HomeMy WebLinkAbout01-0995
PETITION FOR PROBATE and GRANT OF LETTERS
Estate of . In Fl fGl9l?ET // 23/1/1 R /6'<- No. ~ 1- 0 J - q q ~
also known as To:
Register of Wills for the
, Deceased. County of &;/~/J.3&,~A.../b in the
Social Security No. de):;?".:y~ - cc;( ?::"') 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 executRI 5(5
in the last will of the above decedent, dated L Ju t- '/ 2.tJ /9,.?:?
and codicil(s) dated
named
,19_
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in c: U //7 BE/!? U? /L).i")
lL. last f~ily or principal residence at 7':::::;;"}(~LUAlL/1
:zjr;;7/7') /}? /-r'b, C:./ H /? L.J 5 L'=- . /../",'/ / 'C/.
(list street, number and muncipality)
County, Pennsylvania, with
;L(/?//1 k- 4 ~:;; Lu/9 LL'u;;-
. ,
Decendent, then 8S years of age, died
at '7Hc'/?.Alcuij,I.../J HCV>>E
Except as follows, 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:
OC? To ,(j,c/e
/9
~ .200/
, ,
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:
$ 2, c?O'o
$
$
$
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters
theron.
(testamentary; administration c. La.; administration d. b.n.c. La.)
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OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA } 58
COUNTY OF .lli[hB ~'\.LANI) .
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.
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Estate of IY1AR6ARET V. \BARRI C..J(.
, Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW ~T 01 __~___.__}FO I . in con,ideration 0' · ,;< ",,;t;og an
the reverse side hereof, satisfactory proof having been presented before ~e,
IT IS DECREED that the instrument(s) dated .JU.L" 25 I 1'1 '?
described therein be admitted to probate and filed of record as the last will of
and Le~~R~1~~~Il:K..
are hereby granted to V'E:-5 TA CALA rnA N I VE:LV A LL"130 /)(N ILl) N bA-:
D u.R I1PdY\ .
~cJd~vm~
FEES 1-0.00
Probate, Letters, Etc. ......... $
Short Certificates( ).......... $ \3 . OD
lttuuu.i.tiun i_~_e~ ~ ~',~~
rTAL $'3 ,00
Filed . ~O : ~.I: P. . . . . . . .~. . . . . . . . . . . .
ATTORNEY (Sup. Ct. I.D. No.)
ADDRESS
PHONE
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H 105.805 REV 9/86
This is to certify t~at the information here given is correctly copied from an original certificate of death duly filed with me as
Local Registrar.. The original certificate will be forwarded to the State Vital Records Office for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $2.00
p
7744379
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Local Registrar '1 '
OCT 2 2 2001
No.
Date
5.;43 Rev, 2117
COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH' VITAL RECORDS
CERTIFICATE OF OEATH
NAME OF DEcEDENT (fll'Sf. MIddle. l.J
.. MM Met V. Ba)r.JI.-i.c.k.
AGE (l..Il"'._V1 UNDER , YEAR UNDER . ow
85 Yrs. - De.. -- 1 -
SEX
'WE FilE,.."..,,.
SOCIAL SECURITY NUM8E:A
DAlE OF OEAfH ,MotWt. 0.." -.."
~(C.._
sa.. Of Faeql CDlWtIryt
2. Female .. 202 - 36 -6275
fIt.ACI 0# DeATH fCNctt 0Ny llf\e - ....It\SIrUCIoOns on QIheI __
HOSPItAL
......... 0 E~ 0 IlOA 0
.. 10-19-2001
COUNTY OF DEATH
PA
::':",,0
Cumbvr.i.a.nd
DECEDENT'S USUAl t:lCC\JPllIrJON
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Thoknwaid N~4-i.n Home
""'B DECEDENT EVER.. DECEDENT'S EllUCRIOH
U.s. ARMED FORCES'/
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PA
lWlITAL STATUS._
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DUE lOlOR "'ACONSEguE~ ~ ~
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DUE 10 lOR AS A CONSEOUENCE ~
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PART I: 0lIl0r......... _ --........ _.....
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DUE 10 lOR AS A CONSEOUENCE OF).
WEllE AU1lJPSY_ _R OF DEATH
-..au; PAIOR lO
COUPlETlON OF CAusE ~ 0
OF DERH7 - -
-.. 0 -.g -..gallon 0
No lid" _0 No 00 -- 0 Could noli .. OeIenNneC:I 0
DATE OF INJURY
,-.Dty. -,
Tlue OF INJURY
INJURy IfI lMJRK? DESCRllIE HOW lNJUllY OCCURRED.
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_.IEJl'~_cnat
.ClllTFtINQ PHYSICIAN (PhfSlC*'l~ c-... ~ dtMh wt\er1 anothet DhVSIt..., has pronounced deelh ana Cornp6eIed Item 23)
T........ot...Wknowlecftte.deatheccunN...IO....cauM(.laNIm.....'..aIMed.."......"..................... -....... -..".
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PlACE OF tNJURy. AI home. farm, III... fadory. ofIce
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"IIEDlCAL EllAliUNI!R1COROHER
On the bui. oIeJlamm.tton and/or I,,"_ligation. in my opinion. death occurred at UN time. dat., and place. Met due to the cauu(.) and
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REGISTRAA~NATURE AND NUMBER
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LAST WILL AND TESTAMENT
OF
MARGARET V. BARRICK
I, MARGARET V. BARRICK, of 1231 Claremont Road, Carlisle,
Cumberland County, pennsylvania, being of sound and disposing mind,
memory and understanding, do hereby make, publish and declare this
as and for my Last will and Testament, hereby revoking all other
wills and codicils heretofore made by me.
FIRST: I direct that all my just debts and funeral
expenses, including my grave marker, shall be paid from the assets
of my estate as soon as practicable after my decease.
SECOND: I give, devise and bequeath the residue of my
estate, of every nature and wherever situate, to my children, VESTA
CALAMAR, VELVA LEBO, and LINDA DURHAM, equally, provided that the
share of any child who predeceases me or dies on or before the
thirtieth day following my death, shall be distributed to her
issue, per stirpes, living on the thirty-first day following my
death, and in default of any such then living issue, such share
shall be added to the shares for my other children.
