HomeMy WebLinkAbout05-26-05
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COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
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INHERITANCE TAX RETURN
RESIDENT DECEDENT
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
AbAIUSl. Vr.eQ,IN//"l f2-.
DATE OF DEATH (MM-DD.YEAR) DATE OF BIRTH (MM.DD-YEARI
12--J?~D 2r-~- { II
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
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OFFICIAL USE ONLY
FILE NUMBER
.2. \.- - .Q. .5
COUNTY CODE YEAR
.1)...1)2.0_
NUMBER
~ 1. Original Return
o 4. Limited Estate
~. Decedent Died Testate (Mach copy 01 Will)
o 9. Litigation Proceeds Recei'ied
o 2. Supplemental Return
o 4a. Future Interest Compromise (date 01 death after 12-12-82)
o 7. Decedent Maintained a Living Trust (Attach copy of Trust)
o 10. Spousal Poverty Credit (date ofdealh between 12-31-91 aoo 1-1.95)
SOCIAL SECURITY NUMBER
ZoL/ - D I
/371
THIS RETURN MUST BE ALED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
o 3. Remainder Return (date of death prior to 12.13-82)
o 5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
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NAME A {tiff V (2...
FIRM NAME (II Applicable)
E~G...
COMPLETE MAILING ADDRESS
/309 BfQ./vf:>f- -57.
/f/t:-u:J C. eM B I!.f. 0<)PlJV, PA I 7{) '70
141.. Fe-LV
TELEPHONE NUMBER
2---
OFF! IAL USE ONLY
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"2. z 5"'/1 5"~, 'I S
15, 2 3&>.. ~5"
(14)
"2.
,g,8
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
(1)
(2)
(3)
(4)
(5)
2 "2S( 45" (,. <-j 3
(17)
(18)
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3( (006 (O\:'
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4. Mortgages & Noles Receivable (Schedule Dj
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5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule EI
6. JoinlIy Owned Property (Schedule F)
o Separate Billing Requested
7. Inter.Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or l)
(7)
(19)
(6)
8. Total Gross Assets (tolallines 1.7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent. Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (lolall1nes 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
(9)
(10)
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 Une 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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15. Amount of Line 14 taxable at the spousal tax
rate. or tralisfers under Sec. 9116 (a}(1.2)
x 0_ (15)
16. Amount of Line 14 taxable at lineal rate
xO_ (16)
17. Amount of Line 14 taxable at sibling rate
x .12
18. Amount of Line 14 taxable at collateral rate
7--ID7 1,/ ,q<t x15
, ~
19. Tax Due
20.0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Decedent's Complete Address:
STREET ADDRESS
(IjJf2-T
!\Ju<JER..
'5/.
CITY
C:
ZIP
/10/3
Tax Payments and Credits:
1. Tax Due (Page 1 Une 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1) -:3 \ ( loft'6,OO
'2...% SOD. <Ill
1;6'oO.OC
Total Credits ( A + B + C )
(2) 30 (OO([),~
3. InteresVPenalty if applicable
D.lnterest
E. Penalty
TotallnteresVPenalty ( D + E )
4. If Une 2 is greater than Une 1 + Une 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund
5. if Une 1 + Une 3 is greater Ihan Une 2, enter Ihe difference. This is the TAX DUE.
A. Enter the interest on the tax due.
B. Enter the total of Une 5 + 5A 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
ADDRESS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of Ihe property transferred;.............. ............................................................ 0 ~
b. relain the right to designate who shall use the property transferred or its income; ............................................ 0 ~
c. retain a reversionary interest; or.................................... .................................................."............. ................... 0 ~
d. receive the promise for life 01 either payments, benefits or care?.. ................................................................. 0 I8J
2. If dealh occurred after December 12, 1982, did decedent transfer property within one year of death
wilhout receiving adequate consideration? .............. ........."..................... ................................ 0 ~
3. Did decedent own an "in Ir r" or payable upon death bank account or security at his or her death? .............. 0 ~
4. Did decedent own an lndivi ual tirement Account, annuity, or other non.probate property which
contains a benefidary desi ation? ................ ...........................m 0 ~
UEST NS IS YES, YOU MUST COMPLETE SCHEDULE G AND FilE IT AS PART OF THE RETURN.
f2-[ U~R- 812/1)f? IZmOL/1
DATE 9~~
f1A. /70ZS
ADDRESS t ~ o<{,
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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 sUl\living spouse is 3%
[72 P.S. 59116 (a) (1.1) (i)l.
