HomeMy WebLinkAbout01-0886
MARY C. LEWIS, REGISTER OF WILLS
CUMBERLAND COUNTY, PENNSYLVANIA
PETITION FOR GRANT OF LETTERS
Estate of HELEN L. ROGERS
No.21
01
ff(P
also known as HELEN LOUISE ROGERS
, Deceased
Social Security No. 206348555
DOUGLAS ROGERS
Petitioner(s), who is/are 18 years of age or older, apply)ies) for:
(COMPLETE "A" OR "B" BELOW:)
Gl
A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execut OR
Decedent, dated 12/29/75 and codicil(s) dated N/A
named in the Last Will of the
State relevant circumstances, e.g., renunciation, death of executor, etc
Except as follows, Decedent did not marry, was not divorced and did not have a child born or adopted after execution of the documents offered
for probate; was not the victim of a killing and was never adjudicated incapacitated:
o
B. Grant of Letters of Administration
(c.t.a., d.b.n.c.t.a.: pendente lite, durante absentia; durante minoritate)
Petitioner(s) after a proper search has/have ascertained the Decedent left no Will and was survived by the following spouse
(if any) and heirs:
Name
Relationship
Residence
I
(COMPLETE IN ALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in CUMBERLAND County, Pennsylvania, with his/her last family or principal
residence at 622 MESSIAH VILLAGE, UPPER ALLEN TOWNSHIP, MECHANICSBURG, PA 17055
(list street, number and municipality)
Decedent, then 88 years of age, died SEPTEMBER 5 ,2001 , at HOLY SPIRIT HOSPITAL, HARRISBURG, PA
(Location)
Decedent 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 ........................................................................................ $
Total ..................................................................................................................... $
Bl!., l!>(!;)G).l>--'U
&3 fa CS> (!;)LJ (J u
Real Estate situated as follows:
Wherefore, Petitioner(s) respectfully request(s) the probate of the Last Will and Codicil(s) presented with this Petition and the grant of letters in
the appropriate form to the undersigned:
Typed or printed name and residence
DOUGLAS ROGERS
1254 BROWNING COURT LANSDALE PA 19446
RW-1 /1-9- / '-i
Oath of Personal Representative
Commonwealth of Pennsylvania
County of CUMBERLAND
The Petitioner(s) above-named swear(s) and 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 representative(s) of the
Decedent, Petijioner(s) will well and truly administer the ~ ~ . .
Sworn to and affirmed and subscribed -;L
DOUGLAS ROG S
before me this 2;5 TH day of
DECREE OF REGISTER
Estate of HELEN L. ROGERS
also known as HELEN LOUISE ROGERS
Social Security No: 206348555
AND NOW, SEPTEMBER 26TH
reverse side hereon, satisfactory proof having been presented before me,
Deceased
No.21
01
886
Date of Death:
September 5th,2001
2001 ,in consideration of the Petition on the
IT IS DECREED that Letters J;I Testamentary a of Administration
are hereby granted to
((c.t.a., d.b.n.c.t.; pendente lite; durante absentia; durante minoriate)
OOUGLAS ROGERS
in the above estate and that the instrument(s), if any, dated DECEMBER 29TH, 1975
described in the Petition be admitted to probate and filed of record as the Last Will of Decedent.
$ 11:\ nn
$
$
$
$
$
$
$
FEES
Letters .................................... $ 200.00
Short Certificates(s) ...........5.
Renunciation........................ ..
Extra Pages ( 2 ) ...............
I. T. Roo. ................. .... .... ...........
JCP Fee.................................
Inventory ................................
Other..................................... .
6.00
~~.(' -~
/ Signature
5.00
Attorney: GERALD J. BRINSER
I.D. No: 09655
Address: 6 E. MAIN STREET, P.O. BOX 323
PALMYRA PA 17078
Telephone: (717)838-6348
226.00
TOTAL............................ .$
",0.
Ct _ "2!>~ - v I
MAILED LETTERS 'IO ATTORNEY
DATE FILED:
REGISTER OF WILLS OF COUNTY
OATH OF SUBSCRIBING WITNESS
codicil
(each) a subscribing . ess to the will presented herewith, (each) being dul
law, depose(s) and say(s) tha
lfied according to
present and saw
the testat , sign the same and tha
request of testat_ in h
other subscribing witness(es)).
Sworn to or affirmed and s
me this
cribed before
day of
19_
(Name)
Register
(Name)
(Address)
21-2001-886
REGISTER OF WILLS OF CUMBERLAND COUNTY
OATH OF NON-SUBSCRIBING WITNESS
x~L/t1f1t G: ~I(/Se
.. .
~ 'f) t) UIP /A--:J Ro6E i~
_ (each) being duly qualified according to law, depose(s) and say(s) that
'they are familiar with the signature of Helen L. Rogers
codicil
testat~ of s~) the (wil~ presented herewith and
codicil
that thEW believesKhe signature on the (wil~ is in the handwriting of
Helen L. Rogers
to the best of their knowledge and belief.
