Loading...
HomeMy WebLinkAbout94-00022 K:'i' ( i;J.t: 'I , /', ,,;'1" 1,1'. ,'I ; 1,1.,:, \.'. ' 111',':,1_ ,,- lit' ;\1: . ~I:: '. 1:;' ~'I"ii.' '"II: ;,1;l':. '\1,1{ j,-' "I'i, .J",. '~~~ / '.I;' ;,Ir!' i: '!Yi\:_","i.,' '_;1'1:-'-" Y' i \1:\.,,," , \h,~' , J?ri['< ,\;',1_: ~'-' :i) , t_'J'~'i \c1!';' ';,,1-' \'; ., t :i \,' '1,1 'J" \ \', ......,'l,. " ~ I, ',,:_ J - ~.~ ,- 17 't (,I' " , I Ii kl :I~O. " , , , ","" , " i,j' II;, :,~(I ; , ,. 'j:'!, ':1"': ',', >\: '~1.94 .1;; ," " 1" ,,'" ", ,I ," .. " (, .j. 'Ii Estate oJ , ii /n. ~~ I' . .,~, !Jj},..)- / ~) S:V4J~~J ,; ~/~..I_{ ,t () AAA1.A ~ ',' , , ~"I..,) II I', " , , " \' , ' , ,', I ' ~ ' " ,'I 1,' i~. (/\, '-Vi:'-,'! " . L ,t,," ," " ii' ~ " " , ". " \i I.'. .. ,iI ,i. ~';', i : JI. ,,' ,', . ':: I ~ , " il , , I": ;; " j.. " \" " , , ',I , ii , 'I, ,\ '", , '\'" ',_1',. 'I,' " I 1 ..',1 l.c- , I)ETITION FOR PROBA'I'E lInd GRANT m' LETTERS No, ~C;lL~_'!'I:.-.'::~ To: /!.:Wate oj ,,~~_!o!~_B!llrriJ,I~EL_,__,__,_ ulso klloWII us ___~,._______.._______________ -.-----'------'------------------.'------. Regisler of Wills for lhe --_~____..____u__.________'. De('eased. County of --Cuuherland~ In the Sodal Semrlty No, --L1.'t,:_..'~;._=_,:2_'2_""L,___ Conllnonweuhh of I'ennsylvunlu The pelilion of thc undersigued respeclfully represenls thut: Your pelitloner(s), who IS/l\'(e I R yeurs of uge or older un the e,xecul.P-X In the lust \1'11101' the IIhove decl'denl, duted ,__J~.-_Q,________ und codlcll(s) dilled ....N/A,,_.________________,____________.-__, numed , 19-'lL -------...---.. -.... ---._.-. ---..--.-...--------. -~------------_. -~-_______U'___'U__'_'_'.n. ----..-_._..___.~__4~..___________. --.----.-.-.-.-.... .. --_.-.-......___ ... h ...._________.__..___ (~lilll.' h.'kvanl drCllllhllll1l.:c'i, l',g, rClIlllldllllull, dc.lth of c'\cctllnr, ell:,) Decendent wus domiciled ut dClllh In .--------.-'~3e5r;T.~~---=i-COlll\ty, j'elll\sylvllnla, with her, lust fumily or prin'j!!'l1l rcsidcncc ltt_~_, .__~~-':~y_~!-....1,T~Ll_!echah1Csburg __~~.!:..0_~~1,_'='--___~,~!;"_~"'1) __.___ .._,._____________________, Oi'll 'llrl'l'l, !lull1ber und IJIllnclpality) Deeendelll, then ___,I!-'L____ ycars of age, died ____.,J-"'_~~~,:l~~'I_._!_____, 19 '1'1 at__hLiW t1ilLL!I,_,U('!L_________ _"" ____ _'___'__,.___,____, , Execpllls follolVs, dcccdcnt did nOlmllrl'Y, Wll!; not divorced lInd did not hllve u child born or adopted ~fler exe~ullon '!4}){e will offcl'ed 1'01' prohale; \l'lIS IWlthc viet 1m of II killing und \l'UI never adjudicated IIlcompetent: _____.~,__,__,.,. '________._________"..____,_.__.-_____ , Dccendent at delllh owned properlY \l'i1h estinlllled values liS follows: (If domlcilcd In I'n,) All pel'sonlll properlY (If I\ot domiciled in I'll,) I'crsonlll propcrly In I'cnnsylvllnlu (If not domiciled in I'll,) I'crsonal propcrlY In ('ounty Yulue of rcul cst ale In I'cnnsylvanill situated us follows: __.______.____.__ _.'.-__________________, $,-,.- $----.-- $ $ --- -~-----_.._.._-'-------- ------------~-_.,-_.__.,..----~-_._----------- WHEREFORE, petilioner(s) respcctfully requcsl(s) the prohfile of the lusl will and codlell(s) presented hcrewlth und thc grunt of Icllel's,.-_.-__testammt:al:)(,__, (ICsllllllclllllry: lIdI111111~lrlllll)11 C,I,II.j lldminl~lrRtlon d,b.n.c,t,ll,) lheron, ~ B 'tl_ '6. o:1i' g lE ~~ 'G'_ ~ 0 ! Iii , '> " /' - /, ---,----____c..~.., "'.-,--.;~.;..:;)'~/ ii1; '...w ----,___ /::.....Jan~t~~-~rIL -------- / __32ZQ8_d'iortheast 195th -----'-,-------------,---1 -Duvall.-toll\ 9RQ19 J ~-( ~_,,,l., /' St:T'~et -----.---..-..-------.-.- ------..-------.------.-- -------.--------- ..----_.._ _______. _h____ ._______ _. -----~---~----_. OATH 01<' I)ERSONAL REPRESENTATIVE COMMONW~:ALTII Olll'ENNsnv ANIA } !:IS COUNTY m --.ClM3ERLANIL_________. Thc petltloner(s) lIhovc,nllllled s\l'cal'(-\) or lIfflrm(s) thlllthc sllllemcnts In lhe forcgoing pelltlon urc true lInd eortCctto thc hCII of till' knowledgl' lInd ['ellef of pClllloner(s) lInd thllt us pcrsonal represen- tlltlvc(s) of the lIhovc deccdclII pClilioner(s)/ill welllllll~I'UIY udn\lni~\e~ the estule lIceordlng to luw, Sworn to or lIlllnncd and SUhSCrlhC(f'-,l_ /'I':''-_l:I/~.. ';;){:-C!...!ii.c.f:.~F-' . .-__ III 7TH - -r>'" - ci;' hcforcmclhls,,_._ . .",dayol /'n_n__nu__u______________----, _ ~ ~~t.Ya:" I :,.:::i1/__-'u: _-~'~~:~_~,==--==-=--= I I If ~ Irf~ ~(p No 21 - 94 - 22 . . Estate of Anna M, B11nr/,p.rg , Deceased DECREE OF PROBATE AND GRANT OF LETTERS . AND NOW ,JBI1URry '11. _ 19~, in con~lderatlon of the pelhlon on lhe reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the Instrument(s) daled_JRTl11R'Y 6, 1<189.. described therein be admitted to probatc and flied of record as the last will of AmR M RhmhF\l~g and Lellers '!'''A tRl1'PntRry are hereby granted to ---l!!llet L, B1umerg tlSle'. or li!~I Kei th 0, rennamn Sne1baker & BrennEm!lIl, p, C. 47077 44 W, '}.tIlW~H~8tc,.I.D, No,) Mechanicsburg PA 17055 ADDR~SS FEES Probate, Lellers, Etc, "..,.". $, 80.00 Short Certlficates( 5) " . , , . , , ., $ 15 .00 Renunciation ,.",."",."" $ X-Pages $ 6.00 JCP TOTAL $--S-;1JlJ' JANUARY 11 ;-1994 1[l6. 80- Flied "".....",.,.,....,.,.,...",..,. a, ~..3S:00 II.;';:: tr;U5-1.1.- 9", (717)697-8528 rHONB ~~. ,~ '(I .....:0 ....", ,~8 -,":1 l~: u. I' I', ,t._ '~ I,. '~I .., , "", , , :':';{"; Vi () ~, ,'" ;1-1 ,ID (11 \11' " '::Oc ~;:1. , ' , " Ca 11 ed a Horney on 1-1 '1-9.4. This h \\1 ('('nih- Ih,1I rill' illl!li'llJ.lfi(J1l hl'IT .l~I\.t1\ j" lIJlIt'{ II)' ('1111(,11111111 .nl Ijfj.~jl\.d It'lldll,llr d d(',llh dll!) rill'd wilh 1lIl' ,IS !.nr,lI Hl:I!i'ill',lr 'Till' 1Iligill,d l'('llIlilall' will bl.' IpI wHded 111 tlll' ~l.llt. ViLlI 11.<'< OJ d'i {lUlu' hll" l'l'f11lillll'lll lilill1-:. WARNING: ilia 1II0gallo dupilcuto lhls copy by photostat or photograph: Fl'c (01' Ihh tl,rtdil'.llt.', ~/,OO ,..~., ... L~'we ~,'.,~i~,~,~~t"~~ 2132811 JAN, ~-j 199~ Nil 1>,111' H'MIQ,*,Ir1' COMMOHWEALTH 0' PBHHSVLV^HIA . OEPARTMEHT OP HEALTH' VITAL RECOROS CERTIFICATE OF DEATH "" <NT "" IIII"lllolAolf' S<<;'ALltr.IJf\lNIlIoN~A " 174 _ 05 _ 2083 1I1.UtUI L." I, Anne 1.1.. Blumberg !WI DI.IIH 1Wtr.... or, 'tIMrl I, :'Yn.o Wlr'j ~, Icrl'l A.........." -l.N1Of"'O,y .......7r~" f1::fytO '"'" ..... ~. O.tlIOl'IA'H JU~"f1,r;.I'"i 1100 l'AIHI'\ACli<:"~1 $I... ro ,tll"'1'<:''''......,l 87 ,. ,ny, RO. P tit II .W'It.ft( 3,\ Cumberland Camp Hili . ...~ ~&.r.O~'\l"'lll La1>3';etl"'.~I\Ql'...~.11 .,1, U,,~b~...n~r Wl8!lmif" " "~:~'~ =J Shoe Fsctory OIClDtIO'.L...,.."'OAOO-nll..,~...""i"""'.S1I'1!.pC(...1 I 'l'lt, ~""ol"'l ~_ L.ow9t Allen wp. - PA "I,!llll.