For dates of death on or after January 1, 1995, the tax rale imposed on the net vaiue of transfers to Of for the use of the surviving spouse is 0% [72 P.S. 59116 (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
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 t'Nenty--one years of age or younger at death to or for the use of a natural parent, an adoptive paren
or a stepparent of the child is 0% [72 P.S. 59116(3)(1.2)].
The tax rate imposed on the net vaiue of transfers to or forthe use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 59116(1.2) [72 P.S. 59116(a)(1)1.
The tax rate imposed on the net value of transfers to or for the use of the decedent's sibiings is 12% [72 P.S. 59116(a)(1.3)]. A sibling is defined, under Section 9102, as a,
individual who has at least one parent in common with the decedent, whether by blood or adoption.
REV.1S08 EX + (1.g7)
'*'
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
R. ,AO/lf\( S
FILE NUMBER
2/-D5- DO~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
'VleGltlJlA
ITEM
NUMBER
1.
InclOOe the proceeds 01 litigation and the dale the proceeds were received by lI1e ..!ale. All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
VALUE AT DATE
OF DEATH
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ct.
$.,
3.
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Co.
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DESCRIPTION
,.4 ~ b"-vrs AI --tf;U :P11Cst- lVA. hoD\IAL-
a.. ,1Jo'<J /1c:,.y- ..JI, 41~ la{-~
k- <2.1> -it 3osl/:7aS
C. 'P *- 305 %')30
c2. 'D 4t- '306'%'i':r7
CJ> :Ii. 'S"5"6~1::;~
A ec.o r)/lf( 5" t4 T ev A 'i'nl/AJT BIJIIJ~
CO l4 /11t.-'t2..-z.<<:lZ70
C-1) ..g tq"'~2.203l~
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10/53'3. 'f'
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2.cr, '117. tB
2'- 6'G,()~ '1 ~
,
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Lo( &Lb.S3
71 ~.2o_ 35""
CHl!c ~/Na:. 11=T.
f1t ~ } 73A fIJ IL
L-A.D'/'S 14~
U.'Di's (I.{ ~
L.Ab'fS I~JC..
LAD'{'S \ '* ~
Itt2f16
COQ'-D llIPlf/o,,",'J> P-;AJc.
GOLD 1:>(144(O"ll]) )et~
(',,0 l.,)> fJ,vA) I Vel2AP-y R./fIJG.
G,OL) S:Y/llfI/Q1<:.- Rr4c.
1'&.12., ,<)7Y;Jcfi 12]> APPf<?A/ML
50.00
(AJ~ ,~
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'(fi,t..L.o00
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5' 2..5:' 00
/10.0D
40.<lt)
8'- CA.Sf.J (N J)E:aDe'1Jr~ flossE>f?toq) ) 13 ,D;)
q. f2.f.JP () tV[) rlColl1. c:"fj oj';:. GH. oc:' Go]) IV?.A R:T >lite"" 25 ,-/-oo.(JJ
,
/0. PfC{XE I:: b 5 Dr:: SALf.... Fg'i)t<< ,APT. ~l>l?rVlll..>K 2, D. ()~
1). F{.(OCEtDS, e>r:. Gfl LE- f"f:.tJ"1. c;.eA-\1p 1AiH.E.R, CLoc./C J 200'=
DES ~C-
/2.. . /1lJ'SvJC.fl.vcf:.. Rr: F'v J\)p [.. ,00
TOTAL (Also enter on line 5, Recapitulation I $ 2Z.s;: q '5'~' L./3
(If more space is needed, Insert additional sheets of the same size)
REV-1511 EX+ (12-99) i;
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
t< ' AD,; t1(S
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1.
