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HomeMy WebLinkAbout01-1020 PETITION FOR PROBATE and GRANT OF LETTERS Estate of - El eo f'qe. F. F="~v be r-- also known as No. To: 21-01-1020 Register of Wills for the I Deceased. County of in the Social Security No. i (~ -- I ~ -/ )<0'1 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 execut\'~ in the last will of the above decedent, dated ,\ - II - and codicil(s) dated named , 19~ (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in C l-\. 'f'v"\ \ h \ ~ last family or principal residence at . er~~ .{~ A (list street, number and muncipality) CCt. or \ "S( ere Cl Q ~ at Dt~I~{IC~en erf'tQ(-]CJAearftb ~'led Oe+o b-e , 19 .~~ I. 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: 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: $ ~ 6)000100 $ $ $ WHEREFORE, petitioner(s) respectfully ~e uest(s) the probate of the last will and codicil(s) presented herewith and the grant of letters TIc... VY) e. V)-t theron. (testamentary; administration c.La.; administration d.h.n.c.La.) '" - ~ ~_ -kct-th\e. ~V\ Ie V\I\ \J" Yl ~'5' ',0 1 ~ Vt \/\CLVeM C \v-C\ e "8.g M e ~ l.A .'V\ \C ~--, b u..\r(~ P A ~'.:::' .' 1-10~ 3~ ~..... so ~ c: bI) Vi -k(Ut~ I,V\M~ OATH OF-PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA I ss COUNTY OF CUMBERLAND J 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. Sworn 10 or affirmed and subscribed . t<!,~~ ~ before me this 5th day of ~ ~ - ;: ~ ~ No. 21-01-1020 Estate of GEORGE F FAWBER , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW NOVEMBER 6, ._.. _._~~_1-001, in c0n~ideration ( . L"t.$:~!:\..';.f:'. f)Il the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated NOVEMBER 1]. 1996 described therein be admitted to probate and filed of record as the last will of GEORGE F FAWBER and Letters TESTAMENTAR Y are hereby granted t~THLEEN TEMPLIN '77;h~yar;fD~f((j /ft/ ~~y Re ter of WI S FEES 60.00 3.00 5.00 30.00 98.00 Probate, Letters, Etc. ......... 1~~P Certificates( ).......... Renunciation ................ x-pages $ $ $ $ TOTAL _ $ A TIORNEY (Sup. Ct. I.D. No.) ADDRESS Filed PHONE :105.805 REV 9/11.6 This is to certify that 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. No. ~ fi(~r- Local Registrar Fee for this certificate, $2.00 p 7744542 ocr 2 3 ZOO~ Date :J Rev. 2117 COMMONWEALTH OF PENNSYLVANIA · OEPARTMENT OF HEALTH · VITAL RECOROS CERTIFICATE OF DEATH 1. FJta.nkl-i..n Fawbvr. UNDeR 1 YEAR UNOER 1 DAY MonlIle Oeya Huon! MInu1.. SEX 2. NAME Of' DeCEDENT (for". Uod<lIe. Las, 8/RTHPI..4CE (Cly and S- 01 fcr"9' CounuVl HaJr.Jt,U,bWL P =~IO .. 801 N. Ha.novVt S~eet ,.. CMl.i.6le PAl 70 1 3 FRHER'S NAME IF... Uo<ldIe. LaII) 17a. SlaIe PA Old decedeN _..a -.hip? 174..0 :;...~=oI CMl-iAle MOTHER'S NANI! ,F..l. Moddle. ..-. Sufnamel MARI1Al STRUS . ........, Ne_Manied. ~. Olvorcecl~ 14. MMJt ..i.ed 17C.O ......~......ift hIP nit. cilyIllonl. 21c. 24. O. MAT I: Enter... ___, injuries or ~ which c:eus4Kllhe ..ath. 00 l.iM only ..... c:a.- Oft __..... ~ool . s/loc:k or _'a"'. 21. ,Awox- ''''''''''_n :..... _ dHIII I I I PART n: Olhac ....... ---... -'IIUlInDlO cIPlII.1IUl nul raaulUng in ... \IIIdIllying _ giwW in PART I. (~f,'IJVP.~oJ~ j0t:'~ A,4-t~,'t,U5('~~~"''--L ~d ----_._--~---- ---- - --~-- j)) ~, f.( t~'1 Ill? IA/-tJ!J1At 11~, , '-'~ '-" L Prte. LA vtA-fH1.~ "- DUE 10 COR AS A CONSEQUENCE OF): lb. c. ... DUE 10 COR AS A CONSEQUENCE OF): DUE 10 toR AS A CONSEOUENCE OF): *5 1M AIJ10PSY WERE AUlOPSY FINOlNGS MANNER OF DEATH PEAFOAuEO? AIIIlU'8LE PfIlOA 10 COMPLETION OF CAUSE ~ Of'DERH? ........ Hamic:ida Acaclenl 0 '"-ndinlI~ ... 0 No .0 No~ Suk:ldII 0 Could_be_ DATE OF INJURY (Moolll. Day. _I TINE OF tNJUAV INJURV I<< WORK? DESCfll8E HOW lHJUAY OCCUAflED. ... :tA. CEJIT....lC/l<<:k onty or>aI 'CEJlTII'YING PHYSICIAN (PhySlCl8ll ~ caused _ _ anolN< \lhYSlC...-haspr<lnCllJf'Ced dealh anocamplelaO"em 231 _........ot...'lInowledge...1haoc__Io...c...M(.'___.._....................................................... . n. o o o . . ~ Pl..4CE OF INJUflY . AI honle.latm. SltH!. lactory. ()Iflce building. ate. tSpeolv) 3Oa. ... 0 NoD 'UElMCAL EXAIotIHEAlCORONER On !he bMla of ...amlnetlon andfor Investigation, in my 0911\101\. deatll occurfad atlha Urna. da'...nd placa. and dualO Ih. c.use(.,and 31.