THIRD: I direct that all taxes that may be assessed in
consequence of my death, of whatever nature and by whatever
jurisdiction imposed, shall be paid from my residuary estate as a
part of the expense of the administration of my estate.
FOURTH: I nominate, constitute and appoint my Daughters,
VESTA CALAMAR, VEL VA LEBO and LINDA DURHAM, Co-Executrices of this
my Last will and Testament.
FIFTH: I direct my Executrices shall not be required to
give bond for the faithful performance of their duties in this or
any other jurisdiction.
IN WITNESS WHEREOF, I have hereunto set
this, my Last will and Testament, consisting
pages, each identified by my signature, this
-:rU I V , 1988.
/
my hand and seal to
of two~2) typewritten
~ .s- day of
~~
...-:"'--:?) " /) /
. i'~a.-u/ J/ . SEAL)
. M garet V. Barrick
,
~
- Page 2 of 2 Pages -
Signed, sealed, published and declared by the above-named
Testatrix, Margaret V. Barrick, as and for her Last will and
Testament, in the presence of us, who, at her request, in her sight
and presence, and in the sight and presence of each other, have
hereunto subscribed our names as witnesses.
~d/r~
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COMMONWEALTH OF PENNSYLVANIA)
COUNTY OF CUMBERLAND
SSe
I, MARGARET V. BARRICK, 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 and Testament; that I signed it
willingly; and that I signed it as my free and voluntary act for the
purposes therein expressed.
Sworn or affirmed to and
BARRICK, the Testatrix, this
1988.
ackno~edged before/me by MARGARET V.
~S day of :r-t-t V
/
EAL)
TAYLOR P. ANDREWS. NOTARY I'U~UC
CARLISLE BOROUGH. CUIIERLANa coliNrv .
IY COMMISSION EXPIRES DEC. 23/1!9'1).. ,. ;
..mber. P.nnsylvenia Association iitMfll.l'iti.:-:
COMMONWEALTH OF PENNSYLVANIA)
'..: /;'
~.' '
SSe
COUNTY OF CUMBERLAND
We, RONALD E. JOHNSON and , 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 and Testament; that MARGARET V. BARRICK
signed willingly and that she executed it as her free and voluntary
act for the purpose 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 18
or more years of age, of sound mind and under no constraint or
undue influence.
Sworn or affirmed to and subscribed to before me by RONALO~E.
JOHNSO~ an1d 51, ~fWn Ii S~t1.l:Jo,,/{ , witnesses, this 2r fl( day
of -J u_y , 1988.
. (SEAL)
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(SEAL)
blic
TAYLOI P. Awnr.r.\'l, ~:TH'R";' PUBliC I
CARLISLE IOl!8$t: ': ;;iI,~!:IlLA'W COUNTY '
IY COIIISSION ti::1\t1l.'.S DEC. 23, 1991
tltmbtr. Plllnsyl~ln";{l~i&tig\l ,,1 Notari..
j;
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent:
{nfJRGI1/("er V. ,Cla/V2leK
Date of Death:
otlr let, 2 ct? I
Will No.
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 t::JC?r 20.. Z~/
Name
Address
ltE:srn tJ,4~A/'J?A/I/
/tJ7 A/. PJ/~.lJL.t!'cS~~ /& &,.eLl~t:S" p~ / ?O/.3
~V)1 ie-L30
L/,VL)p J:>V/?#.4n
2/,/ S'Io/lf1 t'Mrcn R~ (!/J.-AlL.;~U"t//l / At//d
/t17 S.~/LJ6e Ab
'&JIL/.lJ6 L50A'/-t/65 /J/1 /7t7t17
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Date: ;::- e6. J:../!dd' 2
v~ ~ Af}~-??J
Signature
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Name b~g./l ~_~RI-I;q/?}
Address //l? J. ~6S ~
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Telephone \717) 2t/3-967S
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Capacity: ~Personal Representative
_Counsel for personal representative
~
Cumberland County - Register Of Wills
Hanover and High Street
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 1/28/2002
DURHAM LINDA
107 SOUTH RIDGE RD
BOILING SPRINGS, PA 17007
RE: Estate of BARRICK MARGARET V
File Number: 2001-00995
Dear Sir/Madam:
It has come to my attention that you have not filed the Certification
of Notice Under Rule 5.7 (a) in the above captioned estate.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103
SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after July 1,
1992, the personal representative or his counsel, within ten (10) days
after giving proper notice to the beneficiaries and intestate heirs as
required by subdivision (a) of Rule 5.7, shall file with the Register of
Wills or Clerk of the Orphans' Court his/her Certification of Notice.
This filing will become delinquent on 2/10/2002.
Your prompt attention to this matter will be appreciated.
Thank You.
Sincerely,
MARY C. LEWIS
REGISTER OF WILLS
cc: File
Counsel
Judge
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
LEBO VELVA
261 STONE CHURCH RD
CARLISLE, PA 17013
-------- fold
ESTATE INFORMATION: SSN: 202-36-6275
FILE NUMBER: 2101-0995
DECEDENT NAME: BARRICK MARGARET V
DATE OF PAYMENT: 03/05/2002
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 10/19/2001
REMARKS: VELVA B LEBO
CHECK# 3211
SEAL
ACN
ASSESSMENT
CONTROL
NUMBER
101
TOTAL AMOUNT PAID:
INITIALS: CW
RECEIVED BY:
REGISTER OF WILLS
REV-1162 EX(11-96)
NO. CD 000920
MARY C. LEWIS
REGISTER OF WILLS
AMOUNT
$212.80
$212.80
/?-/?-/O
\v BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
*'
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
REV-15~7 EX AFP 101-O2l
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
~e:-.ootriy
ACN
04-15-2002
BARRICK
10-19-2001
21 01-0995
CUMBERLAND
101
MARGARET
v
'02 (\PR 19
VELVA B LEBO
261 STONE CHURCH RD
CARLISLE PA 17013
Allount R.llitt.d
C.Li,
Clllnt:.... .