CUfC-0t 5(J) ,01;>0
B. ADMINISTRATIVE COSTS:
,. Personal Representative's Commissions
Name of Personal Representative(s) LV { l-L-, t1 VZ{ L. I-Iv#1/1(~L
Social Security Number(s)/EIN Number of Personal Representative(s}
Street Address 5\)2- HAl-- Y;Ja.i) {AlA y ~(750. D1)
City /2 riP LA State P.<) Zip /702&
,
Year{s) Commission Paid: -"200<
2. Attorney Fees jJ r2- T J4 ,,!e.- M, F12-L0 ftz10<90 .Q)
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City Slate _ lip
Relationship of Claimant to Decedent
4. Probate Fees Lf2~ 3t;,y,OD
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. L-11(",J L. 14 UV lZk2n SiNe - 7H~ 'SfitV'IINN L.. /2Cj.!:>7
C U Il{ i31Z12. LtJ..uP LA 10 ~ /!J".o<:>
~ -.10IJ(2
t) fJ P tJiMi~L c?F -T1Z-'1JE LfLf _ 'J;u'2,(ip H -;J'tJ4{€5 12720
~ (
q l~ 12-13 rj) /-. S/tly))ti..P..- ~ 'SC:;/lV - 1#5 Ci!..t PTID.v '1 8'. CI:>
01\} '5' ID r\Ji':
TOTAL (Also enter on line 9, Recapitulation) $ /'3 >'1 3. 1
V I ~G (I()(/J
Debts of decedent must be reported on Schedule I.
(If more space IS needed, Insert additional sheets of the same size)
FILE NUMBER
2./ - ()5:;. - oai)
,
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RfV.15128(-ll.97j ~
-
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE. 1AX "RETURN
RESIQENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
ESTATE OF
V ( P-G:n vJ fA
P- - A t:>A fl<$
FILE NUMBER
"2-1 ~05 ~ Oazv
Include un reimbursed medical expenses.
ITEM
NUMBER
DESCRIPTION
AMOUNT
L,
?A, bf:.f'T_
CfilY~CH
of ,l2.r;v 5/l) \) Ii.- r flVJJ '- IZ.J;Tuf. t1J
OF &09 f{OIf,Cr!!: - f1: /uJA t.. 1-V~OIq;:
<69,00
/ -55'3, (, (,
I
1
TOTAL (Alsoenleron line 1O,Recapitulation) $ I ~ ,"/:2., b{p
(If more space IS needed, insert additional sheets of the same size)
REV-1513 EX+ (g-QO)
*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
V/R.0rNrA
NUMBER
I
II
9 P-lZY s:: i<-lR.-<\C- '?J!lJV\Jf{.
!2- D +t-:3 i 80'1' 6tff
.owAI\J LA y...!Z. "DR. .
f)~LPA5ir I t1I ALIVE \/ cf"lIS
:TeAN IVO LA rJ'<) Ct)i,eD z.f1~/~)
'10 DA lZ.l2-ec...' L., e.,e.A M; ~~@..
A b!l\lllIl~T#>'\'0i2-. t9~ ~STATE-
"2.07 f:;l.BEMf)f<-L.1? AVE.. 'b,w.
R-ofv-JO\'-E: I VA ?-'-/t;>I(;,- L[71("
&Ag...p,M.A f-R.. tX.Ef2-
3\2. LAf\JcASTE-/Z- 10\/";'.
~LA I PI'- 170zs Slit /lJRXT PllcG. - (S),vIW()tl,770'\J
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH lB, AS APPROPRIATE. ON REV-150Q COVER SHEET
12 < A Oil rtt 9>
1.
NAME AND ADDRESS OF PERSON(Sl RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (al (1.2)1
jL,14( C,. VI' rv-A V (0 H SUJl>.1"
s 3 \ L.JWa y,<1L.E: -:;q-
MfJ~Y5\J(L.I.-i? t fA l1'OS3
'2..
'3.
't
FILE NUMBER
'2,l ~()S _ D02'O
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
Do Not UstTrustee(s) OF ESTATE
IUMJt:
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/Vl!-f'f{ f-tV
r5%1Re~(b"e
1>ga..eA $12])
IV r f!...(!f.
