) in the above captioned
estate.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO.
103 SUPREME COURT RULES DOCKET NO. I, for decedents dying on or after
July I, 1992, the personal representative or his counsel, within two
(2) years of the decedent's death, shall file with the Register of
Wills a Status Report of completed or uncompleted administration.
This filing will become delinquent on: 4/05/2003
Your prompt attention to this matter will be appreciated.
Thank You.
Sincerely,
~~~~
DEPUTY REGISTER OF WILLS
cc: ./File
Counsel
Judge
R[V1500EXI6)OI'
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL)
Ke..lJt /1l~/<? ;.
DATE OF DEATH (MM- D-YEAR) DATE OF BIRTH (MM-DD-YEAR)
/1f'IV/L ,~ :2tJO I J'ql+:'I?J/,e'1 1;)/ /'j/y
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDlE INITIAL)
NJ<1
C!11. Original Return
o 4. Limited Estate
~ 6. Decedent Died Testate (Mach copy of VViIl)
o 9. Litigation Proceeds Received
o 2. Supplemental Return
o 4a. Future Interest Compromise (date o/death after 12.12-82)
o 7. Decedent Mainlained a Living Trust (Attach copy ofTrusl)
o 10. Spousal Poverty Credit (date ofdeath between 12-W:l1 aM 1-H\5\
OFFiCIAL USE ONLY
I (p - ~d.4~ .Q;
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FILE NUMBER
QLL-DL
COUNTY CODE YEAR
DO Q?{ d--
NUMBER
SOCIAL SECURITY NUMBER
J9/-'-fD
7J'1..J/
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER ,OF WILLS
SOCIAL SECURITY NUMBER
1\;11
o 3. Remainder R.eturn (dale of death prior to 12-13.82)
o 5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
o 11. Electioo to tax under Sec. 9113(A} (AUochSchO)
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,.~Ji '1~, ;o:~ :C':~Ji~J:::\G'H;rt::, Htlol'!
......~-x~~""'~~~ ~""~!...~ """,,,-_ = _".....,o."h'5~',,""".'~... ~=~""",._~ ......~.,_=~ _~__.,..~-",~~.. )2,'", ~~~-W.:A.~.. ""~;\,"'-~_"'r-~<~~~~ ."",<Ji;;:
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121
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COMPLETE MAILING ADDRESS
C~ful J'YR-ee.-t-
Cum ben./Nnl. fl9
x.o_ (15)
x ,0 'is: (16) 1'-1 /JIb
x .12 (17)
x .15 (lB)
(19)
FIRM NAME (If Applicabie)
,TELEPHONE NUMBER
Ii... 717-77y-(;oolf
w~-tY- 717 - 7'1~' fJ.b.J..
/7tJ7tJ
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ONLY
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
(1)
(2)
(3)
(4)
(5)
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3. Closely Held Corporation, Partnership Of Sole-Proprietorship
4. Mortgages & Notes Receiliable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule f)
o Separate Billing Requested
7. InterNivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
(7)
(B)
3)0
O'fY
73. NO
(6)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent Mortgage Liabilities, & Liens (Schedule 1)
11. Total Deductions (total Lines 9 & 10)
(9)
(10)
/ '-!{,]
,
Ill)
(12)
(13)
/, "163
a I;). ~gl
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12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to lax 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
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15. Amount of Line 14 taxable at the spousal tax
rale, or transfers under Sec. 9116 (a)(1.2)
16. Amount of line 14 taxable at lineal rate
3 J~, S~I
. I .