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-Ex-AFP-foY=o2Y-NoYicE--oF-YtiHER-iTAifcE-TAirA-PPRA-isEi'-ENT~--Aii-oWAi'-CE-(fR------------ -----
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF BARRICK MARGARET V FILE NO. 21 01-0995 ACN 101 DATE 04-15-2002
TAX RETURN WAS: (X) ACCEPTED AS FILED
) CHANGED
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)
S. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
.00
.00
.00
.00
6.913.51
.00
.00
(8)
NOTE: To insure proper
credit to your account,
subllit the upper portion
of this forll with your
tax paYllent.
U)
(2)
(3)
(4)
(5)
(6)
(7)
6,913.51
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adll. 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
1,763.00
(9)
UO)
421.79
(11)
(2)
(3)
(4)
2 . ] 84 79
4, 728 . 72
.00
4, 728 . 72
NOTE: I~ an assessment was issued previously, lines
re~lect ~igures that include the total o~ ALL
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. AIIount of Line 14 at Sibling rate (17)
18. Allount of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
14, 15 and/or 16, 17, 18 and 19 will
returns assessed to date.
.OOXOO=
4,728.72 X 045 =
.00 X 12 =
.00xI5=
(9)=
.00
212.80
.00
.00
212.80
TAX CREDITS:
IU:L.C.LI" I l+J AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
03-05-2002 CDOO0920 .00 212.80
TOTAL TAX CREDIT 212.80
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
· 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.)
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STATUS REPORT UNDER RULE 6.12
Date of Death:
Decedent :_MRR6J\.IR.f=:..T
Dct I q ) Q.()(:) I
ell 01 -- () 9'1 S-
v
BARR \c...K
'02
I'II\'! 1.1
[J \ :1',2
Name of
Pursuant to Rule
Court Rules, I report the
the administration of the
L
Ct I::
6.12 of the Supreme Court Orphans'
following with respect to completion of
above-captioned estate:
Admin. No.
Will No.
1.
State whether administration of the estate is complete:
Yes V No
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 pers~al representative file a final
account with the Court? Yes ~ No .
b. The separate Orphans' Court No. (if any) for
the personal representative's account is:
c. Did the personal representative state an
account informally to the parties in interest? Yes ~ No
d. Copies of receipts, releases, joinders and
approvals of formal or informal accounts may be filed with the
Cerk of the Orphans' Court and may be attached to this report.
Date:
5-~{-~~ VU-Jo- J W~
~d^- < ~ Signature
L/~D~ /( ~~'-< . /;1m. l/es-fi7- V ~ hn?8-'PJ
/,J~S' /(:/d.d..eL. . ~ Name (Please type or print)
.~- ~J/l~7
'7/7~f"'.?C}56 /07 IV. fk-<.~~ f?~
AddressQ~l:d~ ~ /70/:1
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VEL-VA -.6. la~o I/J I
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(717) ;;C'fQ-3JO-:l-
(MAH:rmf/AM3)
(7/7) .;;L~''9 - cP<.G. 3
Tel. No.
Capacity:
Personal Representative
Counsel for personal
representative
, . ...
, -.l<<E'/.'500 EX (6-00)
REV-1500
OFFICIAL USE ONLY
17- I'!./d
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COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
~L-.12..L
COUNTY CODE YEAR
.QO..3~b
NUMBER
....
Z
W
C
W
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W
C
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
I'Y\A-RGPtRG:, V. 6A-RR\c.\~
SOCIAL SECURITY NUMBER
Jo Q... - 3 G:,
,,~ 7~
DATE OF DEATH (MM-DD-YEAR)
19e;t. \q 1 Cloo \
DATE OF BIRTH (MM-DD.YEAR)
tJe..T 30) 1 q IS-
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
N/A
W
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~:$en
ua:~
wn.u
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n.ClI
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o 1. Original Return
o 4. Limited Estate
[8" 6. Decedent Died Testate (Attach copy of \'viII)
o 9. Litigation Proceeds Received
o 2. Supplemental Return
o 4a. Future Interest Compromise (dale of death after 12.12-<12)
D 7. Decedent Maintained a Living Trust (Attach oopy of Trust)
D 10. Spousal Poverty Credit (daleofdealh between 12-31.91 and 1.1.95)
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
N 1.4
o 3. Remainder Return (date of death prior 1012.13-<12)
D 5. Federal Estate Tax Return Required
1) 8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
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NAME
FIRM NAME (If Applicable)
COMPLETE MAILING ADDRESS
9-10\ bTone. Church R~
~o.. (' \t ~ \ e. PA \ I' 0 \ "3
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V€. LVA
6.
LE60
TELEPHONE NUMBER
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1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non.Probate Property
(Schedule G or L)
(7)
~
(1)
(2)
(3)
(4)
(5)
~
~
~
~
G:>, 8j \ '0,5 \
(6)
~
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)
12. Net Value of Estate (Line 8 minus Line 11)
(9)
(10)
(8)
\. 'ftc6.DO
L4-~ L 7g
13. Charitable and Governmental Bequests/Sec 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)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
z
o
~
~
::J
Q",
:!:
o
o
><
~
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
x.O _ (15)
J.../ 1 '1 ~~. 7 -g.. X.o $" (16)
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
x .12 (17)
18. Amount of Line 14 taxable at collateral rate
x .15 (18)
19. Tax Due
20.0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
OFFICIAL USE ONLY
to. q , 3 . S {
.
(11)
(12)
(13)
d..,t8'J.t.7Q _
Jf, 7 J. ~. '7 'd.-
'y\~
(14)
t+, '1a8 7'J-
(19)
~
a..1 a . 8 0
~
~
~l'~.<60
> >BE SURE TO ANsV\l!;~
CITY
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
STATE PA ZIP I c <9 l "3
(1) ~la.8'O
~
~o
Y\-<h\..Q. Total Credits ( A + B + C ) (2) -0-
(3) -0-
(4) ~
(5) ~la.~O
(5A) -c-
(5B) ald.'~()
3.
Interest/Penalty if applicable
D. Interest
E. Penalty
..~
~
4.
Total Interest/Penalty ( D + E )
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
5.
If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
B. Enter the total of Line 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
1. Did decedent make a transfer and: Ves
a. retain the use or income of the property transferred;.......................................................................................... D
b. retain the right to designate who shall use the property transferred or its income; ............................................ D
c. retain a reversionary interest; or.......................................................................................................................... D
d. receive the promise for life of either payments, benefits or care? ...................................................................... D
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. D
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. D
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ D
No
~
~
~
~
~
~
~
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct
and complete.