15% D('J!.E51D\)~
/I.;r::>(IlJ1Z.
j-o??" t>~ !2E31.b Ilj
1.
NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART 1I- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
(If more space is needed, insert additional sheets 01 the same s'lze)
CONTtr/A'ATltW -of/a,
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I70U ~FI 0.4 '2-1 ES
~<SI,aIE C)F vr.'2.c",,1IJ/4 f!-. IfDA1J1S
r tiP A).. '2-/ ~-~ '()0ZQ
6"". fi..;V;A fY1 A Cl--M /IJ
"ll> HAl\JotJ$"~ 0/ .
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b. JO~JtJ HMt{LsTtc...r::;-
Lflc" rcoSE C.Uti./ 1'<.(1)
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7. <f<-t ~tfAt:.D v -P{2...{fJLDt-.A E...vbfff!-.
Cfo Y4-/. t2J-( .4, f L ~/H-{ LM A rA)
'j-D'1 NE0/!)..Y~ '( L--,4,J{;...
WA 'f-E.- J=.o~s"i Ilk c:z.. 7$'8'7
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1239 1!,{N/l/A C-LL Pi?
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.:;)lJ~VI.vING:> !-ftz.tlZS of (J\2.CEA&i:b Sl"e.e
of \)\'Lc.e:.V.€tlJT Cr;.rH.{L.Y f<,tJt;$"'f"'''-J SWA.#\J'f-)
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17053-0017
DUNCANNON OFFICE:
55 South Main Street
Phone: (717) 834-5161
Fax: (717) 834-5639
MAIN OFFICE:
101 Lincoln Street
Phone: (717) 957-2196
Fax: (717) 957-4578
RIDGEVIEW OFFICE:
500 S. State Road
Phone: (717) 957-2114
Fax: (717) 957-4678
JUIUY 12, 2005
Arthor M. Fekl
AttDmey at Law
1309 Bridge Street
lew CWerlud, PI. 17070-1116
ie: Estate ef V"<<!)iIia R. Adams
Dear Mr. re1d:
As .f tke date or deatk, December 3, 2004, Mrs. Adam' dep.sit haJuces were:
low Accont #41-131-5
Certificate Dr Deposit #3054733
Certifi~ate or Deposit #3053930
Certificate of Dep.sit #3053497
Certificate or Deposit #3056002
Tota! as .r December 3, 2004
$ 10,333.49
$ 35,033.71
$ 29,977.63
$ 26,561.93
$ 30,090.73
$132,046.59
Respectfully,
L~-1~J
Assistant Vic;G;esideDt
DAT
!1 M&fBank
499 Mitchell Road, MiIIsboro, DE 19966 Mail Code DE-MB-12
Phone (&&&) 502-4349
Fax (302) 934-2955
January 27. 2005
Arthur M. Field, Esquire
Attorney At Law
1309 Bridge Street
Cumberland, Pennsylvania 17070
Re: Estate of: Virltinia R Adams
Account Number: 1132202
Date of Death: December 08. 2004
Dear Sir or Madam:
Per a memo from Timothy Parry at the Branch. dated January 19, 2005, please be advised that at the time of death, the
balance on the above referenced account was:
1. Type of Account Checking Account
Account Number II 32202
Ownership (Names of) Virginia R Adams
Opening Date 6/] 6/92
Balance on Date of Death $7,1 20.35
Accrued Interest $ 0.00
Total
For further account information, regarding ownership, closures and/or reimbursement of funds, etc., please caU the
Stonehedge Office # 717-240-4524.
Sincerely,
qv-~/tY~
Nancy Clagett
Records Management
~lWaYRqi!lt
1/26/2005
ARTIillR M FELD
1309 BRIDGE ST
NEW CUMBERLAND P A 17070-1172
The information which you requested on the account(s) of VIRGINIA R ADAMS
(Social Security Number 204-01-1371) is/are as follows:
Account Number
1968220270
CERTIFICATE
060392
40000.00
38.96
40038.96
1968220318.