Sworn (0 or affirmed and subscribed before ~~ "" ff~
m~~~ber 26th ,;;a~o~fl~~.' (N m~e)
Z!{a~~01/J~J fV1/JX;;;;). Mddr..
c. ewlS / R' t
egis er
) (Name)
.LA~:) d" h: ) p,.,.
(Address)
~ f',,; ~"', ',' '<...'r:,
This is to certify that the information here given is correctly copied fro~ an original certificate of death dul~ filed with me as
Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filmg.
WARNING: It is illegal to duplicate this copy by photostat or photograph"
No.
~
Fee for this certificate, $2.00
p
7621922
SEP 0 7 200)
Date
21-2001-886
143 Rev. 2IffT
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH · VITAL RECORDS
CERTIFICATE OF DEATH
CUn'iJer land
s USUAL 0CCUPRl0N
l~"':':~ C::':::'.I:'r
11 Re istered Nurse I1It. Private DJty
DECSlENT'S YAIUtG ADOIlESS CSlr"'~, s.. ZipCodel DECEDENT'S
ACTUAL
RESIDENCE
-
on llltlef IIClel
SEll
SlATE FIlE NUldEA
SOCIAL SECURITY NUMBER
NAME Of' DECEDENT (for.. ModclIe. l",
1. Helen L.
AGE (l811 ~ UNDER' YEAR
ManItIe 0.,.
Fanale ~ 206
34
utlDER , OM
....... I ~
!
81RT~ (c.....and
$We Of Fcreogn CounlrYl
SUR\/MNG SPOUSE
,...... go-..-. ".,....
11.. $I-.
P.(;J
,..
'71:,Xl ......... ......
TTpf'Pr AllAn
.
622 Pine Place
,.. Mechanicsburg, pa 17055
FRMER'SNAME\fW1I. ~.I.MI)
,n..
DicI
......
he in.
Ctmberland -....' ,u.o ~-:":::of
MOTHER'S NAME IF... Modele. MMlen &./WIle)
,~ Minnie Manzer
INfORMANTS MMlNO AODAlE8S(SlrwI. CiIyIbwn. s... Zip CclCMI
1254 Brownin Ct Lansdale ,pa 19446
PlACE OF 0ISP0SIT10N. N-. oIc-y. er-.o.y LOCA1'ION. ClIyIlOwn. se.. ZlpCacllo
Of 0IIlet PIKe
CilP'.:--
11.. Harrisburg, pa
~ In~ mI~;tp~tB8i
ORESlGNEO .. --
(Monft. OIly. -,
L :t:1JTY2.~
. n..
'WoSCASl! REFEAAEOlO MEDICAl ElWoI~I"
..lB r/J HoD
2t.
I AppnlaiINlIe
'---.-.
:_ MIIdN11l
I
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I
PART I: 0lIw..... -.dIIioIw--....._.....ltul
"'lMUIIinlI in.... UftdeItwiItg _ gi.- in A\RT I.
~\~
E
DUE 10 lOR AS A CONSEQUENCe Of):
DUE 10 lOft AS A CONSEOUENCE Of):
WEAE AU10PSY FINDINGS
~PAIOftlO
OF CAUSE
Ml\HNER Of DfATH
DATE OF INJURY
,........ Day. \Ioafl
TIME OF INJURY
INJURV R WORK1 DESCAltlE HOW IHJURV OCCUNIEO.
"-'Iing~
. 0 NoD
.0 ...0
....... 0
AccideIIl 0
SuIcidt 0
HomicicIe
OERH?
CO<lkI_ be _..........s
za. n.
CSIT....lO>eck only llMI
"CSlTFtWG I'HYSICIAIt (PttyllClllftcenlyong e-.- d _ ...... anolNr pl\vsoC_MsIllOflOlJf'QO dellll> ana ~ nem 23) .
To.............,..--.......eocunM..........c8UM(.)....._..__.................................................... .
"PIIOMOlIMClflQ AHO CIInll'YlNO PttYStC!AH ~ bOIh ;JIanauncong _ _ ce<1oIylng 10_ 01_1
To \he..... of My 1InowIedQe. ..... eccuned.. ....... ...... MIl piece. ......... ... c.....c.) MIl m.nne,.. ...-.. . . - . . . . . . . .
"IEDICAL EXAMlNIRIC<lftONER
On lIW...... of ..aminatlon andIOIltweatlgatioft.ln my opinIoII. death occurred at the time. dat., and piKe. ..... due to the ""..(a) ancI
_.. etated.. .. . . . . . . .,. . ... . . . . . . . ... . . . . . . .. . . . . . . . . ... .. . . .. . . ... . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . ... . .
:l1a.
... REGIST" SlGNAI'UAE.;;;'U~
_ U?cAt:/ "<. ';7 ~-"' b? ,/ ~ 1/ J
1EClSt JlIt11 Club Qrt~tClttttut
I, HELEN L. ROGERS, a resident of the Township
of Jackson, County of Susquehanna and State of Pennsylvania,
do make, publish and declare this to be my Last Will and
Testament, hereby revoking all wills and codicils heretofore
made by me.