Declaration of preparer other than the personal representative is based on all information of which preparer has any kn wledge.
ON RESPON?~LE FOR FILING R.ETURN. ,\ _I. ~. . ~j~ ~..z.
3 / ~ Ilr2-- !. (l J...J.llf PLWW'-
7 S' 4t1Cf.1-
/7t7t17
ADDRESS
DATE
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. ~9116 (a) (1.1) (i)].
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 exemot 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. ~9116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. ~9116(1.2) [72 P.S. ~9116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. ~9116(a)(1.3)]. 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-l508 EX. (1-97)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
l{V\ A-R<q A-R. aT V. '8A-R'R \.c..k.
FILE NUMBER
(j.{-Of OOqqs
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.
~ ~
B
DESCRIPTION
All~lrst ()Q~k
~ we.si t+ ~~ h st 1 c.6..(' II S i e. Pit- 17013
. Q..h.~c-k-, Yl' A-cc.t", 0 O'J.?> S- - ( "g 3-to Do D lOo..la Y\C~
LUo..sh'rl"Jt~ tJC\tt~"'-( InS/Ar-o.'f'\Le. e~.
~e.<!l"se.c.o Servtc...~s.1 h .I-.c.. 0
(J. ~ ./bO)( (ergo) (!C\.C rnell IN 4 10 CJ8 9.. - lor 0 ()
Ahr\t,\.~t"\ A-cc.T. #000IS~1c5Q
Cre"",,- t,"o-v-, So,,; "- t'1 ,,9 PA P /710"1
4-1 60 JoY' e s-to w Y\RJ.. I \-10\ r- V- l S b LA'l Pr
flre-~'ld C-re.MQ-+1 ~ 'S~ rv' t ce.~
'"'1lIe.Y\'\ be 1"'(. hi - p fk-c.t. ~ ,,~ ~ '3
VALUE AT DATE
OF DEATH
fa ~~O.3(~
I
l1 ~ I 5"'. 7 4-
I)OgO.QO
yq.qG:,
~.'Jl
L) 5?:>4. ().Lf
t-I.
T\) Cl~ mCL%<t "2-1.t'~
s l.i. '-0 ~ c.. r: f> + t ~ re ~ LA Act
5
Spr; nt I~\e..pho"'~ ~o.
P.o. ~6~ 7Q7'1 6)~r'o..t'"'Id.. Pa.r--l<.., I(o.ns(\~ 1o~d.11
R~~L\,"'\d c-t 6i)e....rfXt~V\Il e.'\1 ~f 0 w e..cl
b. ~~r h lA)cd d [40 W\e r'O \ ( p^
41..f-a vVQlhlA-+ eoito~ ~cl'l ~r lCi; ~l Ii
R~44.~d. 04' ()Ve_J"'PCl~ine. r'\-t ot
r~s lJ.e.->"\t ~C\r,\~~
170(-5
TOTAL (Also enter on line 5, Recapitulation) $ ~ 1 q \ 2>. 5' I
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX+ (12-99) .
" '.
' ... . ~.. ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
M.,:l.R~A-RPT Y. 13HRR)(!.k
FILE NUMBER
;J l-Ol OOqq,5""
ITEM
NUMBER
A,
Debts of decedent must be reported on Schedule 1.
1,
DESCRIPTION AMOUNT
FUNERAL EXPENSES: '
G.. e.Mc<.:t 1 ()."" ~~C. <i ~ A.,} c.re..mqi't<:H"\. PrepcHcf Se~V(C ~~ I J Cl '1'0.0-()
~reMG\.t-/o-Y' ~OG ~ PA; S/~n-c,.., 8..h.jr1leMO('(cd C'a.~~ CiYlc1.
Ti'\ a "k y a ..... co.. ('d. S +t> /'" m~m c9 ('( cd S' E. (' V l c<S i . Ale. ~ '" ~ a. \" e r ( If 5' . () 0
?fa.c.;-Mef'\T 4ee.~ Co.:..H"'\f'4 ec)t'"'\~~r (!.reMc::t TfCJ"'Y'.. ftFprcH/G\..l
9e.e.) O~a;i11. Ce..r,cFlc..~'7e..... ~rp";LS .
meVh.orlcJI..l ServIce. -le...l'o/""T Ul')/te-J.1Yl4l.tnc:lcll$tC.~(.(rck '2>oCo,Ckj
re..II\1"',e:tc.; Pa.sfor e.. R~nner> -For $~rv"f'\9 ;a..v0. 6eClr,\e
F~~(.U~ r-~ f~ r +- I () WISH'S' ; a. is c fl'Ie.. YY\ ... 1'1 C\ ( phQfV\\?h l~_t-s .... prCl~ra.m S. .
eo.~(, 'Sl ~ yne. 1\'\0/""1 a. ( Se 0V I C ~ .Tnc . -t?or h~ o.d nO^e... Q.lI\~ ra. v'j ('j, I g~ . (to
8-.
3
4.
1.
B. ADMINISTRATIVE COSTS:
6)
2.
Personal Representative's Commissions
1\b n e.
Name of Personal Representative(s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City
State _ Zip
Year(s) Commission Paid:
Attorney Fees
(~)
1\0ne.
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
4.
5.
6.
7.
(3)
il <;) n€
Street Address
City
State _ Zip
Relationship of Claimant to Decedent
Probate Fees <! to(,. 1'>'", b~ r-{ Q f\ d e c .R oe.'1. IS ft2.. r- Cl 13 (;..) t 0\ \ So .; .
Pre be.. t~ ~ h o~ -r C e rr I fr I co. t--e.. -t- JC P; .f E. Q..
Accountant's Fees I
(4) '39.DO
Tax Return Preparer's Fees
lS"") h 0'1'\ €..
rtc) n~
-
TOTAL (Also enter on line 9, Recapitulation) $ I) ry ~ ~, 0 0
(If more space is needed, insert additional sheets of the same size)
',~EV.'5'2EX:(I.~71 W. '" .