____t:>d ~- ,...". -.' r..cCIOf~I' /.tTU.l.l NU'otlofl'" ~~.,.,,'...... ''''~''h)ol ~ 33llWMfO/OM I -IcoWv, PA ml1l1fu""'-W(",U<llItIUl George W, Koontz "'I~""'I Jenel Lou e Blumberg ~'''M~;g~;~iVHeiie\t''''1o '....1 ~i Of\",AHl.llol.IJ\It,tQAOOAU r.,..... I,'\>"" $I... 1(>(........1 32700 NOIIh EuI lQ$1h _ Oub.' WA QOO1P h.lliDlS oON.N.....n/Cf<nf''''c.~ llfOl1ot<....~ Ml. Holly aprtnQt """"'ry .., Cumberland lI.e ~:"'~~~I\.j "_,r.lV\ ~~IlI"O 0.1. Oi I ,1,l,VII'C\f'_1 o , Jenuary 6, 1994 II \O::;INUlIVlot I FS.011569-L ly'aprlOgo, PA lTOOS Ml Ho/~ lli>Mllo, ~A 1_ . "1~"'110....,1_\~ "U'~"'I..t"'lrl""'''1 ~1"'''''f''k'I''''' ""~ct'V<11"'1 .'I:!'dtliUI.'UII "" AUl OJ IA.'IOAoo.'l. f/.tl\I'V 101> &01 H.8&I Tl\' C ~"Il S:M ...... I f(fll'llOIOIolICllCAI .Wt~ "nO ..1jI . (R,~\l"'''t-''\C''/' ~~C~'\(Q\J(''''E(~, 1"<<-0,,,,1, "....II_..~ lont...~lIt.'~ 1 - ~~.:I~~~~C>f'I~~~~ H..IIl,. A(i.-\~ 0\If mlCll-'J A COIISI;QlI[lO;:I ClI MTO,~.'lCc-tifr)<J('.cI(f, \llll"" OCIIH MlOltWII1 ,1,I....,'tlt'....1 llloll I~'W '!MtIl'A1'M)l\Jl;1 OUCII'Ml<MkNll'OCt:VIINO .." pel C1 U I""'"'''''' ,.. Cl ,-0 [J LJ t<<*l""""'''''.."'"'Id 0 'V. ( ~1V1Il1.AI"-... 1..1~..,,~tt'o;. ... bu"'~"1,1roc'11 I. h ~. '~~~~I"''''''_'''UIII'''Il(_rJ~''''''I''''''''r'(''''-a",.".,.."."-al,)oO",,v,ltl''I'''''''.~11' ".....tf..,'--..,..........,............IIUWl"......_.",'11N ."........"...,..,.,.,.. _,..,. ...... ~1"<Jo^q.......'9.1Cl~ ...0 ..D ....~ .CiClflOli,.....C.,"'" HI 'PI'1C aIllC..oAHOC&II1WT111Ol'lNtJelAH~t(~""""'......"..Q,..."V<II..",'Q"'(......tjl,,1f1 ......iIlNltf""'.~....C1.......I...IIoot.fe:I,........'.lrd....II.......M('I........_..NMd .. \tJ'III'1f!AlrtlllhtO#e~I'" [J1IL~~" , fI1t'l l'Ct"'!~f'i- c-"\ oijlflQ"'O"t;:'I~""l M'1I- 0"1'1 00 UL 1- -'II.. r. ..l...IA..OIOOllIUOl'''~IO'I....,.OCOtot~tt fOeA1J1 (/~ "fV'1nl'~Of"nN M IJ " G"-'4ts-~~~~-~ c" fJd I PI\, 0.1.11,\(01\,1.... '1._' J(\.~, G \9<'\4_ I =~':~~tlfIwttI.ltlt*t'"I'I'fOflnIOn,6t.'''OCe~"td.llllt'''''.,dlt.,.IIll''tc.,.I'Id..,.I.t.....'''"(III/ld __.....td"'.""'."'.."........,,...,.,.."'....."...,.,.'".........".".",..,......."".,..,.." UI. S-'<''\ -<;0-" ~.\.8J--_uQI " 2 1 ~ 94- 22 , , " " ,I I' 'I" ,,' i: " 11' ", I' '" " " " ,Ii "." ...' ,f.' '\1 I', ,I, " ,,' , " " I " . " " " " 'i' I"~ \' I": ','1 " " I' " HI .... , () ill' 11'[;'_'::1, , ~-:' , LI'\ \f) 9~' , ti,~l '"'. '.) " " ',' " " I. ,. ,"' 'I.' " 'I;' ,!,',' 'I' ,<I f'o-':. I ~ " j.' , " ,(.,' ,~;! ~: (/, I ~ . " ~ ij(' ,o:CC ", " ;'1 ('; " " ,1/ " -.;1" ',(J "a I. eu ,0 ".t P" " ;. " , " II I' .','IlI' " "1' , '1 " -, ',:il" 1,1 , " " '" /0 " ,I", ;\, " ,.'.' , ,;, I,', , I, 'IiI , ' ',i , ,..I' "" I' ,I';. " " , , " 'j "I ,- .;; , ' ,\ " ,I '" " " " " I:.". ,-- ,I, 1'., ,It, " " 'tl ,,' I I", ',' " , '" , '" , ", '-., " , " " ..1. 1,1, ,/,r ,'\ I' /,';'1: ,'. i' ", t. " " " " I I'" I , l'It' " , ',J., ',1' ,d' " I' ,'le, ., J_I" 'I,' " ,; , , ", , " .), 1",. " :1,': I' ,\\' Ii . " d' I, "j' i' ,:" ,I' " " , ' " ,\l. I'.. "I" ,I' ,'.' j'I.1 ,1"'1 " !II' " , " ,:,', " '" , j. I' ,'I '" ' " ',\)', ." 'I " "'I " " , \ ',,' (' " ,-" I II l'" ,.' /' , I t,ll\ ", "1< . ,I 1:,'. '1'1" " Ii. " " 1'-\ ",I/,t " , ,'J' 'I, ,. ;'PI" -I, I,", :1\ 11'1' ,I '-" '" " '" I:, " ,/. 0"1 I', "";" " " /. I, ,- , ' " " , ,," ". I ,(', 'I.. \' II I,,: ,\ , 'I , ' H '.. , , 'I '" , ,,-j " "':,,'1" II','" " " '/\1, ,I", '''', '" " " " .' 'I' ", ,,1" " . , ,,' I', ii', I, " (I, " , " ,", d, " ,I' " '!!. fI'I" " " " , Ii,l ')i' " ."j"". ", 1,1" ", ," " ,. " " I,!, " 'i " ' ,I' I' " ", , '" " , " " I' " " '.', , , , i' (",' 1', ," " I;. ,I' '\', , " I' " ,',I " " ," 1" "'j, " .. '" 'Iii; I' "j, , ' ,,' " ,~i' ,I , ',. " " , , ,\\r; " ;,' " ',!; . ~-. c' ~ . ,', I I " " , , , , " (t(' :'11.;' , ,,'. , " I ,. ,.~ ." "~,I / ,:/' '\. " I, " " I'.. " ," \' ,,, .,' ,- , ." " ;(1' ,', I 'I '1.\ ;,1', "'j ,,, ,. II , ' '--'I " ,I' 1',/' " ',,\ ,,' I, I, , I :i " " ", .' '. ..' ~ ' " :13 to ./I)fS' 'u):: " 'I. 'II... {~;i,O ,tir:t' lo.. ,_ \ , 8l? ' !Cl; '., I, .', " .\ ',i, ", ',j, ~ C" '00: ", ~', ~: ~ " I, " 1 "( " " " " " 'l' " , "j ',I,,, " 'II If;' ,r' '>1'; ,,", " 5~' '1 . -; , " :,.\1 " .~ ~a ~ '\/ .," t', '! .<' I: I', ,"" " d I', " 'l', I " t.: , , ':1' t', "~I " " ", " :\, " " :'.' ,..' ,',l :'o'-; ',',1,. i' " " 'I' I' :' I,' " , " " .,' " I. ,,~ ,~ lil :d i " , " ," " '" y. " " " 'I " " " , '!I II" 'j', 'I, \, ,- " ,I' " , 1"'\\ ,- io" '" " " ,,' 'I, \, , 'j I' " ,:1' -I' " , "" '\. i' , /' " ., I' t,', " " " il' ""', " " " ': " " ,,' " " " 'I., ;"; " III" ,. '" , I." II " ",j' ", n ",\ " ,l ", ;\ !t ' Iii, " " 'f.ji , ' ',,., ", '", , " l " '" "\ " , , , , ,I C' " " '"i", " .v, , , " ",. " I,'. ,: \ \ " " /", ,,' !"!' 1" " " " " , " " ,'I " I'. ii' !,. .'! I, " 1'" " '.1 "I " /' .1" " " " II :,. , I"" "!!, I." .' \, " , h, "J" II ,"; (.,' " , '.1' 'i" " ", '" III ~:,' ! g I'~ !~ ~ ~.~ ~"'I ~ I : ~I ~ ~ ~ ~ :~~'~. ~ ~ ~< 1 ~ ',' " ,1\' (, ;, " fl', f', " , ,I '" , .. " , " I', 'I ;.' '" ,.' ,. 'I'" " ..; " I: 1,.;,-: " " n " it' ",' " 'J 1_' Ii \1 .,,j \~\'l ,.J ~:, <:- I, \0' ;~ ~ . '" ~ ", '-.. \ " .' \ "'-'\ ~w OI"PICU 8NEt.D^KER r!lI t:L.ICKER '. , ',. " LAST WILL AND T~STAMENT QE ANNA M. BLUMBERG I, ANNA M. BLUMBERG, of Lower Allen Townohip, 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 and making void any and all wills by me ilt any time heretofore made. FIRST. I order and direct that all my just debts and funeral expenses be paid as soon as practicable after my death by my Executrix or Executor, as the case may be, hereinafter namea. SEC~ND. All the rest, residue and remainder of my estate, real, personal and mixed, and wharesoever the same may be situate, I give, devise and bequeath to my daughter, JANET L. BLUMBERG, absolutely and in fee simple, if she survives me. If my said daughter should predecease me leaving lawful issue to survive me, I order and direct that said residuary estate be distributed unto such issue per stirpes by representation and not per capita. THIRD. Should my said daughter, JANET L. BLUMBERG, predecease me, leaving no issue surviving, I give, devise and bequeath the remainder of my estate to those then living of my brothers and sisters, but with the further provision that if my sister, CARRIE I. DULL, fails to survive my death, the share which would have been hers shall go to her daughter, KAREN DULL, LAW Ol'l'lCU 8NELDAKER A ELICKER " '. provided she survives my death. L~STLY, I hereby nominate, constitute and appoint my daughter, J~NET L. BLUMBERG, to be the Executrix of this my Last Will and Testament, but if for any reason my said daughter should fail to qualify as my Executrix or cease so to serve, then and in that event, I nominate, constitute and appoint my attorney, namely, E. ROBERT ELICKER, II, ESQUIRE, to be the Executor hereof, each and both to serve without bond or security as a condition of qualification hereunder. I r , i\ I I i I , I ! IN WITNESS WHEREOF, I have hereunto set my hand and seal to this this my Last Will and Testament {rtv, day of(--Jt1 ,((((f'< (JF written on two (2) pages , 1989. /! , ;1) ./1/~~ J I { eft' 'it-: ~nna M. Blumberg (SE~r. ) Signed, sealed, published and declared by ANN~ M. BLUMBERG, the Testatrix above named, as and for her Last Will and Testament, in our presence, who, in her presence, at her request, and in the presenoe of each other, have hereunto subscribed our names as attesting witnesses. l)- UAo\J.. /- )1'/. 