HomeMy WebLinkAbout08-10-88
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INHERITANCE TAX RETURN
RESIDENT DECEDENT
(TO BE FilED IN DUPLICATE
WITH REGISTER OF WillS)
21 78 665
REV-1500 EX+ (6-85)
.... .... 81 $URI 1.0 "'N$W.."'....c:n.Jf$'I'.c;>N$<>~.~VE.$.$.'>E"'~'>1'c;>.JCH.CKM~T.... ...
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and 10 the best of my knowledge and belief,
it is true, correct and complete. I declare that all real estate has been reported at true market value. Declaration of preparer other than the personal representative is
based on all information of which preparer has any knowledge.
SIGNATURE OF PERSON RESPO~E FOR RETURN ADDRESS ; DATE / !
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
POST OFFICE BOX 8327
HARRISBURG, PA 17105-8327
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
DECEDENT'S COMPLETE ADDRESS
BERLIN
SOCIAL SECURITY NUMBER
STELLA
DATE OF DEATH
A
1000 West South Street
Carlisle, PA 17013
Count Cumberland
174 05 1225
Nov. 16, 1987
~ 1. Original Return
o 4. Limited Estate
o 2. Supplemental Return
o 4a. Future Interest Compromise
o 3. Remainder Return
o 5. Federal Estate Tax
Return Required
.l.... 8. Total N umber of Safe Deposit Boxes
o 6. Decedent Died Testate 0 7. Decedent Maintained a Living Trust
(Attach copy of Will) (Attach copy of Trust)
~t~)cc:i'R,'$~c:ifi"'.'~"~/~c:i""F'~'~ll.!J!~~'"".~Ic:iN$HC;>Qt;Q
NAME COMPlE E MAIL!
Farme~rust Company P.O. Box 220
TELEPHONE NUMBER Carlisle, PA 17013
243-3212
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1. Real Estate (Schedule A) ( 1)
2. Stocks and Bonds (Schedule B) ( 2)
3. Closely Held Stock/Partnership Interest (Schedule C) (3)
4. Mortgages and Notes Receivable (Schedule D) ( 4)
5. Cash, Bank Deposits & Miscellaneous Personal Property( 5)
(Schedule E)
6. Jointly Owned Property (Schedule F) ( 6)
7. Transfers (Schedule G) (Schedule L) ( 7J
8. Total Gross Assets (total lines 1-7)
9. Funeral Expenses, Administrative Costs, Miscellaneous ( 9)
Expenses (Schedule H)
10. Debts, 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 (Schedule J)
14. Net Value Subject to Tax (line 12 minus line 13)
15. Amount of line 14 taxable at 6% rate
(Include values from Schedule K or Schedule M.)
16. Amount of line 14 taxable at 15% rate
(Include values from Schedule K or Schedule M.)
17. Principal tax due (Add tax from line 15 and from line 16.)
18. Credits Prior Payments Discount
26,OUO.00 + 1,368.42
rl
CD
;;,~
O'r."
-1(-1
.00
149.343.06
.00
.00
87,748.10
'~"',
~
_-;;:;J
.00
.00
( 8)
237,091.16
18,742.63
5,019.60
(15)
.00
(11 )
(12)
(13)
(14)
x .06 =
23,762.23
213,328.93
1,000.00
212.328.93
.00
212,328.93
x .15 =
31,849.34
(16)
(17)
31,849.34
Interest
(18)
(19)
27,368.42
19. If line 18 is greater than line 17, enter the difference on line 19. This is the OVERPAYMENT.
A. 0 Check here if you are requesting a refund of your overpayment.
20. If line 17 is greater than line 18, enter the difference on line 20. This is the TAX DUE.
A. Enter the interest on the balance due on line 20A.
B. Enter the total of line 20 and 20A on line 20B. This is the BALANCE DUE.
Make Check Payable to: Register of Wills, Agent
4,480.92
(20)
(20A)
(20B)
4,480~~
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PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING A CHECK MARK (v) IN THE
APPROPRIATE BLOCKS.
1. Did decedent make a transfer and:
a. retain the use or income of the property transferred, .......................................
b. retain the right to designate who shall use the property transferred or its income,
c. retain a reversionary interest or ....................................................................
d. receive the promise for life of either payments, benefits or care? .......................