K ~').)c ,
, ..~ . SCHEDULE I
..,,~ N
COMMON~~lTHOFPENNSYLVANIA DEBTS OF DECEDENT,
tNH~i~~~~~i 6:2E~~~~RN MORTGAGE LIABILITIES, & LIENS
EST ATE OF FILE NUMBER
{"<'I Pr R G A- R. ~ T ". (0 A R Rt C \<. c1 ( - 0 l 00 q q 5
Include unreimbursed medical expenses.
ITEM
NUMBER
1.
a.
j,
AMOUNT
11 8(", ?D
DESCRIPTION
l"'f"e-e, Ser\"':1~ Fo..~\ \"\ Pr-a.c't-lC.e. ({Jr. Do.~\~\~)
-303 N. 60. ~ ~, Mor-e. Ave..
P\+. !-to ( l ~ ~ pn 1\ 'i!:.' P A trOtoS'
(Un l'e.\ I'V\b LA r-sed.'fY'€ cL ~ct I e)C.. p~s e.....S,j
Ph a. r- me. r; Lo....
\Ii R~+hCtr Grt'V~
N~ U.M.. f' k... be: f q"7 It
( u.(\r~1 YVl bL\ f'~ e d... ~ eel ,'" Coo..*- I ~ Q)( pG-1\ ~ e..~)
J05. 'J,5
4--,
srr\'f\f
p. 0. ~O1'- ~OOO
~o.,,(\51e.. PA \'7DI3
C La.. ~-r te.. \ e pho n€-
Qa.'P';tD.\ b\v.e. Cros~ (\ nS\A['o.l"\ce PreTY\\~~)
J..SDO E\Mer+6Y\ A,,~.
WCA.(,(,I~ bv..r,\,,?A 17/10
lc to. is
'9, 3.d, cr
S t;I_rv l C. E- S +0.. -te... rn e..- ~ )
TOTAL (Also enter on line 10, Recapitulation) $ Lf a I , ',q
(If more space is needed, insert additional sheets of the same size)
REV-~~13 ~X+ (9-00.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
(t1 A-R~rr~ E-T V ~ ~A- RR ~ d<..
FILE NUMBER
~I-Cl( ooqQS-
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
, Sec. 9116 (a) (1.2)]
1. Ll ndQ.. lJu.C',","'O'\ \)Olu..,\ '-'T<:..r- '/31cl.
tOl 5: R\.d~~ Rd..-
~~ll. n~ S:f:>rl Y'l1s PA /7007
d-. Ve.\vc,,- lebo
~lo\ $to r"\e. Chu rch. R~
<!.o..rl~s.\e f>A ('7~I~
t)<'-l,I..\ hie r-
I(~ rei
3. Ve..gTCf.. e""la.. ynQ.n
Id/"f tV. r1; ad\eSex' ReA.
furl~ s/e.. PA 1(0\ 3
p~lA '\ ~ 1-~r-
If g .,cl
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, 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. ~e....
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
)'"\0 n e..
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)
Check No.615514
1V GUIDE
P.O. Box 806
Radnor, PA 19088
Payable . through 62-4
Mellon Bank N.A. (DE), Wilmington. DE 19889 ~
Mellon Bank N.A. (East). Philadelphia. PA '9102
Identitfication Number 4500079
Pay Forty nine and 96/100 Dollars
Date
Nov 05, 2001
To MARGARET BARRICK EST OF
the CoO VELVA LEBO
Order 261 STONE CHURCH RD
of CARLISLE PA 17013
Amount
**$49.96
II. b ~ 5 5 ~ ....11. I: 0 j ~ ~ 0 0 0 .... ? I:
2 "' q 2.... q q ~ II.
DETACH ALONG THIS PERFORATION
SUBS(fRIPTION REFUND
Copies: 052
01 Cancellation
02 Duplicate Payment
03 Overage
04 Duplicate Renewal
05 Over Payment
Type: 01
Amount: $49.96
Identification Number 4500079
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Wasnlna~an
na~lanal~
INSURANCE COMPANY
STATEMENT OF ACCOUNT VALUE
CARLISLE
PA 17013-!142
Washington National
One Presidential Parkway
Post Office Box 9019
Kokomo, Indiana 46904-9019
1-800-866-9922
MARGARET V BARRICK
442 WALNUT BOTTOM RD
~gi~tlif1gJ)~ti/ ..
01/11/01
......___...._......._n_n.
..RelereneeNo.
....-.-,.....-- --,---.
Effective. ..
1,559.95 04/11/01
CONFIRMATION OF TRANSACTIONS
1,575.11
041101
. interest .. DiSab ility
Rate.. . PremJMisc
SUMMARY OF ACCUMULATED VALUE
638.86
INTEREST RATES
936. 25
0.00
MESSAGES
1,575.11
...... ...... .........
Ii."...............
07/11/90
07/11/91
07/11/92
07/11/93
07/11/94
07/11/95
07/11/96
07/11/97
07/11/98
07/11/99
07/11/00
lnterestRate
....EffeCtive..071111DO
4.000
4.000
4.000
4.000
4.000
4.000
4.000
4.000
4.000
4.000
5.000
Most of Washington National's Annuities guarantee current
interest rates for each contract year (WNPlans I and II)
or each "'calendar'" year beginning January 15 (WNPlans II +
and IV). Funds in your annuity earn different interest
rates based on the date deposits were made. The chart
at the left reflects the "'old money'" interest rates
currently in effect for deposits made during each twelve
month period listed in the "'contract year'" column. The
last rate in the column is the "'new money'" rate effective
for any deposits made during the current period.
NOT TO BE USED FOR TAX PURPOSES
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CREMATION SOCIETY OF PENNSYLVANIA
211176
Statement of Goods and Services Selected
Charges are only for items that you selected or are required. If we'are required by law or by a cemetery or crematory to use
any items you have not selected, we will explain the reasons in writing below. If you have selected a funeral that may require
embalming, such as a funeral with a viewing, you' may have to pay for embalming. You do not have to pay for embalming
you did not approve if you selected arrangements such as a direct cremation or immediate burial. Embalming is not required
by law, except in certain special cases. If we char~d for embalming, we will explain why below.
