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Form No. RCC.62 (4-71) THIS FORM REQUIRED IN ALL ESTATES WITH GROSS ASSETS UNDER '10,000. UNDER SECTION 701 OF ACT OF JUNE 18. 1..1.
EFl"ECTIVE IANUARY 1,1962. (FILE IN DUPUCATE WITH COpy OF WILL ATTACHED)
*'
OFFICE OF THE REGISTER OF WILLS
3-2/-11
.
County of . . . . . .C.Ul'fU3.ERLALJP. . . . . . . . .
:V:~:rg,~r;.~.q. f".e.q~r.l1?~.t:.~. .l'J?-nc:y. .r'1~;L'p'E;~.~~... of ~+.4. .I:I9-.~=!-;L.t.?~. .~t;r:~C?~.". 9.cg>;L.:i)'?J.f.". P.E1:...
(Nune) (Addr_)
being duly____n_m!?_~~E_~mn_nnm___.according to law, deposes and says thathwis thc_E.x.$.Q1l_t.;r.i_Q_~.s..__mmnum._mm_m_._
(Exec., Adm., L__. ElC.)
of the estate of __mN.E}_t.t.;L~nJ~.~.ugb.srl;,"Jj~.9XLmm._. whose last residence was ..5_0_.J1QQ.r-elanduAv.:enu.e.~--nmn.m
(No.) (Street)
Qar.li-.s.ls;.~..'p.g".mm.mmnnmn.deceased, and that the whole of the estate of said decedent, who died .A..ug.ustu2.7.-".m19 7 8 .
(CitY, Borough or Township) (Date)
consisted of:
REAL PROPERTY
REAL PROPERTY IN PENNSYLVANIA. WITH STATEMENT OF MORTGAGE ENCUMBRANCES UPON EACH PARCEL AT DEATH OF DECEDENT,
WHERE PROPERTY HELD AS JOINT TENANT OR TENANCY BY ENTIRETIES, GIVE NAMES, ADDRESSES A:tCm RELATIONSHIP OF OTHER OWNERS.
Real Estate Estimated
N 0 N E Value
Personal Property
/"
l. Miscellaneous nersonal nronertv 1$ 100.0'0
2. 19" natural Dastel mink stole. actual sale nrice 200. nr(/
3. 14 K yellow gold ring with 2 ad.i oining diamonds. see attached
/
appraisal of Elizabeth Schiffman 225.00
4. 14 K vellow gold band. see attached aDPraisal of Elizabeth
/
Schiffman 20 00
S. Checkinp' ::!ccollnt: #lQ2.1 n~247. R r 1 t: 'h T\T", t- -i r\ Y\ '" 1 'R::! Y1 k-
~.s62.47; /'
Carlisle. Fa.. see attached letter
6. Todd Memorial Home, room refund 130. oo.~
4.237.47
NOTE: You may expedite the processing of this return by filing with it, and as a part of the return,
letters from financial institutions or mortgage holders, certifying to amounts on deposit or owed by the
decedent as of the date of death. Such letters must be signed by a responsible officer of the financial
institution or mortgage holder and indicate clearly amounts of principal and interest in the decedent's
account at the date of death and the type of account, account number and the exact name or names in
which the account is registered. x
Jointly Held Property Estimated
Value
!
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Transfeu within TWO YEARS Prior to Death
That at the time of death there was no safe deposit box registered ih decedent's individual name, or jointly with, or as agent or deputy of
another, or in decedent's individual name, with right of access by another as agent or deputy, with the exception of the following:-
NAME AND ADDRESS OF BANK OR OTHER INSTITUTION
IN WHICH DECEDENT RENTED A SAFE DEPOSIT BOX
THIS SAFE DEPOSIT BOX RENTED
IN NAME OR NAMES OF
RELATIONSHIP OF JOINT
HOLDERS TO DECEDENT
Commonwealth National Bank
Sharon Branch
665 North East Street
Carlisle
Penns lvania 1 01
BENEFICIARIES
RELA TIONSHIP SURVIVED AGE OF LIFE
BENEFICIARIES AND ADDRESSES (If step-children or DECEDENT TENANTS OR INTEREST OF
(State full names of all and their addresses who have ilIegitimate children STATE YES ANNUITANTS BENEFICIARY
an interest, vested, contingent or otherwise, in estate.) are involved, set OR NO AT DEATH OF IN ESTATE
forth this fact.) DECEDENT
See atr!:lr>n<=>d list
DEBTS AND DEDUCTIONS CLAIMED
List first five items in the spaces so provided, observe notations thereon, and instructions.
DEBT OR CLAIM NATURE OF SAME
AMOUNT
Funeral expenses paid
$
Family exemption (will not be allowed unless
decedent died residing with a spouse or children.)
Administration Expenses *
Counsel fees *
Fiduciary
commission *
(*) See Note below
Total
Note: The estate agrees to advise the Register of Wills if the amount actually paid in settlement of any fee, commission 01' debt is greatel'
01' less than the estimated amount claimed and allowed. _./. . .(5. 1~../ ~_
. '~t' .. .').~.~~"~.. '. ...... .., .......
, %ecutor~lft ~
I
~/?. Y{rp....... .... .~r.9-~E.=.~ -'.. .~I}.q-,.. A9.q~=!-;r:~.
(Street Number)
One Irvine Row
C.ar.lisle.,. .P.ennsy.ly.ania.. .17.0l3....
(City or Town and State)
Subscl'ibed a1 sworn to before me this. . . . . . . . . . . . .. . . . . . . . .
.... .Q.((Lt...:.... day of . mOJL~. 7.9
. ~.~~...~) .... -P~ ~n( VUJ..J-i::Q....
MERLE. MARHEVKA, No;~r~' p:bik~
(:arl;sl~, umberlond County, Po.
"AI" r ---:..:- i' ~if" '- ~
Having been duly sworn according to law, I do hereby certify that the above appraisement is made in conformity with law on this
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . day of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ., 19. . . . .
........................0..............0... .............. eo.o
Apprllioer
In the event that any future interest in this estate is transferred in possession or enjoyment to collateral heirs of the decedent after the
expiration of any estate for life 01' for years,the Commonwealth hereby expressly reserves the right to appraise and assess transfer'inheri-
tance taxes at the lawful collateral rate on any such future interest.
REPORT OF THE REGISTER OF WILLS
I, the undersigned duly elected Register of Wills in and for. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. County, Pennsylvania, do respectfully
report that I have allowed debts and deductions in the amounts claimed by deponent, except as to those items where a greater or lesser amount
is set fort~ in the last column to the right in said schedule above, which greater or lesser amount represents the sum allowed as a deduction.
Dated: .............................................
...............................................0..... .
Register of Wills
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