(14)
31;), f;N
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
20,0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Decedent's' Complete Address:
STREET ADDRESS
CITY
~
Mil
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. CreditsJPayments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
/'2. ,r;u-
t, 7~
Total Credits (A + B + C ) (2)
3. InteresUPenalty if applicable
D. Interest
E. Penalty
o
TotallnteresUPenalty ( D + E ) (3)
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)
ZIP /7011
Pi. ()6' 6
/3, 060
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
S7:~'
A. Enter the interest on the tax due.
(SA)
(5B)
.,
Ub,O<-
B. Enter the total of Line 5 + SA. This is the BALANCE DUE.
Make Check Payable to: REGISTER OF WILLS, AGENT
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; or. ............................................ ............................. .......................
d. receive the promise for life of either payments, benefits or care? ........ .......................................
2. If death occurred after 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? ........................................ ............................ ................
Ves
............................0
.....................0
............0
o
o
.............0
..........0 [l;J
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
No
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Under penalties of perjury, I declare that I have examined this retum, including accompanying schedules and statements, and to the best of my knowledge and belief. it is true, correct
and complete
Declaration of pre parer olher than the personal representative is based on all information of which preparer has any knowledge
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN
aL ..4 CZ//
ADDRESS F <7'
J.;L{ C'9'f.IJ( J'rk~
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
DATE
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ADDRESS
DATE
_urn H3i:lT
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. 99116 (a) (1.1) (ill.
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 (a) (1.1) (ii)].
The statute does not exemDt 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 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 stepparent of the child is 0% [72 P.S. 99116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedenl's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 99116(1.2) [72 P.S. 99116(a)(I)].
The tax rate imposed on the net value of transfers to or for the use of the decedenl's siblings is 12% [72 P.S. 99116(a)(I.3)]. 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-1500EX(6-0ol
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COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
REV-1500
DATE OF DEATH (MM-DD-YEAR)
DATE OF BIRTH (MM-DD-YEAR)
'- .
OFFICIAL USE ONLY
FILE NUMBER
COUNTY CODE
NUMBER
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
D 1. Original Return
D 4. Limited Estate
D 6. Decedent Died Testate (Attach copy of Will)
D 9. Litigation Proceeds Received
D 2. Supplemental Return
D 4a. Future Interest Compromise {date of death after 12-12.82)
D 7. Decedent Maintained a Living Trust (AttachcopyofTrusl)
D 10. Spousal Poverty Credit (date o/dealh between 12-31-91 and 1-1-95)
YEAR
SOCIAL SECURITY NUMBER
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
D 3. Remainder Return (date of death prior to 12-13-82)
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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FIRM NAME (If Applicable)
TELEPHONE NUMBER
COMPLETE MAILING ADDRESS
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(B)
(9)
(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)
OFFICIAL USE ONLY
(11)
(12)
(13)
(14)
(19)
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
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4. Mortgages & Notes 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)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
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
'.0_ (15)
,_0_ (16)
, .12 (17)
, .15 (1B)
CHECK HERE IF YOU ARE REQUESTING A REFUNO OF AN OVERPAYMENT
20.0
REV.I50' EX. 1I'.B5! *'
COMMONWEALTH Of PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF
/fl/VR.y
C Keller
FILE NUMBER
.:2/-:21)1)/ ~o31?pl.
(Property jointly-owned with Right of Survi,,:,orship must b. disclosed on Schedule F) All r.~1 .slate should be ntported at fair market value
which is defined as the price at which property would b. exchanged between a willing buyer and a willing s.lIef, neith.r being compelled
to buy or sell. both having reasonable knowledge of the relevant fads.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
1.
I-!DI.-tJ,e /111.) rR.Oj>€,-,,'1}
:1 ;). FA tt:? ff'R. -c.e h J< 0 I(l ~
C"n-,r /1,// I P,k; ) /O/!
,(
/)01 /'to
TOTAL (Also dnter on line 1, Roccoitulationl
~
"""'''''''''0. SCHEDULE B
COMMON'NEAl rH OF PENNSYLVANIA STOCKS & BONDS
INHERJ.TANCE T/JoY. RETURN
RESIDENT DECEDENT
ESTATE OF ~J/e-,/
/llI1R'j &:. FILE NUMBER
:V - :200 I - o-3&>.:.(
All property jointty-owned with right of sUl'Vivorship must be disclosed on Schedule F.