Margaret V. Barrick
For the Service of \ Date 10-20-2001
PROFESSIONAL CREMATION SERVICES
Direct cremation
. ..~" Special 48 hour or weekend cremation service
Medical documents / courier fee
Nationwide guarantee program
Worldwide travel protection program
Private family identification and/or witnessing cremation
at crematory (includes cremation container)
FINAL DISPOSITION
Packaging and forwarding cremated remains
Express mail
Arranging with a cemetery for burial of cremated
remalOS
Arranging, packaging and forwarding cremated remains
to a national or private cemetery for burial
Scattering of cremated remains over land or sea
Burial of cremated remains at sea
MERCHANDISE f
Register book '-)~. ~ROSt
~~p
Memorial folders/prayer cards
Thank you cards 7 C) '1 'K '<-
Do-It- Y({l)a;rlf~iaC~ffl~i ner
Urn #
Cremation container
Urn burial vault
~w\P
~
CASH ADVANCES (We charge you for our services in buying rhese irems)
Cemetery charges
Honorari urn
Certified copies of the death certificate
County coroner cremation approval fee
Flowers
Newspaper placement fee
tJfi'f-SPf-ger eh'M"~lh i ne 1
rat New::; 116
If a cremation container, urn, burial vault or
embalming is required this is why:
$895.00
$195.00
~~
- P~,,'('o-'.<;,; \...
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~~
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$0.00
$20.00
$25.00
.$15.00
SALE PRICE
DOWN PAYMENT
UNPAID BALANCE
$1,150.00
:H,090.00
~6..kfd'0
~ /1-5~.:::?
For atGteliel:Vices only: I hert.by agree thar I have examined rhe above stated irems and found them to be coreecr and according ro the arrangements requesred and I
hereby acknowledge receipt of a copy of this srarement. r hereby represent that r have sufficient assers legy-lIy avail~b~e for paymenr of rhe cash price and hereby agree and
covenant jointly and severally to make pa~ents of $ wirhin days. A late charge o~ I 2 -0 per month amounring 1,8Jl;_ per year is
applied to rhe unpaid balance beginning days from rhe date of rhis agreement. Any additional services or merchandise ordered or requesred after rhe dare of
this agreement will be considered pare of this agreement and the COSt thereof will be reflected on [he final statement.
c-~.da ~~~. .
Purchaser ~
.'
....
Il allftrst
MARGARET V BARRICK
107 S. RIDGE RD.
BOILING SPRINGS PA 17007-9712
1.1111I11I11111I" 11I111I11.111111I1.1111..1.11111I111I11.1111
Page 1 of 3
Relationship With Interest
October 13, 2001 thru November 13, 2001
MiirYill ~i 'y Da. r-i~i\
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Customer Service
1-800-533-4630
Activity Summary
Annual percentage yield earned
Avg. daily ledger balance
Avg. daily collected balance
Interest earned this statement
Interest paid this statement
Interest paid this year
Days covered by this statement
0.457-
$2,532.25
$2,532.21
$1. 00
$1. 00
$55.87
32
Balance on 10/12
Deposits and additions
Checks
Other activity
Balance on 11/13
$2,620.36
1.00
-23.69
-106.15
$2,491. 52
Deposits and additions
Date
DescriptIon
Amount
11/13 INTERESTPAID
-Jf $1.00
$1.00
Checks
· Denotes missing sequence number
Number Date Amount
3202
10/29
$23.69
~
$23.69
Other activity
Date DeSCription
Amount
10/22 ACH DEBIT
CAPITALBLUECROSS INS. PREM 204036771
1230455154BARRICK MARGA20012923359819
,"*,-106.15
-106.15
015626 1
0006.98317452046 050
,
'.<
iii allfirst
End of Day Ledger Balance
Account balances are updated in the section below on days when transactions posted
to this account.
Dille
Balllnee
Balllnee Dille
Blllllnee
Dille
10/12
10/22
$2,620.36
2,514.21
$2,490.52 11/13
$2,491.52
10/29
Click or Call to reorder your checks! Just go to www.allfirst.com to find check
reorder options and select Check Reorder Express(SM). Or, call ServiceLine Plus(SM)
at 1-800-355-8123. It's the easy and convenient way to reorder checks when no name
or address changes are needed. You can change your check choice and order selected
accessories - like planners, covers, and calculators. Access and Convenience -
just one more way that Allfirst is making it easier for you.
The annual percentage yield earned reflects the amount of interest earned on the account
during the statement period and the average daily balance in the account for that period.
The interest rate paid will fluctuate according to money market conditions.
About your Relationship Checking with Interest account. When you maintain an average
daily ledger balance of $1,000 in your checking account; or $2,500 in your checking,
money market and savings accounts; or $7,500 in all related accounts you will not be
assessed the $10 monthly maintenance fee.
Balancing your checkbook. Look on the back of your first statement page for a fast and easy
way to balance your checkbook.
What your icons mean
[
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\
\
60-831871
3~
Date! j
3202
l'lld(}6\
I $1iX6 'rl-
~ V. aJ~ B-oW
442 <fIJaImm qjoU;onv 9U.
6'adMk, gu 170M
140~< ,'Z2&.:5 < j'll 20 <4\..lY3 4\..1.93
Pay to
the order of
ffi ~~--~ ~& ~ ----~ mE"::
~ fff.DAUPHIN D~OSIT BANK AND TRUS~ co.
: A ~URG, PA 17105.2961
I 7l1'-d-'f~-'td-q5-C~ ~~.-€-6 V~ M'
. For -~~<L~%Jb~~---
1:0 1 ~ 100B ~""I: 2 ~ 5 ~lIlb8 ~bll' gg ~ 20 2 Illoo006cf~bgl,1
0006-SB317452046 050
Pllge 3 of 3
For questions about
your statement or
change of address
information, please see
page 2.
, .'
IIIII~IIII~II
JDAP11EM 003064 1
Vendor # U000241677
Vendor Name: MARGARET V BARRICK
Check Date: 12/04/2001
Check No. 0005030004
Voucher ID Invoice Number
U0241677 717-243-4295-086
FINAL CREDIT
PO Number Invoice Date
11/28/2001
Gross Amount
3.21
Discount
0.00
Paid Amount
3.21
-;;y
~~~ }.oO
~ _ ~";),~ l
\.}Y~~ tV'"
~
Customer ReflUlds
Total Gross Amount Total Discounts Total Paid Amount
: .
.