2. If death occurred on or before December 12, 1982, did decedent within two years
preceding death transfer property without receiving adequate consideration? If death
occurred after December 12, 1982, did decedent transfer property within one year of
d h . h . . d 'd' 2
eat Wit out recelvmg a equate consl eratlon. .................................................
3. Did decedent own an 'in trust for' bank account at his or her death?......................
YES NO
X
X
X
X
X
X
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,
YOU MUST COMPLETE SCHEDULE G AND FILE 11 AS PART OF THE RETURN.
"
REV-l503 EX+ (9-81)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Stella A. Berlin
(All ~roperty Jolntly-owned with Right of Survivorship must be dllCloled on Schedule "F")
SCHEDULE "B"
STOCKS AND BONDS
FILE NUMBER
21-78-665
ITEM
NUMBER DESCRIPTION
1. 15 shs. American Infonnation Technologies Corp.
2. 100 shs. American Telephone & Telegraph Co.
3. 400 shs. Atlantic Richfield Co.
4. Div 400 shs. Atlantic Richfield Co. ex-div 11-6-87
5. 20 shs. Bell Atlantic Corp.
6. 45 shs. Bell South Corp.
7. 340 shs. Carlisle Companies
8. Div 340 shs. Carlisle Companies, ex-div 11-12-87
9. 826 shs. Financial Trust Corp.
10. 821 shs. General Public Utilities Corp.
11. Div 821 shs. General Public Utilities Corp. ex-div 10-19-87
12. 500 shs. Ingersoll Rand Co.
13. Div 500 shs. Ingersoll Rand Co. ex-div 11-16-87
14. 800 shs. May tag Corp.
1 5 . 20 shs. NYNEX Corp.
16. 40 shs. Pacific Telesis Group
17. 280 shs. Pennsylvania Power & Light Co.
18. 30 shs. Southwestern Bell Corp.
19. 20 shs. U.S. West, Inc.
VALUE AT DATE
OF DEATH
1,288.13
2,925.00
29,650.00
400.00
1,381.26
1,724.07
8,882.50
95.20
35,931.00
19,704.00
123. 15
16,000.00
130.00
16,700.00
1,351.25
1,092.50
9,835.00
1,110.00
1,020.00
TOTAL (Also enter on line 2, Recapitulation)
$ 149,343.06
(If more Ipace II naeded inlert additional Iheetl of 18me Ilze)
REV-l:;08 E~+ (7-83)
SCHEDULE "E"
CASH, BANK DEPOSITS AND
MISCELLANEOUS
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Stella A. Berlin
(All property jOintly-owned with the Right of Survivorship must be disclosed on Schedule UFU)
FILE NUMBER
21-78-665
ITEM
NUMBER
DESCRIPTION
VALUE AT
DATE OF DEATH
10,000.00
41.79
10,000.00
33.34
10,000.00
61.74
20,000.00
20.01
346.92
103.33
16.40
17.40
16.40
19.00
24.75
19.20
18.75
30.00
153.33
100.00
187.60
141.39
633.55
10,247.48
20.08
10.10
104.00
1.00
2,000.00
12.54
20,630.79
34.94
815.65
1,886.62
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
CD 06-32-816890 Dauphin Deposit Bank 8.394% 1-20-88
Interest to DOD Item 1
CD A52045 Farmers Trust Co. 6% 1-25-88
Interest To DOD Item 3
CD A40139 Farmers Trust Co. 6.35% 4-11-88
Interest to DOD Item 5
OD A38028 Farmers Trust Co. 6% 1-8-88
Interest to DOD Item 7
Dividend Chk dated 11-10-87 Financial Trust Corp.
Interest Chk dated 11-10-87 CD l-A38028 Farmers Trust. Co.
Dividend Chk dated 11-2-87 U.S. West Inc.
Dividend Chk dated 11-1-87 Southwestern Bell Corp.
Dividend Chk dated 11-2-87 Pacific Telesis Group
Dividend Chk dated 11-2-87 NYNEX Corp.
Dividend Chk dated 11-2-87 Bell South Corp.
Dividend Chk dated 11-1-87 Bell Atlantic Corp.
Dividend Chk dated 11-2-87 Ameritech
Dividend Chk dated 11-2-87 American Tel & Tel Co.