ITEM I
I direct that all my just debts and
funeral expenses, including my gravemarker and all expenses
of my last illness, shall be paid from my residuary estate
as soon as practicable after my decease as a part of the
expense of the administration of my estate.
ITEM II
All the rest, residue and remainder
of the property which I may own at the time of my death,
real and personal, I bequeath and devise in equal shares to
my sons, Douglas Rogers, Wayne Rogers and Paul Rogers, per
stirpes.
ITEM III
Should any of my issue entitled to
~
~
"'t-
a share of my estate not have attained the age of twenty
five years at the time of distribution to him or her, I
devise and bequeath the share of each such issue to County
National Bank of Montrose, Pa. (IN SEPARATE TRUST), to hold,
manage, invest and reinvest the share so received, and the
accumulation of income thereon, and to use and apply the
income and principal or so much thereof, as in Trustee's
discretion, may be necessary or appropriate for such issue's
support and education (including college education, both
graduate and undergraduate, or trade school), or to make
payment for these purposes, without further responsibility
to such issue or to any person taking care of such issue.
Trustee may accumulate the income from such trust until
such issue attains the age of twenty one years; thereafter
the net income shall be paid at least semi-annually to
such issue.
(i) As each of my issue attains the age of
twenty one years, or if he or she has attained the age of
twenty one years at the time of distribution, each of such
issue shall have the right then and continuing thereafter
to withdraw one-third (1/3) of the balance of the separate
trust fund established for each such issue, and any accumu-
lated income thereon.
(ii) As each of my issue attains the age of
twenty five years, Trustee shall pay over to such issue the
then-remaining balance of principal and income.
(iii) If any of my issue shall die after the
establishing of the separate trust but before attaining the
age of twenty five years, the trust shall then terminate and
such share shall be distributed to his or her personal
representative.
ITEM IV
I appoint my son, Douglas Rogers,
executor of this my Will. In the event my said son shall
predecease me or fail to qualify as such executor, I appoint
\:L
~
::1:
my son, Wayne Rogers, substitute executor; and I vest my
said executor or substitute executor with full power and
authority to sell, transfer and convey any property, real
or personal, which I may own at the time of my death at
such time and price and upon such terms and conditions as
he may determine.
ITEM V
I direct that neither my executor,
substitute executor, nor trustee be required to give bond or
other security for the performance of their duties in any
jurisdiction.
ITEM VI
My corporate fiduciary shall be
entitled to compensation based on its regular schedule of
fees for such services in effect from time to time during
the period over which its services are performed.
IN WITNESS WHEREOF, I have hereunto set my hand
this ..E:L day of ~ ' 197 6 .
/~"\ c:f (/~~/
Helen L. Rog~s
~
\.(
~
The foregoing instrument, consisting of this and
two preceding pages, was on the day and date thereof signed,
published and declared by HELEN L. ROGERS, the testatrix
therein named, as and for her Last Will and Testament, in
the presence of us, who, at her request, in her presence
and in the presence of each other, have subscribed our
names as witnesses hereto.
;2 ~~ l .~
. 7) ~'1 r:(. .residing at /4 7-'l~-?<#~' - ~ '
,c-<:_-~."....) '- ~/~ .../
.. - "'x~" \.-.k //
&:7_~~;77-a~..~,~~ residing at
1//
~.~ . ~:;"~
,..',.. d---tAL~ -----
F,
MARY C. LEWIS, REGISTER OF WILLS
CUMBERLAND COUNTY, PENNSYLVANIA
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent: HEl.,~~HOGERS
Date of Death: ~LqlQl_~~_~____~__ Estate No. ____~__~____~_______
SSN: 206-34:85~5
File No.
.~L- 01 ~ oot8'G
Date Letters Granted: 9/25/01_~
Will or Administration No. _~____~____~____n~_~___~__~__~_______
To the Register:
I certify that Notice of 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 9/27/0~__~ ------------------ ~-------
Name
WAYNE ROGERS
Address
R.D. #2, BOX 2665
~_________________ ____n__ _J:lALLSTEAD ___
_______n_______H_~_____ __ P A 1~822 ___ _
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
R()lJg~~_RQGERS A~QYAUL RO~ERS, ~HO M~T INOUR OFFICE.
Personal Representative
X Counsel for Personal
Representative
~~.~j~-
Signature
GERALD J. BRINSE~ESQUIRE 1#09~~____.
Name (Please type or print)
Date: 9/27/01
Capacity:
Address
6 E. MAIN STREET. P.O,J;lOX 323 __
PALMY~
______ _____ __P_A_.Jl_078____
Telephone No. (717)838-6348 ____.___ _______~______
.
.