$3.21
$0.00
$3.21
. .
.
.....
.....
Sprint@
Sprint United Management Company
Paying Agent on Behalf of Itself and Sprint Corporation's Affiliates
P. O. Box 7977
Overland Pwk. Kansas 66211
1-877-604-8464
000503000,
56-382/412
12/04/2001
"BPAY'****************3 OOLLARS AND 21 CENTS ****************3.21
PAYTOTJU
ORDU
0.
iiiiiiii
-
iiiiiiii
. !!!!!!!!
00003084 1 AS 0.280 01
**********AUTO**~~~~D~[AADC,~,O ....
MARGARET V BARRICK--':.C:"h"" .-.___
.281 STONE CKJRCH RD .._
CARLISLE PA 17013-8387
VOID IF NOT CASHED WITHIN 180 DAYS
-
=
III:
=
!!!!!!!
Authopfzed Signature
111111111111111111111..11.1..1...11.1.1..1.111.1111.1111.1..11
J~;II ~
.......t a..k all.., ~ A.
v.. W.., 011.. .....
111000 5 0 ~ 0 00 1.,111
-:01., ~ 20~8 21.,-: ~bOOO ~b 21.,~1I1
PHARMERI~ <l~
For Payment:
PO Box 6176
Carol Stream, IL 60197-6176
IF YOU HAVE ANY QUESTIONS CONCERNING THIS STATEMENT OR WISH TO PAY WITH YOUR VISA, MASTERCARD
AMERICAN EXPRESS, OR DISCOVER PLEASE CALL A BIlliNG REPRESENTATIVE AT 800-352-9161
For Comments and lor Concerns:
111 RUTHAR DRIVE
NEWARK, DE 19711-
CUSTOMER NAME
BARRICK MARGARET
PHYSICIAN NAME
DANIELS MICHAEL 0
STATEMENT
DATE
10/31/01
ACCT. NO.
5702-01-03716
FROM THRU DATE! DOLLAR
DATE RXNO. DESCRIPTION QTY. CODE AMOUNT
09/30/01 BALANCE FORWARD 599.96
10/12/01 403533 ILEX SKIN PHO r EC rANT 49.8% P~T OTe 60 6.65
10/17/01 393927 CELEXA 40MG TABLET RX 30 71.65
10/17/01 400948 FLJH~E 40MG TABLET RX 30 8.80
10/17/01 400949 SPIRONOLACTONE 25MG TABLET RX 30 17.10
10/17/01 433981 ULTRAM 50MG TABLET RX 60 55.15
FINANCE CHARGE 9.00
AMOUNT DUE UPON RECEIPT $768.31
CV=CONVERT TR=TRANSFER CR=CREDIT RX T=TAXABLE D=DISCOUNTED N=NON-COVERED
FINANCE CHARGES ARE CALCULATED AT A MONTHLY PERIODIC RATE OF 1.5% (ANNUAL RATE OF 18.0%)
BASED UPON AN UNPAID BALANCE OF 30 OUTSTANDING DAYS OR MORE AS OF THE ABOVE STATEMENT DATE
PHARMERICA <li~
PLEASE RETURN BOTTOM PORTION WITH PAYMENT - Retain top portion for your records
438
PLEASE DO NOT STAPLE CHECK TO STUB
0lC85
AMOUNT
30 60 90+ STMT. ACCOUNT DUE UPON AMOUNT
CURRENT DAYS DAYS DAYS DATE NUMBER RECEIPT ENCLOSED
$168.35 $175.66 $219.05 $205.25 10/31/01 5702-01-03716 $768.31
CUSTOMER NAME
BARRICK, MARGARET
FACILITY NAME
THORNWALD HOME
TO:
MARGARET BARRICK
C/O THE THORNWALD HOME
442 WALNUT BOTTOM RD
CARLISLE, PA 17013-3742
1".111,"111"....11..11...11.1,.,1,1,,1..1.1,1,,1,,1.1,111,1
PHARMERICA
PO Box 6176
Carol Stream, IL 60197
1.11"1/"""111,1.,1".1,11"",111,,,1,11.,1..,1,11.,,1.,11
OIC 85
5702010371600076831000009
P~~ERlCA .~~
...
For Payment:
PO Box 6176
Carol Stream, IL 60197-6176
IF YOU HAVE ANY QUESTIONS CONCERNING THIS STATEMENT OR WISH TO PAY WITH YOUR VISA, MASTERCARD.
AMERICAN EXPRESS, OR DISCOVER PLEASE CALL A BILLING REPRESENTATIVE AT 800-352-9161
For Comments and lor Concerns:
111 RUTHAR DRIVE
NEWARK, DE 19711-
CUSTOMER NAME
BARRICK MARGARET
PHYSICIAN NAME
DANIELS MICHAEL 0
STATEMENT
DATE
07/31/01
ACCT. NO.
5702-01-03716
FROM THRU DATE! DOLLAR
DATE RXNO. DESCRIPTION QTY. CODE AMOUNT
06/30/01 BALANCE FORWARD 153.80
07/08/01 384221 r clt.lanr 1.....I-I-IIINI::OIN.rMENT .. aTC 113 5.00
07/10/01 385277 AMOXICILLlN 500MG CAPSULE RX 30 15.10
07/20/01 394855 ,....-It.ll\/Ir 1....1-1-1 liNt:. GIN 'VI'-''I' .. aTC 113 5.00 ....
07/20/01 395735 VITAMIN C 250MG TABLET aTC 10 .50
07/20/01 395737 ZINC CHELATED 25MG TABLET ... . aTG 10 .50
07/23/01 396554 NEUTROGENA ORIGINAL FORM aTC 1 2.20
07/23/01 396555 ILEXciKIN PROTE\JTANT 49.8%P::>I aTe 60 6.65
07/23/01 396556 ALOE VESTA 2-N-1 OINTMENT aTC 240 8.15
07/25/01 PAYMENT - TBANK yoU 153.80 CR
07/25/01 393927 CELEXA 40MG TABLET RX 30 71.65
07/25/01 394158 ULTRAM 50MG TABLET RX 60 55.15
07/25/01 395812 VITAMIN C 250MG TABLET aTC 60 1.25
07/25/01 395813 ZINC CHELATED 25MG TABLET aTC 60 1.50
07/27/01 400683 LOWSIUM SUSPENSION OTC 360 3.45
07/27/01 400948 FUROSEMIDE 40MG TABLET RX 27 8.35
07/27/01 400949 SPIRONOLACTONE 25MG TABLET RX 27 15.80
07/30/01 394855 CALMOSEPTINE OINTMENT OTC 113 5.00 ,
..
