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Form No. RCC-62 (6-70) THIS FORK REQUIRED IN ALL ESTATES WITH GROSS ASSETS UNDER 110,000, UNDER SECTION 701 OF ACT OF JUNE I', IMl,
EF'P'ZC'TIVE .JANUARY 1, 1912. (FILE IN DUPIJCATE WITH COpy OF WILL ATTACHED)
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OFFICE OF'THE RI'GISTER OF WILLS
SUPPLEMENTAL
County of ,C!JJl\b,~l,"land. . . . . . . , . . . . . . .
Adam R. Heberlig R. D. 1 Newburg, Pennsylvania
..,.....................................,........ of ,..............................................
(Name) (Addreu)
sworn Executor
being duly __nnn_mhnmumum____m___according to law, deposes and says that he is the mm---nn_____nh___m-.Uhm___mhnnuhnuu
(Ex~c., Adm_. Lq:a~. Etc.)
A. Ethel Heberlig ,36 North Earl Street
of the estate Of___Hn__nm_nnn__uh_mn_____nm___..nm___uu whose lase residence was----iN;;~j--nh-.Un--m.h-n-is-t~j._nn----hn--m---
...~h!pp-~n.~!:>lc1?:&.,nJ?Anm__..nm_deceased, and that the whole of the estate of said decedent, who died mQ~!:~~ll.!.}QL!~78
(City, Borough or TownshIp) (Datt')
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 AND RELATIONSHIP OF OTHER OWNERS.
- Estimated
Real Estate Value
NONE
.
Personal Property
2 ~l (ho..~1'nwn..Bank PennSYlvania Common stock @
76.00 per share 152.00
~
.
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. .
Jointly Held Property
Estimated
Value
NONE
TafAL
j
,
I
,
,
I
I
I
I
I
I
~
,
i
I
Transfers within TWO YEARS Prior to Death
NONE
152.00
That at the time of death there was no safe deposit box registered in 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:-
e sbur
THIS SAJo"E DEPOSIT BOX RENTED
IN NAME OR NAMES OF
I RELATIONSHIP OF JOINT
HOLDERS TO DECEDENT
NAME AND ADDRESS OF BANK OR OTHER INSTITUTION
IN WHICH DECEDENT RENTED A SAFE DEPOSIT BOX
Adam R. Heberli
SOIl
17257
BENEFICIARIES
RELATIONSHIP SURVIVED AGE OF LIFE
BENEFICIARIES AND ADDRESSES (If step.-children or DECEDENT TENANTS OR INTEREST OF
(State full name. of all and their addre.... who hay ilJegitimate 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
~~~~geM~. B~n~son, .500 S~d Bank . ; -1'; ~ .
"ae
Eugene D'D~eb~1i!a, Box 233 "ae I. ; -I'~ _ T
Glen F. Heber11~i Box 233 Grandson ves Snecific Le"atee
Danboro PA 18 6
Linda M. Plasterer,.R.1~?A~ v..e I. "'~ - .
Gra
Vale n. Plasterer, K. ~':'?~n v... '.c~ _ .
Np.whnrg, Pp.nm'ylvan; ~
John C. Davidson Grandson yes Specific Legatee
Adam R. Heberlig, R. D. 1 "'nn "... , ,~_.
Np.w~"r1i PA 17:MO Box 233
t:lanfreo GpAH~~~nig, "'0" ves ,-- i ~"T"V
~~~t~ce E. Davj.dson (Mpxrs) r v... . . , a.....
V1V1an G. Plasterer, K. V. I ,,-~ . .
NAWhl1'rg, PA 171AO
.-
I
RESIDENT DECEDENT DEBTS AND DEDUCTIONS CLAIMED
OTE: 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 agl'ees to advise the Register of Wills if the amount actually paid in settJement of any fee, commission or debt is greater
or less than the estimated amount claimed and allowed.
80
.... "....."...".. ". 19....
crk.:p?.~~...;,..........
(EXecutor-A~~i~is~i ..
Subscribed and sworn to before me this. . . . . . . . . .
. .R. . D.. .1.......................................
(Street Number)
1931
c...
. .~_bw:g.. .PtUlM11Yania. ...... ... ......... .
(City or Town and State)
Having been duly sworn to Jaw, I do her~by certify that the above appraisement is made in conformity with law on this
. . . . . . . . . . . . . . '.' . . . . . . . . . . . . . . . . . . day of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ., 19. . . . .
........................................... ..................
Appraiser
In the event that any future interest in this estate is transferred in possession 01' enjoyment to collateral heirs. of the decedent after the
expiration of any estate fol' life 01' for years,the Commonwealth hereby expressly reserves the right to appraise and assess transfer-inheri-
tance taxes lit the lawful collateral rate on any such future intel'est.
REPORT OF THE REGISTER OF WILLS
I, the uhdersigned 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 forth in the last column to the right in said schedule above, which greater or lesser amount represents the sum allowed as a deduction.
Dated: .............................................
. . . . . . . . . . . . . . . . . . . Regi~ie'r' ~i wiil~ . . . . . . . . . . . . . . . . . . .