~ a. ata'ed.. . . . . . . . . . . . . . . . ''; . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . REG 'S SIGN 0Jf/1&/ / o -.;..o~1 'PRONOllNCtNG AND CEJlTIFY\NO I'HYSlCIAN (f'hvsoa;ln boIh pronounc:ong _ Mld cllf1llY'"V 10 causa d dea"'l To" .....01..., 1InowtacIge.....occ..... at......... clala. _ p\ac.. _due to \llacauM(a'.nd manne,.. .................... ..... / ;','6t:;'" u. W.l II,., . \: LAST WILL AND TEST AMENT OF GEORGE F. FAWBER I, GEORGE F. FA WBER, residing at New Cumberland, Cumberland County, Pennsylvania, do make, publish and declare this to be my Last Will and Testament, hereby revoking all Wills and Codicils by me at any time made. ITEM I: I direct that all inheritance and estate taxes becoming due by reason of my death, whether such taxes may be payable by my estate or by any recipient of any property, shall be paid by my Executrix out of the property passing under ITEM VI of this Will, as an expense and cost of administration of my estate. My Executrix shall have no duty or obligation to obtain reimbursement for any such tax so paid, even though on proceeds of insurance or other property not passing under this Will. In the absolute discretion of my Executrix, such taxes may be paid immediately or may be postponed on future or remainder interests until the time possession thereof accrues to the beneficiaries. Page 1 ~ " ~ ' ITEM n: I direct my Executrix to pay the expenses of my last illness and funeral expenses from the property passing under this Item VI of this Will as an expense and cost of administration of my estate. ITEM III: I give and bequeath all of my masonic jewelry to Craig Fawber. ITEM IV: I give and bequeath the sum of five hundred dollars ($500.00) to the Community United Methodist Church, 16th and Bridge Streets, New Cumberland, Pennsylvania. ITEM V: If I predecease my wife, Dorothea C. Fawber, I give and bequeath to her absolutely all of my remaining household furniture and furnishings, books, pictures, wearing apparel and all other articles of household or personal use or adornment (not including cash or securities) together with any existing insurance thereon. If I do not predecease my wife, I make said bequest to my children Craig, Kathleen and George, in equal shares. ITEM VI: I devise and bequeath the residue of my estate of every nature and wherever situate, including any policies of insurance, including all lapsed legacies and devises, as well as any property over which I may have any power or Page 2 k t . appointment, to my wife, Dorothea C. Fawber, providing she shall survive me by thirty days. Should my wife, Dorothea C. Fawber predecease me or die on or before the thirtieth (30th) day following my death, I devise and bequeath the residue of my estate of every nature and wherever situate, to my then living children, Craig, Kathleen and George in equal shares. Should any of my children predecease me or die on or before the thirtieth (30th) day following my death, I devise and bequeath said child's share to that child's then living children, in equal shares. ITEM VII: No interest of any beneficiary under this Will or any Codicil hereto shall be subject to anticipation or voluntary or involuntary alienation, and the personal receipt of such beneficiary shall be the sufficient and only discharge of Executrix unless otherwise provided herein. ITEM VIII: My Executrix shall have the following powers in addition to those vested in it by law applicable to all property, whether principal and income, exercisable without Court approval and effective until actual distribution of all property: Page 3 k Page 4 (a) To retain any investments I may have at my death, including specifically those consisting of stock of any bank even if I have named such bank as my Executrix herein, as long as my Executrix may deem it advisable to my estate so to do. (b) To vary investments, when deemed desirable by my Executrix, and to invest in such bonds, stocks, notes, real estate mortgages or other securities or in such other property, real or personal, as the Executrix shall deem wise, without being restricted to so-called "legal