HomeMy WebLinkAbout04-20-78
Form No. RCC.62 (6.70) THIS FORM REQUIRED IN ALL ESTATES WITH GROSS ASSETS UNDER '10,000. UNDER SECTION 701 OF ACT OF JUNE 1.. 1"1.
EFll'EC'J'IVE JANUARY 1. 1982. (FILE IN DUPUCATE WITH COpy OF WILL ATTACHED)
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OFFICE OF'THE REGISTER .oF WI~LS
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APR12 0197~
County of . C.U~R.L~O. ~ . : , . . . . . , . . . . . . . .
.,.;.. .M~~.~~: .BP~~I.N~~R...&. ~.;D..,~u.r~~19,!~ ,J~~,..,..,..... of .6.2~ .B.e)~~d.er~j.S~~~~, .C.ar-1i.s.1~,:f~.. ~........,........
(Name) (Addrea)
being duly ----m~~-~~-~--h-------------________according to law, deposes and says thac he is the -mm~?::~-~!-~~~-~~h____~_m_____mmm.n____m__
(Exec., Adm., Legattt, Etc.)
of the estate OL-n---~~--~)-~~-~-~_~~_~~9_~~_~~____m_m___mhh____ whose last residence was -~-~~:-~~-!~-~~-..~~..r:~~-~L~-~~_(!.~.l~_)________________nnn_
(No.) Street
----:nm~~!:.!!-~~-~L?~m------hn___m_n___deceased, and that the whole of the estate of saiddecedenr, who died ----~~~_~n~_~_~?_~__n_m___
(City, Botough or Township) (Date)
consisted of:
REAL PROPERTY
REAL PROPERTY IN PENNSYLVANIA. WITH STATEMENT OF MORTGAGE ENCUMBRANCES UPON EACH PARCEL AT DEATH OF DECEDENT.
WHERE PROPERTY HELD AS JOINT TENANT OR TENANCY BY ENTIRETIES. GIVE NAMES. ADDRESSES AND RELATIONSHIP OF OTHER OWNERS,
Real Estate Estimated
NONE Value
Personal Property
Household Contentss ". /' 1350.00
f'efund frum St;..te of p;~ v /' 93.85
15 shares Farmers Trust Company stocl cd) (')..'L . f) () . " ' I. / 480~O~r
Refund from Social Security 'p.- ~,-Q55 .00 .
Cash , j, 6.50
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Refund from UTS L.- / - 4.04
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NOTE: You may expedite the processing of this return by filing with it, and as a part of the return,
letters from financial institutions or mortgage holders, certifying to amounts on deposit or owed by the
decedent as of the date of death. Such letters must be signed by a responsible officer of the financial
institution or mortgage holder and indicate clearly amounts of principal and interest in the decedent's
account at the date of death and the type of account, account number and the exact name or names in
which the account is registered. ,
Jointly Held Property /'
V
Checking Account - Farmers Trust Co. "-0610-4 (Est. 9/25/71)
1a,Sl,
E,stima~
Value
I)~<I~ . ~ g
'(1345.5V
Certificates of Depesit as below: (all in Farmers Trust Ce., Carlisle, PA)
116200 ~ 6201- 620~~ .i ~slad 1/20/71 r $1500
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116203 - 6204 issued 1/20/711
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$6205 ,. 6206/', . issued 8/11/71
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#7725Y.. 772t' i ssu ed 6/4/73
$1000
500.00
750.00
$1 000
500.00
$1500
750.00
Interest on above CD,s
t' 929. ~;;
q:3::1 ii' 4 I/:;?)
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Transfers within TWO YEARS Prior to Death
NONE
That at the time of death there was no safe deposit box registered ih decedent's individual name, or jointly with, or as agent or deputy of
another, or in decedent's individual name, with right of access by another as agent or deputy, with the exception of the following:-
NAME AND ADDRESS OF BANK OR OTHER INSTITUTION THIS SAFE DEPOSIT BOX RENTED I RELATIONSHIP OF JOINT
IN WHICH DECEDENT RENTED A SAFE DEPOSIT BOX IN NAME OR NAMES OF ~LDERS TO DECEDENT
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BENEFICIARIES
M
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. ' P.ELA TIONSHIP AGE OF LIFE , I: " '. I
BENEFICIARIES AND ADDRESSES (If step-children or SURVIVED TENANTS OR INTEREST OF
DECEDENT
(State full names of all and their addresses who have illegitimate children STATE YES ANNUITANTS BENEFICIARY
an'interest,vested, contingent or otherwise, in estate.) are involved, set OR NO AT DEATH OF IN ESTATE
forth this fact.) DECEDENT
ary K. Bollinger, 623 Belvedere St., Carlisle, PA Baughter I ,
yes 25%
ohn D. Burkhqlder, Jr., 217 N. Hanover st.
Carlisle, PA Son yes 25%
nn Louise Shatzer, 445 B Street, Carlisle, PA Daughter yes 25%
ichard M. BurKholder, 913 Forbes Rd., Carlisle, PA Son yes 25%
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RESIDENT 'DECEDENT DEBTS AND DEDUCTIONS CLAIMED
TE: List first five items in the spaces so provided, observe notations thereon, and instructions.
DEBT OR CLAIM NATURE OF SAME
AMOUNT
Funeral expenses paid
$
Family exemption (will not be allowed unless
decedent died residing with a spouse or children.)
Administration Expenses ·
Counsel fees ·
Fiduciary
commission ·
(.) See Note below
Total
r-:ote: The estate agrees to advise the Register of Wills if the amount actually paid in settlement of any fee, commission or debt is greater
or less than the estimated amount claimed and allowed.
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Subscribed and s~orn to before me this. . . ./7;:C;(',. . . . . . .
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(E:recutor-A inistrator)
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, (Street Number)
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(City or Town and State)
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. .. . .. . . .. . .. .. . .. ' . .. . . day of . .'. /(--,-: .r.. r;. !~ .. .. . ., 19/<(
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::RIMD COtJNTY IP'P-.I,"'A My C " Cu'
, ~..,. cmmlSSlon ""e1rQi
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Having been duly sworn according to law, I do hereby certify that the above appraisement is made in conformity with law on this
. . . . . . . . . . - . . . . . ' . . . . . . . . . . . . . . . . . day of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ., 19. . . . .
Appr..iaer
In the event that any futul'e interest in this estate is tl'ansfened in possession 01' enjoyment to collatel'al heil's of the decedent after the
expiration of any estate fol' life 01' fol' years, the Commonwealth hel'eby expressly resel'ves the right to appraise and assess transferinheri-
tance taxes at the lawful collateral I'ate on any such futul'e intel'est.
REPORT OF THE REGISTER OF WILLS
I, the undersigned duly elected Register of Wills in and for. . . . _ . . . . . . . . , . . . . . . . . . . . . . . , . . . . . .. County, Pennsylvania, do respectfully
report that I have allowed debts and deductions in the amounts claimed by deponent, except as to those items where a greater or lesser amount
is set forth in the last column to the right in said schedule above, which greater or lesser amount represents the sum allowed as a deduction.
Dated: .............................................
Register of Wills
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