~ MARY C. LEWIS, REGISTER OF WILLS
CUMBERLAND COUNTY, PENNSYLVANIA
INVENTORY
, Deceased
No. 21 01 0886
Date of Death 09/05/2001
Social Security No. 206-34-8555
Estate of HELEN L. ROGERS
also known as HELEN LOUISE ROGERS
Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory include all of the
personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation
placed opposite each item of said inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no
real estate outside the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. IN/e
verify that the statements made in this inventory are true and correct. IN/e understand that false statements herein made are subject to the
penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. .
Personal Representative:
Name of
Attorney: GERALD J. BRINSER
1.0. No.: 09655
Address: 6 E. MAl N STREET
DOUGLAS ROGERS
EXECUTOR
Dated MAY 14, 2002
PALMYRA
PA 17078
Telephone: (717)838-6348
Description
Value
Mortgages & Notes Receivable
P
I'"
CHARLES & JUNE BOMANIWILLlAM, AND KATHRYN BOMAN- MTG.
RECEIVABLE - BALANCE AT DATE OF DEATH
16,733.99
f',J
\....oJ
Cash, Bank Deposits, & Misc. Personal Property
PNC BANK - CHECKING ACCOUNT #5070098747
(INCLUDES ACCRUED INTEREST OF $.12)
',-'J
1,739.18
PNC BANK - SAVINGS ACCOUNT #5001902412
(INCLUDES ACCRUED INTEREST OF $1.25)
3,170.52
PNC BANK - CERTIFICATE OF DEPOSIT #21001015120
(INCLUDES ACCRUED INTEREST OF $2.16)
3,227.45
Total
69,179.40
(Attach Additional Sheets if necessary)
NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative,
include the value of each item, but such figures should not be extended into the total of the Inventory.
RW-4
Continuation of Inventory
H~LEN L. ROGERS
21
01
0886
PaQe 1
Description of Inventory
Description
PNC BANK - CERTIFICATE OF DEPOSIT #31800190667
(INCLUDES ACCRUED INTEREST OF $4.37)
Value
7,565.91
PNC BANK - CERTIFICATE OF DEPOSIT #31600212847
(INCLUDES ACCRUED INTEREST OF $92.58)
13,070.39
BRETHREN IN CHRIST FOUNDATION - CERTIFICATE OF DEPOSIT
(INCLUDES ACCRUED INTEREST OF $176.12)
23,176.12
FUNERAL HOME - REFUND OF EXCESS BURIAL INSURANCE
185.70
MAGAZINE SUBSCRIPTION - REFUND
7.20
A.F.L. INSURANCE - REFUND
302.94
Subtotal
$
44,308.26
69,179.40
Grand Total $
"
"MARY C. LEWIS, REGISTER OF WILLS
CUMBERLAND COUNTY, PENNSYLVANIA
INVENTORY
Estate of HELEN L. ROGERS
also known as HELEN LOUISE ROGERS
, Deceased
No. 21 01 0886
Date of Death 09/05/2001
Social Security No. 206-34-8555
Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory include all of the
personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation
placed opposite each item of said inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no
real estate outside the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. I/We
verify that the statements made in this inventory are true and correct. I/We understand that false statements herein made are subject to the
penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities.
Personal Representative:
Name of
Attorney: GERALD J. BRINSER
I.D. No.: 09655
Address: 6 E. MAIN STREET
DOUGLAS ROGERS
EXECUTOR
Dated MAY 14, 2002
PALMYRA
PA 17078
Telephone: (717)838-6348
Description
Value
Mortgages & Notes Receivable
~.1 ~
P
I "V
CHARLES & JUNE BOMANIWILLlAM, AND KATHRYN BOMAN - MTG.
RECEIVABLE - BALANCE AT DATE OF DEATH
16,733.99
f'J
W
Cash, Bank Deposits, & Misc. Personal Property
\,..IJ
PNC BANK - CHECKING ACCOUNT #5070098747
(INCLUDES ACCRUED INTEREST OF $.12)
1,739.18
PNC BANK - SAVINGS ACCOUNT #5001902412
(INCLUDES ACCRUED INTEREST OF $1.25)
3,170.52
PNC BANK - CERTIFICATE OF DEPOSIT #21001015120
(INCLUDES ACCRUED INTEREST OF $2.16)
3,227.45
Total
(Attach Additional Sheets if necessary)
69,179.40
NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative,
include the value of each item, but such figures should not be extended into the total of the Inventory.
RW-4
.