investments," and without being limited by any statute or rule of law regarding investments by fiduciaries. (c) In order to effect a division of the principal of my estate or for any other purpose, including any final distribution, the Executrix is authorized to make said divisions or distributions of the personalty and realty partly or wholly in kind. In the event a division or distribution is made in kind, such division or distribution shall made ~tJ1fi / " Page 5 at the fair market value of the property at the date of division or distribution. Should it appear desirable to partition any real estate, the Executrix is authorized to make, join in and consummate partitions of lands, voluntarily or involuntarily, including giving of mutual deeds, recognizances or other obligations, with as wide powers as an individual owner in fee simple. (d) To sell either at public or private sale and upon such terms and conditions as the Executrix may deem advantageous to the estate, any or all real or personal estate or interest therein owned by the estate severally or in conjunction with other persons or acquired after my death by my Executrix, and to consummate said sale or sales by sufficient deeds or other instruments to the purchaser or purchasers, conveying a fee simple title, free and clear of all trust and without obligation or liability of the purchaser or purchasers to see to the application of the purpose money or make inquiry into the validity of said sale or sales; also, to make, execute, acknowledge and deliver any and all ~ " Page 6 deeds, assignments, options or other writings which may be necessary or desirable in carrying out any of the powers conferred upon my Executrix in this paragraph or elsewhere in my Will. (e) To mortgage real estate, and to make leases of real estate. (f) To borrow money from any party, including the Executrix, to pay indebtedness of mine or of my estate, expenses of administration or inheritance, legacy, estate any other taxes, and to assign and pledge assets of my estate therefor. (g) To pay all costs, taxes, expenses and charges in connection with the administration of my estate. (h) To vote any shares of stock which form a part of the estate, and to otherwise exercise all the powers incident to the ownership of such stock. fk- " (i) In the discretion of my Executrix, to unite with other owners of similar property in carrying out any plans for the reorganization of any corporation or company whose securities form a part of the estate. G) To do all other acts in the Executrix's judgment deemed necessary or desirable for the proper and advantageous management, investment and distribution of the estate. ITEM IX: Any person who shall have died at the same time as I shall have, or in a common disaster with me, or under such circumstances that it is difficult or impossible to determine who died first, or within thirty (30) days of my death, shall be deemed to have predeceased me. ITEM X: I nominate, constitute and appoint Kathleen Templin as my Executrix. My Executrix is specifically relieved of the duty or obligation of filing any bonds or other security. Page 7 ~ .' IN WITNESS WHEREOF, I have set my hand and seal to this, my Last Will and Testament, consisting of this and the preceding seven (7) pages at the end of each page of which I have also set my initials for greater security and better identification, this I 1 1ft day of November, 1996. ~~.dd.H~AJ /' ORGE F. FAWBER (SEAL) Page 8 ~ .' We, the undersigned, hereby certify that the foregoing Will was signed, sealed, published and declared by the above-named Testator as and for his Last Will and Testament, in the presence of us, who, at his request and in his presence and in the presence of each other, have hereunto set our hands and seals the day and year first above written, and we certify that at the time of the execution thereof, the said Testator was of sound and disposing mind and memory. , ,4. L...,q' .dff -- (SEAL) , Residing at #~~/dJ~~~ / ~. oK~.9'~EAL) Residing at ~cA.QMA. ~ f~ 0' ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND I, GEORGE F. FAWBER, Testator, 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 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 acknowledged before me, by GEORGE F. FA WBER, the Testator, thi~111iday of November, 1996. ~~~Lu(~ No~ liliLuY (Official cap city of officer) (SEAL) Notarial Seal Susan J. Witmer, Notary Public Harrisburg, Dauphin County My Commission E~ires Feb. 16, 1998 l',::;mber, PennsY~Jania Association of Notaries , · . J AFFIDA VIT COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND , We, ~. .e..,/Io:P 7J.A/....