HomeMy WebLinkAbout10-09-81 (6)
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JACOB H. HILLER, SR.
NO. 21-78-121
deceased
1. Personal property as contained on Schedule "B" attached hereto
TCYTAL
104,630 51
104,630 51
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
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ss:
~EMLll~ MJRRISON,
sworn according to law, deposes and says that
Executor of the Estate of
late of _~__ NQ:r!l1_li:id.sll~tQIl To~sj1.iL
he _
.Jacob ll.
is
Miller. Sr..
being duly
, Cumberland County, Pa., deceased and that the
within is an inventory made by him ., the said p.xecutor
of the entire estate of said decedent, consisting of all the personal property 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.
Sworn
and subscribed before me,
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October
19 81
Gerald K. orrison
Center So are
New Bloomfield, PA
Address
MARY AN GORMAN, Notary Public
Carlisle, Cumberland Co., Pa.
My Commissibn Expires Sept. 19, 1983
Date of Death
13
Day
.January
Month
1981
Year
INSTRUCTIONS
I. 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. Additi~nal sheets may be attached os to personalty or realty
4. See Article IV, Fiduciari.. Act of 1949.
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,","WEAL TH OF PENNSYLVANIA
OEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
:"dEDULE "8"
PERSONAL PROPERTY
(Instructions on Reverse Side)
Estate of
:
JACOB H. MILLER, SR.
ITEM
NO,
DESCRIPTION
UNIT
VALUE
1. Cumberland Valley Cooperative Association,
Certificate No. 13271 for twenty-two (22) shares
of preferred stock @ $10.00. Patronage dividend
on said stock. 10.00
2. Mortgage given by the Mechanicsburg Club to
Jacob H. Miller dated April 27, 1978 and recorded
in Cumberland County Mortgage Book 640, page 344,
at 7-1/2% interest.
Principal Balance as of 1/13/81: $41,750.00
Accrued Interest as of 1/13/81: 111.54
See copy of First & Final Account of Commonwealth
National Bank, Guardian of the Estate of Jacob H.
Miller, attached hereto and marked Exhibit "A."
3. Cash and amounts temporarily invested in Common-
wealth National Bank Common Fund A-I:
Principal $59,968.25
Income 647.00
See EJChibit "A," page 2.
4. Church of God Home: Refund of prepaid care
5. Church of God Home: Refund of prepaid care
6. Atlantic Breeders Co-Operative
7. Medicare Payment: F.S. Bryan, M.D.
8. Cumberland Valley Co-Operative Assn.: Dividend
9. Medicare Payment: K. Guistwite, M.D.
If additional space is nacassary, usa Bll" x Il" shoots.
TOTAL
ESTIMATED
MARKET
VALUE
220.00
69.16
41,861. 54
59,615.25
2,156.00
5.04
8.36
75.96
8.80
610.40
104,630.51
DEPARTMENT
VALUATION
{OFFICIAL USE ON.