7' "'-"-"-0 (SE~L) d.~#n,,'J ,) >'~ ' &(" ) <:--~ , (SE~L) -2- LAW O"ICEU 8NEL.DAKER a ELICKER ., , . -. COMMONWEALTH OF PENNSYLVANIA) COUNTY : SS. CUMBERLAND) OF We, ANNA M. BLUMBERG, JANET M. FORRY, and SUSAN A. McCOY, the Testatrix and the witnesses, respectively, whose names are signed to the attached or forgoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and Testament and that she had signed willingly, and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as witness and that to the best of her knowledge the Testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue.!nfluence. "1 . (IHtI t1 'Ill l16f J I( (~(>l J Testatr x r)::-c.....'-'.-I,/1'1. -1 ~<-;J " witness I xi // ~/ (~ ..-....~".-. wtt~es~c. Subscribed, sworn to and acknowledged before me by ANNA M. BLUMBERG, Testatrix, and subscribed and sworn to before me by JANET M. FORRY and SUSAN A. McCOY, wi tnesses, th is 6.iL day of" 9a?l<-UHy , 1989. ,--) . ~::J) .. ~.-' { , (-I at.~<c:a- c, .<,...-,.'-4..{...~ No ary public HOTA!IAL SEAL ':~~f~~BtRa T~ROSOH. NOTARY PUBLIC MY C""'ls . CUMBEr.L,\HO co. ..., SION EXPIRES DEC. 31. 1110 " 'i' , I.: ',:' , " i,! ." " ,. , ,':' . I ~ " , , , " . " ,- " " 11: " , /. , il 1- " " " I " . , I :"",,,.. " ,,,' ;.'; 1< ,.1' " " " " ' ",'.1' , , , , "., , " , . " , "1' " ,1 1'\; , I' ,- "Ii oIlr; 1'\ ,. I' , '. j" , " 'j", . , ," . , 'I,,, "1' I'.j, I; ,,' ..,. '.1' " ," , " ;I' , '" 'i'" '. :} \, . ,,' ,.' , . " ;j ,'1 " I' " .. , fl,P " , .' ;,'1 " II " , '.' , ' 'I', " t.l, .,. " " ,"' " ,.,t 1,.__ . ,;', \', ;, " .,.' " " "I ,\J, , " 'I , I l f , , ,.,. , L i' 1 ,I , / I 1 , ,. CERTIFICATION OF NOTICE UNDER RULE 5.6/AI Name of Deoedent: Anna M. Blumberg Date of death: January 2, 1994 To the Register: I oertify that notioe of benefioial interest required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following benefioiaries of the above-oaptioned eBtate on January 14, 1994 ~ Address Janet L. Blumberg 32708 Northeast 195th st. Duvall, WA 98019 Notice has now been given to all persons entitled thereto under Rule 5.6(a) exoept: NONE. Date: January 17, 1994 f -, !/~ ,\:~,/ItW"t{~ Ke th O. Brenneman, Esqu re snelbaker & Brenneman P. C. 44 West Main street Meohaniosburg PA 17055-0318 Personal Representative X Counsel for personal representative '- '" Cl - t: ':( , /J " r,-) ',\(1. P, N ;, ~;2 capaoity: " '--; 01'.\ I lUa: 'SJ " 0: f)" . f' .~ :5 U(,) (! r LAW o....le.:. SNELDAKER a BREtmEMAN NOTICE OF BENEFICIAL INTER~ST IN ESTATE BEFORE THE REGISTER OF WILLS COUNTY OF CUMBERLAND PENNSYLVANIA In re Estate of Anna M. Blumberg N 2194-0022 o. : TO: Jan~t L. Blumberg 32708 Northeast 195th st. Duvall, WA 98019 the grant of You may have Please take notice of the death of deoedent and letters to the personal representative named below. a beneficial interest in the estate as follows: As residuary beneficiary under deoedent's Last Will and Testament. Name of decedent: Anna M. Blumberg Last known address of decedent: 335 Wesley Drive, Mechanicsburg, PA 17055 Date of death: January 2, 1994 Place of death: Camp Hill, Pennsylvania county of grant of original letters: Cumberland Decedent died _..JL... testate A copy of the will is intestate X is not attached. Names(s) address(es) and telephone number(s) of all personal representatives appointed: ~ Address TeleDluml (206) 788-4112 Janet L. Blumberg 32708 Northeast 195th street Duvall, WA 98019 ~w O"IOU SNILn4KER . SRENNEMAN . ' , . ama(s) address (es) telephone number(s) of all counsell Address TeleDhone eith O. Brenneman, Esq. nelbaker , Brenneman, P. C 44 W. Main street Mechanicsbur9, PA 17055 (717) 697-8528 dctitional information may be obtained from the undersigned. Signature: /' / I I / ,I, I ",'t!.'! tll ,-;.~tw nit Ie t M t~(..-., ate: January 14, 1994 Name: Keith o. Brenneman Address: 44 W. Main street capacity: ____Personal Representative --X-Counsel for personal representative I I I I I I I I \ I Telephone: (717) 697-8528 LAW O"lC.:t SNILBAKIA a BAENNF.MAN -2- ........". "n.. ", ..1 - ...1_ .._... __ .--._ O'_~' .-..........~ _~_ _~ .__.... ,_._ ~ ..~ .._..~ ~ ""t. ____ ___ ._.__ ...._~ _.~ .__ "'_ ~ _...-..--_ :--_.__ _......... __...:...-. __ : RECEIVED FROMI i ACN ASSESSMENT Ii' CONTROL I:iI NUMBER AMOUNT '. rJRENNIrMAN 1<1:: J TH 0 44 W MAIN BTRr!ET -.-0-1 1I'c,~\IV.()() , . MEeHAN I CS~lllr~GI PA 17055 '010 HU'. ' " I,' I saN 1?4-05-e0I3:i\ (fiRST) IMII " .,' DA . /94 j NTY CIJMaERI.AND ATE Of DEATH " I .e,500;OO PEl m TO~Al AMOUNT PAID 01/0f:1.L'l.4 REMARKS JANET L. IJLUMElERt:l SEAL RECEIVED BY/;"; II" /, ~" ;.'..J>;: " J " ,r, "10 lE" '-' (./ , , . ( ,'.' I', . f I ': , -I." I "I f_ MARY L. L.F-wI"" v. "/,,/1,, 1.;../ {":,II/'f}' nf13JlHF.R OF WIl.l-S " IiI V' ~EQISTER OF WILLS _~__ __ __ -.0 _ ___, ___ ~..":'__ _:.... ._._ ._____ ._~_. .__. --:-- __. ....._ ____ __.._ ._. ___. _.__._ _ ____. . I I , . ~" ^' ,.~ ,', I ",.1 I () , J-,\ .."('~' ""\""I/'J,''')' I '",I "~, .... ......, ~. I"':'" '" <4 ",' ~4 .. ...! '., 'I, ',..,,, I~ ,. .. .....,. ',1",1' 1 Al TN 1II....uINANIA l : j' \,\\", I "\/-.'V'~ 1t J' UI ~ ~ L.. .l.I"... H ~ cOttN'A' OF ~UM"RLAND , iN ~, ;:" 'r Llr ff ~ I " .....\ 'I :'l1.Jd .J z ':-, I' , ~\ I U ),. .~ ". , "/ ~ .'It'' 22 ... ~~a:~:- .:('j':: ( Janet L. Blurber" " \- O;"~"''''''''''\'.J'__~ - -=-- ------" ,--,f.,l'V~:,:o4' , swom . according tl> law, deposes aM\u.,.'lI\'et 8 he i8 the Exe(..~trlx_____ of the ElIat~ of Anna M, Blurberg III. of _,__"l!PperAlle11~OWI18h_iP.,_,,_,______, Cumb.rland County, Pa" deoused and that the within I. an Inventory mede by "__,____l~,!;;J,,, Blurb~rg-__ ____, the uld-Executrix of the entire ellate of \lId deoedent, conslllln9 of all the personal prop.rty and real utatt, except rul ellate oultlde the Commonwealth of Pennsylvanle, and that the figures opposite oech Item Qf the Inventory represent It'. fair value at of the date of dace dent's death, being duly.. swom and subscribed before e, 1i~ J41!-~)}A;~/, 1994 J ~ 'JOANN GARCIA Notary Public 1(.. ./.."Jj , V ,/z:.. ...... C:~-r-t, - fl(t5f'c-"'~:' r....... G}I~~/C~-~ ~tf'.