Interest Chk dated 10-27-87 CD l-A52045 Farmers Trust Co.
Interest Chk dated 10-10-87 CD l-A38028 Farmers Trust Co.
Dividend Chk dated 10-1-87 Penna. Power & Light Co.
Interest Chk dated 9-25-87 CD A38028 Farmers Trust Co.
Checks dated 10-1-87 Diocese of Harrisburg
Checking Acct. 4-03008 Farmers Trust Co.
Interest to DOD Item 24
Refund, The Sentinel
Refund, Homeowners premium Richard Neiderer Insurance
Refund Post Office Box key
Diocese of Harrisburg Acct. LP01-02730
Refund, UGI Corp.
Acct. 15-13-2544 Dauphin Deposit Bank
Interest to DOD on Item 31
Internal Revenue Service, tax refund Form 1040
Charles Spahr, proceeds sale of personal property
TOTAL (Also enter on line 5, Recapitulation)
$ 87,748.10
(If more space is needed insert additionel sheets of same size)
.. ~~~~~s~e~ TR~~~, p~~~n~Y
Date
.,jC-,,:~~~!:-.(/cr ,~, 1 ~'iJ7
Go i ](:. L' ij r'i(C
r?01erS frust GO. - TrLsI UP0t.
l ~'. t; i~d i ~T. " ;J. \j. uCX (:>\)
,>? r 1 j s 1 !", ~; ; 1/ "-, I ::,
Re: Estate of.
Stelli1 /'\. Gerlii
Date of Death
hCVC""LJi'f 1c, J';,u/
DeM rs. ~ur~G
In answer to your request concerning accounts owned, either separately or jointly, by
the above referenced decedent and the balance in each account ,as of the date of
death, we have checked our records and Me submitting the following information in
duplicate. We suggest that you file one of these letters attached to the Pennsylvania Inven-
tory forms (RCC) to substantiate the balance you report.
Note that we have shown the correct registration for each account. Also, interest accrued to
the date of death, if any, is listed as a sepMate figure.
Very truly yours,
i ,
I L/t., ~ (
(, ",'''i'', /1
<- "-Y"''-r: ~.-.,..-.......
L.,.~(~r}i;(~ 1__ c..,~,.r(ij~)(?r!
j a 1 (,,'TV i Cf"':
l. .' r't i. i i c ai, C'
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i.SSLC:C 1.....J!t~_u~. lor ~(jJ,v\.I;(';.V\) pJ.L~ ~,:;ccrl.{ec i(}t(~r~:;~-;r
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VTC if' i c a (, irNi'v l:)~ issuer: it- 'l0-v:, fJ~:t.1U, l1Uu. \A 1 Li:S (j CCTlAec i rnCTCS.,
i rCd Lllf ~,\j.1. /4.
nf (;'O{:T.l'I t
L E:~ rl if i c ar (; ii- r,,:Jr.. \.J'~t J is s ue(~ 1-~-.~v"~u4 i~ c: r y 1 L , ul,U. ~d.) ~_,} u s c:~ CC fLP(
'<'. :t,.
,1.1.1 rJl tile (iDOVe certifiu:ces are re,JsT.t'ref! in th" f:i"i:'('S of :,'[1"112';. _~.jl
<"I'-'n;.' .
FARMERS
TRUST
One West High Street P.O. Box 220
Carlisle, Pennsylvania 17013
~"I~
Date
l~ovember 30, 19 ~ 7
Jane Burke
Farmers TrUE't l~ompanv
1 W. High St., PO Box 220
Carlisle, VA 17013
Re: Estate of.
Stella A. Berlin
Date of Death
Nov'.?mber 16, 1987
Dear
(.'f:rs. fhlr!re
In answer to your request concerning accounts owned, either separately or jointly, by
the above referenced decedent and the balance in each account .as of the date of
death, we have checked our records and are submitting the following information in
duplicate. We suggest that you file one of these letters attached to the Pennsylvania Inven-
tory forms (RCC) to substantiate the balance you report.
Note that we have shown the correct registration for each account. Also, interest accrued to
the date of death, if any, is listed as a separate figure.