Continuation of Inventory
HELEN L. ROGERS
21
01
0886
PaQe 1
Description of Inventory
Description
PNC BANK - CERTIFICATE OF DEPOSIT #31800190667
(INCLUDES ACCRUED INTEREST OF $4.37)
Value
7,565.91
PNC BANK - CERTIFICATE OF DEPOSIT #31600212847
(INCLUDES ACCRUED INTEREST OF $92.58)
13,070.39
BRETHREN IN CHRIST FOUNDATION - CERTIFICATE OF DEPOSIT
(INCLUDES ACCRUED INTEREST OF $176.12)
23,176.12
FUNERAL HOME - REFUND OF EXCESS BURIAL INSURANCE
185.70
MAGAZINE SUBSCRIPTION - REFUND
7.20
A.F.L. INSURANCE - REFUND
302.94
Subtotal
$
44,308.26
69,179.40
Grand Total $
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
ROGERS DOUGLAS
1254 BROWNING COURT
LANSDALE, PA 19446
-------- fold
ESTATE INFORMATION: SSN: 206-34-8555
FILE NUMBER: 21-2001- 0886
DECEDENT NAME: ROGERS HELEN L
DA TE OF PAYMENT: 11/30/2001
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 09/05/2001
NO. CD 000577
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $5,225.00
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$5,225.00
REMARKS: DOUGLAS ROGERS
CANNOT READ POSTMARK OR CHECK
SEAL
INITIALS: PB
RECEIVED BY:
REGISTER OF WILLS
MARY C. LEWIS
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
NO. CD 000573
HAMILTON C DAVIS
20 EAST BURD STREET
SUITE 6 POBOX 40
SHIPPENSBURG, PA 17257
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
-------- fold
101
$1,381.97
ESTATE INFORMATION:
SSN:
206-34-8555
FILE NUMBER:
21-2001- 0886
ROGERS HELEN L
11/29/2001
DECEDENT NAME:
DATE OF PAYMENT:
POSTMARK DATE:
COUNTY:
DATE OF DEATH:
,/
TOTAL AMOUNT PAID:
$1,381.97
/""
REMARKS: HAMILTON C DAVIS
CHECK# 0282
SEAL
INITIALS: SK
RECEIVED BY:
MARY C. LEWIS
REGISTER OF WILLS
REGISTER OF WILLS
nns~EIPT IS REPLACED WITH CD 000601
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
BRINSER GERALD J
22 N RAILROAD ST
PALMYRA, PA 17078
-------- fold
ESTATE INFORMATION: SSN: 206-34-8555
FILE NUMBER: 2101-0886
DECEDENT NAME: ROGERS HELEN L
DA TE OF PAYMENT: OS/23/2002
POSTMARK DATE: OS/21/2002
COUNTY: CUMBERLAND
DATE OF DEATH: 09/05/2001
NO. CD 001202
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $223.68
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$223.68
REMARKS: GERALD J BRINSER
SEAL
INITIALS: AC
RECEIVED BY:
REGISTER OF WILLS
MARY C. LEWIS
REGISTER OF WILLS
\I?~ 9~/Y
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG. PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEHENTI ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
:C~OUNTY
ACN
06-24-2002
ROGERS
09-05-2001
21 01-0886
CUMBERLAND
101
GERALD J BRINSER
BRINSER ETAL
PO BOX 323
PALMYRA
.02
JUL -1
L"
PA 1707Bur
*
REV-15~7 EX IFP 101-02>
HELEN
L
Allount Rellitted
) CHANGED
1I)
(2)
(3)
(4)
(5)
(6)
(7)
.00
.00
.00
16.733.99
52.445.41
.00
62.455.01
(8)
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLEI PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REv=is4-j-iX--AFP--rcff:ozi--No'fici--oF-.rNHiiiifAifci-'fAx-APPRAisiMENT~--Ar.l-owANci-iri-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF ROGERS HELEN L FILE NO. 21 01-0886 ACN 101 DATE 06-24-2002
TAX RETURN WAS: (X) ACCEPTED AS FILED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Rea~ Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. Hortgages/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/Hisc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adll. Costs/Hisc. Expenses (Schedule H)
10. Debts/Hortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governllental Bequestsj Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
re~lect ~igures that include the total o~ abb 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. Allount 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:
NOTE:
(9)
1I0)
41291.51
NOTE: To insure proper
credit to your accountl
subllit the upper portion
of this forll with your
tax paYllent.
1311634.41
4.441 1)1
1271192.90
.00
1271192.90
1I9)=
.00
51723.68
.00
.00
51723.68
150.00
1I1)
1I2)
1I3)
1I4)
.00 X 00 =
1271192.90 X 045 =
.00 X 12 =
.00 X 15 =
I"ATnt:NI KC~C.l.rl {+J AHOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
11 30 2001 CDOO0577 275.00 51225.00
05-21-2002 CDOO1202 .00 223.68
TOTAL TAX CREDIT 51723.68
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
. IF PAID AFTER DATE INDICATED I SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $11 NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR)I YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.)