~ -J-"J<;. Date of Death 2 D,v Executrix / .' Duvall, WA 98019 Addtlll January Month 1994 Vur INSTRUCTIONS I. An Inventory mutt be filed within three months alter appointment of peraonal reprennhtlve. 2. A .upplemant Inventory must be fllad within thirty days of discovery of additional unit. 3. Additional sheets may be attached as to personalty or realty 4. S.. Article IV, Flducla'rl81 p;~t:Qf 1949, . , , " (',I ". ~ j ill 1.'\)::: u: , ~:) \ c; ..:: :J ()() ~ l!;! 1 1 Jl ~ ~ <, R " u . ~ ~ " ~ ~ w ~ Q III ;:a :. J iE 0.. -l ~ U. :. u. -l jj 0 i! ~ w 0 ~ tr: f ~ JI . o Q ~ 0 - ffi ~ rj fj 0 4It Z ... "0 ~ c .. ... "l: 0 " ..a 1 .... " e 8 ... j d it lIll Inventory of the real and personal estate of _Arma M. Bltmberg deoeased REAL ESTATE OONE TOTAL VALUE REAL ESTATE: -0- PERSONAL'IY 1. O1ecking account No. 5140180704, PNC Bank,N.A.: $10,349,42 2, Savings account No. 5130172903, PNC Bank, N.A.I 26,737,06 3. Certificate of Deposit No, 1153200144186, PNC Bank, N,A. : 1,500.00 4. Certificate of Deposit No. 1153200144210 , PNC Bank, N,A,: 3,598.08 5. Certificate of Deposit No. 1153200152851, PNC Bank, N.A. : 6,000.00 6, Proceeds, ForethoughtLife Insurance 1/001091300 : 5,440,98 7. Proceeds, Prudential Life Insurance Policies 1~9011351 and 1189011355: 2,795,85 8, Reftmd, Farmers' Mutual Insurance Canpany: 1.1.00 9, Reftmd, security deposit, Bethany Towers: 23.03 10. Cash on hand at t:lrne of death: 151.52 11. Proceeds of sale of miscellaneous personalty: 1,838,75 12. Insurance renmd - Capital Blue Cross: 186,40 13. Miscellaneous personal property: 97,50 14. Right of Sepulcher, Mt. Holly Springs Cemetery: 100.00 'IDI'AL VALUE PERSONAL'lY: . $58,829 59 RECAPITUlATION 'IDI'AL REAL ESTATE: -0- 'IDI'AL PERSONAL'lY: $ 58 , 829 , 59 'IDI'AL VALUE OF ESTATE: $58,829,59 R!VoI500!K+ 111,911 .' , 1. Real Ellare (Schedule AI I II 2, Slack. and Bond. (Schedule B) ( 21_ 3. Cla..ly Held SlocklPa'lne"hlp Inler..1 (Schodulo q (3) 4, Morlgogll and Nolo. Recolvoblo (Schodulo 01 ( 41____----.; 5. Ca.h, Bonk Depa.I" & Mlscollanoou. Po"onol Properly I 51_--.58jl29...J9..__' ' (Schodulo EI 6, Jalnlly Ownod Properly ISchodulo FI 7, Tran.fo" (Schodul. G) (Schodulo L) B, Talol Grall AIIOI.llolallinOl 1.71 9, Funeral Expon..., Admlnlllratlve Call" MllCOllonoou. I 91 Expen... (Schodulo HI 10, Deb", Mortgogo Uobllltl.., Lion. (Schodulo I) (10) 11. Talal Ooductlon. (lololllnOl 9 & 10) 12, Nel Voluo of E'lalo(lIno 8 mlnu.llno II) 13, Charltoblo and Governmonlal BequIII' (Schedulo J) 14, Nil Valuo Subloct 10 Tax (IIno 12 mlnu. IIno 131 15, Amaunl of IIno lA loxable 01 6% role (Includo valuOl from Schodulo K or Schodulo M,I 16, Amaunl of IIno lAlaxablo 01 15% role (Includo valulI from Schodulo K or Schedulo M,) 17, Principal la' duolAdd lax from line 15 and from lino 16,1 19, Crodl" Spou.al Povorty Crodlt Prior Parmont. Dllcounl + $2.50u,00 + $125,Q!L 19, If lino 181. groaler than line 17, onler Iho dlHoronce an line 19, Thl.I.lhe OVERPAYMENT, 110 20, If line 171. groaler Ihan IIno 19, onler Iho dlHeronce on line 20, Thl.I.lho TAX DUE, A, Enler Ihe InlerOlI on Iho balance due on IIno 20A, 8, Enter Ihe 10101 of IIno 20 and 20A on IIno 209, Thll II tho BALANCE DUE, Make Chock Payable tal .egl.ter al Will., Agent . . III SURI TO AN5Wn ALL QUUnONS ON REVER5I SIDE AND TO RECHECK MATH.... Under P'IMOlti'l of p;,jury, I dedor. thaI I have examined thll ,.'urn, Including accompanying I(h.dul.. and Ilallmenh, and 10 th. bill of my knowledge and b.ll,f, It I, ,ru" corrin and comple'.. I d,clar. that all real ellal. hOI bun r'porl.d allrue market value. Declaration of prepar., olh" Ihan Ih, perlonal r.pr.l.nlc.llvl II baNd- lllnformallon of which prepare' ho. any knowledge, 1 A U N~R NSII,1fOifffilNO REIURN ADDRESS 32708 Northwe~t 195th st. bAT! I 'I ~ ~ ,q <I- {,""II' '<",{i. """,,,,,tri,, nl1vnll. Wl'L..-9llllll ' ' I A ilHlR THAN R! REs(,~----.;o6rrfr- ,. ,-..'---- DATE ~- 44 W. Main St., Mechanicsburgr FA 17055 :;~ I l!! ~f~ i5f~ ooC Ii Rz u 2 z o I z o ~ I ; ;'tf--/f.{-( INHERITANCE TAX RETURN RESIDENT DECEDENT (TO BE FILED iN DUPLICATE WITH REGISTER OF WILLS) '. ~~Itl}~ ..,llW," COMMONWfALTH Of P~NN5nVANIA D!PARIM!NI 0/ R!V!NU! om 2'06Ot HARRISBURG, PA 111:28.0601 A- A. IAn. A.ND MIODL! INITIALI t"..... PORDATU 0' DIATH Am. 12131/91 CHICKHI.I I' A lPOUIAL POVI.lY C.IDIlII CLAIMIII 0 _ PILI HUM'I. 21 COUNTY CODE t.: !"tTI's COMPlue ADORUS 94 VEAR 22 NUMBER B1uriJel:g, Anna M. oCI~~~~~;~~~~;r--~/20;;~~7 i06 ~ 1. Orlglnol Roturn 0 2, Supplomonlol Return o 4, Unlllod E.lal. [J 40, Futu.. Inl...II Comproml.. (ior dalOl 01 dealh a~or 12.12.821 Ga 6, DlCodonl Dlod rollato 0 7, Do"dlnl Malnlolned a living Trull (Atrac~ copy of Willi (Atroch copy of Tru.tl ALL CORRESPONDINCI AND CONPlDINTtAL TAX INFO~nON SHOULb III DIRICTID TO. M i5MmTfi..WNO AOORm 335 Wesley Drive Mechanicsburg, PA Cunberland 17055 Count o 3, R.malndor Roturn (for dOl.. of d.al~ prior 10 12.13.82) o 5, Foderal E.tale Tax Rolurn Requl..d .19, TolOI Numbor of 5af. Dopo.1t Box.. Sne1baker & Brermanan, p, C. HE NUMIER - 44 W, Main S~t Mechanicsburg~ 'PA 11055 --, i,;, 697-8528 I 6} ( 7], (91 --51l,829.59 9,178,27 67.7?' (11) (12) (131 __ (141 9,246 .00 49 , 583 . 59 (15) 49,583.59 x ,06.. 49,583.59 2.975,02 (161_ _x ,15 .. (171 2,975,02 Interelt 2,625.00 CIll'ck her(' if you cue 1Nlu('..ltng u w'und 01 you. O\lcrpClVllwnt. (10) (19)___.. 350 ,02 (201 120A) .-_ (20B) 350.02 " I I'. ,. " " ..' , ':1....... , '.".. I l PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING A CHECK MARK (...) IN THE APPROPRIATE BLOCKS. . ., . . . 1. Did decedent make a transfer and: a, retain Ihe use or income of the property transferred, """""""""""",..""......" b, retain the right to designate who shalll.lse 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 dealh occurred afler December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? "".",....",,,,,,,,,,,,,,,,,,,,,,,,,,,,,....,, 3. Did decedent own an 'in trust for' bank account at his or her death?"",,,,,,,,,,,,..;,, m"~Q x X X X X X IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. ", I " " (. ',', " ,i ., If " " " 'I, ,,' " 11'1.15010:+ 11.!~ 5CH.DULI I CASH, lANK DIPOSITS AND MIICILLANIOUS . ~ PI_R~~~~~..P~~P!R!_Y_.. __ __ Plea.. Print or Type FILE NUMBER w COMMONWI~H OMI~VYlV~N'~ INN..I CII I IN 11110 NI 01 0 N ESTATE OF Anna M. B1urberj:\ __h_._.."_'__"'..'_..-..'___"..___'... !AII prop.rly 1.lntly-.wn.d with tho Rleht .f lu,vlv..~hlp .!".u,,_~~,..._~....~,!"_'!~!u!!_!L.___ ITEM NUMBER 1. 2, 3, 4. 5. 6. 7. 8, 9, 10, 11, 12. 13. 14. ~. DISCRIPTION Checking accOlU1t No, 51110180704, 1'NC flank, N,A,: Savings accotUlt No, 5130172903, I'NC llank, N.A,: Certificate of Deposit No, 115320011f41B6, I'NC Bank, N,A,: Certificate of Deposit No, 1153200144210, PNC Bank, N,A,: Certificate of Deposit No, 11.53200152851., PNC llank, N,A,: Proceeds, Forethought Ufo 1M, ('.0" 1/001091300: Proceeds, Prudential. Ufo Innurnnco l'oHcicn 1/89011351 and #89011355 Refund, Farmers' MutlJn1. 