I ,
X _, ,i,.I,t. ~ /~
'" ........".
f
',I' ,)'
, i
/Ii
, ^
Checking aecount ff4-03nng wa~1 od rinallv
oTHmed 9/1/(-,7. The aecount \UiS ne]il in
Stella A. 1).erl:lr-.I1" HilDe alone. The ;'R],i!:'CC
as of 11/16/87 was Sln.747.4~ nluE' RccrupA
jntere!?t of' S10.0R for a :-0tal of qi'.',~::;7.56.
'TrH? acco'nnt ,vas a rnonev t'.18.r1(E'.t ~hecking i,:'Hrnli:('.
5. 3~: ;'.t rlate of de'lth. Tne total a~l()U'I' ot-
:int~reBt earned in 19~7 to the ~ate of
death W3P ~~A5.74.
Very truly yours,
Dehra Harclern~e
01stomer Service
There vere D.! "'afe dec.osit hoxe8 11t~1(l in
the d eceaeed nRrH~.
'['here> waf' a savinplo' 'lccount !ll--:r(!hW!l j.,,01ci
at the Farmr.>rn Tn.l9t C01'1;)an': ff'": th(~ h r'j ,iJ
serViClo,8 of Stella A" n~rI h,. )1-,1'" 'hi '11 '.'a~-
oaid on 1 J /?3/?'/ to the l}..;i rF' Brot'iPL"
FunerRl Home fOT ~4,Rfi~.11.
01 (i
~WdL
(~~)
D Dauphin Deposit Bank
and Trust Company
MAIN OFFICE: 213 MARKET STREET, HARRISBURG, PENNSYLVANIA 17105
717255-2121
January 4, 1988
Farmers Trust
One West High Street
P.O. Box 220
Carlisle, PA 17013
Re:
Stella A. Berlin
November 16, 1987 DOD
Attn:
Jane F. Burke
Dear Ms. Burke:
In regards to the above mentioned, we submit the following
information as of the date of death:
~Checking #14-57 0602 opened 1-26-83 balance $300641
interest $5.26 joint with Charles R. Sheehy
--Checking #15-13 2544 opened prior to 1964 balance $20,630.79
interest $34.94 Stella A. Berlin only
o~~1q~5S3Certificate of Deposit #06-32-816890 opened 1-26-83
balance $10,000.00 interest $41.79 Stella A. Berlin only
Safe Deposit Box #06-0040 Stella A. Berlin only
If we can be of any further assistance, please do not hesitate
to contact us.
Very truly yours,
~~~
Assistant Vice President
JCS/wds
REV.1509 EX + (7-83)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE "F"
JOINTLY-OWNED PROPERTY
ESTATE OF
Stella A. Berlin
FILE NUMBER
21-78-665
Joint tenant(I):
NAME
A. Charles D. Sheehy
ADDRESS
P.O. Box 204
Ligonier, PA 15658
RELATIONSHIP TO DECEDENT
nephew
B.
C.
Jolntly-owned property:
LmER
ITEM FOR DATE TOTAL VALUE DECO'S DOLLAR VALUE OF
NUMBER JOINT MADE DESCRIPTION OF PROPERTY OF ASSET % INT. DECEDENT'S INTEREST
TENANT JOINT
1. A 1-26-83 Acct. 14-57-0602 3,011.67 50 1,505.84
Dauphin Deposit Bank
NOTE: PA Inheritance Tax
paid by Joint Owner on 3/23/88--
See attached Receipt, I\.CN 1188012328
TOTAL (Also enter on line 6, Recapitulation) $
(If more space is needed insert additional sheets of same size)
. M 365383 c:oMMoNWEAl.THOFPENNSYlV ANIA
NO. DEPARTMENT OF REVENUE
OFFICIAL RECEIPT . PENNSYLVANIA INHERITANCE AND ESTATE TAX
.
EV.1162 EX (12.861
RECEIVED FROM:
~
ACN
ASSESSMENT r:'I
CONTROL 1.:.1
NUMBER
AMOUNT
Charles D. Sheehy
P. O. Box 204
Ligonier, PA 15658
88012328
$225.48
FOlD HEilE _
r~~T."-T.E-.!!':"'~.!l~!,.~O~-L
FilE NUMBER
(FIRSTl
(MI)
March 2 8-#~~
POSTMARK DATE
COUNTY
MFl rc,h 25, 1 9 8
.