~ ~, -- ) ewtJpJ I ,., , 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 Testator sign and execute the instrument as his last Will; that he signed willingly and that he executed it as his free and voluntary act for the purposes herein expressed; that each of us in the hearing and sight of the Testator signed the Will as witnesses; and that to the best of our knowledge the Testator was at that time 18 or and K a....f h I (.lli. r: more years of age, of sound mind and under no constraint or undue influence. Sworn or affirmed to and subscribed to before me by t:. AfAl/4"~ ~.el--r~~and -Ka..fh I ftll\ F. Tlinf II n~ witnesses, thi!lJlltday of November, 1996. ./~~-ra/r Witness ~~!3.~ Witness (SEAL) 3L L1\t'iJY\ }: I VI ~ tJ~~ (Official c acity of officer) Notarial Seal Susa~ J. Witmer, N. otary Public Harnsbur9t Da,uphin County My CommissiOne_ea Feb. 16, 1998 M0n;ber, Per.!1S',"'I$1ia~ of Notaries ~ --- CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Will No. q eor:3 t ID ugJCl 02cot- \O;;W F. FQV\llo~r Name of Decedent: Date of Death: Admin. No. To the Register: I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of thet.J!rS' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on J I f 0 , : Name Address l'hu. rch of 6DdHom '\j Do ro +It\ eG\, . C, F Q w~e \I ~D, N. i1l'A.\I\OV~"'" St. C'o..v- hs Ie f-A ) '"o,~ C fQ\'<j ~ . tt=-~w bf r- p. 0 , ~O1-- ~3 <& G fc\V\+hQ Wl1 P-A I. t) J..-l Notice has now been given to all persons entitled thereto under Rule 5.6(a) except Co ('f\ fY) u f\ \+ lj lA n \ -t cd M e-\.hod IS-+ \\ \ ,~\() , C hur~h ct<Ct~ ?-1'~ Date: Signature Name 1<O\-\-h \ e..e ': F tf. Vh () I \ ~ Address '101 SUY\ hew ~'() C \ r. M L\\f)(AV\ \ t~bLAY9 I Pl\ 11 D SS Telephone (} 11) 1 (p ~ ... 1', :J-lf- Capacity: ~ Personal Representative _Counsel for personal representative /7-jtj_g BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISE"ENT~ ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX ~:~~~~1:;r30i DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 01-21-2002 FAWBER 10-19-2001 21 01-1020 CUMBERLAND 101 *' )-~ REV-1547 EX AFP [12-00) GEORGE F Allount Rellitted A",~;'::'~;'~,*lJi'!,-"i':'~ ' .j-:, ~ '~~ '-'~rl~;~~_;,~~t - ''"" ~f ~~lry-K 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 ~ RE'Y=is4j-Ex-AFP--fli:oiir-NoTicE--oF-'rtiHEiiiTANci-i'-Ax-'A-PPRAisEMEN:r;-AiioWANCE-oi----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF FAWBER GEORGE F FILE NO. 21 01-1020 ACN 101 DATE 01-21-2002 ) CHANGED 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~ ALL returns assessed to date. ASSESSMENT OF TAX: IS. Allount of Line 14 at Spousal rate (IS) 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 RETURN WAS: (X) ACCEPTED AS FILED 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. Hortgages/Notes Receivable (Schedule D) S. Cash/Bank Deposits/Hisc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets (I) (2) (3) (4) (5) (6) 0) .00 .00 .00 .00 25,451.96 .00 .00 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adll. Costs/Hisc. Expenses (Schedule H) (9) 10. Debts/Hortgage Liabilities/Liens (Schedule I) (10) 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 .00 .00 (II) (12) (13) (14) NOTE: 25~451.96 X 00 = . 00 X 045 = .00 X 12 = .00 X 15 = NOTE: To insure proper credit to your account~ subllit the upper portion of this forll with your tax paYIIBnt. 25~451.96 00 25~451.96 .00 25~451.96 (19)= .00 .00 .00 .00 .00 TAX CREDITS: PAYHENT RECEIPT DISCOUNT (+) AHOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) TOTAL TAX CREDIT .00 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 $l~ 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.) ( STATUS REPORT UNDER RULE 6.12 Name of Decedent: G, eor~ e Date of Death: JO II C\ \ 0 , Will No. d.l-Ol- IO~o F. i=oJNber Adm; R. tlo. Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State wh~her administration of the estate is complete: Yes ~ 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 personal representative file a final account with the Court? Yes No ____a 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:~ ,cuUtw- ~ 1'~ 5i nat.ure KC\.+h I f"t: VI F. ~mp II n Name (Please type or print) 707 SUYI ho.,\fen (111.1 0e-('hCtn IC-sbu m Address fA /7()S~ ) {7/7 } 7(P0-77~Li Te 1. No. Capacity: ~ Personal Representative Counsel for personal representative (MAH:rmf/AM3) ( STATUS REPORT UNDER RULE 6.12 Name of Decedent: (}eorg€ Date of Death: l D , \ q \ 0 \ Will No. 2-1 - 0 , - 0 toW F fuwber' Admin. No. Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1 . State~wpether 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 per~QPal r~nresentative 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 s~ate 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. .;:j I c..J ~-, c:::J c) +(~ ?, /foAM sJ~_A " Signature ~Yrvr --y~ ~ 'e,t1!\ F: --rem gll v) Name (Please type or p~int) 1 07 Su n ~lMUI\ C'r. fU C "'/1 fA 110 E 6 Address ~) D 11) 110b - '--(7 ~f Tel. No. Capacity: X Personal Representative DateG .1~} y ~) = ...... ".-.... ','~:!' 0... :.'''' <;,! ~~ (1: """;'1 <~ .....~ u ~ p (U ,;,. ..Q -~ s:: m= aU Counsel for personal representative (MAH:rmf/AM3) .~ REV-150G~~ (6-00) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 W I- ~~1Il uD::~ wo..u :J:oo uD::..J o..a1 0.. <I: I- Z W C W U w C INHERITANCE TAX RETURN RESIDENT DECEDENT DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) F 0... W b e r' C t:"Ot( e r::-. DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) 10.. J q -0 J () "7 .- .3 0 - ~ (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) FtA vv be r Do (ot h f" (..( C B 1. Original Return D 4. Limited Estate D 6. Decedent Died Testate (Attach copy of Will) D 9. Litigation Proceeds Received D 2. Supplemental Return D 4a. Future Interest Compromise (date of death after 12-12-82) D 7. Decedent Maintained a Living Trust (Attach copy ofTrust) D 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) C- 1 "7 - 'Cf - 8 FILE NUMBER 2..1_0f o O;CO COUNTY CODE NUMBER YEAR SOCIAL SECURITY NUMBER Iq~ - J) 7~O THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER j g 3 - I ~ - 7~O ~ D 3. Remainder Return (date of death prior to 12-13-82) D 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes D 11. Election to tax under Sec. 9113(A) (Attach Sch 0) z o ~ ..I ~ t:: 0.. <( U w 0:: z o ~ ~ ~ 0.. :iE o u >< ~ NAMka +h I e FIRM NAME (If Applicable) F. TfvVl 1/ yj COMPL~TE MAILING ADDRESS f)_ 70 1 Sq Y) ha~('c t'l l i r t I -e. ~(eC hCn'l / C--6 bu. rg ,-PA 7D55 TELEPHONE NUMBER 111 - lbb'l f 'd-Y- 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) (1) (2) (3) (4) (5) ~5.Y61.q~ op :=: (,;';" ::f""::; V".,.. ';':1' !~T-" d - :0 CD c) () """' 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) D Separate Billing Requested (6) c:::J CJ A . ~ ~ J-j 5 (~R (p N o .0> 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) (7) Jb- J-j61.q~ CJb (19) 00 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) 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 Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) ~5. 451 .9lP x.O _ (15) 16. Amount of Line 14 taxable at lineal rate x.O _ (16) 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 I" REV-1508 E~ + (1-97) ESTATE OF SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY 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. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER ITEM NUMBER 1. DESCRIPTION (he~/<-I{)'J QCCOu.nL VALUE AT DATE OF DEATH ()5, '--I 5/q b TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) REV-1513 EX+ (9-00) .". " SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER RELATIONSHIP TO DECEDENT NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. J)o(otht'~ L. FO.lI\J be, SpOLt S e. AMOUNT OR SHARE OF ESTATE I OD ?:> 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. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II - 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)