11111U1'OOCO ('.nllpnny: Refund, security dopmd,t, !loth/my TCMcrs: Cash on hand at tilOO of death: Proceeds of 111110 of m!llcollllnl.'Ollll personalty: Insurance rof1Dld - CapHlIl Blue Crolla I Miscellal100lUl poruolllll proporty I Right of Sepul.chor, t1t, Holly Springs Cenetery: 21-94-22 VALUE AT DATE OF DEATH $10,349,42 26,737,06 1,500,00 3,598.08 6,000.00 5,440,98 2,795.85 11.00 23.03 151. 52 1,838~75 186.40 97.50 100.00 .-.l.o___ IA".ch nddlllo,.1 ev," . II" ,ho'" II Mart "." II ,,,dld,1 Ily,un U+ fI,l1) " .... W COMMONW'AUH 0' 'tNNiYI......NI... lHHII"AHCI 'AM InUIN IIIIDlN' OlelNNT SCHEDULE J BENEFICIARIES IITATE OF 'ILl NUM.I. Anna M. B1urbe N~~~IR NAME AND ADDRESS 0' BENE',CIARY 21-94-22 RlLATlONSHI,. AMOUNT OR SHARI O' ISTATE I I A, Ta.able aequtllll 1. Janet L. Bl1.mberg 32708 Northeast 195th Street . Ibval1,. WA 98019 Daughter 100% of residue of Estate (,\ ,I' ITEM . NUMBER NAME AND ADDRISS OF BENEFICIARY AMOUNT OR SHARI O' ISTATI a, Charitable and Goyernmen'al aequtllll 1. II, '" 'j'(1 TOTAL CHARITAalE AND GOVERNMENTAL aEQUESTS (AlIa enl.r on IIn. 13, Recapllulollonl S II' more Ipoce II n..ded, Inlert additional .heell o'lame II.., - 1.------ , LAST WILL AND TE8TA~ENT Qf. ANNA M. BLUMBERG I, ANNA M. BLUMBERG, of Lower Allen Township, cumbstland county, Pennlylvanla, being of lound and dlspollng mind, memoty and undlt.tandlng, do hetlby maks, publllh and dlolate this as and fot my Last Will and Testament, heteby tevoklng and making void any and all wills by me at any time hetetofore made. ~ ~. I otdet and dl rect that all my just debts and ~ .~I funetal expenses be paid as soon as ptactlcable aftet my death by \~l , my Executrix or Executor, as the case may be, hereinafter named. '-'I'lO"ICII iHllLlAKI,. I 'LlOKI" SECOND. All the reot, residue and [omalnder of my estate, real, pet.onal and mixed, and wheteloever the eame may be situats, I give, devise and bequeath to my daughter, JANET L. BLUMBERG, absolutely and In fee simple, if ohe elltvives me. If my eaid daughter should ptedecease me leaving lawful Issue to sutvlve me, 1 otder and direct that eald residuary estate be distributed unto such Issue psr stirpes by reprsssntatlon and not per capl ta. !!!lJ!.!!. Should my oald daughter, JANET L, BLUMBERG, prodeoease me, leaving no Issue sutvlvlng, 1 glvs, devise and bequeath the temalndet of my estate to those then living of my btothers and sisters, but with the futthet ptovlslon that if my elater, CARRIE I. DULL, falls to ourvlve my doath, the share which would havs bsen hers shall go to het daughtst, KAREN DULL, " , 'I' '1\ provided ehe .urvlveo my death. !-ASTLY. I hereby nominate, constitute alld appoint my daughter, JANET L. BLUMBERG, to be the ExecutriX af thl. my La.t Will nnd Te.tament, but If for any reason my oald daught.r ohould fall to qualifY ao my Executrix or oeaDe 00 to sorve, then .nd In that event, I nominate, oonotltute and appoint my attornoy, namely, E. ROBERT ELICKER, II, ESQUIRE, to b. the Exeoutor hereof, each and both to .orve without bond or .eourl ty as a condition of quallflcat.lon hereunder. IN WITNESS IIHEREOF, 1 have hereunto set my hand and .eal to thl. my Laet Will and Te.tament thl. {r (;, day of, "Jo1 ""./\ Il-- written on two (2) page. , 1989. , ' (DEAL) Signed, .ealed, publi.hed and declared by AHNA M. ULUMUtRO, tile Te.tatrlx above named, .. and for her Last 11111 and Te.tament, In uur pre.ence, who, In her preeenc., at her reque.t, and in the pre.ence of each other, have hereunto .ub.oribed our name. a. atteeting wltn.o.... J .( II i..... \ )/1, I'>"~'J (SEAL) ,> 0.. ~.If.'" /t. (SEALI {II{ ('> , UWOHtCU IHlLaAKIIl , CLICKIA -2.. .:> I' ,- ,:' -.- ,\\'j ~/./6'" /....d ' ':'. i',~~ ..,n\\\,,''Jt')'' \....... "'"' ........ . ",n'", 'II ... ,.' ~~ .- ".. " I, "}' ~ :&.VAN" I i j' \,\C"Y,'Vi'~' '\ ~ J' - UI ~ ~ ....". ~ ~ COUNTY OF CUMIIRLAHD f (/1 \ ::'; /r L (. ! ~ i I, ~\', " ,j \.... z', fI '1'\' U b '1 '-11I" " .... <<,1'1,' .?2" ~~ :::" ,.(j':! ( ,____ __ _!~et .-b_I~ll1Tbe~_,_, -- - .- ,-- -. ,_, _!!.'-O~W\"A":~/~~P' " v ':- I bolng duly __ SWO)JL __'__-"_ according to law, dopos.. o'\lhl&,.'lIl'.t S he is the ExeclItrix Arma M, B1tmberg -.-..-_.___._,..,______,~, _.____ of tho Estate of lete of ---- "Upper_Allen Township. . __. __________.., Cumberland County, Po., deco."d and th.t the within Is an Inventory medo by _ ..________J~_t,_L,_ID.llnb.~rg__.__ ___'___, the "Id~trix of the entire "tate of said decedent, consisting of all the personal prop'~rty and rul"t.te, .xcept rul"tate outsld. the Commonwealth of Pennsylvania, and that the figures opposlt. uoh Item of the Inventory represent It's felr Yllu. II of the dale of deoodent's death. _- sworn end subsorlbed before e, -+1, d::JiL /J.... /) j).,4t~l 19.9.4-_ (~ "~I ,'1" Or~--J f-~<t"-<-. ~L-.!IQANN GARCIA {I . Notary Public i(o,{'''J ,It ,~.~.)<, 6-t-$', - nfh.~c""'''':' ",~..... Q~,!j'.,-<,'Cl(.r/. ......pJ, I"~ .- j'-~ Date of Death ___,---1., Oar Executrix D..ivall, WA 98019 Addltll January Month 1994 Y..r INSTRUCTIONS I, All Inventory must be fllod within three months after appointment of perlonal repr...ntatlv.. 2. A supplement Inventory must be flied wl~hln thirty days of discovery of additional a".ts. 3. Additional sheets may be atteched as to perlonelty or realty 4. S.. Article IV, Fiduciaries Act of 1949. no. C: (r, :,1 , 'r.1 .t..... "('):T.J " (II. (" n ", " .:. :::0 !'; I; , I I" .. , ,"I (" i' ") '{.. ~'i . ~, I'.', ,'" .,' ~ l!! 1 If ~ .. R .. ~ E u .. ~ ~ .. 1 ~ w ~ Q j!: . ~ ... -l U. .,; l!l ... .::li 0 ~ ... ~ ~ or: t I!:l< ~ J . o Q ~ 0 - ~ ~ <3 oS 0 ~ z: ... 'V ~ c .. ... 't: 0 J ." ... .. E .. J ... j (J it Inventory 01 the real and personal estate of ~. Anna M. B1unberg deceased REAL ESTATE !'mE TOTAL VALUE REAL ESTATE: -0- PERSONAL'IY 1. Checking acccnmt No. 5140180704, PNC Bank, N,A,: $10,349.42 2. Savings account No, 5130172903, PNC Bank, N.A,: 26,737,06 3, Certificate of Deposit No, 1153200144186, mc Bank, N.A.: 1,500.00 4, Certificate of Deposit No, 1153200144210, mc Bank, N,A,: 3,598.08 5, Certificate of ~sit No, 1153200152851, PNC Bank, N,A,: 6,000.00 6. Proceeds, ForethoughtLife Insurance 1/001091300 : 5,440.98 7. Proceeds, Pntdential Life Insurance Policies 1189011351 and 1189011355: 2,795.85 8. Refund, Fanners' Mutual Insurance Canpany: 11.00 9. Refund, security deposit, BethRny TONers: 23.03 10. Cash on hand at time of death: 151. 