CERTIFICATE
090292
20000.00
16.53
20016.53
Class of Account
Date Opened
Principal Balance
Accrued Interest
Balance at Date of
Death
Account Ownership SOLE
Name of Joint
Owner, jf any
SOLE
Date Ownership 060392
Was Established
090292
Account Number
Class of Account
Date Opened
Principal Balance
Accrued Interest
Balance at Date of
Death
Account Ownership
Name of Joint
Owner, if any
Date Ownership
Was Established
Additional
Information
Requested
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SENIOR SERVICES REP.
P.O. Box 1711. HARRISBURG. PENNSY\JJANIA 17105-1711
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JOSEph J.~M ES JEWELERS
TO WHOM IT MAY CONCERN:
This is to certify that we are engaged in the jewelry bllsiness, appraising diamonds, watches, jewelry a.nd Pftci=$ stones of all descriptiolUl. We herewith certify that we have this
day carefully
examined the following Jisted and described artides, the property of:
NAME: William Hummel c/o Estate of Virginia Adams
ADDRESS: 502 Halyard Way Enol. PA 17025
We estimate the v.uue as listed for insurance or other purposes at the ctlrrem retail value, excluding Federal and otlta taxes. In making this Appraisal we DO NOT -.gree to pun:bue (>f
nplace
theartides
DESCRIPTION
The following items were evaluated for Estate Purposes
Lady's 14K white gold diamond engagement ring. The round brilliant cut diamond measures approximately
4.70mm x 4.70mm x 2.38mm deep, approximately .45cl. The clarity is Sll. The color is H. The illusion crown
has four prongs. The fmger size is 5.75.
Value: $525.00
Lady's 14K white gold diamond engagement ring. The round brilliant cut diamond measures approximately
3.35mm x 3.30mm x 2.00mm deep, approximately .14cl. The clarity is VS. The color is G. The illusion crown
has four prongs. The fmger size is 5.5.
Valne: $110.00
Lady's 14K yellow gold garnet anniversary style ring. Each of the five round garnets measure
approximately 2.6-2.7mm in diameter. The ring has heavy wear. The finger size is 5.5.
Value: $40.00
Lady's 14K white gold ring synthetic stone ring. Each of the three round rutile (fabulite) stones measures
approximately 5.0mm in diameter. The heavy (5 grams) shank measures a fmger size 6.
Value: $50.00
c- JAIVfiK~~:Z
February 23,2005
The foregoing Appntisal is made with the understanding that the Appraiser assumes no liability w,th respect to any action that may be taken on the basis of this Appraisal.
301 East Main Street. Mechanicsburg, PA 17055 . (717) 795-9224
,Scolt trim.,. hq\tl"
CRAMU, CLAfU(,
McPHIIl:'ON
P. 0, Drlwtr 1'9
'Ufl~r.r.on, p~ 17~O
LAST WILL AND TESTAMENT
I, VIRGINIA R. ADAMS, of the Borough of Marysville, Perry County,
Pennsylvania, being of sound and disposing mind, memory and under-
standing, do make, publish and declare this writing as and for my Last
Will and Testament, hereby expressly revoking all writings in nature
testamentary by me at any time heretofore made.
FIRST: I direct that all my just debts, to which there are no
defenses in law or equity, and the expenses of my last illness and
funeral be paid out of my estate as soon after my death as is convenient
and expeditious in the judgment of my Executor hereinafter named.
SECOND: I give and bequeath my fur coat, family heirloom picture
above T.V. set, desk, and grandfather clock, to my sister, Emily Rossman
Shank.
THIRD: I give and bequeath my colonial dresser, chest of drawers,
night stands, the six Hitchcock chairs, pearls and bracelet, and
necklace, to my friend, Kim Kavanaugh Sload.
FOURTH: I give and bequeath the brass bed, to my friend, Timothy
Loutzenhiser.
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FIFTH: I give and bequeath the cut glass mirrors
fireplace, to my friend, Jane Barkey Eckrod.
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L Scolt (ram,r, E1qulr.
CRAMER, CI.ARK 80
McPHIR50N
P. O. Dr.w.r 159
Duotl!ltmon, PA 17020
SIXTH: I give and bequeath my automobile to my niece, Jean Noland.