.. CllIDberlan:
DA TE OF DEATH
. Novzmbpr lA, lq87
REMARKS
r3 TOTAL AMOUNT PAID - $225.48
SEAL
TAXPAYER
,.
.:~
REV. 1543EX (12-86)
COMMONWEAL TH OF PENNSYlVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
P.O. BOX 8327
HARRISBURG. PA 17105-B327
..~. . INFORMATION NOTICE FILE NO.
. AND ACN
< . TAXPAYER RESPONSE DATE
'/~ OPILhJ..L~ ~,.., N')fIC,.efirld '~.
ESTATE OF BERLIN STELLA
5.S. NO. 174-05-1225
DATE OF DEATH 11-16-87
COUNTY CUMBERLAND
21 78-0665
88012328
03-18-88
/7bI'3TYPE OF ACCOUNT:
? \ '1-) \ ~
A [K] SAVINGS
o CHECKING
o TRUST
o TIME
CERTIFICATE
SHEEHY CHARLES R
118 S HANOVER ST
CARLISLE PA 17013
THIS IS NOT A TAX BILL
.. "'," ".-.-.,-.-.- , "'.." " .. "'., " ". .-. .
....FAILURET'ORESPONOH
WILL RESULT. IN . ASSESSMENT.
DAUPHIN DEPOSIT BK & T has advised us that the ownership of the bank account reported below was
transferred to you as a result of the death of the above decedent. This transfer is taxable in accordance with
the Inheritance Tax Laws of the Commonwealth of Pennsylvania. Questions mav be answered by calling (717) 187-8327.
~O~PlfTE P^PT ~BELOW ~ ~ ~ SEE REVERSE srDe ~CR r:~:N~ ~~c ~AYMENI IN~TRUCiIONS
To insure proper credit to your account a
copy of this notice must accompany your pay-
ment to the Register of Wills of the county
indicated above. Make check payable to:
"Register of Wills, Agent".
NOTE: If tax payments are made within 3
months of the decedent's date of death, YOU
may deduct a 5% discount of the tax paid.
Any inheritnce tax due will become delinquent
nine (9) mcnths after the date of death.
Account No.
14570602
Date
Established
01-26-83
Account Balance
Percent Taxable
Amounts SubjecI
Tax Rate
Potential Tax Due
x
3,006.41
50.000
1,503.21
.15
225.48
to Tax
x
ART '1!
~
i I
I CHECK I
ONE I
I BLOCK I
i ONLY
L J
TAXPAYER RESPONSE
A. \P( The above information and tax due is correct.
;^< 1. You may choose to pay the 'Register of Wills with this notice to obtain
a discount or avoid Interest. OR
2. You may await the official assessment from the Department of Revenue.
B. 0 The above asset has been or will be reported and paid by the estate fiduciary,
C. 0 The above information is INCORRECT and/or debts and deductions are being claimed.
You must complete PART @ and/or @; below.
ART [2] TAX RETURN - TAX CALCULAiION OF .,JOINT/TRUST ACCOUNTS
Date Established
,
I
I
IPAD
FOR OFFICIAL USE ONLY
o AAF
Ac..CU,",II~ Dd;anCt:
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Relte
Tax Due
3 X
4
5
6
7 X
8
2
3
4
5
6
7
8
ART :3
DEBTS ANO DEDUCTIONS CLAIMED
DATE PAID
PAYEE
DESCRIPTIOf\:
AMOUNT PAID
TOT AL (Enter on Line 5 of Tax Calculation)
$
Under penalties of per jury, I declare that
and belief, it is true, correct and complete.
best of my k.nowledge
('1/1-) '23?_ S-J',;?
TELEPHONE NUMBER
~h
DATE
REV-1511 EX + 15-85)
.
SCHEDULE "M"
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES
Please Print or Type
COMMONWEALTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Stella A. Berlin
FILE NUMBER
21-78-665
ITEM
NUMBER
AMOUNT
DESCRIPTION
A.
B.
C.
1.
2.
3.
4.
5.
Funeral Expenses:
Ewing Brothers Funderal Home
729.50
1.
Administrative Costs:
Fanners Trust Company
Charles D. Sheehy
11,044.28
6,000.00
1.
Personal Representative Commissions
Social Security Number of Personal Representative:
Year Commissions paid 1989
177 - 03 -0751
2.