" REV-1SOOEX' (~)
'w/ .' COMMONWEALTH OF
PENNSYLVANIA
, DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAl USE ONLY
____/?_=_. c?-~_____
FilE NUMBER
21 -01 0 8 86
COUN'ricOOE -YEAR- - - iWiER- -
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
SOCIAL SECURITY NUMBER
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ROGERS HELEN L. A/K1A HELEN LOUISE
DATE OF DEATH (MM-DD-Year) DATE OF BIRTH (MM-DD-Year)
09/05/2001 11/22/1912
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
N/A
2 06- 3 4 - 8 5 5 5
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
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[Xl 1. Original Return
D 4. limited Estate
00 6. Decedent Died Testate (Al!ach copy of Wil)
D 9. Litigation Proceeds Received
D 2. Supplemental Return
D 4a. Future Interest Compromise (dale of death after 12-12-82)
o 7. Decedent Maintained a Living Trust (Al!achtopYOfTruSI)
o 10. Spousal Poverty Credn (daleo/death between 12-31-91 and 1-1-95)
o 3. Remainder Return (dale of death prior III 12-13-82)
o 5. Federal Estate Tax Retum Required
.L 8. Total Number of Safe Deposn Boxes
o 11. Election to tax under See. 9113(A) (Al!ach Sch 0)
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THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
NAME COMPLETE MAILING ADDRESS
GERALD J. BRINSER 6 E. MAIN STREET
FIRM NAME (If Applicable)
BRINSER WAGNER & ZIMMERMAN P.O. BOX 323
TELEPHONE NUMBER
717838-6348 PALMYRA PA 17078
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1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposils & Miscellaneous Personal Property (5)
(Schedule E)
6. Jointly Owned Property (Schedule F) (6)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
8. Total Gross Assets (total lines 1-7)
9. Funeral Expenses & Administrative Cools (Schedule H) (9)
10. Debls of Decedent. Mortgage Liabilities, & Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (line 8 minus line 11)
13. Charitable and Governmental Bequests/See 9113 Trusls for which an election to tax has not been
made (Schedule J)
~<
I ,~
I
I
16.733.991
I
52,445.41 !
OFFICIAL USE ONLY
i
I
62,455.01 L~'
___I
(8)
131,634.41
4,291.51
150.00
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 atlhe spousal tax
rate, artransfers under See. 9116 (a)(1.2)
19. Tax Due
0.00 X .0L (15)
127,192.90 X .04.5 (16)
0.00 X .12 (17)
0.00 X .15 (18)
(19)
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
20. 0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF M OVERPAYMENT
(11)
(12)
(13)
4,441.51
127,192.90
(14)
127,192.90
5,723.68
5,723.68
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
~-~.,,~ '*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RlETURN
RlESIDENT DECEDENT
SCHEDULE D
MORTGAGES & NOTES
RECEIVABLE
ESTATE OF
ROGERS. HELEN L.. A1K1A HELEN LOUISE
All property jointly-owned with the right of survivorship must be'disclosed on Schedule F.
ITEM
NUMBER
1.
FILE NUMBER
21 01
0886
DESCRIPTION
CHARLES & JUNE BOMANIWILLlAM, AND KATHRYN BOMAN - MORTGAGE
RECEIVABLE - BALANCE AT DATE OF DEATH
VALUE AT DATE
OF DEATH
16,733.99
TOTAL (Also enter on line 4, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
16733.99
.r
/
~(Q)~\~-
Ray Davis
0'6/20'/0'0'
LO^N ^MORTIZATION SCHEDULE
PAGE
1
BUYER. .rCHARLES & JUNE BOMAN AND
WII,LIAM & KATHRYN BOMAN
R. r. #1. Box 512
Susquehanna. PA 18847
AGENT..rHELEN ROGERS . /.1
~22 Messiah Village.; f,(). ~~(J/.s
Mechanicsburg. Pa 170'55-2015
Property. r Township of Jackson
County of Susquehanna
Commonwealth of Pennsylvania
PURCHASE PRICE......
INITIAL DEBT. ......
INTEREST RATE.......
PAYMENT FREQUENCY... (M)
NUMBER OF PAYMENTS..
ADDITIONAL PRINCIPAL
26.000.00
21.000.00
7.000
.. Monthly
60
0.00
DOWN PAYMENT
PAyBACK..... .
INTEREST. . . . .
PAYMENTS. .'. . .
STARTING. . . . .
STARTING PYMT
5.000.00
24.949.80'
'3.949.80
" 415.83
07/20/00
1
PAYMENT. . . . . . . . . . . . . . . . . . . .
NO. DATE AMOUNT INTEREST . PRINCIPAL BALANCE AFTER
l..- -21,0ge.&e
~07120'/00 ..v415.83 1.22.50' .....-293.33 20.W_6.....,67_.
~--. ~~--" s-r20..J9 ~95-. 0'4 ::;20. 4+-1:.-~-
U3-09J20/00' (~.cr};; J,....~-8.L___.:...11.9--.-01---~-..~-. ].9~0-..1-14.-37--._.
4 10/20 /00'- ~i 0 I ~4--1-5--0~_3-~-1-1--.~ - -- ---;-u.___un.__ ..2.98 .49 ----- ...-1-9-,--816.---38
V~0100'-------4-15. 83-------..H.~.-60------------.----- .j~'0. ~ 1-9-.,..s16. 15-
Y"6 12/201-0'0' 415. 8~ ----.-u-------.-11-3.;-84--____:-_--.- 30'1...99 _0' ____~1~T-2-l4..-16---
2,494.98* 709.14* 1.785.R4* FOR YEAR 1900'
f 0:1/20/~1_~Jf~/Jo--'-- 415.83 _ 112.08 . 30..3.75 ---1-8 .-9Hb-.-41-~
I ~lli0'ltJ-(.~c.:./1 col _41~:::8}=.:, - IJ.~_._}l__ ._._-- __ _}0' 5 ~.5 }---!_~.._~~!:.-.8..2_.