SEVENTH: I direct my Executor, hereinafter named, to sell all the
rest, residue and remainder of my property, at public or private sale
whichever my Executor in his sole discretion deems to be in the best
interest of my estate, and after payment of all costs of sale, debts and
administration expenses, distribute the net proceeds of said sale along
with all other cash assets of my estate as follows:
A. Twenty-five (25%) percent to my friend, Kim Kavanaugh
Sload.
B. Twenty-five (25%) percent to my sister, Emily Rossman
Shank, or her then-living issue, in equal shares, share and share alike.
C. Fifteen (15%) percent to my nephew, Frederick Keene.
D. Fifteen (15%) percent to my niece, Jean Noland.
E' Ten (10%) percent to my friend, Barbara Kruger.
F. Five (5%) percent to my friend, John Haverstick.
G. Five (5%) percent to my sister-in-law, Tena MacLean.
EIGHTH: I nominate, constitute and appoint, William L. Hummell,
Executor of this my Last Will and Testament. I direct that my personal
representative shall not be required to post any bond to secure the
faithful performance of their duties in the Commonwealth of Pennsylvania
or in any other jurisdiction.
It is my desire that the Executor conclude all estate
administration matters within one year of the date of my death.
t. Scott Cramer, EsquIre
CRAMER, CLARK &
McPHERSON
P. O. Drawer 159
DUl1crannon, PA 17020
IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my
Last Will and Test~ment, which consists of three (3) sheets of paper,
~t'1
dated this 0 (lay of May, 1990.
~d:~~
V ginia R.
If Q('L1~EAL)
Adams
The writing coatained on this and the two preceding pages was
signed and sealed by Virginia R. Adams, and by her published and
declared as her Last Will and Testament, in the presence of us, who have
hereunto subscribed our names as witnesses at her request, in her
presence, and in the jlresence of each other.
/)
,I? ~n 2~~
~7f}~.."f!
R. Scott Cramtr. Esquire
CRAMER, ClARK &
McPHERSON
P. O. Drawer 159
DunCl:lnnon, PA 17020
COMMONWEALTH OF PENNSYLVANIA)
)SS
COUNTY OF PERRY )
I, Virginia R. Adams, testatrix, whose name is signed to the
attached or foregoing instrument, having been duly qualified according
to law, do hereby acknowledge that I signed and executed the instrument
as my Last Will; that 1 signed it willingly; and that 1 signed it as my
free and voluntary act for the purposes therein expressed.
(7/ /J"
l/"A!4<~ If. (~
SWORN or affirmed to and acknowledged
before me by Virginia R. Adams, testatrix,
this $""" day of May, 1990. (] ?1
Pi?~~~,~~~
- 1
I NOTAR!I\L SEAL ~
I RUTH El[ANO~ GUHTRUM, NotJryPubk; !
uun::;:;nri'Ji'i D.:Jro, Pt}l!y Couay, PJ.. J
I My Commission [;.:piws MaylB, '19'":-)::
"""~,;,,,,;"',<b' _
COMMONWEALTH OF PENNSYLVANIA)
)SS
COUNTY OF PERRY )
We, If :)(!."d.i- (fnn-" <>r and 8ettY' :J. /V~) j
the witnesses whose names are signed to the attached or foregoing
instrument, being duly qualified according to law, do depose and say
that we were present and saw testatrix sign and execute the instrument
as her Last Will; that Virginia R. Adams 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 the time 18 or more years of age, of sound mind and
under no constraint or undue influence.
,ll #{!~
~l~~ny:}_ 7Z-f/
SWORN or affirmed to and subscribed
to be~e me by I? :551/. r..t'J mer
and ell,;:J. No , w1tnesses,
this "day of May, 1990.
...",
,. rR~La, <'. ~::-~
f-- NQINilAI. SEAL '1
I. HUTH ELEA.'IOII GUNTHlIM, NotJiYP"U,,; i
Dl.nUJlti,:.n 1~\'lra, Pt"lTY County, P':', '
My Cornrni:::sinn Lipil'es MOl)' HI, 19!J~
-...-_---...-...-.~--_.,~.,.
R. S~ott Cramer, EsquIre
CRAMER, CLARK &
McPHER.SON
? O. Drawer 159
Dun:;lannon, PA 17020
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