52 11. Proceeds of sale of miscellaneous personalty: 1,838,75 12. Insurance refi.md - Capital Blue Cross: 186,40 13, Miscellaneous personal property: 97.50 14, Right of Sepulcher, Mt, Holly Springs Cemetery: 100 , 00 TOTAL VALUE PERSONAL'IY: $58,829 59 RECAPITULATION TOTAL REAL ESTATE: 'IDTAL PERSONAL'IY: 'IDTAL VALUE OF ESTATE: -0- $58,829.59 $58,829.59 . .,Xi ;,__';jj:;t 'I' ",;" .--"l'~ , , L;J I?~ ~ ~l!V.1547 EX AFP tl0.93w COHHOHWEALTH Of PENNSVLVANIA DEPARTHENT OF REVENUE BUREAU OF INDIVIDUAL TAXES OEPT, 280601 HARRISBURa, PA 17128-0601 ESTATE nF FILE NO. DATE OF DEATH 01-02-94 COUNTY CUMBERLAND NOTE, TO INSURE ~ROPER CREDIT TO YOUR ACCOUNT, SUBHIT THE UPPER PORTION OF THIS FORH WITH YOUR TAM PAYHENT TO THE REOISTER OF WILLS. HAKE CHECK PAYABLE TO "REgISTER OF WILLS, AgENT" REMIT PAYMENT TOI NOTICE OF INHERITANCE TAM APPRAISEHENT, ALLOWANCE OR DISALLOWANCE OF OEDUCTIONS, AND ASSESSHENT OF TAM ACN 101 DATI! 09-06-94 SNELBAKER a BRENNEMAN 44 W MAIN ST MECHANICSBURG PA 17055 REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 r Anount RoiiiTI.d CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV: isijj" iii"AF p"" i i ii: 93")" NoYi ci" "oF "INHiiiiTANci" TAx" A"PPRAf 8ii1"ENr;"A r. rowANci" iili'" """ OM OM -""".."" DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATI! OF BLUMBERG ANNA M FILE NO. 21 94-0022 ACN 101 DATI 09-06"94 TAK RETURN WAS, (X) ACCEPTEO AS FILED I I CHANgED RESERVATION CONCERNING FUTURE INTEREST " SEE REVERSE APPRAISED VALUE OF RETURN BASED ONI ORIGINAL RETURN 1. R..I Eltet. ISoh.duI. Al III 2. Stookl and Bondi ISoh.dul. B) 121 $, Clol.l~ HIld Stook/P.rtnlr.hlp Int.r..t ISoh.dul. CI (3) 4. Hortg.gll/Notll Rlo.I..bb ISoh.dul. DI 14) 5, C.lh/Bonk D.POlltI/HIIO, F.rlon.l Proplrt~ (Soh.dul. E) IS) 6. Jolntl~ Own.d Prop.rt~ (Sohldul. F) (6) 7. Tr.nlforl (Soh.dul. 0) (7) B, Totl1 huh ,00 .00 ,00 .00 58,829.39 .00 .00 (B) 58,829,59 APPROVED DEDUCTIONS AND EXEMPTIONS I ,. FUMer.1 E.p.n..I/Ad.lnl.trltl.. COlt II Hllo.llonooul E,plnl.1 (Soh.dul. HI (,) 10, Dobtl/Hortglg. Lllbllltlll/LI.nl (Sohldul. I) (10) 11. Tot.l O.duotlonl 12, N.t V.lu. of To. R.turn 13, Chlrlhbl./go.orn..nhl Boqu..h (Sohodul. J) 14. Not V.lu. of Elt.t. SubJlot to TI. 9,178,2L 67.73 1111_ (12) (m (14) 9,246.00 49,583,59 ,iiQ 49,58~ NOTl!I If .n a.....m.nt wa. i..uld prlvioully, lin.. 14, 15 .nd/or 16 Ind 17 will rlfl.ot figurel thlt includ. the tot.l of ~ r.turnl .I.....d to d.t.. ASSESSMENT OF TAXI 1&. Aoount of Llno 14 t..obl. It ~% roto 16. Aoount of Llno 14 t...blo .t 15% rot. 17. Prlnolpol To. Duo TAX CREDITS I PAYHENT RECEIPT DISCOUNT 1+) DATE NUHBER INTEREST (-) 115) (16) 49,583.59 K,06' .00 M,lS' 117) _. 2,975,02 .00 2,975,02 AHOUNT PAID 0~-29-94 05-02-94 856094 8S6019 131.58 .00 2,500.00 350.02 TOTAL TAX CREDIT BALANCE OF TAX DUE INUREST TOTAL DUE 2,981.60 6.58CR ,00 6.58CR . IF PAlO AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF AOOITIONAL INTEREST. IF TOTAL DUE IS LESS THAN '1, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREOIT" (CRI, YOU HAY BE DUE A REFUND, SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS,) 0(') ~: \:: ,'i .'; .;" :',1 r, , "u I u' , " .' (..:, R!HRVATlOHI ht_t.. of decldenh dV!nt on or blfor. o..,..btr 12, 1912 .. If any future Intlrllt In the ..t.t. 11 tren'flrred In po.....lon or .nJoy..nt to el,.. . hollllttrlll hln.Uet,r... of the dlllldent IUer the IMplrttlon 0' MY IItat. far life or for ~"rl, thl C~.l~h hereby upr...ly r...r\lll the rlght to ."r.1I1 .w ...... trenlftr InhtrltlnClI TIMII' ft' thl l''''ul ell.. . (ool1lt1r,1) rlt. on any .uoh fulur. Interut. PURPOSE Of NOTJCEI To fulfill thl ,.quir..'"h of Stotlon 2140 of thl Inhlrltanel Ind E,tat, Tile Act, Act 2Z of 1991. 12 Ptl. S..tlon 2140, PAVMENTI DttlCh the top portion 0' thlt HoUe. and lub,U with your ply..nt to thl Rtgltt,r of WU11 prlrttd on thl r'v'rM I1dt, ".Kek, cheok or IIOMY urder Plyebll tal REGISTER OF MILLS, ADENT All PIVMntl rlollvld .hlll flr.t b, .ppUtd to ony Inter..t which .IY b, M with Inv r..llndtr .pp1ttd to the '8)C. REFUHD eCA)1 " r.fund of I tell or~1t, whlch ..... not r.qut,ted on the fix Return, 'I~ be requ..t.d b~ COllPllt1ng ItI "Appllclt1on for R,fund of PIMulvlnl. tnhlritlncl and Eltet. T'll" (REY-IllS), Application, Irl '''llllbll.t thlOfUc. of thl Righter af WUlI, Invaf the 2J R.".nu. District OfficII, or b~ clUing the .p.olll 24"hour an,wrlng ..rvlc. ~r' for for.. ord.rln'lI In PIM'v!"lnll 1"800-36Z-2050, out.ld. Plnnul111t111 Ind within 100.1 Harrisburg ar.. (717) 787-8094, TOO. (7171 7n.U52 (Hllrln, IIPllrld Onlv)' OIJECTIONSI Anv puh' In lnt.r..t not "thflld with the apprllll....nt, tUowaoc. or dhlUnwano. of deduotlon., or ......lInt of t'll (Including dlloount or Int.r..tl I' ,hown nn thl' Hotlc. .u~t objlot within .IMtv (60) dlv' of r.o.lpt ~f thh Hotie. byl "wrlttln prot..t to thl PA O'Plrt.lnt of RI".nu., BOlrd of APPlll., DEPT. 241021, Hlrrlsburg, PA l11U.IOZl, OR ....I.eUon to hlv. thl ..ttlr detar.ln.d It ludlt of the ICr.Ount of the plrtOMI r~r'lent.tlv., ON --tlPPIII to the Orphan,,' Court, ~OttIN ISTRAlIY! CORRECTIONS, ~'eotUll Irror. dllcoy.r.d on this .......ont .hould bt addr....d 1n wrJtJng tOI PA o.p.rtHnt of R.vtnUl, lur.1Y of Indlvldu.l TtlC", ATTNI Po.t A.......nt Rlvl... Unit. DEPT. 280601, Htrrhburll, PA 17128-0601 Phone (717) 787.6505. Sn Pl" 1 of thl bookl.t ''In.tructJon. for Inherltancl Till A.turn for I A..ldent n.ctdtnt" (REV"1I0l) for." .1lPlan.Uon of IdIIlnlstreUvth corrlctlbit Irror.. DUCOONT I INTERUT, If tny tlM dul II plld ..ithln thr.. (S) clllndar llOnthl aftlr thl deetdtnt'l o.lth, " flvl ptrclnt (liO dltcOlM1t of thl tlM plld It fll1owd, Intlr..t h charpd betlnnlot with first dav of dellnqutnCly, or nine (,) tonth, tlnd OM (1) day fra thl date of death, to the dlt, of Ply""t. TIH.. whloh b,cHe d4lllnqutnt be fori JlI"IUary I, I'at bell' Intlr..t It thl rlt. of .IM U:<) ptIrclnt p.r ~ ollculetld It I daUv r.tl of ,aaOl6,.. All t.HU which bee... dtllnqwnt on 1M Iftlr Jenuary I, n8Z will b..r Intu..t It a ,.,tl which will vlry frol cllendu y..r to c.ltndlr Yllr with thlt rite IMO\I\Old by thl PA DIPlrtttnt of Rlv.nut, The aJlpllotbl1 lnter..t rlt.. for 198Z through 1994 Ir" ~ Inter..t A.te Ollly Inter..t Flctor !!!! Int.r..t Alt. Dlllv Int.rl.t Flotor 1911 10l ,000546 1986 lOX .000174 1'61 III ,000456 1967 9l ,000147 1914 III .000101 19aa-I991 IIX .000101 I9DI III ,000156 1991 9X ,000147 1995-1994 7X .000191 --Intlr..t It cltcul.tad II followlt IHTERElT . BALAHCE DF TAX UHPAID X HUHIER OF DAYI DELIHQUEHT X DAILY IHTERElT FACTOR ....Any HoUe. ll1utd .ftlr thl till btclo", del1nquent will nf1tot en Intunt cllcullUon to flft"" UI) dlV' beyond the dltl of thl ........"t. If ply..nt II .,de .ftn thl Int.r..t cOtPUtltlon det. lhown on thl Notlc., tckUtlOMI Inhr..t lU.t be a.hut.te, ...l:\' - . . .J . "....