..
AMOUNT DUE UPON RECEIPT $205.25
CV=CONVERT TR=TRANSFER CR=CREDIT RX T=TAXABLE D=DISCOUNTED N=NON-COVERED
PLEASE RETURN BOTTOM PORTION WITH PAYMENT - Retain top portion lor your records
425
PHARMERlCA <ll~
PLEASE DO NOT STAPLE CHECK TO STUB
OIC 445
AMOUNT
30 60 90+ STMT. ACCOUNT DUE UPON .AMOUNT
CURRENT DAYS DAYS DAYS DATE NUMBER RECEIPT ENCLOSED
$205.25 $0.00 $0.00 $0.00 07/31/01 5702-01-03716 $205.25
CUSTOMER NAME
BARRICK, MARGARET
FACILITY NAME
THORNWALD HOME
TO:
MARGARET BARRICK
C/O THE THORNWALD HOME
442 WALNUT BOTTOM RD
CARLISLE, PA 17013-3742
1",111,"111'"'1111"11,"11.1,..1,1.,1,.1,1,1,,1,,1,1,11,,1
PHARMERICA
PO Box 6176
Carol Stream, IL 60197
1,11"11"""111.1"1",1,11",,,111,,,1,11..1,"1,11,,,1,.11
OIC 445
5702010371600020525000004
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STATEMEMT
RETURN UPPER PORTION OF
STATEMENT WITH PAYMENT
l,.'ELV(.i LEBO
261 STONE CHRUCH ROAD
PATIENT'S NAME
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CL.OSING DATE
NEW BALANCE
CARLISLE, PO 17013
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NOTE: Charge. and payments not appearing on this statement will appear on next
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SHOW AMOUNTS
PAID HERE
CHARGES APPEARING ON THIS STATEMENT ARE NOT INCLUDED ON ANY HOSPITAL BILL OR STATEMENT
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EXPLANATION OF ACTIVITY
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PLEASE REMIT PA YMENT
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LAST WILL AND TESTAMENT
OF
MARGARET V. BARRICK
I, MARGARET V. BARRICK, of 1231 Claremont Road, carlisle,
Cumberland County, Pennsylvania, being of sound and disposing mind,
memory and understanding, do hereby make, publish and declare this
as and for my Last will and Testament, hereby revoking all other
wills and codicils heretofore made by me.
FIRST: I direct that all my just debts and funeral
expenses, including my grave marker, shall be paid from the assets
of my estate as soon as practicable after my decease.
SECOND: I give, devise and bequeath the residue of my
estate, of every nature and wherever situate, to my children, VESTA
CALAHAN, VELVA LEBO, and LINDA DURHAM, equally, provided that the
share of any child who predeceases me or dies on or before the
thirtieth day following my death, shall be distributed to her
issue, per stirpes, living on the thirty-first day following my
death, and in default of any such then living issue, such share
shall be added to the shares for my other children.
THIRD: I direct that all taxes that may be assessed in
consequence of my death, of whatever nature and by whatever
jurisdiction imposed, shall be paid from my residuary estate as a
part of the expense of the administration of my estate.
FOURTH: I nominate, constitute and appoint my Daughters,
VESTA CALAMAN, VELVA LEBO and LINDA DURHAM, Co-Executrices of this
my Last will and Testament.
FIFTH: I direct my Executrices shall not be required to
give bond for the faithful performance of their duties in this or
any other jurisdiction.
IN WITNESS WHEREOF, I have hereunto set
this, my Last will and Testament, consisting
pages, each identified by my signature, this
-Tulv , 1988.
/
my hand and seal to
of two~2) typewritten
Y S- t. day of
,~ .,. '
- '17 .' ., /./ x-/ ~> .. . . ,.. (
/ I/:~j ,<--,4,-,-,1.<--/ ;/ '^:--7"'':'<'l./L.--, e-/";( SEAL)
- M~rgaret v. Barrick
~ /
"
- Page 2 of 2 Pages -
~.. '-
Signed, sealed, published and declared by the above-named
Testatrix, Margaret V. Barrick, as and for her Last will and
Testament, in the presence of us, who, at her request, in her sight
and presence, and in the sight and presence of each other, have
hereunto subscribed our names as witnesses~
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COMMONWEALTH OF PENNSYLVANIA)
SSe
COUNTY OF CUMBERLAND
I, MARGARET V. BARRICK, 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 and Testament; that I signed it
willingly; and that I signed it as my free and voluntary act for the
purposes therein expressed.
Sworn or affirmed to and
BARRICK, the Testatrix, this
1988.
ackno~edged before/me by MARGARET V.
..<.s:- 1 day of 7?t V
/
EAL)
TAYLOR P. ANDREWS, NOTAIIY FU~IIC
CARLISLE BOROUGH, CUlaEllAHiJCOuHTv .
IY COMMISSION ElPIIlES DEC. 2J.C199'1' . ,.'
.ember. 'ennsrlvania Association iJt . M(,~.ri.s. .:.:
COMMONWEALTH OF PENNSYLVANIA)
SSe
COUNTY OF CUMBERLAND
)
We, RONALD E. JOHNSON and , 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 and Testament; that MARGARET V. BARRICK
signed willingly and that she executed it as her free and voluntary
act for the purpose 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 18
or more years of age, of sound mind and under no constraint or
undue influence.
Sworn or affirmed to and subscribed to before me by RONAL~E.
JOHNSON and 5~ ~ift;t'l.f{ S';::>.t.{hOY/f , witnesses, this 2.~ '( day
of -JU I Y , 1988. !
(SEAL)
"'---.
TAYLOI P. ANnr.r.:~', ~.:'J!'^ll";, ?USlIC ,
CARLISlE aORoue.:. .:. '.:~~::IU.AfI;;\ COUNTY .
I' COIllSSIOfll (~:,.IHS Df.C. n 1991
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