: :~2-0+01~~1-S-. 8s-------108. 5..3_.-----.-.____....3.07.60-~.:::---: .18--.297-;.59--
A -- L20 /01 ~~. 41-~--~ - .1-06-;-7-4-.--..------.~-~9_'T'0_9_--_..--. -1.1-.98-&-..--5-0-
11 05/2-0/01 -4' I,? Q~ HH. ~J ~--."----..--3_i~_0__----1:.7-.. 6''1'1760
~0L0-l_.~~~. 1"3- o. 415_..83---.----~--~-103-. 12- 312 ~ 71." 17, 364. 8 i ~
1-3 07 ~20/0:r- C)~ -o-'::<,):j 415. 3--3----- ----10-1:-;-30- _;:"31.4-._-.5.3_."'_.___.___17....050.. 3.6. ~9.l
1-4--0-81 2-0-/4-1--8~-2'4-0 \.41-5..-8-3~__--.. ..- _ 99_.46_ _ 316.37 . _06.7-3-3...-99)
1 5 '09/20'/01 4 1 5 . 83 9'7 . 61 318 . 22 16 . 415 . 77
16 10/20/01 415.83 95.76 320.07 16.095.70
17 11/20/0'1 415.83 93.89 321.94 15,773.76
18 12/20/01 415.83 92.0'1 323.82 15.449.94
4,989.96* 1.225.74* 3.764.22* FOR YEAR 190'1
19 01/20/02 415.83 90.12 325.71 15.124.23
20 0'2/20/0'2 415.83 88.22 327.61 14,796.62
21 03/20/02 415.83 86.31 329.52 14.467.10
22 04/20'/0'2 415.83 84.39 331.44 14.135.66
23 0'5/20/02 415.83 82.46 333.37 13.802.29
24 06/20'/02 415.83 80.51 335.32 13.466.97
25 07/20/02 415.83 78.56 337.27 13.12~.70
26 0'8/20/02 415.83 76.59 339.24 12.790.46
f~ eM 2--0 -'fA.
\ ~ ./~Z~ Ib / 5 z r -=-5--2-
__D.,~ '*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
ROGERS. HELEN L.. AlKlA HELEN LOUISE
FilE NUMBER
21 01
0886
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
PNC BANK - CHECKING ACCOUNT #5070098747
(INCLUDES ACCRUED INTEREST OF $.12)
PNC BANK - SAVINGS ACCOUNT #5001902412
(INCLUDES ACCRUED INTEREST OF $1.25)
PNC BANK - CERTIFICATE OF DEPOSIT #21001015120
(INCLUDES ACCRUED INTEREST OF $2.16)
PNC BANK - CERTIFICATE OF DEPOSIT #31800190667
(INCLUDES ACCRUED INTEREST OF $4.37)
2.
3.
4.
5.
PNC BANK - CERTIFICATE OF DEPOSIT #31600212847
(INCLUDES ACCRUED INTEREST OF $92.58)
BRETHREN IN CHRIST FOUNDATION - CERTIFICATE OF DEPOSIT
(INCLUDES ACCRUED INTEREST OF $176.12)
FUNERAL HOME - REFUND OF EXCESS BURIAL INSURANCE
6.
7.
8.
MAGAZINE SUBSCRIPTION - REFUND
9.
A.F.L. INSURANCE - REFUND
VALUE AT DATE
OF DEATH
1,739.18
3,170.52
3,227.45
7,565.91
13,070.39
23,176.12
185.70
7.20
302.94
TOTAl (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
52 445.41
~.'"~.,~ '*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
ESTATE OF
ROGERS. HELEN L.. AJI<JA HELEN LOUISE
FILE NUMBER
21 01
0886
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
DESCRIPTION OF PROPERTY %OF
ITEM INCLUDE THE NAME Of THE l1WISfEREE. THEIR RELATIOIlSHIP TO DECEOEKT AAD THE CATE OF TRANSFER DATE OF DEATH DECO'S EXCLUSION TAXABLE VALUE
NUMBER AITACH A COPY OF THE DEED FOR REAl ESTATE. VALUE OF ASSET INTEREST (IF APPUCAIllE)
1. GLEN BROOK LIFE - (2) ANNUITIES WITH TWO NAMED 47,155.15 100. 47,155.15
BENEFICIARIES
2. FEDERAL HOME LIFE INSURANCE CO. - ANNUITY 15,299.86 100. 15,299.86
WITH TWO NAMED BENEFICIARIES
TOTAL (Also enter on line 7, Recapitulation) $ 62.455.01
(If more space is needed, insert additional sheets of the same size)
-...."."'" '*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
ROGERS. HELEN L.. A1K1A HELEN LOUISE
FILE NUMBER
21
01
0886
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. HONORARIUMS - MINISTERS/MUSICIANS 200.00
2. FUNERAL LUNCHEON 180.00
3. FLOWERS 110.51
4. JACSON CEMETERY 50.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s)
Social Security Number(s) I EIN Number of Personal Representative(s)
Street Address
City State Zip
Year(s) Commission Paid:
2. Attomey Fees BRINSER, WAGNER & ZIMMERMAN 3,500.00
3. Family Exemption: (If deoedenfs address is not the same as c1aimanfs, attach explanation)
Claimant
Street Address
City Stale Zip
Relationship of Claimant to Decedent
4. Probate Fees REGISTER OF WILLS 226.00
5. Accounlanfs Fees
6. Tax Retum Preparer's Fees
7. REGISTER OF WILLS -INHERITANCE TAX RETURN FILING FEE 15.00
8. REGISTER OF WILLS - INVENTORY FILING FEE 10.00
TOTAL (Also enter on line 9. Recapitulation) $ 4291.51
(If more space is needed, insert additional sheets of the same size)
~."u.,,~ '*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
ROGERS. HELEN L.. A/K1A HELEN LOUISE
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
FILE NUMBER
21 01
0886
Include un reimbursed medical expenses.