('. .. I' , " " " ': '\,". ',!' !, I ,I" ", , 'I , I" " \ , 1'\: , I, , " .. .: " t." " " , \" , , , I ,',I' " .. , , I,") ,\ ,,' " ',' " " " 'II i: '\' I " ,i, , " .' , I , '. ; , " '", 'd' " 11(, i, " 1/, " '.. " ,\ '" , , , 'It \, .., ~.' ,,'. "'" '. '~', '" ", I I" " " I' '\' 'l. " ,. , . 1 \' " " , " I' " . 1 .~ . , , '" " " " ," '" '" ),'",. /, ,- " " . ~' , , " " " I' " /" 'I, i, , "il",1 ", , ( )1' j,' ."" I' ',': " ',,' , , '! .' .' " "" 'I ,. It, .' I I' " " " !' " I I . RECEIPT AND RELEASE WHEREAS, ANNA M. BLUMBERG, late of Lower Allen Township, County of Cumberland and Commonwealth of Pennsylvania, died on the 2nd day of January, 1994, having first made her Last Will and Testament in writing dated January 6, 1989, which since her decease was duly probated before the Register of Wills of Cumberland County and Letters Testamentary were issued to JANET L. BLUMBERG, the Executrix named in the Last Will and Testament of said Decedent; and NOW KNOW ALL MEN BY THESE PRESENTS, that I, JANET L. BLUMBERG, being a beneficiary named in the Will of said Decedent and the sole person entitled to share in the residuary distribution of the Estate of said Decedent, do hereby declare and say that I have examined the attached Account and Schedule of Proposed Distribution, and find the same to be true and correct, and in strict accordance ~Ii th the terlns and provisions of said Will, and I do horeby acknowledge that I this day have, had and received of and from JANET L. BLUMBERG, Executrix of the Estate of ANNA M. BLUMBERG, the cash and/or personalty set opposite my name in the above stated Schedule of proposed Distribution, in full sl:\tisfaction, payment and discharge of all such sum or sums of money, legacies and bequests, share or LAW 0I',.IOr.8 SNEL.IlAKCR . [3RI:NNEMAN shares, purparts and dividends which were due, owing and payable and belonging to me, by any means whatsoElver, for or on account of my full share, part or dividend of the Estate of ANNA M. BLUMBERG, Deceased, and all interests accrued thereon. NOW, THEREFORE, I, JANET L. BLUMBERG, do by these presents, remise, release, quit-claim and forever discharge the said JANET L. BLUMBERG, her heirs, executors and administrators, of and from my said share or dividend of the Estate aforesaid, and of and from all actions, suits, payments, accounts, reckonings, claims and demands whatsoever, for or by reason thereof, or of any act, matter, cause or thing whatsoever, from the beginning of the world to the day and date of these presents. AND, desiring to avoid the delay and expense of the settlement of said Estate by filing the foregoing Account of said administration in the Office of the Register of Wills of Cumberland County and by having the balance in the hands of the Executrix, as shown by said Account, distributed by the Court of Common Pleas of Cumberland County - Orphans' Court Division, I do hereby agree that the foregoing Account and statement concerning the matter of settlement may be recorded with the same effect upon me as if the same had been reported upon by said Court, in a decree of distribution made on such report by the said Court of Common Pleas - orphans' Court Division. AND in consideration of the aforesaid settlement being made without the aid of such Court of Common Pleas - Orphans' Court Division, that I, JANET L. BLUMBERG, do hereby agree that if any LAW Ofl'ICl:1l SNELOM,EA . BRENNEMAN -2- debts or demands other than those included in the above referenced Firat and Final Acoount of JANET L. BLUMBERG, Executrix of the Estate of ANNA M. BLUMBERG, Deceased, as hereinbefore set forth, shall be hereafter recovered against the Estate of said Decedent and be legally payable out of the same, that I will return to the said Executrix such amounts thereof as may be neoessary to pay suoh debts or demands. IN WITNESS WHEREOF, I have hereunto set my hand and seal this /3111 day of - 14t' r II' f}f ,r , 1994. r . WITNESSED BY: SEAL) :~ eOCm,J ~ .' " ; '" LAW Ol'FIOU SNE~"AKER o BRENNEMAN ,-3- " , ,'I FIRST AND FINAL ACCOUNT OF JANET L. BLUMBERG, EXECUTRIX UNDER THE LAST WILL AND TESTAMENT OF ANNA M. BLUMBERG LATE OF LOWER ALLEN TOWNSHIP, CUMBERLAND COUNTY, PENNSYLVANIA JANET L. BLUMBERG, Executrix and Accountant herein states as follows: DATE OF DECEDENT'S DEATH: January 2, 1994 DATE LETTERS TESTAMENTARY ISSUED: January 11, 1994 LETTERS WERE ADVERTISED AS FOLLOWS: The Patriot-News Company: Cumberland Law Journal: January 25, February 1, 8, 1994 January 21, 28, F'ebruary 4, 1994 PERSONALTY - PRINCIPAL ACCOUNT PEBITS The Aocount charges herself with receipt of the Decedent's personal property as more fully set forth in the Inventory and Appraisement filed in the Office of the Register of wills in and for Cumberland County, Pennsylvania: Adjustment for typographical error respecting value of Certificate: $58.829.59 .90 TOTAL, PERSONALTY, PRINCIPAL ACCOUNT, DEBITS: $58.830.49 LAW 01'1101:8 SNELBAKf.R " BRENNEMAN LAW O'f'ICE:& SNEUMKER " BRENNEMAN " '. PE6S0NAI,TY - INCOME ACCOUNT C;REDITS The Acoountant olaims credit for the payment of the following items from personalty income: TOTAL, PERSONALTY, INCOME ACCOUNTS CREDITS: NONE NONE REAL ESTATE - PRINCIPAL ACCOUNT DEBIT~ The Acoountant charges herBelf with receipt of the Decedent's real estate as follows: NONE TOTAL, REAL ESTATE, PRINCIPAL ACCOUNT, DEBITS: NONE ~AL ESTATE - PRINCIPAL ACCOUNT CRED~ The Accountant olaims credit for payment of the following items from real estate principal: NONE TOTAL, REAL ESTATE, PRINCIPAL ACCOUNT, CREDITS: NONE REAL, ESTATE - INCOME (\gQQ1JNT DEBITS The Accountant oharges herself with receipt of the following income from real estate: NONL TOTAL, REAL ESTATE, INCOME ACCOUNT, DEBITS: NON~ REAL ESTATE - INCOME ACCOUNT CREDIT~ The Accountant olaims credit for p~yment of the following items from real estate income: ilL NONE TOTAL, REAL ESTATE, INCOME ACCOUNT, CREDITS: -&UiL -4- " . RECAPITULATION I. PERSONALTY A. PRINCIPAL ACCOUNT Debits $58,830.49 Net Loss -0- Sub-total 58,830.49 credits $12.203.55 Balanoe $46,626.94 B. ;J:NCOME ACCOUNT Debits $ 850.12 Credits -0- ~alance $ 850.1~ C. Net Balance of Personalty: $47,477.06 II. REAL ESTATE A. PRINCIPAL ACCOUNT Debits $ -0- Credits -0- Balance $ -0- B. INCOME ACCOUNT Debits $ -0- Credits -0- Balanoe $ -0- C. Net Balance of Personalty l $ -00lll L,.\W O"ICEI III. NET BALANCE OF ESTATE FOR DISTRIBUTION: $~ SNE~BAKER . -5- BRENNEMAN , , , SqHEDULE OF PROPOSED DISTRIBUTIQH 1. Tal JANET I.. BLUMBERG, per item Second of Decedent'o Will: a. Value of property reoeived b. Distribution made 2/22/94: c. . Distribution made 8/24/94: d. Balanoe for distribution: Total: in kindl $ 97.50 11,336.71 35,000.00 J.042.85 $~7J477.06 , , I. " , " , I "., , , , I '. , , , '.. , I,t ". ',i , ; !, " ,II ' '" " ~ I . 