ITEM
NUMBER DESCRIPTION VALUE AT DATE
1. Of DEATH
LfIJ0 ShY/flet- ALL"l';h eny 6,1:.-<1/1 Y6. ~-9 J t) b 3{'
3"0 J' h /IY?..er;- /1meQlc/Vw DuJ~I~ fowfJ<l. y) Sy 1'i}:2.6~
0/ ()O .J hJt 'J..C (J PPL 2).7D-" :2 'I, 17S-
;;wo .J h#l./'O PtlL t.;6 ,:)') 9, :2 /0
600 S).,frl-er J ~(g"-~ hp17/Y/? BIJ'Il1v);pu.r n.rFf ) t), ").;(f
4Po VVZI::l1>;y VOC1;LDh '19.s0 J ,/, pOI>
f ;S" J~I1(1.4r FeJql ;2.;? J S- "1,'161
J? Jh I/?", r- VI" r-e drV' J'f. ,f,/ Ii'!
/0;;!..,t.2/' pJt:.f;, (
bO'-l'-f J h'h"f' F,Jll,t, rmlfJt"l-lJ tfUJ<f,e 7. 2,,/ 431 7Sr
f60.,J rlA.,d
I 'f 71 rh,fJMif FtJlefJ7 'i"..,t'ep.llJeJ"fe.. 10, ;LO 16', tl 76
Bv""R F....'i.(
$"39 .JIJ 19<i,ld VflJ1j't.f!Y/1.P( Welltl1jt, h~) .)l', J ^- 1~ I 0;)
J'
Tof'~/ 176J7f,<j
TOTAL (Also enter on line 2, Recapitulation I $
(If more space is needed, insert additional sheets of the same sue)
1E~.Is::aEX'('''1)
'*
COMMONWEAlTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
/ilt9f1'1 G- k€ JI-ey
,
FILE NUMBER
;< /~fJ(!) I~ () 3?;L
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointty-owned with the right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
.
VALUE AT DATE
OF DEATH
DESCRIPTION
J17d/.nI E'I,v1( (h~j(,,,? /fc.."v""i
J3)5r:?-
feA'! ~ 'flv/V/}/IV ) f" te rE""rl,,/e-fJr ffi..J, r J,{'1I~rr
<..f,strf
PeR.SPn<11 fRJ)f1U'l
J;O'? D
.;
'-3) 1'1:0
TOTAL (Also enler on line 5, Recapitulation) $
(~ l1lQ(e space is needed, insert additional sheets of the same size)
ReV.1Sl1El('(1.971
.~
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SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
m/Yf71
c:... K.e-J J r. 7
FILE NUMBER
:2-1- ~Ool ' D3J' ~
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. /II eill Fv.,,,,,mll) 1-/1>>71 ~ ~\J31
Jr<fh~"JJ'" ... F L.';"N Vl..6' iJ(;, If
f<.V::_~/tl '" 7'fy
C-.n 1'1.1 cfr.. ~~,''-'n Irr y'Nj
. #;)13)",
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name o/PelSonal Represenlalive (s) '1" OhN ~ ~/I~~
Social Securi<yNumbe~sll EIN Number 01 Personal Represenlalive(s)
Street Address I:>' { ("I'M.' J r-R <.L r-
City lif'l?(.! eun.be,,/l!I'.1 Stale p/f lip I 7p 70 ,fl.
.
~.
Yearts) Commission Paid: 1-""
.
2. Attomey Fees
Family Exemption; (If decedenrs address is not the same as claimanrs. attach explanation) Q
3.
Claimant
Street Address
.
City Slate lip
Relationship of Claimanlto Decedent .
4. Probate Fees I
330.
5. Accountan(s Fees
0
6. Tax Return Preparer's Fees - C>
7. ot
)Y6J
,
-
TOTAL (Also enter on line 9, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)