Attorney Fees George B. Faller, Esquire
500.00
3. Family Exemption
Claimant
Relationship
Address of Claimant at decedent's death
Street Address
City
State
Zip Code
4.
Probate Fees
87.00
Register of Wills, Letters Testamentary
Miscellaneous Expenses:
Cwnberland Law Journal, Advertising Letters Testamentary
rrhe Sentinel, Advertising Letters Testamentary
Register of Wills, Short Certificates
Notary fees
Closing and Filing Costs
25.00
28.85
36.00
42.00
250.00
TOTAL (Also enter on line 9, Recapitulation)
$
18.742.63
(If more space is needed, insert additional sheets of same size)
REV-1S12 EX+ (7-83)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENJ' DECEDENT
ESTATE OF
Stella A. Berlin
SCHEDULE "1"
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, AND LIENS
FILE NUMBER
21-78-665
ITEM
NUMBER DESCRIPTION
AMOUNT
1. Belvedere Medical Corp.
2. PP&L
3. Sarah A. TOdd Memorial Home
4. 'IV Cable
5. Kitner & Cook
6. Uni ted Telephone Co.
7. Claremont Pharm-A-Care
8. UGI Corp.
9. Harrisburg Healthcare
10. Mutual Benefit Life, claim for checks dated 12-3-87 and 1-3-88
11. Kenneth R. Guistwite MD
12. Dauphin Deposit Bank, reimburse for 12-31-87 Social Security
deposited into Acct. 15-13243-4
13. Tax preparation fee
1 4 . Internal Revenue Service, tax due Form 1 041
15. PA Dept. of Revenue, Tax due PA41
16. Internal Revenue Service, tax due Form 1040
17. American Transtech, surety bond premium replacement of Bell
South Corp.
18. American Transtech, surety bond premium replacement of Bell
Atlantic Corp.
19. Federal Insurance Co., Surety bond premium replacement General
Public Utilities
4.00
17.86
2,322.52
2.20
46.54
84.38
126.98
11. 03
424.52
254.96
255.00
281 .00
35.00
3.00
13.00
588.00
12.53
14.20
522.88
TOTAL (Also enter on line 10, Recapitulation)
$ 5,019.60
(If more spece is needed insert additional sheets of same size)
..
REV-1513 EX+ (2-871
ESTATE OF
,
*
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF P~NNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
Stella A. Berlin
ITEM
NUMBER
ITEM
NUMBER
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
NAME AND ADDRESS OF BENEFICIARY
RELATIONSHIP
21-78-665
AMOUNT OR
SHARE OF ESTATE
A. Taxable Bequests:
Charles D. Sheehy, Sr. and Pauline Sheehy Class B Ben.
P.O. Box 204, Ligonier, PA 15658
Thomas Sheehy and Judith Sheehy Class B Ben.
726 South Grove, Ave., Oak Park, IL 60304
Rita Sheehy O'Halloran Class B Ben.
11511 113 St. North, Apt. 5B, Largo, FL 33540
Madeline Julien Class B Ben.
111104 Spartan Court, Sun City, AZ 85351
iEugene Laughlin ill1Q Beverly Laughlin Class B Ben.
\315 N.W. 48 Terrace, Plantation, FL 33317
George Edward Laughlin and Gloria Laughlin Class B Ben.
7420 Russell St. South, Minneapolis, MN 55423
Rita St. Aubin Stepenski Class B Ben.
612 East 158th St. 1st Floor, Harvey, IL 60426
Katherine K. Port Class B Ben.
934 Columbian Ave, Oak Park, IL 60302
John B. Kidney Class B Ben.
507 Impala Dr., Hazelwood, MO 63042
Elizabeth Berlin Kidney, deceased 1-23-84
NAME AND ADDRESS OF BENEFICIARY
1.
B. Charitable and Governmental Bequests:
St. Patricks Church, Carlisle, PA 17013
TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Also enter on line 13, Recapitulation)
(If more space is needed, insert additional sheets of same size)
1/8 of Residue
1/8 of Residue
1/8 of Residue
1/8 of Residue
1/8 of Residue
1/8 of Residue
1/8 of Residue
1/16 of Residue
1/16 of Residue
AMOUNT OR
SHARE OF ESTATE
1,000.00
s
1,000.00