'I " " ;1.' I. '1, " I ",r, ,'" 1;' ;1, STATE OF WASHINGTON) as. COUNTY OF KING ) JANET L. BLUMBERG, being duly sworn aooording to law deposes and says: that she is the Executrix of the Estate of ANNA M. BLUMBERG, Deceased; that she is the Accountant herein; that the foregoing Accounting is true and complete, that the attached list or schedule [*] contains the names and addresses of all persons who have given notioe of their claims, and whose olaims remain unpaid; that the attaohed list or schedule [**] oontains the names of all persons interested in the distribution of said Estate; and that the facts set forth in the within Account are true and oorrect to the best of her knowledge, information and belief. ) /) Sworn to and subsoribed T\.\ 13 day before me this '-~t..ClIA ~I?(L , 1994. tltljr.J"'4'" ,I" -. ~_... ,I \\l~\N() 1,'1/ ~, ~~ )., II.. ~ I \1 "" of f "y"';':/IIIJ!v I'~..l. I,P,'\. I '."", ,. ,-l. ... (I ',.... :",0' "1/"....'(',., . 1) .\"" r :_i 110 fAr,'). ',": ) " . (fll . " - . ",\..",/'/lIII.\C( ":.l ,.,~ ,,-,.,) ()/..).I.~". f . '~.'; .:. () I \r.~'/,'.5',1 \" t. ,_ r''' I ') . '"'~I" \ \.) # 1.,(' II'M'\\\\>,1,1 ......~~....,,";I,#II , ue~~ Notary Publ c LAW OFFICES SNEI.9AKER a BRENNEMAN 'l5 e:~ ~j~ 't':r; JI ,. ., " '" "I' .. " , I ".1 i.I' .i I ,.' .," :1 ", ,. " " , 18 01 00: 01 - .~! C..l ~ /",8 '., ;0 ;" (~ f " ~.(. . II c.:t - Cl i!t " ., ", ... ') " " , " , ., " , " 'I:, , , " " (Ill 'I, , ". "f. 'I' " ,. , ., "'.." I' ','I' I. II,' \\ " ,:!j II', " l' ,.. " " " '!, .,. " ,,': " " " , " , .,1 ""':' 'il ", "j , I ~ " '" Ill, "", It ~l 'II' Iii I' ,. "I j: " ii" ,;.': " " \. , '1', , Ii,. , , ".(. .' , ,I. " ,"I' ". " " j'l', " " . ". " " '", " " " ,. II " ,I 'i, " " " , " , , ..,1' " i.. I'" " " " , " , '" "', ,. \' ". l ~ .. ". , " I ., I.. 1\" t /,',;' 1: 'I. , , " , ,;' ". \',' ,,',',. " ",1,/ " '. '. 'I: ." ,. \ ~ n \.' "I ,I:' " " " ,t',', " I. 'II " \, " ,,' ,. " " ';'\, '.... d " " ,. '-I' \' " " ,. , ,. ,'I " ",' '/1' "1, '" iii' , '1\ I 'i! "~,IF, " \1, 'i' \: "\r <I\l'll " , , " " i"I',; " .Ii "\'; " 1':\ "'0-' " ,'i " i" I'll "d ",. ." " I' ,. \'" " i, " 'i' " " 'I' \' ,It ",1;'1\ ,. ". .' ", ,. " :'.:1:\-, , '1,1' ., I", 1'1' I \ ~ I, ~ , II,,,, " i,' ,l ',. I' " " '., i, ,. I' " ",l 01 ~, "."\ ! 'I " ",j :J '; " ,. " , .' ';,i " ',1" , , I,' ,I' " ,\ " . , ,. '" " " , 'I"~ ", . " " " " I' '.' ..' ," " " "~I '\', " '. I,: " i"l' 'I" ",' " .., " I" " ", ," , ','" ". ',' I': { ~ . . I', " " " ,. " " t,,' " \l\ \~I~'~ REV-11m EX AFP (1-91) '* COHHOHWEAllll OF PEHHSvLvAHIA OEPAATHEHT Of REVENUE BUREAU OF INDIYIDUAl TAXES nEPT. zao601 IlARRISBURO, PA 17128-0601 INHERITANCE TAX STATEMENT OF ACCOUNT ACN DATE 101 ~ 01-17-95 BLUMBERG ANNA M FILE NO. 21 94-0022 DATE OF DEATH 01-02-94 COUNry CUMBERLAND NOTE, TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS FORM WITH YOUR TAX PAYMENT TO THE ADDRESS SHOWN, MAKE CHECK PAYABLE AND REMIT PAYMENT TOI , SNELBAKER & BRENNEMAN 44 W MAIN ST MECHANICSBURG PA 17055 REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 E A.aunt R..ltti'd - CUT ALONO THIS LINE .. RETAIN LOWER PORTION FOR YOUR FILES ~ R 'EV: i6 '07 - E)( - AilP'- i i :'9 i)''' - -i.i.-' iNHERi i'A"NCE ufAX" 'sf Ai"EH~iif" OF"" Accfciuil'f -- ilili -" - -""" ...,m ,- -...,. ESTATE OF BLUMBERG ANNA M FILE NO.21 94-0022 ACN 101 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF TNE STATED ACN IN THE NAMED ESTATE, SHOWN BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND. IF APPLICABLE, A PROJECTEO INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT I OB-29-94 PRINCIPAL TAX DUE, PAYMENTS (TAX CREDITS): PAYMENT DATE 03-29-94 05-02-94 10-14-94 RECEIPT NUMBER XA856094 XA886019 REFUND DISCOUNT (+) INTEREST (-) 131. 58 .00 .00 AMOUNT PAID 2.500,00 35111'3 ~~- O' ~t: ( 1<- i:l ~) ~~, )i;:.> TOTAL TAX OREDIT BALANCE OF TAX DUE INTEREST TOTAL DUE . IF PAID AFTER THIS DATE. SEE REVERSE SIDE FOR CALCULATION OF ADDITIOHAL INTEREST, ( IF TOTAL DUE IS LESS THAN .1. NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTP.D AS A "CREDn" ICRI, YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FDRM FOR INSTRUCTIONS, I DATE 01-H-95 2.975:!t :D :D~ 10 rrl. "', ;:: n, c-, r.\1 (\ ') .'.' ,ll .\ .. ;.;-!(I) ~'o .... 2,975,02 .00 .00 ,00 PAYHf;NT, Detlch the top portion of thll Notloft a~d lubllt with your pay~.nt .ad, payable to the na.. ~nd addr... printed on thl rIY,r,,' .Ide. All Ply.tnt. r,cllvld Ih,ll flrlt b, applied to any Inter..t ~hlch ~fty b, due with any r"llndlr applied to the tlX. REfUND (CAli A r.fund of a tax cr,dlt, which wa. not r.qulltld on the TIK Rtturn, .IY b, r.quI.tld by coeplltlng In "APPUcfltlon for R,fund of Plnn,Vlvanla Inherltanoe and E.tltc TalC" (REY.UUJ. APPllcltlon. Ir. IVlllIbll.t the OffiCI of the Rlgl,t., of Will., any of th. 24 Rlvlnul Olltrlet OffiCI., or by callIng the 'PloJal Z4.hour anlwarlna ,.rvlol nueber. for fOf.' orderlngl HEW l'l PENNSVlVANIA 1-800-362-2050, outlld. Plnn,ylvlnla and within the looat HarrJsburg .raa (717) 787-8094. R1!PLY TO' QUlltlonl rlgardJn~ .rror. contaln.d on thl. notlcl .hould b. addr....d tOI PA Dapart'lnt of Revlnul, Burllu of Individual TalCu, ATTHl Po.t A.......nt R.vl.w Unit. DEPT. 280601, Harr1.bUr~, J'lA 17J2a.0601, phone (111) 181-6505, If any ta. due I. paid within three (3) cal.ndar lonth. aft.r the d.ctd.nt'. daath. a flvl Plrelnt (S~) discount of the ta. Plld I. allowad, DISCOUNT' INTEREST, Intarut ,. charud blglnnlnu wUh IIr.t dllY of dlllnquonoy, or nlnl (9) lonthl and OM (1) dav fro. thl dltl of dleth, to thl dati of paYllnt, la... which ~acal' d.llnquent buforl January 1, 1982 bllr Jntlfllt ~t thl rlt. of .IM (6XJ parclnt pur annul caloulettd at a dally rate of .000164. All t~M" which blca.. dllJnqu.nt un tnd tftlf JanulI'y I, 1982 will blnr Int.rut ftt II rat. which will vary frol cal.ndar '1l11r to oalendar yur with that rat. announc.d by th. PA Dapart'tnt of Rlv.nul. The applicable Jntarl.t ratl' for 1982 through 1995 ar.. '!m Interut Rate Dally Interut Fllntnr ~ Interut Rat. Dally Intlr..t FaciO.[ 1982 20:1.1 .000548 1981 9:1. .000241 1983 16:1. .000438 1988.1991 11% ,000301 198.-. m .000101 1992 9% ,000241 1985 13% .000356 19CJS~1994 7% .000192 1986 10% ,000274 ICJ9!'i 9% .000247 ~.Intlr..t I~ calculatld .. followlI INTEREST . BALANCE OF TAK UNPAID K NUHBER OF DAYB DELINQUENT K DAILY INTEREST FACTOR ..Any HotJc. I..uld aft.r the tllK b.eoa.. dallnqulnt will rafl.ct nn Intlra.t calculation to flftl.n (IS) dlV' bavond the date of the a.......nt. If paye.nt II aadl aftlr thl lnt.rut eoaputetlon d,t. thown on thlt HoUel, .ddltlon.l Intlrll' autt b, c.lculatad. "