ITEM
NUMBER
DESCRIPTION
1.
OUTSTANDING CHECK AT TIME OF DEATH
AMOUNT
150.00
TOTAl (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
150.00
-~'Q':," '*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
FILE NUMBER
NUMBER
I.
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS (include outright spousal distributions)
AMOUNT OR SHARE
OF ESTATE
1.
DOUGLAS ROGERS
1254 BROWNING COURT, LANSDALE, PA 19446
WAYNE ROGERS
R.D. #2, BOX 2065, HALLSTEAD, PA 18822
PAUL ROGERS
103 LAKES VALLEY RD., STRASBURG, VA 22657
SON
1/3 RESIDUE
2.
SON
1/3 RESIDUE
3.
SON
1/3 RESIDUE
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART n - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
.'
11Last JIItll attb m~stattttttt
I, HELEN L. ROGERS, a resident of the Township
of Jackson, County of Susquehanna and State of Pennsylvania,
do make, publish and declare this to be my Last Will and
Testament, hereby revoking all wills and codicils heretofore
made by me.
ITEM I
I direct that all my just debts and
funeral expenses, including my gravemarker and all expenses
of my last illness, shall be paid from my residuary estate
as soon as practicable after my decease as a part of the
expense of the administration of my estate.
ITEM II
All the rest, residue and remainder
of the property which I may own at the time of my death,
real and personal, I bequeath and devise in equal shares to
my sons, Douglas Rogers, Wayne Rogers and Paul Rogers, per
stirpes.
~
~
"'t-
ITEM III
Should any of my issue entitled to
a share of my estate not have attained the age of twenty
five years at the time of distribution to him or her, I
devise and bequeath the share of each such issue to County
National Bank of Montrose, Pa. (IN SEPARATE TRUST), to hold,
manage, invest and reinvest the share so received, and the
accumulation of income thereon, and to use and apply the
income and principal or so much thereof, as in Trustee's
discretion, may be necessary or appropriate for such issue's
support and education (including college education, both
graduate and undergraduate, or trade school), or to make
payment for these purposes, without further responsibility
to such issue or to any person taking care of such issue.
Trustee may accumulate the income from such trust until
such issue attains the age of twenty one years; thereafter
the net income shall be paid at least semi-annually to
such issue.
,
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(i) As each of my issue attains the age of
twenty one years, or if he or she has attained the age of
twenty one years at the time of distribution, each of such
issue shall have the right then and continuing thereafter
to withdraw one-third (1/3) of the balance of the separate
trust fund established for each such issue, and any accumu-
lated income thereon.
(ii) As each of my issue attains the age of
twenty five years, Trustee shall pay over to such issue the
then-remaining balance of principal and income.
(iii) If any of my issue shall die after the
establishing of the separate trust but before attaining the
age of twenty five years, the trust shall then terminate and
such share shall be distributed to his or her personal
representative.
ITEM IV
I appoint my son, Douglas Rogers,
executor of this my Will. In the event my said son shall
predecease me or fail to qualify as such executor, I appoint
my son, Wayne Rogers, substitute executor; and I vest my
said executor or substitute executor with full power and
authority to sell, transfer and convey any property, real
or personal, which I may own at the time of my death at
such time and price and upon such terms and conditions as
he may determine.
ITEM V
I direct that neither my executor,
substitute executor, nor trustee be required to give bond or
other security for the performance of their duties in any
jurisdiction.
ITEM VI
My corporate fiduciary shall be
entitled to compensation based on its regular schedule of
fees for such services in effect from time to time during
the period over which its services are performed.
IN WITNESS WHEREOF, I have hereunto set my hand
this ~1 day of ~ , 197b.
/~of~/
Helen L. Rog s